2021-06-14T16:43:14-05:00 2020-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2019-07-01 741385192 COMMUNITY HOSPITAL OF BRAZOSPORT COMM 9792851803 100 MEDICAL DRIVE LAKE JACKSON TX 77566 CHUCK JEFFRESS PRESIDENT 9792851803 2021-06-14 1 ANGELA NOEL P01051055 3032989100 2019 2022-09-23 18:48:47Z STEVEN FOSTER 100 MEDICAL DRIVE LAKE JACKSON TX 77566 70313800 0 X HTTPS://WWW.CHISTLUKESHEALTH.ORG/LOCATIONS/CHI-ST X 1967 TX TO PROVIDE HEALTHCARE SERVICES TO THE PATIENTS AND COMMUNITIES SERVED IN THE LAKE JACKSON, TEXAS AREA WITH EXCELLENCE AND COMPASSION. 15 13 773 74 5340 4340 0 2590694 74731178 66572699 87009 831170 307299 319237 75125486 70313800 67478 40936 0 0 37773210 36644550 0 0 0 35132593 34435104 72973281 71120590 2152205 -806790 82008256 85461163 57865672 62548894 24142584 22912269 TO PROVIDE HEALTHCARE SERVICES TO THE PATIENTS AND COMMUNITIES SERVED IN THE LAKE JACKSON, TEXAS AREA WITH EXCELLENCE AND COMPASSION. 0 0 56425575 40936 66572699 PROVIDE VARIOUS HEALTHCARE SERVICES TO THE CITIZENS OF BRAZOSPORT AND THE SURROUNDING BRAZORIA COUNTY AREAS. SPECIALTIES AVAILABLE WERE ALLERGY, ANESTHESIA, CARDIOLOGY, EMERGENCY CARE, OTOLARYNGOLOGY, FAMILY PRACTICE, INTERNAL MEDICINE, NEPHROLOGY, NEUROLOGY, OBSTETRICS/GYNECOLOGY, ONCOLOGY, OPHTHALMOLOGY, ORAL SURGERY, ORTHOPEDICS, PATHOLOGY, PEDIATRICS, REHABILITATION, GENERAL SURGERY, AND UROLOGY. 56425575 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 773 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 13 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X CHUCK JEFFRESS 9792851803 100 MEDICAL DRIVE LAKE JACKSON TX 77566 T DOUGLAS LAWSON PHD PRESIDENT/CEO OF CHI ST. LUKE'S HEALTH SYSTEM 1.00 49.00 X 0 1536576 212997 PAUL EDGETT III EX-OFFICIO BOARD MEMBER 1.00 49.00 X 0 1631607 47118 ALFRED GUEVARA CEO 40.00 2.00 X 0 328827 53285 CHUCK JEFFRESS CFO 40.00 2.00 X 234993 0 29213 SHANNON HALTOM VP, PATIENT CARE SERVICES 40.00 0.00 X 187847 0 17821 JOAN BELL VP, QUALITY SERVICES 40.00 0.00 X 152899 0 16207 AZARA IDDRISU REGISTERED NURSE 40.00 0.00 X 148595 1625 14730 BRIAN STACKS PHARMACIST 40.00 0.00 X 146638 0 14692 PREMILA MARTIN DIRECTOR-REHAB SERVICES 40.00 0.00 X 118478 0 31104 MARILYN CLEMONS NUCLEAR MED TECHNOLOGIST LEAD 40.00 0.00 X 112303 0 14000 CHARLES ELLISON BOARD MEMBER 1.00 9.00 X 0 0 0 JOHN GLICK BOARD MEMBER & VICE CHAIR 1.00 4.00 X X 0 0 0 BERNARD HARRIS MD BOARD MEMBER 1.00 1.00 X 0 0 0 PAUL KLOTMAN MD BOARD MEMBER 1.00 3.00 X 0 0 0 TONY LIN MD BOARD MEMBER 1.00 1.00 X 0 0 0 SR NANCY LINENKUGEL BOARD MEMBER 1.00 1.00 X 0 0 0 GINA LUNA BOARD MEMBER/TREASURER 1.00 1.00 X X 0 0 0 EARL SHIPP BOARD MEMBER/CHAIR 1.00 2.00 X X 0 0 0 LEONARD TALLERINE JR BOARD MEMBER 1.00 8.00 X 0 0 0 HOWARD TELLEPSEN JR BOARD MEMBER/SECRETARY 1.00 2.00 X X 0 0 0 INDIRA VISHNAMPET BOARD MEMBER 1.00 2.00 X 0 0 0 ADAM KUSPA PHD BOARD MEMBER 1.00 1.00 X 0 0 0 SCOTT SILVAS BOARD MEMBER 1.00 1.00 X 0 0 0 1101753 3498635 451167 12 0 1 0 MILESTONE HEALTHCARE LLC L-3542 COLUMBUS OH 43260 CONTRACT LABOR 747198 INPATIENT SERVICES OF TEXAS 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOSPITALIST 624000 TOTAL RENAL CARE INC 2438 N PONDEROSA DRIVE STE C101 CAMARILLO CA 930102465 DIALYSIS SERVICES 231628 COTTON COMMERCIAL USA INC 5443 KATY HOCKLEY CUT-OFF RD KATY TX 77493 INFRASTRUCTURE SUPPORT SERVICES 189753 VANGUARD MANAGEMENT GROUP INC 9300 N 16TH ST STE 101 TAMPA FL 33612 MANAGEMENT SERVICES 180000 10 1095887 1494807 2590694 NET PATIENT SERVICES 900099 66572699 66572699 0 0 66572699 424251 5340 418911 34800 0 34800 34800 34800 406466 453 0 0 406466 453 406919 406919 INTERCOMPANY TRANSACTI 900099 138021 0 0 138021 CAFETERIA 722100 112042 0 0 112042 MEDICAL RECORDS REVENU 541200 20742 0 0 20742 13632 13632 284437 70313800 66572699 5340 1145067 X 40936 40936 482769 111037 371732 28239797 22833940 5405857 1489030 1205997 283033 4441976 3571884 870092 1990978 1592783 398195 1307 1307 10569837 8286132 2283705 47268 47268 727784 436670 291114 2268660 1361196 907464 1857493 1485994 371499 50919 40735 10184 5145 5145 1738073 1738073 988140 988140 2273807 1819046 454761 231765 185412 46353 MEDICAL SUPPLIES 9253098 9253098 0 0 STATE PROVIDER TAX 2179691 2070706 108985 0 REPAIRS AND MAINTENANCE 1200753 1140715 60038 0 INTERCOMPANY ALLOCATION 699576 664597 34979 0 341788 324697 17091 71120590 56425575 14695015 0 87 340092 4383142 7568609 0 25335219 22571593 0 0 0 0 120944 10944 1478023 1860479 205017 270018 46596201 13893246 33568946 32702955 11912254 0 5000000 17378854 0 0 0 4624 2757619 82008256 85461163 7142846 8726923 0 0 0 278233 0 0 0 0 0 0 324974 0 0 50397852 53543738 57865672 62548894 X 22556837 21326522 1585747 1585747 24142584 22912269 82008256 85461163 X -806790 -332267 -91258 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1307 0 0 0 1307 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $1,307 1740000 1740000 34498114 6166431 28331683 90000 14310 75690 10026687 7712505 2314182 241400 241400 32702955 CHI OIP 17378854 F 17378854 CHI DEBT PROGRAM 36222196 INTERCOMPANY PAYABLES 13244888 OPERATING LEASE LIABILITY 2854273 OTHER CURRENT LIABILITIES 1222381 53543738 X PART X, LINE 2: THE COMMUNITY HOSPITAL OF BRAZOSPORT'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 1 265 535936 535936 0.00750 9094 5620028 4413052 1206976 0.01700 9359 6155964 4413052 1742912 0.02450 9359 6155964 4413052 1742912 0.02450 1 17643372 0 18029421 21112726 -3083305 X 1 1 1 1 COMMUNITY HOSPITAL OF BRAZOSPORT 100 MEDICAL DRIVE LAKE JACKSON TX 77566 SEE STATEMENT 436 X X X URGENT CARE CENTER COMMUNITY HOSPITAL OF BRAZOSPORT 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X SEE STATEMENT X 1 17 0 1 0 1 X 300.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X SEE STATEMENT X SEE STATEMENT X SEE STATEMENT X X X X X X X 1 X 0 X X X X X 1 X 0 0 PART V, SECTION B, LINE 3E: THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA. PART V, SECTION B, LINE 5: THE METHODOLOGY TO DEVELOP THE CHNA TAKES A COMPREHENSIVE APPROACH TO THE SOLICITATION OF WRITTEN COMMENTS. INPUT WAS OBTAINED FROM COMMUNITY SOURCES AND EXPANDED INPUT TO INCLUDE OTHER REPRESENTATIVE GROUPS. THE HOSPITAL ASKED ALL PARTICIPATING IN THE WRITTEN COMMENT SOLICITATION PROCESS TO SELF-IDENTIFY THEMSELVES INTO ANY OF THE FOLLOWING REPRESENTATIVE CLASSIFICATIONS. WRITTEN COMMENT PARTICIPANTS SELF-IDENTIFIED INTO THE FOLLOWING CLASSIFICATIONS:(1) PUBLIC HEALTH - PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH(2) DEPARTMENTS AND AGENCIES - FEDERAL, TRIBAL, REGIONAL, STATE, OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES, WITH CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY(3) PRIORITY POPULATIONS - LEADERS, REPRESENTATIVES, OR MEMBERS OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE NEEDS IN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. ALSO, IN OTHER FEDERAL REGULATIONS THE TERM PRIORITY POPULATIONS, WHICH INCLUDE RURAL RESIDENTS AND LGBT INTERESTS, IS EMPLOYED AND FOR CONSISTENCY IS INCLUDED IN THIS DEFINITION(4) CHRONIC DISEASE GROUPS - REPRESENTATIVE OF OR MEMBER OF CHRONIC DISEASE GROUP OR ORGANIZATION, INCLUDING MENTAL AND ORAL HEALTH(5) BROAD INTEREST OF THE COMMUNITY - INDIVIDUALS, VOLUNTEERS, CIVIC LEADERS, MEDICAL PERSONNEL, AND OTHERS TO FULFILL THE SPIRIT OF BROAD INPUT REQUIRED BY THE FEDERAL REGULATIONSTHE METHODOLOGY ALSO TAKES A COMPREHENSIVE APPROACH TO ASSESS COMMUNITY HEALTH NEEDS BY PERFORMING SEVERAL INDEPENDENT DATA ANALYSES BASED ON SECONDARY SOURCE DATA, AUGMENTING THIS WITH LOCAL EXPERT ADVISOR OPINIONS, AND RESOLVING ANY DATA INCONSISTENCY OR DISCREPANCIES BY REVIEWING THE COMBINED OPINIONS FORMED FROM LOCAL EXPERTS. THE HOSPITAL RELIES ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCES USE THE COUNTY AS THE SMALLEST UNIT OF ANALYSIS.LOCAL EXPERT AREA RESIDENTS WERE ASKED TO NOTE IF THEY PERCEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES EXISTED IN THEIR PORTION OF THE COUNTY.MOST DATA USED IN THE ANALYSIS IS AVAILABLE FROM PUBLIC INTERNET SOURCES AND PROPRIETARY DATA. ANY CRITICAL DATA NEEDED TO ADDRESS SPECIFIC REGULATIONS OR DEVELOPED BY THE LOCAL EXPERT ADVISOR INDIVIDUALS COOPERATING IN THIS STUDY ARE DISPLAYED IN THE CHNA REPORT APPENDIX.DATA SOURCES INCLUDE:WWW.COUNTYHEALTHRANKINGS.ORGIBM WATSON HEALTH (FORMERLY KNOWN AS TRUVEN HEALTH ANALYTICS)HTTP://SVI.CDC.GOVHTTP://WWW.HEALTHDATA.ORG/USCOUNTY-PROFILESWWW.WORLDLIFEEXPECTANCY.COM/USAHEALTH-RANKINGSA STANDARD PROCESS OF GATHERING COMMUNITY INPUT WAS DEVELOPED. IN ADDITION TO GATHERING DATA FROM THE ABOVE SOURCES:* A CHNA "ROUND 1" SURVEY WAS DEPLOYED TO THE HOSPITAL'S LOCAL EXPERT ADVISORS TO GAIN INPUT ON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED ACCORDING TO CRITERIA REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS AND THE HOSPITAL'S DESIRE TO REPRESENT THE REGION'S GEOGRAPHICALLY AND ETHNICALLY DIVERSE POPULATION. COMMUNITY INPUT FROM 22 LOCAL EXPERT ADVISORS WAS RECEIVED. SURVEY RESPONSES STARTED MAY 7, 2018 AND ENDED WITH THE LAST RESPONSE ON MAY 18, 2018.* INFORMATION ANALYSIS AUGMENTED BY LOCAL OPINIONS SHOWED HOW BRAZORIA COUNTY RELATES TO ITS PEERS IN TERMS OF PRIMARY AND CHRONIC NEEDS AND OTHER ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS. RESPONDENTS COMMENTED ON WHETHER THEY BELIEVE CERTAIN POPULATION GROUPS ("PRIORITY POPULATIONS") NEED HELP TO IMPROVE THEIR CONDITION, AND IF SO, WHO NEEDS TO DO WHAT TO IMPROVE THE CONDITIONS OF THESE GROUPS. * LOCAL OPINIONS OF THE NEEDS OF PRIORITY POPULATIONS, WHILE PRESENTED IN ITS ENTIRETY IN THE APPENDIX, WAS ABSTRACTED IN THE FOLLOWING "TAKE-AWAY" BULLETED COMMENTSLOW INCOME RESIDENTSPEOPLE WITH MAJOR CO-MORBIDITY AND COMPLICATIONSRACIAL AND ETHNIC MINORITY GROUPSACCESS TO CARE FOR THESE POPULATIONS WAS EXPRESSEDWHEN THE ANALYSIS WAS COMPLETE, THE INFORMATION AND SUMMARY CONCLUSIONS WAS PUT BEFORE THE HOSPITAL'S LOCAL EXPERT ADVISORS WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL COMMENTS OF NEED. CONSULTATION WITH 17 LOCAL EXPERTS OCCURRED AGAIN VIA AN INTERNETBASED SURVEY BEGINNING MAY 30, 2018 AND ENDING JUNE 15, 2018. HAVING TAKEN STEPS TO IDENTIFY POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS THEN PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A "WISDOM OF CROWDS" METHOD. THE PREMISE OF THIS APPROACH RELIES ON A PANEL OF EXPERTS WITH THE ASSUMPTION THAT THE COLLECTIVE WISDOM OF PARTICIPANTS IS SUPERIOR TO THE OPINION OF ANY ONE INDIVIDUAL, REGARDLESS OF THEIR PROFESSIONAL CREDENTIALS.IN THE ST. LUKE'S BRAZOSPORT PROCESS, EACH LOCAL EXPERT HAD THE OPPORTUNITY TO INTRODUCE NEEDS PREVIOUSLY UNIDENTIFIED AND TO CHALLENGE CONCLUSIONS DEVELOPED FROM THE DATA ANALYSIS. WHILE THERE WERE A FEW OPINIONS OF THE DATA CONCLUSIONS NOT BEING COMPLETELY ACCURATE, MOST OF THE COMMENTS AGREED WITH THE FINDINGS. A LIST OF ALL NEEDS IDENTIFIED BY ANY OF THE ANALYZED DATA WAS DEVELOPED. THE LOCAL EXPERTS THEN ALLOCATED 100 POINTS AMONG THE LIST OF HEALTH NEEDS, INCLUDING THE OPPORTUNITY TO LIST ADDITIONAL NEEDS THAT WERE NOT IDENTIFIED FROM THE DATA. PART V, SECTION B, LINE 7: HTTPS://WWW.STLUKESHEALTH.ORG/LOCATIONS/BRAZOSPORT-HOSPITAL/ABOUT-US PART V, SECTION B, LINE 11: ST. LUKE'S BRAZOSPORT (SLB) IS ADDRESSING THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN OUR MOST RECENT CHNA IN THE FOLLOWING WAYS: COMMUNITY NEEDS 1. AND 2., BEHAVIORAL/MENTAL HEALTH AND SUICIDE - SLB HAS EXPLORED THE IMPLEMENTATION OF TELEMEDICINE FOR PSYCHIATRY AND BY PROVIDING SUICIDE PREVENTION EDUCATION AND INFORMATION TO PATIENTS WITH MODERATE RISK AND ABOVE. COMMUNITY NEED 3. CANCER - PARTIPATING IN THE MERMAID FUND FOR LOW-INCOME PATIENTS, DEPLOYING A MOBILE PET SCANNER, FULL-SERVICE CANCER CENTER ON-SITE, ACCESS TO THE SURGICAL PRIGRAM THROUGH BAYLOR COLLEGE OF MEDICINE, PROVIDING ON-SITE COLONOSCOPIES, AND ANNUAL PARTICIPATION WITH BRAZOSPORT COLLEGE IN THE WOMAN;S CONFERENCE. ADDITIONALLY, WE HAVE ADDED AN ADDITIONAL CT SCANNER,HAVE ACCREDITED MAMMOGRAPHY, AND HAVE AN OUTREACH PROCESS TO AID MAMMOGRAPHY COMPLIANCE. COMMUNITY NEED 4. PREVENTION SLB OFFERS ANNUAL FLU SHOT CLINICS, COVID-19 SCREENINGS, EDUCATION/ACCESS DURING FLU SEASON, PARTICIPATION IN HEALTHY SOUTH TEXAS, OFFER CARDIAC PHASE 3 PROGRAM, OFFER TRAUMA AND STROKE EDUCATIONAL SERVICES TO THE COMMUNITY, PARTNER WITH BRZAPSPORT COLLEGE IN THE ANNUAL WOMEN'S CONFERENCE. SLB OFFERS REDUCED PRICE SCREENING PHYSICALS AND ORTHOPEDIC SUPPORT FOR ATHLETICS TRAINING FOR LOCAL SCHOOLS AND PARTICIPATES IN COMMUNITY HEALTH FAIRS.COMMUNITY NEED 5. OBESITY HEALTY OPTIONS ARE OFFERED IN THE CAFETERIA , AND PARTICIPATION IN HEALTHY SOUTH TEXAS.REASONS NEEDS WERE NOT ADDRESSED INCLUDE LACK OF STAFFING, OR FUNDING, DISCONTINUATION OF SERVICES, AND COVID-19. 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. PART V, SECTION B, LINES 16A, 16B, & 16C: HTTPS://WWW.STLUKESHEALTH.ORG/LOCATIONS/BRAZOSPORT-HOSPITAL/ABOUT-YOUR-VISIT/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE IN THE HOSPITAL HANDBOOK AND PATIENTS ARE NOTIFIED OF THE POLICY PRIOR TO DISCHARGE FROM THE HOSPITAL. PART V, SECTION B, LINE 20E: NEITHER ST. LUKE'S BRAZOSPORT, NOR THIRD PARTIES AUTHORIZED BY ST. LUKE'S BRAZOSPORT, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. PART I, LINE 3C: UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: - THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. - THE PATIENT'S FAMILY INCOME MUST BE AT OR BELOW 300% OF THE FPG. - THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED [IN THE FAP]. - THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: - RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS; - HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS CLINIC; - PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); - FOOD STAMP ELIGIBILITY; - SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; - ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID SPEND-DOWN); - LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR - PATIENT IS DECEASED WITH NO KNOWN ESTATE. PART I, LINE 7: GROSS PATIENT CHARGES NET OF BAD DEBT EXPENSES ARE ADJUSTED BY COST-TO-CHARGE RATIO CALCULATED IN WORKSHEET 2. PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 21.56% 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: THE COMMUNITY HOSPITAL OF BRAZOSPORT 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: THE COMMUNITY HOSPITAL OF BRAZOSPORT 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. THE ORGANIZATION'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: $18,029,421TOTAL MEDICARE COSTS: $21,112,726SURPLUS (SHORTFALL): (3,083,305)THE 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. 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 V, SECTION A, HOSPITAL WEBSITE: HTTPS://WWW.STLUKESHEALTH.ORG/LOCATIONS/BRAZOSPORT-HOSPITAL PART VI, LINE 2: BRAZOSPORT REGIONAL HEALTH SYSTEM CONDUCTS A COMPREHENSIVE ENVIRONMENTAL ANALYSIS, INCLUDING A PHYSICIAN MANPOWER ANALYSIS AND MEETING WITH KEY COMMUNITY STAKEHOLDERS, AS PART OF THE 3 YEAR STRATEGIC PLANNING PROCESS. THE BRAZOSPORT REGIONAL BOARD OF DIRECTORS ANALYZES THE DATA FROM THE PRIMARY SERVICE AREA TO IDENTIFY SPECIFIC HEALTH CARE NEEDS FOR THE AREA RESIDENTS. PART VI, LINE 3: NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM CHI HOSPITAL ORGANIZATIONS SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO: - CONSPICUOUS PUBLICATION OF NOTICES IN PATIENT BILLS; - NOTICES POSTED IN EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING/REGISTRATION DEPARTMENTS, BUSINESS OFFICES, AND AT OTHER PUBLIC PLACES AS A HOSPITAL FACILITY MAY ELECT; AND - PUBLICATION OF A SUMMARY OF THIS POLICY ON THE HOSPITAL FACILITY'S WEBSITE AND AT OTHER PLACES WITHIN THE COMMUNITIES SERVED BY THE HOSPITAL FACILITY AS IT MAY ELECT. SUCH NOTICES AND SUMMARY INFORMATION SHALL INCLUDE A CONTACT NUMBER AND SHALL BE PROVIDED IN ENGLISH, SPANISH, AND OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVED BY AN INDIVIDUAL HOSPITAL FACILITY, AS APPLICABLE. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE CHI HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.IN ADDITION, HOSPITAL REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. COUNSELORS ASSIST MEDICARE ELIGIBLE PATIENTS IN ENROLLMENT BY PROVIDING REFERRALS TO THE APPROPRIATE GOVERNMENT AGENCIES. ONCE IT IS DETERMINED THAT THE PATIENT DOES NOT QUALIFY FOR ANY THIRD PARTY FUNDING, THE PATIENT IS VERBALLY NOTIFIED ABOUT THE EXISTENCE OF FINANCIAL ASSISTANCE APPLICATION AND ADDITIONAL SCREENING TAKES PLACE BY A HOSPITAL EMPLOYEE TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR CHARITY SERVICE PRIOR TO DISCHARGE. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY OF THAT POLICY, AND AN APPLICATION FOR ASSISTANCE. HOSPITAL REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON-ENGLISH-SPEAKING INDIVIDUALS. PATIENTS THAT HAVE BEEN DISCHARGED PRIOR TO CHARITY SCREENING, SUCH AS EMERGENCY ROOM PATIENTS, RECEIVE A WRITTEN NOTIFICATION OF POSSIBLE ELIGIBILITY FOR SERVICES. IF THE PATIENT IS DETERMINED NOT TO BE ELIGIBLE FOR GOVERNMENT ASSISTANCE, HE/SHE MAY NOTIFY THE HOSPITAL THAT THEY SEEK CHARITY ASSISTANCE. THE APPROPRIATE CHARITY FORM IS SENT TO THE PATIENT/GUARANTOR FOR COMPLETION AND THEN RETURNED TO THE HOSPITAL FOR EVALUATION AND QUALIFICATION. ONCE DETERMINATION OF ELIGIBILITY IS MADE, THE PATIENT IS SENT A NOTICE INFORMING HIM/HER IF THEY QUALIFY FOR FULL, PARTIAL, OR NO CHARITY CARE SERVICES.HOSPITAL FACILITIES MUST MAKE REASONABLE EFFORTS THROUGH ITS BILLING AND COLLECTIONS PROCESSES, PURSUANT TO TREAS. REG. 1.501(R)-6(C), TO DETERMINE WHETHER ANY INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: ST. LUKE'S BRAZOSPORT DEFINES ITS SERVICE AREA AS BRAZORIA COUNTY IN TEXAS. FROM 10/1/2015 - 9/30/2016, THE HOSPITAL RECEIVED 92.4% OF ITS PATIENTS FROM THIS SERVICE AREA. BRAZORIA COUNTY INCLUDES RESIDENTS LIVING IN THE TOWNS OF BRAZORIA, DAMON, SWEENY, WEST COLUMBIA, ANGLETON, CLUTE, DANBURY, FREEPORT, LAKE JACKSON, LIVERPOOL, MANVEL, AND ROSHARON.BRAZORIA COUNTY'S 2018 TOTAL POPULATION IS 190,935, WITH THE FOLLOWING AGE DISTRIBUTION:0-14 YEARS: 39,325; 15-24 YEARS: 26,365; 25-34 YEARS: 25,464; 35-54 YEARS: 51,248; 55-64 YEARS: 23,780; 65+ YEARS: 24,753MEDIAN AGE IS 37 YEARS OLD.TOTAL MALE POPULATION: 98,819TOTAL FEMALE POPULATION: 92,116RACE/ETHNICITYWHITE, NON-HISPANIC: 95,312BLACK, NON-HISPANIC: 23,261HISPANIC: 63,094ASIAN & PACIFIC ISLANDS, NON-HISPANIC: 5,546ALL OTHERS: 3,722MEDIAN HOUSEHOLD INCOME IS $70,520UNEMPLOYMENT RATE (DECEMBER 2017) IS 4.60%HIGH SCHOOL GRADUATION RATE IS 83.9% PART VI, LINE 5: THE ORGANIZATION'S HOSPITAL FACILITY PROMOTES HEALTH FOR THE BENEFIT OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITY HAS AN OPEN MEDICAL STAFF. ITS BOARD OF TRUSTEES IS COMPOSED OF PROMINENT CITIZENS IN THE COMMUNITY. EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT IN PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. THE FACILITY TREATS 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. 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 IS THE SOLE CORPORATE MEMBER OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. COMMONSPIRIT HEALTH IS COMPRISED OF 137 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 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 $4.5 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $29.57 BILLION IN FISCAL YEAR 2020, HAS TOTAL ASSETS OF APPROXIMATELY $46.77 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. PART VI, LINE 7, REPORTS FILED WITH STATES TX 1 BRAZOSPORT COLLEGE FOUNDATION 500 COLLEGE DR LAKE JACKSON TX 77566 760486628 501(C)(3) 10000 PROGRAM SERVICES BRAZOSPORT CHAMBER OF COMMERCE 300 ABNER JACKSON PKWY LAKE JACKSON TX 77566 741016652 501(C)(6) 9250 PROGRAM SERVICES 1 1 PART I, LINE 2: DISTRIBUTIONS IN FURTHERANCE OF THE INSTITUTION'S EXEMPT PROGRAMS ARE MADE IN ACCORDANCE WITH PROCEDURES SUBJECT TO CONDITIONS ESTABLISHED BY THE INSTITUTION'S GOVERNING BOARD OR MANAGEMENT DESIGNED TO ENSURE THAT RECIPIENTS OF SUCH DISBURSEMENTS FROM THE ORGANIZATION ARE ADEQUATELY INVESTIGATED AND GRANTED TO QUALIFIED RECIPIENTS. 0 1 0 0 0 0 0 0 0 T DOUGLAS LAWSON PHD PRESIDENT/CEO OF CHI ST. LUKE'S HEAL 0 1020839 0 499895 0 15842 0 180475 0 32522 0 1749573 0 0 PAUL EDGETT III EX-OFFICIO BOARD MEMBER 0 848293 0 608753 0 174561 0 14455 0 32663 0 1678725 0 0 ALFRED GUEVARA CEO 0 311783 0 0 0 17044 0 32595 0 20690 0 382112 0 0 CHUCK JEFFRESS CFO 224073 0 0 0 10920 0 8688 0 20525 0 264206 0 0 0 SHANNON HALTOM VP, PATIENT CARE SERVICES 184883 0 0 0 2964 0 6649 0 11172 0 205668 0 0 0 JOAN BELL VP, QUALITY SERVICES 152077 0 0 0 822 0 5422 0 10785 0 169106 0 0 0 AZARA IDDRISU REGISTERED NURSE 143651 1625 2500 0 2444 0 4658 0 10042 30 163295 1655 0 0 BRIAN STACKS PHARMACIST 143794 0 0 0 2844 0 5175 0 9517 0 161330 0 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. 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. 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. 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: PAUL EDGETT, $141,855. FORM 990, PART VI, SECTION A, LINE 1 PURSUANT TO SECTION 6.2 OF THE BYLAWS OF THE CORPORATION, THE CORPORATION SHALL HAVE AN ADVISORY BOARD THAT IS ORGANIZED TO PROVIDE INPUT TO THE CORPORATE MEMBER ON SUCH MATTERS RELATING TO THE CORPORATION AS MAY BE REQUESTED FROM TIME TO TIME BY THE CORPORATE MEMBER, AND WHICH MAY INCLUDE, BUT MAY NOT BE LIMITED TO, THE FOLLOWING: (I) MONITOR AND ENSURE THAT THE ORGANIZATION ACHIEVES KEY PERFORMANCE OUTCOMES CRITICAL TO THE CORPORATE MEMBER'S LONG-TERM SUCCESS FOCUSING ON: (1) FURTHERING THE MISSION OF THE CORPORATE MEMBER IN THE REGION, ESPECIALLY IN THE SERVICE TO THOSE WHO ARE POOR AND VULNERABLE, (2) THE "VALUE PROPOSITION" OF QUALITY, SAFETY, SERVICE, AND COST-EFFECTIVE DELIVERY OF CARE, (3) ENGAGEMENT OF STAFF AND CAREGIVERS, AND ( 4) MARKET COMPETITIVENESS, GROWTH, TRANSFORMATION, AND OPERATING PERFORMANCE; (II) DEVELOP AND RECOMMEND REGIONAL STRATEGIES AND PARTNERSHIPS, CONSISTENT WITH THE OVERALL STRATEGIC DIRECTION OF THE CORPORATE MEMBER, AND OVERSEE THEIR EFFECTIVE IMPLEMENTATION; (III) IDENTIFY AND ADDRESS COMMUNITY HEALTH NEEDS AND ACHIEVE COMMUNITY HEALTH IMPROVEMENTS AS INCLUDED IN THE PLANS APPLICABLE TO A CHI MARKET BASED ORGANIZATION; (IV) CREDENTIAL MEDICAL PROFESSIONALS; (V) ADVOCATE LOCALLY OR REGIONALLY FOR THE CORPORATION AND THE CORPORATE MEMBER'S MINISTRY; AND (VI) ENSURE THAT PHYSICIANS, ALL CLINICAL PARTNERS, AND STAFF ARE ENGAGED. THE ADVISORY BOARD SHALL CONSIST OF REPRESENTATIVES OF THE CORPORATE MEMBER AND OF INDIVIDUALS REPRESENTATIVE OF THE COMMUNITIES SERVED BY THE CORPORATION. THE ADVISORY BOARD SHALL MEET PERIODICALLY AND ON AN ANNUAL BASIS AND SHALL CONDUCT ITS BUSINESS BY SUCH PROCEDURES AS A MAJORITY OF ITS MEMBERS CONSIDER APPROPRIATE. THE ADVISORY BOARD SHALL REPORT TO THE CORPORATE MEMBER WITH THE PROCEEDINGS OF THE ADVISORY BOARD MEETINGS. FORM 990, PART VI, SECTION A, LINE 2 GINA LUNA AND JOHN GLICK - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 ACCORDING TO THE BYLAWS OF BRAZOSPORT REGIONAL HEALTH SYSTEM, THE SOLE MEMBER OF THE CORPORATION IS ST. LUKE'S HEALTH SYSTEM CORPORATION, A TEXAS NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS THE POWER TO APPOINT, REMOVE OR REPLACE THE MEMBERS OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, THE SOLE MEMBER SHALL FILL ALL VACANCIES ON THE BOARD OF TRUSTEES CREATED BY REMOVAL, RESIGNATION OR DEATH; PROVIDED HOWEVER, THAT FOLLOWING SUCH ACTION, NO MORE THAN FORTY-NINE PERCENT OF TOTAL MEMBERS OF THE BOARD OF TRUSTEES SHALL BE COMPRISED OF THE CEO OF THE CORPORATION AND THE PHYSICIAN MEMBERS. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS ST LUKE'S HEALTH CORPORATION (SLHC). PURSUANT TO ARTICLE V, SECTION 5.4.1 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 SLHC BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE SLHC CHIEF EXECUTIVE OFFICER: - AMENDMENT OF THE CORPORATE DOCUMENTS OF COMMUNITY HOSPITAL OF BRAZOSPORT (CHB) - APPROVE MEMBERS OF THE CHB BOARD - REMOVAL OF A MEMBER OF THE GOVERNING BODY OF CHB - ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR CHB (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. THEN THE ORGANIZATION PROVIDES HARD COPIES TO BOARD MEMBERS FOR REVIEW PRIOR TO FILING. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO 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 15 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 ORGANIZATION'S OTHER OFFICERS IS DETERMINED BY THE COMPENSATION COMMITTEE OF ST. LUKE'S HEALTH SYSTEM CORPORATION, A RELATED ORGANIZATION. THE COMMITTEE MEETS AS NEEDED, BUT TYPICALLY MEETS TWO TIMES PER YEAR. THIS COMMITTEE CONSISTS OF THREE OUTSIDE DIRECTORS. ITS FUNCTION IS TO MAKE RECOMMENDATIONS/DECISIONS ON SALARY AND BENEFITS FOR KEY EXECUTIVES. VARIOUS DATA ARE UTILIZED IN DECISION-MAKING INCLUDING COMPENSATION CONSULTANTS, MANAGEMENT'S LEVEL OF ACHIEVEMENT OF STIPULATED PERFORMANCE TARGETS, EXTERNAL SURVEYS, AND LOCAL MARKET CONDITIONS. PERMANENT MINUTES ARE PREPARED AND REVIEWED BY COMPENSATION COMMITTEE MEMBERS PRIOR TO THEIR RATIFICATION. THESE MINUTES ARE SUFFICIENTLY DETAILED TO PROVIDE SUBSTANTIATION OF THE DECISIONS MADE BY THE COMMITTEE WITH REGARD TO EACH KEY EXECUTIVE'S COMPENSATION AND BENEFITS. A REPORT IS MADE TO THE FULL BOARD BY THE COMPENSATION COMMITTEE CHAIR AT WHICH TIME RATIFICATION OF COMMITTEE ACTION IS VOTED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS ARE MADE 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: THE COMMUNITY HOSPITAL OF BRAZOSPORT 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; AND (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS. 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 2,328,299. MANAGEMENT AND GENERAL EXPENSES 122,542. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,450,841. CONSULTING: PROGRAM SERVICE EXPENSES 65,506. MANAGEMENT AND GENERAL EXPENSES 3,448. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,954. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 350,594. MANAGEMENT AND GENERAL EXPENSES 38,955. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 389,549. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,564,058. MANAGEMENT AND GENERAL EXPENSES 134,950. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,699,008. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,977,675. MANAGEMENT AND GENERAL EXPENSES 1,983,810. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,961,485. FORM 990, PART XI, LINE 9: ASC 842 ADJUSTMENT -91,258. 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 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SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(C)(3) LINE 3 BRHS 1 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 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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 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