2021-05-13T17:03:11-05:00 2020-06-30 135565207 KPMG LLP 1225 17TH STREET SUITE 800 DENVER CO 80202 990 2019-07-01 470376601 SAINT FRANCIS MEDICAL CENTER SAIN 3083985407 2620 W FAIDLEY GRAND ISLAND NE 68803 JEANETTE WOJTALEWICZ CFO CHI HEALTH 3083985407 2021-05-13 1 MARK SHELTON P01203482 4159635100 2019 2022-09-23 18:48:47Z CHI HEALTH ST FRANCIS CLIFF ROBERTSON 12809 WEST DODGE ROAD OMAHA NE 68154 186168294 0 0928 X WWW.CHIHEALTH.COM X 1887 NE AN ACUTE CARE HOSPITAL PROVIDING ADVANCED DIAGNOSTIC AND MEDICAL TREATMENT SERVICES TO CENTRAL NEBRASKA. HONORING OUR CATHOLIC TRADITION, WE CARE FOR ALL IN NEED, REGARDLESS OF ABILITY TO PAY. 14 10 977 369 85464 0 100902 3931077 186003953 164043577 32045383 14723440 3093053 3371430 221243291 186069524 41671 36120 0 0 47343571 49535708 0 0 0 100279973 112036656 147665215 161608484 73578076 24461040 700813052 821604764 130964174 215048946 569848878 606555818 X 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 28601034 9382 44772237 THE ST. FRANCIS CANCER TREATMENT CENTER HAS SERVED CENTRAL NEBRASKA SINCE 1994 AND IS ACCREDITED BY THE COMMISSION ON CANCER FROM THE AMERICAN COLLEGE OF SURGEONS WITH COMMENDATION FOR EXCELLING IN EVERY ASPECT OF CANCER CARE. HERE, PATIENTS HAVE ACCESS TO MEDICAL AND RADIATION ONCOLOGY TREATMENT, A DEDICATED PHARMACY, CLINICAL TRIALS, AND A CANCER REHABILITATION TEAM ALL IN ONE LOCATION - CONVENIENCE NOT TYPICALLY FOUND IN OTHER CANCER CENTERS. IN ADDITION, THE HIGHLY SKILLED TEAM PROVIDES CERTIFIED GENETICS COUNSELING, TOBACCO CESSATION COUNSELING, NURSE NAVIGATION, SURVIVORSHIP SERVICES, AN EDUCATIONAL LIBRARY, SUPPORT GROUPS, AND EDUCATIONAL SEMINARS. 13325553 3285 15676855 ST. FRANCIS IS EQUIPPED WITH STATE-OF-THE-ART OPERATING ROOMS, AND THE SURGEONS ON STAFF CONTINUE TO EXPAND THE PROCEDURES AVAILABLE ACROSS MANY SPECIALTIES INCLUDING ORTHOPEDICS, NEUROSURGERY, UROLOGY, AND BARIATRIC AND RECONSTRUCTIVE SURGERY. 7179923 3645 17395624 THE PATHOLOGY DEPARTMENT AT ST. FRANCIS OFFERS AN ARRAY OF ON-SITE TESTING SERVICES. WE UTILIZE STATE-OF-THE-ART INSTRUMENTATION AND HAVE A HIGHLY SKILLED STAFF AVAILABLE 24/7. IN ADDITION TO OUR STAFF OF REGISTERED MEDICAL TECHNOLOGISTS AND PHLEBOTOMISTS, WE HAVE THREE PATHOLOGISTS ON SITE, A QUALIFIED HISTOLOGY TEAM, AND SECRETARIES WHO ARE BEYOND COMPARISON IN EFFICIENCY AND CUSTOMER SERVICE. TESTING CAPABILITIES VARY FROM ROUTINE SCREENING TESTS TO MORE SPECIALIZED TESTING SUCH AS PROTEIN ELECTROPHORESIS. WE ALSO HAVE A COMPREHENSIVE MICROBIOLOGY DEPARTMENT OPERATING SEVEN DAYS A WEEK. 75234023 19808 86198861 OTHER SERVICES 75234023 19808 86198861 124340533 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 2 0 1 977 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 X JEANETTE WOJTALEWICZ 4023434671 12809 WEST DODGE ROAD OMAHA NE 68154 ANTHONY JONES BOARD MEMBER 1.00 49.00 X 0 2459531 14470 CLIFF ROBERTSON MD BOARD MEMBER/CEO CHI HEALTH 1.00 49.00 X X 0 2271574 46283 JEANETTE WOJTALEWICZ CFO CHI HEALTH 5.00 45.00 X 0 1053501 42366 CARY WARD MD CHIEF MEDICAL OFFICER 5.00 45.00 X 0 555669 34565 AMY L MCGAHA MD BOARD MEMBER 1.00 59.00 X 0 434812 26872 EDWARD HANNON PRESIDENT 40.00 1.00 X 0 381146 52129 STEVE HOUSTON SVP STRATEGY AND TECHNOLOGY 5.00 45.00 X 0 371218 34814 JASON KRUGER MD BOARD MEMBER 1.00 59.00 X 0 338835 44134 NANCY WALLACE FORMER SVP HR CHI HEALTH 5.00 45.00 X 0 315144 25201 LISA WEBB VP OF FINANCE 25.00 25.00 X 250 244036 41315 SHU-MING WANG VP MEDICAL OPERATIONS, CHI HEALTH 0.00 40.00 X 0 265825 18030 DAVID CROSS PHARMACIST 40.00 0.00 X 213686 0 31500 MIKE WATTERS FORMER VP - SENIOR COUNSEL 5.00 0.00 X 0 191790 32614 BETH BARTLETT VP - PATIENT CARE SERVICES 40.00 0.00 X 194688 0 29668 JACQUELINE LIESS PED NURSE PRACT-NEONATAL 0.00 40.00 X 173 177070 35734 DOUGLAS RICHLING DIRECTOR-PHARMACY 40.00 0.00 X 164788 0 38844 ROBERT NORVELL DIRECTOR, ONCOLOGY SERVICES 40.00 0.00 X 123684 22990 36889 JENNIFER BEATY MD BOARD MEMBER 1.00 11.00 X 0 0 0 LARRY BUTLER FORMER TREASURER 1.00 11.00 X X 0 0 0 FR JAMES CLIFTON SJ SECRETARY 1.00 11.00 X X 0 0 0 RICHARD HERINK BOARD CHAIR 1.00 12.00 X X 0 0 0 SUSANNE L HRUZA MD BOARD MEMBER 1.00 11.00 X 0 0 0 ROBERT LANIK TREASURER 1.00 11.00 X X 0 0 0 THOMAS MURRAY PHD BOARD MEMBER 1.00 11.00 X 0 0 0 BARRY SANDSTROM BOARD MEMBER 1.00 11.00 X 0 0 0 SISTER MAURITA SOUKUP VICE CHAIR 1.00 12.00 X X 0 0 0 BILL YATES BOARD MEMBER 1.00 11.00 X 0 0 0 NADINE HEIMANN OSF BOARD MEMBER 1.00 11.00 X 0 0 0 697269 9083141 585428 39 1 1 0 MCCARTHY HOLDINGS INC 14217 DAYTON CIRCLE SUITE 8 OMAHA NE 68137 GENERAL CONSTRUCTION 1466612 MEDS 320 EAST US HIGHWAY 50 OFALLON IL 622692704 STAFFING SERVICES 930967 G4S SECURE SOLUTIONS USA INC 1395 UNIVERSITY DR JUPITER FL 33458 SECURITY SERVICES 434280 AMBASSADOR LINCOLN 4404 NORMAL BLVD LINCOLN NE 68506 POST-ACUTE HEALTHCARE 357716 LIVANOVA USA INC 100 CYBERONICS BLVD HOUSTON TX 77058 TECHNOLOGY SERVICES 354444 23 115822 3815255 12726 3931077 PATIENT SERVICES 900099 163814988 163814988 0 0 SERVICES SOLD 900099 199542 199542 0 0 PHARMACY SERVICES 446110 29047 29047 0 0 164043577 5436039 85464 5350575 2871520 0 2871520 2871520 2871520 9287401 0 9287401 9287401 9287401 131139 98770 32369 32369 CAFETERIA 722100 426885 0 0 426885 REHAB SERVICES REVENUE 621400 13570 0 0 13570 MEDICAL SERVICES 621300 9233 0 0 9233 17853 17853 467541 186069524 164043577 85464 18009406 X 36120 36120 37775808 33242711 4533097 1923483 1692665 230818 7152116 6293862 858254 2684301 2362185 322116 6146 6146 24298154 23025377 1272777 1774409 1419528 354881 139188 97431 41757 8090423 6957764 1132659 66434 43182 23252 5225 2090 3135 2998 2998 5912548 4848289 1064259 572386 572386 MEDICAL SUPPLIES 41266643 41266643 0 0 INTERCOMPANY ALLOCATION 27273580 0 27273580 0 REPAIRS AND MAINTENANCE 2227731 2116344 111387 0 DUES & SUBSCRIPTIONS 218902 207957 10945 0 181889 153001 28888 161608484 124340533 37267951 0 1300 6449 417710307 362072341 0 32965922 28361582 0 0 0 0 113149 1864235 4405504 4645376 265835 344932 203801927 127367998 68054462 76433929 0 0 119113218 276698163 0 4117356 4117356 54065999 67060401 700813052 821604764 13106740 39594197 0 0 2225478 0 0 0 0 0 0 0 0 0 0 115631956 175454749 130964174 215048946 X 569845038 606551978 3840 3840 569848878 606555818 700813052 821604764 X 24461040 -7548939 19794839 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 6146 0 0 0 6146 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $1,794 CATHOLIC HEALTH ASSOCIATION - $1,252 NEBRASKA HOSPITAL ASSOCIATION - $3,100 1028062 233463 177476 1084049 974878 162856 19570 113738 15504 1028062 1040658 149307 115248 99839 974878 1052622 370049 76499 305514 1040658 1453251 680750 1081372 7 1052622 0.00000 1.00000 0.00000 0 1 1 785411 785411 76035729 43257364 32778365 62852 52816 10036 105860834 81027577 24833257 21057101 3030241 18026860 76433929 CHI OIP 276698163 F 276698163 INTERCOMPANY RECEIVABLES 35982491 RIGHT OF USE ASSETS 16123364 INVESTMENT IN UNCONSOLIDATED ORGANIZATIONS 8498155 DEFERRED COMPENSATION 6456391 67060401 INTERCOMPANY PAYABLES 158473760 LT PORTION OF LEASE LIABILITIES 13735602 CURRENT PORTION OF LEASE LIABILITIES 3011884 ENVIRONMENTAL REMEDIATION LIABILITY 190007 OTHER LIABILITIES 43496 175454749 X PART V, LINE 4: THESE FUNDS ARE RAISED AND USED PRIMARILY FOR THE SUPPORT OF SAINT FRANCIS MEDICAL CENTER THROUGH COMMUNITY, GOVERNMENT, AND STAFF CONTRIBUTIONS. PERMANENT ENDOWMENT FUNDS ARE RAISED THROUGH STAFF CONTRIBUTIONS, AND ONLY THE EARNINGS ARE USED TO SUPPORT PROGRAMS OF SAINT FRANCIS MEDICAL CENTER. PART X, LINE 2: SAINT FRANCIS MEDICAL CENTER'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH'S ASC 740 FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2020, READS AS FOLLOWS: COMMONSPIRIT HAS ESTABLISHED ITS STATUS AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND THE LAWS OF THE STATES IN WHICH IT OPERATES, AND AS SUCH, IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, COMMONSPIRIT'S EXEMPT ORGANIZATIONS ARE SUBJECT TO INCOME TAXES ON NET INCOME DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, WHICH DOES NOT FURTHER THE ORGANIZATIONS' EXEMPT PURPOSES. NO SIGNIFICANT INCOME TAX PROVISION HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR NET INCOME DERIVED FROM UNRELATED TRADE OR BUSINESS. COMMONSPIRIT'S FOR-PROFIT SUBSIDIARIES ACCOUNT FOR INCOME TAXES RELATED TO THEIR OPERATIONS. THE FOR-PROFIT SUBSIDIARIES RECOGNIZE DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF THEIR ASSETS AND LIABILITIES, ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS, FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. INCOME TAX INTEREST AND PENALTIES ARE RECORDED AS INCOME TAX EXPENSE. FOR THE YEARS ENDED JUNE 30, 2020 AND 2019, COMMONSPIRIT'S TAXABLE ENTITIES RECORDED AN IMMATERIAL AMOUNT OF INTEREST AND PENALTIES AS PART OF THE PROVISION FOR INCOME TAXES. COMMONSPIRIT'S TAXABLE ENTITIES DID NOT HAVE ANY MATERIAL UNRECOGNIZED INCOME TAX EXPENSE AS OF JUNE 30, 2020 AND 2019. COMMONSPIRIT REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 4861 4082138 0 4082138 0.02530 8146 13951298 7790800 6160498 0.03810 0 0 0 13007 18033436 7790800 10242636 0.06340 16 9703 520553 18923 501630 0.00310 4 349 856287 222039 634248 0.00390 0 0 0 0 2 0 11666 0 11666 0.00010 7 4575 448896 1072 447824 0.00280 29 14627 1837402 242034 1595368 0.00990 29 27634 19870838 8032834 11838004 0.07330 0 0 0 0 0 0 0 0 2 3 460 0 460 0.00000 0 0 0 0 0 0 0 0 1 0 5288 2624 2664 0.00000 1 0 60 0 60 0.00000 2 15 1071 0 1071 0.00000 0 0 0 0 6 18 6879 2624 4255 0.00000 1 12895132 0 53478114 61802967 -8324853 X 1 1 1 GRAND ISLAND SURGICAL CENTER LLC SURGERY 0.50000 0.50000 3 1 SAINT FRANCIS MEDICAL CENTER 2620 W FAIDLEY GRAND ISLAND NE 68803 WWW.CHIHEALTH.COM 37001, LTCH014, MHSU011 X X X A 2 CHI HEALTH ST FRANCIS 2116 W FAIDLEY GRAND ISLAND NE 68803 WWW.CHIHEALTH.COM LTCH014 X LONG TERM CARE A 3 CHI HEALTH ST FRANCIS 2116 W FAIDLEY GRAND ISLAND NE 68803 WWW.CHIHEALTH.COM MHSU011 X MENTAL HEALTH SUBSTANCE ABUSE A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 18 1 0 1 1 X WWW.CHIHEALTH.COM/CHNA X X 1 19 0 1 0 1 X 300.000000000000 300.000000000000 X X X X 1 1 X X X 1 X WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: SAINT FRANCIS MEDICAL CENTER, - FACILITY 2: CHI HEALTH ST. FRANCIS, - FACILITY 3: CHI HEALTH ST. FRANCIS FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5: THE PROCESS OF IDENTIFYING THE COMMUNITY HEALTH NEEDS IN HALL COUNTY FOR THE PURPOSES OF THIS CHNA WAS LED BY CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD) AND INVOLVED A SECONDARY DATA REVIEW AND THREE COMMUNITY INPUT SESSIONS. FOLLOWING THESE ACTIVITIES, THE COMMUNITY BENEFIT ACTION TEAM FOR CHI HEALTH ST. FRANCIS AND THE SKILLED NURSING FACILITY - LONG TERM CARE HOSPITAL (SNF) FURTHER VALIDATED THE IDENTIFIED NEEDS THROUGH THE HOSPITAL'S GRAND ISLAND COMMUNITY BOARD. INPUT FROM THE COMMUNITY WAS PRIMARILY SOUGHT THROUGH THREE COMMUNITY-BASED MEETINGS. STAKEHOLDERS PARTICIPATING IN THESE INPUT SESSIONS REPRESENTED LOW-INCOME, MINORITY POPULATIONS, MEDICALLY UNDERSERVED POPULATIONS, AND THE AGING POPULATION, AS WELL AS THOSE AFFECTED BY VIOLENCE. MULTIPLE ORGANIZATIONS AND AGENCIES PROVIDED INPUT AT THE COMMUNITY ENGAGEMENT SESSION. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B: IN FISCAL YEAR 2019, CHI HEALTH ST. FRANCIS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN PARTNERSHIP WITH CENTRAL DISTRICT HEALTH DEPARTMENT AND WITH INPUT FROM NUMEROUS COMMUNITY PARTNERS. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 7D: THE TOP IDENTIFIED NEEDS WERE SHARED WITH THE CENTRAL DISTRICT HEALTH DEPARTMENT BOARD OF HEALTH AND CHI HEALTH ST. FRANCIS COMMUNITY BOARD FOR FURTHER VALIDATION, AND TO BEGIN TO PRIORITIZE HEALTH NEEDS THAT CHI HEALTH ST. FRANCIS WOULD ADDRESS IN THE IMPLEMENTATION STRATEGY PLAN. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11: THE MOST RECENT CHNA AND CORRESPONDING IMPLEMENTATION PLAN WAS COMPLETED IN THE TAX REPORTING YEAR 2018. THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON WWW.CHIHEALTH.COM/CHNA.THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH FACILITATED CONVERSATIONS AT THREE COMMUNITY INPUT SESSIONS CONDUCTED BY THE CENTRAL DISTRICT HEALTH DEPARTMENT AND WITH ADDITIONAL VALIDATION WITH THE CHI HEALTH ST. FRANCIS COMMUNITY BOARD.TOP HEALTH NEEDS (FROM 2018 CHNA):1. ACCESS TO CARE2. AGING ISSUES3. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH & SUBSTANCE ABUSE)4. CULTURE OF HEALTH (ALSO IDENTIFIED AS SOCIAL DETERMINANTS OF HEALTH)5. MATERNAL, INFANT & CHILD HEALTH6. OBESITY7. VIOLENCEFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: ACCESS TO HEALTHCARE SERVICESTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:*SUPPORT A HEALTH-DEPARTMENT LED WORK GROUP IN IDENTIFYING AND ADDRESSING KNOWN BARRIERS TO ACCESSING TIMELY AND EFFECTIVE HEALTH CARE IN HALL COUNTY, TO ENSURE SERVICES ARE COORDINATED, OPTIMIZED, AND PROMOTED- COLLABORATE WITH EXISTING SAFETY-NET PROVIDERS (CENTRAL DISTRICT HEALTH DEPARTMENT, HEARTLAND HEALTH, THIRD CITY COMMUNITY CLINIC, COMMUNITY SCHOOL & HEARTLAND UNITED WAY, OTHERS) THROUGH A HEALTH DEPARTMENT LED WORK GROUP TO IDENTIFY AND ADDRESS GAPS IN THE CONTINUUM OF HEALTHCARE AND HEALTH RELATED SERVICES FOR ALL. (CHI HEALTH ST. FRANCIS & SKILLED NURSING FACILITY) WORK MAY FOCUS ON:- IMPROVING COLLABORATION BETWEEN EMERGENCY DEPARTMENT AND THE SAFETY NET PROVIDERS(HEARTLAND HEALTH - FEDERALLY QUALIFIED HEALTH CENTER, AND THIRD CITY COMMUNITY CLINIC) TO ENSURE REFERRAL OF RELEVANT PATIENTS TO THE FQHC MEDICAL HOME, AND/OR COMMUNICATING WITH THE PATIENTS PRIMARY CARE PHYSICIAN REGARDING ED VISIT- ENSURE SERVICES ARE OPTIMIZED ACROSS PROVIDERS AND REDUCE DUPLICATION WHERE POSSIBLE- ENSURE THE CONNECTION AND COMMUNICATION TO SOCIAL SERVICE PROVIDERS IN SUPPORT OF MEETING PATIENTS SOCIAL NEEDS WHICH MAY BE AFFECTING THEIR HEALTH- IDENTIFYING COMMON BARRIERS TO ACCESSING TIMELY AND EFFECTIVE CARE WHEN NEEDED (I.E. TRANSPORTATION, LACK OF CHILD CARE, OR HOURS OF OPERATION) AND WORK COLLECTIVELY TO IDENTIFY STRATEGIES TO REDUCE BARRIERS- ASSESS AND ADDRESS GAPS IN ACCESSING HEALTHCARE SERVICES FOR THE AGING POPULATION SPECIFICALLY (SKILLED NURSING FACILITY)* EXPLORE WORK RELATED TO SCHOOL-BASED PRIMARY HEALTH CARE AND DETERMINE NEED AND CAPACITY TO INCREASE/IMPROVE SERVICES ALREADY OFFERED BY CHI HEALTH ST. FRANCIS IN SCHOOL SETTINGS. (CHI HEALTH ST. FRANCIS)PRIORITY HEALTH NEED #2: BEHAVIORAL HEALTH (TO INCLUDE MENTAL HEALTH, SUBSTANCE ABUSE, AND VIOLENCE)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:*ENGAGE WITH CENTRAL DISTRICT HEALTH DEPARTMENT AND HALL COUNTY COMMUNITY COLLABORATIVE (H3C) TO IMPROVE CLINICAL AND COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES, AND ADDRESS GAPS IN CARE TO ENSURE BEHAVIORAL HEALTH SERVICES ARE OPTIMIZED WITHIN THE HALL COUNTY COMMUNITY.-ENGAGE WITH CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD) LEADERSHIP AND HALL COUNTY COMMUNITY COLLABORATIVE (H3C) TO CONTINUE TO BUILD CAPACITY AND SUSTAINABILITY OF THE COLLECTIVE IMPACT BEHAVIORAL HEALTH COALITION WHICH MAY INCLUDE FUNDING AND/OR TECHNICAL ASSISTANCE (CHI HEALTH ST. FRANCIS)* SUPPORT THE COALITION TO PRIORITIZE COLLECTIVE STRATEGIES TO ADDRESS MENTAL HEALTH, SUBSTANCE ABUSE, AND VIOLENCE ISSUES WHICH MAY INCLUDE (CHI HEALTH ST. FRANCIS)- PROMOTE AND SUPPORT COMMUNITY-BASED TRAININGS RELATED TO CRISIS RESPONSE FOR COMMUNITY-BASED PUBLIC HEALTH AND SOCIAL SERVICE PROVIDERS.- SUPPORTING REGION 3 STRATEGY TO CREATE A YOUTH SYSTEM OF CARE- COLLABORATE WITH LAW ENFORCEMENT ON INVOLUNTARY COMMITMENTS TO IMPROVE THE RELEVANT PLACEMENT FOR BH PATIENTS (CIVIL PROTECTIVE CUSTODY) AND EXPLORE OPPORTUNITIES TO ADVOCATE FOR LEGISLATIVE CHANGE ALLEVIATING CHALLENGES WITH PLACEMENT.- CONTINUED SUPPORT TO FAMILY PROGRAMS SUPPORTING PARENTS AND BUILDING STRONGER FAMILY CONNECTIONS (I.E. ROOTED IN RELATIONSHIPS AND CIRCLE OF SECURITY) AND SOCIAL EMOTIONAL LEARNING FOR CHILDREN (I.E. DISCOVERY KIDS)- EXPLORE GAPS AND BUILD CAPACITY TO ADDRESS OPIOID ADDICTION IN THE AREA- EXPLORE EXISTING VIOLENCE PREVENTION EFFORTS AND IDENTIFY AND BUILD CAPACITY TO ADDRESS GAPS IN COMMUNITY RESPONSE TO VIOLENCETHE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS:IN ACKNOWLEDGING THE RANGE OF PRIORITY HEALTH NEEDS THAT EMERGED FROM THE CHNA PROCESS, CHI HEALTH ST. FRANCIS PRIORITIZED THE HEALTH NEED AREAS ABOVE IN ORDER TO MOST EFFECTIVELY FOCUS RESOURCES AND PRODUCE A POSITIVE IMPACT. THE HOSPITAL TOOK INTO CONSIDERATION EXISTING PARTNERSHIPS, AVAILABLE RESOURCES, THE HOSPITAL'S LEVEL OF EXPERTISE, EXISTING INITIATIVES (OR LACK THEREOF), POTENTIAL FOR IMPACT, AND THE COMMUNITY'S INTEREST IN THE HOSPITAL ENGAGING IN THAT AREA IN ORDER TO SELECT THE PRIORITIES. THE FOLLOWING IDENTIFIED NEEDS WILL NOT BE PRIORITIZED IN THIS IMPLEMENTATION PLAN FOR THE REASONS DESCRIBED BELOW.AGING ISSUES - IN ORDER TO MEANINGFULLY ADDRESS PRIORITIZED HEALTH NEEDS, AND MAXIMIZE IMPACT AND RESOURCES, CHI HEALTH ST. FRANCIS WILL NOT WRITE A STRATEGY TO DIRECTLY ADDRESS AGING ISSUES. MANY ISSUES FOR THE AGING POPULATION ARE RELATED TO ACCESS TO CARE, WHICH THE HOSPITAL IS ACTIVELY ADDRESSING THROUGH THE PLANS DESCRIBED ABOVE.CULTURE OF HEALTH - LEADERS REPRESENTING THE HOSPITAL ARE ACTIVELY ENGAGING ON A REGULAR BASIS WITH COMMUNITY PARTNERS WHO ARE CURRENTLY DOING WORK IN THIS AREA, SUCH AS GROW GRAND ISLAND, HALL COUNTY COMMUNITY COLLABORATIVE, AND CENTRAL DISTRICT HEALTH DEPARTMENT. MUCH OF THE WORK TO ADDRESS THIS HEALTH NEED AREA FOCUSES ON IMPROVING SOCIAL FACTORS SUCH AS POVERTY AND HOUSING. WHILE IT WILL BE IMPORTANT FOR THE HOSPITAL TO SUPPORT THIS WORK, THE COMMUNITY IS JUST BEGINNING THIS WORK, AND AS SUCH THE HOSPITAL WILL BE WORKING TO DETERMINE ITS ROLE OVER THE COURSE OF THE NEXT FEW YEARS. AS SUCH, CHI HEALTH ST. FRANCIS WILL NOT WRITE A STRATEGY TO ACTIVELY ADDRESS THIS BROAD HEALTH NEED UNTIL THE HOSPITAL'S ROLE BECOMES CLEARER BUT WILL CONTINUE TO BE PRESENT AND ACTIVELY INVOLVED IN THE COMMUNITY CONVERSATIONS THAT ARE SHAPING THIS WORK.MATERNAL & CHILD HEALTH - THE PRIMARY FACTORS DRIVING THIS HEALTH NEED ARE RELATED TO A SHORTAGE OF OBSTETRICS AND GYNECOLOGICAL PROVIDERS. AS THE HOSPITAL WILL BE WORKING WITH THE HEALTH DEPARTMENT LED WORK GROUP TO IDENTIFY AND ADDRESS GAPS IN THE CONTINUUM OF HEALTHCARE AND HEALTH RELATED SERVICES FOR ALL, AND IN ORDER TO ENSURE RESOURCES CAN BE LEVERAGED TO MAKE IMPACT IN THE PRIORITIZED HEALTH NEED AREA ACCESS TO CARE, CHI HEALTH ST. FRANCIS WILL NOT BE WRITING A STRATEGY TO ADDRESS THIS SPECIFIC HEALTH NEED.OBESITY - IN ORDER TO MEANINGFULLY ADDRESS THE SELECTED PRIORITY HEALTH NEEDS ABOVE AND MAXIMIZE IMPACT, CHI HEALTH ST. FRANCIS DID NOT PRIORITIZE WORK IN THIS AREA. ADDITIONALLY, THERE ARE EXISTING BODIES OF WORK BEING LED BY COMMUNITY PARTNERS, AND CHI HEALTH ST. FRANCIS IS ENGAGED WITH THIS GROUP TO DETERMINE ITS ROLE IN ADDRESSING BARRIERS TO, AND PROMOTING HEALTHY EATING AND ACTIVE LIVING ACROSS THE COMMUNITY. FACILITY REPORTING GROUP - A 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. 3 1 - SAINT FRANCIS MEDICAL CENTER ADTC 314 S 14TH ORD NE 68862 OUTPATIENT SUBSTANCE ABUSE 2 - SAINT FRANCIS MEDICAL CENTER ADTC 315 S 8TH ST BROKEN BOW NE 68822 OUTPATIENT SUBSTANCE ABUSE 3 - SAINT FRANCIS MEDICAL CENTER ADTC 1755 PRAIRIE VIEW PLACE KEARNEY NE 68847 OUTPATIENT SUBSTANCE ABUSE 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 6A: THE 2019 COMMUNITY BENEFIT REPORT FOR ST. FRANCIS MEDICAL CENTER WAS PREPARED BY ALEGENT CREIGHTON HEALTH, DBA CHI HEALTH, A RELATED ORGANIZATION. THE COMMUNITY BENEFIT REPORT CONTAINS INFORMATION FOR SEVERAL RELATED ORGANIZATIONS IN IOWA AND NEBRASKA. PART I, LINE 7G: A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING WORKSHEET 2 TO COMPUTE THE COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 77,544. PART II, COMMUNITY BUILDING ACTIVITIES: CHI HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT INVESTMENTS, AS WELL AS HOSPITAL SPECIFIC INVESTMENTS THAT ADDRESS COMMUNITY HEALTH NEEDS WHICH INCLUDE SUPPORT OF LOCAL HEALTH COALITIONS, INVESTMENTS IN PARTNERSHIPS AND PROGRAMS THAT ADDRESS TOP COMMUNITY HEALTH NEEDS, PARTICIPATION IN LOCAL COMMITTEES AND BOARDS TIED TO TOP HEALTH NEEDS, AND INVESTMENTS IN MANY OTHER WAYS AS DESCRIBED IN OTHER AREAS OF THE SCHEDULE H NARRATIVE. BELOW ARE SPECIFIC EXAMPLES OF WORK THAT FALLS WITHIN THE DEFINITION OF COMMUNITY BUILDING ACTIVITIES. THESE ACTIVITIES ARE CRITICAL IN HELPING BUILD SOCIAL, HEALTH, AND ECONOMIC OPPORTUNITIES IN OUR COMMUNITY THAT ULTIMATELY DRIVE HEALTH STATUS AND QUALITY OF LIFE FOR OUR RESIDENTS: * WORKFORCE DEVELOPMENT-THE FOLLOWING ACTIVITIES WORK TO STRENGTHEN THE COMMUNITY'S CAPACITY TO PROMOTE THE HEALTH AND WELL-BEING OF OUR RESIDENTS BY DRIVING ENTRY INTO HEALTHCARE CAREERS:- HEALTHCARE CAREER EXPLORATION CAMP-DAY CAMP FUNDED BY CHI HEALTH FOR STUDENTS GRADES 10-12 TO GIVE THEM THE OPPORTUNITY TO EXPLORE A VARIETY OF HEALTHCARE PROFESSIONS- PRESENTATIONS TO HIGH SCHOOL STUDENTS ABOUT HEALTHCARE CAREERS* COMMUNITY AND ECONOMIC DEVELOPMENT INCLUDING SUPPORT OF LOCAL CHAMBERS OF COMMERCE PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 28.42%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: SAINT 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: SAINT 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 IS PERFORMED AT LEAST QUARTERLY USING PRIMARILY A ROLLING EIGHTEEN-MONTH COLLECTION HISTORY AND WRITE-OFF DATA. SUBSEQUENT CHANGES TO ESTIMATES OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO NET PATIENT REVENUE IN THE PERIOD OF CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN A THIRD-PARTY PAYOR'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE IN PURCHASED SERVICES AND OTHER IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGE IN NET ASSETS. BAD DEBT EXPENSE FOR 2020 WAS NOT SIGNIFICANT. PART III, LINE 8: USING ESSENTIALLY THE SAME MEDICARE COST REPORT PRINCIPLES AS TO THE ALLOCATION OF GENERAL SERVICES COSTS AND "APPORTIONMENT" METHODS, THE "CHI WORKBOOK" CALCULATES A PAYERS' GROSS ALLOWABLE COSTS BY SERVICE (SO AS TO FACILITATE A CORRESPONDING COMPARISON BETWEEN GROSS ALLOWABLE COSTS AND ULTIMATE PAYMENTS RECEIVED). THE TERM "GROSS ALLOWABLE COSTS" MEANS COSTS BEFORE ANY DEDUCTIBLES OR CO-INSURANCE ARE SUBTRACTED. SAINT FRANCIS MEDICAL CENTER'S ULTIMATE REIMBURSEMENT WILL BE REDUCED BY ANY APPLICABLE COPAYMENT/ DEDUCTIBLE. WHERE MEDICARE IS THE SECONDARY INSURER, AMOUNTS DUE FROM THE INSURED'S PRIMARY PAYER WERE NOT SUBTRACTED FROM MEDICARE ALLOWABLE COSTS BECAUSE THE AMOUNTS ARE TYPICALLY IMMATERIAL.ALTHOUGH NOT PRESENTED ON THE MEDICARE COST REPORT, IN ORDER TO FACILITATE A MORE ACCURATE UNDERSTANDING OF THE "TRUE" COST OF SERVICES (FOR "SHORTFALL" PURPOSES) THE CHI WORKBOOK ALLOWS A HEALTH CARE FACILITY NOT TO OFFSET COSTS THAT MEDICARE CONSIDERS TO BE NON-ALLOWABLE, BUT FOR WHICH THE FACILITY CAN LEGITIMATELY ARGUE ARE RELATED TO THE CARE OF THE FACILITY'S PATIENTS. IN ADDITION, ALTHOUGH NOT REPORTABLE ON THE MEDICARE COST REPORT, THE CHI WORKBOOK INCLUDES THE COST OF SERVICES THAT ARE PAID VIA A SET FEE-SCHEDULE RATHER THAN BEING REIMBURSED BASED ON COSTS (E.G. OUTPATIENT CLINICAL LABORATORY). FINALLY, THE CHI WORKBOOK ALLOWS A FACILITY TO INCLUDE OTHER HEALTH CARE SERVICES PERFORMED BY A SEPARATE FACILITY (SUCH AS A PHYSICIAN PRACTICE) THAT ARE MAINTAINED ON SEPARATE BOOKS AND RECORDS (AS OPPOSED TO THE MAIN FACILITY'S BOOKS AND RECORDS WHICH HAS ITS COSTS OF SERVICE INCLUDED WITHIN A COST REPORT). TRUE COSTS OF MEDICARE COMPUTED USING THIS METHODOLOGY:TOTAL MEDICARE REVENUE: $53,478,114TOTAL MEDICARE COSTS: $61,802,967SURPLUS (SHORTFALL): ($8,324,853)SAINT FRANCIS MEDICAL CENTER BELIEVES THAT EXCLUDING MEDICARE LOSSES FROM COMMUNITY BENEFIT MAKES THE OVERALL COMMUNITY BENEFIT REPORT MORE CREDIBLE FOR THESE REASONS: UNLIKE SUBSIDIZED AREAS SUCH AS BURN UNITS OR BEHAVIORAL-HEALTH SERVICES, MEDICARE IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS. IN FACT, FOR-PROFIT HOSPITALS FOCUS ON ATTRACTING PATIENTS WITH MEDICARE COVERAGE, ESPECIALLY IN THE CASE OF WELL-PAID SERVICES THAT INCLUDE CARDIAC AND ORTHOPEDICS. SIGNIFICANT EFFORT AND RESOURCES ARE DEVOTED TO ENSURING THAT HOSPITALS ARE REIMBURSED APPROPRIATELY BY THE MEDICARE PROGRAM. THE MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC), AN INDEPENDENT CONGRESSIONAL AGENCY, CAREFULLY STUDIES MEDICARE PAYMENT AND THE ACCESS TO CARE THAT MEDICARE BENEFICIARIES RECEIVE. THE COMMISSION RECOMMENDS PAYMENT ADJUSTMENTS TO CONGRESS ACCORDINGLY. THOUGH MEDICARE LOSSES ARE NOT INCLUDED BY CATHOLIC HOSPITALS AS COMMUNITY BENEFIT, THE CATHOLIC HEALTH ASSOCIATION GUIDELINES ALLOW HOSPITALS TO COUNT AS COMMUNITY BENEFIT SOME PROGRAMS THAT SPECIFICALLY SERVE THE MEDICARE POPULATION. FOR INSTANCE, IF HOSPITALS OPERATE PROGRAMS FOR PATIENTS WITH MEDICARE BENEFITS THAT RESPOND TO IDENTIFIED COMMUNITY NEEDS, GENERATE LOSSES FOR THE HOSPITAL, AND MEET OTHER CRITERIA, THESE PROGRAMS CAN BE INCLUDED IN THE CHA FRAMEWORK IN CATEGORY C AS "SUBSIDIZED HEALTH SERVICES." MEDICARE LOSSES ARE DIFFERENT FROM MEDICAID LOSSES, WHICH ARE COUNTED IN THE CHA COMMUNITY BENEFIT FRAMEWORK, BECAUSE MEDICAID REIMBURSEMENTS GENERALLY DO NOT RECEIVE THE LEVEL OF ATTENTION PAID TO MEDICARE REIMBURSEMENT. MEDICAID PAYMENT IS LARGELY DRIVEN BY WHAT STATES CAN AFFORD TO PAY, AND IS TYPICALLY SUBSTANTIALLY LESS THAN WHAT MEDICARE PAYS. 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: THE PROCESS OF IDENTIFYING THE COMMUNITY HEALTH NEEDS IN HALL COUNTY FOR THE PURPOSES OF THIS CHNA WAS LED BY CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD) AND INVOLVED A SECONDARY DATA REVIEW AND THREE COMMUNITY INPUT SESSIONS. FOLLOWING THESE ACTIVITIES, THE COMMUNITY BENEFIT ACTION TEAM (CBAT)FOR CHI HEALTH ST. FRANCIS FURTHER VALIDATED THE IDENTIFIED NEEDS THROUGH THE HOSPITAL'S GRAND ISLAND COMMUNITY BOARD.CHI HEALTH ST. FRANCIS HOSTED A BROAD GROUP OF COMMUNITY STAKEHOLDERS CONVENED BY CDHD FOR A DATA PRESENTATION AND DISCUSSION TO IDENTIFY TOP HEALTH NEEDS. THE GROUP REVIEWED THE SECONDARY DATA, PARTICIPATED IN LARGE-GROUP DIALOGUE TO ADD CONTEXT, AND THEN SPLIT INTO SMALL GROUPS TO PUT FORTH TOP HEALTH NEEDS. SIMILAR DISCUSSIONS WERE LED WITH MEMBERS OF THE HALL COUNTY COMMUNITY COLLABORATIVE (H3C) AND THE CDHD BOARD OF HEALTH. FOLLOWING COMPLETION OF THE COMMUNITY PROCESS AND THREE MEETINGS HOSTED BY CDHD, THE INTERNAL MULTIDISCIPLINARY TEAM COMMUNITY BENEFIT ACTION TEAM (CBAT) WAS CONVENED TO VALIDATE THE COMMUNITY FINDINGS AND CONFIRM THE TOP IDENTIFIED HEALTH NEEDS. THE TOP IDENTIFIED NEEDS WERE THEN SHARED WITH THE CHI HEALTH ST. FRANCIS COMMUNITY BOARD ON JANUARY 17, 2019 FOR FURTHER VALIDATION.SUMMARY OF ASSESSMENT FINDINGS CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD) CONDUCTED FACILITATED CONVERSATIONS IN THE THREE COMMUNITY INPUT SESSIONS, TO ENGAGE PARTICIPANTS IN PRIORITIZING HEALTH NEEDS. THE HEALTH DEPARTMENT ASKED PARTICIPANTS TO PRIORITIZE HEALTH NEEDS BASED ON: * PREVALENCE * SEVERITY * TREND * DISPARITIES, AND * EXISTING RESOURCES UPON COMPLETION OF THE THREE SESSIONS, THE HEALTH DEPARTMENT AGGREGATED THE SCORING OF THE COMMUNITY STAKEHOLDERS TO IDENTIFY SEVEN TOP HEALTH NEEDS PRIORITIZED BY THE COMMUNITY.TOP HEALTH NEEDS FROM CHNA:1. ACCESS TO CARE2. AGING ISSUES3. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH & SUBSTANCE ABUSE)4. CULTURE OF HEALTH (ALSO IDENTIFIED AS SOCIAL DETERMINANTS OF HEALTH)5. MATERNAL, INFANT & CHILD HEALTH6. OBESITY7. VIOLENCEPRIORITIZED COMMUNITY HEALTH NEEDS:1. ACCESS TO HEALTHCARE SERVICES2. BEHAVIORAL HEALTH (TO INCLUDE MENTAL HEALTH, SUBSTANCE ABUSE, AND VIOLENCE) 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, WWW.CATHOLICHEALTH.NET, 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: FOR THE PURPOSE OF THE 2018 CHNA AND FUTURE IMPLEMENTATION STRATEGY, CHI HEALTH ST. FRANCIS CONSIDERS ITS PRIMARY COMMUNITY TO BE HALL COUNTY, NEBRASKA. THIS DEFINITION WAS DETERMINED BY INTERNAL HOSPITAL LEADERS ENGAGED IN THE HOSPITAL'S COMMUNITY BENEFIT ACTION TEAM (CBAT) AND THE LOCAL HEALTH DEPARTMENT, CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD). KEY CONSIDERATIONS FOR DETERMINING THIS COMMUNITY DEFINITION INCLUDED THE FOLLOWING: * HALL COUNTY IS THE GEOGRAPHIC AREA FROM WHICH A SIGNIFICANT NUMBER OF CHI HEALTH ST. FRANCIS PATIENTS UTILIZING HOSPITAL SERVICES RESIDE. WHILE THE CHNA CONSIDERS OTHER TYPES OF HEALTH CARE PROVIDERS, HOSPITALS ARE THE SINGLE LARGEST PROVIDER OF ACUTE CARE SERVICES. FOR THIS REASON, THE UTILIZATION OF HOSPITAL SERVICES PROVIDES THE CLEAREST DEFINITION OF THE COMMUNITY. * SURROUNDING COUNTIES OF HAMILTON AND MERRICK ALSO HAVE A SIGNIFICANT NUMBER OF CHI HEALTH ST. FRANCIS PATIENTS, HOWEVER BOTH COUNTIES HAVE A LOCAL HOSPITAL WHICH IS ALSO UNDERGOING A CHNA PROCESS. IN ALL THREE COUNTIES THE HOSPITALS ARE WORKING CLOSELY WITH CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD) TO ENSURE INPUT FROM, AND ALIGNMENT WITH CDHD. HALL COUNTY COVERS APPROXIMATELY 550 SQUARE MILES, INCLUDING FIVE COMMUNITIES WITH OVER 61,000 RESIDENTS. IT IS BOUNDED ON THE NORTH BY HOWARD COUNTY, ON THE EAST BY HAMILTON AND MERRICK, ON THE SOUTH BY ADAMS AND ON THE WEST BY BUFFALO.THE 2018 POPULATION ESTIMATE FOR HALL COUNTY IS 61,607, AND HAS INCREASED BY 5% SINCE 2010. THE PERCENT OF AFRICAN AMERICAN INCREASED FROM 2.7% OF THE POPULATION TO 3.3% SINCE THE 2014 CENSUS ESTIMATE, AND HISPANIC POPULATIONS HAVE INCREASED FROM 25.9% IN 2014 TO 27.9% IN 2018. FOREIGN BORN POPULATION MAKES UP MUCH MORE SIGNIFICANT PORTION OF THE POPULATION IN HALL COUNTY (13.8%) COMPARED TO THE STATE (6.9%). AS OF 2017, OVER 13% OF HALL COUNTY RESIDENTS WERE BORN OUTSIDE THE U.S., HOWEVER THIS IS A DECREASE FROM 14.4% IN 2016. COMPARED TO NEIGHBORING COUNTIES OF HAMILTON AND MERRICK, WITH BETWEEN ONE AND TWO PERCENT OF THEIR POPULATIONS BEING FOREIGN BORN, THIS IS A SIGNIFICANT PORTION OF THE HALL COUNTY POPULATION, AND PRESENTS UNIQUE CHALLENGES FOR HEALTHCARE AND OTHER PUBLIC SECTOR SERVICES.MEDIAN HOUSEHOLD INCOME IS $53,807PERSONS IN POVERTY IS 12.0%CHILDREN IN POVERTY IS 17.0%.UNEMPLOYMENT RATE WAS 3.4%.HIGH SCHOOL GRADUATION RATES WAS 90%.SOME COLLEGE IS 55%.PERCENT OF POPULATION UNDER 65 WITHOUT INSURANCE IS 13.4%.PERCENT OF UNINSURED CHILDREN WAS 7%. PART VI, LINE 5: THE ORGANIZATION'S HOSPITAL FACILITIES 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 FACILITIES 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 FACILITIES 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.CHI HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT AND HOSPITAL SPECIFIC COMMUNITY BENEFIT INVESTMENTS TO ADDRESS COMMUNITY HEALTH NEEDS OF THE PARTICULAR SERVICE AREA. EXAMPLES OF HOW CHI HEALTH FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY INCLUDE: - FINANCIAL ASSISTANCE AND UNPAID COSTS OF MEDICAID- COMMUNITY HEALTH IMPROVEMENT SERVICES - COMMUNITY EDUCATION, CLASSES AND PROGRAMS (INFANT CARE, BREASTFEEDING, TRAUMA, COMMUNITY BEHAVIORAL HEALTH SUPPORT AND EDUCATION, DIABETES, CANCER, PHYSICAL ACTIVITY AND HEALTHY EATING AND COOKING) - SUPPORT GROUPS (ALCOHOL & DRUG, BREASTFEEDING, SMOKING CESSATION, CANCER, BEREAVEMENT, YOUTH, ETC.) - COMMUNITY HEALTH FAIRS AND SCREENINGS- SCHOOL BASED HEALTHCARE SERVICES- MENTAL HEALTH HOTLINE-STAFF AND OPERATE 717-HOPE MENTAL HEALTH HOTLINE FOR ANYONE IN THE COMMUNITY TO ACCESS. THIS PROGRAM AVERAGES OVER 5,000 PHONE CALLS PER MONTH FROM COMMUNITY MEMBERS IN NEED.- PARISH NURSING PROGRAM AND FAITH COMMUNITY HEALTH NETWORK-THE CHI HEALTH FAITH COMMUNITY HEALTH NETWORK PARTNERS WITH CONGREGATIONS OF ALL FAITHS TO BUILD CAPACITY AND SUPPORT THE GROWTH OF HEALTH MINISTRIES WHICH PROMOTE HEALTH, HEALING AND WHOLENESS IN THE COMMUNITIES SERVED.- 5-4-3-2-1GO!- HEALTHY LIFESTYLE CAMPAIGN FOR KIDS; OPERATED IN SCHOOLS, OUT OF SCHOOL SETTINGS, CLINICS, COMMUNITY SETTINGS IN DOUGLAS, SARPY, CASS, AND COLFAX COUNTIES IN NE. INITIAL WORK COMPLETED BY CHI HEALTH IN FY19 AND FOLLOWING CONTRACTOR DEPARTURE, WORK WAS TRANSITIONED THROUGH A GRANT TO LIVE WELL OMAHA FOR THE BROADER OMAHA COMMUNITY STRATEGY IN DOUGLAS COUNTY AS PART OF A 2-YEAR GRANT. - COUNSELING AND ASSISTANCE IN ENROLLING INDIVIDUALS IN MEANS TESTED INSURANCE PROGRAMS TO IMPROVE ACCESS TO CARE.- PROVIDED FREE TEMPORARY HOUSING TO LOW INCOME, OUT-OF-TOWN PATIENTS WITH SPECIAL NEEDS AS WELL AS THEIR FAMILIES. - SUBSIDIZED LOW INCOME PATIENT CARE, POST-DISCHARGED TO SKILLED NURSING- LIFELINE-PROVIDED LIFELINE PERSONAL RESPONSE SYSTEMS FOR ELDERLY PATIENTS TO ENSURE RAPID RESPONSE AND MEDICAL ASSISTANCE IF NEEDED.- SUPPORT TO HEALTH COALITIONS AND INVESTMENTS IN SOCIAL AND ENVIRONMENTAL IMPROVEMENT STRATEGIES. THESE ARE PROGRAMS, ACTIVITIES AND PARTNERSHIPS THAT IMPROVE THE HEALTH OF PERSONS IN THE COMMUNITY BY ADDRESSING THE DETERMINANTS OF HEALTH, WHICH INCLUDES THE SOCIAL, ECONOMIC AND PHYSICAL ENVIRONMENT. SEE SPECIFIC EXAMPLES BY COMMUNITY BELOW:REGIONAL- NEBRASKA APPLESEED - TYPICALLY PROVIDES FUNDS TO SUPPORT HUNGER/FOOD ACCESS EFFORTS; THIS INCLUDES SUMMER MEALS PROGRAM OUTREACH, ENRICHMENT PROGRAMMING AT SUMMER MEALS SITES AND SUPPORT TO LAUNCH STATE'S FIRST SNAP EMPLOYMENT & TRAINING (E&T) THIRD PARTY PARTNERSHIP, WHICH PROVIDES JOB TRAINING FOR SNAP RECIPIENTS. IN THIS RECENT YEAR NEBRASKA APPLESEED PROVIDED SNAP OUTREACH TO NEWLY ELIGIBLE INDIVIDUALS THAT WERE EXPERIENCING ECONOMIC HARDSHIP DUE TO COVID19.- ALZHEIMER'S ASSOCIATION-PROVIDED FUNDS TO SUPPORT THE CONTINUED OFFERING OF FREE SUPPORT SERVICES FOR FAMILIES WITH A LOVED ONE WITH DEMENTIA/ALZHEIMER'S. SUPPORTS INCLUDE ASSISTANCE IN FINDING MEMORY UNITS, APPROPRIATE LEVELS OF CARE OR SPECIALTY PROVIDERS, CAREGIVER SUPPORT GROUPS, ETC. - NEBRASKA BREASTFEEDING COALITION-PROVIDED FUNDS THAT SUPPORTS THE BUILDING OF COALITION INFRASTRUCTURE TO INCLUDE EVALUATION OF EXISTING WORK AND DEVELOPMENT OF LONG-TERM STRATEGIC PLAN TO SECURE SUSTAINABLE FUNDING. FUTURE FOCUS IS MOVING TOWARD STRATEGIES THAT CONNECT BREASTFEEDING AND BREASTFEEDING SUPPORT WITH MENTAL HEALTH. - NEBRASKA EXTENSION-PROVIDED FUNDS TO SUPPORT DOUBLE UP FOOD BUCKS IN OMAHA AND LINCOLN; PROGRAM FOR SNAP RECIPIENTS TO RECEIVE AN ADDITIONAL $1 FOR EVERY $1 THEY SPEND (UP TO $20/DAY) ON FRUITS AND VEGETABLES AT PARTICIPATING SITES; NUTRITION/COOKING EDUCATION IS ALSO PROVIDED AT ALL SITES.GRAND ISLAND- UNITED WAY-COMPASSION FUND DONATION TO ASSIST IN COMMUNITY RELIEF WITH REGARDS TO COVID19- SALVATION ARMY-INITIAL INVESTMENT TO ASSIST IN COMMUNITY RELIEF WITH REGARDS TO COVID19- COMMUNITY EMT'S-GRAND ISLAND COMMUNITY INVESTMENT TO HELP SUPPORT RELIEF EFFORTS WITH REGARDS TO COVID19HEALTH PROFESSIONAL EDUCATION-- SUPPORTS THE EDUCATION OF MEDICAL STUDENTS BY PROVIDING SPECIALTY SPECIFIC PHYSICIAN-SUPERVISED ROTATIONS IN CONJUNCTION WITH THE MEDICAL SCHOOLS.- CLINICAL PRECEPTORSHIPS AND CLINICAL ROTATIONS FOR HEALTHCARE PROFESSIONALS- ADMINISTRATION AND STUDENT ONBOARDING COSTS FOR NURSING PRECEPTORSHIPS AND CLINICALS- STAFF TIME FACILITATING THE SMALL-GROUP ETHICS CASE DISCUSSIONS WITH MEDICAL STUDENTS- CLINICAL PASTORAL EDUCATION- SCHOLARSHIPS FOR HEALTHCARE EDUCATION- ACADEMIC AFFILIATION WITH CREIGHTON UNIVERSITY AND ITS HEALTH PROFESSIONS PROGRAMS, INCLUDING THE SCHOOL OF MEDICINE, COLLEGE OF ARTS & SCIENCES, SCHOOL OF DENTISTRY, SCHOOL OF PHARMACY AND HEALTH PROFESSIONS, COLLEGE OF NURSING.- PHYSICIAN RESIDENCY AND FELLOWSHIP PROGRAMS TRAIN MORE THAN 250 RESIDENTS AND FELLOWS ANNUALLY RESEARCH - UNFUNDED STAFF SUPPORT OF THE NATIONAL CANCER INSTITUTE COMMUNITY ONCOLOGY RESEARCH PROGRAM (NCORP)- TRAUMA INFORMED CARE-THIS WAS AN IDENTIFIED NEED ON THE COMMUNITY HEALTH IMPROVEMENT PLAN. CHI HEALTH IS PARTNERING TO IMPLEMENT STAFF TRAINING FOR AWARENESS OF TRAUMA AND ITS IMPACT AND COMPLETING A RESEARCH STUDY ON THE EFFECTIVENESS OF THE TRAINING TO HELP BUILD PUBLIC TRAINING AND EDUCATION RESOURCES.FINANCIAL AND IN-KIND CONTRIBUTIONS- CORPORATE SPONSORSHIPS- TANZANIA HEALTH MINISTRY-CHI HEALTH IS A MINISTRY PARTNER WITH THE MACHAME LUTHERAN HOSPITAL IN TANZANIA WHICH PROVIDES FULL SERVICE HEALTH CARE IN A DESPERATELY IMPOVERISHED AREA OF THE COUNTRY INCLUDING A FULL SERVICE HOSPITAL, PHARMACY, HOSPICE OUTREACH, CLINICS, CLINICAL OFFICER SCHOOL, AND THE RECENTLY ESTABLISHED SCHOOL OF NURSING. - STAFF SERVICE ON HEALTH RELATED BOARD AND COALITIONS- PARTICIPATION IN AND FUNDING OF MATERNAL HEALTH, SUBSTANCE ABUSE, FOOD ACCESS, VIOLENCE PREVENTION, CANCER AND OTHER COMMUNITY HEALTH COALITIONS.- PARTICIPATION IN AND SPONSORSHIP OF MENTAL HEALTH COALITIONS INCLUDING VOICES FOR CHILDREN, COMMUNITY ALLIANCE FOUNDATION AND PROJECT HARMONY.- IN-KIND DONATIONS OF PPE FOR SURROUNDING COMMUNITIES TO ASSIST IN STAYING SAFE DURING THE PANDEMIC.- IN-KIND STAFF TIME ORGANIZING THE DONATION OF ITEMS TO VARIOUS NON-PROFIT GROUPS AND VOLUNTEERING TIME AT FOOD BANK OF THE HEARTLAND.- IN-KIND DONATIONS OF SPACE, FOOD AND STAFF TIME PROVIDING STRATEGIC PLANNING, FACILITATION AND CONSULTING SERVICES FOR NOT-FOR-PROFIT ORGANIZATIONS AND COMMUNITY GROUPS- IN-KIND DONATIONS (STAFF TIME, SPACE, ETC.) SUPPORTING GRANTS FOR BEHAVIORAL HEALTH, VIOLENCE PREVENTION, AND COMMUNITY LINK.- IN-KIND DONATIONS OF MEETING ROOM SPACE AND STAFF TIME FOR NOT-FOR-PROFIT ORGANIZATIONS AND COMMUNITY GROUPSCOMMUNITY BUILDING ACTIVITIES - HEALTHCARE CAREER EXPLORATION CAMP-DAY CAMP FUNDED BY CHI HEALTH FOR STUDENTS GRADES 10-12 TO GIVE THEM THE OPPORTUNITY TO EXPLORE A VARIETY OF HEALTHCARE PROFESSIONS- PRESENTATIONS TO HIGH SCHOOL STUDENTS ABOUT HEALTHCARE CAREERS- TEAMMATES-MENTORING PROGRAM TO CARE FOR A YOUNGER POPULATION (K-12) THAT MAY NOT HAVE AN IDEAL SITUATION AT HOME OR LACK OF LEADERSHIP- COMMUNITY AND ECONOMIC DEVELOPMENT INCLUDING SUPPORT OF LOCAL CHAMBERS OF COMMERCE CHILD SAFETY PROGRAM- FUNDED STAFF TO PARTICIPATE IN GRASS ROOTS, COMMUNITY BASED COALITION TO PROMOTE THE WELL-BEING OF CHILDREN; MONTHLY COALITION MEETS TO DEVELOP SAFETY/ACCIDENT PREVENTION ACTIVITIES. INCLUDES COST OF PAID COORDINATOR, CAR SEAT SAFETY CHECKS, DONATION OF CHILD SAFETY SEATS AND RELATED COSTS OF PROVIDING COMMUNITY EDUCATION ON CHILD SAFETY. PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH AS A SINGLE MINISTRY IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND COMPRISES 142 HOSPITALS, INCLUDING THREE ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS AS WELL AS 31 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 2020, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.2 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 $4.6 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED "SHARE 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. 1 GRAND ISLAND AREA HABITAT FOR HUMANITY 502 W 2ND STREET GRAND ISLAND NE 68801 470754122 501C3 5500 PROGRAM SUPPORT 1 0 PART I, LINE 2: GRANTS ARE TO COMPANIES AND COMMUNITY ORGANIZATIONS WHO ENGAGE IN ACTIVITIES THAT BENEFIT THE COMMUNITY AT LARGE. NO CONSIDERATION IS RECEIVED IN EXCHANGE FOR THESE CONTRIBUTIONS, AS THEY ARE CONSIDERED TO BE A GIFT TO BE USED BY THE RECIPIENT IN ACCORDANCE WITH THEIR CHARITABLE PURPOSE. AS SUCH, USE OF THE FUNDS GIVEN TO THE GRANTEE IS NOT MONITORED BEYOND THE DISTRIBUTION. SAINT FRANCIS MEDICAL CENTER RELIES ON THOSE ORGANIZATIONS TO USE THE GRANTS IN ACCORDANCE WITH EACH ORGANIZATION'S EXEMPT PURPOSE. 1 1 0 0 0 0 0 1 0 ANTHONY JONES BOARD MEMBER 0 1193615 0 1247337 0 18579 0 0 0 14470 0 2474001 0 0 CLIFF ROBERTSON MD BOARD MEMBER/CEO CHI HEALTH 0 1062248 0 848919 0 360407 0 16675 0 29608 0 2317857 0 136676 JEANETTE WOJTALEWICZ CFO CHI HEALTH 0 569967 0 340681 0 142853 0 15642 0 26724 0 1095867 0 48668 CARY WARD MD CHIEF MEDICAL OFFICER 0 509754 0 23303 0 22612 0 16294 0 18271 0 590234 0 0 AMY L MCGAHA MD BOARD MEMBER 0 433436 0 0 0 1376 0 16574 0 10298 0 461684 0 0 EDWARD HANNON PRESIDENT 0 333775 0 18259 0 29112 0 32671 0 19458 0 433275 0 9480 STEVE HOUSTON SVP STRATEGY AND TECHNOLOGY 0 333551 0 15372 0 22295 0 16675 0 18139 0 406032 0 0 JASON KRUGER MD BOARD MEMBER 0 338106 0 0 0 729 0 16505 0 27629 0 382969 0 0 NANCY WALLACE FORMER SVP HR CHI HEALTH 0 104558 0 12441 0 198145 0 11953 0 13248 0 340345 0 0 LISA WEBB VP OF FINANCE 0 233845 250 6499 0 3692 0 15484 5 25826 255 285346 0 0 SHU-MING WANG VP MEDICAL OPERATIONS, CHI HEALTH 0 263306 0 0 0 2519 0 16410 0 1620 0 283855 0 0 DAVID CROSS PHARMACIST 206441 0 250 0 6995 0 13022 0 18478 0 245186 0 0 0 MIKE WATTERS FORMER VP - SENIOR COUNSEL 0 184089 0 0 0 7701 0 16525 0 16089 0 224404 0 0 BETH BARTLETT VP - PATIENT CARE SERVICES 184131 0 5420 0 5137 0 12491 0 17177 0 224356 0 0 0 JACQUELINE LIESS PED NURSE PRACT-NEONATAL 173 174778 0 2000 0 292 0 10341 5 25388 178 212799 0 0 DOUGLAS RICHLING DIRECTOR-PHARMACY 161189 0 3270 0 329 0 11105 0 27739 0 203632 0 0 0 ROBERT NORVELL DIRECTOR, ONCOLOGY SERVICES 117668 22990 2907 0 3109 0 0 9490 6137 21262 129821 53742 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2019, 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. COMPENSATION FOR THE OTHER OFFICERS OF SAINT FRANCIS MEDICAL CENTER WAS ESTABLISHED BY THE CHI HEALTH CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE. PART 1, LINE 4A FOR REPORTABLE INDIVIDUALS EMPLOYED PRIOR TO 2019, POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. OFFICERS, KEY EMPLOYEES AND CERTAIN HIGHLY COMPENSATED EMPLOYEES WHO BEGAN EMPLOYMENT AFTER NOVEMBER 1ST OF 2019 ARE COVERED BY A SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS 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 POLICY. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM COMMONSPIRIT HEALTH (A RELATED ORGANIZATION) DURING THE 2019 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUALS' W-2 INCOME AND REPORTABLE COMPENSATION ON PART VII AND SCHEDULE J, PART II, COLUMN (B)(III): NANCY WALLACE, $188,001. PART 1, LINE 4B DURING THE 2019 CALENDAR YEAR, COMMONSPIRIT MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/HOSPITAL PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DURING 2019 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON, $139,927; JEANETTE WOJTALEWICZ, $62,916; EDWARD HANNON, $10,101. 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 2019 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 2019, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: CLIFF ROBERTSON, $182,082; JEANETTE WOJTALEWICZ, $57,305. PART 1, LINE 7 DURING THE 2019 CALENDAR YEAR, COMMONSPIRIT MAINTAINED A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES, QUALITY IMPROVEMENT, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON REACHING MINIMUM LEVELS OF OPERATING MARGIN AND CHARITY CARE LEVELS, UNLESS THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES USES ITS DISCRETION TO APPROVE AN EXCEPTION. SUCH EXCEPTIONS ARE NOT APPLIED TO INDIVIDUALS OR CLASSES OF INDIVIDUALS, BUT RATHER TO THE PROGRAM AS A WHOLE. PART V, LINE 1C PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF COMMONSPIRIT HEALTH ARE MADE BY COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH FILES THE FORM 1099'S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099'S ISSUED BY COMMONSPIRIT HEALTH ON BEHALF OF CHI HEALTH SAINT FRANCIS ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 1 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. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE CORPORATE MEMBER IS CHI NEBRASKA, A NEBRASKA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A IN ACCORDANCE WITH THE ORGANIZATION'S CORPORATION BYLAWS, THE SOLE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS CHI NEBRASKA. PURSUANT TO SECTION 5.4.1 OF THE ORGANIZATION'S BYLAWS, CHI NEBRASKA, AND COMMONSPIRIT HEALTH (CHI NEBRASKA'S SOLE CORPORATE MEMBER) HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI NEBRASKA BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI NEBRASKA CHIEF EXECUTIVE OFFICER: - SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF SAINT FRANCIS MEDICAL CENTER - AMENDMENT OF THE CORPORATE DOCUMENTS OF SAINT FRANCIS MEDICAL CENTER - APPROVE MEMBERS OF SAINT FRANCIS MEDICAL CENTER'S BOARD - REMOVAL OF A MEMBER OF THE GOVERNING BODY OF SAINT FRANCIS MEDICAL CENTER - APPROVAL OF ISSUANCE OF DEBT BY SAINT FRANCIS MEDICAL CENTER - APPROVAL OF PARTICIPATION OF SAINT FRANCIS MEDICAL CENTER IN A JOINT VENTURE - APPROVAL OF FORMATION OF A NEW CORPORATION BY SAINT FRANCIS MEDICAL CENTER - APPROVAL OF A MERGER INVOLVING SAINT FRANCIS MEDICAL CENTER - APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF SAINT FRANCIS MEDICAL CENTER - TO REQUIRE THE TRANSFER OF ASSETS BY THE SAINT 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 SAINT 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. FORM 990, PART VI, SECTION B, LINE 11B FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE COMMONSPIRIT HEALTH TAX DIRECTOR AND THE LOCAL CHIEF FINANCIAL OFFICER. THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW AND ARE ABLE ASK THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR QUESTIONS PRIOR TO FILING WITH THE IRS. UPON CHIEF FINANCIAL OFFICER APPROVAL AND SIGNATURE, THE TAX ANALYST FILES THE FINAL FORM 990 AS PRESENTED TO THE BOARD AND FINANCE COMMITTEE, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER 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 MAINTAIN THE INTEGRITY OF ITS ACTIVITIES. THE POLICY APPLIES TO THE FOLLOWING PERSONS ("COVERED PERSONS"): MEMBERS OF THE COMMONSPIRIT HEALTH ("COMMONSPIRIT") BOARD OF STEWARDSHIP TRUSTEES AND ITS COMMITTEES; COMMONSPIRIT HEALTH CORPORATE OFFICERS; MEMBERS OF THE DIGNITY HEALTH BOARD OF STEWARDSHIP TRUSTEES AND ITS COMMITTEES. IN ADDITION, THE POLICY APPLIES TO ORGANIZATIONS THAT WERE AFFILIATES AND SUBSIDIARIES OF COMMONSPIRIT HEALTH PRIOR TO ITS AFFILIATION WITH DIGNITY HEALTH ("CHI ENTITIES"). COVERED PERSONS OF CHI ENTITIES INCLUDE: MEMBERS OF ANY CHI ENTITY DIRECT AFFILIATE OR SUBSIDIARY BOARD AND THEIR COMMITTEES; EMPLOYEES OF CHI ENTITIES; AND CHI ENTITY RESEARCHERS (AS DEFINED BY THE POLICY). DISCLOSURE, REVIEW AND MANAGEMENT OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS AND MUST DISCLOSE THAT CONFLICT TO HIS/HER DIRECT MANAGER (OR OTHER PERSON AS IS APPROPRIATE PER POLICY). SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON (E.G. UPON HIRING OR BOARD APPOINTMENT), AND ANNUALLY THEREAFTER. DISCLOSURES OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS ARE INITIALLY REVIEWED BY NATIONAL OR REGIONAL LEGAL OR CORPORATE RESPONSIBILITY TEAM MEMBERS TO DETERMINE WHETHER AN ACTUAL OR POTENTIAL CONFLICT MAY EXIST. IF IT IS DETERMINED THAT A POTENTIAL OR ACTUAL CONFLICT EXISTS, ISSUES ARE ELEVATED TO THE BOARD EXECUTIVE COMMITTEE OR BOARD CHAIR (FOR BOARD OR OFFICER CONFLICTS), OR THE CONFLICTS OF INTEREST REVIEW COMMITTEE (FOR ANY OTHER CONFLICT). THE PROCEDURES FOR ADDRESSING A CONFLICT RELATED TO A PROPOSED TRANSACTION IN THE CASE OF GOVERNING BODIES OR A CORPORATE OFFICER INCLUDE, BUT ARE NOT LIMITED TO 1) DISCLOSURE TO THE BOARD, 2) THE TRUSTEE OR CORPORATE OFFICER BEING EXCUSED FROM THE MEETING DURING DISCUSSION AND VOTE ON THE CONFLICT OF INTEREST (ALTHOUGH HE OR SHE MAY RESPOND TO PERTINENT QUESTIONS IF THE KNOWLEDGE IS RELEVANT), AND 3) BOARD APPROVAL OF THE TRANSACTION BY A MAJORITY OF DISINTERESTED MEMBERS. IN ADDITION, BOARDS CAREFULLY REVIEW AND SCRUTINIZE ANY NON-TRANSACTIONAL CONFLICTS OF INTEREST. IN SUCH CIRCUMSTANCES, BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES, THE BOARD TAKES WHATEVER ACTION IS DEEMED APPROPRIATE. FOR CONFLICTS NOT INVOLVING A BOARD MEMBER OR OFFICER, THE CONFLICTS OF INTEREST REVIEW COMMITTEE ("C-CIRC") WILL FACILITATE A COI MANAGEMENT PLAN TO MITIGATE THE CONFLICT IF ADEQUATE CONTROLS AREN'T ALREADY IN PLACE. NOTWITHSTANDING THE FOREGOING, AT ITS SOLE DISCRETION, AN ENTITY MAY REJECT A PERSON'S REQUEST TO ENTER INTO THE RELATIONSHIP IN QUESTION, OR REQUIRE THE RELATIONSHIP BE SUFFICIENTLY ALTERED TO AVOID A POTENTIAL CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15B 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 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 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. COMPENSATION FOR THE OTHER OFFICERS OF SAINT FRANCIS MEDICAL CENTER WAS ESTABLISHED BY THE CHI HEALTH CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG. PART VI, LINE 16B SAINT FRANCIS MEDICAL CENTER HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER COMMONSPIRIT HEALTH'S SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S-LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. ANY JOINT VENTURE AGREEMENTS THAT DO NOT CONFORM TO THE MODEL AGREEMENT ARE GENERALLY REVIEWED BY COUNSEL. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 9,665,896. MANAGEMENT AND GENERAL EXPENSES 508,732. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,174,628. CONSULTING: PROGRAM SERVICE EXPENSES 210,306. MANAGEMENT AND GENERAL EXPENSES 11,069. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 221,375. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,146,738. MANAGEMENT AND GENERAL EXPENSES 127,415. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,274,153. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,336,508. MANAGEMENT AND GENERAL EXPENSES 122,974. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,459,482. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,665,929. MANAGEMENT AND GENERAL EXPENSES 502,587. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,168,516. FORM 990, PART XI, LINE 9: ASC 842 ADJUSTMENT 15,014,963. CNRS NONCONTROLLING INTEREST -3,535,841. OTHER CHANGES IN NET ASSETS -12,726. EQUITY CHANGES IN UNCONSOLIDATED ORGS 8,328,443. ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HOSPITAL NE 501(C)(3) LINE 3 ACH 0 ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL MO VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(C)(3) LINE 10 CSH 0 APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(C)(3) LINE 10 SFH 0 ARROYO GRANDE COMMUNITY HOSPITAL FOUNDATION 345 S HALCYON RD ARROYO GRANDE CA 93420 203256066 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 BAKERSFIELD MEMORIAL HOSPITAL 420 34TH STREET BAKERSFIELD CA 93301 951802779 HOSPITAL CA 501(C)(3) LINE 3 DCC 0 BARROW NEUROLOGICAL FOUNDATION 350 WEST THOMAS ROAD PHOENIX AZ 85013 860174371 FUNDRAISING 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 SLCHS 0 BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON TX 77030 760458535 PHYSICIANS TX 501(C)(3) LINE 3 SLHS 0 BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232187242 HEALTHCARE 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 BRHS 0 BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(C)(3) LINE 3 BRHS 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 HEALTHCARE 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 1150 KELLY JOHNSON BLVD 204 COLORADO SPRINGS CO 80920 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 HEALTHCARE CO 501(C)(3) LINE 12A, I CSH 0 CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 PHYSICIANS CO 501(C)(3) LINE 12A, I CHINS 0 CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 SURGERY CENTER OR 501(C)(3) LINE 10 MMC 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 HOSPITAL KS 501(C)(3) LINE 3 CSH 0 CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 FUNDRAISING FOUNDATION 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 COMMONSPIRIT HEALTH RESEARCH INSTITUTE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(C)(3) LINE 12A, I CSH 0 CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(C)(3) LINE 12A, I CSH 0 CHI LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE OH 501(C)(3) LINE 12A, I SFH 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 HEALTHCARE CO 501(C)(3) LINE 10 CHI NS 0 CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(C)(3) LINE 12A, I CSH 0 CHI NEBRASKA 12809 WEST DODGE ROAD OMAHA NE 68510 363233121 HEALTHCARE 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 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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 SUITE 200 SAN FRANCISCO CA 94107 815009488 HOSPITAL CO 501(C)(3) LINE 3 CSH 0 DIGNITY HEALTH 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 941196203 HOSPITAL CA 501(C)(3) LINE 3 CSH 0 DIGNITY HEALTH CONNECTED LIVING 200 MERCY OAKS DRIVE REDDING CA 96003 237115371 SENIOR CENTER SERVICES CA 501(C)(3) LINE 7 DH 0 DIGNITY HEALTH FOUNDATION 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 462037641 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH FOUNDATION - INLAND EMPIRE 2101 N WATERMAN AVENUE SAN BERNARDINO CA 92404 237440086 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH FOUNDATION EAST VALLEY 475 SOUTH DOBSON ROAD CHANDLER AZ 85224 742418514 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH HPL SELF-INSURANCE TRUST 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 943006034 SELF INSURANCE CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH INSURANCE NEVADA LTD 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 813800752 SELF INSURANCE NV 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH MEDICAL FOUNDATION 3400 DATA DRIVE RANCHO CORDOVA CA 95670 680220314 MULTI-SPECIALTY OUTPATIENT MEDICAL CLINIC CA 501(C)(3) LINE 12A, I DCC 0 DIGNITY HEALTH WORKERS COMP SELF-INSURANCE TRUST 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 946612446 SELF INSURANCE CA 501(C)(3) LINE 12A, I DH 0 DOMINICAN HEALTH SERVICES 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 770056778 COMMUNITY HEALTH SYSTEM CA 501(C)(3) LINE 12A, I DH 0 DOMINICAN HOSPITAL FOUNDATION 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 942450442 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 DOMINICAN OAKS CORPORATION 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 770127719 OPERATION AND MANAGEMENT OF HOUSING COMPLEX TO ELDERLY PERSONS CA 501(C)(3) LINE 10 DHS 0 EAST TEXAS CLINICAL SERVICES 2801 VIA FORTUNA 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