2025-05-11T08:37:04-05:00 2024-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2023-07-01 410721642 UNITY FAMILY HEALTHCARE UNIT 3206325441 815 SE 2ND STREET LITTLE FALLS MN 56345 NICK O'TOOL MARKET CFO 4023434323 2025-05-11 1 0 MARK STOCKI P00642127 3032989100 2023 2025-03-06 01:10:19Z STEVEN SMITH 815 SE 2ND STREET LITTLE FALLS MN 56345 78483115 0 0928 X WWW.CHISTGABRIELS.COM X 2001 MN THE VISION IS TO CREATE THE BEST HEALTHCARE EXPERIENCE BY IGNITING THE SPIRIT FOR SUPERIOR CARE AND SERVICE. 10 6 469 109 1229512 0 1557750 636038 68536002 73545007 601945 628876 4353097 3605564 75048794 78415485 56685 59339 0 0 40607233 41889748 0 0 0 39196505 45460240 79860423 87409327 -4811629 -8993842 124362678 128710233 79351169 91928149 45011509 36782084 AS AN AFFILIATE OF COMMONSPIRIT HEALTH, WE MAKE THE HEALING PRESENCE OF GOD KNOWN IN OUR WORLD BY IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL. 0 0 75862334 59339 73545007 SEE SCHEDULE H 75862334 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 X 0 0 469 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X VICKI MALESKI 3206315674 815 SE 2ND STREET LITTLE FALLS MN 56345 PAUL JOHNSON MD PHYSICIAN 45.00 0.00 X 1096971 0 49130 DAVID EDGERTON JR MD PHYSICIAN 45.00 0.00 X 844405 0 45014 JONATHAN ZELLMER MD GENERAL SURGEON 45.00 0.00 X 483729 0 55405 DAVID JONES BOARD MEMBER/MARKET PRESIDENT REGIONAL HOSPITAL 1.00 45.00 X 0 460692 53617 ALICIA FRANKWITZ MD PHYSICIAN 45.00 0.00 X 472997 0 9357 STEVEN SMITH BOARD MEMBER/CEO 1.00 45.00 X X 0 388077 57477 DAYLE QUIGLEY MD PHYSICIAN 45.00 0.00 X 396903 0 47297 TIM SCHNACK MARKET CFO 1.00 45.00 X 0 369715 48053 NICK O'TOOL MARKET CFO (PARTIAL YEAR) 1.00 49.00 X 0 349020 50949 AMBER STOWMAN FORMER OFFICER 0.00 40.00 X 0 221301 44587 PETER GERMSCHEID MD BOARD MEMBER/PHYSICIAN 45.00 0.00 X 190797 0 23246 KRISTINE ERICKSON VICE CHAIRPERSON 1.00 1.00 X X 0 0 0 CHRISTINE GAMMON-KRUSCHEK BOARD MEMBER 1.00 1.00 X 0 0 0 JON VETTER CHAIRPERSON 1.00 1.00 X X 0 0 0 DOUG DAHLBERG BOARD MEMBER 1.00 1.00 X 0 0 0 ROXANNE THOMPSON BOARD MEMBER 1.00 1.00 X 0 0 0 SR CAROLINE STOLTZ SECRETARY 1.00 1.00 X X 0 0 0 JOHN HACKER BOARD MEMBER 1.00 1.00 X 0 0 0 3485802 1788805 484132 73 1 1 0 CLINICAL COLLEAGUES INC 1765 E NINE MILE RD PENSACOLA FL 32514 CRNA SERVICES 2094092 CENTRACARE LABORATORIES SVC 20 NINTH ST SE LONG PRAIRIE MN 56347 LAB SERVICES 1688954 NATIONAL GOVERNMENT SVCS INC 5000 BRITTONFIELD PKWY STE 100 EAST SYRACUSE NY 13057 MEDICARE CONTRACTING SERVICES 1429400 WAPITI MEDICAL STAFFING 6112 CHANCELLOR DR CEDAR FALLS IA 50613 MEDICAL STAFFING SERVICES 1369151 CENTRAL MINNESOTA DIAGNOSTIC PO BOX 158 MILACA MN 56353 CT SCANS, ULTRASOUND 775320 16 23967 391274 220797 636038 NET PATIENT SERVICES 900099 71065520 71065520 0 0 INTERCOMPANY 900099 2479487 2479487 0 0 73545007 231218 231218 151900 0 151900 151900 151900 379065 18593 0 0 379065 18593 397658 397658 18474 23967 12357 6117 6117 3875 0 3875 3875 54655 55273 -618 -618 PHARMACY SERVICES 446110 2408755 0 1229512 1179243 REIMBURSEMENT OF EXPEN 900099 669442 0 0 669442 CAFETERIA 722100 108084 0 0 108084 258009 258009 3444290 78415485 73545007 1229512 3004928 X 15879 15879 43460 43460 209000 209000 32977685 31319498 1658187 1498919 1423416 75503 5014662 4763338 251324 2189482 2080008 109474 103739 103739 3236 3236 18233397 13667110 4566287 203055 67008 136047 1058737 805749 252988 2998015 2968035 29980 3371744 2967135 404609 236988 201440 35548 505 278 227 436567 436567 3004149 3004149 3999857 3439877 559980 312346 306099 6247 MEDICAL SUPPLIES 8455213 8455213 0 0 REPAIRS AND MAINTENANCE 1078017 1024116 53901 0 OTHER TAXES 1064458 1011235 53223 0 MISCELLANEOUS EXPENSES 431076 214686 216390 0 469141 443187 25954 87409327 75862334 11546993 0 100195 35044 872898 1752161 0 0 10691699 8804470 0 0 0 0 132961 418910 2254633 2137657 356923 373596 56025957 37600500 19586329 18425457 103500 103500 18192057 11518883 0 0 0 0 72071483 85140555 124362678 128710233 5631695 6038000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 73719474 85890149 79351169 91928149 X 44659213 36551675 352296 230409 45011509 36782084 124362678 128710233 -8993842 764417 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3236 0 0 0 3236 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION: $1403 CATHOLIC HEALTH ASSOCIATION: $605 MN HOSPITAL ASSOCIATION: $1161 ALLOCATED 340B $67 9330 9330 9330 9330 9330 9330 9330 9330 9330 9330 1.00000 0 0 679204 679204 17247191 10249245 6997946 4552806 1868382 2684424 32592098 24857384 7734714 954658 625489 329169 18425457 CSH OPERATING INVESTMENT POOL 11518883 F 11518883 INTERCOMPANY RECEIVABLES 73816082 RIGHT OF USE ASSETS 10383436 DIVIDEND RECEIVABLE 941037 85140555 INTERCOMPANY DEBT 73411138 LEASE LIABILITY 11409522 ENVIRONMENTAL REMEDIATION LIABILITY 820055 VENDOR ACCRUALS 96223 OTHER LIABILITIES 1956 PHYSICIAN RECRUIT AND GUARANTEE PAYABLE 151255 85890149 X PART V, LINE 4: THE INCOME FROM THIS PERMANENT ENDOWMENT IS TO BE USED TO MEET THE HOSPITAL'S GREATEST NEEDS. PART X, LINE 2: UNITY FAMILY HEALTHCARE'S FINANCIAL INFORMATION IS INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS, WHICH INCLUDES THE FOLLOWING DISCLOSURE: COMMONSPIRIT REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. SPRING MAGIC 11628 4839 6789 3897 100 1336 644 GOLF TOURNAMENT/DRIVE FORE CANCER 30813 19128 11685 6220 160 42441 23967 18474 3897 6320 1336 804 12357 6117 1 1 X 1 X 1 X 1 1 0 1 1 983 229396 0 229396 0.00260 20800 10251813 8502845 1748968 0.02000 21783 10481209 8502845 1978364 0.02260 8 963 223899 27357 196542 0.00220 0 0 2 7049 1539188 0 1539188 0.01760 6 5247 87052 0 87052 0.00100 16 13259 1850139 27357 1822782 0.02080 16 35042 12331348 8530202 3801146 0.04340 1 10 4187 4187 0.00000 2 72 111245 5207 106038 0.00120 3 82 115432 5207 110225 0.00120 1 2183046 7298627 11294166 -3995539 X 1 1 1 1 ST GABRIEL'S HOSPITAL 815 SE SECOND STREET LITTLE FALLS MN 56345 WWW.CHISTGABRIELS.COM/ 8392027 X X X X ST GABRIEL'S HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X HTTPS://WWW.CHISTGABRIELS.COM/CHNA/ X 1 22 1 HTTPS://WWW.CHISTGABRIELS.COM/CHNA/ 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X X 1 X 0 X X X X 1 X 0 0 ST. GABRIEL'S HOSPITAL PART V, SECTION B, LINE 5: AS A HOSPITAL WITHIN ONE OF THE THREE COUNTIES SERVED BY THE MORRISON-TODD-WADENA COMMUNITY HEALTH BOARD, CHI ST. GABRIEL'S HEALTH ONCE AGAIN TURNED TO COLLEAGUES WITHIN THE HOSPITALS AND PUBLIC HEALTH ORGANIZATIONS IN THIS REGION TO FORM A WORKING COMMITTEE (INFORMALLY KNOWN AS THE MTW COMMITTEE) TO CONDUCT A FORMAL SURVEY OF THE COMMUNITY. MEMBERS OF THE MTW COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE INCLUDED REPRESENTATIVES FROM: PUBLIC HEALTH PROFESSIONALS FROM MORRISON, TODD, AND WADENA COUNTIES; LAKEWOOD HEALTH SYSTEM, STAPLES (TODD COUNTY); TRI-COUNTY HEALTH, WADENA (WADENA COUNTY); CENTRACARE HEALTH -LONG PRAIRIE (TODD COUNTY); AND CHI ST. GABRIEL'S HEALTH (MORRISON COUNTY).THE MORRISON-TODD-WADENA COMMITTEE PLANNED AND CONDUCTED INTERVIEWS WITH COMMUNITY STAKEHOLDERS AT THE SAME TIME AS PLANNING THE SURVEY AND WAITING FOR THE SURVEY RESULTS. EACH HOSPITAL CONDUCTED ITS OWN STAKEHOLDER INTERVIEWS BASED UPON THE SET OF QUESTIONS DEVELOPED BY THE COMMITTEE MEMBERS IN COLLABORATION, EXPECTING THAT DOING SO WOULD ALLOW THEM TO COMPARE ANSWERS AND INFORMATION AFTER THE INTERVIEWS WERE COMPLETED.IN THE SUMMER OF 2021, THE MTW COMMITTEE CONVENED TO CONDUCT A SURVEY OF THE COMMUNITY. LED BY KATHERINE MACKEDANZ, MPH, MANAGER OF TODD COUNTY PUBLIC HEALTH AND HUMAN SERVICES, TO REVIEW AND MODIFY 2018 SURVEY QUESTIONS FOR THE 2021 SURVEY. 6,400 PAPER SURVEYS WERE MAILED TO HOUSEHOLDS IN MORRISON, TODD AND WADENA COUNTIES BETWEEN OCTOBER AND DECEMBER 2021. AN ELECTRONIC SURVEY WAS ALSO ALSO ADMINISTERED DURING THIS SAME TIMEFRAME AND WAS DISSEMINATED THROUGH MTW MEMBER WEBSITES AND SOCIAL MEDIA OUTLETS. THE DATA COLLECTED INFORMS THE WORK OF THE 2022 CHNA. ST. GABRIEL'S HOSPITAL PART V, SECTION B, LINE 6A: LAKEWOOD HEALTH SYSTEM, STAPLES (TODD COUNTY); CENTRACARE HEALTH -LONG PRAIRIE (TODD COUNTY) ST. GABRIEL'S HOSPITAL PART V, SECTION B, LINE 6B: MORRISON COUNTY PUBLIC HEALTH AND HUMAN SERVICES ST. GABRIEL'S HOSPITAL PART V, SECTION B, LINE 11: THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON HTTPS://WWW.CHISTGABRIELS.COM/CHNA THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY AND SECONDARY DATA FROM RESIDENT SURVEYS AND COUNTY PUBLIC HEALTH INFORMATION. TOP HEALTH NEEDS (FROM 2022 CHNA): 1. OBESITY, NUTRITION, AND DIABETES2. ADVERSE CHILDHOOD EXPERIENCES (ACES)3. MENTAL HEALTH4. HIRING HEALTHCARE PROFESSIONALS5. INCREASING CHILDCARE OPPORTUNITIESFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: OBESITY, NUTRITION, AND DIABETESTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023-2025:- STRATEGY 1.1: IMPLEMENT THE TOTAL HEALTH ROADMAP AT FAMILY MEDICAL CENTER (FMC) CLINICS TO SCREEN FOR NUTRITION SECURITY VIA COMMUNITY HEALTH WORKERS. PARTNER WITH EXTENSION SNAP EDUCATORS TO INCREASE ENROLLMENT OF SNAP ELIGIBLE PERSONS.FY24 ACTIONS AND IMPACT: COMMUNITY HEALTH WORKER CONTINUED TO SCREEN PATIENTS FOR SOCIAL DETERMINANTS OF HEALTH. A FOOD PANTRY HAS BEEN STARTED ONSITE AT ST. GABRIEL'S HOSPITAL. CHW IS SERVING AS A LOCAL COOK FOR OUR NEIGHBORS COMMITTEE DISCUSSING MEALS TO BE PREPARED FOR STUDENTS IN THE SUMMER.MEASURES:# OF PATIENTS SCREENED: 360 PATIENTS SCREENED POSITIVE FOR HRSN IN FY24- STRATEGY 1.2 SUPPORT THE EXPANSION OF A COMMUNITY WELLNESS CALENDAR IN PARTNERSHIP WITH LITTLE FALLS SCHOOLS AND UNIVERSITY OF MINNESOTA.FY24 ACTIONS AND IMPACT: LOCAL COMMUNITY PARTNER, UNIVERSITY OF MINNESOTA EXTENSION, CREATED A WELLNESS CALENDAR FOR THE COMMUNITY.MEASURES: THERE ARE NO MEASURES TO REPORT.-STRATEGY 1.3 EXPAND DIABETES EDUCATION. FY24 ACTIONS AND IMPACT: NO DATA AVAILABLE AT TIME OF REPORTINGMEASURES: THERE ARE NO MEASURES TO REPORT.- STRATEGY 1.4 EXPAND FITNESS OPPORTUNITIES IN THE COMMUNITY THROUGH PUBLIC AND PRIVATE PARTNERSHIPS.FY24 ACTIONS AND IMPACT: LOCAL SCHOOLS HAVE CREATED A LOW COST (8 DOLLARS PER PERSON) OPPORTUNITY TO UTILIZE SCHOOL BUILDINGS FOR WALKING.MEASURES: THERE ARE NO MEASURES TO REPORT.PRIORITY HEALTH NEED #2: ACESTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023-2025:- STRATEGY 2.1 INTEGRATE ACES SCREENING AND REFERRAL IN PRIMARY CARE AT FMC CLINICS.FY24 ACTIONS AND IMPACT: NO DATA AVAILABLE AT TIME OF REPORTINGMEASURES: THERE ARE NO MEASURES TO REPORT.- STRATEGY 2.2 PROVIDE EDUCATION TO STAFF AND PROVIDERS REGARDING ACES AWARENESS.FY24 ACTIONS AND IMPACT: ACE'S AND TRAUMA INFORMED CARE (TIC) EDUCATION WAS PROVIDED TO 6 DIFFERENT GROUPS OF NURSING STUDENTS FROM RASMUSSEN AND CLC. EDUCATION WAS PROVIDED REGARDING ACE, RESILIENCE AND WELLBEING (PCE), & TIC FOR NEW EMPLOYEE ORIENTATION GROUPS IN NOVEMBER 2024.MEASURES: THERE ARE NO MEASURES TO REPORT.- STRATEGY 2.3 PROVIDE COMMUNITY EDUCATION ON ACES.FY24 ACTIONS AND IMPACT: NO DATA AVAILABLE AT TIME OF REPORTINGMEASURES: THERE ARE NO MEASURES TO REPORT.- STRATEGY 2.4 SUPPORT THE TRAIN THE TRAINER PROGRAM THROUGH MORRISON COUNTY FAMILY SERVICES.FY24 ACTIONS AND IMPACT: NO DATA AVAILABLE AT TIME OF REPORTINGMEASURES: THERE ARE NO MEASURES TO REPORT.- STRATEGY 2.5 EXPLORE ACES EDUCATION IN AREA SCHOOLS.FY24 ACTIONS AND IMPACT: NO DATA AVAILABLE AT TIME OF REPORTINGMEASURES: THERE ARE NO MEASURES TO REPORT.PRIORITY HEALTH NEED #3: MENTAL HEALTH, INCLUDING SUICIDE PREVENTIONTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- STRATEGY 3.1 CONTINUE INVOLVEMENT/SUPPORT FOR MORRISON COUNTY SUICIDE PREVENTION COHORT.FY24 ACTIONS AND IMPACT: A TABLE OFFERING EDUCATION AND RESOURCES ON SUICIDE PREVENTION WAS PROVIDED AT AT THE HIGH SCHOOL IN MAY THROUGH THE MORRISON COUNTY SUICIDE PREVENTION COHORT WITH 400 STUDENTS IN ATTENDANCE.MEASURES: THERE ARE NO MEASURES TO REPORT.- STRATEGY 3.2 EXPAND EDUCATION AND REACH OF THE NEW 988 RESOURCE.FY24 ACTIONS AND IMPACT: NO DATA AVAILABLE AT TIME OF REPORTING.MEASURES: THERE ARE NO MEASURES TO REPORT.-STRATEGY 3.3 CONTINUE LEAD SUPPORT FOR MINNESOTA PREVENTION ALLIANCE.FY24 ACTIONS AND IMPACT: THE MINNESOTA PREVENTION ALLIANCE HELD A THREE DAY CONFERENCE IN BRAINERD, MN. THE ANNUAL MINNESOTA PREVENTION PROGRAM SHARING CONFERENCE PROVIDES LEARNING, NETWORKING AND SKILL BUILDING OPPORTUNITIES TO ENHANCE ALCOHOL, TOBACCO AND OTHER DRUG MISUSE PREVENTION EFFORTS. BY SHARING EFFECTIVE PREVENTION STRATEGIES AND PROGRAMS, PRESENTERS AND PARTICIPANTS LEARNED FROM ONE ANOTHER IN THIS EXEMPLARY, TWO-DAY LEARNING COMMUNITY.MEASURES: THERE ARE NO MEASURES TO REPORT.- STRATEGY 3.4 RECRUIT ADDITIONAL MENTAL AND BEHAVIORAL HEALTH PROVIDERS. FY24 ACTIONS AND IMPACT:THE FAMILY MEDICAL CENTER ADDED AN ADDITIONAL 2 BEHAVIORAL HEALTH ADVANCED PRACTICE PROVIDERS.MEASURES: # OF BEHAVIORAL HEALTH PROVIDERS HIRED: 2- STRATEGY 3.5 START KETAMINE INFUSION CLINICFY24 ACTIONS AND IMPACT: CONTINUE TO RECEIVE REFERRALS AND ONGOING TREATMENTS.MEASURES: THERE ARE NO MEASURES TO REPORT.THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS: HIRING HEALTHCARE PROFESSIONALS - THE HOSPITAL WILL FOCUS ON ITS OWN PROGRAM FOR RECRUITMENT OF PROVIDERS, NURSES, AND STAFF TO CONTINUE TO PROVIDE EXCELLENT PATIENT CARE IN OUR COMMUNITY.INCREASING CHILDCARE OPPORTUNITIES - THE HOSPITAL WORKED WITH COMMONSPIRIT HEALTH AND THE CITY OF LITTLE FALLS TO ADD UP TO 24 ADDITIONAL CHILD CARE OPENINGS IN 2023. ST. GABRIEL'S WILL REMODEL THE FORMER ST. CAMILLUS PLACE AND MAKE IT AVAILABLE FOR DAYCARE PROVIDERS. ST. GABRIEL'S HOSPITAL PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. PATIENT COOPERATION STANDARDS - A PATIENT MUST COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS. PART V, SECTION B, LINE 3E THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA. PART V, SECTION B, LINES 16A-C: HTTPS://WWW.CHISTGABRIELS.COM/FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE-REVIEW/ 4 1 - LITTLE FALLS ORTHOPEDICS 1108 1ST STREET SE LITTLE FALLS MN 56345 OUTPATIENT CLINIC 2 - FAMILY MEDICAL CENTER PIERZ 200 1ST AVE S PIERZ MN 56364 OUTPATIENT CLINIC 3 - FAMILY MEDICAL CENTER RANDALL 250 WHITE OAK DRIVE RANDALL MN 56475 OUTPATIENT CLINIC 4 - FAMILY MEDICAL CENTER 811 SE SECOND STREET LITTLE FALLS MN 56345 OUTPATIENT CLINIC PART I, LINE 3C: UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: - THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. - THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED [IN THE FAP]. - THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: - RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS; - HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS CLINIC; - PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); - FOOD STAMP ELIGIBILITY; - ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID SPEND-DOWN); - LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR - PATIENT IS DECEASED WITH NO KNOWN ESTATE. PART I, LINE 7: THE HOSPITALS USE AN ADJUSTED COST TO CHARGE RATIO (CCR) CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 IS USED IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA) SOFTWARE TO CALCULATE MEDICAID AND OTHER MEANS-TESTED PROGRAMS EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES INCLUDING COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS. PART II, COMMUNITY BUILDING ACTIVITIES: ST. GABRIEL'S HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT INVESTMENTS, AS WELL AS HOSPITAL SPECIFIC INVESTMENTS THAT ADDRESS COMMUNITY HEALTH NEEDS WHICH INCLUDE SUPPORT OF LOCAL HEALTH COALITIONS, INVESTMENTS IN PARTNERSHIPS AND PROGRAMS THAT ADDRESS TOP COMMUNITY HEALTH NEEDS, PARTICIPATION IN LOCAL COMMITTEES AND BOARDS TIED TO TOP HEALTH NEEDS, AND INVESTMENTS IN MANY OTHER WAYS AS DESCRIBED IN OTHER AREAS OF THE SCHEDULE H NARRATIVE. CHI SUPPORTS: COMMUNITY SUPPORTBELOW ARE SPECIFIC EXAMPLES OF WORK THAT FALLS WITHIN THE DEFINITION OF COMMUNITY BUILDING ACTIVITIES. THESE ACTIVITIES ARE CRITICAL IN HELPING BUILD SOCIAL, HEALTH, AND ECONOMIC OPPORTUNITIES IN OUR COMMUNITY THAT ULTIMATELY DRIVE HEALTH STATUS AND QUALITY OF LIFE FOR OUR RESIDENTS: - HOSTED THE LITTLE FALLS COMMUNITY DAY OF CARING TO ASSIST LOCAL RESIDENTS WITH YARD CLEAN UP- PROVIDE FINANCIAL SUPPORT TO COMMUNITY SERVICES OF LITTLE FALLS TO HELP DEFRAY COSTS OF RECREATION PROGRAMS IN THE COMMUNITY - ASSISTS 5,333 COMMUNITY YOUTH. PART III, LINE 2: THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR ADDITIONAL DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: UNITY FAMILY HEALTHCARE MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. UNITY FAMILY HEALTHCARE'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. UNITY FAMILY HEALTHCARE ALSO UTILIZES A WAYSTAR SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. WAYSTAR USES A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, UNITY FAMILY HEALTHCARE DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. PART III, LINE 4: UNITY FAMILY HEALTHCARE DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2024, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 11-12."PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES." PART III, LINE 8: COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. UNITY FAMILY HEALTHCARE'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $3,995,539 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS. PART III, LINE 9B: COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. PART VI, LINE 3: INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. PART VI, LINE 4: RANKING AS THE 30TH MOST RURAL OF MINNESOTA'S 87 COUNTIES, AND MEETING FEDERAL DEFINITIONS OF RURAL WITH NEARLY 75 PERCENT OF ITS PEOPLE LIVING OUTSIDE OF A U.S. CENSUS BUREAU DESIGNATED URBAN AREA, MORRISON COUNTY IS HOME TO JUST MORE THAN 34,000 PEOPLE. MORRISON IS MINNESOTA'S 17TH LARGEST COUNTY BY AREA, ENCOMPASSING 1,124.5 SQUARE MILES. WITH A POPULATION DENSITY OF FEWER THAN 29 PEOPLE IN EACH SQUARE MILE, MORRISON COUNTY RANKS 41ST AMONG MINNESOTA COUNTIES FOR POPULATION DENSITY. IN 2020, MORE THAN 26.8 PERCENT OF MORRISON COUNTY'S RESIDENTS LIVED IN LITTLE FALLS, AN INCREASE OF MORE THAN 1.5 PERCENT OVER 2019 ESTIMATES. THE COUNTY'S OTHER TOWNS COMBINED CONTINUE TO BE HOME TO 18 PERCENT OF THE COUNTY'S RESIDENTS.PEOPLE OVER THE AGE OF 65 REPRESENT A GREATER PORTION OF THE MORRISON COUNTY POPULATION THAN THEY DO IN MINNESOTA AND THE UNITED STATES OVERALL. THE PERCENTAGE OF PEOPLE IN THAT AGE GROUP IS INCREASING IN MORRISON COUNTY FASTER THAN IT IS STATEWIDE. (20% 65 YEARS OF AGE AND OLDER IN MORRISON, COMPARED TO 13.6% IN MINNESOTA). WHILE THE POPULATION IS DIVERSIFYING IN TERMS OF RACE AND ETHNICITY, MORRISON COUNTY RESIDENTS ARE PREDOMINANTLY NON-HISPANIC WHITE (95% OF MORRISON COUNTY RESIDENTS IDENTIFIED AS WHITE IN 2020 AND ONLY 2% OF ALL RESIDENTS IDENTIFIED AS HISPANIC). IN 2021, 3.9% OF RESPONDENTS (WEIGHTED) IDENTIFIED THEMSELVES AS NOT WHITE IN THE MORRISON-TODD WADENA COMMUNITY HEALTH SURVEY; IN 2019, 1.8% IDENTIFIED THEMSELVES AS NOT WHITE. IN 2016, ONLY 0.9% IDENTIFIED THEMSELVES AS NOT WHITE.ACCORDING TO THE U.S. CENSUS BUREAU, IN 2020, THE MEDIAN ANNUAL INDIVIDUAL AND FAMILY INCOME IN MORRISON COUNTY WAS $34,103 AND $57,815, RESPECTIVELY. THE ANNUAL COST OF LIVING FOR AN INDIVIDUAL AND FAMILY OF FOUR WAS $30,402 AND $61,023, RESPECTIVELY. THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY IS 10.3%, DOWN FROM 13% IN 2010. THE PROPORTION OF CHILDREN UNDER 18 LIVING IN POVERTY DECREASED FROM 16% IN 2010 TO 13.2%.COMMUNITY DEVELOPMENT MORRISON COUNTY REPORTED THAT IN OCTOBER 2021 THERE WERE 12,536 PEOPLE WORKING IN THE COUNTY (COUNTY UNEMPLOYMENT RATE WAS 5% IN DECEMBER 2022). THE AVERAGE HOURLY WAGE OF THE WORKERS IN MORRISON COUNTY IN DECEMBER 2021 WAS $15.91, OR $33,093 ANNUALLY FOR A 40-HOUR WORK WEEK, WHILE THE ANNUAL COST OF LIVING FOR A FAMILY OF THREE WAS $49,625, ACCORDING TO THE MINNESOTA DEPARTMENT OF EMPLOYMENT AND ECONOMIC DEVELOPMENT.THE ENTIRETY OF MORRISON COUNTY IS CONSIDERED UNDERSERVED BY MENTAL HEALTH PROFESSIONALS. THIS DESIGNATION WAS ORIGINALLY MADE IN OCTOBER 2002 AND UPDATED IN SEPTEMBER 2021. TWO TOWNSHIPS MORRILL IN THE SOUTHEAST AND SCANDIA VALLEY IN THE NORTHWEST ARE DESIGNATED AS UNDERSERVED BY PRIMARY CARE PRACTITIONERS.ALL OF MORRISON COUNTY IS DESIGNATED AS A LOW INCOME PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA. ALL BUT THREE OF ITS 30 TOWNSHIPS, AND THE CITIES AND TOWNS WITHIN THEM, RECEIVED THIS DESIGNATION AS A GROUP IN 2003 AND WERE REDESIGNATED IN 2021. MORRISON COUNTY IS ALSO DESIGNATED AS AN HPSA FOR DENTAL HEALTH, RECEIVING THAT DESIGNATION IN 2020. ALL OF MORRISON COUNTY IS CURRENTLY DESIGNATED AS AN HPSA FOR MENTAL HEALTH AS PART OF THE REGION 5 MENTAL HEALTH SERVICE AREA. THIS DESIGNATION WAS FIRST MADE IN 2002 AND UPDATED IN 2021. PART VI, LINE 5: FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE.USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE.OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS.ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. HOSPITAL COMMUNITY BOARDS (OR THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AND PROGRESS TOWARD IDENTIFIED GOALS. PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 24 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS. COMMONSPIRIT HEALTH AND SUBSTANTIALLY ALL OF ITS DIRECT AFFILIATES AND SUBSIDIARIES HAVE BEEN GRANTED EXEMPTIONS FROM FEDERAL INCOME TAX AS CHARITABLE ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF SEPTEMBER 25, 2024, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,300 CARE SITES, CONSISTING OF 137 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. AN ADDITIONAL 21HOSPITALS ARE OPERATED THROUGH UNCONSOLIDATED JOINT VENTURES. IN FISCAL YEAR 2024, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.574 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.22 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $37.5 BILLION IN FISCAL YEAR 2024, HAS TOTAL ASSETS OF APPROXIMATELY $54.73 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. 1 SCHOLARSHIPS 4 2000 BOOK PATIENT INTERPRETERS 105 41460 BOOK PAYMENTS TO INTERPRETERS FOR NON-ENGLISH SPEAKING PATIENTS PART I, LINE 2: REQUESTS FOR GRANTS TO BE PAID TO INDIVIDUALS OR ORGANIZATIONS ARE SENT TO THE MANAGER OF COMMUNICATIONS AND/OR THE FOUNDATION DIRECTOR FOR APPROVAL. THESE REQUESTS ARE REVIEWED TO ENSURE THEIR PURPOSE BENEFITS THE COMMUNITY AND ARE IN LINE WITH UNITY FAMILY HEALTHCARE'S MISSION AND VALUES. LARGE GRANT FUND REQUESTS ARE REVIEWED AND SIGNED OFF ON BY THE PRESIDENT/CEO. THE FOUNDATION DIRECTOR IS RESPONSIBLE FOR WORKING WITH EACH GRANTEE TO MEET THEIR REPORTING GUIDELINES AS STIPULATED TO ENSURE GRANT AWARDS ARE USED ACCORDING TO THE CONTRACT SIGNED BY BOTH PARTIES. GRANT CONTRACTS ARE MAINTAINED IN MEDITRACT WITH REMINDERS OF EXPIRATION DATES TO ENSURE TIMELY REPORTING AND COMPLETION. 0 1 0 0 0 0 0 0 0 PAUL JOHNSON MD PHYSICIAN 1095711 0 0 0 1260 0 19000 0 30130 0 1146101 0 0 0 DAVID EDGERTON JR MD PHYSICIAN 842473 0 0 0 1932 0 19350 0 25664 0 889419 0 0 0 JONATHAN ZELLMER MD GENERAL SURGEON 482835 0 0 0 894 0 19175 0 36230 0 539134 0 0 0 DAVID JONES BOARD MEMBER/MARKET PRESIDENT REGION 0 303052 0 156175 0 1465 0 19175 0 34442 0 514309 0 0 ALICIA FRANKWITZ MD PHYSICIAN 466105 0 0 0 6892 0 7625 0 1732 0 482354 0 0 0 STEVEN SMITH BOARD MEMBER/CEO 0 282695 0 91828 0 13554 0 33858 0 23619 0 445554 0 12311 DAYLE QUIGLEY MD PHYSICIAN 391359 0 0 0 5544 0 19175 0 28122 0 444200 0 0 0 TIM SCHNACK MARKET CFO 0 290959 0 74901 0 3855 0 19529 0 28524 0 417768 0 0 NICK O'TOOL MARKET CFO (PARTIAL YEAR) 0 252554 0 96047 0 419 0 16660 0 34289 0 399969 0 0 AMBER STOWMAN FORMER OFFICER 0 195050 0 25800 0 451 0 14252 0 30335 0 265888 0 0 PETER GERMSCHEID MD BOARD MEMBER/PHYSICIAN 187471 0 0 0 3326 0 12288 0 10958 0 214043 0 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2023, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY COMMONSPIRIT HEALTH , A RELATED ORGANIZATION. COMMONSPIRIT HEALTH USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART I, LINE 4A: CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY AN EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 52 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION AND TENURE, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. SCHEDULE J, PART I, LINE 4B: DURING THE 2023 CALENDAR YEAR, COMMONSPIRIT HEALTH ("COMMONSPIRIT") MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DURING 2023 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: STEVEN SMITH, $12,311. DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2023 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. SCHEDULE J, PART II UNITY FAMILY HEALTHCARE FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST COMMONSPIRIT IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE COMMONSPIRIT TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES COMMONSPIRIT SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND COMMONSPIRIT'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL, AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2023. LISA GERMSCHEID SPOUSE OF DIRECTOR 213789 EMPLOYEE PAYROLL WAGES 0 MICHELLE DAHLBERG SPOUSE OF DIRECTOR 140583 EMPLOYEE PAYROLL WAGES 0 PART V, LINE 1C: PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF COMMONSPIRIT HEALTH ARE MADE BY COMMONSPIRIT HEALTH. THEREFORE, NO FORMS 1099 ARE ISSUED BY UNITY FAMILY HEALTHCARE. COMMONSPIRIT HEALTH FILES THE FORMS 1099 AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAME WINNINGS. THE FORMS 1099 ISSUED ON BEHALF OF UNITY FAMILY HEALTHCARE ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 1A PURSUANT TO SECTION 8.6 OF THE BYLAWS OF UNITY FAMILY HEALTHCARE, THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION AND SHALL BE COMPOSED OF THE CHAIRPERSON, VICE CHAIRPERSON, AND THE PRESIDENT AND CEO, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE. EACH INDIVIDUAL APPOINTED SHALL SERVE A TERM OF ONE YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. EXCEPT AS PROVIDED BY LAW, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. ADDITIONALLY, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT SUCH ACTIONS TAKEN SHALL BE CONSISTENT WITH AND NOT CONFLICT WITH ANY ACTIONS OR POLICIES OF THE BOARD OF DIRECTORS OR OF THE CORPORATE MEMBER, WITH THE BYLAWS, OR WITH APPLICABLE LAWS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE CORPORATE MEMBER IS COMMONSPIRIT HEALTH, A COLORADO NON-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS COMMONSPIRIT HEALTH. PURSUANT TO SECTION 5.5.1 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: - SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF UNITY FAMILY HEALTHCARE ("UFH"); - AMENDMENT OF THE CORPORATE DOCUMENTS OF UFH; - APPROVE MEMBERS OF THE UFH BOARD; - REMOVAL OF A MEMBER OF THE GOVERNING BODY OF UFH; - APPROVAL OF ISSUANCE OF DEBT BY UFH; - APPROVAL OF PARTICIPATION OF UFH IN A JOINT VENTURE; - APPROVAL OF FORMATION OF A NEW CORPORATION BY UFH; - APPROVAL OF A MERGER INVOLVING UFH; - APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF UFH; - TO REQUIRE THE TRANSFER OF ASSETS BY UFH TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS. - ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR UFH. PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, COMMONSPIRIT HEALTH MAY, IN EXERCISE OF ITS APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION B, LINE 11B FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE COMMONSPIRIT HEALTH TAX DIRECTOR AND THE LOCAL VP OF OPERATIONAL FINANCE. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW VIA EMAIL AND ARE ABLE TO ASK THE VP OF OPERATIONAL FINANCE AND TAX DIRECTOR QUESTIONS PRIOR TO FILING WITH THE IRS. UPON VP OF OPERATIONAL FINANCE APPROVAL AND SIGNATURE, THE TAX ANALYST FILES THE FINAL FORM 990 AS PRESENTED TO THE BOARD, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO PROTECT THE INTERESTS OF COMMONSPIRIT HEALTH ("COMMONSPIRIT") IN CIRCUMSTANCES THAT MAY RESULT IN A CONFLICT BETWEEN PERSONAL INTERESTS OF A PERSON AND THE INTERESTS OF THE ORGANIZATION AND THOSE IT SERVES. COMMONSPIRIT'S COI POLICY APPLIES TO COMMONSPIRIT, ITS DIRECT AFFILIATES AND SUBSIDIARIES AND ANY RELATED ENTITY THE GOVERNING DOCUMENTS OF WHICH REQUIRE THE ENTITY TO COMPLY WITH COMMONSPIRIT POLICY (COLLECTIVELY THE "SYSTEM ENTITIES"). THE FOLLOWING PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY (VIA A FORMAL SYSTEM-ADMINISTERED SURVEY) IF THE PERSON'S AFFILIATION WITH COMMONSPIRIT CONTINUES: - MEMBERS OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF COMMITTEES OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM ("ELT") OF COMMONSPIRIT - CORPORATE OFFICERS OF SYSTEM ENTITIES - EMPLOYED PHYSICIANS AND ADVANCED PRACTICE PROVIDERS - KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES AS SPECIFIED BY THE INTERNAL REVENUE SERVICE FOR FORM 990 PURPOSES WHO ARE NOT OTHERWISE INCLUDED IN THE CATEGORIES ABOVE - EMPLOYEES OF SYSTEM ENTITIES AT THE VICE PRESIDENT LEVEL AND ABOVE - ALL INDIVIDUALS ENGAGED IN RESEARCH AT INSTITUTIONS OWNED OR OPERATED BY A SYSTEM ENTITY - SELECT EMPLOYEES AS DETERMINED FROM TIME TO TIME BY LEADERSHIP DISCLOSURE, REVIEW, AND MANAGEMENT OF PERCEIVED, POTENTIAL, OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. EACH PERSON IS REQUIRED TO PROMPTLY AND FULLY DISCLOSE ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST AS SOON AS SHE/HE BECOMES AWARE OF IT. IN ADDITION, AT THE INCEPTION OF AN INDIVIDUAL'S RELATIONSHIP WITH COMMONSPIRIT (E.G. HIRING, BOARD APPOINTMENT), AND FOR CERTAIN POSITIONS, ANNUALLY THEREAFTER, WRITTEN CONFLICT OF INTEREST DISCLOSURE FORMS MUST BE COMPLETED. A FAILURE TO DISCLOSE MAY RESULT IN DISCIPLINARY OR CORRECTIVE ACTIONS. REPORTED POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE INITIALLY REVIEWED BY LEGAL, CORPORATE RESPONSIBILITY OR RESEARCH INTEGRITY STAFF. IF NECESSARY, A CONFLICT OF INTEREST MANAGEMENT PLAN IS DEVELOPED, WHICH PLAN SHALL BE SUBJECT TO ACCEPTANCE BY THE APPROPRIATE DIRECT MANAGER, SUPERVISOR, MEDICAL STAFF OFFICE, BOARD OR BOARD COMMITTEE (FOR BOARD, BOARD COMMITTEE, ELT OR CORPORATE OFFICER CONFLICTS), OR OTHER APPROPRIATE INDIVIDUAL OR BODY. ONCE ACCEPTED, THE CONFLICT OF INTEREST MANAGEMENT PLAN IS COMMUNICATED TO THE PERSON WITH THE ACTUAL OR POTENTIAL CONFLICT AND THE INDIVIDUAL MUST CONDUCT THEMSELVES IN CONFORMITY WITH THE PLAN. IN THE EVENT THAT A TRANSACTIONAL CONFLICT INTEREST ARISES IN CONNECTION WITH A SYSTEM ENTITY BOARD MEETING, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THAT CONFLICT PRIOR TO OR AT THE BEGINNING OF THE MEETING IN WHICH THE MATTER IS TO BE CONSIDERED. THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE TRANSACTION AND IS PROHIBITED FROM USING PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, BUT IS NOT PROHIBITED FROM PROVIDING INPUT IF REQUESTED TO DO SO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT PUBLICLY AVAILABLE. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 5,745. MANAGEMENT AND GENERAL EXPENSES 1,915. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,660. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 640,576. MANAGEMENT AND GENERAL EXPENSES 213,525. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 854,101. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,605,619. MANAGEMENT AND GENERAL EXPENSES 1,535,206. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,140,825. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,312,393. MANAGEMENT AND GENERAL EXPENSES 1,114,715. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,427,108. OTHER FEES: PROGRAM SERVICE EXPENSES 5,102,777. MANAGEMENT AND GENERAL EXPENSES 1,700,926. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,803,703. 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