4A (Expenses $ 199244556 including grants of $ 19029) (Revenue $ 287637323)
St. Francis Medical Center provides quality hospital and medical services primarily to residents of Northeast Louisiana. The Medical Center is an active, caring member of the communities it serves. In carrying out its mission of meeting the healthcare needs of the people of God, the Medical Center has established a policy under which it provides care to needy members of its communities. Following that policy, health care services costing approximately, $1,429,871 were provided without charge. The Medical Center provided 79,643 inpatient days, 14,339 inpatient discharges and 51,484 ER visits in the year ended June 30, 2019.

4B (Expenses $ 22320843 including grants of $ 0) (Revenue $ 22478006)
ST. FRANCIS MEDICAL CENTER'S PHYSICIAN PRACTICE PROVIDES CARE TO THE NEEDY MEMBERS OF ITS COMMUNITIES.

PART V, SECTION B, LINE 5
ST. FRANCIS MEDICAL CENTER (SFMC) AND P&S SURGICAL HOSPITAL: THE ORGANIZATIONS ENGAGED KEY COMMUNITY PARTNERS THROUGH PERSONAL INTERVIEWS. SFMC TOOK INTO ACCOUNT INPUT FROM THOSE WITH SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH BY INTERVIEWING SHEILA HUTSON, WHO IS AN RN AT THE OFFICE OF PUBLIC HEALTH. ADDITIONALLY, SFMC ALSO TOOK INTO ACCOUNT INPUT FROM THOSE WHO REPRESENT A BROAD INTEREST IN THE COMMUNITY BY CONDUCTING AN ONLINE SURVEY. THE PARTICIPANTS WERE ASKED TO SELECT FOUR HEALTH ISSUES.

PART V, SECTION B, LINE 7A
ST. FRANCIS MEDICAL CENTER: THE CHNA CAN BE FOUND AT HTTPS://STFRAN.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT P&S SURGERY CENTER, LLC: THE CHNA CAN BE FOUND AT HTTPS://STFRAN.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

PART V, SECTION B, LINE 11
ST. FRANCIS MEDICAL CENTER DURING THE CURRENT YEAR, SFMC FOCUSED ON IDENTIFIED COMMUNITY NEEDS OF OBESITY/SEDENTARY LIFESTYLES, CHRONIC DISEASE MANAGEMENT, HEART ATTACK AND STROKE, AND SUBSTANCE ABUSE (TOBACCO USE). WHILE WORKING ON ITS NEXT CHNA, SFMC IDENTIFIED ADDITIONAL PRIORITY AREAS: CARE FOR THE ELDERLY AND ACCESS TO CARE, AND BEGAN WORKING ON AN IMPLEMENTATION PLAN AND RELATED STRATEGIES TO ADDRESS THESE PRIORITY AREAS. WHILE SFMC IDENTIFIED NINE HEALTH NEEDS, IT CHOSE NOT TO FOCUS ON MENTAL HEALTH, CANCER, HEART DISEASE/STROKE, AND PREVENTABLE HOSPITAL STAYS. HOWEVER, SINCE THERE ARE LINKAGES AMONG ALL OF THESE AREAS, SFMC ANTICIPATES THAT THE OUTCOMES OF THE NON FOCUS AREAS WILL IMPROVE DUE TO THE TIE-INS THAT EXIST. FOR EXAMPLE, WHILE SFMC DID NOT CHOOSE TO ADDRESS MENTAL HEALTH AS A PRIORITY AREA, WE DID CHOOSE SUBSTANCE ABUSE AND ACCESS TO CARE, WHICH COULD HAVE TIE-INS WITH MENTAL HEALTH. ADDITIONALLY, WE DID NOT ADDRESS CANCER, BUT WORK DONE IN THE PRIORITY AREAS OF ACCESS TO CARE AND CARE FOR THE ELDERLY MAY CONNECT PATIENTS WITH CANCER-RELATED CARE. ST. FRANCIS MEDICAL CENTER HAS DONE THE FOLLOWING TO HELP ADDRESS THE IDENTIFIED COMMUNITY HEALTH NEEDS OBESITY/SEDENTARY LIFESTYLES: SFMC ESTABLISHED GOALS REGARDING 1) RETENTION OF TWO CERTIFIED LACTATION COUNSELORS (STRETCH GOAL = 3; RESULT = 2), 2) NUMBER OF PATIENTS RECEIVING LACTATION COUNSELING (AVERAGE 200/QUARTER; STRETCH GOAL = 300; RESULT = 240), 3) PERCENTAGE OF PATIENTS RECEIVING BREASTFEEDING EDUCATION AS THEIR PRIMARY SOURCE OF INFORMATION ABOUT NEWBORN NUTRITION (GOAL = 90; STRETCH = 100; RESULT = 100), AND 4) PERCENTAGE OF ADULTS RECEIVING BMI SCREENINGS AND FOLLOW-UP EDUCATION (GOAL = 53; STRETCH = 55; RESULT = 55.35). CHRONIC DISEASE MANAGEMENT: AFTER ESTABLISHING A SPEAKERS BUREAU IN FY 2017, SFMC SET A GOAL TO PRESENT 24 EDUCATIONAL PROGRAMS / SPEAKING OPPORTUNITIES IN THE COMMUNITY RELATED TO HEALTH AND WELLNESS IN FY 2018 WITH A STRETCH TARGET OF 36 AND SURPASSED THE GOAL WITH 41. SFMC LOWERED ITS READMISSIONS RATE GOAL FROM THE PRIOR YEARS RATE OF 9.28% TO A BASELINE OF 8.61% AND MET THE FY STRETCH GOAL OF 8.3% WITH A FINAL AVERAGE OF 8.27%. HEART ATTACK AND STROKE: SFMC IMPROVED THE PERCENTAGE OF ST. FRANCIS MEDICAL GROUP PATIENTS RECEIVING EFFECTIVE CLINICAL CARE FOR CORONARY ARTERY DISEASE THROUGH ANTIPLATELET THERAPY FROM A PRIOR YEARS BASELINE OF 82.81% TO 83.95%. SFMC SET AND MET A STRETCH GOAL OF PROVIDING EDUCATION TO 100% OF NEW SFMC TEAM MEMBERS ABOUT HEART ATTACK AND STROKE. SFMC SET A GOAL TO IMPROVE TIME FROM HOSPITAL ARRIVAL TO PERCUTANEOUS INTERVENTION (PCI) FOR ELIGIBLE PATIENTS WITH HEART ATTACKS. THE BASELINE, WHICH WAS THE FY TARGET. SFMC MET THE STRETCH TARGET OF LESS THAN 75 MINUTES AT 100% EVERY QUARTER. SUBSTANCE USE (TOBACCO USE): SFMC DID NOT MEET ITS GOAL TO INCREASE THE NUMBER OF NEW PATIENTS WHO ATTEND AN INTAKE SESSION AND AT LEAST ONE COUNSELING SESSION (GOAL = 275; STRETCH GOAL = 325; RESULT = 172). SFMC PROVIDED 11 SUPPORT GROUP SESSIONS (GOAL = 4; STRETCH GOAL = 6). SFMC MET BOTH ITS GOALS RELATED TO HIRING A THIRD CERTIFIED TOBACCO TREATMENT SPECIALIST AND DEVELOPMENT OF A PROGRAM MANUAL TO PROVIDE PATIENTS WITH EASILY UNDERSTOOD EDUCATION MATERIALS TO INCREASE LONGTERM CESSATION SUCCESS. P&S SURGERY CENTER DURING THE CURRENT YEAR, P&S FOCUSED ON IDENTIFIED COMMUNITY NEEDS OF ACCESS TO DENTAL CARE AND OBESITY. WHILE IT IDENTIFIED NINE HEALTH NEEDS DURING ITS LAST CHNA, IT CHOSE NOT TO FOCUS ON CHRONIC DISEASE MANAGEMENT, CARE FOR THE ELDERLY, SUBSTANCE ABUSE, MENTAL HEALTH, HEART ATTACK/STROKE, COMMUNICABLE/INFECTIOUS DISEASE, AND NUTRITION/HEALTHY EATING. EACH NEED NOT ADDRESSED IS EITHER BEING ADDRESSED BY OTHER ORGANIZATIONS IN THE COMMUNITY OR P&S IS NOT EQUIPPED TO ADDRESS THE NEED. P&S DID THE FOLLOWING: ACCESS TO DENTAL CARE: P&S IS PROVIDING DENTAL CARE TO INDIVIDUALS WHO MIGHT NOT OTHERWISE HAVE ACCESS TO SUCH CARE. LAST YEAR, 270 CASES WERE HANDLED. IN THE CURRENT YEAR, 320 CASES WERE HANDLED. OBESITY: P&S HAS MET ALL ITS GOALS RELATED TO OBESITY: EMPLOYMENT/RETENTION OF ONE DIETITIAN; RETAINING CENTER OF EXCELLENCE DESIGNATION; RETAINING CENTER OF DISTINCTION DESIGNATION; PROVIDING A SUPPORT GROUP.

PART V, SECTION B, LINE 16J
St. Francis Medical Center and P&S SURGERY CENTER, LLC Registration personnel refer patients that may have difficulty paying for their medical care to financial counselors to discuss qualifications for fully discounted care.

PART V, SECTION B, LINE 13H
St. Francis Medical Center: Presumptive eligibility may be determined on the basis of individual life circumstances that may include: 1. The patient receiving free care from a community clinic and is referred to the hospital; 2. State-funded prescription programs; 3. Homeless, indigent, or homeless clinic patient; 4. Patients children who qualify for other financial assistance programs; 5. Patient eligible for food stamps; 6. Medicaid eligible patient; 7. Patient is deceased with no known responsible party; 8. Patient is incarcerated and has no other responsible party

PART V, SECTION B, LINE 16
PART V, SECTION B, LINE 16A, 16B 16C ST. FRANCIS MEDICAL CENTER: THE FINANCIAL ASSISTANCE POLICY, FAP APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT: HTTPS://FMOLHS.ORG/FINANCIAL-ASSISTANCE-POLICY/ P&S SURGERY CENTER, LLC: THE FINANCIAL ASSISTANCE POLICY, FAP APPLICATION FORM, AND A PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT: HTTPS://FMOLHS.ORG/FINANCIAL-ASSISTANCE-POLICY/

SUPPLEMENTAL INFORMATION
P&S SURGERY CENTER WAS ACQUIRED BY ST. FRANCIS MEDICAL CENTER IN SEPTEMBER OF 2018, SO ALL LINKS TO P&S DOCUMENTS WILL BE TO ST. FRANCIS MEDICAL CENTER'S WEBSITE.

PART I, LINE 3C
FINANCIAL ASSISTANCE IS AVAILABLE FOR INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. FULL AND PARTIAL DISCOUNTED CARE IS AVAILABLE IF INCOME AND ASSETS MEET CERTAIN FEDERAL POVERTY GUIDELINE LEVELS. DISCOUNTED CARE IS ALSO AVAILABLE FOR THOSE PATIENTS WITH CATASTROPHIC MEDICAL BILLS AND IS AVAILABLE IF MEDICAL BILLS EXCEED A CERTAIN PERCENTAGE OF INCOME AND ASSETS. FULLY DISCOUNTED CARE IS ALSO AVAILABLE WHERE THE PATIENT OR OTHER SOURCES CAN PROVIDE SUFFICIENT EVIDENCE OF PRESUMPTIVE ELIGIBILITY. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: 1) PATIENT RECEIVING FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL; 2) STATE-FUNDED PRESCRIPTION PROGRAMS; 3) HOMELESS, INDIGENT, OR HOMELESS CLINIC PATIENT; 4) PATIENT'S CHILDREN WHO QUALIFY FOR OTHER FINANCIAL ASSISTANCE PROGRAMS; 5) PATIENT ELIGIBLE FOR FOOD STAMPS; 6) MEDICAID ELIGIBLE PATIENT; 7) PATIENT IS DECEASED WITH NO KNOWN RESPONSIBLE PARTY; 8) PATIENT IS INCARCERATED AND HAS NO OTHER RESPONSIBLE PARTY.

PART I, LINE 7G
ST. FRANCIS MEDICAL CENTER PROVIDES SUBSIDIZED HEALTH SERVICES, INCLUDING SERVICES THAT PROVIDE PEDIATRIC NEUROLOGY, PEDIATRIC NEUROSURGERY, AND ADULT NEUROLOGY. THESE SPECIALIZED SERVICES ARE SUBSIDIZED BY ST. FRANCIS MEDICAL CENTER SINCE THESE ARE UNDER-SERVED SPECIALTY AREAS.

PART I, LINE 7
THE COST-TO-CHARGE RATIO IS UTILIZED AS THE COSTING METHODOLOGY TO CALCULATE THE AMOUNTS REPORTED IN PART I LINES 7A-7D AND IS BASED ON THE COST ACCOUNTING SYSTEM OF THE ORGANIZATION. FOR PART I LINES 7E, 7F, 7G, 7H AND 7I, DIRECT COSTS WERE CAPTURED FROM THE HOSPITAL'S AUDITED FINANCIAL STATEMENT AND THE MEDICARE COST REPORT WHERE APPLICABLE. FOR PART I LINE 7G, COST FIGURES WERE CALCULATED FROM DEPARTMENTAL COSTS LESS DIRECT OFFSETTING REVENUE.

PART III, LINE 4
THE BAD DEBT FOOTNOTE IS ON PAGE 19 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8
THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE MEDICARE COST REPORT IS BASED ON REGULATORY REQUIREMENTS AND GUIDELINES. THE ORGANIZATION CURRENTLY DOES NOT BELIEVE THAT ANY SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT.

PART III, LINE 9B
PATIENTS WITH NO MEANS OF PAYMENT MAY APPLY FOR FINANCIAL ASSISTANCE. APPROVAL WILL BE BASED ON INCOME, ASSETS, AND MEDICAL EXPENSES AS SET FORTH IN THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS MAY ALSO BE FULLY DISCOUNTED BASED ON A PRESUMPTIVE CHARITY SCORING SYSTEM WHICH IS SIMILAR TO CREDIT SCORING. TO THE EXTENT APPROPRIATE AND PERMITTED BY LAW, FINANCIAL COUNSELING AND SCREENINGS ARE CONDUCTED AT THE TIME OF ENCOUNTER TO ASSIST IN IDENTIFYING PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S POLICY. THESE PROCESSES HELP IDENTIFY (EARLY IN THE PROCESS) PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. THIS HELPS KEEP QUALIFYING PATIENTS OUT OF THE HOSPITAL'S COLLECTION PROCESSES BECAUSE AMOUNTS COVERED BY FINANCIAL ASSISTANCE ARE NOT SUBJECT TO THE HOSPITAL'S COLLECTION PRACTICES. HOWEVER, IF IT IS DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE AFTER THE INDIVIDUAL'S ACCOUNT HAS BEEN SENT TO COLLECTIONS, THE DISCOUNTED AMOUNT IS IMMEDIATELY REMOVED FROM THE COLLECTIONS PROCESS.

PART VI, LINE 2
NEEDS ASSESSMENT: Responding to the health needs of our community, especially to those most in need, is primary to the hospital's mission. As such, St. Francis Medical Center, Inc. works to conduct health care needs assessments. They work closely with Families helping Families, The Wellspring, The Children's Coalition, YMCA and many other organizations to define community needs and to consolidate efforts to meet those community needs. For example, a school-based health center and a diabetes and nutrition center was initiated after a health care assessment identified the need. The hospital conducted an updated community based needs assessment in tax year 2018 and will continue to use community based data to support decisions for outreach in the community.

PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: Patients are informed through a patient handbook that contains information on the financial policies of St. Francis Medical Center. Additionally, signs are posted in the Admissions areas that Financial Counseling is available upon request. Systems and tools are utilized to conduct high level financial screening to assist in identifying patients eligible for financial assistance. Financial counselors work closely with patients to assist with enrollment for those who are eligible for Medicaid as well as assist those who are eligible for HOSPITAL FINANCIAL ASSISTANCE in determining eligibility.

PART VI, LINE 4
COMMUNITY INFORMATION: ST. FRANCIS MEDICAL CENTER (SFMC) IS A COMMUNITY-BASED, NOT-FOR-PROFIT HOSPITAL LOCATED IN MONROE, LOUISIANA THAT SERVES OUACHITA PARISH AND PORTIONS OF THE SURROUNDING PARISHES. FOR THE PURPOSE OF THE CHNA, SFMC DEFINES ITS PRIMARY SERVICE AREA AS LINCOLN AND OUACHITA PARISHES. PURSUANT TO THE HOSPITAL'S LAST CHNA, SFMC'S PRIMARY SERVICE AREA HAS A POPULATION OF APPROXIMATELY 205,383 AND THE SENIOR POPULATION COMPRISES ABOUT 13.48% OF THE TOTAL POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $40,167 IN OUACHITA PARISH AND $37,842 IN LINCOLN PARISH. APPROXIMATELY 19% OF THE PARISH'S RESIDENTS LIVE BELOW THE POVERTY LEVEL.

PART VI, LINE 6
St. Francis Medical Center is a not-for-profit hospital, non-stock member corporation of which Franciscan Missionaries of Our Lady Health System, Inc. (FMOL Health System) is the sole member. St. Francis Medical Center is part of the FMOL Health System which includes several hospitals and tax-exempt affiliates throughout the state of Louisiana. St. Francis Medical Center serves the community in Northeastern Louisiana and Southern Arkansas. Other related hospitals in Louisiana include: Our Lady of Lourdes Regional Medical Center Our Lady of the Lake Hospital St. Elizabeth Hospital Our Lady of the Lake Assumption Hospital OUR LADY OF THE ANGELS HOSPITAL

PART III, SECTION A, LINE 2
AMOUNTS REPRESENT THE ACTUAL CUSTOMER AMOUNTS DUE TO ST. FRANCIS MEDICAL CENTER THAT WERE WRITTEN OFF BECAUSE THEY WERE UNCOLLECTIBLE.

PART I, LINE 7F
FOR THE PURPOSE OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN F, FUNCTIONAL EXPENSES WERE USED WHICH DID NOT INCLUDE BAD DEBT EXPENSE.

PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH: St. Francis Medical Center participates in community improvement activities because it understands that improvements to a community have a direct link to the improved health of community residents. Community improvement activities include the following: SFMC provides occupancy and utilities free of charge to St. Vincent DePaul charitable pharmacy so that the poorest individuals in the community have access to prescription drugs. SFMC also provides occupancy free of charge to a primary health care clinic located in one of the poorest areas of Monroe. These activities allow the recipient organizations to spend their available funds on activities that have more direct impact on those in need. SFMC provides management oversight of community programs and activities, including Meals on Wheels, taxi and medication provided to the needy, and community benefit salary dollars. SMFC proudly serves as the designated regional hospital for Region 8 and provides leadership and coordination for emergency preparedness activities. SFMC provides leadership development and training for Roman Catholic Priests to serve in the SFMC Community. SFMC improves access to public health through its financial support of an adult day health care facility and a school based health center. SFMC has many programs designed to promote leadership development and provide exposure to various careers in health care. Such programs include health information management, sports medicine program, AHEC (area health education center) program, Carroll High School Housekeeping Program and the Jr. Volunteer Program. A majority of the governing body of SFMC is comprised of individuals from a broad cross-section of the community who reside in the primary service area and who are neither employees nor contractors of the organization. SFMC extends medical staff privileges to all qualified physicians in the community for some or all of the departments, as needed. SFMC applies surplus funds to improvements in patient care through investment in Clinical technology, medical information technology, and continued training of clinical staff.