2021-05-18T13:34:16-05:00 2020-06-30 KPMG LLP 1225 17th Street Suite 800 Denver CO 80202 990 2019-07-01 450227752 Garrison Memorial Hospital % THOMAS SPAIN GARR 7014632275 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 TOD GRAEBER ADMINISTRATOR 2021-05-17 true Mark E Shelton P01203482 3032962323 2021-05-17 2019 2022-09-23 18:48:47Z TOD GRAEBER 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 10930724 false 0928 X HTTPS://WWW.CHISTALEXIUSHEALTH>ORG/LOCATIONS X 1952 ND PROVISION OF HEAL HEALTHCARE TO GARRISON AND THE SURROUNDING AREA 11 6 153 10 0 0 30361 17293 10467331 10114421 328 75 729444 798935 11227464 10930724 500 800 0 0 7569830 8014459 0 0 0 3081950 3286783 10652280 11302042 575184 -371318 9565552 13929831 2502121 7239885 7063431 6689946 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. false false 10394295 800 10906986 Garrison Memorial Hospital delivers primary health care to a population of approximately 6,000 in McLean, Ward, McHenrey, and Mountrail Counties. We operate a 22-bed Critical Access Hospital and a 26-bed skilled nursing facility. Two beds were put on layaway in FY 20. We also operate a rural health clinic in Garrison, North Dakota. Our facility employs approximately 100 people with another 30 third party vendor employees. SEE SCHEDULE O. 10394295 true true false true false false false false true false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 15 0 true 153 true false false false false false false false false false false false false X 11 6 false false false false true true true true true false false false true true true true true true true false X THOMAS SPAIN 7014632275 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 CLIFF ROBERTSON MD DIRECTOR 1.0 59.0 X 0 2271574 46283 KURT SCHLEY DIRECTOR 5.0 40.0 X 0 585573 83318 KEVIN DAHMEN md SECRETARY/TREASURER 1.0 44.0 X X 0 609968 47782 TODD PRESZLER MD DIRECTOR 1.0 44.0 X 0 601917 34490 MICHAEL L CASSIDY MD DIRECTOR (END: 10/30/2019) 1.0 7.0 X 0 465951 33734 JON DORNACKER DOCTOR OF MEDICINE 40.0 0.0 X 468051 0 23534 SHIRAZ HYDER DIRECTOR 1.0 44.0 X 0 392975 53489 TESSA MARBURGER MD DIRECTOR (END: 10/30/2019) 1.0 44.0 X 0 394767 25950 ART RENNER PHYSICIAN'S ASSISTANT 40.0 0.0 X 160609 0 22283 TOD GRAEBER PRESIDENT 40.0 0.0 X 148065 0 12951 CASSANDRA HAIDER NURSE PRACTITIONER 40.0 0.0 X 151779 0 8275 FORREST HIRSCH OPEN 40.0 0.0 X 117608 0 14620 BETH HETLETVED VP OF NURSING 40.0 0.0 X 95853 0 10148 THOMAS SPAIN CFO 40.0 0.0 X 81801 0 9522 TIMOTHY BOPP MD DIRECTOR 1.0 7.0 X 0 0 0 JOHN GIESE CHAIR 2.0 7.0 X X 0 0 0 MICHAEL LEFOR DIRECTOR 1.0 6.0 X 0 0 0 SR NANCY MILLER OSB VICE CHAIR 1.0 7.0 X X 0 0 0 JOHN MONGEON DIRECTOR 1.0 5.0 X 0 0 0 PATRICK SOGARD DIRECTOR (END: 10/30/2019) 1.0 5.0 X 0 0 0 JULIE TRAYNOR DIRECTOR (END: 10/30/2019) 1.0 5.0 X 0 0 0 SR THOMAS WELDER DIRECTOR (END: 06/06/2020) 1.0 7.0 X 0 0 0 MIKE WEISBECK DIRECTOR 1.0 0.0 X 0 0 0 1223766 5322725 426379 5 false true false ROLINC 333 W HAMPDEN STE 545 ENGLEWOOD CO 80110 LOCUM PROVIDER 268099 GUARDIAN HEALTHCARE PROVIDERS PO BOX 306098 NASHVILLE TN 372306098 LOCUM PROVIDER 221553 NORTHERN PLAINS LAB PO BOX 2036 BISMARCK ND 585020000 CLINICAL LAB 175782 NORTHLAND IMAGING SERVICES 2223 EAST ROSSER AVE BISMARCK ND 58501 MRI IMAGING SERVICES 109891 4 7000 10293 17293 NET PATIENT SERVICE REVENUE 622110 10114421 10114421 10114421 0 0 0 2100 2100 0 2100 2100 75 75 75 75 0 0 0 0 0 0 0 0 0 CAFETERIA 722100 4270 4270 PHARMACY SERVICES 446110 652962 652962 OTHER MISCELLANEOUS REVENUE 900099 139603 139603 796835 10930724 10906986 0 6445 X 800 800 0 0 0 302810 302810 0 6463984 6201871 262113 0 897376 850935 46441 350289 332774 17515 0 0 0 1292 1292 0 0 1166267 1069373 96894 5062 4809 253 593552 563874 29678 0 0 135374 128605 6769 20760 19722 1038 0 0 2211 2100 111 0 220184 209175 11009 1483 1409 74 RECRUITMENT 864674 821440 43234 REPAIRS AND MAINTENANCE 164094 155889 8205 DUES & SUBSCRIPTIONS 19043 18091 952 RECRUITMENT AND RELOCATION 14135 13428 707 78652 78652 11302042 10394295 907747 0 0 8377033 0 0 0 0 2437695 2975168 0 0 0 0 0 0 290737 301052 24657 7367 4270900 2069644 2414028 2201256 0 0 0 0 0 0 0 0 4398435 67955 9565552 13929831 2002158 1579781 0 0 35000 3776249 0 0 5225 17507 0 0 430143 306464 0 0 29595 1559884 2502121 7239885 X 7063431 6689946 0 0 7063431 6689946 9565552 13929831 -371318 -2167 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 1292 false false false 1292 false SCHEDULE C, PART II-B, LINE 1 - DETAILED DESCRIPTION OF THE LOBBYING THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: NORTH DAKOTA LONG TERM CARE ASSOCIATION - $469 NORTH DAKOTA HEALTHCARE ASSOCIATION - $823 true 5225 44268 31986 17507 true X 3269493 1241378 2028115 1001406 828265 173141 0 0 2201256 0 RELATED PARTY PAYABLES 1490532 OPERATING LEASE LIABILITY 69352 1559884 X SCHEDULE D, PART IV, LINE 1B AGENT, TRUSTEE, CUSTODIAN, OR OTHER THIS IS A TRUST FUND FOR RESIDENTS OF OUR SKILLED NURSING FACILITY. SOME PATIENTS REQUEST THAT WE PLACE THEIR INCOME IN A TRUST FUND TO PAY THEIR BILLS. THIS MONEY IS HELD IN A SEPARATE CHECKING ACCOUNT IN THE RESIDENT'S NAME, AND NOT COMINGLED WITH HOSPITAL FUNDS. THE TRUST ACCOUNT IS BONDED. SCHEDULE D, PART IV, LINE 2B EXPLANATION OF ESCROW AGREEMENT THE EMPLOYEE FUND IS LISTED AS A LIABILITY ON THE BALANCE SHEET. THE MONEY COMES FROM TWO SOURCES; MONEY THAT IS RAISED BY EMPLOYEES, AND RESTRICTED DONATIONS FOR CERTAIN DEPARTMENTS WITHIN THE HOSPITAL. ALL THE MONEY IS USED FOR THE BENEFIT OF OUR PATIENTS AND RESIDENTS. A SMALL AMOUNT IS USED FOR EMPLOYEE RECOGNITION. RESIDENTS. A SMALL AMOUNT IS USED FOR EMPLOYEE RECOGNITION. SCHEDULE D, PART X, LINE 2 FASB ASC 740 FOOTNOTE: UNCERTAIN TAX POSITIONS GARRISON MEMORIAL HOSPITAL'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. true true X true X 300. true X true true false true true 37200 37200 0.00330 1917126 1839117 78009 0.00690 1954326 1839117 115209 0.01020 4238 4238 0.00040 45358 45358 0.00400 1667127 1483295 183832 0.01630 200 200 0.00000 1716923 1483295 233628 0.02070 3671249 3322412 348837 0.03090 9 2057 11860 11860 9 2057 11860 11860 false 703916 71096 3049292 3087198 -37906 X true true 1 1 GARRISON MEMORIAL HOSPITAL 407 THIRD AVE SE GARRISON ND 58540 HTTPS://WWW.CHISTALEXIUSHEALTH.ORG 5019 X X X X PROVIDER BASED MEDICARE CERTIFIED RHC GARRISON MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 18 true false false true X SEE STATEMENT X true 18 false true false true X 300. 300. X X X X true true X X X true X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3E THE SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED THROUGH THE CHNA AND INCLUDED IN A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS. SCHEDULE H, PART V, SECTION B, LINE 5 GARRISON MEMORIAL HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY AND BY COLLECTING DATA FROM 1. A SURVEY SOLICITED FEEDBACK FROM AREA RESIDENTS 2. COMMUNITY LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY TOOK PART IN ONE-ON-ONE KEY INFORMANT INTERVIEWS 3. THE COMMUNITY GROUP, COMPRISED OF COMMUNITY LEADERS AND AREA RESIDENTS, WAS CONVENED TO DISCUSS AREA HEALTH NEEDS AND INFORM THE ASSESSMENT PROCESS 4. A RANGE OF SECONDARY SOURCES OF DATA WERE EXAMINED, PROVIDING INFORMATION ON A MULTITUDE OF MEASURES INCLUDING DEMOGRAPHICS; HEALTH CONDITIONS, INDICATORS, AND OUTCOMES; RATES OF PREVENTIVE MEASURES; RATES OF DISEASE; AND AT-RISK BEHAVIOR. ONE-ON-ONE INTERVIEWS, WITH SIX KEY INFORMANTS, WERE CONDUCTED IN PERSON IN GARRISON ON AUGUST 21, 2018 AND NOVEMBER 5, 2018. A REPRESENTATIVE FROM THE CENTER FOR RURAL HEALTH CONDUCTED THE INTERVIEWS. INTERVIEWS WERE HELD WITH SELECTED MEMBERS OF THE COMMUNITY GROUP AS WELL AS OTHER KEY INFORMANTS WHO COULD PROVIDE INSIGHTS INTO THE COMMUNITY'S HEALTH NEEDS. INCLUDED AMONG THE INFORMANTS WERE PUBLIC HEALTH PROFESSIONALS WITH SPECIAL KNOWLEDGE IN PUBLIC HEALTH ACQUIRED THROUGH SEVERAL YEARS OF DIRECT EXPERIENCE IN THE COMMUNITY, INCLUDING WORKING WITH MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AS WELL AS WITH POPULATIONS WITH CHRONIC DISEASES. SCHEDULE H, PART V, SECTION B, LINE 7 HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENTS SCHEDULE H, PART V, SECTION B, LINE 11 HOW HOSPITAL FACILITY IS ADDRESSING NEEDS IDENTIFIED IN CHNA THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED ABILITY TO RECRUIT AND RETAIN PRIMARY CARE PROVIDERS, YOUTH DRUG USE AND ABUSE, ADULT DRUG USE AND ABUSE, AND ADULT OBESETY AND OVERWEIGHT. TO ADDRESS THE ABILITY TO RECRUIT AND RETAIN PRIMARY CARE PROVIDER, CHI ST. ALEXIUS HEALTH GARRISON IS WORKING TO FULLY STAFF THE CLINIC, HOSPITAL, AND ER WITH A FULL COMPLEMENT OF PROVIDERS TO MEET THE NEEDS OF THE GROWING COMMUNITY BY THE FOLLOWING STRATEGIES: A. MAINTAIN CHI ST. ALEXIUS HEALTH GARRISON HOSPITAL AND CLINIC DESTINATIONS AS A NATIONAL HEALTH SERVICE CORE SITE. B. UPDATE THE RECRUITMENT FOLDERS TO DISTRIBUTE TO POTENTIAL PROFESSIONAL CANDIDATES. C. CONTINUE TO PROMOTE HEALTH CAREER SCHOLARSHIPS TO STUDENTS IN OUR COMMUNITY. D. ENGAGE THE COMMUNITY AND COMMUNITY LEADERS IN THE RECRUITMENT AND RETENTION OF PROVIDERS. E. DEVELOP NEW AND MORE FLEXIBLE PRACTICE MODELS WITHIN THE HOSPITAL AND CLINIC SETTING. F. OFFER CONTINUING EDUCATION OPPORTUNITIES TO CURRENT STAFF. G. CONTINUE AS A RURAL ROTATION SITE FOR UND CENTER FOR FAMILY MEDICINE. H. OFFER OPPORTUNITIES FOR ADVANCED PRACTICE CLINICIANS (APC) AND APC STUDENTS TO FOLLOW OUR PROVIDERS IN HOPES OF GAINING INTEREST IN WORKING IN A RURAL FACILITY. G. PARTNERED WITH BISMARCK STATE COLLEGE TO START AN LPN AND RN DEGREE PROGRAM IN GARRISON MEMORIAL HOSPITAL. TO ADDRESS YOUTH DRUG AND ABUSE, CHI ST. ALEXIUS HEALTH GARRISON IS EDUCATING THE YOUTH OF OUR COMMUNITY OF THE DANGERS OF DRUG USE AND ABUSE THROUGH THE FOLLOWING STRATEGIES: A. PARTNER WITH THE PUBLIC SCHOOL DISTRICT ON IMPLEMENTING A DRUG AWARENESS DAY OR LYCEUM. B. PARTNER WITH THE MCLEAN COUNTY SHERIFF'S DEPARTMENT AND PUBLIC HEALTH OFFICE ON EDUCATION FOR STUDENTS, PARENTS, AND COMMUNITY MEMBERS. C. DEVELOP A LIST OF MENTAL HEALTH DRUG AND ALCOHOL ADDICTION COUNSELORS FOR REFERRAL OF PATIENTS AND COMMUNITY MEMBERS IN NEED OF ASSISTANCE. D. PROVIDE EDUCATION AT PUBLIC HEALTH FAIRS. TO ADDRESS ADULT OBESITY AND OVERWEIGHT, CHI ST. ALEXIUS HEALTH GARRISON IS EDUCATING THE PUBLIC ON THE HEALTH RISKS OF OBESITY AND CREATING OPPORTUNITIES FOR WEIGHT LOSS AND HEALTHIER LIFESTYLES WITH THE FOLLOWING STRATEGIES: A. PROVIDE EDUCATION ON HEALTH RISKS OF OBESITY B. CREATE AND DESIGN OPPORTUNITIES FOR CHOOSING A HEALTHIER LIFESTYLE AND DIETARY OPTIONS. C. IMPLEMENTATION STRATEGIES D. EDUCATE PUBLIC AT HEALTH FAIRS AND OTHER COMMUNITY EVENTS, AS AVAILABLE. E. USE WEBSITE AND FACEBOOK TO POST HEALTH LIVING OPTIONS AND EDUCATION. F. PLAN A 5K RUN/WALK EVENT. G. SPONSOR A HEALTH COOKING CLASS. H. PROMOTE WEIGHT LOSS CHALLENGES IN THE COMMUNITY. OTHER NEEDS IDENTIFIED IN THE CHNA BUT NOT ADDRESSED IN THIS PLAN THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEED IDENTIFIED IN THE CHNA AS PART OF THIS IMPLEMENTATION PLAN DUE TO FACTORS OUT OF OUR CONTROL AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO THE THREE PRIORITY HEALTH NEEDS IDENTIFIED ABOVE. CHILD DAYCARE SERVICE: ENOUGH CHILD DAYCARE SERVICES: ALTHOUGH WE ARE UNABLE TO DIRECTLY CONTROL THE AVAILABILITY OF CHILD DAYCARE OPTIONS AND IT WOULD BE FINANCIALLY UNFEASIBLE TO START A DAYCARE SERVICE OF OUR OWN, WE CAN MAKE KNOWN THAT WE ARE ABLE TO OFFER FREE OR LOW-COST CPR AND BABYSITTING CLASSES TO THOSE INTERESTED. SCHEDULE H, PART V, SECTION B, LINE 13H OTHER ELIGIBILITY CRITERIA 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 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 16A HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-VISITORS/OUR-PATIENTS/ FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16B FAP APPLICATION FORM WEBSITE: HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-VISITORS/OUR-PATIENTS/ FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16C PLAIN LANGUAGE FAP SUMMARY WEBSITE: HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-VISITORS/OUR-PATIENTS/ FINANCIAL-ASSISTANCE 2 GMH SKILLED NURSING FACILITY 407 3RD AVE SE GARRISON ND 58540 LICENSED NURSING HOME GARRISON FAMILY CLINIC 437 3RD AVENUE GARRISON ND 58540 PROVIDER BASED RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 3 FINANCIAL ASSISTANCE ELIGIBILITY 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. SCHEDULE H, PART I, LINE 7 EXPLANATION OF COSTING METHODOLOGY USED FOR CALCULATING LINE 7 TABLE THE CHARITY CARE INCLUDED IN PART I, LINE 7A IS BASED ON THE AVERAGE COST TO GROSS CHARGES CALCULATED FROM INTERNAL COST SYSTEM. THE UNREIMBURSED MEDICAID IN PART I, LINE 7B IS BASED ON GROSS CHARGES AND CLAIMS FROM THE COST REPORT. THE COMMUNITY HEALTH SERVICES, EDUCATION AND CONTRIBUTIONS IN PART I, LINES 7E, F AND I ARE BASED ON ACTUAL EXPENSES. THE SUBSIDIZED HEALTH SERVICES IN PART I, LINE 7G ARE BASED ON ESTIMATED COSTS FROM THE COST REPORT. SCHEDULE H, PART II Garrison Memorial Hospital no longer employs an LPN as a full-time community resource coordinator. These duties are split up between clinic staff with an estimated with a wage and benefits of $11,813 dedicated to these duties. whose responsibilities include helping the uninsured and underinsured access healthcare through Medicaid, Women's Way, Caring Program, Healthy Steps and charity care. In 2019/2020 clinic staff helped 17 individuals. Staff is also responsible for our adult preventative programs (diabetes, women's and men's health) by tracking these program services and sending reminders to patients to schedule follow-up visits with approximately 1,000 clients served in the county . The staff also tracks and monitors patients through our impaired glucose/pre-diabetes program. The Rx Assist Program also falls under clinic staff duties where they work with our physicians on specialty medication management. The helped 12 client in 2019/2020. They assists with free screenings that are done at our annual health fairs. They also coordinates the clinic's diabetes education program via telemedicine, in conjunction with a diabetic educator at St. Alexius in Bismarck. Other committees that the Community Resource Coordinator serves on are a diabetes task force sponsored by the North Dakota Department of Health. The task force works to improve access and quality care to diabetic patients. The nursing staff also serves on the Mclean County Interagency Committee. This committee works collaboratively with the Mclean County Sheriff's department, county school districts, healthcare entities, and the Mclean County Resource Center on providing access to social services and healthcare. The clinic staff also has established access for dental care for uninsured and under insured patients. This is done collaboratively with the dental program at Northland Community Health Center in Turtle Lake, ND. SCHEDULE H, PART III, LINE 2 METHODOLOGY USED TO ESTIMATE BAD DEBT THE AMOUNT REPORTED AS BAD DEBT EXPENSE REPRESENTS TOTAL CHARGES WRITTEN OFF TO BAD DEBT. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 3 FAP ELIGIBLE PATIENT BAD DEBT CALCULATION METHODOLOGY GARRISON MEMORIAL HOSPITAL DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. SCHEDULE H, PART III, LINE 4 FOOTNOTE IN ORGANIZATION'S FINANCIAL STATEMENTS DESCRIBING BAD DEBT GARRISON MEMORIAL HOSPITAL DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS: COMMONSPIRIT RELIES ON THE RESULTS OF DETAILED REVIEWS OF HISTORICAL WRITE-OFFS AND COLLECTIONS IN ESTIMATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE. UPDATES TO THE HINDSIGHT ANALYSIS 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 2019 WAS NOT SIGNIFICANT. SCHEDULE H, PART III, LINE 8 DESCRIBE EXTENT ANY SHORTFALL FROM LINE 7 TREATED AS COMMUNITY BENEFIT AND COSTING METHOD USED 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. GARRISON MEMORIAL HOSPITAL '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. GARRISON MEMORIAL HOSPITAL 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. SCHEDULE H, PART III, LINE 9B DID COLLECTION POLICY CONTAIN PROVISIONS ON COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR ASSISTANCE 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. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT GARRISON MEMORIAL HOSPITAL HAS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN FY19. THE ORGANIZATION HAS PREPARED AN IMPLEMENTATION STRATEGY FOR ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA. IN ADDITION, THE ORGANIZATION ASSESSES THE NEEDS OF THE COMMUNITY ON AN ONGOING BASIS AND STRIVES TO CONTINUALLY ADDRESS THE HEALTHCARE NEEDS OF THE COMMUNITY. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION 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. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION GARRISON MEMORIAL HOSPITAL IS ONE OF TWO CRITICAL ACCESS HOSPITALS THAT SERVE THE NINETEEN COMMUNITIES IN MCLEAN COUNTY. GARRISON IS LOCATED IN THE NW SECTION OF THE COUNTY. GARRISON MEMORIAL HOSPITAL SERVES NORTHERN AND CENTRAL MCLEAN COUNTY AS WELL AS PARTS OF SOUTHERN WARD COUNTY AND PARTS OF SOUTHEASTERN MOUNTRAIL COUNTY. THE OTHER HOSPITAL IS LOCATED IN TURTLE LAKE, ON THE EAST EDGE OF THE COUNTY. MCLEAN COUNTY HAS AN AREA OF 2,110.88 SQUARE MILES AND IS CLASSIFIED AS A FRONTIER COUNTY. THE AVERAGE MEDIAN HOUSEHOLD INCOME FOR MCLEAN COUNTY IS $65,648 WITH 9.2% OF THE POPULATION BELOW THE FEDERAL POVERTY GUIDELINES; 10-20% OF THE POPULATION IN NOT INSURED. MCLEAN COUNTY IS ALSO CLASSIFIED AS A FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREA. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH 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. SCHEDULE H, PART VI, LINE 6 DESCRIPTION OF AFFILIATED GROUP 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 2019, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.1 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 $4.4 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $20.96 BILLION IN FISCAL YEAR 2019, HAS TOTAL ASSETS OF APPROXIMATELY $40.6 BILLION. 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. X X X false true false false false false false true false MICHAEL L CASSIDY MD DIRECTOR (END: 10/30/2019) 454407 11544 16066 17668 499685 KEVIN DAHMEN md SECRETARY/TREASURER 538026 69320 2622 26600 23234 659802 JON DORNACKER DOCTOR OF MEDICINE 448324 17974 1753 8400 15868 492319 TOD GRAEBER PRESIDENT 141754 5000 1311 7192 6326 161583 CASSANDRA HAIDER NURSE PRACTITIONER 149864 1792 123 8275 176 160230 SHIRAZ HYDER DIRECTOR 368041 17410 7524 30200 24324 447499 TESSA MARBURGER MD DIRECTOR (END: 10/30/2019) 382945 11822 16072 9878 420717 TODD PRESZLER MD DIRECTOR 534680 62335 4902 11200 25546 638663 ART RENNER PHYSICIAN'S ASSISTANT 160294 315 6493 15967 183069 CLIFF ROBERTSON MD DIRECTOR 1062248 848919 360407 16675 29608 2317857 136676 KURT SCHLEY DIRECTOR 441481 123160 20932 57065 26253 668891 SCHEDULE J, PART I, LINE 4A - POST-TERMINATION PAYMENTS 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. SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN 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 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 SCHEDULE J, PART I, LINE 7 - NON-FIXED PAYMENTS EMPLOYEES ARE ELIGIBLE FOR A BONUS BASED ON A BALANCED SCORECARD WHICH MEASURES FINANCIAL PERFORMANCE, QUALITY, AND PERSONAL GOALS. FORM 990, PART III, LINE 4A PROGRAM SERVICE DESCRIPTION (continued) Garrison Memorial Hospital makes medical care accessible to the entire community it serves. It operates a 24-hour, Level 5 state certified emergency room. In 2019/2020 we had 1,696 emergency room visits. We also had 353 acute days of care, 4,092 swing bed days, 8,506 days of skilled nursing care, and 5,800 clinic visits. Garrison Memorial Hospital's charity care policy provides discounted and free services to patients who lack the resources to be fully responsible for the healthcare they receive. The Charity Care policy is designed to ensure the population served by Garrison Memorial Hospital has access to needed healthcare services. In fiscal year 2019/2020, Garrison Memorial Hospital and its clinic had $38,561 in charity care and Indian Health Services and $703,916 in bad debt write offs. Our rural health clinic offers a sliding fee schedule to uninsured and underinsured patients, which is mandated by the National Health Service Corps Program. One hundred percent of qualified uninsured or underinsured sliding fee schedule patients are written off as charity care. In 2019/2020, Garrison Memorial Hospital's payer mix was approximately 34% Medicare, 32% Medicaid, 1% Indian Health Services, 14% self-pay and 19% commercial insurance. All payers are charged the same regardless of insurance. FORM 990, PART VI, LINE 1A DELEGATE BROAD AUTHORITY TO A COMMITTEE PURSUANT TO SECTION 8.6 OF THE BYLAWS OF GARRISON MEMORIAL HOSPITAL, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND CEO, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND TWO VOTING MEMBERS APPOINTED BY THE BOARD OF DIRECTORS. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS ACCORDING TO THE BYLAWS OF GARRISON MEMORIAL HOSPITAL, THE ENTITY'S SOLE MEMBER IS COMMONSPIRIT HEALTH, A COLORADO NONPROFIT ORGANIZATION. FORM 990, PART VI, LINE 7A MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODY 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, LINE 7B DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS THE ORGANIZATION'S CORPORATE MEMBER IS COMMONSPIRIT HEALTH. PURSUANT TO SECTION 5.4 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE ORGANIZATION * AMENDMENT OF THE CORPORATE DOCUMENTS OF THE ORGANIZATION * APPROVE MEMBERS OF THE ORGANIZATION'S BOARD * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ORGANIZATION * APPROVAL OF ISSUANCE OF DEBT BY THE ORGANIZATION * APPROVAL OF PARTICIPATION OF THE ORGANIZATION IN A JOINT VENTURE * APPROVAL OF FORMATION OF A NEW CORPORATION BY THE ORGANIZATION * APPROVAL OF A MERGER INVOLVING THE ORGANIZATION * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION * TO REQUIRE THE TRANSFER OF ASSETS BY THE ORGANIZATION 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 THE ORGANIZATION. PURSUANT TO SECTION 5.5 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, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY ONCE THE RETURN IS PREPARED, THE FORM 990 AND ACCOMPANYING SCHEDULES WERE MADE AVAILABLE TO ALL TRUSTEES EITHER ELECTRONICALLY OR BY HARD COPY, DEPENDING UPON THE TRUSTEES PREFERENCE, BEFORE THE COMPANY FINALIZED AND SENT THE DOCUMENTS TO THE IRS. THIS DRAFT WAS ALSO AVAILABLE AT THE ADMINISTRATIVE OFFICES OF THE REPORTING ENTITY FOR TRUSTEES' REVIEW BEFORE THE FINAL FORM 990 AND ACCOMPANYING SCHEDULES WERE FINALIZED AND SENT TO THE IRS. THE REVIEW WAS UNDER THE DIRECTION OF THE CFO AND/OR EXTERNAL TAX RETURN PREPARERS IF REQUESTED BY THE TRUSTEES. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX RETURN PREPARER 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, LINE 12C CONFLICT OF INTEREST POLICY 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, 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 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. FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC 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 OR WWW.CATHOLICHEALTHINITIATIVES.ORG. FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:289705 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:771619 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:20776 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:84167 ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HOSPITAL NE 501(c)(3) 3 ACH false ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - BERGAN MERCY HEALTH SYS 7500 MERCY RD OMAHA NE 68124 470484764 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false Allegent Health -Comm Memorial HSP IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - IMMANUEL MED CTR 6901 N 72ND ST OMAHA NE 68122 470376615 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - MEMORIAL HOSP SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - MERCY HOSP CORNING IA PO BOX 368 CORNING IA 50841 420782518 HOSPITAL IA 501(c)(3) 3 CHI NEBRASKA false ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(c)(3) 10 CSH false APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(c)(3) 10 SFH false Arroyo Grande Community Hospital FDN 345 S Halcyon Rd Arroyo Grande CA 93420 203256066 FUND. FDN CA 501(c)(3) 12 Type 1 DH false Bakersfield Memorial Hospital 420 34TH Street Bakersfield CA 93301 951802779 HOSPITAL CA 501(c)(3) 3 DCC false Barrow Neurological FDN 350 West Thomas Rd Phoenix AZ 85013 860174371 FUND. FDN AZ 501(c)(3) 7 DH false BAYLOR ST LUKE'S HEALTH VENTURES 17200 ST LUKES WAY STE 170 THE WOODLANDS TX 77384 274499340 PHYSICIANS TX 501(c)(3) 12 Type 1 SLCHS false BAYLOR ST LUKE'S MEDGROUP 6624 FANNIN ST STE 1100 HOUSTON TX 77030 760458535 PHYSICIANS TX 501(c)(3) 3 SLHS false BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DR WEST ENGLEWOOD CO 80112 232187242 HEALTHCARE PA 501(c)(3) 12 Type 1 CSH false BRAZOSPORT HEALTH FDN INC 1 West Way Ct LAKE JACKSON TX 77566 760080110 FUND. FDN TX 501(c)(3) 12 Type 1 BRHS false BRAZOSPORT REGIONAL PHYSICIAN SRVS 100 MEDICAL DR LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(c)(3) 3 BRHS false BURLESON ST JOSEPH HEALTH CTR 2801 FRANCISCAN DR BRYAN TX 77802 742759890 HOSPITAL TX 501(c)(3) 3 SJSC false BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DR BRYAN TX 77802 742913931 HEALTHCARE TX 501(c)(3) 10 SJSC false California Hospital MED CTR FDN 1401 South Grand AVE Los Angeles CA 90015 954000909 FUND. FDN CA 501(c)(3) 12 Type 1 DCC false CARRINGTON HEALTH CTR 800 N 4TH ST CARRINGTON ND 58421 450227311 HOSPITAL ND 501(c)(3) 3 CSH false CATHOLIC HEALTH INITIATIVES - COLORADO 9100 East Mineral Circle Centennial CO 80112 840405257 HOSPITAL CO 501(c)(3) 3 CSH false CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES IA 50314 420680448 HOSPITAL IA 501(c)(3) 3 CSH false CATHOLIC HEALTH INITIATIVES COLORADO FDN 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS CO 80920 840902211 FUND. FDN CO 501(c)(3) 7 CHIC false CATHOLIC HEALTH INITIATIVES NATIONAL FDN 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS CO 80920 270930004 HEALTHCARE CO 501(c)(3) 12 Type 1 CSH false CHI VIRTUAL HEALTH SERVICES 198 INVERNESS DR WEST ENGLEWOOD CO 80112 460992796 PHYSICIANS CO 501(c)(3) 12 Type 1 CHINS false CENTENNIAL MEDGROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 SURGERY CTR OR 501(c)(3) 10 MMC false CENTRAL CALIFORNIA HEALTH CTRS 300 OLD RIVER Rd STE 200 BAKERSFIELD CA 93311 844171789 CLINIC CA 501(c)(3) 3 DCC false CENTRAL KANSAS MED CTR 3515 BRdWAY GREAT BEND KS 67530 480543724 HOSPITAL KS 501(c)(3) 3 CSH false CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 FUND. FDN MN 501(c)(3) 10 CSH false CHI HEALTH FDN 12809 W DODGE RD OMAHA NE 68154 470648586 FUND. FDN NE 501(c)(3) 7 ACH false CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(c)(3) 12 Type 1 CSH false CHI LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE OH 501(c)(3) 12 Type 1 SFH false CHI Memorial Hospital - Georgia 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE GA 30742 822748395 HOSPITAL GA 501(c)(3) 3 MHCS false CHI NATIONAL HOME CARE 198 INVERNESS DR WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(c)(3) 10 CHI NS false CHI NATIONAL SERVICES 198 INVERNESS DR WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(c)(3) 12 Type 1 CSH false CHI NEBRASKA 12809 West Dodge Rd Omaha NE 68510 363233121 HEALTHCARE NE 501(c)(3) 12 Type 1 CSH false CHI ST JOSEPH CHILDREN'S HEALTH 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232342997 HEALTHCARE PA 501(c)(3) 12 Type 1 CSH false CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(c)(3) 12 Type 1 CSH false CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 710236913 HOSPITAL AR 501(c)(3) 3 CHISVHS false CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125064 HOLDING CO AR 501(c)(3) 12 Type 1 SVIMC false CHI ST VINCENT MED GROUP HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125131 PHYSICIANS AR 501(c)(3) 3 CHISVHS false COMMONSPIRIT HEALTH 198 INVERNESS DR WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(c)(3) 12 Type 1 NA false COMMONSPIRIT HEALTH OPER INV POOL LLC 185 BERRY STREET STE 300 SAN FRANCISCO CA 94107 850919176 INVESTMENTS CA 501(c)(3) 12 Type 1 CSH false COMMONSPIRIT HEALTH RESEARCH INSTITUTE 198 INVERNESS DR WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(c)(3) 12 Type 1 CSH false Community Hospital of San Bernardino 1805 Medical CTR DR San Bernardino CA 92411 951643373 HOSPITAL CA 501(c)(3) 3 DCC false COMMUNITY LIMITED CARE DIALYSIS CTR 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 237419853 HOLDING CO OH 501(c)(4) NONE GSH false COMMUNITY MEMORIAL HPL MED SERVICE FDN 631 N 8TH ST MISSOURI VALLEY IA 51555 421294399 FUND. FDN IA 501(c)(3) 12 Type 1 AH-CMHMV false CONTINUING CARE HOSPITAL One Saint Joseph DR LEXINGTON KY 40504 611400619 HOSPITAL KY 501(c)(3) 3 SJHS false Dignity Community Care 185 Berry Street Ste 300 San Francisco CA 94107 815009488 HOSPITAL CO 501(c)(3) 3 CSH false DIGNITY HEALTH 185 BERRY STREET STE 300 SAN FRANCISCO CA 94107 941196203 HOSPITAL CA 501(c)(3) 3 CSH false Dignity Health Connected Living 200 Mercy Oaks DR Redding CA 96003 237115371 Senior CTR SR CA 501(c)(3) 7 DH false Dignity Health FDN 185 Berry Street San Francisco CA 94107 462037641 FUND. FDN CA 501(c)(3) 12 Type 1 DH false Dignity Health FDN - Inland Empire 2101 N Waterman AVE San Bernardino CA 92404 237440086 FUND. FDN CA 501(c)(3) 12 Type 1 DH false Dignity Health FDN East Valley 475 South Dobson Rd Chandler AZ 85224 742418514 FUND. FDN AZ 501(c)(3) 12 Type 1 DH false Dignity Health HPL Self-Insurance Trust 185 Berry Street San Francisco CA 94107 943006034 Self Insuranc CA 501(c)(3) 12 Type 1 DH false Dignity Health Insurance Nevada Ltd 185 Berry Street San Francisco NV 94107 813800752 Self Insuranc NV 501(c)(3) 12 Type 1 DH false Dignity Health MEDFDN 3400 Data DR Rancho Cordova CA 95670 680220314 M/S OUTP. MED CA 501(c)(3) 12 Type 1 DCC false DH Workers' Comp Self-Insurance Trust 185 Berry Street San Francisco CA 94107 946612446 Self Insuranc CA 501(c)(3) 12 Type 1 DH false Dominican Health Services 1555 Soquel DR Santa Cruz CA 95065 770056778 Community Hea CA 501(c)(3) 12 Type 1 DH false Dominican Hospital FDN 1555 Soquel DR Santa Cruz CA 95065 942450442 FUND. FDN CA 501(c)(3) 12 Type 1 DH false Dominican Oaks Corporation 1555 Soquel DR Santa Cruz CA 95065 770127719 Op&M of housi CA 501(c)(3) 10 DHS false East Texas Clinical Services 2801 VIA FORTUNA Ste 500 AUSTIN TX 78746 454736213 HEALTHCARE TX 501(c)(3) 12 Type 1 SLHS false ENUMCLAW REGIONAL HOSPITAL ASSN 1455 BATTERSBY AVE ENUMCLAW WA 98022 910715805 HOSPITAL WA 501(c)(3) 3 FHS false FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 611345363 HOSPITAL KY 501(c)(3) 3 KOH false FLAGET MEMORIAL HOSPITAL FDN INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 562351341 FUND. FDN KY 501(c)(3) 12 Type 1 FH false FRANCISCAN CARE CTR 4111 N HOLLAND-SYLVANIA RD TOLEDO OH 43623 341931806 HEALTHCARE OH 501(c)(3) 10 CHILC false FRANCISCAN FDN 1717 SOUTH J ST TACOMA WA 98405 911145592 FUND. FDN WA 501(c)(3) 10 FHS false FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA WA 98405 910564491 HOSPITAL WA 501(c)(3) 3 CSH false FH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BRdWAY TACOMA WA 98402 431882377 PHYSICIANS MO 501(c)(3) 10 CSH false FRANCISCAN MEDGROUP 1313 BRdWAY STE 200 TACOMA WA 98402 911939739 HEALTHCARE WA 501(c)(3) 10 FHS false FRANCISCAN VILLA OF S MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(c)(3) 10 CSH false French Hospital MED CTR FDN 1911 Johnson AVE San Luis Obispo CA 93401 203256125 FUND. FDN CA 501(c)(3) 12 Type 1 DCC false Glendale Memorial Health FDN 1420 South Central AVE Glendale CA 91204 953625651 FUND. FDN CA 501(c)(3) 12 Type 1 DCC false GLOBAL HEALTH INITIATIVES 198 INVERNESS DR WEST ENGLEWOOD CO 80112 201536108 MINISTRIES CO 501(c)(3) 12 Type 1 CSH false GSC OF NURSING & HEALTH SCIENCE 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311778403 EDUCATION OH 501(c)(3) 2 GSH false GOOD SAMARITAN FDN OF CINCINNATI INC 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311206047 FUND. FDN OH 501(c)(3) 12 Type 1 GSH false GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false GOOD SAMARITAN HOSP FDN 111 W 31ST ST KEARNEY NE 68847 470659443 FUND. FDN NE 501(c)(3) 7 GSH false HARRISON MED CTR 2520 CHERRY AVE BREMERTON WA 98310 910565546 HOSPITAL WA 501(c)(3) 3 FHS false HARRISON MED CTR FDN 2520 CHERRY AVE BREMERTON WA 98310 911197626 FUND. FDN WA 501(c)(3) 7 HMC false HEALTH FDN OF KY ONE INC 1451 HARRODSBURG RD STE D-308 LEXINGTON KY 40504 832170324 FUND. FDN KY 501(c)(3) 12 Type 1 KOH false HEALTHCARE AND WELLNESS FDN 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 760761782 FUND. FDN MN 501(c)(3) 12 Type 1 SFMC false HIGHLINE MED CTR 16251 SYLVESTER RD SW BURIEN WA 98166 910712166 HOSPITAL WA 501(c)(3) 3 FHS false HOUSE OF MERCY 1111 6TH AVE DES MOINES IA 50314 421323808 SHELTER IA 501(c)(3) 7 CHI-IA CORP false JEWISH HOSP& ST MARY'S HEALTHCARE INC 250 E Liberty St Ste 500 LOUISVILLE KY 40202 611029768 HOSPITAL KY 501(c)(3) 3 KOH false KENTUCKYONE HEALTH MEDGROUP INC 100 E Liberty St Ste 800 LOUISVILLE KY 40202 611352729 HEALTHCARE KY 501(c)(3) 10 JHSMH false KENTUCKYONE HEALTH INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029769 HEALTHCARE KY 501(c)(3) 12 Type 1 CSH false LAKEWOOD HEALTH CTR 600 MAIN AVE S BAUDETTE MN 56623 410758434 HOSPITAL MN 501(c)(3) 3 CSH false LAKEWOOD REGIONAL HEALTHCARE FDN 600 MAIN AVE S BAUDETTE MN 56623 411893795 FUND. FDN ND 501(c)(3) 7 LHC false LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON ND 58054 820558836 HOSPITAL ND 501(c)(3) 3 CSH false LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN TX 75901 820563768 PROPERTY MGMT TX 501(c)(3) 12 Type 1 MHSET false MADISON ST JOSEPH HEALTH CTR 2801 FRANCISCAN DR BRYAN TX 77802 742761145 HOSPITAL TX 501(c)(3) 3 SJSC false MADONNA MANOR INC 2344 AMSTERDAM Rd VILLA HILLS KY 51017 610654635 LIVING ASSIST KY 501(c)(3) 10 CHILC false Marian Regional MED CTR FDN 1400 E Church Street Santa Maria CA 93454 953818027 FUND. FDN CA 501(c)(3) 12 Type 1 DH false Mark Twain MED CTR 768 Mountain Ranch Rd San Andreas CA 95249 680127677 HOSPITAL CA 501(c)(3) 3 DCC false MEMORIAL HEALTH CARE SYSTEM FDN INC 2525 DE SALES AVE CHATTANOOGA TN 37404 621839548 FUND. FDN TN 501(c)(3) 7 MHCS false MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA TN 37404 620532345 HOSPITAL TN 501(c)(3) 3 CSH false MEMORIAL HEALTH PARTNERS FDN INC 5600 BRAINERD RD STE 500 CHATTANOOGA TN 37411 030417049 HEALTHCARE TN 501(c)(3) 10 MHCS false MEMORIAL HEALTH SYS OF EAST TX PO BOX 1447 LUFKIN TX 75902 750755367 HOSPITAL TX 501(c)(3) 3 SLHS false MEMORIAL MED CTR - LIVINGSTON PO BOX 1447 LUFKIN TX 75902 760436439 HOSPITAL TX 501(c)(3) 3 MHSET false MEMORIAL MED CTR - SAN AUGUSTINE PO BOX 1447 LUFKIN TX 75902 752663904 HOSPITAL TX 501(c)(3) 3 MHSET false MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVE LUFKIN TX 95904 752721155 PHYSICIANS TX 501(c)(3) 12 Type 1 MHSET false MEMORIAL SPECIALTY HOSPITAL PO BOX 1447 LUFKIN TX 95902 752492741 HOSPITAL TX 501(c)(3) 3 MHSET false MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVE DES MOINES IA 50314 426076069 AUXILIARY IA 501(c)(3) 12 Type 1 MF-DM IA false MERCY CLINICS INC 1111 6TH AVE DES MOINES IA 50314 421193699 PHYSICIANS IA 501(c)(3) 10 CHI-IA CORP false MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVE DES MOINES IA 50314 421511682 EDUCATION IA 501(c)(3) 2 CHI-IA CORP false Mercy FDN Bakersfield PO Box 119 Bakersfield CA 93302 770201321 FUND. FDN CA 501(c)(3) 12 Type 1 DH false MERCY FDN OF DES MOINES IA 1111 6TH AVE DES MOINES IA 50314 237358794 FUND. FDN IA 501(c)(3) 7 CHI-IA CORP false MERCY FDN INC 2700 STEWART PKWY ROSEBURG OR 97471 936088946 FUND. FDN OR 501(c)(3) 7 MMC false MERCY HEALTH CARE FDN PO BOX 368 CORNING IA 50841 421461064 FUND. FDN IA 501(c)(3) 12 Type 1 AHMH-Corning false MERCY HEALTHCARE FDN 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450435338 FUND. FDN ND 501(c)(3) 12 Type 1 MHVC false MERCY HOSPITAL FDN COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS IA 51503 421178204 FUND. FDN IA 501(c)(3) 12 Type 1 AHBMHS false MERCY HOSPITAL OF DEVILS LAKE 1031 7TH ST NE DEVILS LAKE ND 58301 450227012 HOSPITAL ND 501(c)(3) 3 CSH false MERCY HOSPITAL OF DEVILS LAKE FDN 1031 7TH ST NE DEVILS LAKE ND 58301 352367360 FUND. FDN ND 501(c)(3) 7 MHDL false MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450226553 HOSPITAL ND 501(c)(3) 3 CSH false Mercy McMahon Terrace 3865 J Street Sacramento CA 95816 680117340 Senior Hous/R CA 501(c)(3) 10 DH false MERCY MED CTR 1301 15TH AVE WEST WILLISTON ND 58801 450231183 HOSPITAL ND 501(c)(3) 3 CSH false MERCY MED CTR - CTRVILLE ONE ST JOSEPHS DR CTRVILLE IA 52544 420680308 HOSPITAL IA 501(c)(3) 3 CHI-IA CORP false MERCY MED CTR - NEWTON DBA SKIFF MED CTR 204 N 4th Ave E Newton IA 50314 421470935 HOSPITAL IA 501(c)(3) 3 CHI-IA CORP false Mercy MED CTR Merced FDN 301 E 13th Street Merced CA 95340 770035928 FUND. FDN CA 501(c)(3) 12 Type 1 DH false MERCY MED CTR INC 2700 STEWART PKWY ROSEBURG OR 97471 930386868 HOSPITAL OR 501(c)(3) 3 CSH false MERCY MED FDN 1301 15TH AVE WEST WILLISTON ND 58801 450381803 FUND. FDN ND 501(c)(3) 12 Type 1 MMC false NEBRASKA HEART HOSPITAL 7500 S 91ST ST LINCOLN NE 68526 392031968 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false Northland Healthcare Alliance 2223 East Rosser AVE Bismarck ND 58501 911845296 MANAGEMENT ND 501(c)(3) 7 NCHA false Northridge Hospital FDN 18300 Roscoe Blvd Northridge CA 91328 237444901 FUND. FDN CA 501(c)(3) 12 Type 1 DCC false OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES ND 58474 450231675 HOSPITAL ND 501(c)(3) 3 CSH false OAKES COMMUNITY HOSPITAL FDN 1200 N 7TH ST OAKES ND 58474 710966606 FUND. 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