2020-07-11T15:30:27-05:00 2019-06-30 470617373 Commonspirit Health 198 Inverness Drive West Englewood CO 80112 990 2018-07-01 410758434 Lakewood Health Center LAKE 2186342120 600 Main Avenue South Baudette MN 56623 Jay Ross CFO 2020-07-11 true MARK STOCKI P00642127 3032989100 2018 2021-01-29 14:40:06Z CHI Lakewood Health Jeffry Stampohar 600 Main Avenue South Baudette MN 56623 14577635 false 0928 X www.lakewoodhealthcenter.org X 1959 MN LAKEWOOD HEALTH CENTER IS A SMALL FACILITY LOCATED IN A RURAL AND ISOLATED SETTING. THE CONTINUUM OF CARE INCLUDES PHYSICIAN CLINIC, ACUTE CARE, RESIDENTIAL CARE, AND LONG TERM CARE. 5 2 193 82 5489 0 584291 485450 13783815 13554422 542189 332661 179626 205102 15089921 14577635 111731 204454 0 7263518 7869426 0 117594 8361334 8722206 15736583 16796086 -646662 -2218451 20589863 18114531 2045300 1648454 18544563 16466077 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 15372998 204454 13554422 See Schedule H 15372998 true true false true false false false true false true true false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 0 0 193 true true true false false false false false true false false false false false X 5 2 false false false false true true true true true false false true true true true true true true true false MN X Jay Ross 2186163525 600 Main Avenue South Baudette MN 56623 BRUCE BURTON BOARD CHAIR 1.0 1.0 X X 0 0 0 BRAD NYLANDER VICE CHAIR 1.0 0 X X 0 0 0 JEFFRY STAMPOHAR PRESIDENT 1.0 50.0 X X 169064 13654 38692 JEFFREY DROP Board Member/SVP-Operations-CEO 1.0 50.0 X 0 1388860 40427 DR JUSTIN QUO PHYSICIAN/BOARD MEMBER/CHIEF OF STAFF 50.0 0 X 300739 0 39972 JAY P ROSS CFO / Treasurer 1.0 50.0 X 0 150198 35830 Kristi Bowman Secretary 40.0 0 X 40328 0 16255 MOHAN BANGALORE-PUTTAIAH Physician 40.0 0 X 277143 0 41345 MICHELLE BROWN NURSE PRACT-FAMILY MEDICINE 40.0 0.0 X 123083 0 26063 BRENT NOBLE SUPERVISOR-PHARMACY 40.0 0 X 113442 0 15850 CLYDE STEPHENS PHYS ASST-FAMILY MEDICINE 40.0 0 X 136236 0 0 BENJAMIN KOPPELMAN Former PRESIDENT 1.0 50.0 X 0 321630 29068 1160035 1874342 283502 6 true true false NATIONAL GOVERNMENT SVCS INC 5000 Brittonfield Pkwy Suite 100 East Syracuse NY 13057 Medicare contracting services 378775 MEDEFIS INC 2121 N 117th Ave Suite 200 OMAHA NE 68164 WORKFORCE SOLUTIONS 263518 AMN HEALTHCARE 12400 High Bluff Drive San Diego CA 92130 Healthcare consulting 235707 LIFECARE MEDICAL CENTER 715 DELMORE DR ROSEAU MN 56751 MEDICAL SERVICES 124626 HEALTH CAROUSEL LLC 3805 Edwards Rd 700 MECHANICSVILLE VA 23116 WORKFORCE SOLUTIONS 102615 5 X 0 0 0 110761 367235 7454 0 485450 Net Patient Services 900099 13550689 13550689 0 0 Rental Income 900099 3733 3733 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13554422 184969 0 1042 183927 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 150878 -3186 0 0 150878 -3186 147692 0 0 147692 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Services Sold 900099 133252 0 4447 128805 Education 611710 12790 0 0 12790 Cafeteria 722100 8755 0 0 8755 50305 0 0 50305 205102 14577635 13554422 5489 532274 X 204454 204454 638893 575004 63889 5482434 4934191 488137 60106 97651 87886 8077 1688 1213602 1092241 108829 12532 436846 393162 39316 4368 32750 32750 1237 1237 3101892 2917223 184669 0 44996 40496 4050 450 604204 543784 54378 6042 1211578 1090420 109042 12116 352764 317487 31749 3528 58066 52259 5226 581 7245 6521 652 72 22436 20193 2019 224 214632 193169 19317 2146 1346766 1212089 121209 13468 27254 24528 2453 273 Medical Supplies 934943 934943 Other taxes 266018 252717 13301 Miscellaneous Expenses 192522 191235 1287 Repairs and maintenance 182335 173218 9117 120568 114541 6027 0 16796086 15372998 1305494 117594 930 931 692912 404859 0 0 2495821 2062730 0 0 0 38928 13720 156532 202119 38578 45486 22909813 15905834 7984449 7003979 0 0 8755105 8229685 0 0 0 426608 151022 20589863 18114531 1172808 1122158 0 0 3257 -29855 0 0 3419 3385 0 0 0 0 0 865816 552766 2045300 1648454 X 18542539 16465017 2024 1060 0 0 18544563 16466077 20589863 18114531 -2218451 139965 0 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 1237 false false false 1237 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Line 1F: The portion of organization dues that are related to lobbying are as follows: Minnesota Hospital Association - $291 American Hospital Association - $539 Catholic Health Association - $407 false true X 103424 103424 9850393 8460423 1389970 0 0 0 12661263 7202528 5458735 294733 242883 51850 7003979 CHI OPERATING INVESTMENT PROGRAM,LP 8229685 F 8229685 CHI Debt program Intercompany Payables Intercompany Payables 336565 CHI Debt program 216201 552766 X Schedule D, Part IV, Line 2b Explanation of escrow agreement FUNDS ARE HELD ON BEHALF OF RESIDENTS IN LONG TERM CARE. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote LAKEWOOD HEALTH CENTER'S financial information is included in the consolidated audited financial statements of CommonSpirit Health, a related organization. CommonSpirit Health's FIN 48 (ASC 740) footnote for the year ended June 30, 2019, reads as follows: "CommonSpirit has established its status as an organization exempt from income taxes under the 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 judgement occurs. Income tax interest and penalties are recorded as income tax expense. For the years ended June 30, 2019 and 2018, 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 benefits as of June 30, 2019 and 2018. 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 true false true true 76 39510 39510 0.0024 1338 3702088 2975603 726485 0.0433 0 0.0 0 1414 3741598 2975603 765995 0.0456 4 89 16503 16503 0.0010 0 0.0 4 575529 345527 230002 0.0137 0 0.0 8 1031 16294 16294 0.0010 16 1120 608326 345527 262799 0.0156 16 2534 4349924 3321130 1028794 0.0613 0 0.0 1 958 958 0.0001 4 679 29956 6170 23786 0.0014 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 679 30914 6170 24744 0.0015 true 133904 0 4630675 4670437 -39762 X true true 1 1 LakeWood Health Center 600 Main Avenue South Baudette MN 56623 http://lakewoodhealthcenter.org/ 375394 X X X LakeWood Health Center 1 false false true X X X X X X X X X 18 true false false true X http://lakewoodhealthcenter.org/about-us/ X true 19 false true false true X 300.0 300.0 X X X X true true X X X true X http://lakewoodhealthcenter.org/financial-assistance/ X http://lakewoodhealthcenter.org/financial-assistance/ X http://lakewoodhealthcenter.org/financial-assistance/ 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 are included in a prioritized description of the significant health needs of the community, along with a description of the process and criteria used in identifying certain health needs as significant and prioritizing those significant health needs, and are identified through the CHNA. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Lakewood Health Center. Community input was gathered in several ways. Project partners included the 337 community members that completed the Public Health Survey, and the 14 community members that attended our community focus group. Our Public Health Department, which provides Public Health for the county provided the survey results and attended the community focus group meeting. In 2017, a health survey was offered to 1,553 households in Lake of the Woods County through our Public Health Department. The survey was developed with assistance of the Minnesota Department of Health Center for Health Statistics and included questions from the Behavioral Risk Factor Surveillance System (BRFSS). A focus group was conducted with providers of services for our at-risk populations on April 4, 2019. Community representation included: Ministerial (First Lutheran and Catholic Churches) Emergency Medical Services (EMT) Lake of the Woods Social Services Lake of the Woods School (Superintendent, Social Worker, High School Principal) Lake of the Woods County Commissioner Parish Nurse/Community Member Baudette City Council Member Three Public Health Staff CHI LakeWood Health (Vice President of Operations and Foundation/Marketing Leader) The fourteen providers provided their thoughts on the greatest health needs of our vulnerable populations, resources and assets available to respond to the needs, and the perceived barriers that prevent those most in need from accessing services. The focus group participants began the prioritization process by performing an activity on their identified health needs. A listing of their priority concerns was given to the CHI LakeWood Health Senior Leader Team. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Lakewood Health Center. The following significant needs were identified in Lakewood Health Center's most recently conducted CHNA: # 1. Mental Health *CHI LakeWood Health will evaluate and implement Senior Life Solutions, an outpatient counseling program designed to meet the mental health needs of those who are 65 and older. The program will provide additional access to mental health care within our community. *CHI LakeWood Health will continue to collaborate with community partners to sponsor and promote mental health related trainings, workshops and initiatives. In addition, a member of our team will participate on the Suicide Awareness and Prevention Coalition. The hospital will also look to collaborate with our local public school (LOW School) to identify opportunities and next steps to improve mental health resources and awareness for our youth. *Maintain current Behavioral Health services at CHI LakeWood Health and explore options to increase patient access. Anticipated Impact: Increased access and awareness to reduce barriers to mental health care. #2. Transitions of Care/Persons With Complex Medical Issues *Continue relationship with Land of the Dancing Sky Area Agency on Aging by sustaining and growing our local Matter of Balance Program. *Strategize and implement alternative provider care models for our hospital and emergency department. *Continue to collaborate with Sanford Health and explore additional outreach specialty services. *Recruit and develop a list of potential health providers that could deliver homecare and/or hospice within our community. *Encourage and promote preventive medicine with screenings, annual check-ups and Medicare annual wellness visits. Anticipated Impact: Increased access and improve prevention and management of complex medical issues. #3. Low-Income/Poverty and Implications that Result *Play the role of indirect stakeholder through our area's economic development committee to identify priorities and action items that address our under employed population. *Continue to participate in Rainy River Community Colleges Cohort by providing onsite registered nurse program, and continue to apply for the Student Summer Healthcare Internship Program with the Minnesota Hospital Association. *Continue to support local programs that address implications resulting from poverty which includes, but is not limited to: Lake of the Woods School Backpack Program, Early Childhood Family Initiative Breakfast Program, Senior Meals and Dollars for Scholars. *Promote and encourage employees to explore professional development through the organization's lifelong learning benefits that include: education assistance, academic advising, online and call center support through Catholic Health Initiatives' (CHI) education partner, Edcor. *Continue to advocate for members in our community who are low-income and/or living in poverty by providing financial assistance to eligible patients who do not have the capacity to pay for medically necessary health care services, and who otherwise may not be able to receive these services. Anticipated Impact: Increased access to health care services and opportunities that provide assistance and promote growth. Significant Needs the Hospital Does Not Intend to Address Although CHI LakeWood Health recognized the importance of all needs identified by the community, LakeWood will not directly design strategies for the following issues due to limits on resources, expertise or duplication of effort. * Transportation - According to our 2017 Public Health Survey 2.4% of our survey respondents replied they did not receive needed health care due to transportation problems. * Poor life choices in adult - According to 2018 data from the University of Wisconsin 21% of Lake of the Woods County adults were excessive drinkers and 15% were smokers. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - LakeWood Health Center. The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. The patient must submit a completed Financial Assistance application. Patient Cooperation Standards - A patient must exhaust all other payment options, including private coverage, federal, state and local medical assistance programs, and other forms of assistance provided by third-parties prior to being approved. An applicant for Financial Assistance is responsible for applying to public programs for available coverage. He or she is also expected to pursue public or private health insurance payment options for care provided by a CHI Hospital Organization within a Hospital Facility. A patient's and, if applicable, any Guarantor's cooperation in applying for applicable programs and identifiable funding sources, including COBRA coverage (a federal law allowing for a time-limited extension of employee healthcare benefits), shall be required. If a Hospital Facility determines that COBRA coverage is potentially available, and that a patient is not a Medicare or Medicaid beneficiary, the patient or Guarantor shall provide the Hospital Facility with information necessary to determine the monthly COBRA premium for such patient, and shall cooperate with Hospital Facility staff to determine whether he or she qualifies for Hospital Facility COBRA premium assistance, which may be offered for a limited time to assist in securing insurance coverage. A Hospital Facility shall make affirmative efforts to help a patient or patient's Guarantor apply for public and private programs. 3 Lakewood Care Center 600 MAIN AVENUE SOUTH Baudette MN 56623 long term care facility Lakewood health center clinic 600 MAIN AVENUE SOUTH baudette MN 56623 rural health clinic Parkers Arc 600 MAIN AVENUE SOUTH Baudette MN 56623 residential assisted living Schedule H, Part VI, Line 4 Community information (Continued) COMMUNITY BENEFIT APPROACH CHI LakeWood Health is located in Baudette, Minnesota, a rural and isolated area of Northern Minnesota, serving Lake of the Woods County and surrounding counties of Roseau, Koochiching, Beltrami and on occasion residents of Canada. Today, the population of the incorporated cities is: Baudette, 1,059 and Williams 191. According to MDH, the 2017 Lake of the Woods County population is 3,744, a decrease of 179 people from 2015 data. Persons 65 years and over make up 23.9 % of Lake of the Woods County population in 2017. The median household income (2017) was $46,943 and 27.3% of people of all ages in Lake of the Woods County are below poverty level. The annual average unemployment rate for Lake of the Woods County is 4.7 - 4.8 during 2016/2017. There are 3.1 persons per square mile in Lake of the Woods County. The Mission Leader gathers and tracks the community benefit data. The VP of Finance provides the charity care and financial data for input. The Board of Directors and Senior Leadership Team along with Department Heads collaborate throughout the year on how to make a difference in the community we serve and are a part of. A cost to charge ratio is used determined by a worksheet provided by Common Spirit Health, Englewood, Colorado. In April of 2019 a community forum was held as part of the FYE 2019 Community Health Needs Assessment (CHNA). The top three priorities established are: 1) Mental Health; 2) Transitions of care/Persons with complex medical issues; 3) Low-income/poverty and implications that results. Community forums are held with the community every three years to review progress on community goals, assess current needs and update action plans. CHI LakeWood Health has been involved in community health collaboration and has a history of sponsoring community forums to look at area health issues, set priorities and plans for improvement. CHI LakeWood Health continues a deep commitment and involvement in the community health activities. CHI LakeWood Health strives to have community benefit a visible part of who we are and provides an annual report for our community in one of our newsletters published 2 times per year. Collaborating and cooperating with our community is "a way of life" and part of the culture for CHI LakeWood Health and its employees. We are thankful to have the resources of time, talent and other gifts to share for the good of our community. Schedule H, Part VI, Line 2 Needs assessment (continued) Community Building and Community Health Activities 1. The Brink Senior Center is a non-profit organization that provides nutritious meals at noon, five days a week through Lutheran Social Service Program. They also provide meals on wheels in our community. The center also serves as a forum for information related to health, senior issues and advocacy programs for seniors. The Social Worker participates on the Nutrition Board at the Brink Center and assist with fundraisers once or twice a year for the nutrition program. Other LakeWood staff members occasionally assist with special events or fundraisers. CHI LakeWood Health partnered with LakeWood Regional Healthcare Foundation to provide support to the Senior Meals Program in the form of a monetary donation. 2. LakeWood supports four blood drives in our community. CHI LakeWood Health encourages and supports employees to volunteer as blood donors and staff from environmental services offers assistance in set up and clean up for the blood drive event. LakeWood Health Center Lab and Radiology departments took over the responsibilities in 2012 and have had successful blood drives in our community, recently expanding this service from two events to four each year. Communications/marketing staff assist with promoting the blood drive. 3. The Baudette Community Foundation is a non-profit organization seeking to enhance and improve area recreational and social facilities. The Baudette Community Foundation board meets monthly and oversees the theater business and continues to work toward improving the recreational facilities. Baudette Community Foundation also serves as a fiscal agent for the Senior Fishing Program in Lake of the Woods County. CHI LakeWood Health provides one representative on the Baudette Community Foundation board. 4. Lake of the Woods County Prevention Coalition (Alcohol, Tobacco and other Drugs): CHI LakeWood Health Center (mission leader, public health staff) are members of the coalition and CHI LakeWood Health provides space for meetings and occasional refreshments. Lake of the Woods County works with the Department of Human Services/Alcohol and Drug Abuse Division by focusing in part - changing the environment the youth live in. Investing in prevention measures will not only enhance the community it will enhance the lives of our youth. The prevention measures are aimed at: 1) Reducing access and availability 2) Enforcement of existing laws and policies and 3) Changing public attitudes and social norms. 5. Suicide Awareness and Prevention Coalition: CHI LakeWood Health is participating in this coalition partnering with local county social services, school social work and administration, youth group leaders, clergy, public health. CHI LakeWood Health partnered with LakeWood Regional Healthcare Foundation to provide a monetary donation to support the groups' media and education campaign to increase awareness in regards to access to help and life lines. This group has partnered with the school and assisted with grant writing to provide educational guest speakers for students and the public on topics of bullying and self-esteem. 6. The SHIP process has engaged a team of interested community members representing the school, county, city, and CHI LakeWood Health. The group meets to discuss activities that have been shown to prevent chronic disease by increasing access to healthy foods, decreasing tobacco use, and increasing active living opportunities. They work on policy and system changes that can be adopted with our school, communities, places of work and healthcare facilities. Activities include the coordination and prep of community gardens (land, tilling and hauling of garden debris - donated by CHI LakeWood Health), assessment of student health policies at Lake of the Woods School and strengthening the availability of healthy foods at school. Community gardening has been a successful and sustainable project. CHI LakeWood Health provides the garden spaces and prep work each season. 7. Community Health Needs Assessment and Implementation Strategies The purpose of conducting a community health needs assessment is to describe the health of local people, identify use of local health care services, prioritize community needs and identify action needed to address the future delivery of health care in the defined area. A health needs assessment benefits the community by: 1) collecting timely input from the local community, providers and staff; 2) providing an analysis of secondary data related to health conditions, risks and outcomes; 3) compiling and organizing information to guide decision making, education, and marketing efforts, and to facilitate the development of a strategic plan; 4) engaging community members about the future of health care community by: delivery; and 5) allowing the charitable hospital to meet federal regulation requirements of the Affordable Care Act, with required not-for-profit hospital to complete a community health needs assessment at least every three years. LakeWood Health Center completed a health needs assessment and published the findings on the facility website. The Community Health Needs Assessment was completed during September 2018-June 2019. The most recent community forum was held in April 2019. Community Health Improvement Advocacy and Support Services 1. Minnesota Health Care Programs outreach efforts enhanced through Minnesota Community Application Agent (MNCAA) program. Level I organizations are referred to as a Minnesota Community Application Agent (MNCAA). MNCAA contracts with DHS to serve as an application site for those needing assistance with the Minnesota Health Care Programs Application (HCAPP). Employees from LakeWood participated in this training. Level I sites are contracted to: a) Identify the potential health care enrollees b) Assist potentially eligible enrollees with the HCAPP c) Assist applicants with obtaining documentation needed to determine health care eligibility d) Offer use of fax and copy services e) Follow up as needed until an eligibility determination is reached Schedule H, Part I, Line 3c eligibility criteria for a patient to qualify for Financial Assistance 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 Costing Methodology used to calculate financial assistance The approach taken for the community benefit calculation was as follows: Medicaid community benefit was calculated based upon using the cost to charge ratio of 77.5% times the charges for Medicaid patients. This results in estimated Medicaid costs of $3,436,070. Additionally, the Minnesota Care Tax and Medicaid Surcharge Tax of $266,018 was also included as line item costs. This was then compared to projected reimbursement for Medicaid Services of $2,975,603. The total community benefit is estimated at $726,485. The remaining community benefit was taken by compiling the cost of traditional charity care $39,510; Community Health Improvement Services $16,503; subsidized health services $230,002; Financial and In-Kind Contributions $16,294; and Community Building Activities $24,744. The cost-to-charge ratio for the year ended 6/30/19 was computed using the following formula: Total gross charges for the organizations less revenue from subsidized health services divided by total operating expenses less subsidized health service expenses and less other community benefit expenses. Based on that formula the gross charges are $20,046,491 divided by expenses of $15,537,461 results in a 77.5% cost to charge ratio. Subsidized health services was calculated using Estimated Net Revenue as compared to direct costs and overhead allocated. Overhead allocation follows the Medicare Cost Report assignment of allocating overhead to cost centers. The Medicare Cost Report is not yet prepared at time of calculation of the Community Benefit for financial statement purposes. As a result, we utilize an internal calculation model to project this benefit in July. The community benefit from subsidized health services below was $230,002. Worksheet 2 was not used to derive the cost-to-charge ratio. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Costing methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 77.5%. 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 Bad Debt Expense Methodology LAKEWOOD HEALTH CENTER does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote LAKEWOOD HEALTH CENTER does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of CommonSpirit Health. The consolidated footnote reads as follows: CommonSpirit relies on the results of detailed reviews of historical write-offs and collections in estimating the collectability of accounts receivable. Updates to the hindsight analysis is performed at least quarterly using primarily a rolling eighteen-month collection history and write-off data. Subsequent changes to estimates of the transaction price are generally recorded as adjustments to net patient revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in a third-party payor's ability to pay are recorded as bad debt expense in purchased services and other in the accompanying consolidated statements of operations and change in net assets. Bad debt expense for 2019 was not significant. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs LAKEWOOD HEALTH CENTER is designated as a Critical Access Hospital (CAH). CAHs are rural community hospitals that are certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. CAHs are certified under a different set of Medicare Conditions of Participation (CoP). Shortfalls are created when a facility receives payments that are less than the costs of caring for program beneficiaries. 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: $4,630,675 Total Medicare costs: $4,670,437 Surplus or Shortfall $(39,762) LAKEWOOD HEALTH CENTER believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as "subsidized health services." Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial 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 V, Section B, Line 16a FAP website - LakeWood Health Center: Line 16a URL: http://lakewoodhealthcenter.org/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website - LakeWood Health Center: Line 16b URL: http://lakewoodhealthcenter.org/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - LakeWood Health Center: Line 16c URL: http://lakewoodhealthcenter.org/financial-assistance/; Schedule H, Part VI, Line 2 Needs assessment Community Outreach for the Poor LakeWood Health Center provides traditional charity care, an internal program for the medically needy that assists patients, residents or clients financially by forgiving or reducing their medical debt at CHI LakeWood Health. The billing/insurance office or the social worker identifies those individuals or families without insurance coverage or those that are underinsured and provide application assistance for this program. Total expense for this program is $39,510 with 76 persons served. Unpaid cost of Medicaid is $726,485 with 1,338 persons served for fiscal year ending June 30, 2019. Community Outreach for the Broader Community * LakeWood Health partnered with the Lake of the Woods School to screen all fall, winter and spring sports athletes. The program also extended to the community's youth hockey program. The screening involves a 10-minute baseline test on each athlete looking for any physical or cognitive signs of previous concussion. The athlete's normal physical and cognitive abilities are documented, shared with the coach and kept with the student's medical record. Minnesota State High School League adopted new rules (2011) about what steps should be taken before an athlete with a head injury can return to play or practice and this program is assisting the athletic programs to maintain compliance and safety for young athletes. * CHI LakeWood Health partnered with LakeWood Regional Healthcare Foundation to establish an Emergency Medical Technician (EMT) assistance program to grow the number of volunteer EMT's for the community. The program provided funding for EMT course books and tuition assistance to individuals enrolled in the course. Emergency Medical Technicians are a vital in LakeWood's rural community, and vital to its ambulance department. * CHI LakeWood Health in conjunction with the clinic developed the Diabetes Resource Center to bring awareness of the chronic disease to the public and provide education for people with diabetes to help them understand and manage their disease. The program is offered in class sessions and encourages self-management and long-term health maintenance. CHI LakeWood Health provides a dietitian consult as needed for the program. The Diabetes Resource Center Staff is available to meet with individuals to assist them with managing their diabetes. The Diabetic Resource Center is staffed out of the Cardio-Pulmonary Rehab Department. The Diabetes Resource Center offered Prevent T2 Program. A CDC approved year-long program with weekly meetings for the first 6-minths, then once or twice a month for the second 6 months. This is a proven lifestyle change program to help participants prevent or delay type 2 diabetes. Participants learn to manage weight, become more physically active and reduce stress. Along the way they also receive support from others who are on the same journey. A community support group was established for those affected by diabetes and this group is meeting at CHI LakeWood Health three to four times a year, sponsored by CHI LakeWood Health. * CHI LakeWood Health held the annual health fair in July 2018 at the Lake of the Woods County Fair. A three day event was held (Thursday, Friday, Saturday) providing glucose, cholesterol and blood pressure screening. Nurses provided health education during the time of screening. * CHI LakeWood Health has continued to provide child birth education classes locally. Classes are offered 3 - 4 times per year to help build confidence for the expectant mother, to discuss fears about labor and delivery with the instructor and other couples, learn about pain relief options, including massage, relaxation, breathing techniques, medications and how a partner can provide support. Information is available on coping skills, physiology of labor and birth, emotional aspects, healthy lifestyle, childbirth options and early postpartum period. Collaborative Efforts to Improve Community Health CHI LakeWood Health donates cash to programs, projects and special community events. These organizations/community groups are also not for profit where collaboration for safe environment, safe recreational opportunities, growth and development of youth, and other activities/programs that assist in building the community and the health of the community. Through partnerships with LakeWood Regional Healthcare Foundation, CHI LakeWood Health is able to increase its monetary donations to local programs and projects that support its mission. 1. CHI LakeWood Health encourages employees to be involved in community activities and to volunteer where able. CHI LakeWood Health allows use of printers, copy machines, paper, and donation of supplies. Some of the projects include the local food shelf, Take a Kid Fishing Program, Senior Fishing Program, Youth Hockey, Baudette Area Ministerium, Humane Society, Post Prom Party, Job Shadowing Experience, School Career Day, School Booster Club, robotics, coaching sports teams and other school projects. CHI LakeWood Health participates in fundraising for international mission project (along with CHI Fargo Division) the Indigenous People's Hospital in the Philippines with internal fundraising events for employee participation. The funds are used to ship medical supplies and equipment to the Philippines. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance 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 The mission of CHI LakeWood Health and CommonSpirit Health is to make the healing presence of God known in our world be improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. CHI LakeWood Health in Baudette, Minnesota, is a Catholic, not-for-profit care organization, and sponsored by CommonSpirit Health, the largest Catholic, not-for-profit health care systems in America. CHI LakeWood Health is dedicated to the health and well-being of the community and to providing quality, holistic health care services and facilities for the residents of Baudette, Lake of the Woods County and surrounding communities of the Lake of the Woods Region. CHI LakeWood Health is located in a rural and isolated area of Northern Minnesota serving Lake of the Woods County and surrounding counties of Roseau, Koochiching, Beltrami and on occasion residents of Canada. CHI LakeWood Health is federally designated, 15-bed Critical Access Hospital. CHI LakeWood Health offers a continuum of care including long term care, assisted residential community (board and lodging with services), hospital care, public health, rural visiting nurse program, and a rural health clinic. LakeWood continues to have outreach services provided by an orthopedic surgeon, an orthopedic Physician's Assistant, a podiatrist, general surgeon, and an OBGYN all from Sanford Bemidji. CHI LakeWood continues to utilize locum providers for the emergency room and some clinic coverage. CHI LakeWood Health closed OB services in September 2009. CHI LakeWood Health serves all persons in the community on a nondiscriminatory basis and participates in Medicaid, Medicare programs and has an active charity care program. The emergency room is available 24 hours a day, 365 days per year, and is open to all persons regardless of ability to pay. History CHI LakeWood Health opened in March 1950 as Baudette Community Hospital. It was owned by the community and operated by the Sisters of St. Joseph out of Crookston, Minnesota. The hospital was leased to the Sisters of St. Joseph in 1954 and in 1957 the Sisters purchased the hospital and changed the name to "Trinity Hospital". In 1982, the Sisters entered into a management contract with United Health Resources of Grand Forks, North Dakota until they sold the hospital to Franciscan Sisters Health Care, Incorporated in 1985. During this time, Trinity Hospital took over management of the Pioneer Nursing Home, the long-term term care facility located one mile east of the hospital. In 1986, the hospital acquired the county-owned public health service. Trinity Hospital bought the Pioneer Nursing Home in 1990 and the name was changed to "LakeWood Health Center" to reflect the coming together of acute care, long-term care (LakeWood Care Center), and home health/public health (LakeWood Nursing Service) under one umbrella. Dr. A.A. Brink opened his medical practice in 1932 in the First National Bank Building. With the construction of a new hospital in progress, Dr. Brink built a new clinic on Main Avenue, now known as the Brink Senior Center, a community center for events and meals. A new Baudette Medical Clinic was built next to the hospital in 1979. The clinic building was acquired by LakeWood Health in 1994 but the clinic was leased as a satellite clinic of Grand Forks Clinic. In July 2006, the clinic became an outpatient department of LakeWood Health Center. Catholic Health Corporation of Omaha, Nebraska took over sponsorship of LakeWood Health Center in 1993. Two years later they merged with two other large Catholic health care systems to form Catholic Health Initiatives (CHI) based in Englewood, Colorado. Catholic Health Initiatives then merged with Dignity Health to form CommonSpirit Health with headquarters in Chicago, Illinois. LakeWood Health Center completed a building and renovation project in 2000 that resulted in all health care services being available on one campus. Lake of the Woods County transferred ownership of the local EMS Ambulance Service to LakeWood Health and is a department of the health center. LakeWood Nursing Service transferred to Catholic Health Initiatives Health Connect At Home and the operation moved off site in June 2010; the financial operations were separated in December of 2010. Catholic Health Initiatives At Home discontinued home health services in Lake of the Woods County and public health, school nursing, Parker's Arc operations transferred back to LakeWood Health Center by July of 2012. CHI LakeWood Health is the only hospital, clinic and licensed long term care provider in Lake of the Woods County. CHI LakeWood Health is committed to the promotion of healthier communities. CHI LakeWood Health is proud of its Catholic heritage and its ability to provide direct and indirect support to the communities it serves. CHI LakeWood Health is included in the Official Catholic Directory as a tax-exempt hospital. Schedule H, Part VI, Line 5 Promotion of community health The organization's hospital facility(ies) promote health for the benefit of the community. Medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The organization's hospital facility(ies) have an open medical staff. Its board of trustees is composed of prominent citizens in the community. Excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. The facility(ies) treat persons paying their bills with the aid of public programs like Medicare and Medicaid. All patients presenting at the hospital for emergency and other medically necessary care are treated regardless of their ability to pay for such treatment. Schedule H, Part VI, Line 6 Affiliated health care system 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. Schedule H, Part VI, Line 7 State filing of community benefit report MN true LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 Main Ave So Baudette MN 56623 411893795 501(c)(3) 168819 31362 FMV In-Kind Donations Program Support 1 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. THE ORGANIZATION PROVIDES FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE CHI FINANCIAL ASSISTANCE POLICY TO INDIVIDUALS WHO ARE ELIGIBLE FOR FREE OR DISCOUNTED CARE. X X X false true false false false false false false false BENJAMIN KOPPELMAN Former PRESIDENT 0 259982 0 35259 0 26389 0 3506 0 25562 0 350698 0 0 JEFFRY STAMPOHAR PRESIDENT 133596 1154 12500 12500 22968 0 1806 0 36886 0 207756 13654 0 0 JEFFREY DROP Board Member/SVP-Operations-CEO 0 716564 0 535360 0 136936 0 22411 0 18016 0 1429287 0 0 DR JUSTIN QUO PHYSICIAN/BOARD MEMBER/CHIEF OF STAFF 290057 0 10000 0 682 0 15994 0 23978 0 340711 0 0 0 JAY P ROSS CFO / Treasurer 0 135737 0 11524 0 2937 0 9590 0 26240 0 186028 0 0 MOHAN BANGALORE-PUTTAIAH Physician 266698 0 10000 0 445 0 15376 0 25969 0 318488 0 0 0 Schedule J, Part I, Line 4a Post-Termination Payments During the calendar year 2018, post-termination payments were addressed in executive employment agreements for Catholic Health Initiatives and related organizations' employees at the level of Vice President and above, including the MBO CEOs. 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. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan During the 2018 calendar year, Catholic Health Initiatives ("CHI"), a related organization, maintained a supplemental non-qualified deferred compensation plan for MBO CEOs/Presidents and other CHI employees at the level of Senior Vice President and above. Due to the "super" vesting rules under the CHI deferred compensation plan, participants who had met certain requirements such as involuntary termination without cause, age, age and years of service, or more than 5 years of plan participation were eligible to receive their 2018 contributions in cash during the calendar year. These cash payouts are included in the participant's reportable compensation in column (iii) Other Reportable Compensation on Schedule J Part II. During 2018, the following contributions and any associated investment income, gain or loss that would have been made by CHI to the deferred compensation plan were paid in cash: Jeffrey Drop - $110,067 Benjamin A. Koppelman - $11,392 Form 990, Part VI, Line 14 WRITTEN DOCUMENT RETENTION & DESTRUCTION POLICY THE ORGANIZATION'S DOCUMENT RETENTION AND DESTRUCTION POLICY HAS NOT YET BEEN FORMALLY ADOPTED BY THE BOARD. HOWEVER, THE ORGANIZATION HAS A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY ADOPTED BY THE BOARD-APPOINTED FINANCE COMMITTEE. Form 990, Part VI, Line 12c CONFLICT OF INTEREST POLICY c) Board evaluation of non-transactional conflicts - I. The board carefully reviews and scrutinizes any non-transactional conflict of interest (e.g., disclosure of nonpublic information, competition with CHI or a CHI entity, failure to disclose a corporate opportunity, excessive gifts or entertainment, etc.). II. In such circumstances, by a majority vote of the disinterested trustees, the board takes whatever action is deemed appropriate with respect to the trustee or corporate officer under the circumstances (including possible disciplinary or corrective action) to best protect the interests of CHI or the CHI entity. The board is encouraged to consult with the general counsel of CHI or his or her designee when considering disciplinary or corrective action. III. The conflicted trustee or corporate officer is not permitted to use his or her personal influence with respect to the conflict matter. However, if requested, such trustee or corporate officer is not prevented from briefly stating his or her position in the matter, nor from answering pertinent questions from trustees, as his or her knowledge may be relevant. The trustee or corporate officer is excused from the meeting during discussion and vote on the conflict of interest. d) Record of proceedings - with respect to board member and officer conflicts of interest, minutes of the board are expected to reflect the identity of the individual making the disclosure, the nature of the disclosure, discussion regarding any proposed transaction, the decision made by the board, and that the interested trustee or corporate officer was excused during the discussion, and that the interested trustee abstained from voting. D. Conflicts reporting: All conflicts of interest are reported by CHI as required by law, regulations, and policy. Form 990, Part VI, Line 1a Delegate broad authority to a committee Pursuant to Section 8.6 of the Bylaws of LAKEWOOD HEALTH CENTER, the Executive Committee is composed of the board chair, the board vice chair, the President and CEO, each of whom shall serve as an ex officio voting member of the Executive Committee, and two voting members appointed by the Board of Directors. Each individual appointed to the Executive Committee shall serve for a term of one year or until his or her successor is duly appointed by the Board of Directors. The Executive Committee shall consist of only directors of the Corporation. Pursuant to Section 8.1 of the Corporation's bylaws, committees, such as the executive committee, that are granted the authority to act on behalf of the board of directors may include only directors of the corporation. Further, pursuant to Section 8.6 of the Corporation's bylaws, the executive committee has and may exercise such powers as may be delegated to it by the board of directors. The Executive Committee also possesses the power to transact routine business of the corporation in the interim period between regularly scheduled meetings of the board of directors. Form 990, Part VI, Line 6 Classes of members or stockholders According to the bylaws of LAKEWOOD HEALTH CENTER 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 5.4.2 of the organization's bylaws, the Corporate Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CommonSpirit Health Board directly or through powers delegated to the CommonSpirit Health Chief Executive Officer: *Substantial change in the mission or philosophy of the LAKEWOOD HEALTH CENTER *Amendment of the corporate documents of the LAKEWOOD HEALTH CENTER *Approve members of the LAKEWOOD HEALTH CENTER board *Removal of a member of the governing body of the LAKEWOOD HEALTH CENTER *Approval of issuance of debt by LAKEWOOD HEALTH CENTER *Approval of participation of LAKEWOOD HEALTH CENTER in a joint venture *Approval of formation of a new corporation by LAKEWOOD HEALTH CENTER *Approval of a merger involving the LAKEWOOD HEALTH CENTER *Approval of the sale of all or substantially all of the assets of the LAKEWOOD HEALTH CENTER *To require the transfer of assets by the LAKEWOOD HEALTH CENTER to CommonSpirit Health to accomplish CommonSpirit Health's goals and objectives, and to satisfy CommonSpirit Health debts. *Adoption of long range and strategic plans for LAKEWOOD HEALTH CENTER Pursuant to Section 5.5.2 of the organization's bylaws, CommonSpirit Health may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. (CHCF Reserved Rights) Except as otherwise provided in the Corporation's Articles of Incorporation or the laws of the State of organization, Catholic Health Care Federation ("CHCF") shall have such rights as are reserved to the Corporate Member, acting in its capacity as the membership body of CHCF, under the Governance Matrix. Form 990, Part VI, Line 11b Review of form 990 by governing body ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. THE CFO WILL PROVIDE A COPY OF THE RETURN TO THE BOARD EITHER AT A BOARD MEETING OR BY EMAILING A COPY OF THE RETURN TO EACH BOARD MEMBER. 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, 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. Through February 7, 2019, conflicts were administered solely through Catholic Health Initiatives' ("CHI") Governance Policy No. 1 (described below). On February 8, 2019, in connection with the alignment of the Catholic Health Ministries of CHI and Dignity Health, the CommonSpirit Health Board of Stewardship Trustees approved CommonSpirit Health Corporate Responsibility Policy No. G-001, a CommonSpirit Health conflicts of interest policy. This policy stipulates that, at minimum, the pre-closing CHI COI policies and pre-closing Dignity Health COI policies identify the individuals that are covered under the new policy. In addition, subject to certain exceptions, pre-closing CHI COI policies shall continue to apply to the CHI entities and the individuals who were subject to the Pre-Closing CHI COI policies; and the Pre-Closing Dignity Health COI policies shall continue to apply to the Dignity Health entities and the individuals who were subject to the Pre-Closing Dignity Health COI policies. Until CommonSpirit Health adopts a single process for identifying and managing conflicts of interest for all system entities, the following individuals shall be subject to the Pre-Closing CHI COI policies from and after the effective date of Corporate Responsibility Policy No. G-001: 1. Members of the CommonSpirit Health Board of Stewardship Trustees and members of the committees of the Board of Stewardship Trustees; 2. Corporate officers of CommonSpirit Health; 3. Members of the Board of Directors of Dignity Health and members of the committees of the Board of Directors of Dignity Health. CHI Governance Policy No. 1: The policy applies to the following persons: members of the CHI board of stewardship trustees and its committees; members of any CHI direct affiliate or subsidiary (each a CHI entity) board and their committees; employees of CHI entities, and all CHI researchers (as defined in the policy). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure review process. A. Disclosure obligations: 1. Ongoing: Each person is required to promptly and fully disclose to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The person must disclose the actual or potential conflict as soon as she/he becomes aware of it. In any situation in which the person is in doubt it is expected that full disclosure be made to permit an impartial and objective determination as to the existence of a conflict. 2. Periodic written: In addition to the ongoing disclosure obligation, periodic written conflict of interest disclosure forms must be completed as follows: a) Initially: 1) Upon hiring (employees), 2) Appointment (board / committee members), 3) Upon consideration of affiliation with research sponsor (researchers). b) Annually: 1) Board / committee members, 2) Employees at the level vice president or above, 3) Researchers, 4) Supply chain employees at the level of vice president and above and those employees involved in contracting regardless of employment level, 5) Other employees as determined by CommonSpirit Health leadership. 3. Failure to disclose - an individual who fails to disclose a perceived, potential, or actual conflict of interest, or all material facts surrounding an actual or potential conflict or fails to abide by the final decision regarding the conflict may be subject to disciplinary or corrective actions such as termination of employment, removal from a board or committee, loss or restriction of clinical privileges, or restrictions on research activities in accordance with applicable laws, regulations, rules, contracts, and bylaws. B. Conflicts review: 1. No disclosed conflicts: In the absence of perceived, potential or actual conflicts of interest, no follow-up conflicts review is required or performed. 2. Disclosure of perceived, potential or actual conflicts: a) Are initially reviewed by national or regional legal or corporate responsibility team members (depending upon the role of the individual disclosing the actual or potential conflict) to determine whether an actual or potential for a conflict may exist. b) If it is determined that a potential or actual conflict may exist, I. In the case of board or committee members or officers, issues are elevated to the executive committee of the board or board chair. II. In the case of other persons, conflicts issues are elevated to the conflicts of interest review committee ("C-CIRC"). C. Conflicts determination and management: 1. Matters elevated to C-CIRC: a) The C-CIRC determines whether a disclosed or otherwise identified interest is a conflict of interest. If the C-CIRC determines that a COI exists, and adequate controls are not in place to mitigate the conflict, the C-CIRC facilitates development of a COI management plan designed to mitigate the conflict. Designated entity staff are responsible for monitoring the COI management plan and for documenting monitoring activities. 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. b) Appeal - if a person does not agree with a determination made by the C-CIRC, its interpretation of the COI policy, still seeks an exemption or exception, or seeks further clarification of the C-CIRC 's decision, the individual may appeal the decision through his or her manager for reconsideration by the C-CIRC, and the C-CIRC will review and issue a final determination based upon any new or additional information presented. 2. Matters elevated to the executive committee or board chair: a) Determination of existence of conflict - the board chair or his or her designee performs any further investigation of any conflict of interest disclosures as he or she may deem appropriate. If the conflict involves the board chair, the vice chair assumes the chair's role outlined in the COI policy. Based on review and evaluation of the relevant facts and circumstances, the board chair makes an initial determination as to whether a conflict of interest exists and whether, pursuant to the COI policy, review and approval or other action by the board is required. A written record of the board chair's determination, including relevant facts and circumstances, is made. The board chair then makes an appropriate report to the executive committee of the board concerning the COI review, evaluation and determination. If a difference of opinion exists between the board chair and another trustee as to whether the facts and circumstances of a given situation constitute a conflict of interest or whether board review and approval or other action is required under the COI policy, the matter is submitted to the board's executive committee, which makes a final determination as to the matter presented. That determination, including relevant facts and circumstances, is reflected in the executive committee minutes and is reported to the board. b) Board evaluation of transactions involving an officer / board member conflict of interest - I. The board carefully scrutinizes and must in good faith approve or disapprove any transaction in which CHI or a CHI entity is a party and in which the trustee or a corporate officer either: 1. Has a material financial interest; or 2. Is a trustee or corporate officer of the other party (other than a CHI affiliated organization). II. The board must approve the transaction by a majority of the trustees on the board (not counting any interested trustee). In reviewing such transactions between CHI or CHI entities and vendors or other contractors who are, or are affiliated with, trustees or corporate officers, the board acts no more or less favorably than it would in reviewing transactions with unrelated third parties. The transaction is not approved unless the board determines that the transaction is fair to CHI or the CHI entity. III. A conflicted trustee or corporate officer is not permitted to use his or her personal influence with respect to the approval or disapproval of the conflicted transaction. However, if requested, such trustee or corporate officer is not prevented from briefly stating his or her position in the matter, nor from answering pertinent questions from trustees, as his or her knowledge may be relevant. The trustee or corporate officer is excused from the meeting during discussion and vote on the conflict of interest. (CONTINUED ON SCHEDULE O) Form 990, Part VI, Line 15a Process to establish compensation of top management official Catholic Health Initiatives (CHI) Lakewood Health used Gallagher as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executive was reviewed annually. Gallagher reviewed both cash and total compensation for overall reasonableness, for adherence to Catholic Health Initiatives' compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review was delivered by Gallagher to the CHI Lakewood Health committee of the Board of Stewardship Trustees at their November 2019 meeting. Form 990, Part VI, Line 15b Process to establish compensation of other employees ALL EXECUTIVE COMPENSATION PAID TO OFFICERS AND KEY EMPLOYEES WAS SET BY A COMPENSATION COMMITTEE UTILIZING AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THE BOARD OF DIRECTORS OVERSEES THE COMPENSATION SETTING PROCESS AND ENSURES REASONABLENESS AND COMPLIANCE WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY. 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 VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 50305, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 50305; Form 990, Part IX, Line 11g Other Fees Contract Labor - Total Expense: 1243789, Program Service Expense: 1181600, Management and General Expenses: 62189, Fundraising Expenses: 0; Purchased Services - Total Expense: 891747, Program Service Expense: 847160, Management and General Expenses: 44587, Fundraising Expenses: 0; Contract Services - Total Expense: 591514, Program Service Expense: 532363, Management and General Expenses: 59151, Fundraising Expenses: 0; Other Fees for Services - Total Expense: 352136, Program Service Expense: 334529, Management and General Expenses: 17607, Fundraising Expenses: 0; Consulting - Total Expense: 22706, Program Service Expense: 21571, Management and General Expenses: 1135, Fundraising Expenses: 0; 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 SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA 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 Foundation 345 S Halcyon Rd Arroyo Grande CA 93420 203256066 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Bakersfield Memorial Hospital 420 34TH Street Bakersfield CA 93301 951802779 HOSPITAL CA 501(c)(3) 3 DCC false Barrow Neurological Foundation 350 West Thomas Road Phoenix AZ 85013 860174371 FUNDRAISING 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) Type I SLCHS false BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON TX 77030 760458535 PHYSICIANS TX 501(c)(3) 3 SLHS false BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232187242 HEALTHCARE PA 501(c)(3) Type I CSH false BRAZOSPORT HEALTH FOUNDATION INC 1 West Way Ct LAKE JACKSON TX 77566 760080110 FUNDRAISING FOUNDATION TX 501(c)(3) Type I BRHS false BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(c)(3) 3 BRHS false BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HOSPITAL TX 501(c)(3) 3 SJSC false BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 HEALTHCARE TX 501(c)(3) 10 SJSC false California Hospital Medical Center Foundation 1401 South Grand Avenue Los Angeles CA 90015 954000909 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DCC false CARRINGTON HEALTH CENTER 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 FOUNDATION 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS CO 80920 840902211 FUNDRAISING FOUNDATION CO 501(c)(3) 7 CHIC false CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS CO 80920 270930004 HEALTHCARE CO 501(c)(3) Type I CSH false CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 PHYSICIANS CO 501(c)(3) Type I CHINS false CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 SURGERY CENTER OR 501(c)(3) 10 MMC false CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY 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 FUNDRAISING FOUNDATION MN 501(c)(3) 10 CSH false CHI HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING FOUNDATION NE 501(c)(3) 7 ACH false CHI INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(c)(3) Type I CSH false CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(c)(3) Type I CSH false CHI LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE OH 501(c)(3) Type II 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 DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(c)(3) 10 CHI NS false CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(c)(3) Type I CSH false CHI NEBRASKA 12809 West Dodge Road Omaha NE 68510 363233121 HEALTHCARE NE 501(c)(3) Type I CSH false CHI ST JOSEPH CHILDREN'S HEALTH 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232342997 HEALTHCARE PA 501(c)(3) Type I CSH false CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(c)(3) Type I 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) Type II SVIMC false CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125131 PHYSICIANS AR 501(c)(3) 3 CHISVHS false COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(c)(3) Type I NA false Community Hospital of San Bernardino 1805 Medical Center Drive San Bernardino CA 92411 951643373 HOSPITAL CA 501(c)(3) 3 DCC false COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 237419853 HOLDING CO OH 501(c)(4) GSH false COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY IA 51555 421294399 FUNDRAISING FOUNDATION IA 501(c)(3) Type I AH-CMHMV false CONTINUING CARE HOSPITAL One Saint Joseph Drive LEXINGTON KY 40504 611400619 HOSPITAL KY 501(c)(3) 3 SJHS false Dignity Community Care 185 Berry Street Suite 300 San Francisco CA 94107 815009488 HOSPITAL CO 501(c)(3) 3 NA 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 Drive Redding CA 96003 237115371 Senior Center Services CA 501(c)(3) 7 DH false Dignity Health Foundation 185 Berry Street San Francisco CA 94107 462037641 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Dignity Health Foundation - Inland Empire 2101 N Waterman Avenue San Bernardino CA 92404 237440086 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Dignity Health Foundation East Valley 475 South Dobson Road Chandler AZ 85224 742418514 FUNDRAISING FOUNDATION AZ 501(c)(3) Type I DH false Dignity Health HPL Self-Insurance Trust 185 Berry Street San Francisco CA 94107 943006034 Self Insurance CA 501(c)(3) Type I DH false Dignity Health Insurance Nevada Ltd 185 Berry Street San Francisco NV 94107 813800752 Self Insurance NV 501(c)(3) Type I DH false Dignity Health Medical Foundation 3400 Data Drive Rancho Cordova CA 95670 680220314 MULTI-SPECIALTY OUTPATIENT MEDICAL CLINIC CA 501(c)(3) Type I DCC false Dignity Health Workers Comp Self-Insurance Trust 185 Berry Street San Francisco CA 94107 946612446 Self Insurance CA 501(c)(3) Type I DH false Dominican Health Services 1555 Soquel Drive Santa Cruz CA 95065 770056778 Community Health System CA 501(c)(3) Type I DH false Dominican Hospital Foundation 1555 Soquel Drive Santa Cruz CA 95065 942450442 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Dominican Oaks Corporation 1555 Soquel Drive Santa Cruz CA 95065 770127719 Operation and management of housing complex to elderly persons CA 501(c)(3) 10 DHS false East Texas Clinical Services 2801 VIA FORTUNA SUITE 500 AUSTIN TX 78746 454736213 HEALTHCARE TX 501(c)(3) Type I SLHS false ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 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 FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 562351341 FUNDRAISING FOUNDATION KY 501(c)(3) Type I FH false FRANCISCAN CARE CENTER 4111 N HOLLAND-SYLVANIA RD TOLEDO OH 43623 341931806 HEALTHCARE OH 501(c)(3) 10 FLC false FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA WA 98405 911145592 FUNDRAISING FOUNDATION 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 FRANCISCAN HEALTH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BROADWAY TACOMA WA 98402 431882377 PHYSICIANS MO 501(c)(3) 10 CSH false FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA WA 98402 911939739 HEALTHCARE WA 501(c)(3) 10 FHS false FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(c)(3) 10 CSH false French Hospital Medical Center Foundation 1911 Johnson Avenue San Luis Obispo CA 93401 203256125 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DCC false GARRISON MEMORIAL HOSPITAL 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 450227752 HOSPITAL ND 501(c)(3) 3 SAMC false Glendale Memorial Health Foundation 1420 South Central Avenue Glendale CA 91204 953625651 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DCC false GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 201536108 MINISTRIES CO 501(c)(3) Type I CSH false GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311778403 EDUCATION OH 501(c)(3) 2 GSH false GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311206047 FUNDRAISING FOUNDATION OH 501(c)(3) Type I GSH false GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY NE 68847 470659443 FUNDRAISING FOUNDATION NE 501(c)(3) 7 GSH false HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON WA 98310 910565546 HOSPITAL WA 501(c)(3) 3 FHS false HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVE BREMERTON WA 98310 911197626 FUNDRAISING FOUNDATION WA 501(c)(3) 7 HMC false HEALTH FOUNDATION OF KENTUCKYONE INC 1451 HARRODSBURG RD STE D-308 LEXINGTON KY 40504 832170324 FUNDRAISING FOUNDATION KY 501(c)(3) Type II KOH false HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 760761782 FUNDRAISING FOUNDATION MN 501(c)(3) Type I SFMC false HIGHLINE MEDICAL CENTER 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 HOSPITAL AND 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 MEDICAL GROUP 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) Type II CSH false LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVE S BAUDETTE MN 56623 411893795 FUNDRAISING FOUNDATION ND 501(c)(3) 7 LHC true LINUS OAKES INC 2700 STEWART PKWY ROSEBURG OR 97471 930821381 SENIOR LIVING OR 501(c)(3) 10 MMC 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) Type I MHSET false MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742761145 HOSPITAL TX 501(c)(3) 3 SJSC false MADONNA MANOR INC 2344 AMSTERDAM ROAD VILLA HILLS KY 51017 610654635 LIVING ASSIST KY 501(c)(3) 10 FLC false Marian Regional Medical Center Foundation 1400 E Church Street Santa Maria CA 93454 953818027 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Mark Twain Medical Center 768 Mountain Ranch Road San Andreas CA 95249 680127677 HOSPITAL CA 501(c)(3) 3 NA false MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA TN 37404 621839548 FUNDRAISING FOUNDATION 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 FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA TN 37411 030417049 HEALTHCARE TN 501(c)(3) 10 MHCS false MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN TX 75902 750755367 HOSPITAL TX 501(c)(3) 3 SLHS false MEMORIAL MEDICAL CENTER - LIVINGSTON PO BOX 1447 LUFKIN TX 75902 760436439 HOSPITAL TX 501(c)(3) 3 MHSET false MEMORIAL MEDICAL CENTER - 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) Type I 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) Type I 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 Foundation Bakersfield PO Box 119 Bakersfield CA 93302 770201321 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES IA 50314 237358794 FUNDRAISING FOUNDATION IA 501(c)(3) 7 CHI-IA CORP false MERCY FOUNDATION INC 2700 STEWART PKWY ROSEBURG OR 97471 936088946 FUNDRAISING FOUNDATION OR 501(c)(3) 7 MMC false MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 421461064 FUNDRAISING FOUNDATION IA 501(c)(3) Type I AHMH-Corning false MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450435338 FUNDRAISING FOUNDATION ND 501(c)(3) Type I MHVC false MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS IA 51503 421178204 FUNDRAISING FOUNDATION IA 501(c)(3) Type I 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 FOUNDATION 1031 7TH ST NE DEVILS LAKE ND 58301 352367360 FUNDRAISING FOUNDATION 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 Citizen's Housing/Retirement Communities CA 501(c)(3) 10 DCC false MERCY MEDICAL CENTER 1301 15TH AVE WEST WILLISTON ND 58801 450231183 HOSPITAL ND 501(c)(3) 3 CSH false MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 420680308 HOSPITAL IA 501(c)(3) 3 CHI-IA CORP false MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER 204 N 4th Ave E Newton IA 50314 421470935 HOSPITAL IA 501(c)(3) 3 CHI-IA CORP false Mercy Medical Center Merced Foundation 301 E 13th Street Merced CA 95340 770035928 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false MERCY MEDICAL CENTER INC 2700 STEWART PKWY ROSEBURG OR 97471 930386868 HOSPITAL OR 501(c)(3) 3 CSH false MERCY MEDICAL FOUNDATION 1301 15TH AVE WEST WILLISTON ND 58801 450381803 FUNDRAISING FOUNDATION ND 501(c)(3) Type I 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 Avenue Bismarck ND 58501 911845296 MANAGEMENT ND 501(c)(3) 7 NCHA false Northridge Hospital Foundation 18300 Roscoe Blvd Northridge CA 91328 237444901 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DCC false OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES ND 58474 450231675 HOSPITAL ND 501(c)(3) 3 CSH false OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH ST OAKES ND 58474 710966606 FUNDRAISING FOUNDATION ND 501(c)(3) Type I OCH false Pacific Central Coast Health Centers 1400 E Church Street Santa Maria CA 93454 770447575 Clinic CA 501(c)(3) 3 DH false PINEYWOODS MEDICAL DEVELOPMENT CORP PO BOX 1447 LUFKIN TX 75902 752493116 PROPERTY MGMT TX 501(c)(3) Type I MHSET false Port City Operating Company LLC 3400 Data Drive Rancho Cordova CA 95670 465322209 HOSPITAL CA 501(c)(3) 3 DH false PROVIDENCE CARE CENTER 2025 HAYES AVENUE SANDUSKY OH 44870 341658625 HEALTHCARE OH 501(c)(3) 10 FLC false PROVIDENCE CARE CENTERS 2025 HAYES AVENUE SANDUSKY OH 44870 341826099 HOLDING CO OH 501(c)(3) Type II FLC false PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY OH 44870 341896807 LIVING COMM OH 501(c)(3) 10 FLC false PUEBLO STEPUP 1925 E ORMAN AVE STE G52 PUEBLO CO 81004 841234295 COMMUNITY CO 501(c)(3) 7 CHIC false REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE 16251 Sylvester Road SW Burien WA 98166 911170040 HOSPITAL WA 501(c)(3) 3 FHS false SET OF COLORADO SPRINGS INC 9100 E Mineral Circle Centennial CO 80112 841183335 Senior Center Services CO 501(c)(3) 7 CHIC false SAINT CLARE'S COMMUNITY CARE INC 25 POCONO RD DENVILLE NJ 07834 222876836 HEALTHCARE NJ 501(c)(3) 10 SCHS false SAINT CLARE'S FOUNDATION INC 25 POCONO RD DENVILLE NJ 07834 222502997 FUNDRAISING FOUNDATION NJ 501(c)(3) 7 SCHS false SAINT CLARE'S HEALTH SERVICES INC 25 POCONO RD DENVILLE NJ 07834 223639733 MANAGEMENT NJ 501(c)(3) 10 CSH false SAINT CLARE'S HOSPITAL INC 25 POCONO RD DENVILLE NJ 07834 223319886 HEALTHCARE NJ 501(c)(3) 3 SCHS false SAINT ELIZABETH FOUNDATION 555 S 70TH ST LINCOLN NE 68510 470625523 FUNDRAISING FOUNDATION NE 501(c)(3) 7 SERMC false SAINT ELIZABETH HEALTH SERVICES 555 S 70TH ST LINCOLN NE 68510 363233120 HOSPITAL NE 501(c)(3) 3 SERMC false SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 S 70TH ST LINCOLN NE 68510 470379836 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false SAINT FRANCIS MEDICAL CENTER 2620 W FAIDLEY GRAND ISLAND NE 68803 470376601 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND NE 68802 470630267 FUNDRAISING FOUNDATION NE 501(c)(3) 7 SFMC false Saint Francis Memorial Hospital 900 Hyde Street San Francisco CA 94109 941156295 HOSPITAL CA 501(c)(3) 3 DCC false SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL ST BEREA KY 40403 260152877 FUNDRAISING FOUNDATION KY 501(c)(3) 7 SJHS false SAINT JOSEPH HEALTH SYSTEM INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611334601 HOSPITAL KY 501(c)(3) 3 KOH false SAINT JOSEPH HOSPITAL FOUNDATION INC 701 Bob Olink Dr 200 LEXINGTON KY 40504 611159649 FUNDRAISING FOUNDATION KY 501(c)(3) Type I SJHS false SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON KY 40741 260438748 FUNDRAISING FOUNDATION KY 501(c)(3) 7 SJHS false SAINT JOSEPH MOUNT STERLING FOUNDATION INC 225 FALCON DR MOUNT STERLING KY 40353 272884584 FUNDRAISING FOUNDATION KY 501(c)(3) 7 SJHS false SAINT JOSEPH'S HOSPITAL FOUNDATION 2500 Fairway Street DICKINSON ND 58601 363418207 FUNDRAISING FOUNDATION ND 501(c)(3) Type I SJHHC false San Gabriel Valley Medical Center Foundation 438 West Las Tunas Drive San Gabriel CA 91776 953430341 INACTIVE CA 501(c)(3) Type I DH false SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC 104 W 17TH ST SCHUYLER NE 68661 363630014 FUNDRAISING FOUNDATION NE 501(c)(3) Type I AHMHS false Sierra Nevada Memorial-Miners Hospital 155 Glasson Way Grass Valley CA 95945 941439787 HOSPITAL CA 501(c)(3) 3 DCC false SJRMC JOPLIN MISSOURI 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 440545809 HOSPITAL MO 501(c)(3) 3 CSH false St Francis Foundation of Santa Barbara 2323 De La Vina St Suite 104 Santa Barbara CA 93105 237137119 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Francis Hospital Support Corporation 601 E Micheltorena Street Santa Barbara CA 93103 770022302 INACTIVE CA 501(c)(3) Type I DH false St Johns Healthcare Foundation 1600 North Rose Avenue Oxnard CA 93030 202865781 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Josephs Foundation (Phoenix) 350 West Thomas Road Phoenix AZ 85013 942941245 FUNDRAISING FOUNDATION AZ 501(c)(3) Type I DH false St Josephs Foundation of San Joaquin 1800 N California Street Stockton CA 95204 510432777 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Mary Medical Center Foundation 1050 Linden Avenue Long Beach CA 90813 237153876 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Mary Professional Building Inc 1050 Linden Avenue Long Beach CA 90813 237373088 INACTIVE CA 501(c)(3) Type I DH false St Marys Medical Center Foundation 450 Stanyan Street San Francisco CA 94117 943336143 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Rose Dominican Health Foundation 3001 St Rose Parkway Henderson NV 89052 880349432 FUNDRAISING FOUNDATION NV 501(c)(3) Type I DH false ST ALEXIUS MEDICAL CENTER 900 EAST BROADWAY AVENUE BISMARCK ND 58501 450226711 HOSPITAL ND 501(c)(3) 3 CSH false ST ANTHONY HOSPITAL 2801 St Anthony Way PENDLETON OR 97801 930391614 HOSPITAL OR 501(c)(3) 3 CSH false ST ANTHONY HOSPITAL FOUNDATION 2801 St Anthony Way PENDLETON OR 97801 930992727 FUNDRAISING FOUNDATION OR 501(c)(3) Type I SAH false ST ANTHONY'S HOSPITAL ASSOCIATION FOUR HOSPITAL DR 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