4A (Expenses $ 170922877 including grants of $ 295898) (Revenue $ 188824741)
ST. JOSEPH MERCY CHELSEA (CHELSEA HOSPITAL) IS A 133-BED, NOT-FOR-PROFIT JOINT VENTURE HOSPITAL, WHOSE PARTNERS ARE TRINITY HEALTH - SOUTHEAST MICHIGAN, A MEMBER OF NATIONAL CATHOLIC HEALTH CARE SYSTEM TRINITY HEALTH BASED IN LIVONIA, MICH., AND MICHIGAN MEDICINE (UM), THE ACADEMIC MEDICAL CENTER OF THE UNIVERSITY OF MICHIGAN. FOUNDED IN 1970, CHELSEA HOSPITAL IS NATIONALLY RECOGNIZED FOR BOTH QUALITY OF CARE AND PATIENT SATISFACTION BY NATIONAL RANKING ORGANIZATION PRESS GANEY, AND IS ACCREDITED BY THE JOINT COMMISSION. CHELSEA HOSPITAL EMPLOYS MORE THAN 1,300 INDIVIDUALS WITH A MEDICAL STAFF OF APPROXIMATELY 500 PHYSICIANS. KEY SERVICES INCLUDE ROBUST MEDICAL AND SURGICAL SERVICE LINES, EIGHT OPERATING ROOMS, A 24-HOUR EMERGENCY DEPARTMENT AND SENIOR EMERGENCY ROOM, A STATE-OF-THE-ART CANCER CENTER, A PHYSICAL MEDICINE AND REHABILITATION DEPARTMENT, A COMPREHENSIVE HEAD PAIN TREATMENT UNIT AND BEHAVIORAL HEALTH SERVICES. AS A NOT-FOR-PROFIT HOSPITAL, CHELSEA HOSPITAL REINVESTS ITS PROFITS INTO THE COMMUNITY THROUGH PROGRAMS TO SERVE THE POOR AND UNINSURED, MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDE HEALTH EDUCATION, AND OUTREACH TO THE ELDERLY.PLEASE SEE SCHEDULE H AND VISIT OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITIONS AND AWARDS:WWW.STJOESCHELSEA.ORG

CHELSEA HOSPITAL
PART V, SECTION B, LINE 3J: N/ALINE 3E: ST. JOSEPH MERCY CHELSEA (CHELSEA HOSPITAL) INCLUDED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED CHNA. THE FOLLOWING COMMUNITY HEALTH NEEDS FOR CHELSEA HOSPITAL WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED FOR FISCAL YEAR 2021 (FY21) THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1. MENTAL HEALTH AND SUBSTANCE USE DISORDERS2. OBESITY AND RELATED ILLNESSES3. PRECONCEPTUAL AND PERINATAL HEALTH

CHELSEA HOSPITAL
PART V, SECTION B, LINE 5: BEGINNING IN THE FALL OF 2020 AND THROUGH THE SPRING OF 2021, CHELSEA HOSPITAL, AS A PART OF THE COLLABORATIVE NEEDS ASSESSMENT PROCESS WITH TRINITY HEALTH ANN ARBOR (THAA) AND MICHIGAN MEDICINE, CONSULTED MANY COMMUNITY ORGANIZATIONS TO TAKE INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY AND MINORITY POPULATIONS THROUGH KEY STAKEHOLDER INTERVIEWS AND COMMUNITY SURVEYS. THE HOSPITAL COLLABORATORS, NAMED UNIFIED NEEDS ASSESSMENT IMPLEMENTATION PLAN TEAM ENGAGEMENT (UNITE), SOUGHT QUALITATIVE INPUT FROM COMMUNITY MEMBERS AND KEY STAKEHOLDERS ON THE TOP COMMUNITY HEALTH NEEDS, AS WELL AS BROADER COMMUNITY NEEDS.UNITE MEMBERS COLLECTED THIS DATA DURING VIRTUAL MEETINGS OF WELLNESS COALITIONS, SAFETY-NET ORGANIZATIONS, FOOD PANTRIES, MINISTERIAL ASSOCIATIONS, AND WASHTENAW HEALTH INITIATIVE STAKEHOLDERS. THE HOSPITALS ALSO COLLECTED THIS DATA ELECTRONICALLY, VIA A SURVEY SENT TO COMMUNITY PARTNERS (INCLUDING HEALTH CARE PROVIDERS, SOCIAL SERVICE PROVIDERS, AND COMMUNITY-BASED ORGANIZATIONS). THESE ORGANIZATIONS INCLUDED: THE CHELSEA, DEXTER, MANCHESTER, GRASS LAKE AND STOCKBRIDGE WELLNESS COALITIONS, AND THE CHELSEA HOSPITAL PATIENT EXPERIENCE TEAM. THESE ORGANIZATIONS REPRESENT THE LOW-INCOME, MINORITY, AND MEDICALLY UNDERSERVED POPULATIONS IN THE CHELSEA HOSPITAL SERVICE AREA.

CHELSEA HOSPITAL
PART V, SECTION B, LINE 6A: CHELSEA HOSPITAL CONDUCTED THE CHNA WITH TRINITY HEALTH ANN ARBOR HOSPITAL AND MICHIGAN MEDICINE (D/B/A UNIVERSITY OF MICHIGAN HEALTH SYSTEM).

CHELSEA HOSPITAL
PART V, SECTION B, LINE 6B: CHELSEA HOSPITAL CONDUCTED THE CHNA WITH THE WASHTENAW COUNTY HEALTH DEPARTMENT.

CHELSEA HOSPITAL
PART V, SECTION B, LINE 7D: ANNUALLY, CHELSEA HOSPITAL PRODUCES A COMMUNITY BENEFIT REPORT INCLUDING FINANCIAL INFORMATION AND STORIES ABOUT THE HOSPITAL'S PROGRAMS. THE REPORT DESCRIBES THE COMMUNITY HEALTH NEEDS ASSESSMENT, AND CHELSEA HOSPITAL MAKES IT AVAILABLE TO OUR EMPLOYEES AND COMMUNITY MEMBERS IN KIOSKS THROUGHOUT THE HOSPITAL.

CHELSEA HOSPITAL
PART V, SECTION B, LINE 11: AS A PART OF THE COLLABORATIVE CHNA PROCESS WITH TRINITY HEALTH ANN ARBOR HOSPITAL (THAA) AND MICHIGAN MEDICINE, THE COMMUNITY HEALTH NEEDS PRIORITIZED WERE MENTAL HEALTH AND SUBSTANCE USE, OBESITY-RELATED ILLNESSES, AND PRECONCEPTUAL/PERINATAL HEALTH. CHELSEA HOSPITAL ADDRESSED THE FOLLOWING NEEDS IN FY22:MENTAL HEALTH AND SUBSTANCE USE DISORDER - IN FY22, CHELSEA HOSPITAL CONTINUED WORKING TO IMPROVE THE COORDINATION OF AND SUPPORT FOR EXISTING COMMUNITY RESOURCES ADDRESSING BEHAVIORAL HEALTH IN OUR COMMUNITY BY:- CONTRIBUTING TOWARD IMPROVING ACCESS TO AND INTEGRATION OF BEHAVIORAL HEALTH SERVICES ACROSS THE LIFESPAN, SUBSTANCE USE DISORDER TREATMENT, AND SUPPORT FOR PATIENT COMPLIANCE;- ADDRESSING ACCESS TO CARE BARRIERS FOR THOSE MOST VULNERABLE IN THE COMMUNITY WE SERVE;- PARTNERING WITH SCHOOLS TO EXPAND COUNSELING RESOURCES FOR YOUTH AT RISK OF DEVELOPING SUBSTANCE USE DISORDER;- COORDINATING COMMUNITY COALITIONS TO PREVENT YOUTH SUBSTANCE ABUSE AND PROMOTE YOUTH MENTAL HEALTH; AND- ENGAGING SOCIAL SERVICE ORGANIZATIONS PROVIDING SERVICES AROUND MENTAL HEALTH AND SUBSTANCE USE DISORDER THROUGH A PUBLIC-PRIVATE FUNDING PARTNERSHIP THAT ENCOURAGES ALIGNMENT AND REDUCTION OF DUPLICATION ACROSS COMMUNITY-LEVEL OUTCOMES AROUND BEHAVIORAL HEALTH SERVICES.OBESITY - IN FY22, CHELSEA HOSPITAL CONTINUED WORKING TO IMPROVE THE COORDINATION OF AND SUPPORT FOR EXISTING COMMUNITY RESOURCES ADDRESSING OBESITY-RELATED ILLNESSES, AND THEIR ROOT CAUSES, IN OUR COMMUNITY. CHELSEA HOSPITAL SUPPORTED THE COMMUNITY THROUGH:- EFFORTS SEEKING TO INCREASE ACCESS TO NUTRITIOUS FOODS THROUGH THE AVAILABILITY OF AFFORDABLE, LOCALLY SOURCED OPTIONS, COUPLED WITH NUTRITION EDUCATION AND SYSTEMS CHANGE TO ENCOURAGE LONG-TERM BEHAVIOR CHANGE;- OPPORTUNITIES FOR PHYSICAL ACTIVITY THROUGH SUPPORTING POLICY AND ENVIRONMENTAL CHANGE BUILT AROUND ENVIRONMENT STRATEGIES;- THE EVIDENCE-BASED DIABETES PREVENTION PROGRAM FOR ADULTS AT RISK OF DEVELOPING DIABETES; AND- ENGAGEMENT OF SOCIAL SERVICE ORGANIZATIONS PROVIDING SERVICES AROUND FOOD INSECURITY THROUGH A PUBLIC-PRIVATE FUNDING PARTNERSHIP THAT ENCOURAGES ALIGNMENT AND REDUCTION OF DUPLICATION ACROSS COMMUNITY-LEVEL OUTCOMES AROUND NUTRITION AND HUNGER RELIEF.PRECONCEPTUAL/PERINATAL HEALTH - BECAUSE CHELSEA HOSPITAL IS NOT A BIRTHING HOSPITAL, PREGNANT WOMEN LIVING IN OUR SERVICE AREA GO TO OTHER PROVIDERS FOR CARE. IN ORDER TO INCREASE ACCESS TO INFORMATION THAT SUPPORTS BREASTFEEDING, CHELSEA HOSPITAL BEGAN OFFERING FREE BREASTFEEDING EDUCATION CLASSES IN FY22.

CHELSEA HOSPITAL
PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.

CHELSEA HOSPITAL
PART V, SECTION B, LINE 20E: THE HOSPITAL OFFERED INFORMATION FOR OTHER VARIETIES OF PAYMENT PLAN OPTIONS, AND OFFERED AUTOMATED PRESUMPTIVE CHARITY FOR SELF-PAY ACCOUNTS.

ST. JOSEPH MERCY CHELSEA - PART V, SECTION B, LINE 7A
WWW.STJOESHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/

ST. JOSEPH MERCY CHELSEA - PART V, SECTION B, LINE 7B
WWW.UOFMHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

ST. JOSEPH MERCY CHELSEA - PART V, SECTION B, LINE 9
AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC.

ST. JOSEPH MERCY CHELSEA - PART V, SECTION B, LINE 10A
WWW.STJOESHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT/

ST. JOSEPH MERCY CHELSEA - PART V, SECTION B, LINE 16A
WWW.STJOESHEALTH.ORG/FOR-PATIENTS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE/

ST. JOSEPH MERCY CHELSEA - PART V, SECTION B, LINE 16B
WWW.STJOESHEALTH.ORG/FOR-PATIENTS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE/

ST. JOSEPH MERCY CHELSEA - PART V, SECTION B, LINE 16C
WWW.STJOESHEALTH.ORG/FOR-PATIENTS/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE/

PART I, LINE 3C:
IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS.

PART I, LINE 6A:
ST. JOSEPH MERCY CHELSEA (CHELSEA HOSPITAL) REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG. IN ADDITION, CHELSEA HOSPITAL INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE.

PART I, LINE 7:
THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM.

PART I, LN 7 COL(F):
THE FOLLOWING NUMBER, $4,810,148, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F).

PART III, LINE 2:
METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.

PART III, LINE 3:
CHELSEA HOSPITAL USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, CHELSEA HOSPITAL IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, CHELSEA HOSPITAL IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL.

PART III, LINE 4:
"CHELSEA HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE PATIENT ACCOUNTS RECEIVABLE, ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS FOOTNOTE FROM PAGE 13 OF THOSE STATEMENTS: AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTABLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE.THE CORPORATION HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE CORPORATION'S HEALTH MINISTRIES AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS AND OTHER CHANGES IN ESTIMATES ARE INCLUDED IN NET PATIENT SERVICE REVENUE AND ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED.""PART III, LINE 5: TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE ONE PERCENT SEQUESTRATION REDUCTION FOR THE PERIOD APRIL 1, 2022 THROUGH JUNE 30, 2022."

PART III, LINE 8:
CHELSEA HOSPITAL DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT.

PART III, LINE 9B:
THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS.

PART VI, LINE 2:
NEEDS ASSESSMENT - THE HOSPITAL ASSESSES THE HEALTH STATUS OF ITS COMMUNITIES, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITIES. IN THE ASSESSMENT OF ITS COMMUNITIES, THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, COMMITTEE MEETINGS WITH MEDICAL STAFF (PHYSICIANS) AND DEPARTMENT STAFF, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES, AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - CHELSEA HOSPITAL COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES, FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS, AND OTHER COMMUNITY-BASED CHARITABLE PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. CHELSEA HOSPITAL OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. CHELSEA HOSPITAL HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. CHELSEA HOSPITAL MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER.

PART VI, LINE 4:
THE CHELSEA HOSPITAL SERVICE AREA IS DEFINED AS THE GEOGRAPHIC AREA ENCOMPASSING THE ZIP CODES OF CHELSEA, DEXTER, GRASS LAKE, GREGORY, MANCHESTER, MUNITH, AND STOCKBRIDGE, MICHIGAN. THIS INCLUDES SECTIONS OF FOUR COUNTIES (WESTERN WASHTENAW, SOUTHEASTERN INGHAM, SOUTHWESTERN LIVINGSTON, AND EASTERN JACKSON) AND ALL OR PART OF THE FOLLOWING CITIES, VILLAGES, AND TOWNSHIPS: BRIDGEWATER, CHELSEA, DEXTER, DEXTER TOWNSHIP, FREEDOM, GRASS LAKE, HENRIETTA, LIMA, LYNDON, MANCHESTER, SCIO, SHARON, STOCKBRIDGE, SYLVAN, UNADILLA, WATERLOO, WEBSTER, VILLAGE OF GRASS LAKE, VILLAGE OF MANCHESTER, AND VILLAGE OF STOCKBRIDGE. ACCORDING TO THE HOSPITAL'S PLANNING DEPARTMENT, THE CHELSEA HOSPITAL SERVICE AREA WAS DETERMINED BY THE GEOGRAPHIC PROXIMITY OF THESE COMMUNITIES TO THE HOSPITAL IN CHELSEA, MI. THE TOTAL POPULATION OF THE SIX ZIP CODES INCLUDED IN THE CHELSEA HOSPITAL SERVICE AREA IS 56,023 ACCORDING TO THE 2010 CENSUS. THE AVERAGE RACE DISTRIBUTION FOR THE SERVICE AREA IS 95% CAUCASIAN, 2.1% HISPANIC, AND LESS THAN 1% EACH OF OTHER RACES. THE AVERAGE AGE FOR THE SERVICE AREA IS 42.5.

PART VI, LINE 5:
OTHER INFORMATION - CHELSEA HOSPITAL PROVIDES FINANCIAL AND IN-KIND STAFF SUPPORT TO COMMUNITY ORGANIZATIONS SERVING THOSE WHO ARE POOR AND VULNERABLE IN OUR SERVICE AREA. THESE INCLUDE FOOD PANTRIES, SENIOR CENTERS, AND AGENCIES THAT PROVIDE TRANSPORTATION. THROUGH THESE FUNDS, CHELSEA HOSPITAL AIMS TO MAKE POSITIVE CHANGES IN SOCIAL INFLUENCERS (DETERMINANTS) OF HEALTH, INCLUDING FOOD ACCESS, TRANSPORTATION, SOCIAL ISOLATION, AND HOUSING. CHELSEA HOSPITAL ALSO SERVES AS THE FISCAL AGENT FOR THE CHELSEA FARMERS MARKET AND PROVIDES SIGNIFICANT FINANCIAL AND IN-KIND SUPPORT TO THAT MARKET, WITH THE GOAL OF INCREASING ACCESS TO HEALTHY FOODS, AND CONTRIBUTING TO THE LOCAL ECONOMY. CHELSEA HOSPITAL ALSO HELPS FACILITATE COMMUNITY COALITIONS TO PROMOTE YOUTH MENTAL HEALTH AND PREVENT YOUTH SUBSTANCE ABUSE. CHELSEA HOSPITAL STAFF PARTICIPATE ON FIVE LOCAL WELLNESS COALITIONS, AIMED AT IMPROVING HEALTH FOR ALL RESIDENTS OF THE HOSPITAL'S PRIMARY SERVICE AREA.

PART VI, LINE 6:
CHELSEA HOSPITAL IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH'S COMMUNITY HEALTH AND WELL-BEING (CHWB) STRATEGY PROMOTES OPTIMAL HEALTH FOR PEOPLE EXPERIENCING POVERTY AND OTHER VULNERABILITIES IN THE COMMUNITIES WE SERVE BY CONNECTING SOCIAL AND CLINICAL CARE, ADDRESSING SOCIAL NEEDS, DISMANTLING SYSTEMIC RACISM, AND REDUCING HEALTH INEQUITIES. WE DO THIS BY: 1. INVESTING IN OUR COMMUNITIES, 2. ADVANCING SOCIAL CARE, AND 3. IMPACTING SOCIAL INFLUENCERS OF HEALTH.TO FURTHER OUR STRATEGY IN FISCAL YEAR 2022 (FY22), CHWB LAUNCHED TWO TRAINING SERIES TO ADVANCE HEALTH AND RACIAL EQUITY IN OUR COMMUNITIES.1. CHWB LEADER SERIES TO ADVANCE HEALTH AND RACIAL EQUITY: A YEAR-LONG PEER LEARNING SERIES TO BUILD THE CAPACITY OF OUR CHWB LEADERS TO DELIVER ON OUR CHWB STRATEGY WITH A FOCUS ON COMMUNITY LEADERSHIP AND ENGAGEMENT, AND THE USE OF A RACIAL EQUITY LENS IN ALL OF OUR DECISION MAKING. 2. COMMUNITY ENGAGEMENT TO ADVANCE RACIAL JUSTICE - PREPARING FOR IMPLEMENTATION STRATEGY: A FOUR-PART SERIES ON ENGAGING OUR COMMUNITIES IN MEANINGFUL WAYS USING A HEALTH EQUITY AND RACIAL EQUITY LENS TO BUILD LASTING PARTNERSHIPS AND IMPACTFUL IMPLEMENTATION STRATEGIES.INVESTING IN OUR COMMUNITIES - TRINITY HEALTH AND ITS MEMBER HOSPITALS ARE COMMITTED TO THE DELIVERY OF PEOPLE-CENTERED CARE AND SERVING AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN THE COMMUNITIES THEY SERVE. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITIES AND IS COMMITTED TO ADDRESSING THE UNIQUE NEEDS OF EACH COMMUNITY. IN FY22, TRINITY HEALTH CONTRIBUTED $1.37 BILLION IN COMMUNITY BENEFIT SPENDING TO AID THOSE WHO ARE VULNERABLE AND LIVING IN POVERTY, AND TO IMPROVE THE HEALTH STATUS OF THE COMMUNITIES IN WHICH WE SERVE. SOME EXAMPLES OF THESE INVESTMENTS INCLUDE: TRINITY HEALTH AWARDED OVER $1.6 MILLION IN COMMUNITY GRANTS THAT DIRECTLY ALIGN WITH INTERVENTIONS AND LOCAL PARTNERSHIPS IDENTIFIED IN ITS MEMBER HOSPITALS' COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IMPLEMENTATION STRATEGIES, INCLUDING ACCESS TO HEALTH CARE, MENTAL HEALTH, TRANSPORTATION, COMMUNITY ENGAGEMENT, FOOD ACCESS, AND HOUSING SUPPORTS. WITH A $1.2 MILLION INITIAL INVESTMENT, TRINITY HEALTH LAUNCHED ROUND 2 OF THE TRANSFORMING COMMUNITIES INITIATIVE (TCI), A FIVE-YEAR, INNOVATIVE FUNDING AND TECHNICAL ASSISTANCE INITIATIVE, PARTNERING WITH COMMUNITY-BASED ORGANIZATIONS AND RESIDENTS TO ADVANCE HEALTH AND RACIAL EQUITY IN NINE OF OUR COMMUNITIES EXPERIENCING HIGH POVERTY AND OTHER VULNERABILITIES. HEALTH MINISTRIES RECEIVING TCI FUNDING ARE COLLABORATING WITH A LOCAL MULTI-SECTOR COLLABORATIVE TO DEVELOP AND IMPLEMENT EVIDENCE-BASED STRATEGIES THAT ADVANCE HEALTH AND RACIAL EQUITY THROUGH ADDRESSING AT LEAST ONE ROOT CAUSE OF POOR HEALTH IDENTIFIED IN THE DEVELOPMENT OF THEIR MOST RECENT CHNA IMPLEMENTATION STRATEGY. TRINITY HEALTH AWARDED OVER $1 MILLION IN COVID-19 FUNDING TO SUPPORT NEW AND ONGOING COMMUNITY ENGAGEMENT AND MOBILIZATION EFFORTS AROUND MAKING THE COVID-19 VACCINATION ACCESSIBLE TO ALL ELIGIBLE POPULATIONS. THIS FUNDING WAS DESIGNED TO SUPPORT ALL COMMUNITIES TO ENSURE EASY AND EQUITABLE ACCESS TO THE VACCINE BY REMOVING BARRIERS FOR ALL PEOPLE TO RECEIVE THE VACCINE, ESPECIALLY COMMUNITIES THAT HAVE LESS THAN A 75% VACCINATION RATE. WITH THIS FUNDING, HEALTH MINISTRIES FACILITATED 3,200 COVID-19 VACCINE EVENTS, ADMINISTERED 80,000 COVID-19 VACCINE DOSES, AND REACHED 874,000 PEOPLE WITH EDUCATIONAL MATERIALS ON COVID-19 AND THE BENEFITS OF VACCINATION.IN ADDITION TO THE $1.37 BILLION IN COMMUNITY BENEFIT SPENDING, OUR COMMUNITY INVESTING PROGRAM HAD THE MOST ROBUST YEAR OF LENDING SINCE THE PROGRAM'S INCEPTION OVER 20 YEARS AGO: $17.8 MILLION IN NEW LOANS AND $8.3 MILLION IN LOAN RENEWALS WERE APPROVED, FOCUSING ON BUILDING AFFORDABLE HOUSING AND INCREASING ACCESS TO EDUCATION IN PARTNERSHIP WITH OUR HEALTH MINISTRIES. ADVANCING SOCIAL CARE - TRINITY HEALTH'S SOCIAL CARE PROGRAM WAS DEVELOPED TO ADDRESS SOCIAL NEEDS, SUCH AS ACCESS TO TRANSPORTATION, CHILDCARE, OR AFFORDABLE MEDICATIONS BY FACILITATING CONNECTIONS BETWEEN OUR PATIENTS, HEALTH CARE PROVIDERS AND COMMUNITY PARTNERS THAT PROMOTE HEALTHY BEHAVIORS. HIGHLIGHTS FROM FY22 INCLUDE THE FOLLOWING SUCCESSES:- LAUNCHED TRINITY HEALTH COMMUNITY HEALTH WORKER (CHW) CERTIFICATION PROGRAM, TRAINING 86 CHWS WITH 40+ HOURS OF TRAINING, AND INCREASED CHW STAFF ACROSS MOST HEALTH MINISTRIES- LAUNCHED A SYSTEM-WIDE ASSESSMENT OF LANGUAGE ACCESS SERVICES TO RECOMMEND SYSTEM STANDARDS THAT ENSURE CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES FOR ALL OF OUR PATIENTS, THEIR COMPANIONS, AND CAREGIVERS- ENGAGED OVER 1,100 PARTICIPANTS IN THE NATIONAL DIABETES PREVENTION PROGRAM, EXCEEDING OUR PROGRAM YEAR 5 GOAL- INCREASED THE NUMBER OF ACTIVE COMMUNITY PARTNER ORGANIZATIONS ON THE COMMUNITY RESOURCE DIRECTORY BY 120% FROM FISCAL YEAR 2021- ENGAGED 5,300+ PATIENTS WHO ARE DUALLY ENROLLED IN MEDICARE AND MEDICAID IN A SOCIAL CARE OR MEDICAL CARE ACTIVITY, IN SUPPORT OF REDUCING PREVENTABLE HOSPITALIZATIONS (SUCH AS DIABETES AND ASTHMA)IMPACTING SOCIAL INFLUENCERS OF HEALTH - LEVERAGING INVESTOR POWER TO CATALYZE CORPORATE SOCIAL RESPONSIBILITY, TRINITY HEALTH'S SHAREHOLDER ADVOCACY WORK FOCUSES ON DISMANTLING RACISM ACROSS FIVE STRATEGIC FOCUS AREAS BY HOLDING CORPORATIONS ACCOUNTABLE FOR THE HUMAN RIGHTS VIOLATIONS THOSE COMPANIES PERPETUATE IN THE U.S. AND BEYOND. IN FY22, TRINITY HEALTH FACILITATED OVER 135 SHAREHOLDER ADVOCACY ENGAGEMENTS, WITH GREAT SUCCESS:- FIVE BELOW COMMITTED TO ASSESS AND MANAGE THE RISKS/HAZARDS ASSOCIATED WITH CHEMICALS OF HIGH CONCERN CONTAINED IN THEIR PRIVATE LABEL PRODUCTS- UNILEVER AGREED TO STOP FOOD AND BEVERAGE MARKETING TO CHILDREN UNDER AGE 16, AND WILL ADOPT NEW TARGETS TO REDUCE SALT, ADDED SUGARS AND CALORIES, AND INCREASE SALES OF THEIR HEALTHIER PRODUCTS- PEPSICO SET GOALS TO INCREASE POSITIVE NUTRIENTS IN THEIR PRODUCTS- PDC ENERGY ACCELERATED ITS GOAL TO END ROUTINE FLARING OF METHANE, FROM 2030 TO 2025, THUS REDUCING ENVIRONMENTAL HEALTH RISKS AND GREENHOUSE GAS EMISSIONSADDITIONALLY, TRINITY HEALTH AND OTHER MEMBERS OF THE INTERFAITH CENTER ON CORPORATE RESPONSIBILITY GUN SAFETY GROUP SUBMITTED A SHAREHOLDER RESOLUTION ASKING STURM RUGER, ONE OF THE NATION'S LEADING MANUFACTURERS OF FIREARMS, TO CONDUCT AND PUBLISH AN INDEPENDENT HUMAN RIGHTS IMPACT ASSESSMENT OF ITS POLICIES, PRACTICES AND PRODUCTS, AND MAKE RECOMMENDATIONS FOR IMPROVEMENT. THE RESOLUTION RECEIVED A 68.5% VOTE IN FAVOR, WELL ABOVE THE THRESHOLD REQUIRED FOR THE RESOLUTION TO BE RESUBMITTED IN 2023, INDICATING A LARGE MAJORITY OF STURM RUGER INVESTORS BELIEVE THE COMPANY HAS TO ADDRESS ITS HUMAN RIGHTS IMPACTS. TRINITY HEALTH AND TRINITY HEALTH OF NEW ENGLAND ARE CITED AS PART OF THE GROUP WHO MOVED FORWARD THIS RESOLUTION.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG.