4A (Expenses $ 3817046504 including grants of $ 8427689) (Revenue $ 4569834721)
THE TWENTY-nine HOSPITALS INCLUDED ON THIS RETURN EXTEND THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH AND WELL-BEING OF OUR COMMUNITIES AND BRINGING GOOD HELP TO THOSE IN NEED, ESPECIALLY PEOPLE WHO ARE POOR, DYING AND UNDERSERVED. THIS IS ACCOMPLISHED BY DEMONSTRATING BEHAVIORS REFLECTING OUR CORE VALUES OF HUMAN DIGNITY, INTEGRITY, COMPASSION, STEWARDSHIP, AND SERVICE. TOTAL COMMUNITY BENEFIT PROVIDED IN 2020 WAS $454,193,209.

4B (Expenses $ 2401601190 including grants of $ 0) (Revenue $ 1913138555)
BON SECOURS MERCY HEALTH IS A MISSION-DRIVEN, NONPROFIT, CATHOLIC HEALTH SYSTEM. BON SECOURS MERCY HEALTH OPERATES ACUTE CARE HOSPITALS, LONG-TERM CARE FACILITIES, HOUSING SITES FOR THE ELDERLY, HOME HEALTH AGENCIES, HOSPICE PROGRAMS, WELLNESS CENTERS AND OTHER HEALTHCARE ORGANIZATIONS. BON SECOURS MERCY HEALTH'S HOME OFFICE PROVIDES SERVICES AND SUPPORT TO THE ENTIRE SYSTEM, INCLUDING BUT NOT LIMITED TO: PROVIDING GOVERNANCE, MANAGEMENT OVERSIGHT, STRATEGIC LEADERSHIP, FOCUSING RESOURCES TO ASSURE THE HEALING MISSION, PROVIDING ACCESS TO LOWER COST DEBT FINANCING TO SUPPORT OPERATIONS, IMPROVING CLINICAL OUTCOMES AND REDUCING OPERATING COSTS.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - Mercy Health - St. Vincent Medical Center LLC, Mercy Health - St. Anne Hospital LLC, Mercy Health - St. Charles Hospital LLC, St. Vincent Mercy Children's Hospital, Mercy Health - Perrysburg Hospital. The hospitals participated in a county-wide health needs assessment for Lucas County, which was coordinated by The Hospital Council of Northwest Ohio. The county-wide health needs assessment was cross-sectional in nature and included a written survey of adults (19 years of age and older), youth (ages 12-18), and children (ages 0-11). Input from persons representing the broad interest of the community was taken into account via stakeholder interviews and end-user surveys which included individuals with specific knowledge of or expertise in public health, the local health department, agencies with current data or information about the health needs of the community, and leaders, representatives and members of medically underserved, low income, and minority populations, and populations with chronic disease needs. Local community agencies were invited to participate in the health assessment process, including choosing questions for the surveys, providing local data, reviewing draft reports and planning the community event, release of the data and setting priorities. The needs of the population, especially those who are medically underserved, low-income, minority populations and populations with chronic disease needs, were taken into account through the sample methodology that surveyed these populations and over-sampled minority populations. In addition, the organizations that serve these populations participated in the health assessment and community planning process, such as Toledo-Lucas County CareNet, Toledo-Lucas County Commission on Minority Health, United Way of Greater Toledo, etc. Three specific population groups, adults (ages 19-75 years), youth (grades 6-12), and children (ages 0-5 and 6-11 years) were surveyed. To facilitate the Community Health Improvement Process, the Toledo-Lucas County Health Department, along with local hospitals, invited key community leaders to participate in an organized process of strategic planning to improve the health of residents of the county. The National Association of City County Health Officer's (NACCHO) strategic planning tool, Mobilizing for Action through Planning and Partnerships (MAPP), was used throughout this process. Beginning in October 2017, Healthy Lucas County met five times to review the process and timeline, finalize committee members, create or review the vision, choose priorities based on quantitative and qualitative data, rank the priorities, assess existing resources and community strengths, identify gaps in community resources, and draft plans to address the needs. Health problems were ranked based on magnitude, seriousness of consequences and feasibility of correcting the issue. Quantitative and qualitative data was used to prioritize the target areas. In addition, existing programs, services and activities in the community were identified that address the priority target impact area. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 5 Facility A, 2
Facility A, 2 - Mercy Health - St. Rita's Medical Center LLC. As part of the community health needs assessment (CHNA) process, many community stakeholders from Allen, Auglaize, and Putnam counties came together to create one county-level community health assessment (CHA) for each of their respective counties. As a result, these partnerships have resulted in less duplication, increased collaboration, and sharing of resources. Therefore, the data for this CHNA was obtained from the 2016 Putnam County CHA, 2017 Allen County CHA, and 2017 Auglaize County CHA. This community health needs assessment (CHNA) was cross-sectional in nature and included a written survey of adults within Allen, Auglaize, and Putnam Counties, as well as youth within Allen and Auglaize Counties. While Allen and Auglaize counties collect county-level youth health data, Putnam County does not. However, the Putnam County Task Force, does collect health data for individual grade levels using the PRIDE survey, which Mercy Health financially supports in addition to being a member of the task force. Two survey instruments were designed, and pilot tested for this study: one for adults and one for adolescents in grades 6-12. Input from members of the community was obtained through various methods for each county. Question selection meetings, questionnaires, rough draft meetings, community data release events, and written comments from community stakeholders were the main methods of collecting community feedback. Committee members expressed their opinions, needs, services or specific health-related topics while choosing certain questions to ask on the adult and adolescent questionnaires. The committee requested secondary data and correlations at rough draft meetings. Questions and written comments from the public were received at the community data release event from the community stakeholder perceptions worksheets. From the beginning, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid CHNA. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 5 Facility A, 3
Facility A, 3 - Mercy Health - Willard Hospital LLC. Mercy Health - Willard Hospital is a key stakeholder and partner of Huron County Health Partners, a collaborative strategic planning process involving many community agencies and coalitions from various sectors. Huron County Health Partners commissioned a Community Health Needs Assessment (CHNA) for Huron County to assess and identify the health needs of the community. The CHNA was conducted by various social service, business and government organizations in Huron County to collect data that reports the health and health behaviors of Huron County residents. Data was collected for this assessment with the assistance of the Hospital Council of Northwest Ohio. This community health assessment was cross-sectional in nature and included a written survey of adults, youth, and parents within Huron County. From the beginning, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. From the beginning phases of the Huron County CHNA, community leaders were actively engaged in the planning process and helped define the content, scope and sequence of the project. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. Under the leadership of the Hospital Council of Northwest Ohio, the survey questions were drafted and reviewed in a series of meetings with the planning committee from Huron County. Local community agencies were invited to participate in the health assessment process, including choosing questions for the surveys, providing local data, reviewing draft reports, planning the community event, releasing the data and setting priorities. The needs of the population, especially those who are medically under-served, low-income, minority or face a chronic disease, were taken into account through a sample methodology that surveyed these populations and over-sampled minority populations. In addition, the organizations that serve these populations participated in the health assessment and community planning process, including the Huron County Public Health, Fisher-Titus Medical Center, Mercy Health - Willard Hospital, The Bellevue Hospital and Norwalk Area United Fund. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 5 Facility A, 4
Facility A, 4 - Mercy Health - Defiance Hospital LLC. Mercy Health - Defiance Hospital participated in a Community Health Needs Assessment (CHNA) process coordinated by POWER Defiance County Coalition. The CHNA was conducted by various social service, business and government organizations in Defiance County to collect data that reports the health and health behaviors of Defiance County residents. Data was collected for this assessment with the assistance of the Hospital Council of Northwest Ohio. The most recent Defiance County Health Assessment was cross-sectional in nature and included a written survey of adults, adolescents and parents within Defiance County between January to March 2018. From the beginning phases of the Defiance County CHA, community leaders were actively engaged in the planning process and helped define the content, scope and sequence of the project. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. Under the leadership of the Hospital Council of Northwest Ohio, the survey questions were drafted and reviewed in a series of meetings held at the end of 2017 with the planning committee from Defiance County. The needs of the population, especially those who are medically under-served, low-income, minority populations and populations with chronic disease needs, were accounted for through the sample methodology that surveyed these populations and over-sampled minority populations. In addition, the organizations that serve these populations participated in the health assessment and community planning process. Those participating organizations are listed below. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 5 Facility A, 5
"Facility A, 5 - Mercy Health - St. Elizabeth Health Center, Mercy Health - St. Elizabeth Boardman Health Center, Mercy Health - St. Joseph Health Center. Mercy Health - St. Elizabeth Health Center, Mercy Health - St. Elizabeth Boardman Health Center, and Mercy Health - St. Joseph Health Center, collectively referred to as ""MHY,"" was a lead partner with Mahoning and Trumbull County Health Partners (MTCHP) in completing the CHNA process which was carried out from March 2018 through August 2019 with over 25 planning meetings and conference calls. MTCHP contracted with the Hospital Council of Northwest Ohio (HCNO) to guide the CHNA process. HCNO collected the data, guided the health assessment process, and integrated sources of primary and secondary data for Mahoning County and Trumbull County Community Health Assessment reports. The process for the CHNA was cross-sectional in nature and included a written survey of adults within Mahoning and Trumbull Counties and focus groups of at-risk populations as well as incorporation of other health data sources to provide a comprehensive assessment of the health of the residents of Mahoning and Trumbull Counties. Mahoning County and Trumbull County adults (ages 19 and older) participated in a written, self-administered health assessment survey from September 2018 through January 2019. Initially, seven focus groups were conducted in November 2018 with residents from several at-risk or underserved populations including, African American, Hispanic/Latino, senior, young adult, low-income, and residents from rural areas. Community Release Events were held June 6, 2019 in both Mahoning and Trumbull counties to present the survey and focus group data and get input from the community. Community members had the opportunity to provide feedback through discussion at the event, by written comments on a feedback form and by submitting comments to the health department websites. Based on these comments, additional focus groups were held in June 2019 for African Americans, Hispanic/Latino, low income, LGBTQIA+, and young adults. The community participated in Community Health Improvement Plan (CHIP) planning meetings on June 27, July 8, July 25 and August 27, 2019 in Mahoning and Trumbull counties to identify and prioritize significant health needs. MHY staff attended and shared significant health needs previously identified by MHY Executive and Service Line Leaders. Each participant was asked to identify what they perceived to be the top five health problems, and this generated a list of 25-30 health needs. From this list, organizations voted to determine the top health needs in each county. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment"

Schedule H, Part V, Section B, Line 5 Facility A, 6
"Facility A, 6 - Mercy Health - Regional Medical Center LLC, Mercy Health - Allen Hospital LLC. The Mercy Health Lorain Market (""Mercy Health Lorain"") worked collaboratively with the Lorain County Public Health in the development and the implementation of the Community Health Assessment for all of Lorain County. The data for the Lorain County CHA was compiled and collected in 2018 and released on May 23, 2019. The Lorain County CHA was a cross-sectional in nature survey which included a written survey of adults and an electronic survey of youth with Lorain County. Mercy Health Lorain and Lorain County Public Health contracted with the Hospital Council of Northwest Ohio (HCNO), a neutral, regional, and non-profit hospital association, to facilitate the CHNA, CHA and CHIP. Several community stakeholders participated in the process and were members of the Lorain County CHIP Steering Committee. Under the direction of HCNO, the Lorain County CHA included community input in its assessment process in several different ways as follows: surveyed adults and youth in the community; engaged in a Community Themes and Strengths Assessment (CTSA) to gain a deeper understanding on what the residents of Lorain County felt were most important; collected Quality of Survey Survey responses to 394 community members; and participated in a Forces of Change Assessment to identify forces such as legislation, technology, and other impending changes that affect the community and its public health system. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment"

Schedule H, Part V, Section B, Line 5 Facility A, 7
Facility A, 7 - Jewish Hospital LLC, Mercy Health - West Hospital LLC, Mercy Health - Anderson Hospital LLC, Mercy Health - Fairfield Hospital LLC, Mercy Health - Clermont Hospital LLC. Mercy Health Cincinnati participated alongside regional health partners and hospitals to develop the 2019 Community Health Needs Assessment (CHNA). Hospital members of the Health Collaborative and Greater Dayton Area Hospital Association (GDAHA) joined the collaboration which resulted in a robust portrait of the larger Southwest Ohio region. Numerous qualitative and quantitative data methods were leveraged to identify, collect, interpret, and analyze data. CHNA Consultants sought data that reflected recent as well as emerging issues by people who lived in the hospitals' service areas, with attention to vulnerable populations and social determinants of health. Primary data from meetings and surveys was collected from April through July of 2018. The technique of discourse analysis was used to categorize comments, sort and count them, and calculate how often ideas were repeated. Secondary data started with the resources of County Health Rankings with additional data from reputable national and state sources in Indiana, Kentucky, and Ohio. The process included an oversampling of vulnerable populations including African Americans; Elderly residents; Latino residents; LBGTQ+ residents; refugees from Rwanda; and urban residents. Community Need Index scores were utilized to identify the likelihood of healthcare disparities at the ZIP Code level for all ZIP Codes in 25 counties. The regional CHNA included 35 hospitals, 28 local health departments, more than 1,400 healthcare consumers, and organizations and non-profits serving the needs of residents across 25 counties in the Greater Cincinnati and Dayton areas. Community input was received through a series of community meetings and surveys. From April to July 2018, there were 42 meetings, held in 23 counties, which attracted representatives of community organizations, the general public, and/or members of medically underserved and vulnerable populations. A total of 440 people attended 42 meetings. Of these, 283 were speaking on behalf of an organization; 127 were individuals representing their own point of views; 17 represented themselves and an organization; and 13 did not check either box to identify if they were attending as an individual or representing an agency. Additionally, online surveys were distributed throughout the Region cataloguing responses from individuals (828), agencies (96), and public health departments (28). The CHNA team used SurveyMonkey (Gold) for tracking responses at meetings, interviews, and surveys creating custom tags for each response. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - Mercy Health - St. Vincent Medical Center LLC, Mercy Health - St. Anne Hospital LLC, Mercy Health - St. Charles Hospital LLC, St. Vincent Mercy Children's Hospital, Mercy Health - Perrysburg Hospital. Promedica Health System Community Memorial Hospital Mercy Health - St. Vincent Medical Center Mercy Health - St. Anne Hospital Mercy Health - St. Charles Hospital Mercy Health - Perrysburg Hospital St. Vincent Mercy Children's Hospital

Schedule H, Part V, Section B, Line 6a Facility A, 2
Facility A, 2 - Mercy Health - St. Rita's Medical Center LLC. Lima Memorial Health System Institute of Orthopaedic Surgery Blanchard Valley Health System, Putnam County Grand Lake Health Systems

Schedule H, Part V, Section B, Line 6a Facility A, 3
Facility A, 3 - Mercy Health - Willard Hospital LLC. The Bellevue Hospital FisherTitus Medical Center

Schedule H, Part V, Section B, Line 6a Facility A, 4
Facility A, 4 - MERCY HEALTH - DEFIANCE HOSPITAL LLC. ProMedica Defiance Regional Hospital

Schedule H, Part V, Section B, Line 6a Facility A, 5
Facility A, 5 - Mercy Health - St. Elizabeth Health Center, Mercy Health - St. Elizabeth Boardman Health Center, Mercy Health - St. Joseph Health Center. Mercy Health - St. Elizabeth Health Center Mercy Health - St. Elizabeth Boardman Health Center Mercy Health - St. Joseph Health Center

Schedule H, Part V, Section B, Line 6a Facility A, 6
Facility A, 6 - Mercy Health - Regional Medical Center LLC, Mercy Health - Allen Hospital LLC. Special Hospital of Lorain University Hospitals Elyria Medical Center Cleveland Clinic Avon Hospital Mercy Health - Allen Hospital Mercy Health - Regional Medical Center

Schedule H, Part V, Section B, Line 6a Facility A, 7
Facility A, 7 - Jewish Hospital LLC, Mercy Health - West Hospital LLC, Mercy Health - Anderson Hospital LLC, Mercy Health - Fairfield Hospital LLC, Mercy Health - Clermont Hospital LLC. The Christ Hospital Health Network Cincinnati Children's Hospital Medical Center Clinton Memorial Hospital Highpoint Health Fort Hamilton Hospital Grandview Medical Center Greene Memorial Hospital Kettering Behavioral Medic Center Kettering Medical Center Soin Medical Center Southview Medical Center Sycamore Medical Center Lindner Center of HOPE Mercy Health - Anderson Hospital Mercy Health - West Hospital Mercy HEalth - Clermont Hospital Mercy Health - Fairfield HOspital Jewish Hospital LLC Mercy Health - Springfield Regional Medical Center Mercy Health - Urbana Hospital Atrium Medical Center Miami Valley Hospital Miami Valley Hospital North Miami Valley Hospital South Upper Valley Medical Center Bethesda Butler Hospital Bethesda North HOspital Good Samaritan Hospital McCullough Hyde Memorial Hospital TriHealth Evendale Hospital Daniel Drake Center for Post-Acute Care University of Cincinnati Medical Center West Chester Hospital Wayne HealthCare Wilson Health

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - Mercy Health - St. Vincent Medical Center LLC, Mercy Health - St. Anne Hospital LLC, Mercy Health - St. Charles Hospital LLC, St. Vincent Mercy Children's Hospital, Mercy Health - Perrysburg Hospital. Adelante Advocates for Basic Legal Equality, Inc. American Cancer Society Area Office on Aging of Northwest Ohio, Inc. Family and Child Abuse Prevention Center Healthy Lucas County Hospital Council of Northwest Ohio Lake Erie West Traffic Safety Lucas County Family and Children First Mental Health Recovery Services Board of Lucas County New Concepts Neighborhood Health Association Ottawa Hills Schools Ohio State University Extension Toledo Community Foundation Toledo Fire and Rescue Department Toledo Lucas County CareNet Toledo Lucas County Health Department Toledo Public Schools United Way of Greater Toledo United Pastors of Social Empowerment YMCA Live Well Toledo YWCA Hope Center Toledo Lucas-County Health Department Toledo Public Schools Pediatricare Associates, Inc.

Schedule H, Part V, Section B, Line 6b Facility A, 2
Facility A, 2 - Mercy Health - St. Rita's Medical Center LLC. Activate Allen County Allen County Public Health Auglaize County Board of Developmental Disabilities Auglaize County Commissioners Auglaize County Council on Aging Auglaize County Family and Children First Council Auglaize County Head Start Auglaize County Health Department Auglaize County Job and Family Services Auglaize County Juvenile Court Hancock, Hardin, Wyandot and Putnam Community Action Commission, Putnam County Health Partners of Western Ohio Mental Health and Recovery Services Board, Allen and Auglaize County New Bremen Local Schools, Auglaize County Pathways Counseling Center, Inc., Putnam County Putnam County Council on Aging Putnam County Family and Children First Council Putnam County Health Department Putnam County Homecare and Hospice The Mental Health, Alcohol and Drug Addiction Recovery Board of Putnam County The Ohio State University, Lima Campus United Way of Greater Lima United Way of Putnam County University of Toledo Wapakoneta City Schools Waynesfield-Goshen Local Schools West Ohio Community Action Partnership

Schedule H, Part V, Section B, Line 6b Facility A, 3
Facility A, 3 - Mercy Health - Willard Hospital LLC. Firelands Counseling and Recovery Services Huron County Health Partners Hospital Council of Northwest Ohio Huron County Public Health Huron County Commissioners Huron County Mental Health and Addiction Services (MHAS) Board Huron County Schools (School districts of Bellevue, Monroeville, New London, Norwalk, South Central, Western Reserve and Willard, St. Paul High and Immaculate Conception) National Alliance of Mental Illness (NAMI) of Huron County University of Toledo

Schedule H, Part V, Section B, Line 6b Facility A, 4
Facility A, 4 - Mercy Health - Defiance Hospital LLC. City of Defiance CPC Women's Health Resource Defiance Area Foundation Defiance Area YMCA Defiance City Schools Defiance County Commissioners Defiance County Emergency Management Agency Defiance County General Health District Defiance County Help Me Grow - Early Intervention Defiance County Juvenile Court Defiance County - Ohio State University Extension Office Defiance Development and Visitors Bureau Defiance County Family and Children First Council Four County ADAMhs Board Four County Family Center Hicksvilee Village Northwestern Ohio Community Action Commission Recovery Services of Northwest Ohio United Way of Defiance County

Schedule H, Part V, Section B, Line 6b Facility A, 5
Facility A, 5 - Mercy Health - Regional Medical Center LLC, Mercy Health - Allen Hospital LLC. Lorain County Public Health Hospital Council of Northwest Ohio (HCNO) Alcohol and Drug Addiction Services Board of Lorain County Lorain County Board of Mental Health Lorain County Health and Dentistry Lorain County Metro Parks Lorain County Office of Aging Lorain County Public Health Mental Health, Addiction and Recovery Services Board of Lorain County Lorain County Community College

Schedule H, Part V, Section B, Line 6b Facility A, 6
Facility A, 6 - Mercy Health - St. Elizabeth Health Center, Mercy Health - St. Elizabeth Boardman Health Center, Mercy Health - St. Joseph Health Center. Mahoning County Public Health Trumbull County Combined Health District Healthy Community Partnership Mahoning Valley Youngstown City Health District Mahoning County Mental Health and Recovery Board Mercy Health Foundation Mahoning Valley Trumbull County Mental Health and Recovery Board Warren City Health District

Schedule H, Part V, Section B, Line 6b Facility A, 7
Facility A, 7 - Jewish Hospital LLC, Mercy Health - West Hospital LLC, Mercy Health - Anderson Hospital LLC, Mercy Health - Fairfield Hospital LLC, Mercy Health - Clermont Hospital LLC. The Health Collaborative in Cincinnati Greater Dayton Area Hospital Association Public Health - Dayton & Montgomery County Southwest District of the Association of Ohio Health Commissioners Gwen Finegan - Lead Consultant and Project Manager

Schedule H, Part V, Section B, Line 11 Facility A, 1
"Facility A, 1 - Mercy Health - St. Vincent Medical Center LLC, Mercy Health - St. Anne Hospital LLC, Mercy Health - St. Charles Hospital LLC, St. Vincent Mercy Children's Hospital, Mercy Health Perrysburg Hospital. Mercy Health Toledo Mercy Health Toledo is comprised of Mercy Health - St. Vincent Medical Center, St. Vincent Mercy Children's Hospital, Mercy Health Perrysburg Hospital, Mercy Health - St. Anne Hospital, and Mercy Health - St. Charles Hospital. These hospitals are collectively referred to as ""Mercy Health Toledo (MHT)."" MHT address each need identified in its CHNA with regional strategies. Unless noted below, all MHT hospitals participated in the regional strategies. Chronic Disease Implementation Activities: Goal: Improve access to adult patients with chronic disease. Improve Population Health Engagement through Community Paramedicine. Improve access to health foods for patients living in identified food desert. Increase footprint for health outreach programming. 2020 Strategies and Outcomes: * MHT plans to enroll 300 adult patients in care coordination services by the end of 2022, but due to COVID-19, the start of the project was delayed until 2021. * During 2020, 65 patients were referred to the Community Paramedicine Program and 27 enrolled in the program with multiple visits. The remaining referred patients were sent links to resources. * MHT plans to implement several other programs to address this need, including deploying a nutrition prescription program linked to food pharmacies and expanding the Mercy Kids in Action and Starting Fresh programs to additional locations in Toledo. Due to COVID-19, these projects were delayed and will resume in 2021. Mental Health Implementation Activities: Goal: Reduce number of suicide attempts. Increase youth mental health services. 2020 Strategies and Outcomes: * MHT has begun implementing a C-SSRS Screening process to decrease suicide ideation. In 2020, MHT provided behavioral health screenings at the emergency department, behavioral health institute and at certain medical practice locations. * Due to COVID-19, MHT's plans to implement a training program during 2020 were delayed until 2021. * MHT has a three-year plan to investigate the feasibility to expanding mental health services for youth. This project was put on hold until 2021 due to COVID-19. Addiction/Drug and Opiate Use Implementation Activities: Goal: Reduce youth substance abuse. 2020 Strategies and Outcomes: * MHT plans to implement Generation Rx, a school-based alcohol and drug prevention program to reduce youth substance abuse, in six new schools within Lucas County by the end of 2022. No progress was made during 2020 due to COVID-19 restrictions in schools. Maternal and Infant Health/Infant Mortality Implementation Activities: Goal: Increase access to health care. Increase the number of pregnant women receiving lead testing during pregnancy. 2020 Strategies and Outcomes: * The Pathways Community HUB Model helps communities work together to support their vulnerable populations. Local community health workers work closely with families to connect to social and medical services to remove barriers to health. During 2020, MHT was unable to begin distribution or collection of NWO Pathway surveys in the OB-GYN clinics due to COVID-19. This project is expected to begin again in 2021. * During 2020, MHT began to explore the feasibility of implementing lead testing of pregnant women in all MHT OB/GYN clinics. Due to COVID-19, the project was paused until 2021. Health Care System and Access to Care Implementation Activities: Goal: Increase the cultural competence of Mercy Health Toledo staff. 2020 Strategies and Outcomes: * MHT continued to investigate the feasibility of implementing implicit bias training to MHT staff. Due COVID-19, the training of the instructors was paused until 2021. Social Determinants of Health Implementation Activities: Goal: Increase early childhood home visiting programs. 2020 Strategies and Outcomes: * MHT will create an internal process for referring patients to home visiting programs and educate staff on the benefits of the program, enroll patients and families in the program with a goal to increase number of children ready for Kindergarten. Due to COVID-19 the program was cut short during 2020 but is expected to restart in 2021. In 2020, 38 children were served by the program. All prioritized needs in the hospital CHNA have been addressed."

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - Mercy Health - St. Rita's Medical Center LLC. Mercy Health - St. Rita's Medical Center LLC (SRMC) Chronic Disease Implementation Activities: Goal: Reduce heart disease. Create a Paramedicine to assist with transition of care. Expand Meds-to-Beds Program. Reduce diabetes. Increase the number of cancer screenings reported. 2020 Strategies and Outcomes: * SRMC's will continue to implement school-based nutrition and physical activity programming, such as GoNoodle and the Activated School Challenge, to schools. In 2020, SRMC had 1,471,388 total engagements, including 1,464,699 GoNoodle engagements and 6,689 Activated School Challenge engagements. The total engagements were a 63% increase from the 2018 baseline of 898,029 engagements * The Meds-to-Beds Program is a free service that offers education about medication and delivers prescriptions and over-the-counter medications to patients before they leave the hospital. SRMC expanded its Meds-to-Beds program to 3,600 patients in 2020 compared to 168 patients in 2018. * SRMC continues to collaborate with Mercy Health- Lima ambulatory care practices to identify and track the number of people receiving A1C screenings, education, and/or treatment. During 2020, SRMC had 3,370 patients or 81% of the total ambulatory care patients maintain A1c<9 compared to its goal of 80%. * SRMC is leveraging and increasing awareness around the Diabetes Prevention Program and Diabetes Clinic and working on building referrals and educate providers on the Diabetes Prevention Program. Currently 85% of patients of the Diabetes Clinic have an A1c<9. * SRMC provides cancer awareness, outreach, and screening efforts focused on breast, colon and lung cancers within the minority community. In 2020, SRMC collected baseline data on the number of cancer screening results reported through EPIC through awareness campaigns to track future progress. * SRMC received a grant from BSMH Foundation to help address prostate cancer disparities for African American males. The purpose of the program is to help 1) enhance education and outreach; 2) facilitate access to a shared decision-making visit with primary care providers; and 3) remove barriers that prevent Black/African American males from accessing preventive care. SRMC's goal is to connect with 100 African American males at educational events and follow-up or connect with 80% of those attendees within 3 months post educational/outreach event. Mental Health and Addiction Implementation Activities: Goal: Reduce youth substance abuse. Increase drug and alcohol screening. Offer alternative therapies to behavioral health patients, other than medication, for coping and strengthening positive mental and spiritual well-being. Increase access to Naloxone. 2020 Strategies and Outcomes: * SRMC supports a comprehensive school-based strategy collaborated in conjunction with the Mental Health & Recovery Services Board to help address behavior-based issues. The strategy includes implementing programs that include: GoNoodle, GenRx, Saturday Steps, Activated School Challenge and Resiliency Grant through the Legacy Fund. In 2020, the baseline was established with 12 schools participating. * In 2020, SRMC explored the feasibility of implementing SBIRT screenings at Mercy Health - Lima primary care offices. As identified through this exploration process, Mercy Health - Lima intends to implement pilot programs at 2 Mercy Health - Lima family medicine practices in 2021. * SRMC collaborated with community partners to determine alternative therapy options for behavioral health patients, such as art therapy, music therapy, etc. During 2020, SRMC established 2 alternative therapy programs within behavioral health services, including art and music therapy programs. Art Therapy programs are offered to in-patient behavioral health patients 3 times per week. In 2020, SRMC served a total of 685 patients in the Art Therapy program, and 7 individuals were taking classes at ArtSpace Lima upon discharge. Music therapy programs were offered 1 time per quarter to in-patient behavioral health patients. This activity was put on pause due to COVID-19. * During 2020, St. Rita offered 143 Naloxone kits were offered through the outpatient pharmacy to patients, and 43 outpatient prescriptions were written by the emergency department. Maternal and Infant Health Implementation Activities: Goal: Offer addiction counseling to pregnant women. Increase breastfeeding. Increase home visiting that begins prenatally. 2020 Strategies and Outcomes: * SRMC implemented the Embrace Program, which offers addiction counseling to pregnant women. As of 2019, Mercy Health Lima had not implemented this program at any OB/GYN offices. During 2020, SRMC implemented this program at one office and had 48 total referrals. * SRMC continues to increase the number of staff certified in lactation counseling to provide increased breastfeeding support at birth facilities. In 2020, 9 healthcare providers were certified compared to a goal of 7. * SRMC continues to focus on improving collaboration with the pharmacy to increase the Vitamin D supplementation provided to infants. In 2020, the baseline data was collected, which will be used to track progress in future years. * During 2020, SRMC conducted 762 home visits before and after birth. SRMC intends to increase the number of home visits, and will utilize 2020 as its baseline for future progress. * SRMC staff educated its healthcare providers on home visiting programs and identifying additional staff to do home visiting. SRMC has a Home Visiting Task Force that meets quarterly to review goals and additional ways to help educate providers. The Task force consists of providers, care coordinators, nursing staff, support staff and community partners. Social Determinants of Health (Including Access to Care) Implementation Activities: Goal: Support Activate Allen County (a local coalition of key stakeholders) to address the health & wellbeing of the community. 2020 Strategies and Outcomes: * During 2020, SRMC continued to be a key sponsor of the Activate Allen County coalition and to engage in leadership and work groups to help address their goals and objectives to address this need. * Initiatives of the coalition and SRMC in 2020 included: - Housing: Preparing a proposal for an internal housing strategy - Food Insecurity: Piloting Green Prescription program through Family Medicine Resident Clinic screening patients for food insecurity, connecting them to care coordination and existing community resources within community. - Transportation: Mercy Express- 1,465 patients provided transportation to and from medical appointments. Public Health System, Prevention and Health Behaviors Implementation Activities: Goal: Reduce smoking. 2020 Strategies and Outcomes: * During 2020, SRMC collaborated and supported the work of Tobacco Free Coalition. * SRMC obtained a $100,000 grant from the BSMH Foundation to begin a Tobacco Cessation program in 2020. The program had 166 total referrals, 63 patients enrolled with 21 completing the full 12-week program, and 555 total patient contacts through visit or phone. * SRMC began a mobile clinic available at Ohio Northern University. All prioritized needs in the hospital CHNA have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 3
Facility A, 3 - Mercy Health - Willard Hospital LLC. Mercy Health - Willard Hospital Chronic Disease Implementation Activities: Goal: Improving physical health by providing education on healthy eating habits, exercise and chronic disease management through the Complete Health Improvement Program (CHIP). 2020 Strategies and Outcomes: * Mercy Health Willard continued to provide free health screenings to all employees during 2020. * Mercy Health Willard provided employer agencies with Zoom training on Chronic disease and preventive health to help prevent chronic illness in adults during the pandemic. * Due to the impact of COVID-19, many of the programs and strategies that Mercy Health Willard intended to implement to address this health need were delayed until 2021. Mercy Health Willard plans to resume these programs in 2021. Mental Health/Substance Abuse Implementation Activities: Goal: Improve mental health and substance abuse awareness in Huron County 2020 Strategies and Outcomes: * Counseling services were available through Firelands Counseling and Recovery Services and the Vivitrol Clinic. The clinic is located on the second floor of Mercy Health Willard. * Mercy Health Willard provided employer agencies with Zoom training on Mental Health and Substance Abuse to help increase awareness of these issues during the pandemic. * Due to the impact of COVID-19, many of the programs and strategies that Mercy Health Willard intended to implement to address this health need were delayed until 2021. Mercy Health Willard plans to resume these programs in 2021. Mercy Health Willard will not directly address Injury and Violence Prevention community need as other organizations in Huron County are specifically designed and better prepared to respond to this need through resources and experience. Mercy Health Willard will support them as needed.

Schedule H, Part V, Section B, Line 11 Facility A, 4
Facility A, 4 - Mercy Health - Defiance Hospital LLC. Mercy Health - Defiance Hospital Mental Health and Addiction Implementation Activities: Goal: Through proven and promising best practices, effective programs will be better able to help achieve the Healthy People 2020 Mental Health and Mental Disorders Objectives to improve mental health through prevention and ensure access to appropriate, quality mental health services. To increase community awareness of the problem of addiction and of the availability of effective treatment opportunities. 2020 Strategies and Outcomes: * Mercy Health Defiance continues to support the Four County L.O.S.S. (Local Outreach to Suicide Survivors) program. Due to the COVID-19 pandemic, many of the volunteer hours and other activities were put on hold until 2021. * Mercy Health Defiance continued community collaboration with POWER Defiance County Coalition and active participation in workgroups to address the community needs and strategies. * Due to the impact of COVID-19, many of the programs and strategies that Mercy Health Defiance intended to implement to address this health need were delayed until 2021. Mercy Health Defiance plans to resume these programs in 2021. Chronic Disease Implementation Activities: Goal: Reduce the percentages of overweight or obese adults and children and reduce the percentage of heart disease in adults in Defiance County by implementing a communitywide physical activity and nutrition campaign in collaboration with at least 4 Defiance County organizations. 2020 Strategies and Outcomes: * Mercy Health Defiance continues to maintain the walking path on property owned by Defiance County and adjacent to Mercy property. * Due to the impact of COVID-19, many of the programs and strategies that Mercy Health Defiance intended to implement to address this health need were delayed until 2021. Mercy Health Defiance plans to resume these programs in 2021. Increase Injury prevention Implementation Activities: Goal: Reduce the number of falls in the adult population and increase the number of parents who put their child to sleep on his/her back. 2020 Strategies and Outcomes: * Mercy Health Defiance continued community collaboration with POWER Defiance County Coalition and active participation in workgroups to address the community needs and strategies. * Due to the impact of COVID-19, many of the programs and strategies that Mercy Health Defiance intended to implement to address this health need were delayed until 2021. Mercy Health Defiance plans to resume these programs in 2021. All prioritized needs in the hospital CHNA have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 5
"Facility A, 5 - Mercy Health - Regional Medical Center LLC, Mercy Health - Allen Hospital LLC. Mercy Health Lorain Mercy Health - Lorain is comprised of Mercy Health - Regional Medical Center and Mercy Health - Allen Hospital. These hospitals are collectively referred to as ""Mercy Health Lorain."" Mercy Health Lorain address each need identified in its CHNA with regional strategies. Unless noted below, all Mercy Health Lorain hospitals participated in the regional strategies. Chronic Disease Implementation Activities: Goal: The Mercy Health Lorain Market will look at the main factors that impact Chronic Disease - Obesity, Diabetes and Heart disease by using diabetes and food education coupled with an exercise prescription program to bring awareness to the impact it has on the body. 2020 Strategies and Outcomes: * In partnership with United in Glory, Thrive, and a physician champion, Mercy Health Lorain developed ""Our Men's Chronic Disease Program"" in 2020. a men's Chronic Disease program that encompasses the key chronic disease components. The program is the first program to allow direct coaching of individuals to reach weight-loss goals. 50 participants were enrolled in 2020 during the first year. Mercy Health Lorain will continue to expand this program with goal of enrolling 150 at the end of the three years. * During 2020, Mercy Health Lorain implemented an exercise prescription program to connect patients to free/low cost exercise options and develop a relationship with the individual's primary care provider throughout the county. In 2020, one Mercy Health Lorain physician began prescribing his patients to the program and participated in the program with the patients. It is expected that this program will be piloted in the southern part of the County in 2021. * During 2020, Mercy Health Lorain implemented a food prescription program connecting patients to health food options throughout the county. Programs included participation from Second Harvest Food Bank, Salvation Army of Lorain and Elyria, and Oberlin Community Services Center. Continued expansion of the program is planned for 2021 by implementing Produce Perks at primary care practices. Cancer - Men and Women Implementation Activities: Goal: Mercy Health Lorain Market will increase cancer awareness for men and women between the ages of 50-75 throughout Lorain County on the three top ranking cancers: Breast; Colon; and Prostate Cancer. 2020 Strategies and Outcomes: * During 2020, Mercy Health Lorain increased presence, awareness and Mammogram screenings with a continued highlight in the Southern portion of Lorain County. Mercy Health Lorain saw growth of 3.5% in 2020, which was lower than expected due to COVID-19 impacts. This will be a continued focus in 2021 with a new Director at the Cancer Center coupled with a renewed partnership with the Women's Health Center. * During 2020, Mercy Health Lorain increased presence, awareness and Colorectal screenings for both men and women. During 2020, Mercy Health Lorain saw growth of 2%, which was lower than expected due to COVID-19 impacts. In addition to the new cancer center director, Mercy Health Lorain plans to collaborate with the United in Glory Program and Thrive to increase access to GI and Colon education and testing. Tours have been scheduled with the community around the new GI/Colon Center of Excellence. * During 2020, Mercy Health Lorain increased worked toward increasing education and screenings for Prostate cancer in men by 2.5%. The growth was lower than expected due to COVID-19 impacts. The PSA testing in our churches then leads to education. In addition to the new cancer center director and collaborations with United in Glory Program and Thrive, increased PSA testing in our churches and providing education will be a continued focus in 2021. * Mercy Health Lorain had an educational session for men with Dr. Haas. Maternal and Child Health Implementation Activities: Goal: Mercy Health Lorain Market will focus on Infant mortality by decreasing the number of preterm births in which the gestational period is less than 37 weeks. 2020 Strategies and Outcomes: * Mercy Health Lorain increased utilization of Mercy Health Resource Mothers Program by 4.2%, compared to a goal of 3.5%. Despite COVID-19, we continued seeing our clients, managing their births and following their child for 1 year. * Mercy Health Lorain worked with local high school counselors during 2020 to ensure there was a connector to care for young women who became pregnant. Providing virtual visits and home drop offs of food and other baby supplies. * During 2020, Mercy Health Lorain monitored the gestational period of mothers in the Mercy Health Resource Mother Program. In 2020, 99% of mothers reached the 37-week threshold of pregnancy surpassing the goal of 98%. * Certified healthcare workers through Resource Mothers focused on education and discussions with their moms around 37-week gestational period for the first time in 2020 to ensure the pregnant mothers had access to necessary care prior to delivery. Mental Health Implementation Activities: Goal: The Mercy Health Lorain Market will increase the number of patients that access and utilize Mercy Health for care for their mental health. 2020 Strategies and Outcomes: * During 2020, Mercy Health Lorain collaborated with Lorain County Community College (LCCC) and the local high schools to raise awareness to careers in mental health. A program with LCCC was not able to be implemented during 2020 due to COVID-19, but a virtual tour and education on the Behavioral Health Unit to high school students was held. * Mercy Health Lorain continues to focus on increasing utilization of mental health services through use of Clinical Psychologists. In 2020, 2,010 patients utilized these services. Virtual visits were implemented during the year due to COVID-19. * To increase suicide awareness through programs and partnerships, Mercy Health Lorain offered suicide awareness programs to 3 local school systems, churches, and congregations in 2020 to increase suicide awareness. Mercy Health Lorain provided virtual educational sessions around suicide to parish nursing volunteers. 320 parish nursing volunteers participated in 2020."

Schedule H, Part V, Section B, Line 11 Facility A, 6
Facility A, 6 - CONTINUED DESCRIPTION: Mercy Health - Regional Medical Center LLC, Mercy Health - Allen Hospital LLC. Substance Abuse Implementation Activities: Goal: Mercy Health Lorain Market will increase substance abuse education and connect addiction support to those in need throughout Lorain County. 2020 Strategies and Outcomes: * During 2020, Mercy Health Lorain worked to enhance the opioid/substance abuse awareness and education for high school students throughout the county with a goal of the completion of 6 courses throughout the county by the end of the three-year period. In collaboration with LCADA Way, three virtual sessions were provided to local high school students in 2020. * Mercy Health Lorain continued to provide education through the Let's Get Real Program. Despite COVID-19 and the decrease in patients seen in the ER, this program had 125 patient referrals in 2020. Access to Care Implementation Activities: Goal: Mercy Health Lorain Market will increase the number of patients that choose a Primary Care Physician or Nurse Practitioner. 2020 Strategies and Outcomes: * Mercy Health Lorain educates the community on the benefits of selecting a Primary Care Physician to care for their health and mental needs through introduction talks and discussions through our relationships with the Mercy Health Parish Nursing program. Exceeding its 50% goal, Mercy Health Lorain had 55% of its patients without a primary care physician scheduled to see an Mercy Health physician at the time or soon after the time of their ER visit. * Despite the COVID-19 pandemic, Mercy Health Lorain ERs ensured that there was access to Primary Care Physician appointments. Mercy Health Lorain implemented a focus on MH Parish Nursing Screenings and MH Occupational Health Services access to connect individuals to the benefits of a primary care physician. Social Determinants of Health/Health Equity Implementation Activities: Goal: Mercy Health Lorain Market will eliminate implicit bias towards patients and the community we serve in order to improve health equity (Social Determinants of Heath). 2020 Strategies and Outcomes: * During 2020, Mercy Health Lorain implemented a cultural competency training for all new hires. In 2020, 100% of all new hires received cultural competency training. * In collaboration with the Diversity and Inclusion team, Mercy Health Lorain plans to develop policies and standards to be developed to ensure all are treated with justice. Although the planned implementation of countywide policies and procedures was delayed due to COVID-19, there was a focused effort on this body of work as a result of national focus on racial disparities in 2020. Currently, the LCPH and Mercy Health sit on the Anti-Racism Community Group through the Community Foundation of Lorain County. * Mercy Health Lorain worked in collaboration with the Lorain County Public Health in determining and improving health equity throughout Lorain County. The first step of this goal was achieved during 2020 by having a countywide Census being completed that assessed if Lorain meets the needs of cultural competency throughout Lorain County. The collaborative groups have plans in place to address the cultural needs identified. Mercy Health Lorain will not directly focus on Preventative Health as other organizations in Lorain County are specifically designed and better prepared to respond to this need through resources and experience. Mercy will support them as needed. Mercy Health Lorain will ensure that a level of preventative health is included in each goal of Community Health Needs Assessment and Community Health Needs Implementation Plan. Mercy will continue collaboration efforts with the County to address this need. Mercy Health Lorain will not directly work on the Sexually Transmitted Diseases (STD's) community need as there are other organizations in Lorain County specifically designed and better prepared both through resources and experience to respond to this need. We will continue to work with our physicians such as Primary Physicians, Nurse Practitioners and OB/GYN's that will run into this test outcome more frequently ensuring they have the medicinal and support resources needed.

Schedule H, Part V, Section B, Line 11 Facility A, 7
"Facility A, 7 - Mercy Health - St. Elizabeth Health Center, Mercy Health - St. Elizabeth Boardman Health Center, Mercy Health - St. Joseph Health Center. Mercy Health - Youngstown Market Mercy Health - St. Elizabeth Health Center, Mercy Health - St. Elizabeth Boardman Health Center, and Mercy Health - St. Joseph Health Center are collectively referred to as ""Mercy Health Youngstown"" (MHY). MHY will address each need identified in its CHNA with regional strategies. Unless noted below, all MHY hospitals participated in the regional strategies. Mental Health Implementation Activities: Goal: Improve the behavioral health of the community. 2020 Strategies and Outcomes: * MHY intends to educate primary care providers on screening tools and evidence-based treatment for mental health and addiction through the use of a mental health and addiction assessment and referral program. In 2020, MHY collected baseline data for assessments being done at 5 primary care offices and tracked usage of in-person assessment versus telehealth. In 2020, there were 140 visits and 202 telehealth visits among the primary care offices. These will service as the baseline to measure progress in future years. * MHY will increase prevention and education on tobacco use by increase the number of outreach and education events and prevention lessons in schools. During 2020, MHY collected baseline data of the number of facilitated outreach/education events on tobacco use and began planning school-based prevention lessons in middle school and high school. The total number of facilitated events in 2020 was 14. * MHY developed a Trauma Informed Care sub-committee in 2020 and developed a training plan with scheduled training sessions for Q1 2021. Beginning in 2021, a BHI Social Worker and community educator will attend Mahoning and Trumbull Counties' Trauma Informed Care committees Chronic Disease with a Focus on Cardiovascular Disease and Obesity Implementation Activities: Goal: Reduce the impact of chronic disease and obesity on our community. 2020 Strategies and Outcomes: * MHY will focus on increasing the number of prediabetes screenings in the community with a focus on reaching target populations. In 2020, a total of 729 screenings were performed during the year, and will become the baseline for tracking future progress. Screening totals include glucose, pre-diabetes assessment and Hemoglobin A1c done by Community Health Education, St. Joe's at the Mall, Heart & Vascular, Lab, Hispanic Health, Neighborhood Health Watch, Stepping Out, Diabetes Education. * MHY will also focus on increasing the number of free or reduced hypertension screenings in the community with a focus on reaching target populations. In 2020, a baseline of 2,537 screenings were provided and will be used to track future progress. * During 2020, MHY participated in collaborations and local community efforts, including: - Healthy Community Partnership Mahoning Valley - participation in steering committee and two action teams, Healthy Food and Parks and Green Spaces - Trumbull County Creating Healthy Communities Coalition * MHY continued the MHY Fruit and Vegetable Prescription Program to reduce chronic disease through healthy food options for residents within the area. During 2020, MHY counted 790 total food insecurity screenings across Mahoning and Trumbull counties. Of those screenings, 580 participants were screened once, and 210 participants were screened twice. Maternal and Infant Health Implementation Activities: Goal: 1. Total preterm births: Percent of live births that are preterm:<37 weeks gestation (Baseline: 14%, Ohio Department of Health, 2018) 2. Infant mortality: Rate of infant deaths per 1,000 live births (Baseline: 7.8, Ohio Department of Health, 2013-2017) 3. Low birth weights: Percent of births in which the newborn weighed <2,500 grams (Baseline: 12%, Ohio Department of Health, 2018) 2020 Strategies and Outcomes: * MHY provided prenatal and post-partum education for mothers and fathers by initiating the ""Learn N Go"" app. The ""Learn N Go"" app was initiated in 2020 and 260 women were enrolled. The need for digital learning increased significantly due to COVID so lactation consultants visited patients in OB/GYN offices and instructed on accessing the app during pregnancy. This along with instruction in the use of the app post-partum will continue in 2021. * During 2020, Youngstown assisted in the development of a Trumbull County Maternal and Infant Health Coalition. Initial and ongoing meetings were convened in 2020. MHY participated in Zoom meetings with Trumbull County Racial Disparities sub-committee in October, November and December 2020. The 11/19/20 and 12/17/20 meetings discussed maternal and infant health with discussion about a plan to increase progesterone use, home visiting programs and establishing an infant mortality task force. * In an effort to increase the use of progesterone for eligible pregnant women, MHY gathered data to identify how progesterone candidates are currently identified and track progesterone distribution to eligible pregnant women. During 2020, 49 eligible pregnant women who delivered at St. Elizabeth Boardman Hospital and St. Joseph Warren Hospital received progesterone. Barriers identified include education and identification of eligible women by physicians, education of expectant mothers about the importance of progesterone in preventing pre-term labor, and access to and compliance with progesterone therapy once prescribed. Social Determinants of Health with a Focus on Cultural Bias and Inequity, Access to Care, Transportation and Housing Implementation Activities: Goal: Improve overall health by eliminating and/or decreasing barriers to receive high quality care. 2020 Strategies and Outcomes: * MHY is focused on improving healthy equity associate education and trainings to increase competency of serving diverse patients and community members. The goal for 2020 was to implement bias training for MHY associates and that goal was achieved with 183 associates receiving the training during the year. * During 2020, Youngstown piloted an implementation of SDOH screening and process referral to resources within the market's primary care practices. The program asks patients 3 SDOH domain questions about financial, transportation and food insecurity status. Referral process for positive screen on any domain is to ask patient if they want additional help in that domain. Patients who respond ""yes"" receive a referral to a social worker who then does a full SDOH assessment and guides the patient to appropriate MHY or community resources. The pilot was implemented at 2 market primary care practices in 2020. * MHY continues to participate in community efforts to address SDOH, with a focus on cultural bias and inequity, access to care, transportation and housing. MHY is represented on the steering committee of the Healthy Community Partnership Mahoning Valley (HCP) which has action teams addressing healthy food retail, active transportation and parks and green spaces. HCP also has been working with a lens to develop and support initiatives to reduce racial inequity. MHY has representatives on M/Y Baby's 1st and MORE 1st Birthdays coalitions working to reduce infant mortality, preterm births and low birth weights with a focus on reaching our African American community. We are represented on the Mahoning County Homeless Continuum of Care and the Healthy Homes Healthy Families working to reduce lead poisoning. We also are represented on the Trumbull County Creating Healthy Communities Coalition whose focus is strategies for active living and healthy eating. All prioritized needs in the hospital CHNA have been addressed."

Schedule H, Part V, Section B, Line 11 Facility A, 8
"Facility A, 8 - Mercy Health - Anderson Hospital, Mercy Health - Clermont Hospital, Mercy Health - Fairfield Hospital, Jewish Hospital LLC, Mercy Health - West Hospital. Mercy Health - Cincinnati Market Mercy Health Cincinnati is comprised of Mercy Health - Anderson Hospital, Mercy Health - Clermont Hospital, Mercy Health - Fairfield Hospital, Jewish Hospital LLC, and Mercy Health - West Hospital. These hospitals are collectively referred to as ""Mercy Health Cincinnati."" Mercy Health Cincinnati will address each need identified in its CHNA with regional strategies. Unless noted below, all Mercy Health Cincinnati hospitals participated in the regional strategies. Substance Abuse Implementation Activities: Goal: Reduce unintentional drug overdose deaths. 2020 Strategies and Outcomes: * During 2020, Mercy Health Cincinnati provided a Mercy Serves AmeriCorps Program which is a unique, service-learning program preparing the next generation of healthcare leaders to think differently about healthcare by exposing them to patient care at its most challenging level. Participants work alongside Emergency Department staff to provide critical support to patients with opiate-use disorders. They screen, provide brief interventions and referrals, and follow patients after discharge, serving as a supportive resource throughout the treatment process. More importantly, participants work for the patient - they advocate, listen and support any patient who is ready for treatment with the necessary resources and follow up throughout their recovery. Funding is resourced through a Federal grant (managed by Bon Secours Mercy Health Foundation), Bon Secours Mercy Health Foundation and Community Health- Cincinnati. 8 members enrolled in the 2019 - 2020 class with 5 members enrolling in the 2020 - 2021 class. These classes moved to being held remotely due to COVID-19. Mercy Serves members also submitted 18 OHRP applications requesting $40,695 due to impact of COVID on the program. * The Mercy Serves AmeriCorps Program worked with 1,972 patients during 2020 and 49% of the patients with current/former substance abuse identified an action step toward recovery/treatment because of the actions of the program. Mental Health Implementation Activities: Goal: Improve coverage rates; reduce percentage of uninsured patients. Decrease unnecessary ED utilization. 2020 Strategies and Outcomes: * The Mercy Health Partnership Program provides supportive services for uninsured/underinsured patients or those at risk for losing their coverage. Three LSWs serve the Cincinnati Region and take referrals from ambulatory and acute providers. Mercy Health Cincinnati assists with funding this program. * Mercy Health Cincinnati continued to help individuals maintain their care through prescription benefits and co-pay support while providing case management and community connections to help move clients from a state of crisis to self-sufficiency. During 2020, there were 2,480 total encounters with perspective patients. 307 patients received financial assistance, 179 patients completed Medicaid applications, 20 patients were provided emergency assistance, and 28 patients were referred to specialty care. The impact of COVID-19 made the case management more complex due to the higher number of clients who had lost jobs, income, health insurance, had food and housing insecurity, and struggled to gain benefits. Access to Care Implementation Activities: Goal: Reduce chronic absenteeism, improve school performance, reduce trauma/adverse childhood experiences (ACE's), reduce health disparities, reduce ED utilization, and increase early identification of cancer. 2020 Strategies and Outcomes: * Mercy Health's School-Based Health Centers provide critical healthcare access to students and their families by offering a location that is safe, convenient, and accessible. These health centers are strategically placed within medical deserts and open to the community to help support the broader primary care needs. 75% of those served have Medicaid coverage and another 4% have no insurance coverage at all. The school-based health team works alongside school leadership, community organizations and families to ensure children and adolescents have the resources they need to thrive in the classroom and beyond. * Mercy Health Cincinnati had planned to implement school-based health centers in 20202. Due to COVID-19, the programming of these centers was postponed until 2021. Utilization of an existing school-based health center remained low, and therefore those students and families were paired with one of Mercy Health Cincinnati's local clinics to provide services as needed. * Mercy Health Cincinnati provides community clinics that provide critical primary care access to uninsured and underinsured patients. During 2020, the Mercy Care Clinic Anderson served 734 patients and the Mercy Care Clinic Clermont served 281 patients. * Mercy Health Cincinnati operates a Mobile Mammography Program which served 54 patients in 2020. The number of patients served was significantly less than anticipated due to the impact of COVID-19. Chronic Disease and Healthy Behaviors Implementation Activities: Goal: Reduce food insecurity, heart disease, diabetes, and health disparities. 2020 Strategies and Outcomes: * Mercy Health Cincinnati provided the Healthy Neighborhoods program which addresses individual barriers and community conditions to address food insecurity and improve the health and wellness of underserved communities in the Greater Cincinnati Region. The Heathy Neighborhoods program includes robust assessment of the local food systems in neighborhoods surrounding our primary care offices and school-based health centers, especially those serving high numbers of Medicaid patients. It also provides healthy food vouchers, nutrition incentives and supportive programming to families seen by participating Mercy Health PCPs. During 2020, 17 patients had care appointments at the 3-month mark. Of those patients 53% showed weight loss ranging from 3 - 15 pounds, 10 patients had Hemoglobin A1c data recorded and 70% of those patients had healthier levels of A1c at the 3-month mark. * Mercy Health Cincinnati also used the Healthy Neighborhoods program to complete a regional food assessment, resulting in an enrollment 91 participants in a nutrition prescription program. Total fruit and vegetable consumption/servings was 1,170,318. Infant Mortality Implementation Activities: Goal: Reduce the infant mortality rate (deaths/1,000 live births). 2020 Strategies and Outcomes: * Mercy Health Cincinnati provided a Perinatal Outreach Program that encompasses external partnerships and internal programs aimed at addressing infant mortality. During 2020, Mercy Health Cincinnati hired two dedicated CHWs that served 57 clients. * During 2020, the Perinatal Outreach Program also had 164 total pathways completed by clients with 431 total contacts. * In 2020, Mercy Health Cincinnati referred 6 patients to virtual grief and loss group opportunities with a partner organization and had 92 health consults from OB patients that were not enrolled. Due to the impact from COVID-19, in-person grief and loss groups through the Perinatal Outreach Program were postponed * The Perinatal Outreach Program tracks the number of health birth outcomes to gauge progress made in the Cincinnati area. In 2020, 76 babies died before their first birthday in the Hamilton County area, 20 fewer than in 2019 and the fewest by far since modern record keeping began in 1968. With 10,314 births, the infant mortality rate was 7.4 deaths per 1,000 live births, an 18% decline from the 2015-2019 rate and a record low. In 2020, 36 black babies died in Hamilton County, a rate of 10.6 deaths per 1,000 live births. This is a 42% decline from the rates recorded for 2017 and an all-time low for the second year in a row. This is also the first time since 1994 that Hamilton County's black infant mortality rate was lower than the national average. All prioritized needs in the hospital CHNA have been addressed."

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - BON SECOURS MERCY HEALTH HOSPITALS. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT OR FAMILY MEMBER TO COMPLETE AN APPLICATION INCLUDING GROSS INCOME FOR A MINIMUM OF 3 MONTHS (UP TO 12 MONTHS) PRIOR TO THE DATE OF APPLICATION OR DATE OF SERVICE. PROOF OF INCOME IS REQUIRED WITH THE EXCEPTIONS OF PATIENTS WHO QUALIFY FOR PRESUMPTIVE ELIGIBILITY. PROOF OF INCOME IS NOT REQUIRED IF A PATIENT OR FAMILY MEMEBER ATTESTS TO AN INCOME LEVEL THAT QUALIFIES THE APPLICANT FOR DISCOUNTED CARE UNDER OHIO'S HEALTHCARE ASSURANCE PROGRAM (HCAP). THIRD PARTY INCOME SCORING MAY BE USED TO VERIFY INCOME IN SITUATIONS WHERE INCOME VERIFICATION IS UNABLE TO BE OBTAINED THROUGH OTHER METHODS. Patients are presumed to be eligible for financial assistance based on individual life circumstances including but not limited to when the Patient's income is below 200% Federal Poverty Guidelines and considered self-pay, the Patient is discharged to a SNF, the Patient is deceased with no known estate and below 200% Federal Poverty Guidelines, the patient is supported by State-funded prescription programs, the patient is Homeless or received care from a homeless clinic, the patient has Participated in Women, Infants and Children programs (WIC), the patient is eligible for Food stamps, the patient is eligible Subsidized school lunch program, the patient is eligible for other state or local assistance programs that are unfunded (e.g., Medicaid spend-down), the Patient is referred through the National Association of Free Clinics, the patient provides Low income/subsidized housing as a valid address, or Other significant barriers are present.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - BON SECOURS MERCY HEALTH HOSPITALS. There are situations where individuals may not have reported income but have significant assets available to pay for healthcare services. In these situations, BON SECOURS MERCY HEALTH may evaluate and require documented proof of any assets that are categorized as convertible to cash and unnecessary for the patient's essential daily living expenses. PATIENTS WHO LIVE IN THE COMMUNITY SERVED BY A BON SECOURS MERCY HEALTH HOSPITAL WILL BE OFFERED HEALTHCARE FINANCIAL ASSISTANCE. FOR THOSE PATIENTS LIVING OUTSIDE OF THE COMMUNITY, EXTENUATING CIRCUMSTANCES MUST BE DOCUMENTED AND APPROVED BY THE PFS MANAGER AND BE MEDICALLY NECESSARY OR EMERGENT IN NATURE. A LIST OF THE ZIP CODES OF THE COMMUNITY SERVED FOR EACH BON SECOURS MERCY HEALTH HOSPITAL IS MAINTAINED IN A SEPARATE DOCUMENT AND READILY AVAILABLE VIA THE CONTACT LIST AT THE END OF THE POLICY LOCATED AT HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE AND AT https://www.bonsecours.com/patient-resources/financial-assistance. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT TO APPLY FOR HEALTH INSURANCE COVERAGE AND/OR ENTER THE MARKETPLACE/EXCHANGE BEFORE FINANCIAL ASSISTANCE MAY BE EXTENDED. EXCEPTIONS TO THIS POLICY INCLUDE PATIENTS DISCHARGED TO A SKILLED NURSING FACILITY, PATIENTS WHO ARE DECEASED WITH NO ESTATE, AND PATIENTS WHO HAVE DOCUMENTED HOMELESSNESS.

Schedule H, Part V, Section B, Line 5 Facility B, 1
Facility B, 1 - BON SECOURS - DEPAUL MEDICAL CENTER LLC. In collaboration with Children's Hospital of The King's Daughters, Sentara Healthcare, and the Virginia Department of Health - Norfolk and Virginia Beach, an online and hard copy survey was disseminated in English and Spanish. The survey was distributed widely via Bon Secours networks, as well as meetings, clinics and programs supported by Bon Secours DePaul Medical Center, such as the Care-A-Van, a mobile medical unit that provides care to the uninsured population, in the East Ocean View site of the Bon Secours Hampton Roads Health Communities initiative, Bon Secours DePaul Medical Center Senior Health members, and a Norfolk LGBTQ community resource site. The survey was taken by 330 residents and key stakeholders who indicated Norfolk and Virginia Beach as their primary service area. Individuals were asked to choose the top five health issues and services they thought should be addressed in their community. Epidemiological data was provided by the Virginia Department of Health - Portsmouth. A total of 11 focus group meetings called Community Dialogues were held in the Hampton Roads region in which 283 individuals participated. The purpose of the meetings was to elicit feedback from community members about publically available health data describing health conditions in the service area and to review the online survey results to further explore the findings. Six Community Dialogues were held in Norfolk and Virginia Beach in which 108 individuals participated. The meetings began with community members participating in a matrix exercise in which they selected the three most important of the top ten health concerns identified in the Survey. Following matrix exercise, a presentation explaining the CHNA process was shown. For sessions with larger numbers in attendance, participants were then divided into groups to discuss the top concerns identified in the matrix exercise. Smaller sessions were discussed as a single group. Breakout session facilitators lead the discussions with the following questions: Why are these issues? What is causing the issues? What can be done to address the issues? Comments were written down by a staff member or volunteer. Bon Secours DePaul Medical Center's senior leadership team met to review primary and secondary data gathered through the CHNA process (community meetings, community and key stakeholder surveys, and meetings with regional health systems and health departments). The team evaluated each of the top ten health concerns and services that need strengthening identified, the hospitals strategic goals, services currently provided, available hospital resources, and the current CHNA Implementation Plan's progress. Additional detail can be found on the Bon Secours website at https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment

Schedule H, Part V, Section B, Line 5 Facility B, 2
Facility B, 2 - BON SECOURS - MARY IMMACULATE HOSPITAL LLC. Mary Immaculate Hospital (MIH) collaborated with Children's Hospital of The King's Daughters, Sentara Healthcare, and the Virginia Department of Health - Peninsula and Hampton, to obtain input from the community. An online and hard copy survey was disseminated in English and Spanish. The survey was distributed widely via Bon Secours networks, as well as meetings, clinics and programs supported by MIH, such as the Care-A-Van, a mobile medical unit that provides care to the uninsured population, MIH SeniorHealth members, and a LGBTQ community resource site. The survey was taken by 443 residents and key stakeholders who indicated Newport News, Hampton, Gloucester, Poquoson, Williamsburg, James City County or York County as their primary service area. Individuals were asked to choose the top five health issues and services they thought should be addressed in their community. A total of 11 focus group meetings called Community Dialogues were held in the Hampton Roads region in which 283 individuals participated. The purpose of the meetings was to elicit feedback from community members about publically available health data describing health conditions in the service area and to review the online survey results to further explore the findings. Three Community Dialogues were held in the Mary Immaculate community, including one with the Hispanic community. The meetings began with community members participating in a matrix exercise in which they selected the three most important of the top ten health concerns identified in the survey. Following the matrix exercise, a presentation explaining the CHNA process was shown. For sessions with larger numbers in attendance, participants were then divided into groups to discuss the top concerns identified in the matrix exercise. Smaller sessions were discussed as a single group. Breakout session facilitators lead the discussions with the following questions: Why are these issues? What is causing the issues? What can be done to address the issues? Comments were written down by a staff member or volunteer. Mary Immaculate Hospital's senior leadership team met to review primary and secondary data gathered through the CHNA process (community meetings, community and key stakeholder surveys, and meetings with regional health systems and health departments). The team evaluated each of the top ten health concerns and services that need strengthening identified, the hospitals strategic goals, services currently provided, available hospital resources, and the current CHNA Implementation Plan's progress. Additional detail can be found on the Bon Secours website at https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment

Schedule H, Part V, Section B, Line 5 Facility B, 3
Facility B, 3 - BON SECOURS - MARYVIEW HOSPITAL LLC. A collaborative team from Maryview Medical Center, Children's Hospital of The King's Daughters, Sentara Healthcare, Riverside Health System and the Virginia Department of Health - Portsmouth (Collaborative) began meeting in May 2018 to begin the work on the 2020 - 2022 Community Health Needs Assessment. In order to obtain input from the community, an online and hard-copy survey was disseminated in English and Spanish. The survey was distributed widely via Bon Secours networks, as well as meetings, clinics and programs supported by Maryview Hospital, such as the Care-A-Van, a mobile medical unit that provides care to the uninsured population; the Maryview Foundation Health Center (free clinic); Bon Secours Maryview Hospital Senior Health members; and an LGBTQ community resource site. The survey was taken by 271 residents and key stakeholders who indicated Chesapeake, Portsmouth or Suffolk as their primary service area. Individuals were asked to choose the top five health issues and services they thought should be addressed in their community. Overall, survey participants represent a blend of perspectives across age, race and income. Epidemiological data was provided by the Virginia Department of Health - Portsmouth. A total of 11 focus group meetings called Community Dialogues were held in the Hampton Roads region in which 283 individuals participated. The purpose of the meetings was to elicit feedback from community members about publically available health data describing health conditions in the service area and to review the online survey results to further explore the findings. The meetings began with community members participating in a matrix exercise in which they selected the three most important of the top ten health concerns identified in the Survey. Following the matrix exercise, a presentation explaining the CHNA process was shown. For sessions with larger numbers in attendance, participants were then divided into groups to discuss the top concerns identified in the matrix exercise. Smaller sessions were discussed as a single group. Breakout session facilitators lead the discussions with the following questions: Why are these issues? What is causing the issues? What can be done to address the issues? Comments were written down by a staff member or volunteer. Maryview Medical Center's senior leadership team met to review primary and secondary data gathered through the CHNA process (community meetings, community and key stakeholder surveys, and meetings with regional health systems and health departments). The team evaluated each of the top ten health concerns and services that need strengthening identified, the hospitals strategic goals, services currently provided, available hospital resources, and the current CHNA Implementation Plan's progress. Additional detail can be found on the Bon Secours website at https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment

Schedule H, Part V, Section B, Line 6a Facility B, 1
Facility B, 1 - BON SECOURS - DEPAUL MEDICAL CENTER LLC, BON SECOURS - MARY IMMACULATE HOSPITAL LLC, BON SECOURS - MARYVIEW HOSPITAL LLC. Children's Hospital of The King's Daughters Sentara Healthcare BON SECOURS - DEPAUL MEDICAL CENTER LLC BON SECOURS - MARY IMMACULATE HOSPITAL LLC BON SECOURS - MARYVIEW HOSPITAL LLC

Schedule H, Part V, Section B, Line 6b Facility B, 1
Facility B, 1 - BON SECOURS - DEPAUL MEDICAL CENTER LLC. Virginia Department of Health - Norfolk and Virginia Beach

Schedule H, Part V, Section B, Line 6b Facility B, 2
Facility B, 2 - BON SECOURS - MARYVIEW HOSPITAL LLC. Virginia Department of Health - Portsmouth

Schedule H, Part V, Section B, Line 6b Facility B, 3
Facility B, 3 - BON SECOURS - MARY IMMACULATE HOSPITAL LLC. Virginia Department of Health - Peninsula and Hampton

Schedule H, Part V, Section B, Line 11 Facility B, 1
Facility B, 1 - BON SECOURS - DEPAUL MEDICAL CENTER LLC. Bon Secours - DePaul Medical Center (DMC) Alcohol and Substance Abuse Implementation Activities: Goal: Reduce risk of opioid dependency and addiction in community. 2020 Strategies and Outcomes: * To reduce risk of opioid dependency and addiction, DMC will monitor opiate prescribing patterns within the hospital. During 2020, 97 patients per 1,000 were prescribed opiates from the DMC ER and 131 patients per 1,000 were prescribed opiates from inpatient care. These metrics will be used as a baseline to track future prescription patterns and to reduce those frequencies. * DMC held partnership planning discussions with local schools during 2020 to provide opioid and other resiliency training within middle and high schools within the market. Due to COVID-19, planned school interactions were postponed to 2021. Heart Conditions/Diabetes Implementation Activities: Goal: Improve access to healthcare opportunity to treat and manage cardiovascular disease. 2020 Strategies and Outcomes: * During 2020, DMC tracked readmissions among STEMI and CHF patients to establish a baseline for future years progress on the improvement of readmission conversion rates for these types of patients. The baseline established was 22 patients. * DMC provided one on one patient education for diabetes management at the hospital prior to discharge. Additional initiatives to provide diabetes community education classes were postponed due to COVID-19. Chronic Health in Aging Adults Implementation Activities: Goal: Improve access to healthcare opportunity to treat and manage chronic conditions for aging population. 2020 Strategies and Outcomes: * DMC will partner with medical providers and community groups to provide education at SeniorHealth Lunch & Learns on five health topics from the CHNA survey. Speakers will provide a pre- and post- test to group to demonstrate knowledge gained. During Q1 2020, DMC offered senior health educational lunch and learns and had 88 participants. The remainder of these events were postponed to 2021 due to COVID-19. Overweight/Obesity Implementation Activities: Goal: Positively impact the incidence of childhood and adult obesity. 2020 Strategies and Outcomes: * DMC partners with the East Ocean View community to develop programs and educational opportunities that increase knowledge of healthy eating and exercise. Many of the weight loss and physical activity initiatives DMC had planned aimed at reducing the incidence of obesity were postponed due to COVID-19. DMC pivoted to provide the following during 2020: - Q1 Performed spring planting of vegetables at the East Ocean View community garden. Provided $300 a month in funding to the Storehouse (local food bank) to provide additional resources for families in need. - Q2 Increased the amount allotted to the Storehouse Food Pantry to $500 a month. Care-A-Lot pet foods donated $2500 (wholesale cost) in dog and cat food to help families during the Covid-19 pandemic. - Q3 & Q4 Grant funding continued for the Storehouse. Additional funding provided for the Storehouse's Annual Thanksgiving dinner, feeding over 500 residents up from approx. 300 residents the previous year. * DMC plans to reduce the incidence of obesity through a variety of Bon Secours InMotion and Medical Surgical weight loss and physical activity programs. In 2020, 20 patients began the 12-week program. 12 of these participants realized an average BMI reduction of 3. In Q2 of 2020, the program went virtual due to COVID-19. In Q3 and Q4 of 2020, 8 participants completed the program and had an average BMI reduction of 2.43. * DMC partners with middle and high schools to provide nutrition and physical activity education to students. In 2020, DMC provided trainers through InMotion to a Catholic High School, which was approximately $10,324 of community benefit. This program was suspended during Q2 of 2020 due to COVID-19 but restarted during Q3. DMC will not add any additional strategies to directly address the Behavioral/Mental Health community need and thus not be making it one of its top priorities. DMC will continue the mental health initiatives identified in the previous CHNA through offering community education. Referrals to local community service boards by the emergency department Life Coaches and the Bon Secours Care-A-Van will also continue. Active participation in coalitions addressing behavioral/mental health, especially in the area of opioid abuse, will continue. There are other resources in the DMC service area with more resources or expertise to address behavioral and mental health.

Schedule H, Part V, Section B, Line 11 Facility B, 2
Facility B, 2 - BON SECOURS - MARY IMMACULATE HOSPITAL LLC. Bon Secours - Mary Immaculate Hospital (MIH) Alcohol and Substance Abuse Implementation Activities: Goal: Reduce risk of opioid dependency and addiction in community. 2020 Strategies and Outcomes: * MIH will increase awareness and implementation of SBIRT and MAT through the Emergency Department. During 2020, MIH identified and prioritized key stakeholders through the emergency department and provided MAT and SBIRT training. * MIH worked to increase awareness of opioid and substance abuse risks among all hospital employees by developing staff training on substance abuse and providing training to all employees in 2020. Substance abuse video training was developed and is now part of mandatory employee annual trainings. Employee education is also continued through daily staff huddles. Chronic health in Aging Adults Implementation Activities: Goal: Improve access to healthcare opportunity to treat and manage chronic conditions for aging population. 2020 Strategies and Outcomes: * MIH will partner with medical providers and community groups to provide education at SeniorHealth Lunch & Learns on five health topics from the CHNA survey. Speakers will provide a pre- and post- test to group to demonstrate knowledge gained. During Q1 2020, MIH offered monthly senior health educational lunch and learns at Bon Secours - DePaul Medical Center and had 393 participants. The remainder of these events were postponed to 2021 due to COVID-19.MIH continued to work on improving quality of care delivery for aging population through NICHE membership. During 2020, MIH identified associates and prepared NICHE education protocols. Annual NICHE membership was renewed. * MIH focuses on increasing awareness of congestive heart failure (CHF) risks through a CHF study, which consists of providing education on 6 topics related to CHF at 6 sessions. Pre- and post-testing will be used to evaluate success. During January 2020, MIH presented a heart disease program to senior health lunch & learn attendees and invited them to participate in the MIH CHF camp to serve as a placebo group. Due to the Covid-19 pandemic and visitor restrictions, the community portion of the CHF camp was suspended. CHF education continues for inpatients. * With SeniorHealth programming being postponed, MIH provided COVID-19 testing to 1,000 residents within the Peninsula Health District with on-site drive-thru testing at three local churches. Additionally, MIH lead weekly planning for logistics of testing and other COVID-19 support. Obesity Implementation Activities: Goal: Positively impact the incidence of childhood and adult obesity. 2020 Strategies and Outcomes: * MIH is working towards expanding the Passport to Health program that began in the East Ocean View area of Norfolk to Newport News. The Passport to Health program is aimed at reducing the incidence of obesity through a variety of weight loss and physical activity programs. The program had 18 participants during 2020. These participants had an average weight loss of 0.9 pounds and an A1C OF 5.9. * Due to COVID-19 restricting in person interaction a virtual Passport to Health session was established by MIH to continue healthy lifestyle education in the market. Additionally, MIH distributed food bags and recipe cards, while following social distancing guidelines, in a local church parking lot program participants. MIH will not add any additional strategies to directly address the Behavioral/Mental Health community need and thus not be making it one of its top priorities. MIH will continue the mental health initiatives identified in the previous CHNA through offering community education. Referrals to local community service boards by the emergency department Life Coaches and the Bon Secours Care-A-Van will also continue. Active participation in coalitions addressing behavioral/mental health, especially in the area of opioid abuse, will continue. MIH will not add any additional strategies to directly address the Diabetes community need and thus not be making it one of its top priorities. Resources are limited within the organization to prioritize all of the needs. There are other providers and organizations addressing these needs with specialized programs and services. MIH will continue the diabetes initiatives identified in the previous CHNA through offering community education. Active participation in coalitions addressing diabetes will continue.

Schedule H, Part V, Section B, Line 11 Facility B, 3
Facility B, 3 - BON SECOURS - MARYVIEW HOSPITAL LLC. Bon Secours - Maryview Hospital (Maryview) Alcohol and Substance Abuse Implementation Activities: Goal: Reduce risk of opioid dependency and addiction in community. 2020 Strategies and Outcomes: * To reduce risk of opioid dependency and addiction, Maryview will monitor opiate prescribing patterns within the hospital. During 2020, 98 patients per 1,000 were prescribed opiates from the Maryview ER and 100 patients per 1,000 were prescribed opiates from inpatient care. These metrics will be used as a baseline to track future prescription patterns and to reduce those frequencies. * Maryview held partnership planning discussions with local schools during 2020 to provide opioid and other resiliency training within middle and high schools within the market. Due to COVID-19, planned school interactions were postponed to 2021. Heart Conditions/Diabetes Implementation Activities: Goal: Improve access to healthcare opportunity to treat and manage cardiovascular disease. 2020 Strategies and Outcomes: * During 2020, Maryview tracked readmissions among STEMI and CHF patients to establish a baseline for future years progress on the improvement of readmission conversion rates for these types of patients. The baseline established was 11 patients. * Maryview provided one on one patient education for diabetes management at the hospital prior to discharge. Additional initiatives to provide diabetes community education classes were postponed due to COVID-19. Chronic health in Aging Adults Implementation Activities: Goal: Improve access to healthcare opportunity to treat and manage chronic conditions for aging population. 2020 Strategies and Outcomes: * Maryview will partner with medical providers and community groups to provide education at SeniorHealth Lunch & Learns on five health topics from the CHNA survey. Speakers will provide a pre- and post- test to group to demonstrate knowledge gained. During Q1 2020, Maryview offered senior health educational lunch and learns and had 176 participants. The remainder of these events were postponed to 2021 due to COVID-19. * With SeniorHealth and community programming postponed through 2020, the Maryview community health team worked with the Western Tidewater Health District to distribute masks, hand sanitizer, and COVID-19 awareness literature in the market area during the pandemic to help prevent the spread of COVID-19. * Maryview provided COVID-19 testing to 1,000 residents within the Western Tidewater Health district with drive-thru testing at four local churches. Additionally, Maryview lead weekly planning for logistics of testing and other COVID-19 support. Overweight/Obesity Implementation Activities: Goal: Positively impact the incidence of childhood and adult obesity. 2020 Strategies and Outcomes: * During 2020, Maryview partnered with Healthy Portsmouth to develop programs and educational opportunities. Due to COVID-19, programs and educational opportunities to the community were postponed, but meetings with Healthy Portsmouth for planning and development continued virtually. * During 2020, Maryview worked to reduce the incidence of obesity with a 12-week physical activity program. There were 20 participants that started this program and at the end of Q1 12 patients realized an average BMI reduction of 3. Starting in Q2 the program went virtual and by the end of the year 12 participants had seen an average BMI reduction of 3.25. * Maryview partnered with several middle and high schools to provide nutrition and physical activity education to students during 2020. Maryview used InMotion athletic trainers to provide support to a catholic high school realizing a community benefit of $205,896. This program was suspended in Q2 and restarted in Q3. Behavioral/Mental Health Implementation Activities: Goal: Improve behavioral/mental health through efforts around suicide prevention. Protect the dignity of behavioral/mental health patients and community by providing space in Maryview Behavioral Medicine Services for court sessions and substance abuse support groups. 2020 Strategies and Outcomes: * Maryview maintained a safe cafe environment by performing an environmental risk assessment to identify and rate risks. In 2020, the environmental risk assessment was completed and evaluated. Measures were immediately implemented to mitigate any identified risks. * Maryview worked to reduce sentinel events while maintaining patient safety by ensuring completion of daily C-SSRS assessments for 100% of all admissions during 2020. Maryview placed its high-risk patients on 1:1 monitoring, patient assessments were performed twice daily to identify change of status and rounding, and documenting was performed every 15 minutes on all patients. * To reduce the suicide rate of patients who were recently treated and released from a healthcare setting, Maryview placed follow-up calls with 100% of all discharged patients within 24 hours. Maryview assured all patients were connected to outpatient resources prior to discharge, utilized social workers to safely discharge patients, collaborated with outpatient services to offer alternative services for discharged patients, and postponed unsafe discharge until all necessary measures were met. * During 2020, Maryview provided space for the Portsmouth Department of Justice to hold court and counselling sessions at the Maryview Behavioral Medicine Services within the hospital to protect the dignity for behavioral/mental health patients and community. This service was provided for 252 people in 2020. * Maryview also provides space for various behavioral and mental health support groups, such as Alcoholics Anonymous, Narcotics Anonymous, and Gamblers Anonymous, to meet. This service was provided to 898 people in 2020. All prioritized needs in the hospital CHNA have been addressed.

Schedule H, Part V, Section B, Line 13 Facility B, 1
Facility B, 1 - BON SECOURS MERCY HEALTH HOSPITALS. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT OR FAMILY MEMBER TO COMPLETE AN APPLICATION INCLUDING GROSS INCOME FOR A MINIMUM OF 3 MONTHS (UP TO 12 MONTHS) PRIOR TO THE DATE OF APPLICATION OR DATE OF SERVICE. PROOF OF INCOME IS REQUIRED WITH THE EXCEPTIONS OF PATIENTS WHO QUALIFY FOR PRESUMPTIVE ELIGIBILITY. PROOF OF INCOME IS NOT REQUIRED IF A PATIENT OR FAMILY MEMEBER ATTESTS TO AN INCOME LEVEL THAT QUALIFIES THE APPLICANT FOR DISCOUNTED CARE UNDER OHIO'S HEALTHCARE ASSURANCE PROGRAM (HCAP). THIRD PARTY INCOME SCORING MAY BE USED TO VERIFY INCOME IN SITUATIONS WHERE INCOME VERIFICATION IS UNABLE TO BE OBTAINED THROUGH OTHER METHODS. Patients are presumed to be eligible for financial assistance based on individual life circumstances including but not limited to when the Patient's income is below 200% Federal Poverty Guidelines and considered self-pay, the Patient is discharged to a SNF, the Patient is deceased with no known estate and below 200% Federal Poverty Guidelines, the patient is supported by State-funded prescription programs, the patient is Homeless or received care from a homeless clinic, the patient has Participated in Women, Infants and Children programs (WIC), the patient is eligible for Food stamps, the patient is eligible Subsidized school lunch program, the patient is eligible for other state or local assistance programs that are unfunded (e.g., Medicaid spend-down), the Patient is referred through the National Association of Free Clinics, the patient provides Low income/subsidized housing as a valid address, or Other significant barriers are present.

Schedule H, Part V, Section B, Line 13 Facility B, 1
Facility B, 1 - BON SECOURS MERCY HEALTH HOSPITALS. There are situations where individuals may not have reported income but have significant assets available to pay for healthcare services. In these situations, BON SECOURS MERCY HEALTH may evaluate and require documented proof of any assets that are categorized as convertible to cash and unnecessary for the patient's essential daily living expenses. PATIENTS WHO LIVE IN THE COMMUNITY SERVED BY A BON SECOURS MERCY HEALTH HOSPITAL WILL BE OFFERED HEALTHCARE FINANCIAL ASSISTANCE. FOR THOSE PATIENTS LIVING OUTSIDE OF THE COMMUNITY, EXTENUATING CIRCUMSTANCES MUST BE DOCUMENTED AND APPROVED BY THE PFS MANAGER AND BE MEDICALLY NECESSARY OR EMERGENT IN NATURE. A LIST OF THE ZIP CODES OF THE COMMUNITY SERVED FOR EACH BON SECOURS MERCY HEALTH HOSPITAL IS MAINTAINED IN A SEPARATE DOCUMENT AND READILY AVAILABLE VIA THE CONTACT LIST AT THE END OF THE POLICY LOCATED AT HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE AND AT https://www.bonsecours.com/patient-resources/financial-assistance. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT TO APPLY FOR HEALTH INSURANCE COVERAGE AND/OR ENTER THE MARKETPLACE/EXCHANGE BEFORE FINANCIAL ASSISTANCE MAY BE EXTENDED. EXCEPTIONS TO THIS POLICY INCLUDE PATIENTS DISCHARGED TO A SKILLED NURSING FACILITY, PATIENTS WHO ARE DECEASED WITH NO ESTATE, AND PATIENTS WHO HAVE DOCUMENTED HOMELESSNESS.

Schedule H, Part V, Section B, Line 5 Facility D, 1
Facility D, 1 - Mercy Health - Lourdes Hospital, LLC. Lourdes Hospital engaged Crowe LLP to gather information and data in order to complete its CHNA. Lourdes Hospital obtained input from twenty-two stakeholders representing public health, local government officials, various nonprofit organizations, local churches through face-to-face meetings. In addition, three focus groups were conducted to obtain input from public health, social service agencies, local governmental agencies, public schools and libraries. One-on-one interviews were performed with leaders from 22 community organizations/agencies representing public health, local government officials, various nonprofit organizations, local churches and Lourdes Hospital. Interviews were conducted between October 29 and November 13, 2018. To ensure consistency in the topics covered a semi-structured interview guide was used. All interviews were conducted by Crowe. Feedback was gathered on pressing health care concerns, access challenges and identification of populations with serious unmet health care needs. Approaches to improve the community's health were also solicited. Three focus groups were conducted between October 29 and 31, 2018. To assure that medically underserved were included in this CHNA, focus group participants represented agencies serving persons who are homeless, disabled, victims of domestic violence, unemployed and/or persons with low-income. Focus groups were held in McCracken, Marshall and Graves Counties and 42 individuals participated in the focus group sessions. Focus groups explored areas to identify significant health needs of the community as well as potential ways to address identified needs. Each participant was also asked to provide their opinion as to the top three issues that Lourdes Hospital should focus its community benefit investments over the next 3-5 years. Survey results from a 2018 Community Survey conducted by the Purchase District Health Department regarding important health issues facing the community and the most serious risky behaviors in the community were reviewed and included in the CHNA. The CHNA relied heavily on input from key stakeholders that participated in one-on-one interviews and/or focus groups. Stakeholders identified significant health needs and resources available to address those needs. Stakeholders who participated in one-on-one interviews identified serious health issues, financial and non-financial barriers to care, underserved populations and provided input for prioritizing health needs. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 6a Facility D, 1
Facility D, 1 - Mercy Health - Lourdes Hospital LLC. Marshall County Hospital, Murray-Calloway County Hospital

Schedule H, Part V, Section B, Line 11 Facility D, 1
"Facility D, 1 - Mercy Health-Lourdes Hospital LLC. Mercy Health - Lourdes Hospital LLC Cancer Implementation Activities: Goal: Reduce the number of preventable deaths caused by cancer through increasing access to screening, implementing prevention programs based on risk factors, and promoting healthy living. 2020 Strategies and Outcomes: * Lourdes Hospital requires a Successful Certificate of Need application for state-of-the-art radiotherapy program that, combined with medical oncology program, will offer full-service cancer services to the region. In 2020, the Certificate of Need application was completed and submitted. Scheduled Certificate of Need hearings were delayed due to the pandemic and held in January 2021. Decision from State Department of Health is in process. * Full-service cancer services, including both surgical and medical oncology services, were available during 2020. Both service lines saw increases, year over year, with 454 total cancer surgeries (97 inpatient and 357 outpatient) performed during 2020. As noted above, access to radiation therapy is dictated by the State Certificate of Need process. * During 2020, Lourdes Hospital worked on further expansion of high-risk cancer genetics testing beyond mammography and GYN services to include lung cancer screening and colonoscopy services. Screened patients doubled between 2019 and 2020 with 45 patients tested. Similar expansions planned in 2021, as services are expanded to primary care services. * In 2020, 512 Low Dose CT Lung Screenings were performed at Lourdes Hospital. * In 2020, 5,247 Mammogram screenings were performed at Lourdes Hospital. * In 2020, 2,272 Colonoscopies were performed at Lourdes Hospital. * Lourdes Hospital planned to provide free smoking cessation classes in collaboration with community partners. However, due to the pandemic, American Lung Association Freedom from Smoking Classes were quickly pivoted to a virtual platform. Two full six-week sessions were held virtually in 2020. Mental Health Implementation Activities: Goal: Improve prevention, early detection, and access to mental and behavioral health resources through collaborative partnerships. 2020 Strategies and Outcomes: * Continued efforts to increase access to behavioral health services in collaboration with community partners. In 2020, Lourdes Hospital provided inpatient behavioral health services to 524 patients, and outpatient behavioral health services to 8,003 patients. * Lourdes Hospital planned to host Camp Robin on March 28, 2020. Due to COVID shutdowns, we made the decision to cancel the camp. At the time, we had 62 children and 35 adults pre-registered. All materials had already been purchased. We chose instead to utilize the materials and hand-deliver each camper a ""Camp Robin in a bag"". These care packages contained materials and instructions for memory projects as well as fictional books related to grief in children according to their age and a balloon with a letter writing tool for their own balloon release. * Lourdes Hospital continued to participate in community events with partner programs focused on suicide awareness and prevention. In 2020, Lourdes Hospital participated in the American Foundation for Suicide Prevention's Out of the Darkness Walk for Suicide Prevention. * In partnership with Four Rivers Behavioral Health, Lourdes Hospital offered free training sessions to educate attendees on how to prevent a person from suicide. The one-hour suicide prevention training session utilized the Question, Persuade, Refer (QPR) technique. Due to the COVID pandemic, these were held virtually in 2020 and had 17 attendees. Substance Use Disorder Implementation Activities: Goal: Provide community with resources to prevent and recognize substance use disorder. 2020 Strategies and Outcomes: * Lourdes Hospital committed to work with community partners and law enforcement to raise awareness on western Kentucky drug trends and combating the opioid epidemic in our community, with a focus on adolescents and parents. In 2020, Lourdes was on a planning committee for the Opioid Summit through the Opioid Taskforce. Millicent Kadner, APRN, from Lourdes Physical and Pain Medicine, was a speaker/presenter during the free virtual event on 10/2/2020 that had 228 attendees. * The Kentucky Agency for Substance Abuse Policy (KY ASAP) was created to help manage local policies and prevention efforts that affect alcohol and substance abuse. Lourdes Hospital sits on McCracken County ASAP, Graves County ASAP, and Marshall County ASAP coalitions. In 2020, 524 and 8,003 patients were served in inpatient and outpatient settings, respectively. * McCracken County ASAP received a Harm Reduction grant to provide free Narcan in the community and worked with a variety of community partners to distribute. Two Lourdes Hospital representatives are active participants with this ASAP coalition. * Lourdes Hospital provided drug disposal collection boxes in Lourdes Hospital Emergency Department. The collection boxes were closed for collections once the COVID pandemic hit due to hospital visitor policies. During 2020, 25 lbs. of medication was collected despite the temporary closure. * Lourdes Hospital provided Hospice/Homecare with a box of Deterra pouches. All patients with controlled substance prescriptions in Retail Pharmacy were offered Deterra pouches. In 2020, 225 Deterra bags were distributed. Chronic Illness Implementation Activities: Goal: Prevent and reduce chronic disease by focusing on risk factors and healthy behavior changes. 2020 Strategies and Outcomes: * Lourdes Hospital continued partnership with the Community Health Worker program. The Community Health Worker program is run through Purchase Area Health Connections and Purchase District Health Department, focused on reducing readmissions for chronic diseases. In 2020, the following measures were accomplished: - Track readmissions to monitor progress. In 2020, there were 229 readmissions. - Lourdes referred 364 patients to the CHW program in 2020 - 40 patients completed CHF program. 18 additional patients began the program but did not successfully complete. * In 2020, Lourdes Hospital was an active participant in 14 various community health coalitions, including: multiple county health coalitions, Purchase Area Health Connections, and the United Way's Community Impact/COVID-19 Response Committee. * In 2020, Lourdes Hospital held four free flu shot events in October and November with a variety of community partners. Additionally, Lourdes Hospital donated remaining flu shot doses to Hope Unlimited, Kentucky Care, and Heartland Cares. In total 400 doses were administered. * Lourdes Hospital continued its participation in region-wide Purchase Area Diabetes Connection health coalition. The Annual Diabetes Health Fair was cancelled due to COVID but provided virtual educational opportunities instead. All prioritized needs in the hospital CHNA have been addressed."

Schedule H, Part V, Section B, Line 13 Facility D, 1
Facility D, 1 - BON SECOURS MERCY HEALTH HOSPITALS. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT OR FAMILY MEMBER TO COMPLETE AN APPLICATION INCLUDING GROSS INCOME FOR A MINIMUM OF 3 MONTHS (UP TO 12 MONTHS) PRIOR TO THE DATE OF APPLICATION OR DATE OF SERVICE. PROOF OF INCOME IS REQUIRED WITH THE EXCEPTIONS OF PATIENTS WHO QUALIFY FOR PRESUMPTIVE ELIGIBILITY. PROOF OF INCOME IS NOT REQUIRED IF A PATIENT OR FAMILY MEMEBER ATTESTS TO AN INCOME LEVEL THAT QUALIFIES THE APPLICANT FOR DISCOUNTED CARE UNDER OHIO'S HEALTHCARE ASSURANCE PROGRAM (HCAP). THIRD PARTY INCOME SCORING MAY BE USED TO VERIFY INCOME IN SITUATIONS WHERE INCOME VERIFICATION IS UNABLE TO BE OBTAINED THROUGH OTHER METHODS. Patients are presumed to be eligible for financial assistance based on individual life circumstances including but not limited to when the Patient's income is below 200% Federal Poverty Guidelines and considered self-pay, the Patient is discharged to a SNF, the Patient is deceased with no known estate and below 200% Federal Poverty Guidelines, the patient is supported by State-funded prescription programs, the patient is Homeless or received care from a homeless clinic, the patient has Participated in Women, Infants and Children programs (WIC), the patient is eligible for Food stamps, the patient is eligible Subsidized school lunch program, the patient is eligible for other state or local assistance programs that are unfunded (e.g., Medicaid spend-down), the Patient is referred through the National Association of Free Clinics, the patient provides Low income/subsidized housing as a valid address, or Other significant barriers are present.

Schedule H, Part V, Section B, Line 13 Facility D, 1
Facility D, 1 - BON SECOURS MERCY HEALTH HOSPITALS. There are situations where individuals may not have reported income but have significant assets available to pay for healthcare services. In these situations, BON SECOURS MERCY HEALTH may evaluate and require documented proof of any assets that are categorized as convertible to cash and unnecessary for the patient's essential daily living expenses. PATIENTS WHO LIVE IN THE COMMUNITY SERVED BY A BON SECOURS MERCY HEALTH HOSPITAL WILL BE OFFERED HEALTHCARE FINANCIAL ASSISTANCE. FOR THOSE PATIENTS LIVING OUTSIDE OF THE COMMUNITY, EXTENUATING CIRCUMSTANCES MUST BE DOCUMENTED AND APPROVED BY THE PFS MANAGER AND BE MEDICALLY NECESSARY OR EMERGENT IN NATURE. A LIST OF THE ZIP CODES OF THE COMMUNITY SERVED FOR EACH BON SECOURS MERCY HEALTH HOSPITAL IS MAINTAINED IN A SEPARATE DOCUMENT AND READILY AVAILABLE VIA THE CONTACT LIST AT THE END OF THE POLICY LOCATED AT HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE AND AT https://www.bonsecours.com/patient-resources/financial-assistance. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT TO APPLY FOR HEALTH INSURANCE COVERAGE AND/OR ENTER THE MARKETPLACE/EXCHANGE BEFORE FINANCIAL ASSISTANCE MAY BE EXTENDED. EXCEPTIONS TO THIS POLICY INCLUDE PATIENTS DISCHARGED TO A SKILLED NURSING FACILITY, PATIENTS WHO ARE DECEASED WITH NO ESTATE, AND PATIENTS WHO HAVE DOCUMENTED HOMELESSNESS.

Schedule H, Part V, Section B, Line 2
Effective January 1, 2020, the assets and business operations of Southside Regional Medical Center was acquired by Bon Secours Mercy Health Petersburg LLC . Bon Secours Mercy Health Petersburg LLC dba Bon Secours - Southside Medical Center was licensed as a hospital on January 1, 2020. Effective January 1, 2020, the assets and business operations of Southern Virginia Regional Medical Center was acquired by Bon Secours Mercy Health Emporia LLC . Bon Secours Mercy Health Emporia LLC dba Southern Virginia Medical Center was licensed as a hospital on January 1, 2020. Bon Secours Mercy Health Petersburg LLC and Bon Secours Mercy Health Emporia LLC are single member limited liability companies of Bon Secours Richmond, LLC. Bon Secours Richmond, LLC is a single member limited liability company of Bon Secours Mercy Health, Inc, a tax exempt 501(c)(3) organization. As such, Bon Secours Mercy Health Petersburg LLC and Bon Secours Mercy Health Emporia, LLC are tax-exempt 501(c)(3) organizations as of January 1, 2020.

Schedule H, Part V, Section B, Line 5 Facility G, 1
"Facility G, 1 - Bon Secours - Southside Medical Center, Bon Secours - Southern Virginia Medical Center. Bon Secours - Southside Medical Center and Bon Secours - Southern Virginia Medical Center, collectively referred to as ""Bon Secours Richmond South"", performed its Community Health Needs Assessment by examining qualitative input provided by community members coupled with quantitative data on health conditions in the area. The data was compiled from public documents prepared by the Cameron Foundation, United Way, and the Crater Health District. Quantitative data presented in this report was gathered from publicly available sources through the Virginia Department of Health and BeHealthyRVA. As the report was prepared during the COVID-19 pandemic, a grassroots approach was taken in order to obtain input from the community. We did so by engaging the community in an online survey, virtual community conversations, and conducting 1:1 key informant interviews. A survey to assess community health needs was conducted as part of the CHNA process during a six-week period between July and August 2020. A total of 324 individual responses were collected. Individuals were asked to ""Please choose the TOP 5 health issues you think should be addressed in your community"" from a list of 13 health issues. Individuals were then asked to ""Please choose the TOP 5 causes of poor health in your community"" from a list of 14 health causes. Interviews were conducted with local content experts to gain insight on top community health needs and the root causes of these health needs. Interviews took place with local law enforcement, local health care nurses, non-profit community partners, and local spiritual leaders. These conversations eluded to what was later confirmed in the online community engagement survey and community conversations. As this report was conducted during the COVID-19 pandemic, two virtual community conversations were held via Zoom in October 2020. A group of 75 key informants, consisting of local community leaders and members were invited to join and the meeting information was widely distributed to the public. A total of 62 participants attended the meetings. The purpose of the community conversations was to dig deeper into the results of the CHNA community engagement survey, specifically surrounding the identified top health issues and causes along with how the COVID-19 pandemic and social justice issues have impacted the health of these communities. Lastly, the purpose of this meeting was to elicit feedback from community members about publicly available health data describing health conditions in the service areas. The top 10 health issues as identified from the survey results were presented to the attendees and they were asked to 1) identify 3 health issues that could be addressed in the next two years, 2) identify root causes that contribute to these health issues (i.e. social determinants, racism, inequities, etc.), and 3) what is currently being done to help address these health issues? Where are there gaps? Conversations with community leaders and community members, as well as findings from the online engagement survey, helped to identify top health issues and associated root causes of health issues. Additionally, these discussions helped to identify significant linkages between each identified health need. Furthermore, the themes of Equity, Poverty, and Race were discussed as underlying concerns related to all of the health issues and causes identified. Leaders within the Community Health Division at Bon Secours Richmond Health System grouped the identified needs into the following categories based on the feedback provided by the community: 1) Chronic Disease, 2) Behavioral Health, 3) Social Determinants of Health, and 4) Stress/Trauma. Community health leaders presented the data gathered through the CHNA process (publicly available health data, online survey, virtual community conversations, and key informant interviews). Recognizing the importance of each of the health concerns identified, the team evaluated them, the hospital's strategic goals, and services currently provided. Based on these criteria, the team narrowed their focus to the top four health concerns. The team then determined the areas in which they could have the greatest impact. Additional detail can be found on the Bon Secours website at https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment"

Schedule H, Part V, Section B, Line 6a Facility G, 1
Facility G, 1 - Bon Secours - Southside Medical Center, Bon Secours - Southern Virginia Medical Center. Bon Secours - Southside Medical Center Bon Secours - Southern Virginia Medical Center

Schedule H, Part V, Section B, Line 11 Facility G, 1
Facility G, 1 - Bon Secours - Southside Medical Center, Bon Secours - Southern Virginia Medical Center. BON SECOURS - SOUTHSIDE MEDICAL CENTER AND BON SECOURS - SOUTHERN VIRGINIA MEDICAL CENTER WERE registered as new hospitals in tax year 2020. The hospitals' initial Community Health Needs Assessment was completed and adopted in tax year 2020. BON SECOURS - SOUTHAMPTON MEDICAL CENTER and Bon SEcours - Southern Virginia Medical Center have not yet begun performing any actions to address the significant health needs identified in its most recently conducted CHNA.

Schedule H, Part V, Section B, Line 13 Facility G, 1
Facility G, 1 - BON SECOURS MERCY HEALTH HOSPITALS. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT OR FAMILY MEMBER TO COMPLETE AN APPLICATION INCLUDING GROSS INCOME FOR A MINIMUM OF 3 MONTHS (UP TO 12 MONTHS) PRIOR TO THE DATE OF APPLICATION OR DATE OF SERVICE. PROOF OF INCOME IS REQUIRED WITH THE EXCEPTIONS OF PATIENTS WHO QUALIFY FOR PRESUMPTIVE ELIGIBILITY. PROOF OF INCOME IS NOT REQUIRED IF A PATIENT OR FAMILY MEMEBER ATTESTS TO AN INCOME LEVEL THAT QUALIFIES THE APPLICANT FOR DISCOUNTED CARE UNDER OHIO'S HEALTHCARE ASSURANCE PROGRAM (HCAP). THIRD PARTY INCOME SCORING MAY BE USED TO VERIFY INCOME IN SITUATIONS WHERE INCOME VERIFICATION IS UNABLE TO BE OBTAINED THROUGH OTHER METHODS. Patients are presumed to be eligible for financial assistance based on individual life circumstances including but not limited to when the Patient's income is below 200% Federal Poverty Guidelines and considered self-pay, the Patient is discharged to a SNF, the Patient is deceased with no known estate and below 200% Federal Poverty Guidelines, the patient is supported by State-funded prescription programs, the patient is Homeless or received care from a homeless clinic, the patient has Participated in Women, Infants and Children programs (WIC), the patient is eligible for Food stamps, the patient is eligible Subsidized school lunch program, the patient is eligible for other state or local assistance programs that are unfunded (e.g., Medicaid spend-down), the Patient is referred through the National Association of Free Clinics, the patient provides Low income/subsidized housing as a valid address, or Other significant barriers are present.

Schedule H, Part V, Section B, Line 13 Facility G, 1
Facility G, 1 - BON SECOURS MERCY HEALTH HOSPITALS. There are situations where individuals may not have reported income but have significant assets available to pay for healthcare services. In these situations, BON SECOURS MERCY HEALTH may evaluate and require documented proof of any assets that are categorized as convertible to cash and unnecessary for the patient's essential daily living expenses. PATIENTS WHO LIVE IN THE COMMUNITY SERVED BY A BON SECOURS MERCY HEALTH HOSPITAL WILL BE OFFERED HEALTHCARE FINANCIAL ASSISTANCE. FOR THOSE PATIENTS LIVING OUTSIDE OF THE COMMUNITY, EXTENUATING CIRCUMSTANCES MUST BE DOCUMENTED AND APPROVED BY THE PFS MANAGER AND BE MEDICALLY NECESSARY OR EMERGENT IN NATURE. A LIST OF THE ZIP CODES OF THE COMMUNITY SERVED FOR EACH BON SECOURS MERCY HEALTH HOSPITAL IS MAINTAINED IN A SEPARATE DOCUMENT AND READILY AVAILABLE VIA THE CONTACT LIST AT THE END OF THE POLICY LOCATED AT HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE AND AT https://www.bonsecours.com/patient-resources/financial-assistance. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT TO APPLY FOR HEALTH INSURANCE COVERAGE AND/OR ENTER THE MARKETPLACE/EXCHANGE BEFORE FINANCIAL ASSISTANCE MAY BE EXTENDED. EXCEPTIONS TO THIS POLICY INCLUDE PATIENTS DISCHARGED TO A SKILLED NURSING FACILITY, PATIENTS WHO ARE DECEASED WITH NO ESTATE, AND PATIENTS WHO HAVE DOCUMENTED HOMELESSNESS.

Schedule H, Part V, Section B, Line 5 Facility C, 1
Facility C, 1 - Mercy Health - Tiffin Hospital LLC. Mercy Health - Tiffin Hospital is a key stakeholder and partner of the Seneca County Health Alliance, a collaborative strategic planning process involving many community agencies and coalitions from various sectors. The Seneca County Health Alliance developed a Community Health Needs Assessment (CHNA) for Seneca County to assess and identify the health needs of the community. The CHNA was conducted by various social service, business and government organizations in Seneca County to collect data that reports the health and health behaviors of Seneca County residents. Data was collected for this assessment with the assistance of the Hospital Council of Northwest Ohio (HCNO). From the beginning phases of the Seneca County CHNA, community leaders were actively engaged in the planning process and helped define the content, scope and sequence of the project. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. Under the leadership of the HCNO, the survey questions were drafted and reviewed in a series of meetings with the planning committee from Seneca County. Local community agencies were invited to participate in the health assessment process, including choosing questions for the surveys, providing local data, reviewing draft reports and planning the community event, release of the data and setting priorities. The needs of the population, especially those who are medically underserved, low-income, minority populations and populations with chronic disease needs, were taken into account through the sample methodology that surveyed these populations and over-sampled minority populations. In addition, the organizations that serve these populations participated in the health assessment and community planning process, such as Seneca County School District, Seneca County Commission on Aging, Seneca County United Way. During the Spring of 2019, a survey instrument was designed to assess the health status and needs of adults in the community. The project coordinator from the HCNO conducted a series of meetings with the Seneca County Health Alliance. During these meetings, HCNO and the Seneca County Health Alliance reviewed and discussed banks of potential survey questions. The surveys were distributed to 1,200 adults in Seneca County. Additionally, HCNO obtained the results from a youth health survey offered by the Ohio Department of Mental Health and Addiction Services, Ohio Department of Health, and Ohio Department of Education that was administered to Seneca County youth in grades 7-12 in 2018 to 2019. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 5 Facility C, 2
Facility C, 2 - Mercy Health - Marcum and Wallace Hospital LLC. Marcum and Wallace Hospital (MWH) contracted with the Community and Economic Development Initiative of Kentucky (CEDIK) and with the University of Kentucky in the summer of 2019 to conduct a Community Health Needs Assessment (CHNA). The CHNA relied heavily on input from local residents and health-related organizations. The primary sources of data included one-on-one interviews with numerous local stakeholders, a variety of local focus groups, and survey data gathered from individuals within the service area. Combined input was received from local public health departments, social agencies, healthcare providers and local employers within the geographic service region. Through both the focus groups and the surveys, questions asked how the respondent felt the hospital could address the health needs of the community. Four focus groups for 41 participants were held between May and October 2019. A survey was developed with MWH staff and the Community Steering Committee which focused on the service are populations overall health and wellbeing as well as the medical diagnosis in the service area and was available in paper form and online. A mobile survey option was used to increase the number of surveys completed. Each member of the steering committee was responsible for distributing and collecting surveys as well as sharing the mobile link with coworkers and the populations that they served. The surveys were available at MWH, public health departments, the Interfaith Wellness Ministry, Estill County Schools and Carhartt, Inc. 483 surveys were completed and returned. The Community Steering Committee reviewed the results of the surveys completed and input received from the community focus groups, compared the survey and focus group data to the various health data, and made recommendations to MWH for CHNA health priorities to be addressed. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 6b Facility C, 1
Facility C, 1 - Mercy Health - Tiffin Hospital LLC. Firelands Counseling and Recovery Services Fostoria Community Schools Fostoria United Way Hospital Council of Northwest Ohio Mental Health and Recovery Services Board of Seneca, Sandusky and Wyandot Counties Seneca County Children and Family First Council Seneca County Health Alliance Seneca County Health Department Tiffin City Schools Tiffin-Seneca United Way

Schedule H, Part V, Section B, Line 6b Facility C, 2
Facility C, 2 - Mercy Health - Marcum and Wallace Hospital LLC. Estill County EMS Interfaith Wellness Ministry KY River Foothills Development Council, Inc Powell County Health Department Housing Authority of Irvine Kentucky River District Health Department Estill Development Alliance Estill County Chamber of Commerce Estill County Schools Lee County Fiscal Court Carhartt Community and Economic Development Initiative of Kentucky (CEDIK) at the University of Kentucky

Schedule H, Part V, Section B, Line 11 Facility C, 1
Facility C, 1 - Mercy Health - Tiffin Hospital LLC. Mercy Health - Tiffin Hospital Mental Health and Substance Abuse Implementation Activities: Goal: Increase awareness of adult and youth mental health and addiction issues of Seneca County 2020 Strategies and Outcomes: * Mercy Health Tiffin provided employer agencies with Zoom training on Mental Health and Substance Abuse to help increase awareness of these issues during the pandemic. * Due to the impact of COVID-19, many of the programs and strategies that Mercy Health Tiffin intended to implement to address this health need were delayed until 2021. Mercy Health Tiffin plans to resume these programs in 2021. Preventative Health/Chronic Disease Implementation Activities: Goal: Focus on prevention of chronic illnesses of adults and youth of Seneca County. 2020 Strategies and Outcomes: * Mercy Health Tiffin continued to provide free health screenings to all employees during 2020. * Mercy Health Tiffin provided employer agencies with Zoom training on Chronic disease and preventive health to help prevent chronic illness in adults during the pandemic. * Due to the impact of COVID-19, many of the programs and strategies that Mercy Health Tiffin intended to implement to address this health need were delayed until 2021. Mercy Health Tiffin plans to resume these programs in 2021. All prioritized needs in the hospital CHNA have been addressed.

Schedule H, Part V, Section B, Line 11 Facility C, 2
Facility C, 2 - Mercy Health - Marcum and Wallace Hospital LLC. Mercy Health - Marcum and Wallace Hospital Substance Abuse Implementation Activities: Goal: Increase substance abuse education and awareness of treatment resources within the community ensuring prevention and recognition of substance abuse. 2020 Strategies and Outcomes: * During 2020, Marcum and Wallace Hospital (MWH) partnered with local school districts to conduct substance abuse prevention education within school systems in the service area. The goal for 2020 was to complete 1 event and this was achieved. * The HELP (Healing, Empowering, Living Program) Team, also known as the Quick Response Team (QRT), provides a coordinated response to the opioid crisis in Estill County. The HELP Team is comprised of a Peer Support Specialist, Community Paramedic and Behavioral Health Consultant. The goal of the team is to build relationships that are respectful and work hand in hand with people to get the help they need. MWH participates in this program. During 2020, 1 program was available to the service area. * MWH worked to achieve their goal of enhancing partnerships with local boards and civic organizations through increased staff and leader membership. During 2020, the goal was to have 1 new meeting/member, and this was surpassed with 3. * During 2020, MWH collaborated with KY-ASAP to complete 1 event promoting community awareness and education about substance abuse. Mental Health Implementation Activities: Goal: Increase awareness and improve access to mental and behavioral health services within the service area. 2020 Strategies and Outcomes: * During 2020, MWH provided behavioral health services within the MWH ED and primary care clinics, including via telehealth encounters. MWH had 109 total encounters in 2020. * MWH worked to increase community awareness of behavioral health issues and resources available to address behavioral health needs during 2020 by having 25 discussions and communications with community leaders. * During 2020, MWH worked to increase early intervention treatments by providing patient assessments completed by the behavioral health consultant. 40 early interventions occurred in 2020. * During 2020, MWH hired a LCSW to be used as the Behavioral Health Consultant to address mental health needs. * MWH worked throughout 2020 to ensure they were represented on community advocacy boards and groups. MWH attended 55 meetings throughout 2020. Obesity Implementation Activities: Goal: Increase awareness of the impact obesity has on one's overall health including impact on chronic illness and encourage health heating habits and an active lifestyle. 2020 Strategies and Outcomes: * During 2020, MWH promoted increased physical activity and proper nutrition to fight obesity by hosting 1 event at The Children's Clinic in Irvine and providing healthy choices educational information. * MWH collaborates with partners to offer educational community-based events. In 2020, 3 events were held. * MWH successfully implemented the Population Health Management (PHM) clinic with a Nurse Practitioner and Pharmacist seeing patients in November 2020. The goal was to see 2 patients by the end of 2020, but that goal was surpassed with 4 patients seen. All prioritized needs in the hospital CHNA have been addressed.

Schedule H, Part V, Section B, Line 13 Facility C, 1
Facility C, 1 - BON SECOURS MERCY HEALTH HOSPITALS. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT OR FAMILY MEMBER TO COMPLETE AN APPLICATION INCLUDING GROSS INCOME FOR A MINIMUM OF 3 MONTHS (UP TO 12 MONTHS) PRIOR TO THE DATE OF APPLICATION OR DATE OF SERVICE. PROOF OF INCOME IS REQUIRED WITH THE EXCEPTIONS OF PATIENTS WHO QUALIFY FOR PRESUMPTIVE ELIGIBILITY. PROOF OF INCOME IS NOT REQUIRED IF A PATIENT OR FAMILY MEMEBER ATTESTS TO AN INCOME LEVEL THAT QUALIFIES THE APPLICANT FOR DISCOUNTED CARE UNDER OHIO'S HEALTHCARE ASSURANCE PROGRAM (HCAP). THIRD PARTY INCOME SCORING MAY BE USED TO VERIFY INCOME IN SITUATIONS WHERE INCOME VERIFICATION IS UNABLE TO BE OBTAINED THROUGH OTHER METHODS. Patients are presumed to be eligible for financial assistance based on individual life circumstances including but not limited to when the Patient's income is below 200% Federal Poverty Guidelines and considered self-pay, the Patient is discharged to a SNF, the Patient is deceased with no known estate and below 200% Federal Poverty Guidelines, the patient is supported by State-funded prescription programs, the patient is Homeless or received care from a homeless clinic, the patient has Participated in Women, Infants and Children programs (WIC), the patient is eligible for Food stamps, the patient is eligible Subsidized school lunch program, the patient is eligible for other state or local assistance programs that are unfunded (e.g., Medicaid spend-down), the Patient is referred through the National Association of Free Clinics, the patient provides Low income/subsidized housing as a valid address, or Other significant barriers are present.

Schedule H, Part V, Section B, Line 13 Facility C, 1
Facility C, 1 - BON SECOURS MERCY HEALTH HOSPITALS. There are situations where individuals may not have reported income but have significant assets available to pay for healthcare services. In these situations, BON SECOURS MERCY HEALTH may evaluate and require documented proof of any assets that are categorized as convertible to cash and unnecessary for the patient's essential daily living expenses. PATIENTS WHO LIVE IN THE COMMUNITY SERVED BY A BON SECOURS MERCY HEALTH HOSPITAL WILL BE OFFERED HEALTHCARE FINANCIAL ASSISTANCE. FOR THOSE PATIENTS LIVING OUTSIDE OF THE COMMUNITY, EXTENUATING CIRCUMSTANCES MUST BE DOCUMENTED AND APPROVED BY THE PFS MANAGER AND BE MEDICALLY NECESSARY OR EMERGENT IN NATURE. A LIST OF THE ZIP CODES OF THE COMMUNITY SERVED FOR EACH BON SECOURS MERCY HEALTH HOSPITAL IS MAINTAINED IN A SEPARATE DOCUMENT AND READILY AVAILABLE VIA THE CONTACT LIST AT THE END OF THE POLICY LOCATED AT HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE AND AT https://www.bonsecours.com/patient-resources/financial-assistance. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT TO APPLY FOR HEALTH INSURANCE COVERAGE AND/OR ENTER THE MARKETPLACE/EXCHANGE BEFORE FINANCIAL ASSISTANCE MAY BE EXTENDED. EXCEPTIONS TO THIS POLICY INCLUDE PATIENTS DISCHARGED TO A SKILLED NURSING FACILITY, PATIENTS WHO ARE DECEASED WITH NO ESTATE, AND PATIENTS WHO HAVE DOCUMENTED HOMELESSNESS.

Schedule H, Part V, Section B, Line 2
Effective January 1, 2020, the assets and business operations of Southampton Memorial Hospital was acquired by Bon Secours Mercy Health Franklin LLC dba Bon Secours - Southampton Medical Center. Bon Secours Mercy Health Franklin LLC was licensed as a hospital on January 1, 2020. Bon Secours Mercy Health Franklin LLC is a single member limited liability company of Bon Secours Hampton Roads Health System, LLC. Bon Secours Hampton Roads Health System, LLC is a single member limited liability company of Bon Secours Mercy Health, Inc, a tax exempt 501(c)(3) organization. As such, Bon Secours Mercy Health Franklin LLC is a tax-exempt 501(c)(3) organization as of January 1, 2020.

Schedule H, Part V, Section B, Line 3E

Schedule H, Part V, Section B, Line 5 Facility E, 1
Facility E, 1 - BON SECOURS - SOUTHAMPTON MEDICAL CENTER. Bon Secours - Southampton Medical Center in collaboration with Bon Secours Mary Immaculate Hospital, Sentara Healthcare, Children's Hospital of the King's Daughters, Riverside Health System, the Peninsula Health District, and the Hampton Health district, collectively known as The Peninsula Community Health Collaborative (PCHC), began meeting in May 2018 to begin the work on the 2020 - 2022 Community Health Needs Assessment. In order to obtain input from the community, an online and hard-copy Community Health Assessment Survey (Survey) was disseminated in English and Spanish to the community and key stakeholders. The survey was disseminated from October 23, 2019 through December 12, 2019 and was widely distributed via Bon Secours and PCHC networks, as well as meetings, clinics and programs. Overall, survey participants represent a blend of perspectives across age, race and income. A total of 12 focus group meetings called Community Dialogues were held in the Hampton Roads region in which 300 individuals participated. The purpose of the meetings was to elicit feedback from community members about publicly available health data describing health conditions in the service area and to review the online survey results to further explore the findings. The meetings began with community members participating in a matrix exercise in which they selected the three most important of the top ten health concerns identified in the Survey. Following the matrix exercise, a presentation explaining the CHNA process was shown. For sessions with larger numbers in attendance, participants were then divided into groups to discuss the top concerns identified in the matrix exercise. Smaller sessions were discussed as a single group. Breakout session facilitators lead the discussions with the following questions: Why are these issues? What is causing the issues? What can be done to address the issues? Comments were then written down by a staff member or volunteer. Bon Secours - Southampton Medical Center's senior leadership team met to review primary and secondary data gathered through the CHNA process (community meetings, community and key stakeholder surveys, and meetings with regional health systems and health departments). Recognizing the importance of each of the health concerns identified, the team evaluated them, the hospital's strategic goals, and services currently provided. Based on these criteria, the team narrowed their focus to the top five health concerns selected by both the community and key stakeholders. The team then determined the areas in which they could have the greatest impact. Additional detail can be found on the Bon Secours website at https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment

Schedule H, Part V, Section B, Line 6a Facility E, 1
Facility E, 1 - BON SECOURS - SOUTHAMPTON MEDICAL CENTER. Children's Hospital of The King's Daughters Sentara CarePlex Sentara Williamsburg Regional Medical Center Riverside Doctor's Hospital Williamsburg Riverside Regional Medical Center Riverside Behavioral Health Center Riverside Rehabilitation Hospital Hampton Roads Specialty Hospital Riverside Walter Reed Hospital Bon Secours Mary Immaculate Hospital

Schedule H, Part V, Section B, Line 6b Facility E, 1
Facility E, 1 - BON SECOURS - SOUTHAMPTON MEDICAL CENTER. Virginia Department of Health - Peninsula and Hampton

Schedule H, Part V, Section B, Line 11 Facility E, 1
Facility E, 1 - BON SECOURS - SOUTHAMPTON MEDICAL CENTER. BON SECOURS - SOUTHAMPTON MEDICAL CENTER was registered as a new hospital in tax year 2020. The hospital's initial Community Health Needs Assessment was completed and adopted in tax year 2020. BON SECOURS - SOUTHAMPTON MEDICAL CENTER has not yet begun performing any actions to address the significant health needs identified in its most recently conducted CHNA.

Schedule H, Part V, Section B, Line 13 Facility E, 1
Facility E, 1 - BON SECOURS MERCY HEALTH HOSPITALS. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT OR FAMILY MEMBER TO COMPLETE AN APPLICATION INCLUDING GROSS INCOME FOR A MINIMUM OF 3 MONTHS (UP TO 12 MONTHS) PRIOR TO THE DATE OF APPLICATION OR DATE OF SERVICE. PROOF OF INCOME IS REQUIRED WITH THE EXCEPTIONS OF PATIENTS WHO QUALIFY FOR PRESUMPTIVE ELIGIBILITY. PROOF OF INCOME IS NOT REQUIRED IF A PATIENT OR FAMILY MEMEBER ATTESTS TO AN INCOME LEVEL THAT QUALIFIES THE APPLICANT FOR DISCOUNTED CARE UNDER OHIO'S HEALTHCARE ASSURANCE PROGRAM (HCAP). THIRD PARTY INCOME SCORING MAY BE USED TO VERIFY INCOME IN SITUATIONS WHERE INCOME VERIFICATION IS UNABLE TO BE OBTAINED THROUGH OTHER METHODS. Patients are presumed to be eligible for financial assistance based on individual life circumstances including but not limited to when the Patient's income is below 200% Federal Poverty Guidelines and considered self-pay, the Patient is discharged to a SNF, the Patient is deceased with no known estate and below 200% Federal Poverty Guidelines, the patient is supported by State-funded prescription programs, the patient is Homeless or received care from a homeless clinic, the patient has Participated in Women, Infants and Children programs (WIC), the patient is eligible for Food stamps, the patient is eligible Subsidized school lunch program, the patient is eligible for other state or local assistance programs that are unfunded (e.g., Medicaid spend-down), the Patient is referred through the National Association of Free Clinics, the patient provides Low income/subsidized housing as a valid address, or Other significant barriers are present.

Schedule H, Part V, Section B, Line 13 Facility E, 1
Facility E, 1 - BON SECOURS MERCY HEALTH HOSPITALS. There are situations where individuals may not have reported income but have significant assets available to pay for healthcare services. In these situations, BON SECOURS MERCY HEALTH may evaluate and require documented proof of any assets that are categorized as convertible to cash and unnecessary for the patient's essential daily living expenses. PATIENTS WHO LIVE IN THE COMMUNITY SERVED BY A BON SECOURS MERCY HEALTH HOSPITAL WILL BE OFFERED HEALTHCARE FINANCIAL ASSISTANCE. FOR THOSE PATIENTS LIVING OUTSIDE OF THE COMMUNITY, EXTENUATING CIRCUMSTANCES MUST BE DOCUMENTED AND APPROVED BY THE PFS MANAGER AND BE MEDICALLY NECESSARY OR EMERGENT IN NATURE. A LIST OF THE ZIP CODES OF THE COMMUNITY SERVED FOR EACH BON SECOURS MERCY HEALTH HOSPITAL IS MAINTAINED IN A SEPARATE DOCUMENT AND READILY AVAILABLE VIA THE CONTACT LIST AT THE END OF THE POLICY LOCATED AT HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE AND AT https://www.bonsecours.com/patient-resources/financial-assistance. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT TO APPLY FOR HEALTH INSURANCE COVERAGE AND/OR ENTER THE MARKETPLACE/EXCHANGE BEFORE FINANCIAL ASSISTANCE MAY BE EXTENDED. EXCEPTIONS TO THIS POLICY INCLUDE PATIENTS DISCHARGED TO A SKILLED NURSING FACILITY, PATIENTS WHO ARE DECEASED WITH NO ESTATE, AND PATIENTS WHO HAVE DOCUMENTED HOMELESSNESS.

Schedule H, Part V, Section B, Line 5 Facility H, 1
Facility H, 1 - Our Lady of Bellefonte Hospital LLC. The CHNA was a collaborative effort between OLBH, King's Daughters Medical Center (KDMC), the Healthy Choices, Healthy Communities Coalition, the CHNA Advisory Group, and local health departments, including Ashland-Boyd County, Carter County, Greenup County, and Lawrence County (Ohio). The CHNA was conducted between November 2018 and June 2019 and included both primary and secondary data analyses. The primary data included a questionnaire and focus groups with key individuals in the community, including residents, public health representatives, and those with special knowledge of medically underserved, low income, and vulnerable populations and people with chronic diseases. The questionnaire focused on multiple areas including personal health, the health of the community, community support and services, health programs, health care services, and access. The 21-question survey was administered throughout the four-county service area, with 1,511 respondents. There were 1,396 individuals who provided their county of residence. Focus groups were held in all four service area counties with a total of 56 organizations and key individuals in the community, including residents, public health representatives, and those with special knowledge of medically underserved, low income, and vulnerable populations and people with chronic diseases to identify health priorities of the service area. Facilitation was provided to the groups by area health departments, hospitals, and non-profits. Sessions focused on learning the attendees' opinions about the strengths, weaknesses, opportunities, and threats (SWOT) to the communities' health. These health priorities were then considered against the resources presently available within the counties served and then aligned with the efforts of other local agencies. Additional detail can be found on the Bon Secours website at https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment

Schedule H, Part V, Section B, Line 6a Facility H, 1
Facility H, 1 - Our Lady of Bellefonte Hospital LLC. King's Daughters Medical Center

Schedule H, Part V, Section B, Line 6b Facility H, 1
Facility H, 1 - Our Lady of Bellefonte Hospital LLC. The Healthy Choices Healthy Communities Coalition CHNA Advisory Group Ashland-Boyd County local health department Carter County local health department Greenup County local health department Lawrence County (Ohio) local health department

Schedule H, Part V, Section B, Line 7 Facility H, 1
Facility H, 1 - Our Lady of Bellefonte HOspital LLC. The CHNA is available to the public in the following locations: Hospital and coalition web sites, printed copies were made available at the hospital in various departments including the emergency department, administration, marketing and mission departments.

Schedule H, Part V, Section B, Line 11 Facility H, 1
Facility H, 1 - Our Lady of Bellefonte Hospital LLC. In January 2020, Bon Secours Mercy Health announced its plans to close Our Lady of Bellefonte Hospital (OLBH), system-owned care sites and its physician network Bellefonte Physician Services. All sites began to phase out operations beginning in February 2020 and all hospital operations ceased as of April 30, 2020. Due to the closure, OLBH did not take any actions to address the needs identified in the CHNA or Implementation Strategy.

Schedule H, Part V, Section B, Line 13 Facility H, 1
Facility H, 1 - BON SECOURS MERCY HEALTH HOSPITALS. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT OR FAMILY MEMBER TO COMPLETE AN APPLICATION INCLUDING GROSS INCOME FOR A MINIMUM OF 3 MONTHS (UP TO 12 MONTHS) PRIOR TO THE DATE OF APPLICATION OR DATE OF SERVICE. PROOF OF INCOME IS REQUIRED WITH THE EXCEPTIONS OF PATIENTS WHO QUALIFY FOR PRESUMPTIVE ELIGIBILITY. PROOF OF INCOME IS NOT REQUIRED IF A PATIENT OR FAMILY MEMEBER ATTESTS TO AN INCOME LEVEL THAT QUALIFIES THE APPLICANT FOR DISCOUNTED CARE UNDER OHIO'S HEALTHCARE ASSURANCE PROGRAM (HCAP). THIRD PARTY INCOME SCORING MAY BE USED TO VERIFY INCOME IN SITUATIONS WHERE INCOME VERIFICATION IS UNABLE TO BE OBTAINED THROUGH OTHER METHODS. PATIENTS ARE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON INDIVIDUAL LIFE CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO WHEN THE PATIENT'S INCOME IS BELOW 200% FEDERAL POVERTY GUIDELINES AND CONSIDERED SELF-PAY, THE PATIENT IS DISCHARGED TO A SNF, THE PATIENT IS DECEASED WITH NO KNOWN ESTATE AND BELOW 200% FEDERAL POVERTY GUIDELINES, THE PATIENT IS SUPPORTED BY STATE-FUNDED PRESCRIPTION PROGRAMS, THE PATIENT IS HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC, THE PATIENT HAS PARTICIPATED IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC), THE PATIENT IS ELIGIBLE FOR FOOD STAMPS, THE PATIENT IS ELIGIBLE SUBSIDIZED SCHOOL LUNCH PROGRAM, THE PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (E.G., MEDICAID SPEND-DOWN), THE PATIENT IS REFERRED THROUGH THE NATIONAL ASSOCIATION OF FREE CLINICS, THE PATIENT PROVIDES LOW INCOME/SUBSIDIZED HOUSING AS A VALID ADDRESS, OR OTHER SIGNIFICANT BARRIERS ARE PRESENT.

Schedule H, Part V, Section B, Line 13 Facility H, 1
Facility H, 1 - BON SECOURS MERCY HEALTH HOSPITALS. THERE ARE SITUATIONS WHERE INDIVIDUALS MAY NOT HAVE REPORTED INCOME BUT HAVE SIGNIFICANT ASSETS AVAILABLE TO PAY FOR HEALTHCARE SERVICES. IN THESE SITUATIONS, BON SECOURS MERCY HEALTH MAY EVALUATE AND REQUIRE DOCUMENTED PROOF OF ANY ASSETS THAT ARE CATEGORIZED AS CONVERTIBLE TO CASH AND UNNECESSARY FOR THE PATIENT'S ESSENTIAL DAILY LIVING EXPENSES. PATIENTS WHO LIVE IN THE COMMUNITY SERVED BY A BON SECOURS MERCY HEALTH HOSPITAL WILL BE OFFERED HEALTHCARE FINANCIAL ASSISTANCE. FOR THOSE PATIENTS LIVING OUTSIDE OF THE COMMUNITY, EXTENUATING CIRCUMSTANCES MUST BE DOCUMENTED AND APPROVED BY THE PFS MANAGER AND BE MEDICALLY NECESSARY OR EMERGENT IN NATURE. A LIST OF THE ZIP CODES OF THE COMMUNITY SERVED FOR EACH BON SECOURS MERCY HEALTH HOSPITAL IS MAINTAINED IN A SEPARATE DOCUMENT AND READILY AVAILABLE VIA THE CONTACT LIST AT THE END OF THE POLICY LOCATED AT HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE AND AT HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT TO APPLY FOR HEALTH INSURANCE COVERAGE AND/OR ENTER THE MARKETPLACE/EXCHANGE BEFORE FINANCIAL ASSISTANCE MAY BE EXTENDED. EXCEPTIONS TO THIS POLICY INCLUDE PATIENTS DISCHARGED TO A SKILLED NURSING FACILITY, PATIENTS WHO ARE DECEASED WITH NO ESTATE, AND PATIENTS WHO HAVE DOCUMENTED HOMELESSNESS.

Schedule H, Part V, Section B, Line 5 Facility F, 1
Facility F, 1 - Institute for Orthopaedic Surgery. As part of the community health needs assessment (CHNA) process, many community stakeholders from Allen, Auglaize, and Putnam counties came together to create one county-level community health assessment (CHA) for each of their respective counties. As a result, these partnerships have resulted in less duplication, increased collaboration, and sharing of resources. Therefore, the data for this CHNA was obtained from the 2016 Putnam County CHA, 2017 Allen County CHA, and 2017 Auglaize County CHA. This community health needs assessment (CHNA) was cross-sectional in nature and included a written survey of adults within Allen, Auglaize, and Putnam Counties, as well as youth within Allen and Auglaize Counties. While Allen and Auglaize counties collect county-level youth health data, Putnam County does not. However, the Putnam County Task Force, does collect health data for individual grade levels using the PRIDE survey, which Mercy Health financially supports in addition to being a member of the task force. Two survey instruments were designed, and pilot tested for this study: one for adults and one for adolescents in grades 6-12. Input from members of the community was obtained through various methods for each county. Question selection meetings, questionnaires, rough draft meetings, community data release events, and written comments from community stakeholders were the main methods of collecting community feedback. Committee members expressed their opinions, needs, services or specific health-related topics while choosing certain questions to ask on the adult and adolescent questionnaires. The committee requested secondary data and correlations at rough draft meetings. Questions and written comments from the public were received at the community data release event from the community stakeholder perceptions worksheets. From the beginning, community leaders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid CHNA. Additional detail can be found on the Mercy Health website at https://www.mercy.com/about-us/mission/giving-back/community-health-needs-assessment

Schedule H, Part V, Section B, Line 6a Facility F, 1
Facility F, 1 - Institute for Orthopaedic Surgery. Lima Memorial Health System Mercy Health - St. Rita's Medical Center Blanchard Valley Health System, Putnam County Grand Lake Health Systems

Schedule H, Part V, Section B, Line 6b Facility F, 1
Facility F, 1 - Institute for Orthopaedic Surgery. Activate Allen County Allen County Public Health Auglaize County Board of Developmental Disabilities Auglaize County Commissioners Auglaize County Council on Aging Auglaize County Family and Children First Council Auglaize County Head Start Auglaize County Health Department Auglaize County Job and Family Services Auglaize County Juvenile Court Hancock, Hardin, Wyandot and Putnam Community Action Commission, Putnam County Health Partners of Western Ohio Mental Health and Recovery Services Board, Allen and Auglaize County New Bremen Local Schools, Auglaize County Pathways Counseling Center, Inc., Putnam County Putnam County Council on Aging Putnam County Family and Children First Council Putnam County Health Department Putnam County Homecare and Hospice The Mental Health, Alcohol and Drug Addiction Recovery Board of Putnam County The Ohio State University, Lima Campus United Way of Greater Lima United Way of Putnam County University of Toledo Wapakoneta City Schools Waynesfield-Goshen Local Schools West Ohio Community Action Partnership

Schedule H, Part V, Section B, Line 11 Facility F, 1
"Facility F, 1 - Institute for Orthopaedic Surgery. The Institute of Orthopaedic Surgery (IOS) Mental Health and Addiction Implementation Activities: Goal: Improve mental well-being through prevention, early detection and by ensuring access to appropriate, quality mental health services. Reduce substance abuse in the primary service area to protect the health, safety and quality of life for everyone. Reduce substance abuse in the primary service area to protect the health, safety and quality of life 2020 Strategies and Outcomes: * IOS continues to have pre-admission testing nurses perform screenings of patients for ""suicidal thoughts of harming themselves."" In 2020, over 6,000 patients were screened. Individuals who reported prior thoughts of self-harm and not currently receiving treatment were offered contact information for mental health resources. * During 2020, IOS continued to maintain its list of substance abuse resources located within the Case Management Department. The pharmacy department facilitated increased awareness among staff and patients of the National Prescription Drug take back days in 2020. * IOS continued its participation in St. Rita's Health Partners Opiate Addiction Task Force during 2020. The Institute for Orthopaedic Surgery (IOS) is an orthopaedic surgical specialty hospital that provides specialized services focused on acute recovery. Because of this, the prioritization team determined there is a limited ability to impact several of the prioritized health needs, including: * Chronic Disease * Maternal and Infant Health * Cross-cutting factor: Access to Care * Cross-cutting factor: Social determinants of health * Cross-cutting factor: Public health system, prevention and health behaviors"

Schedule H, Part V, Section B, Line 13 Facility F, 1
Facility F, 1 - Institute for Orthopaedic Surgery. IOS's financial assistance policy requires a patient or family member to complete an application including gross income for a minimum of 3 months (up to 12 months) prior to the date of application or date of service. Proof of income is required with the exceptions of patients discharged to a skilled nursing facility, patients who are deceased with no estate, and patients who have documented homelessness. Third party income scoring may be used to verify income in situations where income verification is unable to be obtained through other methods.

Schedule H, Part V, Section B, Line 13 Facility F, 1
Facility F, 1 - Institute for Orthopaedic Surgery. IOS's financial assistance policy requires proof that Health Savings Account and/or Medical Savings Account funds be depleted prior to providing healthcare financial assistance. Patients who live in the community served by IOS (Allen county and counties contiguous to Allen county) will be offered healthcare financial assistance. For those patients living outside of the geographic area, extenuating circumstances must be documented and approved by the Administrative Director. IOS's financial assistance policy may require a patient to apply for health insurance coverage or enter the marketplace/exchange before financial assistance may be extended. Exceptions to this policy include patients discharged to a SNF, patients who are deceased with no estate, and patients who have documented homelessness.

Schedule H, Part I, Line 7e Community Health Improvement Services
BSMH hospitals incurred significant additional costs in responding to the COVID-19 pandemic in 2020. Certain costs associated with health care support services, including executive and other employee time spent planning for and recovering from the public health emergency and for planning for community COVID-19 vaccine services were included as Community Health Improvement Services. These costs were not directly reimbursed by any provider relief funds or other government funding sources.

Schedule H, Part I, Line 7g Subsidized Health Services
$2,321,041 of costs attributable to physician clinics was included as subsidized health services in 2020. These clinics provide community benefit by improving access to physician services for the poor and underserved.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
380353927

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Cost of financial assistance at cost was calculated with a cost to charge ratio using worksheet 2. The cost related to Medicaid patients was determined using Bon Secours Mercy Health's cost accounting system and included both inpatients and outpatients for traditional Medicaid and Medicaid managed care plans. For subsidized services Bon Secours Mercy Health's cost accounting system used to determine cost related to the specific service excluding traditional Medicaid and Medicaid managed care patients. Costs for charity and bad debt accounts are deducted using a ration of cost to charge specific to that subsidized service. Costs for other programs reflect the direct and indirect costs of providing those programs.

Schedule H, Part II Community Building Activities
Bon Secours Mercy Health (BSMH) addresses various community concerns including health improvement, poverty, workforce development, and access to health care. BSMH hospitals conduct community health education and support groups, health fairs and screenings for the communities served. BSMH hospitals work with state and local leadership to address community needs and provide healthcare services to the poor and underserved. BSMH hospitals provide programs to improve the physical surroundings and housing in the communities served. Inadequate housing has a negative impact on the health of residents in the area by leading to violence in the neighborhoods. A robust economy positively impacts residents covered by health insurance and improves the capacity of the community to support health services. Social support services such as HELP (Hospital Eligibility Link Program) are also important to support the ability of residents to gain and retain employment and therefore access to health insurance and improved access to health services.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. NET PATIENT ACCOUNTS ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED UPON BON SECOURS MERCY HEALTH'S (BSMH) HISTORICAL COLLECTION EXPERIENCE ADJUSTED FOR CURRENT ENVIRONMENTAL RISKS AND TRENDS FOR EACH MAJOR PAYOR SOURCE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS IN THE PERIOD OF SERVICE BASED ON PAST COLLECTION EXPERIENCE. BSMH'S CONCENTRATION OF CREDIT RISK RELATED TO NET PATIENT ACCOUNTS IS LIMITED DUE TO THE DIVERSITY OF PATIENTS AND PAYORS. NET PATIENT ACCOUNTS CONSIST OF AMOUNTS DUE FROM GOVERNMENTAL PROGRAMS (PRIMARILY MEDICARE AND MEDICAID), PRIVATE INSURANCE COMPANIES, MANAGED CARE PROGRAMS AND PATIENTS THEMSELVES. NET PATIENT SERVICE REVENUE FOR SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE IS RECOGNIZED BASED ON CONTRACTUAL RATES FOR SERVICES RENDERED. BSMH RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). AMOUNTS RECOGNIZED ARE SUBJECT TO ADJUSTMENT UPON REVIEW BY THIRD-PARTY PAYORS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, BSMH RECOGNIZES REVENUE WHEN SERVICES ARE PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF BSMH'S ININSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, BSMH RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. ANY DISCOUNTS APPLIED TO SELF-PAY PATIENTS WOULD BE DEEMED EITHER CHARITY OR A CONTRACTUAL ADJUSTMENT. BAD DEBT WOULD BE BASED ON THE BALANCE AFTER THE CHARITY OR CONTRACTUAL ADJUSTMENT THAT IS DEEMED UNCOLLECTABLE FOLLOWING A REASONABLE COLLECTION EFFORT.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
"BON SECOURS MERCY HEALTH (BSMH) FOLLOWS THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY (""CHA GUIDELINES"") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE MEDICARE LOSSES AS COMMUNITY BENEFIT. BSMH'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE MEDICARE AMOUNTS IN PART III."

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE NOT SENT TO A COLLECTION AGENCY. THE ORGANIZATION REPEATEDLY OFFERS PATIENTS ACCESS TO FINANCIAL HELP DURING THEIR HOSPITAL STAYS AND AFTER, AS WELL AS WITH EACH BILLING NOTICE. BILLS ARE SENT TO A COLLECTION AGENCY AS A LAST RESORT AND ONLY: WHEN PATIENTS HAVE THE ABILITY TO PAY SOME PORTION OF THEIR HEALTHCARE EXPENSES BUT REFUSE TO DO SO; WHEN PATIENTS REFUSE TO WORK WITH THE ORGANIZATION TO DETERMINE IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE VIA FEDERAL, STATE, LOCAL OR HOSPITAL ASSISTANCE PROGRAMS; WHEN THE ORGANIZATION IS UNABLE TO LOCATE THE PATIENT OR PERSON RESPONSIBLE FOR THE BILL.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
"BON SECOURS MERCY HEALTH'S (BSMH) FINANCIAL ASSISTANCE POLICY DOES NOT PERMIT THE COST OF PATIENTS WHO ARE UNCOOPERATIVE OR UNABLE TO BE LOCATED TO BE RECLASSIFIED FROM FINANCIAL ASSISTANCE TO BAD DEBT. BSMH'S FINANCIAL ASSISTANCE POLICY REQUIRES AN APPLICATION AND SUPPORTING DOCUMENTATION. THEREFORE, ZERO DOLLARS ARE BEING REPORTED ON PART III, LINE 3 AS AMOUNTS INCLUDED IN BAD DEBT THAT COULD BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER BSMH'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL FOLLOWS THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY (""CHA GUIDELINES"") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE BAD DEBT EXPENSE AS COMMUNITY BENEFIT."

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
BON SECOURS MERCY HEALTH'S (BSMH) AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. BSMH ELECTED TO EARLY ADOPT ASU 2011-07. ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AS AN OPERATING EXPENSE. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS, 2. SIGNIFICANT ACCOUNTING POLICIES, (d) NET PATIENT ACCOUNTS AND NET PATIENT SERVICE REVENUE (PAGE 17) STATES Patient receivables are recorded at net realizable value based on certain assumptions determined by payor class. For third party payors including Medicare, Medicaid, and commercial insurance, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. For self-pay receivables, which includes patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries and any anticipated changes in trends.

Schedule H, Part V, Section B, Line 16a FAP website
A - Mercy Health - St. Vincent Medical Center LLC: Line 16a URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; A - Mercy Health - St. Elizabeth Health Center: Line 16a URL: https://bsmhealth.org/financial-assistance/; B - BON SECOURS - MARYVIEW HOSPITAL LLC: Line 16a URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; D - Mercy Health - Lourdes Hospital LLC: Line 16a URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; G - BON SECOURS - SOUTHSIDE MEDICAL CENTER: Line 16a URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; C - Mercy Health - Tiffin Hospital LLC: Line 16a URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; E - BON SECOURS - SOUTHAMPTON MEDICAL CENTER: Line 16a URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; H - Our Lady of Bellefonte Hospital: Line 16a URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; C - Mercy Health - Marcum and Wallace Hospital LLC: Line 16a URL: https://bsmhealth.org/financial-assistance/; F - Institute for Orthopaedic Surgery: Line 16a URL: HTTPS://WWW.IOSHOSPITAL.COM/ORTHOPAEDICS/HOSPITALBILLINGFINANCIALASSISTANCEPOLICY.ASPX;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - Mercy Health - St. Vincent Medical Center LLC: Line 16b URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; A - Mercy Health - St. Elizabeth Health Center: Line 16b URL: https://bsmhealth.org/financial-assistance/; B - BON SECOURS - MARYVIEW HOSPITAL LLC: Line 16b URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; D - Mercy Health - Lourdes Hospital LLC: Line 16b URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; G - BON SECOURS - SOUTHSIDE MEDICAL CENTER: Line 16b URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; C - Mercy Health - Tiffin Hospital LLC: Line 16b URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; E - BON SECOURS - SOUTHAMPTON MEDICAL CENTER: Line 16b URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; H - Our Lady of Bellefonte Hospital: Line 16b URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; C - Mercy Health - Marcum and Wallace Hospital LLC: Line 16b URL: https://bsmhealth.org/financial-assistance/; F - Institute for Orthopaedic Surgery: Line 16b URL: HTTPS://WWW.IOSHOSPITAL.COM/ORTHOPAEDICS/HOSPITALBILLINGFINANCIALASSISTANCEPOLICY.ASPX;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - Mercy Health - St. Vincent Medical Center LLC: Line 16c URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; A - Mercy Health - St. Elizabeth Health Center: Line 16c URL: https://bsmhealth.org/financial-assistance/; B - BON SECOURS - MARYVIEW HOSPITAL LLC: Line 16c URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; D - Mercy Health - Lourdes Hospital LLC: Line 16c URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; G - BON SECOURS - SOUTHSIDE MEDICAL CENTER: Line 16c URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; C - Mercy Health - Tiffin Hospital LLC: Line 16c URL: HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; E - BON SECOURS - SOUTHAMPTON MEDICAL CENTER: Line 16c URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; H - Our Lady of Bellefonte Hospital: Line 16c URL: HTTPS://WWW.BONSECOURS.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE; C - Mercy Health - Marcum and Wallace Hospital LLC: Line 16c URL: https://bsmhealth.org/financial-assistance/; F - Institute for Orthopaedic Surgery: Line 16c URL: HTTPS://WWW.IOSHOSPITAL.COM/ORTHOPAEDICS/HOSPITALBILLINGFINANCIALASSISTANCEPOLICY.ASPX;

Schedule H, Part VI, Line 2 Needs assessment
BON SECOURS MERCY HEALTH (BSMH) HOSPITALS ASSESS AND CONTINUALLY RESPOND TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. BSMH HOSPITALS JOIN AN EXISTING COMMUNITY-BASED NEEDS ASSESSMENT EVERY THREE YEARS AND UPDATES ARE PROVIDED BETWEEN ASSESSMENTS. BSMH HOSPITALS INCORPORATE PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. BSMH HOSPITALS RECOGNIZE THE HEALTH OF THE COMMUNITY IS INFLUENCED BY SOCIAL, ECONOMIC, AND ENVIRONMENTAL FACTORS, NOT JUST BY DISEASE AND ILLNESS. OUR COMMUNITY BENEFIT INCLUDES BOTH QUALITATIVE AND QUANTITATIVE DATA; DEMOGRAPHICS INCLUDING RACE, AGE, AND ETHNICITY; SOCIOECONOMIC DATA INCLUDING INCOME, EDUCATION, AND HEALTH INSURANCE RATES; PRIMARY CARE AND CHRONIC DISEASE NEEDS OF UNINSURED PERSONS; AND DATA ON HEALTH DISPARITIES IN HEALTH OUTCOMES AMONG MINORITY GROUPS. BSMH HAS A DEDICATED STAFF TO ASSIST IN THE COMMUNITY BENEFIT EFFORT. BSMH'S COMMUNITY BENEFITS COMMITTEES MEET TO PROVIDE OVERSIGHT TO THE ORGANIZATION'S COMMUNITY BENEFITS PROGRAM. BSMH HOSPITALS WORK CLOSELY WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS IN THE AREA, PARTNERING WITH SOME TO PROVIDE SERVICES TO AVOID DUPLICATION.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
BON SECOURS MERCY HEALTH (BSMH) HOSPITALS POST THEIR CHARITY CARE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY DEPARTMENTS AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. BSMH HOSPITALS PROVIDE A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS. ADDITIONALLY, A COPY OF THE POLICY OR A SUMMARY ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION IS INCLUDED IN PATIENT BILLS. BSMH HOSPITALS DISCUSS WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. THE HOSPITAL ELIGIBILITY LINK PROGRAM (HELP) IS A FREE REFERRAL SERVICE PROVIDED BY BSMH HOSPITALS. THE PURPOSE OF HELP IS TO ASSIST PATIENTS IN OBTAINING MEDICAL BENEFITS THROUGH FEDERAL, STATE, AND HOSPITAL PROGRAMS. HELP REPRESENTATIVES WILL PROVIDE THE FOLLOWING SERVICES AT NO COST TO THE PATIENT: *EXPLORE ELIGIBILITY UNDER PUBLIC ASSISTANCE PROGRAMS *FILE APPLICATIONS ON PATIENT'S BEHALF *SCHEDULE AND ATTEND APPOINTMENTS *PROVIDE TRANSPORTATION WHEN NECESSARY *PROVIDE MEDICAL DOCUMENTATION TO SOCIAL SECURITY ADMINISTRATION FOR DISABILITY CLAIMS. THROUGH HELP, PATIENTS AND THEIR COUNSELORS LOOK AT WHAT OPTIONS ARE AVAILABLE. BSMH HOSPITALS UNDERSTAND THAT NOT EVERYONE CAN PAY FOR HEALTHCARE SERVICES. HELP IS HERE TO OFFER OPTIONS AND ASSISTANCE FOR THOSE WHO ARE UNINSURED OR UNDERINSURED. HELP IS AN EXTENSION OF BSMH'S MISSION TO IMPROVE THE HEALTH OF OUR COMMUNITY WITH EMPHASIS ON THE POOR AND UNDERSERVED. MEETING THE NEEDS OF THOSE WITH LIMITED RESOURCES HAS ALWAYS BEEN THE HEART OF OUR MISSION. BSMH IS PROUD TO MAKE OUR FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO THE PUBLIC THROUGH ANY OF OUR WEBSITES, WHICH CAN BE FOUND AT: https://bsmhealth.org/financial-assistance/ https://www.mercy.com/patient-resources/financial-assistance https://www.bonsecours.com/patient-resources/financial-assistance OTHER PATIENT EDUCATION INFORMATION THAT IS PROVIDED FOR ELIGIBILITY OF ASSISTANCE IS AS FOLLOWS: *BILINGUAL REPRESENTATIVES ARE AVAILABLE IN OUR CUSTOMER SERVICE DEPARTMENTS. *STAFF TRAINING ON HOSPITAL CARE ASSURANCE PROGRAM (HCAP) AND HOSPITAL FINANCIAL ASSISTANCE (HFA) WAS PROVIDED. TRAINING INCLUDED A MANUAL AND IN-DEPTH INFORMATION REGARDING THE PREPARATION OF THE COST REPORT LOGS, ACCURATE COMPLETION OF THE HCAP APPLICATION AS WELL AS AN OVERVIEW OF THE FAQ'S PROVIDED BY THE OHIO HOSPITAL ASSOCIATION. *STAFF TRAINING PROVIDED BY SOCIAL SECURITY ADMINISTRATION TO ASSIST PATIENTS IN OBTAINING DISABILITY BENEFITS. *FINANCIAL ASSISTANCE COUNSELORS WORK WITH CASE MANAGERS TO EXPEDITE THE TRANSFER OF PATIENTS TO EXTENDED CARE FACILITIES. *FEDERAL POVERTY GUIDELINES ARE POSTED ON OUR WEBSITE AS WELL AS A COPY OF OUR CHARITY APPLICATION. *ALL THIRD PARTIES THAT WORK ON BEHALF OF THE ORGANIZATION TO COLLECT FEES (SUCH AS COLLECTION AGENCIES AND LAW FIRMS) ARE REQUIRED TO FOLLOW BSMH'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. *CONSISTENT REVIEW OF SELF PAY PATIENTS FOR RETROACTIVE MEDICAID COVERAGE. *SERVICES PROVIDED BY VENDOR TO REACH OUT TO PATIENTS IN BAD DEBT TO SCREEN FOR HCAP ELIGIBILITY.

Schedule H, Part VI, Line 4 Community information
THE COMMUNITY FOR EACH HOSPITAL IN THE BON SECOURS MERCY HEALTH (BSMH) SYSTEM IS DEFINED BOTH BY MISSION AND GEOGRAPHY. THE GEOGRAPHIC COMMUNITY IS DEFINED BY EACH HOSPITAL'S IMMEDIATELY CONTIGUOUS AREAS AS WELL AS BY THE BROADER SURROUNDING COUNTIES/REGIONS WHERE THE MAJORITY OF DISCHARGED PATIENTS RESIDE. ADDITIONALLY, THE COMMUNITY INCLUDES PATIENTS WHO REQUIRE THE EXPERTISE AND SPECIALIZED SERVICES OF A BSMH HOSPITAL. ADDITIONAL DETAIL REGARDING THE COMMUNITY FOR EACH HOSPITAL IN THE BSMH SYSTEM CAN BE FOUND IN EACH HOSPITAL'S CHNA AT THE FOLLOWING LINKS: HTTPS://WWW.MERCY.COM/ABOUT-US/MISSION/GIVING-BACK/COMMUNITY-HEALTH-NEEDS-ASSESSMENT https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment ADDITIONAL DETAIL REGARDING THE COMMUNITY FOR INSTITUTE FOR ORTHOPAEDIC SURGERY CAN BE FOUND IN THE HOSPITAL'S CHNA AT THE FOLLOWING LINK: https://www.ioshospital.com/orthopaedics/communityHealthNeedsAssessment.aspx

Schedule H, Part VI, Line 5 Promotion of community health
BON SECOURS MERCY HEALTH (BSMH) HOSPITALS OPERATE EMERGENCY ROOMS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, BSMH HOSPITALS ALSO PROVIDE MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. BSMH HOSPITALS OPERATE TRAUMA SERVICES, AIR AMBULANCE SERVICES, DISEASE MANAGEMENT, WOUND CARE, SPECIALTY CLINICS, DEVELOPMENTAL THERAPY, HOSPICE, HOME CARE, CRISIS INTERVENTION, BEHAVIORAL SERVICES AND SUBSTANCE ABUSE SERVICES. BSMH HOSPITALS HAVE OPEN MEDICAL STAFFS WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE MAJORITY OF THE GOVERNING BODY CONSISTS OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITIES SERVED BY BSMH HOSPITALS. THE BSMH BOARD AND ITS MARKET GOVERNING BOARDS ARE COMPOSED OF MEMBERS OF THE COMMUNITIES SERVED WHO DIRECT AND GUIDE MANAGEMENT IN CARRYING OUT THE MISSION OF BSMH. BOARD MEMBERS ARE SELECTED ON THE BASIS OF THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS BENEFICIAL TO BSMH AND ITS AFFILIATED HOSPITALS IN FULFILLING ITS MISSION OF PROVIDING HEALTHCARE SERVICES TO THE POOR AND UNDER SERVED. BSMH HOSPITALS ENGAGE IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS. BSMH HOSPITALS PROVIDE RESIDENCY PROGRAMS AND OTHER TRAINING PROGRAMS. BSMH HOSPITALS PARTICIPATE IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. BSMH HOSPITAL'S EMERGENCY DEPARTMENTS TREAT AN INCREASING NUMBER OF PATIENTS WHO USE THE FACILITY FOR PRIMARY CARE NEEDS. PATIENT DEMOGRAPHICS REFLECT THE CHANGING COMMUNITY. AS IN OTHER COMMUNITIES, SOME AREA PHYSICIANS PLACE LIMITS ON THEIR ACCEPTANCE OF MEDICAID PATIENTS. IN ADDITION, SOME PRIMARY CARE PHYSICIANS REFER PATIENTS WITH AFTER-HOURS NEEDS DIRECTLY TO AREA EMERGENCY ROOMS. COMMUNITY GROUPS AND INDIVIDUALS ARE VERY SUPPORTIVE OF BSMH. BSMH FORGES COLLABORATIVE RELATIONSHIPS WITH THE FEDERALLY QUALIFIED HEALTH CENTERS IN ITS COMMUNITIES.

Schedule H, Part VI, Line 6 Affiliated health care system
"Bon Secours Mercy Health, Inc., a Maryland nonprofit, nonstock membership corporation (BSMH), and all of the other entities that are controlled directly or indirectly by BSMH are described collectively as the System. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of Ohio, New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSMH aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. As a member of the Catholic health ministry and a member of BSMH, this organization and its related entities are called to continue the healing ministry of Jesus. We exist to benefit the people living in the communities it serves. Through all of the services offered to the community, the mission is ""to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a System of caregivers, we commit ourselves to help bring people and communities to health and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church."" This organization and related organizations share the BSMH Vision. BSMH's vision to partner with communities to create a more humane world, build social justice for all and provide exceptional value for those served is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2019-2021). - Co-Create Healthy Communities: We recognize that the factors which drive health outcomes extend well beyond the scope of traditional health care services. Thus, we commit to improve the health of communities through partnership and collaboration with a broad range of constituencies including committed community residents - Be Person Centric: We recognize that those whom we serve are increasingly engaged in their own care and are seeking convenience, affordability and reliability. Thus, we commit to anticipate and respond to the changing expectations of health care consumers, and to ensure that we engage each person in an individualized plan for health with a focus on prevention and wellness. - Serve Those Who Are Vulnerable: We recognize, by our Catholic identity, that the struggle for a more humane world is not an option, but an integral part of spreading the gospel. Thus, we commit to serve those who are vulnerable in many ways, addressing health disparities, sustaining global ministries, healing the environment and working to end violence and oppression. - Strengthen Our Culture and Capabilities: We recognize that the health care delivery system is undergoing rapid change with increasing complexity. Thus, we commit to liberate the potential of our people by strengthening individual and collective capabilities with respect to ministry leadership, knowledge, analytics, innovation and finances. Please see Schedule R for listings of the related organizations. Each of the reported entities play a role in achieving the vision of BSMH and the SQP (Strategic Quality Plan). System-wide community benefit for 2020 per the audit footnote is as follows: Total 2020 Community Benefit: $687.5 Million Benefits to the Broader Community: $117.1 million Unreimbursed Care for Those Who Are Poor and Qualify for Medicaid: $447 million Cost of Care for Those Who Could Not Afford to Pay: $123.4 million Community Benefit as Percent of Total Expense: 7.1 percent."