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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) KARL CARRIER...................................................................... BOD CHAIR	40.00 ................. 4.00	X	X		0	0
(2) CAROL AARON...................................................................... DIRECTOR/VICE CHAIR	10.00 ................. 2.00	X	X		4,413	10,474
(3) ANDREA NENZEL CSJP...................................................................... VICE CHAIR	40.00 ................. 4.00	X	X		0	0
(4) TIM ACKMAN...................................................................... DIRECTOR	10.00 ................. 2.00	X			0	0
(5) CHARLOTTE DAVENPORT CSJP...................................................................... DIRECTOR	10.00 ................. 2.00	X			0	0
(6) DAN HOLLINGSHEAD...................................................................... DIRECTOR	10.00 ................. 2.00	X			0	0
(7) LEE KEARNEY...................................................................... TREASURER	40.00 ................. 2.00	X	X		0	0
(8) DONNA KING BSN...................................................................... DIRECTOR	10.00 ................. 2.00	X			0	0
(9) MARY O MCWILLIAMS...................................................................... DIRECTOR (AS OF 9/21)	10.00 ................. 2.00	X			0	0
(10) KEVIN MURPHY PHD...................................................................... SECRETARY	40.00 ................. 2.00	X	X		0	0
(11) KATHLEEN PRUITT CSJP...................................................................... DIRECTOR	10.00 ................. 2.00	X			0	0
(12) TODD STRUMWASSER MD...................................................................... DIRECTOR	10.00 ................. 2.00	X			0	0
(13) RICK WOLLENBERG...................................................................... DIRECTOR	10.00 ................. 2.00	X			0	0
(14) ELIZABETH V DUNNE...................................................................... PRESIDENT & CEO	40.00 ................. 2.00		X		5,635,752	574,482
(15) CRAIG ARMSTRONG...................................................................... ASST GEN COUNSEL/ASST SEC (THRU 4/22)	40.00 ................. 2.00		X		320,449	53,211
(16) RICHARD DECARLO...................................................................... CHIEF OPERATING OFFICER/EVP	40.00 ................. 2.00			X	1,923,811	331,220
(17) RON L SAXTON...................................................................... EVP GEN COUNSEL/ASST SECRETARY	40.00 ................. 2.00			X	1,398,098	86,118

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) MICHAEL P DWYER........................................................................ EVP STRATEGY/COMMUNITY HEALTH	40.00 .......................2.00	X			1,230,999	244,896
(19) STEVEN GLENN........................................................................ EVP CAO	40.00 .......................2.00	X			1,311,550	234,485
(20) JOLINE M TREANOR........................................................................ EVP PEOPLE & CULTURE (THRU 12/21)	40.00 .......................2.00	X			1,124,974	178,603
(21) WILLIAM R WEIDER........................................................................ SVP CIO	40.00 .......................2.00	X			700,392	217,974
(22) MICHAEL C METCALF........................................................................ CHIEF EXECUTIVE PHMG (THRU 1/22)	40.00 .......................2.00	X			719,303	230,075
(23) CHARLES PROSPER........................................................................ CHIEF EXECUTIVE NORTHWEST	40.00 .......................0.00	X			1,018,166	233,426
(24) DARRIN MONTALVO........................................................................ EVP CHIEF FINAN-GROWTH OFFICER	40.00 .......................2.00	X			1,771,176	237,382
(25) SARAH NESS........................................................................ EVP PEOPLE AND CULTURE	40.00 .......................2.00	X			724,167	154,206
(26) SEAN GREGORY MD........................................................................ CHIEF EXECUTIVE COLUMBIA	40.00 .......................2.00	X			1,025,353	297,451
(27) TODD SALNAS........................................................................ CHIEF EXECUTIVE OREGON	40.00 .......................2.00	X			940,151	57,075
(28) WEN-HUAN S HO MD........................................................................ MD GASTROENTEROLOGY	40.00 .......................0.00		X		1,273,910	217,712
(29) JOHN F MACGREGOR MD........................................................................ MD CARDIOLOGY	40.00 .......................0.00		X		1,030,631	174,568
(30) MARK EICHLER MD........................................................................ MD GENERAL SURGERY	40.00 .......................0.00		X		1,087,795	82,993
(31) NANDAKUMAR SRINIVASAN MD........................................................................ MD GASTROENTEROLOGY	40.00 .......................0.00		X		1,023,151	137,134
(32) MANJUNATH G RAJU MD........................................................................ MD CARDIOLOGY	40.00 .......................0.00		X		1,202,220	106,561
(33) KIMBERLY A HODGKINSON........................................................................ FORMER EVP CFO	0.00 .......................0.00			X	344,359	0
(34) MARK B HALLETT........................................................................ FORMER SVP CMO	0.00 .......................0.00			X	1,174,457	191,662
(35) DIANNA KIELIAN........................................................................ FORMER SVP MISSION/THEOLOGY & ETHICS	0.00 .......................0.00			X	124,790	0
(36) JOHN C BENNETT........................................................................ FORMER CHIEF EXEC AMBULATORY	0.00 .......................0.00			X	891,353	19,813
(37) MARY E KINGSTON........................................................................ FORMER CHIEF EXECUTIVE OREGON	0.00 .......................0.00			X	1,109,937	33,549
(38) DALE J ZENDER........................................................................ FORMER CHIEF EXECUTIVE NW	0.00 .......................0.00			X	257,021	0

(A) Name and business address	(B) Description of services	(C) Compensation
AYA HEALTHCARE INC 5930 CORNERSTONE CT W SUITE 300 SAN DIEGO,CA92121	HEALTHCARE STAFFING	104,990,533
NURSEFINDERS LLC 524 E LAMAR BLVD SUITE 300 ARLINGTON,TX76011	HEALTHCARE STAFFING	39,061,121
QUEST DIAGNOSTICS 1737 AIRPORT WAY SUITE 200 SEATTLE,WA98134	LABORATORY SERVICES	36,666,668
TRIMEDX HOLDINGS LLC 5451 LAKEVIEW PKWY S DRIVE INDIANAPOLIS,IN46268	CLINICAL ENGINEERING	18,496,601
EXPRESS SERVICES INC 8516 NW EXPRESSWAY OKLAHOMA CITY,OK73162	HEALTHCARE STAFFING	10,946,219
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 358

- 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.
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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

PEACEHEALTH

Employer identification number

91-0939479

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

PEACEHEALTH

Employer identification number

91-0939479

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 PEACEHEALTH

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 PEACEHEALTH		Employer identification number 91-0939479

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 PEACEHEALTH			Employer identification number 91-0939479
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

PEACEHEALTH

Employer identification number

91-0939479

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)? ........

Yes

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

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

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

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

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

Yes

1,062,916

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

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

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

1,062,916

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 1B	PEACEHEALTH ENGAGES IN LOBBYING ACTIVITIES THROUGH EMPLOYEES DIRECTLY CONTACTING LEGISLATORS, THEIR STAFFS, OR GOVERNMENT OFFICIALS TO ADVOCATE IN SUPPORT OF OR OPPOSITION TO PENDING MEASURES THAT IMPACT PEACEHEALTH HEALTHCARE OPERATIONS AND THE HEALTH AND WELL-BEING OF THE COMMUNITIES PEACEHEALTH SERVES.
PART II-B, LINE 1G	PEACEHEALTH ENGAGES IN LOBBYING ACTIVITIES THROUGH EMPLOYEES, PAID OUTSIDE CONSULTING FIRMS, AND MEMBERSHIP DUES PAID TO STATE AND NATIONAL ASSOCIATIONS. THESE INDIVIDUALS AND ENTITIES DIRECTLY CONTACT LEGISLATORS, THEIR STAFFS, OR GOVERNMENT OFFICIALS TO ADVOCATE IN SUPPORT OF OR OPPOSITION TO PENDING MEASURES THAT IMPACT PEACEHEALTH HEALTHCARE OPERATIONS AND THE HEALTH AND WELL-BEING OF THE COMMUNITIES PEACEHEALTH SERVES.
PART II-B, LINE 1I	PEACEHEALTH ENGAGES IN LOBBYING ACTIVITIES BY MAKING CONTRIBUTIONS TO LOCAL AND STATE BALLOT MEASURE CAMPAIGN COMMITTEES, IN CAMPAIGNS THAT IMPACT PEACEHEALTH HEALTHCARE OPERATIONS AND THE HEALTH AND WELL-BEING OF THE COMMUNITIES PEACEHEALTH SERVES.

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

PEACEHEALTH

Employer identification number

91-0939479

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 ....	52,125,596	41,480,654	41,337,915	40,596,095	41,485,058
b	Contributions ...	10,331,158	579,275	923,802	1,162,077	1,057,545
c	Net investment earnings, gains, and losses	-3,897,780	10,381,977	-17,819	1,202,504	2,691,393
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	3,054,686	316,310	773,244	1,622,761	4,637,901
f	Administrative expenses ....
g	End of year balance ......	55,504,288	52,125,596	41,470,654	41,337,915	40,596,095

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

Board designated or quasi-endowment SchDMd Bullet

14.192 %

Permanent endowment SchDMd Bullet

61.874 %

Term endowment SchDMd Bullet

23.934 %

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)

Yes

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

Yes

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 .....	82,012,923		82,012,923
b	Buildings ....	1,540,610,852	995,952,735	544,658,117
c	Leasehold improvements	140,791,996	67,915,077	72,876,919
d	Equipment ....	1,407,517,023	1,036,440,783	371,076,240
e	Other .....	124,987,683	1,278,321	123,709,362
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				1,194,333,561

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)PENDING TRADES RECEIVABLE				98,927,431
(2)INTEREST IN RELATED FOUNDATIONS				183,196,238
(3)RIGHT OF USE ASSETS				75,769,346
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				357,893,015

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
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	307,934,964
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 V, LINE 4:	THE REPORTED ENDOWMENT FUNDS BELONG TO THE PEACEHEALTH FOUNDATIONS. THE PEACEHEALTH FOUNDATIONS ARE SEPARATELY INCORPORATED AND EACH FOUNDATION FILES A SEPARATE FORM 990. REFER TO THE SCHEDULE R, PART II FOR A LISTING OF THESE RELATED FOUNDATIONS. THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS ARE FOR: 1) THE PURCHASE OF PROPERTY, PLANT, AND EQUIPMENT 2) SUPPORT FOR HOSPICE AND INDIGENT CARE 3) PATIENT CARE AND OTHER OPERATING ACTIVITIES
PART X, LINE 2:	PEACEHEALTH AND PEACEHEALTH NETWORKS HAVE RECEIVED DETERMINATION LETTERS FROM THE INTERNAL REVENUE SERVICE STATING THAT THEY ARE EXEMPT FROM FEDERAL AND STATE INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE EXCEPT FOR TAX ON UNRELATED BUSINESS INCOME. IT IS MANAGEMENT S BELIEF THAT NONE OF ITS ACTIVITIES HAVE PRODUCED MATERIAL UNRELATED BUSINESS INCOME. THE CORPORATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT EXCEEDS A 50% PROBABILITY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN ESTIMATE OCCURS. CERTAIN AFFILIATED ENTITIES INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS MAY BE SUBJECT TO TAXATION. THE TAX EXPENSE AND RELATED PROVISION FOR THESE ENTITIES ARE NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS.
PART X, LINE 2	THE CORPORATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT EXCEEDS A 50 PERCENT PROBABILITY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN ESTIMATE OCCURS.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

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
PEACEHEALTH

Employer identification number

91-0939479

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in the region
	CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS,	1	1	GRANTMAKING	154,936
















3a	Sub-total ....	1	1		154,936
b	Total from continuation sheets to Part I ...	0	0		0
c	Totals (add lines 3a and 3b)	1	1		154,936

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2021

Schedule F (Form 990) 2021

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance
CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS,	PROGRAM SERVICES	154,936	BANK WIRE	0

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......	1
3	Enter total number of other organizations or entities .......................	0

Schedule F (Form 990) 2021

Schedule F (Form 990) 2021Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

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

Schedule F (Form 990) 2021

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2021

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
PART I, LINE 2:	PEACEHEALTH SUPPORTS A MEDICAL MISSION PROGRAM IN EL SALVADOR. THIS MISSION USES PEACEHEALTH MEDICAL PROFESSIONALS TO RENDER HEALTHCARE ASSISTANCE TO PEOPLE WITH LIMITED FINANCIAL RESOURCES. THESE ACTIVITIES ARE IN THE PEACEHEALTH BUDGET AND ARE INCLUDED IN THE OPERATING RESULTS OF PEACEHEALTH THE SAME AS OTHER PEACEHEALTH OPERATIONS. THE MISSION PROGRAM IS SUBJECT TO THE SAME MANAGEMENT CONTROL AND OVERSIGHT AS THE ORGANIZATION'S DOMESTIC PROGRAMS.
PART III ACCOUNTING METHOD:

Schedule F (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

PEACEHEALTH

Employer identification number

91-0939479

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other 30000.0000000000 %

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? . . . . . .

Yes

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		(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) . . .	47,905,880	0	47,905,880	1.380 %
b	Medicaid (from Worksheet 3, column a) . . . . .	755,729,744	493,739,028	261,990,716	7.550 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	0	0
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	803,635,624	493,739,028	309,896,596	8.930 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	3,913,857	114,307	3,799,550	0.110 %
f	Health professions education (from Worksheet 5) . . .	4,531,092	1,227,895	3,303,197	0.100 %
g	Subsidized health services (from Worksheet 6) . . . .	7,768,602	5,271,322	2,497,280	0.070 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	3,675,800	48	3,675,752	0.110 %
j	Total. Other Benefits . .	19,889,351	6,613,572	13,275,779	0.390 %
k	Total. Add lines 7d and 7j .	823,524,975	500,352,600	323,172,375	9.320 %

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.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	9,923	0	9,923	0 %
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	9,923		9,923	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

76,207,452

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. ......

30,066,128

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).....

610,402,422

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

691,903,876

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

-81,501,454

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?10Name, 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	PH SACRED HEART MED CTR AT RIVERBEND 3333 RIVERBEND DRIVE SPRINGFIELD,OR97477	X	X		X
2	PH SACRED HEART MED CTR UNIV DISTRICT 1255 HILYARD STREET EUGENE,OR97401	X	X		X
3	PH SOUTHWEST MEDICAL CENTER 400 NE MOTHER JOSEPH PL VANCOUVER,WA98683	X	X		X
4	PH ST JOSEPH MEDICAL CENTER 2901 SQUALICUM PARKWAY BELLINGHAM,WA98225	X	X		X
5	PH ST JOHN MEDICAL CENTER 1615 DELAWARE STREET LONGVIEW,WA98632	X	X		X
6	PH KETCHIKAN MEDICAL CENTER 3100 TONGASS AVENUE KETCHIKAN,AK99901	X	X	X	X
7	PH PEACE HARBOR MEDICAL CENTER 400 9TH STREET FLORENCE,OR97439	X		X	X
8	PH COTTAGE GROVE COMMUNITY MED CTR 1515 VILLAGE DRIVE COTTAGE GROVE,OR97424	X		X	X
9	PH PEACE ISLAND MEDICAL CENTER 1117 SPRING STREET FRIDAY HARBOR,WA97401	X		X	X
10	PH UNITED GENERAL MEDICAL CENTER 4000 HOSPITAL DRIVE SEDROWOOLLEY,WA98284	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)

	FACILITY REPORTING GROUP A
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 19

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

Yes

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): SEE PART V

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 19

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

Yes

If "Yes" (list url): SEE PART V

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)

	FACILITY REPORTING GROUP A
Name of hospital facility or letter of facility reporting group

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 300.000000000000%
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):

WWW.PEACEHEALTH.ORG/PATIENT-FINANCIAL-ASSISTANCE

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

WWW.PEACEHEALTH.ORG/FINANCIAL-ASSISTANCE-APPLICATION

A plain language summary of the FAP was widely available on a website (list url):
WWW.PEACEHEALTH.ORG/PLAIN-LANGUAGE-SUMMARY

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

	FACILITY REPORTING GROUP A
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)

	FACILITY REPORTING GROUP A
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
FACILITY REPORTING GROUP A	PART V, SECTION B, LINE 5: TO OBTAIN CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE PEACEHEALTH MEDICAL CENTERS, THE COMMUNITY HEALTH NEEDS ASSESSMENTS TOOK INTO ACCOUNT INFORMATION FROM: 1) PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. 2) FEDERAL, TRIBAL, REGIONAL, STATE, AND LOCAL HEALTH DEPARTMENTS AND AGENCIES. 3) LEADERS, REPRESENTATIVES, AND MEMBERS OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE NEEDS IN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. 4) REVIEW OF AVAILABLE PUBLISHED COMMUNITY HEALTH DATA. 5) MEETINGS WITH COMMUNITY GROUPS AND PUBLIC OFFICIALS; PUBLIC FORUMS, FOCUS GROUPS AND COMMUNITYWIDE HEALTH ASSET SURVEY AND KEY INFORMANT INTERVIEWS.PLEASE REFER TO THE PUBLISHED CHNAS FOR FURTHER DETAILS. THESE REPORTS CAN BE FOUND AT: WWW.PEACEHEALTH.ORG/ABOUT-PEACEHEALTH/COMMUNITY-HEALTH/NEEDS-ASSESSMENT
FACILITY REPORTING GROUP A	PART V, SECTION B, LINE 6A: PEACEHEALTH HOSPITALS WORK IN CONCERT TO CONDUCT CHNAS IF THEY SERVE THE SAME COMMUNITY OR AN OVERLAPPING COMMUNITY. PEACEHEALTH HOSPITALS WITHIN A NETWORK (GEOGRAPHIC REGION) ALSO WILL WORK TOGETHER EVEN WHEN THE COMMUNITIES ARE NOT OVERLAPPING.ALL HOSPITALS CONDUCTED INDEPENDENT CHNA'S FOR THE 2019-2021 CYCLE. ALTHOUGH INDEPENDENT, THE OVERALL PEACEHEALTH SYSTEM SHARED ASSESSMENT OUTCOMES FROM ALL LOCATIONS. THE FOLLOWING HOSPITALS CONDUCTED CHNA'S: SACRED HEART MEDICAL CENTER AT RIVERBEND; SACRED HEART MEDICAL CENTER UNIVERSITY DISTRICT; PEACEHEALTH SOUTHWEST MEDICAL CENTER; ST. JOSEPH MEDICAL CENTER; ST. JOHN MEDICAL CENTER; KETCHIKAN MEDICAL CENTER; PEACE HARBOR MEDICAL CENTER; COTTAGE GROVE COMMUNITY MEDICAL CENTER; PEACE ISLAND MEDICAL CENTER; UNITED GENERAL MEDICAL CENTER.
FACILITY REPORTING GROUP A	PART V, SECTION B, LINE 6B: REFER TO THE PUBLISHED CHNAS AT: WWW.PEACEHEALTH.ORG/ABOUT-PEACEHEALTH/COMMUNITY-HEALTH/NEEDS-ASSESSMENTFOR DETAILS ABOUT WHAT ORGANIZATIONS PARTICIPATED IN THE CHNAS. THE PEACEHEALTH HOSPITALS' CHNAS WERE UNDERTAKEN CONCURRENT WITH THE PLANNING ACTIVITIES OF COMMUNITY HEALTH ORGANIZATIONS IN THE STATE, REGION AND COUNTY. THE FOLLOWING HOSPITAL FACILITIES AND ORGANIZATIONS COLLABORATED IN THE COMPLETION OF THE CHNAS:SACRED HEART MEDICAL CENTER RIVERBEND, SACRED HEART MEDICAL CENTER UNIVERSITY DISTRICT, COTTAGE GROVE COMMUNITY MEDICAL CENTER AND PEACE HARBOR MEDICAL CENTER COLLABORATED WITH THE OREGON STATE HEALTH IMPROVEMENT PLAN, LIVE HEALTHY LANE (LHL), UNITED WAY OF LANE COUNTY, SIUSLAW VISION, AND BE YOUR BEST.ST. JOSEPH MEDICAL CENTER, PEACE ISLAND MEDICAL CENTER, AND UNITED GENERAL MEDICAL CENTER COLLABORATED WITH THE WASHINGTON STATE HEALTH IMPROVEMENT PLAN, SAN JUAN COUNTY COMMUNITY HEALTH INITIATIVES CONSORTIUM (CHIC), SAN JUAN ISLAND COMMUNITY FOUNDATION'S COMMUNITY NEEDS TASKFORCE, WHATCOM COUNTY HEALTH DEPARTMENT, HEALTHY WHATCOM TEAM, SKAGIT COUNTY POPULATION HEALTH TRUST, AND THE NORTH SOUND ACCOUNTABLE COMMUNITY OF HEALTH (NS-ACH). THE NS-ACH INCLUDES REPRESENTATIVES FROM THE FIVE-COUNTY AREA THAT INCLUDES SAN JUAN ISLAND, SKAGIT, SNOHOMISH AND WHATCOM COUNTIES.KETCHIKAN MEDICAL CENTER COLLABORATED WITH THE STATE OF ALASKA, THE KETCHIKAN WELLNESS COALITION, ALASKA NATIVE TRIBAL HEALTH CONSORTIUM, AND KETCHIKAN INDIAN COMMUNITY. SOUTHWEST MEDICAL CENTER COLLABORATED WITH THE WASHINGTON STATE HEALTH IMPROVEMENT PLAN, CLARK COUNTY PUBLIC HEALTH DEPARTMENT, THE HEALTHY LIVING COLLABORATIVE OF SOUTHWEST WASHINGTON, AND SOUTHWEST WASHINGTON ACCOUNTABLE COMMUNITY OF HEALTH (SWACH).ST. JOHN MEDICAL CENTER COLLABORATED WITH THE WASHINGTON STATE HEALTH IMPROVEMENT PLAN, COWLITZ COUNTY PUBLIC HEALTH DEPARTMENT, CASCADE PACIFIC ACTION ALLIANCE; THE HEALTHY LIVING COLLABORATIVE OF SOUTHWEST WASHINGTON, AND PATHWAYS 2020.
FACILITY REPORTING GROUP A	PART V, SECTION B, LINE 7D: ALL CHNA'S AND CHNA REPORTS ARE AVAILABLE UPON REQUEST.FACILITY REPORTING GROUP A:PART V, SECTION B, LINE 9: ALL PEACEHEALTH HOSPITALS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FROM APRIL THROUGH JUNE 2020. THESE ASSESSMENTS ARE CONDUCTED EVERY THREE YEARS. PEACEHEALTH COMPLETED THE 2022-2025 CHNA CYCLE IN THE FALL OF 2022.
FACILITY REPORTING GROUP A	PART V, SECTION B, LINE 11: PLEASE REFER TO THE PUBLISHED CHNAS LOCATED AT:WWW.PEACEHEALTH.ORG/ABOUT-PEACEHEALTH/COMMUNITY-HEALTH/NEEDS-ASSESSMENTTHE PUBLISHED CHNAS CONTAIN THE IMPLEMENTATION PLAN(S) COVERING HOW THE PEACEHEALTH MEDICAL CENTERS ARE ADDRESSING THE SIGNIFICANT NEEDS OF THEIR RESPECTIVE COMMUNITIES.
FACILITY REPORTING GROUP A	PART V, SECTION B, LINE 13H: PEACEHEALTH USES THE FEDERAL POVERTY GUIDELINES (FPL) AND CRITERIA THAT ASSESS AN INDIVIDUAL'S ABILITY TO PAY FOR DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE THAT WILL BE PROVIDED. EACH INDIVIDUAL SITUATION IS REVIEWED INDEPENDENTLY WITH ALLOWANCES MADE FOR EXTENUATING CIRCUMSTANCES.FOR ADDITIONAL DESCRIPTION, REFER TO SCHEDULE H, PART VI EXPLANATION FOR PART I, LINE 3C.FACILITY REPORTING GROUP A:PART V, SECTION B, LINE 22D: IRS REQUIREMENTS FOR CHARITABLE HOSPITALS 501(R)LIMITATION ON CHARGES AN ELIGIBLE INDIVIDUAL RECEIVING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE UNDER A PEACEHEALTH'S FINANCIAL ASSISTANCE POLICY (FAP) WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE. TO DETERMINE AMOUNTS GENERALLY BILLED (AGB), THE "LOOK BACK" METHOD IS APPLIED FOR MEDICARE FEE-FOR-SERVICE AND PRIVATE INSURER ACCOUNTS.PEACEHEATH HAS A FAP THAT PROVIDES FOR DISCOUNTS TO ELIGIBLE INDIVIDUALS ON A SLIDING SCALE UP TO 400% OF THE FEDERAL POVERTY LEVEL. WHILE THE RATE INSURED INDIVIDUALS ARE ULTIMATELY CHARGED VARIES WITH CONTRACT AND BENEFIT TERMS, WE BELIEVE THAT OUR FAP DISCOUNTS PROVIDE ELIGIBLE INDIVIDUALS WITH BETTER OR SIMILAR DISCOUNTS. OUR MINIMUM UNINSURED FAP REDUCTION IS 70% WITH A MAXIMUM UNINSURED DISCOUNT OF 100%. FOR INSURED ACCOUNTS WE OFFER DISCOUNTS RANGING FROM 70% TO 100% DEPENDING ON FEDERAL POVERTY GUIDELINES. WE DO NOT USE GROSS CHARGES WITHOUT DISCOUNTS FOR INDIVIDUALS ELIGIBLE UNDER OUR FAP.
PART V, SECTION B, LINES 7A AND 10A:	THE CHNA CAN BE VIEWED AT:WWW.PEACEHEALTH.ORG/ABOUT-PEACEHEALTH/PAGES/COMMUNITY-HEALTH-NEEDS-ASSESSMENTTHE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY IS INCLUDED IN THE CHNA.

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?
Name and address		Type of Facility (describe)
1
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:	PEACEHEALTH USES THE FEDERAL POVERTY GUIDELINES (FPL) AS WELL AS THE FOLLOWING CRITERIA FOR DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE THAT WILL BE PROVIDED. EACH INDIVIDUAL SITUATION IS REVIEWED INDEPENDENTLY WITH ALLOWANCES MADE FOR EXTENUATING CIRCUMSTANCES.CONSIDERATION FOR FINANCIAL ASSISTANCE INCLUDES A REVIEW OF:* GROSS HOUSEHOLD INCOME* NUMBER OF PEOPLE IN THE HOME* OTHER EXTENUATING CIRCUMSTANCES. EXAMPLES INCLUDE: THE REMAINING BALANCE TO BE PAID AFTER ALL REDUCTIONS, HOUSEHOLD INCOME, AND MEDICAL STATUS OF PATIENT/FAMILY.
PART I, LINE 7:	THE COSTING METHOLODOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I LINE 7 IS AS FOLLOWS:COST TO CHARGE RATIOS WERE CALCULATED BY TOTAL BUSINESS UNIT OPERATING EXPENSE DIVIDED BY TOTAL GROSS PATIENT REVENUE. THIS RATIO WAS THEN APPLIED TO THE PATIENT CHARGES BY FINANCIAL CLASS IN THE BUSINESS UNIT TO ESTIMATE COST BY FINANCIAL CLASS. THE COST BY FINANCIAL CLASS WAS THEN OFFSET BY REVENUE, INCLUDING ALLOCATIONS OF REVENUE OUTSIDE OF THE BILLING SYSTEM. THE REVENUE OUTSIDE OF THE BILLING SYSTEM CONSISTS OF PROVIDER TAXES, 3RD PARTY SETTLEMENTS, AND OTHER OFFSETTING REVENUE RECORDED IN THE GENERAL LEDGER. FOR CHARITY CARE, THE COST TO CHARGE RATIO WAS APPLIED TO ALL CHARITY CARE DEDUCTIONS.PART I, LINE 7THE REPORTED COMMUNITY BENEFIT AMOUNTS DO NOT CAPTURE CERTAIN ADDITIONAL COMMUNITY BENEFIT ACTIVITIES AND CONTRIBUTIONS MADE DIRECTLY BY THE PEACEHEALTH AFFILIATED, SEPARATELY INCORPORATED FOUNDATIONS. PROCESSES ARE STILL UNDERWAY TO ALIGN AND COORDINATE ALL COMMUNITY BENEFIT TRACKING.
PART II, COMMUNITY BUILDING ACTIVITIES:	PEACEHEALTH'S COMMUNITY BUILDING ACTIVITIES ARE AIMED AT THE CAUSES OF HEALTH PROBLEMS, FREQUENTLY REFERRED TO AS SOCIAL DETERMINANTS OF HEALTH IN A LOCAL COMMUNITY, SUCH AS POVERTY, HOMELESSNESS, AND CARE ACCESS. THESE ACTIVITIES PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITY'S RESIDENTS BY OFFERING THE EXPERTISE AND RESOURCES OF THE PEACEHEALTH MEDICAL CENTERS.
PART III, LINE 2:	REFER TO PART III, LINE 4 EXPLANATION FOR A DESCRIPTION OF THE METHODOLOGY FOR COMPUTING BAD DEBTS.THE AMOUNTS REPORTED REPRESENT THE PATIENT ACCOUNT BALANCES WRITTEN OFF TO BAD DEBT DURING THE YEAR ALONG WITH THE CHANGE IN THE ESTIMATE IN THE BAD DEBT RESERVES ON OUTSTANDING PATIENT ACCOUNTS RECEIVABLE BALANCES LESS ANY RECOVERIES ON PATIENT ACCOUNTS.
PART III, LINE 3:	THE METHODOLOGY USED TO DETERMINE THE AMOUNT ON PART III, LINE 3 IS AS FOLLOWS:DEMOGRAPHIC DATA REGARDING POPULATION POVERTY LEVELS IN EACH FACILITY'S SERVICE AREA WERE USED TO DETERMINE THE AMOUNT OF BAD DEBT REASONABLY ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY.PART III, LINE 4: 6/30/2022 AUDITED FINANCIAL STATEMENTS - FOOTNOTE (3) REVENUE RECOGNITION (A) NET PATIENT SERVICE REVENUE:PATIENT SERVICE REVENUE RELATES TO CONTRACTS WITH PATIENTS INVOLVING THIRD-PARTY PAYORS WHERE THE CORPORATION HAS AN OBLIGATION TO PERFORM HEALTHCARE SERVICES. THIS REVENUE IS RECORDED AT THE AMOUNT DUE FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS WHEN THE PERFORMANCE OBLIGATIONS ARE SATISFIED. THE CORPORATION BASES THE IMPLICIT PRICE CONCESSIONS ON HISTORICAL COLLECTIBILITY DATA BY PAYOR USING A PORTFOLIO APPROACH TO RECOGNIZE THE DEDUCTIONS NETTED AGAINST REVENUE WHEN IT IS RECOGNIZED.
PART III, LINE 8:	THE CALCULATION FOR PART III, LINE 8 IS COMPLETED USING MEDICARE COST REPORT DATA.THE MEDICARE AMOUNTS LISTED IN PART III, SECTION B ON LINES 5, 6, AND 7 ARE REPORTED FROM THE MEDICARE COST REPORTS AND DO NOT REPRESENT ALL OF THE REVENUES AND COSTS ASSOCIATED WITH PARTICIPATION IN MEDICARE PROGRAMS BY PEACEHEALTH. PART III SECTION B DOES NOT ALLOW FOR A FULL REPORTING OF MEDICARE REVENUES AND COSTS AS THE INSTRUCTIONS TO THE FORM 990 LIMIT MEDICARE REVENUES AND ALLOWABLE COSTS TO THOSE FROM THE MEDICARE COST REPORT. REVENUE AND COSTS FROM MEDICARE PART C PATIENTS, PART B PHYSICIAN SERVICES BILLED BY THE ORGANIZATION, AND CLINICAL LABORATORY SERVICES WERE NOT INCLUDED IN THE MEDICARE COST REPORT. IN ADDITION, HOSPITALS INCUR OTHER COSTS TO PROVIDE CARE THAT MEDICARE DOES NOT ALLOW IN THE COST REPORT.THE TOTAL REVENUES AND COSTS ATTRIBUTABLE TO ALL MEDICARE SERVICES ARE $610,402,422 AND $691,903,876 RESPECTIVELY. THIS RESULTS IN A TOTAL MEDICARE SHORTFALL OF $81,501,454.
PART III, LINE 9B:	FINANCIAL ASSISTANCE PROGRAM INFORMATION IS PRESENT ON PEACEHEALTH STATEMENTS AND BILLINGS. ACCOUNTS ARE NOT ASSIGNED TO COLLECTION AGENCIES PRIOR TO 120 DAYS FROM THE DATE OF FIRST BILLING. FINANCIAL ASSISTANCE APPLICATIONS FOR ACCOUNTS THAT HAVE BEEN ASSIGNED TO A COLLECTION AGENCY MUST BE SUBMITTED WITH PROOF OF INCOME FOR THE DATE(S) OF SERVICE, IF A FINANCIAL ASSISTANCE APPLICATION IS RECEIVED FOR AN ACCOUNT PREVIOUSLY ASSIGNED TO COLLECTION, THE COLLECTION AGENCY IS REQUESTED TO HOLD FURTHER ACTIONS UNTIL THE RESULTS OF THE PENDING FINANCIAL ASSISTANCE REVIEW ARE AVAILABLE. IF THE REVIEW SHOWS THE PATIENT QUALIFIES FOR THE REDUCTION OR ELIMINATION OF THE DEBT, APPROPRIATE ACTIONS ARE TAKEN TO AMEND OR CORRECT PREVIOUS ACTIONS.THE COLLECTION POLICIES INVOLVE THE ISSUANCE OF A BILL ON OR SHORTLY AFTER DISCHARGE OR DEATH OF THE BENEFICIARY TO THE PARTY RESPONSIBLE FOR THE PATIENTS PERSONAL FINANCIAL OBLIGATIONS. THESE POLICIES ALSO INCLUDE OTHER ACTIONS SUCH AS SUBSEQUENT BILLINGS, COLLECTION LETTERS AND TELEPHONE CALLS OR PERSONAL CONTACTS WITH THIS PARTY WHICH CONSTITUTE A GENUINE, RATHER THAN A TOKEN, COLLECTION EFFORT.NO ACTIONS CONSTITUTING EXTRAORDINARY COLLECTION ACTIONS ARE UNDERTAKEN PRIOR TO DETERMINING IF AN INDIVIDUAL IS FAP ELIGIBLE. REFER TO THE SCHEDULE H, PART V SECTION ON BILLING AND COLLECTIONS.
PART VI, LINE 2:	THE COMMUNITY HEALTH NEEDS ASSESSMENT IS CUSTOMIZED TO THE LOCAL COMMUNITY. EACH PEACEHEALTH HOSPITAL CONDUCTS ITS OWN COMMUNITY HEALTH NEEDS ASSESSMENT.PEACEHEALTH PARTNERS WITH A DIVERSE GROUP OF COMMUNITY ORGANIZATIONS, INCLUDING MEDICAL PROFESSIONALS, OTHER NOT-FOR-PROFIT ORGANIZATIONS, AND STATE AND LOCAL GOVERNMENT AGENCIES TO IDENTIFY AND ASSESS THE SPECIFIC NEEDS OF THE COMMUNITIES IN WHICH IT SERVES.IN ORDER TO DETERMINE AND ACT ON THE HEALTH CARE NEEDS OF THE COMMUNITY PEACEHEALTH HAS ESTABLISHED A COMMITTEE OF STAFF, BOARD MEMBERS AND VOLUNTEERS TO REVIEW AND ACT ON FUNDING REQUESTS FROM COMMUNITY-BASED ORGANIZATIONS. IN MAKING THE CASE FOR FUNDING, APPLICANTS MUST THOROUGHLY EXPLAIN THE NEED, THE POPULATION SERVED, THE EFFECTIVENESS OF THEIR PROGRAMS AND THE DESIRED OUTCOME. IN ADDITION TO HELPING BOARD COMMITTEES MAKE WISE STRATEGIC INVESTMENT IN PROGRAMS THAT EFFECTIVELY ADDRESS COMMUNITY NEEDS, THIS PROCESS ALSO KEEPS STAFF AND BOARD MEMBERS ATTUNED TO CHANGES IN THE COMMUNITY.WHEN PEACEHEALTH EVALUATES A COMMUNITY'S NEED FOR A PARTICULAR SERVICE, A HOST OF FACTORS ARE ASSESSED, INCLUDING:-ALTERNATIVE WAYS TO ACCESS CARE-THE ABILITY TO PROVIDE THE NECESSARY STAFF, EQUIPMENT AND SPACE-THE EFFECT ON THE COMMUNITY AND PATIENTS IF PEACEHEALTH DID NOT PROVIDE THE SERVICE-THE COMMUNITY'S BEST INTEREST-THE RESULTS OF AN ETHICAL DISCERNMENT ON THE OVERALL IMPACT TO THE COMMUNITY-ADDITIONAL COMMUNITY RESOURCES OR FUNDS AVAILABLE TO SUPPORT COMMUNITY NEED-OVERALL IMPACT OF ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND BARRIERS TO CARE.ADDITIONAL WAYS PEACEHEALTH STAYS IN TOUCH WITH THE COMMUNITY:- PATIENT COUNCILS: COMMUNITY MEMBERS PROVIDE INPUT AND FEEDBACK ON THE PATIENT EXPERIENCE, ISSUES, CONCERNS AND IDEAS.-COMMUNITY INVOLVEMENT: HOSPITAL STAFF SERVE ON NUMEROUS BOARDS, COMMITTEES AND TASK FORCES THAT ADDRESS COMMUNITY HEALTH PROBLEMS AND PROMOTE COMMUNITY HEALTH.- SPEAKERS BUREAU: HOSPITAL LEADERS AND EXPERTS ARE CALLED UPON TO ADDRESS COMMUNITY GROUPS ON A VARIETY OF HEALTH CARE TOPICS TAKING FEEDBACK, ANSWERING QUESTIONS AND LISTENING TO CONCERNS AND NEEDS. -VOLUNTEERING: HOSPITAL STAFF PARTICIPATE IN SERVICE DAYS, GROUP ACTIVITIES AND ONE ON ONE ACTIVITIES TO DONATE TIME AND EXPERTISE TO LOCAL NONPROFITS ADDRESSING SOCIAL DETERMINANTS OF HEALTH.
PART VI, LINE 3:	PEACEHEALTH HAS A TIME-HONORED TRADITION OF PROVIDING HEALTH CARE SERVICES TO THE SICK AND AFFLICTED REGARDLESS OF ABILITY TO PAY. THIS CONCEPT IS CENTRAL TO OUR MISSION AND IS REINFORCED THROUGH OUR NEW EMPLOYEE ORIENTATION TRAINING AND DEVELOPMENT PROGRAMS, LEADERSHIP MEETINGS, AND SPECIAL PROGRAMS SUCH AS LEADERSHIP IN MINISTRY.PEACEHEALTH DELIVERS COST SAVINGS TO NEEDY PATIENTS VIA OUR FINANCIAL ASSISTANCE POLICY (FAP). THE FAP PROGRAM PROVIDES FREE OR REDUCED-COST CARE TO LOW-INCOME INDIVIDUALS. QUALIFIED INDIVIDUALS RECEIVE A LETTER WHICH THEY MAY PRESENT JUST AS ONE WOULD AN INSURANCE CARD. MANY INDEPENDENT PROVIDERS IN THE COMMUNITY NOW ACCEPT PEACEHEALTH'S FAP PROGRAM AS THEIR BENCHMARK FOR PROVIDING SERVICES AT REDUCED OR NO CHARGE. OUR FAP ASSISTANCE PROVIDES MEDICALLY NECESSARY AND SOME PREVENTATIVE SERVICES AT PEACEHEALTH FACILITIES AT A REDUCED COST OR WITHOUT CHARGE WHEN PAYMENT CANNOT BE OBTAINED THROUGH ALL OTHER AVAILABLE FINANCIAL RESOURCES. THE FAP PROGRAM IS SECONDARY TO ALL OTHER RESOURCES SUCH AS INSURANCE, THIRD PARTY LIABILITY PAYERS, GOVERNMENT PROGRAMS, OUTSIDE AGENCY PROGRAMS, OR PRIVATE MEANS. THE PURPOSE OF THE PROGRAM IS TO HELP MANAGE THE DELICATE BALANCE OF FINANCIAL HEALTH AND WISE STEWARDSHIP WITH OUR MISSION OF PROVIDING COMMUNITY SERVICES IN ALL OF OUR SERVICE AREAS. OUR FAP ENSURES THAT PATIENTS RECEIVE FAIR AND EQUAL FINANCIAL TREATMENT ACROSS PEACEHEALTH, AND IT WORKS TOGETHER WITH OUR FINANCIAL COUNSELING SERVICES TO HELP PEACEHEALTH IDENTIFY PATIENTS WHO CAN BENEFIT FROM FINANCIAL ASSISTANCE.HERE IS AN EXAMPLE OF HOW WE WORK WITH OUR LOCAL COMMUNITIES TO ENROLL PEOPLE IN THE PROGRAM: PEACEHEALTH SACRED HEART MEDICAL CENTER-UNIVERSITY DISTRICT WORKS CLOSELY WITH THE WHITEBIRD CLINIC THE AREA FEDERALLY QUALIFIED HEALTH CENTER (FQHC) TO ENSURE THAT ALL ELIGIBLE PATIENTS SEEKING MEDICAL CARE KNOW ABOUT THE PEACEHEALTH FINANCIAL ASSISTANCE PROGRAM. WHITEBIRD STAFF WORK WITH THE MEDICAL CENTER TO FOLLOW UP ON PATIENTS WHO FREQUENT THE EMERGENCY DEPARTMENT FOR CARE AND INFORM THEM OF AVAILABLE RESOURCES, INCLUDING POSSIBLE FINANCIAL ASSISTANCE. PATIENTS REFERRED FROM COMMUNITY HEALTH CENTERS SEEKING ACCESS TO DONATED SPECIALTY CARE ARE ROUTINELY ENROLLED IN FINANCIAL ASSISTANCE AS PART OF THE PROCESS FOR DETERMINING ELIGIBILITY FOR COMMUNITY-WIDE DONATED CARE. OUR UNIVERSITY DISTRICT HOSPITAL LOCATION IN PARTNERSHIP WITH WHITEBIRD IS PARTICULARLY POISED TO SERVE MINORITY POPULATIONS, THE UNDER-INSURED AND UN-INSURED AND THOSE NOT ACCESSING CARE.COMMUNICATION: ELIGIBLE PATIENTS ARE MADE AWARE OF THIS PROGRAM THROUGH A VARIETY OF COMMUNICATION CHANNELS INCLUDING:-REFERRALS FROM COMMUNITY PARTNERS, INCLUDING NONPROFIT COMMUNITY CLINICS THAT ARE FREE OR LOW-COST- INFORMATION POSTED ON OUR WEB SITE AT WWW.PEACEHEALTH.ORG-SIGNAGE IN OUR WAITING ROOMS-BROCHURES THROUGHOUT OUR FACILITIES-FINANCIAL COUNSELING.AS PART OF OUR BASELINE OUTREACH PLAN, PEACEHEALTH POSTS SIGNS IN THE FOLLOWING AREAS:- REGISTRATION AREAS- RECEPTION AREA- PAY STATIONS**BROCHURES ARE MADE AVAILABLE IN THE FOLLOWING AREAS:-PHYSICIAN OFFICES-COUNTY HEALTH DEPARTMENTS-REGISTRATION BOOTH/DESK-CHECK-IN AREAS (LAB, IMAGING, ETC.)-WAITING AREAS-EXISTING BROCHURE DISPLAYS-ADMINISTRATION-PATIENT EXAM ROOMS (PROVIDER OFFICES)-PAY STATIONS
PART VI, LINE 4:	PEACEHEALTH OPERATES TEN HOSPITALS IN THREE STATES. IN ALASKA, PEACEHEALTH RUNS THE KETCHIKAN MEDICAL CENTER IN KETCHIKAN. IN OREGON, PEACEHEALTH OPERATES SACRED HEART MEDICAL CENTER UNIVERSITY DISTRICT (EUGENE), SACRED HEART MEDICAL CENTER AT RIVERBEND (SPRINGFIELD), PEACE HARBOR MEDICAL CENTER (FLORENCE), AND COTTAGE GROVE COMMUNITY MEDICAL CENTER (COTTAGE GROVE). IN WASHINGTON, PEACEHEALTH OPERATES SOUTHWEST WASHINGTON MEDICAL CENTER (VANCOUVER), PEACEHEALTH ST. JOHN MEDICAL CENTER (LONGVIEW), PEACEHEALTH ST. JOSEPH MEDICAL CENTER (BELLINGHAM), PEACEHEALTH UNITED GENERAL MEDICAL CENTER (SEDRO-WOOLLEY), AND PEACEHEALTH PEACE ISLAND MEDICAL CENTER (FRIDAY HARBOR).THE 2020 POPULATION OF ALASKA IS APPROXIMATELY 724,357, A 1.95% INCREASE COMPARED TO 2010. THE POPULATION OF KETCHIKAN GATEWAY-BOROUGH, AK IS APPROXIMATELY 13,991, AN INCREASE OF 3.08% COMPARED TO 2010. OF THE KETCHIKAN GATEWAY-BOROUGH POPULATION:- 63.9% ARE WHITE (60.2% STATEWIDE) 7% LIVE BELOW THE FEDERAL POVERTY LINE- 3.7% ARE BLACK (3.7% STATEWIDE) 34.6% LIVE BELOW THE FEDERAL POVERTY LINE- 15.6% ARE AMERICAN INDIANA/ALASKA NATIVE (15.6% STATEWIDE) 18.2% LIVE BELOW THE FEDERAL POVERTY LINE- 6.5% ARE ASIAN (6.5% STATEWIDE) 4.9% LIVE BELOW THE FEDERAL POVERTY LINE- 1.4% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (1.4% STATEWIDE) 50% LIVE BELOW THE FEDERAL POVERTY LINE- 7.3% ARE LATINX (7.3% STATEWIDE) 9.6% LIVE BELOW THE FEDERAL POVERTY LINE- 7.5% ARE MULTI-RACIAL (7.5% STATEWIDE) 15.3% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF ALASKA IS APPROXIMATELY 724,357, A 1.95% INCREASE COMPARED TO 2010. THE POPULATION OF PRINCE OF WALES-HYDER, AK IS APPROXIMATELY 5,889:- 44.9% ARE WHITE (60.2% STATEWIDE) 15.5% LIVE BELOW THE FEDERAL POVERTY LINE- 0.6% ARE BLACK (3.7% STATEWIDE) 10.3% LIVE BELOW THE FEDERAL POVERTY LINE- 42.6% ARE AMERICAN INDIANA/ALASKA NATIVE (15.6% STATEWIDE) 19.9% LIVE BELOW THE FEDERAL POVERTY LINE- 1.2% ARE ASIAN (6.5% STATEWIDE) 5.5% LIVE BELOW THE FEDERAL POVERTY LINE- 0.4% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (1.4% STATEWIDE) 70% LIVE BELOW THE FEDERAL POVERTY LINE- 3.9% ARE LATINX (7.3% STATEWIDE) 13.8% LIVE BELOW THE FEDERAL POVERTY LINE- 8.6% ARE MULTI-RACIAL (7.5% STATEWIDE) 16.2% LIVE BELOW THE FEDERAL POVERTY LINE- 1% ARE MULTI-RACIAL (5% COUNTYWIDE, 4% STATEWIDE) 14% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF LANE COUNTY, OR IS APPROXIMATELY 382,971, A 10.57% INCREASE COMPARED TO 2010. THE POPULATION OF EUGENE, OR IS APPROXIMATELY 176,654, AN INCREASE OF 12.98% COMPARED TO 2010. OF THE EUGENE POPULATION:- 78% ARE WHITE (81% COUNTYWIDE, 75% STATEWIDE) 18% LIVE BELOW THE FEDERAL POVERTY LINE- 2% ARE BLACK (1% COUNTYWIDE, 2% STATEWIDE) 28% LIVE BELOW THE FEDERAL POVERTY LINE- 1% ARE AMERICAN INDIANA/ALASKA NATIVE (2% COUNTYWIDE, 2% STATEWIDE) 36% LIVE BELOW THE FEDERAL POVERTY LINE- 5% ARE ASIAN (3% COUNTYWIDE, 5% STATEWIDE) 33% LIVE BELOW THE FEDERAL POVERTY LINE- 1% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (1% COUNTYWIDE, 1% STATEWIDE) 28% LIVE BELOW THE FEDERAL POVERTY LINE- 10% ARE LATINX (9% COUNTYWIDE, 13% STATEWIDE) 26% LIVE BELOW THE FEDERAL POVERTY LINE- 6% ARE MULTI-RACIAL (5% COUNTYWIDE, 4% STATEWIDE) 33% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF LANE COUNTY, OR IS APPROXIMATELY 382,971, A 10.57% INCREASE COMPARED TO 2010. THE POPULATION OF SPRINGFIELD, OR IS APPROXIMATELY 64,078, AN INCREASE OF 7.87% COMPARED TO 2010. OF THE SPRINGFIELD POPULATION:- 80% ARE WHITE (81% COUNTYWIDE, 75% STATEWIDE) 20% LIVE BELOW THE FEDERAL POVERTY LINE- 11% ARE BLACK (1% COUNTYWIDE, 2% STATEWIDE) 40% LIVE BELOW THE FEDERAL POVERTY LINE- 6% ARE AMERICAN INDIANA/ALASKA NATIVE (2% COUNTYWIDE, 2% STATEWIDE) 23% LIVE BELOW THE FEDERAL POVERTY LINE- 2% ARE ASIAN (3% COUNTYWIDE, 5% STATEWIDE) 10% LIVE BELOW THE FEDERAL POVERTY LINE- 2% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (1% COUNTYWIDE, 1% STATEWIDE) 78% LIVE BELOW THE FEDERAL POVERTY LINE- 1% ARE LATINX (9% COUNTYWIDE, 13% STATEWIDE) 20% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF LANE COUNTY, OR IS APPROXIMATELY 382,971, A 10.57% INCREASE COMPARED TO 2010. THE POPULATION OF FLORENCE, OR IS APPROXIMATELY 9,329, AN INCREASE OF 10.19% COMPARED TO 2010. OF THE FLORENCE POPULATION:- 90% ARE WHITE (81% COUNTYWIDE, 75% STATEWIDE) 14.7% LIVE BELOW THE FEDERAL POVERTY LINE- 0% ARE BLACK (1% COUNTYWIDE, 2% STATEWIDE) 100% LIVE BELOW THE FEDERAL POVERTY LINE- 1.4% ARE AMERICAN INDIANA/ALASKA NATIVE (2% COUNTYWIDE, 2% STATEWIDE) 25.4% LIVE BELOW THE FEDERAL POVERTY LINE- 1.8% ARE ASIAN (3% COUNTYWIDE, 5% STATEWIDE) 9.7% LIVE BELOW THE FEDERAL POVERTY LINE- 0.1% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (1% COUNTYWIDE, 1% STATEWIDE) 0% LIVE BELOW THE FEDERAL POVERTY LINE- 4.2% ARE LATINX (9% COUNTYWIDE, 13% STATEWIDE) 24.4% LIVE BELOW THE FEDERAL POVERTY LINE- 2.9% ARE MULTI-RACIAL (5% COUNTYWIDE, 4% STATEWIDE) 39.2% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF LANE COUNTY, OR IS APPROXIMATELY 382,971, A 10.57% INCREASE COMPARED TO 2010. THE POPULATION OF COTTAGE GROVE, OR IS APPROXIMATELY 10,657, AN INCREASE OF 10.02% COMPARED TO 2010. OF THE COTTAGE GROVE POPULATION:- 82% ARE WHITE (81% COUNTYWIDE, 75% STATEWIDE) 17.6% LIVE BELOW THE FEDERAL POVERTY LINE- 1.2% ARE BLACK (1% COUNTYWIDE, 2% STATEWIDE) 10.3% LIVE BELOW THE FEDERAL POVERTY LINE- 0.7% ARE AMERICAN INDIANA/ALASKA NATIVE (2% COUNTYWIDE, 2% STATEWIDE) 26.4% LIVE BELOW THE FEDERAL POVERTY LINE- 0.5% ARE ASIAN (3% COUNTYWIDE, 5% STATEWIDE) 0% LIVE BELOW THE FEDERAL POVERTY LINE- 0% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (1% COUNTYWIDE, 1% STATEWIDE) N/A- 9.6% ARE LATINX (9% COUNTYWIDE, 13% STATEWIDE) 36.8% LIVE BELOW THE FEDERAL POVERTY LINE- 6.8% ARE MULTI-RACIAL (5% COUNTYWIDE, 4% STATEWIDE) 36.3% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF CLARK COUNTY, WA IS APPROXIMATELY 501,869, A 17.62% INCREASE COMPARED TO 2010. THE POPULATION OF VANCOUVER, WA IS APPROXIMATELY 187,615, AN INCREASE OF 15.96% COMPARED TO 2010. OF THE VANCOUVER POPULATION:- 71.5% ARE WHITE (77.5% COUNTYWIDE, 67.5% STATEWIDE) 7.9% LIVE BELOW THE FEDERAL POVERTY LINE- 2.3% ARE BLACK (2.4% COUNTYWIDE, 4.4% STATEWIDE) 14.8% LIVE BELOW THE FEDERAL POVERTY LINE- 0.6% ARE AMERICAN INDIANA/ALASKA NATIVE (1.2% COUNTYWIDE, 1.9% STATEWIDE) 11.4% LIVE BELOW THE FEDERAL POVERTY LINE- 5.6% ARE ASIAN (5% COUNTYWIDE, 9.6% STATEWIDE) 11% LIVE BELOW THE FEDERAL POVERTY LINE- 1.5% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (0.9% COUNTYWIDE, 0.8% STATEWIDE) 19.9% LIVE BELOW THE FEDERAL POVERTY LINE- 13.9% ARE LATINX (10.2% COUNTYWIDE, 13% STATEWIDE) 16.1% LIVE BELOW THE FEDERAL POVERTY LINE- 6.0% ARE MULTI-RACIAL (4.3% COUNTYWIDE, 4.9% STATEWIDE) 12.5% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF COWLITZ COUNTY, WA IS APPROXIMATELY 114,275, A 11.64% INCREASE COMPARED TO 2010. THE POPULATION OF LONGVIEW, WA IS APPROXIMATELY 12,685, AN INCREASE OF 6.37% COMPARED TO 2010. OF THE LONGVIEW POPULATION:- 78.7% ARE WHITE (83.2% COUNTYWIDE, 67.5% STATEWIDE) 13% LIVE BELOW THE FEDERAL POVERTY LINE- 1.4% ARE BLACK (1.1% COUNTYWIDE, 4.4% STATEWIDE) 14% LIVE BELOW THE FEDERAL POVERTY LINE- 1.3% ARE AMERICAN INDIANA/ALASKA NATIVE (2.1% COUNTYWIDE, 1.9% STATEWIDE) 40.7% LIVE BELOW THE FEDERAL POVERTY LINE- 1.8% ARE ASIAN (1.6% COUNTYWIDE, 9.6% STATEWIDE) 4.2% LIVE BELOW THE FEDERAL POVERTY LINE- 0.1% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (0.4% COUNTYWIDE, 0.8% STATEWIDE) 0.5% LIVE BELOW THE FEDERAL POVERTY LINE- 11% ARE LATINX (9.3% COUNTYWIDE, 13% STATEWIDE) 25.8% LIVE BELOW THE FEDERAL POVERTY LINE- 8.1% ARE MULTI-RACIAL (3.7% COUNTYWIDE, 4.9% STATEWIDE) 16.4% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF COWLITZ COUNTY, WA IS APPROXIMATELY 114,275, A 11.64% INCREASE COMPARED TO 2010. THE POPULATION OF KELSO, WA IS APPROXIMATELY 12,685, AN INCREASE OF 6.37% COMPARED TO 2010. OF THE KELSO POPULATION:- 75.4% ARE WHITE (83.2% COUNTYWIDE, 67.5% STATEWIDE) 13% LIVE BELOW THE FEDERAL POVERTY LINE- 1.3% ARE BLACK (1.1% COUNTYWIDE, 4.4% STATEWIDE) 14% LIVE BELOW THE FEDERAL POVERTY LINE- 4.1% ARE AMERICAN INDIANA/ALASKA NATIVE (2.1% COUNTYWIDE, 1.9% STATEWIDE) 40.7% LIVE BELOW THE FEDERAL POVERTY LINE- 1.4% ARE ASIAN (1.6% COUNTYWIDE, 9.6% STATEWIDE) 4.2% LIVE BELOW THE FEDERAL POVERTY LINE- 0% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (0.4% COUNTYWIDE, 0.8% STATEWIDE) 0.5% LIVE BELOW THE FEDERAL POVERTY LINE- 16.8% ARE LATINX (9.3% COUNTYWIDE, 13% STATEWIDE) 25.8% LIVE BELOW THE FEDERAL POVERTY LINE- 6.2% ARE MULTI-RACIAL (3.7% COUNTYWIDE, 4.9% STATEWIDE) 16.4% LIVE BELOW THE FEDERAL POVERTY LINE(SEE PART VI, LINE 4 CONTINUED)
PART VI, LINE 5:	PEACEHEALTH IS AN INTEGRATED, NOT-FOR-PROFIT HEALTH SYSTEM THAT OFFERS A FULL CONTINUUM OF HEALTH AND WELLNESS SERVICES IN THE NORTHWEST. PEACEHEALTH CONTRIBUTES TO THE HEALTH OF THE COMMUNITY BY OFFERING A VARIETY OF SERVICES TO ATTEND TO PREVENTATIVE, ACUTE AND CHRONIC HEALTH CARE SERVICES WITHIN THE COMMUNITIES IT SERVES, THE PEACEHEALTH MISSION IS TO CARRY ON THE HEALING MISSION OF JESUS CHRIST BY PROMOTING PERSONAL AND COMMUNITY HEALTH RELIEVING PAIN AND SUFFERING AND TREATING EACH PERSON IN A LOVING AND CARING WAY. OUR VISION IS TO ENSURE THAT EVERY PERSON RECEIVES SAFE, COMPASSIONATE CARE; EVERY TIME, EVERY TOUCH. PEACEHEALTH PROVIDES EXCEPTIONAL MEDICINE, AND ENDEAVORS TO ALWAYS SERVE THE MOST VULNERABLE AMONG US. PEACEHEALTH RECOGNIZES THE NEED FOR INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED TO ACCESS HEALTH CARE AND PEACEHEALTH PROVIDES THOSE SERVICES EQUALLY TO ALL BASED ON THEAFFORDABLE CARE ACTS CHNA GUIDELINES, EVERY 501(C)3 HOSPITAL MUST CONDUCT ITS OWN UNIQUE CHNA. A CHNA HAS BEEN COMPLETED FOR EACH PEACEHEALTH HOSPITAL.THE COMPLETED CHNAS ALLOW FOR DEEPER UNDERSTANDING OF THE HEALTH NEEDS OF OUR COMMUNITIES. OUR BROAD ANALYSIS OF SECONDARY DATA, COMMUNITY FEEDBACK, AND SYSTEMWIDE PEACEHEALTH INPUT REVEALED A REMARKABLE LEVEL OF COMMONALITY IN THE HEALTH CONCERNS OF OUR VARIOUS COMMUNITIES. EACH HOSPITAL HAS IDENTIFIED PLANS TO ADDRESS PRIORITIZED NEEDS AND CONTINUES TO PURSUE OPPORTUNITIES TO ENHANCE THE OVERALL WELLBEING OF THE COMMUNITY. THESE PLANS ARE OUTLINED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IMPLEMENTATION PLANS FOR EACH AREA, WERE RELEASED IN WINTER 2019 AND ARE AVAILABLE ONLINE AT HTTPS://WWW.PEACEHEALTH.ORG/COMMUNITY-HEALTH-IMPROVEMENT-PLANS AND WILL BE UPDATED ANNUALLY.PEACEHEALTH HAS THE WHEREWITHAL TO IMPROVE POPULATION HEALTH IN ALL REGIONS SERVED BY PEACEHEALTH MEDICAL FACILITIES. THROUGH SYSTEMWIDE SHARING OF BEST PRACTICES, PEACEHEALTH IS IMPROVING AND SUPPORTING THE POPULATION HEALTH OF OUR COMMUNITIES ACROSS THE NORTHWEST.
PART VI, LINE 6:	PEACEHEALTH IS NOT PART OF AN AFFILIATED HEALTHCARE SYSTEM.
PART VI, LINE 7, REPORTS FILED WITH STATES	AK,OR,WA
PART V, LINE 4 (CONTINUED):	THE 2020 POPULATION OF WHATCOM COUNTY, WA IS APPROXIMATELY 237,347, A 17.76% INCREASE COMPARED TO 2010. THE POPULATION OF BELLINGHAM, WA IS APPROXIMATELY 96,014, AN INCREASE OF 18.70% COMPARED TO 2010. OF THE BELLINGHAM POPULATION:- 78.2% ARE WHITE (78.3% COUNTYWIDE, 67.5% STATEWIDE) 12.5% LIVE BELOW THE FEDERAL POVERTY LINE- 1.6% ARE BLACK (1.3% COUNTYWIDE, 4.4% STATEWIDE) 26.7% LIVE BELOW THE FEDERAL POVERTY LINE- 1.1% ARE AMERICAN INDIANA/ALASKA NATIVE (3.4% COUNTYWIDE, 1.9% STATEWIDE) 24.9% LIVE BELOW THE FEDERAL POVERTY LINE- 5.9% ARE ASIAN (4.8% COUNTYWIDE, 9.6% STATEWIDE) 19.6% LIVE BELOW THE FEDERAL POVERTY LINE- 0.2% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (0.3% COUNTYWIDE, 0.8% STATEWIDE) 11.1% LIVE BELOW THE FEDERAL POVERTY LINE- 9.2% ARE LATINX (9.8% COUNTYWIDE, 13% STATEWIDE) 19.7% LIVE BELOW THE FEDERAL POVERTY LINE- 4.8% ARE MULTI-RACIAL (4% COUNTYWIDE, 4.9% STATEWIDE) 16.4% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF SKAGIT COUNTY, WA IS APPROXIMATELY 131,945, A 12.83% INCREASE COMPARED TO 2010. THE POPULATION OF SEDRO-WOOLEY, WA IS APPROXIMATELY 12,182, AN INCREASE OF 15.58% COMPARED TO 2010. OF THE SEDRO-WOOLEY POPULATION:- 74.8% ARE WHITE (74.1% COUNTYWIDE, 67.5% STATEWIDE) 9% LIVE BELOW THE FEDERAL POVERTY LINE- 2.1% ARE BLACK (1.1% COUNTYWIDE, 4.4% STATEWIDE) 18.4% LIVE BELOW THE FEDERAL POVERTY LINE- 0.7% ARE AMERICAN INDIANA/ALASKA NATIVE (2.7% COUNTYWIDE, 1.9% STATEWIDE) 24.9% LIVE BELOW THE FEDERAL POVERTY LINE- 1.3% ARE ASIAN (2.3% COUNTYWIDE, 9.6% STATEWIDE) 11.1% LIVE BELOW THE FEDERAL POVERTY LINE- 0.2% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (0.4% COUNTYWIDE, 0.8% STATEWIDE) 7% LIVE BELOW THE FEDERAL POVERTY LINE- 18.5% ARE LATINX (18.6% COUNTYWIDE, 13% STATEWIDE) 23% LIVE BELOW THE FEDERAL POVERTY LINE- 6.6% ARE MULTI-RACIAL (3.2% COUNTYWIDE, 4.9% STATEWIDE) 18.6% LIVE BELOW THE FEDERAL POVERTY LINETHE 2020 POPULATION OF SAN JUAN COUNTY, WA IS APPROXIMATELY 18,498, A 17.20% INCREASE COMPARED TO 2010. THE POPULATION OF FRIDAY HARBOR, WA IS APPROXIMATELY 2,740, AN INCREASE OF 26.73% COMPARED TO 2010. OF THE SAN JUAN COUNTY POPULATION:- 88% ARE WHITE (67.5% STATEWIDE) 9.5% LIVE BELOW THE FEDERAL POVERTY LINE- 0.8% ARE BLACK (4.4% STATEWIDE) 6.7% LIVE BELOW THE FEDERAL POVERTY LINE- 1..1% ARE AMERICAN INDIANA/ALASKA NATIVE (1.9% STATEWIDE) 5% LIVE BELOW THE FEDERAL POVERTY LINE- 1.5% ARE ASIAN (9.6% STATEWIDE) 16.8% LIVE BELOW THE FEDERAL POVERTY LINE- 0.2% ARE NATIVE HAWAIIAN/PACIFIC ISLANDER (0.8% STATEWIDE) 7.7% LIVE BELOW THE FEDERAL POVERTY LINE- 6.8% ARE LATINX (13% STATEWIDE) 20.4% LIVE BELOW THE FEDERAL POVERTY LINE- 2.6% ARE MULTI-RACIAL (4.9% STATEWIDE) 11.8% LIVE BELOW THE FEDERAL POVERTY LINE

Schedule H (Form 990) 2021

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
PEACEHEALTH

Employer identification number
91-0939479

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) SISTERS OF ST JOSEPH OF PEACE 1663 KILLAMEY WAY PO BOX 248 BELLEVUE,WA98009	91-0567741	501(C)(3)	452,455	MISSION SUPPORT
(2) UNITY CARE NW 1616 CORNWALL AVE STE 2015 BELLINGHAM,WA98225	91-2168190	501(C)(3)	300,000	COMMUNITY BENEFIT
(3) LANE COMMUNITY COLLEGE 4000 E 30TH AVE EUGENE,OR97405	93-0546223	GOVT	285,000	EDUCATION SUPPORT
(4) COMMUNITY ACTION OF SKAGIT COUNTY 330 PACIFIC PLACE MT VERNON,WA98273	91-1140086	501(C)(3)	250,000	COMMUNITY BENEFIT
(5) COLUMBIA RIVER MENTAL HEALTH SERVICES 6926 NE FOURTH PLAIN BLVD VANCOUVER,WA98661	91-0609138	501(C)(3)	250,000	COMMUNITY BENEFIT
(6) DAYBREAK YOUTH SERVICES 960 E 3RD AVE SPOKANE,WA99202	91-1083936	501(C)(3)	250,000	COMMUNITY BENEFIT
(7) ST VINCENT DE PAUL PO BOX 24608 EUGENE,OR97402	93-0454786	501(C)(3)	182,625	COMMUNITY BENEFIT
(8) THE OREGON COMMUNITY 1221 SW YAMHILL ST SUITE 100 PORTLAND,OR97205	23-7315673	501(C)(3)	150,000	COMMUNITY BENEFIT
(9) EMERGENCY SUPPORT SHELTER 1330 11TH AVE LONGVIEW,WA98632	91-1074716	501(C)(3)	106,500	COMMUNITY BENEFIT
(10) SAN JUAN ISLAND FAMILY PO BOX 1981 FRIDAY HARBOR,WA98250	91-2014083	501(C)(3)	102,000	COMMUNITY BENEFIT
(11) NW WA INDIAN HEALTH BOARD 1400 KING ST SUITE 104 BELLINGHAM,WA98229	91-0998755	501(C)(3)	88,500	COMMUNITY BENEFIT
(12) AREA AGENCY ON AGING AND DISABILITIES OF SW WASHINGTON 1338 COMMERCE AVE UNIT 309 LONGVIEW,WA98632	80-0224907	GOVT	68,216	COMMUNITY BENEFIT
(13) COMMUNITIES IN SCHOOLS OF WHATCOM COUNTY PO BOX 6071 BELLINGHAM,WA98227	64-0956619	501(C)(3)	60,000	COMMUNITY BENEFIT
(14) FOOD FOR LANE COUNTY 770 BAILEY HILL ROAD EUGENE,OR97402	93-0888347	501(C)(3)	60,000	COMMUNITY BENEFIT
(15) COUNTY OF WHATCOM 311 GRAND AVE STE 103 BELLINGHAM,WA98225	91-6001383	GOVT	60,000	COMMUNITY BENEFIT
(16) CATHOLIC RELIEF SERVICES PO BOX 17090 BALTIMORE,MD20297	13-5563422	501(C)(3)	60,000	COMMUNITY BENEFIT
(17) SAN JUAN ISLAND EMS 1079 SPRING STREET FRIDAY HARBOR,WA98250	91-1666544	501(C)(3)	55,000	COMMUNITY BENEFIT
(18) BRIGID COLLINS FAMILY SUPPORT 1231 N GARDEN STREET 200 BELLINGHAM,WA98225	94-3121951	501(C)(3)	52,500	COMMUNITY BENEFIT
(19) NW YOUTH SERVICES 1020 N STATE ST BELLINGHAM,WA98225	91-0970561	501(C)(3)	52,500	COMMUNITY BENEFIT
(20) BOYS AND GIRLS CLUB OF WESTERN 1501 AIRPLACE ROAD FLORENCE,OR97439	93-1236854	501(C)(3)	52,500	COMMUNITY BENEFIT
(21) WESTERN LANE AMBULANCE DIST 2625 HWY 101 FLORENCE,OR97439	93-6010869	GOVT	50,000	COMMUNITY BENEFIT
(22) SOUTHWEST WASHINGTON LULAC COUNCIL PO BOX 820749 VANCOUVER,WA98662	45-2823779	501(C)(4)	50,000	COMMUNITY BENEFIT
(23) BELLINGHAM FOOD BANK 1824 ELLIS ST BELLINGHAM,WA98225	91-0918619	501(C)(3)	47,000	COMMUNITY BENEFIT
(24) YWCA CLARK COUNTY 3609 MAIN ST VANCOUVER,WA98663	91-0569882	501(C)(3)	46,845	COMMUNITY BENEFIT
(25) OSLC DEVELOPMENTS INC 10 SHELTON MCMURPHEY BLVD EUGENE,OR97401	26-0423551	501(C)(3)	45,000	COMMUNITY BENEFIT
(26) CLARK COUNTY PO BOX 9825 VANCOUVER,WA98661	91-6001299	GOVT	40,000	COMMUNITY BENEFIT
(27) OREGON BUSINESS COUNCIL 1100 SW 6TH AVE 1608 PORTLAND,OR97204	93-1240928	501(C)(3)	37,500	COMMUNITY BENEFIT
(28) ROAD2HOME PO BOX 3091 BELLINGHAM,WA98227	84-3552212	501(C)(3)	33,000	COMMUNITY BENEFIT
(29) OPPORTUNITY COUNCIL 1111 CORNWALL AVE BELLINGHAM,WA98225	91-0787820	501(C)(3)	30,000	COMMUNITY BENEFIT
(30) COMMON THREADS FARM 516 E NORTH STREET BELLINGHAM,WA98225	20-5163417	501(C)(3)	30,000	COMMUNITY BENEFIT
(31) LYDIA PLACE PO BOX 28487 BELLINGHAM,WA98228	94-3111948	501(C)(3)	28,500	COMMUNITY BENEFIT
(32) UNITED WAY OF LANE COUNTY 3171 GATEWAY LOOP SPRINGFIELD,OR97477	93-0394142	501(C)(3)	27,500	COMMUNITY BENEFIT
(33) UNITED GENERAL DISTRICT 304 2031 HOSPITAL DR SEDRO WOOLLEY,WA98284	81-0622393	GOVT	26,960	MISSION SUPPORT
(34) CATHOLIC CHARITIES 2740 SE POWELL BLVD 1 PORTLAND,OR97202	93-0386801	501(C)(3)	25,000	COMMUNITY BENEFIT
(35) HIV ALLIANCE 1195 CITY VIEW STREET EUGENE,OR97402	93-0963546	501(C)(3)	25,000	COMMUNITY BENEFIT
(36) VOLUNTEERS IN MEDICINE CLINIC 2260 MARCOLA ROAD SPRINGFIELD,OR97477	93-1276816	501(C)(3)	25,000	COMMUNITY BENEFIT
(37) CLARK COUNTY SHERIFFS OFFICE CITIZEN SEARCH AND RESCUE TEAM 505 NW 179TH RIDGEFIELD,WA98642	60-2596667	501(C)(3)	25,000	COMMUNITY BENEFIT
(38) CHUCKANUT HEALTH FDTN 1500 CORNWALL SUITE 201 BELLINGHAM,WA98225	91-1192943	501(C)(3)	24,500	COMMUNITY BENEFIT
(39) WHATCOM FAMILY YMCA 1256 N STATE ST BELLINGHAM,WA98225	91-0482690	501(C)(3)	24,000	COMMUNITY BENEFIT
(40) RESIDENTIAL YOUTH CARE INC PO BOX 7475 KETCHIKAN,AK99901	92-0146378	501(C)(3)	23,000	COMMUNITY BENEFIT
(41) LOWER COLUMBIA SCHOOL GARDENS PO BOX 3010 LONGVIEW,WA98632	91-0823636	501(C)(3)	20,000	NUTRITION EDUCATION
(42) FRIENDS OF THE COTTAGE GROVE PUBLIC LIBRARY PO BOX 104 COTTAGE GROVE,OR97424	93-0762350	501(C)(3)	20,000	COMMUNITY BENEFIT
(43) IDENTITY CLARK COUNTY 915 BROADWAY SUITE 302 VANCOUVER,WA98660	91-1623724	501(C)(3)	20,000	COMMUNITY BENEFIT
(44) WASHINGTON STATE CATHOLIC CONFERENCE 710 NINTH AVENUE SEATTLE,WA98104	91-0973641	501(C)(3)	20,000	COMMUNITY BENEFIT
(45) CHILDREN OF THE VALLEY 1318 S 18TH STREET MT VERNON,WA98274	26-2867395	501(C)(3)	20,000	COMMUNITY BENEFIT
(46) SAN JUAN COUNTY ECONOMIC DEVELOPMENT COUNCIL PO BOX 3053 FRIDAY HARBOR,WA98250	41-2067708	501(C)(3)	19,000	COMMUNITY BENEFIT
(47) JUBILEE WOMENS CENTER 620 18TH AVENUE EAST SEATTLE,WA98112	91-1539920	501(C)(3)	18,500	COMMUNITY BENEFIT
(48) KETCHIKAN WELLNESS COALITION 602 DOCK ST STE 108 KETCHIKAN,AK99901	27-0897521	501(C)(3)	16,000	COMMUNITY BENEFIT
(49) DOMESTIC VIOLENCE AND SEXUAL ASSAULT SERVICES OF WHATCOM COUNTY 1407 COMMERCIAL ST BELLINGHAM,WA98225	91-1066325	501(C)(3)	15,000	COMMUNITY BENEFIT
(50) AHA AMER HEART ASSN 7272 GREENVILLE AVENUE DALLAS,TX75231	13-5613797	501(C)(3)	15,000	COMMUNITY BENEFIT
(51) FAMILY PROMISE OF SKAGIT VALLEY PO BOX 335 SEDRO WOOLLEY,WA98284	46-2556043	501(C)(3)	15,000	COMMUNITY BENEFIT
(52) UNITED WAY OF WHATCOM COUNTY 1511 CORNWALL AVE BELLINGHAM,WA98225	91-0570788	501(C)(3)	15,000	COMMUNITY BENEFIT
(53) HOPE PO BOX 145 CRAIG,AK99921	73-1668460	501(C)(3)	15,000	COMMUNITY BENEFIT
(54) FIRST CITY HOMELESS SVC PO BOX 23095 KETCHIKAN,AK99901	26-2565838	501(C)(3)	12,000	COMMUNITY BENEFIT
(55) FRIENDS OF FLORENCE PO BOX 598 FLORENCE,OR97439	93-0931139	501(C)(3)	10,800	COMMUNITY BENEFIT
(56) INTERFAITH COALITION OF WHATCOM COUNTY PO BOX 30767 BELLINGHAM,WA98228	91-1202013	501(C)(3)	10,500	COMMUNITY BENEFIT
(57) MERCY HOUSING NW 6930 MARTIN LUTHER KING JR S SEATTLE,WA98118	91-1546525	501(C)(3)	10,000	HOUSING ASSISTANCE
(58) INTERCOMMUNITY PEACE AND JUSTICE CENTER 1216 NE 65TH ST SEATTLE,WA98115	94-3083964	501(C)(3)	10,000	MISSION SUPPORT
(59) COUNTY OF SOUTH LANE DIST 4553 1275 SOUTH RIVER RD COTTAGE GROVE,OR97424	93-6000589	GOVT	10,000	COMMUNITY BENEFIT
(60) RONALD MCDONALD HOUSE 2620 N COMMERCIAL AVE PORTLAND,OR97227	93-0806912	501(C)(3)	10,000	COMMUNITY BENEFIT
(61) FRIENDSHIP HOUSE PO BOX 517 MT VERNON,WA98273	91-1335750	501(C)(3)	10,000	COMMUNITY BENEFIT
(62) DOCTORS WITHOUT BORDERS USA INC 333 SEVENTH AVENUE 2ND FLOOR NEW YORK,NY10001	13-3433452	501(C)(3)	10,000	COMMUNITY BENEFIT
(63) SAN JUAN AGRICULTURAL GUILD PO BOX 1945 FRIDAY HARBOR,WA98250	26-2167336	501(C)(3)	10,000	COMMUNITY BENEFIT
(64) SOUTHEAST ALASKA INDEPENDENT LIVING 3225 HOSPITAL DRIVE STE 300 JUNEAU,AK99801	92-0144370	501(C)(3)	9,000	COMMUNITY BENEFIT
(65) THE WATERFALL FOUNDATION PO BOX 70049 FAIRBANKS,AK99707	54-1980898	501(C)(3)	6,170	COMMUNITY BENEFIT
(66) ADELANTE MUJER INC 757 S MAIN STREET SUITE 9 FOND DU LAC,WI54935	46-5147538	501(C)(3)	6,000	COMMUNITY BENEFIT
(67) BURLINGTON-EDISON SCHOOL DISTRICT 927 E FAIRHAVEN AVE BURLINGTON,WA98233	91-0793880	GOVT	5,100	COMMUNITY BENEFIT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

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

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference

Explanation

PART I, LINE 2:

PEACEHEALTH PRE-SCREENS APPLICANTS TO DETERMINE THE NEED OF THE ORGANIZATION RECEIVING THE GRANT. GRANTS AND DONATIONS ARE THEN DETERMINED AND GIVEN TO THOSE ORGANIZATIONS WHOSE MISSION FALLS IN LINE WITH PROMOTING HEALTHCARE OR THE FURTHERANCE OF A COMMUNITY NEED, SUCH AS HEALTHCARE EDUCATION. SINCE EACH GRANT IS CAREFULLY EXAMINED BEFORE IT IS GIVEN AND THE PURPOSE OF THE GRANT IS KNOWN BEFORE IT IS GIVEN, NO FOLLOW UP IS PERFORMED TO FIND OUT HOW THE GRANT WAS USED.

Schedule I (Form 990) 2021

Additional Data

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- 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

PEACEHEALTH

Employer identification number

91-0939479

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 .....

Yes

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? ....

Yes

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

Yes

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)
1ELIZABETH V DUNNE PRESIDENT & CEO	(i) (ii)	1,497,814 ------------- 0	4,109,867 ------------- 0	28,071 ------------- 0	561,806 ------------- 0	12,676 ------------- 0	6,210,234 ------------- 0	0 ------------- 0
2RICHARD DECARLO CHIEF OPERATING OFFICER/EVP	(i) (ii)	927,542 ------------- 0	984,818 ------------- 0	11,451 ------------- 0	311,834 ------------- 0	19,386 ------------- 0	2,255,031 ------------- 0	0 ------------- 0
3DARRIN MONTALVO EVP CHIEF FINAN-GROWTH OFFICER	(i) (ii)	904,371 ------------- 0	860,548 ------------- 0	6,257 ------------- 0	216,673 ------------- 0	20,709 ------------- 0	2,008,558 ------------- 0	0 ------------- 0
4STEVEN GLENN EVP CAO	(i) (ii)	620,084 ------------- 0	660,005 ------------- 0	31,461 ------------- 0	230,438 ------------- 0	4,047 ------------- 0	1,546,035 ------------- 0	0 ------------- 0
5WEN-HUAN S HO MD MD GASTROENTEROLOGY	(i) (ii)	1,273,910 ------------- 0	0 ------------- 0	0 ------------- 0	187,254 ------------- 0	30,458 ------------- 0	1,491,622 ------------- 0	0 ------------- 0
6RON L SAXTON EVP GEN COUNSEL/ASST SECRETARY	(i) (ii)	617,662 ------------- 0	763,766 ------------- 0	16,670 ------------- 0	66,038 ------------- 0	20,080 ------------- 0	1,484,216 ------------- 0	0 ------------- 0
7MICHAEL P DWYER EVP STRATEGY/COMMUNITY HEALTH	(i) (ii)	608,656 ------------- 0	610,022 ------------- 0	12,321 ------------- 0	232,759 ------------- 0	12,137 ------------- 0	1,475,895 ------------- 0	0 ------------- 0
8MARK B HALLETT FORMER SVP CMO	(i) (ii)	195,139 ------------- 0	571,503 ------------- 0	407,815 ------------- 0	185,017 ------------- 0	6,645 ------------- 0	1,366,119 ------------- 0	0 ------------- 0
9SEAN GREGORY MD CHIEF EXECUTIVE COLUMBIA	(i) (ii)	670,813 ------------- 0	354,540 ------------- 0	0 ------------- 0	271,794 ------------- 0	25,657 ------------- 0	1,322,804 ------------- 0	0 ------------- 0
10MANJUNATH G RAJU MD MD CARDIOLOGY	(i) (ii)	1,202,220 ------------- 0	0 ------------- 0	0 ------------- 0	80,487 ------------- 0	26,074 ------------- 0	1,308,781 ------------- 0	0 ------------- 0
11JOLINE M TREANOR EVP PEOPLE & CULTURE (THRU 12/21)	(i) (ii)	571,550 ------------- 0	533,012 ------------- 0	20,412 ------------- 0	166,513 ------------- 0	12,090 ------------- 0	1,303,577 ------------- 0	0 ------------- 0
12CHARLES PROSPER CHIEF EXECUTIVE NORTHWEST	(i) (ii)	661,597 ------------- 0	348,119 ------------- 0	8,450 ------------- 0	207,784 ------------- 0	25,642 ------------- 0	1,251,592 ------------- 0	0 ------------- 0
13JOHN F MACGREGOR MD MD CARDIOLOGY	(i) (ii)	1,030,631 ------------- 0	0 ------------- 0	0 ------------- 0	148,463 ------------- 0	26,105 ------------- 0	1,205,199 ------------- 0	0 ------------- 0
14MARK EICHLER MD MD GENERAL SURGERY	(i) (ii)	1,087,795 ------------- 0	0 ------------- 0	0 ------------- 0	57,451 ------------- 0	25,542 ------------- 0	1,170,788 ------------- 0	0 ------------- 0
15NANDAKUMAR SRINIVASAN MD MD GASTROENTEROLOGY	(i) (ii)	882,137 ------------- 0	141,014 ------------- 0	0 ------------- 0	110,889 ------------- 0	26,245 ------------- 0	1,160,285 ------------- 0	141,014 ------------- 0
16MARY E KINGSTON FORMER CHIEF EXECUTIVE OREGON	(i) (ii)	97,641 ------------- 0	371,356 ------------- 0	640,940 ------------- 0	30,762 ------------- 0	2,787 ------------- 0	1,143,486 ------------- 0	0 ------------- 0
17TODD SALNAS CHIEF EXECUTIVE OREGON	(i) (ii)	623,220 ------------- 0	304,501 ------------- 0	12,430 ------------- 0	31,477 ------------- 0	25,598 ------------- 0	997,226 ------------- 0	0 ------------- 0
18MICHAEL C METCALF CHIEF EXECUTIVE PHMG (THRU 1/22)	(i) (ii)	468,819 ------------- 0	246,683 ------------- 0	3,801 ------------- 0	211,040 ------------- 0	19,035 ------------- 0	949,378 ------------- 0	0 ------------- 0
19WILLIAM R WEIDER SVP CIO	(i) (ii)	457,923 ------------- 0	240,950 ------------- 0	1,519 ------------- 0	192,060 ------------- 0	25,914 ------------- 0	918,366 ------------- 0	0 ------------- 0
20JOHN C BENNETT FORMER CHIEF EXEC AMBULATORY	(i) (ii)	0 ------------- 0	141,347 ------------- 0	750,006 ------------- 0	19,813 ------------- 0	0 ------------- 0	911,166 ------------- 0	0 ------------- 0
21SARAH NESS EVP PEOPLE AND CULTURE	(i) (ii)	414,716 ------------- 0	297,258 ------------- 0	12,193 ------------- 0	150,809 ------------- 0	3,397 ------------- 0	878,373 ------------- 0	0 ------------- 0
22CRAIG ARMSTRONG ASST GEN COUNSEL/ASST SEC (THRU 4/22	(i) (ii)	245,675 ------------- 0	74,774 ------------- 0	0 ------------- 0	29,088 ------------- 0	24,123 ------------- 0	373,660 ------------- 0	0 ------------- 0
23KIMBERLY A HODGKINSON FORMER EVP CFO	(i) (ii)	0 ------------- 0	6,041 ------------- 0	338,318 ------------- 0	0 ------------- 0	0 ------------- 0	344,359 ------------- 0	0 ------------- 0
24DALE J ZENDER FORMER CHIEF EXECUTIVE NW	(i) (ii)	0 ------------- 0	3,242 ------------- 0	253,779 ------------- 0	0 ------------- 0	0 ------------- 0	257,021 ------------- 0	0 ------------- 0
25DIANNA KIELIAN FORMER SVP MISSION/THEOLOGY & ETHICS	(i) (ii)	0 ------------- 0	0 ------------- 0	124,790 ------------- 0	0 ------------- 0	0 ------------- 0	124,790 ------------- 0	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 1A

THE ORGANIZATION HAS POLICIES REGARDING THE ELIGIBILITY OF EXECUTIVES FOR THESE ITEMS. FOR EXAMPLE, TRAVEL FOR COMPANIONS AND HOUSING ALLOWANCES ARE RELATED TO RELOCATION BENEFITS OR FIRST CLASS TRAVEL FOR FLIGHTS EXCEEDING SIX HOURS IN DURATION. THESE BENEFITS WERE REPORTED AND TREATED AS TAXABLE INCOME.

PART I, LINES 4A-B

THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, CERTAIN PHYSICIANS, AND OTHER HIGHLY COMPENSATED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN VARIOUS NONQUALIFIED RETIREMENT PLANS. CONTRIBUTIONS TO THESE PLANS AND RELATED INVESTMENT RETURNS ARE DISCLOSED ON SCHEDULE J AS DEFERRED COMPENSATION AND AS BONUS COMPENSATION WHEN PAID TO THE INDIVIDUAL. THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR YEAR 2021: KIMBERLY A. HODGKINSON $338,318 MARK B. HALLETT $404,530 DIANNA KIELIAN $124,790 JOHN C. BENNETT $750,006 MARY E. KINGSTON $638,316 DALE J. ZENDER $253,779 THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN CALENDAR YEAR 2021 (DEFERRED/PAID): ELIZABETH V. DUNNE: $471,783/$2,120,806 CAROL AARON: $0/$4,413 RICHARD DECARLO: $280,173/$0 RON SAXTON: $0/$144,716 KIMBERLY A. HODKINSON: $0/$6,041 MICHAEL P. DWYER: $200,771/$0 STEVEN GLENN: $163,935/$0 JOLINE M. TREANOR: $139,005/$0 WILLIAM R. WEIDER: $139,471/$0 MARK B. HALLETT: $153,732/$320,805 MICHAEL C. METCALF: $170,352/$0 JOHN C. BENNETT: $0/$141,347 MARY E. KINGSTON: $1,755/$371,356 CHARLES PROSPER: $170,667/$0 DALE ZENDER: $0/$3,242 WEN-HUAN S. HO, MD: $74,377/$0 JOHN F. MACGREGOR, MD: $60,024/$0 MANJUNATH RAJU, MD: $43,940/$0 MARK EICHLER, MD: $28,363/$0 NANDAKUMAR SRINIVASAN: $32,942/$141,014 SEAN GREGORY: $244,447/$0 SARAH NESS: $90,040/$0 DARRIN MONTALVO: $213,773/$0 ADDITIONAL COMMENTARY WE ARE COMMITTED TO LIVING OUR CORE VALUES OF RESPECT, STEWARDSHIP, COLLABORATION AND SOCIAL JUSTICE. PEACEHEALTH MINISTRIES COMPETE FOR EXECUTIVE TALENT WITH BOTH FOR-PROFIT AND NON-PROFIT HOSPITALS AND HEALTH CARE SYSTEMS THROUGHOUT THE COUNTRY DUE TO THE COMPLEXITY OF THE JOB. COMPETITIVE COMPENSATION PROGRAMS ARE CRITICAL TO ATTRACT AND RETAIN THE BEST EXECUTIVE TALENT. PEACEHEALTH IS COMMITTED TO COMPENSATION PRACTICES THAT ARE BOTH JUST AND COMPETITIVE. PEACEHEALTH USES A SINGLE PROCESS TO DETERMINE COMPENSATION FOR ALL CAREGIVERS, INCLUDING EXECUTIVES. THIS PROCESS INCLUDES REVIEWING THIRD-PARTY SURVEY DATA TO BENCHMARK SALARIES AGAINST SIMILAR JOBS AT OTHER HEALTH CARE SYSTEMS OF COMPARABLE SIZE AND COMPLEXITY. WE ALSO EVALUATE EXECUTIVE PERFORMANCE ON AN ANNUAL BASIS. THE PEACEHEALTH BOARD HAS A GOVERNANCE COMMITTEE COMPRISED OF DIVERSE INDIVIDUALS WITH MISSION, INDEPENDENT BUSINESS AND HUMAN RESOURCES EXPERTISE. THE COMMITTEE IS CHARGED WITH SETTING EXECUTIVE COMPENSATION, INCLUDING INCENTIVE PAY, BENEFITS AND RELATED POLICIES. AS PART OF THE TOTAL COMPENSATION PACKAGE, OTHER BENEFITS ARE PROVIDED CONSISTENT WITH THE HEALTH CARE MARKET. BENEFITS ARE DESIGNED TO SUPPORT OUR CULTURE AND VALUES, AND TO ENCOURAGE COMMITMENT AND RETENTION.

Schedule J (Form 990) 2021

Additional Data

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

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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
PEACEHEALTH

Employer identification number
91-0939479

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	WA HEALTHCARE FAC AUTH	91-1108929	NONEAVAIL	02-27-2013	53,464,898	REFUND WHCFA 2008A ISSUED 11/2008		X		X		X
B	OR FACILITIES AUTHORITY	93-6001787	68608JSB8	03-18-2014	71,088,211	REFUND OFA08A&B '08, HHECFA '98		X		X		X
C	OR FACILITIES AUTHORITY 2018 A	93-6001787	68608JXD8	10-31-2018	45,975,000	REFUND OFA 2008 A-B		X		X		X
D	OR FACILITIES AUTHORITY 2018 B	93-6001787	68608JXF3	10-31-2018	100,000,000	REFUND OFA 2008 A-B		X		X		X
	OR FACILITIES AUTHORITY 2018 C	93-6001787	NONEAVAIL	12-03-2018	75,000,000	REFUND OFA 2011 A		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	53,464,898		71,088,211		45,975,000		100,000,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............			1,019,562
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	53,464,898		70,068,649		45,975,000		100,000,000
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013		2014
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X		X		X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.010 %		0.010 %		0.010 %		0.010 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	0.010 %		0.010 %		0.010 %		0.010 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X	X		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

SCHEDULE K, PART III, LINES 3A AND 4

PERCENTAGE OF BOND FINANCED PROPERTY USED IN PRIVATE BUSINESS: A DE MINIMIS AMOUNT OF PRIVATE USE OCCURS. THE PUBLIC AUTHORITY'S BOND COUNSEL HAS REVIEWED AND APPROVED OF PEACEHEALTH'S CONTRACTS AND COMPLIANCE WITH REGARD TO THE PRIVATE BUSINESS USE OF BOND FINANCED PROPERTY.

SCHEDULE K, PART III, LINES 8A, 8B AND 8C:

DISPOSITION OF BOND-FINANCED PROPERTY: IN THE ORDINARY COURSE OF BUSINESS, PEACEHEALTH ROUTINELY DISPOSES OF PROPERTY. DISPOSALS ARE GENERALLY DUE TO EQUIPMENT OBSOLESCENCE OR A TRADE IN ON NEW EQUIPMENT. IN A DISPOSAL WHERE CASH PROCEEDS ARE RECEIVED, THE PROCEEDS ARE EITHER: 1) REINVESTED IN QUALIFIED ASSETS AT A LOCATION COVERED BY A TEFRA NOTICE (TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1982), OR 2) BONDS ARE CALLED AND REDEEMED WITH THE PROCEEDS.

Schedule K (Form 990) 2021

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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
PEACEHEALTH

Employer identification number
91-0939479

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	WA HEALTHCARE FAC AUTH	91-1108929	NONEAVAIL	02-27-2013	53,464,898	REFUND WHCFA 2008A ISSUED 11/2008		X		X		X
B	OR FACILITIES AUTHORITY	93-6001787	68608JSB8	03-18-2014	71,088,211	REFUND OFA08A&B '08, HHECFA '98		X		X		X
C	OR FACILITIES AUTHORITY 2018 A	93-6001787	68608JXD8	10-31-2018	45,975,000	REFUND OFA 2008 A-B		X		X		X
D	OR FACILITIES AUTHORITY 2018 B	93-6001787	68608JXF3	10-31-2018	100,000,000	REFUND OFA 2008 A-B		X		X		X
	OR FACILITIES AUTHORITY 2018 C	93-6001787	NONEAVAIL	12-03-2018	75,000,000	REFUND OFA 2011 A		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	53,464,898		71,088,211		45,975,000		100,000,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............			1,019,562
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	53,464,898		70,068,649		45,975,000		100,000,000
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013		2014
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X		X		X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.010 %		0.010 %		0.010 %		0.010 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	0.010 %		0.010 %		0.010 %		0.010 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........		X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X	X		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

SCHEDULE K, PART III, LINES 3A AND 4

SCHEDULE K, PART III, LINES 8A, 8B AND 8C:

Schedule K (Form 990) 2021

Additional Data

Software ID:
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- 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

PEACEHEALTH

Employer identification number

91-0939479

Return Reference	Explanation
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:	CHARITY CARE AND COMMUNITY BENEFITS: PEACEHEALTH PROVIDES FINANCIAL ASSISTANCE TO PATIENTS UNABLE TO PAY FOR SERVICE. FINANCIAL ASSISTANCE PATIENTS RECEIVE CARE AT REDUCED COST OR NO CHARGE WHEN IT IS DETERMINED THAT PAYMENT CANNOT BE OBTAINED THROUGH INSURANCE, OUTSIDE AGENCIES, OR PRIVATE MEANS. PEACEHEALTH OFFERS INFORMATION ON AVAILABLE ASSISTANCE PRIOR TO ADMISSION, FINANCIAL ASSISTANCE IS ALSO AVAILABLE POST-CARE THROUGH FINANCIAL COUNSELING OTHER COMMUNITY BENEFIT COSTS INCLUDE THE UNREIMBURSED COST OF MEDICAID AND GOVERNMENT PROGRAMS, HEALTH EDUCATION, AND COMMUNITY HEALTH IMPROVEMENT INITIATIVES. NET COMMUNITY BENEFIT EXPENSE AND COMMUNITY BUILDING ACTIVITIES FOR TAX YEAR 2021 WAS $323,172,375 AND 9,923 RESPECTIVELY AS INDICATED ON THE SCHEDULE H IN PART I, LINE 7K COLUMN (E) AND PART II, LINE 10 COLUMN (E).
FORM 990, PART VI, SECTION A, LINE 6	PEACEHEALTH NETWORKS (EIN: 91-1230425) IS THE SOLE CORPORATE MEMBER OF PEACEHEALTH. PEACEHEALTH NETWORKS IS A 501(C)(3) ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11B	THE ORGANIZATION'S ACCOUNTING DEPARTMENT WORKS CLOSELY WITH THE OUTSIDE ACCCOUNTING FIRM IT ENGAGES (KPMG) TO PREPARE AND REVIEW THE RETURN. THE EVP, CFO AND LEGAL DEPARTMENT REVIEW A DRAFT OF THE FORM 990 AND PROVIDE COMMENTS. THE FINAL DRAFT IS MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C	A FORMAL CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO PEACEHEALTH BOARD MEMBERS AND OFFICERS AT LEAST ANNUALLY. RESPONSES ARE REVIEWED BY THE PEACEHEALTH ORGANIZATIONAL INTEGRITY DEPARTMENT AND ANY PERCEIVED OR REAL CONFLICTS OF CONCERN ARE DOCUMENTED IN A MANAGEMENT PLAN AND REVIEWED BY NETWORK AND BOARD LEADERSHIP. BOARD MEMBERS AND OFFICERS ARE OBLIGATED TO BRING ANY CHANGES IN STATUS VIS-A-VIS THE CONFLICT OF INTEREST POLICY TO THE BOARD'S ATTENTION FOR REVIEW AND DISPOSITION BETWEEN SURVEY PERIODS. IF PEACEHEALTH ORGANIZATIONAL INTEGRITY BELIEVES A DISCLOSURE POSES A POTENTIAL OR ACTUAL CONFLICT, IT MUST INDICATE TO THE COVERED PERSON HOW TO DISPOSE OF OR MANAGE THE CONFLICT. PEACEHEALTH ORGANIZATIONAL INTEGRITY INVOLVES LEADERS FROM OTHER DEPARTMENTS AS NEEDED TO REVIEW AND MANAGE DISCLOSED CONFLICTS OF INTEREST. IF PEACEHEALTH HAS REASONABLE CAUSE TO BELIEVE THAT AN INDIVIDUAL HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST OR OTHERWISE VIOLATED THIS POLICY OR REFUSED TO COOPERATE IN AN INVESTIGATION RELATED TO COMPLIANCE WITH THIS POLICY, IT MUST INFORM THE PERSON OF THE BASIS FOR THE BELIEF AND AFFORD AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF AFTER HEARING THE RESPONSE AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, PEACEHEALTH DETERMINES A PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT MAY TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION UP TO AND INCLUDING DISSOLUTION OF THE PERSON'S AFFILIATION WITH PEACEHEALTH.
FORM 990, PART VI, SECTION B, LINE 15	THE INDEPENDENT CHAIR OF THE PEACEHEALTH BOARD OF DIRECTORS REVIEWS AND RECOMMENDS, IN PARTNERSHIP WITH REPRESENTATIVES OF AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT RETAINED BY THE BOARD OF DIRECTORS, THE COMPENSATION OF PEACEHEALTH'S PRESIDENT/CHIEF EXECUTIVE OFFICER. THE BOARD OF DIRECTORS HAS ULTIMATE APPROVAL AUTHORITY FOR THE COMPENSATION FOR THE PRESDIENT/CHIEF EXECUTIVE OFFICER. FURTHERMORE, THE INDEPENDENT COMPENSATION CONSULTANT, WITH SUPPORT FROM MEMBERS OF THE HUMAN RESOURCES DEPARTMENT, DETERMINES COMPARABILITY DATA ACROSS VARIOUS INDUSTRY AND APPLICABLE FOR-PROFIT/NOT-FOR-PROFIT ORGANIZATIONS FOR PERIODICALLY INFORMING THE GOVERNANCE COMMITTEE OF THE BOARD ON THE MARKET COMPETITIVENESS OF THE PAY FOR PEACEHEALTH EXECUTIVES. DISCUSSIONS AND DECISIONS MADE DURING THE COMMITTEE MEETINGS ARE DOCUMENTED IN MEETING MINUTES. THE MOST RECENT COMPENSATION REVIEW WAS COMPLETED IN SEPTEMBER 2022, AND INCLUDED THE PRESIDENT/CHIEF EXECUTIVE OFFICER, EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, NETWORK CHIEF EXECUTIVES, MEDICAL GROUP CHIEF EXECUTIVE, AND OTHER SENIOR NETWORK ROLES (INCLUDING CFO, COO, CAO).
FORM 990, PART VI, SECTION C, LINE 19	ALL GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE ON REQUEST.
FORM 990, PART VII, SECTION A:	CAROL AARON WAS COMPENSATED AS AN EMPLOYEE, NOT IN HER CAPACITY AS A DIRECTOR. CRAIG ARMSTRONG WAS COMPENSATED AS AN EMPLOYEE, NOT IN HIS CAPACITY AS A DIRECTOR.
FORM 990, PART XI, LINE 9:	CHANGE IN VALUE OF INTEREST RATE SWAPS 49,900,760. LOSS ON BOND REFINANCING LOSS ON DEFINED BENEFIT PENSION TERMINATION -78,957,834. CHANGE IN INTEREST IN NET ASSETS OF RELATED FOUNDATIONS 71,894,112. CHANGE IN PENSION LIABILITY 69,522,411. OTHER CHANGES IN UNRESTRICTED NET ASSETS -282,610. NET TRANSFERS FROM AFFILIATES 1,739,209.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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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

PEACEHEALTH

Employer identification number

91-0939479

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
(1) ZOOM MANUFACTURING LLC 1115 SE 164TH AVE VANCOUVER,WA98683 86-1967518	SALES	WA	-900,282	-1,490,473	PEACEHEALTH

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)PEACEHEALTH NETWORKS 1115 SE 164TH AVENUE VANCOUVER,WA98683 91-1230425	SUPPORT	WA	501(C)(3)	LINE 12B, II	N/A		No
(2)PEACEHEALTH SW MEDICAL CENTER FDN PO BOX 1600 VANCOUVER,WA98668 91-1231436	FUNDRAISING	WA	501(C)(3)	LINE 7	PEACEHEALTH	Yes
(3)HEALTH VENTURES 1115 SE 164TH AVENUE VANCOUVER,WA98683 91-1350776	HEALTHCARE JV	WA	501(C)(3)	LINE 12A, I	PEACEHEALTH	Yes
(4)KETCHIKAN MEDICAL CENTER FDN 3100 TONGASS AVENUE KETCHIKAN,AK99901 65-1225184	FUNDRAISING	AK	501(C)(3)	LINE 7	PEACEHEALTH	Yes
(5)COTTAGE GROVE MEDICAL CENTER FDN 1515 VILLAGE DRIVE COTTAGE GROVE,OR97424 93-0688381	FUNDRAISING	OR	501(C)(3)	LINE 7	PEACEHEALTH	Yes
(6)PEACE HARBOR MEDICAL CENTER FDN 400 NINTH STREET FLORENCE,OR97439 93-1084126	FUNDRAISING	OR	501(C)(3)	LINE 7	PEACEHEALTH	Yes
(7)SACRED HEART MEDICAL CENTER FDN PO BOX 10905 EUGENE,OR97440 93-6026548	FUNDRAISING	OR	501(C)(3)	LINE 7	PEACEHEALTH	Yes
(8)ST JOHN MEDICAL CENTER FDN 1615 DELAWARE STREET PO BOX 3 LONGVIEW,WA98632 91-1538852	FUNDRAISING	WA	501(C)(3)	LINE 7	PEACEHEALTH	Yes
(9)ST JOSEPH MEDICAL CENTER FDN 2901 SQUALICUM PARKWAY BELLINGHAM,WA98225 72-1545902	FUNDRAISING	WA	501(C)(3)	LINE 7	PEACEHEALTH	Yes

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	(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) RB AMBULATORY SURGERY CENTER 3355 RIVERBEND DR SPRINGFIELD,OR97477	MEDICAL	OR	N/A				No			No
(2) ARDON HEALTH HOLDINGS LLC 601 SW 2ND AVENUE 24TH FLOOR PORTLAND,OR97204 82-1561337	PHARMACY	DE	PEACEHEALTH				No			No	35.000 %

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) CLARE REASSURANCE 1115 SE 164TH AVE VANCOUVER,WA98683 98-1560395	REINSURANCE	CJ	PH NETWORKS	C					No
(2) LOWER COLUMBIA REGION POOLED INCOME FUND 1115 SE 164TH AVE VANCOUVER,WA98683 46-6157497	POOLED INC FUND	WA	PEACEHEALTH	T	95,433	1,834,667	100.000 %		No
(3) OREGON REGION POOLED INCOME FUND 1115 SE 164TH AVE VANCOUVER,WA98683 46-6180599	POOLED INC FUND	WA	PEACEHEALTH	T	106,879	6,227,183	100.000 %		No
(4) PEACEHEALTH AMBULATORY LLC 1115 SE 164TH AVE VANCOUVER,WA98683 86-2027568	MEDICAL	WA	PH NETWORKS	C					No
(5) PEACEHEALTH CLINICALLY INTEGRATED NETWORK 1115 SE 164TH AVE VANCOUVER,WA98683 86-1975269	MEDICAL	WA	PH AMBULATORY LLC	C					No
(6) PEACEHEALTH DIRECT CONTRACTING LLC 1115 SE 164TH AVE VANCOUVER,WA98683 86-1344009	MEDICAL	WA	PH AMBULATORY LLC	C					No
(7) PEACEHEALTH NETWORKS ON DEMAND LLC 1115 SE 164TH AVE VANCOUVER,WA98683 83-2849989	MEDICAL CLINICS	WA	PH NETWORKS	C					No
(8) POOLED INCOME FUND OF PEACEHEALTH #1 1115 SE 164TH AVE VANCOUVER,WA98683 27-6030191	POOLED INC FUND	WA	PEACEHEALTH	T	883,362	10,104,804	100.000 %		No
(9) SIUSLAW REGION POOLED INCOME FUND 1115 SE 164TH AVE VANCOUVER,WA98683 46-6221760	POOLED INC FUND	WA	PEACEHEALTH	T	87,380	1,933,480	100.000 %		No
(10) SOUTHWEST REGION POOLED INCOME FUND 1115 SE 164TH AVE VANCOUVER,WA98683 46-6168710	POOLED INC FUND	WA	PEACEHEALTH	T	184,795	5,065,510	100.000 %		No
(11) WHATCOM REGION POOLED INCOME FUND 1115 SE 164TH AVE VANCOUVER,WA98683 46-6129451	POOLED INC FUND	WA	PEACEHEALTH	T	197,037	3,578,982	100.000 %		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) ............................

Yes

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

Yes

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

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) .....................

Yes

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) ............................

Yes

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

Yes

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

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

Yes

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

Yes

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
(1) HEALTH VENTURES	C	2,750,000	AT COST
(2) HEALTH VENTURES	L	41,550	AT COST
(3) PEACEHEALTH POOLED INCOME FUNDS	R	1,519,633	AT COST
(4) PEACEHEALTH POOLED INCOME FUNDS	S	738,180	AT COST
(5) RELATED FOUNDATIONS	C	866	AT COST
(6) RELATED FOUNDATIONS	N	15,415	AT COST
(7) RELATED FOUNDATIONS	O	935,233	AT COST
(8) RELATED FOUNDATIONS	P	198,257	AT COST

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, PART IV:

SPLIT INTEREST TRUSTS DISCLOSURE PEACEHEALTH HAS FORMED SEVERAL SPLIT INTEREST TRUSTS. THE TRUSTS ARE LISTED AS POOLED INCOME FUNDS ON THE SCHEDULE R, PART IV. THESE ENTITIES ACQUIRED PROPERTY FROM PEACEHEALTH IN SALE LEASE-BACK TRANSACTIONS CREATING A CAPITAL LEASE OBLIGATION. DURING THE YEAR A SERIES OF TRANSACTIONS OCCURRED BETWEEN PEACEHEALTH AND THE SPLIT INTEREST TRUSTS INCLUDING: 1) $2.2 MILLION IN RENT PAYMENTS FROM PEACEHEALTH TO THE SPLIT INTEREST TRUSTS AND 2) SPLIT INTEREST TRUSTS MADE $738,180 IN INTEREST AS PAYMENT ON DEBT TO PEACEHEALTH. AS OF 06/30/2022, THE SPLIT INTEREST TRUSTS HAVE A LIABILITY TO THE DONORS OF CERTAIN INTERESTED PERSONS AND OTHERS ENGAGED IN TRANSACTIONS WITH THE SPLIT INTEREST TRUSTS. DURING THE CURRENT FISCAL YEAR THESE INDIVIDUALS CONTRIBUTED NO MONEY TO THE SPLIT INTEREST TRUSTS. THE SPLIT INTEREST TRUSTS PAID IN AGGREGATE TO THESE INDIVIDUALS $115,582. UPON THE DEATH OF THE INDIVIDUAL, AND OR THEIR SUCCESSOR, THEIR OWNERSHIP INTERESTS IN THESE SPLIT INTEREST TRUSTS WILL REVERT BACK TO PEACEHEALTH.

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: WE CARRY ON THE HEALING MISSION OF JESUS CHRIST.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	20,658
6	Total number of volunteers (estimate if necessary) .............	6	1,713
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	47,385,349	116,988,641
9	Program service revenue (Part VIII, line 2g) .........	2,880,939,039	3,072,066,252
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	114,167,074	89,816,646
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	12,364,479	12,603,722
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	3,054,855,941	3,291,475,261
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	3,760,859	4,519,629
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)	1,766,272,614	2,096,479,199
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 1,218,684
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	1,252,325,231	1,367,368,265
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	3,022,358,704	3,468,367,093
19	Revenue less expenses. Subtract line 18 from line 12.......	32,497,237	-176,891,832
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	5,237,184,240	4,620,922,535
21	Total liabilities (Part X, line 26).............	2,521,427,896	2,312,470,406
22	Net assets or fund balances. Subtract line 21 from line 20.....	2,715,756,344	2,308,452,129

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 2,492,490,674 including grants of $ 4,519,629 ) (Revenue $ 2,693,587,690 )
	HOSPITALS: FOUNDED BY THE SISTERS OF ST. JOSEPH OF PEACE, PEACEHEALTH HAS PROVIDED EXCEPTIONAL MEDICINE AND COMPASSIONATE CARE TO NORTHWEST COMMUNITIES FOR MORE THAN A CENTURY. PEACEHEALTH IS A NOT-FOR-PROFIT HEALTH CARE SYSTEM WITH HOSPITALS LOCATED IN ALASKA, WASHINGTON AND OREGON. RURAL COMMUNITIES RELY ON THEIR HOSPITALS AS CRITICAL COMPONENTS OF THE COMMUNITIES' ECONOMIC AND SOCIAL FABRIC. THESE HOSPITALS ARE TYPICALLY THE LARGEST OR SECOND LARGEST EMPLOYER IN THE COMMUNITY, AND OFTEN STAND ALONE IN THEIR ABILITY TO OFFER HIGHLY-SKILLED JOBS. (COMMENTARY CONTINUED ON SCHEDULE O.)

4b	(Code: ) (Expenses $ 571,042,603 including grants of $ 0 ) (Revenue $ 378,478,562 )
	CLINICS AND MEDICAL GROUPS: IN ADDITION TO PROVIDING ACUTE CARE THROUGH A NETWORK OF HOSPITALS SUMMARIZED ON LINE 4A, THE PEACEHEALTH HEALTH CARE SYSTEM ALSO INCLUDES CLINICS AND MEDICAL GROUPS LOCATED IN ALASKA, WASHINGTON AND OREGON.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses3,063,533,277

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	29,368,378	0	4,105,070

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	7,713,611
e	Government grants (contributions)		1e	102,431,704

f	All other contributions, gifts, grants, and similar amounts not included above		1f	6,843,326

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

h Total. Add lines 1a-1f.......		116,988,641

		Business Code
2a	PATIENT SERVICE REV	621110	3,025,788,024	3,025,788,024
b	OTHER OPERATING REV	621110	46,278,228	46,278,228
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		3,072,066,252

3 Investment income (including dividends, interest, and othersimilar amounts) ......			46,148,871			46,148,871
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		10,447,805	6a
b	Less: rental expenses		2,161,190	6b
c	Rental income or (loss)		8,286,615	6c
d	Net rental income or (loss).......			8,286,615			8,286,615
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		43,667,775	7a
b	Less: cost or other basis and sales expenses		0	7b
c	Gain or (loss)		43,667,775	7c
d	Net gain or (loss).........			43,667,775			43,667,775
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	CAFETERIA			4,317,107			4,317,107
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			4,317,107
12	Total revenue. See instructions.....			3,291,475,261	3,072,066,252	0	102,420,368

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	4,364,693	4,364,693
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. .............	154,936	154,936
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	31,675,421	27,983,232	3,692,189
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........	1,777,413,817	1,569,566,914	207,093,211	753,692
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	91,138,934	80,488,010	10,619,822	31,102
9	Other employee benefits .......	89,000,683	78,540,647	10,362,881	97,155
10	Payroll taxes ...........	107,250,344	94,701,774	12,495,227	53,343
11	Fees for services (non-employees):
a	Management ......	4,554,982	4,024,039	530,943
b	Legal .........	2,715,480	2,398,955	316,525
c	Accounting ...........	498,049	428,289	56,510	13,250
d	Lobbying ...........	435,000	384,295	50,705
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	601,951	531,786	70,165
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	330,432,146	291,807,513	38,501,929	122,704
12	Advertising and promotion ....	3,297,253	2,894,097	381,856	21,300
13	Office expenses .......	8,323,494	7,368,305	972,195	-17,006
14	Information technology ......	38,122,808	33,668,202	4,442,280	12,326
15	Royalties ..
16	Occupancy ...........	83,288,656	73,580,263	9,708,393
17	Travel ............	10,076,705	8,890,636	1,173,056	13,013
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	10,225	9,033	1,192
20	Interest ...........	41,957,836	37,067,096	4,890,740
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	145,046,731	128,138,215	16,906,928	1,588
23	Insurance ...	34,550,131	30,522,857	4,027,274
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	MED SUPPLIES AND SVCS	512,731,987	452,966,300	59,765,687
b	OTHER TAX	109,546,945	96,777,801	12,769,144
c	ALL OTHER EXPENSES	41,177,886	36,275,389	4,786,280	116,217
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	3,468,367,093	3,063,533,277	403,615,132	1,218,684
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 ........			161,420,740	1	10,437,262
2	Savings and temporary cash investments .........			1,303,273,123	2	642,134,840
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			378,729,522	4	474,195,437
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 ...........			78,364,695	7	138,364,695
8	Inventories for sale or use ............			95,776,350	8	101,522,501
9	Prepaid expenses and deferred charges ......			43,073,972	9	36,795,835
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	3,295,920,477
b	Less: accumulated depreciation	10b	2,101,586,916	1,177,865,311	10c	1,194,333,561
11	Investments—publicly traded securities .			1,656,950,206	11	1,480,082,687
12	Investments—other securities. See Part IV, line 11 .....			118,984,417	12	140,483,890
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			52,297,094	14	44,678,812
15	Other assets. See Part IV, line 11 ...........			170,448,810	15	357,893,015
16	Total assets. Add lines 1 through 15 (must equal line 33)...			5,237,184,240	16	4,620,922,535

17	Accounts payable and accrued expenses .....	690,710,148	17	587,085,161
18	Grants payable ...		18
19	Deferred revenue .........	725,689	19	1,992,508
20	Tax-exempt bond liabilities .........	1,429,192,739	20	1,415,457,773
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	400,799,320	25	307,934,964
26	Total liabilities. Add lines 17 through 25..	2,521,427,896	26	2,312,470,406

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	2,715,756,344	27	2,308,452,129
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 ...........	2,715,756,344	32	2,308,452,129
33	Total liabilities and net assets/fund balances ........	5,237,184,240	33	4,620,922,535

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No