LAKEWOOD HEALTH CENTER: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: LAKEWOOD HEALTH CENTER (EIN 41-0758434)
Tax period: 2021-07-01 to 2022-06-30
Filed: 2023-05-11
IRS object ID: 202341319349300734
Schema version: 2021v4.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2023-05-11T07:26:12-05:00	ReturnTs
Tax Period End	2022-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	470617373	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	COMMONSPIRIT HEALTH	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	198 INVERNESS DRIVE WEST	AddressLine1Txt
City	ENGLEWOOD	CityNm
State Abbreviation	CO	StateAbbreviationCd
ZIP	80112	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2021-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	410758434	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	LAKEWOOD HEALTH CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	LAKE	BusinessNameControlTxt
Phone	2186342120	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	600 MAIN AVENUE SOUTH	AddressLine1Txt
City	BAUDETTE	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	56623	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	NICK O'TOOL	PersonNm
Person Title	INTERIM SVP OF FINANCE	PersonTitleTxt
Phone	4027178118	PhoneNum
Signature	2023-05-11	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	NICK	PersonFirstNm
Person Last	OTOOL	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MARK STOCKI	PreparerPersonNm
PTIN	P00642127	PTIN
Phone	3032989100	PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2023-04-26 12:10:37Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	CHI LAKEWOOD HEALTH	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	JEFFRY STAMPOHAR	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	600 MAIN AVENUE SOUTH	AddressLine1Txt
City	BAUDETTE	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	56623	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$15,666,121	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.LAKEWOODHEALTHCENTER.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1959	FormationYr
Legal Domicile State	MN	LegalDomicileStateCd
Activity Or Mission	LAKEWOOD HEALTH CENTER IS A SMALL FACILITY LOCATED IN A RURAL AND ISOLATED SETTING, THE CONTINUUM OF CARE INCLUDES PHYSICIAN CLINIC, ACUTE CARE, RESIDENTIAL CARE, AND LONG TERM CARE.	ActivityOrMissionDesc
Voting Members Governing Body	5	VotingMembersGoverningBodyCnt
Voting Members Independent	2	VotingMembersIndependentCnt
Total Employee	184	TotalEmployeeCnt
Total Volunteers	15	TotalVolunteersCnt
Total Gross UBI	$2,896	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$569,538	PYContributionsGrantsAmt
CY Contributions Grants	$882,401	CYContributionsGrantsAmt
PY Program Service Revenue	$13,179,037	PYProgramServiceRevenueAmt
CY Program Service Revenue	$13,863,290	CYProgramServiceRevenueAmt
PY Investment Income	$625,017	PYInvestmentIncomeAmt
CY Investment Income	$474,138	CYInvestmentIncomeAmt
PY Other Revenue	$437,732	PYOtherRevenueAmt
CY Other Revenue	$446,292	CYOtherRevenueAmt
PY Total Revenue	$14,811,324	PYTotalRevenueAmt
CY Total Revenue	$15,666,121	CYTotalRevenueAmt
PY Grants And Similar Paid	$48,543	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$53,456	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$8,483,067	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$8,954,138	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$133,512	CYTotalFundraisingExpenseAmt
PY Other Expenses	$8,273,721	PYOtherExpensesAmt
CY Other Expenses	$9,883,187	CYOtherExpensesAmt
PY Total Expenses	$16,805,331	PYTotalExpensesAmt
CY Total Expenses	$18,890,781	CYTotalExpensesAmt
PY Revenues Less Expenses	-$1,994,007	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$3,224,660	CYRevenuesLessExpensesAmt
Total Assets BOY	$20,974,664	TotalAssetsBOYAmt
Total Assets EOY	$16,442,011	TotalAssetsEOYAmt
Total Liabilities BOY	$4,591,308	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$4,162,793	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$16,383,356	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$12,279,218	NetAssetsOrFundBalancesEOYAmt
Mission	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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$17,254,264	ExpenseAmt
Grant	$53,456	GrantAmt
Revenue	$13,863,290	RevenueAmt
Desc	SEE SCHEDULE H.	Desc
Total Program Service Expenses	$17,254,264	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	184	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	5	GoverningBodyVotingMembersCnt
Independent Voting Member	2	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	MN	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	JAY ROSS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	2186343440	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	600 MAINE AVENUE SOUTH	AddressLine1Txt
City	BAUDETTE	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	56623	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
JEANETTE WOJTALEWICZ
DIV SVP CFO/BOARD MEMBER (PARTIAL YEAR)	1.00	50.00	Yes (X)	$0	$1,233,421	$51,903
CARY WARD
DIV SVP CMO/BOARD MEMBER	1.00	50.00	Yes (X)	$0	$813,683	$43,227
BENJAMIN KOPPELMAN
FORMER PRESIDENT	0.00	50.00		$0	$416,354	$49,105	Yes (X)
DR JUSTIN QUO
PHYSICIAN/BOARD MEMBER	50.00	1.00	Yes (X)	$322,069	$0	$49,602
JEFFRY STAMPOHAR
PRESIDENT	50.00	1.00	Yes (X)	$165,489	$0	$46,889		Yes (X)
JAY ROSS
CFO / TREASURER	1.00	50.00		$0	$172,992	$37,853		Yes (X)
KRISTIN COAUETTE
VP PATIENT CARE SERVICES	40.00	0.00		$141,350	$0	$30,878			Yes (X)
BRENT NOBLE
SUPERVISOR-PHARMACY	40.00	0.00		$128,777	$0	$19,440			Yes (X)
ROBIN CONAWAY
COORDINATOR RN MNA	40.00	0.00		$121,283	$0	$23,511			Yes (X)
WENDI EASTHOUSE
SUPV-LABORATORY SERVICES NON-EXEMPT	40.00	0.00		$124,496	$0	$6,945			Yes (X)
CLYDE STEPHENS
PHYS ASST FAMILY MEDICINE	40.00	0.00		$126,136	$0	$4,559			Yes (X)
KRISTI BOWMAN
SECRETARY	40.00	0.00		$44,798	$0	$20,058		Yes (X)
BRAD NYLANDER
BOARD CHAIR	1.00	1.00	Yes (X)	$0	$0	$0		Yes (X)
SISTER BERNICE EBNER
BOARD MEMBER	1.00	1.00	Yes (X)	$0	$0	$0
CRYSTAL OLSON
BOARD MEMBER (PARTIAL YEAR)	1.00	1.00	Yes (X)	$0	$0	$0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,174,398	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,636,450	TotReportableCompRltdOrgAmt
Total Other Compensation	$383,970	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	13	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
MEDICUS HEALTHCARE SOLUTIONS
22 ROULSTON RD	WINDHAM	NH	03087	EMPLOYMENT SERVICES	$331,377
MEDEFIS INC
2121 N 117TH AVE STE 200	OMAHA	NE	68164	VENDOR MANAGEMENT/STAFFING	$178,377
NATIONAL GOVERNMENT SVCS INC
5000 BRITTONFIELD PKWY SUITE 100	EAST SYRACUSE	NY	13057	MEDICARE CONTRACTING SERVICES	$158,298
MAYO CLINIC
200 1ST ST SW	ROCHESTER	MN	55905	MEDICAL SERVICES, ETC.	$141,180

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	4	CntrctRcvdGreaterThan100KCnt
Government Grants	$875,650	GovernmentGrantsAmt
All Other Contributions	$6,751	AllOtherContributionsAmt
Total Contributions	$882,401	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
PATIENT SERVICES	900099	$13,858,620	$13,858,620	$0	$0
RENTAL INCOME	900099	$4,670	$4,670	$0	$0

Field	Value	IRS element (for citing)
Total Program Service Revenue	$13,863,290	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$77,548	TotalRevenueColumnAmt
Exclusion	$77,548	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$396,518	SecuritiesAmt
Other	$72	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$396,518	SecuritiesAmt
Other	$72	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$396,590	TotalRevenueColumnAmt
Exclusion	$396,590	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
PHARMACY SERVICES	446110	$189,255	$0	$0	$189,255
SERVICES SOLD	900099	$101,887	$0	$2,896	$98,991
MAINTENANCE SERVICES	811000	$74,851	$0	$0	$74,851

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$80,299	TotalRevenueColumnAmt
Exclusion	$80,299	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$446,292	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$15,666,121	TotalRevenueColumnAmt
Related Or Exempt Func Income	$13,863,290	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$2,896	UnrelatedBusinessRevenueAmt
Exclusion	$917,534	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$53,456	TotalAmt
Program Services	$53,456	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$647,445	TotalAmt
Program Services	$582,700	ProgramServicesAmt
Management And General	$64,745	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$6,582,410	TotalAmt
Program Services	$5,924,169	ProgramServicesAmt
Management And General	$587,040	ManagementAndGeneralAmt
Fundraising	$71,201	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$157,237	TotalAmt
Program Services	$141,514	ProgramServicesAmt
Management And General	$13,761	ManagementAndGeneralAmt
Fundraising	$1,962	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$1,000,420	TotalAmt
Program Services	$900,378	ProgramServicesAmt
Management And General	$89,330	ManagementAndGeneralAmt
Fundraising	$10,712	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$566,626	TotalAmt
Program Services	$509,964	ProgramServicesAmt
Management And General	$50,996	ManagementAndGeneralAmt
Fundraising	$5,666	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$61,499	TotalAmt
Management And General	$61,499	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$630	TotalAmt
Program Services	$630	ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$3,340,910	TotalAmt
Program Services	$3,131,062	ProgramServicesAmt
Management And General	$209,848	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$33,745	TotalAmt
Program Services	$30,371	ProgramServicesAmt
Management And General	$3,037	ManagementAndGeneralAmt
Fundraising	$337	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$384,843	TotalAmt
Program Services	$346,359	ProgramServicesAmt
Management And General	$34,636	ManagementAndGeneralAmt
Fundraising	$3,848	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$564,804	TotalAmt
Program Services	$508,324	ProgramServicesAmt
Management And General	$50,832	ManagementAndGeneralAmt
Fundraising	$5,648	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$314,146	TotalAmt
Program Services	$282,732	ProgramServicesAmt
Management And General	$28,273	ManagementAndGeneralAmt
Fundraising	$3,141	FundraisingAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$81,699	TotalAmt
Program Services	$73,529	ProgramServicesAmt
Management And General	$7,353	ManagementAndGeneralAmt
Fundraising	$817	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$1,869	TotalAmt
Program Services	$1,682	ProgramServicesAmt
Management And General	$168	ManagementAndGeneralAmt
Fundraising	$19	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,764	TotalAmt
Program Services	$1,587	ProgramServicesAmt
Management And General	$159	ManagementAndGeneralAmt
Fundraising	$18	FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$556,165	TotalAmt
Program Services	$500,548	ProgramServicesAmt
Management And General	$50,055	ManagementAndGeneralAmt
Fundraising	$5,562	FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$2,422,766	TotalAmt
Program Services	$2,180,489	ProgramServicesAmt
Management And General	$218,049	ManagementAndGeneralAmt
Fundraising	$24,228	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$35,305	TotalAmt
Program Services	$31,775	ProgramServicesAmt
Management And General	$3,177	ManagementAndGeneralAmt
Fundraising	$353	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
MEDICAL SUPPLIES	$1,482,736	$1,482,736	$0	$0
REPAIRS AND MAINTENANCE	$239,148	$227,191	$11,957	$0
OTHER TAXES	$221,981	$210,882	$11,099	$0
DUES & SUBSCRIPTIONS	$64,376	$61,157	$3,219	$0

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$74,801	TotalAmt
Program Services	$71,029	ProgramServicesAmt
Management And General	$3,772	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$18,890,781	TotalAmt
Program Services	$17,254,264	ProgramServicesAmt
Management And General	$1,503,005	ManagementAndGeneralAmt
Fundraising	$133,512	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$929	BOYAmt
EOY	$9,364	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$2,890,239	BOYAmt
EOY	$104,767	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,044,997	BOYAmt
EOY	$2,861,244	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
EOY	$2,185	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$246,597	BOYAmt
EOY	$287,589	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$91,676	BOYAmt
EOY	$49,590	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$24,598,472	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$19,637,369	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$7,110,449	BOYAmt
EOY	$4,961,103	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$8,419,455	BOYAmt
EOY	$8,105,371	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$170,322	BOYAmt
EOY	$60,798	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$20,974,664	BOYAmt
EOY	$16,442,011	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$4,150,787	BOYAmt
EOY	$3,991,961	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$138,564	BOYAmt
EOY	$131,090	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$2,612	BOYAmt
EOY	$3,411	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$299,345	BOYAmt
EOY	$36,331	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$4,591,308	BOYAmt
EOY	$4,162,793	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$16,381,997	BOYAmt
EOY	$12,276,981	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,359	BOYAmt
EOY	$2,237	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$16,383,356	BOYAmt
EOY	$12,279,218	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$20,974,664	BOYAmt
EOY	$16,442,011	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$3,224,660	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$788,030	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$91,448	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (1)	GrantsOtherOrganizationsInd
Grants Other Organizations	$630	GrantsOtherOrganizationsAmt
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	0	OtherActivitiesInd
Total Lobbying Expenditures	$630	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $203 CATHOLIC HEALTH ASSOCIATION - $134 MINNESOTA HOSPITAL ASSOCIATION - $293	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	Yes (1)	InclEscrowCustodialAcctLiabInd
Explanation Provided	Yes (X)	ExplanationProvidedInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$103,424	OtherCostOrOtherBasisAmt
Book Value	$103,424	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$10,624,728	OtherCostOrOtherBasisAmt
Depreciation	$9,192,829	DepreciationAmt
Book Value	$1,431,899	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$13,499,232	OtherCostOrOtherBasisAmt
Depreciation	$10,193,640	DepreciationAmt
Book Value	$3,305,592	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$371,088	OtherCostOrOtherBasisAmt
Depreciation	$250,900	DepreciationAmt
Book Value	$120,188	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$4,961,103	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

Field	Value	IRS element (for citing)
Desc	CSH OPERATING INVESTMENT POOL	Desc
Book Value	$8,105,371	BookValueAmt
Method Valuation	F	MethodValuationCd

Field	Value	IRS element (for citing)
Total Book Value Securities	$8,105,371	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
CURRENT PORTION OF FINANCE LEASE LIABILITY	$17,112
LONG-TERM PORTION OF FINANCE LEASE LIABILITY	$19,219

Field	Value	IRS element (for citing)
Total Liability	$36,331	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART IV, LINE 2B:	FUNDS ARE HELD ON BEHALF OF RESIDENTS IN LONG TERM CARE.
PART X, LINE 2:	LAKEWOOD HEALTH CENTER'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.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Persons Served	203	PersonsServedCnt
Total Community Benefit Expns	$83,400	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$83,400	NetCommunityBenefitExpnsAmt
Total Expense	0.00440	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Persons Served	1441	PersonsServedCnt
Total Community Benefit Expns	$4,908,215	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,593,768	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,314,447	NetCommunityBenefitExpnsAmt
Total Expense	0.06960	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Persons Served	1644	PersonsServedCnt
Total Community Benefit Expns	$4,991,615	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,593,768	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,397,847	NetCommunityBenefitExpnsAmt
Total Expense	0.07400	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	6	ActivitiesOrProgramsCnt
Persons Served	90	PersonsServedCnt
Total Community Benefit Expns	$18,101	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$18,101	NetCommunityBenefitExpnsAmt
Total Expense	0.00100	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$617,511	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$396,972	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$220,539	NetCommunityBenefitExpnsAmt
Total Expense	0.01170	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	5	ActivitiesOrProgramsCnt
Persons Served	17	PersonsServedCnt
Total Community Benefit Expns	$42,175	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$42,175	NetCommunityBenefitExpnsAmt
Total Expense	0.00220	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	15	ActivitiesOrProgramsCnt
Persons Served	107	PersonsServedCnt
Total Community Benefit Expns	$677,787	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$396,972	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$280,815	NetCommunityBenefitExpnsAmt
Total Expense	0.01490	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	15	ActivitiesOrProgramsCnt
Persons Served	1751	PersonsServedCnt
Total Community Benefit Expns	$5,669,402	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,990,740	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,678,662	NetCommunityBenefitExpnsAmt
Total Expense	0.08890	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Persons Served	25	PersonsServedCnt
Total Community Benefit Expns	$20,556	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$20,556	NetCommunityBenefitExpnsAmt
Total Expense	0.00110	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Persons Served	25	PersonsServedCnt
Total Community Benefit Expns	$20,556	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$20,556	NetCommunityBenefitExpnsAmt
Total Expense	0.00110	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$304,109	BadDebtExpenseAmt
Reimbursed By Medicare	$3,823,887	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$3,825,807	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$1,920	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	LAKEWOOD HEALTH CENTER	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	600 MAIN AVENUE SOUTH	AddressLine1Txt
City	BAUDETTE	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	56623	ZIPCd

Field	Value	IRS element (for citing)
Website Address	HTTP://LAKEWOODHEALTHCENTER.ORG/	WebsiteAddressTxt
State License	375394	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	LAKEWOOD HEALTH CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	21	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE SCHEDULE H SUPPLEMENTAL INFO	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	22	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	SEE SCHEDULE H SUPPLEMENTAL INFO	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	HTTP://LAKEWOODHEALTHCENTER.ORG/FINANCIAL-ASSISTANCE/	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	HTTP://LAKEWOODHEALTHCENTER.ORG/FINANCIAL-ASSISTANCE/	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	HTTP://LAKEWOODHEALTHCENTER.ORG/FINANCIAL-ASSISTANCE/	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART V, SECTION B, LINE 3E:	THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.
PART V, SECTION B, LINE 7A:	HTTPS://LAKEWOODHEALTHCENTER.ORG/ABOUT-US
PART V, SECTION B, LINE 10A:	HTTPS://LAKEWOODHEALTHCENTER.ORG/ABOUT-US/
PART V SECTION B LINE 5	COMMUNITY INPUT WAS GATHERED IN SEVERAL WAYS. PROJECT PARTNERS INCLUDED THE 109 COMMUNITY MEMBERS THAT COMPLETED THE PUBLIC HEALTH SURVEY, AND THE 10 COMMUNITY MEMBERS THAT ATTENDED OUR COMMUNITY FOCUS GROUP. OUR PUBLIC HEALTH DEPARTMENT, WHICH PROVIDES PUBLIC HEALTH FOR THE COUNTY PROVIDED THE SURVEY RESULTS AND ATTENDED THE COMMUNITY FOCUS GROUP MEETING. COMMUNITY REPRESENTATION INCLUDED:MINISTERIAL (FIRST LUTHERAN)EMERGENCY MEDICAL SERVICES (EMT)LAKE OF THE WOODS SOCIAL SERVICESLAKE OF THE WOODS SCHOOL (BOARD MEMBER & SUPERINTENDED & SOCIAL WORKER)LAKE OF THE WOODS PREVENTION COALITION & CARA GRANTCOMMUNITY MEMBERPUBLIC HEALTH DIRECTORCHI LAKEWOOD HEALTH (FOUNDATION/MARKETING LEADER)THE TEN PROVIDERS PROVIDED THEIR THOUGHTS ON THE GREATEST HEALTH NEEDS OF OUR VULNERABLE POPULATIONS, RESOURCES AND ASSETS AVAILABLE TO RESPOND TO THE NEEDS, AND THE PERCEIVED BARRIERS THAT PREVENT THOSE MOST IN NEED FROM ACCESSING SERVICES. THE FOCUS GROUP PARTICIPANTS BEGAN THE PRIORITIZATION PROCESS BY PERFORMING AN ACTIVITY ON THEIR IDENTIFIED HEALTH NEEDS. A LISTING OF THEIR PRIORITY CONCERNS WAS GIVEN TO THE CHI LAKEWOOD HEALTH SENIOR LEADER TEAM.
PART V, SECTION B, LINE 13(H):	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 11	THE MOST RECENT CHNA AND CORRESPONDING IMPLEMENTATION PLAN WAS COMPLETED IN THE TAX REPORTING YEAR 2022. THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON HTTPS://LAKEWOODHEALTHCENTER.ORG/ABOUT-US/.THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY AND SECONDARY DATA FROM COMMUNITY SURVEY AND FOCUS GROUP:TOP HEALTH NEEDS (FROM 2022 CHNA):1. LACK OF HEALTH CARE PROVIDERS2. SUBSTANCE ABUSE3. MENTAL HEALTH4. DAYCARE5. AFFORDABLE HOUSINGFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: LACK OF HEALTH CARE PROVIDERSTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025: -CONTINUE TO WORK COLLABORATIVELY WITH COMMONSPIRIT RECRUITMENT FOR EXPANDED SUPPORT TO RECRUIT QUALIFIED PROVIDERS FOR BOTH ER AND PRIMARY CARE. -CONTINUE COLLABORATION WITH SANFORD HEALTH FOR OUTREACH SPECIALIST SERVICES. -EXPLORE OPPORTUNITIES WITH ALTRU AND LIFECARE MEDICAL CENTER. -EVALUATE THE FEASIBILITY OF ADDING ADDITIONAL OUTREACH SPECIALISTS. -UTILIZE LOCAL COMMUNITY HEALTH WORKER TO ASSIST AND ALIGN HEALTHCARE RESOURCES FOR COMMUNITY MEMBERS. -CONTINUE COLLABORATIVE EFFORTS WITH SANFORD HEALTH AND EXPLORE OPPORTUNITIES TO INCREASE SURGICAL COVERAGE. -EXPLORE OTHER SURGICAL OPPORTUNITIES WITH ADDITIONAL HEALTH CARE FACILITIES SUCH AS LIFECARE MEDICAL CENTER.PRIORITY HEALTH NEED #2: SUBSTANCE ABUSETO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025: -DESIGNATE A HOSPITAL REPRESENTATIVE TO COLLABORATE AND ASSIST IN PROMOTING THE LAKE OF THE WOODS PREVENTION COALITION ACTIVITIES. -CONTINUE TO PROVIDE SPACE AS NEEDED FOR PREVENTION COALITION MEETINGS. -CONTINUE PARTICIPATION AS AN ACTIVE STAKEHOLDER IN THE LAKE OF THE WOODS CARA GRANT. -CONTINUE TO PROVIDE SPACE FOR MEETINGS WITH STAKEHOLDERS. -SUPPORT AND PROMOTE SUBSTANCE ABUSE EDUCATION EFFORTS FOR BOTH THE COMMUNITY AND HOSPITAL EMPLOYEES.PRIORITY HEALTH NEED #3: MENTAL HEALTH -IMPLEMENT SENIOR LIFE SOLUTIONS: AN INTENSIVE OUTPATIENT GROUP THERAPY PROGRAM DESIGNED TO MEET THE MENTAL HEALTH NEEDS OF THOSE 65 AND OLDER. -PROMOTE THE NEW SERVICE TO INCREASE AWARENESS AND PARTICIPATION. -PROMOTE AND GROW CURRENT BEHAVIORAL HEALTH SERVICES AND ONSITE LICENSED SOCIAL WORKER. -COLLABORATE WITH OTHER ORGANIZATIONS THAT HAVE A MISSION TO PROMOTE MENTAL HEALTH SERVICES, RESOURCES AND EDUCATION. -INTEGRATION OF THE COMMUNITY HEALTH WORKER TO GUIDE INDIVIDUALS TO APPROPRIATE MENTAL HEALTH RESOURCES.THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS:ALTHOUGH CHI LAKEWOOD HEALTH RECOGNIZED THE IMPORTANCE OF ALL NEEDS IDENTIFIED BY THE COMMUNITY, WE WILL NOT DIRECTLY DESIGN STRATEGIES FOR -DAY CARE- DUE TO LIMITED EXPERTISE AND RESOURCES -AFFORDABLE HOUSING DUE TO LIMITED RESOURCE, EXPERTISE, OR DUPLICATIVE EFFORTSTHE FOLLOWING TOP HEALTH NEEDS WERE IDENTIFIED AND PRIORITIZED AS PART OF THE CHNA AND IMPLEMENTATION STRATEGY PLAN APPROVED IN 2019. ALTHOUGH A MORE RECENT CHNA WAS COMPLETED IN 2022, THE RELATED IMPLEMENTATION PLAN WAS NOT APPROVED UNTIL NOVEMBER 7, 2022. THEREFORE THE WORK DESCRIBED BELOW IS TIED TO THE 2019 ASSESSMENT AND PLANS AND REPRESENTS WORK CARRIED OUT BY THE HOSPITAL DURING FISCAL YEAR 2022.THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY DATA OBTAINED THROUGH THE COMMUNITY HEALTH SURVEY AND KEY INFORMANT SURVEY, AS WELL AS A REVIEW OF SECONDARY DATA ON A VARIETY OF HEALTH INDICATORS.TOP HEALTH NEEDS (FROM 2019 CHNA): 1. MENTAL HEALTH2. TRANSITIONS OF CARE / PERSONS WITH COMPLEX MEDICAL ISSUES3. LOW-INCOME / POVERTY AND IMPLICATIONS THAT RESULTFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: MENTAL HEALTH - CHI LAKEWOOD HEALTH WILL EVALUATE AND IMPLEMENT SENIOR LIFE SOLUTIONS, AN OUTPATIENT COUNSELING PROGRAM DESIGNED TO MEET THE MENTAL HEALTH NEEDS OF THOSE WHO ARE 65 AND OLDER. THE PROGRAM WILL PROVIDE ADDITIONAL ACCESS TO MENTAL HEALTH CARE WITHIN OUR COMMUNITY. - CHI LAKEWOOD HEALTH WILL CONTINUE TO COLLABORATE WITH COMMUNITY PARTNERS TO SPONSOR AND PROMOTE MENTAL HEALTH RELATED TRAININGS, WORKSHOPS AND INITIATIVES. IN ADDITION, A MEMBER OF OUR TEAM WILL PARTICIPATE ON THE SUICIDE AWARENESS AND PREVENTION COALITION. THE HOSPITAL WILL ALSO LOOK TO COLLABORATE WITH OUR LOCAL PUBLIC SCHOOL (LOW SCHOOL) TO IDENTIFY OPPORTUNITIES AND NEXT STEPS TO IMPROVE MENTAL HEALTH RESOURCES AND AWARENESS FOR OUR YOUTH. - MAINTAIN CURRENT BEHAVIORAL HEALTH SERVICES AT CHI LAKEWOOD HEALTH AND EXPLORE OPTIONS TO INCREASE PATIENT ACCESS.FY22 ACTIONS AND IMPACT:CHI LAKEWOOD HEALTH HAS DEDICATED MOST OF ITS RESOURCES TO ADDRESS THE RESPONSE TO THE ON-GOING CORONAVIRUS PANDEMIC. DUE TO THIS, MANY AREAS OF THE CHNA WERE NOT ABLE TO BE ADDRESSED AS INITIALLY PLANNED, IN ADDITION THE PANDEMIC HAS BROUGHT MANY CHANGES WITH BOTH NEW REGULATIONS AND RECOMMENDATIONS THAT HAVE SIGNIFICANTLY TRANSFORMED THE WAY WE OPERATE. AS WE CONTINUE TO EVOLVE OUR GOAL IS TO FIND ALTERNATIVES TO ADDRESS THE AREAS THAT HAVE BEEN IMPACTED BY THE PANDEMIC AND TO CONSIDER ONGOING SUPPORT AND COLLABORATION FOR THE THREE PRIORITIZED AREAS OF OUR 2019 CHNA. THROUGH THIS APPROACH LAKEWOOD HAS CONTINUED TO SUPPORT AND ADDRESS THE AREAS IN OUR 2019 CHNA AS FOLLOWS:MENTAL HEALTH: LAKEWOOD REMAINS COMMITTED TO EVALUATE AND IMPLEMENT MENTAL HEALTH PROGRAM, SENIOR LIFE SOLUTIONS, AN OUTPATIENT COUNSELING PROGRAM DESIGNED TO MEET THE MENTAL HEALTH NEEDS OF THOSE WHO ARE 65 AND OLDER. ALTHOUGH THE IMPLEMENTATION WAS DELAYED DUE TO COVID LAKEWOOD HAS CONTINUE TO MOVE FORWARD BY ESTABLISHING A RELATIONSHIP WITH THE VENDOR AND COMPLETING A FACILITY SPACE ASSESSMENT TO DETERMINE THE BEST LOCATION FOR THE SERVICES. IN ADDITION TO INCREASING MENTAL HEALTH SERVICES IN OUR COMMUNITY, LAKEWOOD CONTINUES TO COLLABORATE WITH COMMUNITY PARTNERS BY SPONSORING AND PROMOTING MENTAL HEALTH RELATED TRAININGS, WORKSHOPS AND INITIATIVES. AS PART OF THIS, A REPRESENTATIVE FROM LAKEWOOD'S PUBLIC HEALTH DEPARTMENT ATTENDS AND IS A PARTICIPATING COMMITTEE MEMBERS OF THE SUICIDE AWARENESS PREVENTION COALITION. LAKEWOOD ALSO CONTINUES THE SUPPORT OF THIS COMMITTEE AND THEIR MENTAL HEALTH AWARENESS ACTIVITIES THROUGH MONETARY DONATIONS FROM LAKEWOOD REGIONAL HEALTHCARE FOUNDATION. LAKEWOOD ADDED ITS OWN MENTAL HEALTH EMPLOYED PROVIDER DURING FYE 2022.
PART V SECTION B LINE 11 (CONTINUED)	PRIORITY HEALTH NEED #2: TRANSITIONS OF CARE / PERSONS WITH COMPLEX MEDICAL ISSUES- CONTINUE RELATIONSHIP WITH LAND OF THE DANCING SKY AREA AGENCY ON AGING BY SUSTAINING AND GROWING OUR LOCAL MATTER OF BALANCE PROGRAM.- STRATEGIZE AND IMPLEMENT ALTERNATIVE PROVIDER CARE MODELS FOR OUR HOSPITAL AND EMERGENCY DEPARTMENT.- CONTINUE TO COLLABORATE WITH SANFORD HEALTH AND EXPLORE ADDITIONAL OUTREACH SPECIALTY SERVICES.- RECRUIT AND DEVELOP A LIST OF POTENTIAL HEALTH PROVIDERS THAT COULD DELIVER HOMECARE AND/OR HOSPICE WITHIN OUR COMMUNITY.- ENCOURAGE AND PROMOTE PREVENTIVE MEDICINE WITH SCREENINGS, ANNUAL CHECK-UPS AND MEDICARE ANNUAL WELLNESS VISITS.FY22 ACTIONS AND IMPACT:TRANSITIONS OF CARE/PERSONS WITH COMPLEX MEDICAL ISSUES: LAKEWOOD HAS REMAINED COMMITTED TO THE RECRUITMENT OF BOTH A FULL TIME MD AND ADVANCED PRACTICE PRACTITIONERS (APPS) IN OUR RURAL HEALTH CLINIC TO INCREASE ACCESS TO CARE THE COMMUNITY, AND CONTINUES TO WORK COLLABORATIVELY WITH THEIR PHYSICIAN ENTERPRISE RECRUITMENT TEAM TO POST, RECRUIT AND INTERVIEW POTENTIAL CANDIDATES. FOR IMPROVED CONTINUITY IN CARE LAKEWOOD ALSO TRANSITIONED THE EMERGENCY ROOM PROVIDER COVERAGE MODEL. THE NEW MODEL SUPPORTS THREE FULL-TIME APPS. LAKEWOOD HAS CONTINUED ITS LONG STANDING RELATIONSHIP WITH SANFORD HEALTH IN BEMIDJI, MN AND THROUGH THIS COLLABORATIVE OUTREACH SPECIALTY SERVICES ARE PROVIDED SUCH AS: ORTHOPEDICS, CARDIOLOGIST, GENERAL SURGEON AND OBGYN. LAKEWOOD CONTINUES TO PROMOTE AND PRIORITIZE INITIATIVES THAT IMPROVE ACCESS AND IMPROVE PREVENTION AND MANAGEMENT OF THOSE WITH MEDICAL ISSUES, AS PART OF THIS THEY PURCHASED AND INSTALLED A NEW 3D MAMMOGRAPHY UNIT IN JUNE OF 2021 AND PROVIDED HEALTH SCREENINGS THAT SAME MONTH AT NORTH STAR ELECTRIC.MEASURES:PRIORITY HEALTH NEED #3: LOW-INCOME / POVERTY AND IMPLICATIONS THAT RESULT:- PLAY THE ROLE OF INDIRECT STAKEHOLDER THROUGH OUR AREA'S ECONOMIC DEVELOPMENT COMMITTEE TO IDENTIFY PRIORITIES AND ACTION ITEMS THAT ADDRESS OUR UNDER EMPLOYED POPULATION.- CONTINUE TO PARTICIPATE IN RAINY RIVER COMMUNITY COLLEGES COHORT BY PROVIDING ONSITE REGISTERED NURSE PROGRAM, AND CONTINUE TO APPLY FOR THE STUDENT SUMMER HEALTHCARE INTERNSHIP PROGRAM WITH THE MINNESOTA HOSPITAL ASSOCIATION.- CONTINUE TO SUPPORT LOCAL PROGRAMS THAT ADDRESS IMPLICATIONS RESULTING FROM POVERTY WHICH INCLUDES, BUT IS NOT LIMITED TO: LAKE OF THE WOODS SCHOOL BACKPACK PROGRAM, EARLY CHILDHOOD FAMILY INITIATIVE BREAKFAST PROGRAM, SENIOR MEALS AND DOLLARS FOR SCHOLARS.- PROMOTE AND ENCOURAGE EMPLOYEES TO EXPLORE PROFESSIONAL DEVELOPMENT THROUGH THE ORGANIZATION'S LIFELONG LEARNING BENEFITS THAT INCLUDE: EDUCATION ASSISTANCE, ACADEMIC ADVISING, ONLINE AND CALL CENTER SUPPORT THROUGH CATHOLIC HEALTH INITIATIVES' (CHI) EDUCATION PARTNER, EDCOR. - CONTINUE TO ADVOCATE FOR MEMBERS IN OUR COMMUNITY WHO ARE LOW-INCOME AND/OR LIVING IN POVERTY BY PROVIDING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE CAPACITY TO PAY FOR MEDICALLY NECESSARY HEALTH CARE SERVICES, AND WHO OTHERWISE MAY NOT BE ABLE TO RECEIVE THESE SERVICES.FY22 ACTIONS AND IMPACT:LOW INCOME/POVERTY AND IMPLICATIONS THAT RESULT: LAKEWOOD CONTINUES ITS RELATIONSHIP WITH THE ECONOMIC DEVELOPMENT COMMITTEE AND SUPPORTS A ROLE OF INDIRECT STAKEHOLDER, HOWEVER, COVID HAS CONTINUED TO SLOW THESE EFFORTS. LAKEWOOD PROMOTES AND ENCOURAGES EMPLOYEES TO EXPLORE PROFESSIONAL DEVELOPMENT THROUGH THE ORGANIZATION'S LIFELONG LEARNING BENEFITS WHICH SUPPORT: EDUCATION ASSISTANCE, ACADEMIC ADVISING, ONLINE AND CALL CENTER SUPPORT THROUGH COMMONSPIRIT HEALTH'S EDUCATION PARTNER, EDCOR. THE HUMAN RESOURCE MANAGER HAS PROMOTED PROFESSIONAL DEVELOPMENT THROUGH EMPLOYEE TOWN HALLS. IN ADDITION LAKEWOOD CONTINUES ITS COHORT WITH RAINY RIVER COMMUNITY COLLEGE TO ASSIST STUDENTS TO COMPLETE AN ASSOCIATE IN SCIENCE DEGREE. THE PROGRAM/INITIATIVE IMPROVES ACCESS TO ADVANCED EDUCATION AND CAREER DEVELOPMENT THROUGH THE USE OF TECHNOLOGY AND CHI LAKEWOOD HEALTH FACILITIES AND PROCTORS. TO IMPROVE ACCESS TO HEALTH SERVICES FOR LOW INCOME POPULATIONS LAKEWOOD HAS PROMOTED THE FINANCIAL ASSISTANCE PROGRAM WITHIN THE COMMUNITY THROUGH SOCIAL MEDIA AND WEBSITE COVERAGE. THE PROGRAM PROVIDES FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE CAPACITY TO PAY FOR MEDICALLY NECESSARY HEALTH CARE SERVICES, AND WHO MAY OTHERWISE NOT BE ABLE TO RECEIVE THESE SERVICES.MEASURES : FOR PRIORITY HEALTH NEED #1:- NO. OF MENTAL HEALTH PROVIDERS RECRUITED/ EMPLOYED: 1FOR PRIORITY HEALTH NEED #2 AND #3 :-NO MEASURES TO REPORT AT THIS TIME.

Field	Value	IRS element (for citing)
Facility	3	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - LAKEWOOD CARE CENTER
600 MAIN AVENUE SOUTH	BAUDETTE	MN	56623	LONG TERM CARE FACILITY
2 - LAKEWOOD HEALTHCARE CLINIC
600 MAIN AVENUE SOUTH	BAUDETTE	MN	56623	RURAL HEALTH CLINIC
3 - PARKER'S ARC
600 MAIN AVENUE SOUTH	BAUDETTE	MN	56623	RESIDENTIAL ASSISTED LIVING

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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. -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.
PART I, LINE 7:	COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO 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 HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS.
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 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 PROMPT PAY DISCOUNTS, AND 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:	LAKEWOOD HEALTH CENTER MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. LAKEWOOD HEALTH CENTER '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. LAKEWOOD HEALTH CENTER ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED 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, LAKEWOOD HEALTH CENTER 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:	LAKEWOOD HEALTH CENTER 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, 2022, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 12-13."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. LAKEWOOD HEALTH CENTER'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $1,920 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:	LAKE OF THE WOODS COUNTY WAS FOUNDED ON JANUARY 1, 1923 AND WAS NAMED AFTER THE LAKE THAT COVERS A LARGE PORTION OF IT. IT IS A RURAL COUNTY LOCATED IN NORTHERN MINNESOTA; IN FACT, IT IS THE NORTHERNMOST POINT OF THE LOWER 48 STATES. IT IS BOUND ON THE NORTH BY CANADA, ON THE EAST BY KOOCHICHING COUNTY, ON THE SOUTH BY BELTRAMI COUNTY, AND ON THE WEST BY ROSEAU COUNTY. IT HAS A TOTAL AREA OF 1,775 SQUARE MILES, OF WHICH 1,298 SQUARE MILES IS LAND AND 477 SQUARE MILES IS WATER.OUR SERVICE AREA IS DEFINED BASED ON THE LOCATION OF THE MEDICAL FACILITIES, THE GEOGRAPHIC DISTANCE TO OTHER HOSPITALS, AND THE HISTORY OF USE BY CONSUMERS. THE CLOSEST HOSPITALS TO LAKEWOOD ARE LIFECARE MEDICAL CENTER IN ROSEAU, MN AND RAINY LAKE MEDICAL CENTER IN INTERNATIONAL FALLS, MN - BOTH OVER 60 MILES AWAY AND BOTH ARE CRITICAL ACCESS HOSPITALS. THE NEAREST SECONDARY AND TERTIARY CARE FACILITIES TO LAKEWOOD ARE LOCATED IN BEMIDJI, MN, AT 101 MILES SOUTH, GRAND FORKS, ND AT 180 MILES SOUTHWEST, AND FARGO, ND AT 236 MILES SOUTHWEST. OUR SERVICE AREA ZIP CODES:ANGLE INLET 56711 BAUDETTE 56623 BIRCHDALE 56629 KELLIHER 56650 ROOSEVELT 56672 WASKISH 56685 WILLIAMS 56686THE US CENSUS BUREAU LISTS THE 2020 POPULATION OF OUR INCORPORATED CITIES AS: BAUDETTE 966 RESIDENTS AND WILLIAMS 157. ACCORDING TO THE MDH, THE 2019 LAKE OF THE WOODS COUNTY POPULATION IS 3,763, WHICH IS A DECREASE OF 23 RESIDENTS SINCE 2019.
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 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. AS OF JUNE 30, 2022, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 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. IN FISCAL YEAR 2022, COMMONSPIRIT HEALTH PROVIDED MORE THAN $3.16 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 $4.89 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.9 BILLION IN FISCAL YEAR 2022, HAS TOTAL ASSETS OF APPROXIMATELY $50.31 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.
PART VI, LINE 7, REPORTS FILED WITH STATES	MN

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Non Cash AssistanceNonCashAssistanceAmt	Valuation Method UsedValuationMethodUsedDesc	Non Cash AssistanceNonCashAssistanceDesc	Purpose Of GrantPurposeOfGrantTxt
LAKEWOOD REGIONAL HEALTHCARE FOUNDATION
600 MAIN AVENUE SOUTH	BAUDETTE	MN	56623	411893795	501(C)(3)	$0	$24,732	FMV	IN-KIND DONATION	PROGRAM SUPPORT
LAKE OF THE WOODS INTERNATIONAL ARENA BOARD INC
656 22ND AVENUE NW	BAUDETTE	MN	56623	472602214	501(C)(3)	$25,000	$0			PROGRAM SUPPORT

Field	Value	IRS element (for citing)
Total501c3 Org	2	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 2:	FormAndLineReferenceDesc
Explanation	THE ORGANIZATION PROVIDES FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY TO INDIVIDUALS WHO ARE ELIGIBLE FOR FREE OR DISCOUNTED CARE.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JEANETTE WOJTALEWICZ
DIV SVP CFO/BOARD MEMBER (PARTIAL YE	$0	$646,728	$0	$527,651	$0	$59,042	$0	$17,100	$0	$34,803	$0	$1,285,324	$0	$0
CARY WARD
DIV SVP CMO/BOARD MEMBER	$0	$540,018	$0	$268,121	$0	$5,544	$0	$17,100	$0	$26,127	$0	$856,910	$0	$0
BENJAMIN KOPPELMAN
FORMER PRESIDENT	$0	$278,890	$0	$123,602	$0	$13,862	$0	$17,138	$0	$31,967	$0	$465,459	$0	$0
DR JUSTIN QUO
PHYSICIAN/BOARD MEMBER	$297,896	$0	$23,500	$0	$673	$0	$17,475	$0	$32,127	$0	$371,671	$0	$0	$0
JEFFRY STAMPOHAR
PRESIDENT	$163,187	$0	$0	$0	$2,302	$0	$18,974	$0	$27,915	$0	$212,378	$0	$0	$0
JAY ROSS
CFO / TREASURER	$0	$140,110	$0	$32,535	$0	$347	$0	$10,113	$0	$27,740	$0	$210,845	$0	$0
KRISTIN COAUETTE
VP PATIENT CARE SERVICES	$104,688	$0	$29,726	$0	$6,936	$0	$4,466	$0	$26,412	$0	$172,228	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

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.

PART I, LINE 4B:

DURING THE 2021 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. 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 2021 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. DURING 2021, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: BENJAMIN A. KOPPELMAN $12,891; JEANETTE M. WOJTALEWICZ $55,430.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1A	PURSUANT TO SECTION 8.6 OF THE BYLAWS OF LAKEWOOD HEALTH CENTER THE MEMBERS OF THE EXECUTIVE COMMITTEE SHALL BE 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, THESE BYLAWS, OR APPLICABLE LAW. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE PROMPTLY REPORTED TO THE BOARD OF DIRECTORS AT THE NEXT REGULAR OR ANNUAL MEETING OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL KEEP REGULAR MINUTES OF ITS PROCEEDINGS AND REPORT THE SAME TO THE BOARD OF DIRECTORS AT EACH REGULAR MEETING OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 6	ACCORDING TO THE BYLAWS OF LAKEWOOD HEALTH CENTER, THE ENTITY'S SOLE MEMBER IS COMMONSPIRIT HEALTH, A COLORADO NONPROFIT ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	PURSUANT TO SECTION 6.5 OF THE BYLAWS DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. PRIOR TO EACH ANNUAL MEETING OF THE CORPORATE MEMBER, OR SUCH OTHER MEETING CALLED FOR THE PURPOSE OF APPOINTING DIRECTORS OF THE CORPORATION, THE GOVERNANCE COMMITTEE SHALL SELECT AND SUBMIT TO THE BOARD OF DIRECTORS A SLATE OF NOMINEES QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. THE BOARD OF DIRECTORS SHALL REVIEW THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ON THE RECOMMENDED SLATE AND SHALL VOTE TO ACCEPT OR REFUSE EACH NOMINEE. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL THEN BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL THEN APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE GOVERNANCE MATRIX AND WITH THE RECOMMENDATION OF THE PRESIDENT HEALTH SYSTEM DELIVERY AND CHIEF OPERATING OFFICER OR OTHER DESIGNEE. NOTWITHSTANDING ANYTHING IN THESE BYLAWS TO THE CONTRARY, 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 IN ACCORDANCE WITH THIS SECTION.
FORM 990, PART VI, SECTION A, LINE 7B	THE ORGANIZATION'S CORPORATE MEMBER IS COMMONSPIRIT HEALTH. PURSUANT TO SECTION 5.4.2 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 THE LAKEWOOD HEALTH CENTER AMENDMENT OF THE CORPORATE DOCUMENTS OF THE LAKEWOOD HEALTH CENTER APPROVE MEMBERS OF THE LAKEWOOD HEALTH CENTER BOARD REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE LAKEWOOD HEALTH CENTER APPROVAL OF ISSUANCE OF DEBT BY LAKEWOOD HEALTH CENTER APPROVAL OF PARTICIPATION OF LAKEWOOD HEALTH CENTER IN A JOINT VENTURE APPROVAL OF FORMATION OF A NEW CORPORATION BY LAKEWOOD HEALTH CENTER APPROVAL OF A MERGER INVOLVING THE LAKEWOOD HEALTH CENTER APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE LAKEWOOD HEALTH CENTER TO REQUIRE THE TRANSFER OF ASSETS BY THE LAKEWOOD HEALTH CENTER 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 LAKEWOOD HEALTH CENTER 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	ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. THE CFO WILL PROVIDE A COPY OF THE RETURN TO THE BOARD EITHER AT A BOARD MEETING OR BY EMAILING A COPY OF THE RETURN TO EACH BOARD MEMBER. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY 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 - 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	LINE 15A: COMMONSPIRIT HEALTH, CHI LAKEWOOD HEALTH USED GALLAGHER AS THE INDEPENDENT THIRD PARTY TO ASSESS EXECUTIVE COMPENSATION PROGRAMS AND TO ENSURE THE REASONABLENESS OF ACTUAL SALARIES AND TOTAL COMPENSATION PACKAGES. COMPENSATION OF THE SENIOR MOST EXECUTIVE WAS REVIEWED ANNUALLY. GALLAGHER REVIEWED BOTH CASH AND TOTAL COMPENSATION FOR OVERALL REASONABLENESS, FOR ADHERENCE TO COMMONSPIRIT HEALTH'S COMPENSATION PHILOSOPHY, AND FOR COMPARABILITY TO THE NOT-FOR-PROFIT HEALTHCARE MARKET. THIS INDEPENDENT REVIEW WAS DELIVERED BY GALLAGHER TO THE CHI LAKEWOOD HEALTH COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES AT THEIR NOVEMBER 2021 MEETING. LINE 15B: ALL EXECUTIVE COMPENSATION PAID TO OFFICERS AND KEY EMPLOYEES WAS SET BY THE BOARD UTILIZING AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THE BOARD OF DIRECTORS OVERSEES THE COMPENSATION SETTING PROCESS AND ENSURES REASONABLENESS AND COMPLIANCE WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. 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 VI, LINE 14- WRITTEN DOCUMENT RETENTION & DESTRUCTION POLICY	THE ORGANIZATION'S DOCUMENT RETENTION AND DESTRUCTION POLICY HAS NOT YET BEEN FORMALLY ADOPTED BY THE BOARD. HOWEVER, THE ORGANIZATION HAS A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY ADOPTED BY THE BOARD-APPOINTED FINANCE COMMITTEE.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,109,577. MANAGEMENT AND GENERAL EXPENSES 58,398. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,167,975. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,031,377. MANAGEMENT AND GENERAL EXPENSES 54,283. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,085,660. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 770,442. MANAGEMENT AND GENERAL EXPENSES 85,605. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 856,047. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 178,558. MANAGEMENT AND GENERAL EXPENSES 9,398. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 187,956. CONSULTING: PROGRAM SERVICE EXPENSES 41,108. MANAGEMENT AND GENERAL EXPENSES 2,164. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,272.
FORM 990, PART XI, LINE 9:	TRANSFER TO AFFILIATES -91,448.
FORM 990, 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 LAKEWOOD HEALTH CENTER. 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 LAKEWOOD HEALTH CENTER ARE REPORTED TO THE IRS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (210 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
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	DH	0
BAKERSFIELD MEMORIAL HOSPITAL
420 34TH STREET	BAKERSFIELD	CA	93301	951802779	HOSPITAL	CA	501(C)(3)	LINE 3	DCC	0
BARROW NEUROLOGICAL FOUNDATION
350 WEST THOMAS ROAD	PHOENIX	AZ	85013	860174371	FUNDRAISING FOUNDATION	AZ	501(C)(3)	LINE 7	DH	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 HEALTH FOUNDATION INC
100 MEDICAL DRIVE	LAKE JACKSON	TX	77566	760080110	FUNDRAISING FOUNDATION	TX	501(C)(3)	LINE 12A, I	TCHB	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	DCC	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 - IOWA CORP
1111 6TH AVE	DES MOINES	IA	50314	420680448	HOSPITAL	IA	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	CHI NS	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	DCC	0
CENTRAL KANSAS MEDICAL CENTER
3515 BROADWAY	GREAT BEND	KS	67530	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 WYNN ROAD	OREGON	OH	43616	341892096	SENIOR LIVING	OH	501(C)(3)	LINE 12A, I	SFH-OH	0
CHI MEMORIAL HOSPITAL - GEORGIA
100 GROSS CRESCENT CIRCLE	FORT OGLETHORPE	GA	30742	822748395	HOSPITAL	GA	501(C)(3)	LINE 3	MHCS	0
CHI NATIONAL HOME CARE
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	451261716	HOME HEALTH	CO	501(C)(3)	LINE 10	CHI NS	0
CHI NATIONAL SERVICES
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	452532084	HOLDING CO	CO	501(C)(3)	LINE 12A, I	CSH	0
CHI NEBRASKA
12809 WEST DODGE ROAD	OMAHA	NE	68510	363233121	HOLDING CO	NE	501(C)(3)	LINE 12A, I	CSH	0
CHI ST JOSEPH CHILDREN'S HEALTH
1929 LINCOLN HWY E STE 150	LANCASTER	PA	17602	232342997	HEALTHCARE	PA	501(C)(3)	LINE 12A, I	CSH	0
CHI ST JOSEPH'S CHILDREN
1516 5TH ST NW	ALBUQUERQUE	NM	87102	710897107	COMMUNITY	NM	501(C)(3)	LINE 12A, I	CSH	0
CHI ST VINCENT HOSPITAL HOT SPRINGS
300 WERNER ST	HOT SPRINGS	AR	71913	710236913	HOSPITAL	AR	501(C)(3)	LINE 3	CHI-SVHS	0
CHI ST VINCENT HOT SPRINGS
300 WERNER ST	HOT SPRINGS	AR	71913	261125064	HOLDING CO	AR	501(C)(3)	LINE 12A, I	SVIMC	0
CHI ST VINCENT MEDICAL GROUP HOT SPRINGS
300 WERNER ST	HOT SPRINGS	AR	71913	261125131	PHYSICIANS	AR	501(C)(3)	LINE 3	CHI-SVHS	0
COMMONSPIRIT HEALTH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	470617373	HEALTHCARE	CO	501(C)(3)	LINE 12A, I		0	N/A
COMMONSPIRIT HEALTH FOUNDATION
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	853374038	FUNDRAISING FOUNDATION	CO	501(C)(3)	LINE 7	CSH	0
COMMONSPIRIT HEALTH OPERATING INVESTMENT POOL LLC
185 BERRY STREET STE 200	SAN FRANCISCO	CA	94107	850919176	OPERATING INVESTMENTS	DE	501(C)(3)	LINE 12A, I	CSH	0
COMMONSPIRIT HEALTH RESEARCH INSTITUTE
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	271050565	RESEARCH	CO	501(C)(3)	LINE 12A, I	CSH	0
COMMUNITY HOSPITAL OF SAN BERNARDINO
1805 MEDICAL CENTER DRIVE	SAN BERNARDINO	CA	92411	951643373	HOSPITAL	CA	501(C)(3)	LINE 3	DCC	0
COMMUNITY LIMITED CARE DIALYSIS CENTER
625 EDEN PARK DRIVE 7TH FLOOR	CINCINNATI	OH	45202	237419853	HOLDING CO	OH	501(C)(2)		GSH	0
COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION
631 N 8TH ST	MISSOURI VALLEY	IA	51555	421294399	FUNDRAISING FOUNDATION	IA	501(C)(3)	LINE 12A, I	AH-CMHMV	0
CONTINUING CARE HOSPITAL
ONE SAINT JOSEPH DRIVE	LEXINGTON	KY	40504	611400619	HOSPITAL	KY	501(C)(3)	LINE 3	SJHS	0
DIGNITY COMMUNITY CARE
185 BERRY STREET STE 200	SAN FRANCISCO	CA	94107	815009488	HOSPITAL	CO	501(C)(3)	LINE 3	CSH	0
DIGNITY HEALTH
185 BERRY STREET STE 200	SAN FRANCISCO	CA	94107	941196203	HOSPITAL	CA	501(C)(3)	LINE 3	CSH	0
DIGNITY HEALTH CONNECTED LIVING
200 MERCY OAKS DRIVE	REDDING	CA	96003	237115371	SENIOR CENTER SERVICES	CA	501(C)(3)	LINE 7	DH	0
DIGNITY HEALTH FOUNDATION
185 BERRY STREET STE 200	SAN FRANCISCO	CA	94107	462037641	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
DIGNITY HEALTH FOUNDATION - INLAND EMPIRE
2101 N WATERMAN AVENUE	SAN BERNARDINO	CA	92404	237440086	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
DIGNITY HEALTH FOUNDATION EAST VALLEY
475 SOUTH DOBSON ROAD	CHANDLER	AZ	85224	742418514	FUNDRAISING FOUNDATION	AZ	501(C)(3)	LINE 12A, I	DH	0
DIGNITY HEALTH MEDICAL FOUNDATION
3400 DATA DRIVE	RANCHO CORDOVA	CA	95670	680220314	MULTI-SPECIALTY OUTPATIENT MEDICAL CLINIC	CA	501(C)(3)	LINE 12A, I	DCC	0
DOMINICAN HEALTH SERVICES
1555 SOQUEL DRIVE	SANTA CRUZ	CA	95065	770056778	COMMUNITY HEALTH SYSTEM	CA	501(C)(3)	LINE 12A, I	DH	0
DOMINICAN HOSPITAL FOUNDATION
1555 SOQUEL DRIVE	SANTA CRUZ	CA	95065	942450442	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
DOMINICAN OAKS CORPORATION
1555 SOQUEL DRIVE	SANTA CRUZ	CA	95065	770127719	OPERATION AND MANAGEMENT OF HOUSING COMPLEX TO ELDERLY PERSONS	CA	501(C)(3)	LINE 10	DHS	0
EAST TEXAS CLINICAL SERVICES
101 VISION PARK SUITE 100	SHENANDOAH	TX	77384	454736213	HEALTHCARE	TX	501(C)(3)	LINE 12A, I	SLHS	0
ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
1455 BATTERSBY AVE	ENUMCLAW	WA	98022	910715805	HOSPITAL	WA	501(C)(3)	LINE 3	FHS	0
FLAGET HEALTHCARE INC
4305 NEW SHEPHERDSVILLE RD	BARDSTOWN	KY	40004	611345363	HOSPITAL	KY	501(C)(3)	LINE 3	KOH	0
FLAGET MEMORIAL HOSPITAL FOUNDATION INC
4305 NEW SHEPHERDSVILLE RD	BARDSTOWN	KY	40004	562351341	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 12A, I	FH	0
FRANCISCAN CARE CENTER
4111 N HOLLAND-SYLVANIA RD	TOLEDO	OH	43623	341931806	HEALTHCARE	OH	501(C)(3)	LINE 10	CHILC	0
FRANCISCAN FOUNDATION
1717 SOUTH J ST	TACOMA	WA	98405	911145592	FUNDRAISING FOUNDATION	WA	501(C)(3)	LINE 10	FHS	0
FRANCISCAN HEALTH SYSTEM
1717 SOUTH J ST	TACOMA	WA	98405	910564491	HOSPITAL	WA	501(C)(3)	LINE 3	CSH	0
FRANCISCAN MEDICAL GROUP
1313 BROADWAY STE 200	TACOMA	WA	98402	911939739	PHYSICIANS	WA	501(C)(3)	LINE 10	FHS	0
FRENCH HOSPITAL MEDICAL CENTER FOUNDATION
1911 JOHNSON AVENUE	SAN LUIS OBISPO	CA	93401	203256125	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DCC	0
GARRISON MEMORIAL HOSPITAL
407 THIRD AVENUE SOUTHEAST	GARRISON	ND	58540	450227752	HOSPITAL	ND	501(C)(3)	LINE 3	SAMC	0
GLENDALE MEMORIAL HEALTH FOUNDATION
1420 SOUTH CENTRAL AVENUE	GLENDALE	CA	91204	953625651	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DCC	0
GLOBAL HEALTH INITIATIVES
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	201536108	INACTIVE	CO	501(C)(3)	LINE 12A, I	CSH	0
GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE
625 EDEN PARK DRIVE 7TH FLOOR	CINCINNATI	OH	45202	311778403	EDUCATION	OH	501(C)(3)	LINE 2	GSH	0
GOOD SAMARITAN HOSPITAL
PO BOX 1990	KEARNEY	NE	68848	470379755	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA	0
GOOD SAMARITAN HOSPITAL FOUNDATION
111 W 31ST ST	KEARNEY	NE	68847	470659443	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	GSH-KN	0
GOOD SAMARITAN HOSPITAL FOUNDATION OF CINCINNATI INC
625 EDEN PARK DRIVE 7TH FLOOR	CINCINNATI	OH	45202	311206047	FUNDRAISING FOUNDATION	OH	501(C)(3)	LINE 12A, I	GSH	0
HARRISON MEDICAL CENTER
2520 CHERRY AVE	BREMERTON	WA	98310	910565546	HOSPITAL	WA	501(C)(3)	LINE 3	FHS	0
HEALTHCARE AND WELLNESS FOUNDATION
2400 ST FRANCIS DR	BRECKENRIDGE	MN	56520	760761782	FUNDRAISING FOUNDATION	MN	501(C)(3)	LINE 12A, I	SFMC-MN	0
HOUSE OF MERCY
1111 6TH AVE	DES MOINES	IA	50314	421323808	ASSISTED LIVING	IA	501(C)(3)	LINE 7	CHI-IA CORP	0
JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC
ONE SAINT JOSEPH DRIVE	LEXINGTON	KY	40504	611029768	HOSPITAL	KY	501(C)(3)	LINE 3	KOH	0
KENTUCKYONE HEALTH MEDICAL GROUP INC
100 E LIBERTY ST STE 800	LOUISVILLE	KY	40202	611352729	PHYSICIANS	KY	501(C)(3)	LINE 10	JHSMH	0
KENTUCKYONE HEALTH INC
ONE SAINT JOSEPH DRIVE	LEXINGTON	KY	40504	611029769	HEALTHCARE	KY	501(C)(3)	LINE 12A, I	CSH	0
LAKEWOOD HEALTH CENTER
600 MAIN AVE S	BAUDETTE	MN	56623	410758434	HOSPITAL	MN	501(C)(3)	LINE 3	CSH	0
LAKEWOOD REGIONAL HEALTHCARE FOUNDATION
600 MAIN AVE S	BAUDETTE	MN	56623	411893795	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 7	LHC	Yes (1)
LEGACY FOUNDATION OF KENTUCKIANA INC
1451 HARRODSBURG RD STE D-308	LEXINGTON	KY	40504	832170324	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 12A, I	KOH	0
LISBON AREA HEALTH SERVICES
905 MAIN ST	LISBON	ND	58054	820558836	HOSPITAL	ND	501(C)(3)	LINE 3	CSH	0
LUFKIN VISION ACQUISITIONS
PO BOX 1447	LUFKIN	TX	75901	820563768	PROPERTY MGMT	TX	501(C)(3)	LINE 12A, I	MHSET	0
MADISON ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	742761145	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
MADONNA MANOR INC
2344 AMSTERDAM ROAD	VILLA HILLS	KY	51017	610654635	ASSISTED LIVING	KY	501(C)(3)	LINE 10	CHILC	0
MARIAN REGIONAL MEDICAL CENTER FOUNDATION
1400 E CHURCH STREET	SANTA MARIA	CA	93454	953818027	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
MARK TWAIN MEDICAL CENTER
768 MOUNTAIN RANCH ROAD	SAN ANDREAS	CA	95249	680127677	HOSPITAL	CA	501(C)(3)	LINE 3	DCC	0
MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC
2525 DE SALES AVE	CHATTANOOGA	TN	37404	621839548	FUNDRAISING FOUNDATION	TN	501(C)(3)	LINE 7	MHCS	0
MEMORIAL HEALTH CARE SYSTEM INC
2525 DE SALES AVE	CHATTANOOGA	TN	37404	620532345	HOSPITAL	TN	501(C)(3)	LINE 3	CSH	0
MEMORIAL HEALTH PARTNERS FOUNDATION INC
5600 BRAINERD RD STE 500	CHATTANOOGA	TN	37411	030417049	HEALTHCARE	TN	501(C)(3)	LINE 10	MHCS	0
MEMORIAL HEALTH SYSTEM OF EAST TEXAS
PO BOX 1447	LUFKIN	TX	75902	750755367	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
MEMORIAL MEDICAL CENTER-LIVINGSTON
PO BOX 1447	LUFKIN	TX	75902	760436439	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
MEMORIAL MEDICAL CENTER-SAN AUGUSTINE
PO BOX 1447	LUFKIN	TX	75902	752663904	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
MEMORIAL MULTISPECIALTY ASSOCIATES
1201 FRANK AVE	LUFKIN	TX	75904	752721155	PHYSICIANS	TX	501(C)(3)	LINE 12A, I	MHSET	0
MEMORIAL SPECIALTY HOSPITAL
PO BOX 1447	LUFKIN	TX	75902	752492741	INACTIVE	TX	501(C)(3)	LINE 3	MHSET	0
MERCY AUXILIARY OF CENTRAL IOWA
1111 6TH AVE	DES MOINES	IA	50314	426076069	AUXILIARY	IA	501(C)(3)	LINE 12A, I	MF-DM IA	0
MERCY CLINICS INC
1111 6TH AVE	DES MOINES	IA	50314	421193699	PHYSICIANS	IA	501(C)(3)	LINE 10	CHI-IA CORP	0
MERCY COLLEGE OF HEALTH SCIENCES
1111 6TH AVE	DES MOINES	IA	50314	421511682	EDUCATION	IA	501(C)(3)	LINE 2	CHI-IA CORP	0
MERCY FOUNDATION BAKERSFIELD
PO BOX 119	BAKERSFIELD	CA	93302	770201321	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
MERCY FOUNDATION OF DES MOINES IA
1111 6TH AVE	DES MOINES	IA	50314	237358794	FUNDRAISING FOUNDATION	IA	501(C)(3)	LINE 7	CHI-IA CORP	0
MERCY FOUNDATION INC
2700 STEWART PKWY	ROSEBURG	OR	97471	936088946	FUNDRAISING FOUNDATION	OR	501(C)(3)	LINE 7	MMC - ROSEBURG	0
MERCY HEALTH CARE FOUNDATION
PO BOX 368	CORNING	IA	50841	421461064	FUNDRAISING FOUNDATION	IA	501(C)(3)	LINE 12A, I	AHMH-CORNING	0
MERCY HEALTHCARE FOUNDATION
570 CHAUTAUQUA BLVD	VALLEY CITY	ND	58072	450435338	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 12A, I	MHVC	0
MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS
800 MERCY DR	COUNCIL BLUFFS	IA	51503	421178204	FUNDRAISING FOUNDATION	IA	501(C)(3)	LINE 12A, I	AHBMHS	0
MERCY HOSPITAL OF DEVILS LAKE
1031 7TH ST NE	DEVILS LAKE	ND	58301	450227012	HOSPITAL	ND	501(C)(3)	LINE 3	CSH	0
MERCY HOSPITAL OF DEVILS LAKE FOUNDATION
1031 7TH ST NE	DEVILS LAKE	ND	58301	352367360	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 7	MHDL	0
MERCY HOSPITAL OF VALLEY CITY
570 CHAUTAUQUA BLVD	VALLEY CITY	ND	58072	450226553	HOSPITAL	ND	501(C)(3)	LINE 3	CSH	0
MERCY MCMAHON TERRACE
3865 J STREET	SACRAMENTO	CA	95816	680117340	SENIOR CITIZEN'S HOUSING/RETIREMENT COMMUNITIES	CA	501(C)(3)	LINE 10	DH	0
MERCY MEDICAL CENTER
1301 15TH AVE WEST	WILLISTON	ND	58801	450231183	HOSPITAL	ND	501(C)(3)	LINE 3	CSH	0
MERCY MEDICAL CENTER - CENTERVILLE
ONE ST JOSEPHS DRIVE	CENTERVILLE	IA	52544	420680308	HOSPITAL	IA	501(C)(3)	LINE 3	CHI-IA CORP	0
MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER
204 N 4TH AVE E	NEWTON	IA	50314	421470935	HOSPITAL	IA	501(C)(3)	LINE 3	CHI-IA CORP	0
MERCY MEDICAL CENTER MERCED FOUNDATION
301 E 13TH STREET	MERCED	CA	95340	770035928	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
MERCY MEDICAL CENTER INC
2700 STEWART PKWY	ROSEBURG	OR	97471	930386868	HOSPITAL	OR	501(C)(3)	LINE 3	CSH	0
MERCY MEDICAL FOUNDATION
1301 15TH AVE WEST	WILLISTON	ND	58801	450381803	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 12A, I	MMC WILLISTON	0
NEBRASKA HEART HOSPITAL
7500 S 91ST ST	LINCOLN	NE	68526	392031968	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA	0
NORTHLAND HEALTHCARE ALLIANCE
2223 EAST ROSSER AVENUE	BISMARCK	ND	58501	911845296	MANAGEMENT	ND	501(C)(3)	LINE 7	SAMC	0
NORTHRIDGE HOSPITAL FOUNDATION
18300 ROSCOE BLVD	NORTHRIDGE	CA	91328	237444901	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DCC	0
OAKES COMMUNITY HOSPITAL
1200 N 7TH ST	OAKES	ND	58474	450231675	HOSPITAL	ND	501(C)(3)	LINE 3	CSH	0
OAKES COMMUNITY HOSPITAL FOUNDATION
1200 N 7TH ST	OAKES	ND	58474	710966606	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 12A, I	OCH	0
PACIFIC CENTRAL COAST HEALTH CENTERS
1400 E CHURCH STREET	SANTA MARIA	CA	93454	770447575	CLINIC	CA	501(C)(3)	LINE 3	DCC	0
PINEYWOODS MEDICAL DEVELOPMENT CORP
PO BOX 1447	LUFKIN	TX	75902	752493116	PROPERTY MGMT	TX	501(C)(3)	LINE 12A, I	MHSET	0
PORT CITY OPERATING COMPANY LLC
3400 DATA DRIVE	RANCHO CORDOVA	CA	95670	465322209	HOSPITAL	CA	501(C)(3)	LINE 3	DH	0
PROVIDENCE CARE CENTER
2025 HAYES AVENUE	SANDUSKY	OH	44870	341658625	LTERM CARE	OH	501(C)(3)	LINE 10	CHILC	0
PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION
5055 PROVIDENCE DRIVE	SANDUSKY	OH	44870	341896807	LIVING COMM	OH	501(C)(3)	LINE 10	CHILC	0
SAINT CLARE'S COMMUNITY CARE INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	222876836	INACTIVE	NJ	501(C)(3)	LINE 12B, II	SCHS	0
SAINT CLARE'S HEALTH SERVICES INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	223639733	INACTIVE	NJ	501(C)(3)	LINE 10	CSH	0
SAINT CLARE'S HOSPITAL INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	223319886	INACTIVE	NJ	501(C)(3)	LINE 3	SCHS	0
SAINT ELIZABETH FOUNDATION
555 S 70TH ST	LINCOLN	NE	68510	470625523	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	SERMC	0
SAINT ELIZABETH HEALTH SERVICES
555 S 70TH ST	LINCOLN	NE	68510	363233120	INACTIVE	NE	501(C)(3)	LINE 3	SERMC	0
SAINT ELIZABETH REGIONAL MEDICAL CENTER
555 S 70TH ST	LINCOLN	NE	68510	470379836	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA	0
SAINT FRANCIS MEDICAL CENTER
2620 W FAIDLEY	GRAND ISLAND	NE	68803	470376601	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA	0
SAINT FRANCIS MEDICAL CENTER FOUNDATION
PO BOX 9804	GRAND ISLAND	NE	68802	470630267	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	SFMC-NE	0
SAINT FRANCIS MEMORIAL HOSPITAL
900 HYDE STREET	SAN FRANCISCO	CA	94109	941156295	HOSPITAL	CA	501(C)(3)	LINE 3	DCC	0
SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC
305 ESTILL ST	BEREA	KY	40403	260152877	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 7	SJHS	0
SAINT JOSEPH HEALTH SYSTEM INC
ONE ST JOSEPHS DRIVE	LEXINGTON	KY	40504	611334601	HOSPITAL	KY	501(C)(3)	LINE 3	KOH	0
SAINT JOSEPH HOSPITAL FOUNDATION INC
701 BOB OLINK DR 200	LEXINGTON	KY	40504	611159649	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 12A, I	SJHS	0
SAINT JOSEPH LONDON FOUNDATION INC
1001 SAINT JOSEPH LANE	LONDON	KY	40741	260438748	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 7	SJHS	0
SAINT JOSEPH MOUNT STERLING FOUNDATION INC
225 FALCON DR	MOUNT STERLING	KY	40353	272884584	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 7	SJHS	0
SAINT JOSEPH'S HOSPITAL FOUNDATION
2500 FAIRWAY STREET	DICKINSON	ND	58601	363418207	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 12A, I	SJHHC	0
SAN GABRIEL VALLEY MEDICAL CENTER FOUNDATION
438 WEST LAS TUNAS DRIVE	SAN GABRIEL	CA	91776	953430341	INACTIVE	CA	501(C)(3)	LINE 12A, I	DH	0
SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC
104 W 17TH ST	SCHUYLER	NE	68661	363630014	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 12A, I	AHMHS	0
SIERRA NEVADA MEMORIAL-MINERS HOSPITAL
155 GLASSON WAY	GRASS VALLEY	CA	95945	941439787	HOSPITAL	CA	501(C)(3)	LINE 3	DCC	0
SJRMC JOPLIN MISSOURI
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	440545809	INACTIVE	MO	501(C)(3)	LINE 3	CSH	0
ST FRANCIS FOUNDATION OF SANTA BARBARA
2323 DE LA VINA ST SUITE 104	SANTA BARBARA	CA	93105	237137119	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
ST FRANCIS HOSPITAL SUPPORT CORPORATION
601 E MICHELTORENA STREET	SANTA BARBARA	CA	93103	770022302	INACTIVE	CA	501(C)(3)	LINE 12A, I	DH	0
ST JOHNS HEALTHCARE FOUNDATION
1600 NORTH ROSE AVENUE	OXNARD	CA	93030	202865781	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
ST JOSEPHS FOUNDATION (PHOENIX)
350 WEST THOMAS ROAD	PHOENIX	AZ	85013	942941245	FUNDRAISING FOUNDATION	AZ	501(C)(3)	LINE 12A, I	DH	0
ST JOSEPHS FOUNDATION OF SAN JOAQUIN
1800 N CALIFORNIA STREET	STOCKTON	CA	95204	510432777	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
ST MARY MEDICAL CENTER FOUNDATION
1050 LINDEN AVENUE	LONG BEACH	CA	90813	237153876	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
ST MARY PROFESSIONAL BUILDING INC
1050 LINDEN AVENUE	LONG BEACH	CA	90813	237373088	INACTIVE	CA	501(C)(3)	LINE 12A, I	DH	0
ST MARYS MEDICAL CENTER FOUNDATION
450 STANYAN STREET	SAN FRANCISCO	CA	94117	943336143	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH	0
ST ROSE DOMINICAN HEALTH FOUNDATION
3001 ST ROSE PARKWAY	HENDERSON	NV	89052	880349432	FUNDRAISING FOUNDATION	NV	501(C)(3)	LINE 12A, I	DH	0
ST ALEXIUS MEDICAL CENTER
900 EAST BROADWAY AVENUE	BISMARCK	ND	58501	450226711	HOSPITAL	ND	501(C)(3)	LINE 3	CSH	0
ST ANNE OC
1145 BROADWAY PLAZA STE 1200	TACOMA	WA	98402	863590968	INACTIVE	WA	501(C)(3)	LINE 10	FHS	0
ST ANTHONY HOSPITAL
2801 ST ANTHONY WAY	PENDLETON	OR	97801	930391614	HOSPITAL	OR	501(C)(3)	LINE 3	CSH	0
ST ANTHONY HOSPITAL FOUNDATION
2801 ST ANTHONY WAY	PENDLETON	OR	97801	930992727	FUNDRAISING FOUNDATION	OR	501(C)(3)	LINE 12A, I	SAH	0
ST ANTHONY'S HOSPITAL ASSOCIATION
FOUR HOSPITAL DR	MORRILTON	AR	72110	710245507	HOSPITAL	AR	501(C)(3)	LINE 3	SVIMC	0
ST CATHERINE HOSPITAL
401 EAST SPRUCE ST	GARDEN CITY	KS	67846	480543721	HOSPITAL	KS	501(C)(3)	LINE 3	CSH	0
ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION
401 EAST SPRUCE ST	GARDEN CITY	KS	67846	200598702	FUNDRAISING FOUNDATION	KS	501(C)(3)	LINE 12A, I	SCH	0
ST CLARE COMMONS
12469 FIVE POINT ROAD	TOLEDO	OH	43551	270163752	LIVING COMM	OH	501(C)(3)	LINE 10	CHILC	0
ST DOMINIC OF ONTARIO OREGON
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	930433692	INVESTMENTS	OR	501(C)(4)		CSH	0
ST FRANCIS HOME
2400 ST FRANCIS DR	BRECKENRIDGE	MN	56520	410729978	LTERM CARE	MN	501(C)(3)	LINE 10	CSH	0
ST FRANCIS LIFE CARE CORPORATION
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	222536017	INACTIVE	NJ	501(C)(3)	LINE 8	SCHS	0
ST FRANCIS MEDICAL CENTER
2400 ST FRANCIS DR	BRECKENRIDGE	MN	56520	410695598	HOSPITAL	MN	501(C)(3)	LINE 3	CSH	0
ST JOSEPH FOUNDATION OF BRYAN TEXAS
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	742351158	FUNDRAISING FOUNDATION	TX	501(C)(3)	LINE 12A, I	SJSC	0
ST JOSEPH MANOR
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	742847594	LTERM CARE	TX	501(C)(3)	LINE 10	SJSC	0
ST JOSEPH MEDICAL CENTER INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	520591461	INACTIVE	MD	501(C)(3)	LINE 3	CSH	0
ST JOSEPH PHYSICIAN ASSOCIATES
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	203159302	PHYSICIANS	TX	501(C)(3)	LINE 3	SJSC	0
ST JOSEPH PHYSICIAN ENTERPRISE INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	521311775	INACTIVE	MD	501(C)(3)	LINE 12A, I	SJMC	0
ST JOSEPH REGIONAL HEALTH CENTER
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	741282696	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
ST JOSEPH REGIONAL HEALTH PARTNERS
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	454088170	HOSPITAL	TX	501(C)(3)	LINE 3	SJSC	0
ST JOSEPH REGIONAL HEALTH PARTNERS ACO
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	463265423	HEALTHCARE	TX	501(C)(3)	LINE 10	SJSC	0
ST JOSEPH SERVICES CORPORATION
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	742455161	MANAGEMENT	TX	501(C)(3)	LINE 12A, I	SLHS	0
ST JOSEPH'S AREA HEALTH SERVICES
600 PLEASANT AVE	PARK RAPIDS	MN	56470	410695603	HOSPITAL	MN	501(C)(3)	LINE 3	CSH	0
ST JOSEPH'S HOSPITAL AND HEALTH CENTER
2500 FAIRWAY ST	DICKINSON	ND	58601	450226429	HOSPITAL	ND	501(C)(3)	LINE 3	CSH	0
ST LEONARD
8100 CLYO ROAD	CENTERVILLE	OH	45458	341940863	LIVING COMM	OH	501(C)(3)	LINE 10	CHILC	0
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	261947374	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	260335902	HOSPITAL	TX	501(C)(3)	LINE 3	SLHS	0
ST LUKE'S COMMUNITY HEALTH SERVICES
6624 FANNIN ST STE 1100	HOUSTON	TX	77030	760536234	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
ST LUKE'S FOUNDATION
1213 HERMANN DRIVE STE 855	HOUSTON	TX	77004	453811485	FUNDRAISING FOUNDATION	TX	501(C)(3)	LINE 7	SLHS	0
ST LUKE'S HEALTH CLINICAL OPERATIONS
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	273733278	HOSPITAL	TX	501(C)(3)	LINE 3	SLHS	0
ST LUKE'S HEALTH SYSTEM CORP
PO BOX 20269	HOUSTON	TX	77225	760536232	MANAGEMENT	TX	501(C)(3)	LINE 12A, I	CSH	0
ST LUKE'S HOSPITAL AT THE VINTAGE
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	263734606	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
ST LUKE'S PROPERTIES CORPORATION
1213 HERMANN DRIVE STE 855	HOUSTON	TX	77004	760531716	PROPERTY MGMT	TX	501(C)(3)	LINE 12A, I	SLHS	0
ST LUKE'S SUGAR LAND PROPERTIES CORPORATION
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	454120549	PROPERTY MGMT	TX	501(C)(3)	LINE 12A, I	SLCDC-SL	0
ST MARY'S COMMUNITY HOSPITAL
1301 GRUNDMAN BOULEVARD	NEBRASKA CITY	NE	68410	470443636	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA	0
ST MARY'S HOSPITAL FOUNDATION
1301 GRUNDMAN BLVD	NEBRASKA CITY	NE	68410	470707604	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	SMCH	0
ST VINCENT FOUNDATION
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	510169537	FUNDRAISING FOUNDATION	AR	501(C)(3)	LINE 12A, I	SVIMC	0
ST VINCENT INFIRMARY MEDICAL CENTER
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710236917	HOSPITAL	AR	501(C)(3)	LINE 3	CSH	0
ST VINCENT MEDICAL GROUP
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710830696	PHYSICIANS	AR	501(C)(3)	LINE 10	SVIMC	0
SYLVANIA FRANCISCAN HEALTH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	341412964	HOLDING CO	OH	501(C)(3)	LINE 12A, I	CSH	0
SYLVANIA FRANCISCAN HEALTH FOUNDATION
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	455357161	INACTIVE	OH	501(C)(3)	LINE 12A, I	SFH-OH	0
THE COMMONS OF PROVIDENCE
5000 PROVIDENCE DRIVE	SANDUSKY	OH	44870	341826097	ASSISTED LIVING	OH	501(C)(3)	LINE 10	CHILC	0
THE COMMUNITY HOSPITAL OF BRAZOSPORT
100 MEDICAL DRIVE	LAKE JACKSON	TX	77566	741385192	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO	0
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH
625 EDEN PARK DRIVE 7TH FLOOR	CINCINNATI	OH	45202	310537486	HOSPITAL	OH	501(C)(3)	LINE 3	CSH	0
THE PHYSICIAN NETWORK
2000 Q ST STE 500	LINCOLN	NE	68503	470780857	PHYSICIANS	NE	501(C)(3)	LINE 12A, I	CHI NEBRASKA	0
TOTAL HEALTHCARE
9100 E MINERAL CIRCLE	CENTENNIAL	CO	80112	840927232	INACTIVE	CO	501(C)(3)	LINE 3	CHIC	0
TRINITY HEALTH FOUNDATION
380 SUMMIT AVENUE	STEUBENVILLE	OH	43952	311329423	FUNDRAISING FOUNDATION	OH	501(C)(3)	LINE 12A, I	THS	0
TRINITY HEALTH SYSTEM
380 SUMMIT AVENUE	STEUBENVILLE	OH	43952	341818681	HEALTHCARE	OH	501(C)(3)	LINE 12A, I		0	N/A
TRINITY HOSPITAL TWIN CITY
819 NORTH FIRST STREET	DENNISON	OH	44621	275401105	HOSPITAL	OH	501(C)(3)	LINE 3	THS	0
TRI-STATE HEALTH SERVICES INC
ONE ROSS PARK BLVD	STEUBENVILLE	OH	43952	341522484	ASSISTED LIVING	OH	501(C)(3)	LINE 7	THS	0
UNITY FAMILY HEALTHCARE
815 SE 2ND ST	LITTLE FALLS	MN	56345	410721642	HOSPITAL	MN	501(C)(3)	LINE 3	CSH	0
VILLA NAZARETH INC
801 PAGE DR	FARGO	ND	58103	450226714	LTERM CARE	ND	501(C)(3)	LINE 10	CSH	0
VISITING NURSE ASSOCIATION OF ST CLARE'S INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	221768334	INACTIVE	NJ	501(C)(3)	LINE 10	SCHS	0
YAVAPAI COMMUNITY HOSPITAL ASSOCIATION
1003 WILLOW CREEK ROAD	PRESCOTT	AZ	86301	860098923	HOSPITAL	AZ	501(C)(3)	LINE 3	DCC	0
YAVAPAI REGIONAL MEDICAL CENTER FOUNDATION
1003 WILLOW CREEK ROAD	PRESCOTT	AZ	86301	861038463	FUNDRAISING FOUNDATION	AZ	501(C)(3)	LINE 12A, I	YRMC	0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (83 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Predominant Income TypePredominantIncomeTypeTxt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	Address Line1ForeignAddress/AddressLine1Txt	CityForeignAddress/CityNm	CountryForeignAddress/CountryCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd
AMERICAN MERCY HOME CARE LLC
6281 TRI RIDGE BLVD STE 300	LOVELAND	OH	45150	830486150	HOME HEALTH	OH	N/A	N/A	0	0
ARIZONA CARE NETWORK - NEXT LLC
4222 E THOMAS RD STE 400	PHOENIX	AZ	85018	474696671	CARE NETWORK	AZ	N/A	N/A	0	0
ARIZONA CARE NETWORK LLC (ACN LLC)
4222 E THOMAS RD STE 400	PHOENIX	AZ	85013	454494682	CARE NETWORK	AZ	N/A	N/A	0	0
ARIZONA DIAGNOSTIC RADIOLOGY GROUP LLC
1510 COTNER AVENUE	LOS ANGELES	CA	90025	851067265	DIAGNOSTIC SERVICES	CA	N/A	N/A	0	0
AUDUBON LAND COMPANY LLC
630 SOUTHPOINTE COURT 200	COLORADO SPRINGS	CO	80906	841513085	REAL ESTATE	CO	N/A	N/A	0	0
BAYLOR CHI ST LUKES HEALTH SERVICES LLC
3100 MAIN STE 566	HOUSTON	TX	77002	472079184	HEALTHCARE SRVC	TX	N/A	N/A	0	0
BERGAN MERCY SURGERY CENTER LLC
7500 MERCY RD STE 4300	OMAHA	NE	68124	208671994	AMBUL SURG CTR	NE	N/A	N/A	0	0
BERYWOOD OFFICE PROPERTIES LLC
2501 CITICO AVENUE	CHATTANOGA	TN	37404	621875199	PHYS OFFICE	TN	N/A	N/A	0	0
BIOLIFE DIGNITY HEALTH INTERNATIONAL LTD
					HEALTH SERVICES		N/A	N/A	0	0	709 WING ON PLAZA 62 MODY ROAD TS	HONG KONG	CH	CH
BLUEGRASS REGIONAL IMAGING CENTER
1218 SOUTH BROADWAY STE 310	LEXINGTON	KY	40504	611386736	DIAGNOSTIC IMAGING	KY	N/A	N/A	0	0
CBCC OUTSMARTING CANCER LLC
6501 TRUXTUN AVENUE	BAKERSFIELD	CA	93309	461602286	RADIATION / ONCOLOGY	CA	N/A	N/A	0	0
CENTRAL NEBRASKA REHABILITATION SVCS LLC
3004 W FAIDLEY AVE	GRAND ISLAND	NE	68803	810653461	PHYSICAL THERAPY	NE	N/A	N/A	0	0
CENTURA SUMMIT ORTHOPEDICS LLC
68 SCHOOL RD	FRISCO	CO	80443	871308304	HEALTHCARE SRVC	CO	N/A	N/A	0	0
CHICAMSURG SURGERY CENTERS LLC
1A BURTON HILLS BLVD	NASHVILLE	TN	37215	465683027	SURGERY CENTER	CO	N/A	N/A	0	0
COLORADO SPRINGS CK LEASING LLC
630 SOUTHPOINTE COURT 200	COLORADO SPRINGS	CO	80906	262982714	REAL ESTATE	CO	N/A	N/A	0	0
COMMUNITY MERCY HOME CARE OF SPRINGFLD LLC
6281 TRI RIDGE BLVD 300	LOVELAND	OH	45150	311746556	HOME HEALTH	OH	N/A	N/A	0	0
DE JV LLC
8686 NEW TRAILS DRIVE	THE WOODLANDS	TX	77381	320496548	EMERGENCY CARE	NV	N/A	N/A	0	0
DHHP SURGERY CENTERS LLC
1513 S GRAND AVENUE STE 350	LOS ANGELES	CA	90015	831847466	SURGERY	DE	N/A	N/A	0	0
DHRT HOLDINGS LLC
185 BERRY STREET SUITE 200	SAN FRANCISCO	CA	94107	352484591	HOLDING COMPANY	DE	N/A	N/A	0	0
DIGNITY- GOHEALTHURGENT CARE MANAGEMENT LLC
5555 GLENRIDGE CONNECTOR SUITE 700	ATLANTA	GA	30342	352548698	MANAGEMENT SERVICES	DE	N/A	N/A	0	0
DIGNITY HEALTH AT HOME LLC
6281 TRI RIDGE BLVD STE 300	LOVELAND	OH	45150	824674115	HEALTHCARE SRVC	DE	N/A	N/A	0	0
DIGNITY HEALTH SPECIALTY PHARMACY LLC
185 BERRY STREET SUITE 200	SAN FRANCISCO	CA	94107	320589462	SPECIALTY PHARMACY SERVICES	DE	N/A	N/A	0	0
DIGNITY HOME RECOVERY CARE LLC
49 MUSIC SQUARE WEST SUITE 401	NASHVILLE	TN	37203	832832522	HOME RECOVERY PROGRAM	DE	N/A	N/A	0	0
DIGNITYUSP LAS VEGAS SURGERY CENTERS LLC
14201 DALLAS PARKWAY	DALLAS	TX	75254	202999237	SURGERY	TX	N/A	N/A	0	0
DIGNITYUSP NORCAL SURGERY CENTERS LLC
14201 DALLAS PARKWAY	DALLAS	TX	75254	202468509	SURGERY	TX	N/A	N/A	0	0
DIGNITYUSP PHOENIX SURGERY CENTERS LLC
14201 DALLAS PARKWAY	DALLAS	TX	75254	134248908	SURGERY	TX	N/A	N/A	0	0
DIGNITYUSPJOHN MUIR EAST BAY SURG CTRS LLC
14201 DALLAS PARKWAY	DALLAS	TX	75254	352584991	SURGERY	TX	N/A	N/A	0	0
DIGNITY-ABRAZO HEALTH NETWORK LLC
4222 E THOMAS RD STE 400	PHOENIX	AZ	85018	465477985	MANAGEMENT SERVICES	AZ	N/A	N/A	0	0
DOMINICAN MAGNETIC RESONANCE IMAGING CENTER
1545 SOQUEL DRIVE	SANTA CRUZ	CA	94065	770095477	IMAGING CENTER	CA	N/A	N/A	0	0
ECCS ACQUISITION COMPANY LLC
2940 NORTH CIRCLE DRIVE	COLORADO SPRINGS	CO	80909	352656413	AMBUL SURG CTR	CO	N/A	N/A	0	0
ENDOSCOPY CENTER OF ARKANSAS
1024 NORTH UNIVERSITY AVE	LITTLE ROCK	AR	72207	201337002	DIAGNOSTIC SERVICES	AR	N/A	N/A	0	0
FOLSOM SIERRA ENDOSCOPY CENTER LP
1671 CREEKSIDE DRIVE SUITE 100	FOLSOM	CA	95630	680482416	ENDOSCOPY	CA	N/A	N/A	0	0
FRANCISCAN MEDICAL PAVILION BONNEY LAKE LLC
6622 WOLLOCHET DR NW	GIG HARBOR	WA	98335	463494108	REAL ESTATE	WA	N/A	N/A	0	0
FRANCISCAN SPECIALTY CARE LLC
330 SEVEN SPRINGS WAY	BRENTWOOD	TN	37027	813725123	HEALTHCARE SRVC	WA	N/A	N/A	0	0
GOLDEN RIDGE SURGERY CENTER LLC
660 GOLDEN RIDGE RD 100	GOLDEN	CO	80401	841498087	HEALTHCARE SRVC	CO	N/A	N/A	0	0
GOOD SAMARITAN HOME CARE SVCS OF VINCENNE LLC
6281 TRI RIDGE BLVD 300	LOVELAND	OH	45150	201792869	HOME HEALTH	OH	N/A	N/A	0	0
HC SL VINTAGE I LLC
1400 N WATER ST STE 500	MILWAUKEE	WI	53202	270453767	PROPERTY HOLDING	WI	N/A	N/A	0	0
HEALTHCARE SUPPORT SERVICES LLC
PO BOX 9804	GRAND ISLAND	NE	68802	721546196	LAUNDRY	NE	N/A	N/A	0	0
HEARTLAND ONCOLOGY LLC
2337 E CRAWFORD ST	SALINA	KS	67402	464265403	ONCOLOGY	KS	N/A	N/A	0	0
LAKESIDE AMBULATORY SURGICAL CENTER LLC
17030 LAKESIDE HILLS PLAZA STE 110	OMAHA	NE	68130	204267902	AMBUL SURG CTR	NE	N/A	N/A	0	0
LAKESIDE ENDOSCOPY CENTER LLC
17001 LAKESIDE HILLS PLZ STE 201	OMAHA	NE	68130	205544496	ENDOSCOPY SRVC	NE	N/A	N/A	0	0
LEXINGTON MBO PARTNERS LTD
5050 SOUTH SYRACUSE ST STE 800	DENVER	CO	80237	651132855	REAL ESTATE	CO	N/A	N/A	0	0
LINCOLN CK LEASING LLC
555 SOUTH 70TH STREET	LINCOLN	NE	68510	262496856	REAL ESTATE	NE	N/A	N/A	0	0
MEMORIAL MEDICAL PLAZA
3838 SAN DIMAS SUITE B 201	BAKERSFIELD	CA	93301	364510880	REAL ESTATE	CA	N/A	N/A	0	0
MERCY DAVIS CANCER CENTER MANAGEMENT CO LLC
2740 M STREET	MERCED	CA	95340	943358445	MANAGEMENT OF CANCER CENTER	CA	N/A	N/A	0	0
MERCY REHABILITATION HOSPITAL LLC
330 SEVEN SPRINGS WAY	BRENTWOOD	TN	37027	814437201	HEALTHCARE SRVC	TX	N/A	N/A	0	0
MILITARY ROAD PROPERTIES LLC
18229 TERRACE COURT SW	NORMANDY PARK	WA	98166	912067879	REAL ESTATE	WA	N/A	N/A	0	0
NEBRASKA SPINE HOSPITAL LLC
6901 N 72ND ST STE 20300	OMAHA	NE	68122	270263191	SPINE HOSPITAL	NE	N/A	N/A	0	0
NICU OPERATING CO OF SANTA CRUZ LLC
1555 SOQUEL DRIVE	SANTA CRUZ	CA	95065	460502935	NEONATAL HEALTHCARE	CA	N/A	N/A	0	0
NORTH RIVER SURGERY CENTER LLC
2209 WILDWOOD AVE	SHERWOOD	AR	72120	710799771	AMBUL SURG CTR	AR	N/A	N/A	0	0
NORTHERN PLAINS LABORATORY LLC
401 N 9 STREET	BISMARK	ND	58501	841641341	DIAGNOSTIC SERVICES	ND	N/A	N/A	0	0
NSC CHANNEL ISLANDS LLC
569 BROOKWOOD VILLAGE SUITE 901	BIRMINGHAM	AL	35209	770409291	AMBULATORY SURGICAL CENTER	CA	N/A	N/A	0	0
ORTHOCOLORADO LLC
11650 WEST 2ND PLACE	LAKEWOOD	CO	80228	371577105	ORTHO HOSPITAL	CO	N/A	N/A	0	0
PARK RAPIDS AREA HEALTH CARE
600 PLEASANT AVENUE S	PARK RAPIDS	MN	56470	204926259	HEALTHCARE SRVC	MN	N/A	N/A	0	0
PENINSULA RADIATION ONCOLOGY CENTER LLC
4230 BRIDGEPORT WAY W STE B	UNIVERSITY PLACE	WA	98466	870808610	HEALTHCARE SRVC	WA	N/A	N/A	0	0
PENRAD IMAGING LLC
1390 KELLY JOHNSON BLVD	COLORADO SPRINGS	CO	80920	841072619	MEDICAL IMAGING	CO	N/A	N/A	0	0
PERFORMANCE MED EQUIP & RESPIR SVSC LLC
19625 62ND AVE SOUTH 101	KENT	WA	98032	452901632	HOLDING COMPANY	WA	N/A	N/A	0	0
PLAZA SURGERY CENTER LP
525 E PLAZA DRIVE SUITE 100	SANTA MARIA	CA	93454	770573567	SURGERY	CA	N/A	N/A	0	0
PMC HOSPITAL LLC
3100 MAIN ST STE 500	HOUSTON	TX	77002	273280598	HOSPITAL	TX	N/A	N/A	0	0
PRECISION MEDICINE ALLIANCE LLC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	352569159	DIAGNOSTIC SERVICES	CO	N/A	N/A	0	0
RADIATION ONCOLOGY CENTERS OF VENTURA COUNTY
1700 N ROSE AVENUE SUITE 120	OXNARD	CA	93030	770191706	IMAGING	CA	N/A	N/A	0	0
RBR MANAGEMENT LLC
91 CORPORATE PARK DRIVE SUITE 120	HENDERSON	NV	89074	271466450	AMBULANCE	NV	N/A	N/A	0	0
REID-ANC HOME CARE SERVICES LLC
6281 TRI RIDGE BLVD STE 300	LOVELAND	OH	45150	371454747	HOME HEALTH	IN	N/A	N/A	0	0
SAINT JOSEPH - SCA HOLDINGS LLC
1451 HARRODSBURG RD	LEXINGTON	KY	40503	453801157	INACTIVE	DE	N/A	N/A	0	0
SAINT JOSEPH HEALTH ASC LLC
ONE SAINT JOSEPH DRIVE	LEXINGTON	KY	40504	852155230	SURGERY	KY	N/A	N/A	0	0
SAINT JOSEPH-ANC HOME CARE SERVICES
6281 TRI RIDGE BLVD STE 300	LOVELAND	OH	45150	263330545	HOME HEALTH	KY	N/A	N/A	0	0
SANTA CRUZ COMPREHENSIVE IMAGING LLC
1661 SOQUEL DRIVE SUITE G	SANTA CRUZ	CA	95065	010550623	IMAGING	CA	N/A	N/A	0	0
SANTA CRUZ LAND & BUILDING LP
1555 SOQUEL DRIVE	SANTA CRUZ	CA	95065	770285236	REAL ESTATE	CA	N/A	N/A	0	0
SANTA CRUZ SURGERY CENTER LLC
3003 PAUL SWEET ROAD	SANTA CRUZ	CA	95065	770194916	SURGERY	CA	N/A	N/A	0	0
SEVEN OAKS SURGERY CENTER LLC
1801 ORANGE TREE LANE SUITE 200	REDLANDS	CA	92374	851559544	SURGERY	CA	N/A	N/A	0	0
SOUTHEASTERN HOME CARE LLC
6281 TRI RIDGE BLVD STE 300	LOVELAND	OH	45150	271219638	HOME HEALTH	OH	N/A	N/A	0	0
ST JOSEPH'S SURGERY CENTER LP
15305 DALLAS PARKWAY SUITE 1600 LB	ADDISON	TX	75001	201019390	SURGERY	TX	N/A	N/A	0	0
ST ELIZABETH HOME CARE SERVICES LLC
6281 TRI RIDGE BLVD STE 300	LOVELAND	OH	45150	261236191	HOME HEALTH	KY	N/A	N/A	0	0
ST FRANCIS LAND COMPANY
5390 N ACADEMY BLVD STE 300	COLORADO SPRINGS	CO	80918	263134100	REAL ESTATE	CO	N/A	N/A	0	0
ST LUKE'S DIAGNOSTIC CATH LAB LLP
6624 FANNIN ST STE 800	HOUSTON	TX	77030	710959365	DIAGNOSTIC SERVICES	TX	N/A	N/A	0	0
ST LUKE'S LAKESIDE HOSPITAL LLC
6624 FANNIN STE 2505	HOUSTON	TX	77030	300427437	HOSPITAL	TX	N/A	N/A	0	0
ST LUKE'S THE WOODLANDS SLEEP CENTER LLC
6624 FANNIN STE 800	HOUSTON	TX	77030	462795726	DIAGNOSTIC SERVICES	TX	N/A	N/A	0	0
TEMPLETON SURGERY CENTER LLC
1310 LAS TABLAS ROAD SUITE 104	TEMPLETON	CA	94365	202246616	SURGERY	CA	N/A	N/A	0	0
THE MEDICAL PAVILION AT ST JOHN'S
1600 ROSE AVENUE	OXNARD	CA	93030	770332349	REAL ESTATE	CA	N/A	N/A	0	0
THREE SPRING IMAGING LLC
1 MERCADO ST STE 200A	DURANGO	CO	81301	813571570	HEALTHCARE SRVC	CO	N/A	N/A	0	0
TIA ARIZONA LLC
3030 N CENTRAL AVENUE SUITE 1402	PHOENIX	AZ	85012	863158670	CLINIC	AZ	N/A	N/A	0	0
VALLEY PHYSICIANS SURGERY CENTER AT NORTHRIDGE LLC
18330 ROSCOE BLVD	NORTHRIDGE	CA	91328	800864336	SURGERY	CA	N/A	N/A	0	0
WEST LAKES SURGERY CENTER LLC
12499 UNIVERSITY AVE STE 100	CLIVE	IA	50325	205345295	HEALTHCARE SRVC	IA	N/A	N/A	0	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (59 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Address Line1ForeignAddress/AddressLine1Txt	CityForeignAddress/CityNm	CountryForeignAddress/CountryCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd
ALEGENT HEALTHCREIGHTON ST JOSEPH MANAGED CARE SVCS INC
12809 WEST DODGE RD	OMAHA	NE	68154	470802396	MANAGED CARE	NE	N/A	C	0
ALLIANCE HEALTH PROVIDERS OF BRAZOS VALLEY INC
2801 FRANCISCAN DRIVE	BRYAN	TX	77802	742466914	HEALTHCARE	TX	N/A	C	0
ALTERNATIVE INSURANCE MANAGEMENT SERVICE INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	841112049	MANAGEMENT SERVICES	CO	N/A	C	0
AMERICAN NURSING CARE INC
1700 EDISON DR	MILFORD	OH	45150	311085414	HOME HEALTH	OH	N/A	C	0
AMERIMED INC
1700 EDISON DR	MILFORD	OH	45150	311158699	HOME HEALTH	OH	N/A	C	0
BC HOLDING COMPANY INC
1850 BLUEGRASS AVE	LOUISVILLE	KY	40215	311542851	INACTIVE	KY	N/A	C	0
BRAZOSPORT HEALTH ALLIANCE
1 WEST WAY COURT	LAKE JACKSON	TX	77566	760518376	HEALTHCARE	TX	N/A	C	0
CADUCEUS MEDICAL ASSOCIATES INC
5600 BRAINERD ROAD STE 500	CHATTANOOGA	TN	37411	621570736	HEALTHCARE	TN	N/A	C	0
CATHOLIC HEALTH INITIATIVES CENTER FOR TRANSLATIONAL RESEARCH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	272269511	INACTIVE	CO	N/A	C	0
CHI ST LUKE'S HEALTH - MEMORIAL CONDOMINIUM ASSOCIATION INC
1201 W FRANK AVE	LUFKIN	TX	75904	834184717	CONDO ASSOC	TX	N/A	C	0
COASTAL SURGICAL SPECIALISTS INC
921 OAK PARK BLVD SUITE 101	PISMO BEACH	CA	93449	743000596	AMBULATORY SURGERY CENTER	CA	N/A	S	0
COMCARE SERVICES INC
9100 E MINERAL CIRCLE	CENTENNIAL	CO	80112	840904813	INACTIVE	CO	N/A	C	0
CONSOLIDATED HEALTH SERVICES
1700 EDISON DR	MILFORD	OH	45150	311378212	HOME HEALTH	OH	N/A	C	0
DES MOINES MEDICAL CENTER INC
1111 6TH AVE	DES MOINES	IA	50314	420837382	REAL ESTATE	IA	N/A	C	0
DIGNITY HEALTH HOLDING CORPORATION
185 BERRY STREET SUITE 200	SAN FRANCISCO	CA	94107	460675371	HOLDING CO	NV	N/A	C	0
DIGNITY HEALTH INSURANCE LTD
				981065338	CAPTIVE INSURANCE		N/A	C	0	PO BOX 1051 GRAND CAYMAN ISL	GRAND CAYMAN ISL	CJ	CJ
DIGNITY HEALTH PROVIDER RESOURCES INC
185 BERRY STREET SUITE 200	SAN FRANCISCO	CA	94107	473366764	HEALTH PLAN	CA	N/A	C	0
DIVERSIFIED HEALTH RESOURCES INC
100 MEDICAL DRIVE	LAKE JACKSON	TX	77566	760222679	HEALTHCARE	TX	N/A	C	0
FRANCISCAN CITY URGENT CARE SERVICES PS
C/O CPGUSA 1345 AVE OF THE AMERICAS	NEW YORK	NY	10105	812174959	INACTIVE	NY	N/A	C	0
FRANCISCAN SERVICES INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	232487967	HOLDING CO	CO	N/A	C	0
GALLERIA PAVILION OWNERS'ASSOCIATION
800 N GIBSON RD	HENDERSON	NV	89011	824275367	REAL ESTATE	NV	N/A	C	0
GOOD SAMARITAN OUTREACH SERVICES
PO BOX 1990	KEARNEY	NE	68848	470659440	MEDICAL CLINIC	NE	N/A	C	0
HARVESTPLAINS HEALTH OF IOWA
32129 WEYERHAEUSER WAY S STE 201	FEDERAL WAY	WA	98001	473451750	INSURANCE	WA	N/A	C	0
HEALTH SERVICES OF THE PACIFIC CENTRAL COAST INC
1400 E CHURCH STREET	SANTA MARIA	CA	93454	770074057	HEALTH SERVICES	CA	N/A	C	0
HEALTH SYSTEMS ENTERPRISES INC
PO BOX 1990	KEARNEY	NE	68848	470664558	MGMT	NE	N/A	C	0
HEALTHCARE MGMT SERVICES ORGANIZATION INC
1149 MARKET ST	TACOMA	WA	98402	911865474	INACTIVE	WA	N/A	C	0
HEARTLANDPLAINS HEALTH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	464368223	INSURANCE	NE	N/A	C	0
HIGHLINE MEDICAL GROUP
1717 S J STREET	TACOMA	WA	98405	911407026	MEDICAL SERVICES	WA	N/A	C	0
INTEGRATED MEDICAL SERVICES
9250 N 3RD STREET SUITE 4010	PHOENIX	AZ	85020	860783428	MULTI-SPECIALTY PHYSICIANS GROUP	AZ	N/A	C	0
MEDICAL OFFICE BUILDING HORIZONTAL PROPERTY REGIME INC
300 WERNER ST	HOT SPRINGS	AR	71913	710720429	REAL ESTATE	AR	N/A	C	0
MEDQUEST
1301 15TH AVENUE WEST	WILLISTON	ND	58801	450392137	SALE OF DME	ND	N/A	C	0
MEMORIAL CV SERVICE LINE MANAGEMENT COMPANY LLC
1201 W FRANK AVE	LUFKIN	TX	75904	463622849	INACTIVE	TX	N/A	C	0
MERCY PARK APARTMENTS LTD
1111 6TH AVE	DES MOINES	IA	50314	421202422	INACTIVE	IA	N/A	C	0
MERCY SERVICES CORP
2700 STEWART PARKWAY	ROSEBURG	OR	97471	930824308	RETAIL SALES	OR	N/A	C	0
MHI CLINICAL SERVICES
1201 W FRANK AVE	LUFKIN	TX	75904	461967952	HEALTHCARE	TX	N/A	C	0
MILLENNIUM SURGERY CENTER INC
9300 STOCKDALE HWY 200	BAKERSFIELD	CA	93311	770513445	OUTPAITENT SURGERY SERVICES	CA	N/A	S	0
MOUNTAIN MANAGEMENT SERVICES INC
6028 SHALLOWFORD RD	CHATTANOOGA	TN	37421	621570739	MGMT SVC ORG	TN	N/A	C	0
NORTH CENTRAL HEALTH CARE ALLIANCE
PO BOX 5538	BISMARK	ND	58506	450439894	HEALTHCARE	ND	N/A	C	0
QUALCHOICE ADVANTAGE
32129 WEYERHAEUSER WAY S STE 201	FEDERAL WAY	WA	98001	473433912	INSURANCE	WA	N/A	C	0
QUALCHOICE HEALTH PLAN SERVICES INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	461224037	ADMIN SERVICES	CO	N/A	C	0
QUALCHOICE HEALTH INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	461222808	HOLDING CO	CO	N/A	C	0
QUALCHOICE HOLDINGS INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	274075520	HOLDING CO	AR	N/A	C	0
QUALCHOICE OF NEBRASKA
2401 S 73RD ST	OMAHA	NE	68124	810738827	INACTIVE	NE	N/A	C	0
RIVERLINK HEALTH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	464380824	INSURANCE	OH	N/A	C	0
RIVERLINK HEALTH OF KENTUCKY INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	464828332	INSURANCE	KY	N/A	C	0
ROSS PARK PHARMACY INC
380 SUMMIT AVE	STEUBENVILLE	OH	43952	341832654	PHARMACY	OH	N/A	C	0
SAINT CLARE'S PRIMARY CARE INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	222441202	INACTIVE	NJ	N/A	C	0
SJH SERVICES CORPORATION
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	232307408	INACTIVE	CO	N/A	C	0
SJL PHYSICIAN MANAGEMENT SERVICES INC
424 LEWIS HARGETT CR STE 160	LEXINGTON	KY	40503	270164198	INACTIVE	KY	N/A	C	0
SOUNDPATH HEALTH INC
32129 WEYERHAEUSER WAY S STE 201	FEDERAL WAY	WA	98001	421720801	INSURANCE	WA	N/A	C	0
ST MARY HEALTH VENTURES INC
1050 LINDEN AVENUE	LONG BEACH	CA	90813	951912528	RETAIL PHARMACY	CA	N/A	C	0
ST ANTHONY DEVELOPMENT COMPANY
1415 SOUTHGATE	PENDLETON	OR	97801	931216943	ATHLETIC CLUB	OR	N/A	C	0
ST JOSEPH DEVELOPMENT COMPANY INC
1717 SOUTH J ST	TACOMA	WA	98405	911480569	RENTAL	WA	N/A	C	0
ST LUKE'S HEALTH SYSTEM HOLDINGS INC
6624 FANNIN STE 800	HOUSTON	TX	77030	760637138	HOLDING CO	TX	N/A	C	0
ST VINCENT COMMUNITY HEALTH SERVICES INC
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710710785	HEALTHCARE	AR	N/A	C	0
STE HOLDINGS
12809 WEST DODGE RD	OMAHA	NE	68154	822383629	HOLDING CO	NE	N/A	C	0
SUGAR LAND DOCTOR GROUP
1317 LAKE POINT PARKWAY	SUGAR LAND	TX	77478	454270163	INACTIVE	TX	N/A	C	0
TOWSON MANAGEMENT INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	521710750	INACTIVE	MD	N/A	C	0
TRINITY MANAGEMENT SERVICES ORGANIZATION
380 SUMMIT AVE	STEUBENVILLE	OH	43952	341471026	MGMT SERVICES	OH	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (1)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	LAKEWOOD REGIONAL HEALTHCARE FOUNDATION	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Transaction Type	B	TransactionTypeTxt
Involved	$24,732	InvolvedAmt
Method Of Amount Determination	ACTUAL	MethodOfAmountDeterminationTxt