2022-05-13T12:48:18-05:00 2021-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2020-07-01 410695598 ST FRANCIS MEDICAL CENTER STFR 2186433000 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 DAVID NELSON DIV VP OPERATIONAL FINANCE 2186433000 2022-05-13 1 DAVID NELSON MARK STOCKI P00642127 3032989100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CHI ST FRANCIS HEALTH DAVID NELSON 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 26046948 0 0928 X WWW.SFCARE.ORG X 1899 MN ST. FRANCIS MEDICAL CENTER PROVIDES INPATIENT AND OUTPATIENT SERVICES, WITH A 24-HOUR EMERGENCY ROOM. THE ORGANIZATION ALSO PARTICIPATES IN MEDICARE AND MEDICAID AND HAS AN ACTIVE CHARITY CARE PROGRAM. 11 8 269 8 57340 33306 2038975 1248653 19875119 18416865 3755183 6226562 167706 154796 25836983 26046876 50 1192 0 0 8779746 7995666 0 0 149737 14405861 11846379 23185657 19843237 2651326 6203639 108557648 127422671 28970091 28695643 79587557 98727028 AS AN AFFILIATE OF COMMONSPIRIT HEALTH, WE MAKE THE HEALING PRESENCE OF GOD KNOWN IN OUR WORLD BY IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL. 0 0 17385457 1192 18416865 SEE SCHEDULE H 17385457 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 269 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 MN X VICKI MALESKI 3206315674 815 SE 2ND STREET LITTLE FALLS MN 56345 ROBERTSON CLIFF BOARD MEMBER/CSH SVP DIVISION OFFICER (PARTIAL YEA 1.00 59.00 X 0 2330702 46702 JEFFREY DROP BOARD MEMBER/CSH SVP DIVISION OFFICER (PARTIAL YEA 1.00 59.00 X 0 1263797 34793 JEANETTE WOJTALEWICZ BOARD MEMBER/CSH SVP DIVISION OFFICER (PARTIAL YEA 1.00 59.00 X 0 986312 50266 BRENNEN SMITH MD ORTHOPEDIST-SPINE 20.00 40.00 X 663233 118557 43671 DAVID NELSON PRESIDENT/CEO 32.00 28.00 X X 0 277804 37137 DR NANCY TORSON PSYCHIATRIST 40.00 0.00 X 243728 0 30073 JAMES HEFFELE CRNA 40.00 0.00 X 218131 0 24745 HEIDI GENEREUX CRNA 40.00 0.00 X 211172 0 20841 JENNIFER SHEFFIELD PHYSICIAN FAM MED 40.00 0.00 X 195267 0 7935 JOSHUA SENGER VP OPERATIONAL FINANCE/CFO/TREASURER 14.00 34.00 X 0 134482 38239 MARY JACKLITCH SECRETARY/MARKETING MANAGER 25.00 20.00 X 74237 0 22306 TAMERA ALTHOFF BOARD MEMBER/RN 1.00 40.00 X 0 48998 24225 DANIEL ANDERSON BOARD MEMBER 1.00 2.00 X 0 0 0 CRAIG CASPERS BOARD MEMBER 1.00 2.00 X 0 0 0 CLINT CONZEMIUS VICE CHAIR 1.00 2.00 X X 0 0 0 GLORIA DOHMAN BOARD MEMBER 1.00 4.00 X 0 0 0 SR CHARLENE GROSSMAN BOARD MEMBER 1.00 2.00 X 0 0 0 CARTER HANSEN CHAIR 1.00 2.00 X X 0 0 0 MICHAEL MCCARTNEY BOARD MEMBER 1.00 2.00 X 0 0 0 DOREEN REINKE BOARD MEMBER 1.00 2.00 X 0 0 0 1605768 5160652 380933 15 0 1 0 ACUTE CARE INC 1690 N ANKENY BLVD STE 200 ANKENY IA 50023 EMERGENCY MEDICAL STAFFING 1503886 CENTRAL MINNESOTA DIAGNOSTIC INC 525 10TH ST NE MILACA MN 56353 CT SCANS, ULTRASOUND 565546 SANFORD HEALTH OCCUPATIONAL MEDICINE 3838 12TH AVE N FARGO ND 58102 OCCUPATIONAL MEDICAL SERVICES 389468 HEALTH CAROUSEL LLC 3805 EDWARDS RD 700 CINCINNATI OH 45209 HEALTHCARE STAFFING 356225 COMSTOCK CONSTRUCTION 4511 15TH AVENUE NORTH FARGO ND 58102 CONSTRUCTION 347961 6 251122 989368 8163 1379 1248653 PATIENT SERVICES 900099 18416865 18416865 0 0 18416865 994340 14943 979397 11910 0 11910 11910 11910 5231414 808 0 0 5231414 808 5232222 5232222 193 72 121 121 MEDICAL SERVICES 621300 55111 0 0 55111 CAFETERIA 722100 44864 0 42397 2467 INTERCOMPANY TRANSACTI 900099 8336 0 0 8336 34454 34454 142765 26046876 18416865 57340 6324018 X 1192 1192 94509 94509 6176091 5749650 363945 62496 349815 326097 20173 3545 902505 845340 47977 9188 472746 434927 33092 4727 32264 32264 26376 26376 5845121 5401777 384629 58715 94288 94288 461431 323397 138034 897602 825794 62832 8976 336670 303003 33667 21168 19474 1482 212 187764 172743 13143 1878 880138 880138 1144872 1087629 57243 68813 68813 MEDICAL SUPPLIES 1108485 1108485 0 0 STATE PROVIDER TAX 353694 353694 0 0 REPAIRS AND MAINTENANCE 212684 202050 10634 0 UNRELATED BUSINESS TAXE 5125 0 5125 0 169884 161392 8492 19843237 17385457 2308043 149737 1535 1464 6123219 2038213 0 2917265 2909440 0 0 0 549912 561695 34421 32179 32794004 20533256 12133185 12260748 0 66031595 84729875 0 0 20766516 24889057 108557648 127422671 4766199 4928968 0 2602285 130810 0 0 0 0 0 21601607 23635865 28970091 28695643 X 79587557 98727028 0 79587557 98727028 108557648 127422671 X 6203639 10981153 -9409 1964088 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 2466 1 23910 0 0 26376 0 PART II-B, LINE 1: LINE 1F: DURING THE TAX YEAR ENDED 6/30/2021, ST. FRANCIS INCURRED ANCILLARY EXPENSES AS A RESULT OF ITS LOBBYING EFFORTS IN SUPPORT OF ACTIONS IN THE BEST INTEREST OF THE ORGANIZATION'S MISSION. THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION (AHA): $760 CATHOLIC HEALTH ASSOCIATION: $404 MINNESOTA HOSPITAL ASSOCIATION (MHA): $428 MCG HEALTH: $874 LINE 1G: THE ORGANIZATION INCURRED $23,910 IN ADVOCACY EXPENSES FOR TRAVEL TO MEETINGS WITH MHA, AHA, AND RURAL HEALTH CONFERENCE. DIRECT CONTACT WITH LEGISLATORS: $23,910 320961 320961 8778161 4241786 4536375 22143014 15451104 6691910 1551868 840366 711502 12260748 CSH OPERATING INVESTMENT POOL 84729875 F 84729875 CMDI EQUITY RECEIVABLE 525014 INTERCOMPANY RECEIVABLES 23958938 RIGHT OF USE LEASE ASSETS 405105 24889057 INTERCOMPANY PAYABLES 20220729 CHI DEBT PROGRAM 3132111 LEASE LIABILITIES 282773 ONPLAN SERVICE FEE LIABILITY 252 23635865 X PART X, LINE 2: ST. FRANCIS 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 0 1 1 430 595091 595091 0.03000 3370020 2252356 1117664 0.05630 430 3965111 2252356 1712755 0.08630 7 39970 69420 69420 0.00350 0 0 0 2 5634 968107 601233 366874 0.01850 0 5 6234 71704 71704 0.00360 14 51838 1109231 601233 507998 0.02560 14 52268 5074342 2853589 2220753 0.11190 1 100 205 205 0.00000 0 0 0 0 0 1 657 414 414 0.00000 0 2 660000 23910 23910 0.00120 0 0 0 4 660757 24529 24529 0.00120 1 1175239 0 5448939 5090656 358283 X 1 1 1 1 ST FRANCIS MEDICAL CENTER 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 WWW.SFCARE.ORG 375871 X X X ST FRANCIS MEDICAL CENTER 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE STATEMENT X 1 19 1 SEE STATEMENT 0 1 X 300.000000000000 300.000000000000 X X X X 1 1 X X X 1 X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X X 1 X 0 X X X X 1 X 0 0 ST. FRANCIS MEDICAL CENTER PART V, SECTION B, LINE 5: PUBLIC HEALTH DIRECTORS FROM RICHLAND COUNTY, ND AND WILKIN COUNTY MN WERE PART OF THE CHNA STEERING COMMITTEE, AS WELL AS THE ADMINISTRATOR & DIRECTOR OF CLINIC OPERATIONS FROM THE TWO PRIMARY CARE CLINICS IN THE COMMUNITY & RETIRED ASSOCIATE VICE PRESIDENT FOR INSTITUTIONAL EFFECTIVENESS ND STATE COLLEGE OF SCIENCE. ALL MEMBERS PROVIDED DATA, HELPED DESIGN COMMUNITY SURVEY, IDENTIFIED COMMUNITY NEEDS, AND DEVELOPED IMPLEMENTATION STRATEGIES TOGETHER. ST. FRANCIS MEDICAL CENTER PART V, SECTION B, LINE 6B: ST. FRANCIS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN FISCAL YEAR 2019 IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS FROM BOTH WILKIN COUNTY, MN AND RICHLAND COUNTY, ND, AS WELL AS BOTH PRIMARY CARE CLINICS IN OUR COMMUNITY. ST. FRANCIS MEDICAL CENTER PART V, SECTION B, LINE 11: THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED: OBESITY MANAGEMENT, SUBSTANCE USE/ABUSE AND MENTAL HEALTH, AND CHILD CARE. THE STEERING COMMITTEE CONTINUES TO BELIEVE THE MOST OVERALL BENEFIT WILL BE ACHIEVED BY FOCUSING ON PRIMARY PREVENTION IN THE AREAS OF OBESITY AND SUBSTANCE USE AND ABUSE. THESE FACTORS ARE LEADING CONTRIBUTORS TO OTHER DISEASE AND CHRONIC HEALTH CONDITIONS, SUCH AS CANCER, DIABETES, AND HYPERTENSION. BECAUSE OF THE SUBSTANCE ABUSE AND MENTAL HEALTH ARE OFTEN INTERRELATED, THEY WERE COMBINED IN THE 2019 IMPLEMENTATION PLAN. WORK PLANS: THE WORK OF THE ACTIVE TASK FORCE ADDRESSING OBESITY MANAGEMENT WILL CONTINUE AS THEY STRIVE FOR THEIR 2025 GOAL OF A 5% REDUCTION IN ADULT OBESITY. THEIR OBJECTIVES INCLUDE THE FOLLOWING: 1. TO WORK WITH SENIORS IN OUR COMMUNITY TO DEVELOP AND/OR ENHANCE POLICIES AND PROGRAMS TO PROMOTE HEALTHY LIFESTYLES THAT MEET THEIR NEEDS. 2. TO WORK WITH LOCAL WORKSITES TO DEVELOP AND IMPLEMENT A COMPREHENSIVE WORKSITE WELLNESS POLICY THAT PROMOTES HEALTHY LIFESTYLE CHOICES. 3. TO WORK WITH LOCAL SCHOOLS AND DAY CARE PROVIDERS TO DEVELOP AND IMPLEMENT COMPREHENSIVE APPROACHES TO PROMOTING HEALTHY LIFESTYLES. 4. TO INCREASE COMMUNITY AWARENESS AND KNOWLEDGE OF HEALTHY LIFESTYLE OPPORTUNITIES AND EVENTS. 5. TO INCREASE COMMUNITY AWARENESS IN THE GARDENING PROCESS: INVOLVE COUNTY EXTENSION, 4H, AG SCHOOL, MASTER GARDNER, AND FOOD PANTRY. INITIATE A MENTORING PARTNERSHIP PROGRAM. HAVE EDUCATION CLASSES ON GARDENING. THE BEHAVIORAL HEALTH STAKEHOLDERS GROUP WILL CONTINUE TO DEVELOP THEIR STRATEGIES TO ADDRESS SUBSTANCE USE AND ABUSE, AS WELL AS MENTAL HEALTH ISSUES IN OUR COMMUNITY. THE GOAL OF THIS GROUP IS TO DEVELOP A CONSISTENT AND COMPREHENSIVE APPROACH TO ADDRESSING SUBSTANCE USE/ABUSE IN THE WILKIN AND RICHLAND COUNTY COMMUNITY. THE OBJECTIVES ARE AS FOLLOWS: DEVELOP A PLAN FOR TRANSPORTATION OF INDIVIDUALS NEEDING INPATIENT SERVICES FOR MENTAL HEALTH AND/OR CHEMICAL DEPENDENCY CRISES BY JUNE 2020. THE CHILDCARE STEERING COMMITTEE WILL CONTINUE TO WORK WITH THE DAY CARE LICENSING AGENCIES AND OTHER COMMUNITY RESOURCES TO DETERMINE WHAT ISSUES ARE INCORPORATED IN THE COMMUNITY'S EXPRESSED CONCERN REGARDING CHILD CARE. ONCE THE ISSUES ARE DETERMINED, THE GOALS AND OBJECTIVES CAN BE SET. THE GOAL AT THIS TIME IS TO IDENTIFY THE ISSUES AND CONTRIBUTING FACTORS RELATED TO CHILD CARE IN THE RICHLAND-WILKIN COMMUNITY. THE COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE WILL FIND A COMMUNITY MEMBER WITH VESTED INTEREST TO CHAIR THESE EFFORTS. NEEDS NOT ADDRESSED: SMALL RURAL COMMUNITIES HAVE LIMITED RESOURCES AVAILABLE TO ADDRESS ISSUES. OFTEN THE SAME INDIVIDUALS ARE INVOLVED IN COMMUNITY EFFORTS BY VIRTUE OF THEIR POSITIONS, ETC. THEREFORE, THE STEERING COMMITTEE FELT THE MOST EFFECTIVE RESULTS WOULD BE ACHIEVED BY CONCENTRATING OUR LIMITED RESOURCES ON THREE PRIMARY FOCUS AREAS. THE LIMIT ON RESOURCES IS JUST ONE OF THE CHALLENGES OUR COMMUNITY FACES AS WE ADDRESS COMMUNITY HEALTH NEEDS. ANOTHER DIFFICULT CHALLENGE FOR OUR COMMUNITY IS THAT WE RESIDE IN NOT ONLY TWO COUNTIES, BUT ALSO TWO STATES WITH DIFFERING FUNDING RESOURCES, REGULATIONS, ETC. THE MAIN PURPOSE OF OUR EFFORTS WILL BE TO DEVELOP COMPREHENSIVE AND CONSISTENT PROGRAMS IN THESE FOCUS AREAS ACROSS THE COMMUNITY. AT THIS TIME, THE STEERING COMMITTEE DID NOT FEEL OUR COMMUNITY HAD THE RESOURCES AVAILABLE TO ADEQUATELY ADDRESS THE ISSUE OF AFFORDABLE HEALTH CARE. CHILD ABUSE/NEGLECT AND DOMESTIC VIOLENCE ARE ALREADY BEING ADDRESSED BY THE VIOLENCE PREVENTION TASK FORCE THAT CONNECTS BOTH COUNTIES. ST. FRANCIS MEDICAL CENTER 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. SCHEDULE H, PART V, SECTION B, LINE 7 - HOSPITAL FACILITY'S WEBSITE HTTPS://WWW.SFCARE.ORG/EN/OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS.HTML SCHEDULE H, PART V, SECTION B, LINE 10A - IMPLEMENTATION STRATEGY WEBSITE HTTPS://WWW.SFCARE.ORG/EN/OUR-COMMUNITY/COMMUNITY-HEALTH-NEEDS.HTML SCHEDULE H, PART V, SECTION B, LINE 3E - SIGNIFICANT HEALTH NEEDS THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 16A - FAP AVAILABLE WEBSITE HTTPS://WWW.SFCARE.ORG/EN/PATIENT-VISITOR-INFORMATION/FINANCIAL-PAYMENTS/FINANCIAL-ASSISTANCE-DOCUMENTS.HTML SCHEDULE H, PART V, SECTION B, LINE 16B - FAP APPLICATION FORM WEBSITE HTTPS://WWW.SFCARE.ORG/EN/PATIENT-VISITOR-INFORMATION/FINANCIAL-PAYMENTS/FINANCIAL-ASSISTANCE-DOCUMENTS.HTML SCHEDULE H, PART V, SECTION B, LINE 16C - PLAIN LANGUAGE FAP SUMMARY WEBSITE HTTPS://WWW.SFCARE.ORG/EN/PATIENT-VISITOR-INFORMATION/FINANCIAL-PAYMENTS/FINANCIAL-ASSISTANCE-DOCUMENTS.HTML 3 1 - OP CLINICS 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 MENTAL HEALTH & ORTHOPEDICS 2 - MILNOR CLINIC 401 MAIN STREET MILNOR ND 58060 RURAL HEALTH CLINIC 3 - CHEMICAL DEPENDENCY 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 CHEMICAL DEPENDENCY PART I, LINE 3C: UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT'S FAMILY INCOME MUST BE AT OR BELOW 300% OF THE FPG. THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED [IN THE FAP]. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS; HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS CLINIC; PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); FOOD STAMP ELIGIBILITY; SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID SPEND-DOWN); LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR PATIENT IS DECEASED WITH NO KNOWN ESTATE. PART I, LINE 7: THE ORGANIZATION'S COST ACCOUNTING SYSTEM WAS USED TO REPORT FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS IN PART I, LINE 7. THE ORGANIZATION'S COST ACCOUNTING SYSTEM ADDRESSES ALL OF THE PATIENTS SERVED BY ST. FRANCIS MEDICAL CENTER. PART I, LINE 7G: THERE ARE PHYSICIAN CLINICS INCLUDED IN SUBSIDIZED HEALTH SERVICES. ST. FRANCIS MEDICAL CENTER SUBSIDIZES PRIMARY CARE RURAL HEALTH CLINIC, ORTHOPEDIC, AND CRNA ANESTHESIA SERVICES IN THEIR RURAL SERVICE AREA. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ST. FRANCIS IS AN ACTIVE PARTICIPANT IN SEVERAL COMMUNITY COALITIONS WHOSE PRIMARY FOCUS IS TO IMPROVE THE HEALTH OF THE COMMUNITY. RICHLAND WILKIN HEALTHY COMMUNITIES, INC. IS A COALITION OF OVER TEN COMMUNITY ORGANIZATIONS IN RICHLAND COUNTY, NORTH DAKOTA AND WILKIN COUNTY, MINNESOTA. THE VISION OF THIS COALITION IS TO ASSIST THE CITIZENS OF THE TWO COUNTIES TO WORK TOGETHER TO IMPROVE THE QUALITY OF LIFE FOR THOSE WHO LIVE, WORK, AND VISIT THE AREA. THE COALITION FOCUSES THEIR EFFORTS ON UTILIZING THE ASSETS OF THE TWO COUNTIES TO DEVELOP A WORK PLAN FOR IMPROVING THE OVERALL HEALTH OF THEIR CITIZENS. ST. FRANCIS PLAYS AN ACTIVE ROLE ON THE BOARD FOR THIS COALITION. THIS COALITION SERVES AS THE 501(C)3 PARENT ORGANIZATION FOR SEVERAL COMMUNITY GROUPS FOCUSED ON IMPROVING HEALTH, SUCH AS SOUTHERN VALLEY HEALTH WATCH, TWIN TOWN GARDENERS' MARKET, AND SOUTHERN VALLEY EARLY CHILDHOOD INITIATIVE. THE VIOLENCE PREVENTION TASK FORCE WAS FORMED TO DEVELOP PRIMARY PREVENTION STRATEGIES FOR OUR COMMUNITY. IN FISCAL YEAR 2021, $36,325 IN COMMUNITY BENEFIT WAS APPLIED TO VIOLENCE PREVENTION. THE FOCUS OF THIS GROUP IS TO REDUCE DOMESTIC VIOLENCE BY CONDUCTING EARLY CHILDHOOD EDUCATION FOR ALL NEW PARENTS IN RICHLAND AND WILKIN COUNTIES. AS PART OF THE PREVENTION STRATEGIES, ST. FRANCIS OPERATES THE FAMILY FOOTPRINTS PROGRAM, WHICH CONDUCTS THE INITIAL VISITS AND ASSESSMENTS FOR NEW PARENTS. FAMILY FOOTPRINTS UTILIZES THE EVIDENCE-BASED PROGRAM CURRICULUM PARENTS AS TEACHERS. ADVOCACY ST. FRANCIS CONTINUES TO ADVOCATE FOR ACCESS TO QUALITY HEALTH CARE ACROSS THE CONTINUUM OF CARE FOR RURAL COMMUNITIES. EFFORTS INCLUDED CONTACTS WITH BOTH STATE AND NATIONAL LEGISLATORS REGARDING THESE ISSUES. IN FISCAL YEAR 2021, ST. FRANCIS APPLIED $23,910 IN PAID STAFF HOURS TO ADVOCACY IN THE AREAS OF ACCESS TO CARE, TRANSPORTATION, HOUSING, AND CRIME REDUCTION. IN TOTAL, $24,529 IN COMMUNITY BENEFIT WAS APPLIED TO COMMUNITY BUILDING ACTIVITIES IN FY21. PART III, LINE 2: THE ORGANIZATION HAS REPORTED BAD DEBT EXPENSE AT GROSS CHARGES WRITTEN OFF. THE ORGANIZATION'S BAD DEBT EXPENSE REPRESENTS AMOUNTS BILLED TO PATIENTS THAT WAS DEEMED UNCOLLECTIBLE AND DOES NOT INCLUDE ANY CHARGES THAT WERE ULTIMATELY REIMBURSED OR DISCOUNTED. PATIENT DISCOUNTS ARE RECORDED IN CONTRACTUAL ALLOWANCE OR FINANCIAL ASSISTANCE, AS APPROPRIATE, AS AN OFFSET TO GROSS REVENUE AND ARE NOT INCLUDED IN BAD DEBT EXPENSE. PART III, LINE 3: ST. FRANCIS 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: ST. FRANCIS 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. ST. FRANCIS MEDICAL CENTER'S SURPLUS, AS REPORTED ON PART III, SECTION B, LINE 7, OF $358,283 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: MISSION, VISION, AND TAX-EXEMPT PURPOSEST. FRANCIS MEDICAL CENTER WAS FOUNDED IN BRECKENRIDGE, MINNESOTA IN 1899 BY THE FRANCISCAN SISTERS OF LITTLE FALLS IN RESPONSE TO A REQUEST FROM THE COMMUNITY FOUNDERS TO PROVIDE HEALTH CARE IN THIS RURAL AREA. CONTINUING THE FRANCISCAN TRADITION OF SERVICE, ST. FRANCIS IS PROUD TO BE THE ONLY HEALTH CARE FACILITY IN THE RED RIVER VALLEY TO SERVE ITS COMMUNITY UNDER THE SAME NAME FOR OVER ONE HUNDRED AND TWENTY YEARS. IN 1996, THE FRANCISCAN SISTERS JOINED WITH OTHER RELIGIOUS CONGREGATIONS TO FORM CATHOLIC HEALTH INITIATIVES, BASED IN ENGLEWOOD, CO. THE MISSION OF ST. FRANCIS MEDICAL CENTER COMPELS US TO PROVIDE CARE TO ALL IN NEED AND TO WORK IN COLLABORATION WITH OTHERS TO BUILD A HEALTHY COMMUNITY. THE 11-MEMBER, VOLUNTEER, BOARD OF DIRECTORS OVERSEES ST. FRANCIS MEDICAL CENTER'S COMMITMENT TO PROMOTE THE DEVELOPMENT OF HEALTHY COMMUNITIES. THE BOARD MEMBERS RESIDE IN THE COMMUNITIES SERVED BY ST. FRANCIS. THEY INCLUDE AN ATTORNEY, EDUCATORS, LOCAL BUSINESS PERSONS, FARMER, ETC. CARE IS TAKEN TO RECRUIT BOARD MEMBERS WHO REPRESENT VARIOUS SECTORS OF THE COMMUNITY. THE MAJORITY OF THE MEMBERS ARE NEITHER EMPLOYEES NOR CONTRACTORS OF ST. FRANCIS, NOR FAMILY MEMBERS THEREOF.ST. FRANCIS MEDICAL CENTER IS A RURAL CRITICAL ACCESS HOSPITAL THAT PROVIDES BOTH INPATIENT AND OUTPATIENT SERVICES, AS WELL AS OPERATING A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THE EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. ST. FRANCIS MEDICAL CENTER HAS AN OPEN MEDICAL STAFF, WHICH EXTENDS PRIVILEGES TO ALL QUALIFIED PHYSICIANS. ST. FRANCIS ALSO PARTICIPATES IN MEDICARE AND MEDICAID AND HAS AN ACTIVE CHARITY CARE PROGRAM. ST. FRANCIS MEDICAL CENTER IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL.COMMUNITY PARTICIPATION HAS ALWAYS BEEN A FUNDAMENTAL COMPONENT OF ST. FRANCIS. IN ADDITION TO BEING A VITAL ECONOMIC PARTNER IN THE RICHLAND AND WILKIN COUNTY AREAS, ST. FRANCIS ALSO PROVIDES HEALTH AND WELLNESS SERVICES FOR OTHER COMMUNITIES OUTSIDE THE TWO COUNTIES. EACH YEAR, EFFORTS ARE MADE TO EXPAND SERVICES AND PROGRAMS TO PROMOTE HEALTHIER COMMUNITIES IN THE AREA. THE PROGRAMS AND SERVICES DESCRIBED THROUGHOUT THIS REPORT NOT ONLY SERVE THE COMMUNITY BUT ALSO REDUCE THE BURDEN ON GOVERNMENTAL RESOURCES. 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: COMMUNITY BENEFIT APPROACHST. FRANCIS IS THE SOLE ACUTE CARE PROVIDER SERVING APPROXIMATELY 23,000 RESIDENTS OF WILKIN COUNTY, MINNESOTA, RICHLAND COUNTY, NORTH DAKOTA AND THE SURROUNDING CONTIGUOUS COUNTIES. THE BUREAU OF PRIMARY HEALTHCARE HAS DESIGNATED WILKIN COUNTY AS MEDICALLY UNDERSERVED AREA. DATA FROM THE 2020 U.S. CENSUS SHOWS THAT WILKIN COUNTY HAS A MEDIAN AGE OF 43.3, AND RICHLAND COUNTY'S MEDIAN AGE IS 37.3. 19.7% OF WILKIN COUNTY RESIDENTS ARE AGE 65 OR OLDER, AND 22.5% ARE 18 AND YOUNGER. WHILE IN RICHLAND COUNTY 18.7% OF THE RESIDENTS ARE 65 YEARS OLD OR OLDER, AND 21.9% ARE 18 OR YOUNGER.THE MEDIAN INCOME FOR WILKIN COUNTY, MINNESOTA IS $56,829, AND $60,833 FOR RICHLAND COUNTY, NORTH DAKOTA. THE UNEMPLOYMENT RATE IN WILKIN COUNTY IS 3.0% AND 2.8% IN RICHLAND COUNTY. 8.3% OF THE FAMILIES IN WILKIN COUNTY HAD AN ANNUAL INCOME BELOW THE POVERTY LEVEL. 9.4% OF THE FAMILIES IN RICHLAND COUNTY HAD AN ANNUAL INCOME BELOW THE POVERTY LEVEL. SINGLE PARENT FAMILIES COMPRISE 34.6% OF ALL FAMILIES IN WILKIN COUNTY, AND 33.3% OF ALL FAMILIES IN RICHLAND COUNTY. 13.3% OF THE POPULATION OF BOTH WILKIN COUNTY AND RICHLAND COUNTY AGE 25 AND OVER DO NOT HAVE A HIGH SCHOOL DIPLOMA.SINCE THE 1980'S, ST. FRANCIS MEDICAL CENTER HAS BEEN ACTIVELY INVOLVED WITH COMMUNITY HEALTH COLLABORATION. ST. FRANCIS HAS TAKEN THE LEAD IN ORGANIZING COMMUNITY TEAMS AND FOCUS GROUPS TO LOOK AT HEALTH ISSUES, SET PRIORITIES AND PLANS FOR IMPROVEMENT. THAT COMMITMENT CONTINUES TODAY WITH ST. FRANCIS' MEMBERSHIP ON THE RICHLAND-WILKIN HEALTHY COMMUNITIES, INC. BOARD OF DIRECTORS, THE BRECKENRIDGE ACTIVE LIVING COMMITTEE, THE ACTIVE TASK FORCE, THE VIOLENCE PREVENTION TASK FORCE, THE STATE-WIDE HEALTH IMPROVEMENT PLAN AND OTHER COMMUNITY GROUPS.ST. FRANCIS' COMMUNITY BENEFIT PLAN HAS BEEN ESTABLISHED IN CONJUNCTION WITH ITS SISTER CORPORATIONS OF ST. FRANCIS HOME, APPLETREE COURT, AND THE HEALTHCARE AND WELLNESS FOUNDATION. THE PLAN IS BASED ON AN UNDERSTANDING OF UNIQUE COMMUNITIES' NEEDS DERIVED FROM COLLABORATIVE NEEDS ASSESSMENTS, FOCUS GROUPS, AND SURVEYS CONDUCTED WITH OUR COMMUNITY PARTNERS. ST. FRANCIS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN FISCAL YEAR 2019 IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS FROM BOTH WILKIN COUNTY, MN AND RICHLAND COUNTY, ND, AS WELL AS BOTH PRIMARY CARE CLINICS IN OUR COMMUNITY. THE RESULTS IDENTIFIED THREE MAIN FOCUS AREAS FOR IMPROVEMENT: OBESITY MANAGEMENT, BEHAVIORAL HEALTH, AND CHILD CARE. OBESITY AND BEHAVIORAL HEALTH CONTINUE TO BE CONCERNS THAT WERE IDENTIFIED IN THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. AN IMPLEMENTATION PLAN WAS DEVELOPED TO ADDRESS THESE PRIMARY AREAS OF FOCUS. THE ACTIVE TASK FORCE CONTINUES ITS WORK WITH REDUCING OBESITY THROUGH PROMOTION OF PHYSICAL ACTIVITY AND NUTRITION. ST. FRANCIS WORKS IN CONJUNCTION WITH STAKEHOLDERS FROM THE VARIOUS COMMUNITY GROUPS INVOLVED IN OBESITY MANAGEMENT. THEY ARE WORKING WITH THREE MAIN POPULATIONS YOUTH, SENIORS, AND WORKSITE WELLNESS PROGRAMS. MOST OF THE WORK TO DATE HAS BEEN FOCUSED ON RAISING AWARENESS OF OPPORTUNITIES TO INCREASE PHYSICAL ACTIVITY. THE LONG TERM GOAL IS TO DECREASE OBESITY IN RICHLAND AND WILKIN COUNTIES BY 5% BY 2025. THE SUBSTANCE ABUSE TASK FORCE INVOLVES KEY STAKEHOLDERS FROM THROUGHOUT THE COMMUNITY, SUCH AS SCHOOLS, PUBLIC HEALTH, AND LAW ENFORCEMENT. THE FOCUS AREAS IDENTIFIED ARE MEDICATION DISPOSAL, COORDINATION OF PAIN MEDICATIONS, COLLABORATION FOR PREVENTION, AND TRANSPORTATION FOR INPATIENT SERVICES. THE MENTAL HEALTH FOCUS WAS INCORPORATED INTO THIS GROUP AS A RESULT OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT. THE GROUP NOW LOOKS AT ALL AREAS OF BEHAVIORAL HEALTH. STRATEGIC PLANNING WAS CONDUCTED IN APRIL OF 2017, WHICH RESULTED IN A FOCUS ON TRANSPORTATION TO INPATIENT BEHAVIORAL HEALTH SERVICES, INCREASING COMMUNITY AWARENESS, AND COMMUNITY EDUCATION. IN EARLY 2020, EFFORTS CONTINUED TO ADDRESS THE TRANSPORTATION ISSUE, AS MOST OF THE STAKEHOLDERS INVOLVED FELT THIS NEEDED TO BE RESOLVED BEFORE OTHER AREAS COULD BE SUCCESSFULLY ADDRESSED. THE COVID-19 PANDEMIC DID PAUSE THIS WORK BEGINNING IN MARCH 2020 BUT WILL TENTATIVELY RESUME IN SUMMER/FALL 2021.THE CHNA STEERING COMMITTEE HAS BEEN FURTHER RESEARCHING THE TOPIC OF CHILD CARE TO DETERMINE THE ACTUAL VERSUS PERCEIVED NEEDS IN THE COMMUNITY. SURVEYS WERE CONDUCTED WITH THE CHILD CARE PROVIDERS AND PARENTS. THE NEXT STEP IS TO WORK WITH THE EMPLOYERS IN OUR COMMUNITY. PART VI, LINE 5: THE ORGANIZATION'S HOSPITAL FACILITY(IES) PROMOTE HEALTH FOR THE BENEFIT OF THE COMMUNITY.MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITY(IES) HAVE AN OPEN MEDICAL STAFF. ITS BOARD OF TRUSTEES IS COMPOSED OF PROMINENT CITIZENS IN THE COMMUNITY. EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT IN PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. THE FACILITY(IES) TREAT PERSONS PAYING THEIR BILLS WITH THE AID OF PUBLIC PROGRAMS LIKE MEDICARE AND MEDICAID. ALL PATIENTS PRESENTING AT THE HOSPITAL FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH TREATMENT.COMMUNITY OUTREACH FOR THE LOW INCOMEPRESCRIPTION DRUG PROGRAM ST. FRANCIS MEDICAL CENTER PROVIDES PRESCRIPTION MEDICATIONS TO PERSONS WHO HAVE NO MEANS TO PROCURE THOSE MEDICATIONS. PROVISION OF THESE MEDICATIONS HELPS THE RECIPIENTS TO RECOVER MORE QUICKLY FROM THEIR ILLNESSES, BETTER MANAGE CHRONIC CONDITIONS, AND AVOID COSTLY HOSPITALIZATIONS AND INTERVENTIONS. IN FISCAL YEAR 2021, PRESCRIPTION DRUGS (VALUED AT $3,289) WERE PROVIDED TO NINE LOW-INCOME, ELDERLY, AND/OR UNINSURED INDIVIDUALS.COMMUNITY OUTREACH FOR THE BROADER COMMUNITYSUBSIDIZED HEALTH SERVICES (C) ST. FRANCIS IS THE SOLE PROVIDER FOR SEVERAL NEEDED HEALTH SERVICES IN OUR COMMUNITY, SUCH AS THE FOLLOWING: MILNOR CLINIC IS A RURAL HEALTH CLINIC LOCATED IN SOUTHEAST NORTH DAKOTA, 40 MILES WEST OF BRECKENRIDGE. CLINIC SERVICES ARE PROVIDED TO A MEDICALLY UNDERSERVED COMMUNITY THROUGH A NURSE PRACTITIONER. APPROXIMATELY 356 PATIENT VISITS WERE CONDUCTED DURING FISCAL YEAR 2021 AT A NET COST OF $91,977. THE HOPE UNIT PROVIDES OUTPATIENT PSYCHIATRIC, PSYCHOLOGICAL, AND SUBSTANCE USE DISORDER TREATMENT SERVICES TO HELP ADDRESS THE BEHAVIORAL HEALTH NEEDS OF THE COMMUNITY. WILKIN COUNTY HAS BEEN DESIGNATED AS A MENTAL HEALTH PROVIDER SHORTAGE AREA, AND THE HOPE UNIT STAFFS THE ONLY PSYCHIATRIST IN THE COMMUNITY. HOPE UNIT STAFF CONDUCTED 1,913 PATIENT ENCOUNTERS DURING FISCAL YEAR 2021 AT A NET COST OF $98,879. ST. FRANCIS HAS ALSO CONTRACTED TO PROVIDE E-PSYCHIATRY SERVICES IN THE ACUTE CARE AREA FOR EMERGENCY CONSULTS. WHILE THE FOLLOWING SERVICES WERE NOT SUBSIDIZED THIS PAST YEAR, ST. FRANCIS CONTINUES TO ENSURE THEY ARE AVAILABLE IN OUR COMMUNITY. THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT, IT WAS DETERMINED THAT OUR COMMUNITY NEEDED MORE ACCESS TO PRIMARY CARE, ESPECIALLY AFTER REGULAR BUSINESS HOURS. ST. FRANCIS ESTABLISHED AN AFTER-HOURS WALK-IN CLINIC DURING FY17. THE CLINIC'S HOURS WERE EXPANDED IN 2019 TO FURTHER ATTEMPT TO MEET COMMUNITY NEEDS. ST. FRANCIS IS ACTIVELY INVOLVED IN PROVIDER RECRUITMENT IN OUR COMMUNITY AND CONTINUES TO EXPAND OUTPATIENT SERVICES. THE WALK-IN CLINIC PROVIDED $267,995 IN NET EXCESS COST SERVICES IN FY21. ST. FRANCIS MEDICAL CENTER'S EMERGENCY ROOM IS CLASSIFIED AS A LEVEL IV TRAUMA CENTER IN BOTH MINNESOTA AND NORTH DAKOTA. THIS DESIGNATION ALLOWS ST. FRANCIS TO PROVIDE EMERGENCY TREATMENT FOR TRAUMA VICTIMS IN THE SERVICE AREA. BEING ABLE TO STABILIZE TRAUMA PATIENTS DURING THE GOLDEN HOUR HAS PROVEN TO SAVE LIVES. MOST PATIENTS IN THIS AREA WOULD REQUIRE AN HOUR'S TRANSPORTATION TO REACH THE TERTIARY CENTERS IN FARGO. MAINTAINING THIS CLASSIFICATION IS A COLLABORATIVE EFFORT BETWEEN ST. FRANCIS AND THE AREA EMERGENCY RESPONDERS. ST. FRANCIS PROVIDES 24/7 PHYSICIAN COVERAGE IN THE EMERGENCY ROOM. HEALTH PROFESSIONS EDUCATION (B) IT IS IMPERATIVE THAT WE ATTRACT STUDENT INTEREST IN HEALTH CARE CAREERS IF WE WISH TO CONTINUE RURAL HEALTH CARE INTO THE FUTURE. IN RESPONSE TO THIS NEED, ST. FRANCIS SERVES AS A CLINICAL SITE FOR STUDENTS FROM SEVERAL HIGH SCHOOLS AND COLLEGES. IN FISCAL YEAR 2021, DUE TO COVID 19 ST. FRANCIS DID NOT ASSIST IN THE EDUCATION OF STUDENTS IN THE FOLLOWING HEALTH PROFESSIONS: MEDICAL STUDENTS, NURSING, MEDICAL LABORATORY, ANESTHESIA, OCCUPATIONAL THERAPY, PHYSICAL THERAPY, IMAGING, AND PHARMACY. THE COMMUNITY BENEFIT AMOUNT FOR FISCAL YEAR 2021 IN THIS AREA OF HEALTH PROFESSIONS EDUCATION TOTALED $0. THIS TOTAL REFLECTS A DECREASE FROM FY20 DUE TO THE IMPACT OF THE COVID-19 PANDEMIC. TO PROTECT THE HEALTH AND SAFETY OF HEALTH PROFESSION STUDENTS, ST. FRANCIS STAFF, PATIENTS AND RESIDENTS, ST. FRANCIS MEDICAL CENTER DID NOT ALLOW HEALTH PROFESSIONS STUDENTS IN-PERSON EDUCATIONAL OPPORTUNITIES FROM JULY 1, 2020 THROUGH JUNE 30, 2021. 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. 0 1 0 0 0 0 0 0 0 ROBERTSON CLIFF BOARD MEMBER/CSH SVP DIVISION OFFICE 0 1011674 0 921351 0 397677 0 16975 0 29727 0 2377404 0 157178 JEFFREY DROP BOARD MEMBER/CSH SVP DIVISION OFFICE 0 692085 0 430582 0 141130 0 16844 0 17949 0 1298590 0 0 JEANETTE WOJTALEWICZ BOARD MEMBER/CSH SVP DIVISION OFFICE 0 553985 0 277663 0 154664 0 17649 0 32617 0 1036578 0 49946 BRENNEN SMITH MD ORTHOPEDIST-SPINE 583458 117165 0 0 79775 1392 0 16975 24184 2512 687417 138044 0 0 DAVID NELSON PRESIDENT/CEO 0 240414 0 25856 0 11534 0 18208 0 18929 0 314941 0 0 DR NANCY TORSON PSYCHIATRIST 238272 0 0 0 5456 0 12984 0 17089 0 273801 0 0 0 JAMES HEFFELE CRNA 210567 0 0 0 7564 0 11087 0 13658 0 242876 0 0 0 HEIDI GENEREUX CRNA 203330 0 5000 0 2842 0 9598 0 11243 0 232013 0 0 0 JENNIFER SHEFFIELD PHYSICIAN FAM MED 182708 0 0 0 12559 0 2734 0 5201 0 203202 0 0 0 JOSHUA SENGER VP OPERATIONAL FINANCE/CFO/TREASURER 0 128810 0 5426 0 246 0 8941 0 29298 0 172721 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2020, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B 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 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: JEANETTE WOJTALEWICZ, $71,692 AND CLIFF ROBERTSON, $186,901. DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2020 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2020, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: JEFFREY DROP, $113,534; DAVID NELSON, $5,944; JEANETTE WOJTALEWICZ, $77,144 AND CLIFF ROBERTSON, $195,187. FORM 990, PART VI, SECTION A, LINE 1 PURSUANT TO SECTION 8.6 OF THE BYLAWS OF ST. FRANCIS MEDICAL CENTER, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND CEO, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND TWO VOTING MEMBERS APPOINTED BY THE BOARD OF DIRECTORS. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 ACCORDING TO THE BYLAWS OF ST. FRANCIS MEDICAL CENTER THE ENTITY'S SOLE MEMBER IS COMMONSPIRIT HEALTH, A COLORADO NONPROFIT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS COMMONSPIRIT HEALTH. PURSUANT TO SECTION 5.4.2 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX, THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: *SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF ST. FRANCIS MEDICAL CENTER; *AMENDMENT OF THE CORPORATE DOCUMENTS OF ST. FRANCIS MEDICAL CENTER; *APPROVE MEMBERS OF THE ST. FRANCIS MEDICAL CENTER'S BOARD; *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF ST. FRANCIS MEDICAL CENTER; *APPROVAL OF ISSUANCE OF DEBT BY ST. FRANCIS MEDICAL CENTER; *APPROVAL OF PARTICIPATION OF ST. FRANCIS MEDICAL CENTER IN A JOINT VENTURE; *APPROVAL OF FORMATION OF A NEW CORPORATION BY ST. FRANCIS MEDICAL CENTER; *APPROVAL OF A MERGER INVOLVING ST. FRANCIS MEDICAL CENTER; *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ST. FRANCIS MEDICAL CENTER; *TO REQUIRE THE TRANSFER OF ASSETS BY ST. FRANCIS MEDICAL CENTER TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH 'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS; *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR ST. FRANCIS MEDICAL CENTER. PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, COMMONSPIRIT HEALTH MAY, IN EXERCISE OF ITS APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION B, LINE 11B ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE DIVISION VP OF OPERATIONAL FINANCE. AFTER ANY NECESSARY REVISIONS ARE MADE, THE RETURN IS PROVIDED TO THE BOARD MEMBERS FOR REVIEW. SUBSEQUENT TO PROVIDING THE RETURN TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO PROTECT THE INTERESTS OF COMMONSPIRIT HEALTH ("COMMONSPIRIT") IN CIRCUMSTANCES THAT MAY RESULT IN A CONFLICT BETWEEN PERSONAL INTERESTS OF A PERSON AND THE INTERESTS OF THE ORGANIZATION AND THOSE IT SERVES. THE POLICY WAS LAST UPDATED DURING THE TAX YEAR ENDED 6/30/2021. COMMONSPIRIT'S COI POLICY APPLIES TO COMMONSPIRIT, ITS DIRECT AFFILIATES AND SUBSIDIARIES AND ANY RELATED ENTITY THE GOVERNING DOCUMENTS OF WHICH REQUIRE THE ENTITY TO COMPLY WITH COMMONSPIRIT POLICY (COLLECTIVELY THE "SYSTEM ENTITIES"). THE FOLLOWING PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY (VIA A FORMAL SYSTEM-ADMINISTERED SURVEY) IF THE PERSON'S AFFILIATION WITH COMMONSPIRIT CONTINUES: - MEMBERS OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF COMMITTEES OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM ("ELT") OF COMMONSPIRIT - CORPORATE OFFICERS OF SYSTEM ENTITIES - 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 15B ST. FRANCIS MEDICAL CENTER HAS A COMPENSATION SUBCOMMITTEE OF THE BOARD OF DIRECTORS THAT REVIEWS PROPOSED WAGE INCREASES FOR OFFICERS AND KEY EMPLOYEES. THE SUBCOMMITTEE UTILIZES COMPARABILITY STUDIES AND BOARD APPROVAL TO DETERMINE COMPENSATION. 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 REQUERST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG. FORM 990, PART VI, LINE 15A: THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION WAS PAID BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION THE COMMONSPIRIT HEALTH BOARD OF STEWARDSHIP TRUSTEES APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED EXCLUSIVELY OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR APPROVING 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 AN INDEPENDENT CONSULTANT 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 STEWARDSHIP TRUSTEES. 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 IX, LINE 11G OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,822,376. MANAGEMENT AND GENERAL EXPENSES 138,659. FUNDRAISING EXPENSES 19,808. TOTAL EXPENSES 1,980,843. CONSULTING: PROGRAM SERVICE EXPENSES 16,629. MANAGEMENT AND GENERAL EXPENSES 1,265. FUNDRAISING EXPENSES 181. TOTAL EXPENSES 18,075. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 507,159. MANAGEMENT AND GENERAL EXPENSES 38,588. FUNDRAISING EXPENSES 5,513. TOTAL EXPENSES 551,260. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,828,012. MANAGEMENT AND GENERAL EXPENSES 112,712. FUNDRAISING EXPENSES 19,870. TOTAL EXPENSES 1,960,594. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,227,601. MANAGEMENT AND GENERAL EXPENSES 93,405. FUNDRAISING EXPENSES 13,343. TOTAL EXPENSES 1,334,349. FORM 990, PART XI, LINE 9: REALLOCATION OF CARES ACT REVENUE 1,964,088. FORM 990, PART XI, LINE 8 PRIOR PERIOD ADJUSTMENT: CENTRALIZED TRANSACTIONS: TRANSFERS FOR JOURNAL ENTRIES RECORDED CENTRALLY AT COMMONSPIRIT TO STANDARDIZE CONTRACTUAL ALLOWANCE METHODOLOGY ACROSS ALL COMMONSPIRIT AFFILIATES AND SUBSIDIARIES. RECORDED CENTRALLY AT YEAR END AND TRANSFERRED TO FACILITIES IN THE FOLLOWING YEAR. 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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 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