TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) Corinne A Allen SECRETARY	1.0 ................. 2.0	X	X	0	0
(2) JILL APLIN VICE CHAIR	1.0 ................. 2.0	X	X	0	0
(3) JAMES PESNELL CHAIR	1.0 ................. 2.0	X	X	0	0
(4) LARRY SCHUMACHER CEO/CHI SR VP	1.0 ................. 59.0	X	X	1,402,247	153,141
(5) John F Boxell MD BOARD MEMBER	1.0 ................. 10.0	X		72,605	2,541
(6) CHRISTOPHER P CRIMMINS BOARD MEMBER	1.0 ................. 2.0	X		0	0
(7) ARLENE DONOWITZ MD BOARD MEMBER	1.0 ................. 49.0	X		441,704	18,079
(8) CHRISTOPHER GREENE MD EX-OFFICIO/CHIEF OF MED STAFF	50.0 ................. 0	X		465,863	40,228
(9) ROBERT GREVING BOARD MEMBER	1.0 ................. 2.0	X		0	0
(10) JAMES LE HILL BOARD MEMBER	1.0 ................. 2.0	X		0	0
(11) DOROTHY JACKSON SCN BOARD MEMBER	1.0 ................. 2.0	X		0	0
(12) MATTHEW KODSI MD BOARD MEMBER	1.0 ................. 49.0	X		41,340	0
(13) MARY STEWART LEWIS BOARD MEMBER	1.0 ................. 4.0	X		0	0
(14) JOHN NASH MD BOARD MEMBER	1.0 ................. 2.0	X		0	0
(15) CYNTHIA NESSON BOARD MEMBER	1.0 ................. 2.0	X		0	0
(16) JUDITH RALEY SCN BOARD MEMBER	1.0 ................. 6.0	X		0	0
(17) JANELLE REILLY EX-OFFICIO/COO	1.0 ................. 49.0	X		794,722	75,485

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CHI Memorial Hospital - Georgia

Employer identification number

82-2748395

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHI Memorial Hospital - Georgia

Employer identification number

82-2748395

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	1,750,000		1,750,000
b	Buildings ....	2,473,426	21,697	2,451,729
c	Leasehold improvements	702,516	142	702,374
d	Equipment ....	4,477,447	357,017	4,120,430
e	Other .....	4,487,829	0	4,487,829
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				13,512,362

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	28,587,672
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	CHI Memorial Hospital - GA's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives ("CHI"), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2018, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements."

Return Reference

Explanation

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

CHI Memorial Hospital - GA's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives ("CHI"), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2018, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements."

Schedule D (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHI Memorial Hospital - Georgia

Employer identification number

82-2748395

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 30000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .		479	87,926	0	87,926	0.92 %
b	Medicaid (from Worksheet 3, column a) . . . . .			0	0	0	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			0	0	0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	479	87,926	0	87,926	0.92 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			0	0	0	0 %
f	Health professions education (from Worksheet 5) . . .			0	0	0	0 %
g	Subsidized health services (from Worksheet 6) . . . .			0	0	0	0 %
h	Research (from Worksheet 7) .			0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			0	0	0	0 %
j	Total. Other Benefits . .	0	0	0	0	0	0 %
k	Total. Add lines 7d and 7j .	0	479	87,926	0	87,926	0.92 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	0	0	0	0

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

155,333

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

741,712

Enter Medicare allowable costs of care relating to payments on line 5.....

1,262,590

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-520,878

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	CHI Memorial - Georgia 100 Gross Crescent Circle Fort Oglethorpe,GA30742 www.memorial.org 023-626	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	CHI Memorial - Georgia
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

Yes

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url):

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Indicate the tax year the hospital facility last adopted an implementation strategy: 20

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CHI Memorial - Georgia
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.0%
and FPG family income limit for eligibility for discounted care of 300.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

www.memorial.org/financial-assistance-discount

The FAP application form was widely available on a website (list url):

www.memorial.org/financial-assistance-discount

A plain language summary of the FAP was widely available on a website (list url):
www.memorial.org/financial-assistance-discount

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	CHI Memorial - Georgia
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	CHI Memorial - Georgia
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 2	CHI Memorial Hospital - GA acquired the hospital formerly known as Cornerstone Medical Center. The acquisition was effective December 29, 2017.
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - CHI Memorial Hospital - GA. The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. The patient must submit a completed Financial Assistance application. Patient Cooperation Standards - A patient must exhaust all other payment options, including private coverage, federal, state and local medical assistance programs, and other forms of assistance provided by third-parties prior to being approved. An applicant for Financial Assistance is responsible for applying to public programs for available coverage. He or she is also expected to pursue public or private health insurance payment options for care provided by a CHI Hospital Organization within a Hospital Facility. A patient's and, if applicable, any Guarantor's cooperation in applying for applicable programs and identifiable funding sources, including COBRA coverage (a federal law allowing for a time-limited extension of employee healthcare benefits), shall be required. If a Hospital Facility determines that COBRA coverage is potentially available, and that a patient is not a Medicare or Medicaid beneficiary, the patient or Guarantor shall provide the Hospital Facility with information necessary to determine the monthly COBRA premium for such patient, and shall cooperate with Hospital Facility staff to determine whether he or she qualifies for Hospital Facility COBRA premium assistance, which may be offered for a limited time to assist in securing insurance coverage. A Hospital Facility shall make affirmative efforts to help a patient or patient's Guarantor apply for public and private programs.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?0
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part I, Line 3c Financial Assistance Eligibility Criteria	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 Bad Debt Expense excluded from financial assistance calculation	155333
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 28.3 %. 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	CHI MEMORIAL - GA 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	CHI MEMORIAL - GA DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, TAKING INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHI FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY. THE PROVISION FOR BAD DEBTS IS PRESENTED IN THE CONSOLIDATED STATEMENT OF OPERATIONS AS A DEDUCTION FROM PATIENT SERVICES REVENUES (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) SINCE CHI ACCEPTS AND TREATS ALL PATIENTS WITHOUT REGARD TO THE ABILITY TO PAY.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	USING ESSENTIALLY THE SAME MEDICARE COST REPORT PRINCIPLES AS TO THE ALLOCATION OF GENERAL SERVICES COSTS AND "APPORTIONMENT" METHODS, THE "CHI WORKBOOK" CALCULATES A PAYERS' GROSS ALLOWABLE COSTS BY SERVICE (SO AS TO FACILITATE A CORRESPONDING COMPARISON BETWEEN GROSS ALLOWABLE COSTS AND ULTIMATE PAYMENTS RECEIVED). THE TERM "GROSS ALLOWABLE COSTS" MEANS COSTS BEFORE ANY DEDUCTIBLES OR CO-INSURANCE ARE SUBTRACTED. CHI MEMORIAL HOSPITAL - GA'S ULTIMATE REIMBURSEMENT WILL BE REDUCED BY ANY APPLICABLE COPAYMENT/ DEDUCTIBLE. WHERE MEDICARE IS THE SECONDARY INSURER, AMOUNTS DUE FROM THE INSURED'S PRIMARY PAYER WERE NOT SUBTRACTED FROM MEDICARE ALLOWABLE COSTS BECAUSE THE AMOUNTS ARE TYPICALLY IMMATERIAL. ALTHOUGH NOT PRESENTED ON THE MEDICARE COST REPORT, IN ORDER TO FACILITATE A MORE ACCURATE UNDERSTANDING OF THE "TRUE" COST OF SERVICES (FOR "SHORTFALL" PURPOSES) THE CHI WORKBOOK ALLOWS A HEALTH CARE FACILITY NOT TO OFFSET COSTS THAT MEDICARE CONSIDERS TO BE NON-ALLOWABLE, BUT FOR WHICH THE FACILITY CAN LEGITIMATELY ARGUE ARE RELATED TO THE CARE OF THE FACILITY'S PATIENTS. IN ADDITION, ALTHOUGH NOT REPORTABLE ON THE MEDICARE COST REPORT, THE CHI WORKBOOK INCLUDES THE COST OF SERVICES THAT ARE PAID VIA A SET FEE SCHEDULE RATHER THAN BEING REIMBURSED BASED ON COSTS (E.G. OUTPATIENT CLINICAL LABORATORY). FINALLY, THE CHI WORKBOOK ALLOWS A FACILITY TO INCLUDE OTHER HEALTH CARE SERVICES PERFORMED BY A SEPARATE FACILITY (SUCH AS A PHYSICIAN PRACTICE) THAT ARE MAINTAINED ON SEPARATE BOOKS AND RECORDS (AS OPPOSED TO THE MAIN FACILITY'S BOOKS AND RECORDS WHICH HAS ITS COSTS OF SERVICE INCLUDED WITHIN A COST REPORT). TRUE COSTS OF MEDICARE COMPUTED USING THIS METHODOLOGY: THESE COSTS AND REIMBURSEMENTS ARE NOT LIMITED TO TRADITIONAL MEDICARE PLANS EITHER BUT ENCOMPASS MEDICARE MANAGED CARE PLANS. TOTAL MEDICARE REVENUE: $741,712 TOTAL MEDICARE COSTS: $1,262,590 SHORTFALL: $520,878 CHI MEMORIAL HOSPITAL - GA 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. 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	CHI MEMORIAL HOSPITAL - GA'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 THIRDPARTY 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	- CHI Memorial - Georgia: Line 16a URL: www.memorial.org/financial-assistance-discount;
Schedule H, Part V, Section B, Line 16b FAP Application website	- CHI Memorial - Georgia: Line 16b URL: www.memorial.org/financial-assistance-discount;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- CHI Memorial - Georgia: Line 16c URL: www.memorial.org/financial-assistance-discount;
Schedule H, Part VI, Line 2 Needs assessment	CHI Memorial Hospital - Georgia (CHI-GA) IS A FAITH BASED, TAX-EXEMPT 501(C)(3) ORGANIZATION THAT PROVIDES MEDICAL CARE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. CHI-GA FIRST BECAME RECOGNIZED AS A SECTION 501 (C)(3) HOSPITAL IN SEPTEMBER OF 2017. OUR TAX EXEMPT STATUS IS SUBSTANTIATED BY ITS INCLUSION IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. COMMUNITY SERVICES HAVE ALWAYS BEEN A SIGNIFICANT PART OF CHI-GA. EACH YEAR, SERVICES AND PROGRAMS OFFERED TO THE COMMUNITY ARE EVALUATED AND EXPANDED TO PROMOTE INCREASED ACCESS TO HEALTHCARE AND HEALTHIER COMMUNITIES THAT TARGETS CHRONIC DISEASE PREVENTION AND MANAGEMENT FOR VULNERABLE AND UNDERSERVED POPULATIONS. TO ENHANCE THE HEALTH STATUS OF NORTH GEORGIA (FORT OGLETHORPE- CHI-GA) RESIDENCES, CHI-GA FOCUSES ON THE WHOLE PERSON INCLUDING THE PERSON'S SPIRITUAL, EMOTIONAL, AND PHYSICAL WELL-BEING. IN ACCORDANCE WITH ITS MISSION AND PHILOSOPHY, CHI-GA COMMITS SUBSTANTIAL RESOURCES TO SPONSOR A BROAD RANGE OF SERVICES TO BOTH THE POOR AS WELL AS THE BROADER COMMUNITY. BENEFITS FOR THE POOR INCLUDE THE COST OF PROVIDING SERVICES TO INDIVIDUALS WHO ARE UNABLE TO AFFORD HEALTH CARE DUE TO INADEQUATE RESOURCES AND/OR THOSE THAT ARE UNINSURED OR UNDERINSURED. BENEFITS FOR THE POOR INCLUDE TRADITIONAL CHARITY CARE, UNPAID COSTS OF MEDICAID, SUBSIDIZED OR FREE HEALTH SERVICES, AND CASH AND IN-KIND DONATIONS TO ORGANIZATIONS THAT SERVE THE POOR. THE AMOUNTS REPORTED REFLECT THE COSTS OF THESE SERVICES, NET OF CONTRIBUTIONS, GOVERNMENT PAYMENTS AND OTHER REVENUES RECEIVED AS DIRECT ASSISTANCE. COMMUNITY BENEFITS PROVIDED TO THE BROADER COMMUNITY INCLUDES THE COSTS OF PROVIDING SERVICES TO OTHER POPULATIONS WHO MAY NOT QUALIFY AS POOR BUT MAY NEED SPECIAL SERVICES AND SUPPORT. BENEFITS TO THE BROADER COMMUNITY INCLUDE: HEALTH PROMOTION AND EDUCATION; HEALTH FAIRS AND SCREENINGS; UNPAID COSTS OF TRAINING HEALTH PROFESSIONALS; CASH AND INKIND DONATIONS TO ORGANIZATIONS THAT SERVE THE BROADER COMMUNITY; AND THE UNPAID COSTS OF TESTING MEDICAL EQUIPMENT AND CONTROLLED STUDIES OF THERAPEUTIC PROTOCOLS. IN FISCAL YEAR 2018, CHI-GA PROVIDED COMMUNITY BENEFITS AND COMMUNITY BUILDING ACTIVITIES TO APPROXIMATELY 479 PEOPLE. EMERGENCY ROOM CHI-GA OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR AT MEMORIAL GEORGIA HOSPITAL. THE EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. CHI-GA HAS AN OPEN MEDICAL STAFF, PARTICIPATES IN MEDICARE AND MEDICAID, AND HAS AN ACTIVE CHARITY CARE PROGRAM. DURING FY 2018, OVER 11,108 PATIENTS VISITED THE GEORGIA EMERGENCY ROOM. UNCOMPENSATED CARE CHARITY CARE IS THE COST OF CARE OF UNINSURED OR UNDERINSURED, LOW-INCOME PATIENTS WHO ARE NOT EXPECTED TO PAY ALL OF A BILL, OR WHO ARE ABLE TO PAY ONLY A PORTION USING AN INCOME RELATED SCALE. THOSE RECEIVING CHARITY CARE ARE NOT ELIGIBLE FOR PUBLIC PROGRAMS SUCH AS TENNCARE. CHI-GA HAS A CHARITY CARE POLICY, WHICH ASSURES THAT ALL PERSONS RECEIVE MEDICALLY NECESSARY HOSPITAL SERVICES REGARDLESS OF THEIR ABILITY TO PAY. CHI-GA PROVIDES A SIGNIFICANT LEVEL OF CHARITY CARE EACH YEAR. IN FY 2018, THE COST OF CHARITY CARE FOR CHI-GA WAS $87,926. IN FY 2018, CHI-GA CLASSIFIED CHARITY AND UNREIMBURSED TENNCARE COSTS FOR REPORTING PURPOSES IN A MANNER CONSISTENT WITH A STANDARDIZED APPROACH DEVELOPED BY CHI FOR REPORTING AND BUDGETING BENEFITS PROVIDED TO THE COMMUNITY.
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 COMMUNITY IDENTIFIED BY CHI MEMORIAL HOSPITAL INCLUDES MEDICALLY UNDERSERVED, LOW INCOME OR MINORITY POPULATIONS WHO LIVE IN THE GEOGRAPHIC AREAS FROM WHICH CHI MEMORIAL HOSPITAL DRAWS ITS PATIENTS. 90% OF OUR PATIENTS COME FROM TWO COUNTIES AND THE DEMOGRAPHICS OF EACH COUNTY ARE DISCLOSED BELOW. ALL PATIENTS WERE USED TO DETERMINE THE SERVICE AREA WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER CHI MEMORIAL HOSPITAL'S FINANCIAL ASSISTANCE POLICY. DEMOGRAPHICS: CATOOSA COUNTY, GA THE POPULATION OF CATOOSA COUNTY IS PROJECTED TO INCREASE FROM 2015 TO 2020 0.55% PER YEAR, LESS THAN THE RATE OF GA (0.90%) AND THE U.S. (0.75%). BASED ON 2015 DATA, CATOOSA COUNTY WAS OLDER (39.6 MEDIAN AGE) THAN GA AND THE U.S. AND HAD LOWER MEDIAN HOUSEHOLD INCOME ($48,950) THAN BOTH GA AND THE U.S. THE MEDICAL CARE INDEX MEASURES HOW MUCH THE COUNTY SPENDS OUT-OF-POCKET ON MEDICAL CARE SERVICES. THE U.S. INDEX IS 100. CATOOSA COUNTY (83 INDEX) SPENT 17% LESS THAN THE AVERAGE U.S. HOUSEHOLD OUT-OF-POCKET ON MEDICAL CARE (DOCTOR'S OFFICE VISITS, PRESCRIPTIONS, HOSPITAL). THE RACIAL MAKE-UP OF CATOOSA COUNTY WAS 92% WHITE, 3% BLACK, 4% "OTHER", 1% MIXED RACE, AND 3% WERE OF HISPANIC ORIGIN. THE INCOME DISTRIBUTION OF CATOOSA COUNTY WAS 15% HIGHER INCOME (OVER $100,000), 61% MIDDLE INCOME, AND 23% LOWER INCOME (UNDER $24,999). WALKER COUNTY, GA THE POPULATION OF WALKER COUNTY IS PROJECTED TO REMAIN FLAT FROM 2015 TO 2020 WITH 0.01% GROWTH PER YEAR, LESS THAN THE RATE OF GA (0.90%) AND THE U.S. (0.75%). BASED ON 2015 DATA, WALKER COUNTY WAS OLDER (40.9 MEDIAN AGE) THAN GA AND THE U.S. AND HAD A MEDIAN HOUSEHOLD INCOME ($37,910) LOWER THAN BOTH GA AND THE U.S. THE MEDICAL CARE INDEX MEASURES HOW MUCH THE COUNTY SPENDS OUT-OF-POCKET ON MEDICAL CARE SERVICES. THE U.S. INDEX IS 100. WALKER COUNTY (75 INDEX) SPENT 25% LESS THAN THE AVERAGE U.S. HOUSEHOLD OUT-OF-POCKET ON MEDICAL CARE (DOCTOR'S OFFICE VISITS, PRESCRIPTIONS, HOSPITAL). THE RACIAL MAKE-UP OF WALKER COUNTY WAS 92% WHITE, 4% BLACK, 3% "OTHER", 1% MIXED RACE, AND 2% WERE OF HISPANIC ORIGIN. THE INCOME DISTRIBUTION OF WALKER COUNTY WAS 10% HIGHER INCOME (OVER $100,000), 60% MIDDLE INCOME, AND 30% LOWER INCOME (UNDER $24,999). ACCESS TO HEALTHCARE: GEORGIA COUNTIES TEND TO HAVE HIGHER PERCENTAGES OF UNINSURED INDIVIDUALS THAN THOSE OF THE NATION, THE HISPANIC/LATINO POPULATION'S PERCENTAGE OF UNINSURED IS MORE THAN TWICE THAT OF OTHER GROUPS IN THE REGION WALKER COUNTY'S PERCENTAGE OF UNINSURED IS ALSO TWICE THAT OF THE REGION; ITS PERCENTAGE OF MEDICAID RECIPIENTS IS ALSO HIGHEST AMONG THE THREE COUNTIES *IN CATOOSA, WALKER, AND HAMILTON COUNTY, AFRICAN AMERICANS ARE ALSO MORE LIKELY TO BE UNINSURED
Schedule H, Part VI, Line 5 Promotion of community health	THE ORGANIZATION'S HOSPITAL FACILITIES PROMOTE HEALTH FOR THE BENEFIT OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITIES HAVE AN OPEN MEDICAL STAFF. ITS BOARD OF TRUSTEES IS COMPOSED OF PROMINENT CITIZENS IN THE COMMUNITY. EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT IN PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. THE FACILITIES TREAT PERSONS PAYING THEIR BILLS WITH THE AID OF PUBLIC PROGRAMS LIKE MEDICARE AND MEDICAID. ALL PATIENTS PRESENTING AT THE HOSPITAL FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH TREATMENT.
Schedule H, Part VI, Line 6 Affiliated health care system	CHI Memorial Hospital - GA, ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES WERE, for the year ended 6/30/18, affiliated with Catholic Health Initiatives ("CHI"). Following the close of the 6/30/2018 tax year, on 2/1/19, in connection with the alignment of the Catholic ministries of CHI and Dignity Health, CHI changed its name to CommonSpirit Health. The narrative below reflects the activities of the organization's affiliate, CHI, as of and for the year ended 6/30/18: CHI, a nonprofit, faith-based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where we provide care. One of the nation's largest nonprofit health systems, Englewood, Colorado-based CHI serves as the Parent company of the system. It operates in 18 states and comprises 100 hospitals, including two academic health centers, major teaching hospitals as well as 29 critical-access facilities; community health-services organizations; accredited nursing colleges; home-health agencies; living communities; and other facilities and services that span the inpatient and outpatient continuum of care. In fiscal year 2018, CHI provided more than $1.1 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 $2.0 billion with the inclusion of the unpaid costs of Medicare. The health system, which generated operating revenues of $14.98 billion in fiscal year 2018, has total assets of approximately $20.6 billion. CHI provides strategic planning and management services as well as centralized "share services" for the MBOs. 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 MBOs. The cost savings achieved through CHI's centralization enable MBOS to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society.

Schedule H (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CHI Memorial Hospital - Georgia

Employer identification number
82-2748395

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) CHARITY CARE ASSISTANCE	479	310,665	Book	Financial Assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.	GRANT REQUESTS ARE COORDINATED THROUGH THE CHI MEMORIAL HOSPITAL - GA. THE BENEFICIARY OF THE GRANT IS RESPONSIBLE FOR USING THE FUNDS IN ACCORDANCE WITH THE GRANT REQUIREMENTS. ALL GRANT SPENDING IS REVIEWED BY FISCAL SERVICES BEFORE GRANT SPENDING IS REIMBURSED. PERIODIC REPORTING IS COORDINATED BETWEEN THE BENEFICIARY AND FISCAL SERVICES.

Schedule I (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHI Memorial Hospital - Georgia

Employer identification number

82-2748395

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1LARRY SCHUMACHER CEO/CHI SR VP	(i) (ii)	0 ------------- 735,553	0 ------------- 641,436	0 ------------- 25,258	0 ------------- 128,458	0 ------------- 24,683	0 ------------- 1,555,388	0 ------------- 0
2ARLENE DONOWITZ MD BOARD MEMBER	(i) (ii)	0 ------------- 334,213	0 ------------- 100,892	0 ------------- 6,599	0 ------------- 16,075	0 ------------- 2,004	0 ------------- 459,783	0 ------------- 0
3CHRISTOPHER GREENE MD EX-OFFICIO/CHIEF OF MED STAFF	(i) (ii)	0 ------------- 322,938	0 ------------- 140,142	0 ------------- 2,783	0 ------------- 16,075	0 ------------- 24,153	0 ------------- 506,091	0 ------------- 0
4JANELLE REILLY EX-OFFICIO/COO	(i) (ii)	0 ------------- 488,896	0 ------------- 164,554	0 ------------- 141,272	0 ------------- 53,212	0 ------------- 22,273	0 ------------- 870,207	0 ------------- 0
5WILLIAM WARREN MD BOARD MEMBER	(i) (ii)	0 ------------- 629,956	0 ------------- 122,830	0 ------------- 1,552	0 ------------- 16,075	0 ------------- 21,684	0 ------------- 792,097	0 ------------- 0
6TROY HAMMETT CFO/TREASURER	(i) (ii)	0 ------------- 367,409	0 ------------- 77,934	0 ------------- 15,734	0 ------------- 17,044	0 ------------- 24,691	0 ------------- 502,812	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation

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 2017 calendar year Catholic Health Initiatives ("CHI"), a related organization, maintained a supplemental non-qualified deferred compensation plan for MBO CEOs and other CHI employees at the level of Senior Vice President and above. The following reportable individuals were eligible to participate in that plan: Larry Schumacher Janelle Reilly DURING 2017 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: Larry Schumacher - $112,320 Janelle Reilly - $45,002

Schedule J (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CHI Memorial Hospital - Georgia

Employer identification number

82-2748395

Return Reference	Explanation
Form 990, Part I, Line 1	THE ORGANIZATION WAS, FOR THE YEAR ENDED 6/30/18, AFFILIATED WITH CATHOLIC HEALTH INITIATIVES ("CHI"). FOLLOWING THE CLOSE OF THE 6/30/2018 TAX YEAR, ON 2/1/19, IN CONNECTION WITH THE ALIGNMENT OF THE CATHOLIC MINISTRIES OF CHI AND DIGNITY HEALTH, CHI CHANGED ITS NAME TO COMMONSPIRIT HEALTH.
Form 990, Part III, Line 1 MISSION STATEMENT	(CONTINUTED FROM LINE 1) THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION.
Form 990, Part III, Line 2 New program services	CHI Memorial Hospital - GA was formed 9/11/2017 in the state of Georgia. The hospital was formed to serve the healthcare needs of Fort Oglethorpe, Georgia and the surrounding areas.
Form 990, Part III, Line 4d Description of other program services	(Expenses $ 7,201,813 including grants of $ 85,169)(Revenue $ 1,602,997) Other Services: Other services provided by CHI Memorial Hospital - GA include an on-site pharmacy, surgical services, and outpatient treatments as well as other medical services.
Form 990, Part VI, Line 12c CONFLICT OF INTEREST POLICY	The Board Chair or designee shall make such 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 will assume the Chair's role outlined in the COI Policy. Based on review and evaluation of the relevant facts and circumstances, the Board Chair will make 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, will be made. The Board Chair shall then make an appropriate report to the Executive Committee of the Board concerning such 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 within the COI Policy, the matter shall be submitted to the Board's Executive Committee, which shall make a final determination as to the matter presented. Such determination, including relevant facts and circumstances, will be reflected in the Executive Committee minutes and will be reported to the Board. The Board shall carefully scrutinize 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 Corporate Officer either: * Has a material financial interest; or * Is a Trustee or Corporate Officer of the other party (other than a CHI-affiliated organization). The Board must approve the transaction by a majority of the Trustees on the Board, without counting the vote of any individual who has an interest in the transaction. 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 shall act no more or less favorably than it would in reviewing transactions with unrelated third parties. The transaction will not be approved unless the Board determines that the transaction is fair to CHI or the CHI Entity. The Board shall carefully review and scrutinize 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.). By a majority vote of the disinterested Trustees, the Board shall take whatever action is deemed appropriate with respect to the Trustee or Corporate Officer under the circumstances, including possible disciplinary or corrective action, in order to best protect the interests of CHI or the CHI Entity. The Board should consult with the General Counsel of CHI or his or her designee when considering disciplinary or corrective action. When any conflict of interest is considered by the Board, the Trustee or Corporate Officer, as appropriate, must disclose all of the material facts to the Board. The Trustee shall not vote and the Trustee or Corporate Officer shall not use his or her personal influence on the 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 of significant importance. The Trustee or Corporate Officer shall be excused from the meeting during discussion and vote on the conflict of interest. Minutes of the Board shall reflect the following: 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. If the Board reasonably believes that a Trustee or Corporate Officer has failed to disclose either an actual or potential conflict of interest, or all material facts surrounding an actual or possible conflict as required by the COI Policy, the Trustee or Corporate Officer will be given an opportunity to explain such alleged failure to disclose. After hearing the response of the Trustee or Corporate Officer, the Board will conduct such additional investigation as may be appropriate. If the Board determines that the Trustee or Corporate Officer has in fact failed to disclose as required by the COI Policy, the Board shall take appropriate disciplinary or corrective action. All determinations of conflicts of interest are reported as required by law, regulations, and CHI policy.
Form 990, Part VI, Line 15 Process for Determining CEO and Officers/Key Employees Compensation	During the tax year ended 6/30/2018, 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 14 DOCUMENT RETENTION POLICY	WHILE THE ORGANIZATION DOES HAVE A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY IT HAS NOT BEEN FORMALLY ADOPTED BY THE BOARD.
Form 990, Part VI, Line 1a Delegate broad authority to a committee	PURSUANT TO SECTION 8.6 OF THE BYLAWS OF CHI MEMORIAL - GEORGIA, THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION AND SHALL BE COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, THE IMMEDIATE PAST CHAIRPERSON OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, AND THE SECRETARY, WITH ONE (1) OR TWO (2) OTHER DIRECTORS; PROVIDED THAT THE EXECUTIVE COMMITTEE SHALL INCLUDE: (1) TO THE EXTENT POSSIBLE, AT LEAST ONE MEMBER OF A PARTICIPATING CONGREGATION OR OTHER RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH, AND (2) AT LEAST ONE DIRECTOR WHO IS A PHYSICIAN MEMBER OF THE MEDICAL STAFF. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE (1) YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. ANY VACANCY OF AN APPOINTED EXECUTIVE COMMITTEE MEMBERSHIP MAY BE FILLED FOR THE UNEXPIRED PORTION OF THE TERM IN THE MANNER THAT THE ORIGINAL COMMITTEE MEMBER WAS APPOINTED. PURSUANT TO SECTION 8.1 OF THE CORPORATIONS BYLAWS, THE BOARD OF DIRECTORS MAY, BY RESOLUTION ADOPTED BY A MAJORITY OF THE DIRECTORS THEN IN OFFICE, ESTABLISH ONE OR MORE COMMITTEES, AS NEEDED OR REQUIRED TO CONDUCT AND TRANSACT THE BUSINESS OF THE CORPORATION. EXCEPT AS OTHERWISE PROVIDED IN THESE BYLAWS, THE BOARD OF DIRECTORS MAY SET THE QUALIFICATIONS FOR MEMBERSHIP ON ANY COMMITTEE IT MAY ESTABLISH; PROVIDED THAT EACH COMMITTEE SHALL CONSIST OF AT LEAST TWO (2) BOARD MEMBERS. COMMITTEES MAY INCLUDE PERSONS OTHER THAN DIRECTORS, EXCEPT THAT A COMMITTEE THAT HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MUST INCLUDE ONLY DIRECTORS OF THE CORPORATION. COMMITTEE MEMBERS SHALL SERVE FOR A TERM OF ONE (1) YEAR OR UNTIL THEIR SUCCESSORS ARE DULY APPOINTED AND QUALIFIED. 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 CHI Memorial - Georgia, the sole member of the Corporation shall be Memorial Health Care System, Inc., a Kentucky nonprofit corporation.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30TH 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 AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	CHI MEMORIAL HOSPITAL - GA'S CORPORATE MEMBER IS MEMORIAL HEALTH CARE SYSTEM ("MHCS"). PURSUANT TO SECTION 5.4 OF CHI MEMORIAL HOSPITAL - GA'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 MHCS BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE MHCS CHIEF EXECUTIVE OFFICER: * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF MHCS * AMENDMENT OF THE CORPORATE DOCUMENTS OF CHI MEMORIAL HOSPITAL - GA * APPROVE MEMBERS OF THE CHI MEMORIAL HOSPITAL - GA BOARD * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF CHI MEMORIAL HOSPITAL - GA * APPROVAL OF ISSUANCE OF DEBT BY CHI MEMORIAL HOSPITAL - GA * APPROVAL OF PARTICIPATION OF CHI MEMORIAL HOSPITAL - GA IN A JOINT VENTURE * APPROVAL OF FORMATION OF A NEW CORPORATION BY CHI MEMORIAL HOSPITAL - GA * APPROVAL OF A MERGER INVOLVING CHI MEMORIAL HOSPITAL - GA * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF CHI MEMORIAL HOSPITAL - GA * TO REQUIRE THE TRANSFER OF ASSETS BY CHI MEMORIAL HOSPITAL - GA TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR CHI MEMORIAL HOSPITAL - GA. IN ADDITION, PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, CHI MAY, IN EXERCISE OF ITS APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE.
Form 990, Part VI, Line 11b Review of form 990 by governing body	CHI MEMORIAL HOSPITAL - GA'S FORM 990 IS PREPARED AND REVIEWED BY THE INTERNAL TAX DEPARTMENT OF ITS PARENT ORGANIZATION, CHI. THE RETURN IS THEN REVIEWED BY CHI MEMORIAL HOSPITAL - GA'S FISCAL SERVICES DEPARTMENT AND ITS CHIEF FINANCIAL OFFICER. PRIOR TO FILING, A COPY OF THE RETURN IS PROVIDED TO EACH MEMBER OF THE BOARD ELECTRONICALLY. SUBSEQUENT TO PRESENTATION 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	Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy (the "Policy") in place to maintain the integrity of all of its activities. The Policy applies to CHI Board of Stewardship Trustees and members of its committees; all CHI Entity board and board committee members; all CHI employees; and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure review process. Each Person must 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 where the Person may be in doubt, a full disclosure should be made to permit an impartial and objective determination. In addition to the general ongoing obligation, there are initial disclosure obligations. At the time of initial appointment, a copy of the Policy shall be distributed to the board or committee member along with a conflict of interest disclosure. The board or committee member will complete and submit the disclosure. The completed disclosure shall be maintained in confidence and access shall be limited to persons who have a reasonable need to know the contents. At the time of hiring, a copy of the Policy shall be distributed to all Employees. In addition, a conflict of interest disclosure will be provided. The Employee must complete and submit a conflict of interest disclosure. The completed disclosure shall be maintained in confidence and access shall be limited to persons who have a reasonable need to know the contents. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. On an annual basis, the following Persons must complete a new conflict of interest disclosure: * Board and board committee members; * Employees at the level of vice president and above; * Researchers * Supply Chain Employees at the level of vice president and above and those employees involved in contracting regardless of employment level; * Other Employees as deemed applicable by CHI Leadership Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC"), National or Regional Legal Services, National, Entity, or Research Corporate Responsibility Program, or the Executive Committee of the Board or Board Chair, for review depending on the position of the person involved. Among the factors that should be considered in determining whether a conflict exists are the nature and magnitude of the opportunity, transaction or arrangement, the degree to which it is related to CHI's business, whether the Person with the conflict is the ultimate decision-maker or holds significant influence over the ultimate decision-maker (i.e., degree of independence of the decision-making process), the unique nature of the opportunity, transaction or arrangement, the existence of other viable alternatives and the quality of those alternatives, and what is customary and reasonable in the health care or research industry. When a Person has, or is considering initiating, a business interest or relationship outside of CHI but is uncertain whether the interest constitutes a conflict of interest requiring disclosure under this Policy, the Person should consult with local Corporate Responsibility Program (CRP) staff or CHI Legal Services Group (LSG) staff, as appropriate. As appropriate, a COI management plan will be developed. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such COI management plan in collaboration with local CRP staff or CHI LSG staff, as appropriate. This plan will include documentation of the C-CIRC's determinations and recommendations. As necessary, reports to an appropriate governmental agency or sponsor will be made according to the relevant appendices to this Policy to provide required information regarding how the conflict of interest will be managed, reduced, or eliminated. Designated CHI Entity staff are responsible for monitoring the COI management plan and for documenting monitoring activities. At its sole discretion, a CHI 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. The C-CIRC will determine whether a disclosed or otherwise identified interest is a conflict of interest. If the C-CIRC determines that a potential or actual conflict of interest exists that does not currently have appropriate controls to address the conflict of interest, it may recommend that the disclosing Person be allowed to participate in the activity or transaction subject to restrictions as outlined in a written COI management plan. All determinations of conflicts of interest will be reported as required by law, regulations, and CHI policy. If a Person, other than a board or board committee member or corporate officer, required to complete a COI disclosure 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 following steps should be followed. Within a reasonable period of time after receiving notice of the C-CIRC's decision, the Person must present the matter to the Person's immediate direct manager or supervisor (or in the case of a Researcher, to [fill in the title or position to whom Researchers report]) and request reconsideration, submitting at that time any new or additional information that may support or recommend reconsideration. If the Person's manager individually or in consultation with the manager's Vice President (or higher if the manager is a Vice President) finds that new information supporting reconsideration has been presented, the manager will contact local or National CRP staff, as appropriate, and request that the matter be re-presented to the C-CIRC. The C-CIRC will be reconvened for this purpose and, following such reconsideration, issue a final determination. This appeals process is intended to be narrowly applied, as Persons seeking conflict of interest exemptions or exceptions are expected to offer all available information supporting an exemption or exception at the time the matter is first presented to the C-CIRC. Management of actual or potential conflicts of interest of board or board committee members and corporate officers will be determined by the appropriate board, as reflected in the Policy. Reviews and determinations involving board and board committee members and corporate officers will be the responsibility of the board, board executive committee, or board chair, with guidance from the Legal Services Group (LSG). Each Trustee and Corporate Officer must promptly and fully report to the Board Chair situations that may create a conflict of interest when he or she becomes aware of such situations. In any situation when a Trustee or Corporate Officer is in doubt, full disclosure should be made to permit an impartial and objective determination. A written record of the disclosure will be made. In addition to the ongoing disclosure obligation, all Trustees and Corporate Officers shall complete a COI disclosure questionnaire on an annual basis. A copy of the COI Policy shall be available to Trustees and Corporate Officers. Definitions of terms used in the disclosure questionnaire/form shall also be included. Each Trustee and Corporate Officer must promptly complete the COI disclosure. COI disclosures that involve no disclosures of conflicts of interest will not require review. Disclosures of perceived, potential or actual conflicts of interest on the COI questionnaire involving financial interests will be reviewed by National or Regional LSG. (Continued on Schedule O)
Form 990, Part VI, Line 19 Required documents available to the public	THE ORGANIZING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINITIATIVES.ORG.
Form 990, Part IX, Line 11g Other Fees	Other Fees for Services - Total Expense: 40424, Program Service Expense: 40424, Management and General Expenses: 0, Fundraising Expenses: 0; Contract Services - Total Expense: 1848, Program Service Expense: 1663, Management and General Expenses: 185, Fundraising Expenses: ; Contract Labor - Total Expense: 63799, Program Service Expense: 63799, Management and General Expenses: , Fundraising Expenses: ; Purchased Services - Total Expense: 1591600, Program Service Expense: 1512020, Management and General Expenses: 79580, Fundraising Expenses: ;

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHI Memorial Hospital - Georgia

Employer identification number

82-2748395

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA,NE68154 47-0765154	HEALTHCARE	NE	501(c)(3)	3	ACH	Yes
(2)ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA,NE68154 47-0757164	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(3)ALEGENT CREIGHTON HEALTH FOUNDATION 12809 W DODGE RD OMAHA,NE68154 47-0648586	FUNDRAISING	NE	501(c)(3)	7	ACH	Yes
(4)ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA,NE68124 47-0484764	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(5)ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY,IA51555 42-0776568	HEALTHCARE	IA	501(c)(3)	3	CHI NEBRASKA	Yes
(6)ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA,NE68122 47-0376615	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(7)ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER,NE68661 47-0399853	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(8)ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING,IA50841 42-0782518	HEALTHCARE	IA	501(c)(3)	3	CHI NEBRASKA	Yes
(9)ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS,MN56345 41-1351177	LTERM CARE	MN	501(c)(3)	10	CHI	Yes
(10)APPLETREE COURT 601 OAK ST BRECKENRIDGE,MN56520 41-1850500	SENIOR LIVING	MN	501(c)(3)	10	SFH	Yes
(11)BAYLOR ST LUKE'S HEALTH VENTURES 17200 ST LUKES WAY STE 170 THE WOODLANDS,TX77384 27-4499340	PHYSICIANS	TX	501(c)(3)	Type I	SLCHS	Yes
(12)BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0458535	PHYSICIANS	TX	501(c)(3)	3	SLHS	Yes
(13)BELLEVILLE ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 27-4005511	HEALTHCARE	TX	501(c)(3)	3	SHSC	Yes
(14)BISHOP DRUMM RETIREMENT CENTER 5837 Winwood Dr Johnston,IA50131 42-0725196	LTERM CARE	IA	501(c)(3)	10	CHI-IA CORP	Yes
(15)BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 23-2187242	HEALTHCARE	CO	501(c)(3)	Type I	CHI	Yes
(16)BRAZOSPORT HEALTH FOUNDATION INC 1 West Way Ct LAKE JACKSON,TX77566 76-0080110	FUNDRAISING	TX	501(c)(3)	Type I	BRHS	Yes
(17)BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON,TX77566 80-0240261	HEALTHCARE	TX	501(c)(3)	3	BRHS	Yes
(18)BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2759890	HEALTHCARE	TX	501(c)(3)	3	SJSC	Yes
(19)BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2913931	HEALTHCARE	TX	501(c)(3)	10	SJSC	Yes
(20)CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON,ND58421 45-0227311	HEALTHCARE	ND	501(c)(3)	3	CHI	Yes
(21)CATHOLIC HEALTH INITIATIVES - COLORADO 9100 East Mineral Circle Centennial,CO80112 84-0405257	HEALTHCARE	CO	501(c)(3)	3	CHI	Yes
(22)CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES,IA50314 42-0680448	HEALTHCARE	IA	501(c)(3)	3	CHI	Yes
(23)CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS,CO80920 84-0902211	FUNDRAISING	CO	501(c)(3)	7	CHIC	Yes
(24)CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS,CO80920 27-0930004	FUNDRAISING	CO	501(c)(3)	Type I	CHI	Yes
(25)CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-0992796	HEALTHCARE	CO	501(c)(3)	Type I	CHINS	Yes
(26)CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG,OR97471 26-3946191	PHYSICIANS	OR	501(c)(3)	10	MMC	Yes
(27)CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND,KS67530 48-0543724	SURGERY CENTER	KS	501(c)(3)	3	CHI	Yes
(28)CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO,ND58104 27-1966847	HEALTHCARE	ND	501(c)(3)	10	CHI	Yes
(29)CHI INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 27-1050565	HEALTHCARE	CO	501(c)(3)	Type I	CHI	Yes
(30)CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER,KY41018 20-2741651	HEALTHCARE	KY	501(c)(3)	Type I	CHI	Yes
(31)CHI LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO,OH43623 34-1892096	HEALTHCARE	OH	501(c)(3)	Type II	SFH	Yes
(32)CHI Memorial Hospital - Georgia 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE,GA30742 82-2748395	HEALTHCARE	GA	501(c)(3)	3	MHCS	Yes
(33)CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 45-1261716	HEALTHCARE	CO	501(c)(3)	10	CHI NS	Yes
(34)CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 45-2532084	HEALTHCARE	CO	501(c)(3)	Type I	CHI	Yes
(35)CHI NEBRASKA 12809 West Dodge Road Omaha,NE68510 36-3233121	HEALTHCARE	NE	501(c)(3)	Type I	CHI	Yes
(36)CHI ST JOSEPH CHILDREN'S HEALTH 1929 LINCOLN HWY E STE 150 LANCASTER,PA17602 23-2342997	HEALTHCARE	PA	501(c)(3)	Type I	CHI	Yes
(37)CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE,NM87102 71-0897107	COMMUNITY	NM	501(c)(3)	Type I	CHI	Yes
(38)CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER 6624 FANNIN ST 1100 HOUSTON,TX77030 74-1161938	HEALTHCARE	TX	501(c)(3)	3	SLHS	Yes
(39)CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS,AR71913 71-0236913	HEALTHCARE	AR	501(c)(3)	3	CHISVHS	Yes
(40)CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS,AR71913 26-1125064	HOLDING CO	AR	501(c)(3)	Type II	SVIMC	Yes
(41)CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 300 WERNER ST HOT SPRINGS,AR71913 26-1125131	HEALTHCARE	AR	501(c)(3)	3	CHISVHS	Yes
(42)COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 47-0617373	HEALTHCARE	CO	501(c)(3)	Type I	NA	Yes
(43)COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK ST ACCOUNTING-3 W CINCINNATI,OH45206 23-7419853	HOLDING CO	OH	501(c)(4)		GSH	Yes
(44)COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY,IA51555 42-1294399	FUNDRAISING	IA	501(c)(3)	Type I	AH-CMHMV	Yes
(45)CONTINUING CARE HOSPITAL One Saint Joseph Drive LEXINGTON,KY40504 61-1400619	LT ACH	KY	501(c)(3)	3	SJHS	Yes
(46)East Texas Clinical Services 2801 VIA FORTUNA SUITE 500 AUSTIN,TX78746 45-4736213	HEALTHCARE	TX	501(c)(3)	Type I	MHSET	Yes
(47)ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1455 BATTERSBY AVE ENUMCLAW,WA98022 91-0715805	HEALTHCARE	WA	501(c)(3)	3	FHS	Yes
(48)FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN,KY40004 61-1345363	HEALTHCARE	KY	501(c)(3)	3	KOH	Yes
(49)FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN,KY40004 56-2351341	FUNDRAISING	KY	501(c)(3)	Type I	FH	Yes
(50)FRANCISCAN CARE CENTER 4111 N HOLLAND-SYLVANIA RD TOLEDO,OH43623 34-1931806	HEALTHCARE	OH	501(c)(3)	10	FLC	Yes
(51)FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA,WA98405 91-1145592	FUNDRAISING	WA	501(c)(3)	10	FHS	Yes
(52)FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA,WA98405 91-0564491	HEALTHCARE	WA	501(c)(3)	3	CHI	Yes
(53)FRANCISCAN HEALTH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BROADWAY TACOMA,WA98402 43-1882377	PHYSICIANS	WA	501(c)(3)	10	CHI	Yes
(54)FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA,WA98402 91-1939739	HEALTHCARE	WA	501(c)(3)	10	FHS	Yes
(55)FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE,WI53172 39-1093829	HEALTHCARE	WI	501(c)(3)	10	CHI	Yes
(56)GARRISON MEMORIAL HOSPITAL 407 THIRD AVENUE SOUTHEAST GARRISON,ND58540 45-0227752	HEALTHCARE	ND	501(c)(3)	3	SAMC	Yes
(57)GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 20-1536108	MINISTRIES	CO	501(c)(3)	Type I	CHI	Yes
(58)GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK ST ACCOUNTING-3 W CINCINNATI,OH45206 31-1778403	EDUCATION	OH	501(c)(3)	2	GSH	Yes
(59)GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK ST ACCOUNTING-3 W CINCINNATI,OH45206 31-1206047	FUNDRAISING	OH	501(c)(3)	Type I	GSH	Yes
(60)GOOD SAMARITAN HOSPITAL 110 N MAIN ST STE 500 DAYTON,OH45402 31-0536981	HEALTHCARE	OH	501(c)(3)	3	SHP	Yes
(61)GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY,NE68848 47-0379755	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(62)GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY,NE68847 47-0659443	FUNDRAISING	NE	501(c)(3)	7	GSH	Yes
(63)GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON 110 N MAIN ST STE 500 DAYTON,OH45402 23-7296923	FUNDRAISING	OH	501(c)(3)	7	SHP	Yes
(64)HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON,WA98310 91-0565546	HEALTHCARE	WA	501(c)(3)	3	FHS	Yes
(65)HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVE BREMERTON,WA98310 91-1197626	FUNDRAISING	WA	501(c)(3)	7	HMC	Yes
(66)HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 76-0761782	FUNDRAISING	MN	501(c)(3)	Type I	SFMC	Yes
(67)HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN,WA98166 91-0712166	HEALTHCARE	WA	501(c)(3)	3	FHS	Yes
(68)HOUSE OF MERCY 1111 6TH AVE DES MOINES,IA50314 42-1323808	SHELTER	IA	501(c)(3)	7	CHI-IA CORP	Yes
(69)JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 250 E Liberty St Ste 500 LOUISVILLE,KY40202 61-1029768	HEALTHCARE	KY	501(c)(3)	3	KOH	Yes
(70)KENTUCKYONE HEALTH MEDICAL GROUP INC 100 E Liberty St Ste 800 LOUISVILLE,KY40202 61-1352729	HEALTHCARE	KY	501(c)(3)	10	JHSMH	Yes
(71)KENTUCKYONE HEALTH INC 200 ABRAHAM FLEXNER WAY LOUISVILLE,KY40202 61-1029769	HEALTHCARE	KY	501(c)(3)	Type II	CHI	Yes
(72)LAKEWOOD HEALTH CENTER 600 MAIN AVE S BAUDETTE,MN56623 41-0758434	HEALTHCARE	MN	501(c)(3)	3	CHI	Yes
(73)LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVE S BAUDETTE,MN56623 41-1893795	FUNDRAISING	MN	501(c)(3)	7	LHC	Yes
(74)LINUS OAKES INC 2700 STEWART PKWY ROSEBURG,OR97471 93-0821381	SENIOR LIVING	OR	501(c)(3)	10	MMC	Yes
(75)LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON,ND58054 82-0558836	HEALTHCARE	ND	501(c)(3)	3	CHI	Yes
(76)LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN,TX75901 82-0563768	PROPERTY MGMT	TX	501(c)(3)	Type I	MHSET	Yes
(77)MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2761145	HEALTHCARE	TX	501(c)(3)	3	SJSC	Yes
(78)MADONNA MANOR INC 2344 AMSTERDAM ROAD VILLA HILLS,KY51017 61-0654635	LIVING ASSIST	KY	501(c)(3)	10	FLC	Yes
(79)MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA,TN37404 62-1839548	FUNDRAISING	TN	501(c)(3)	7	MHCS	Yes
(80)MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA,TN37404 62-0532345	HEALTHCARE	TN	501(c)(3)	3	CHI	Yes
(81)MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA,TN37411 03-0417049	HEALTHCARE	TN	501(c)(3)	10	MHCS	Yes
(82)MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN,TX75902 75-0755367	HEALTHCARE	TX	501(c)(3)	3	CHI	Yes
(83)MEMORIAL MEDICAL CENTER - LIVINGSTON PO BOX 1447 LUFKIN,TX75902 76-0436439	HEALTHCARE	TX	501(c)(3)	3	MHSET	Yes
(84)MEMORIAL MEDICAL CENTER - SAN AUGUSTINE PO BOX 1447 LUFKIN,TX75902 75-2663904	HEALTHCARE	TX	501(c)(3)	3	MHSET	Yes
(85)MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVE LUFKIN,TX95904 75-2721155	PHYSICIANS	TX	501(c)(3)	Type I	MHSET	Yes
(86)MEMORIAL SPECIALTY HOSPITAL PO BOX 1447 LUFKIN,TX95902 75-2492741	HEALTHCARE	TX	501(c)(3)	3	MHSET	Yes
(87)MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVE DES MOINES,IA50314 42-6076069	AUXILIARY	IA	501(c)(3)	Type I	MF-DM IA	Yes
(88)MERCY CLINICS INC 1111 6TH AVE DES MOINES,IA50314 42-1193699	PHYSICIANS	IA	501(c)(3)	10	CHI-IA CORP	Yes
(89)MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVE DES MOINES,IA50314 42-1511682	EDUCATION	IA	501(c)(3)	2	CHI-IA CORP	Yes
(90)MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES,IA50314 23-7358794	FUNDRAISING	IA	501(c)(3)	7	CHI-IA CORP	Yes
(91)MERCY FOUNDATION INC 2700 STEWART PKWY ROSEBURG,OR97471 93-6088946	FUNDRAISING	OR	501(c)(3)	7	MMC	Yes
(92)MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING,IA50841 42-1461064	FUNDRAISING	IA	501(c)(3)	Type I	AHMH-Corning	Yes
(93)MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BLVD VALLEY CITY,ND58072 45-0435338	FUNDRAISING	ND	501(c)(3)	Type I	MHVC	Yes
(94)MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS,IA51503 42-1178204	FUNDRAISING	IA	501(c)(3)	Type I	AHBMHS	Yes
(95)MERCY HOSPITAL OF DEVILS LAKE 1031 7TH ST NE DEVILS LAKE,ND58301 45-0227012	HEALTHCARE	ND	501(c)(3)	3	CHI	Yes
(96)MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 7TH ST NE DEVILS LAKE,ND58301 35-2367360	FUNDRAISING	ND	501(c)(3)	7	MHDL	Yes
(97)MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BLVD VALLEY CITY,ND58072 45-0226553	HEALTHCARE	ND	501(c)(3)	3	CHI	Yes
(98)MERCY MEDICAL CENTER 1301 15TH AVE WEST WILLISTON,ND58801 45-0231183	HEALTHCARE	ND	501(c)(3)	3	CHI	Yes
(99)MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE,IA52544 42-0680308	HEALTHCARE	IA	501(c)(3)	3	CHI-IA CORP	Yes
(100)MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER 204 N 4th Ave E Newton,IA50314 42-1470935	PHYSICIANS	IA	501(c)(3)	3	CHI-IA CORP	Yes
(101)MERCY MEDICAL CENTER INC 2700 STEWART PKWY ROSEBURG,OR97471 93-0386868	HEALTHCARE	OR	501(c)(3)	3	CHI	Yes
(102)MERCY MEDICAL FOUNDATION 1301 15TH AVE WEST WILLISTON,ND58801 45-0381803	FUNDRAISING	ND	501(c)(3)	Type I	MMC	Yes
(103)NEBRASKA HEART HOSPITAL 7500 S 91ST ST LINCOLN,NE68526 39-2031968	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(104)North Central Health Care Alliance dba PrimeCare Health Group 401 N 9th St BISMARCK,ND585014507 45-0439894	HEALTHCARE	ND	501(c)(3)	7	NHCA	Yes
(105)OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES,ND58474 45-0231675	HEALTHCARE	ND	501(c)(3)	3	CHI	Yes
(106)OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH ST OAKES,ND58474 71-0966606	FUNDRAISING	ND	501(c)(3)	Type I	OCH	Yes
(107)PINEYWOODS MEDICAL DEVELOPMENT CORP PO BOX 1447 LUFKIN,TX75902 75-2493116	PROPERTY MGMT	TX	501(c)(3)	Type I	MHSET	Yes
(108)PROVIDENCE CARE CENTER 2025 HAYES AVENUE SANDUSKY,OH44870 34-1658625	HEALTHCARE	OH	501(c)(3)	10	FLC	Yes
(109)PROVIDENCE CARE CENTERS 2025 HAYES AVENUE SANDUSKY,OH44870 34-1826099	HOLDING CO	OH	501(c)(3)	Type II	FLC	Yes
(110)PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY,OH44870 34-1896807	LIVING COMM	OH	501(c)(3)	10	FLC	Yes
(111)PUEBLO STEPUP 1925 E ORMAN AVE STE G52 PUEBLO,CO81004 84-1234295	COMMUNITY	CO	501(c)(3)	7	CHIC	Yes
(112)REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE 16251 Sylvester Road SW Burien,WA98166 91-1170040	HEALTHCARE	WA	501(c)(3)	3	FHS	Yes
(113)SET OF COLORADO SPRINGS INC 9100 E Mineral Circle Centennial,CO80112 84-1183335	LTERM CARE	CO	501(c)(3)	7	CHIC	Yes
(114)SAINT CLARE'S COMMUNITY CARE INC 25 POCONO RD DENVILLE,NJ07834 22-2876836	HEALTHCARE	NJ	501(c)(3)	10	SCHS	Yes
(115)SAINT CLARE'S FOUNDATION INC 25 POCONO RD DENVILLE,NJ07834 22-2502997	FUNDRAISING	NJ	501(c)(3)	7	SCHS	Yes
(116)SAINT CLARE'S HEALTH SERVICES INC 25 POCONO RD DENVILLE,NJ07834 22-3639733	MANAGEMENT	NJ	501(c)(3)	10	CHI	Yes
(117)SAINT CLARE'S HOSPITAL INC 25 POCONO RD DENVILLE,NJ07834 22-3319886	HEALTHCARE	NJ	501(c)(3)	3	SCHS	Yes
(118)SAINT ELIZABETH FOUNDATION 555 S 70TH ST LINCOLN,NE68510 47-0625523	FUNDRAISING	NE	501(c)(3)	7	SERMC	Yes
(119)SAINT ELIZABETH HEALTH SERVICES 555 S 70TH ST LINCOLN,NE68510 36-3233120	HEALTHCARE	NE	501(c)(3)	3	SERMC	Yes
(120)SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 S 70TH ST LINCOLN,NE68510 47-0379836	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(121)SAINT FRANCIS MEDICAL CENTER 2620 W FAIDLEY GRAND ISLAND,NE68803 47-0376601	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(122)SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND,NE68802 47-0630267	FUNDRAISING	NE	501(c)(3)	7	SFMC	Yes
(123)SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL ST BEREA,KY40403 26-0152877	FUNDRAISING	KY	501(c)(3)	7	SJHS	Yes
(124)SAINT JOSEPH HEALTH SYSTEM INC 200 ABRAHAM FLEXNER WAY LOUISVILLE,KY40202 61-1334601	HEALTHCARE	KY	501(c)(3)	3	KOH	Yes
(125)SAINT JOSEPH HOSPITAL FOUNDATION INC 701 Bob Olink Dr 200 LEXINGTON,KY40504 61-1159649	FUNDRAISING	KY	501(c)(3)	Type I	SJHS	Yes
(126)SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON,KY40741 26-0438748	FUNDRAISING	KY	501(c)(3)	7	SJHS	Yes
(127)SAINT JOSEPH MOUNT STERLING FOUNDATION INC 225 FALCON DR MOUNT STERLING,KY40353 27-2884584	FUNDRAISING	KY	501(c)(3)	7	SJHS	Yes
(128)SAINT JOSEPH'S HOSPITAL FOUNDATION 2500 Fairway Street DICKINSON,ND58601 36-3418207	FUNDRAISING	ND	501(c)(3)	Type I	SJHHC	Yes
(129)SAMARITAN BEHAVIORAL HEALTH INC 110 N MAIN ST STE 500 DAYTON,OH45402 02-0633634	HEALTHCARE	OH	501(c)(3)	7	SHP	Yes
(130)SAMARITAN HEALTH PARTNERS 110 N MAIN ST STE 500 DAYTON,OH45402 31-1107411	HEALTHCARE	OH	501(c)(3)	Type I	CHI	Yes
(131)SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC 104 W 17TH ST SCHUYLER,NE68661 36-3630014	FUNDRAISING	NE	501(c)(3)	Type I	AHMHS	Yes
(132)SJRMC JOPLIN MISSOURI 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 44-0545809	HEALTHCARE	CO	501(c)(3)	3	CHI	Yes
(133)ST ALEXIUS MEDICAL CENTER 900 EAST BROADWAY AVENUE BISMARCK,ND58501 45-0226711	HEALTHCARE	ND	501(c)(3)	3	CHI	Yes
(134)ST ANTHONY HOSPITAL 2801 St Anthony Way PENDLETON,OR97801 93-0391614	HEALTHCARE	OR	501(c)(3)	3	CHI	Yes
(135)ST ANTHONY HOSPITAL FOUNDATION 2801 St Anthony Way PENDLETON,OR97801 93-0992727	FUNDRAISING	OR	501(c)(3)	Type I	SAH	Yes
(136)ST ANTHONY'S HOSPITAL ASSOCIATION FOUR HOSPITAL DR MORRILTON,AR72110 71-0245507	HEALTHCARE	AR	501(c)(3)	3	SVIMC	Yes
(137)ST CATHERINE HOSPITAL 401 EAST SPRUCE ST GARDEN CITY,KS67846 48-0543721	HEALTHCARE	KS	501(c)(3)	3	CHI	Yes
(138)ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION 401 EAST SPRUCE ST GARDEN CITY,KS67846 20-0598702	FUNDRAISING	KS	501(c)(3)	Type I	SCH	Yes
(139)ST CLARE COMMONS 12469 Five Point Road TOLEDO,OH43551 27-0163752	LIVING COMM	OH	501(c)(3)	10	FLC	Yes
(140)ST DOMINIC OF ONTARIO OREGON 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 93-0433692	HEALTHCARE	CO	501(c)(4)		CHI	Yes
(141)ST FRANCIS HOME 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 41-0729978	LTERM CARE	MN	501(c)(3)	10	CHI	Yes
(142)ST FRANCIS LIFE CARE CORPORATION 19 POCONO RD DENVILLE,NJ07834 22-2536017	ELDERLY CARE	NJ	501(c)(3)	10	SCHS	Yes
(143)ST FRANCIS MEDICAL CENTER 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 41-0695598	HEALTHCARE	MN	501(c)(3)	3	CHI	Yes
(144)ST JOSEPH FOUNDATION OF BRYAN TEXAS 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2351158	FUNDRAISING	TX	501(c)(3)	Type II	SJSC	Yes
(145)ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2847594	HEALTHCARE	TX	501(c)(3)	10	SJSC	Yes
(146)ST JOSEPH MEDICAL CENTER INC 201 INTERNATIONAL CIRCLE STE 212 HUNT VALLEY,MD21030 52-0591461	HEALTHCARE	MD	501(c)(3)	3	CHI	Yes
(147)ST JOSEPH PHYSICIAN ASSOCIATES 2801 FRANCISCAN DRIVE BRYAN,TX77802 20-3159302	HEALTHCARE	TX	501(c)(3)	3	SJSC	Yes
(148)ST JOSEPH PHYSICIAN ENTERPRISE INC 201 INTERNATIONAL CIRCLE STE 212 HUNT VALLEY,MD21030 52-1311775	PHYSICIANS	MD	501(c)(3)	Type I	SJMC	Yes
(149)ST JOSEPH REGIONAL HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-1282696	HEALTHCARE	TX	501(c)(3)	3	SJSC	Yes
(150)ST JOSEPH REGIONAL HEALTH PARTNERS 2801 FRANCISCAN DRIVE BRYAN,TX77802 45-4088170	HEALTHCARE	TX	501(c)(3)	3	SJSC	Yes
(151)ST JOSEPH REGIONAL HEALTH PARTNERS ACO 2801 FRANCISCAN DRIVE BRYAN,TX77802 46-3265423	HEALTHCARE	TX	501(c)(3)	10	SJSC	Yes
(152)ST JOSEPH SERVICES CORPORATION 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2455161	MANAGEMENT	TX	501(c)(3)	Type I	SFH	Yes
(153)ST JOSEPH'S AREA HEALTH SERVICES 600 PLEASANT AVE PARK RAPIDS,MN56470 41-0695603	HEALTHCARE	MN	501(c)(3)	3	CHI	Yes
(154)ST JOSEPH'S HOSPITAL AND HEALTH CENTER 2500 Fairway St DICKINSON,ND58601 45-0226429	HEALTHCARE	ND	501(c)(3)	3	CHI	Yes
(155)ST LEONARD 8100 CLYO ROAD CENTERVILLE,OH45458 34-1940863	LIVING COMM	OH	501(c)(3)	10	FLC	Yes
(156)ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - PMC 6624 FANNIN ST STE 2505 HOUSTON,TX77030 27-3733278	HEALTHCARE	TX	501(c)(3)	3	SLCDC	Yes
(157)ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-1947374	HEALTHCARE	TX	501(c)(3)	3	SLHS	Yes
(158)ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-0335902	HEALTHCARE	TX	501(c)(3)	3	SLCDC	Yes
(159)ST LUKE'S COMMUNITY HEALTH SERVICES 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0536234	HEALTHCARE	TX	501(c)(3)	3	SLHS	Yes
(160)ST LUKE'S FOUNDATION 1213 HERMANN DRIVE STE 855 HOUSTON,TX77004 45-3811485	FUNDRAISING	TX	501(c)(3)	7	SLHS	Yes
(161)ST LUKE'S HEALTH SYSTEM CORPORATION PO Box 20269 HOUSTON,TX77225 76-0536232	MANAGEMENT	TX	501(c)(3)	Type I	CHI	Yes
(162)ST LUKE'S HOSPITAL AT THE VINTAGE 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-3734606	HEALTHCARE	TX	501(c)(3)	3	SLHS	Yes
(163)ST LUKE'S MEDICAL TOWER CORPORATION 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0531713	PROPERTY MGMT	TX	501(c)(3)	Type I	CHI-SLH	Yes
(164)ST LUKE'S PROPERTIES CORPORATION 1213 Hermann Drive Ste 855 HOUSTON,TX77004 76-0531716	PROPERTY MGMT	TX	501(c)(3)	Type I	SLHS	Yes
(165)ST LUKE'S SUGAR LAND PROPERTIES CORPORATION 6624 FANNIN ST STE 2505 HOUSTON,TX77030 45-4120549	PROPERTY MGMT	TX	501(c)(3)	Type I	SLCDC-SL	Yes
(166)ST MARY'S COMMUNITY HOSPITAL 1301 Grundman Boulevard NEBRASKA CITY,NE68410 47-0443636	HEALTHCARE	NE	501(c)(3)	3	CHI NEBRASKA	Yes
(167)ST MARY'S HOSPITAL FOUNDATION 1314 3RD AVE NEBRASKA CITY,NE68410 47-0707604	FUNDRAISING	NE	501(c)(3)	7	SMCH	Yes
(168)ST VINCENT FOUNDATION TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 51-0169537	FUNDRAISING	AR	501(c)(3)	Type I	SVIMC	Yes
(169)ST VINCENT INFIRMARY MEDICAL CENTER TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 71-0236917	HEALTHCARE	AR	501(c)(3)	3	CHI	Yes
(170)ST VINCENT MEDICAL GROUP TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 71-0830696	HEALTHCARE	AR	501(c)(3)	10	SVIMC	Yes
(171)SYLVANIA FRANCISCAN HEALTH 1715 INDIAN WOOD CIR 200 MAUMEE,OH43537 34-1412964	HEALTHCARE	OH	501(c)(3)	Type I	CHI	Yes
(172)SYLVANIA FRANCISCAN HEALTH FOUNDATION 1715 INDIAN WOOD CIR 200 MAUMEE,OH43537 45-5357161	FUNDRAISING	OH	501(c)(3)	Type I	FLC	Yes
(173)THE COMMONS OF PROVIDENCE 5000 PROVIDENCE DRIVE SANDUSKY,OH44870 34-1826097	ASSIST LIVING	OH	501(c)(3)	10	FLC	Yes
(174)THE COMMUNITY HOSPITAL OF BRAZOSPORT 100 MEDICAL DRIVE LAKE JACKSON,TX77566 74-1385192	HEALTHCARE	TX	501(c)(3)	3	SLHS	Yes
(175)THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH 619 OAK ST ACCOUNTING-3 W CINCINNATI,OH45206 31-0537486	HEALTHCARE	OH	501(c)(3)	3	CHI	Yes
(176)THE HEART INSTITUTE OF DAYTON 110 N MAIN ST STE 500 DAYTON,OH45402 30-0502367	HEALTHCARE	OH	501(c)(3)	10	CHS	Yes
(177)THE PHYSICIAN NETWORK 2000 Q ST STE 500 LINCOLN,NE68503 47-0780857	PHYSICIANS	NE	501(c)(3)	Type I	CHI NEBRASKA	Yes
(178)TOTAL HEALTHCARE 9100 E Mineral Circle Centennial,CO80112 84-0927232	HEALTHCARE	CO	501(c)(3)	3	CHIC	Yes
(179)TRINITY HEALTH FOUNDATION 380 SUMMIT AVENUE STEUBENVILLE,OH43952 31-1329423	FUNDRAISING	OH	501(c)(3)	Type I	THS	Yes
(180)TRINITY HEALTH SYSTEM 380 SUMMIT AVENUE STEUBENVILLE,OH43952 34-1818681	HEALTHCARE	OH	501(c)(3)	Type I	SFH	Yes
(181)TRINITY HEALTH SYSTEM GROUP 380 SUMMIT AVENUE STEUBENVILLE,OH43952 30-0752920	HEALTHCARE	OH	501(c)(3)	Type II	THS	Yes
(182)TRINITY HOSPITAL TWIN CITY 819 NORTH FIRST STREET DENNISON,OH44621 27-5401105	HEALTHCARE	OH	501(c)(3)	3	SFH	Yes
(183)TRI-STATE HEALTH SERVICES INC ONE ROSS PARK BLVD STEUBENVILLE,OH43952 34-1522484	ASSIST LIVING	OH	501(c)(3)	7	THS	Yes
(184)UNITY FAMILY HEALTHCARE 815 SE 2ND ST LITTLE FALLS,MN56345 41-0721642	HEALTHCARE	MN	501(c)(3)	3	CHI	Yes
(185)VILLA NAZARETH INC 801 PAGE DR FARGO,ND58103 45-0226714	LTERM CARE	ND	501(c)(3)	10	CHI	Yes
(186)VISITING NURSE ASSOCIATION OF ST CLARE'S INC 191 WOODPORT RD SPARTA,NJ07871 22-1768334	HOME HEALTH	NJ	501(c)(3)	10	SCHS	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Audubon Land Company LLC 630 Southpointe Court 200 COLORADO SPRINGS,CO80906 84-1513085	Real Estate	CO	CHIC	Related	298,037	20,270,617		No			No	73 %
(2) AVON EMERGENCY AND URGENT CARE CENTER LLC 9100 E Mineral Circle Centennial,CO80112 81-1727282	HEALTHCARE SRVC	CO	CHIC	Related	-757,555	6,191,153		No		Yes		77 %
(3) BAYLOR CHI ST LUKES HEALTH SERVICES LLC 6624 Fannin St Ste 1100 HOUSTON,TX77030 47-2079184	HEALTHCARE SRVC	TX	SLHS	Related	0	3,250,000		No		Yes		65 %
(4) BERGAN MERCY SURGERY CENTER LLC 7710 Mercy Rd Ste 200 OMAHA,NE68124 20-8671994	AMBUL SURG CTR	NE	ACH	Related	1,187,048	2,549,504		No			No	53 %
(5) BERYWOOD OFFICE PROPERTIES LLC 2501 Citico Avenue CHATTANOGA,TN37404 62-1875199	PHYS OFFICE	TN	MHCS	Related	133,390	918,922		No		Yes		63 %
(6) BLUEGRASS REGIONAL IMAGING CENTER 1218 SOUTH BROADWAY STE 310 LEXINGTON,KY40504 61-1386736	DIAGNOSTIC IMAGING	KY	SJHS	Related	122,291	3,216,558		No			No	65 %
(7) CATHOLIC HEALTH INITIATIVES PHYSICIAN SERVICES LLC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-2945938	PRACTICE MGMT SRVC	CO	CHI	Related	1,263,355	-272,620		No		Yes		100 %
(8) CENTRAL NEBRASKA REHABILITATION SERVICES LLC 3004 W FAIDLEY AVENUE GRAND ISLAND,NE68803 81-0653461	Physical Therapy	NE	SFMC	Related	3,422,589	3,722,591		No			No	51 %
(9) CENTURA-SCA HOLDINGS LLC 569 BROOK VILLAGE STE 901 BIRMINGHAM,AL35209 47-4823023	OP SURGERY CENTER	AL	CHIC	Related	1,734,228	2,020,115		No		Yes		65 %
(10) CHI OPERATING INVESTMENT PROGRAM LP 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 47-0727942	INVESTMENTS	CO	CHI	Unrelated	468,697,209	6,697,320,773		No	1,194,677	Yes		100 %
(11) CHICAMSURG Surgery Centers LLC 1A Burton Hills Blvd Nashville,TN37215 46-5683027	SURGERY CENTER	TN	CHIC	Related	76,843	134,172		No			No	51 %
(12) CHICLARKIN VENTURES LLC 9100 E Mineral Circle Centennial,CO80112 47-4210888	URGENT CARE	CO	CHIC	Related	167,285	7,823,355		No		Yes		87 %
(13) Colorado Springs CK Leasing LLC 630 Southpointe Court 200 COLORADO SPRINGS,CO80906 26-2982714	REAL ESTATE	CO	CHIC	Related	668,738	-132,333		No		Yes		52 %
(14) FRANCISCAN SPECIALTY CARE LLC 680 SOUTH FOURTH STREET LOUISVILLE,KY40202 81-3725123	HEALTHCARE SRVC	KY	FHS	Related	0	101,598		No		Yes		51 %
(15) HC SL VINTAGE I LLC 18000 W SARAH LANE STE 250 BROOKFIELD,WI53045 27-0453767	PROPERTY HOLDING	WI	SL HOSP-VINTAGE	Related	1,686,676	52,912,453		No			No	51 %
(16) HEALTHCARE SUPPORT SERVICES LLC PO BOX 9804 GRAND ISLAND,NE68802 72-1546196	LAUNDRY	NE	na	Related	376,035	4,358,356		No			No	100 %
(17) Heartland Oncology LLC 2337 E Crawford St Salina,KS67401 46-4265403	ONCOLOGY	KS	SCH	Related	-403,368	850,579		No			No	51 %
(18) LAKESIDE AMBULATORY SURGICAL CENTER LLC 17031 LAKESIDE HILLS DR OMAHA,NE68130 20-4267902	AMBUL SURG CTR	NE	ACH	Related	3,108,510	2,029,071		No			No	60 %
(19) LAKESIDE ENDOSCOPY CENTER LLC 17001 LAKESIDE HILLS PLZ STE 201 OMAHA,NE68130 20-5544496	ENDOSCOPY SRVC	NE	ACH	Related	699,620	777,431		No			No	51 %
(20) LINCOLN CK LEASING LLC 555 SOUTH 70TH STREET Lincoln,NE68510 26-2496856	Real Estate	NE	SERMC	Related	812,108	301,911		No			No	54 %
(21) Mercy Rehabilitation Hospital LLC 680 SOUTH FOURTH STREET LOUISVILLE,KY40202 81-4437201	HEALTHCARE SRVC	KY	CHI IA	Related	0	1,138,872		No			No	51 %
(22) NEBRASKA SPINE HOSPITAL LLC 6901 N 72ND ST STE 20300 OMAHA,NE68122 27-0263191	SPINE HOSPITAL	NE	ACH	Related	11,039,563	19,771,159		No			No	51 %
(23) NORTH RIVER SURGERY CENTER LLC 2209 WILDWOOD AVE SHERWOOD,AR72120 71-0799771	AMBUL SURG CTR	AR	SVIMC	Related	279,520	1,700,868		No			No	67 %
(24) ORTHOCOLORADO LLC 11650 WEST 2ND PLACE LAKEWOOD,CO80228 37-1577105	ORTHO HOSPITAL	CO	CHIC	Related	15,065,598	3,364,245		No			No	60 %
(25) Pasadena Urgency Center LLC 4600 E SAM HOUSTON PKWY SOUTH PASADENA,TX77505 81-2482854	URGENT CARE	TX	SLHS	Related	-1,031,166	1,686,969		No			No	57 %
(26) PENINSULA RADIATION ONCOLOGY LLC 314 MLK JR WAY STE 11 TACOMA,WA98405 87-0808610	HEALTHCARE SRVC	WA	FHS	Related	377,689	1,738,875		No			No	60 %
(27) Penrad Imaging LLC 1390 Kelly Johnson Blvd COLORADO SPRINGS,CO80920 84-1072619	Medical Imaging	CO	CHIC	Related	-2,396,662	1,744,893		No			No	70 %
(28) PMC HOSPITAL LLC 3100 MAIN ST STE 500 HOUSTON,TX77002 27-3280598	HOSPITAL	TX	SL CDC-PMC	Related	3,630,803	64,361,393		No		Yes		51 %
(29) Pueblo Ambulatory Surgery Center LLC 25 Montebello Rd Pueblo,CO81003 62-1488737	SURGERY CENTER	CO	CHIC	Related	-74,501	210,538		No			No	51 %
(30) Saint JOSEPH - PAML LLC 200 ABRAHAM FLEXNER WAY LOUISVILLE,KY40202 45-2116736	MGMT SVCS	KY	SJHS	Related	-19,517	1,393,440		No		Yes		63 %
(31) SAINT JOSEPH - SCA HOLDINGS LLC 1451 Harrodsburg RD LEXINGTON,KY40503 45-3801157	OP SURGERY	KY	SJHS	Related	0	0		No		Yes		51 %
(32) SAINT JOSEPH-ANC HOME CARE SERVICES 1700 EDISON DR MILFORD,OH45150 26-3330545	HOME HEALTH	OH	CHINHC	Related	4,139,859	13,245,757		No			No	100 %
(33) ST FRANCIS LAND COMPANY 5390 N ACADEMY BLVD STE 300 COLORADO SPRINGS,CO80918 26-3134100	REAL ESTATE	CO	CHIC	Related	151,050	13,285,935		No			No	59 %
(34) ST LUKE'S DIAGNOSTIC CATH LAB LLP 6624 FANNIN ST STE 800 HOUSTON,TX77030 71-0959365	DIAGNOSTICS	TX	SLHS HOLDINGS	Related	469,596	609,938		No		Yes		45 %
(35) ST LUKE'S LAKESIDE HOSPITAL LLC 6624 FANNIN STE 2505 HOUSTON,TX77030 30-0427437	HOSPITAL	TX	SL CDC-W	Related	1,269,122	36,450,234		No		Yes		51 %
(36) ST LUKE'S THE WOODLANDS SLEEP CENTER LLC 6624 FANNIN STE 800 HOUSTON,TX77030 46-2795726	DIAGNOSTICS	TX	SLHSH	Related	-76,895	1,135,073		No		Yes		51 %
(37) SURGERY CENTER OF LEXINGTON LLC 200 ABRAHAM FLEXNER WAY LOUISVILLE,KY40202 62-1179539	SURGERY CENTER	KY	SJHS	Related	-108,052	0		No		Yes		51 %
(38) THREE SPRING IMAGING LLC 1 Mercado St STE 200A DURANGO,CO81301 81-3571570	HEALTHCARE SRVC	CO	CHIC	Related	76,753	84,093		No		Yes		51 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) Alegent HealthCreighton St Joseph Managed Care Services Inc 12809 West Dodge Rd Omaha,NE68154 47-0802396	Managed Care	NE	CHI Nebraska	C Corporation	9,217,638	22,568,323	100 %	Yes
(2) All Saints Insurance Company SPC Ltd PO BOX 10073 APO Georgetown,GRAND CAYMANKY11001 CJ 98-0556913	Insurance	CJ	CHI	C Corporation	0	0	100 %	Yes
(3) ALLIANCE HEALTH PROVIDERS OF BRAZOS Valley Inc 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2466914	Healthcare	TX	SJSC	C Corporation	236,684	699,916	100 %	Yes
(4) Alternative Insurance Management Service Inc 3900 OLYMPIC BLVD STE 400 Erlanger,KY41018 84-1112049	Management Services	KY	CHI	C Corporation	5,601	6,045,874	100 %	Yes
(5) AMERICAN NURSING CARE Inc 1700 EDISON DR MILFORD,OH45150 31-1085414	HOME HEALTH	OH	CHS	C Corporation	91,529,470	56,968,045	100 %	Yes
(6) AMERIMED INC 1700 EDISON DR MILFORD,OH45150 31-1158699	HOME HEALTH	OH	ANC	C Corporation	21,023,902	15,079,827	100 %	Yes
(7) BC HOLDING COMPANY INC 1850 BLUEGRASS AVE LOUISVILLE,KY40215 31-1542851	Fitness Club	KY	JHSMH	C Corporation	0	0	100 %	Yes
(8) BrazoSport Health Alliance 1 WEST WAY COURT LAKE JACKSON,TX77566 76-0518376	Health Care	TX	BRHS	C Corporation	134,400	35,529	100 %	Yes
(9) Caduceus Medical Associates INC 5600 Brainerd Road Ste 500 Chattanooga,TN37411 62-1570736	Healthcare	TN	MHCS	C Corporation	0	1,008	100 %	Yes
(10) Captive Management Initiatives Ltd PO BOX 10073 APO Georgetown,GRAND CAYMANKY11001 CJ 98-0663022	Captive Management	CJ	CHI	C Corporation	3,500	176,569	100 %	Yes
(11) Carmona-DeSoto Building Horizontal Property Regime Inc 300 Werner St Hot Springs,AR71913 71-0771076	Healthcare	AR	CHI-SVHS	C Corporation	0	0	100 %	Yes
(12) Catholic Health Initiatives Center for Translational Research 198 INVERNESS DRIVE WEST Englewood,CO80112 27-2269511	Research	CO	CIRI	C Corporation	497,688	1,989,262	100 %	Yes
(13) CHI St Luke's Health Baylor College of Medicine Medical Center Condominium Assoc 6624 Fannin STE 1100 Houston,TX77030 46-5079545	Condo Assoc	TX	CHI-SLHBCM	C Corporation	0	0	100 %	Yes
(14) ClearRiver Health 198 INVERNESS DRIVE WEST Englewood,CO80112 46-4495960	Insurance	CO	PHPSI	C Corporation	80,448	5,368,013	100 %	Yes
(15) Comcare Services Inc 5570 DTC Parkway Englewood,CO80111 84-0904813	Inactive	CO	CHIC	C Corporation	0	0	100 %	Yes
(16) CONSOLIDATED HEALTH SERVICES 1700 EDISON DR MILFORD,OH45150 31-1378212	HOME HEALTH	OH	CHI	C Corporation	1,295,835	52,264,929	100 %	Yes
(17) Des Moines Medical Center Inc 1111 6TH AVE Des Moines,IA50314 42-0837382	Real Estate	IA	CHI-IA Corp	C Corporation	71,628	1,079,124	93 %	Yes
(18) Diversified Health Resources Inc 100 MEDICAL DRIVE LAKE JACKSON,TX77566 76-0222679	Health Care	TX	BRHS	C Corporation	22,442	182,538	100 %	Yes
(19) First Initiatives Insurance LTD PO BOX 10073 APO Georgetown,GRAND CAYMANKY11001 CJ 98-0203038	Insurance	CJ	CHI	C Corporation	0	0	100 %	Yes
(20) Franciscan City Urgent Care Services PS dba City MD - Franciscan Urgent Car e C/O CPGUSA 1345 AVE OF THE AMERICAS NEW YORK,NY10105 81-2174959	Healthcare	NY	FHS	C Corporation	3,755,671	1,106,230	100 %	Yes
(21) Franciscan Services Inc 198 INVERNESS DRIVE WEST Englewood,CO80112 23-2487967	Healthcare	CO	CHI	C Corporation	0	15,522,048	100 %	Yes
(22) Good Samaritan Outreach Services PO Box 1990 Kearney,NE68848 47-0659440	Medical Clinic	NE	CHI Nebraska	C Corporation	260,344	212,541	100 %	Yes
(23) HarvestPlains Health of Iowa 32129 Weyerhaeuser Way S STE 201 FEDERAL WAY,WA98001 47-3451750	Insurance	WA	QCHPS	C Corporation	45,119	3,244,070	100 %	Yes
(24) Health Systems Enterprises Inc PO BOX 1990 Kearney,NE68848 47-0664558	MGMT	NE	GSH	C Corporation	150,551	1,318,274	100 %	Yes
(25) Healthcare MGMT Services Organization INC 1149 MARKET ST Tacoma,WA98402 91-1865474	Health Org.	WA	FHS	C Corporation	0	0	100 %	Yes
(26) HeartlandPlains Health 198 INVERNESS DRIVE WEST Englewood,CO80112 46-4368223	Insurance	CO	PHPSI	C Corporation	5,739,433	5,513,263	100 %	Yes
(27) Highline Medical Group 1717 S J Street Tacoma,WA98405 91-1407026	Medical Services	WA	HMC	C Corporation	0	0	100 %	Yes
(28) Medical Office Building Horizontal Property Regime Inc 300 Werner St Hot Springs,AR71913 71-0720429	Real Estate	AR	CHI-SVHS	C Corporation	177,558	81,158	77 %	Yes
(29) Medquest 1301 15TH AVENUE WEST Williston,ND58801 45-0392137	Sale of DME	ND	MMC Williston	C Corporation	561,543	852,276	100 %	Yes
(30) Memorial CV Service Line Management Company LLC 1201 W Frank Ave Lufkin,TX75904 46-3622849	Heath Care	TX	MHSET	C Corporation	0	0	100 %	Yes
(31) Mercy Park Apartments LTD 1111 6th AVE Des Moines,IA50314 42-1202422	Housing	IA	CHI-IA Corp	C Corporation	951,900	0	100 %	Yes
(32) Mercy Services Corp 2700 STEWART PARKWAY Roseburg,OR97471 93-0824308	Retail Sales	OR	MMC	C Corporation	34,601	126,694	100 %	Yes
(33) MHI Clinical Services 1201 W Frank Ave Lufkin,TX75904 46-1967952	Healthcare	TX	MHSET	C Corporation	11,048,138	1,739,550	100 %	Yes
(34) Mountain Management Services Inc 6028 Shallowford Rd Chattanooga,TN37421 62-1570739	MGMT SVC ORG	TN	MHCS	C Corporation	13,439,403	3,317,936	100 %	Yes
(35) PATIENT TRANSPORT SERVICES INC 1700 EDISON DR MILFORD,OH45150 31-1100798	HOME HEALTH	OH	ANC	C Corporation	10,173,794	6,744,244	100 %	Yes
(36) QCA Health Plan Inc 12615 Chenal Parkway STE 300 Little Rock,AR72211 71-0794605	Insurance	AR	QCHI	C Corporation	193,555,136	75,365,153	100 %	Yes
(37) QualChoice Advantage 32129 WEYERHAEUSER WAY S STE 201 FEDERAL WAY,WA98001 47-3433912	Insurance	WA	QCPS	C Corporation	11,810,605	6,432,511	100 %	Yes
(38) QualChoice Health Plan Services Inc (fka CollabHealth Plan Services Inc) 198 INVERNESS DRIVE WEST Englewood,CO80112 46-1224037	Admin Services	CO	QCHI	C Corporation	63,300,575	219,676,343	100 %	Yes
(39) QualChoice Health Inc (fka CollabHealth Managed Solutions Inc) 198 INVERNESS DRIVE WEST Englewood,CO80112 46-1222808	Holding Co	CO	CHI	C Corporation	308,157	1,222,966	100 %	Yes
(40) QualChoice Holdings Inc 198 INVERNESS DRIVE WEST Englewood,CO80112 27-4075520	Holding Co	CO	PHPS	C Corporation	0	9,944	100 %	Yes
(41) QualChoice Life and Health Insurance Company Inc 12615 Chenal Parkway STE 300 Little Rock,AR72211 71-0386640	Insurance	AR	QCH	C Corporation	111,184,831	54,451,054	100 %	Yes
(42) QualChoice of Nebraska 2401 S 73rd St Omaha,NE68124 81-0738827	Insurance	NE	QCH	C Corporation	0	0	100 %	Yes
(43) RiverLink Health 198 INVERNESS DRIVE WEST Englewood,CO80112 46-4380824	Insurance	CO	PHPS	C Corporation	9,198,897	6,690,368	100 %	Yes
(44) RiverLink Health of Kentucky Inc 198 INVERNESS DRIVE WEST Englewood,CO80112 46-4828332	Insurance	CO	PHPS	C Corporation	8,666,516	6,927,980	100 %	Yes
(45) Ross Park Pharmacy Inc 380 SUMMIT AVE STEUBENVILLE,OH43952 34-1832654	Pharmacy	OH	THS	C Corporation	1,513,328	2,686,059	100 %	Yes
(46) Saint Clare's Primary Care Inc 198 INVERNESS DRIVE WEST Englewood,CO80112 22-2441202	Billing Services	CO	SCCC	C Corporation	0	0	100 %	Yes
(47) SAMARITAN FAMILY CARE INC 40 W FOURTH ST STE 1700 Dayton,OH45402 31-1299450	Healthcare	OH	SHP	C Corporation	29,440,066	8,967,737	100 %	Yes
(48) SJH Services Corporation 198 INVERNESS DRIVE WEST Englewood,CO80112 23-2307408	Healthcare	CO	FSI	C Corporation	0	1,598,610	100 %	Yes
(49) SJL PHYSICIAN MANAGEMENT SERVICES INC 424 LEWIS HARGETT CR STE 160 Lexington,KY40503 27-0164198	Mgmt	KY	SJHS	C Corporation	0	0	100 %	Yes
(50) SoundPath Health Inc 32129 Weyerhaeuser Way S STE 201 Federal Way,WA98001 42-1720801	Insurance	WA	PHPS	C Corporation	181,743,407	66,769,322	100 %	Yes
(51) St Alexius Health Services Inc 900 East Broadway Avenue Bismarck,ND58501 45-0402812	Healthcare	ND	SAMC	C Corporation	0	0	100 %	Yes
(52) St Anthony Development Company 1415 Southgate Pendleton,OR97801 93-1216943	Athletic Club	OR	SAH	C Corporation	1,609,675	2,187,406	100 %	Yes
(53) St Joseph Development Company Inc 1717 SOUTH J ST Tacoma,WA98405 91-1480569	Rental	WA	FSI	C Corporation	4,387,694	34,715,309	100 %	Yes
(54) St Luke's Episcopal Hospital Physician Hospital Organization Inc 6720 Bertner MC4-262 Houston,TX77030 76-0377932	PHO	TX	CHI-SLH	C Corporation	0	0	100 %	Yes
(55) St Luke's Health System Holdings Inc 6624 Fannin STE 800 Houston,TX77030 76-0637138	Holding Co	TX	SLHS	C Corporation	3,074,493	39,559,748	100 %	Yes
(56) St Vincent Community Health Services Inc TWO ST VINCENT CIRCLE Little Rock,AR72205 71-0710785	Healthcare	AR	SVIMC	C Corporation	4,768,531	29,679,087	100 %	Yes
(57) StableView Health Inc 198 INVERNESS DRIVE WEST Englewood,CO80112 46-4373713	Insurance	CO	PHPS	C Corporation	62,195	5,180,266	100 %	Yes
(58) STE Holdings 12809 West Dodge Rd Omaha,NE68154 82-2383629	Holding Co	NE	SERMC	C Corporation	334,599	2,195,538	100 %	Yes
(59) Sugar Land Doctor Group 1317 Lake Point Parkway Sugar Land,TX77478 45-4270163	Medical Clinic	TX	SLCDC-SL	C Corporation	0	0	100 %	Yes
(60) The Texas Heart Institute at St Luke's Episcopal Hospital Denton A Cooley B uilding Comdominium Association 6624 Fannin STE 1100 Houston,TX77030 90-0064009	Condo Assoc	TX	CHI-SLH	C Corporation	0	0	100 %	Yes
(61) Towson Management Inc 7601 OSLER DR Towson,MD21204 52-1710750	Mgmt Services	MD	FSI	C Corporation	0	0	100 %	Yes
(62) TRINITY MANAGEMENT SERVICES ORGANIZATION 380 SUMMIT AVE STEUBENVILLE,OH43952 34-1471026	Mgmt Services	OH	THS	C Corporation	13,543,963	184,008	100 %	Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

1	Briefly describe the organization’s mission or most significant activities: Emphasize human dignity and social justice as we create healthier communities by providing health care services regardless of ability to pay for those in Fort Oglethorpe, GA and the surrounding area. See Schedule O
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	9
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	17,262
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	16,262

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........		0
9	Program service revenue (Part VIII, line 2g) .........		5,847,189
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....		0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)		17,262
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	0	5,864,451
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		310,665
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)		4,061,557
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....		5,362,325
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)		9,734,547
19	Revenue less expenses. Subtract line 18 from line 12.......	0	-3,870,096
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	0	25,880,197
21	Total liabilities (Part X, line 26).............	0	29,750,293
22	Net assets or fund balances. Subtract line 21 from line 20.....	0	-3,870,096

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 1,515,607 including grants of $ 105,344 ) (Revenue $ 1,982,738 )
	Emergency Medicine: CHI Memorial Hospital Georgia's 24/7 emergency department is equipped and prepared to provide immediate emergency medical management with access to larger health systems as needed. Our board-certified physicians and staff are dedicated to serving the emergency needs of our patients. Commonly treated emergency room conditions include: chest pain, abdominal pain, broken bone, headache, laceration, infection, difficulty breathing, and fainting.

4b	(Code: ) (Expenses $ 252,744 including grants of $ 65,545 ) (Revenue $ 1,233,662 )
	Laboratory Services: The laboratory team at CHI Memorial Hospital Georgia works with the emergency department team to enhance your care. Often, your doctor will order blood work or other tests from the laboratory to help guide the correct diagnosis and treatment. The lab team will analyze cells, tissue and bodily fluids to identifyabnormalities, disease, or infection.

4c	(Code: ) (Expenses $ 64,506 including grants of $ 54,607 ) (Revenue $ 1,027,792 )
	Diagnostic Services: Radiologists use medical imaging techniques to diagnose diseases and injuries. If your condition requires an computed tomography (CT), digital radiography (x-ray), ultrasound, nuclear medicine, echocardiography, stress testing or other imaging, your physician will order studies from our radiology team. CHI Memorial Hospital Georgia's board-certified radiologists and radiology technologists will ensure that your imaging is performed quickly, safely and accurately.

	(Code: ) (Expenses $ 7,201,813 including grants of $ 85,169 ) (Revenue $ 1,602,997 )
	Other Services: Other services provided by CHI Memorial Hospital - GA include an on-site pharmacy, surgical services, and outpatient treatments as well as other medical services.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 7,201,813 including grants of $ 85,169 ) (Revenue $ 1,602,997 )
4e	Total program service expenses9,034,670

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Mary P Tanner PHD BOARD MEMBER	1.0 .......................2.0	X		0	0	0
(19) WILLIAM WARREN MD BOARD MEMBER	1.0 .......................49.0	X		0	754,338	37,759
(20) JEFFREY T WILSON BOARD MEMBER	1.0 .......................2.0	X		0	0	0
(21) SR ELIZABETH BLANDFORD BOARD MEMBER	1.0 .......................1.0	X		0	0	0
(22) MARILYN HELMS MD Board Member	1.0 .......................1.0	X		0	0	0
(23) TROY HAMMETT CFO/TREASURER	1.0 .......................59.0		X	0	461,077	41,735

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	4,433,896	368,968

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..		1a	0
b	Membership dues..		1b	0
c	Fundraising events..		1c	0
d	Related organizations		1d	0
e	Government grants (contributions)		1e	0

f	All other contributions, gifts, grants, and similar amounts not included above		1f	0

g	Noncash contributions included in lines 1a - 1f:$		1g	0

h Total. Add lines 1a-1f.......		0

		Business Code
2a	Patient Services	900099	5,847,189	5,847,189	0	0
b			0	0	0	0
c			0	0	0	0
d			0	0	0	0
e			0	0	0	0
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		5,847,189

3 Investment income (including dividends, interest, and othersimilar amounts) ......			0	0	0	0
4 Income from investment of tax-exempt bond proceeds			0	0	0	0
5 Royalties...........			0	0	0	0
		(ii) Personal	(i) Real
6a	Gross rents	0	0	6a
b	Less: rental expenses	0	0	6b
c	Rental income or (loss)	0	0	6c
d	Net rental income or (loss).......			0	0	0	0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	0	0	7a
b	Less: cost or other basis and sales expenses	0	0	7b
c	Gain or (loss)	0	0	7c
d	Net gain or (loss).........			0	0	0	0
8a	Gross income from fundraising events (not including $ 0of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0		0	0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0	0	0	0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0	0	0	0
Business Code			Miscellaneous Revenue
11a	Other Revenue			17,262	0	17,262	0
b				0	0	0	0
c				0	0	0	0
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			17,262
12	Total revenue. See instructions.....			5,864,451	5,847,189	17,262	0

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	310,665	310,665
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	3,398,459	3,043,077	355,382
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	38,261	34,435	3,826
9	Other employee benefits .......	330,293	297,264	33,029
10	Payroll taxes ...........	294,544	265,090	29,454
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	78,459		78,459
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	1,697,671	1,617,907	79,765	0
12	Advertising and promotion ....	32,030		32,030
13	Office expenses .......	302,620	272,358	30,262
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	696,994	696,994
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	378,856	378,856
23	Insurance ...	257,775	257,775
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	609,207	609,207
b	Bad debts	155,333	155,333
c	Miscellaneous Expenses	78,589	74,660	3,929
d	Repairs and Maintenance	1,031,895	980,300	51,595
e	All other expenses	42,896	40,749	2,147	0
25	Total functional expenses. Add lines 1 through 24e	9,734,547	9,034,670	699,878	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........				1	600
2	Savings and temporary cash investments .........				2	469,102
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............				4	4,062,530
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6	0
7	Notes and loans receivable, net ...........				7	0
8	Inventories for sale or use ............				8	572,928
9	Prepaid expenses and deferred charges ......				9	49,853
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	13,891,218
b	Less: accumulated depreciation	10b	378,856		10c	13,512,362
11	Investments—publicly traded securities .				11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14	7,212,822
15	Other assets. See Part IV, line 11 ...........			0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 33)...			0	16	25,880,197

17	Accounts payable and accrued expenses .....		17	555,941
18	Grants payable ...		18	0
19	Deferred revenue .........		19	0
20	Tax-exempt bond liabilities .........		20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22	0
23	Secured mortgages and notes payable to unrelated third parties ..		23	606,680
24	Unsecured notes and loans payable to unrelated third parties ..		24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	0	25	28,587,672
26	Total liabilities. Add lines 17 through 25..	0	26	29,750,293

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	0	32	-3,870,096
33	Total liabilities and net assets/fund balances ........	0	33	25,880,197