2025-05-03T16:49:00-05:00 2024-06-30 135565207 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2023-07-01 951643373 COMMUNITY HOSPITAL OF SAN BERNARDINO COMM 9098876333 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 941071777 DOUGLAS BROWN CFO 9098876333 2025-05-03 1 1 JAMES R LANCASTER P00742579 4159635100 2023 2025-03-06 01:10:19Z JUNE COLLISON 1805 MEDICAL CENTER DR SAN BERNARDINO CA 92411 382812620 0 X WWW.DIGNITYHEALTH.ORG/SAN-BERNARDINO/ X 1938 CA AS AN AFFILIATE OF COMMONSPIRIT HEALTH ("COMMONSPIRIT"), COMMUNITY HOSPITAL OF SAN BERNARDINO IS COMMITTED TO IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL. 13 7 1782 211 0 0 2695154 2940383 297396557 379153884 57352 146092 5919567 572261 306068630 382812620 1457319 2529929 0 0 175967118 177655588 0 0 0 127023224 156981814 304447661 337167331 1620969 45645289 160119521 235330278 247703868 275609918 -87584347 -40279640 X COMMUNITY HOSPITAL OF SAN BERNARDINO ("CHSB") IS A NON-PROFIT, FULL-SERVICE, ACUTE CARE FACILITY IN BUSINESS TO PROVIDE ACUTE INPATIENT CARE, LONG-TERM CARE AND A WIDE RANGE OF ANCILLARY AND THERAPEUTIC CARE TO THE COMMUNITY WE SERVE. OUR VISION IS TO CREATE AND PROVIDE HEALTH CARE SOLUTIONS, AND MEET THE HEALTH CARE NEEDS OF OUR COMMUNITY. 0 0 298970466 2529929 379153884 CHSB'S MISSION IS TO CONTRIBUTE TO THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES IN A COMPASSIONATE AND COST EFFECTIVE MANNER. THE HOSPITAL IS LICENSED FOR 431 BEDS AND CURRENTLY HAS 382 BEDS AVAILABLE. THE HOSPITAL HAD 89,325 TOTAL PATIENT DAYS, 11,239 ADMISSIONS, AND 65,186 EMERGENCY ROOM VISITS. INPATIENT SERVICES: ACUTE PATIENT CARE; MATERNAL CHILD CARE; MENTAL HEALTH CARE; NEUROLOGICAL CARE; AND A VARIETY OF OUTPATIENT CARE. 298970466 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 36 0 1 1782 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 CA X MARY JOHNSON ACCOUNTING DEPARTMENT 6022944117 3033 NORTH 3RD AVENUE PHOENIX AZ 85013 X NICHOLAS TESTA MD DIRECTOR (THRU 3/11/24) 1.00 50.00 X 0 1045649 51127 JUNE COLLISON HOSPITAL PRESIDENT 50.00 0.00 X X 0 913116 152562 GAIL DALY DIRECTOR 1.00 50.00 X 0 897214 137400 RUBY A SKINNER VP/CMO 50.00 0.00 X 470977 0 30840 ANITA CHOU VP/CFO 25.00 25.00 X 0 412602 61168 VICTORIA SELBY COO 50.00 0.00 X 377625 0 40105 ROSILYN NOLAN CNEO 50.00 0.00 X 357775 0 58647 DAVID J EVANS FORMER OFFICER-VP/CFO (THRU 2/22/23) 50.00 0.00 X 382521 0 27524 RACHELLE WENGER DIRECTOR 1.00 50.00 X 0 314091 84862 PATRICIA WOMACK DIRECTOR OF PHARMACY 50.00 0.00 X 309330 0 44612 NELLIE B MGENI CLINICAL NURSE II 50.00 0.00 X 283805 0 66700 LYNDA CASTRO CONTROLLER 50.00 0.00 X 274595 0 52038 CAROLINE SWINTON DIRECTOR OF QUALITY PATIENT SAFETY 50.00 0.00 X 260962 0 47362 DAWIT G TESFAGIORGIS CLINICAL NURSE II 50.00 0.00 X 259290 0 20196 JOHNNY NEGUSSE MD DIRECTOR 1.00 10.00 X 36000 0 0 BETTY DANIELS MD DIRECTOR (START 1/1/24) 1.00 0.00 X 24000 0 0 JOE M MAWAD MD DIRECTOR 4.50 5.00 X 0 5000 0 CHEHAB ELAWAR DIRECTOR 1.00 0.00 X 0 0 0 RICHARD GONZALEZ ESQ DIRECTOR 1.00 0.00 X 0 0 0 VICKI R LEE DIRECTOR 1.00 0.00 X 0 0 0 GABRIEL RAMIREZ DIRECTOR 1.00 0.00 X 0 0 0 CLAUDIA M DAVIS PHD VICE CHAIR 1.00 0.00 X X 0 0 0 NICOLE HENLEY PHD SECRETARY 1.00 0.00 X X 0 0 0 TONY MYRELL CHAIR 1.00 0.00 X X 0 0 0 3036880 3587672 875143 473 1 1 0 PALM SPRINGS ANESTHESIA 10 COMMERCE DR NEW ROCHELLE NY 10801 MEDICAL/PHYSICIAN SERVICES 5111483 ALIGNED TELEHEALTH INC 6200 CANOGA AVE WOODLAND HILLS CA 91367 MEDICAL SERVICES 2201500 INPATIENT SPECIALISTS OF CALIFORNIA PO BOX 742936 LOS ANGELES CA 900742936 MEDICAL SERVICES 2031987 CORE MEDSTAFF 3946 WILSHIRE BLVD LOS ANGELES CA 90010 STAFFING SERVICES 1573080 INLAND EMPIRE WOMANS CTR 1800 N WESTERN AVE STE 204 SAN BERNARDINO CA 924111308 MEDICAL SERVICES 1501961 58 2805784 134599 1637 2940383 MEDICARE/MEDICAID PAYM 900099 233416716 233416716 PATIENT NET OF CHARITY 900099 144245811 144245811 MEDICAL OFFICE BUILDIN 900099 1385230 1385230 COUNTY EMERGENCY MED S 900099 97122 97122 EDUCATION 611430 8851 8851 154 154 379153884 146092 146092 CAFETERIA 722514 495233 495233 RECEIPT WRITE OFF 900099 71872 71872 VENDING MACHINE COMMIS 900099 4572 4572 584 584 572261 382812620 379153884 0 718353 X 2459529 2459529 70400 70400 1416426 1323127 93299 1901647 1901647 131516479 122417772 9098707 8563139 7682584 880555 24984014 24725635 258379 9273883 9273032 851 464517 464517 76115 76115 48415214 35402682 13012532 1931616 24440 1907176 4229857 3829919 399938 11452646 495899 10956747 4323702 4323702 98308 34296 64012 40328 28884 11444 10659223 10659223 9541665 9541665 2761256 2761256 MEDI-CAL PROVIDER FEE 43037607 43037607 MEDICAL SUPPLIES 16468852 16468852 FOOD & INVENTORY SUPPLI 1725612 1671875 53737 LICENSES AND TAXES 794461 324537 469924 960835 511903 448932 337167331 298970466 38196865 0 2400 2400 3947833 39185452 313350 415941 28662597 29687458 74143 66667 5673059 5688851 63900540 69283864 93734914 36230220 57482644 57504694 62955 33494951 160119521 235330278 35548193 54330591 113622 1623652 1352722 210532023 219812983 247703868 275609918 X -87584347 -40279640 0 -87584347 -40279640 160119521 235330278 X 45645289 1659418 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 2801 0 0 0 0 1 73314 76115 0 PART II-B, LINE 1: SCHEDULE C, PART II - B, LINE 1D COMMUNITY HOSPITAL OF SAN BERNARDINO ENGAGED IN LETTER-WRITING CAMPAIGNS, CO-SPONSORSHIP CAMPAIGNS, EDUCATION WITH MEMBERS OF CONGRESS, AND OTHER LOBBYING ACTIVITIES AIMED AT INFLUENCING PUBLIC POLICY. THIS IS DONE PRIMARILY THROUGH EMPLOYED DIVISION-LEVEL ADVOCACY LEADERS WITH LEADERSHIP AND GUIDANCE FROM NATIONAL EMPLOYEES. DRAFT LETTERS WERE PROVIDED ON THE ORGANIZATION'S ADVOCACY PRIORITIES; DIVISION-EMPLOYED ADVOCACY LEADERS WERE ABLE TO CREATE THEIR OWN LETTERS AS WELL. THE ORGANIZATION COMMUNICATES WITH LEADERS OF THE SYSTEM'S HOSPITALS AND HEALTH CARE ORGANIZATIONS ON ADVOCACY ACTIVITIES PRIMARILY THROUGH E-MAIL. MOST COMMUNICATIONS WITH CONGRESS OCCUR THROUGH EMAIL AND PHONE. ADVOCACY ACTIVITIES INVOLVED COMMUNICATIONS ON THE ORGANIZATION'S ADVOCACY PRIORITIES, INCLUDING ISSUES RELATED TO ACCESS AND COVERAGE FOR ALL, HOSPITAL AND HEALTH PROVIDER REIMBURSEMENT, COVID-19 RELIEF FOR INDIVIDUALS AND HEALTH ENTITIES, PHYSICIAN AND NURSING SHORTAGES, AND SOCIAL JUSTICE ISSUES (E.G. ENVIRONMENTAL STEWARDSHIP, HOUSING). CENTRAL TO THE ORGANIZATION'S MISSION AND VISION IS A COMMITMENT TO ADVOCATE FOR SYSTEMIC CHANGES TO IMPROVE THE HEALTH AND WELL-BEING OF INDIVIDUALS AND COMMUNITIES WITH A SPECIFIC CONCERN FOR PERSONS WHO ARE POOR AND MARGINALIZED. THE HOSPITAL'S ADVOCACY ACTIVITIES ARE INEXTRICABLY LINKED TO ITS FUNDAMENTAL GOAL TO BUILD HEALTHIER COMMUNITIES. ONE DIMENSION OF THE ORGANIZATION'S ADVOCACY PROGRAM FOCUSES ON PUBLIC POLICY ADVOCACY, WHICH INCLUDES ATTENTION TO FEDERAL LEGISLATIVE AND REGULATORY MEASURES, FORMATION OF POSITIONS ON PRIORITY ISSUES, AND POLITICAL ACTIVISM. THE COMMONSPIRIT HEALTH PUBLIC POLICY AGENDA INCLUDES BOTH TRADITIONAL HEALTH CARE POLICIES (E.G., PAYMENT ISSUES, QUALITY AND SAFETY, ETC.) AS WELL AS SOCIAL JUSTICE POLICIES. SCHEDULE C, PART II - B, LINE 1I LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS $ 64 ASSOCIATION OF NUTRITION & FOODSERVICE PROFESSIONALS $ 2 PEACH INC $ 55,000 HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA $ 11,793 AMERICAN HOSPITAL ASSOCIATION $ 6,379 340 B HEALTH $ 74 SOCIETY FOR HUMAN RESOURCE MANAGEMENT $2 TOTAL $ 73,314 0 1 X 9200000 9200000 60455847 27939652 32516195 17328087 8201180 9126907 6750980 89388 6661592 57504694 RIGHT OF USE ASSET - OPERATING AMORTIZATION 1785 LT PREPAID EXPENSES 14854 OTHER ASSETS - LT 23250 MCAL SUP PMT REC-PROV FEE LT 33455062 33494951 DUE TO RELATED PARTIES 202183669 PENSION PAYABLE 10945368 OTHER NON-CURRENT LIABILITY 6683946 219812983 X PART IV, LINE 2B: CHSB MAINTAINS A RESIDENT TRUST FUND ACCOUNT FOR RESIDENTS OF THE LONG TERM CARE FACILITY WHO CHOOSE TO PARTICIPATE AND THAT IS MANAGED BY THE FACILITY ON BEHALF OF RESIDENTS TO HOLD AND MANAGE THEIR PERSONAL FUNDS. THE PRIMARY FUNCTION OF THE RESIDENT TRUST FUND IS TO SAFEGUARD A RESIDENT'S PERSONAL MONEY AND FACILITATE ACCESS FOR PERSONAL EXPENSES SUCH AS FUNERAL NEEDS AND CLOTHING. CHSB HOLDS THE ACCOUNT AND MANAGES THE FUNDS ON BEHALF OF THE RESIDENT. RESIDENTS, OR THEIR REPRESENTATIVES, RETAIN THE RIGHT TO DETERMINE HOW THE FUNDS ARE SPENT. UNDER THE WRITTEN AUTHORIZATION OF THE RESIDENT OR THEIR REPRESENTATIVE, CHSB WILL ISSUE PAYMENT FOR EXPENSES TO SPECIFIED VENDORS FOR PERSONAL NEEDS OR RECEIVE DEPOSITS INTO THE RESIDENT TRUST ACCOUNT. ON A MONTHLY BASIS, CHSB RECONCILES THE ACCOUNT AND ISSUES STATEMENTS TO THE RESIDENTS OR THEIR REPRESENTATIVE FOR ALL TRANSACTIONS THAT OCCURRED IN THE RESIDENT ACCOUNT. THE ACCOUNT IN BONDED TO PROTECT RESIDENT FUNDS. PART X, LINE 2: THE ORGANIZATION 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. 1 1 X 1 X 250.000000000000 1 X 500.000000000000 1 1 0 1 1 3502 4773607 0 4773607 0.01420 58402 198599685 282936895 0 0.00000 61904 203373292 282936895 4773607 0.01420 14 24696 531843 33622 498221 0.00150 2 51 543000 0 543000 0.00160 3 2389 31081504 28860995 2220509 0.00660 5 685 2187289 2187289 0.00650 24 27821 34343636 28894617 5449019 0.01620 24 89725 237716928 311831512 10222626 0.03040 348 125724 125724 0.00040 348 125724 125724 0.00040 1 1624573 12133793 14976187 -2842394 X 1 1 1 1 COMMUNITY HOSPITAL OF SAN BERNARDINO 1805 MEDICAL CENTER DRIVE SAN BERNARDINO CA 92411 WWW.DIGNITYHEALTH.ORG/SOCAL/LOCATIONS/ 240000198 X X X COMMUNITY HOSPITAL OF SAN BERNARDINO 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X SEE PART V, SECTION C X X 1 22 1 SEE PART V, SECTION C 0 1 X 250.000000000000 500.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION A: PRESENTATION OF HOSPITAL'S COMPLETE WEBSITE ADDRESS:WWW.DIGNITYHEALTH.ORG/SOCAL/LOCATIONS/SAN-BERNARDINO COMMUNITY HOSPITAL OF SAN BERNARDINO PART V, SECTION B, LINE 5: CHSB CONDUCTED AN IN-DEPTH ASSESSMENT OF COMMUNITY HEALTH NEEDS BY METICULOUSLY ANALYZING SECONDARY DATA FROM LOCAL, COUNTY, AND STATE SOURCES. THIS COMPREHENSIVE ANALYSIS ENCOMPASSED A RANGE OF FACTORS, INCLUDING COMMUNITY DEMOGRAPHICS, SOCIAL DETERMINANTS OF HEALTH, HEALTHCARE ACCESS, BIRTH INDICATORS, LEADING CAUSES OF DEATH, CHRONIC DISEASES, HEALTH BEHAVIORS, MENTAL HEALTH, SUBSTANCE USE AND MISUSE, AND PREVENTIVE PRACTICES.TO COMPLEMENT THIS QUANTITATIVE DATA, CHSB SOUGHT QUALITATIVE INSIGHTS THROUGH INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS ACROSS SAN BERNARDINO COUNTY. THESE INTERVIEWS, CONDUCTED IN SEPTEMBER AND OCTOBER 2023, AIMED TO IDENTIFY PREVALENT HEALTH NEEDS, BARRIERS TO CARE, AND EXISTING RESOURCES TO ADDRESS THESE CHALLENGES. A TOTAL OF 21 STAKEHOLDERS WERE CAREFULLY SELECTED, REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AS WELL AS LOCAL HEALTH DEPARTMENTS AND AGENCIES WITH ACCESS TO CURRENT AND RELEVANT DATA ON THE COMMUNITY'S HEALTH NEEDS.CHSB COLLABORATED WITH A DIVERSE NETWORK OF ORGANIZATIONS AND AGENCIES WITHIN ITS SERVICE AREAS TO ENSURE A COMPREHENSIVE UNDERSTANDING OF COMMUNITY HEALTH ISSUES. THESE PARTNERSHIPS INCLUDED THE OFFICE OF STATE SENATOR ROSILICIE OCHOA BOGH, CALIFORNIA STATE UNIVERSITY-SAN BERNARDINO, NATIONAL CORE, FAMILY ASSISTANCE PROGRAM, EL SOL NEIGHBORHOOD EDUCATIONAL CENTER, MARY'S MERCY CENTER, INC., CITY OF SAN BERNARDINO, LESTONNAC FREE CLINIC, FIRST PRESBYTERIAN CHURCH OF SAN BERNARDINO, SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT, SAN BERNARDINO DIOCESE, MAKING HOPE HAPPEN FOUNDATION, LEGAL AID OF SAN BERNARDINO, HOUSING AUTHORITY OF THE COUNTY OF SAN BERNARDINO, CATHOLIC CHARITIES SAN BERNARDINO & RIVERSIDE COUNTIES, SAN BERNARDINO DEPARTMENT OF PUBLIC HEALTH ADMINISTRATION, YOUNG VISIONARIES YOUTH LEADERSHIP ACADEMY, AND THE COMMUNITY HEALTH ASSOCIATION INLAND SOUTHERN REGION. COMMUNITY HOSPITAL OF SAN BERNARDINO PART V, SECTION B, LINE 6A: ST. BERNARDINE MEDICAL CENTER COMMUNITY HOSPITAL OF SAN BERNARDINO PART V, SECTION B, LINE 7D: THE 2022 (TY2021) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS DISTRIBUTED TO MEMBERS OF THE COMMUNITY BENEFIT INITIATIVE COMMITTEE AT COMMUNITY HOSPITAL SAN BERNARDINO (CHSB) AND ST. BERNARDINE MEDICAL CENTER, AS WELL AS TO THEIR RESPECTIVE HOSPITAL BOARD MEMBERS AND PARTNER ORGANIZATIONS. THE ASSESSMENT WAS MADE AVAILABLE IN BOTH ELECTRONIC AND PRINTED FORMATS, ENSURING BROAD ACCESSIBILITY AND CONVENIENCE FOR ALL STAKEHOLDERS. COMMUNITY HOSPITAL OF SAN BERNARDINO PART V, SECTION B, LINE 11: CHSB IS ACTIVELY ADDRESSING SEVERAL SIGNIFICANT COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THESE INCLUDE IMPROVING ACCESS TO HEALTHCARE, ADDRESSING BEHAVIORAL HEALTH CHALLENGES, MANAGING CHRONIC DISEASES, TACKLING HOUSING AND HOMELESSNESS ISSUES, PROMOTING PREVENTIVE HEALTH PRACTICES, AND ENHANCING SAFETY AND VIOLENCE PREVENTION EFFORTS. TO MEET THESE NEEDS, CHSB IS COMMITTED TO A VARIETY OF PROGRAMS AND RESOURCES INCLUDING OFFERING FINANCIAL ASSISTANCE, PROVIDING COMMUNITY HEALTH NAVIGATION SERVICES, AND FACILITATING PARA SU SALUD ENROLLMENT. PARA SU SALUD IS A COMMUNITY RESOURCE PROGRAM THAT ASSISTS INDIVIDUALS AND FAMILIES IN NAVIGATING THE APPLICATION PROCESS FOR HEALTH INSURANCE PROGRAMS SUCH AS MEDI-CAL, COVERED CALIFORNIA, AND OTHER HEALTH ACCESS INITIATIVES. IT HELPS THE COMMUNITY MAKE INFORMED DECISIONS RELATED TO HEALTHCARE NEEDS. THE HOSPITAL OFFERS A VARIETY OF FREE CLASSES AND SUPPORT GROUPS AIMED AT IMPROVING COMMUNITY HEALTH AND WELLNESS, THROUGH ITS HEALTH EDUCATION CENTER (HEC). THESE PROGRAMS ARE DESIGNED TO EMPOWER INDIVIDUALS WITH KNOWLEDGE AND SKILLS TO MANAGE THEIR HEALTH EFFECTIVELY, PROMOTE PREVENTIVE CARE, AND SUPPORT OVERALL WELL-BEING. PROGRAMS INCLUDE BIRTHING CLASSES, DIABETES EDUCATION, CPR TRAINING, ASTHMA CARE, AND HEALTHY COOKING CLASSES. THE HEC ALSO PROVIDES ONE-ON-ONE BREASTFEEDING SUPPORT BY APPOINTMENT. SOME CLASSES ARE AVAILABLE IN SPANISH, AND TRANSLATION SERVICES CAN BE ARRANGED FOR OTHERS. THE HOSPITAL ALSO CONNECTS INDIVIDUALS TO VITAL SERVICES THROUGH THE CONNECTED COMMUNITY NETWORK AND SUPPORTS LOCAL AGENCIES AND ORGANIZATIONS THROUGH ITS COMMUNITY HEALTH IMPROVEMENT GRANTS PROGRAM. MOREOVER, CHSB IS IMPLEMENTING SEVERAL TARGETED INITIATIVES SUCH AS THE ADULT BEHAVIORAL HEALTH PROGRAM AND EARLY START PROGRAM. CHSB IS FURTHER SUPPORTING PREVENTIVE PRACTICES IN THE COMMUNITY BY ADMINISTERING VACCINES AND DISTRIBUTING PERSONAL PROTECTIVE EQUIPMENT (PPE) TO PATIENTS, RESIDENTS, AND COMMUNITY PARTNERS. THE EMERGENCY DEPARTMENT SYPHILIS/HIV/HCV SCREENING PROGRAM (EDSP) EXPANDS ROUTINE OPT-OUT TESTING FOR SYPHILIS, HIV, AND HEPATITIS C IN EMERGENCY DEPARTMENTS (EDS). THIS PROGRAM SEEKS TO IMPROVE PUBLIC HEALTH BY IDENTIFYING AND TREATING INDIVIDUALS AT HIGH RISK FOR THESE INFECTIONS, WHO MAY OTHERWISE REMAIN UNDIAGNOSED. EDS PLAY A CRUCIAL ROLE IN REACHING UNDERSERVED POPULATIONS, OFFERING IMMEDIATE CARE, AND CONNECTING PATIENTS TO FOLLOW-UP TREATMENT. THE PROGRAM EMPHASIZES HEALTH EQUITY, TRAUMA-INFORMED CARE, AND HARM REDUCTION, SUPPORTING HOSPITALS WITH FUNDING AND RESOURCES TO ENHANCE SCREENING AND PATIENT NAVIGATION.RECOGNIZING THE LIMITATIONS OF ITS RESOURCES, CHSB HAS MADE STRATEGIC DECISIONS REGARDING ITS FOCUS AREAS. THE HOSPITAL WILL NOT DIRECTLY ADDRESS CERTAIN NEEDS, INCLUDING BIRTH INDICATORS, DENTAL CARE, ECONOMIC INSECURITY, AND FOOD INSECURITY, AND SEXUALLY TRANSMITTED INFECTIONS. THIS DECISION REFLECTS AN UNDERSTANDING THAT NOT ALL COMMUNITY HEALTH NEEDS CAN BE EFFECTIVELY ADDRESSED WITHIN THE HOSPITAL'S CAPACITY AND EXPERTISE. IN MANY CASES, THESE NEEDS ARE ALREADY BEING ADDRESSED BY OTHER ORGANIZATIONS WITHIN THE COMMUNITY. BY CONCENTRATING ITS EFFORTS ON AREAS WHERE IT CAN MAKE THE GREATEST IMPACT, CHSB AIMS TO MAXIMIZE ITS CONTRIBUTIONS TO IMPROVING THE HEALTH AND WELL-BEING OF ITS SERVICE AREA. COMMUNITY HOSPITAL OF SAN BERNARDINO 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. IF APPLICABLE, BALANCES BELOW TEN DOLLARS ($10.00) WOULD BE ADJUSTED USING A SMALL BALANCE ADJUSTMENT AND NOT BILLED TO THE PATIENT/GUARANTOR.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.THE FOLLOWING REQUIREMENTS FOR ADDITIONAL HARDSHIP DISCOUNTS IS AN ADDENDUM OF THE FINANCIAL ASSISTANCE POLICY THAT APPLY TO PATIENTS RECEIVING SERVICES AT A COMMONSPIRIT HOSPITAL ORGANIZATION IN THE STATE OF CALIFORNIA ONLY.A PATIENT WHO RECEIVES DISCOUNTED CARE, BUT (1) WHOSE LIABILITY STILL EXCEEDS 30% OF THE SUM OF (A) HIS OR HER FAMILY INCOME, AND (B) HIS OR HER MONETARY ASSETS, AND (2) WHO DOES NOT HAVE THE ABILITY TO PAY HIS OR HER BILL, AS DETERMINED BY A REVIEW OF FACTORS SUCH AS PROJECTED FAMILY INCOME FOR THE COMING YEAR AND EXISTING OR ANTICIPATED HEALTH CARE LIABILITIES MAY BE GIVEN AN ADDITIONAL HARDSHIP DISCOUNT. FOR PURPOSES OF THE DETERMINATION OF THIS HARDSHIP DISCOUNT, THE COMMONSPIRIT HOSPITAL ORGANIZATION WILL NOT CONSIDER ASSETS IN RETIREMENT PLANS QUALIFIED UNDER THE INTERNAL REVENUE CODE IN EFFECT AT THE TIME OF THE DETERMINATION OR DEFERRED COMPENSATION PLANS.IF THE PATIENT MEETS ALL ELIGIBILITY CRITERIA, THE PATIENT WILL RECEIVE A HARDSHIP DISCOUNT, WHICH WILL REDUCE THE PATIENT'S REMAINING LIABILITY TO NO MORE THAN 30% OF THE SUM OF HIS OR HER (1) PATIENT FAMILY INCOME, AND (2) MONETARY ASSETS.A PATIENT MAY ALSO RECEIVE DISCOUNTS OR WAIVERS UNDER THIS ADDENDUM IF CONSIDERED HOMELESS OR TRANSIENT OR IF THEY PARTICIPATE IN A FEDERAL, STATE, OR LOCAL MANAGED INDIGENT CARE PROGRAM. SCHEDULE H, PART V, SECTION B, LINE 3E THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 7A HTTPS://WWW.DIGNITYHEALTH.ORG/SOCAL/LOCATIONS/SAN-BERNARDINO/ABOUT-US/SERVING-THE-COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-PLAN SCHEDULE H, PART V, SECTION B, LINE 10A DIGNITY HEALTH HOSPITAL FACILITY IMPLEMENTATION STRATEGY DOCUMENTS CAN BE ACCESSED ATHTTPS://WWW.DIGNITYHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH/COMMUNITY-HEALTH-PROGRAMS-AND-REPORTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTSCOMMUNITY HOSPITAL SAN BERNARDINO'S IMPLEMENTATION STRATEGY IS ALSO ON THE HOSPITAL'S WEB SITE, AT THE SAME LOCATION AS THE CHNA REPORT LISTED IN PART V, SECTION B, LINE 7A ABOVE. SCHEDULE H, PART V, SECTION B, LINE 16A-16C HTTPS://WWW.DIGNITYHEALTH.ORG/SOCAL/LOCATIONS/SAN-BERNARDINO/PATIENTS-AND-VISITORS/FOR-PATIENTS/BILLING-PAYMENT-FINANCIAL-SERVICES/FINANCIAL-ASSISTANCE 1 1 - COMMUNITY CONVALESCENT CENTER 1676 MEDICAL CENTER DR SAN BERNARDINO CA 92411 SKILLED NURSING 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 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 COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED IN SCHEDULE H, PART V, SECTION B, LINE 13H, 3RD PARAGRAPH.- THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA).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 OR FREE CARE CLINIC;- PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);- FOOD STAMP ELIGIBILITY;- ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID);- LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR- PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE.THE FOLLOWING REQUIREMENTS FOR ADDITIONAL HARDSHIP DISCOUNTS IS AN ADDENDUM OF THE FINANCIAL ASSISTANCE POLICY THAT APPLY TO PATIENTS RECEIVING SERVICES AT A COMMONSPIRIT HOSPITAL ORGANIZATION IN THE STATE OF CALIFORNIA ONLY.A PATIENT WHO RECEIVES DISCOUNTED CARE, BUT (1) WHOSE LIABILITY STILL EXCEEDS 30% OF THE SUM OF (A) HIS OR HER FAMILY INCOME, AND (B) HIS OR HER MONETARY ASSETS, AND (2) WHO DOES NOT HAVE THE ABILITY TO PAY HIS OR HER BILL, AS DETERMINED BY A REVIEW OF FACTORS SUCH AS PROJECTED FAMILY INCOME FOR THE COMING YEAR AND EXISTING OR ANTICIPATED HEALTH CARE LIABILITIES MAY BE GIVEN AN ADDITIONAL HARDSHIP DISCOUNT. FOR PURPOSES OF THE DETERMINATION OF THIS HARDSHIP DISCOUNT, THE COMMONSPIRIT HOSPITAL ORGANIZATION WILL NOT CONSIDER ASSETS IN RETIREMENT PLANS QUALIFIED UNDER THE INTERNAL REVENUE CODE IN EFFECT AT THE TIME OF THE DETERMINATION OR DEFERRED COMPENSATION PLANS.IF THE PATIENT MEETS ALL ELIGIBILITY CRITERIA, THE PATIENT WILL RECEIVE A HARDSHIP DISCOUNT, WHICH WILL REDUCE THE PATIENT'S REMAINING LIABILITY TO NO MORE THAN 30% OF THE SUM OF HIS OR HER (1) PATIENT FAMILY INCOME, AND (2) MONETARY ASSETS. A PATIENT MAY ALSO RECEIVE DISCOUNTS OR WAIVERS UNDER THIS ADDENDUM IF CONSIDERED HOMELESS OR TRANSIENT OR IF THEY PARTICIPATE IN A FEDERAL, STATE, OR LOCAL MANAGED INDIGENT CARE PROGRAM. PART I, LINE 7: COMMUNITY HOSPITAL SAN BERNARDINO (CSHB) FOLLOWS THE METHOD USED BY COMMONSPIRIT HEALTH (COMMONSPIRIT), A RELATED ORGANIZATION. FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, BMH USES A COST ACCOUNTING SYSTEM OR 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 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY ("CBISA") SOFTWARE ARE USED TO CALCULATE 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 SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTHSERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS.SCHEDULE H, PART I, LINE 7B, COLUMN (F)BEGINNING IN 2009, THE STATE OF CALIFORNIA ESTABLISHED PROVIDER FEE PROGRAMS. THESE PROGRAMS ARE FUNDED BY QUALITY ASSURANCE FEES PAID BY PARTICIPATING HOSPITALS AND MATCHING FEDERAL FUNDS. CHSB RECOGNIZED QUALITY ASSURANCE FEES DURING THE YEAR OF $43.0 MILLION WHICH ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO UNREIMBURSED MEDICAID (PART I, LINE 7B, COLUMN C), AND RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $142.0 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D).SCHEDULE H, PART I, LINE 7IINCLUDED IN CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT IS $1.8 MILLION IN GRANTS TO A FUND ESTABLISHED BY THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT") FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA, CONSISTENT WITH CHFT'S MISSION OF SUPPORTING HEALTH CARE, ACCESS TO HEALTH CARE, RESEARCH AND EDUCATION. PART II, COMMUNITY BUILDING ACTIVITIES: CHSB IS DEEPLY COMMITTED TO FOSTERING COMMUNITY DEVELOPMENT IN THE NEIGHBORHOODS IT SERVES. ITS EFFORTS TO ENHANCE THE HEALTH AND WELL-BEING OF THE COMMUNITY EXTEND FAR BEYOND DELIVERING HEALTHCARE SERVICES AND COMMUNITY HEALTH IMPROVEMENT INITIATIVES. CHSB ADOPTS A PROACTIVE STANCE IN ADDRESSING THE SOCIAL, ECONOMIC, AND ENVIRONMENTAL FACTORS THAT CREATE BARRIERS TO GOOD HEALTH. THE HOSPITAL ALIGNS ITS MISSION WITH THE WORLD HEALTH ORGANIZATION'S DEFINITION OF HEALTH, WHICH EMPHASIZES A STATE OF COMPLETE PHYSICAL, MENTAL, AND SOCIAL WELL-BEING, RATHER THAN MERELY THE ABSENCE OF DISEASE OR INFIRMITY.AS PART OF THIS INITIATIVE, CHSB IMPLEMENTS STEPPING STONES, A COMMUNITY-BUILDING PROGRAM DEDICATED TO LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS. THIS INNOVATIVE PROGRAM PROVIDES TEENS AND YOUNG ADULTS WITH VALUABLE WORKPLACE EXPERIENCE IN A HOSPITAL SETTING THROUGH VOLUNTEER OPPORTUNITIES AND MENTORSHIP ACTIVITIES. BY EXPANDING EXPOSURE TO HEALTHCARE CAREERS, STEPPING STONES SEEKS TO INSPIRE AND PREPARE PARTICIPANTS FOR FUTURE EMPLOYMENT IN THE MEDICAL FIELD. THE PROGRAM PARTNERS WITH HIGH SCHOOLS, COLLEGES, AND UNIVERSITIES ACROSS SAN BERNARDINO, RIVERSIDE, ORANGE, LOS ANGELES, SAN DIEGO, CENTRAL VALLEY, NORTHERN CALIFORNIA, TEXAS, ILLINOIS, TENNESSEE, MASSACHUSETTS, NEW JERSEY, AND ARIZONA. FOSTERING STRONG PARTNERSHIPS THAT SUPPORT BOTH COMMUNITY DEVELOPMENT AND THE PROFESSIONAL ASPIRATIONS OF ITS PARTICIPANTS.FOR ADDITIONAL INFORMATION ON CHSB'S COMPREHENSIVE COMMUNITY-BUILDING EFFORTS, THE HOSPITAL'S PUBLICLY AVAILABLE ANNUAL COMMUNITY BENEFIT REPORTS PROVIDE DETAILED DESCRIPTIONS OF SPECIFIC PROGRAMS AND INITIATIVES, INCLUDING A SECTION TITLED "OTHER PROGRAMS AND NON-QUANTIFIABLE BENEFITS." PART III, LINE 2: THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE SCHEDULE H, PART I, LINE 7) 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 DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE AND ARE OTHERWISE UNINSURED.CHSB PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS THAT FALL INTO THREE CATEGORIES: AT OR BELOW 250%, 251%-400% OR 401%-500% OF THE FEDERAL POVERTY LEVEL. CHSB ALSO PROVIDES PATIENTS OPTIONS FOR UNINSURED PATIENT DISCOUNT AND SELF-PAY DISCOUNTS. IN CALIFORNIA, PATIENTS WHO ARE UNINSURED OR WITH HIGH MEDICAL COSTS ARE ELIGIBLE TO RECEIVE DISCOUNTED CARE IN ADDITION TO AN INTEREST-FREE EXTENDED PAYMENT PLAN THAT WILL ALLOW PAYMENT OF THE DISCOUNTED AMOUNT OVER TIME. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: THE HOSPITAL FOLLOWS THE COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY.CHSB MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. COMMONSPIRIT HEALTH'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. COMMONSPIRIT HEALTH ALSO UTILIZES A WAYSTAR (FORMERLY PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. WAYSTAR IS 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, THE HOSPITAL 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: THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT HEALTH'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2024, RELATED TO ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT HEALTH 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, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE 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 TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR THE INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS.COMMONSPIRIT, INCLUDING DIGNITY COMMUNITY CARE AND ITS SUBORDINATES, WHICH INCLUDES CHSB, BELIEVES 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 HOSPITAL FACILITIES 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. THIS SHORTFALL INCLUDES $2.8 MILLION REPORTED ON PART III, SECTION B, LINE 7. PART III, LINE 9B: CHSB ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. CHSB ALSO FOLLOWS COMMONSPIRIT HEALTH'S COLLECTION POLICY. CHSB'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHOM THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF CHSB OR THE 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 FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT'S PATIENT FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, CHSB 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 CHSB. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNTS TO A COLLECTION AGENCY, CHSB REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. PART VI, LINE 2: CHSB IS PROUD TO COLLABORATE WITH THE CITY OF SAN BERNARDINO TO ADDRESS THE PRESSING CHALLENGES OF HEALTHCARE ACCESS, HOUSING INSTABILITY, AND HOMELESSNESS IN THE INLAND EMPIRE. TOGETHER, WE ARE EXPLORING INNOVATIVE SOLUTIONS, INCLUDING TRANSITIONAL HOUSING AND RECUPERATIVE CARE INITIATIVES, TO PROVIDE MEANINGFUL SUPPORT FOR OUR LOCAL COMMUNITY AND WORK TOWARDS ELIMINATING THESE CRITICAL ISSUES. PART VI, LINE 3: COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC:INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE FACILITY'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 THE HOSPITAL MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES THE HOSPITAL 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, A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRES 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 WORKS, 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: COMMUNITY HOSPITAL OF SAN BERNARDINO SERVES 31 ZIP CODES IN 17 CITIES, 8 OF WHICH ARE LOCATED IN THE CITY OF SAN BERNARDINO. A SUMMARY DESCRIPTION OF THE COMMUNITY IS PROVIDED BELOW, AND ADDITIONAL DETAILS CAN BE FOUND IN THE CHNA REPORT. THE POPULATION OF THE CHSB SERVICE AREA IS 1,208,298. CHILDREN AND YOUTH, AGES 0-17, MAKE UP 28% OF THE POPULATION, 61.8% ARE ADULTS, AGES 18-64, AND 10.2% OF THE POPULATION ARE SENIORS, AGES 65 AND OLDER. THE MAJORITY OF THE POPULATION IN THE SERVICE AREA IDENTIFIES AS HISPANIC/LATINO 60.6%. 22.9% OF THE POPULATION IDENTIFIES AS WHITE/CAUCASIAN, 8.9% AS BLACK/AFRICAN AMERICAN AND 4.9% AS ASIAN. 2.2% OF THE POPULATION IDENTIFIES AS MULTIRACIAL (TWO-OR-MORE RACES), 0.2% AS AMERICAN INDIAN/ALASKAN NATIVE, 0.2% AS NATIVE HAWAIIAN/PACIFIC ISLANDER, AND 0.1% AS OTHER RACE. AMONG THE RESIDENTS IN THE SERVICE AREA, 17.3% ARE AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) AND 40.3% ARE 200% OF THE FPL OR BELOW. IN THE HOSPITAL SERVICE AREAS. 23.7% OF ADULTS, AGES 25 AND OLDER, WITH NO HIGH SCHOOL DIPLOMA, WHICH IS HIGHER THAN THE STATE RATE OF (16.7%). THE DEMOGRAPHICS DATA BELOW REPRESENTS ONLY THE TOP 75% OF COMMUNITY HOSPITAL SAN BERNARDINO'S DISCHARGES (BASED ON ZIP CODE):TOTAL POPULATION: 427,191ASIAN/PACIFIC ISLANDER: 2.8%BLACK/AFRICAN AMERICAN - NON-HISPANIC:8.4%HISPANIC OR LATINO: 77.2%WHITE NON-HISPANIC: 8.9%ALL OTHERS: 2.7%% BELOW POVERTY: 16.4%UNEMPLOYMENT: 7.9%NO HIGH SCHOOL DIPLOMA: 32.8%MEDICAID: 41.1%UNINSURED: 8.0%OTHER AREA HOSPITALS: 6 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: AFFILIATES OF CHSB ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN CALIFORNIA, ARIZONA, AND NEVADA AND IN 20 ADDITIONAL STATES THROUGH THE ALLIANCE WITHIN COMMONSPIRIT HEALTH SYSTEM. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. THE SUMMARY OF TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE NET OF OFFSETTING REVENUE FOR COMMONSPIRIT AND ITS AFFILIATED CORPORATIONS, WHICH INCLUDES CHSB, FOR THE YEAR ENDED JUNE 30, 2024, IS $2.6 BILLION. A SUMMARY OF COMMONSPIRIT'S COMMUNITY BENEFITS CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT HEALTH CONSOLIDATED FINANCIAL STATEMENTS ON PAGE 41. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 DIGNITY HEALTH FOUNDATION-INLAND EMPIRE 2101 N WATERMAN AVENUE SAN BERNARDINO CA 92404 237440086 501(C)(3) 336944 0 N/A N/A FOUNDATION SUPPORT DIGNITY HEALTH 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 941196203 501(C)(3) 148012 0 N/A N/A HOSPITAL SUPPORT LEGAL AID SOCIETY OF SAN BERNARDINO 588 W SIXTH ST SAN BERNARDINO CA 92410 951997024 501(C)(3) 80000 0 N/A N/A COMMUNITY HEALTH LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST 2502 E UNIVERSITY DR STE 125 PHOENIX AZ 85034 860252302 501(C)(3) 50000 0 N/A N/A COMMUNITY HEALTH RESCUE A GENERATION INC 2065 W COLLEGE AVE 2055 SAN BERNARDINO CA 92404 811290695 501(C)(3) 12081 0 N/A N/A COMMUNITY HEALTH CALIFORNIA HEALTH FOUNDATION TRUST 1215 K STREET SUITE 800 SACRAMENTO CA 95814 941498697 501(C)(3) 1831742 0 N/A N/A COMMUNITY HEALTH 6 0 PROVISION OF FOOD/MEALS 7802 69171 FMV MEALS/FOOD DONATION OF CLOTHING/OTHER TO PATIENTS/NEEDY 4 115 FMV CLOTHING/TRANSPORTATION TRANSPORTATION 90 1114 FMV TRANSPORTATION PART I, LINE 2: GRANTS ARE PROVIDED BY CHSB TO RELATED ORGANIZATIONS, DIGNITY HEALTH FOUNDATION-INLAND EMPIRE AND DIGNITY HEALTH, THAT FURTHER DIGNITY COMMUNITY CARE AND CHSB'S EXEMPT PURPOSE. SUCH GRANTS ARE PROVIDED TO THE FUNDRAISING FOUNDATION TO SUPPORT AND FUND THE OPERATIONS OF THE ORGANIZATION. SCHEDULE I, PART II $1,831,742 IN GRANT PAYMENTS TO THE CALIFORNIA HEALTH FOUNDATION AND TRUST, A 501(C)(3) PUBLIC BENEFIT CHARITY ESTABLISHED TO SPONSOR AND SUPPORT HEALTH CARE, WERE RECOGNIZED IN CONNECTION WITH THE CALIFORNIA PROVIDER FEE PROGRAMS IN FISCAL YEAR 2024. 1 0 0 0 0 0 0 0 0 NICHOLAS TESTA MD DIRECTOR (THRU 3/11/24) 0 677234 0 366770 0 1645 0 30188 0 20939 0 1096776 0 0 JUNE COLLISON HOSPITAL PRESIDENT 0 473950 0 418629 0 20537 0 98268 0 54294 0 1065678 0 0 GAIL DALY DIRECTOR 0 405748 0 482865 0 8601 0 80874 0 56526 0 1034614 0 0 RUBY A SKINNER VP/CMO 367119 0 102305 0 1553 0 19800 0 11040 0 501817 0 0 0 ANITA CHOU VP/CFO 0 311896 0 100299 0 407 0 27150 0 34018 0 473770 0 0 VICTORIA SELBY COO 291939 0 81671 0 4015 0 28970 0 11135 0 417730 0 0 0 ROSILYN NOLAN CNEO 266455 0 76842 0 14478 0 34539 0 24108 0 416422 0 0 0 DAVID J EVANS FORMER OFFICER-VP/CFO (THRU 2/22/23) 63225 0 59735 0 259561 0 19657 0 7867 0 410045 0 0 0 RACHELLE WENGER DIRECTOR 0 202675 0 106834 0 4582 0 52815 0 32048 0 398954 0 0 PATRICIA WOMACK DIRECTOR OF PHARMACY 253741 0 53465 0 2124 0 41810 0 2802 0 353942 0 0 0 NELLIE B MGENI CLINICAL NURSE II 273186 0 800 0 9819 0 47480 0 19220 0 350505 0 0 0 LYNDA CASTRO CONTROLLER 203201 0 49142 0 22252 0 31809 0 20229 0 326633 0 0 0 CAROLINE SWINTON DIRECTOR OF QUALITY PATIENT SAFETY 188674 0 52393 0 19895 0 34968 0 12393 0 308323 0 0 0 DAWIT G TESFAGIORGIS CLINICAL NURSE II 255072 0 800 0 3418 0 19937 0 259 0 279486 0 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, COMMONSPIRIT, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S CEO'S COMPENSATION: (1) HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE COMMONSPIRIT BOARD OF STEWARDSHIP TRUSTEES; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; AND (4) APPROVAL BY THE BOARD OR HUMAN RESOURCES AND COMPENSATION COMMITTEE. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION. PART I, LINE 4A CERTAIN LISTED PERSONS ARE COVERED BY AN EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 TO 24 MONTHS 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 LISTED PERSONS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 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. A PAYMENT OCCURED UNDER THESE PLANS DURING 2023 INCLUDE D. EVANS, $212,786. SCHEDULE J, PART II SUPPLEMENTAL DISCLOSURES THE ORGANIZATION FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE 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 IT 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 THE ORGANIZATION'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. JOE MAWAD DBA INLAND EMPIRE WOMANS CENTER MEDICAL ASSOCIATION J MAWAD, BOD/GREATER THAN 35% OWNERSHIP 1901647 MEDICAL SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE CORPORATE MEMBER IS DIGNITY COMMUNITY CARE, A 501(C)(3) EXEMPT ORGANIZATION. ON FEBRUARY 1, 2019, DIGNITY HEALTH AND CATHOLIC HEALTH INITIATIVES ("CHI"), A COLORADO NONPROFIT CORPORATION, EFFECTED A BUSINESS COMBINATION. ON THAT DATE, CHI CHANGED ITS NAME TO COMMONSPIRIT HEALTH AND BECAME THE SOLE CORPORATE MEMBER OF DIGNITY HEALTH. COMMONSPIRIT HEALTH ("COMMONSPIRIT") IS A CATHOLIC HEALTHCARE SYSTEM SPONSORED BY THE PUBLIC JURIDIC PERSON, CATHOLIC HEALTH CARE FEDERATION (CHCF"). AS PART OF THE ALIGNMENT, ON THE EFFECTIVE DATE OF FEBRUARY 1, 2019, DIGNITY HEALTH CAUSED TO TRANSFER NON-CATHOLIC OWNED COMMUNITY HOSPITALS, NON-CATHOLIC SUBSIDIARY HOSPITALS, AND CERTAIN OTHER NON-CATHOLIC OPERATIONS TO DIGNITY COMMUNITY CARE, A COLORADO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A DIGNITY COMMUNITY CARE, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY COMMUNITY CARE BOARD APPROVES NEW BOARD MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBER INCLUDE: ADOPTION OF MISSION & PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; DISSOLUTION OF THE CORPORATION, ACQUIRE ANOTHER CORPORATION, OR CREATE A SUBSIDIARY; MERGING OR CONSOLIDATING WITH ANOTHER CORPORATION; PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE; INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS; RATIFICATION OF BOARD MEMBER APPOINTMENTS & DISMISSALS; SELECTION OR REMOVAL OF INDEPENDENT AUDITORS; TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. THE ORGANIZATION IS SUBJECT TO THE GOVERNANCE REQUIREMENTS OF THE COMMONSPIRIT HEALTH GOVERNANCE MATRIX. THUS, MANY KEY DECISIONS ADDRESSED IN THE BYLAWS REQUIRE THE ORGANIZATION TO ACT BY MAKING A "RECOMMENDATION," WHICH IS THEN FORMALLY ACTED ON BY THE DIGNITY COMMUNITY CARE BOARD. EXAMPLES INCLUDE AMENDING CORPORATE DOCUMENTS, APPROVING MEMBERS OF GOVERNING BOARD, APPROVING REMOVAL OF MEMBERS OF GOVERNING BOARD, APPROVAL OF DISSOLUTION, SELLING OR DISPOSING OF ASSETS AND ADOPTING A CONSOLIDATED HEALTHCARE SYSTEM OPERATING AND CAPITAL BUDGET. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CFO WORKED CLOSELY WITH THE COMMONSPIRIT'S TAX DEPARTMENT AND AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. THE BOARD OF DIRECTORS HAS DELEGATED THE REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE. MANAGEMENT PRESENTED THE FORM 990 TO THE FINANCE COMMITTEE. SUBSEQUENT TO ITS REVIEW, THE FINANCE AND INVESTMENT COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS REVIEW AND PROVIDED THE RETURN TO THE BOARD OF DIRECTORS, AGAIN EXCLUDING COMPENSATION FOR CERTAIN DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED THE RELATED ORGANIZATION, COMMONSPIRIT'S CONFLICTS OF INTEREST POLICY. THE CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") WAS PUT IN PLACE TO PROTECT THE INTERESTS OF 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 B, LINE 15 FOR 2023 COMPENSATION, COMPENSATION LEVELS FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL WERE ESTABLISHED BY THE RELATED ORGANIZATION, COMMONSPIRIT. COMMONSPIRIT'S BOARD OF STEWARDSHIP TRUSTEES APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED EXCLUSIVELY OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PRACTICES FOR THE ORGANIZATION. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT CONSULTANT AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO VALIDATE THE ORGANIZATION'S BENCHMARKING APPROACH FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES FOR CERTAIN EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED BY THE COMMONSPIRIT HEALTH COMPENSATION DEPARTMENT FROM INDEPENDENT THIRD-PARTY SALARY SURVEYS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). THE DOCUMENTATION OF COMPENSATION DECISIONS INCLUDES (A) THE DECISION MADE AND THE DATE APPROVED; AND (B) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMPENSATION DEPARTMENT AND THE SOURCES FROM WHICH THE DATA WAS OBTAINED. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION IS INCLUDED IN COMMONSPIRIT'S CONSOLIDATED FINANCIAL STATEMENTS WHICH IS AVAILABLE ON COMMONSPIRIT'S WEBSITE AND UPON REQUEST. FORM 990, PART VII, SECTION A DR. DANIELS AND DR. J. NEGUSSE RECEIVED COMPENSATION FOR PHYSICIAN SERVICES PROVIDED TO THE FILING ORGANIZATION. DR. J. MAWAD RECEIVED COMPENSATION FOR PHYSICIAN SERVICES PROVIDED TO A RELATED ORGANIZATION, DIGNITY HEALTH. G. DALY, N. TESTA, MD, R. WENGER AND J. COLLISON RECEIVED COMPENSATION FOR SERVICES PROVIDED TO A RELATED ORGANIZATIONS, DIGNITY HEALTH AND DIGNITY COMMUNITY CARE. FORM 990, PART IX, LINE 11G REVENUE CYCLE SERVICES: PROGRAM SERVICE EXPENSES 5,925,296. MANAGEMENT AND GENERAL EXPENSES 50,797. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,976,093. MEDICAL FEES/SERVICES: PROGRAM SERVICE EXPENSES 19,177,372. MANAGEMENT AND GENERAL EXPENSES 323,469. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,500,841. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 6,505,975. MANAGEMENT AND GENERAL EXPENSES 7,982,926. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,488,901. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 2,289,374. MANAGEMENT AND GENERAL EXPENSES 2,809,095. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,098,469. STORAGE & VARIOUS SERVICES: PROGRAM SERVICE EXPENSES 1,026,885. MANAGEMENT AND GENERAL EXPENSES 1,260,002. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,286,887. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 299,715. MANAGEMENT AND GENERAL EXPENSES 367,754. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 667,469. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 178,065. MANAGEMENT AND GENERAL EXPENSES 218,489. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 396,554. FORM 990, PART XI, LINE 9: GAIN ON ADOPTION OF ASU 2017-17 1,659,418. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART XII, LINE 3B - FINANCIAL STATEMENTS AND REPORTING THE ORGANIZATION'S FEDERAL AWARDS WERE INCLUDED IN COMMONSPIRIT'S CONSOLIDATED UNIFORM GUIDANCE AUDITED SCHEDULE OF FEDERAL EXPENDITURES FOR THE PERIOD OF JULY 1, 2023, TO JUNE 30, 2024. ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HOSPITAL NE 501(C)(3) LINE 3 ACH 0 ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - COMM MEM HOSPITAL OF MO VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(C)(3) LINE 10 CSH 0 APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(C)(3) LINE 10 SFH 0 ARROYO GRANDE COMMUNITY HOSPITAL FOUNDATION 345 S HALCYON RD ARROYO GRANDE CA 93420 203256066 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 BAKERSFIELD MEMORIAL HOSPITAL 420 34TH STREET BAKERSFIELD CA 93301 951802779 HOSPITAL CA 501(C)(3) LINE 3 DIGNITY COMMUNITY CARE 0 BARROW FOUNDATION UK 13 CHURCH STREET NUNNEY ENGLAND UK BA11 4LW 311724184 FUNDRAISING FOUNDATION UK 501(C)(3) PF N/A 0 BARROW NEUROLOGICAL FOUNDATION 350 WEST THOMAS ROAD PHOENIX AZ 85013 860174371 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 7 N/A 0 BAYLOR ST LUKE'S HEALTH VENTURES 17200 ST LUKES WAY STE 170 THE WOODLANDS TX 77384 274499340 PHYSICIANS TX 501(C)(3) LINE 12A, I SLHS 0 BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON TX 77030 760458535 PHYSICIANS TX 501(C)(3) LINE 3 BSLHV 0 BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232187242 INACTIVE PA 501(C)(3) LINE 12A, I CSH 0 BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(C)(3) LINE 3 TCHB 0 BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HOSPITAL TX 501(C)(3) LINE 3 SLH-CO 0 BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 REHABILITATION TX 501(C)(3) LINE 10 SJSC 0 CALIFORNIA HOSPITAL MEDICAL CENTER FOUNDATION 1401 SOUTH GRAND AVENUE LOS ANGELES CA 90015 954000909 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DIGNITY COMMUNITY CARE 0 CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HOSPITAL ND 501(C)(3) LINE 3 CSH 0 CATHOLIC HEALTH INITIATIVES - COLORADO 9100 EAST MINERAL CIRCLE CENTENNIAL CO 80112 840405257 HOSPITAL CO 501(C)(3) LINE 3 CSH 0 CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 9100 EAST MINERAL AVE CENTENNIAL CO 80112 840902211 FUNDRAISING FOUNDATION CO 501(C)(3) LINE 7 CHIC 0 CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 1150 KELLY JOHNSON BLVD 204 COLORADO SPRINGS CO 80920 270930004 FUNDRAISING FOUNDATION CO 501(C)(3) LINE 12A, I CSH 0 CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 TELEHEALTH CO 501(C)(3) LINE 12A, I CSH 0 CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 SURGERY CENTER OR 501(C)(3) LINE 10 MMC - ROSEBURG 0 CENTRAL CALIFORNIA HEALTH CENTERS 300 OLD RIVER ROAD STE 200 BAKERSFIELD CA 93311 844171789 CLINIC CA 501(C)(3) LINE 3 DIGNITY COMMUNITY CARE 0 CENTRAL KANSAS MEDICAL CENTER 9100 E MINERAL CIRCLE CENTENNIAL CO 80112 480543724 INACTIVE KS 501(C)(3) LINE 3 CSH 0 CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 SENIOR LIVING MN 501(C)(3) LINE 10 CSH 0 CHI HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING FOUNDATION NE 501(C)(3) LINE 7 ACH 0 CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 INVESTMENTS KY 501(C)(3) LINE 12A, I CSH 0 CHI LIVING COMMUNITIES 930 S 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