2022-04-30T23:45:03-05:00 2021-06-30 135565207 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2020-07-01 941156295 SAINT FRANCIS MEMORIAL HOSPITAL SAIN 4153536600 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 CHARLES THEVNIN CFO 4153536635 2022-04-30 1 CHARLES THEVNIN JAMES LANCASTER P00742579 4159635100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CHARLES THEVNIN 900 HYDE STREET SAN FRANCISCO CA 94109 211676871 0 X WWW.DIGNITYHEALTH.ORG/SAINTFRANCIS X 1938 CA AS AN AFFILIATE OF COMMONSPIRIT HEALTH ("COMMONSPIRIT"), SFMH IS COMMITTED TO IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL. 20 16 1093 78 50649 0 14879032 13513988 197524549 195282147 7445028 688487 1709875 2153744 221558484 211638366 5054748 2968783 0 0 129681405 135905501 0 0 0 110005438 110075902 244741591 248950186 -23183107 -37311820 329731857 317451684 88349690 91880348 241382167 225571336 X SAINT FRANCIS MEMORIAL HOSPITAL ("SFMH") IS COMMITED TO PROVIDING COMPASSIONATE, HIGH-QUALITY, AFFORDABLE HEALTH SERVICES FOR OUR SISTERS AND BROTHERS WHO ARE POOR AND DISENFRANCHISED; AND PARTNERING WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE 0 0 216760993 2968783 195282147 SFMH'S MISSION IS TO CONTRIBUTE TO THE HEALTH OF THE COMMUNITY THROUGH THE PROVISIONS OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST EFFECTIVE MANNER. THE HOSPITAL HAS 294 BEDS AND SERVICED PATIENTS AS FOLLOWS: OUTPATIENT VISITS OF 61,887; EMERGENCY VISITS OF 19,890; INPATIENT AND OUTPATIENT OPERATING ROOM CASES OF 2,641.INPATIENT SERVICES: ACUTE MEDICAL SURGICAL CARE AND REHAB, INTENSIVE AND BURN CARE, ADULT PSYCH, PHARMACY, CARDIOPULMONARY, SURGERY AND TELEMETRY UNIT, GENDER AFFIRMATION SERVICES. OUTPATIENT SERVICES: EMERGENCY CARE, SPORTS MEDICINE AND OCCUPATIONAL HEALTH CLINICS, PULMONARY REHAB, OUTPATIENT BURN CARE, SPINE AND JOINT/PAIN/MS CLINIC, DIAGNOSTIC IMAGING, RADIATION ONCOLOGY, GASTROINTESTINAL SERVICES AND PHYSICAL THERAPY SERVICES, HYPERBARIC OXYGEN CLINIC. SUPPORT SERVICES: CHAPLAINCY PROGRAM, FAMILY SUPPORT SERVICES, PALLIATIVE CARE, PARKING SERVICES, NURSING EDUCATION SERVICES, HEALTH SCIENCES LIBRARY; AS WELL AS SUPPORT, TIME AND MONEY TO ORGANIZATIONS AND INDIVIDUALS THROUGHOUT THE COMMUNITY. 216760993 1 1 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 118 0 1 1093 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 20 16 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 1 1 CA X LARA CARTOSCELLI ACCOUNTING DEPT 9166313334 3400 DATA DRIVE RANCHO CORDOVA CA 95670 X DANIEL J MORISSETTE CPA BOARD MEMBER 3.00 50.00 X 0 3318389 416464 TODD A STRUMWASSER MD BOARD MEMBER 3.00 50.00 X 0 1761287 127026 TRACEY PIERCE FORMER KEY EMPLOYEE 0.00 50.00 X 0 676313 88500 JILL WELTON FORMER KEY EMPLOYEE 0.00 50.00 X 0 644454 88820 DAVID KLEIN MD PRESIDENT & CEO (THRU 8/28/20) 50.00 0.00 X X 0 469328 69834 KECIA M KELLY VP COO/CNO 50.00 0.00 X 399450 0 59881 KATHLEEN JORDAN MD VP CMO (THRU 7/1/20) 50.00 0.00 X 412342 0 45111 CHARLES THEVNIN CFO 25.00 25.00 X 369343 0 52787 BRADLEY GROTE FORMER KEY EMPLOYEE 0.00 50.00 X 0 367181 48445 DARYN KUMAR PRESIDENT & CEO (STARTED 1/3/21) 50.00 0.00 X X 0 352077 42645 DEBORAH CHEW REGISTERED NURSE 50.00 0.00 X 312748 0 79699 YIPI YANG REGISTERED NURSE 50.00 0.00 X 303383 0 77162 JASON L DENNISON VP HUMAN RESOURCES 50.00 0.00 X 341497 0 35501 ALBINA GUERRERO REGISTERED NURSE 50.00 0.00 X 257724 0 98607 ISATOU E NJIE STAFF NURSE II 50.00 0.00 X 274074 0 57155 OSARIEMEN N NOSA-IDAHOSA DIRECTOR OF PHARMACY 50.00 0.00 X 266680 0 28190 CHARLENE BATTAGLIA SENIOR DIRECTOR - NURSING 50.00 0.00 X 255458 0 31410 JEFFREY FEE INTERIM PRESIDENT & CEO (8/24/20 - 1/8/21) 50.00 0.00 X X 0 174000 0 MAN-KIT LEUNG MD BOARD CHAIR 3.00 1.00 X X 6500 0 0 RICHARD WARD MD BOARD MEMBER 3.00 0.50 X 4490 0 0 ROBERT HARVEY MD SECRETARY 3.00 0.00 X X 0 0 0 KIMBERLY MACPHERSON VICE CHAIR 3.00 0.00 X X 0 0 0 N THOMAS AHLBERG MD BOARD MEMBER 3.00 0.00 X 0 0 0 CHARLES CASEY BOARD MEMBER 3.00 0.00 X 0 0 0 MICHAELA CASSIDY BOARD MEMBER 3.00 0.00 X 0 0 0 ROBERT DEVENS BOARD MEMBER 3.00 0.00 X 0 0 0 DARRAGH FLYNN MD BOARD MEMBER 3.00 0.00 X 0 0 0 CLEMENT JONES MD BOARD MEMBER 3.00 0.00 X 0 0 0 KENNETH KIM PHYSD BOARD MEMBER 3.00 0.00 X 0 0 0 JACLYN MCGOWAN MD BOARD MEMBER 3.00 0.00 X 0 0 0 EMILY O'ROURKE MD BOARD MEMBER 3.00 0.00 X 0 0 0 MICHAEL PENN MD BOARD MEMBER 3.00 0.00 X 0 0 0 MICHAEL A TAYLOR MD BOARD MEMBER 3.00 0.00 X 0 0 0 SCOTT TAYLOR BOARD MEMBER 3.00 0.00 X 0 0 0 JOSEPH YANG BOARD MEMBER 3.00 0.00 X 0 0 0 3203689 7763029 1447237 420 1 1 0 MEDICAL SOLUTIONS LLC 1010 N 102ND ST OMAHA NE 68114 STAFFING SERVICES 2514627 SAN FRANCISCO CYBERKNIFE LLC 18201 VON KARMAN AVE IRVINE CA 92612 MEDICAL SERVICES 1760000 CEP AMERICA PSYCHIATRY PC 2100 POWELL ST SUITE 400 EMERYVILLE CA 946081803 MEDICAL/PHYSICIAN SERVICES 1475517 VITUITY HOSPITALISTS PC 2100 POWELL ST EMERYVILLE CA 946081803 MEDICAL/PHYSICIAN SERVICES 1442750 INPATIENT SPECIALISTS OF CALIF PO BOX 742936 LOS ANGELES CA 900742936 MEDICAL/PHYSICIAN SERVICES 1385590 36 5197 11211918 2296873 13513988 PATIENT NET OF CHARITY & BAD DEBT 900099 126546341 126546341 MEDICARE/MEDICAID PAYMENTS 900099 65690486 65690486 MEDICAL OFFICE BUILDING 621110 1943431 1943431 PHYSICIAN PROFESSIONAL FEES REV 900099 699022 699022 RALLY FAMILY VISITATION 446110 145458 145458 257409 257409 195282147 688487 688487 35812 2367 33445 33445 33445 52999 36138 16861 16861 PARKING LOT 812930 936822 936822 REBATES AND REFUND 900099 372888 372888 A/R FINANCE CHARGES 900099 226573 226573 567155 50649 516506 2103438 211638366 195282147 50649 2791582 X 2918183 2918183 50600 50600 1755249 995282 759967 637089 637089 97321133 92075793 5245340 11145461 10532305 613156 17819896 16800581 1019315 7226673 6793073 433600 518080 518080 12338 12338 40352 40352 39712588 27958223 11754365 806587 13826 792761 3992510 3078739 913771 9019323 317653 8701670 4404595 4363635 40960 61636 24141 37495 74775 69343 5432 535984 535984 15531574 15531574 2021294 2021294 MEDICAL SUPPLIES 15642081 15642081 MEDI-CAL PROVIDER FEE 14051785 14051785 LICENSES AND TAXES 1542868 689159 853709 FOOD COSTS & SUPPLIES 808226 690339 117887 1299306 970311 328995 248950186 216760993 32189193 0 4708 4710 26830334 0 224124 176945 34589292 39439063 0 0 0 4221294 5837168 19889307 16929332 164561470 30603701 139776414 133957769 920258 987383 0 89482833 110217694 0 13793293 9901620 329731857 317451684 53877648 72471763 0 10511775 4731 10000000 0 0 0 62558 0 0 13897709 19403854 88349690 91880348 X 151836941 117134477 89545226 108436859 241382167 225571336 329731857 317451684 X -37311820 23005 967104 20510880 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12338 12338 0 PART II-B, LINE 1: LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: AMERICAN HOSPITAL ASSOCIATION $ 4,167 HOSPITAL ASSOCIATION OF SO CAL $ 7,902 340B HEALTH (FORMERLY SAFETY NET HOSPITALS) $ 78 AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES $ 18 AMERICAN PHYSICAL THERAPY ASSOCIATION $173 TOTAL $12,388 45349214 7916876 53266090 45901737 -552523 45349214 46326828 -425091 45901737 42582994 3743834 46326828 39180096 3402898 42582994 0.00000 0.71000 0.29000 1 0 45552900 45552900 88602922 24094242 64508680 26674 12706 13968 15811967 6496753 9315214 14567007 14567007 133957769 UNCONSOLIDATED FOUNDATION 108436859 F OWNERSHP IN HEALTH-RELATED 1780835 C 110217694 OTHER NON-CURRENT LIABILITIES 811730 DUE TO RELATED PARTIES 15913295 PENSION PAYABLE 2678829 19403854 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE INTENDED TO BE USED TO SUPPORT THE HOSPITAL'S HEALTHCARE NEEDS AND OTHER HOSPITAL PROGRAM NEEDS. PART X, LINE 2: THE ORGANIZATION REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 250.000000000000 1 X 500.000000000000 1 1 1 0 1 1 4552 6149891 0 6149891 0.02470 12299 96237465 52646173 43591292 0.17510 61 422278 1478 420800 0.00170 16912 102809634 52647651 50161983 0.20150 11 18239 1872018 555536 1316482 0.00530 7 368 1330436 227253 1103183 0.00440 1 50 355275 0 355275 0.00140 0 0 0 0 3 701 176612 157702 18910 0.00010 22 19358 3734341 940491 2793850 0.01120 22 36270 106543975 53588142 52955833 0.21270 1 4 18500 250 18250 0.00010 1 6 756 0 756 0.00000 2 10 19256 250 19006 0.00010 1 61316 0 31377056 47414948 -16037892 X 1 1 1 1 SAINT FRANCIS MEMORIAL HOSPITAL 900 HYDE ST SAN FRANCISCO CA 94109 WWW.DIGNITYHEALTH.ORG/BAYAREA/LOCATION 220000069 X X X X SAINT FRANCIS MEMORIAL 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 250.000000000000 500.000000000000 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 X 1 X 0 0 SAINT FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: OBTAINED FROM THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, A CO-CONVENOR OF THE ASSESSMENT, AS WELL AS EXTENSIVE COMMUNITY ENGAGEMENT. THE CHNA INCLUDED FOUR CATEGORIES OF FOCUS GROUP: KEY INFORMANT GROUP INTERVIEW, EQUITY COALITION FOCUS GROUPS, FOOD INSECURE PREGNANT WOMEN FOCUS GROUPS, AND KAISER PERMANENTE FOCUS GROUPS. FOCUS GROUPS WERE CONDUCTED WITH EACH OF THE THREE HEALTH EQUITY COALITIONS IN SAN FRANCISCO: THE CHICANO / LATINO / INDIGENA HEALTH EQUITY COALITION, THE ASIAN PACIFIC ISLANDER HEALTHY PARITY COALITION, AND THE AFRICAN AMERICAN HEALTH EQUITY COALITION. THE HOMELESS PRENATAL PROGRAM HELD FOUR FOCUS GROUPS WITH WOMEN WHO EXPERIENCED FOOD INSECURITY WHILE PREGNANT. EACH FOCUS GROUP FOCUSED ON A DIFFERENT GROUP OF WOMEN: SPANISH, CHINESE, MULTI-ETHNIC ENGLISH SPEAKERS, AND AFRICAN AMERICAN. CHNA PARTNER KAISER PERMANENTE CONDUCTED FOUR FOCUS GROUPS, ONE EACH WITH KAISER PERMANENTE LEADERSHIP, KAISER PERMANENTE STAFF, SPANISH-SPEAKING PARENTS ON YOUTH HEALTHY EATING AND ACTIVE LIVING, AND HOMELESS AND/OR HIV POSITIVE YOUTH. SAINT FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: ST. MARY'S MEDICAL CENTER, SUTTER HEALTH CALIFORNIA PACIFIC MEDICAL CENTER, CHINESE HOSPITAL, KAISER PERMANENTE SAN FRANCISCO, UCSF MEDICAL CENTER SAINT FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP MEMBERS INCLUDING: SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE'S COMMUNITY ENGAGEMENT AND HEALTH POLICY PROGRAM AT UCSF, SAN FRANCISCO UNIFIED SCHOOL DISTRICT, THE ASIAN AND PACIFIC ISLANDER HEALTH PARITY COALITION, HEALTH SERVICES NETWORK, HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIFORNIA, CHICANO/LATINO/INDIGENA HEALTH EQUITY COALITION, AFRICAN AMERICAN COMMUNITY HEALTH EQUITY COUNCIL, COMMUNITY CLINIC CONSORTIUM, SAN FRANCISCO INTERFAITH COUNCIL, METTA FUND, JEWISH HOME. SAINT FRANCIS MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE SIGNIFICANT COMMUNITY HEALTH NEEDS THE HOSPITAL IS HELPING TO ADDRESS AND THAT FORM THE BASIS OF THIS DOCUMENT WERE IDENTIFIED IN THE HOSPITAL'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). NEEDS BEING ADDRESSED BY STRATEGIES AND PROGRAMS ARE: ACCESS TO COORDINATED, CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE AND SERVICES: HEALTHY SAN FRANCISCO POPULATION, PATIENT FINANCIAL ASSISTANCE, TENDERLOIN HEALTH SERVICES, COVID VACCINATION EFFORT, HOMELESS HEALTH INITIATIVE: ED NAVIGATOR, DELANCY STREET FOUNDATION, PHYSICIAN SUPPORT FOR CHARITY CARE PROGRAMS, HEALTH PROFESSIONS EDUCATION, BURN SUPPORT GROUP, US TOO PROSTATE CANCER SUPPORT GROUP, EASY BREATHERS SUPPORT GROUP. FOOD SECURITY, HEALTHY EATING AND ACTIVE LIVING: TENDERLOIN FOOD SECURITY, LA CONICA MUNICIPAL MARKETPLACE AT 101 HYDE STREET. HOUSING SECURITY AND AN END TO HOMELESSNESS: WORKING GROUP OF TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP (TLHIP), HOMELESS HEALTH INITIATIVE, ED SOCIAL WORK AND FLEXIBLE HOUSING SUBSIDY POOL. ECONOMIC OPPORTUNITY, SUPPORTING HOUSING TENANT ENGAGEMENT, CONDITIONS OF HOMELESSNESS, CONNECTION TO RESOURCES FOR HOMELESS PATIENTS. SAFETY FROM VIOLENCE AND TRAUMA: RALLY FAMILY VISITATION SERVICES, TENDERLOIN NEIGHBORHOOD SAFETY GROUP; SOCIAL, EMOTIONAL AND BEHAVIORAL HEALTH: MEDICATION ASSISTED TREATMENT AND SUBSTANCE USE NAVIGATOR, TLHIP WORKING GROUP: NEIGHBORHOOD HARM-REDUCTION, CONVENING GROUP ON CARE FOR PATIENTS UNDER 5150 HOLDS.THE HOSPITAL INTENDS TO TAKE ACTIONS TO ADDRESS ALL OF THE PRIORITIZED SIGNIFICANT HEALTH NEEDS IN THE CHNA REPORT, BOTH THROUGH ITS OWN PROGRAMS AND SERVICES AND WITH COMMUNITY PARTNERS THROUGH THE TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP INITIATIVE. SCHEDULE H, PART V, SECTION B, LINE 7A ALL RELATED DIGNITY HEALTH HOSPITAL FACILITY COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS CAN BE ACCESSED AT HTTPS://WWW.DIGNITYHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH/COMMUNITY-HEALTH-PROGRAMS-AND-REPORTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINE 10A RELATED DIGNITY HEALTH HOSPITAL FACILITY IMPLEMENTATION STRATEGY DOCUMENTS CAN BE ACCESSED ATHTTPS://WWW.DIGNITYHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH/COMMUNITY-HEALTH-PROGRAMS-AND-REPORTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTSIMPLEMENTATION STRATEGIES ARE ALSO ON HOSPITAL FACILITY'S WEBSITE, AT THE SAME LOCATION AS THEIR CHNA REPORTS LISTED IN PART V, SECTION B, LINE 7A ABOVE. SCHEDULE H, PART V, SECTION B, LINE 16A-16C HTTPS://WWW.DIGNITYHEALTH.ORG/BAYAREA/LOCATIONS/SAINTFRANCIS/PATIENTS-AND-VISITORS/FOR-PATIENTS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE 2 1 - SAN FRANCISCO CYBERKNIFE LLC 900 HYDE STREET SAN FRANCISCO CA 94109 ONCOLOGY 2 - GOHEALTH URGENT CARE MANAGEMENT LLC 5555 GLENRIDE CONNECTOR STE 700 ATLANTA GA 30342 CLINIC PART I, LINE 7: FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, SFMH USES AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 IS USED IN THE CBISA SOFTWARE TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS.SCHEDULE H, PART I, LINE 7B, COLUMN (F)BEGINNING IN 2009, THE STATE OF CALIFORNIA ESTABLISHED PROVIDER FEE PROGRAMS. THESE PROGRAMS ARE FUNDED BY QUALITY ASSURANCE FEES PAID BY PARTICIPATING HOSPITALS AND MATCHING FEDERAL FUNDS. SFMH RECOGNIZED QUALITY ASSURANCE FEES DURING THE YEAR OF $14.1 MILLION WHICH ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO UNREIMBURSED MEDICAID (PART I, LINE 7B, COLUMN C), AND RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $20.2 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). THIS NET INCREASE IN THE COST OF THE MEDICAID PROGRAM IS DRIVING THE INCREASE IN THE OVERALL COST OF COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES WHEN COMPARED TO PRIOR YEARS.SCHEDULE H, PART I, LINE 7IINCLUDED IN CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT IS $83 THOUSAND IN GRANTS TO A FUND ESTABLISHED BY THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT") FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA, CONSISTENT WITH CHFT'S MISSION OF SUPPORTING HEALTH CARE, ACCESS TO HEALTH CARE, RESEARCH AND EDUCATION. PART II, COMMUNITY BUILDING ACTIVITIES: SFMH'S EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES EXTEND BEYOND PROVIDING HEALTH CARE SERVICES. SFMH TAKES A PROACTIVE APPROACH TO ADDRESSING THE SOCIAL, ECONOMIC AND ENVIRONMENTAL BARRIERS TO GOOD HEALTH, AND SUPPORTS THE WORLD HEALTH ORGANIZATION DEFINITION OF HEALTH AS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY. SFMH SERVES AS MEMBERS OF COMMUNITY COALITIONS THAT FOCUS ON THE WELL-BEING OF SAN FRANCISCO AND THE TENDERLOIN NEIGHBORHOOD.COALITION BUILDING - UNDER COALITION BUILDING IS THE SAN FRANCISCO HEP B FREE, WHICH IS A CITYWIDE CAMPAIGN, CREATED TO EDUCATE, TEST, VACCINATE AND TREAT SAN FRANCISCO ASIAN AND PACIFIC ISLANDER (API) RESIDENTS OF HEPATITIS B (HBV). SFMH ALONG WITH OTHER COMMUNITY ORGANIZATIONS, HOSPITAL AND THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH ARE COLLABORATING TO PROVIDE CONVENIENT, FREE OR LOW-COST TESTING OPPORTUNITIES AT STREET FAIRS AND CLINICS.WORKFORCE DEVELOPMENT - SFMH HAS PARTNERSHIPS WITH LOCAL HIGH SCHOOLS, COMMUNITY COLLEGES AND UNIVERSITIES TO ADDRESS HEALTH CARE WORKFORCE SHORTAGES, OFFERING HEALTH CAREER MENTORING PROJECTS AND PROVIDING SCHOOL-BASED AND COMMUNITY PROGRAMS THAT DRIVE ENTRY INTO HEALTH CAREERS AND NURSING PRACTICE. PART III, LINE 2: THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE SCHEDULE H, PART I, LINE 7) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT.AS NOTED IN PART I, LINE 3, SFMH PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS THAT FALL INTO THREE CATEGORIES; UNDER 250%, 251%-350% OR 351%-500% OF THE FEDERAL POVERTY LEVEL. SFMH ALSO PROVIDES PATIENTS OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS RECEIVE AN AUTOMATIC UNINSURED DISCOUNT OF 30%. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: SFMH MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. SFMH FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY. DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. DIGNITY HEALTH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE FINANCIAL ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT NO SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE WERE REPORTED AS BAD DEBT. AS SUCH, SFMH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. PART III, LINE 4: THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2021, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE:PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES.SFMH MANAGES ITS COLLECTION RISK BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES. RESERVES FOR CHARITY AND UNCOLLECTIBLE AMOUNTS HAVE BEEN ESTABLISHED AND ARE NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE IN THE CONSOLIDATED BALANCE SHEET. PART III, LINE 8: COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT:TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR 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. SFMH'S SHORTFALL INCLUDES $16 MILLION REPORTED ON PART III, SECTION B, LINE 7, PRIMARILY FOR FEE FOR SERVICE MEDICARE PATIENTS, AS WELL AS THE UNREIMBURSED PORTION OF MEDICARE MANAGED CARE AND MEDICARE CAPITATED PROGRAMS. PART III, LINE 9B: SFMH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. SFMH FOLLOWS DIGNITY HEALTH'S BILLING AND COLLECTION POLICY. DIGNITY HEALTH'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHOM THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF SFMH OR THE BILLING COMPANY RETAINED BY DIGNITY HEALTH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER DIGNITY HEALTH'S PATIENT FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, SFMH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. LEGAL ACTION WILL NOT BE PURSUED TO COLLECT DEBTS FROM PATIENTS WHO HAVE QUALIFIED FOR CHARITY OR ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DEBT.ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY DIGNITY HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, SFMH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. PART VI, LINE 2: IN ADDITION TO CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST EVERY THREE YEARS, SFMH CONTINUOUSLY ASSESSES THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES BY WORKING COLLABORATIVELY WITH LOCAL SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, FEDERALLY QUALIFIED HEALTH CENTERS, NON-PROFIT CLINICS, AND OTHER HEALTH, SOCIAL SERVICE AND COMMUNITY-BASED ORGANIZATIONS. SFMH ALSO GAINS AND MAINTAINS KNOWLEDGE OF HEALTH NEEDS IN PART THROUGH REFERRAL RELATIONSHIPS, SERVICE PLANNING ACTIVITIES, COMMUNITY HEALTH PARTNERSHIPS, AND LOCAL ADVOCACY CONDUCTED IN CONJUNCTION WITH COMMUNITY PARTNERS. SPECIFICALLY THROUGH THE TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP (TLHIP), SFMH AND THE SAINT FRANCIS FOUNDATION HOST REGULAR PARTNER ALIGNMENT CONFERENCES, CONVENING COMMUNITY-BASED ORGANIZATIONS AND REPRESENTATIVES FROM PUBLIC AND PRIVATE AGENCIES TO REVIEW SHARED CONTRIBUTIONS AND STRATEGIES TO ADDRESS HEALTH NEEDS IDENTIFIED BY TENDERLOIN RESIDENTS. SFMH CREATES AND MAKES WIDELY AVAILABLE TO THE PUBLIC ANNUAL COMMUNITY BENEFIT REPORTS THAT SUMMARIZE IDENTIFIED HEALTH NEEDS, UPDATE COMMUNITY DEMOGRAPHIC INFORMATION, AND REPORT ON RECENT AND PLANNED COMMUNITY HEALTH PROGRAMS, INCLUDING GOALS, OBJECTIVES AND MEASURABLE RESULTS. IN ADDITION, SFMH USES DATA ON ADMISSIONS FOR AMBULATORY CARE SENSITIVE CONDITIONS THAT EVIDENCE SUGGESTS COULD HAVE BEEN AVOIDED, AT LEAST IN PART, THROUGH MORE ROBUST COMMUNITY ACCESS TO OR USE OF PRIMARY AND PREVENTIVE CARE RESOURCES.SFMH ALSO MAKES FULL USE OF DIGNITY HEALTH'S COMMUNITY NEEDS INDEX (CNI), A TOOL DEVELOPED IN PARTNERSHIP WITH TRUVEN HEALTH ANALYTICS WHICH PROVIDES AN AGGREGATE SCORE OF THE SOCIOECONOMIC BARRIERS THAT PUT RESIDENTS AT GREATER RISK OF NEEDING HEALTH SERVICES. THE CNI AGGREGATES NINE INDICATORS INTO FIVE SOCIOECONOMIC FACTORS KNOWN TO CONTRIBUTE TO HEALTH DISPARITY. THE FIVE INCLUDE INCOME, CULTURE/LANGUAGE, EDUCATION, HOUSING STATUS, AND INSURANCE COVERAGE. THE INDEX IS CALCULATED ANNUALLY FOR EVERY ZIP CODE IN THE UNITED STATES. RESIDENTS OF COMMUNITIES WITH THE HIGHEST CNI SCORES WERE SHOWN TO BE TWICE AS LIKELY TO EXPERIENCE PREVENTABLE HOSPITALIZATION FOR MANAGEABLE CONDITIONS AS COMMUNITIES WITH THE LOWEST CNI SCORES. THE CNI PROVIDES COMPELLING EVIDENCE FOR ADDRESSING SOCIOECONOMIC BARRIERS WHEN CONSIDERING HEALTH POLICY AND LOCAL HEALTH PLANNING. THE TOOL HIGHLIGHTS HEALTH CARE DISPARITIES AND ENABLES HEALTH CARE PROVIDERS, POLICYMAKERS, AND OTHERS TO TARGET RESOURCES WHERE THEY ARE MOST NEEDED. ADDITIONAL INFORMATION ABOUT THE CNI IS ACCESSIBLE AT HTTP://CNI.DIGNITYHEALTH.ORG/WATSON-HEALTH-2021-COMMUNITY-NEED-INDEX-SOURCE-NOTES.PDF. THE DIGNITY HEALTH CNI FINDINGS ARE IN ALIGNMENT WITH THE OTHER HEALTH INDICATOR DATA FOUND ON THE SFHIP.ORG WEBSITE. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC:SFMH FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE PROGRAM. INFORMATION ABOUT DIGNITY HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE SFMH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS SFMH MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES SFMH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT ALL UNINSURED PATIENTS RECEIVE AN UNINSURED DISCOUNT OF 30%, AND THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION OR WITH PROMPT PAYMENT. FINANCIAL ASSISTANCE INFORMATION, GOVERNMENT PROGRAM RESOURCE INFORMATION, TOOLS TO ASSIST PATIENTS IN FINDING HEALTH COVERAGE, ANSWERS TO FREQUENTLY ASKED BILLING QUESTIONS, AND OTHER SUCH INFORMATION CAN ALSO BE FOUND ON SFMH'S WEBSITE AT HTTPS://WWW.DIGNITYHEALTH.ORG/BAYAREA/LOCATIONS/SAINTFRANCIS/PATIENTS-AND-VISITORS/FOR-PATIENTS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE AND ALSO ON DIGNITY HEALTH'S WEBSITE AT WWW.DIGNITYHEALTH.ORG.IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO UNINSURED PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED, A STATEMENT INFORMING PATIENTS WITHOUT INSURANCE COVERAGE THAT THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED FINANCIAL ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR FINANCIAL ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF SFMH REQUIRES ALL INITIAL STATEMENTS TO UNINSURED PATIENTS TO INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. ALSO, ANY MEMBER OF THE SFMH STAFF OR MEDICAL STAFF MAY MAKE REFERRALS OF PATIENTS FOR FINANCIAL ASSISTANCE. THE PATIENT, A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: SFMH IS THE ONLY HOSPITAL LOCATED IN DOWNTOWN SAN FRANCISCO. PATIENTS ACCESSING THE HOSPITAL'S SERVICES ENCOMPASS BOTH THE CITY'S RICHEST TO POOREST RESIDENTS. THE HOSPITAL PRIMARILY SERVES SAN FRANCISCO; HOWEVER, A NUMBER OF SPECIALIZED PROGRAMS DRAW PATIENTS FROM ALL OVER NORTHERN CALIFORNIA AND BEYOND. SAN FRANCISCO IS DENSELY POPULATED AND BOASTS CULTURALLY DIVERSE NEIGHBORHOODS IN WHICH RESIDENTS SPEAK MORE THAN 12 DIFFERENT LANGUAGES. PARTS OF SAN FRANCISCO (47 CENSUS TRACTS) ARE FEDERALLY-DESIGNATED AS MEDICALLY UNDERSERVED AREAS. MANY OF THE HOSPITAL'S COMMUNITY BENEFIT PROGRAMS FOCUS ON A NEARBY UNDERSERVERD NEIGHBORHOOD CALLED THE TENDERLOIN (ZIP CODE 94102).TOTAL POPULATION: 888,069WHITE - NON-HISPANIC: 39.3%BLACK/AFRICAN AMERICAN: 4.7%HISPANIC OR LATINO: 15.6%ASIAN/PACIFIC ISLANDER: 36.0%ALL OTHERS: 4.4%% BELOW POVERTY: 5.1%UNEMPLOYMENT: 3.8%NO HIGH SCHOOL DIPLOMA: 10.9%MEDICAID (HOUSEHOLD): 7.4%UNINSURED (HOUSEHOLD): 2.7%OTHER AREA HOSPITALS: 8 PART VI, LINE 5: SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP (SFHIP) - SFMH STAFF ARE ACTIVE IN THE SFHIP LEADERSHIP AND STEERING COMMITTEES. SFHIP IS MOTIVATED BY A COMMON VISION, VALUES, AND COMMUNITY-IDENTIFIED HEALTH PRIORITIES AND AS SUCH SFHIP WILL DRIVE COMMUNITY HEALTH IMPROVEMENT EFFORTS IN SAN FRANCISCO. THE ROAD MAP FOR SFHIP IS SAN FRANCISCO'S COMMUNITY HEALTH IMPROVEMENT PLAN, THE DEVELOPMENT PROCESS FOR WHICH ENGAGED COMMUNITY RESIDENTS AND LOCAL PUBLIC HEALTH SYSTEM PARTNERS. THE PLAN IDENTIFIES SAN FRANCISCO'S HEALTH PRIORITIES AS WELL AS GOALS, OBJECTIVES, MEASURES, AND STRATEGIES FOR EACH PRIORITY. THE SFMH COMMUNITY BENEFIT PLAN IS DESIGNED TO ALIGN WITH SFHIP PRIORITIES.TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP (TLHIP) - SFMH CONTINUES TO PARTNER WITH THE SAINT FRANCIS FOUNDATION AS THE BACKBONE OF TLHIP TO STRENGTHEN AND ENHANCE THE CAPACITY OF TENDERLOIN ORGANIZATIONS USING A PLACE-BASED STRATEGY AND A FRAMEWORK THAT PROVIDES BETTER COORDINATION BETWEEN GOVERNMENT, BUSINESS, AND NON-PROFIT SECTORS, AND COMMUNITY TO CO-CREATE SOLUTIONS FOR DEEPER IMPACT ACROSS THE SOCIAL DETERMINANTS OF HEALTH. THE THREE CORE COMMUNITY PRIORITIES OF SAFETY, COMMUNITY CONNECTIONS, AND OPPORTUNITIES FOR HEALTHY CHOICES, AND FIVE TLHIP FOCUS AREAS. THE FOCUS AREAS ARE: ACTIVE VIBRANT, SAFE, AND CLEAN SHARED SPACES; BEHAVIORAL HEALTH AND MENTAL HEALTH; RESIDENT HEALTH; ECONOMIC OPPORTUNITY AND AFFORDABLE RETAIL; AND HOUSING ACCESS.SAN FRANCISCO HEP B FREE - SFMH CONTINUES TO BE AN ACTIVE PARTNER IN THE SAN FRANCISCO HEPATITIS B COALITION, PARTICIPATING IN COALITION ACTIVITIES INCLUDING SPONSORING THE ANNUAL GALA TO INCREASE AWARENESS OF HEPATITIS B. SAN FRANCISCO HEP B FREE STARTED AS A CITYWIDE CAMPAIGN OVER 10 YEARS AGO TO CREATE, EDUCATE, TEST, VACCINATE AND TREAT SAN FRANCISCO ASIAN AND PACIFIC ISLANDER (API) RESIDENTS OF HEPATITIS B (HBV). PARTNERS INCLUDE COMMUNITY-BASED ORGANIZATIONS, HOSPITALS, BUSINESSES AND THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH.AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, SFMH REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, AND SUPPORT COMMUNITY HEALTH PROGRAMS. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR SFMH TO DELIVER ON ITS MISSION, INCLUDING ENSURING THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE.SFMH IS GOVERNED BY A BOARD OF TRUSTEES. SPECIFIC COMMITTEES, INCLUDING THE COMMUNITY ADVISORY COMMITTEE, HAVE ORGANIZATIONAL POLICY-BASED ROLES TO SET PRIORITIES AND TO OVERSEE COMMUNITY BENEFIT AND HEALTH PROGRAMS. THE BOARD OF TRUSTEES RECEIVES REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE.SFMH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA.IN ADDITION, SFMH FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY BY EXERCISING THE FOLLOWING:- OPERATING AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY;- PARTNERING WITH HEALTHRIGHT360'S TENDERLOIN HEALTH SERVICES (FORMERLY GLIDE HEALTH CLINIC), A FQHC SERVING THE UNDERSERVED IN THE TENDERLOIN NEIGHBORHOOD;- ENGAGING IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS IN THE TENDERLOIN NEIGHBORHOOD. PART VI, LINE 6: AFFILIATES OF SFMH ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN CALIFORNIA, ARIZONA, AND NEVADA AND IN 18 ADDITIONAL STATES THROUGH THE ALLIANCE WITHIN COMMONSPIRIT HEALTH SYSTEM.THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE NET OF OFFSETTING REVENUE FOR COMMONSPIRIT AND ITS AFFILIATED CORPORATIONS, WHICH INCLUDES SFMH, FOR THE YEAR ENDED JUNE 30, 2021, IS $2.6 BILLION. A SUMMARY OF COMMONSPIRIT'S COMMUNITY BENEFITS CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT HEALTH CONSOLIDATED FINANCIAL STATEMENTS ON PAGE 45. PART VI, LINE 7, REPORTS FILED WITH STATES CA 1 DIGNITY HEALTH MEDICAL FOUNDATION 3400 DATA DRIVE RANCHO CORDOVA CA 95670 680220314 501(C)(3) 2523127 0 N/A N/A MEDICAL FND SUPPORT SAINT FRANCIS FOUNDATION 900 HYDE STREET SAN FRANCISCO CA 94109 942597514 501(C)(3) 289459 0 N/A N/A FOUNDATION SUPPORT CALIFORNIA HEALTH FOUNDATION AND TRUST 1215 K ST STE 800 SACRAMENTO CA 95814 941498697 501(C)(3) 83322 0 N/A N/A COMMUNITY HEALTH MISSION DOLORES ACADEMY 3371 16TH ST SAN FRANCISCO CA 94114 202849575 501(C)(3) 10000 0 N/A N/A EDUCATION SUPPORT 4 MEDICAL SUPPLIES/EQUIPMENT TO PATIENTS/INDIGENTS 12 1066 BOOK MEDICAL EQUIPMENT PROVISION OF FOOD/MEALS 16291 36655 BOOK MEALS TO LOW INCOME SENIORS AND HOMELESS FINANCIAL ASSISTANCE TO PATIENTS/NEEDY 150 2379 ROOM AND BOARD 3 10500 PART I, LINE 2: AS A 501(C)(3) ORGANIZATION, WE PROVIDE ASSISTANCE TO VARIOUS CHARITABLE ORGANIZATIONS TO PROMOTE COMMONSPIRIT'S MISSION. A DESIGNATED COMMITTEE ESTABLISHES AND EVALUATES PRIORITIES AND ALLOCATION OF FUNDS WITH EMPHASIS ON PROMOTION OF HEALTHY COMMUNITIES AND COMMUNITY COLLABORATION. WE DO NOT MONITOR AND REPORT PROGRAM OUTCOMES. SPENDING IS TRACKED ON AN ONGOING BASIS TO ENSURE THAT ANNUAL SPENDING IS WITHIN THE BUDGETED AMOUNT. X 1 1 1 1 0 0 0 0 0 0 0 DANIEL J MORISSETTE CPA BOARD MEMBER 0 1255586 0 1792008 0 270795 0 376999 0 39464 0 3734852 0 0 TODD A STRUMWASSER MD BOARD MEMBER 0 680696 0 922146 0 158445 0 70350 0 56676 0 1888313 0 0 TRACEY PIERCE FORMER KEY EMPLOYEE 0 318479 0 303750 0 54084 0 55436 0 33064 0 764813 0 0 JILL WELTON FORMER KEY EMPLOYEE 0 401162 0 198583 0 44709 0 49161 0 39659 0 733274 0 0 DAVID KLEIN MD PRESIDENT & CEO (THRU 8/28/20) 0 359223 0 0 0 110105 0 33136 0 36698 0 539162 0 0 KECIA M KELLY VP COO/CNO 342082 0 32220 0 25148 0 23500 0 36381 0 459331 0 0 0 KATHLEEN JORDAN MD VP CMO (THRU 7/1/20) 195408 0 0 0 216934 0 21589 0 23522 0 457453 0 0 0 CHARLES THEVNIN CFO 311273 0 17169 0 40901 0 26490 0 26297 0 422130 0 0 0 BRADLEY GROTE FORMER KEY EMPLOYEE 0 280467 0 42197 0 44517 0 29411 0 19034 0 415626 0 0 DARYN KUMAR PRESIDENT & CEO (STARTED 1/3/21) 0 289499 0 38860 0 23718 0 22758 0 19887 0 394722 0 0 DEBORAH CHEW REGISTERED NURSE 311123 0 1625 0 0 0 42318 0 37381 0 392447 0 0 0 YIPI YANG REGISTERED NURSE 301758 0 1625 0 0 0 62419 0 14743 0 380545 0 0 0 JASON L DENNISON VP HUMAN RESOURCES 248262 0 74095 0 19140 0 20510 0 14991 0 376998 0 0 0 ALBINA GUERRERO REGISTERED NURSE 256274 0 1450 0 0 0 61531 0 37075 0 356330 0 0 0 ISATOU E NJIE STAFF NURSE II 272449 0 1625 0 0 0 37324 0 19831 0 331229 0 0 0 OSARIEMEN N NOSA-IDAHOSA DIRECTOR OF PHARMACY 256408 0 9703 0 569 0 10761 0 17429 0 294870 0 0 0 CHARLENE BATTAGLIA SENIOR DIRECTOR - NURSING 238332 0 9597 0 7529 0 27296 0 4114 0 286868 0 0 0 JEFFREY FEE INTERIM PRESIDENT & CEO (8/24/20 - 1 0 174000 0 0 0 0 0 0 0 0 0 174000 0 0 PART I, LINE 3 ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, RELIED ON A RELATED ORGANIZATION, COMMONSPIRIT, THAT USED A HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE COMMONSPIRIT BOARD OF STEWARDSHIP TRUSTEES; INDEPENDENT COMPENSATION CONSULTANT; COMPENSATION SURVEY OR STUDY; AND APPROVAL BY THE BOARD OR HUMAN RESOURCES AND COMPENSATION COMMITTEE TO ESTABLISH THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION. PART I, LINES 4A-B SCHEDULE J, PART I, LINE 4A THE LISTED PERSONS PAID BY THE PARENT ORGANIZATION PARTICIPATE IN A SEVERANCE PLAN PROVIDED BY DIGNITY HEALTH THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 1 TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. PAYMENTS WERE MADE PURSUANT TO THE PLAN ARRANGEMENT DURING 2020 INCLUDE K. JORDAN, $187,987. THE ORGANIZATION'S NON-CONTRACTUAL EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN PROVIDED BY SFMH THAT PROVIDES FAIR COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 18 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. SEVERANCE FOR EMPLOYEES COVERED BY COLLECTIVE BARGAINING AGREEMENTS VARIES BY AGREEMENT. NO PAYMENTS PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2020. SCHEDULE J, PART I, LINE 4B CERTAIN LISTED PERSONS ARE ELIGIBLE TO PARTICIPATE IN NON-QUALIFIED 457(F) PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES HIRED PRIOR TO JUNE 30, 2006. THE BENEFIT IS INTENDED TO BRIDGE THE DIFFERENCE, IF ANY, BETWEEN THE BENEFIT PROVIDED UNDER THE DIGNITY HEALTH EXCESS BENEFIT PLAN HAD BENEFIT SERVICE NOT BEEN FROZEN AT JANUARY 1, 2008, AND THE BENEFITS PROVIDED FROM ALL OTHER QUALIFIED AND NON-QUALIFIED PLANS. BENEFITS VEST UNDER THIS 457(F) PLAN AT THE LATER OF THE DATE THE PARTICIPANT ATTAINS AGE 62 OR IS CREDITED WITH 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES, PRIMARILY THOSE WHO ARE NOT ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN OR THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN DESCRIBED ABOVE. THIS BENEFIT PROVIDES AN ANNUAL ACCRUAL OF 10% OF TOTAL COMPENSATION AND IS PAYABLE ANNUALLY ON JULY 1 ONCE VESTED, WHICH IS AGE 62 WITH 5 YEARS OF SERVICE; THE PLAN ALSO ALLOWS FOR SPECIAL AWARDS. NO PAYMENTS PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2020. COMPENSATION AMOUNTS FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR ACCRUED (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS OTHER REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)). SCHEDULE J, PART III - SUPPLEMENTAL DISCLOSURES THE ORGANIZATION FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE THE ORGANIZATION TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES THE ORGANIZATION SERVES, PROMOTING EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE COMPENSATION AND BENEFITS COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND THE ORGANIZATION'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2020. PARAGON DIAGNOSTICS OF SAN FRANCISCO EMILY O'ROURKE - BM 453263 MEDICAL SERVICES 0 JUSTIN MCGOWAN FAMILY MEMBER OF JACLYN MCGOWAN (BM) 127979 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE CORPORATE MEMBER IS DIGNITY COMMUNITY CARE, A 501(C)(3) EXEMPT ORGANIZATION. ON FEBRUARY 1, 2019, DIGNITY HEALTH AND CATHOLIC HEALTH INITIATIVES ("CHI"), A COLORADO NONPROFIT CORPORATION, EFFECTED A BUSINESS COMBINATION. ON THAT DATE, CHI CHANGED ITS NAME TO COMMONSPIRIT AND BECAME THE SOLE CORPORATE MEMBER OF DIGNITY HEALTH. COMMONSPIRIT IS A CATHOLIC HEALTHCARE SYSTEM SPONSORED BY THE PUBLIC JURIDIC PERSON, CATHOLIC HEALTH CARE FEDERATION (CHCF"). AS PART OF THE ALIGNMENT, ON THE EFFECTIVE DATE OF FEBRUARY 1, 2019, DIGNITY HEALTH CAUSED TO TRANSFER NON-CATHOLIC OWNED COMMUNITY HOSPITALS, NON-CATHOLIC SUBSIDIARY HOSPITALS, AND CERTAIN OTHER NON-CATHOLIC OPERATIONS TO DIGNITY COMMUNITY CARE, A COLORADO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A DIGNITY COMMUNITY CARE, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY COMMUNITY CARE BOARD APPROVES NEW BOARD MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION IS SUBJECT TO THE GOVERNANCE REQUIREMENTS OF THE COMMONSPIRIT HEALTH GOVERNANCE MATRIX. THUS, MANY KEY DECISIONS ADDRESSED IN THE BYLAWS REQUIRE THE FOUNDATION TO ACT BY MAKING A "RECOMMENDATION," WHICH IS THEN FORMALLY ACTED ON BY THE DIGNITY COMMUNITY CARE BOARD. EXAMPLES INCLUDE AMENDING CORPORATE DOCUMENTS, APPROVING MEMBERS OF GOVERNING BOARD, APPROVING REMOVAL OF MEMBERS OF GOVERNING BOARD, APPROVAL OF DISSOLUTION AND SELLING OR DISPOSING OF ASSETS. RESERVED RIGHTS OF THE CORPORATE MEMBER INCLUDE ADOPTION OF MISSION AND PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF ARTICLES OF INCORPORATION AND BYLAWS, DISSOLUTION OF THE CORPORATION, ACQUISITION OF ANOTHER CORPORATION, CREATION OF A NEW SUBSIDIARY, MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION, PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE, INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS, RATIFICATION OF BOARD MEMBER APPOINTMENTS AND DISMISSALS, SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, AND TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY FINANCE AND ACCOUNTING (REGIONAL DIGNITY HEALTH MANAGEMENT AND COMMONSPIRIT'S TAX DEPARTMENT), WHICH WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. THE BOARD OF TRUSTEES HAS DELEGATED THE REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE. MANAGEMENT PROVIDED THE DRAFT OF THE FORM 990 TO THE FINANCE COMMITTEE BEFORE FILING THE RETURN WITH THE IRS FOR DISCUSSION AT THE COMMITTEE MEETING. THE DRAFT WAS COMPLETE EXCEPT IT EXCLUDED COMPENSATION INFORMATION. SUBSEQUENT TO ITS REVIEW, THE FINANCE COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS REVIEW AND PROVIDED A DRAFT TO THE BOARD OF TRUSTEES, AGAIN EXCLUDING COMPENSATION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED THE RELATED ORGANIZATION, COMMONSPIRIT'S CONFLICTS OF INTEREST POLICY. THE CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") WAS PUT IN PLACE TO PROTECT THE INTERESTS OF COMMONSPIRIT IN CIRCUMSTANCES THAT MAY RESULT IN A CONFLICT BETWEEN PERSONAL INTERESTS OF A PERSON AND THE INTERESTS OF THE ORGANIZATION AND THOSE IT SERVES. 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 - KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES AS SPECIFIED BY THE INTERNAL REVENUE SERVICE FOR FORM 990 PURPOSES WHO ARE NOT OTHERWISE INCLUDED IN THE CATEGORIES ABOVE - EMPLOYEES OF SYSTEM ENTITIES AT THE VICE PRESIDENT LEVEL AND ABOVE - ALL INDIVIDUALS ENGAGED IN RESEARCH AT INSTITUTIONS OWNED OR OPERATED BY A SYSTEM ENTITY - SELECT EMPLOYEES AS DETERMINED FROM TIME TO TIME BY LEADERSHIP DISCLOSURE, REVIEW, AND MANAGEMENT OF PERCEIVED, POTENTIAL, OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. EACH PERSON IS REQUIRED TO PROMPTLY AND FULLY DISCLOSE ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST AS SOON AS SHE/HE BECOMES AWARE OF IT. IN ADDITION, AT THE INCEPTION OF AN INDIVIDUAL'S RELATIONSHIP WITH COMMONSPIRIT (E.G. HIRING, BOARD APPOINTMENT), AND FOR CERTAIN POSITIONS, ANNUALLY THEREAFTER, WRITTEN CONFLICT OF INTEREST DISCLOSURE FORMS MUST BE COMPLETED. A FAILURE TO DISCLOSE MAY RESULT IN DISCIPLINARY OR CORRECTIVE ACTIONS. REPORTED POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE INITIALLY REVIEWED BY LEGAL, CORPORATE RESPONSIBILITY OR RESEARCH INTEGRITY STAFF. IF NECESSARY, A CONFLICT OF INTEREST MANAGEMENT PLAN IS DEVELOPED, WHICH PLAN SHALL BE SUBJECT TO ACCEPTANCE BY THE APPROPRIATE DIRECT MANAGER, SUPERVISOR, MEDICAL STAFF OFFICE, BOARD OR BOARD COMMITTEE (FOR BOARD, BOARD COMMITTEE, ELT OR CORPORATE OFFICER CONFLICTS), OR OTHER APPROPRIATE INDIVIDUAL OR BODY. ONCE ACCEPTED, THE CONFLICT OF INTEREST MANAGEMENT PLAN IS COMMUNICATED TO THE PERSON WITH THE ACTUAL OR POTENTIAL CONFLICT AND THE INDIVIDUAL MUST CONDUCT THEMSELVES IN CONFORMITY WITH THE PLAN. IN THE EVENT THAT A TRANSACTIONAL CONFLICT INTEREST ARISES IN CONNECTION WITH A SYSTEM ENTITY BOARD MEETING, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THAT CONFLICT PRIOR TO OR AT THE BEGINNING OF THE MEETING IN WHICH THE MATTER IS TO BE CONSIDERED. THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE TRANSACTION AND IS PROHIBITED FROM USING PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, BUT IS NOT PROHIBITED FROM PROVIDING INPUT IF REQUESTED TO DO SO. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15A ALTHOUGH THE PRESIDENT IS COMPENSATED BY DIGNITY HEALTH, FOR 2020 COMPENSATION, COMPENSATION LEVELS FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL WERE ESTABLISHED BY THE RELATED ORGANIZATION, COMMONSPIRIT. COMMONSPIRIT'S BOARD OF STEWARDSHIP TRUSTEES, APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PACKAGES FOR EACH OFFICER AND CERTAIN KEY EMPLOYEES (INCLUDING THE PRESIDENT/CEO). THE HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EXECUTIVES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES OUTSIDE LEGAL COUNSEL AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF DIRECTORS. THE DOCUMENTATION OF THE DELIBERATIONS INCLUDES (A) THE TERMS OF THE AGREEMENT APPROVED AND THE DATE APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED AGREEMENT AND THOSE WHO VOTED ON IT; AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. FORM 990, PART VI, SECTION B, LINE 15B FOR 2020, THE PARENT ORGANIZATION'S HUMAN RESOURCES DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF KEY EXECUTIVES. THE COMPENSATION FOR THESE INDIVIDUALS WAS BASED ON THE QUALIFICATION AND EXPERIENCE OF THE CANDIDATES. COMPENSATION IS ALSO REVIEWED ANNUALLY AS PART OF THE MERIT INCREASE PROCESS. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION IS INCLUDED IN COMMONSPIRIT'S CONSOLIDATED FINANCIAL STATEMENTS WHICH ARE AVAILABLE ON COMMONSPIRIT'S WEBSITE AND UPON REQUEST. FORM 990, PART VII, SECTION A D. MORISSETTE, T. STRUMWASSER, MD, J. FEE, D. KLEIN, MD, D. KUMAR, T. PIERCE AND J. WELTON RECEIVED COMPENSATION FOR SERVICES PROVIDED TO A RELATED ORGANIZATION, DIGNITY HEALTH. T. PIERCE RECEIVED COMPENSATION FOR SERVICES PROVIDED TO A RELATED ORGANIZATION, DIGNITY COMMUNITY CARE. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 13,295,993. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,295,993. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 3,611,205. MANAGEMENT AND GENERAL EXPENSES 5,220,070. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,831,275. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 2,206,216. MANAGEMENT AND GENERAL EXPENSES 3,189,129. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,395,345. PROFESSIONAL CONSULTING & OTHER SERVICES: PROGRAM SERVICE EXPENSES 536,642. MANAGEMENT AND GENERAL EXPENSES 775,726. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,312,368. PARKING AND SECURITY: PROGRAM SERVICE EXPENSES 709,690. MANAGEMENT AND GENERAL EXPENSES 1,025,872. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,735,562. STORAGE/SHRED/JANITORIAL: PROGRAM SERVICE EXPENSES 347,934. MANAGEMENT AND GENERAL EXPENSES 502,945. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 850,879. LAUNDRY/LINEN: PROGRAM SERVICE EXPENSES 166,212. MANAGEMENT AND GENERAL EXPENSES 240,263. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 406,475. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 488,949. MANAGEMENT AND GENERAL EXPENSES 706,786. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,195,735. OTHER FEES: PROGRAM SERVICE EXPENSES 6,595,382. MANAGEMENT AND GENERAL EXPENSES 93,574. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,688,956. FORM 990, PART XI, LINE 9: GAIN ON ADOPTION OF ASU 2017-17 1,619,246. INTEREST IN NET ASSETS OF UNCONSOLIDATED FOUNDATION 18,891,634. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART XII, LINE 3B - FINANCIAL STATEMENTS AND REPORTING THE ORGANIZATION'S FEDERAL AWARDS WERE INCLUDED IN COMMONSPIRIT'S CONSOLIDATED UNIFORM GUIDANCE AUDITED SCHEDULE OF FEDERAL EXPENDITURES FOR THE PERIOD OF JULY 1, 2020, TO JUNE 30, 2021. FORM 990, PART XI, LINE 8 - PRIOR PERIOD ADJUSTMENT: $967,102; CENTRALIZED TRANSACTIONS: TRANSFERS FOR JOURNAL ENTRIES RECORDED CENTRALLY AT COMMONSPIRIT TO STANDARDIZE CONTRACTUAL ALLOWANCE METHODOLOGY ACROSS ALL COMMONSPIRIT AFFILIATES AND SUBSIDIARIES. RECORDED CENTRALLY AT YEAR END AND TRANSFERRED TO FACILITIES IN THE FOLLOWING YEAR. ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HOSPITAL NE 501(C)(3) LINE 3 ACH 0 ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - COMM MEM HOSP OF MO VALLEYIA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(C)(3) LINE 10 CSH 0 APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(C)(3) LINE 10 SFH 0 ARROYO GRANDE COMMUNITY HOSPITAL FOUNDATION 345 S HALCYON RD ARROYO GRANDE CA 93420 203256066 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 BAKERSFIELD MEMORIAL HOSPITAL 420 34TH STREET BAKERSFIELD CA 93301 951802779 HOSPITAL CA 501(C)(3) LINE 3 DIGNITY COMMUNITY CARE 0 BARROW FOUNDATION UK 13 CHURCH STREET NUNNEY ENGLAND UK BA11 4LW 311724184 FUNDRAISING FOUNDATION UK 501(C)(3) LINE 12D, III-O N/A 0 BARROW NEUROLOGICAL FOUNDATION 350 WEST THOMAS ROAD PHOENIX AZ 85013 860174371 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 7 DIGNITY HEALTH 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 DIGNITY COMMUNITY CARE 0 CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HOSPITAL ND 501(C)(3) LINE 3 CSH 0 CATHOLIC HEALTH INITIATIVES - COLORADO 9100 EAST MINERAL CIRCLE CENTENNIAL CO 80112 840405257 HOSPITAL CO 501(C)(3) LINE 3 CSH 0 CATHOLIC HEALTH INITIATIVES - 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 DIGNITY COMMUNITY CARE 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 DIGNITY COMMUNITY CARE 0 COMMUNITY LIMITED CARE DIALYSIS CENTER 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI OH 45202 237419853 HOLDING CO OH 501(C)(4) N/A 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 DIGNITY HEALTH 0 DIGNITY HEALTH FOUNDATION 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 462037641 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