Religious Affiliation Due Diligence (Continued): Evidence (e.g., written admission policy, patient/resident application form, written Note: hiring policies, codes of conduct, website information, statistical information, etc.) of each stated fact should be included in this tab. ANSWER (Yes or No) QUESTIONS Please provide explanations as requested – Attach additional pages as needed What percentage of the staff facility’s (professional and non-professional) is of the same religious denomination as the religious affiliation? facility’s Yes (please explain) No Does the facility place any religious-based restrictions on how medical staff performs its duties or what medical procedures can be performed? Yes (please explain) No Are employees or medical staff required to sign or abide by a statement of faith or religious beliefs or similar document? To what degree does the health care facility enjoy institutional harmony apart from the affiliated church or religion? Yes (please explain) No Is the facility sponsored by a church or religion? Yes (please explain) No Must members of the governing board of the facility be members of a particular religion or church? Does the church elect the board members? Yes (please explain) No Does the church dictate how the health care facility allocates its resources? Yes (please explain) No Does the church approve the facility’s financial transactions? Will loan proceeds be used to finance any Yes (please explain) No building or facility that will be used for religious worship?
Religious Affiliation Due Diligence (Continued): Note: Evidence (e.g., written admission policy, patient/resident application form, written hiring policies, codes of conduct, website information, statistical information, etc.) of each stated fact should be included in this tab. QUESTIONS ANSWER (Yes or No) Please provide explanations as requested – Attach additional pages as needed What percentage of the facility’s staff (professional and non-professional) is of the same religious denomination as the facility’s religious affiliation? Does the facility place any religious-based restrictions on how medical staff performs its duties or what medical procedures can be performed? Yes (please explain) No Are employees or medical staff required to sign or abide by a statement of faith or religious beliefs or similar document? Yes (please explain) No To what degree does the health care facility enjoy institutional harmony apart from the affiliated church or religion? Is the facility sponsored by a church or religion? Yes (please explain) No Must members of the governing board of the facility be members of a particular religion or church? Does the church elect the board members? Yes (please explain) No Does the church dictate how the health care facility allocates its resources? Yes (please explain) No Does the church approve the facility’s financial transactions? Yes (please explain) No Will loan proceeds be used to finance any building or facility that will be used for religious worship? Yes (please explain) No
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