2022-05-16T22:38:21-05:00 2021-06-30 135565207 KPMG LLP 1225 17TH ST SUITE 800 DENVER CO 80202 990 2020-07-01 910565546 HARRISON MEDICAL CENTER HARR 5642401000 1800 NW MYHRE RD SILVERDALE WA 98383 DAVID SCHULTZ CFO 5642401000 2022-05-16 1 DAVID SCHULTZ 999009999 MARK SHELTON P01203482 3032962323 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X ST MICHAEL MEDICAL CENTER DAVID SCHULTZ 1800 NW MYHRE RD SILVERDALE WA 98383 647925756 0 X SEE SCHEDULE O X 1918 WA HARRISON MAKES A POSITIVE DIFFERENCE IN PEOPLE'S LIVES THROUGH EXCEPTIONAL HEALTH CARE. 10 10 2367 63 245343 119204 13504335 13782375 575737678 600980863 18297548 31370620 3192900 1791898 610732461 647925756 975424 120000 0 0 170988290 179602323 0 0 0 305194158 371836486 477157872 551558809 133574589 96366947 1114742765 1232445041 283629310 247935910 831113455 984509131 HARRISON MEDICAL CENTER PROVIDES ACUTE MEDICAL AND SURGICAL SERVICES, EMERGENCY SERVICES AND A RANGE OF GENERAL AND SPECIALIZED SERVICES TO RESIDENTS OF THE KITSAP PENINSULA AND ADJACENT AREAS. 0 0 421368855 120000 600980863 SEE SCHEDULE H. 421368855 1 1 0 1 0 0 0 0 0 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 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 2367 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 10 10 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAVID NOSACKA 2536804000 1145 BROADWAY SUITE 1200 TACOMA WA 98402 SATYAVARDHAN PULUKURTHY PHYSICIAN 0.00 60.00 X 0 1543516 29486 NATHAN SEGERSON PHYSICIAN 0.00 60.00 X 0 1466765 23586 R KING PHYSICIAN 0.00 60.00 X 0 1141117 46228 MANAS JAIN PHYSICIAN 0.00 60.00 X 0 1114749 18542 DAVID SCHULTZ PRESIDENT 50.00 0.00 X 1044124 0 45745 MIKE FITZGERALD CFO FHS (THROUGH 6/2/21) 10.00 50.00 X 0 984015 37222 JAMES CLEMEN GENERAL SURGEON 0.00 60.00 X 0 848951 25857 JACOB MATHEW HEMATOLOGIST-ONCOLOGIST 0.00 60.00 X 0 741281 26053 MICHAEL ANDERSON CHIEF MEDICAL OFFICER 20.00 40.00 X 0 715307 36836 GRIFFITH BLACKMON MD CHIEF OF STAFF 50.00 0.00 X 0 470588 25538 DAVID WEISS MKT VP MEDICAL OPERATIONS 0.00 50.00 X 0 405669 19288 MATTHEW WHEELUS COO 50.00 0.00 X 301404 0 39152 JEANELL RASMUSSEN SVP & CNO 50.00 0.00 X 300358 0 29066 RONALD DOMMERMUTH PHYSICIAN-FAM MED (WITH OB) 40.00 0.00 X 263632 0 22566 ERIK SCHWEITZER PHYSICIAN-FAM MED (WITHOUT OB) 40.00 0.00 X 261157 0 18834 LESLIE WALDMAN PHYSICIAN-FAM MED (WITH OB) 40.00 0.00 X 252399 0 23306 PETER LUNDBLAD PHYSICIAN-FAM MED (WITHOUT OB) 40.00 0.00 X 256683 0 16391 AMANDA WOLF PHYSICIAN-FAM MED (WITH OB) 40.00 0.00 X 267362 0 4017 BEAU BAKKEN VICE CHAIR 2.00 0.00 X X 0 0 0 JAMES CIVILLA TRUSTEE 2.00 0.00 X 0 0 0 MARY GARGUILE CHAIR 2.00 6.00 X X 0 0 0 MIKE HOFFMAN TRUSTEE 2.00 0.00 X 0 0 0 DENNY HUNTHAUSEN TRUSTEE 2.00 6.00 X 0 0 0 ANITA MCINTYRE MD TRUSTEE 2.00 6.00 X 0 0 0 KELLY NELSON CPA TRUSTEE 2.00 6.00 X 0 0 0 RONALD REIMER IMMEDIATE PAST CHAIR 2.00 0.00 X 0 0 0 CHRIS RIELAND TRUSTEE 2.00 0.00 X 0 0 0 JOE ROSZAK TRUSTEE 2.00 0.00 X 0 0 0 PETE SCHLICHER TRUSTEE 2.00 0.00 X 0 0 0 JAMES SMALLEY SECRETARY/TREASURER 2.00 0.00 X X 0 0 0 RICK TIFT TRUSTEE 2.00 2.00 X 0 0 0 2947119 9431958 487713 342 1 1 0 BALFOUR BEATTY CONSTRUCTION 415 1ST AVE N STE 400 SEATTLE WA 98109 CONSTRUCTION SERVICES 60560922 RUSH COMMERCIAL CONSTRUCTION 6622 WOLLOCHET DR GIG HARBOR WA 98335 CONSTRUCTION SERVICES 23736980 SELLEN CONSTRUCTION COMPANY IN 227 WESTLAKE AVENUE NORTH SEATTLE WA 98109 GENERAL CONTRACTOR 11190895 HEALTHTRUST WORKFORCE SOL LLC PO BOX 742697 ATLANTA ATLANTA GA 30374 STAFFING SERVICES 10339107 GE PRECISION HEALTHCARE LLC 3000 N GRANDVIEW BLVD WAUKESHA WI 53188 IT SERVICES 8863016 61 1479547 11720519 582309 13782375 NET PATIENT SERVICES 900099 600980863 600980863 0 0 600980863 5008966 75950 4933016 222636 0 222636 222636 222636 26161654 200000 0 0 26161654 200000 26361654 26361654 CAFETERIA 722100 1049410 0 0 1049410 LABORATORY SERVICES 621500 192618 0 169393 23225 GIFT SHOP 453220 82932 0 0 82932 244302 244302 1569262 647925756 600980863 245343 32917175 X 120000 120000 1710908 1710908 140445614 122608401 17837213 7994730 6833947 1160783 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RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 36064 0 0 0 36064 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $4,526 WASHINGTON STATE HOSPITAL ASSOCIATION - $31,538 6695719 6695719 107712331 85026411 22685920 15872387 11195808 4676579 119357570 133648670 -14291100 607392580 1197155 606195425 625962543 COMMONSPIRIT HEALTH OPERATING INVESTMENT POOL, LLC 421127688 F 421127688 INTERCOMPANY PAYABLES 73628482 UNCLAIMED PROPERTY 28069 ENVIRONMENTAL REMEDIATION LIABILITY 556398 CURRENT PORTION OF OPERATING LEASE LIABILITY 3313056 LONG-TERM PORTION OF OPERATING LEASE LIABILITY 19481083 ACCRUED CONTINGENT LIABILITIES 1551325 LT PORTION OF FINANCE LEASE LIABILITY 1369123 CURRENT PORTION OF FINANCE LEASE LIABILITY 440615 100368151 X PART X, LINE 2: HARRISON MEDICAL 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 2758414 2758414 0.00500 90930757 55700871 35229886 0.06390 93689171 55700871 37988300 0.06890 7 4704 375737 375737 0.00070 2 369 289523 289523 0.00050 3 51399 38048 38048 0.00010 12 56472 703308 703308 0.00130 12 56472 94392479 55700871 38691608 0.07020 1 40 3429 3429 0.00000 1 6 238 238 0.00000 2 46 3667 3667 0.00000 1 9955191 144967086 205256135 -60289049 X 1 1 2 1 HARRISON MEDICAL CENTER 2520 CHERRY AVENUE BREMERTON WA 98310 HTTPS://WWW.CHIFRANCISCAN.ORG/HARRISON HAC.FS.00000142 X X X RURAL HEALTHCARE CLINIC A 2 HARRISON MEDICAL CENTER 1800 NW MYHRE ROAD SILVERDALE WA 98383 HTTPS://WWW.CHIFRANCISCAN.ORG/HARRISON HAC.FS.00000142 X X X RURAL HEALTHCARE CLINIC A HARRISON MEDICAL CENTER 0 0 1 X X X X X X X X X 19 1 0 1 1 X SEE SCHEDULE H SUPPLEMENTAL INFO X 1 19 1 WWW.CHIFRANCISCAN.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML 0 1 X 300.000000000000 300.000000000000 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 1 X 0 0 SCHEDULE H, PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE CHNA ARE A PRIORITIZED DESCRIPTION OF THE HEALTH NEEDS OF THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 5: HARRISON MEDICAL CENTER DBA ST MICHAEL MEDICAL CENTER IS PART OF THE KITSAP COMMUNITY HEALTH PRIORITIES (KCHP) STEERING COMMITTEE, WHICH PRODUCED THE JOINT CHNA. KCHP CONDUCTED A COMMUNITY SURVEY WITH 1,173 RESPONSES. 10 KEY INFORMANT INTERVIEWS WERE CONDUCTED. OUTREACH TO VULNERABLE POPULATIONS WAS CONDUCTED THROUGH PARTNER ORGANIZATIONS. 145 PAPER SURVEYS WERE COMPLETED AND ANALYZED ALONG WITH THE ONLINE SURVEY AND KEY INFORMANT INTERVIEWS. SCHEDULE H, PART V, SECTION B, LINE 6B: THE KCHP STEERING COMMITTEE MEMBERS INCLUDE: CHI FRANCISCAN, HOLLY RIDGE CENTER, KAISER PERMANENTE, KITSAP COMMUNITY FOUNDATION, KITSAP COMMUNITY RESOURCES, KITSAP COUNTY, KITSAP MENTAL HEALTH SERVICES, KITSAP PUBLIC HEALTH DISTRICT, OLYMPIC EDUCATIONAL SERVICE DISTRICT, PENINSULA COMMUNITY HEALTH SERVICES, SUQUAMISH TRIBE, AND UNITED WAY OF KITSAP COUNTY. SCHEDULE H, PART V, SECTION B, LINE 7A: HTTPS:///WWW.CHIFRANCISCAN.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML SCHEDULE H, PART V, SECTION B, LINE 11: PRIORITY HEALTH NEEDS FROM THE CHNA INCLUDE: AFFORDABLE HOUSING, HEALTH CARE ACCESS, OBESITY/HEALTHY EATING/ACTIVE LIVING, SUBSTANCE USE, AND WELL-BEING. HEALTH CARE ACCESS: CHI FRANCISCAN PROVIDES FINANCIAL SUPPORT AND DONATED CARE TO PROJECT ACCESS NORTHWEST IN KITSAP COUNTY, WHICH HELPS PROVIDE CARE TO UNINSURED AND UNDER-INSURED RESIDENTS. A FAMILY RESIDENCY PROGRAM WAS STARTED IN KITSAP COUNTY, WHICH HELPS TRAIN NEW PHYSICIANS IN THE COMMUNITY. CHI FRANCISCAN PROVIDES SUPPORT TO LOW-INCOME PATIENTS NEEDING LONG TERM SUPPORT PROGRAMS, TRANSPORTATION, MEDICAL EQUIPMENT, MEDICATION AND OTHER NEEDS. THE HEALTH SYSTEM SUPPORTS MEDICAL RESPITE PROGRAMS FOR PATIENTS WHO ARE EXPERIENCING HOMELESSNESS OR CANNOT RECUPERATE AT HOME. ALL CHI FRANCISCAN FACILITIES OPERATED COVID-19 VACCINE CLINICS ON SITE AND PARTNERED WITH COMMUNITY ORGANIZATIONS TO BRING VACCINES TO VULNERABLE COMMUNITY MEMBERS. BEHAVIORAL HEALTH: ST. MICHAEL COMBINED THE SUBSTANCE USE AND WELL-BEING CATEGORIES INTO A BEHAVIORAL HEALTH PRIORITY. THE HOSPITAL IS IMPLEMENTING AN EVIDENCE-BASED PROGRAM TO INCREASE CAPACITY FOR SERVICES. ST. MICHAEL MEDICAL CENTER IS PARTNERING WITH KITSAP MENTAL HEALTH ON SEVERAL PROJECTS AND COMMITTING FINANCIAL AND STAFF RESOURCES TO INCREASING CAPACITY FOR BEHAVIORAL HEALTH TREATMENT. OBESITY/HEALTHY EATING/ACTIVE LIVING: THE FAMILY RESIDENCY PROGRAM AT ST. MICHAEL MEDICAL CENTER IS ADDRESSING OBESITY AND DIABETES THROUGH EDUCATION AND PROVIDING SERVICES AT A LOCAL FOOD BANK. CHI FRANCISCAN SUPPORTS SEVERAL EDUCATION CLASSES AROUND HEALTHY EATING, ESPECIALLY FOR THOSE LIVING WITH DIABETES.VIOLENCE PREVENTION: ST MICHAEL MEDICAL CENTER OPERATES A SEXUAL ASSAULT NURSE EXAMINER PROGRAM. THE HOSPITAL ALSO PROVIDES STAFF TIME AND FINANCIAL SUPPORT TO NON-PROFIT PROGRAMS THAT ADDRESS SEXUAL ASSAULT AND HUMAN TRAFFICKING. WHILE ST MICHAEL WILL ADDRESS THE HEALTH NEEDS OF THOSE EXPERIENCING HOMELESSNESS, THE HOSPITAL WILL NOT ADDRESS AFFORDABLE HOUSING DIRECTLY DUE TO A LACK OF RESOURCES AND EXPERTISE. SCHEDULE H, PART V, SECTION B, LINE 13H: 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. PATIENT COOPERATION STANDARDS SHALL ONLY APPLY TO THE EXTENT THEY WILL:1) ALLOW THE HOSPITAL FACILITY TO PURSUE REIMBURSEMENT FROM ANY THIRD-PARTY COVERAGE THAT MAY BE IDENTIFIED TO THE HOSPITAL FACILITY, IN ACCORDANCE WITH WAC 246-453-020(1);2) ALLOW THE HOSPITAL FACILITY TO MAKE EVERY REASONABLE EFFORT TO DETERMINE THE EXISTENCE OR NONEXISTENCE OF THIRD-PARTY SPONSORSHIP THAT MIGHT COVER IN FULL OR IN PART THE CHARGES FOR SERVICES PROVIDED TO EACH PATIENT, IN ACCORDANCE WITH WAC 246-453-020(4); AND3) NOT IMPOSE APPLICATION PROCEDURES FOR CHARITY CARE SPONSORSHIP WHICH PLACE AN UNREASONABLE BURDEN UPON THE RESPONSIBLE PARTY, TAKING INTO ACCOUNT ANY PHYSICAL, MENTAL, INTELLECTUAL, OR SENSORY DEFICIENCIES OR LANGUAGE BARRIERS WHICH MAY HINDER THE RESPONSIBLE PARTY'S CAPABILITY OF COMPLYING WITH THE APPLICATION PROCEDURES, IN ACCORDANCE WITH WAC 246-453-020(5). SCHEDULE H, PART V, SECTION B, LINE 16A: WWW.CHIFRANCISCAN.ORG/BILLING-INSURANCE-AND-FINANCES/FINANCIAL-ASSISTANCE-DISCOUNTS-FOR-PATIENTS SCHEDULE H, PART V, SECTION B, LINE 16B: WWW.CHIFRANCISCAN.ORG/BILLING-INSURANCE-AND-FINANCES/FINANCIAL-ASSISTANCE-DISCOUNTS-FOR-PATIENTS SCHEDULE H, PART V, SECTION B, LINE 16C: WWW.CHIFRANCISCAN.ORG/BILLING-INSURANCE-AND-FINANCES/FINANCIAL-ASSISTANCE-DISCOUNTS-FOR-PATIENTS 7 1 - OLYMPIC PROFESSIONAL BUILDING 2600 CHERRY AVENUE SUITE 203 BREMERTON WA 98310 IV OPTIMUM CLINIC 2 - HARRISON HOME HEALTH 4205 WHEATON WAY SUITE A BREMERTON WA 98310 HOME HEALTH SERVICES 3 - HARRISON BELFAIR URGENT & PRIMARY CARE 21 NE ROMANCE HILL ROAD BELFAIR WA 98528 PRIMARY & URGENT CARE 4 - HARRISON PORT ORCHARD URGENTPRIMARY CAR 450 S KITSAP BLVD PORT OCHARD WA 98366 PRIMARY & URGENT CARE 5 - HARRISON HEALTH AND WELLNESS 3909 NW RANDALL WAY SUITE 201 SILVERDALE WA 98383 CARDIOPULMONARY REHAB, OUTPATIENT REHAB, NUTRITION COUNSELING, MASSAGE 6 - HARRISON WOUND CARE 742 LEBO BLVD SUITE A BREMERTON WA 98310 WOUND CARE, HYPERARIC MEDICINE & INFUSION CENTER 7 - HARLOW MEDICAL BUILDING 1780 NW MYHRE RD SILVERDALE WA 98383 HOSPITAL PHARM, PED REHAB CLINIC, HOSPITAL LAB, BREAST CARE, GEN SURGERY 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:* NO MINIMUM ACCOUNT BALANCE SHALL BE REQUIRED FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE.* 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] TO THE EXTENT THEY WILL:1) ALLOW THE HOSPITAL FACILITY TO PURSUE REIMBURSEMENT FROM ANY THIRD-PARTY COVERAGE THAT MAY BE IDENTIFIED TO THE HOSPITAL FACILITY, IN ACCORDANCE WITH WAC 246-453-020(1);2) ALLOW THE HOSPITAL FACILITY TO MAKE EVERY REASONABLE EFFORT TO DETERMINE THE EXISTENCE OR NONEXISTENCE OF THIRD-PARTY SPONSORSHIP THAT MIGHT COVER IN FULL OR IN PART THE CHARGES FOR SERVICES PROVIDED TO EACH PATIENT, IN ACCORDANCE WITH WAC 246-453-020(4); AND3) NOT IMPOSE APPLICATION PROCEDURES FOR CHARITY CARE SPONSORSHIP WHICH PLACE AN UNREASONABLE BURDEN UPON THE RESPONSIBLE PARTY, TAKING INTO ACCOUNT ANY PHYSICAL, MENTAL, INTELLECTUAL, OR SENSORY DEFICIENCIES OR LANGUAGE BARRIERS WHICH MAY HINDER THE RESPONSIBLE PARTY'S CAPABILITY OF COMPLYING WITH THE APPLICATION PROCEDURES, IN ACCORDANCE WITH WAC 246-453-020(5).* 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.IN THE EVENT THE RESPONSIBLE PARTY'S IDENTIFICATION AS AN INDIGENT PERSON IS OBVIOUS TO HOSPITAL FACILITY PERSONNEL, AND THE HOSPITAL FACILITY PERSONNEL ARE ABLE TO ESTABLISH THE POSITION OF THE INCOME LEVEL WITHIN THE BROAD CRITERIA DESCRIBED IN WAC 246-453-040, BASED ON THE INDIVIDUAL LIFE CIRCUMSTANCES CONTAINED WITHIN POLICY 15 OR OTHERWISE, THE HOSPITAL FACILITY IS NOT OBLIGATED TO ESTABLISH THE EXACT INCOME LEVEL OR TO REQUEST DOCUMENTATION FROM THE RESPONSIBLE PARTY, UNLESS THE RESPONSIBLE PARTY REQUESTS FURTHER REVIEW.HOSPITAL FACILITIES SHALL MAKE EVERY REASONABLE EFFORT TO REACH INITIAL AND FINAL DETERMINATIONS OF ELIGIBILITY FOR FINANCIAL ASSISTANCE IN A TIMELY MANNER. NEVERTHELESS, HOSPITAL FACILITIES SHALL MAKE THOSE DETERMINATIONS AT ANY TIME, EVEN AFTER THE APPLICATION PERIOD, UPON LEARNING OF FACTS OR RECEIVING THE DOCUMENTATION DESCRIBED HEREIN, INDICATING THAT THE RESPONSIBLE PARTY'S INCOME IS EQUAL TO OR BELOW TWO HUNDRED PERCENT (200%) OF THE FEDERAL POVERTY GUIDELINES AS ADJUSTED FOR FAMILY SIZE. PART I, LINE 7: WORKSHEET 2 WAS UTILIZED TO COMPUTE THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/21 USING THE FOLLOWING FORMULA: OPERATING EXPENSE (LESS NON-PATIENT CARE ACTIVITIES, MEDICARE PROVIDER TAXES, COMMUNITY BENEFIT EXPENSE AND COMMUNITY BUILDING EXPENSE) DIVIDED BY GROSS PATIENT REVENUE (LESS GROSS CHARGES FOR COMMUNITY BENEFIT PROGRAMS).BASED ON THAT FORMULA, 538,842,711/$2,723,971,465 RESULTS IN A 19.78% 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 19.78 %. 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: HARRISON MEDICAL 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: HARRISON MEDICAL 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 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. HARRISON MEDICAL CENTER 'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $60,289,049 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: CHI FRANCISCAN USES THE CHNA DOCUMENTS FOR EACH OF OUR REGIONS AS THE MAIN WAY WE ASSESS HEALTH CARE NEEDS. 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: ST MICHAEL MEDICAL CENTER IS LOCATED IN AND SERVES KITSAP COUNTY, AN AREA THAT INCLUDES AROUND 270,100 RESIDENTS. POPULATION - APPROXIMATELY 270,100 PEOPLE LIVE IN THE ST MICHAEL MEDICAL CENTER PRIMARY SERVICE AREA: AN INCREASE OF 16% SINCE THE YEAR 2000. AGE- KITSAP COUNTY'S POPULATION HAS BEEN SLOWLY SHIFTING FROM THE MAJORITY BEING AGE 35-49 IN 2000 TO THE MAJORITY BEING OVER 55 TO 69 IN 2018. ALTHOUGH IN GENERAL THE CHILD POPULATION HAS BEEN DECREASING, 2018 SAW A SLIGHT INCREASE IN THOSE AGES 0-4 COMPARED TO 2000.RACE AND ETHNICITY -THE MAJORITY OF THE POPULATION IN KITSAP COUNTY IS NON-HISPANIC WHITE (76%), BUT ALL MINORITY RACE POPULATIONS HAVE BEEN INCREASING AS PROPORTIONS OF THE POPULATION FROM 2005 TO 2018, EXCEPT FOR NON-HISPANIC AMERICAN INDIAN AND ALASKA NATIVE POPULATIONS. BREMERTON AND CENTRAL KITSAP ARE THE MOST DIVERSE AREAS OF THE COUNTY, AND YOUNGER AGE GROUPS ARE MORE DIVERSE THAN OLDER AGE GROUPS.POVERTY - IN 2017, APPROXIMATELY 8% OF KITSAP'S POPULATION LIVED BELOW THE POVERTY LEVEL, UNCHANGED SINCE 2005 AND LOWER THAN THE STATE'S RATE OF 11%. BREMERTON HAS A MUCH HIGHER PERCENTAGE THAN OTHER AREAS, FOLLOWED BY SOUTH KITSAP. NON-HISPANIC BLACK RESIDENTS AND NON-HISPANIC AMERICAN INDIAN/ALASKA NATIVE RESIDENTS HAVE MUCH HIGHER PERCENTAGES THAN OTHER RACES AND ETHNICITIES. THOSE AGE 0 TO 4 YEARS, THOSE WITH LOWER EDUCATION AND FEMALES ALL HAVE HIGHER PERCENTAGES LIVING IN POVERTY THAN THEIR COUNTERPARTS. PART VI, LINE 5: CHI FRANCISCAN SPONSORS SUPPORT GROUPS AROUND GRIEF, HEART FAILURE, STROKE, CANCER, SUBSTANCE USE RECOVERY, AND MORE AT ALL OF THE FACILITIES IN THIS REPORT. CHI FRANCISCAN PROVIDES SIGNIFICANT FINANCIAL CONTRIBUTIONS TO NON-PROFIT ORGANIZATIONS IN OUR COMMUNITY THAT PROMOTE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. THIS INCLUDES MAJOR PARTICIPATION AND SPONSORSHIP IN THE AMERICAN HEART ASSOCIATION, SUSAN G KOMEN RACE FOR THE CURE, RELAY FOR LIFE AND MORE. ALL CHI FRANCISCAN FACILITIES PARTICIPATE IN AND CONTRIBUTE TO OUR LOCAL UNITED WAY AFFILIATES TO ACHIEVE THEIR GOAL OF SUPPORTING RESIDENTS. 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 WA 1 GIG HARBOR FAMILY YMCA 10550 HARBOR HILL DR GIG HARBOR WA 98332 910565562 501(C)3 90000 GENERAL SUPPORT PROJECT ACCESS NORTHWEST 1111 HARVARD AVE SEATTLE WA 98122 204377921 501(C)3 30000 GENERAL SUPPORT 2 PART I, LINE 2: WHEN CONSIDERING FINANCIAL DONATIONS TO OTHER ORGANIZATIONS, HARRISON MEDICAL CENTER FOCUSES ON THREE AREAS: HEALTH AND WELLNESS PROGRAMS THAT ENHANCE OPPORTUNITIES FOR FAMILIES IN KITSAP COUNTY; SPORTS PROGRAMS THAT SUPPORT HEALTHY, ACTIVE LIFESTYLES; AND BUSINESS DEVELOPMENT OPPORTUNITIES THAT EXPAND THE WELLNESS COMPONENT OF OUR SERVICES. WE BELIEVE OUR EMPLOYEES ARE THE BEST RESOURCE WE CAN OFFER OUR COMMUNITIES AND THEREFORE WE ALSO SUPPORT ORGANIZATIONS IN WHICH THEY ARE ACTIVE VOLUNTEERS. X X X X X 0 1 0 0 0 0 0 0 0 SATYAVARDHAN PULUKURTHY PHYSICIAN 0 1382383 0 159825 0 1308 0 16975 0 12511 0 1573002 0 0 NATHAN SEGERSON PHYSICIAN 0 1280337 0 185120 0 1308 0 16975 0 6611 0 1490351 0 0 R KING PHYSICIAN 0 1118081 0 0 0 23036 0 36975 0 9253 0 1187345 0 0 MANAS JAIN PHYSICIAN 0 1113877 0 0 0 872 0 15945 0 2597 0 1133291 0 0 DAVID SCHULTZ PRESIDENT 624202 0 296471 0 123451 0 18466 0 27279 0 1089869 0 47402 0 MIKE FITZGERALD CFO FHS (THROUGH 6/2/21) 0 623680 0 293110 0 67225 0 16885 0 20337 0 1021237 0 0 JAMES CLEMEN GENERAL SURGEON 0 837873 0 0 0 11078 0 16424 0 9433 0 874808 0 0 JACOB MATHEW HEMATOLOGIST-ONCOLOGIST 0 740409 0 0 0 872 0 16800 0 9253 0 767334 0 0 MICHAEL ANDERSON CHIEF MEDICAL OFFICER 0 564747 0 142726 0 7834 0 16975 0 19861 0 752143 0 0 GRIFFITH BLACKMON MD CHIEF OF STAFF 0 467150 0 0 0 3438 0 18025 0 7513 0 496126 0 0 DAVID WEISS MKT VP MEDICAL OPERATIONS 0 356127 0 45450 0 4092 0 16975 0 2313 0 424957 0 0 MATTHEW WHEELUS COO 265096 0 34724 0 1584 0 9724 0 29428 0 340556 0 0 0 JEANELL RASMUSSEN SVP & CNO 262590 0 33903 0 3865 0 16210 0 12856 0 329424 0 0 0 RONALD DOMMERMUTH PHYSICIAN-FAM MED (WITH OB) 260106 0 0 0 3526 0 15747 0 6819 0 286198 0 0 0 ERIK SCHWEITZER PHYSICIAN-FAM MED (WITHOUT OB) 253047 0 0 0 8110 0 15088 0 3746 0 279991 0 0 0 LESLIE WALDMAN PHYSICIAN-FAM MED (WITH OB) 250515 0 0 0 1884 0 14462 0 8844 0 275705 0 0 0 PETER LUNDBLAD PHYSICIAN-FAM MED (WITHOUT OB) 255530 0 0 0 1153 0 15059 0 1332 0 273074 0 0 0 AMANDA WOLF PHYSICIAN-FAM MED (WITH OB) 253575 0 0 0 13787 0 2863 0 1154 0 271379 0 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. DURING 2020 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: DAVID SCHULTZ - $53,481. 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. INCLUDE IF APPLICABLE: DURING 2020, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: MIKE FITZGERALD, $59,391; DAVID SCHULTZ - $65,812. DURING THE 2020 CALENDAR YEAR, HARRISON MEDICAL CENTER MAINTAINED A SUPPLEMENTAL, NON QUALIFIED DEFERRED COMPENSATION PLAN. DURING 2020 THE FOLLOWING DISTRIBUTIONS WERE MADE BY HARRISON MEDICAL CENTER FROM THE DEFERRED COMPENSATION PLAN: ROBERT KING - $20,095 ALEXANDRA MCLAUGHLIN FAMILY MEMBER OF BOARD MEMBER 145170 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 1 PURSUANT TO SECTION 7.5 OF THE BYLAWS OF HARRISON MEDICAL CENTER, THE EXECUTIVE COMMITTEE IS COMPOSED OF CHAIRPERSON OF THE BOARD OF DIRECTORS AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND SUCH OTHER MEMBERS AS THE BOARD OF DIRECTORS MAY APPOINT. 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 7.1 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 7.5 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 4 HARRISON MEDICAL CENTER AMENDED THE BYLAWS TO ENACT THE FOLLOWING CHANGES: ARTICLE II, SECTION 2.2 - ADD A MISSION STATEMENT ARTICLE IV, SECTION 5.1 MODIFY THE RESPONSIBILITIES OF THE GOVERNING BOARD ARTICLE IV, SECTION 5.2 - MODIFY COMPOSITION OF THE GOVERNING BOARD AND REVISE THE NUMBER OF GOVERNING BOARD MEMBERS ARTICLE IV, SECTION 5.5 MODIFY WHO HAS THE POWER TO APPOINT MEMBERS OF THE GOVERNING BOARD ARTICLE VI, SECTION 6.1 REMOVE CHIEF EXECUTIVE OFFICER TITLE AS AN OFFICER OF THE CORPORATION FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF HARRISON MEDICAL CENTER IS FRANCISCAN HEALTH VENTURES (FORMERLY SJM GROUP). FORM 990, PART VI, SECTION A, LINE 7A PER SECTION 5.5 OF THE BY-LAWS, THE CORPORATE MEMBER HAS THE POWER TO APPOINT TWO PERSONS TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS FRANCISCAN HEALTH VENTURES (FORMERLY SJM GROUP). PURSUANT TO SECTION 4.4.3 OF THE ORGANIZATION'S BYLAWS, BOTH FRANCISCAN HEALTH VENTURES AND COMMONSPIRIT HEALTH (FRANCISCAN HEALTH VENTURES'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE COMMONSPIRIT HEALTH GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE FRANCISCAN HEALTH VENTURES BOARD: *APPROVE MEMBERS OF THE HARRISON MEDICAL CENTER BOARD *AMENDMENT OF THE CORPORATE DOCUMENTS OF THE HARRISON MEDICAL CENTER *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE HARRISON MEDICAL CENTER *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE HARRISON MEDICAL CENTER 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 HARRISON MEDICAL CENTER *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE HARRISON MEDICAL CENTER *APPROVAL OF ISSUANCE OF DEBT BY HARRISON MEDICAL CENTER *APPROVAL OF PARTICIPATION OF HARRISON MEDICAL CENTER IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY HARRISON MEDICAL CENTER *APPROVAL OF A MERGER INVOLVING THE HARRISON MEDICAL CENTER *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE HARRISON MEDICAL CENTER *TO REQUIRE THE TRANSFER OF ASSETS BY THE [NAME OF SUBSIDIARY] TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS. PURSUANT TO SECTION 4.4.3 OF THE ORGANIZATION'S BYLAWS, FRANCISCAN HEALTH VENTURES OR COMMONSPIRIT HEALTH MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE 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 THE FORM 990 IS REVIEWED BY THE DIRECTOR OF FINANCE AND THE CHIEF FINANCIAL OFFICER TO ENSURE ACCURACY AND COMPLETENESS OF DATA. ONCE THEIR REVIEW IS COMPLETE, THE FORM 990 IS SHARED WITH THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS RECEIVES AN ELECTRONIC COPY OF THE FORM PRIOR TO FILING. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NONSUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RESUBMITTED 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 IS PAID BY HARRISON MEDICAL CENTER. ALL EXECUTIVE COMPENSATION ARRANGEMENTS ARE SUBJECT TO REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS, OR AN AUTHORIZED COMMITTEE OF THE BOARD, IN ACCORDANCE WITH THE EXECUTIVE COMPENSATION REVIEW POLICY. EXECUTIVE COMPENSATION ARRANGEMENTS WITH ANY PHYSICIAN WHO IS A PERSON OF SUBSTANTIAL INFLUENCE ARE NOT SUBJECT TO THIS POLICY, BUT SHALL BE REVIEWED AND APPROVED IN ACCORDANCE WITH THE SYSTEM'S PHYSICIAN TRANSACTION REVIEW POLICY. LINE 15B: ALL EXECUTIVE COMPENSATION ARRANGEMENTS WITH ANY PERSON OF SUBSTANTIAL INFLUENCE ARE SUBJECT TO REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS, OR AN AUTHORIZED COMMITTEE OF THE BOARD, IN ACCORDANCE WITH THE EXECUTIVE COMPENSATION REVIEW POLICY. EXECUTIVE COMPENSATION ARRANGEMENTS WITH ANY PHYSICIAN WHO IS A PERSON OF SUBSTANTIAL INFLUENCE ARE NOT SUBJECT TO THIS POLICY, BUT SHALL BE REVIEWED AND APPROVED IN ACCORDANCE WITH THE SYSTEM'S PHYSICIAN TRANSACTION REVIEW POLICY. 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 OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 18,464,913. MANAGEMENT AND GENERAL EXPENSES 971,837. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,436,750. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 14,384,499. MANAGEMENT AND GENERAL EXPENSES 1,598,278. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,982,777. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 32,471,321. MANAGEMENT AND GENERAL EXPENSES 1,709,017. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,180,338. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 62,344,954. MANAGEMENT AND GENERAL EXPENSES 3,281,313. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,626,267. FORM 990, PART XI, LINE 9: PENSION ADJUSTMENT 3,054,765. CAPITAL CONTRIBUTION FROM AFFILIATE 5,659,097. CENTRALIZED TRANSACTIONS -6,381,979. 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. FORM 990, PAGE 1, ITEM J HTTPS://WWW.VMFH.ORG/OUR-HOSPITALS/ST-MICHAEL-MEDICAL-CENTER 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 237419853 HOLDING CO OH 501(C)(4) GSH 0 COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY IA 51555 421294399 FUNDRAISING FOUNDATION IA 501(C)(3) LINE 12A, I AH-CMHMV 0 CONTINUING CARE HOSPITAL ONE SAINT JOSEPH DRIVE LEXINGTON KY 40504 611400619 HOSPITAL KY 501(C)(3) LINE 3 SJHS 0 DIGNITY COMMUNITY CARE 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 815009488 HOSPITAL CO 501(C)(3) LINE 3 CSH 0 DIGNITY HEALTH 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 941196203 HOSPITAL CA 501(C)(3) LINE 3 CSH 0 DIGNITY HEALTH CONNECTED LIVING 200 MERCY OAKS DRIVE REDDING CA 96003 237115371 SENIOR CENTER SERVICES CA 501(C)(3) LINE 7 DH 0 DIGNITY HEALTH FOUNDATION 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 462037641 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH FOUNDATION - INLAND EMPIRE 2101 N WATERMAN AVENUE SAN BERNARDINO CA 92404 237440086 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH FOUNDATION EAST VALLEY 475 SOUTH DOBSON ROAD CHANDLER AZ 85224 742418514 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH 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 DRIVE SANTA CRUZ CA 95065 770127719 OPERATION AND MANAGEMENT OF HOUSING COMPLEX TO ELDERLY PERSONS CA 501(C)(3) LINE 10 DHS 0 EAST TEXAS CLINICAL SERVICES 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 1145 BROADWAY TACOMA WA 98402 431882377 INACTIVE MO 501(C)(3) LINE 10 CSH 0 FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA WA 98402 911939739 PHYSICIANS WA 501(C)(3) LINE 10 FHS 0 FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE WI 53172 391093829 INACTIVE WI 501(C)(3) LINE 10 CSH 0 FRENCH HOSPITAL MEDICAL CENTER FOUNDATION 1911 JOHNSON AVENUE SAN LUIS OBISPO CA 93401 203256125 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DCC 0 GARRISON MEMORIAL HOSPITAL 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 450227752 HOSPITAL ND 501(C)(3) LINE 3 SAMC 0 GLENDALE MEMORIAL HEALTH FOUNDATION 1420 SOUTH CENTRAL AVENUE GLENDALE CA 91204 953625651 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DCC 0 GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 201536108 INACTIVE CO 501(C)(3) LINE 12A, I CSH 0 GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311778403 EDUCATION OH 501(C)(3) LINE 2 GSH 0 GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 311206047 FUNDRAISING FOUNDATION OH 501(C)(3) LINE 12A, I GSH 0 GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY NE 68847 470659443 FUNDRAISING FOUNDATION NE 501(C)(3) LINE 7 GSH-KN 0 HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON WA 98310 910565546 HOSPITAL WA 501(C)(3) LINE 3 FHS 0 HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVE BREMERTON WA 98310 911197626 FUNDRAISING FOUNDATION WA 501(C)(3) LINE 7 HMC 1 HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 760761782 FUNDRAISING FOUNDATION MN 501(C)(3) LINE 12A, I SFMC-MN 0 HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN WA 98166 910712166 HOSPITAL WA 501(C)(3) LINE 3 FHS 0 HOUSE OF MERCY 1111 6TH AVE DES MOINES IA 50314 421323808 ASSIST LIVING IA 501(C)(3) LINE 7 CHI-IA CORP 0 JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC ONE SAINT JOSEPH DRIVE LEXINGTON KY 40504 611029768 HOSPITAL KY 501(C)(3) LINE 3 KOH 0 KENTUCKYONE HEALTH MEDICAL GROUP INC 100 E LIBERTY ST STE 800 LOUISVILLE KY 40202 611352729 PHYSICIANS KY 501(C)(3) LINE 10 JHSMH 0 KENTUCKYONE HEALTH INC ONE SAINT JOSEPH DRIVE LEXINGTON KY 40504 611029769 HEALTHCARE KY 501(C)(3) LINE 12A, I CSH 0 LAKEWOOD HEALTH CENTER 600 MAIN AVE S BAUDETTE MN 56623 410758434 HOSPITAL MN 501(C)(3) LINE 3 CSH 0 LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVE S BAUDETTE MN 56623 411893795 FUNDRAISING FOUNDATION ND 501(C)(3) LINE 7 LHC 0 LEGACY FOUNDATION OF KENTUCKIANA INC 1451 HARRODSBURG RD STE D-308 LEXINGTON KY 40504 832170324 FUNDRAISING FOUNDATION KY 501(C)(3) LINE 12A, I KOH 0 LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON ND 58054 820558836 HOSPITAL ND 501(C)(3) LINE 3 CSH 0 LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN TX 75901 820563768 PROPERTY MGMT TX 501(C)(3) LINE 12A, I MHSET 0 MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742761145 HOSPITAL TX 501(C)(3) LINE 3 SJSC 0 MADONNA MANOR INC 2344 AMSTERDAM ROAD VILLA HILLS KY 51017 610654635 ASSIST LIVING KY 501(C)(3) LINE 10 CHILC 0 MARIAN REGIONAL MEDICAL CENTER FOUNDATION 1400 E CHURCH STREET SANTA MARIA CA 93454 953818027 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 MARK TWAIN MEDICAL CENTER 768 MOUNTAIN RANCH ROAD SAN ANDREAS CA 95249 680127677 HOSPITAL CA 501(C)(3) LINE 3 DCC 0 MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA TN 37404 621839548 FUNDRAISING FOUNDATION TN 501(C)(3) LINE 7 MHCS 0 MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA TN 37404 620532345 HOSPITAL TN 501(C)(3) LINE 3 CSH 0 MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA TN 37411 030417049 HEALTHCARE TN 501(C)(3) LINE 10 MHCS 0 MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN TX 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