4A (Expenses $ 17467427 including grants of $ 0) (Revenue $ 20482414)
THE HOSPITAL IS DEDICATED TO SPIRTUALLY CENTERED, HOLISTIC CARE THAT SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES. IT FURTHERS THIS GOAL THROUGH DELIVERY OF PATIENT SERVICES, CARE TO THE ELDERLY AND INDIGENT, PATIENT EDUCATION AND HEALTH AWARENESS PROGRAMS FOR THE COMMUNITY. FOR DETAILED INFORMATION ON THE HOSPITAL'S PROGRAM SERVICE ACCOMPLISHMENTS AND STATISTICAL DATA SEE SCHEDULE H.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - ST. VINCENT'S BLOUNT. To prepare the CHNA report, data was gathered from multiple sources in an effort to construct a current and accurate snapshot of the health issues in Blount County, Alabama. Data was obtained from multiple public data bases and opinions were solicited from public health experts, community leaders and patients within the community served by St. Vincent's Blount Hospital. This information was summarized for final consideration by a CHNA team consisting of Hospital and System personnel as well as community leaders.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - St. Vincent's Blount. Community Health Needs Assessment Implementation Plan Narrative FY15 Update- St. Vincent's Blount Hospital The identified community health needs for the defined service area of St. Vincent's Blount are: 1. Prevention of Obesity & Good Nutrition Education 2. Diabetes Education 3. Cardiac Health Education 4. Increased Transportation Options for Health Care Appointments 5. Free or Subsidized Health Care for the Uninsured and/or Poor 1. Good Nutrition/Obesity Prevention - St. Vincent's Blount is actively involved in reducing the obesity rates and improving access to nutritional food in the state of Alabama through a variety of means tested methods. An active member of the Alabama Taskforce on Obesity, and United Way's Bold Goals for Health, St. Vincent's Health System has contributed significantly to regional efforts to promote good nutrition and obesity prevention. According to the CDC, recommended strategies for obesity prevention include: ""Improve availability of mechanisms for purchasing foods from farms; provide incentives for the production, distribution and procurement of foods from local farms, and participate in community coalitions or partnerships to address obesity"" (CDC, 4). In FY15, St. Vincent's Blount participated in providing local community gardens with equipment and resources to enhance their ability to serve others with healthy, fresh vegetables. In addition, St. Vincent's Health System provided over 600 individuals in North Central Alabama with a nutritious holiday meal box including fresh fruits and vegetables as well as healthy recipes. Volunteers from across the Health System, including St. Vincent's Blount, spent over 100 hours of volunteer work at the Bruno Vegetable Garden in the Birmingham Botanical Gardens whose harvest serves a local foodbank. From FY14 to FY15, St. Vincent's Wellness Department conducted 20% more community screenings, reaching almost 20,000 individuals in the community with dietitian counseling on healthy eating and fitness recommendations. Clergy Wellness participation included 40 local clergy who, by extension, serve over 15,000 parishioners in the greater community. These faith leaders worked on personal health goals including weight loss and nutrition. 2. Diabetes Education - St. Vincent's Blount, as a rural, critical access hospital, has a unique role in the community it serves. In FY15, St. Vincent's Blount partnered with 3 local pharmacies to raise awareness of diabetes and diabetes-related complications. A free foot screening was paired with diabetes education at the local pharmacy. Diabetes awareness and education continue to be a part of the community education conducted at local health fairs as well. 3. Cardiac Health Education - St. Vincent's Birmingham promotes Cardiac Health Education in a variety of ways through partnerships with American Heart Association's Go Red initiative. A regional screening event, Heart Day, promotes testing and awareness of the need to become heart healthy. This event focuses on individuals who would otherwise not be able to afford or have access to such screenings and education. The Community Guide recommends a reduction in out of pocket costs can assist patients with compliance to medication and lifestyle modifications (http://thecommunityguide.org/about/What-Works-CVD-factsheet-and-insert.pdf). By providing free screenings and education to the community, STVHS is able to make these services available to all, regardless of ability to pay or insurance coverage. The community screenings are often targeted to individuals living in poverty and provide follow-up phone calls from Dial-A-Nurse department to explain abnormal results and offer health education on what the screening results mean. A Heart Day pre and post-test survey showed increase in heart health knowledge after participation in Heart Day event. Additionally, the 20% increase in screenings contributed to over 20,000 individuals receiving wellness education, especially as it relates to heart disease risk factors such as blood pressure and cholesterol levels. 4. Increased Transportation Options for Health Care Appointments - While St. Vincent's Blount did not directly address transportation for health care appointments, it did support local partners whose priority is transportation. A member of the executive team served on the board of KidOne, a non-profit who provides transportation services to women and children in need of assistance to medical appointments. St. Vincent's Health System sponsored KidOne's major fundraising event and continues to work with the organization to refer qualified patients in need of transportation services. 5. Free/Subsidized Healthcare for Uninsured - St. Vincent's Birmingham has a long history of working with individuals who are uninsured to be able to provide healthcare services. The Access to Care program is a primary care provider program for individuals living less than 200% income over the federal poverty level. In partnership with Enroll Alabama, St. Vincent's encouraged individuals to sign up for healthcare exchanges and publicized benefits of the Affordable Care Act. STVHS was also a CAC (Certified Application Counselor) organization that was able to provide information to the community about healthcare coverage options. The Access to Care Program for individuals not eligible for any other type of assistance, served over 550 unique patients in FY15 and provided primary care and link to specialty care. Cost per patient in Access to Care has decreased over the last 3 years, showing a higher management of chronic illness and health needs for individuals with limited resources. During open enrollment period for the healthcare exchanges, St. Vincent's played an active role in linking eligible residents to Enroll Alabama for assistance. A total of 192 on-site appointments were conducted (and opened to the community as well as current patients) and statewide, over 170,000 individuals enrolled in an exchange plan. St. Vincent's continued to chair the Community Healthcare Provider Round Table meeting which provides ongoing community coordination for the uninsured and links to appropriate resources."

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - St. Vincent's Blount. Partial financial assistance can be granted for those individuals that fall above the FPG. A sliding scale is used to determine the financial assistance amount. For instance if the income level is at 250% then the partial assistance is 90% of the total bill or Best Payor rate, whichever is less.

Schedule H, Part I, Line 7g Subsidized Health Services
The Organization employs its physicians at physician clinics, so the associated costs and charges relating to those physician services are included in all relevant categories in Part I.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
"The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association (""CHA"") guidelines, The Organization uses a cost accounting system that addresses all patient segments (for example: inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay), The best available data was used to calculate the amounts reported in the table. Par the information in the table, a cost-to-charge ratio were calculated and applied."

Schedule H, Part II Community Building Activities
At St. Vincent's Health System, the Community Building activities range from financial assistance for local non-profits to economic development and health professions training. The health and wellness of the North Central Alabama community is at the core of all the community building activities that St. Vincent's Health System reports. The community health approach of St. Vincent's Health System focuses on systemic change in a community to lead individuals to make their own goals of health and wellness. This is demonstrated in programs like Hispanic Outreach and Access to Care. Economic, leadership and workforce development are a priority for maintaining a strong and viable culture for changes in health. According to Robert Wood Johnson Foundation, where individuals live, work and play are essential in determining their health outcomes. St. Vincent's Health System commits significant community benefit resources to collaborating across disciplines and fields to promote communication and pathways to success for patients, associates and community members. St. Vincent's chairs the Community Healthcare Provider Round Table as well as the Community Mental Healthcare Provider Round Table as an example of a shared responsibility to serve those who have barriers to care. Continued advocacy work around Medicaid expansion and other issues that affect the community are working to find ways in which various businesses and community organizations can collaborate for improvement. With a strong rural presence, physician recruitment for Medically Underserved Areas (MUAs) is vitally important for the continuation of medical care in outlying areas. The variety and scope of the community building activities of St. Vincent's Health System shows an ongoing effort to serve as a leader in healthcare as well as a leader in the overall community improvement where we serve.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Bad debt expense recorded on the financial statements is the sum of the following: - Bad debt write-offs on patient accounts that are deemed uncollectible during the year, and - A reserve estimate on accounts receivable (unpaid patient accounts) of what will be deemed uncollectible in the future on these accounts. This estimate is developed using a hindsight methodology.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
From the consolidated audited financial statements of Ascension Health Alliance (which includes the activity of St. Vincent's Blount): The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collet from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
"Ascension Health and related health ministries follow the Catholic Health Association (""CHA"") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. The cost-to-charge ratio method is used in determining the shortfall."

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
St. Vincent's Health System follows the Ascension guidelines for collection practices related to patients qualifying for charity or financial assistance. A patient can apply for charity or financial assistance at any time during the collection cycle. Once qualifying documentation is received the patient's account is adjusted. Patient accounts for the qualifying patient in the previous six months may also be considered for charity or financial assistance. Once a patient qualifies for charity or financial assistance, all collection activity is suspended.

Schedule H, Part V, Section B, Line 16a FAP website
- St. Vincent's Blount: Line 16a URL: http://www.stvhs.com/financialpolicy.asp;

Schedule H, Part VI, Line 2 Needs assessment
Our most recent community needs assessment was conducted in April 2013 by our parent company St. Vincent's Health System and was limited geographically to the seven counties served by St. Vincent's Health System. The assessment was completed by interviewing key stakeholders both within St. Vincent's Health Care System and in the external community. The interviews were conducted between December 2012 and April 2013. Interviewees included a range of CEO's and program managers from area health care organizations, and more than 50 interviews were completed. The needs assessment consists of census data, public health information, and findings from the interviews. These findings include an assessment of the local healthcare infrastructure and the service gaps, especially in regards to those in our community who lack access to basic healthcare services.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
St. Vincent's Health System uses visual aids to inform patients of available financial assistance. The statement of Patient Financial Services Financial Assistance is displayed at all registration areas throughout the Hospital, including the Emergency Department to make patients aware that assistance is available. our staff, when discussing collections with patients, also makes patients aware of the available assistance if they are unable to pay.

Schedule H, Part VI, Line 4 Community information
St. Vincent's Health System primarily services residents of central Alabama in the following seven counties: Blount, Cullman, Jefferson, Shelby, St. Clair, Talladega, and Walker. - Our primary service area consists of both rural and urban communities with a population of 1,242,033; median income of $46,488; and median age of 38.6. - Age of population: 27.28% age 0-19, 30.99% age 20-44, 26.68% age 45-64, 15.05% age 65+. - Sex: 51.8% Female and 48.2% Male. - Ethnicity: 67.1% White non-Hispanic, 27.8% Black non-Hispanic, 4.3% Hispanic, 1.2% Asian non-Hispanic. - Language: English speaking 94.27%, Non-English age 5+ 3.56%. - There are 87 federally designated Medically Underserved Areas (MUA's) in the state and 18% of the population is eligible for Medicaid inside the seven county service areas. - Insurance coverage breakdown is 57.7% Private, 15.8% Medicare, 15.4% Medicaid, and 11.1% Uninsured. -Poverty: 16.5% on average in poverty. Range in 7 counties 7.7% to 22.9%. - Hospitals in service area: 18 total 16 Nonprofit, 2 For profit, 1 academic medical center. - Health Statistics - Obesity: 33%. - Leading causes of death: Heart disease, Cancer, Stroke

Schedule H, Part VI, Line 5 Promotion of community health
"This report illustrates the significant degree to which St. Vincent's Health System, through its four hospitals and Health & Wellness facilities, contributes to the positive health status of the communities we serve. The System's four hospitals include St. Vincent's Birmingham, St. Vincent's East, St. Vincent's Blount and St. Vincent's St. Clair. Each hospital has a separate Tax ID number. Each makes an important contribution to caring for their community, including those who are underserved. As a member of Ascension Health, St. Vincent's Health System continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families and the community as a whole. The Health System's mission is to extend the healing ministry of Christ. The hospitals of the health system further the mission through the delivery of patient services, care to the elderly and indigent, patient education, and health awareness programs for the community. Our concern for all human life and commitment to the dignity of each person leads us to provide medical services to all people in the community without regard to race, creed, national origin, economic status, or ability to pay. Based on our Core Values and in the spirit of principles adopted by Ascension Health, our Health System has taken proactive steps to address those issues that affect accessibility, the financing, and the delivery of health care to all persons, especially the uninsured, underinsured, and the underserved. The following chart demonstrates the significant number of patient days and the estimated unreimbursed cost of services provide by our four hospitals to the uninsured or underserved. FY15 Number of Licensed Beds - Number of Patient Days - Estimated unreimbursed Cost: St, Vincent's Birmingham - 499 - 101,608 - $286,864 St. Vincent's East - 379 - 91,929- $6,685,013 St, Vincent's Blount - 25 - 5,511 - $2,322,853 St. Vincent's St. Clair - 40 - 7,243 - $2,646,642 Total - 943 - 206,291- $19,941,372. St. Vincent's Heath System has a deep commitment to serving the community. We earmark a certain percentage of our yearly profits for charitable donations. Through this charitable donation program, we are able to support local chapters of national organizations such as the American Cancer Society, the American Heart Association, March of Dimes, and Susan G. Komen for the Cure. We also fund local programs and initiatives such as the United Way. Many of our executives serve on the boards of these organizations. We provide essential medical services to the community, train and recruit healthcare professionals to serve the needs of the broader community, provide appropriate charity services to those unable to pay for their health care needs, and provide services to other organizations that allow them to provide quality services to their patients or constituents. Some of these services include Liz Moore Low Vision Center located at St. Vincent's East, Jeremiah's Hope Skills Program, Hispanic Outreach Ministry, Access to Care program and Elder Care Services program in which are all located at St. Vincent's Birmingham. The goal of the Liz Moore Low Vision Center at St. Vincent's East is to assist the person with low vision to use functional vision to the utmost capacity. A person with low vision may be legally blind but able to function with visual aids that enhance the remaining vision. With the assistance of magnification, and adaptations of the special low vision aids that are useful for certain daily tasks, the visually impaired person can function with less difficulty. The Vision Center provides services for the person with low vision. These services are designed to benefit a person's daily life activities, which may be hindered by the visual loss. St. Vincent's Birmingham Jeremiah's Hope Skills Program focuses on training at-risk individuals, particularly women, for entry level jobs in the healthcare industry. Today, more than 500 people have graduated from Jeremiah's Hope, and most are still working in the healthcare industry. St. Vincent's has also recently partnered with Jeff State Community College to begin identifying ""under-employed"" individuals from within our own workforce and training them to become nurses. Philanthropy allowed this revolutionary program to blossom and it has now become a model for other healthcare facilities nationwide. In 2003, St. Vincent's Birmingham initiated a Hispanic Outreach program, La Sana Esperanza/The Healthy Hope, recognizing the changing demographics in Birmingham. This program provides health and medical assistance to the burgeoning Latino population, often an isolated sector of our community. By identifying and placing high-risk persons in our Access To Care Program, we are providing critical care for those in need in a fiscally responsible manner. We have provided health fairs, health screenings, health information, case management assistance, and language assistance to a myriad of persons within the Birmingham community in order to break down the barriers that lead to poor heath in the Latino population. The Access to Care Program is a healthcare option for the ""working poor"" in the Birmingham area, serving individuals who are employed but lack health insurance. The Clinic treats up to 350 patients at any given time, providing for all of their healthcare needs at no cost to the patient. St. Vincent's works with patients to identify ways to acquire insurance and screens patients based on a willingness to make life changes conducive to good health. This charity care is only made possible because of charitable gifts which provide the equipment, space and staffing the Clinic needs. The Clinic is a service for those patients who have no other options and is possible because of the many philanthropists who support this ministry. The St. Vincent's Birmingham Elder Care Services Program was created in response to a need expressed by a donor to St. Vincent's Foundation. That donor is a self-described Elder Orphan. She has few family members and no prospects to assist her with care as she ages. She worries about her future when the time comes when she is no longer able to drive herself to and from physician appointments and to the grocery store. She trusts St. Vincent's to care for her medical needs and wondered if there was a way for St. Vincent's to assist people like her who will need additional assistance as they age. The idea was presented to Susann Montgomery-Clark in the Foundation office, and after more than two years of focus groups and meetings with St. Vincent's associates, the project was officially launched. Initial funding was requested from a group of focus group members who were supportive and excited about the project and a grant was obtained from the Daughters of Charity to begin work on the outline of services that the Elder Care Services Program might provide. Just in its infancy, the Elder Care Program has hopes to become one that assists our original donor and those like her who will need support services in their twilight years. We Are Called To: - Service of the Poor - Generosity of spirit, especially for persons most in need - Reverence - Respect and compassion for the dignity and diversity of life - Integrity-Inspiring trust through personal leadership - Wisdom-Integrating excellence and stewardship - Creativity -Courageous innovation - Dedication - Affirming the hope and joy of our ministry. St. Vincent's Health System is made up of five facilities: St. Vincent's Birmingham, St. Vincent's Blount, St. Vincent's East, St. Vincent's St. Clair, and One Nineteen Health and Wellness. Together, we provide a special brand of high-touch, high-tech quality care to people in more than 40 different zip codes. Our healthcare family has an extensive network of skilled physicians and associates, as well as the most advanced technologies available. We are a part of Ascension Health, the nation's largest Catholic and non-profit health system, with more than 150,000 associates serving in 23 states and the District of Columbia. We are committed to providing healthcare that works, healthcare that is safe, and healthcare that leaves no one behind for life."

Schedule H, Part VI, Line 6 Affiliated health care system
St. Vincent's Health System (the Health Ministry) is a member of Ascension Health. Ascension Health Alliance is a Missouri nonprofit corporation formed on September 13, 2011. Ascension Health Alliance is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia. Ascension is sponsored by Ascension Sponsor, a Public Juridic Person. The Participating Entities of Ascension Sponsor are the Daughters of Charity of St. Vincent de Paul, St. Louise Province; the Congregation of St. Joseph; the Congregation of the Sisters of St. Joseph of Carondelet; the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province. As more fully described in the Organizational Changes note, Marian Health System, which was previously sponsored by the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province, became part of Ascension Health on April 1, 2013. Mission: The System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually centered care which sustains and accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs: 1. Traditional charity care includes the cost of services provided to persons who cannot afford healthcare because of inadequate resources and/or who are uninsured or underinsured. 2. Unpaid cost of public programs represents the unpaid cost of services provided to persons covered by public programs for the persons living in poverty and other vulnerable persons. 3. Cost of other programs for the persons living in poverty and other vulnerable persons includes programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community including substance abusers, the homeless victims of child abuse and persons with acquired immune deficiency syndrome. 4. Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for persons living in poverty and other vulnerable persons, including health promotion and education, health clinics and screenings and medical research. Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and community benefit programs. The cost of providing care to persons living in poverty and community benefit programs is estimated by reducing charges forgone by a factor derived from the ratio of each entity's total operating expenses to the entity's billed charges for patient care.