2022-05-13T14:54:46-05:00 2021-06-30 135565207 KPMG LLP 1225 17TH ST SUITE 800 DENVER CO 80202 990 2020-07-01 930391614 ST ANTHONY HOSPITAL STAN 5412783220 2801 ST ANTHONY WAY PENDLETON OR 978013800 HAROLD GELLER PRESIDENT 5412783220 2022-05-13 1 HAROLD GELLER MARK SHELTON P01203482 3032962323 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z HAROLD GELLER 2801 ST ANTHONY WAY PENDLETON OR 97801 103253531 0 0928 X WWW.SAHPENDLETON.ORG X 1901 OR ST. ANTHONY HOSPITAL WAS FOUNDED IN 1901 BY THE SISTERS OF ST. FRANCIS TO PROVIDE COMPREHENSIVE HEALTH CARE TO EVERYONE IN THIS RURAL COMMUNITY OF EASTERN OREGON, REGARDLESS OF ABILITY TO PAY OR SOCIAL STATUS. 11 7 433 7 159719 76031 3184385 616225 80275151 92439071 4958075 9649899 590883 494406 89008494 103199601 38081 16986 0 0 33666785 36083318 0 0 0 36549855 44664611 70254721 80764915 18753773 22434686 215280199 257254759 38297310 37603896 176982889 219650863 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 72148866 16986 92439071 SEE SCHEDULE H 72148866 1 1 0 1 0 0 0 0 0 0 1 1 0 1 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 0 433 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X HAROLD GELLER 5412783220 2801 ST ANTHONY WAY PENDLETON OR 97801 KETUL PATEL EX-OFFICIO TRUSTEE/SYS SVP MARKET CEO 3.00 57.00 X 0 2315223 221035 AIMEE ROGERS MD UROLOGIST 40.00 0.00 X 492481 0 26611 HAROLD GELLER PRESIDENT/TRUSTEE 39.00 1.00 X X 439404 0 49123 JD WARD DO TRUSTEE/PHYSICIAN-OB-GYN GENERAL 40.00 0.00 X 411537 0 43154 WILLIAM BELL MD PHYSICIAN 40.00 0.00 X 401671 0 34592 MICHAEL BRUNSMAN MD PHYSICIAN-OB-GYN GENERAL 40.00 0.00 X 359295 0 37621 ROBERT QUACKENBUSH MD ONCOLOGIST 40.00 0.00 X 289177 0 748 GWEN LIBBY PHYSICIAN FAM MED 40.00 0.00 X 269516 0 46176 JOHN MCBEE MD TRUSTEE/CHIEF OF MEDICAL STAFF 40.00 0.00 X 251000 0 0 JANEEN REDING MKT VP HUMAN RESOURCES (PARTIAL YEAR) 40.00 0.00 X 176511 0 38434 FRANK BECKER MARKET DIRECTOR OF OPERATIONAL FINANCE 10.00 40.00 X 0 145200 13226 DONALD BENSCHOTER DMD TRUSTEE 3.00 1.00 X 0 0 0 CHERYL DOYLE VICE CHAIR 3.00 1.00 X X 0 0 0 TIM HAWKINS TRUSTEE 3.00 0.00 X 0 0 0 JUNE MOHRLAND SECRETARY 3.00 0.00 X X 0 0 0 BETH O'HANLON TREASURER 3.00 0.00 X X 0 0 0 JERRY SIMPSON CHAIR 3.00 0.00 X X 0 0 0 PATRICIA WINN MD TRUSTEE 3.00 0.00 X 0 0 0 LOHITH REDDY MD TRUSTEE (PARTIAL YEAR) 3.00 0.00 X 0 0 0 3090592 2460423 510720 86 0 1 0 BARTON ASSOCIATES INC 221 W PHILADELPHIA ST YORK PA 17401 STAFFING AND RECRUITING SERVICES 1404540 EMCARE PHYSICIAN SERVICES INC 7032 COLLECTION CENTER DR CHICAGO IL 60693 PATIENT CARE 1277654 INTERPATH LABORATORY PO BOX 1208 PENDLETON OR 97801 CLINICAL LAB SERVICES 921299 APOGEE MEDICAL MGMT 15059 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254 MANAGEMENT SERVICES 826218 WELLTOWER INC 4500 DORR ST TOLEDO OH 43615 REAL ESTATE INVESTMENT SERVICES 731529 21 435945 146362 33918 616225 PATIENT SERVICES 900099 92439071 92439071 0 0 92439071 1593321 78599 1514722 42272 53930 -11658 -11658 -11658 8056578 0 8056578 8056578 8056578 59576 0 59576 59576 CAFETERIA 722100 338103 0 0 338103 SERVICES SOLD 900099 67914 0 47100 20814 OTHER MISCELLANEOUS RE 900099 6451 0 0 6451 34020 34020 446488 103199601 92439071 159719 9984586 X 16986 16986 857484 232000 625484 27763036 25777406 1985630 1392561 1300604 91957 3942045 3661037 281008 2128192 1787172 341020 107051 107051 10305 10305 15029357 14226151 803206 279130 279130 1430932 1068200 362732 1938228 892146 1046082 1880012 1598528 281484 170190 82790 87400 18366 37 18329 34706 34706 1910844 1910844 6141337 5854670 286667 500006 496866 3140 MEDICAL SUPPLIES 8553231 8553231 0 0 STATE PROVIDER TAX 4982270 4982270 0 0 REPAIRS AND MAINTENANCE 647025 614674 32351 0 UNRELATED BUSINESS TAXE 10300 0 10300 0 1021321 969392 51929 80764915 72148866 8616049 0 2102 2099 31929318 23568843 0 11665458 14709365 0 0 788150 625698 2030935 2708731 22085 106001 126616714 68645566 61605052 57971148 0 94973973 142591179 0 0 12263126 14971695 215280199 257254759 18301748 18549952 0 3054110 249461 0 0 0 0 0 16941452 18804483 38297310 37603896 X 176982889 219650863 0 176982889 219650863 215280199 257254759 X 22434686 17042313 3190975 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10305 0 0 0 10305 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $1,227 CATHOLIC HEALTH ASSOCIATION - $653 OREGON ASSOCIATION OF HOSPITAL AND HEALTH SYSTEMS - $8,425 1860719 1860719 78676944 33588926 45088018 3093567 1358832 1734735 41791234 33023086 8768148 1194250 674722 519528 57971148 CSH OPERATING INVESTMENT POOL 142591179 F 142591179 INTERCOMPANY RECEIVABLES 5372437 INVESTMENTS IN UNCONSOLIDATED ORGS 1530000 RIGHT OF USE FINANCE 3108470 RIGHT OF USE OPERATING 4960788 14971695 46758 INTERCOMPANY PAYABLE 6453036 ACCRUED EXPENSES 1647260 ACCRUED GRANTS 143923 LT FINANCE LEASE LIABILITY 2190744 LT OPERATING LEASE LIABILITY 5868223 FINANCE LEASE 798351 OPERATING LEASE 807403 OTHER LIABILITIES 848785 18804483 X PART X, LINE 2: ST. ANTHONY HOSPITAL'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 2078 1043091 1043091 0.01290 2078 1043091 1043091 0.01290 20 4658 595673 110 595563 0.00740 10 82 564505 564505 0.00700 1 205100 205100 0.00250 31 4740 1365278 110 1365168 0.01690 31 6818 2408369 110 2408259 0.02980 1 40 480 480 0.00000 12 12116 348395 2248 346147 0.00430 2 60 2966 2966 0.00000 1 8000 132 132 0.00000 16 20216 351973 2248 349725 0.00430 0 2548494 0 17508123 25852903 -8344780 X 1 1 1 1 ST ANTHONY HOSPITAL 2801 ST ANTHONY WAY PENDLETON OR 97801 HTTP://WWW.SAHPENDLETON.ORG 14-0034 X X X X ST ANTHONY HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X SEE PART V, PAGE 8 X 1 19 1 SEE PART V, PAGE 8 0 1 X 300.000000000000 400.000000000000 X X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X 1 X 0 0 ST. ANTHONY HOSPITAL PART V, SECTION B, LINE 5: ST. ANTHONY HOSPITALDESCRIPTION:THE UMATILLA-MORROW COUNTIES COMMUNITY HEALTH PARTNERSHIP, A COLLABORATION OF VARIOUS ORGANIZATIONS THROUGHOUT UMATILLA AND MORROW COUNTIES, CONDUCTED ANONYMOUS, CONFIDENTIAL SURVEYS OF ADULTS AGED 18 YEARS AND OLDER RESIDING THROUGHOUT UMATILLA AND MORROW COUNTIES TO ASSESS HEALTH NEEDS WITHIN THE COMMUNITY. THE MEMBERS OF THIS PARTNERSHIP INCLUDE AGENCIES THAT SPECIALIZE IN PUBLIC HEALTH SERVICES, AS WELL AS ORGANIZATIONS THAT SERVE MEDICALLY-UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS.THIS PARTNERSHIP CONSISTS OF THE FOLLOWING ORGANIZATIONS:* COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP OF MORROW COUNTY* PENDLETON COMMUNITY HEALTH PARTNERSHIP* MILTON-FREEWATER COMMUNITY HEALTH PARTNERSHIP* UMATILLA COUNTY COMMUNITY ADVISORY COUNCIL* MORROW COUNTY COMMUNITY ADVISORY COUNCIL* BLUE MT. EARLY LEARNING HUB* UMATILLA COUNTY PUBLIC HEALTH* GOOD SHEPHERD HEALTH CARE SYSTEM* CHI ST. ANTHONY HOSPITAL* CAPECO* MORROW COUNTY HEALTH DISTRICT, INTERMOUNTAIN ESD* UMATILLA COUNTY HUMAN SERVICES* EASTERN OREGON CORRECTIONAL INSTITUTE* COLUMBIA RIVER COMMUNITY HEALTH SERVICES* LIFEWAYS* MORROW COUNTY HEALTH DEPARTMENT* MHP SALUD* OREGON CHILD DEVELOPMENT COALITION* YELLOWHAWK TRIBAL HEALTH CENTER* OREGON DEPARTMENT OF HUMAN SERVICES* COMMUNITY COUNSELING SOLUTIONS* CONNEXIONS* CARE* MIRASOL FAMILY HEALTH* SALVATION ARMY ST. ANTHONY HOSPITAL PART V, SECTION B, LINE 6A: ST. ANTHONY HOSPITALDESCRIPTION:GOOD SHEPHERD HEALTH CARE SYSTEM ST. ANTHONY HOSPITAL PART V, SECTION B, LINE 6B: ST. ANTHONY HOSPITALDESCRIPTION:* YELLOWHAWK TRIBAL HEALTH CLINIC* GREATER OREGON BEHAVIORAL HEALTH INC ST. ANTHONY HOSPITAL PART V, SECTION B, LINE 11: ST. ANTHONY HOSPITALDESCRIPTION:THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THE FOLLOWING SIX SIGNIFICANT COMMUNITY HEALTH NEEDS AND STRATEGIES TO ADDRESS THEM:1. BEHAVIORAL HEALTH, WHICH ENCOMPASSES NEEDS RELATING TO MENTAL HEALTH FOR BOTH ADULT AND YOUTH, SUBSTANCE ABUSE, TOBACCO, VAPING, AND TRAUMA.* THE HOSPITAL HAS DEVELOPED A COMPREHENSIVE PROGRAM TO ASSIST PATIENTS IN CESSATION OF TOBACCO USE. THE TOBACCO CESSATION PROGRAM AIMS TO ASSIST PATIENTS IN QUITTING TOBACCO USE. WE ANTICIPATE USING THIS PROGRAM TO HELP PATIENTS IN OUR AREA QUIT USING TOBACCO PRODUCTS INCLUDING CIGARETTES, SMOKELESS TOBACCO, AND VAPING.2. SOCIAL DETERMINANTS OF HEALTH/HEALTH EQUITY, WHICH INCLUDES HOUSING, HOMELESSNESS, FOOD INSECURITY, AND TRAUMA.3. CHRONIC DISEASE, INCLUDING ASTHMA, CANCER, DIABETES, AND TRAUMA.* IN ADDITION TO THE TOBACCO CESSATION PROGRAM, THE HOSPITAL HAS DEVELOPED A PULMONARY REHABILITATION PROGRAM TO ASSIST PATIENTS IN REDUCING THEIR NEED FOR SUPPLEMENTAL OXYGEN AND INCREASING ACTIVITY LEVEL/STAMINA. THESE PROGRAMS WILL AIM TO IMPROVE QUALITY OF LIFE FOR PATIENTS BY ADDRESSING THE HEALTH NEED OF CHRONIC DISEASES, SPECIFICALLY ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE.4. ACCESS TO SERVICES, WHICH IS A BROAD AREA OF NEED INCLUDING TRANSPORTATIONS, INTEGRATED CARE, HOUSING SERVICES, PROVIDERS, PREVENTION & SCREENING, AND NUTRITIONAL ASSISTANCE.* TO IMPROVE ACCESS TO SERVICES, THE HOSPITAL PLANS TO UTILIZE THE FOLLOWING STRATEGIES OR PROGRAMS:- CARE RIDE PROGRAM: THIS PROGRAM PROVIDES TAXI/TRANSPORTATION VOUCHERS TO PATIENTS WITHOUT TRANSPORTATION WHO ARE COMING TO/FROM APPOINTMENTS AT THE HOSPITAL.- COMMUNITY HEALTH FAIR: THIS COMMUNITY HEALTH FAIR IS A FREE PUBLIC EVENT IN WHICH COMMUNITY MEMBERS OF ALL AGES CAN RECEIVE HEALTH EDUCATION AND SCREENINGS WHICH WAS CANCELLED IN 2020 DUE TO COVID-19.- PATIENT FINANCIAL ASSISTANCE: PATIENT FINANCIAL ASSISTANCE IS AVAILABLE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE CAPACITY TO PAY FOR MEDICALLY NECESSARY HEALTHCARE SERVICES.- PROVIDER RECRUITMENT: THIS PROGRAM PROVIDES AGGRESSIVE TACTICS AND STRATEGIES TO RECRUIT PROVIDERS TO OUR RURAL COMMUNITY FOR PRIMARY CARE AND OTHER SERVICES, THUS INCREASING PATIENT ACCESS TO CARE.5. VIOLENCE, INCLUDING CHILD ABUSE, DOMESTIC VIOLENCE, SEXUAL ABUSE, AND TRAUMA.* THE HOSPITAL HAS PARTNERED WITH PIONEER RELIEF NURSERY PROGRAM TO PROVIDE ACCESS TO A COMMUNITY RELIEF NURSERY FOR AT-RISK FAMILIES. THIS RELIEF NURSERY PROVIDES CHILDCARE/PRESCHOOL SERVICES AT NO CHARGE FOR AT RISK FAMILIES, WITH THE GOAL OF REDUCING CHILD ABUSE AND NEGLECT. CURRENTLY THE RELIEF NURSERY IS LOCATED IN PENDLETON, AND ST. ANTHONY HOSPITAL IS SUPPORTIVE OF EFFORTS TO EXPAND SERVICES TO WEST UMATILLA COUNTY IN THE FUTURE.6. OBESITY, INCLUDING PHYSICAL ACTIVITY, TRAUMA, AND NUTRITION.* TO ADDRESS THE COMMUNITY NEEDS RELATED TO OBESITY, THE HOSPITAL HAS A NUTRITION SERVICES PROGRAM, WHICH PROVIDES NUTRITION COUNSELING TO PATIENTS WHO ARE OBESE OR AT RISK FOR OBESITY. WEIGHT MANAGEMENT CLASSES ARE ALSO OFFERED FOR THOSE SEEKING TO LOSE WEIGHT OR MAINTAIN A HEALTHY WEIGHT. IN ADDITION, NUTRITION SERVICES/SCREENING SERVICES WILL BE AVAILABLE ON THE COMMUNITY CARE VAN. SIGNIFICANT NEEDS. THE HOSPITAL INTENDS TO ADDRESS AT LEAST ONE SUB TOPIC IN EACH OF THE SIX IDENTIFIED HEALTH PRIORITY AREAS, WITH THE EXCEPTION OF SOCIAL DETERMINANTS OF HEALTH/HEALTH EQUITY. AT THIS TIME, THE HOSPITAL DOES NOT HAVE THE CAPACITY OR RESOURCES TO ADDRESS THESE ISSUES WHICH INCLUDE HOUSING, HOMELESSNESS, AND FOOD INSECURITY. HOWEVER, THE HOSPITAL INTENDS TO COLLABORATE WITH AND SUPPORT OTHER COMMUNITY ENTITIES ADDRESSING THESE NEEDS HOWEVER POSSIBLE. ST. ANTHONY HOSPITAL PART V, SECTION B, LINE 13H: FACILITY NAME:ST. ANTHONY HOSPITALDESCRIPTION: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. PART V, SECTION B, LINE 3E IN ORDER TO DETERMINE HEALTH PRIORITIES FOR THE TRIENNIUM, COMMUNITY HEALTH NEEDS ASSESSMENT PRIORITIZATION MEETINGS WERE HELD AT TWO LOCATIONS WITHIN THE COUNTY. DURING THESE MEETINGS, COMMUNITY HEALTH PARTNERS FROM MULTIPLE AGENCIES WORKED COLLABORATIVELY TO IDENTIFY THE SIX HEALTH PRIORITIES:* BEHAVIORAL HEALTH* CHRONIC DISEASES* SOCIAL DETERMINANTS* ACCESS TO SERVICES* VIOLENCE* OBESITY PART V, SECTION B, LINE 7A, CHNA WEBSITE HTTPS://WWW.SAHPENDLETON.ORG/EN/ABOUT-US/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML PART V, SECTION B, LINE 10A, IMPLEMENTATION STRATEGY HTTPS://WWW.SAHPENDLETON.ORG/EN/ABOUT-US/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML PART V, LINE 16A, FAP AVAILABLE WEBSITE HTTPS://WWW.SAHPENDLETON.ORG/EN/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE.HTML PART V, LINE 16B, FAP APPLICATION FORM HTTPS://WWW.SAHPENDLETON.ORG/EN/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE.HTML PART V, LINE 16C, PLAIN LANGUAGE FAP HTTPS://WWW.SAHPENDLETON.ORG/EN/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE.HTML 4 1 - ST ANTHONY FAMILY CARE CLINIC 3001 ST ANTHONY WAY PENDLETON OR 97801 RURAL HEALTH CLINIC 2 - ST ANTHONY WOMEN'S CLINIC 3001 ST ANTHONY WAY PENDLETON OR 97801 CLINIC FOR PREGNANCY/OBGYN ISSUES 3 - ST ANTHONY ORTHOPEDIC CLINIC 3001 ST ANTHONY WAY PENDLETON OR 97801 ORTHO PHYSICIAN CLINIC 4 - ST ANTHONY OUTPATIENT PHYSICAL THERAPY 1425 SOUTHGATE PENDLETON OR 97801 CLINIC FOR PHYSICAL, OCCUPATIONAL AND SPEECH OUTPATIENT THERAPY 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 FOR FREE CARE.* ANY PATIENT WHOSE FAMILY INCOME IS BETWEEN 301% OF THE FPG AND AT OR BELOW 400 PERCENT OF THE FPG SHALL RECEIVE DISCOUNTED CARE UP TO 50% FROM HIS OR HER ACCOUNT BALANCE FOR EMCARE PROVIDED TO THE PATIENT AFTER PAYMENT, IF ANY, BY ANY THIRD PARTY(IES).* 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.A DETERMINATION THAT A PATIENT IS PRESUMPTIVELY ELIGIBLE FOR FINANCIAL ASSISTANCE WILL RESULT IN FREE OR DISCOUNTED EMCARE FOR THE PERIOD DURING WHICH THE INDIVIDUAL IS PRESUMPTIVELY ELIGIBLE. PATIENT ACCOUNTS GRANTED PRESUMPTIVE ELIGIBILITY STATUS WILL BE PROVIDED FREE OR DISCOUNTED CARE FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. THIS DECISION WILL NOT CONSTITUTE A STATE OF FREE OR DISCOUNTED CARE AS AVAILABLE THROUGH THE TRADITIONAL APPLICATION PROCESS. PART I, LINE 7: A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE. RATHER, THE COSTS IN THE TABLE WERE COMPUTED USING THE ORGANIZATION'S COST TO CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. PART II, COMMUNITY BUILDING ACTIVITIES: THE COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY BY IMPROVING ACCESS TO HEALTH, SUPPORTING FAMILIES IN THE COMMUNITY, AND PROVIDING DIRECT SUPPORT.THE HOSPITAL IMPROVES ACCESS TO HEALTH THROUGH ITS BREAST CANCER TOUGH ENOUGH TO WEAR PINK AND CANCER RENEWAL PROGRAMS. THESE PROGRAMS HELP ADDRESS AN IMPORTANT UNMET NEED OF THOSE WHO BATTLE WITH BREAST CANCER. THE BREAST CANCER FUND HELPS SUPPORT WOMEN WHO ARE BEING TREATED FOR BREAST CANCER. ITS MAIN PURPOSE IS TO PROVIDE IMMEDIATE EMERGENCY RELIEF MONEY TO BREAST CANCER PATIENTS WITH EMERGENT AND/OR SPECIAL NEEDS; SUCH AS MASTECTOMY PRODUCTS AND TRANSPORTATION ASSISTANCE. THE CANCER RENEWAL PROJECT HELPS SUPPORT SURVIVORS OF CANCER BY OFFERING THEM SERVICES THAT HELP IN THEIR RECOVERY. THESE SERVICES INCLUDE YOGA, EXERCISE CLASSES AND MESSAGES. THE HOSPITAL HELPS THESE PROGRAMS BY SUPPORTING THE FUNDRAISING EVENT "TOUGH ENOUGH TO WEAR PINK," WITH BOTH VOLUNTEER SUPPORT AND CASH DONATIONS.THE HOSPITAL ALSO IMPROVES ACCESS TO HEALTH BY OFFERING A PLACE TO STAY TO THOSE WHO HAVE FAMILY OR LOVED ONES WHO HAVE BEEN HOSPITALIZED AND TO ELIMINATE BARRIERS FOR THOSE WHO ARE IN NEED. THIS PROGRAM IS DESIGNED TO SERVE THE COMMUNITY BY OFFERING THESE SERVICES TO LOW INCOME PERSONS. THERE WAS A NEED FOR PROVIDING ACCESS TO THE LOW INCOME GROUPS AND NOTHING WAS AVAILABLE TO THOSE WHO WERE IN NEED OF MEALS AND LODGING DURING A HOSPITAL STAY. THE HOSPITAL PROVIDES FOOD AND SHELTER TO THOSE WHO ARE IN AN UNEXPECTED SITUATION WHERE A FAMILY MEMBER OR LOVED ONE IS HOSPITALIZED.THE HOSPITAL SUPPORTS FAMILIES IN THE COMMUNITY THROUGH ITS SUPPORT OF PIONEER RELIEF NURSERY. SAH PROVIDES SUPPLIES, UTILITIES AND FREE SPACE FOR PIONEER RELIEF NURSERY. THE NURSERY PROVIDES RESPITE CHILDCARE AND TRAINING TO PARENTS WHO HAVE CHALLENGES WITH CHILDCARE; WHICH IS A CHRONIC UNMET NEED. ITS GOAL IS TO PREVENT CHILD ABUSE AND NEGLECT IN UMATILLA COUNTY THROUGH INTENSIVE FAMILY SUPPORT. THEY ADDRESS THE CYCLE OF CHILD ABUSE AND NEGLECT BY PROVIDING THERAPEUTIC EARLY CHILDHOOD CLASSROOMS, PARENTING EDUCATION, PLANNED RESPITE AND COMPREHENSIVE FAMILY SUPPORT. PRN UTILIZES RESEARCH-BASED STRATEGIES TO HELP FAMILIES BUILD SKILLS TO COPE WITH THE STRESSES OF RAISING CHILDREN IN FAMILIES WITH RISK FACTORS SUCH AS POVERTY, SUBSTANCE ABUSE, DOMESTIC VIOLENCE AND ISOLATION.THE HOSPITAL SUPPORTS THE COMMUNITY BY HELPING TO PROVIDE MEALS WEEKLY FOR THE POOR AT THE SALVATION ARMY. ST. ANTHONY HOSPITAL HAS FAITHFULLY PROVIDED THIS SERVICE TO THOSE IN NEED IN OUR COMMUNITY FOR MANY YEARS. THIS YEAR IT WENT EVEN FURTHER TO MAKE SURE THIS SERVICE WAS NOT INTERRUPTED. THIS YEAR THE HOSPITAL PROVIDED ALMOST TEN PERCENT MORES MEALS OVER THE PRIOR YEAR. OVER 6,047 MEALS WERE SERVED. ST. ANTHONY HOSPITAL CONTINUES TO WORK COLLABORATIVELY WITH OUR COMMUNITY TO PROVIDE SUPPORT DURING THESE DIFFICULT ECONOMIC TIMES. PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 42.69%. 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: ST. ANTHONY HOSPITAL 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: ST. ANTHONY HOSPITAL 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 ARE 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 THE 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 CHANGES 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. ST. ANTHONY HOSPITAL'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $8,344,780 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: ST. ANTHONY HOSPITAL IS VERY ACTIVE IN COMMUNITY BUILDING AND LEADERSHIP ACTIVITIES. ST. ANTHONY HOSPITAL SEES THIS AS AN ESSENTIAL PART OF ITS COMMUNITY BENEFIT ACTIVITIES. THEY MAY NOT NECESSARILY BE SEEN AS HEALTHCARE RELATED, BUT SINCE ALMOST 90% OF WHAT CAUSES INDIVIDUALS TO NEED HEALTHCARE IS LIFE STYLE RELATED THE HOSPITAL SEES ITS INVOLVEMENT IN THESE ACTIVITIES KEY TO PROMOTING HEALTHY COMMUNITIES. THE PROGRAMS THAT HOSPITAL SUPPORTS FOCUS ON THE SUPPORT AND COLLABORATION WITH COMMUNITY GROUPS AND ORGANIZATIONS THAT SEEK TO ADDRESS IDENTIFIED NEEDS IN THE COMMUNITY SUCH AS AFFORDABLE HEALTHCARE, NURTURING HEALTHY ACTIVITIES THAT HELP PREVENT OBESITY AND DIABETES, AND PARTICIPATION IN COALITIONS THAT SEEK TO ADDRESS THE NEEDS OF THE HOMELESS, HOUSING AND JOB SHORTAGES. DUE TO COVID-19, WE EXPERIENCED LIMITED AVAILABILITY OF FULFILLING OUR GOALS.UMATILLA COUNTY COMMUNITY HEALTH PARTNERSHIP (UCCUP)ST. ANTHONY HOSPITAL IS AN ACTIVE MEMBER OF THIS COUNTYWIDE COALITION. THE PURPOSE OF THE COALITION IS AS FOLLOWS: (1) COMPLETE A COMPREHENSIVE COUNTYWIDE COMMUNITY HEALTH ASSESSMENT AND REPORT; (2) COLLABORATIVELY WORK WITH THE PARTNERS TO DEVELOP A 3-YEAR STRATEGIC PLAN BASED ON THE ASSESSMENT. (3) PARTICIPATE IN THE HEALTHY COMMUNITIES' PARTNERSHIP IN A COORDINATED EFFORT TO ADDRESS COMMUNITY HEALTH NEEDS. THE LOCAL REPRESENTATIONS OF THIS PARTNERSHIP IS: HEALTH COMMUNITIES OF HERMISTON, MILTON-FREEWATER COMMUNITY HEALTH PARTNERSHIP AND PENDLETON COMMUNITY HEALTH PARTNERSHIP. SINCE THE PENDLETON AREA IS SAH'S PRIMARY SERVICE AREA IT FOCUSES THE MAJORITY OF ITS RESOURCES ON THE LATTER LOCAL COALITION. HOWEVER, IT ALSO CONTINUES TO COLLABORATE AND SUPPORT ACTIVITIES OF THE UCCUP. HOWEVER, WITH COVID-19 WE HAVE BEEN LIMITED AS TO THE AMOUNT OF RESOURCES AND AVAILABILITY TO PROVIDE SOME OF THESE SERVICES ON A CONTINUING BASIS.UMATILLA COUNTY EARLY CHILDHOOD PARTNERSHIP TEAM (ECPT)ST. ANTHONY HOSPITAL IS AN ACTIVE MEMBER. THIS COUNCIL ACTS IN AN ADVISORY ROLE TO THE EARLY LEARNING HUB FOR UMATILLA, MORROW, AND UNION COUNTIES. THE HUB HAS THREE AREAS IN WHICH TO FOCUS: HEALTH, SAFETY AND EDUCATION. BY FOCUSING ON THESE THREE AREAS, THE GROUP WILL WORK TO MAKE SURE KIDS ARE READY TO GO TO KINDERGARTEN. MEASURABLE OUTCOMES FOR EACH AREA HAVE BEEN SELECTED FOR DIFFERENT AGE RANGES. THE OVERALL GOAL IS TO IMPROVE 3RD GRADE READING LEVEL. HOWEVER, WITH COVID-19 WE HAVE BEEN LIMITED AS TO THE AMOUNT OF RESOURCES AND AVAILABILITY TO PROVIDE SOME OF THESE SERVICES ON A CONTINUING BASIS.UMATILLA COUNTY BEHAVIORAL HEALTH ADVISORY COMMITTEE (UBCHAC)ST. ANTHONY HOSPITAL IS AN ACTIVE MEMBER. THIS COMMITTEE SERVES AS AN ADVISORY COUNCIL TO THE COUNTY COMMISSIONERS AND THOSE AGENCIES IN THE COUNTY WHO PROVIDE MENTAL HEALTH AND DRUG & ALCOHOL TREATMENT SERVICES. THEY ARE APPOINTED BY THE UMATILLA COUNTY COMMISSIONERS. HOWEVER, WITH COVID-19 WE HAVE BEEN LIMITED AS TO THE AMOUNT OF RESOURCES AND AVAILABILITY TO PROVIDE SOME OF THESE SERVICES ON A CONTINUING BASIS.PENDLETON PROGRESS BOARDPENDLETON, LIKE MANY COMMUNITIES, HAS BEEN HIT HARD DURING THIS ECONOMIC DOWNTURN. HUNDREDS OF INDIVIDUALS HAVE LOST THEIR JOBS AND WITH IT THEIR ABILITY TO PAY FOR BASIC NEEDS SUCH AS HEALTHCARE. THIS IS REFLECTED BOTH IN THE RESULTS OF THE COMMUNITY NEEDS ASSESSMENT AND IN THE CONTINUED DEMANDS ON THE HOSPITAL'S CHARITY CARE. FOR THIS REASON, ST. ANTHONY HOSPITAL HAS SEVERAL MEMBERS OF THE HOSPITAL LEADERSHIP PARTICIPATING ON THE PENDLETON PROGRESS BOARD. THE PROGRESS BOARD WORKS ON AN ADVISORY CAPACITY TO THE CITY MAYOR. THEY ARE COMMITTED TO MAKING THE COMMUNITY AN ENJOYABLE AND REWARDING PLACE TO LIVE AND WORK. THIS INCLUDES RETENTION AND RECRUITMENT OF BUSINESS EMPLOYERS AND ADDRESSING THE COMMUNITY'S HOUSING SHORTAGE. HOWEVER, WITH COVID-19 WE HAVE BEEN LIMITED AS TO THE AMOUNT OF RESOURCES AND AVAILABILITY TO PROVIDE SOME OF THESE SERVICES ON A CONTINUING BASIS.COMMUNITY SERVICE GROUPSSERVICE GROUPS PROVIDE A VARIETY OF SUPPORT TO THE PENDLETON COMMUNITY AND SURROUNDING AREA. THIS INCLUDES EDUCATION, SUPPORT GROUPS, SCHOLARSHIPS, HEALTHCARE AND LEADERSHIP TRAINING. MANY OF THE GROUPS ST. ANTHONY SPONSORS AND COLLABORATES WITH IN THE SERVICE THEY PROVIDE. FOR OTHERS, THE SUPPORT FOR THEM COMES BY PROVIDING SPACE AND COMPLEMENTARY MEALS FOR THEIR MEETINGS. IN A SMALL COMMUNITY LIKE PENDLETON, RESOURCES ARE LIMITED. SAH SUPPORT OF THESE GROUPS HELPS THE HEALTH OF THE COMMUNITY AS A WHOLE AND NURTURE FUTURE COLLABORATIVE WORK. HOWEVER, WITH COVID-19 WE HAVE BEEN LIMITED AS TO THE AMOUNT OF RESOURCES AND AVAILABILITY TO PROVIDE SOME OF THESE SERVICES ON A CONTINUING BASIS. 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: SERVICE IS DELIVERED PRIMARILY TO RESIDENCES OF PENDLETON (16,810) AND THE SURROUNDING AREA OF UMATILLA COUNTY WITH A POPULATION OF 59075. IT ALSO SERVES A SECONDARY SERVICE AREA OF OVER 45,900 RESIDENTS IN UNION, MORROW AND GRANT COUNTIES. THESE COUNTIES ARE PRIMARILY MADE OF RURAL AGRICULTURAL COMMUNITIES IN NORTHEASTERN OREGON. UMATILLA COUNTY VAST MAJORITY (67%) OF THE POPULATION IS CAUCASIAN, WITH HISPANICS MAKING UP MOST OF THE MINORITY POPULATION AT AROUND 26%. AMERICAN INDIAN (3%), AFRICAN AMERICANS (LESS THAN 1%), ASIAN (LESS THAN 1%), AND TWO OR MORE RACES (2%) COMPRISE THE REST OF THE POPULATION. (SOURCE: CENSUS, 2018) SAH ALSO SERVES A SIGNIFICANT NATIVE AMERICAN POPULATION OF JUST OVER 3,000 WHO RESIDE ON THE RESERVATION OF THE CONFEDERATED TRIBES OF THE UMATILLA, CAYUSE AND WALLA WALLA. THE CITY OF PENDLETON SHARES A BORDER WITH THIS RESERVATION, WHICH HAS THE DESIGNATION OF BEING MEDICALLY UNDERSERVED. THE MEDIUM AGE OF THE COUNTY IS 35.9 AND THE MEDIUM HOUSEHOLD INCOME IS $50,071. THE UNEMPLOYMENT RATE IS 4.0% (JUN 2018). THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IN 2018 IS 16%. 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 ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH TREATMENT. 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. 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 OR 1 ST ANTHONY HOSPITAL FOUNDATION 2801 ST ANTHOY WAY PENDLETON OR 97801 930992727 501(C)(3) 16833 N/A N/A PROGRAM SUPPORT 1 PART I, LINE 2: THESE ARE DONATIONS DEEMED TO BE MADE BY HOSPITAL ADMINISTRATION WITH THE BACKING OF THE BOARD OF DIRECTORS. EACH DONATION IS BROUGHT TO THE ATTENTION OF THE BOARD PRIOR TO BEING DISPENSED. THE ORGANIZATION DOES NOT MONITOR THE USE OF GRANT FUNDS AFTER THEY ARE GRANTED. X X X 0 1 0 0 0 1 0 0 1 0 KETUL PATEL EX-OFFICIO TRUSTEE/SYS SVP MARKET CE 0 1121755 0 968531 0 224937 0 208971 0 12064 0 2536258 0 175550 AIMEE ROGERS MD UROLOGIST 458906 0 0 0 33575 0 16339 0 10272 0 519092 0 0 0 HAROLD GELLER PRESIDENT/TRUSTEE 267937 0 113094 0 58373 0 17152 0 31971 0 488527 0 26252 0 JD WARD DO TRUSTEE/PHYSICIAN-OB-GYN GENERAL 341381 0 0 0 70156 0 15817 0 27337 0 454691 0 0 0 WILLIAM BELL MD PHYSICIAN 393166 0 0 0 8505 0 16339 0 18253 0 436263 0 0 0 MICHAEL BRUNSMAN MD PHYSICIAN-OB-GYN GENERAL 349214 0 0 0 10081 0 16239 0 21382 0 396916 0 0 0 ROBERT QUACKENBUSH MD ONCOLOGIST 278093 0 0 0 11084 0 0 0 748 0 289925 0 0 0 GWEN LIBBY PHYSICIAN FAM MED 238299 0 0 0 31217 0 15312 0 30864 0 315692 0 0 0 JOHN MCBEE MD TRUSTEE/CHIEF OF MEDICAL STAFF 0 0 0 0 251000 0 0 0 0 0 251000 0 0 0 JANEEN REDING MKT VP HUMAN RESOURCES (PARTIAL YEAR 135060 0 36013 0 5438 0 8507 0 29927 0 214945 0 0 0 FRANK BECKER MARKET DIRECTOR OF OPERATIONAL FINAN 0 117445 0 27549 0 206 0 4536 0 8690 0 158426 0 0 PART I, LINE 4B 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. 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. DURING 2020 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: HAROLD SIDNEY GELLER, $33,045; KETUL J. PATEL, $211,791. 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: HAROLD SIDNEY GELLER, $15,637. PART I, LINE 6 FOR 2020, ST ANTHONY HOSPITAL HAD AN INCENTIVE COMPENSATION PROGRAM THAT WAS BASED IN PART ON THE EARNINGS OF THE ORGANIZATION. THE INCENTIVE IS ALSO BASED ON GROWTH TARGETS AND QUALITY MEASURES RELATED TO CLEANLINESS AND SAFETY. PART I, LINE 8 SOME PHYSICIANS RECEIVE INCENTIVE COMPENSATION PAYMENTS THAT ARE BASED ON A PERCENTAGE OF NET COLLECTED REVENUE FROM SERVICES PERFORMED BY THAT PHYSICIAN SPECIFICALLY. FORM 990, PART VI, SECTION A, LINE 1 PURSUANT TO SECTION 8.6 OF THE BYLAWS OF ST. ANTHONY HOSPITAL, 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 ST. ANTHONY HOSPITAL, 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 5.4.1 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE ST. ANTHONY HOSPITAL * AMENDMENT OF THE CORPORATE DOCUMENTS OF THE ST. ANTHONY HOSPITAL * APPROVE MEMBERS OF THE ST. ANTHONY HOSPITAL'S BOARD * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ST. ANTHONY HOSPITAL * APPROVAL OF ISSUANCE OF DEBT BY ST. ANTHONY HOSPITAL * APPROVAL OF PARTICIPATION OF ST. ANTHONY HOSPITAL IN A JOINT VENTURE * APPROVAL OF FORMATION OF A NEW CORPORATION BY ST. ANTHONY HOSPITAL * APPROVAL OF A MERGER INVOLVING THE ST. ANTHONY HOSPITAL * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ST. ANTHONY HOSPITAL * TO REQUIRE THE TRANSFER OF ASSETS BY THE ST. ANTHONY HOSPITAL 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 ST. ANTHONY HOSPITAL 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 EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER PRESENTS THE RETURN TO THE ST. ANTHONY HOSPITAL'S BOARD AT A BOARD MEETING. SUBSEQUENT TO PRESENTATION 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 THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION IS PAID BY ST. ANTHONY HOSPITAL. ST. ANTHONY HOSPITAL UTILIZES MARKET COMPENSATION RANGES FROM MARKET SURVEYS, COMPARABILITY STUDIES AND BOARD APPROVAL TO SET EXECUTIVE COMPENSATION UNDER THE ORGANIZATION'S COMPENSATION PHILOSOPHY. SPECIAL CONSIDERATION IS MADE FOR HIGH PERFORMERS AND THOSE WITH SPECIALIZED SKILLS OR EXPERIENCE. THIS PROCESS IS USED NOT ONLY FOR NEW HIRES BUT FOR ANNUAL MARKET ADJUSTMENTS AS WELL. THE PROCESS AND DECISIONS ARE DISCUSSED AND REVIEWED WITH A REGIONAL COMPENSATION REVIEW TEAM FOR FINAL APPROVAL AND DOCUMENTED IN EACH EMPLOYEE'S ELECTRONIC FILE IN THE HRIS SYSTEM. ST. ANTHONY HOSPITAL WORKS IN CONJUNCTION WITH THE REGIONAL COMPENSATION CENTER WHO USES A MIX OF REGIONAL AND NATIONAL SURVEY DATA TO DETERMINE AND REVIEW SENIOR EXECUTIVE PAY WAS IN LINE WITH THE REGIONAL MARKET. LINE 15B ST. ANTHONY HOSPITAL DETERMINES ADDITIONAL OFFICER AND KEY EMPLOYEE COMPENSATION USING THE SAME PROCESS DESCRIBED FOR THE TOP MANAGEMENT OFFICIAL. THE PROCESS AND DECISIONS ARE DISCUSSED AND REVIEWED WITH A REGIONAL COMPENSATION REVIEW TEAM FOR FINAL APPROVAL AND DOCUMENTATION. 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 IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 5,994,935. MANAGEMENT AND GENERAL EXPENSES 315,523. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,310,458. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,528,640. MANAGEMENT AND GENERAL EXPENSES 238,349. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,766,989. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 2,731,646. MANAGEMENT AND GENERAL EXPENSES 143,771. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,875,417. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 931,284. MANAGEMENT AND GENERAL EXPENSES 103,476. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,034,760. CONSULTING: PROGRAM SERVICE EXPENSES 39,646. MANAGEMENT AND GENERAL EXPENSES 2,087. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,733. FORM 990, PART XI, LINE 9: REALLOCATION OF CARES ACT REVENUE 2,927,236. CENTRALIZED TRANSACTIONS 263,739. FORM 990, PART XI, LINE 9 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 - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI 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 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 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 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 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VALLEY 475 SOUTH DOBSON ROAD CHANDLER AZ 85224 742418514 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH HPL SELF-INSURANCE TRUST 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 943006034 SELF INSURANCE CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH INSURANCE NEVADA LTD 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 813800752 SELF INSURANCE NV 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 DIGNITY HEALTH WORKERS COMP SELF-INSURANCE TRUST 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 946612446 SELF INSURANCE CA 501(C)(3) LINE 12A, I DH 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 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