2020-07-10T17:30:33-05:00 2019-06-30 470617373 CommonSpirit Health 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2018-07-01 450227311 Carrington Health Center CARR 7016523141 800 North 4th Street Carrington ND 58421 Kurt Sargent VP of Operational Finance 2020-07-10 true Mark Stocki P00642127 3032989100 2018 2021-01-29 14:40:06Z CHI St Alexius Health Carrington Mariann Doeling 800 North 4th Street Carrington ND 58421 15822464 false 0928 X https://www.chistalexiushealth.org/locations/carrington X 1916 ND 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. 15 8 130 204 1482 482 391294 734617 16845466 13324798 671141 374259 1325390 1336092 19233291 15769766 293857 27486 0 0 7312397 6371003 0 0 168611 8730920 8149724 16337174 14548213 2896117 1221553 24671622 25728450 1423109 1125156 23248513 24603294 SEE SCHEDULE O. false false 10675567 27486 13324798 SEE SCHEDULE H 10675567 true true false true false false false false true true true false false true true false true false false false false false false true false true true false false true false false false false false false false false false false false false false true false false false true 0 0 130 true true true false false false false false true false false false false false X 15 8 false false false false true true true true true false false true true true true true true false false false ND X Kurt Sargent 7016527178 800 North 4th Street Carrington ND 58421 JOHN GIESE Chair 1.0 8.0 X X 0 0 0 SR NANCY MILLER OSB Vice Chair 1.0 7.0 X X 0 0 0 Kevin Dahmen MD Secretary/Treasurer 1.0 44.0 X X 0 701598 46725 KURT SCHLEY President/Market CEO 5.0 40.0 X 0 562819 81226 TIMOTHY BOPP MD Director 1.0 7.0 X 0 0 0 MICHAEL L CASSIDY MD Director 1.0 44.0 X 0 466358 35118 JEFFREY DROP Director/CHI SVP Division Officer 1.0 50.0 X 0 1388860 40427 Shiraz Hyder Director 1.0 44.0 X 0 477733 51705 MICHAEL LEFOR Director 1.0 6.0 X 0 0 0 TESSA MARBURGER MD DIRECTOR 1.0 44.0 X 0 379282 26355 LESLIE B OLIVER Director (Partial Year) 1.0 7.0 X 0 0 0 Todd Preszler MD DIRECTOR 1.0 44.0 X 0 561980 34415 PATRICK SOGARD Director 1.0 5.0 X 0 0 0 JULIE TRAYNOR Director 1.0 5.0 X 0 0 0 SR THOMAS WELDER Director 1.0 7.0 X 0 0 0 JOHN MONGEON Director 1.0 5.0 X 0 0 0 MARIANN DOELING president / ceo 1.0 40.0 X 0 241454 23981 KURT SARGENT VP OPERATIONAL FINANCE 1.0 40.0 X 0 143682 25897 RICK GEIER PHYSICIAN 40.0 0 X 337113 0 30114 MARY HOFF PHYSICIAN ASSISTANT 40.0 0 X 158277 0 34662 JACQUELINE NELSON PHYSICIAN ASSISTANT 40.0 0 X 218720 0 13156 MICHAEL PAGE PHYSICIAN 40.0 0 X 430124 0 42269 CHELSEY ZELTINGER NURSE PRACT-FAMILY MEDICINE 40.0 0 X 179940 0 22180 1324174 4923766 508230 9 false true false CENTRAL DAKOTA PHYSICAL THERAPY PC 800 N 4TH ST CARRINGTON ND 58421 PHYSICAL THERAPY 435696 SIEMENS MEDICAL SOLUTIONS USA 40 Liberty Boulevard Malvern PA 19355 Healthcare Services 232781 DMS HEALTH TECHNOLOGIES SCS 12-2208 PO BOX 86 MINNEAPOLIS MN 554862208 NUCLEAR MED, MRI 175728 TRANE INC 10502 E Montgomery Dr Suite 1 Spokane Valley WA 99206 HVAC Services 175165 MIKE SWANSON CONSTRUCTION 6250 24th Avenue NE Rugby NE 58368 Construction Services 125594 5 X 0 0 19572 30352 529180 155513 0 734617 Net Patient Services 900099 13324798 13324798 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13324798 320590 0 1482 319108 0 0 0 0 0 0 0 0 19982 0 0 0 19982 0 19982 0 0 19982 50364 3305 0 0 50364 3305 53669 0 0 53669 20835 19572 19830 1005 0 1005 6184 3080 3104 0 0 3104 59671 29788 29883 0 0 29883 Pharmacy Services 446110 1213025 0 0 1213025 Product Sales 446199 34538 0 0 34538 Cafeteria 722100 20623 0 0 20623 13932 0 0 13932 1282118 15769766 13324798 1482 1708869 X 27486 27486 4972290 4475061 447506 49723 256703 231033 23103 2567 835687 752118 75212 8357 306323 275691 27569 3063 20506 20506 2573 2573 3798096 3298267 485396 14433 29096 13384 13675 2037 270216 171215 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RELATED TO LOBBYING IS AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION - $435 - CATHOLIC HEALTH ASSOCIATION - $328 - NORTH DAKOTA HEALTHCARE ASSOCIATION - $1,810 26636 1571 28207 24669 1967 26636 22006 2741 78 24669 22174 0 -168 22006 16320 5260 594 22174 0.0 0.7182 0.2818 false false 346958 346958 6277558 5569825 707733 8880663 5411439 3469224 307834 242735 65099 4589014 CHI OPERATING INVESTMENT PROGRAM, LP 15421670 F 15421670 INTERCOMPANY PAYABLE 494029 494029 X Schedule D, Part V, Line 4 Intended uses of endowment funds A CONTRIBUTION WAS MADE TO THE FOUNDATION FOR A PERMANENT ENDOWMENT AND THE EARNINGS GENERATED FROM IT ARE TEMPORARILY RESTRICTED FOR THE FOUNDATION TO BE USED TO SUPPORT CARRINGTON HEALTH CENTER'S GREATEST NEEDS. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote CARRINGTON MEDICAL 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". SPRING FLING 40407 19572 20835 9904 400 3294 4461 1771 0 0 40407 19572 20835 9904 400 3294 4461 1771 19830 1005 true true X true X 300 true X true true true false true true 178 163694 163694 0.0113 0 0.0 0 0.0 0 178 163694 0 163694 0.0113 19 21549 157092 157092 0.0108 4 32 49199 49199 0.0034 2 47 7393 7393 0.0005 0 0.0 5 9296 9296 0.0006 30 21628 222980 0 222980 0.0153 30 21806 386674 0 386674 0.0266 0 0.0 0 0.0 9 892 4944 4944 0.0003 1 1260 1260 0.0001 0 0.0 5 42 7529 7529 0.0005 1 164 164 0.0000 13 443 22838 2485 20353 0.0014 0 0.0 29 1377 36735 2485 34250 0.0024 true 193358 0 6231208 6366436 -135228 X true true 1 1 Carrington Health Center 800 North Fourth Street Carrington ND 584210461 https://www.chistalexiushealth.org/locations/carrington 5008 X X X X Carrington Health Center 1 false false true X X X X X X X X X 18 true false true true X https://www.chistalexiushealth.org/carrington/community-health-needs-assessment X true 19 false true false true X 300.0 300.0 X X X X true true X X X true X https://www.chistalexiushealth.org/PATIENTS-VISITORS/OUR-PATIENTS/FINANCIAL-ASSISTANCE X https://www.chistalexiushealth.org/PATIENTS-VISITORS/OUR-PATIENTS/FINANCIAL-ASSISTANCE X https://www.chistalexiushealth.org/PATIENTS-VISITORS/OUR-PATIENTS/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 A Community Group met on November 1, 2018. Fourteen community members attended the meeting. The group was presented with a summary of this report's findings, including background and explanation about the secondary data, highlights from the survey results (including perceived community assets and concerns, and barriers to care), and findings from the key informant interviews. FOLLOWING CAREFUL CONSIDERATION OF THE RESULTS AND FINDINGS OF THIS ASSESSMENT, COMMUNITY GROUP MEMBERS DETERMINED THAT, IN THEIR ESTIMATION, THE SIGNIFICANT HEALTH NEEDS OR ISSUES IN THE COMMUNITY ARE 1) ABILITY TO RETAIN PRIMARY CARE PROVIDERS, 2) ATTRACTING AND RETAINING YOUNG FAMILIES, 3) NOT ENOUGH AFFORDABLE HOUSING, 4) AVAILABILITY OF RESOURCES TO HELP ELDERLY STAY IN THEIR HOMES, 5) ADULT AND YOUTH ALCOHOL USE AND ABUSE. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Carrington Health Center. CHI ST. ALEXIUS HEALTH CARRINGTON, ALONG WITH FOSTER COUNTY PUBLIC HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2019. THE CENTER FOR RURAL HEALTH (CRH) AT THE UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE AND HEALTH SCIENCES (UNDSMHS) FACILITATED THE ASSESSMENT PROCESS, WHICH SOLICITED INPUT FROM AREA COMMUNITY MEMBERS AND HEALTHCARE PROFESSIONALS AS WELL AS ANALYSIS OF COMMUNITY HEALTH-RELATED DATA. THE COMMUNITY HEALTH NEEDS ASSESSMENT FOCUSED PRIMARILY ON FOSTER AND EDDY COUNTIES; HOWEVER, THE SURVEY WAS DISTRIBUTED IN OTHER COMMUNITIES POTENTIALLY SERVED BY CARRINGTON INCLUDING GRIGGS, STUTSMAN, AND WELLS COUNTIES. PLANNING INVOLVED PROFESSIONALS FROM BOTH CHI ST. ALEXIUS HEALTH CARRINGTON, FOSTER COUNTY PUBLIC HEALTH, AS WELL AS COMMUNITY AND ELECTED LEADERS. WE COLLABORATED REGULARLY BY TELEPHONE CONFERENCE, EMAIL, AND HAD SEVERAL FACE TO FACE MEETINGS. THE PROCESS CLOSELY FOLLOWED A MODEL USED DURING THE LAST COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. CHI ST. ALEXIUS HEALTH CARRINGTON DID NOT RECEIVE ANY WRITTEN COMMENTS FROM THE PUBLIC ON THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT OR IMPLEMENTATION STRATEGY. OUR IMPLEMENTATION PLAN WAS ADOPTED IN OCTOBER 2019 BY THE CHI ST. ALEXIUS HEALTH CARRINGTON BOARD. THE ASSESSMENT SOUGHT INPUT FROM AREA COMMUNITY MEMBERS AND HEALTH CARE PROFESSIONALS AS WELL AS ANALYSIS OF COMMUNITY HEALTH-RELATED DATA. TO GATHER FEEDBACK FROM THE COMMUNITY, RESIDENTS OF THE SURROUNDING AREA WERE PROVIDED THE OPPORTUNITY TO PARTICIPATE IN A SURVEY. APPROXIMATELY 226 RESIDENTS FROM THE AFOREMENTIONED COUNTIES AREA TOOK THE SURVEY. ONE-ON-ONE INTERVIEWS WITH FOUR KEY INFORMANTS WERE CONDUCTED IN CARRINGTON ON SEPTEMBER 5, 2018. FOUR ADDITIONAL KEY INFORMANT INTERVIEWS WERE CONDUCTED OVER THE PHONE IN SEPTEMBER OF 2018. A REPRESENTATIVE FROM THE CRH CONDUCTED THE INTERVIEWS. INTERVIEWS WERE HELD WITH SELECTED MEMBERS OF THE COMMUNITY WHO COULD PROVIDE INSIGHTS INTO THE COMMUNITY'S HEALTH NEEDS. THE INFORMANTS INCLUDED PUBLIC HEALTH PROFESSIONALS WITH SEVERAL YEARS OF DIRECT EXPERIENCE IN THE COMMUNITY, INCLUDING WORKING WITH MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AS WELL AS WITH POPULATIONS WITH CHRONIC DISEASES. TOPICS COVERED DURING THE INTERVIEWS INCLUDED THE GENERAL HEALTH NEEDS OF THE COMMUNITY, THE GENERAL HEALTH OF THE COMMUNITY, COMMUNITY CONCERNS, DELIVERY OF HEALTHCARE BY LOCAL PROVIDERS, AWARENESS OF HEALTH SERVICES OFFERED LOCALLY, BARRIERS TO RECEIVING HEALTH SERVICES, AND SUGGESTIONS FOR IMPROVING COLLABORATION WITHIN THE COMMUNITY. FOURTEEN PEOPLE, REPRESENTING A CROSS SECTION DEMOGRAPHICALLY, ATTENDED THE FOCUS GROUP MEETING. THE MEETING WAS HIGHLY INTERACTIVE WITH GOOD PARTICIPATION. CMC AND FCPH STAFF WERE IN ATTENDANCE AS WELL, BUT LARGELY PLAYED A ROLE OF LISTENING AND LEARNING. THE INPUT FROM THESE RESIDENTS REPRESENTED THE BROAD INTERESTS OF OUR AREA COMMUNITIES. TOGETHER WITH SECONDARY DATA GATHERED FROM A WIDE RANGE OF SOURCES, THE INFORMATION GATHERED PRESENTS A SNAPSHOT OF HEALTH NEEDS AND OTHER CONCERNS IN THE COMMUNITY THAT IMPACT THE SOCIAL DETERMINANTS OF HEALTH. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - CARRINGTON HEALTH CENTER. THE CHNA WAS CONDUCTED WITH FOSTER COUNTY PUBLIC HEALTH. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - CARRINGTON HEALTH CENTER. THE HOSPITAL IS A PART OF THE BROADER COMMUNITY AND BY ITSELF CANNOT IMPLEMENT SIGNIFICANT CHANGES FOR THE DIFFICULT SOCIETAL ISSUES. WITH THAT SAID, THE HOSPITAL, ALONG WITH ITS PARTNERS ARE ADDRESSING THE SIGNIFICANT HEALTH NEEDS. THE PARTNERS INCLUDE THE FOSTER COUNTY PUBLIC HEALTH AND OTHER STAKEHOLDERS WITHIN THE CARRINGTON SERVICE AREA. BELOW DESCRIBES THE HOSPITAL ROLE IN THESE EFFORTS, WHICH MAY BE MORE OR LESS THAN OTHER PARTNERS IN MEETING THE ISSUES IDENTIFIED. The community health needs assessment identified the following significant community health needs: 1) Ability to retain primary care providers (MD, DO, NP, PA) - residents need access to primary health care providers for their health needs in order to live in our rural community. 2) Attracting and retaining young families - our community is experiencing a declining population and workforce. 3) Not enough affordable housing - affordable housing prevents residents from staying in Carrington or relocating to Carrington. 4) Availability of resources to help elderly stay in their homes - the elderly could stay in their homes longer versus leaving the community if resources were available. 5) Adult and youth alcohol use and abuse - alcohol use and abuse concerns amongst our population. The hospital intends to take actions and to dedicate resources to address these needs, including: * Ability to retain healthcare providers - active recruitment plans to hire 1 Internal Medicine physician and 1 Family Practice physician over the next 4-5 years. * Attracting and retaining young families - assist in marketing efforts to attract young families and support efforts to offer family friendly events to retain young families. * Not enough affordable housing - creation of a housing resource guide and support of those working to establish housing standards of living within the city/county. * Availability of resources to help elderly stay in their homes - creation of a community resource guide that may allow elderly to stay in their homes longer. * Adult and youth alcohol use and abuse - work with the community and local policy makers to reduce the acceptability of underage drinking among youth by adults in Foster County and reduce the occurrence of underage drinking for youth ages 12-20 in Foster County. Significant Needs the Hospital Does Not Intend to Address: The hospital intends to take actions to address all of the prioritized significant health needs in the CHNA report, both through its own programs and services and with community partners. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - CARRINGTON 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 COMMUNITY HEALTH CENTER 118 1ST STREET NEW ROCKFORD ND 58356 PROVIDER BASED Rural Health Clinic New Rockford Family Clinic 118 1st street south new rockford ND 58356 provider based Rural Health Clinic Carrington Medical Clinic & Urgent Care 820 5th St N Carrington ND 58421 provider based Rural Health Clinic Schedule H, Part VI LINE 2: NEEDS ASSESSMENT I. ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE CHI St. Alexius Health Carrington Medical Center is located in Carrington, North Dakota and is licensed as a 25 bed critical access hospital with two rural health clinics. One clinic is attached to the Carrington hospital and the other is located 16 miles to the north in New Rockford, North Dakota. The hospital is included in the Official Catholic Directory as a tax-exempt hospital. The mission of CommonSpirit Health and CHI ST. ALEXIUS HEALTH CARRINGTON Hospital is "As 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." CHI St. Alexius Health Carrington provides a wide array of health services for our area including a Critical Access Hospital, Emergency Care, Level 5 Trauma Center, ambulance services, inpatient care (acute care, swing bed, respite care), pharmacy, respiratory therapy, surgical services (general, endoscopy - colonoscopies and gastroscopies, ophthalmology, orthopedics, vein ablation), outpatient services including cardiac rehab, pulmonary rehab, stress testing, cardiac support group, diabetic education, laboratory, medical nutrition therapy, weight management support group, IV therapy, physical therapy, occupational therapy, speech therapy, sleep disorder services, telemedicine, back and joint injections, imaging services (CT and DEXA scans, echocardiograms, EKG, fluoroscopy, general x-ray, digital mammography, MRI, cardiac stress testing with nuclear medicine, ultrasound), volunteer auxiliary services, social ministries, and other services available by referral (mental health, hospice, and home health). CHI St. Alexius Health Carrington also provides a Medical Clinic (family practice, elder care, health maintenance exams, DOT exams, nursing home rounds, pediatric and well child exams, prenatal obstetrics, preoperative exams, and women's health) and an outreach clinic in Eddy County. One physician, three physician assistants, one family nurse practitioner, one psychiatric mental health nurse practitioner, a contracted general surgeon, and many outreach specialists provide needed local services for which our patients would otherwise have the inconvenience of traveling long distances to receive. The hospital's services are provided to the community on a non-discriminatory basis and include an emergency room staffed 24/7 with emergency room providers that is open to all persons regardless of ability to pay. CHI St. Alexius Health Carrington has a governing Regional & Executive Board of Directors as well as a Quality Committee-Patient Family Advisory Council, and a Foundation Advisory Council. The hospital is licensed by the North Dakota State Department of Health, and participates in government-sponsored health care programs like Medicaid and Medicare. II. COMMUNITY BENEFIT APPROACH CHI St. Alexius Health Carrington began delivering its health care mission in 1916 as the Carrington Hospital. Since that time, CHI St. Alexius Health Carrington has continued to reach out to provide education, health care and services, collaborating with local partners to improve the health of the community. Community benefit operations include costs associated with staff, the community health needs assessment, the ongoing implementation strategy and planning to address the current community needs, and other costs associated with community benefit operations. The hospital has financial assistance policies and programs for low-income persons like the Uninsured/Underinsured Patient Discount Policy and the Self-Pay and Third-Party Discounts Policy. QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT The service area for CHI St. Alexius Health Carrington include the North Dakota counties of Foster, Eddy, Stutsman, and Wells. CHI St. Alexius Health Carrington considers the service area of the facility to be roughly 8,000 people. In fiscal year ended June 30, 2019, CHI St. Alexius Health Carrington provided $420,924 in community benefit serving 23,183 people. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT An important part of CHI St. Alexius Health Carrington's mission is building healthier communities through programs designed to serve the needs of people who are poor and disadvantaged in our community. This type of community benefit has the added, positive side-effect of delivering an improved quality of life for everyone. Community benefit often takes place outside the walls of our facilities and involves partner organizations in the community. Community Outreach for the Poor CHI St. Alexius Health Carrington offers financial assistance to patients who cannot afford to pay for health care. A Patient Financial Counselor is available to help with the financial assistance application and to apply for Medicaid, Medicaid Expansion Programs, and other programs CHI St. Alexius Health Carrington is the only source of after hour care within the area served. In some cases, the hospital is the only source of care available in the community for the indigent. CHI St. Alexius Health Carrington Emergency Department treated 1,349 ER patients in fiscal year 2019 regardless of their ability to pay. CHI St. Alexius Health Carrington has Cancer Assistance Fund that provides gas cards for patients who must travel beyond Carrington for cancer related treatments. Requests for gas cards can be made via the application form. Carrington's Daily Bread, the local food pantry, is supported by CHI St. Alexius Health Carrington through food and supply donations as well as employee volunteerism. Carrington's Daily Bread assists people living in poverty with nutritional needs as well as children in need through a backpack program in partnership with the public school. CHI St. Alexius Health Carrington's Employees donate Christmas gifts for Children ages birth to 18 years of age through the Angel Tree project. The program is facilitated in part by the Foundation and Community Benefit Lead at CHI St. Alexius Health Carrington. Foster County Public Health coordinates and distributes these gifts to children living in poverty or those in need throughout Foster County. Community Health Improvement Services Community Health Education is offered by CHI St. Alexius Health Carrington at no charge to the broader community. Educational opportunities encompass a wide span of patient types including presentations, newsletters, programs, career fairs, and activities provided to groups without providing clinical or diagnostic services. A few examples of what CHI St. Alexius Health Carrington provided were bereavement/grief material, community education classes, emergency preparedness coordination planning, advance directives education, violence prevention programming, educational demonstrations at the Foster County Fair, presentations to civic groups, and a weekly Health Talk segment on the local radio station, to benefit the local community. The CHI St. Alexius Health Carrington Healthy Communities Coalition was re-formed in June of 2008. The Healthy Communities Coalition collaborates with several community organizations to advocate and improve community health. Several individual community members sit on the coalition as well as larger community groups such as: Foster County Public Health, Foster County Social Services, Carrington Public Schools, Veterans Services, the Chamber of Commerce, and local churches. The coalition has become involved with the local school system in several capacities. Programming in the school system includes: Sources of Strength, Red Ribbon Week, the Backpack Program, Safe Dates programming, Imagination Library, and the Kid Experience. CHI St. Alexius Health Carrington partners with the Center for Rural Health annually to host R-COOL Scrubs Camp for local eighth grade students. Students spend the day doing hands on activities and learning about health care careers. Exposing young children to health care professions and encouraging older youth to explore health careers is fundamental to successfully 'growing our own' rural healthcare workforce. The rotations include activities in emergency services, lab, surgical services, imaging services, physical therapy, public health, dentistry, chiropractics, and optometry. Community Based Clinical Services are provided by the CHI St. Alexius Health Carrington Cardiac Rehab Department. Supervised exercise for patients with special health concerns is offered at an affordable cost in the outpatient setting and is available to all community members through the Cardiac Rehab Phase III Program. This program operates at a loss; however, it provides an affordable and needed service to the community to promote wellness for all types of patients. Schedule H, Part I, Line 3c Financial Assistance Eligibility UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: * THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. * THE PATIENT'S FAMILY INCOME MUST BE AT OR BELOW 300% OF THE FPG. * THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED [IN THE FAP]. * THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: * RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS; * HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS CLINIC; * PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); * FOOD STAMP ELIGIBILITY; * SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY; * ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID SPEND-DOWN); * LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR * PATIENT IS DECEASED WITH NO KNOWN ESTATE. Schedule H, Part VI, Line 2 LINE 2 - NEEDS ASSESSMENT Health Professions Education CHI St. Alexius Health Carrington, partners with several educational institutions to provide hands on health professions education given at no charge to various disciplines in the health care field such as medical, laboratory, pharmacy, and nursing students. The CHI St. Alexius Health Carrington Auxiliary fundraises annually for scholarship money to be awarded to four local students entering into health related fields. CHI St. Alexius Health Carrington also aids in the administration and management of the Meadows Memorial Fund. This fund's intent is to provide financial assistance that will directly enhance both the long term health and health care available to the citizens of Carrington and area serviced by CHI St. Alexius Health, Carrington, through educational scholarships, training, equipment, and educational programs. Subsidized Health Services Subsidized health services are provided by CHI St. Alexius Health Carrington despite a negative margin because the services are needed in the community and would otherwise not be available to meet community needs. As a critical access hospital, cost based reimbursement plays a key role in the services provided. Financial and In-Kind Contributions CHI St. Alexius Health Carrington provides financial and in-kind contributions to individuals and the community at large. In-kind services include hours donated by staff to the community while on work time. Clinic based care team nurse services are offered free of charge to patients for answering questions, providing medical information, communicating with medical staff, and assistance in prescription refills. The Ambulance service also provides standby support for community events such as football games, Fourth of July fireworks, and rodeos. This is just a portion of the activities in this category. Community Building Activities Community building activities include in-kind contributions and budgeted expenditures for the development of community health programs and partnerships. CHI St. Alexius Health Carrington staff involvement on various committees, boards, and coalitions such as the Carrington Development Corporation, Job Development Authority, Carrington Convention and Visitors Bureau, Carrington Chamber of Commerce, Kiwanis, Lions, Ministerial Association, among others, builds relationships in the community with the medical center. Environmental improvements are supported by CHI St. Alexius Health Carrington through an onsite recycling program. CHI St. Alexius Health Carrington also hosts Health Occupations students in collaboration with the public school and other health care providers in the community. The class is geared towards workforce development. High school seniors are able to enroll in the class to obtain real life and some hands on exposure to health related careers with rotations in: acute care, cardiac rehab, central supply, clinic, dental, diabetes education, emergency services, laboratory, imaging services, infection prevention, materials management, nursing home, nutritional services, operating room, pharmacy, physical therapy, public health, risk, respiratory therapy, and wellness. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE ORGANIZATION'S COST ACCOUNTING SYSTEM WAS USED TO REPORT FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS IN PART I, LINE 7. THE ORGANIZATION'S COST ACCOUNTING SYSTEM ADDRESSES ALL OF THE PATIENTS SERVED BY CARRINGTON HEALTH CENTER. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE ORGANIZATION HAS REPORTED BAD DEBT EXPENSE AT GROSS CHARGES WRITTEN OFF. THE ORGANIZATION'S BAD DEBT EXPENSE REPRESENTS AMOUNTS BILLED TO PATIENTS THAT WAS DEEMED UNCOLLECTIBLE AND DOES NOT INCLUDE ANY CHARGES THAT WERE ULTIMATELY REIMBURSED OR DISCOUNTED. PATIENT DISCOUNTS ARE RECORDED IN CONTRACTUAL ALLOWANCE OR FINANCIAL ASSISTANCE, AS APPROPRIATE, AS AN OFFSET TO GROSS REVENUE AND ARE NOT INCLUDED IN BAD DEBT EXPENSE. Schedule H, Part III, Line 3 Bad Debt Expense Methodology CARRINGTON 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 CARRINGTON 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 CARRINGTON 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. BECAUSE SHORTFALLS ARE BASED ON COSTS, NOT CHARGES, CARRINGTON HEALTH CENTER , DUE TO THEIR DESIGNATION AS A CAH, RECEIVED COST-BASED REIMBURSEMENT FOR MEDICARE PURPOSES. 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: $6,231,208 TOTAL MEDICARE COSTS: $6,366,436 SURPLUS OR SHORTFALL: ($135,228) CARRINGTON 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 - Carrington Health Center: Line 16a URL: https://www.chistalexiushealth.org/PATIENTS-VISITORS/OUR-PATIENTS/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - Carrington Health Center: Line 16b URL: https://www.chistalexiushealth.org/PATIENTS-VISITORS/OUR-PATIENTS/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Carrington Health Center: Line 16c URL: https://www.chistalexiushealth.org/PATIENTS-VISITORS/OUR-PATIENTS/FINANCIAL-ASSISTANCE; 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 CHI ST. ALEXIUS HEALTH, CMC IS LOCATED IN A FRONTIER AREA. A FRONTIER AREA IS DEFINED AS A SPARSELY POPULATED RURAL AREA, WHICH IS ISOLATED FROM POPULATION CENTERS AND SERVICES. CMC IS LICENSED AS A CRITICAL ACCESS HOSPITAL WITH TWO PROVIDER-BASED RURAL HEALTH CLINICS. ONE CLINIC IS ATTACHED TO THE CARRINGTON HOSPITAL AND THE OTHER IS LOCATED 16 MILES TO THE NORTH IN NEW ROCKFORD, NORTH DAKOTA. CARRINGTON IS LOCATED IN EAST CENTRAL NORTH DAKOTA, JUST TWO HOURS FROM FOUR MAJOR NORTH DAKOTA CITIES: FARGO, MINOT, GRAND FORKS, AND BISMARCK. ALONG WITH THE HOSPITAL, THE ECONOMY IS BASED ON AGRI-BUSINESS, SERVICE INDUSTRIES, AND RETAIL TRADE. FOSTER COUNTY IS 644 SQUARE MILES OF LAND LOCATED IN THE CENTER OF NORTH DAKOTA. IT IS ONE OF THE SMALLEST OF THE STATE'S 53 COUNTIES, 18 MILES BY 36 MILES IN DIMENSION. IT IS BORDERED BY EDDY, GRIGGS, STUTSMAN AND WELLS COUNTIES. FOSTER IS DIVIDED INTO 18 TOWNSHIPS WITH THE SEAT OF COUNTY GOVERNMENT LOCATED IN CARRINGTON. POPULATION OF FOSTER COUNTY IS 3,759. ACCORDING TO THE U.S. CENSUS BUREAU ESTIMATED CENSUS FOR 2017, FOSTER, EDDY AND WELLS COUNTIES ARE THE THREE MAJOR COUNTIES THAT UTILIZE CMC SERVICES. THE THREE COUNTIES HAVE A TOTAL AREA OF 2,536 SQUARE MILES AND APPROXIMATELY 9,595 PEOPLE, WHICH IS A SLIGHT DECREASE FROM 2010 CENSUS OF 9,935. THE RACIAL MAKEUP OF THE COUNTIES WAS 97.6% WHITE. THE NUMBER OF HOUSEHOLDS DECREASED FROM 4,806 TO 4,538 HOUSEHOLDS. OTHER HEALTHCARE FACILITIES AND SERVICES IN FOSTER, EDDY AND WELLS COUNTIES INCLUDE: FIVE DENTISTS, FOUR CHIROPRACTORS, TWO MASSAGE THERAPISTS, THREE OPTOMETRISTS, AND EACH COUNTY HAS A LONG TERM HEALTHCARE CENTER WITH VARIOUS ADDITIONAL LEVELS OF CARE AND SERVICES. FOSTER, EDDY AND WELLS COUNTY SOCIAL SERVICES ALSO OFFER BATHING, HOUSEKEEPING, AND MEAL PREPARATION SERVICES THROUGH QUALITY SERVICE PROVIDERS. CARRINGTON HAS A NUMBER OF PHYSICAL ASSETS AND FEATURES TO HELP ADDRESS POPULATION HEALTH IMPROVEMENT INCLUDING A BIKE PATH, FITNESS CENTER, FACILITY AVAILABLE FOR WINTER WALKING, SWIMMING POOL, CITY PARK, TENNIS COURTS, GOLF COURSE, MOVIE THEATRE, LOCAL WINERY AND GARDEN, AND BIRDING DRIVES. FOSTER COUNTY OFFERS SEVERAL CULTURAL ATTRACTIONS SUCH AS THE FOSTER COUNTY MUSEUM, WHICH PAYS TRIBUTE TO THE EARLY HISTORY OF THE CITY AND REGION. CARRINGTON OFFERS PUBLIC TRANSPORTATION THROUGH SOUTH CENTRAL TRANSIT AND THROUGH FAITH IN ACTION - AN ENTITY OF CHI ST. ALEXIUS HEALTH, CARRINGTON. THE COMMUNITY ALSO HAS A GROCERY STORE AND TWO PHARMACIES WITH DELIVERY SERVICES. THE CARRINGTON PUBLIC SCHOOL SYSTEM OFFERS A COMPREHENSIVE PROGRAM FOR STUDENTS K-12. THEY ALSO OFFER PRESCHOOL TO A SMALL POPULATION AND A PRIVATELY FUNDED PRESCHOOL IS AVAILABLE IN THE COMMUNITY. SOME LICENSED AS WELL AS UNLICENSED DAYCARES ARE AVAILABLE IN THE AREA. Schedule H, Part VI, Line 5 Promotion of community health THE ORGANIZATION'S HOSPITAL FACILITY PROMOTES HEALTH FOR THE BENEFIT OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITY 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 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 ND false true false false false false false true false Kevin Dahmen MD Secretary/Treasurer 0 480289 0 219722 0 1587 0 26600 0 20125 0 748323 0 0 KURT SCHLEY President/Market CEO 0 433185 0 71446 0 58188 0 54317 0 26909 0 644045 0 37116 MICHAEL L CASSIDY MD Director 0 453646 0 3100 0 9612 0 15934 0 19184 0 501476 0 0 JEFFREY DROP Director/CHI SVP Division Officer 0 716564 0 535360 0 136936 0 22411 0 18016 0 1429287 0 0 Shiraz Hyder Director 0 381969 0 87895 0 7869 0 29500 0 22205 0 529438 0 0 TESSA MARBURGER MD DIRECTOR 0 367563 0 0 0 11719 0 15853 0 10502 0 405637 0 0 Todd Preszler MD DIRECTOR 0 538240 0 21118 0 2622 0 11000 0 23415 0 596395 0 0 MARIANN DOELING president / ceo 0 178745 0 36744 0 25965 0 14379 0 9602 0 265435 0 0 KURT SARGENT VP OPERATIONAL FINANCE 0 124252 0 16240 0 3190 0 10014 0 15883 0 169579 0 0 RICK GEIER PHYSICIAN 129044 0 191571 0 16498 0 16375 0 13739 0 367227 0 0 0 MARY HOFF PHYSICIAN ASSISTANT 141784 0 14659 0 1834 0 9665 0 24997 0 192939 0 0 0 JACQUELINE NELSON PHYSICIAN ASSISTANT 195286 0 23135 0 299 0 12144 0 1012 0 231876 0 0 0 MICHAEL PAGE PHYSICIAN 277278 0 150686 0 2160 0 15408 0 26861 0 472393 0 0 0 CHELSEY ZELTINGER NURSE PRACT-FAMILY MEDICINE 169952 0 5000 0 4988 0 5073 0 17107 0 202120 0 0 0 Schedule J, Part I, Line 4a Post-termination payments During the calendar year 2018, POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") 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 3 Arrangement used to establish the top management official's compensation METHODS USED TO ESTABLISH CEO COMPENSATION - During the calendar year 2018, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. 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. During 2018 the following distributions were made by CHI from the deferred compensation plan: KURT RONALD SCHLEY - $37,136 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 MARIANN K. DOELING - $9,286 Schedule J, Part I, Line 7 Non-fixed payments CHC MAINTAINS A VARIABLE PAY PLAN FOR MIDDLE MANAGEMENT AND SENIOR EXECUTIVE MANAGEMENT THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PLAN ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING PERFORMANCE IN RELATION TO BUDGET, AND ACHIEVEMENT OF INDIVIDUAL GOALS. ALL COMPENSATION, INCLUDING ANY INCENTIVE COMPENSATION, IS CAPPED TO ENSURE THAT COMPENSATION REMAINS AT FMV. PHYSICIAN AND ADVANCED CLINICAL PRACTITIONER INCENTIVE COMPENSATION IS BASED ON THE CMS RBRVS METHODOLOGY (CENTER FOR MEDICARE AND MEDICAID SERVICES RESOURCE-BASED RELATIVE VALUE SCALE METHOD) FOR DETERMINING PHYSICIAN WRVU (RELATIVE VALUE UNIT) FOR PERSONALLY PERFORMED PHYSICIAN SERVICES. THE VALUE OF A WRVU IS DETERMINED WITH REFERENCE TO THE MOST CURRENT NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE. PHYSICIAN AND ADVANCED CLINICAL PRACTITIONER QUALITY INCENTIVE COMPENSATION IS BASED ON PERFORMANCE MEASURES ESTABLISHED TO ACHIEVE QUALITY, SATISFACTION, AND OPERATING TARGETS. Form 990, Part III, Line 1 MISSION STATEMENT 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. 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 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL The organization's top management official's compensation was paid by Catholic Health Initiatives ("CHI"), a related organization. CHI had a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges were reviewed annually in comparison to market data. Catholic Health Initiatives used Korn Ferry 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 executives was reviewed annually. Korn Ferry 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 Korn Ferry to the CHI HR committee of the Board of Stewardship Trustees annually at their September meeting and minutes shared with the full board at the December meeting. The last review was September 25, 2018. In addition, Korn Ferry completed a comprehensive review of all positions at the level of vice president and above in the fall of 2014 to determine and validate appropriate compensation levels. These levels were reviewed annually and revised based on market data, where applicable. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER EMPLOYEES During the tax year ended 6/30/2019, no officers, directors or trustees received compensation from the organization. Any executive compensation paid to officers, directors or trustees by related organizations was set by the related organization's compensation committee utilizing both an independent consultant and comparability studies to determine compensation. Therefore, these questions are more appropriately answered as N/A. Form 990, Part VI, Line 1a Delegate broad authority to a committee PURSUANT TO SECTION 8.6 OF THE BYLAWS OF CARRINGTON 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 CARRINGTON 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 5.1 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE CommonSpirit Health BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CommonSpirit Health CHIEF EXECUTIVE OFFICER: *SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF CARRINGTON HEALTH CENTER *AMENDMENT OF THE CORPORATE DOCUMENTS OF CARRINGTON HEALTH CENTER *APPROVE MEMBERS OF THE CARRINGTON HEALTH CENTER BOARD *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF CARRINGTON HEALTH CENTER *APPROVAL OF ISSUANCE OF DEBT BY CARRINGTON HEALTH CENTER *APPROVAL OF PARTICIPATION OF CARRINGTON HEALTH CENTER IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY CARRINGTON HEALTH CENTER *APPROVAL OF A MERGER INVOLVING CARRINGTON HEALTH CENTER *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF CARRINGTON HEALTH CENTER *TO REQUIRE THE TRANSFER OF ASSETS BY CARRINGTON 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 CARRINGTON 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 VP OF OPERATIONAL FINANCE. THE VP OF OPERATIONAL FINANCE PROVIDES THE RETURN TO THE EXECUTIVE ASSISTANT WHO HANDLES BOARD CORRESPONDENCE. THE EXECUTIVE ASSISTANT FORWARDS TO THE BOARD PRIOR TO FILING WITH THE IRS. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NONSUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RESUBMITTED 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. 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: 13932, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 13932; Form 990, Part IX, Line 11g Other Fees Contract Labor - Total Expense: 1935172, Program Service Expense: 1680503, Management and General Expenses: 247315, Fundraising Expenses: 7354; Purchased Services - Total Expense: 1003861, Program Service Expense: 871753, Management and General Expenses: 128293, Fundraising Expenses: 3815; Other Fees for Services - Total Expense: 636109, Program Service Expense: 552397, Management and General Expenses: 81295, Fundraising Expenses: 2417; Contract Services - Total Expense: 203164, Program Service Expense: 176428, Management and General Expenses: 25964, Fundraising Expenses: 772; Consulting - Total Expense: 19790, Program Service Expense: 17186, Management and General Expenses: 2529, Fundraising Expenses: 75; Form 990, Part XI, Line 9 Other changes in net assets or fund balances CAPITAL RESOURCE POOL CONTRIBUTION - -284746; 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 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 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