2022-05-13T11:30:32-05:00 2021-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2020-07-01 410758434 LAKEWOOD HEALTH CENTER LAKE 2186342120 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 JAY ROSS CFO 2186342120 2022-05-13 1 JAY ROSS 999009999 MARK STOCKI P00642127 3032989100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CHI LAKEWOOD HEALTH JEFFRY STAMPOHAR 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 14811724 0 0928 X WWW.LAKEWOODHEALTHCENTER.ORG X 1959 MN 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. 5 3 196 11 4967 0 1001007 569538 12644590 13179037 496465 625017 402114 437732 14544176 14811324 54676 48543 0 0 8240611 8483067 0 0 116070 8381432 8273721 16676719 16805331 -2132543 -1994007 20759689 20974664 6713718 4591308 14045971 16383356 AS AN AFFILIATE OF COMMONSPIRIT HEALTH, WE MAKE THE HEALING PRESENCE OF GOD KNOWN IN OUR WORLD BY IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL. 0 0 15361722 48543 13179037 SEE SCHEDULE H. 15361722 1 1 0 1 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 196 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JAY ROSS 2186163525 600 MAINE AVENUE SOUTH BAUDETTE MN 56623 JEFFREY DROP BRD MBR/SVP-OPER-CEO (PARTIAL YEAR) 1.00 50.00 X 0 1263797 34793 DR JUSTIN QUO PHYSICIAN/BOARD MEMBER/CHIEF OF STAFF 50.00 1.00 X 398553 0 46707 BENJAMIN KOPPELMAN FORMER PRESIDENT 1.00 50.00 X 0 310312 46590 JEFFRY STAMPOHAR PRESIDENT 50.00 1.00 X X 176089 0 45281 JAY ROSS CFO / TREASURER 1.00 50.00 X 0 143648 36050 BRENT NOBLE SUPERVISOR-PHARMACY 40.00 0.00 X 130714 0 16224 ROBERT WOLFE PHYSICIAN-EMERGENCY MEDICINE 20.00 0.00 X 142529 0 0 SCOTT HARRIS PHYSICIAN EMERGENCY MEDICINE 20.00 0.00 X 126619 0 0 PATRICIA DAVIDSON RN-PATIENT CARE BEDSIDE NON-EXEMPT 40.00 0.00 X 104851 0 11598 WENDI EASTHOUSE SUPV-LABORATORY SERVICES NON-EXEMPT 40.00 0.00 X 109321 0 6176 KRISTI BOWMAN SECRETARY 40.00 0.00 X 44050 0 17734 BRAD NYLANDER BOARD CHAIR 1.00 1.00 X X 0 0 0 SISTER BERNICE EBNER BOARD MEMBER 1.00 1.00 X 0 0 0 CRYSTAL OLSON BOARD MEMBER 1.00 1.00 X 0 0 0 JAMES AUSTAD BOARD MEMBER (PARTIAL YEAR) 1.00 1.00 X 0 0 0 1232726 1717757 261153 9 1 1 0 KRAUS-ANDERSON CONSTRUCTION CO 501 S 8TH ST MINNEAPOLIS MN 55404 CONSTRUCTION SERVICES 698119 MEDEFIS INC 2121 N 17TH AVE STE 200 OMAHA NE 68164 VENDOR MANAGEMENT/STAFFING 322460 AMN HEALTHCARE 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 HEALTHCARE CONSULTING 172124 3 4325 555913 9300 4325 569538 NET PATIENT SERVICES 900099 13156794 13156794 0 0 MEDICARE/MEDICAID 900099 16018 16018 0 0 RENTAL INCOME 900099 6225 6225 0 0 13179037 95804 1580 94224 529613 0 400 529613 -400 529213 529213 340B CONTRACT REVENUE 900099 309394 0 0 309394 SERVICES SOLD 900099 100872 0 3387 97485 CAFETERIA 722100 9027 0 0 9027 18439 18439 437732 14811324 13179037 4967 1057782 X 48543 48543 646917 582225 64692 6077898 5470108 541557 66233 137328 123595 11994 1739 1152263 1037037 103054 12172 468661 421795 42179 4687 48131 48131 1130 1130 3255452 3050493 204959 38350 34515 3451 384 419087 377179 37717 4191 608916 548024 54803 6089 317894 286105 28610 3179 83294 74964 7497 833 6575 5918 591 66 2476 2228 223 25 713424 642082 64208 7134 906168 815551 81555 9062 27552 24796 2480 276 MEDICAL SUPPLIES 1249612 1249612 0 0 REPAIRS AND MAINTENANCE 240393 228373 12020 0 OTHER TAXES 234809 223069 11740 0 DUES & SUBSCRIPTIONS 58736 55799 2937 0 61722 58581 3141 16805331 15361722 1327539 116070 930 929 4731311 2890239 0 2042409 2044997 0 0 0 212917 246597 62685 91676 24967811 17857362 6822767 7110449 0 6692302 8419455 0 0 194368 170322 20759689 20974664 2741048 4150787 0 3370052 138564 0 2804 2612 0 0 0 599814 299345 6713718 4591308 X 14044712 16381997 1259 1359 14045971 16383356 20759689 20974664 X -1994007 1101736 -33866 3263522 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1130 0 0 0 1130 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $609 CATHOLIC HEALTH ASSOCIATION - $324 MINNESOTA HOSPITAL ASSOCIATION - $197 0 1 X 103424 103424 10624728 8813469 1811259 13444436 8800511 4643925 795223 243382 551841 7110449 CSH OPERATING INVESTMENT POOL 8419455 F 8419455 INTERCOMPANY PAYABLES 239704 CURRENT PORTION OF OPERATING LEASE LIABILITY 1474 CURRENT PORTION OF FINANCE LEASE LIABILITY 21836 LONG-TERM PORTION OF FINANCE LEASE LIABILITY 36331 299345 X 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. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 349 176069 176069 0.01050 1521 4369871 3211675 1158196 0.06890 1870 4545940 3211675 1334265 0.07940 10 236 105618 105618 0.00630 4 524962 304605 220357 0.01310 4 89 33548 33548 0.00200 18 325 664128 304605 359523 0.02140 18 2195 5210068 3516280 1693788 0.10080 3 1162 1162 0.00010 3 1162 1162 0.00010 1 366341 3432053 3420977 11076 X 1 1 1 1 LAKEWOOD HEALTH CENTER 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 HTTP://LAKEWOODHEALTHCENTER.ORG/ 375394 X X X LAKEWOOD HEALTH CENTER 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE SCHEDULE H SUPPLEMENTAL INFO X 1 19 1 SEE SCHEDULE H SUPPLEMENTAL INFO 0 1 X 300.000000000000 300.000000000000 X X X X 1 1 X X X 1 X HTTP://LAKEWOODHEALTHCENTER.ORG/FINANCIAL-ASSISTANCE/ X HTTP://LAKEWOODHEALTHCENTER.ORG/FINANCIAL-ASSISTANCE/ X HTTP://LAKEWOODHEALTHCENTER.ORG/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 LAKEWOOD HEALTH CENTER PART V, SECTION B, LINE 5: COMMUNITY INPUT WAS GATHERED IN SEVERAL WAYS. PROJECT PARTNERS INCLUDED THE 337 COMMUNITY MEMBERS THAT COMPLETED THE PUBLIC HEALTH SURVEY, AND THE 14 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. IN 2017, A HEALTH SURVEY WAS OFFERED TO 1,553 HOUSEHOLDS IN LAKE OF THE WOODS COUNTY THROUGH OUR PUBLIC HEALTH DEPARTMENT. THE SURVEY WAS DEVELOPED WITH ASSISTANCE OF THE MINNESOTA DEPARTMENT OF HEALTH CENTER FOR HEALTH STATISTICS AND INCLUDED QUESTIONS FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS). A FOCUS GROUP WAS CONDUCTED WITH PROVIDERS OF SERVICES FOR OUR AT-RISK POPULATIONS ON APRIL 4, 2019. COMMUNITY REPRESENTATION INCLUDED:MINISTERIAL (FIRST LUTHERAN AND CATHOLIC CHURCHES)EMERGENCY MEDICAL SERVICES (EMT)LAKE OF THE WOODS SOCIAL SERVICESLAKE OF THE WOODS SCHOOL (SUPERINTENDENT, SOCIAL WORKER, HIGH SCHOOL PRINCIPAL)LAKE OF THE WOODS COUNTY COMMISSIONERPARISH NURSE/COMMUNITY MEMBERBAUDETTE CITY COUNCIL MEMBERTHREE PUBLIC HEALTH STAFFCHI LAKEWOOD HEALTH (VICE PRESIDENT OF OPERATIONS AND FOUNDATION/MARKETING LEADER)THE FOURTEEN 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.THE TOP THREE PRIORITIES ESTABLISHED ARE: 1) MENTAL HEALTH; 2) TRANSITIONS OF CARE/PERSONS WITH COMPLEX MEDICAL ISSUES; 3) LOW-INCOME/POVERTY AND IMPLICATIONS THAT RESULTS. COMMUNITY FORUMS ARE HELD WITH THE COMMUNITY EVERY THREE YEARS TO REVIEW PROGRESS ON COMMUNITY GOALS, ASSESS CURRENT NEEDS AND UPDATE ACTION PLANS. CHI LAKEWOOD HEALTH HAS BEEN INVOLVED IN COMMUNITY HEALTH COLLABORATION AND HAS A HISTORY OF SPONSORING COMMUNITY FORUMS TO LOOK AT AREA HEALTH ISSUES, SET PRIORITIES AND PLANS FOR IMPROVEMENT. CHI LAKEWOOD HEALTH CONTINUES A DEEP COMMITMENT AND INVOLVEMENT IN THE COMMUNITY HEALTH ACTIVITIES. LAKEWOOD HEALTH CENTER PART V, SECTION B, LINE 11: THE FOLLOWING SIGNIFICANT NEEDS WERE IDENTIFIED IN LAKEWOOD HEALTH CENTER'S MOST RECENTLYCONDUCTED CHNA:# 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.ANTICIPATED IMPACT: INCREASED ACCESS AND AWARENESS TO REDUCE BARRIERS TO MENTAL HEALTH CARE.#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.ANTICIPATED IMPACT: INCREASED ACCESS AND IMPROVE PREVENTION AND MANAGEMENT OF COMPLEX MEDICAL ISSUES.#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.ANTICIPATED IMPACT: INCREASED ACCESS TO HEALTH CARE SERVICES AND OPPORTUNITIES THAT PROVIDE ASSISTANCE AND PROMOTE GROWTH.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.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.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 COMMONSPIRITS 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. SIGNIFICANT NEEDS THE HOSPITAL DOES NOT INTEND TO ADDRESSALTHOUGH CHI LAKEWOOD HEALTH RECOGNIZED THE IMPORTANCE OF ALL NEEDS IDENTIFIED BY THE COMMUNITY, LAKEWOOD WILL NOT DIRECTLY DESIGN STRATEGIES FOR THE FOLLOWING ISSUES DUE TO LIMITS ON RESOURCES, EXPERTISE OR DUPLICATION OF EFFORT.* TRANSPORTATION - ACCORDING TO OUR 2017 PUBLIC HEALTH SURVEY 2.4% OF OUR SURVEY RESPONDENTS REPLIED THEY DID NOT RECEIVE NEEDED HEALTH CARE DUE TO TRANSPORTATION PROBLEMS.* POOR LIFE CHOICES IN ADULT - ACCORDING TO 2018 DATA FROM THE UNIVERSITY OF WISCONSIN 21% OF LAKE OF THE WOODS COUNTY ADULTS WERE EXCESSIVE DRINKERS AND 15% WERE SMOKERS. PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA. PART V, SECTION B, LINE 7A: HTTPS://LAKEWOODHEALTHCENTER.ORG/ABOUT-US/ PART V, SECTION B, LINE 10A: HTTPS://LAKEWOODHEALTHCENTER.ORG/ABOUT-US/ PART V, SECTION B, LINE 13(H): THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) 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 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 CHI 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. 3 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 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 THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. * THE PATIENT'S FAMILY INCOME MUST BE AT OR BELOW 300% OF THE FPG. *THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED [IN THE FAP]. *THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: * RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS; *HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS CLINIC; *PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); *FOOD STAMP ELIGIBILITY; *SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; *ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID SPEND-DOWN); *LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR *PATIENT IS DECEASED WITH NO KNOWN ESTATE. PART I, LINE 7: THE APPROACH TAKEN FOR THE COMMUNITY BENEFIT CALCULATION WAS AS FOLLOWS: MEDICAID COMMUNITY BENEFIT WAS CALCULATED BASED UPON USING THE COST TO CHARGE RATIO OF 74.69% TIMES THE CHARGES FOR MEDICAID PATIENTS. THIS RESULTS IN ESTIMATED MEDICAID COSTS OF $4,141,398. ADDITIONALLY, THE MINNESOTA CARE TAX AND MEDICAID SURCHARGE TAX OF $228,473 WAS ALSO INCLUDED AS LINE ITEM COSTS. THIS WAS THEN COMPARED TO PROJECTED REIMBURSEMENT FOR MEDICAID SERVICES OF $3,211,675. THE TOTAL COMMUNITY BENEFIT IS ESTIMATED AT $1,158,196. THE REMAINING COMMUNITY BENEFIT WAS TAKEN BY COMPILING THE COST OF TRADITIONAL CHARITY CARE $176,069; COMMUNITY HEALTH IMPROVEMENT SERVICES $105,618; SUBSIDIZED HEALTH SERVICES $220,357; FINANCIAL AND IN-KIND CONTRIBUTIONS $33,548; AND COMMUNITY BUILDING ACTIVITIES $1,162. THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/21 WAS COMPUTED USING THE FOLLOWING FORMULA: TOTAL GROSS CHARGES FOR THE ORGANIZATIONS LESS REVENUE FROM SUBSIDIZED HEALTH SERVICES DIVIDED BY TOTAL OPERATING EXPENSES LESS SUBSIDIZED HEALTH SERVICE EXPENSES AND LESS OTHER COMMUNITY BENEFIT EXPENSES. BASED ON THAT FORMULA THE GROSS CHARGES ARE $20,459,715 DIVIDED BY EXPENSES OF $15,280,700 RESULTS IN A 74.69% COST TO CHARGE RATIO. SUBSIDIZED HEALTH SERVICES WAS CALCULATED USING ESTIMATED NET REVENUE AS COMPARED TO DIRECT COSTS AND OVERHEAD ALLOCATED. OVERHEAD ALLOCATION FOLLOWS THE MEDICARE COST REPORT ASSIGNMENT OF ALLOCATING OVERHEAD TO COST CENTERS. THE MEDICARE COST REPORT IS NOT YET PREPARED AT TIME OF CALCULATION OF THE COMMUNITY BENEFIT FOR FINANCIAL STATEMENT PURPOSES. AS A RESULT, WE UTILIZE AN INTERNAL CALCULATION MODEL TO PROJECT THIS BENEFIT IN JULY. THE COMMUNITY BENEFIT FROM SUBSIDIZED HEALTH SERVICES BELOW WAS $220,357. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO. PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 74.69%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: LAKEWOOD HEALTH CENTER DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. 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 CONSOLIDATED FOOTNOTE READS AS FOLLOWS:COMMONSPIRIT RELIES ON THE RESULTS OF DETAILED REVIEWS OF HISTORICAL WRITE-OFFS AND COLLECTIONS IN ESTIMATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE. UPDATES TO THE HINDSIGHT ANALYSIS IS PERFORMED AT LEAST QUARTERLY USING PRIMARILY A ROLLING EIGHTEEN-MONTH COLLECTION HISTORY AND WRITE-OFF DATA. SUBSEQUENT CHANGES TO ESTIMATES OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO NET PATIENT REVENUE IN THE PERIOD OF CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN A THIRD-PARTY PAYOR'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE IN PURCHASED SERVICES AND OTHER IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGE IN NET ASSETS. BAD DEBT EXPENSE FOR 2021 AND 2020 WAS NOT SIGNIFICANT. 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 SURPLUS, AS REPORTED ON PART III, SECTION B, LINE 7, OF $11,076 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS. PART III, LINE 9B: THE ORGANIZATION'S BILLING AND COLLECTIONS POLICY APPLIES TO ALL INDIVIDUALS PRESENTING FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THE POLICY CONTAINS PROVISIONS FOR COLLECTING AMOUNTS DUE FROM THOSE PATIENTS WHO THE ORGANIZATION KNOWS TO QUALIFY FOR FINANCIAL ASSISTANCE EITHER THROUGH THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS OR THROUGH PRESUMPTIVE ELIGIBILITY PROCESSES. BEFORE ENGAGING IN EXTRAORDINARY COLLECTION ACTIONS (ECAS) TO OBTAIN PAYMENT FOR EMCARE, HOSPITAL FACILITIES MUST MAKE REASONABLE EFFORTS THROUGH ITS BILLING AND COLLECTIONS PROCESSES, PURSUANT TO TREAS. REG. 1.501(R)-6(C), TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IN NO EVENT WILL AN ECA BE INITIATED PRIOR TO 120 DAYS FROM THE DATE THE FACILITY PROVIDES THE FIRST POST-DISCHARGE BILLING STATEMENT (I.E., DURING THE NOTIFICATION PERIOD) UNLESS ALL REASONABLE EFFORTS HAVE BEEN MADE.HOSPITAL FACILITIES WILL NOT REFER ACCOUNTS FOR COLLECTION WHERE THE PATIENT HAS INITIALLY APPLIED FOR FINANCIAL ASSISTANCE, AND THE HOSPITAL FACILITY HAS NOT YET MADE REASONABLE EFFORTS WITH RESPECT TO THE ACCOUNT. 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. PATIENTS WHO QUALIFY FOR MEDICAID ARE PRESUMED TO QUALIFY FOR FULL CHARITY WRITE OFF. ANY CHARGES FOR DAYS OR SERVICES WRITTEN OFF (EXCLUDING MEDICAID DENIALS RELATED TO TIMELINESS OF BILLING, INSUFFICIENT MEDICAL RECORD DOCUMENTATION, MISSING INVOICES, AUTHORIZATION, OR ELIGIBILITY ISSUES) AS A RESULT OF A MEDICAID ARE BOOKED AS CHARITY.SOME MEDICAID PLANS OFFER COVERAGE FOR A LIMITED OR RESTRICTED LIST OF SERVICES. IF A PATIENT IS ELIGIBLE FOR MEDICAID, ANY CHARGES FOR DAYS OR SERVICES NOT COVERED BY THE PATIENT'S COVERAGE MAY BE WRITTEN OFF TO CHARITY WITHOUT A COMPLETED APPLICATION. THIS DOES NOT INCLUDE ANY SHARE OF COST (SOC) OR OTHER PATIENT COST-SHARING AMOUNTS SUCH AS DEDUCTIBLES OR COPAYMENTS, AS SUCH COSTS ARE DETERMINED BY THE STATE TO BE AN AMOUNT THAT THE PATIENT MUST PAY BEFORE THE PATIENT IS ELIGIBLE FOR MEDICAID. HEALTH AND HUMAN SERVICES (HSS) USES THE TERM "SPEND DOWN" INSTEAD OF SHARE OF COST.ALL COLLECTION ACTIVITIES CONDUCTED BY THE FACILITY, A DESIGNATED SUPPLIER, OR ITS THIRD-PARTY COLLECTION AGENTS WILL BE IN CONFORMANCE WITH ALL FEDERAL AND STATE LAWS GOVERNING DEBT COLLECTION PRACTICES. ALL THIRD-PARTY AGREEMENTS GOVERNING COLLECTION AND RECOVERY ACTIVITIES MUST INCLUDE A PROVISION REQUIRING COMPLIANCE WITH THE HOSPITAL FACILITIES' FINANCIAL ASSISTANCE AND BILLING AND COLLECTIONS POLICY AND INDEMNIFICATION FOR FAILURES AS A RESULT OF ITS NONCOMPLIANCE. THIS INCLUDES, BUT IS NOT LIMITED TO, AGREEMENTS BETWEEN THIRD PARTIES WHO SUBSEQUENTLY SELL OR REFER DEBT OF THE HOSPITAL FACILITY. PART VI, LINE 2: COMMUNITY OUTREACH FOR THE POORLAKEWOOD HEALTH CENTER PROVIDES TRADITIONAL CHARITY CARE, AN INTERNAL PROGRAM FOR THE MEDICALLY NEEDY THAT ASSISTS PATIENTS, RESIDENTS OR CLIENTS FINANCIALLY BY FORGIVING OR REDUCING THEIR MEDICAL DEBT AT CHI LAKEWOOD HEALTH. THE BILLING/INSURANCE OFFICE OR THE SOCIAL WORKER IDENTIFIES THOSE INDIVIDUALS OR FAMILIES WITHOUT INSURANCE COVERAGE OR THOSE THAT ARE UNDERINSURED AND PROVIDE APPLICATION ASSISTANCE FOR THIS PROGRAM. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY* LAKEWOOD HEALTH PARTNERED WITH THE LAKE OF THE WOODS SCHOOL TO SCREEN ALL FALL, WINTER AND SPRING SPORTS ATHLETES. THE PROGRAM ALSO EXTENDED TO THE COMMUNITY'S YOUTH HOCKEY PROGRAM. THE SCREENING INVOLVES A 10-MINUTE BASELINE TEST ON EACH ATHLETE LOOKING FOR ANY PHYSICAL OR COGNITIVE SIGNS OF PREVIOUS CONCUSSION. THE ATHLETE'S NORMAL PHYSICAL AND COGNITIVE ABILITIES ARE DOCUMENTED, SHARED WITH THE COACH AND KEPT WITH THE STUDENT'S MEDICAL RECORD. MINNESOTA STATE HIGH SCHOOL LEAGUE ADOPTED NEW RULES (2011) ABOUT WHAT STEPS SHOULD BE TAKEN BEFORE AN ATHLETE WITH A HEAD INJURY CAN RETURN TO PLAY OR PRACTICE AND THIS PROGRAM IS ASSISTING THE ATHLETIC PROGRAMS TO MAINTAIN COMPLIANCE AND SAFETY FOR YOUNG ATHLETES.*CHI LAKEWOOD HEALTH IN CONJUNCTION WITH THE CLINIC DEVELOPED THE DIABETES RESOURCE CENTER TO BRING AWARENESS OF THE CHRONIC DISEASE TO THE PUBLIC AND PROVIDE EDUCATION FOR PEOPLE WITH DIABETES TO HELP THEM UNDERSTAND AND MANAGE THEIR DISEASE. THE PROGRAM IS OFFERED IN CLASS SESSIONS AND ENCOURAGES SELF-MANAGEMENT AND LONG-TERM HEALTH MAINTENANCE. CHI LAKEWOOD HEALTH PROVIDES A DIETITIAN CONSULT AS NEEDED FOR THE PROGRAM. THE DIABETES RESOURCE CENTER STAFF IS AVAILABLE TO MEET WITH INDIVIDUALS TO ASSIST THEM WITH MANAGING THEIR DIABETES. THE DIABETIC RESOURCE CENTER IS STAFFED OUT OF THE CARDIOPULMONARY REHAB DEPARTMENT.THE DIABETES RESOURCE CENTER OFFERED PREVENT T2 PROGRAM. A CDC APPROVED YEAR-LONG PROGRAM WITH WEEKLY MEETINGS FOR THE FIRST 6-MONTHS, THEN ONCE OR TWICE A MONTH FOR THE SECOND 6 MONTHS. THIS IS A PROVEN LIFESTYLE CHANGE PROGRAM TO HELP PARTICIPANTS PREVENT OR DELAY TYPE 2 DIABETES. PARTICIPANTS LEARN TO MANAGE WEIGHT, BECOME MORE PHYSICALLY ACTIVE AND REDUCE STRESS. ALONG THE WAY THEY ALSO RECEIVE SUPPORT FROM OTHERS WHO ARE ON THE SAME JOURNEY.A COMMUNITY SUPPORT GROUP WAS ESTABLISHED FOR THOSE AFFECTED BY DIABETES AND THIS GROUP IS MEETING AT CHI LAKEWOOD HEALTH THREE TO FOUR TIMES A YEAR, SPONSORED BY CHI LAKEWOOD HEALTH.COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTHCHI LAKEWOOD HEALTH DONATES CASH TO PROGRAMS, PROJECTS AND SPECIAL COMMUNITY EVENTS. THESE ORGANIZATIONS/COMMUNITY GROUPS ARE ALSO NOT FOR PROFIT WHERE COLLABORATION FOR SAFE ENVIRONMENT, SAFE RECREATIONAL OPPORTUNITIES, GROWTH AND DEVELOPMENT OF YOUTH, AND OTHER ACTIVITIES/PROGRAMS THAT ASSIST IN BUILDING THE COMMUNITY AND THE HEALTH OF THE COMMUNITY. THROUGH PARTNERSHIPS WITH LAKEWOOD REGIONAL HEALTHCARE FOUNDATION, CHI LAKEWOOD HEALTH IS ABLE TO INCREASE ITS MONETARY DONATIONS TO LOCAL PROGRAMS AND PROJECTS THAT SUPPORT ITS MISSION. THESE PROGRAMS INCLUDE SENIOR MEALS, SENIOR BOATS, EARLY CHILDHOOD BREAKFAST, CHILDREN'S THEATER, AND LAKE OF THE WOODS SCHOOL HEALTHY CHOICES PROGRAM.CHI LAKEWOOD HEALTH ENCOURAGES EMPLOYEES TO BE INVOLVED IN COMMUNITY ACTIVITIES AND TO VOLUNTEER WHERE ABLE. CHI LAKEWOOD HEALTH ALLOWS USE OF PRINTERS, COPY MACHINES, PAPER, AND DONATION OF SUPPLIES. SOME OF THE PROJECTS INCLUDE THE LOCAL FOOD SHELF, TAKE A KID FISHING PROGRAM, SENIOR FISHING PROGRAM, YOUTH HOCKEY, BAUDETTE AREA MINISTERIUM, HUMANE SOCIETY, POST PROM PARTY, JOB SHADOWING EXPERIENCE, SCHOOL CAREER DAY, SCHOOL BOOSTER CLUB, ROBOTICS, COACHING SPORTS TEAMS AND OTHER SCHOOL PROJECTS. CHI LAKEWOOD HEALTH PARTICIPATES IN FUNDRAISING FOR INTERNATIONAL MISSION PROJECT (ALONG WITH CHI FARGO DIVISION) THE INDIGENOUS PEOPLE'S HOSPITAL IN THE PHILIPPINES WITH INTERNAL FUNDRAISING EVENTS FOR EMPLOYEE PARTICIPATION. THE FUNDS ARE USED TO SHIP MEDICAL SUPPLIES AND EQUIPMENT TO THE PHILIPPINES.CHI LAKEWOOD HEALTH HAS INITIATED A RELATIONSHIP WITH SENIOR LIFE SOLUTIONS TO EXPLORE AND EVALUATE THE PROGRAM AND HOW IT COULD MEET THE MENTAL HEALTH NEEDS IN OUR COMMUNITY. SENIOR LIFE SOLUTIONS IS AN OUTPATIENT THERAPY PROGRAM DESIGNED TO MEET THE NEEDS OF OLDER ADULTS, AGE 65 AND OLDER, STRUGGLING WITH SYMPTOMS OF DEPRESSION AND ANXIETY. THE PROGRAM WILL PROVIDE ADDITIONAL ACCESS TO MENTAL HEALTH CARE WITHIN THE COMMUNITY AND BE OFFERED AT LAKEWOOD ONCE IMPLEMENTED. COMMUNITY BUILDING AND COMMUNITY HEALTH ACTIVITIES1. THE BRINK SENIOR CENTER IS A NON-PROFIT ORGANIZATION THAT PROVIDES NUTRITIOUS MEALS AT NOON, FIVE DAYS A WEEK THROUGH LUTHERAN SOCIAL SERVICE PROGRAM. THEY ALSO PROVIDE MEALS ON WHEELS IN OUR COMMUNITY. THE CENTER ALSO SERVES AS A FORUM FOR INFORMATION RELATED TO HEALTH, SENIOR ISSUES AND ADVOCACY PROGRAMS FOR SENIORS. THE SOCIAL WORKER PARTICIPATES ON THE NUTRITION BOARD AT THE BRINK CENTER AND ASSIST WITH FUNDRAISERS ONCE OR TWICE A YEAR FOR THE NUTRITION PROGRAM. OTHER LAKEWOOD STAFF MEMBERS OCCASIONALLY ASSIST WITH SPECIAL EVENTS OR FUNDRAISERS. CHI LAKEWOOD HEALTH PARTNERED WITH LAKEWOOD REGIONAL HEALTHCARE FOUNDATION TO PROVIDE SUPPORT TO THE SENIOR MEALS PROGRAM IN THE FORM OF A MONETARY DONATION.2. LAKEWOOD SUPPORTS FOUR BLOOD DRIVES IN OUR COMMUNITY. CHI LAKEWOOD HEALTH ENCOURAGES AND SUPPORTS EMPLOYEES TO VOLUNTEER AS BLOOD DONORS AND STAFF FROM ENVIRONMENTAL SERVICES OFFERS ASSISTANCE IN SET UP AND CLEAN UP FOR THE BLOOD DRIVE EVENT. LAKEWOOD HEALTH CENTER LAB AND RADIOLOGY DEPARTMENTS TOOK OVER THE RESPONSIBILITIES IN 2012 AND HAVE HAD SUCCESSFUL BLOOD DRIVES IN OUR COMMUNITY, RECENTLY EXPANDING THIS SERVICE FROM TWO EVENTS TO FOUR EACH YEAR. COMMUNICATIONS/MARKETING STAFF ASSIST WITH PROMOTING THE BLOOD DRIVE.3. THE BAUDETTE COMMUNITY FOUNDATION IS A NON-PROFIT ORGANIZATION SEEKING TO ENHANCE AND IMPROVE AREA RECREATIONAL AND SOCIAL FACILITIES. THE BAUDETTE COMMUNITY FOUNDATION BOARD MEETS MONTHLY AND OVERSEES THE THEATER BUSINESS AND CONTINUES TO WORK TOWARD IMPROVING THE RECREATIONAL FACILITIES. BAUDETTE COMMUNITY FOUNDATION ALSO SERVES AS A FISCAL AGENT FOR THE SENIOR FISHING PROGRAM IN LAKE OF THE WOODS COUNTY. CHI LAKEWOOD HEALTH PROVIDES ONE REPRESENTATIVE ON THE BAUDETTE COMMUNITY FOUNDATION BOARD.4. LAKE OF THE WOODS COUNTY PREVENTION COALITION (ALCOHOL, TOBACCO AND OTHER DRUGS): CHI LAKEWOOD HEALTH CENTER (MISSION LEADER, PUBLIC HEALTH STAFF) ARE MEMBERS OF THE COALITION AND CHI LAKEWOOD HEALTH PROVIDES SPACE FOR MEETINGS AND OCCASIONAL REFRESHMENTS. LAKE OF THE WOODS COUNTY WORKS WITH THE DEPARTMENT OF HUMAN SERVICES/ALCOHOL AND DRUG ABUSE DIVISION BY FOCUSING IN PART - CHANGING THE ENVIRONMENT THE YOUTH LIVE IN. INVESTING IN PREVENTION MEASURES WILL NOT ONLY ENHANCE THE COMMUNITY IT WILL ENHANCE THE LIVES OF OUR YOUTH. THE PREVENTION MEASURES ARE AIMED AT: 1) REDUCING ACCESS AND AVAILABILITY 2) ENFORCEMENT OF EXISTING LAWS AND POLICIES AND 3) CHANGING PUBLIC ATTITUDES AND SOCIAL NORMS.5. SUICIDE AWARENESS AND PREVENTION COALITION: CHI LAKEWOOD HEALTH IS PARTICIPATING IN THIS COALITION PARTNERING WITH LOCAL COUNTY SOCIAL SERVICES, SCHOOL SOCIAL WORK AND ADMINISTRATION, YOUTH GROUP LEADERS, CLERGY, PUBLIC HEALTH. CHI LAKEWOOD HEALTH PARTNERED WITH LAKEWOOD REGIONAL HEALTHCARE FOUNDATION TO PROVIDE A MONETARY DONATION TO SUPPORT THE GROUPS' MEDIA AND EDUCATION CAMPAIGN TO INCREASE AWARENESS IN REGARDS TO ACCESS TO HELP AND LIFE LINES. THIS GROUP HAS PARTNERED WITH THE SCHOOL AND ASSISTED WITH GRANT WRITING TO PROVIDE EDUCATIONAL GUEST SPEAKERS FOR STUDENTS AND THE PUBLIC ON TOPICS OF BULLYING AND SELF-ESTEEM.PART VI, LINE 2 (CONTINUED BELOW) PART VI, LINE 3: NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM CHI HOSPITAL ORGANIZATIONS SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO: *CONSPICUOUS PUBLICATION OF NOTICES IN PATIENT BILLS; *NOTICES POSTED IN EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING/REGISTRATION DEPARTMENTS, BUSINESS OFFICES, AND AT OTHER PUBLIC PLACES AS A HOSPITAL FACILITY MAY ELECT; AND *PUBLICATION OF A SUMMARY OF THIS POLICY ON THE HOSPITAL FACILITY'S WEBSITE AND AT OTHER PLACES WITHIN THE COMMUNITIES SERVED BY THE HOSPITAL FACILITY AS IT MAY ELECT. SUCH NOTICES AND SUMMARY INFORMATION SHALL INCLUDE A CONTACT NUMBER AND SHALL BE PROVIDED IN ENGLISH, SPANISH, AND OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVED BY AN INDIVIDUAL HOSPITAL FACILITY, AS APPLICABLE. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE CHI 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.IN ADDITION, HOSPITAL REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. COUNSELORS ASSIST MEDICARE ELIGIBLE PATIENTS IN ENROLLMENT BY PROVIDING REFERRALS TO THE APPROPRIATE GOVERNMENT AGENCIES. ONCE IT IS DETERMINED THAT THE PATIENT DOES NOT QUALIFY FOR ANY THIRD PARTY FUNDING, THE PATIENT IS VERBALLY NOTIFIED ABOUT THE EXISTENCE OF FINANCIAL ASSISTANCE APPLICATION AND ADDITIONAL SCREENING TAKES PLACE BY A HOSPITAL EMPLOYEE TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR CHARITY SERVICE PRIOR TO DISCHARGE. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY OF THAT POLICY, AND AN APPLICATION FOR ASSISTANCE. HOSPITAL REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON-ENGLISH-SPEAKING INDIVIDUALS. PATIENTS THAT HAVE BEEN DISCHARGED PRIOR TO CHARITY SCREENING, SUCH AS EMERGENCY ROOM PATIENTS, RECEIVE A WRITTEN NOTIFICATION OF POSSIBLE ELIGIBILITY FOR SERVICES. IF THE PATIENT IS DETERMINED NOT TO BE ELIGIBLE FOR GOVERNMENT ASSISTANCE, HE/SHE MAY NOTIFY THE HOSPITAL THAT THEY SEEK CHARITY ASSISTANCE. THE APPROPRIATE CHARITY FORM IS SENT TO THE PATIENT/GUARANTOR FOR COMPLETION AND THEN RETURNED TO THE HOSPITAL FOR EVALUATION AND QUALIFICATION. ONCE DETERMINATION OF ELIGIBILITY IS MADE, THE PATIENT IS SENT A NOTICE INFORMING HIM/HER IF THEY QUALIFY FOR FULL, PARTIAL, OR NO CHARITY CARE SERVICES.HOSPITAL FACILITIES MUST MAKE REASONABLE EFFORTS THROUGH ITS BILLING AND COLLECTIONS PROCESSES, PURSUANT TO TREAS. REG. 1.501(R)-6(C), TO DETERMINE WHETHER ANY INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: CHI LAKEWOOD HEALTH IS LOCATED IN BAUDETTE, MINNESOTA, A RURAL AND ISOLATED AREA OF NORTHERN MINNESOTA, SERVING LAKE OF THE WOODS COUNTY AND SURROUNDING COUNTIES OF ROSEAU, KOOCHICHING, BELTRAMI AND ON OCCASION RESIDENTS OF CANADA. TODAY, THE POPULATION OF THE INCORPORATED CITIES IS: BAUDETTE, 1,030 AND WILLIAMS 191. ACCORDING TO MDH, THE 2019 LAKE OF THE WOODS COUNTY POPULATION IS 3,740, A DECREASE OF 4 PEOPLE FROM 2017 DATA. PERSONS 65 YEARS AND OVER MAKE UP 25.4% OF LAKE OF THE WOODS COUNTY POPULATION IN 2019. THE MEDIAN HOUSEHOLD INCOME (2019) WAS $49,967. THERE ARE 3.1 PERSONS PER SQUARE MILE IN LAKE OF THE WOODS COUNTY. PART VI, LINE 5: THE ORGANIZATION'S HOSPITAL FACILITY(IES) PROMOTE HEALTH FOR THE BENEFIT OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITY(IES) HAVE AN OPEN MEDICAL STAFF. ITS BOARD OF TRUSTEES IS COMPOSED OF PROMINENT CITIZENS IN THE COMMUNITY. EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT IN PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. THE FACILITY(IES) TREAT PERSONS PAYING THEIR BILLS WITH THE AID OF PUBLIC PROGRAMS LIKE MEDICARE AND MEDICAID. ALL PATIENTS PRESENTING AT THE HOSPITAL FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH TREATMENT.THE MISSION OF CHI LAKEWOOD HEALTH AND COMMONSPIRIT HEALTH IS TO 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.CHI LAKEWOOD HEALTH IN BAUDETTE, MINNESOTA, IS A CATHOLIC, NOT-FOR-PROFIT CARE ORGANIZATION, AND SPONSORED BY COMMONSPIRIT HEALTH, THE LARGEST CATHOLIC, NOT-FOR-PROFIT HEALTH CARE SYSTEM IN AMERICA. CHI LAKEWOOD HEALTH IS DEDICATED TO THE HEALTH AND WELLBEING OF THE COMMUNITY AND TO PROVIDING QUALITY, HOLISTIC HEALTH CARE SERVICES AND FACILITIES FOR THE RESIDENTS OF BAUDETTE, LAKE OF THE WOODS COUNTY AND SURROUNDING COMMUNITIES OF THE LAKE OF THE WOODS REGION.CHI LAKEWOOD HEALTH IS LOCATED IN A RURAL AND ISOLATED AREA OF NORTHERN MINNESOTA SERVING LAKE OF THE WOODS COUNTY AND SURROUNDING COUNTIES OF ROSEAU, KOOCHICHING, BELTRAMI AND ON OCCASION RESIDENTS OF CANADA. CHI LAKEWOOD HEALTH IS FEDERALLY DESIGNATED, 15-BED CRITICAL ACCESS HOSPITAL. CHI LAKEWOOD HEALTH OFFERS A CONTINUUM OF CARE INCLUDING LONG TERM CARE, ASSISTED RESIDENTIAL COMMUNITY (BOARD AND LODGING WITH SERVICES), HOSPITAL CARE, PUBLIC HEALTH, RURAL VISITING NURSE PROGRAM, AND A RURAL HEALTH CLINIC.LAKEWOOD CONTINUES TO HAVE OUTREACH SERVICES PROVIDED BY AN ORTHOPEDIC SURGEON, AN ORTHOPEDIC PHYSICIAN'S ASSISTANT, A PODIATRIST, GENERAL SURGEON, AND AN OBGYN ALL FROM SANFORD BEMIDJI. CHI LAKEWOOD CONTINUES TO UTILIZE LOCUM PROVIDERS FOR THE EMERGENCY ROOM AND SOME CLINIC COVERAGE. CHI LAKEWOOD HEALTH CLOSED OB SERVICES IN SEPTEMBER 2009.CHI LAKEWOOD HEALTH SERVES ALL PERSONS IN THE COMMUNITY ON A NONDISCRIMINATORY BASIS AND PARTICIPATES IN MEDICAID, MEDICARE PROGRAMS AND HAS AN ACTIVE CHARITY CARE PROGRAM. THE EMERGENCY ROOM IS AVAILABLE 24 HOURS A DAY, 365 DAYS PER YEAR, AND IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY.HISTORYCHI LAKEWOOD HEALTH OPENED IN MARCH 1950 AS BAUDETTE COMMUNITY HOSPITAL. IT WAS OWNED BY THE COMMUNITY AND OPERATED BY THE SISTERS OF ST. JOSEPH OUT OF CROOKSTON, MINNESOTA. THE HOSPITAL WAS LEASED TO THE SISTERS OF ST. JOSEPH IN 1954 AND IN 1957 THE SISTERS PURCHASED THE HOSPITAL AND CHANGED THE NAME TO "TRINITY HOSPITAL".IN 1982, THE SISTERS ENTERED INTO A MANAGEMENT CONTRACT WITH UNITED HEALTH RESOURCES OF GRAND FORKS, NORTH DAKOTA UNTIL THEY SOLD THE HOSPITAL TO FRANCISCAN SISTERS HEALTH CARE, INCORPORATED IN 1985. DURING THIS TIME, TRINITY HOSPITAL TOOK OVER MANAGEMENT OF THE PIONEER NURSING HOME, THE LONG-TERM TERM CARE FACILITY LOCATED ONE MILE EAST OF THE HOSPITAL. IN 1986, THE HOSPITAL ACQUIRED THE COUNTY-OWNED PUBLIC HEALTH SERVICE. TRINITY HOSPITAL BOUGHT THE PIONEER NURSING HOME IN 1990 AND THE NAME WAS CHANGED TO "LAKEWOOD HEALTH CENTER" TO REFLECT THE COMING TOGETHER OF ACUTE CARE, LONG-TERM CARE (LAKEWOOD CARE CENTER), AND HOME HEALTH/PUBLIC HEALTH (LAKEWOOD NURSING SERVICE) UNDER ONE UMBRELLA.DR. A.A. BRINK OPENED HIS MEDICAL PRACTICE IN 1932 IN THE FIRST NATIONAL BANK BUILDING. WITH THE CONSTRUCTION OF A NEW HOSPITAL IN PROGRESS, DR. BRINK BUILT A NEW CLINIC ON MAIN AVENUE, NOW KNOWN AS THE BRINK SENIOR CENTER, A COMMUNITY CENTER FOR EVENTS AND MEALS. A NEW BAUDETTE MEDICAL CLINIC WAS BUILT NEXT TO THE HOSPITAL IN 1979. THE CLINIC BUILDING WAS ACQUIRED BY LAKEWOOD HEALTH IN 1994 BUT THE CLINIC WAS LEASED AS A SATELLITE CLINIC OF GRAND FORKS CLINIC. IN JULY 2006, THE CLINIC BECAME AN OUTPATIENT DEPARTMENT OF LAKEWOOD HEALTH CENTER.CATHOLIC HEALTH CORPORATION OF OMAHA, NEBRASKA TOOK OVER SPONSORSHIP OF LAKEWOOD HEALTH CENTER IN 1993. TWO YEARS LATER THEY MERGED WITH TWO OTHER LARGE CATHOLIC HEALTH CARE SYSTEMS TO FORM CATHOLIC HEALTH INITIATIVES (CHI) BASED IN ENGLEWOOD, COLORADO. CATHOLIC HEALTH INITIATIVES THEN MERGED WITH DIGNITY HEALTH TO FORM COMMONSPIRIT HEALTH WITH HEADQUARTERS IN CHICAGO, ILLINOIS.LAKEWOOD HEALTH CENTER COMPLETED A BUILDING AND RENOVATION PROJECT IN 2000 THAT RESULTED IN ALL HEALTH CARE SERVICES BEING AVAILABLE ON ONE CAMPUS. LAKE OF THE WOODS COUNTY TRANSFERRED OWNERSHIP OF THE LOCAL EMS AMBULANCE SERVICE TO LAKEWOOD HEALTH AND IS A DEPARTMENT OF THE HEALTH CENTER. LAKEWOOD NURSING SERVICE TRANSFERRED TO CATHOLIC HEALTH INITIATIVES HEALTH CONNECT AT HOME AND THE OPERATION MOVED OFF SITE IN JUNE 2010; THE FINANCIAL OPERATIONS WERE SEPARATED IN DECEMBER OF 2010. CATHOLIC HEALTH INITIATIVES AT HOME DISCONTINUED HOME HEALTH SERVICES IN LAKE OF THE WOODS COUNTY AND PUBLIC HEALTH, SCHOOL NURSING, PARKER'S ARC OPERATIONS TRANSFERRED BACK TO LAKEWOOD HEALTH CENTER BY JULY OF 2012. CHI LAKEWOOD HEALTH IS THE ONLY HOSPITAL, CLINIC AND LICENSED LONG TERM CARE PROVIDER IN LAKE OF THE WOODS COUNTY.CHI LAKEWOOD HEALTH IS COMMITTED TO THE PROMOTION OF HEALTHIER COMMUNITIES. CHI LAKEWOOD HEALTH IS PROUD OF ITS CATHOLIC HERITAGE AND ITS ABILITY TO PROVIDE DIRECT AND INDIRECT SUPPORT TO THE COMMUNITIES IT SERVES.CHI LAKEWOOD HEALTH IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL.COMMUNITY BENEFIT APPROACHFINANCE OR ACCOUNTING GATHERS AND TRACKS THE COMMUNITY BENEFIT DATA. THE VP OF FINANCE PROVIDES THE CHARITY CARE AND FINANCIAL DATA FOR INPUT. THE BOARD OF DIRECTORS AND SENIOR LEADERSHIP TEAM ALONG WITH DEPARTMENT HEADS COLLABORATE THROUGHOUT THE YEAR ON HOW TO MAKE A DIFFERENCE IN THE COMMUNITY WE SERVE AND ARE A PART OF. A COST TO CHARGE RATIO IS USED DETERMINED BY A WORKSHEET PROVIDED BY COMMON SPIRIT HEALTH, ENGLEWOOD, COLORADO.CHI LAKEWOOD HEALTH STRIVES TO HAVE COMMUNITY BENEFIT A VISIBLE PART OF WHO WE ARE AND PROVIDES AN ANNUAL REPORT FOR OUR COMMUNITY IN ONE OF OUR NEWSLETTERS PUBLISHED 2 TIMES PER YEAR. COLLABORATING AND COOPERATING WITH OUR COMMUNITY IS "A WAY OF LIFE AND PART OF THE CULTURE FOR CHI LAKEWOOD HEALTH AND ITS EMPLOYEES. WE ARE THANKFUL TO HAVE THE RESOURCES OF TIME, TALENT AND OTHER GIFTS TO SHARE FOR THE GOOD OF OUR COMMUNITY. 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 AS A SINGLE MINISTRY 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 OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. COMMONSPIRIT HEALTH IS COMPRISED OF MORE THAN 1,500 CARE SITES, CONSISTING OF 140 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 2021, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.5 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 $5.1 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.25 BILLION IN FISCAL YEAR 2021, HAS TOTAL ASSETS OF APPROXIMATELY $54.87 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 PART VI, LINE 2 (CONTINUED): COMMUNITY BUILDING AND COMMUNITY HEALTH ACTIVITIES6. COMMUNITY GARDENING HAS BEEN A SUCCESSFUL AND SUSTAINABLE PROJECT THAT ORIGINATED FROM LAKEWOOD'S SHIP PUBLIC HEALTH PROGRAM. LAKEWOOD CONTINUES TO PROVIDE THE COMMUNITY GARDEN SPACES AND PREP THE AREAS EACH SEASON. THE GARDENS HAVE ALLOWED COMMUNITY MEMBERS WHO MAY NOT HAVE HAD ACCESS THE ABILITY TO GROW AND HAVE ACCESS TO FRESH FOODS. THE ALSO PROMOTE HEALTH AND WELLBEING AND PHYSICAL ACTIVITY. THROUGH THE SHIP PROGRAM EFFORTS CONTINUED TO TOBACCO EDUCATION. CHI LAKEWOOD HEALTH'S PUBLIC HEALTH SPENT THE YEAR EDUCATING ON THE ADVERSE EFFECTS OF TOBACCO AND E-CIGARETTES. 7. COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGIESTHE PURPOSE OF CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT IS TO DESCRIBE THE HEALTH OF LOCAL PEOPLE, IDENTIFY USE OF LOCAL HEALTH CARE SERVICES, PRIORITIZE COMMUNITY NEEDS AND IDENTIFY ACTION NEEDED TO ADDRESS THE FUTURE DELIVERY OF HEALTH CARE IN THE DEFINED AREA. A HEALTH NEEDS ASSESSMENT BENEFITS THE COMMUNITY BY: 1) COLLECTING TIMELY INPUT FROM THE LOCAL COMMUNITY, PROVIDERS AND STAFF; 2) PROVIDING AN ANALYSIS OF SECONDARY DATA RELATED TO HEALTH CONDITIONS, RISKS AND OUTCOMES; 3) COMPILING AND ORGANIZING INFORMATION TO GUIDE DECISION MAKING, EDUCATION, AND MARKETING EFFORTS, AND TO FACILITATE THE DEVELOPMENT OF A STRATEGIC PLAN; 4) ENGAGING COMMUNITY MEMBERS ABOUT THE FUTURE OF HEALTH CARE COMMUNITY BY: DELIVERY; AND 5) ALLOWING THE CHARITABLE HOSPITAL TO MEET FEDERAL REGULATION REQUIREMENTS OF THE AFFORDABLE CARE ACT, WITH REQUIRED NOT-FOR-PROFIT HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST EVERY THREE YEARS. LAKEWOOD HEALTH CENTER COMPLETED A HEALTH NEEDS ASSESSMENT AND PUBLISHED THE FINDINGS ON THE FACILITY WEBSITE. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED DURING SEPTEMBER 2018-JUNE 2019. THE MOST RECENT COMMUNITY FORUM WAS HELD IN APRIL 2019.8. RAINY RIVER COMMUNITY COLLEGE COHORT: CHI LAKEWOOD HEALTH PARTICIPATES IN A COHORT WITH RAINY RIVER COMMUNITY COLLEGE WHICH OFFERS AREA RESIDENTS AND EMPLOYEES THE OPPORTUNITY TO OBTAIN A REGISTERED NURSE OR LICENSED PRACTICAL NURSE DEGREE BY COMPLETING CLASSES AND COURSEWORK LOCALLY. PARTICIPANTS UTILIZE CHI LAKEWOOD HEALTH'S CONFERENCE ROOM AND TECHNOLOGY TO CONNECT VIA INTERACTIVE TELEVISION (ITV) WITH INSTRUCTORS AND PARTICIPATE IN CLASSES. LAKEWOOD ALSO PROVIDED TWO APPROVED PROCTORS SO THAT STUDENTS COULD COMPLETE EXAMS ONSITE AT LAKEWOOD AS WELL. THE COHORT IS INTENDED TO PROVIDE ACCESS TO ADVANCED EDUCATION AND CAREER DEVELOPMENT. ONCE INDIVIDUALS OBTAIN THEIR DEGREE AND UPON SUCCESSFULLY PASSING THE ACCREDITED BOARD EXAM THEY WILL RECEIVE POSSIBLE JOB PLACEMENT WITHIN THE ORGANIZATION. COMMUNITY HEALTH IMPROVEMENT ADVOCACY AND SUPPORT SERVICES1. MINNESOTA HEALTH CARE PROGRAMS OUTREACH EFFORTS ENHANCED THROUGH MINNESOTA COMMUNITY APPLICATION AGENT (MNCAA) PROGRAM. LEVEL I ORGANIZATIONS ARE REFERRED TO AS A MINNESOTA COMMUNITY APPLICATION AGENT (MNCAA). MNCAA CONTRACTS WITH DHS TO SERVE AS AN APPLICATION SITE FOR THOSE NEEDING ASSISTANCE WITH THE MINNESOTA HEALTH CARE PROGRAMS APPLICATION (HCAPP). EMPLOYEES FROM LAKEWOOD PARTICIPATED IN THIS TRAINING. LEVEL I SITES ARE CONTRACTED TO:A) IDENTIFY THE POTENTIAL HEALTH CARE ENROLLEESB) ASSIST POTENTIALLY ELIGIBLE ENROLLEES WITH THE HCAPPC) ASSIST APPLICANTS WITH OBTAINING DOCUMENTATION NEEDED TO DETERMINE HEALTH CARE ELIGIBILITYD) OFFER USE OF FAX AND COPY SERVICESE) FOLLOW UP AS NEEDED UNTIL AN ELIGIBILITY DETERMINATION IS REACHED 1 LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 411893795 501(C)(3) 20959 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) 25000 PROGRAM SUPPORT 2 PART I, LINE 2: THE ORGANIZATION PROVIDES FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY TO INDIVIDUALS WHO ARE ELIGIBLE FOR FREE OR DISCOUNTED CARE. X X X 0 1 0 0 0 0 0 0 0 JEFFREY DROP BRD MBR/SVP-OPER-CEO (PARTIAL YEAR) 0 692085 0 430582 0 141130 0 16844 0 17949 0 1298590 0 0 DR JUSTIN QUO PHYSICIAN/BOARD MEMBER/CHIEF OF STAF 377992 0 20000 0 561 0 17437 0 29270 0 445260 0 0 0 BENJAMIN KOPPELMAN FORMER PRESIDENT 0 264859 0 28040 0 17413 0 17315 0 29275 0 356902 0 0 JEFFRY STAMPOHAR PRESIDENT 156907 0 17000 0 2182 0 18760 0 26521 0 221370 0 0 0 JAY ROSS CFO / TREASURER 0 137807 0 5536 0 305 0 9586 0 26464 0 179698 0 0 PART I, LINE 4A: FOR REPORTABLE INDIVIDUALS EMPLOYED PRIOR TO 2019, POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. OFFICERS, KEY EMPLOYEES AND CERTAIN HIGHLY COMPENSATED EMPLOYEES WHO BEGAN EMPLOYMENT AFTER NOVEMBER 1ST OF 2019 ARE COVERED BY THE COMMONSPIRIT HEALTH EXECUTIVE SEVERANCE POLICY. THIS POLICY PROVIDES FOR SEVERANCE PAY WHICH VARIES BASED UPON THE EXECUTIVE'S POSITION LEVEL, IN THE EVENT OF A POSITION ELIMINATION OR OTHER QUALIFYING EVENT, IN ACCORDANCE WITH THE GUIDELINES OF THE EXECUTIVE SEVERANCE POLICY. AN EXECUTIVE'S WRITTEN EMPLOYMENT OR SEVERANCE AGREEMENT SHALL CONTROL WHERE THE SEVERANCE PAY AMOUNTS IN THE POLICY CONFLICT WITH THE EXECUTIVE'S WRITTEN EMPLOYMENT OR SEVERANCE AGREEMENT. IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT OF CLAIMS. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. PART I, LINE 4B: DURING THE 2020 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 2020 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 2020, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: JEFFREY DROP - $113,534; BENJAMIN A. KOPPELMAN - $14,462 FORM 990, PART VI, SECTION A, LINE 1 PURSUANT TO SECTION 8.6 OF THE BYLAWS OF LAKEWOOD HEALTH CENTER, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND CEO, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND TWO VOTING MEMBERS APPOINTED BY THE BOARD OF DIRECTORS. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. 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 ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS COMMONSPIRIT HEALTH. PURSUANT TO SECTION 5.4.2 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. THE POLICY WAS LAST UPDATED DURING THE TAX YEAR ENDED 6/30/2021. 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 * 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 (WHICH INCLUDES 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). 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 2020 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 1,040,516. MANAGEMENT AND GENERAL EXPENSES 54,764. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,095,280. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 994,109. MANAGEMENT AND GENERAL EXPENSES 52,322. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,046,431. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 759,358. MANAGEMENT AND GENERAL EXPENSES 84,373. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 843,731. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 222,287. MANAGEMENT AND GENERAL EXPENSES 11,699. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 233,986. CONSULTING: PROGRAM SERVICE EXPENSES 34,223. MANAGEMENT AND GENERAL EXPENSES 1,801. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,024. FORM 990, PART XI, LINE 9: REALLOCATION OF CARES ACT REVENUE 3,263,522. FORM 990, PART XI, LINE 8: PRIOR PERIOD ADJUSTMENT: CENTRALIZED TRANSACTIONS: TRANSFERS FOR JOURNAL ENTRIES RECORDED CENTRALLY AT COMMONSPIRIT TO STANDARDIZE CONTRACTUAL ALLOWANCE METHODOLOGY ACROSS ALL COMMONSPIRIT AFFILIATES AND SUBSIDIARIES. RECORDED CENTRALLY AT YEAR END AND TRANSFERRED TO FACILITIES IN THE FOLLOWING YEAR. 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 HOSP OF MO VALLEYIA 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 1 WEST WAY CT 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 SJSC 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 CIRCLE 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 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 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 CHISVHS 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 CHISVHS 0 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(C)(3) LINE 12A, I N/A 0 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 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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 2801 VIA FORTUNA SUITE 500 AUSTIN TX 78746 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 HEALTH VENTURES TACOMA FNC CTR BLDG 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