TY 2021 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/1099-NEC)
(1) LARRY SCHUMACHER...................................................................... SR VP OF OPERATIONS, SE DIVISION/FORMER CEO	1.00 ................. 49.00	X				0	3,244,309	36,897
(2) JAMES ZELLNER MD...................................................................... BOARD MEMBER	1.00 ................. 49.00	X				0	1,273,382	51,400
(3) TROY HAMMETT...................................................................... FORMER CFO/TREASURER	0.00 ................. 50.00				X	0	1,178,923	102,028
(4) JANELLE REILLY...................................................................... MARKET CEO	1.00 ................. 49.00	X	X			0	1,156,775	108,260
(5) AARON WEBB ESQ...................................................................... BOARD MEMBER(PARTIAL YEAR)	1.00 ................. 49.00	X				0	1,171,189	13,030
(6) WILLIAM WARREN MD...................................................................... FORMER CHAIR	1.00 ................. 49.00				X	0	802,957	50,887
(7) ALLEN ATCHLEY MD...................................................................... BOARD MEMBER	1.00 ................. 49.00	X				0	789,785	51,736
(8) ARLENE DONOWITZ MD...................................................................... BOARD MEMBER	1.00 ................. 49.00	X				0	495,881	39,075
(9) DAVID DENMAN MD...................................................................... BOARD MEMBER / CHIEF OF MEDICAL STAFF	1.00 ................. 49.00	X				0	436,425	47,646
(10) MARK ANDERSON MD...................................................................... BOARD MEMBER	1.00 ................. 49.00	X				0	375,804	56,606
(11) MICHAEL SUTTON...................................................................... CFO/TREASURER	1.00 ................. 49.00		X			0	358,152	30,253
(12) DHARMIN DESAI...................................................................... PHYSICIST	50.00 ................. 0.00			X		218,857	0	41,232
(13) SHERRY JACKSON...................................................................... RN	50.00 ................. 0.00			X		1,884	194,362	32,023
(14) AMY QUINN...................................................................... PHARMACIST	5.00 ................. 45.00			X		8,807	145,008	18,845
(15) JOHN GORDON...................................................................... RN	50.00 ................. 0.00			X		155,227	3,060	9,356
(16) MARK CAMPBELL...................................................................... PHARMACIST	1.00 ................. 49.00			X		1,046	154,527	11,268
(17) JILL APLIN...................................................................... CHAIR	1.00 ................. 0.00	X	X			0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
ENOTS INC 5250 HIGHBANKS ROAD SUITE 240 SPRINGFIELD,OR97478	IT TECHNOLOGY	1,633,400
NHP PARKWAY PHYSICIANS CENTER 500 N HURSTBOURNE PKWY200 LOUISVILLE,KY40222	MEDICAL SERVICES	497,447
TENNESSEE ONCOLOGY PLLC 605 GLENWOOD DRIVE SUITE 200 CHATTANOOGA,TN37404	MEDICAL SERVICES	263,318
CORNERSTONE MEDICAL CENTER LLC 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE,GA30742	MEDICAL SERVICES	169,951
FORT OGLETHORPE EMERGENCY 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE,GA30742	MEDICAL SERVICES	156,344
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 6

- TIN:

SCHEDULE A
(Form 990)

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

2021

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

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

OMB No. 1545-0047

2021

Name of the organization

CHI MEMORIAL HOSPITAL - GEORGIA

Employer identification number

82-2748395

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization CHI MEMORIAL HOSPITAL - GEORGIA

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization CHI MEMORIAL HOSPITAL - GEORGIA		Employer identification number 82-2748395

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization CHI MEMORIAL HOSPITAL - GEORGIA			Employer identification number 82-2748395
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

CHI MEMORIAL HOSPITAL - GEORGIA

Employer identification number

82-2748395

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

472

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

472

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	THE PORTION OF THE ORGANIZATIONS' DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION(AHA) - $284 AND CATHOLIC HEALTH ASSOCIATION(CHA) -$188

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- 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

2021

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) 2021

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 .....	1,778,295		1,778,295
b	Buildings ....	3,175,942	424,858	2,751,084
c	Leasehold improvements	1,410,779	320,088	1,090,691
d	Equipment ....	10,987,733	6,461,104	4,526,629
e	Other .....	300,230		300,230
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				10,446,929

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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
(1)RIGHT-OF-USE FINANCE LEASE				21,569
(2)RIGHT-OF-USE OPERATING LEASE				8,198,659
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				8,220,228

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
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	66,532,570
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) 2021

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
PART X, LINE 2:	CHI MEMORIAL HOSPITAL - GEORGIA'S FINANCIAL INFORMATION IS INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS, WHICH INCLUDES THE FOLLOWING DISCLOSURE: COMMONSPIRIT REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- 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

2021

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 %

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? . . . . . . . . .

Yes

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

Yes

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) . . .		4,178	1,245,251		1,245,251	4.830 %
b	Medicaid (from Worksheet 3, column a) . . . . .		4,162	3,183,294	2,837,953	345,341	1.340 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			0
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		8,340	4,428,545	2,837,953	1,590,592	6.170 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	2	364	347,938		347,938	1.350 %
f	Health professions education (from Worksheet 5) . . .			0
g	Subsidized health services (from Worksheet 6) . . . .			0
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	2	364	347,938		347,938	1.350 %
k	Total. Add lines 7d and 7j .	2	8,704	4,776,483	2,837,953	1,938,530	7.520 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

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	(e) Net community building expense	(f) Percent of total expense
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

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. ......

3,680,791

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).....

3,029,416

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

3,781,266

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

-751,850

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) 2021

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 HOSPITAL - GEORGIA 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE,GA30742 WWW.MEMORIAL.ORG 023-626	X	X	X

Schedule H (Form 990) 2021

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 HOSPITAL - 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...............

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......................

Yes

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 21

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 .................

Yes

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..................................

Yes

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?..............

Yes

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

Hospital facility’s website (list url): HTTPS://WWW.MEMORIAL.ORG/EN/ABOUT-US/COMMUNITY-BENEFIT.HTML

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

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

Yes

If "Yes" (list url): HTTPS://WWW.MEMORIAL.ORG/EN/ABOUT-US/COMMUNITY-BENEFIT.HTML

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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CHI MEMORIAL HOSPITAL - 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 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

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):

SEE STATEMENT

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

SEE STATEMENT

A plain language summary of the FAP was widely available on a website (list url):
SEE STATEMENT

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) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	CHI MEMORIAL HOSPITAL - 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) 2021

Page 7

Part VFacility Information (continued)

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

	CHI MEMORIAL HOSPITAL - 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) 2021

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
CHI MEMORIAL HOSPITAL - GEORGIA	PART V, SECTION B, LINE 5: CHI MEMORIAL CHATTANOOGA, CHI MEMORIAL HIXSON, AND CHI MEMORIAL GEORGIA, AS THE SPONSORS OF THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, ENGAGED NATIONAL LEADERS IN COMMUNITY HEALTH NEEDS ASSESSMENTS TO ASSIST IN THE PROJECT. STRATASAN, A HEALTHCARE ANALYTICS AND FACILITATION COMPANY BASED OUT OF NASHVILLE, TENNESSEE, PROVIDED THE ANALYSIS OF COMMUNITY HEALTH DATA, FACILITATED THE FOCUS GROUPS, CONDUCTED THE INTERVIEWS, FACILITATED THE TELEPHONE SURVEYS, AND FACILITATED A COMMUNITY HEALTH SUMMIT TO RECEIVE COMMUNITY INPUT INTO THE PRIORITIES AND BRAINSTORM GOALS AND ACTIONS THE COMMUNITY COULD TAKE TO IMPROVE HEALTH.23 COMMUNITY MEMBERS REPRESENTING 20 ORGANIZATIONS PARTICIPATED IN TWO FOCUS GROUP SESSIONS AND INDIVIDUAL INTERVIEWS FOR THEIR PERSPECTIVES ON COMMUNITY NEEDS AND ISSUES IN JANUARY, 2022. THESE PARTICIPANTS REPRESENTED NOT-FOR-PROFIT ORGANIZATIONS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, AND THE ELDERLY (AREA AGENCY ON AGING AT NORTHWEST GEORGIA REGIONAL, BRAINERD COMMUNITY FOOD PANTRY, CHATTANOOGA AREA FOOD BANK, CHATTANOOGA HOUSING AUTHORITY, CHATTANOOGA REGIONAL HOMELESS COALITION, HABITAT FOR HUMANITY OF GREATER CHATTANOOGA, TRI STATE FOOD PANTRY), HEALTH PROVIDERS (HOSPITALS, HEALTH DEPARTMENTS, MEDICAL SOCIETY, PRIMARY CARE CENTERS), EDUCATION PROVIDERS , PUBLIC SAFETY OFFICERS POLICE DEPARTMENTS, SHERIFF'S DEPARTMENTS), LOCAL GOVERNMENT OFFICIALS (CITY OF CHATTANOOGA, COLLEGEDALE CITY MAYOR, COUNTY COMMISSIONS), AND OTHERS (YMCA, CITY OF CHATTANOOGA FAMILY JUSTICE CENTER).A COMMUNITY HEALTH SUMMIT WAS CONDUCTED IN FEBRUARY, 2022 WITH 68 COMMUNITY STAKEHOLDERS. THE AUDIENCE CONSISTED OF HEALTHCARE PROVIDERS, BUSINESS LEADERS, GOVERNMENT REPRESENTATIVES, SCHOOLS, NOT-FOR-PROFIT ORGANIZATIONS, EMPLOYERS, AND OTHER COMMUNITY MEMBERS. REPRESENTATIVES OF THE HAMILTON COUNTY AND CATOOSA COUNTY HEALTH DEPARTMENTS PARTICIPATED IN THE INTERVIEWS AS WELL AS THE SUMMIT.
CHI MEMORIAL HOSPITAL - GEORGIA	PART V, SECTION B, LINE 6A: CHI MEMORIAL HOSPITALCHI MEMORIAL HOSPITAL HIXSON
CHI MEMORIAL HOSPITAL - GEORGIA	PART V, SECTION B, LINE 11: THE HOSPITAL INTENDS TO TAKE ACTIONS AND TO DEDICATE RESOURCES TO ADDRESS THESE NEEDS, INCLUDING: ACCESS TO AFFORDABLE CARE AND INSURANCE: INSURANCE ENROLLMENT ASSISTANCE, FINANCIAL SUPPORT, AWARENESS OF COMMUNITY RESOURCES, HEALTH COACH POSITIONS, AND A REPLACEMENT FACILITY FOR CHI MEMORIAL HOSPITAL GEORGIA; MENTAL/BEHAVIORAL HEALTH: COUNSELING SERVICES, AWARENESS OF COMMUNITY RESOURCES, TRAINING AND EDUCATION, PARTICIPATION IN THE FUSE PROJECT, THE ARTS AND HEALTHCARE PROGRAM, AND EXPLORATION OF EXPANDED BEHAVIORAL/MENTAL HEALTH SERVICES PROVIDED BY THE HOSPITAL; AFFORDABLE, HEALTHY HOUSING: MEDICAL RESPITE HOUSING, PARTICIPATION IN THE FUSE PROJECT, AND ACCESS TO AND AWARENESS OF COMMUNITY RESOURCES; SUBSTANCE USE DISORDER: SMOKING CESSATION CLASSES AND DRUG ADDICTION RECOVERY SUPPORT; PREVENTION AND EDUCATION: OUTREACH EVENTS, SUPPORT FOR MEDICAL EDUCATION STUDENTS, AND COMMUNITY EDUCATION/TRAINING SESSIONS; VIOLENCE: SUPPORT LOCAL ORGANIZATIONS, TRAINING AND EDUCATION, EXPLORATION OF GRANT FUNDING, AND AWARENESS OF COMMUNITY RESOURCES; OBESITY: CONTINUATION OF THE OBESITY DASHBOARD AND TRAINING AND EDUCATION; FOOD INSECURITY: FINANCIAL SUPPORT, AWARENESS OF COMMUNITY RESOURCES, AND FOOD DONATIONS; CHRONIC DISEASE: SCREENING AND EDUCATION, TRANSITION OF CARE SUPPORT, EXPANSION OF THE NEUROSCIENCES SERVICE LINE, AND DIABETES MANAGEMENT RESOURCES
CHI MEMORIAL HOSPITAL - GEORGIA	PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) 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 COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. 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 COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS.
PART V, SECTION B, LINE 16A, 16B AND 16C	FAP POLICY, FAP APPLICATION FORM & FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.MEMORIAL.ORG/EN/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-DISCOUNT.HTML

Schedule H (Form 990) 2021

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?1
Name and address		Type of Facility (describe)
1	1 - CHI MEMORIAL REES SKILLER CANCER INSTITU 4750 BATTLEFIELD PKWY RINGGOLD,GA30736	CANCER TREATMENT
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2021

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
PART I, LINE 3C:	UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA).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 OR FREE CARE CLINIC; PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); FOOD STAMP ELIGIBILITY; ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID); LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE
PART I, LINE 7:	COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY ("CBISA") SOFTWARE ARE USED TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS.
PART III, LINE 2:	THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE.
PART III, LINE 3:	CHI MEMORIAL HOSPITAL - GEORGIA MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. CHI MEMORIAL HOSPITAL - GEORGIA'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. CHI MEMORIAL HOSPITAL - GEORGIA ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, CHI MEMORIAL HOSPITAL - GEORGIA DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE.
PART III, LINE 4:	CHI MEMORIAL HOSPITAL - GEORGIA DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 12-13."PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES."
PART III, LINE 8:	COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. CHI MEMORIAL HOSPITAL - GEORGIA'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $ 751,850 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS.
PART III, LINE 9B:	COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.
PART VI, LINE 2:	CHI MEMORIAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES IN ADDITION TO CHNAS. THESE METHODS INCLUDE: ONGOING REVIEWS OF LOCAL PUBLIC HEALTH DATA, PERIODIC PROVIDER DEMAND ASSESSMENTS, AND PROVIDER SURVEYS THAT ASSESS GAPS IN CARE.
PART VI, LINE 3:	INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT 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.
PART VI, LINE 4:	CHI MEMORIAL PRIMARILY SERVES 5 COUNTIES: HAMILTON, BRADLEY, CATOOSA, DADE AND WALKER COUNTIES. THE COMMUNITY INCLUDES MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WHO LIVE IN THE GEOGRAPHIC AREAS FROM WHICH CHI MEMORIAL DRAWS ITS PATIENTS. THE COMMUNITY CONSISTS OF A MIXTURE OF URBAN, RURAL, AND SUBURBAN SETTINGS. THE COMMUNITY CONSISTS OF A HIGHER PROPORTION OF THE 65 AND OLDER AGE GROUP WHEN COMPARED TO THE U.S. THIS POPULATION REQUIRES MORE EXTENSIVE HEALTH CARE SERVICES AND IS GROWING AT A HIGHER RATE THAN OTHER AGE GROUPS IN THE COMMUNITY. THE RACIAL AND ETHNIC MAKE-UP OF THE FIVE COUNTIES WAS 80% WHITE, 13% BLACK, 6% HISPANIC ORIGIN, 2% MIXED RACE, 2% ASIAN/PACIFIC ISLANDER, AND 3% OTHER. (THESE PERCENTAGES TOTAL TO OVER 100% BECAUSE HISPANIC IS AN ETHNICITY, NOT A RACE.) THE MAJORITY OF EMPLOYEES IN THE 5-COUNTY AREA ARE EMPLOYED IN: MANUFACTURING (27.9%), EDUCATION SERVICES (19.2%), RETAIL TRADE (10.0%), HEALTH CARE AND SOCIAL ASSISTANCE (8.4%), AND PUBLIC ADMINISTRATION (6.4%). RETAIL TRADE OFFERS HEALTH INSURANCE AT A LOWER RATE THAN HEALTH CARE, PUBLIC ADMINISTRATION, AND EDUCATION SERVICES.THE HOUSEHOLD INCOME DISTRIBUTION OF THE FIVE COUNTIES WAS 24% HIGHER INCOME (OVER $100,000), 56% MIDDLE INCOME, AND 20% LOWER INCOME (UNDER $25,000). THE COMMUNITY HAS SEVERAL CENSUS TRACTS WITH A HIGH NUMBER OF HOUSEHOLDS MAKING BELOW $15,000 PER YEAR. THESE AREAS ARE AT HIGHER RISK FOR HEALTH INEQUITIES. THE 5-COUNTIES MEDIAN HOUSEHOLD INCOME AT $55,253 WAS LOWER THAN TN ($55,276) AND GA ($60,605), AND THE U.S. ($64,730). THE RATE OF POVERTY IN EACH COUNTY WAS HIGHER THAN THE U.S. EXCEPT CATOOSA. THE HEALTH CARE INDEX MEASURES HOW MUCH THE POPULATIONS SPENT OUT-OF-POCKET ON HEALTH CARE SERVICES INCLUDING INSURANCE PREMIUMS. THE U.S. INDEX WAS 100. THE FIVE COUNTIES WAS 88, INDICATING 12% LESS SPENT OUT OF POCKET THAN THE AVERAGE U.S. HOUSEHOLD ON MEDICAL CARE (DOCTOR'S OFFICE VISITS, PRESCRIPTIONS, HOSPITAL VISITS) AND INSURANCE PREMIUMS.THERE ARE TWO OTHER MAJOR HEALTHCARE SYSTEMS SERVING THE COMMUNITY. THERE ARE FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS PRESENT WITHIN THE 5 COUNTIES (HRSA): 1 IN CATOOSA COUNTY, 1 IN DADE COUNTY, 1 IN WALKER COUNTY, AND 1 IN HAMILTON COUNTY.
PART VI, LINE 5:	FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE.USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE.OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS.ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. HOSPITAL COMMUNITY BOARDS (OR THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AND PROGRESS TOWARD IDENTIFIED GOALS.
PART VI, LINE 6:	THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. AS OF JUNE 30, 2022, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2022, COMMONSPIRIT HEALTH PROVIDED MORE THAN $3.16 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.89 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.9 BILLION IN FISCAL YEAR 2022, HAS TOTAL ASSETS OF APPROXIMATELY $50.31 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY.
PART VI, LINE 7, REPORTS FILED WITH STATES	GA

Schedule H (Form 990) 2021

Additional Data

Software ID:
Software Version:

- 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

2021

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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 SR VP OF OPERATIONS, SE DIVISION/FOR	(i) (ii)	0 ------------- 1,134,683	0 ------------- 1,684,415	0 ------------- 425,211	0 ------------- 17,100	0 ------------- 19,797	0 ------------- 3,281,206	0 ------------- 179,886
2JAMES ZELLNER MD BOARD MEMBER	(i) (ii)	0 ------------- 1,157,456	0 ------------- 108,567	0 ------------- 7,359	0 ------------- 16,623	0 ------------- 34,777	0 ------------- 1,324,782	0 ------------- 0
3TROY HAMMETT FORMER CFO/TREASURER	(i) (ii)	0 ------------- 589,952	0 ------------- 474,815	0 ------------- 114,156	0 ------------- 71,027	0 ------------- 31,001	0 ------------- 1,280,951	0 ------------- 47,312
4JANELLE REILLY MARKET CEO	(i) (ii)	0 ------------- 609,993	0 ------------- 478,735	0 ------------- 68,047	0 ------------- 73,173	0 ------------- 35,087	0 ------------- 1,265,035	0 ------------- 54,188
5AARON WEBB ESQ BOARD MEMBER(PARTIAL YEAR)	(i) (ii)	0 ------------- 382,750	0 ------------- 0	0 ------------- 788,439	0 ------------- 10,659	0 ------------- 2,371	0 ------------- 1,184,219	0 ------------- 0
6WILLIAM WARREN MD FORMER CHAIR	(i) (ii)	0 ------------- 643,795	0 ------------- 155,415	0 ------------- 3,747	0 ------------- 16,844	0 ------------- 34,043	0 ------------- 853,844	0 ------------- 0
7ALLEN ATCHLEY MD BOARD MEMBER	(i) (ii)	0 ------------- 631,295	0 ------------- 155,415	0 ------------- 3,075	0 ------------- 17,275	0 ------------- 34,461	0 ------------- 841,521	0 ------------- 0
8ARLENE DONOWITZ MD BOARD MEMBER	(i) (ii)	0 ------------- 433,528	0 ------------- 50,630	0 ------------- 11,723	0 ------------- 17,100	0 ------------- 21,975	0 ------------- 534,956	0 ------------- 0
9DAVID DENMAN MD BOARD MEMBER / CHIEF OF MEDICAL STAF	(i) (ii)	0 ------------- 387,538	0 ------------- 45,900	0 ------------- 2,987	0 ------------- 19,375	0 ------------- 28,271	0 ------------- 484,071	0 ------------- 0
10MARK ANDERSON MD BOARD MEMBER	(i) (ii)	0 ------------- 369,237	0 ------------- 0	0 ------------- 6,567	0 ------------- 16,962	0 ------------- 39,644	0 ------------- 432,410	0 ------------- 0
11MICHAEL SUTTON CFO/TREASURER	(i) (ii)	0 ------------- 295,726	0 ------------- 60,033	0 ------------- 2,393	0 ------------- 16,461	0 ------------- 13,792	0 ------------- 388,405	0 ------------- 0
12DHARMIN DESAI PHYSICIST	(i) (ii)	217,059 ------------- 0	1,286 ------------- 0	512 ------------- 0	13,385 ------------- 0	27,847 ------------- 0	260,089 ------------- 0	0 ------------- 0
13SHERRY JACKSON RN	(i) (ii)	1,884 ------------- 189,629	0 ------------- 1,000	0 ------------- 3,733	0 ------------- 9,869	0 ------------- 22,154	1,884 ------------- 226,385	0 ------------- 0
14AMY QUINN PHARMACIST	(i) (ii)	8,807 ------------- 143,780	0 ------------- 1,000	0 ------------- 228	0 ------------- 9,204	106 ------------- 9,535	8,913 ------------- 163,747	0 ------------- 0
15JOHN GORDON RN	(i) (ii)	154,212 ------------- 3,060	1,000 ------------- 0	15 ------------- 0	0 ------------- 9,356	0 ------------- 0	155,227 ------------- 12,416	0 ------------- 0
16MARK CAMPBELL PHARMACIST	(i) (ii)	1,046 ------------- 152,685	0 ------------- 1,000	0 ------------- 842	0 ------------- 9,319	6 ------------- 1,943	1,052 ------------- 165,789	0 ------------- 0

Schedule J (Form 990) 2021

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
PART I, LINE 3	COMPENSATION FOR CHI MEMORIAL HOSPITAL - GA'S TOP MANGEMENT OFFICAL IS PAID BY MEMORIAL HEALTH CARE SYSTEM, A RELATED ORGANIZATION. ON AN ANNUAL BASIS MHCS ENGAGES AN EXTERNAL CONSULTANT TO REVIEW THE COMPENSATION OF ITS EXECUTIVES. THE REVIEW IS PERFORMED TO ENSURE THAT EXECUTIVE SALARIES ARE WITHIN COMPARABLE MARKET RANGES FOR THAT POSITION. THE RESULTS OF THE REVIEW ARE PRESENTED TO THE EXECUTIVE COMPENSATION HUMAN ESOURCES COMMITTEE FOR REVIEW AND RECOMMENDATION TO THE BOARD OF DIRECTORS OR APPROVAL.
PART I, LINE 4B	DURING THE 2021 CALENDAR YEAR, COMMONSPIRIT MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/HOSPITAL PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DURING 2020 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: LARRY SCHUMACHER, $226,162; JANELLE REILLY, $64,420; TROY HAMMETT, $110,230 DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2021 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. INCLUDE IF APPLICABLE: DURING 2021, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: LARRY SCHUMACHER, $182,104
PART I, LINE 4A	CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY AN EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 52 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION AND TENURE, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

CHI MEMORIAL HOSPITAL - GEORGIA

Employer identification number

82-2748395

Return Reference	Explanation
FORM 990, PART V, LINE 1C	PAYMENTS TO VENDORS PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF COMMONSPIRIT HEALTH (CSH) ARE MADE BY CSH. CSH FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY CSH ON BEHALF OF CHI MEMORIAL HOSPITAL - GA ARE REPORTED TO THE IRS.
FORM 990, PART VI, SECTION A, LINE 1A	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) BOARDMEMBERS. 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, SECTION A, LINE 6	ACCORDING TO THE BYLAWS OF CHI MEMORIAL - GEORGIA THE ENTITY'S SOLE MEMBER IS COMMONSPIRIT HEALTH, A COLORADO NONPROFIT ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	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, SECTION A, LINE 7B	THE ORGANIZATION'S CORPORATE MEMBER IS MEMORIAL HEALTH CARE SYSTEM ("MHCS"). PURSUANT TO THE ORGANIZATION'S BYLAWS, BOTH MHCS AND COMMONSPIRIT HEALTH (MHCS'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE COMMONSPIRIT HEALTH GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE MHCS BOARD: APPROVE MEMBERS OF THE CHI MEMORIAL - GA BOARD AMENDMENT OF THE CORPORATE DOCUMENTS OF THE CHI MEMORIAL - GA APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE CHI MEMORIAL - GA ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE CHI MEMORIAL - GA THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE CHI MEMORIAL - GA REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE CHI MEMORIAL - GA APPROVAL OF ISSUANCE OF DEBT BY CHI MEMORIAL - GA APPROVAL OF PARTICIPATION OF CHI MEMORIAL - GA IN A JOINT VENTURE APPROVAL OF FORMATION OF A NEW CORPORATION BY CHI MEMORIAL - GA APPROVAL OF A MERGER INVOLVING THE CHI MEMORIAL - GA APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CHI MEMORIAL - GA TO REQUIRE THE TRANSFER OF ASSETS BY THE CHI MEMORIAL - GA TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS. PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, MHCS OR COMMONSPIRIT HEALTH MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX.
FORM 990, PART VI, SECTION B, LINE 11B	AFTER THE RETURN IS PREPARED IT 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, SECTION B, LINE 12C	THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO PROTECT THE INTERESTS OF COMMONSPIRIT HEALTH ("COMMONSPIRIT") IN CIRCUMSTANCES THAT MAY RESULT IN A CONFLICT BETWEEN PERSONAL INTERESTS OF A PERSON AND THE INTERESTS OF THE ORGANIZATION AND THOSE IT SERVES. COMMONSPIRIT'S COI POLICY APPLIES TO COMMONSPIRIT, ITS DIRECT AFFILIATES AND SUBSIDIARIES AND ANY RELATED ENTITY THE GOVERNING DOCUMENTS OF WHICH REQUIRE THE ENTITY TO COMPLY WITH COMMONSPIRIT POLICY (COLLECTIVELY THE "SYSTEM ENTITIES"). THE FOLLOWING PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY (VIA A FORMAL SYSTEM-ADMINISTERED SURVEY) IF THE PERSON'S AFFILIATION WITH COMMONSPIRIT CONTINUES: - MEMBERS OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF COMMITTEES OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM ("ELT") OF COMMONSPIRIT - CORPORATE OFFICERS OF SYSTEM ENTITIES - KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES AS SPECIFIED BY THE INTERNAL REVENUE SERVICE FOR FORM 990 PURPOSES WHO ARE NOT OTHERWISE INCLUDED IN THE CATEGORIES ABOVE - EMPLOYEES OF SYSTEM ENTITIES AT THE VICE PRESIDENT LEVEL AND ABOVE - ALL INDIVIDUALS ENGAGED IN RESEARCH AT INSTITUTIONS OWNED OR OPERATED BY A SYSTEM ENTITY - SELECT EMPLOYEES AS DETERMINED FROM TIME TO TIME BY LEADERSHIP DISCLOSURE, REVIEW, AND MANAGEMENT OF PERCEIVED, POTENTIAL, OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. EACH PERSON IS REQUIRED TO PROMPTLY AND FULLY DISCLOSE ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST AS SOON AS SHE/HE BECOMES AWARE OF IT. IN ADDITION, AT THE INCEPTION OF AN INDIVIDUAL'S RELATIONSHIP WITH COMMONSPIRIT (E.G. HIRING, BOARD APPOINTMENT), AND FOR CERTAIN POSITIONS, ANNUALLY THEREAFTER, WRITTEN CONFLICT OF INTEREST DISCLOSURE FORMS MUST BE COMPLETED. A FAILURE TO DISCLOSE MAY RESULT IN DISCIPLINARY OR CORRECTIVE ACTIONS. REPORTED POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE INITIALLY REVIEWED BY LEGAL, CORPORATE RESPONSIBILITY OR RESEARCH INTEGRITY STAFF. IF NECESSARY, A CONFLICT OF INTEREST MANAGEMENT PLAN IS DEVELOPED, WHICH PLAN SHALL BE SUBJECT TO ACCEPTANCE BY THE APPROPRIATE DIRECT MANAGER, SUPERVISOR, MEDICAL STAFF OFFICE, BOARD OR BOARD COMMITTEE (FOR BOARD, BOARD COMMITTEE, ELT OR CORPORATE OFFICER CONFLICTS), OR OTHER APPROPRIATE INDIVIDUAL OR BODY. ONCE ACCEPTED, THE CONFLICT OF INTEREST MANAGEMENT PLAN IS COMMUNICATED TO THE PERSON WITH THE ACTUAL OR POTENTIAL CONFLICT AND THE INDIVIDUAL MUST CONDUCT THEMSELVES IN CONFORMITY WITH THE PLAN. IN THE EVENT THAT A TRANSACTIONAL CONFLICT INTEREST ARISES IN CONNECTION WITH A SYSTEM ENTITY BOARD MEETING, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THAT CONFLICT PRIOR TO OR AT THE BEGINNING OF THE MEETING IN WHICH THE MATTER IS TO BE CONSIDERED. THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE TRANSACTION AND IS PROHIBITED FROM USING PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, BUT IS NOT PROHIBITED FROM PROVIDING INPUT IF REQUESTED TO DO SO.
FORM 990, PART VI, SECTION B, LINE 15	DURING THE TAX YEAR ENDED 6/30/2022, 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, SECTION C, LINE 19	THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG.
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 IX, LINE 11G	OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,126,088. MANAGEMENT AND GENERAL EXPENSES 59,268. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,185,356. CONSULTING: PROGRAM SERVICE EXPENSES 17,774. MANAGEMENT AND GENERAL EXPENSES 935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,709. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,927,653. MANAGEMENT AND GENERAL EXPENSES 154,087. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,081,740. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,023,002. MANAGEMENT AND GENERAL EXPENSES 53,842. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,076,844.
FORM 990, PART XI, LINE 9:	OTHER CHANGES -48,104.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- 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

2021

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	HOSPITAL	NE	501(C)(3)	LINE 3	ACH		No
(2)ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA,NE68154 47-0757164	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(3)ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA,NE68124 47-0484764	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(4)ALEGENT HEALTH-COMM MEM HOSPITAL OF MO VALLEY IA 631 N 8TH ST MISSOURI VALLEY,IA51555 42-0776568	HOSPITAL	IA	501(C)(3)	LINE 3	CHI NEBRASKA		No
(5)ALEGENT HEALTH-IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA,NE68122 47-0376615	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(6)ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER,NE68661 47-0399853	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(7)ALEGENT HEALTH-MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING,IA50841 42-0782518	HOSPITAL	IA	501(C)(3)	LINE 3	CHI NEBRASKA		No
(8)ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS,MN56345 41-1351177	LTERM CARE	MN	501(C)(3)	LINE 10	CSH		No
(9)APPLETREE COURT 601 OAK ST BRECKENRIDGE,MN56520 41-1850500	SENIOR LIVING	MN	501(C)(3)	LINE 10	SFH		No
(10)ARROYO GRANDE COMMUNITY HOSPITAL FOUNDATION 345 S HALCYON RD ARROYO GRANDE,CA93420 20-3256066	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(11)BAKERSFIELD MEMORIAL HOSPITAL 420 34TH STREET BAKERSFIELD,CA93301 95-1802779	HOSPITAL	CA	501(C)(3)	LINE 3	DCC		No
(12)BARROW NEUROLOGICAL FOUNDATION 350 WEST THOMAS ROAD PHOENIX,AZ85013 86-0174371	FUNDRAISING FOUNDATION	AZ	501(C)(3)	LINE 7	DH		No
(13)BAYLOR ST LUKE'S HEALTH VENTURES 17200 ST LUKES WAY STE 170 THE WOODLANDS,TX77384 27-4499340	PHYSICIANS	TX	501(C)(3)	LINE 12A, I	SLHS		No
(14)BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0458535	PHYSICIANS	TX	501(C)(3)	LINE 3	BSLHV		No
(15)BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 23-2187242	INACTIVE	PA	501(C)(3)	LINE 12A, I	CSH		No
(16)BRAZOSPORT HEALTH FOUNDATION INC 100 MEDICAL DRIVE LAKE JACKSON,TX77566 76-0080110	FUNDRAISING FOUNDATION	TX	501(C)(3)	LINE 12A, I	TCHB		No
(17)BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON,TX77566 80-0240261	PHYSICIANS	TX	501(C)(3)	LINE 3	TCHB		No
(18)BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2759890	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(19)BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2913931	REHABILITATION	TX	501(C)(3)	LINE 10	SJSC		No
(20)CALIFORNIA HOSPITAL MEDICAL CENTER FOUNDATION 1401 SOUTH GRAND AVENUE LOS ANGELES,CA90015 95-4000909	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DCC		No
(21)CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON,ND58421 45-0227311	HOSPITAL	ND	501(C)(3)	LINE 3	CSH		No
(22)CATHOLIC HEALTH INITIATIVES - COLORADO 9100 EAST MINERAL CIRCLE CENTENNIAL,CO80112 84-0405257	HOSPITAL	CO	501(C)(3)	LINE 3	CSH		No
(23)CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES,IA50314 42-0680448	HOSPITAL	IA	501(C)(3)	LINE 3	CSH		No
(24)CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 9100 EAST MINERAL AVE CENTENNIAL,CO80112 84-0902211	FUNDRAISING FOUNDATION	CO	501(C)(3)	LINE 7	CHIC		No
(25)CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 1150 KELLY JOHNSON BLVD 204 COLORADO SPRINGS,CO80920 27-0930004	FUNDRAISING FOUNDATION	CO	501(C)(3)	LINE 12A, I	CSH		No
(26)CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-0992796	TELEHEALTH	CO	501(C)(3)	LINE 12A, I	CHI NS		No
(27)CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG,OR97471 26-3946191	SURGERY CENTER	OR	501(C)(3)	LINE 10	MMC - ROSEBURG		No
(28)CENTRAL CALIFORNIA HEALTH CENTERS 300 OLD RIVER ROAD STE 200 BAKERSFIELD,CA93311 84-4171789	CLINIC	CA	501(C)(3)	LINE 3	DCC		No
(29)CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND,KS67530 48-0543724	INACTIVE	KS	501(C)(3)	LINE 3	CSH		No
(30)CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO,ND58104 27-1966847	SENIOR LIVING	MN	501(C)(3)	LINE 10	CSH		No
(31)CHI HEALTH FOUNDATION 12809 W DODGE RD OMAHA,NE68154 47-0648586	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	ACH		No
(32)CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER,KY41018 20-2741651	INVESTMENTS	KY	501(C)(3)	LINE 12A, I	CSH		No
(33)CHI LIVING COMMUNITIES 930 S WYNN ROAD OREGON,OH43616 34-1892096	SENIOR LIVING	OH	501(C)(3)	LINE 12A, I	SFH-OH		No
(34)CHI MEMORIAL HOSPITAL - GEORGIA 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE,GA30742 82-2748395	HOSPITAL	GA	501(C)(3)	LINE 3	MHCS		No
(35)CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 45-1261716	HOME HEALTH	CO	501(C)(3)	LINE 10	CHI NS		No
(36)CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 45-2532084	HOLDING CO	CO	501(C)(3)	LINE 12A, I	CSH		No
(37)CHI NEBRASKA 12809 WEST DODGE ROAD OMAHA,NE68510 36-3233121	HOLDING CO	NE	501(C)(3)	LINE 12A, I	CSH		No
(38)CHI ST JOSEPH CHILDREN'S HEALTH 1929 LINCOLN HWY E STE 150 LANCASTER,PA17602 23-2342997	HEALTHCARE	PA	501(C)(3)	LINE 12A, I	CSH		No
(39)CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE,NM87102 71-0897107	COMMUNITY	NM	501(C)(3)	LINE 12A, I	CSH		No
(40)CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS,AR71913 71-0236913	HOSPITAL	AR	501(C)(3)	LINE 3	CHI-SVHS		No
(41)CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS,AR71913 26-1125064	HOLDING CO	AR	501(C)(3)	LINE 12A, I	SVIMC		No
(42)CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 300 WERNER ST HOT SPRINGS,AR71913 26-1125131	PHYSICIANS	AR	501(C)(3)	LINE 3	CHI-SVHS		No
(43)COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 47-0617373	HEALTHCARE	CO	501(C)(3)	LINE 12A, I	N/A		No
(44)COMMONSPIRIT HEALTH FOUNDATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 85-3374038	FUNDRAISING FOUNDATION	CO	501(C)(3)	LINE 7	CSH		No
(45)COMMONSPIRIT HEALTH OPERATING INVESTMENT POOL LLC 185 BERRY STREET STE 200 SAN FRANCISCO,CA94107 85-0919176	OPERATING INVESTMENTS	DE	501(C)(3)	LINE 12A, I	CSH		No
(46)COMMONSPIRIT HEALTH RESEARCH INSTITUTE 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 27-1050565	RESEARCH	CO	501(C)(3)	LINE 12A, I	CSH		No
(47)COMMUNITY HOSPITAL OF SAN BERNARDINO 1805 MEDICAL CENTER DRIVE SAN BERNARDINO,CA92411 95-1643373	HOSPITAL	CA	501(C)(3)	LINE 3	DCC		No
(48)COMMUNITY LIMITED CARE DIALYSIS CENTER 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI,OH45202 23-7419853	HOLDING CO	OH	501(C)(2)		GSH		No
(49)COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY,IA51555 42-1294399	FUNDRAISING FOUNDATION	IA	501(C)(3)	LINE 12A, I	AH-CMHMV		No
(50)CONTINUING CARE HOSPITAL ONE SAINT JOSEPH DRIVE LEXINGTON,KY40504 61-1400619	HOSPITAL	KY	501(C)(3)	LINE 3	SJHS		No
(51)DIGNITY COMMUNITY CARE 185 BERRY STREET STE 200 SAN FRANCISCO,CA94107 81-5009488	HOSPITAL	CO	501(C)(3)	LINE 3	CSH		No
(52)DIGNITY HEALTH 185 BERRY STREET STE 200 SAN FRANCISCO,CA94107 94-1196203	HOSPITAL	CA	501(C)(3)	LINE 3	CSH		No
(53)DIGNITY HEALTH CONNECTED LIVING 200 MERCY OAKS DRIVE REDDING,CA96003 23-7115371	SENIOR CENTER SERVICES	CA	501(C)(3)	LINE 7	DH		No
(54)DIGNITY HEALTH FOUNDATION 185 BERRY STREET STE 200 SAN FRANCISCO,CA94107 46-2037641	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(55)DIGNITY HEALTH FOUNDATION - INLAND EMPIRE 2101 N WATERMAN AVENUE SAN BERNARDINO,CA92404 23-7440086	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(56)DIGNITY HEALTH FOUNDATION EAST VALLEY 475 SOUTH DOBSON ROAD CHANDLER,AZ85224 74-2418514	FUNDRAISING FOUNDATION	AZ	501(C)(3)	LINE 12A, I	DH		No
(57)DIGNITY HEALTH MEDICAL FOUNDATION 3400 DATA DRIVE RANCHO CORDOVA,CA95670 68-0220314	MULTI-SPECIALTY OUTPATIENT MEDICAL CLINIC	CA	501(C)(3)	LINE 12A, I	DCC		No
(58)DOMINICAN HEALTH SERVICES 1555 SOQUEL DRIVE SANTA CRUZ,CA95065 77-0056778	COMMUNITY HEALTH SYSTEM	CA	501(C)(3)	LINE 12A, I	DH		No
(59)DOMINICAN HOSPITAL FOUNDATION 1555 SOQUEL DRIVE SANTA CRUZ,CA95065 94-2450442	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(60)DOMINICAN OAKS CORPORATION 1555 SOQUEL DRIVE SANTA CRUZ,CA95065 77-0127719	OPERATION AND MANAGEMENT OF HOUSING COMPLEX TO ELDERLY PERSONS	CA	501(C)(3)	LINE 10	DHS		No
(61)EAST TEXAS CLINICAL SERVICES 101 VISION PARK SUITE 100 SHENANDOAH,TX77384 45-4736213	HEALTHCARE	TX	501(C)(3)	LINE 12A, I	SLHS		No
(62)ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1455 BATTERSBY AVE ENUMCLAW,WA98022 91-0715805	HOSPITAL	WA	501(C)(3)	LINE 3	FHS		No
(63)FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN,KY40004 61-1345363	HOSPITAL	KY	501(C)(3)	LINE 3	KOH		No
(64)FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN,KY40004 56-2351341	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 12A, I	FH		No
(65)FRANCISCAN CARE CENTER 4111 N HOLLAND-SYLVANIA RD TOLEDO,OH43623 34-1931806	HEALTHCARE	OH	501(C)(3)	LINE 10	CHILC		No
(66)FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA,WA98405 91-1145592	FUNDRAISING FOUNDATION	WA	501(C)(3)	LINE 10	FHS		No
(67)FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA,WA98405 91-0564491	HOSPITAL	WA	501(C)(3)	LINE 3	CSH		No
(68)FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA,WA98402 91-1939739	PHYSICIANS	WA	501(C)(3)	LINE 10	FHS		No
(69)FRENCH HOSPITAL MEDICAL CENTER FOUNDATION 1911 JOHNSON AVENUE SAN LUIS OBISPO,CA93401 20-3256125	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DCC		No
(70)GARRISON MEMORIAL HOSPITAL 407 THIRD AVENUE SOUTHEAST GARRISON,ND58540 45-0227752	HOSPITAL	ND	501(C)(3)	LINE 3	SAMC		No
(71)GLENDALE MEMORIAL HEALTH FOUNDATION 1420 SOUTH CENTRAL AVENUE GLENDALE,CA91204 95-3625651	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DCC		No
(72)GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 20-1536108	INACTIVE	CO	501(C)(3)	LINE 12A, I	CSH		No
(73)GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI,OH45202 31-1778403	EDUCATION	OH	501(C)(3)	LINE 2	GSH		No
(74)GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY,NE68848 47-0379755	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(75)GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY,NE68847 47-0659443	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	GSH-KN		No
(76)GOOD SAMARITAN HOSPITAL FOUNDATION OF CINCINNATI INC 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI,OH45202 31-1206047	FUNDRAISING FOUNDATION	OH	501(C)(3)	LINE 12A, I	GSH		No
(77)HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON,WA98310 91-0565546	HOSPITAL	WA	501(C)(3)	LINE 3	FHS		No
(78)HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 76-0761782	FUNDRAISING FOUNDATION	MN	501(C)(3)	LINE 12A, I	SFMC-MN		No
(79)HOUSE OF MERCY 1111 6TH AVE DES MOINES,IA50314 42-1323808	ASSISTED LIVING	IA	501(C)(3)	LINE 7	CHI-IA CORP		No
(80)JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC ONE SAINT JOSEPH DRIVE LEXINGTON,KY40504 61-1029768	HOSPITAL	KY	501(C)(3)	LINE 3	KOH		No
(81)KENTUCKYONE HEALTH MEDICAL GROUP INC 100 E LIBERTY ST STE 800 LOUISVILLE,KY40202 61-1352729	PHYSICIANS	KY	501(C)(3)	LINE 10	JHSMH		No
(82)KENTUCKYONE HEALTH INC ONE SAINT JOSEPH DRIVE LEXINGTON,KY40504 61-1029769	HEALTHCARE	KY	501(C)(3)	LINE 12A, I	CSH		No
(83)LAKEWOOD HEALTH CENTER 600 MAIN AVE S BAUDETTE,MN56623 41-0758434	HOSPITAL	MN	501(C)(3)	LINE 3	CSH		No
(84)LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVE S BAUDETTE,MN56623 41-1893795	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 7	LHC		No
(85)LEGACY FOUNDATION OF KENTUCKIANA INC 1451 HARRODSBURG RD STE D-308 LEXINGTON,KY40504 83-2170324	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 12A, I	KOH		No
(86)LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON,ND58054 82-0558836	HOSPITAL	ND	501(C)(3)	LINE 3	CSH		No
(87)LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN,TX75901 82-0563768	PROPERTY MGMT	TX	501(C)(3)	LINE 12A, I	MHSET		No
(88)MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2761145	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(89)MADONNA MANOR INC 2344 AMSTERDAM ROAD VILLA HILLS,KY51017 61-0654635	ASSISTED LIVING	KY	501(C)(3)	LINE 10	CHILC		No
(90)MARIAN REGIONAL MEDICAL CENTER FOUNDATION 1400 E CHURCH STREET SANTA MARIA,CA93454 95-3818027	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(91)MARK TWAIN MEDICAL CENTER 768 MOUNTAIN RANCH ROAD SAN ANDREAS,CA95249 68-0127677	HOSPITAL	CA	501(C)(3)	LINE 3	DCC		No
(92)MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA,TN37404 62-1839548	FUNDRAISING FOUNDATION	TN	501(C)(3)	LINE 7	MHCS		No
(93)MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA,TN37404 62-0532345	HOSPITAL	TN	501(C)(3)	LINE 3	CSH		No
(94)MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA,TN37411 03-0417049	HEALTHCARE	TN	501(C)(3)	LINE 10	MHCS		No
(95)MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN,TX75902 75-0755367	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(96)MEMORIAL MEDICAL CENTER-LIVINGSTON PO BOX 1447 LUFKIN,TX75902 76-0436439	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(97)MEMORIAL MEDICAL CENTER-SAN AUGUSTINE PO BOX 1447 LUFKIN,TX75902 75-2663904	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(98)MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVE LUFKIN,TX75904 75-2721155	PHYSICIANS	TX	501(C)(3)	LINE 12A, I	MHSET		No
(99)MEMORIAL SPECIALTY HOSPITAL PO BOX 1447 LUFKIN,TX75902 75-2492741	INACTIVE	TX	501(C)(3)	LINE 3	MHSET		No
(100)MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVE DES MOINES,IA50314 42-6076069	AUXILIARY	IA	501(C)(3)	LINE 12A, I	MF-DM IA		No
(101)MERCY CLINICS INC 1111 6TH AVE DES MOINES,IA50314 42-1193699	PHYSICIANS	IA	501(C)(3)	LINE 10	CHI-IA CORP		No
(102)MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVE DES MOINES,IA50314 42-1511682	EDUCATION	IA	501(C)(3)	LINE 2	CHI-IA CORP		No
(103)MERCY FOUNDATION BAKERSFIELD PO BOX 119 BAKERSFIELD,CA93302 77-0201321	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(104)MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES,IA50314 23-7358794	FUNDRAISING FOUNDATION	IA	501(C)(3)	LINE 7	CHI-IA CORP		No
(105)MERCY FOUNDATION INC 2700 STEWART PKWY ROSEBURG,OR97471 93-6088946	FUNDRAISING FOUNDATION	OR	501(C)(3)	LINE 7	MMC - ROSEBURG		No
(106)MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING,IA50841 42-1461064	FUNDRAISING FOUNDATION	IA	501(C)(3)	LINE 12A, I	AHMH-CORNING		No
(107)MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BLVD VALLEY CITY,ND58072 45-0435338	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 12A, I	MHVC		No
(108)MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS,IA51503 42-1178204	FUNDRAISING FOUNDATION	IA	501(C)(3)	LINE 12A, I	AHBMHS		No
(109)MERCY HOSPITAL OF DEVILS LAKE 1031 7TH ST NE DEVILS LAKE,ND58301 45-0227012	HOSPITAL	ND	501(C)(3)	LINE 3	CSH		No
(110)MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 7TH ST NE DEVILS LAKE,ND58301 35-2367360	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 7	MHDL		No
(111)MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BLVD VALLEY CITY,ND58072 45-0226553	HOSPITAL	ND	501(C)(3)	LINE 3	CSH		No
(112)MERCY MCMAHON TERRACE 3865 J STREET SACRAMENTO,CA95816 68-0117340	SENIOR CITIZEN'S HOUSING/RETIREMENT COMMUNITIES	CA	501(C)(3)	LINE 10	DH		No
(113)MERCY MEDICAL CENTER 1301 15TH AVE WEST WILLISTON,ND58801 45-0231183	HOSPITAL	ND	501(C)(3)	LINE 3	CSH		No
(114)MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE,IA52544 42-0680308	HOSPITAL	IA	501(C)(3)	LINE 3	CHI-IA CORP		No
(115)MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER 204 N 4TH AVE E NEWTON,IA50314 42-1470935	HOSPITAL	IA	501(C)(3)	LINE 3	CHI-IA CORP		No
(116)MERCY MEDICAL CENTER MERCED FOUNDATION 301 E 13TH STREET MERCED,CA95340 77-0035928	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(117)MERCY MEDICAL CENTER INC 2700 STEWART PKWY ROSEBURG,OR97471 93-0386868	HOSPITAL	OR	501(C)(3)	LINE 3	CSH		No
(118)MERCY MEDICAL FOUNDATION 1301 15TH AVE WEST WILLISTON,ND58801 45-0381803	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 12A, I	MMC WILLISTON		No
(119)NEBRASKA HEART HOSPITAL 7500 S 91ST ST LINCOLN,NE68526 39-2031968	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(120)NORTHLAND HEALTHCARE ALLIANCE 2223 EAST ROSSER AVENUE BISMARCK,ND58501 91-1845296	MANAGEMENT	ND	501(C)(3)	LINE 7	SAMC		No
(121)NORTHRIDGE HOSPITAL FOUNDATION 18300 ROSCOE BLVD NORTHRIDGE,CA91328 23-7444901	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DCC		No
(122)OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES,ND58474 45-0231675	HOSPITAL	ND	501(C)(3)	LINE 3	CSH		No
(123)OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH ST OAKES,ND58474 71-0966606	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 12A, I	OCH		No
(124)PACIFIC CENTRAL COAST HEALTH CENTERS 1400 E CHURCH STREET SANTA MARIA,CA93454 77-0447575	CLINIC	CA	501(C)(3)	LINE 3	DCC		No
(125)PINEYWOODS MEDICAL DEVELOPMENT CORP PO BOX 1447 LUFKIN,TX75902 75-2493116	PROPERTY MGMT	TX	501(C)(3)	LINE 12A, I	MHSET		No
(126)PORT CITY OPERATING COMPANY LLC 3400 DATA DRIVE RANCHO CORDOVA,CA95670 46-5322209	HOSPITAL	CA	501(C)(3)	LINE 3	DH		No
(127)PROVIDENCE CARE CENTER 2025 HAYES AVENUE SANDUSKY,OH44870 34-1658625	LTERM CARE	OH	501(C)(3)	LINE 10	CHILC		No
(128)PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY,OH44870 34-1896807	LIVING COMM	OH	501(C)(3)	LINE 10	CHILC		No
(129)SAINT CLARE'S COMMUNITY CARE INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 22-2876836	INACTIVE	NJ	501(C)(3)	LINE 12B, II	SCHS		No
(130)SAINT CLARE'S HEALTH SERVICES INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 22-3639733	INACTIVE	NJ	501(C)(3)	LINE 10	CSH		No
(131)SAINT CLARE'S HOSPITAL INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 22-3319886	INACTIVE	NJ	501(C)(3)	LINE 3	SCHS		No
(132)SAINT ELIZABETH FOUNDATION 555 S 70TH ST LINCOLN,NE68510 47-0625523	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	SERMC		No
(133)SAINT ELIZABETH HEALTH SERVICES 555 S 70TH ST LINCOLN,NE68510 36-3233120	INACTIVE	NE	501(C)(3)	LINE 3	SERMC		No
(134)SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 S 70TH ST LINCOLN,NE68510 47-0379836	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(135)SAINT FRANCIS MEDICAL CENTER 2620 W FAIDLEY GRAND ISLAND,NE68803 47-0376601	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(136)SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND,NE68802 47-0630267	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	SFMC-NE		No
(137)SAINT FRANCIS MEMORIAL HOSPITAL 900 HYDE STREET SAN FRANCISCO,CA94109 94-1156295	HOSPITAL	CA	501(C)(3)	LINE 3	DCC		No
(138)SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL ST BEREA,KY40403 26-0152877	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 7	SJHS		No
(139)SAINT JOSEPH HEALTH SYSTEM INC ONE ST JOSEPHS DRIVE LEXINGTON,KY40504 61-1334601	HOSPITAL	KY	501(C)(3)	LINE 3	KOH		No
(140)SAINT JOSEPH HOSPITAL FOUNDATION INC 701 BOB OLINK DR 200 LEXINGTON,KY40504 61-1159649	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 12A, I	SJHS		No
(141)SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON,KY40741 26-0438748	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 7	SJHS		No
(142)SAINT JOSEPH MOUNT STERLING FOUNDATION INC 225 FALCON DR MOUNT STERLING,KY40353 27-2884584	FUNDRAISING FOUNDATION	KY	501(C)(3)	LINE 7	SJHS		No
(143)SAINT JOSEPH'S HOSPITAL FOUNDATION 2500 FAIRWAY STREET DICKINSON,ND58601 36-3418207	FUNDRAISING FOUNDATION	ND	501(C)(3)	LINE 12A, I	SJHHC		No
(144)SAN GABRIEL VALLEY MEDICAL CENTER FOUNDATION 438 WEST LAS TUNAS DRIVE SAN GABRIEL,CA91776 95-3430341	INACTIVE	CA	501(C)(3)	LINE 12A, I	DH		No
(145)SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC 104 W 17TH ST SCHUYLER,NE68661 36-3630014	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 12A, I	AHMHS		No
(146)SIERRA NEVADA MEMORIAL-MINERS HOSPITAL 155 GLASSON WAY GRASS VALLEY,CA95945 94-1439787	HOSPITAL	CA	501(C)(3)	LINE 3	DCC		No
(147)SJRMC JOPLIN MISSOURI 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 44-0545809	INACTIVE	MO	501(C)(3)	LINE 3	CSH		No
(148)ST FRANCIS FOUNDATION OF SANTA BARBARA 2323 DE LA VINA ST SUITE 104 SANTA BARBARA,CA93105 23-7137119	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(149)ST FRANCIS HOSPITAL SUPPORT CORPORATION 601 E MICHELTORENA STREET SANTA BARBARA,CA93103 77-0022302	INACTIVE	CA	501(C)(3)	LINE 12A, I	DH		No
(150)ST JOHNS HEALTHCARE FOUNDATION 1600 NORTH ROSE AVENUE OXNARD,CA93030 20-2865781	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(151)ST JOSEPHS FOUNDATION (PHOENIX) 350 WEST THOMAS ROAD PHOENIX,AZ85013 94-2941245	FUNDRAISING FOUNDATION	AZ	501(C)(3)	LINE 12A, I	DH		No
(152)ST JOSEPHS FOUNDATION OF SAN JOAQUIN 1800 N CALIFORNIA STREET STOCKTON,CA95204 51-0432777	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(153)ST MARY MEDICAL CENTER FOUNDATION 1050 LINDEN AVENUE LONG BEACH,CA90813 23-7153876	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(154)ST MARY PROFESSIONAL BUILDING INC 1050 LINDEN AVENUE LONG BEACH,CA90813 23-7373088	INACTIVE	CA	501(C)(3)	LINE 12A, I	DH		No
(155)ST MARYS MEDICAL CENTER FOUNDATION 450 STANYAN STREET SAN FRANCISCO,CA94117 94-3336143	FUNDRAISING FOUNDATION	CA	501(C)(3)	LINE 12A, I	DH		No
(156)ST ROSE DOMINICAN HEALTH FOUNDATION 3001 ST ROSE PARKWAY HENDERSON,NV89052 88-0349432	FUNDRAISING FOUNDATION	NV	501(C)(3)	LINE 12A, I	DH		No
(157)ST ALEXIUS MEDICAL CENTER 900 EAST BROADWAY AVENUE BISMARCK,ND58501 45-0226711	HOSPITAL	ND	501(C)(3)	LINE 3	CSH		No
(158)ST ANNE OC 1145 BROADWAY PLAZA STE 1200 TACOMA,WA98402 86-3590968	INACTIVE	WA	501(C)(3)	LINE 10	FHS		No
(159)ST ANTHONY HOSPITAL 2801 ST ANTHONY WAY PENDLETON,OR97801 93-0391614	HOSPITAL	OR	501(C)(3)	LINE 3	CSH		No
(160)ST ANTHONY HOSPITAL FOUNDATION 2801 ST ANTHONY WAY PENDLETON,OR97801 93-0992727	FUNDRAISING FOUNDATION	OR	501(C)(3)	LINE 12A, I	SAH		No
(161)ST ANTHONY'S HOSPITAL ASSOCIATION FOUR HOSPITAL DR MORRILTON,AR72110 71-0245507	HOSPITAL	AR	501(C)(3)	LINE 3	SVIMC		No
(162)ST CATHERINE HOSPITAL 401 EAST SPRUCE ST GARDEN CITY,KS67846 48-0543721	HOSPITAL	KS	501(C)(3)	LINE 3	CSH		No
(163)ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION 401 EAST SPRUCE ST GARDEN CITY,KS67846 20-0598702	FUNDRAISING FOUNDATION	KS	501(C)(3)	LINE 12A, I	SCH		No
(164)ST CLARE COMMONS 12469 FIVE POINT ROAD TOLEDO,OH43551 27-0163752	LIVING COMM	OH	501(C)(3)	LINE 10	CHILC		No
(165)ST DOMINIC OF ONTARIO OREGON 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 93-0433692	INVESTMENTS	OR	501(C)(4)		CSH		No
(166)ST FRANCIS HOME 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 41-0729978	LTERM CARE	MN	501(C)(3)	LINE 10	CSH		No
(167)ST FRANCIS LIFE CARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 22-2536017	INACTIVE	NJ	501(C)(3)	LINE 8	SCHS		No
(168)ST FRANCIS MEDICAL CENTER 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 41-0695598	HOSPITAL	MN	501(C)(3)	LINE 3	CSH		No
(169)ST JOSEPH FOUNDATION OF BRYAN TEXAS 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2351158	FUNDRAISING FOUNDATION	TX	501(C)(3)	LINE 12A, I	SJSC		No
(170)ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2847594	LTERM CARE	TX	501(C)(3)	LINE 10	SJSC		No
(171)ST JOSEPH MEDICAL CENTER INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 52-0591461	INACTIVE	MD	501(C)(3)	LINE 3	CSH		No
(172)ST JOSEPH PHYSICIAN ASSOCIATES 2801 FRANCISCAN DRIVE BRYAN,TX77802 20-3159302	PHYSICIANS	TX	501(C)(3)	LINE 3	SJSC		No
(173)ST JOSEPH PHYSICIAN ENTERPRISE INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 52-1311775	INACTIVE	MD	501(C)(3)	LINE 12A, I	SJMC		No
(174)ST JOSEPH REGIONAL HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-1282696	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(175)ST JOSEPH REGIONAL HEALTH PARTNERS 2801 FRANCISCAN DRIVE BRYAN,TX77802 45-4088170	HOSPITAL	TX	501(C)(3)	LINE 3	SJSC		No
(176)ST JOSEPH REGIONAL HEALTH PARTNERS ACO 2801 FRANCISCAN DRIVE BRYAN,TX77802 46-3265423	HEALTHCARE	TX	501(C)(3)	LINE 10	SJSC		No
(177)ST JOSEPH SERVICES CORPORATION 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2455161	MANAGEMENT	TX	501(C)(3)	LINE 12A, I	SLHS		No
(178)ST JOSEPH'S AREA HEALTH SERVICES 600 PLEASANT AVE PARK RAPIDS,MN56470 41-0695603	HOSPITAL	MN	501(C)(3)	LINE 3	CSH		No
(179)ST JOSEPH'S HOSPITAL AND HEALTH CENTER 2500 FAIRWAY ST DICKINSON,ND58601 45-0226429	HOSPITAL	ND	501(C)(3)	LINE 3	CSH		No
(180)ST LEONARD 8100 CLYO ROAD CENTERVILLE,OH45458 34-1940863	LIVING COMM	OH	501(C)(3)	LINE 10	CHILC		No
(181)ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-1947374	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(182)ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-0335902	HOSPITAL	TX	501(C)(3)	LINE 3	SLHS		No
(183)ST LUKE'S COMMUNITY HEALTH SERVICES 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0536234	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(184)ST LUKE'S FOUNDATION 1213 HERMANN DRIVE STE 855 HOUSTON,TX77004 45-3811485	FUNDRAISING FOUNDATION	TX	501(C)(3)	LINE 7	SLHS		No
(185)ST LUKE'S HEALTH CLINICAL OPERATIONS 6624 FANNIN ST STE 2505 HOUSTON,TX77030 27-3733278	HOSPITAL	TX	501(C)(3)	LINE 3	SLHS		No
(186)ST LUKE'S HEALTH SYSTEM CORP PO BOX 20269 HOUSTON,TX77225 76-0536232	MANAGEMENT	TX	501(C)(3)	LINE 12A, I	CSH		No
(187)ST LUKE'S HOSPITAL AT THE VINTAGE 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-3734606	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(188)ST LUKE'S PROPERTIES CORPORATION 1213 HERMANN DRIVE STE 855 HOUSTON,TX77004 76-0531716	PROPERTY MGMT	TX	501(C)(3)	LINE 12A, I	SLHS		No
(189)ST LUKE'S SUGAR LAND PROPERTIES CORPORATION 6624 FANNIN ST STE 2505 HOUSTON,TX77030 45-4120549	PROPERTY MGMT	TX	501(C)(3)	LINE 12A, I	SLCDC-SL		No
(190)ST MARY'S COMMUNITY HOSPITAL 1301 GRUNDMAN BOULEVARD NEBRASKA CITY,NE68410 47-0443636	HOSPITAL	NE	501(C)(3)	LINE 3	CHI NEBRASKA		No
(191)ST MARY'S HOSPITAL FOUNDATION 1301 GRUNDMAN BLVD NEBRASKA CITY,NE68410 47-0707604	FUNDRAISING FOUNDATION	NE	501(C)(3)	LINE 7	SMCH		No
(192)ST VINCENT FOUNDATION TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 51-0169537	FUNDRAISING FOUNDATION	AR	501(C)(3)	LINE 12A, I	SVIMC		No
(193)ST VINCENT INFIRMARY MEDICAL CENTER TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 71-0236917	HOSPITAL	AR	501(C)(3)	LINE 3	CSH		No
(194)ST VINCENT MEDICAL GROUP TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 71-0830696	PHYSICIANS	AR	501(C)(3)	LINE 10	SVIMC		No
(195)SYLVANIA FRANCISCAN HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 34-1412964	HOLDING CO	OH	501(C)(3)	LINE 12A, I	CSH		No
(196)SYLVANIA FRANCISCAN HEALTH FOUNDATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 45-5357161	INACTIVE	OH	501(C)(3)	LINE 12A, I	SFH-OH		No
(197)THE COMMONS OF PROVIDENCE 5000 PROVIDENCE DRIVE SANDUSKY,OH44870 34-1826097	ASSISTED LIVING	OH	501(C)(3)	LINE 10	CHILC		No
(198)THE COMMUNITY HOSPITAL OF BRAZOSPORT 100 MEDICAL DRIVE LAKE JACKSON,TX77566 74-1385192	HOSPITAL	TX	501(C)(3)	LINE 3	SLH-CO		No
(199)THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH 625 EDEN PARK DRIVE 7TH FLOOR CINCINNATI,OH45202 31-0537486	HOSPITAL	OH	501(C)(3)	LINE 3	CSH		No
(200)THE PHYSICIAN NETWORK 2000 Q ST STE 500 LINCOLN,NE68503 47-0780857	PHYSICIANS	NE	501(C)(3)	LINE 12A, I	CHI NEBRASKA		No
(201)TOTAL HEALTHCARE 9100 E MINERAL CIRCLE CENTENNIAL,CO80112 84-0927232	INACTIVE	CO	501(C)(3)	LINE 3	CHIC		No
(202)TRINITY HEALTH FOUNDATION 380 SUMMIT AVENUE STEUBENVILLE,OH43952 31-1329423	FUNDRAISING FOUNDATION	OH	501(C)(3)	LINE 12A, I	THS		No
(203)TRINITY HEALTH SYSTEM 380 SUMMIT AVENUE STEUBENVILLE,OH43952 34-1818681	HEALTHCARE	OH	501(C)(3)	LINE 12A, I	N/A		No
(204)TRINITY HOSPITAL TWIN CITY 819 NORTH FIRST STREET DENNISON,OH44621 27-5401105	HOSPITAL	OH	501(C)(3)	LINE 3	THS		No
(205)TRI-STATE HEALTH SERVICES INC ONE ROSS PARK BLVD STEUBENVILLE,OH43952 34-1522484	ASSISTED LIVING	OH	501(C)(3)	LINE 7	THS		No
(206)UNITY FAMILY HEALTHCARE 815 SE 2ND ST LITTLE FALLS,MN56345 41-0721642	HOSPITAL	MN	501(C)(3)	LINE 3	CSH		No
(207)VILLA NAZARETH INC 801 PAGE DR FARGO,ND58103 45-0226714	LTERM CARE	ND	501(C)(3)	LINE 10	CSH		No
(208)VISITING NURSE ASSOCIATION OF ST CLARE'S INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 22-1768334	INACTIVE	NJ	501(C)(3)	LINE 10	SCHS		No
(209)YAVAPAI COMMUNITY HOSPITAL ASSOCIATION 1003 WILLOW CREEK ROAD PRESCOTT,AZ86301 86-0098923	HOSPITAL	AZ	501(C)(3)	LINE 3	DCC		No
(210)YAVAPAI REGIONAL MEDICAL CENTER FOUNDATION 1003 WILLOW CREEK ROAD PRESCOTT,AZ86301 86-1038463	FUNDRAISING FOUNDATION	AZ	501(C)(3)	LINE 12A, I	YRMC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(k) Percentage ownership
(1) AMERICAN MERCY HOME CARE LLC 6281 TRI RIDGE BLVD STE 300 LOVELAND,OH45150 83-0486150	HOME HEALTH	OH	N/A	N/A				No			No
(2) ARIZONA CARE NETWORK - NEXT LLC 4222 E THOMAS RD STE 400 PHOENIX,AZ85018 47-4696671	CARE NETWORK	AZ	N/A	N/A				No			No
(3) ARIZONA CARE NETWORK LLC (ACN LLC) 4222 E THOMAS RD STE 400 PHOENIX,AZ85013 45-4494682	CARE NETWORK	AZ	N/A	N/A				No			No
(4) ARIZONA DIAGNOSTIC RADIOLOGY GROUP LLC 1510 COTNER AVENUE LOS ANGELES,CA90025 85-1067265	DIAGNOSTIC SERVICES	CA	N/A	N/A				No			No
(5) AUDUBON LAND COMPANY LLC 630 SOUTHPOINTE COURT 200 COLORADO SPRINGS,CO80906 84-1513085	REAL ESTATE	CO	N/A	N/A				No			No
(6) BAYLOR CHI ST LUKES HEALTH SERVICES LLC 3100 MAIN STE 566 HOUSTON,TX77002 47-2079184	HEALTHCARE SRVC	TX	N/A	N/A				No			No
(7) BERGAN MERCY SURGERY CENTER LLC 7500 MERCY RD STE 4300 OMAHA,NE68124 20-8671994	AMBUL SURG CTR	NE	N/A	N/A				No			No
(8) BERYWOOD OFFICE PROPERTIES LLC 2501 CITICO AVENUE CHATTANOGA,TN37404 62-1875199	PHYS OFFICE	TN	N/A	N/A				No			No
(9) BIOLIFE DIGNITY HEALTH INTERNATIONAL LTD 709 WING ON PLAZA 62 MODY ROAD TS HONG KONG CH	HEALTH SERVICES	CH	N/A	N/A				No			No
(10) BLUEGRASS REGIONAL IMAGING CENTER 1218 SOUTH BROADWAY STE 310 LEXINGTON,KY40504 61-1386736	DIAGNOSTIC IMAGING	KY	N/A	N/A				No			No
(11) CBCC OUTSMARTING CANCER LLC 6501 TRUXTUN AVENUE BAKERSFIELD,CA93309 46-1602286	RADIATION / ONCOLOGY	CA	N/A	N/A				No			No
(12) CENTRAL NEBRASKA REHABILITATION SVCS LLC 3004 W FAIDLEY AVE GRAND ISLAND,NE68803 81-0653461	PHYSICAL THERAPY	NE	N/A	N/A				No			No
(13) CENTURA SUMMIT ORTHOPEDICS LLC 68 SCHOOL RD FRISCO,CO80443 87-1308304	HEALTHCARE SRVC	CO	N/A	N/A				No			No
(14) CHICAMSURG SURGERY CENTERS LLC 1A BURTON HILLS BLVD NASHVILLE,TN37215 46-5683027	SURGERY CENTER	CO	N/A	N/A				No			No
(15) COLORADO SPRINGS CK LEASING LLC 630 SOUTHPOINTE COURT 200 COLORADO SPRINGS,CO80906 26-2982714	REAL ESTATE	CO	N/A	N/A				No			No
(16) COMMUNITY MERCY HOME CARE OF SPRINGFLD LLC 6281 TRI RIDGE BLVD 300 LOVELAND,OH45150 31-1746556	HOME HEALTH	OH	N/A	N/A				No			No
(17) DE JV LLC 8686 NEW TRAILS DRIVE THE WOODLANDS,TX77381 32-0496548	EMERGENCY CARE	NV	N/A	N/A				No			No
(18) DHHP SURGERY CENTERS LLC 1513 S GRAND AVENUE STE 350 LOS ANGELES,CA90015 83-1847466	SURGERY	DE	N/A	N/A				No			No
(19) DHRT HOLDINGS LLC 185 BERRY STREET SUITE 200 SAN FRANCISCO,CA94107 35-2484591	HOLDING COMPANY	DE	N/A	N/A				No			No
(20) DIGNITY- GOHEALTHURGENT CARE MANAGEMENT LLC 5555 GLENRIDGE CONNECTOR SUITE 700 ATLANTA,GA30342 35-2548698	MANAGEMENT SERVICES	DE	N/A	N/A				No			No
(21) DIGNITY HEALTH AT HOME LLC 6281 TRI RIDGE BLVD STE 300 LOVELAND,OH45150 82-4674115	HEALTHCARE SRVC	DE	N/A	N/A				No			No
(22) DIGNITY HEALTH SPECIALTY PHARMACY LLC 185 BERRY STREET SUITE 200 SAN FRANCISCO,CA94107 32-0589462	SPECIALTY PHARMACY SERVICES	DE	N/A	N/A				No			No
(23) DIGNITY HOME RECOVERY CARE LLC 49 MUSIC SQUARE WEST SUITE 401 NASHVILLE,TN37203 83-2832522	HOME RECOVERY PROGRAM	DE	N/A	N/A				No			No
(24) DIGNITYUSP LAS VEGAS SURGERY CENTERS LLC 14201 DALLAS PARKWAY DALLAS,TX75254 20-2999237	SURGERY	TX	N/A	N/A				No			No
(25) DIGNITYUSP NORCAL SURGERY CENTERS LLC 14201 DALLAS PARKWAY DALLAS,TX75254 20-2468509	SURGERY	TX	N/A	N/A				No			No
(26) DIGNITYUSP PHOENIX SURGERY CENTERS LLC 14201 DALLAS PARKWAY DALLAS,TX75254 13-4248908	SURGERY	TX	N/A	N/A				No			No
(27) DIGNITYUSPJOHN MUIR EAST BAY SURG CTRS LLC 14201 DALLAS PARKWAY DALLAS,TX75254 35-2584991	SURGERY	TX	N/A	N/A				No			No
(28) DIGNITY-ABRAZO HEALTH NETWORK LLC 4222 E THOMAS RD STE 400 PHOENIX,AZ85018 46-5477985	MANAGEMENT SERVICES	AZ	N/A	N/A				No			No
(29) DOMINICAN MAGNETIC RESONANCE IMAGING CENTER 1545 SOQUEL DRIVE SANTA CRUZ,CA94065 77-0095477	IMAGING CENTER	CA	N/A	N/A				No			No
(30) ECCS ACQUISITION COMPANY LLC 2940 NORTH CIRCLE DRIVE COLORADO SPRINGS,CO80909 35-2656413	AMBUL SURG CTR	CO	N/A	N/A				No			No
(31) ENDOSCOPY CENTER OF ARKANSAS 1024 NORTH UNIVERSITY AVE LITTLE ROCK,AR72207 20-1337002	DIAGNOSTIC SERVICES	AR	N/A	N/A				No			No
(32) FOLSOM SIERRA ENDOSCOPY CENTER LP 1671 CREEKSIDE DRIVE SUITE 100 FOLSOM,CA95630 68-0482416	ENDOSCOPY	CA	N/A	N/A				No			No
(33) FRANCISCAN MEDICAL PAVILION BONNEY LAKE LLC 6622 WOLLOCHET DR NW GIG HARBOR,WA98335 46-3494108	REAL ESTATE	WA	N/A	N/A				No			No
(34) FRANCISCAN SPECIALTY CARE LLC 330 SEVEN SPRINGS WAY BRENTWOOD,TN37027 81-3725123	HEALTHCARE SRVC	WA	N/A	N/A				No			No
(35) GOLDEN RIDGE SURGERY CENTER LLC 660 GOLDEN RIDGE RD 100 GOLDEN,CO80401 84-1498087	HEALTHCARE SRVC	CO	N/A	N/A				No			No
(36) GOOD SAMARITAN HOME CARE SVCS OF VINCENNE LLC 6281 TRI RIDGE BLVD 300 LOVELAND,OH45150 20-1792869	HOME HEALTH	OH	N/A	N/A				No			No
(37) HC SL VINTAGE I LLC 1400 N WATER ST STE 500 MILWAUKEE,WI53202 27-0453767	PROPERTY HOLDING	WI	N/A	N/A				No			No
(38) HEALTHCARE SUPPORT SERVICES LLC PO BOX 9804 GRAND ISLAND,NE68802 72-1546196	LAUNDRY	NE	N/A	N/A				No			No
(39) HEARTLAND ONCOLOGY LLC 2337 E CRAWFORD ST SALINA,KS67402 46-4265403	ONCOLOGY	KS	N/A	N/A				No			No
(40) LAKESIDE AMBULATORY SURGICAL CENTER LLC 17030 LAKESIDE HILLS PLAZA STE 110 OMAHA,NE68130 20-4267902	AMBUL SURG CTR	NE	N/A	N/A				No			No
(41) LAKESIDE ENDOSCOPY CENTER LLC 17001 LAKESIDE HILLS PLZ STE 201 OMAHA,NE68130 20-5544496	ENDOSCOPY SRVC	NE	N/A	N/A				No			No
(42) LEXINGTON MBO PARTNERS LTD 5050 SOUTH SYRACUSE ST STE 800 DENVER,CO80237 65-1132855	REAL ESTATE	CO	N/A	N/A				No			No
(43) LINCOLN CK LEASING LLC 555 SOUTH 70TH STREET LINCOLN,NE68510 26-2496856	REAL ESTATE	NE	N/A	N/A				No			No
(44) MEMORIAL MEDICAL PLAZA 3838 SAN DIMAS SUITE B 201 BAKERSFIELD,CA93301 36-4510880	REAL ESTATE	CA	N/A	N/A				No			No
(45) MERCY DAVIS CANCER CENTER MANAGEMENT CO LLC 2740 M STREET MERCED,CA95340 94-3358445	MANAGEMENT OF CANCER CENTER	CA	N/A	N/A				No			No
(46) MERCY REHABILITATION HOSPITAL LLC 330 SEVEN SPRINGS WAY BRENTWOOD,TN37027 81-4437201	HEALTHCARE SRVC	TX	N/A	N/A				No			No
(47) MILITARY ROAD PROPERTIES LLC 18229 TERRACE COURT SW NORMANDY PARK,WA98166 91-2067879	REAL ESTATE	WA	N/A	N/A				No			No
(48) NEBRASKA SPINE HOSPITAL LLC 6901 N 72ND ST STE 20300 OMAHA,NE68122 27-0263191	SPINE HOSPITAL	NE	N/A	N/A				No			No
(49) NICU OPERATING CO OF SANTA CRUZ LLC 1555 SOQUEL DRIVE SANTA CRUZ,CA95065 46-0502935	NEONATAL HEALTHCARE	CA	N/A	N/A				No			No
(50) NORTH RIVER SURGERY CENTER LLC 2209 WILDWOOD AVE SHERWOOD,AR72120 71-0799771	AMBUL SURG CTR	AR	N/A	N/A				No			No
(51) NORTHERN PLAINS LABORATORY LLC 401 N 9 STREET BISMARK,ND58501 84-1641341	DIAGNOSTIC SERVICES	ND	N/A	N/A				No			No
(52) NSC CHANNEL ISLANDS LLC 569 BROOKWOOD VILLAGE SUITE 901 BIRMINGHAM,AL35209 77-0409291	AMBULATORY SURGICAL CENTER	CA	N/A	N/A				No			No
(53) ORTHOCOLORADO LLC 11650 WEST 2ND PLACE LAKEWOOD,CO80228 37-1577105	ORTHO HOSPITAL	CO	N/A	N/A				No			No
(54) PARK RAPIDS AREA HEALTH CARE 600 PLEASANT AVENUE S PARK RAPIDS,MN56470 20-4926259	HEALTHCARE SRVC	MN	N/A	N/A				No			No
(55) PENINSULA RADIATION ONCOLOGY CENTER LLC 4230 BRIDGEPORT WAY W STE B UNIVERSITY PLACE,WA98466 87-0808610	HEALTHCARE SRVC	WA	N/A	N/A				No			No
(56) PENRAD IMAGING LLC 1390 KELLY JOHNSON BLVD COLORADO SPRINGS,CO80920 84-1072619	MEDICAL IMAGING	CO	N/A	N/A				No			No
(57) PERFORMANCE MED EQUIP & RESPIR SVSC LLC 19625 62ND AVE SOUTH 101 KENT,WA98032 45-2901632	HOLDING COMPANY	WA	N/A	N/A				No			No
(58) PLAZA SURGERY CENTER LP 525 E PLAZA DRIVE SUITE 100 SANTA MARIA,CA93454 77-0573567	SURGERY	CA	N/A	N/A				No			No
(59) PMC HOSPITAL LLC 3100 MAIN ST STE 500 HOUSTON,TX77002 27-3280598	HOSPITAL	TX	N/A	N/A				No			No
(60) PRECISION MEDICINE ALLIANCE LLC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 35-2569159	DIAGNOSTIC SERVICES	CO	N/A	N/A				No			No
(61) RADIATION ONCOLOGY CENTERS OF VENTURA COUNTY 1700 N ROSE AVENUE SUITE 120 OXNARD,CA93030 77-0191706	IMAGING	CA	N/A	N/A				No			No
(62) RBR MANAGEMENT LLC 91 CORPORATE PARK DRIVE SUITE 120 HENDERSON,NV89074 27-1466450	AMBULANCE	NV	N/A	N/A				No			No
(63) REID-ANC HOME CARE SERVICES LLC 6281 TRI RIDGE BLVD STE 300 LOVELAND,OH45150 37-1454747	HOME HEALTH	IN	N/A	N/A				No			No
(64) SAINT JOSEPH - SCA HOLDINGS LLC 1451 HARRODSBURG RD LEXINGTON,KY40503 45-3801157	INACTIVE	DE	N/A	N/A				No			No
(65) SAINT JOSEPH HEALTH ASC LLC ONE SAINT JOSEPH DRIVE LEXINGTON,KY40504 85-2155230	SURGERY	KY	N/A	N/A				No			No
(66) SAINT JOSEPH-ANC HOME CARE SERVICES 6281 TRI RIDGE BLVD STE 300 LOVELAND,OH45150 26-3330545	HOME HEALTH	KY	N/A	N/A				No			No
(67) SANTA CRUZ COMPREHENSIVE IMAGING LLC 1661 SOQUEL DRIVE SUITE G SANTA CRUZ,CA95065 01-0550623	IMAGING	CA	N/A	N/A				No			No
(68) SANTA CRUZ LAND & BUILDING LP 1555 SOQUEL DRIVE SANTA CRUZ,CA95065 77-0285236	REAL ESTATE	CA	N/A	N/A				No			No
(69) SANTA CRUZ SURGERY CENTER LLC 3003 PAUL SWEET ROAD SANTA CRUZ,CA95065 77-0194916	SURGERY	CA	N/A	N/A				No			No
(70) SEVEN OAKS SURGERY CENTER LLC 1801 ORANGE TREE LANE SUITE 200 REDLANDS,CA92374 85-1559544	SURGERY	CA	N/A	N/A				No			No
(71) SOUTHEASTERN HOME CARE LLC 6281 TRI RIDGE BLVD STE 300 LOVELAND,OH45150 27-1219638	HOME HEALTH	OH	N/A	N/A				No			No
(72) ST JOSEPH'S SURGERY CENTER LP 15305 DALLAS PARKWAY SUITE 1600 LB ADDISON,TX75001 20-1019390	SURGERY	TX	N/A	N/A				No			No
(73) ST ELIZABETH HOME CARE SERVICES LLC 6281 TRI RIDGE BLVD STE 300 LOVELAND,OH45150 26-1236191	HOME HEALTH	KY	N/A	N/A				No			No
(74) ST FRANCIS LAND COMPANY 5390 N ACADEMY BLVD STE 300 COLORADO SPRINGS,CO80918 26-3134100	REAL ESTATE	CO	N/A	N/A				No			No
(75) ST LUKE'S DIAGNOSTIC CATH LAB LLP 6624 FANNIN ST STE 800 HOUSTON,TX77030 71-0959365	DIAGNOSTIC SERVICES	TX	N/A	N/A				No			No
(76) ST LUKE'S LAKESIDE HOSPITAL LLC 6624 FANNIN STE 2505 HOUSTON,TX77030 30-0427437	HOSPITAL	TX	N/A	N/A				No			No
(77) ST LUKE'S THE WOODLANDS SLEEP CENTER LLC 6624 FANNIN STE 800 HOUSTON,TX77030 46-2795726	DIAGNOSTIC SERVICES	TX	N/A	N/A				No			No
(78) TEMPLETON SURGERY CENTER LLC 1310 LAS TABLAS ROAD SUITE 104 TEMPLETON,CA94365 20-2246616	SURGERY	CA	N/A	N/A				No			No
(79) THE MEDICAL PAVILION AT ST JOHN'S 1600 ROSE AVENUE OXNARD,CA93030 77-0332349	REAL ESTATE	CA	N/A	N/A				No			No
(80) THREE SPRING IMAGING LLC 1 MERCADO ST STE 200A DURANGO,CO81301 81-3571570	HEALTHCARE SRVC	CO	N/A	N/A				No			No
(81) TIA ARIZONA LLC 3030 N CENTRAL AVENUE SUITE 1402 PHOENIX,AZ85012 86-3158670	CLINIC	AZ	N/A	N/A				No			No
(82) VALLEY PHYSICIANS SURGERY CENTER AT NORTHRIDGE LLC 18330 ROSCOE BLVD NORTHRIDGE,CA91328 80-0864336	SURGERY	CA	N/A	N/A				No			No
(83) WEST LAKES SURGERY CENTER LLC 12499 UNIVERSITY AVE STE 100 CLIVE,IA50325 20-5345295	HEALTHCARE SRVC	IA	N/A	N/A				No			No

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	(h) Percentage ownership	Yes	No
(1) ALEGENT HEALTHCREIGHTON ST JOSEPH MANAGED CARE SVCS INC 12809 WEST DODGE RD OMAHA,NE68154 47-0802396	MANAGED CARE	NE	N/A	C					No
(2) ALLIANCE HEALTH PROVIDERS OF BRAZOS VALLEY INC 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2466914	HEALTHCARE	TX	N/A	C					No
(3) ALTERNATIVE INSURANCE MANAGEMENT SERVICE INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 84-1112049	MANAGEMENT SERVICES	CO	N/A	C					No
(4) AMERICAN NURSING CARE INC 1700 EDISON DR MILFORD,OH45150 31-1085414	HOME HEALTH	OH	N/A	C					No
(5) AMERIMED INC 1700 EDISON DR MILFORD,OH45150 31-1158699	HOME HEALTH	OH	N/A	C					No
(6) BC HOLDING COMPANY INC 1850 BLUEGRASS AVE LOUISVILLE,KY40215 31-1542851	INACTIVE	KY	N/A	C					No
(7) BRAZOSPORT HEALTH ALLIANCE 1 WEST WAY COURT LAKE JACKSON,TX77566 76-0518376	HEALTHCARE	TX	N/A	C					No
(8) CADUCEUS MEDICAL ASSOCIATES INC 5600 BRAINERD ROAD STE 500 CHATTANOOGA,TN37411 62-1570736	HEALTHCARE	TN	N/A	C					No
(9) CATHOLIC HEALTH INITIATIVES CENTER FOR TRANSLATIONAL RESEARCH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 27-2269511	INACTIVE	CO	N/A	C					No
(10) CHI ST LUKE'S HEALTH - MEMORIAL CONDOMINIUM ASSOCIATION INC 1201 W FRANK AVE LUFKIN,TX75904 83-4184717	CONDO ASSOC	TX	N/A	C					No
(11) COASTAL SURGICAL SPECIALISTS INC 921 OAK PARK BLVD SUITE 101 PISMO BEACH,CA93449 74-3000596	AMBULATORY SURGERY CENTER	CA	N/A	S					No
(12) COMCARE SERVICES INC 9100 E MINERAL CIRCLE CENTENNIAL,CO80112 84-0904813	INACTIVE	CO	N/A	C					No
(13) CONSOLIDATED HEALTH SERVICES 1700 EDISON DR MILFORD,OH45150 31-1378212	HOME HEALTH	OH	N/A	C					No
(14) DES MOINES MEDICAL CENTER INC 1111 6TH AVE DES MOINES,IA50314 42-0837382	REAL ESTATE	IA	N/A	C					No
(15) DIGNITY HEALTH HOLDING CORPORATION 185 BERRY STREET SUITE 200 SAN FRANCISCO,CA94107 46-0675371	HOLDING CO	NV	N/A	C					No
(16) DIGNITY HEALTH INSURANCE LTD PO BOX 1051 GRAND CAYMAN ISL GRAND CAYMAN ISL CJ 98-1065338	CAPTIVE INSURANCE	CJ	N/A	C					No
(17) DIGNITY HEALTH PROVIDER RESOURCES INC 185 BERRY STREET SUITE 200 SAN FRANCISCO,CA94107 47-3366764	HEALTH PLAN	CA	N/A	C					No
(18) DIVERSIFIED HEALTH RESOURCES INC 100 MEDICAL DRIVE LAKE JACKSON,TX77566 76-0222679	HEALTHCARE	TX	N/A	C					No
(19) FRANCISCAN CITY URGENT CARE SERVICES PS C/O CPGUSA 1345 AVE OF THE AMERICAS NEW YORK,NY10105 81-2174959	INACTIVE	NY	N/A	C					No
(20) FRANCISCAN SERVICES INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 23-2487967	HOLDING CO	CO	N/A	C					No
(21) GALLERIA PAVILION OWNERS'ASSOCIATION 800 N GIBSON RD HENDERSON,NV89011 82-4275367	REAL ESTATE	NV	N/A	C					No
(22) GOOD SAMARITAN OUTREACH SERVICES PO BOX 1990 KEARNEY,NE68848 47-0659440	MEDICAL CLINIC	NE	N/A	C					No
(23) HARVESTPLAINS HEALTH OF IOWA 32129 WEYERHAEUSER WAY S STE 201 FEDERAL WAY,WA98001 47-3451750	INSURANCE	WA	N/A	C					No
(24) HEALTH SERVICES OF THE PACIFIC CENTRAL COAST INC 1400 E CHURCH STREET SANTA MARIA,CA93454 77-0074057	HEALTH SERVICES	CA	N/A	C					No
(25) HEALTH SYSTEMS ENTERPRISES INC PO BOX 1990 KEARNEY,NE68848 47-0664558	MGMT	NE	N/A	C					No
(26) HEALTHCARE MGMT SERVICES ORGANIZATION INC 1149 MARKET ST TACOMA,WA98402 91-1865474	INACTIVE	WA	N/A	C					No
(27) HEARTLANDPLAINS HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-4368223	INSURANCE	NE	N/A	C					No
(28) HIGHLINE MEDICAL GROUP 1717 S J STREET TACOMA,WA98405 91-1407026	MEDICAL SERVICES	WA	N/A	C					No
(29) INTEGRATED MEDICAL SERVICES 9250 N 3RD STREET SUITE 4010 PHOENIX,AZ85020 86-0783428	MULTI-SPECIALTY PHYSICIANS GROUP	AZ	N/A	C					No
(30) MEDICAL OFFICE BUILDING HORIZONTAL PROPERTY REGIME INC 300 WERNER ST HOT SPRINGS,AR71913 71-0720429	REAL ESTATE	AR	N/A	C					No
(31) MEDQUEST 1301 15TH AVENUE WEST WILLISTON,ND58801 45-0392137	SALE OF DME	ND	N/A	C					No
(32) MEMORIAL CV SERVICE LINE MANAGEMENT COMPANY LLC 1201 W FRANK AVE LUFKIN,TX75904 46-3622849	INACTIVE	TX	N/A	C					No
(33) MERCY PARK APARTMENTS LTD 1111 6TH AVE DES MOINES,IA50314 42-1202422	INACTIVE	IA	N/A	C					No
(34) MERCY SERVICES CORP 2700 STEWART PARKWAY ROSEBURG,OR97471 93-0824308	RETAIL SALES	OR	N/A	C					No
(35) MHI CLINICAL SERVICES 1201 W FRANK AVE LUFKIN,TX75904 46-1967952	HEALTHCARE	TX	N/A	C					No
(36) MILLENNIUM SURGERY CENTER INC 9300 STOCKDALE HWY 200 BAKERSFIELD,CA93311 77-0513445	OUTPAITENT SURGERY SERVICES	CA	N/A	S					No
(37) MOUNTAIN MANAGEMENT SERVICES INC 6028 SHALLOWFORD RD CHATTANOOGA,TN37421 62-1570739	MGMT SVC ORG	TN	N/A	C					No
(38) NORTH CENTRAL HEALTH CARE ALLIANCE PO BOX 5538 BISMARK,ND58506 45-0439894	HEALTHCARE	ND	N/A	C					No
(39) QUALCHOICE ADVANTAGE 32129 WEYERHAEUSER WAY S STE 201 FEDERAL WAY,WA98001 47-3433912	INSURANCE	WA	N/A	C					No
(40) QUALCHOICE HEALTH PLAN SERVICES INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-1224037	ADMIN SERVICES	CO	N/A	C					No
(41) QUALCHOICE HEALTH INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-1222808	HOLDING CO	CO	N/A	C					No
(42) QUALCHOICE HOLDINGS INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 27-4075520	HOLDING CO	AR	N/A	C					No
(43) QUALCHOICE OF NEBRASKA 2401 S 73RD ST OMAHA,NE68124 81-0738827	INACTIVE	NE	N/A	C					No
(44) RIVERLINK HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-4380824	INSURANCE	OH	N/A	C					No
(45) RIVERLINK HEALTH OF KENTUCKY INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-4828332	INSURANCE	KY	N/A	C					No
(46) ROSS PARK PHARMACY INC 380 SUMMIT AVE STEUBENVILLE,OH43952 34-1832654	PHARMACY	OH	N/A	C					No
(47) SAINT CLARE'S PRIMARY CARE INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 22-2441202	INACTIVE	NJ	N/A	C					No
(48) SJH SERVICES CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 23-2307408	INACTIVE	CO	N/A	C					No
(49) SJL PHYSICIAN MANAGEMENT SERVICES INC 424 LEWIS HARGETT CR STE 160 LEXINGTON,KY40503 27-0164198	INACTIVE	KY	N/A	C					No
(50) SOUNDPATH HEALTH INC 32129 WEYERHAEUSER WAY S STE 201 FEDERAL WAY,WA98001 42-1720801	INSURANCE	WA	N/A	C					No
(51) ST MARY HEALTH VENTURES INC 1050 LINDEN AVENUE LONG BEACH,CA90813 95-1912528	RETAIL PHARMACY	CA	N/A	C					No
(52) ST ANTHONY DEVELOPMENT COMPANY 1415 SOUTHGATE PENDLETON,OR97801 93-1216943	ATHLETIC CLUB	OR	N/A	C					No
(53) ST JOSEPH DEVELOPMENT COMPANY INC 1717 SOUTH J ST TACOMA,WA98405 91-1480569	RENTAL	WA	N/A	C					No
(54) ST LUKE'S HEALTH SYSTEM HOLDINGS INC 6624 FANNIN STE 800 HOUSTON,TX77030 76-0637138	HOLDING CO	TX	N/A	C					No
(55) ST VINCENT COMMUNITY HEALTH SERVICES INC TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 71-0710785	HEALTHCARE	AR	N/A	C					No
(56) STE HOLDINGS 12809 WEST DODGE RD OMAHA,NE68154 82-2383629	HOLDING CO	NE	N/A	C					No
(57) SUGAR LAND DOCTOR GROUP 1317 LAKE POINT PARKWAY SUGAR LAND,TX77478 45-4270163	INACTIVE	TX	N/A	C					No
(58) TOWSON MANAGEMENT INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 52-1710750	INACTIVE	MD	N/A	C					No
(59) TRINITY MANAGEMENT SERVICES ORGANIZATION 380 SUMMIT AVE STEUBENVILLE,OH43952 34-1471026	MGMT SERVICES	OH	N/A	C					No

Schedule R (Form 990) 2021

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) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,100,921	174,093
9	Program service revenue (Part VIII, line 2g) .........	13,679,702	19,526,812
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,587	4,000
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	51,649
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	14,783,210	19,756,554
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	10,026,995	10,681,127
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	15,474,662	15,089,710
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	25,501,657	25,770,837
19	Revenue less expenses. Subtract line 18 from line 12.......	-10,718,447	-6,014,283
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	37,470,784	29,342,593
21	Total liabilities (Part X, line 26).............	68,678,269	66,612,465
22	Net assets or fund balances. Subtract line 21 from line 20.....	-31,207,485	-37,269,872

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 2,606,166 including grants of $ ) (Revenue $ 4,163,022 )
	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 $ 1,418,384 including grants of $ ) (Revenue $ 4,536,422 )
	CANCER SERVICES:THE REES SKILLERN CANCER INSTITUTE AT CHI MEMORIAL IS THE LEADING PROVIDER OF ADULT CANCER SERVICES IN THE GREATER CHATTANOOGA AREA. OUR COMPREHENSIVE PROGRAM INCLUDES CENTERS DEDICATED TO SPECIFIC TYPES OF CANCER. A TEAM OF MEDICAL SPECIALISTS GATHER TO REVIEW AND RECOMMEND THE BEST TREATMENT OPTIONS TO CARE FOR YOU, AND OUR NURSE NAVIGATORS ARE AVAILABLE TO ASSIST YOU ON EVERY STEP OF OUR CANCER JOURNEY.

4c	(Code: ) (Expenses $ 660,102 including grants of $ ) (Revenue $ 4,441,722 )
	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 $ 19,356,704 including grants of $ 0 ) (Revenue $ 6,385,646 )
	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 $ 19,356,704 including grants of $ 0 ) (Revenue $ 6,385,646 )
4e	Total program service expenses24,041,356

(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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) CHRISTOPHER CRIMMINS........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(19) DAVEY DANIEL........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(20) MARILYN HELMS MD........................................................................ VICE CHAIR	1.00 .......................0.00	X	X	0	0	0
(21) DOROTHY JACKSON SCN........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(22) MARYSTEWART LEWIS........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(23) MARY TANNER PHD........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(24) JEFFREY WILSON........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(25) JUDITH JUDY RALEY SCN........................................................................ SECRETARY	1.00 .......................0.00	X	X	0	0	0
(26) MICHAEL WEBB........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(27) ELIZABETHBETSY MCCRIGHT........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(28) TRACY WOOD........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	385,821	11,780,539	700,542

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.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	19
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	462
6	Total number of volunteers (estimate if necessary) .............	6	14
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	174,093

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

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

h Total. Add lines 1a-1f.......		174,093

		Business Code
2a	NET PATIENT SERVICES	900099	19,526,812	19,526,812
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		19,526,812

3 Investment income (including dividends, interest, and othersimilar amounts) ......			152			152
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	3,848		7a
b	Less: cost or other basis and sales expenses	0		7b
c	Gain or (loss)	3,848		7c
d	Net gain or (loss).........			3,848			3,848
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	EMPLOYEE RETENTION CRE		900099	51,649			51,649
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			51,649
12	Total revenue. See instructions.....			19,756,554	19,526,812	0	55,649

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 ...........
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........	8,572,502	7,715,252	857,250
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	386,449	347,804	38,645
9	Other employee benefits .......	1,060,789	954,710	106,079
10	Payroll taxes ...........	661,387	595,248	66,139
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	77,339	73,472	3,867
c	Accounting ...........
d	Lobbying ...........	472		472
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)	5,362,649	5,094,517	268,132
12	Advertising and promotion ....	189,051		189,051
13	Office expenses .......	743,570	669,213	74,357
14	Information technology ......	763,776	687,398	76,378
15	Royalties ..
16	Occupancy ...........	2,306,115	2,306,115
17	Travel ............	29		29
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	684	650	34
20	Interest ...........	1,500	1,425	75
21	Payments to affiliates .......	550,488	550,488
22	Depreciation, depletion, and amortization ..	2,375,441	2,375,441
23	Insurance ...	144,025	144,025
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	1,595,586	1,595,586
b	OTHER TAXES	499,263	474,300	24,963
c	REPAIRS AND MAINTENANCE	314,963	299,215	15,748
d	MISCELLANEOUS EXPENSES	133,281	126,593	6,688
e	All other expenses	31,478	29,904	1,574
25	Total functional expenses. Add lines 1 through 24e	25,770,837	24,041,356	1,729,481	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 ........			597	1	598
2	Savings and temporary cash investments .........			4,394,902	2	731,245
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			2,374,170	4	1,969,468
5	Loans and other receivables from 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
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
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			624,673	8	582,534
9	Prepaid expenses and deferred charges ......			200,922	9	178,769
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	17,652,979
b	Less: accumulated depreciation	10b	7,206,050	12,150,513	10c	10,446,929
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			7,212,822	14	7,212,822
15	Other assets. See Part IV, line 11 ...........			10,512,185	15	8,220,228
16	Total assets. Add lines 1 through 15 (must equal line 33)...			37,470,784	16	29,342,593

17	Accounts payable and accrued expenses .....	1,141,434	17	46,540
18	Grants payable ...		18
19	Deferred revenue .........	33,355	19	33,355
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	67,503,480	25	66,532,570
26	Total liabilities. Add lines 17 through 25..	68,678,269	26	66,612,465

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-31,207,485	27	-37,269,872
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 ...........	-31,207,485	32	-37,269,872
33	Total liabilities and net assets/fund balances ........	37,470,784	33	29,342,593