Crozer-Keystone Health System

“The organization is the tax-exempt parent entity in the crozer-keystone health system ("system"); a tax-exempt integrated healthcare delivery system. The organization's federal form 990 was provided to and made available to the audit committee of crozer-keystone health system for review by its members prior to filing with the internal revenue service ("irs"). Following this review the form 990 was provided to each voting member of the organization's governing body, its board of directors, prior to filing with the irs. The crozer-keystone health system board of directors has delegated to its audit committee the responsibility to oversee, review and approve of the federal form 990, including the preparation, review and filing process. As part of the tax return preparation process the organization hired a professional cpa firm with experience and expertise in both healthcare and not-for-profit tax return preparation to prepare the federal form 990. The cpa firm's tax professionals worked closely with the organization's finance personnel and various other individuals of the organization and the system to obtain the information needed in order to prepare a complete and accurate tax return. The cpa firm prepared a draft federal form 990 and furnished it to the organization's finance personnel and other individuals for their review. The organization's finance personnel and other individuals reviewed the draft federal form 990 and discussed questions and comments with the cpa firm. Revisions were made to the draft federal form 990 where necessary and a final draft was furnished by the cpa firm to the organization's finance personnel and various other individuals for final review and approval prior to presentation of the federal form 990 to the members of the crozer-keystone health system audit committee. Thereafter, the form 990 was provided to each voting member of the organization's governing body, its board of directors, prior to filing with the irs.”

“The organization regularly monitors and enforces compliance with its conflict of interest policy. Annually all members of the board of directors, officers and senior management personnel are required to review the existing conflict of interest policy and complete a questionnaire. The completed questionnaires are returned to the organization's legal department and vp/general counsel for review. Thereafter the legal department and vp/general counsel prepare a summary of the completed questionnaires which contains information disclosed on an individual by individual basis. Thereafter, the vp/general counsel of the organization presents this summary to the organization's board of directors for its review and discussion.”

“The organization's board of directors maintains a compensation committee ("committee"). The committee is comprised of members of the board of directors each of whom is independent and free from any conflicts of interest. The committee has adopted a written compensation philosophy which it follows when it reviews and approves or concurs with the compensation and benefits of the organization's senior management, including: the president/chief executive officer, executive vice president/chief operating officer and senior vice president/chief financial officer. The compensation committee bylaws outline the powers and functions of the compensation committee. The committee relies upon appropriate comparable data from an independent consulting firm which specializes in reviewing hospital and healthcare system executive compensation and benefits throughout the united states. This study uses comparable geographical and demographic market data including, but not limited to, similarly sized healthcare systems and hospitals, number of licensed beds, and net patient revenue on both a regional and national basis. The committee documents its basis for its determination through the timely preparation of written minutes of compensation committee meetings during which the executive compensation and benefits are reviewed and subsequently approved. The compensation and benefits of the president/chief executive officer are reviewed by the committee on an annual basis in conjunction with the individual's job performance. The compensation committee then recommends to the ckhs board of directors appropriate compensation for the president/chief executive officer. The board of director's then reviews the committee's recommendation and approves the compensation of the president/chief executive officer based on the committee's recommendation. The president/chief executive officer establishes, after discussion with and concurrence by the committee, the compensation levels of the executive vice president/chief operating officer; senior vice president/chief financial officer; and certain other individuals deemed to be disqualified persons pursuant to the internal revenue service definition. This is done with comparable data provided by an independent consultant. The president/chief executive officer also receives assistance from the ckhs human resources department in conjunction with each individual's job performance during the year. Compensation review and approval is also based upon other objective factors designed to ensure that reasonable and fair market value compensation is paid by the organization. Other objective factors include market survey data for comparable positions, individual goals and objectives, personnel reviews, and evaluations. The activities and procedures followed by the committee enable the organization to qualify for the rebuttable presumption of reasonableness for purposes of internal revenue code section 4958 with respect to the total compensation of all individuals disclosed on this form 990, including the president/ceo, executive vice president/coo and senior vice president/cfo.”

“The organization's filed certificate of incorporation and any amendments can be obtained and reviewed through the commonwealth of pennsylvania.”

“Part vii and schedule j reflect certain board members and officers including the president/chief executive officer, executive vice president/chief operating officer and senior vice president/chief financial officer receiving compensation and benefits from the organization or a related organization. Please note this remuneration was for services rendered as full-time employees or independent contractors of the organization or a related organization and not for services rendered as a voting member or officer of this organization's board of directors.”

“The organization is the parent entity in the crozer-keystone health system and controlled affiliates ("system"). The system includes both for-profit and not for-profit organizations. Certain board of director members, officers and/or directors listed on core form, part vii and schedule j of this form 990 may hold similar positions with both this organization and other affiliates within the system. The hours shown on this form 990, for board members who receive no compensation for services rendered in a non-board capacity, represent the estimated hours devoted per week for this organization. To the extent these individuals serve as a member of the board of directors of other related organizations in the system, their respective hours per week per organization are approximately one hour. The hours reflected on part vii of this form 990, for board members who receive compensation for services rendered in a non-board capacity, paid officers and key employees, reflect total hours worked per week on behalf of crozer-keystone health system and controlled affiliates; not solely this organization.”

“Crozer-Keystone Health System ============================= Crozer-Keystone Health System is the parent entity of a tax-exempt integrated healthcare delivery system ("system"). The system ensures that it provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. Crozer-Chester Medical Center ("CCMC") and Delaware County Memorial Hospital ("DCMH") are affiliates within the system and both file their own separate form 990 which both include a supplemental schedule h, hospitals. For purposes of form 990, schedule h reporting and in accordance with current IRS rules and regulations, CCMC and DCMH both utilized the Catholic Health Association ("CHA") model when quantifying community benefit costs. Under the CHA methodology for quantifying community benefit costs CCMC's and DCMH's fiscal year ended June 30, 2015 net community benefit costs were approximately $53,502,777 and $10,647,022 or approximately 10.38% and 6.35%; respectively of each organizations total fiscal year ended June 30, 2015 expenses less provision for bad debt. The CHA methodology does not include medicare shortfalls and certain costs related to bad debt. Utilizing the model adopted by the American Hospital Association ("AHA"), which CCMC and DCMH both believe more clearly represents actual community benefit, when quantifying its estimated total community benefit costs for the fiscal year ended June 30, 2015 would result in a significantly higher community benefit percentage. Under the AHA model, a hospital may include medicare shortfalls (the amount by which your costs exceed reimbursements), bad debt expense attributable to Charity care and community building activities. Under the AHA model for the 2014 form 990, CCMC and DCMH incurred net community benefit costs of approximately $75,022,144 and $18,853,915 which accounted for approximately 14.55% and 11.24%; respectively of each organizations total fiscal year ended June 30, 2015 expenses. Net costs means costs after all associated reimbursements. Crozer-Keystone Health System ("CKHS") is a not for-profit tax-exempt organization with its central office in Springfield, Pennsylvania. CKHS is the sole corporate member of various healthcare related organizations, including Crozer-Chester Medical Center, the majority of which are tax-exempt entities. The internal revenue service has recognized CKHS as being a tax-exempt organization under internal revenue code ("irc") section 501(c)(3). As the parent organization of a tax-exempt integrated healthcare delivery system in Pennsylvania, CKHS and its affiliates strive to continually develop and operate a multi-hospital healthcare system which provides substantial community benefit through the provision of a comprehensive spectrum of medically necessary healthcare services to the residents of Pennsylvania counties including Delaware, Chester, Montgomery and Philadelphia, Pennsylvania, Southern New Jersey and Northern Delaware. CKHS ensures that its system provides medically necessary healthcare services to all individuals regardless of race, color, creed, sex, national origin, religion or ability to pay. No individuals are denied necessary medical care, treatment or service. CKHS admissions and observations totaled 34,500, CKHS provides treatment and services to approximately 587,000 outpatients, 22,300 same day surgery patients, 128,800 emergency department patients and delivers more than 2,900 babies annually. CKHS includes approximately 6,000 employees and 350 volunteers. Mission ======= Crozer-Keystone Health System is committed to the improved health status of those we serve. We are focused on providing the highest quality of medical care and acting decisively to prevent disease while partnering with the community to educate and encourage healthy life choices. Volunteer services ------------------ Volunteer services at CKHS offer numerous program”

“SelfMade Health Network Tobacco Cessation Marketplace Project Grant. ==================================================================== Community Health Education department was recently awarded a multi-year project grant from the Self Made Health Network to promote the National Self Made Health Network Tobacco (SMHN) Cessation Marketplace Project. CKHS was one of the ten organizations in the county to receive this highly competitive grant. In partnership with the American Lung Association (ALA) Assistors Project Toolkit throughout several geographic regions to reduce the risk of developing some of the nation's leading health concerns associated with tobacco use. Using the ALA toolkit, certified application counselor organizations partners and other types of organizations will gain the resources and knowledge to directly connect clients with cancer prevention tools and tobacco cessation programs during the health insurance enrollment and plan selection process. Comprehensive Screening Events at CKHS locations ================================================ Healthline Services, in collaboration with CKHS Marketing Department and various programs and services across CKHS has coordinated comprehensive "one-stop-shop" screening at CKHS locations in our community this year. Participants can receive up to 12 screenings all in the time span of about 3 hours. Screenings include breast exams, mammograms, prostate, glucose/cholesterol, blood pressure, BMI's, podiatry, leg vein, bone density, scheduling of colonoscopies and lung screenings and walk0in mammography. Fall events have also included free flu shots. Events have been well attended with 75 in attendance at Brinton Lake and Springfield and 82 at the DCMH location. This one-stop-shop for health has made health screenings and connection to CKHS programs and services an easy process for today's busy healthcare consumer. Pediatric asthma task force of Delaware County ============================================== The kids asthma management program provides primary staff support for the pediatric asthma task force of Delaware county (PAFT) and Dr. Vatsala ramprasad, CKHS pediatric pulmonologist is the convener. PAFT is a coalition of providers, managed care organizations, school nurses, universities, EPA and other government representatives, american lung association and other stakeholders working to improve the health and quality of life for children with asthma through collaborative care practices, education, advocacy, and community partnerships that also incorporate sustainability. Some of patf's programs include annual asthma awareness month fairs, educational literature development and distribution for family and providers, and outreach to entities such as the Delaware county school nurse association. The mission of the task force is to improve the health and quality of life for children with asthma through collaborative care practices, education, advocacy, and community partnerships that also incorporate sustainability. Specific objectives of the task force are: - to collect local asthma prevalence data based on such entities as census tracts, zip codes, school districts, er listings or other avenues, identifying resources to support data collection. - to foster collaboration in the identification of funding sources and the subsequent development and submission of grant proposals related to pediatric asthma, including its relationship to obesity and sleep apnea. - to be a forum for community efforts in pediatric asthma control that improves clinical care, child/family self-management and quality of life. - to advocate for the reimbursement of patient education and home-based environmental remediation conducted by both clinical and paraprofessional staff. Bringing people to the table ---------------------------- The community health committee meeting brings individuals together from across the system. This opportunity to share ideas and information, and to collaborate in their”

“Collaboration: community health education program, healthline services and DCMH regional cancer program collaborate to provide education and outreach activities not limited to but including the following: - diversity programs - screening programs - support groups - health fairs - community education programs - local school and community based education/outreach programs and activities - speakers bureau presentations at community locations Congregational nursing program ------------------------------ Congregational nursing is health ministry to faith communities that focuses on the wholeness of body, mind and spirit. The congregational nurse ministry grows out of the belief that all faith communities are places of health and healing and have a role in promoting wholeness through integrating faith and health. A congregational nurse provides health promotion and outreach to a faith-based community in the context with the values, beliefs and practices of that community which they serve. Crozer-Keystone Health System provides outreach, assistance and training to congregational nurses throughout the community that we serve. This commitment to health promotion and access to health services and resources at the community level assists the congregational nurses in connecting their parishioners to programs and services in an effort to ensure optimal community health. Senior health services ---------------------- Senior health services develops, coordinates and implements programs committed to the promotion of a healthy senior community in Delaware county. The services offered are easily accessible; meets the needs of the community served, and are provided with respect and dignity. With the growing number of seniors in the country the elderly population in our county is also expected to surge significantly. By the year 2030 there will be 70 million americans over the age of 65. Delaware county, one of the most densely populated counties in the state will be heavily impacted by the population surge. As one of its many goals senior health services develops initiatives to educate and sensitize healthcare professionals to the unique needs of our growing senior community. These initiatives focus on enhancing the skills of the healthcare and academic communities to develop expertise and best practices in geriatrics. Responsibilities include but not limited to; training employees across the system in areas related to age competency, developing senior friendly hospitals on all levels and bridging the gap between the inpatient and outpatient services. In addition the department is also responsible for the Health System's senior specific support line. The senior support line (1-800-CKHS-key) is a single point of contact for patients, families, physicians and community organizations, to access resources through our Health System, as well as attain services from local and national organizations. Senior health services: - provides ease of access to services for older adults. - stabilizes the individual at home and in the community. - coordinates resources to enhance quality of life. - provides additional support to families and caregivers. - arranges in home support services. - offers assistance in accessing state funded services. - provides assistance with long term care (ltc) or alternative placement. - provides medicare education and enrollment options. - enhances overall health and well-being. Services provided by senior health services include the following: Senior support line ------------------- - toll-free number available to all community members. - triage clinician assesses callers' needs, provides information, and refers to the appropriate services. - all services are coordinated until fully implemented. - remains connected with older adults to ensure systems are in place to meet their needs. Geriatric resource center: the goal of the geriatric resource center located strategically in the center of the county at our Springfield hospital si”

“Crozer-Keystone Health System services ====================================== Crozer-Keystone Health System provides substantial community benefit. Its system includes the following acute care hospitals located throughout the commonwealth of Pennsylvania. 1. Crozer-Chester Medical Center including taylor hospital, Springfield hospital and community hospital; and 2. Delaware County Memorial Hospital. Each hospital operates consistently with the following criteria outlined in IRS revenue ruling 69-545: 1. Provides medically necessary healthcare services in a non-discriminatory manner to all individuals regardless of race, color, creed, sex, national origin, religion or ability to pay, including Charity care, self-pay, medicare and medicaid patients; 2. Operates an active emergency department for all persons; which is open 24 hours a day, 7 days a week, 365 days per year; 3. Maintains an open medical staff, with privileges available to all qualified physicians; 4. Control of each hospital rests with its board of directors and the board of directors of Crozer-Keystone Health System, the tax-exempt parent organization of the hospital. Both boards are comprised of independent civic leaders and other prominent members of the community. 5. Surplus funds are used to improve the quality of patient care, expand and renovate facilities and advance medical care, programs and activities. The operations of each hospital, as shown through the factors outlined above and other information contained herein, clearly demonstrate that the use and control of each hospital is for the benefit of the public and that no part of the income or net earnings of the organization inures to the benefit of any private individual nor is any private interest being served other than incidentally. CROZER-CHESTER MEDICAL CENTER ============================= Crozer-Chester Medical Center (Crozer) is a 300-bed not-for-profit tertiary-care teaching hospital located on a 68-acre campus. Crozer was established in 1963 through the merger of Chester Hospital (c. 1893) and Crozer Hospital (c. 1902), and became one of the founding hospitals of CKHS in 1990. Today, the medical center admits more than 19,000 patients, treats approximately 53,000 Emergency Department patients and delivers about 1,700 babies a year. Featured services include: - Nationally recognized Nathan Speare Regional Burn Treatment Center, celebrating 41 years of care - Comprehensive cardiac services, including open heart surgery and interventional cardiology procedures - Center for Maternal Fetal Medicine - Center for Minimally Invasive and Bariatric Surgery, named a Center of Excellence by the American Society for Metabolic and Bariatric Surgery - Center for Wound Healing and Hyperbaric Medicine - Certified by The Joint Commission as a Primary Stroke Center - Crozer Regional Trauma Center, the only one of its kind in Delaware County, as well as an inpatient Shock Trauma Unit - Crozer Reproductive Endocrinology and Fertility Center - Emergency Department - Fox Chase Crozer-Keystone Cancer Partnership: Crozer Regional Cancer Center - Crozer has been honored by the National Accreditation Program for Breast Centers and is certified by The Joint Commission in Breast Cancer Care - Full range of musculoskeletal services, including orthopedic, rehabilitation, spine and sports medicine services as well as a dedicated Joint/Spine Unit for inpatients - Gastroenterology services, including Endoscopy Laboratory - Inpatient Pediatric Unit - Interventional radiology - Crozer-Keystone Regional Kidney Transplant Center at Crozer-Chester Medical Center - Level III Intensive Care Nursery - Maternity Center and comprehensive gynecologic services - Medical imaging services, including MRI, 3D mammography and women's imaging; Crozer has been named a Breast Imaging Center of Excellence by the American College of Radiology - Surgical services, inpatient and outpatient - daVinci Surgical System - Vascular and endovascular care DEL”

“HEALTHPLEX SPORTS CLUB Established in 1996 to complement the full range of health and wellness programs at Springfield Hospital and throughout the Crozer-Keystone Health System, the Healthplex Sports Club is considered one of the largest and most fully integrated centers of its kind in the United States. More than 6,500 members belong to the 176,000-square-foot sports club. Featured programs and services include: - Member orientation program for each new member - Spacious, state-of-the-art facilities, including 2 indoor pools, 10 tennis courts, 3 NBA size basketball courts, squash/racquetball courts, 3-lane 1/5 mile indoor track and more - Over 150 Group Fitness classes per week, including Zumba, BODYPUMP, BODYFLOW, Pilates, Yoga, Spinning and much more - Comprehensive personal training and wellness programs for people of all ages and conditions - Fitness area featuring cardiovascular and strength-training equipment - Special amenities like The SPA at the Healthplex, saunas, steam rooms and cold plunge - Locker rooms and towel service - Kidz Klub babysitting area - Covered parking garage - Cardio equipment with private viewing screens with over 90 different TV channels - Small Group Training Studio with TRX, Cardio Kick, and more - Mind and Body Studio with Yoga and Pilates - Nutrition programs and counseling - Mindfulness-Based Stress Reduction (MBSR) courses COMMUNITY HOSPITAL ================== Community Hospital is a not-for-profit community hospital that coordinates a full range of outpatient behavioral and community health services as well as primary care. Founded as Sacred Heart Hospital in 1953 and renamed Community Hospital in 1992 when it joined the Crozer-Keystone Health System, the hospital today is a central and convenient place for area families to come for all of their social service needs. The hospital partners with more than 20 local organizations, including the Chester Youth Collaborative, Chester Education Foundation, the Chester Housing Authority, and ChesPenn Health Services. Featured services include: - Mental health services - Adult and pediatric primary care and dentistry through the ChesPenn Center for Family Health - The Wellness Center and Chester Youth Collaborative - Women's and Children's Health Services, including the Crozer-Keystone Healthy Start program, the Nurse-Family Partnership and the Hispanic Resource Center - Substance abuse services CROZER MEDICAL PLAZA AT BRINTON LAKE 300 Evergreen Drive Glen Mills, PA 19342 (610) 579-3400 The Crozer Medical Plaza at Brinton Lake, which opened in 2005, is a comprehensive outpatient center located just off Route 1 in Glen Mills at The Shoppes at Brinton Lake. The facility provides western Delaware County, Chester County, and Northern Delaware residents with convenient access to an array of diagnostic, surgical, and physician services, including full-service medical imaging and an outpatient surgery center. Featured services include: - Asthma and Allergy - Cardiology - Diabetes Education - Dialysis Access Center - Family Medicine - General Surgery - Gynecologic Oncology - Internal Medicine - Laboratory Services - Medical Imaging/Radiology - OB/GYN - Ophthalmology - Orthopedics and Sports Medicine - Osteoporosis Center - Outpatient Physical Therapy - Pain Management - Pediatrics - Pulmonology - Surgery Center at Brinton Lake (outpatient surgery center) - Urogynecology - Vein Center CROZER HEALTH PAVILION 145 S. Brinton Lake Road Glen Mills, PA 19342 1-855-CKHS-4BL (1-855-254-7425) This outpatient facility is located just across Route 1 from the Crozer Medical Plaza at Brinton Lake. Featured services include: - Family Medicine - Crozer-Keystone Sleep Center at Brinton Lake - Neurology CROZER MEDICAL PLAZA AND CROZER-KEYSTONE CANCER CENTER AT BRINTON LAKE 500 Evergreen Drive Glen Mills, PA 19342 1-855-CKHS-4BL (1-855-254-7425) Crozer-Keystone's newest outpatient center features a full-service cancer center, and endoscopy center and other specialties. Featu”

“In addition, the cancer center offers cancer support groups that bring patients and their families and loved ones together with others who share and understand their experiences. Through these support groups, patients can explore complementary alternative approaches - massage therapy and yoga, for example -- to coping with side effects, as well as learn techniques to help them look their best during cancer treatment. Cancer services are also provided at taylor hospital and Springfield hospital. Delaware county regional cancer center (Delaware County Memorial Hospital) ------------------------------------------------------------------------- The Delaware county regional cancer center ("dcrcc") provides a comprehensive approach to cancer care, combining state-of-the-art diagnosis and treatment with supportive care. Physicians and staff work as a multidisciplinary team, using the newest technologies and therapies, to tailor treatment to each patient's condition and situation. The treatment options available include surgery, radiation therapy and medical oncology. Our services are provided to patients by a talented, specially trained and compassionate team of physicians, nurses and staff members. Dcrcc professionals remain on the forefront of cancer care, exploring and implementing the latest technology to enhance each patient's treatment plan. The members of the team work closely together to plan and carry out treatment. The cancer center is partnered with fox CHAse cancer center, which has been designated a comprehensive cancer center by the national cancer institute. The cancer center offers all of the benefits of a large academic medical center, including access to clinical trials. Crozer-Keystone heart institute ------------------------------- CKHS has the longest history of providing cardiovascular care to the people of Delaware county, and we're proud of our many accomplishments. In Delaware county, we're the first healthcare system to: - perform open heart surgery. - perform primary angioplasty. - establish open heart and rehabilitation units. - establish an interventional heart program. - establish an electrophysiology program to treat heart rhythm disorders. - offer cardiac resynchronization therapy, a unique device therapy to treat heart failure. When you come to any Crozer-Keystone hospital with a heart problem, our team of heart specialists evaluates your condition immediately and decides upon a course of action. The team determines the seriousness of your condition, whether it is an emergency, and what treatment you need. Whatever your heart requires, CKHS can help -- from diagnosis to treatment to rehabilitation -- our dedication and experience is unmatched in Delaware county. Maternity --------- Every year, more newborn babies are welcomed into the world by the caring professionals at Crozer-Chester Medical Center and Delaware County Memorial Hospital than by any other Health System in Delaware county. Approximately 1,600 babies are born at CCMC every year, while DCMH delivers about 1,500. Crozer-Keystone human motion institute -------------------------------------- The human motion institute is a unique program offering a comprehensive treatment continuum of care within a highly integrated healthcare delivery network. Our goal is simple: to return our patients to normal function as quickly and safely as possible. To reach this goal, the medical professionals at the human motion institute enlist a comprehensive, leading edge approach to the prevention, assessment, treatment and rehabilitation of musculoskeletal injuries. Our highly trained team of surgeons, nurses, physician assistants, rehabilitation specialists and various medical support personnel works with each patient and their primary care physician to develop a treatment plan specifically for that patient. By combining extensive clinical expertise with a compassionate, caring treatment philosophy, we have created a program known for its quality of care. Cro”

“The center for diabetes offers support programs throughout the year at Springfield hospital. Our support groups discuss topics such as coping skills, resources, foot and eye care related to diabetes, understanding the importance of good blood glucose control and healthy meal planning. Our healthcare team works with patients to teach them how to balance their care and diabetes (what are risk factors for complications, heart disease, etc.); how to recognize and treat hyperglycemia and hypoglycemia; healthy eating and carbohydrate counting; diabetes medications and various medications that can effect blood glucose control; exercise benefits, how diabetes effects the eyes, heart, and kidneys; risk for stroke; and why it is important for the patient to be an active member in the healthcare team. We want the patient to be able to manage their diabetes on a daily basis.”

“Other changes in net assets or fund balances include: - other changes in pension and other accrued retirement benefits liabilities; $188,170.”

“The taxpayer is the parent entity in a tax-exempt, integrated healthcare delivery system. An independent cpa firm audited the consolidated financial statements of the taxpayer and all affiliates for the fiscal years ended june 30, 2015 and june 30, 2014; respectively and issued a consolidated financial statement with consolidating schedules by entity. An unqualified opinion was issued each year by the independent cpa firm. The taxpayer's audit committee assumes responsibility for oversight of the audit of its financial statements and the selection of an independent auditor.”

“The organization is the parent entity in the crozer-keystone health system ("system"); a tax-exempt integrated healthcare delivery system. The system engaged an independent accounting firm to prepare and issue a system wide consolidated a-133 audit. This organization was included in the system wide a-133 audit.”

“Description:purchased services total fees:3319269”

“Description:consulting fees total fees:2018620”

“Description:temporary employees total fees:595788”