4A (Expenses $ 1462133929 including grants of $ 520643) (Revenue $ 1684355053)
PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

Schedule H, Part V, Section B, Line 3E
THE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - Facility Group A. A single online community health needs assessment survey was available for community members across multiple service areas of all collaborating hospital systems, inclusive of Missouri and Illinois. The online community survey was available to complete from April 2021 through July 2021. This survey asked about people's personal health, their thoughts about the community's health, and provided sections for people to provide on ways to improve both individual and community health. The survey took an average of 10 minutes to complete with a total of 2,915 individuals completing the survey. A total of 378 responses were received from St. Louis City zip codes, accounting for 13 percent of survey responses. All respondents were asked to provide their primary zip codes, which were tagged according to the SSM and partner hospital CHNA community geographies. Community members had the option to submit open ended responses, comments and suggestions throughout the survey. Additionally, community conversations were held virtually, engaging individuals from SSM Health service areas where response rates were significantly lower in comparison to other service areas. These conversations helped us learn more about residents' concerns, solicit ideas, learn of their health care experiences and identify opportunities for improvement. These conversations also provided critical insight on community perceptions and generated ideas on how to improve health care access and resources. Community leaders were also engaged to complete the Stakeholder CHNA survey. Stakeholders included a diverse group of community professionals from organizations across service areas, providing a vast array of critical services including health access, social needs, education and emergency services. Upon completion, surveys were analyzed through the survey platform in order to identify common themes. Secondary data was collected from multiple sources including The County Health Rankings, ExploreMoHealth, and Think Health St. Louis. Analysis of these data sources revealed not only the most burdensome health issues, but also health disparities and key issues impacting social determinants of health. Data assessed included demographic information, chronic disease and morbidity/mortality information, health status indicators, health behaviors and general environment information. This data is compared to state and national benchmarks. Primary and secondary data were weighted in order to determine highest priority community health needs, based on importance to community members and the hospital's ability to make meaningful impact over the next several years. Organizations included in stakeholder data gathering and discussion include: St. Charles County: Aging Ahead Calvary Church Community Council EDC of St. Charles County Fort Zumwalt School District Lindenwood Athletics Lutheran High School - St. Charles O'Fallon Fire Protection District Prevent + Ed Saint Louis Crisis Nursery St. Charles County Department of Public Health Sts. Joachim and Ann Care Services United Services for Children US House of Representatives Youth in Need North St. Louis County: Aging Ahead Alive and Well Communities Asthma and Allergy Foundation - St. Louis Cornerstone Realty Jewish and Family Services of St. Louis Our Family's Doing Yoga Refuge and Restoration Prevent + Ed St. Louis Area Diaper Bank St. Louis County Department of Health St. Luke's Hospital St. Louis City: Affinia Healthcare Alive and Well Communities Behavioral Health Network BJC Healthcare Casa de Salud City of St. Louis Department of Health Community Health In Partnership Services (CHIPS) Gateway Region YMCA Health Literacy Media IFM Community Medicine Missouri Department of Health and Senior Services Missouri Foundation for Health Operation Food Search Peoples Health Center Places for People Rise Community Development St. Louis Integrated Health Network St. Vincent DePaul State Farm Urban League of Metropolitan Youth In Need

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - SSM Health St. Mary's Hospital - St. Louis. THE HOSPITAL CONDUCTED AND COMPLETED ITS 2021 CHNA JOINTLY WITH SSM HEALTH CARDINAL GLENNON CHILDREN'S HOSPITAL AND SSM HEALTH SAINT LOUIS UNIVERSITY HOSPITAL.

Schedule H, Part V, Section B, Line 6a Facility A, 2
Facility A, 2 - SSM Health St. Joseph Hospital - St. Charles and SSM Health St. Joseph Hospital - Lake Saint Louis. BOTH HOSPITALS CONDUCTED AND COMPLETED A JOINT 2021 CHNA.

Schedule H, Part V, Section B, Line 6a Facility A, 3
Facility A, 3 - SSM Health DePaul Hospital - St. Louis. THE HOSPITAL CONDUCTED AND COMPLETED ITS 2021 CHNA JOINTLY WITH SSM HEALTH REHABILITATION HOSPITAL.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - SSM Health DePaul Hospital - St. Louis. The hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Behavioral health - Heart health/nutrition - Respiratory diseases Behavioral Health Behavioral Health (BH), inclusive of mental health and substance use disorders, was determined to be a priority health need in each hospital ministry community's CHNA process. The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability. Substance abuse disorders have a major impact on individuals, families, and communities. The effects of substance abuse are cumulative, significantly contributing to costly social, physical, mental, and public health problems. In 2019, 18.5% of residents in the Inner North region of St. Louis County reported experiencing 14 or more poor mental health days in the past month compared to the national average of 13.6%. The hospital has implemented the following strategies to improve community behavioral health: - Increase access to existing mental and behavioral health programs and services - Support initiatives that build capacity of local partners addressing access to behavioral health services and care - Support and advocate for policies that improve access and services to behavioral health - Strengthen internal behavioral health services and capacities - Promote safe medication disposal - Fund evidence-based & innovative approaches - Ensure data equity and public health education The short-term and long-term impacts of these activities are as follows: - Consistent and strategic SSM and community partnerships focused on behavioral health - Increased internal and community knowledge and awareness of the importance and impact of behavioral health care - Increased policies supporting equitable behavioral health treatment and care - Healthier communities with improved access to mental health and substance abuse care Heart health/nutrition Controlling risk factors for heart disease and stroke remains a challenge. High blood pressure, cigarette smoking, and high blood cholesterol are still major contributors to the national epidemic of cardiovascular disease. The risk of Americans developing and dying from cardiovascular disease would be substantially reduced if major improvements were made across the U.S. population in diet and physical activity, control of high blood pressure and cholesterol, smoking cessation, and appropriate aspirin use. Black/African American residents in St. Louis County are disproportionately affected by heart disease to a staggering degree, consistently having higher mortality and hospital visit rates compared to other racial/ethnic groups in the county. The hospital has the following action plan in place to improve the heart health for its community: - Support initiatives that build capacity of local partners addressing nutrition and heart disease - Increase access to heart disease management services - Support and advocate for policies that improve access to nutritious foods - Strengthen internal awareness and knowledge of heart disease disparities through education and skills development - Guide direct and collaborative funding - Ensure data equity and public health education The short-term and long-term impacts of these activities are as follows: - Consistent and strategic SSM and community partnerships focused on heart health and nutrition - Increased internal and community knowledge and awareness of the importance of heart health and nutrition - Increased community consumption of nutritious foods - Increased heart healthy activities - Increased advocacy for change - Increased policies supporting healthy living for all Respiratory Diseases Respiratory diseases affect millions of people in the United States. The burden of respiratory diseases affects individuals and their families, schools, workplaces, neighborhoods, cities, and states. Asthma and chronic obstructive pulmonary disease (COPD) are significant public health burdens. There are also several emerging respiratory health issues such as the impact of environmental change and increasing importance of indoor air quality. North St. Louis County has disproportionately higher rates of asthma compared to other areas in St. Louis County. High asthma hotspots are associated with characteristics of environment risk. The hospital has the following action plan in place to improve respiratory disease health and care in the community: - Support initiatives that build capacity of local partners addressing respiratory health - Increase access to respiratory health services and prescriptions - Support and advocate for policies that improve air quality - Strengthen internal respiratory health services, ensuring equity and cultural competency - Guide direct and collaborative funding - Ensure data equity and public health education The short-term and long-term impacts of these activities are as follows: - Consistent and strategic SSM and community partnerships focused on respiratory diseases - Increased staff awareness, knowledge and abilities to carry out culturally competent care - Increased community knowledge of the importance of respiratory disease management - Increased policies that support healthy environments - Increased advocacy for change - Reduced disparities in respiratory diseases The hospital has no plans to discontinue other community benefit efforts to address additional health needs as outlined in its CHNA.

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - SSM Health St. Mary's Hospital - St. Louis. The hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Behavioral health - Obesity/chronic diseases - High-risk pregnancy/women's health Behavioral Health Behavioral Health (BH), inclusive of mental health and substance use disorders, was determined to be a priority health need in each hospital ministry community's CHNA process. The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability. Substance abuse disorders have a major impact on individuals, families, and communities. The effects of substance abuse are cumulative, significantly contributing to costly social, physical, mental, and public health problems. In St. Louis City, residents experience an average of 5 poor mental health days per month, above the statewide average of 4.5. and sixteen percent of St. Louis City resident experience mental health distress. The hospital has implemented the following strategies to improve community behavioral health: - Increase access to existing behavioral health programs and services - Strengthen internal behavioral health services and capacities - Support initiatives that build capacity of local partners addressing access to behavioral health services and care - Support and advocate for policies that improve access and services to behavioral health - Promote efforts that empower local communities to drive change - Fund evidence-based & innovative approaches - Ensure data equity, public health education, and strategic communication The short-term and long-term impacts of these activities are as follows: - Consistent and strategic SSM and community partnerships focused on behavioral health - Increased internal and community knowledge and awareness of the importance and impact of behavioral health care - Increased policies supporting equitable behavioral health treatment and care - Healthier communities with improved access to mental health and substance abuse care - Increased advocacy for change Obesity/chronic conditions Good nutrition, physical activity, and a healthy body weight are essential parts of a person's overall health and well-being. Most Americans, however, do not eat a healthful diet and are not physically active at levels needed to maintain proper health and weight. In St. Louis City, 35% of Adults are considered obese and about 30% report no leisure time physical activity. Additionally, St. Louis City ranks below the state average when considering factors that contribute to healthy food environments. Chronic diseases, often strongly linked to obesity, are the leading cause of death and disability in the United States, causing 7 out of 10 deaths each year. Examples of chronic diseases include cardiovascular disease, arthritis, diabetes and cancer. Healthy Eating & Active Living (HEAL) is essential to managing obesity and chronic diseases. The hospital has planned the following strategies to reduce obesity and chronic disease: - Support initiatives that build capacity of local partners addressing obesity/chronic disease - Increase access to chronic disease management services - Support and advocate for policies that improve access to healthy eating and active living (HEAL) - Strengthen internal awareness and knowledge of obesity disparities through education and skills development - Guide direct and collaborative funding - Ensure data equity, public health education, and strategic communication The short-term and long-term impacts of these activities are as follows: - Strategic SSM and community partnerships focused on food insecurity and healthy food access, as well as physical activity - Increased internal and community knowledge and awareness of the importance of healthy eating and chronic disease management - Increased community consumption of healthy foods - Increased community physical activity - Increased community environments, schools, and worksites that support HEAL - Increased advocacy for change - Increased policies supporting healthy living for all High-risk pregnancy/women's health Women's health before, during, and after pregnancy can have a major impact on infants' health and wellbeing. Women who get recommended health care services before they get pregnant are more likely to be healthy during pregnancy and to have healthy babies. In St. Louis City, black babies are three times as likely to die before their first birthday as white babies. Strategies to help pregnant women get medical care and avoid risky behaviors like smoking or drinking alcohol can also improve health outcomes for infants. Additionally, providing care that is culturally appropriate, including effective communication, listening, and respect can help to reduces stress in the pregnancy cycle. The hospital has planned the following directives to improve women's health and increase healthy pregnancies: - Increase access to women's health / high-risk pregnancy services - Support initiatives that build capacity of local partners addressing women's health / high-risk pregnancy / infant mortality - Support and advocate for policies that improve access to women's health services - Strengthen internal women's health services, ensuring equity and cultural competency - Guide direct and collaborative funding - Ensure data equity and evaluation focused on measurable impacts - Public health education - Monitoring and evaluating progress The short-term and long-term impacts of these activities are as follows: - Strategic SSM and community partnerships focused on women's health - Increased staff awareness, knowledge and abilities to carry out culturally competent care - Increased community knowledge of importance of self care during pregnancy and access to services - Increased policies that support women's health and prevent high-risk pregnancy - Increased advocacy for change - Reduced disparities in infant and maternal health The hospital has no plans to discontinue other community benefit efforts addressing additional health needs as outlined in its CHNA.

Schedule H, Part V, Section B, Line 11 Facility A, 3
Facility A, 3 - SSM Health St. Joseph Hospital - St. Charles and SSM Health St. Joseph Hospital - Lake St. Louis. The hospitals identified various health needs in their jointly-completed 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospitals will place primary focus on the following key priorities: - Overweight/obesity - Behavioral health - Chronic conditions Overweight/Obesity Good nutrition, physical activity, and a healthy body weight are essential parts of a person's overall health and well-being. Most Americans, however, do not eat a healthful diet and are not physically active at levels needed to maintain proper health and weight. 32% percent of the adult population (age 20 and older) in St. Charles County reported a body mass index (BMI) greater than or equal to 30 kg/m2 classifying them as obese. The hospital has planned the following directives to reduce overweight issues and obesity in the community: - Support initiatives that build capacity of local partners addressing obesity - Increase access to weight management services - Support and advocate for policies that improve access to healthy eating and active living (HEAL) - Strengthen internal awareness and knowledge of obesity disparities through education and skills development - Guide direct and collaborative funding - Ensure data equity and public health education The short-term and long-term impacts of these activities are as follows: - Strategic SSM and community partnerships focused on nutrition insecurity and health food access, as well as physical activity - Increased internal and community knowledge and awareness of the importance of healthy eating and physical activity - Increased community consumption of healthy foods - Increased community physical activity - Increased advocacy for change and policies supporting healthy living for all Behavioral Health Behavioral Health (BH), inclusive of mental health and substance use disorders, was determined to be a priority health need in each hospital ministry community's CHNA process. The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability. Substance abuse disorders have a major impact on individuals, families, and communities. The effects of substance abuse are cumulative, significantly contributing to costly social, physical, mental, and public health problems. 32% percent of driving deaths in St. Charles County involve alcohol. 24% of adults in St. Charles County report binge or heavy drinking. The hospital has implemented the following strategies to improve community behavioral health: - Increase access to existing mental and behavioral health programs and services - Support initiatives that build capacity of local partners addressing access to behavioral health services and care - Support and advocate for policies that improve access and services to behavioral health - Strengthen internal behavioral health services and capacities - Promote safe medication disposal - Fund evidence-based & innovative approaches - Ensure data equity and public health education The short-term and long-term impacts of these activities are as follows: - Consistent and strategic SSM and community partnerships focused on behavioral health - Increased internal and community knowledge and awareness of the importance and impact of behavioral health care - Increased policies supporting equitable behavioral health treatment and care - Healthier communities with improved access to mental health and substance abuse care Chronic conditions Chronic diseases are the leading cause of death and disability in the United States, causing 7 out of 10 deaths each year. Examples of chronic diseases include cardiovascular disease, arthritis, diabetes and cancer. Six in ten Americans live with at least one chronic disease. Chronic diseases are the leading causes of death and disability in St. Charles County, and they are also a leading driver of health care costs. The hospitals have the following action plan in place to improve the community chronic disease: - Support initiatives that build capacity of local partners addressing chronic disease - Support and advocate for policies that improve access to chronic disease management - Strengthen internal awareness and knowledge of chronic disease disparities through education and development - Guide direct and collaborative funding - Ensure data equity and public health education The short-term and long-term impacts of these activities are as follows: - Strategic SSM and community partnerships focused on chronic disease management - Increased internal and community knowledge and awareness of the importance of chronic disease management - Increased staff awareness, knowledge, and abilities to carry out culturally-competent care - Increased advocacy for change and policies supporting healthy living for all The hospitals have no plans to discontinue other community benefit efforts addressing additional health needs as outlined in its CHNA.

Schedule H, Part V, Section B, Line 3E
THE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - SSM Health St. Clare Hospital - Fenton. A single online community health needs assessment survey was available for community members across multiple service areas of all collaborating hospital systems, inclusive of Missouri and Illinois. The online community survey was available to complete from April 2021 through July 2021. This survey asked about people's personal health, their thoughts about the community's health, and provided sections for people to provide on ways to improve both individual and community health. The survey took an average of 10 minutes to complete with a total of 2,915 individuals completing the survey. A total of 378 responses were received from St. Louis City zip codes, accounting for 13 percent of survey responses. All respondents were asked to provide their primary zip codes, which were tagged according to the SSM and partner hospital CHNA community geographies. Community members had the option to submit open ended responses, comments and suggestions throughout the survey. Additionally, community conversations were held virtually, engaging individuals from SSM Health service areas where response rates were significantly lower in comparison to other service areas. These conversations helped us learn more about residents' concerns, solicit ideas, learn of their health care experiences and identify opportunities for improvement. These conversations also provided critical insight on community perceptions and generated ideas on how to improve health care access and resources. Community leaders were also engaged to complete the Stakeholder CHNA survey. Stakeholders included a diverse group of community professionals from organizations across service areas, providing a vast array of critical services including health access, social needs, education and emergency services. Upon completion, surveys were analyzed through the survey platform in order to identify common themes. Secondary data was collected from multiple sources including The County Health Rankings, ExploreMoHealth, and Think Health St. Louis. Analysis of these data sources revealed not only the most burdensome health issues, but also health disparities and key issues impacting social determinants of health. Data assessed included demographic information, chronic disease and morbidity/mortality information, health status indicators, health behaviors and general environment information. This data is compared to state and national benchmarks. Primary and secondary data were weighted in order to determine highest priority community health needs, based on importance to community members and the hospital's ability to make meaningful impact over the next several years. Organizations included in stakeholder data gathering and discussion include: South St. Louis County: Community Treatment, Inc. (COMTREA) Eureka Fire Protection District Hancock Place School District Lemay Child and Family Center Lindbergh Schools Lindbergh Schools Foundation Prevent + Ed (formerly NCADA) Saint Louis County Department of Health St. Louis Suburban School Nurses Association Jefferson County: Aging Ahead Alzheimer's Association, Greater Missouri Children's Advocacy Center of East Central Missouri COMTREA COMTREA Dental First United Methodist Church of Festus - Crystal City Eureka Fire Protection District Festus R-6 Schools Hillsboro R-III School District Jefferson College Jefferson County Health Department Jefferson County Circuit Court Jefferson County Growth Association Jefferson County Juvenile Office Joachim-Plattin Ambulance District Keaton Center Lane Consolidated Mercy Jefferson Northwest School District Path Group Peace Pantry of Cedar Hill Valle Ambulance District

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - SSM Health St. Clare Hospital - Fenton. The hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Mental health - Overweight/obesity - Heart health Mental Health The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability. Mental Health diagnosis have been on the increase in St. Louis County every year, since 2018, in almost every category including anxiety and fear disorders, bipolar mood disorders, depressive mood disorders and schizophrenia and psychotic disorders as well as trauma and stress related disorders. Mental Health is more than the absence of mental illness it is essential for overall health and quality of life. The hospital has implemented the following strategies to improve community mental health: - Increase access to existing mental and behavioral health programs and services - Support initiatives that build capacity of local partners addressing access to behavioral health services and care - Support and advocate for policies that improve access and services to mental and behavioral health - Strengthen internal behavioral health services and capacities - Promote safe medication disposal - Fund evidence-based & innovative approaches - Ensure data equity, education, and strategic communication The short-term and long-term impacts of these activities are as follows: - Consistent and strategic SSM and community partnerships focused on behavioral health - Increased internal and community knowledge and awareness of the importance and impact of behavioral health care - Increased policies supporting equitable behavioral health treatment and care - Healthier communities with improved access to mental health and substance abuse care Overweight/Obesity Good nutrition, physical activity, and a healthy body weight are essential parts of a person's overall health and well-being. Most Americans, however, do not eat a healthful diet and are not physically active at levels needed to maintain proper health and weight. In Jefferson County, 32% of Adults are considered obese and 29% in St. Louis County. Chronic diseases, often strongly linked to obesity, are the leading cause of death and disability in the United States, causing 7 out of 10 deaths each year. Examples of chronic diseases include cardiovascular disease, arthritis, diabetes and cancer. Healthy Eating & Active Living (HEAL) is essential to managing obesity and chronic diseases. The hospital has planned the following directives to reduce overweight issues and obesity in the community: - Support initiatives that build capacity of local partners addressing obesity and chronic disease - Increase access to chronic disease management services - Support and advocate for policies that improve access to healthy eating and active living (HEAL) - Strengthen internal awareness and knowledge of obesity disparities through education and skills development - Guide direct and collaborative funding - Ensure data equity, education, and strategic communication The short-term and long-term impacts of these activities are as follows: - Consistent and strategic SSM and community partnerships focused on food insecurity and health food access, as well as physical activity - Increased internal and community knowledge and awareness of the importance of healthy eating and chronic disease management - Increased community consumption of healthy foods - Increased community physical activity - Improved community environments, schools, and worksites that support HEAL - Increased advocacy for change and policies supporting healthy living for all Heart Health Controlling risk factors for heart disease and stroke remains a challenge. High blood pressure, cigarette smoking, and high blood cholesterol are still major contributors to the national epidemic of cardiovascular disease. The risk of Americans developing and dying from cardiovascular disease would be substantially reduced if major improvements were made across the U.S. population in diet and physical activity, control of high blood pressure and cholesterol, smoking cessation, and appropriate aspirin use. African American residents in St. Louis County are disproportionately affected by heart disease to a staggering degree, consistently having higher mortality and hospital visit rates compared to other racial/ethnic groups in the county. The hospital has the following action plan in place to improve the heart health for its community: - Support initiatives that build capacity of local partners addressing nutrition and heart disease - Increase access to heart disease management services - Support and advocate for policies that improve access to nutritious foods - Strengthen internal awareness and knowledge of heart disease disparities through education and skills development - Guide direct and collaborative funding - Ensure data equity, education, and strategic communication The short-term and long-term impacts of these activities are as follows: - Consistent and strategic SSM and community partnerships focused on heart health and nutrition - Increased internal and community knowledge and awareness of the importance of heart health and nutrition - Increased community consumption of nutritious foods - Increased heart healthy activities - Increased policies supporting healthy living for all The hospital has no plans to discontinue other community benefit efforts to address additional health needs as outlined in its CHNA.

Schedule H, Part V, Section B, Line 3E
THE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - SSM Health Rehabilitation Hospital. A single online community health needs assessment survey was available for community members across multiple service areas of all collaborating hospital systems, inclusive of Missouri and Illinois. The online community survey was available to complete from April 2021 through July 2021. This survey asked about people's personal health, their thoughts about the community's health, and provided sections for people to provide on ways to improve both individual and community health. The survey took an average of 10 minutes to complete with a total of 2,915 individuals completing the survey. A total of 378 responses were received from St. Louis City zip codes, accounting for 13 percent of survey responses. All respondents were asked to provide their primary zip codes, which were tagged according to the SSM and partner hospital CHNA community geographies. Community members had the option to submit open ended responses, comments and suggestions throughout the survey. Additionally, community conversations were held virtually, engaging individuals from SSM Health service areas where response rates were significantly lower in comparison to other service areas. These conversations helped us learn more about residents' concerns, solicit ideas, learn of their health care experiences and identify opportunities for improvement. These conversations also provided critical insight on community perceptions and generated ideas on how to improve health care access and resources. Community leaders were also engaged to complete the Stakeholder CHNA survey. Stakeholders included a diverse group of community professionals from organizations across service areas, providing a vast array of critical services including health access, social needs, education and emergency services. Upon completion, surveys were analyzed through the survey platform in order to identify common themes. Secondary data was collected from multiple sources including The County Health Rankings, ExploreMoHealth, and Think Health St. Louis. Analysis of these data sources revealed not only the most burdensome health issues, but also health disparities and key issues impacting social determinants of health. Data assessed included demographic information, chronic disease and morbidity/mortality information, health status indicators, health behaviors and general environment information. This data is compared to state and national benchmarks. Primary and secondary data were weighted in order to determine highest priority community health needs, based on importance to community members and the hospital's ability to make meaningful impact over the next several years. Organizations included in stakeholder data gathering and discussion include: North St. Louis County: Aging Ahead Alive and Well Communities Asthma and Allergy Foundation - St. Louis Cornerstone Realty Jewish and Family Services of St. Louis Our Family's Doing Yoga Refuge and Restoration Prevent + Ed St. Louis Area Diaper Bank St. Louis County Department of Health St. Luke's Hospital

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - SSM Health Rehabilitation Hospital. THE HOSPITAL CONDUCTED AND COMPLETED ITS 2021 CHNA JOINTLY WITH SSM HEALTH DEPAUL HOSPITAL - ST. LOUIS.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - SSM Health Rehabilitation Hospital. The hospital identified various health needs in the 2018 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiently, the hospital will place primary focus on the following key priorities: - Access to care - Chronic disease - Heart and Vascular disease - Chronic disease - Cerebrovascular disease Access to care Access to primary care providers is a key priority for the hospital. Improvements will increase the likelihood that community members will have routine check-ups and screenings. Moreover, those with access to primary care are more likely to know where to go for treatment in acute situations. Communities that lack a sufficient number of primary care providers typically have members who delay necessary care when sick and conditions can become more severe and complicated. Additional facts and figures that relate to access to care show: - Per 100,000 persons, there are 123 providers in St. Louis County - Clinical Care Ranking - the quality and accessibility of clinical care heavily impacts the health of a community. Without a sufficient number of providers or adequate insurance coverage, people often do not seek care services and are thus at higher risk of developing preventable illnesses or chronic conditions. People with access to high-quality care are more likely to receive effective treatment for their conditions and enjoy better health. St. Louis County is ranked at 2 (1-2 is healthiest). The ranking is based on a summary composite score calculated from the following measures: uninsured, primary care physicians, mental health providers, dentists, preventable hospital stays, diabetic monitoring, and mammography screening - 43% of St. Louis County residents have a bachelor's degree or greater 21% of St. Louis County residents have a high school graduation degree - Approximately 10% of St. Louis County residents don't have health insurance - 6.7% of St. Louis County families live below the poverty line - 82.5% of St. Louis County expecting mothers receive prenatal care and the infant mortality rate for St. Louis County is 7.7 out of 1,000 live births The hospital is involved in the following initiatives to improve access to care in the community served: - Partner with SSM Health Care St. Louis ministries and community collaborators to address access to care barriers, provide screenings and health education materials - Monitor durability of outcomes post-discharge through IT HealthTrack and create action plans, if appropriate - Utilize Care Partner Program to increase community discharges from 70.6% in 2018 to 73.6% by 2021 - Partner with Emergency rooms at other SSM Health hospitals to prevent unnecessary admissions to acute care from the hospital - Transition to Medical Model at the hospital to enhance medical management coverage and increase in-house physician presence - Develop Meds to Beds Program to increase access to prescribed medications at time of patients' discharge from inpatient rehabilitation stay Chronic disease - Heart and Vascular disease Heart and vascular disease is a key priority for the hospital. Heart disease is a term that encompasses a variety of different diseases affecting the heart and is the leading cause of death in the United States, accounting for 25.4% of total deaths. The most common type in the US is coronary artery disease, which can cause heart attack, angina, heart failure, and arrhythmias. Coronary artery disease occurs when plaque builds up in the arteries that supply blood to the heart and the arteries narrow (atherosclerosis). There are many modifiable risk factors for atherosclerosis, including tobacco smoking, obesity, and a sedentary lifestyle. Heart disease is the number one killer of women in the United States. Statistical data on heart and vascular disease shows the following: - According to the Centers for Disease Control and Prevention, approximately 5.7 million people in the United States have heart failure, and about half of people who develop heart failure will die within five years of diagnosis - Age-adjusted ER rate due to heart failure is 3.5 per 10,000 persons in St. Louis County compared to 5,9 in St. Louis City - The percentage of overweight adults is an indicator of the overall health and lifestyle of a community. Being overweight affects quality of life and puts individuals at risk for developing many diseases, especially heart disease, stroke, diabetes, and cancer. 32.6% of St. Louis County adults are overweight - High blood pressure is the number one modifiable risk factor for stroke. In addition to stroke, high blood pressure also contributes to heart attacks, heart failure, kidney failure, and atherosclerosis. The higher your blood pressure, the greater your risk of heart attack, heart failure, stroke, and kidney disease. In the United States, one in three adults has high blood pressure, and nearly one-third of these people are not aware that they have it. 31.9% of St. Louis County adults have high blood pressure. The hospital is implementing the following measures to improve Heart and vascular disease: - Partner with SSM Health Care St. Louis ministries and community collaborators to provide screenings and health education materials - Reduce cardiac-related acute care transfers from 12.5% in 2018 to 10% in 2021 - Monitor durability of outcomes post-discharge through IT HealthTrack and create action plans, if appropriate - Utilize Care Partner Program to increase community discharges from 70.6% in 2018 to 73.6% by 2021 - Partner with Emergency rooms at other SSM Health hospitals to prevent unnecessary admissions to acute care from the hospital - Transition to Medical Model at the hospital to enhance medical management coverage and increase in-house physician presence - Develop Meds to Beds Program to increase access to prescribed medications at time of patients' discharge from inpatient rehabilitation stay Chronic disease - Cerebrovascular disease Cerebrovascular disease is a major concern in the hospital's service area. Cerebrovascular disease refers to conditions, including stroke, caused by problems with the blood vessels supplying the brain with blood. A stroke occurs when blood vessels carrying oxygen to the brain burst or become blocked, thereby cutting off the brain's supply of oxygen and other nutrients. Cerebrovascular disease is a leading cause of death in the United States and can also lead to brain damage and disability. The most important modifiable risk factor for cerebrovascular disease and stroke is high blood pressure. Other risk factors include high cholesterol, heart disease, diabetes mellitus, physical inactivity, obesity, excessive alcohol use, and tobacco use. Additional data on cerebrovascular disease report that: - The age-adjusted death rate due to Cerebrovascular Disease is 38 adults out of 100,000 persons in St. Louis County - 32.6% of St. Louis County adults are overweight - In the United States, one in three adults has high blood pressure, and nearly one-third of these people are not aware that they have it. 31.9% of St. Louis County adults have high blood pressure - Nearly three-quarters of all strokes occur in people over the age of 65. The Centers for Disease Control and Prevention (CDC) states that stroke is the fourth leading cause of death in the United States, is a leading cause of long-term disability, and is the cause of almost 133,000 deaths annually. According to the CDC, strokes cost the United States an estimated $38.6 billion each year. 4.4% of the Medicare population in St. Louis County were treated for a stroke The hospital has the following action plan in place to improve the community measures on cerebrovascular disease: - Partner with SSM Health Care St. Louis ministries and community collaborators to provide screenings and health education materials - Increase stroke community discharges from 67% in 2018 to 70% in 2021 - Utilize the Stroke Program Team to monitor durability of outcomes post-discharge through IT HealthTrack and create action plans, if appropriate - Decrease stroke fall rate per 1000 patient days by 10% - Participate in community events - Improve stroke patients' self-care and mobility activities from admission to discharge change to meet national average - Host stroke support group monthly The hospital has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs and address additional community needs within its efforts. The following community needs were identified but have not been prioritized due to the hospital's limited resources at this time: - Mental health/geriatric psychology and substance abuse - Smoking and tobacco use - Obesity - Care coordination - Health literacy

Schedule H, Part I, Line 3c Discounted Care Exceptions
"Patients whose family income exceeds 400% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the hospital; however the discounted rates shall not be greater than the amounts generally billed to commercially insured [or Medicare] patients. In such cases, other factors may be considered in determining their eligibility for discounted or free services, including: * Bank accounts, investments and other assets * Employment status and earning capacity * Amount and frequency of bills for health care services * Other financial obligations and expenses * Generally, financial responsibility will be no more than 25% of gross family income. The hospital may utilize predictive analytical software or other criteria to assist in making a determination of financial assistance eligibility in situations where the patient qualifies for financial assistance but has not provided the necessary documentation to make a determination. This process is called ""presumptive eligibility."""

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
SSM Health Care Corporation, 46-6029223

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
The amounts reported on Form 990, Schedule H, Part I, Line 7a, 7b, and 7c were determined using the cost to charge ratio derived from worksheet 2 in the schedule h instructions. Form 990, schedule h, part I, Lines 7e, 7f, and 7i are reported at cost as reported in the organization's financial statements. The calculation of Schedule H, Part I, Line 7, Column F utilizes 990, Part IX, Line 25, Column A, which does not include Bad Debt Expense.

Schedule H, Part II Community Building Activities
SSM HEALTH CARE ST. LOUIS PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: PHYSICAL IMPROVEMENTS AND HOUSING: HOSPITALS PARTICIPATED IN THE SAFETY FUND TO PROVIDE BASIC REPAIRS TO HOMES AND AUTOS THAT HAVE BEEN DAMAGED BY INCIDENCES OF INTERPERSONAL, DOMESTIC, OR COMMUNITY VIOLENCE, PARTNERSHIP WITH Pathway to Hope, WHICH provides individualized services to families with children who desire to take action to break the cycle of crisis and vulnerability that repeats generation after generation; COMMUNITY HEALTH IMPROVEMENT ADVOCACY: EFFORTS TO GENERATE COMMUNITY-WIDE IMPROVEMENT AND RESPONSE FROM GOVERNMENT AND PRIVATE ORGANIZATIONS, INCLUDING ADVOCACY ON PUBLIC POLICY ISSUES THAT GO BEYOND HEALTH CARE, SUCH AS HOUSING, SAFETY, AND EDUCATION; WORKFORCE DEVELOPMENT: STUDENT OBSERVATION OF HEALTH CARE AND DIETARY PROFESSIONALS.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
FOR FINANCIAL STATEMENT PURPOSES, SSM Health Care St. Louis HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. SSM HEALTH CARE ST. LOUIS DID NOT MAKE AN ESTIMATE OF THE ORGANIZATION'S BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
SSM Health Care St. Louis is part of the SSM Health consolidated audit. The footnote that references the treatment of uncollectible accounts and implicit price concessions in the December 31, 2021 consolidated audit is contained on page 13, 14 and 15 of the attached financial statements.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
"SSM Health Care St. Louis has established a written credit and collection policy and procedures. The billing and collection policies and practices reflect the mission and values of SSM Health, including our special concern for people who are poor and vulnerable. SSM Health Care St. Louis embraces its responsibility to serve the communities in which it participates by establishing sound business practices. SSM Health Care St. Louis' billing and collection practices will be fairly and consistently applied. All staff and vendors are expected to treat all patients consistently and fairly regardless of their ability to pay. They respond to patients in a prompt and courteous manner regarding any questions about their bills and provide notification of the availability of financial assistance. All uninsured patients will be provided a standard discount for medically necessary inpatient and outpatient services, including services provided at off-campus outpatient sites. The hospital determined the amount of the discount based on the local managed care market, applicable statutory requirements and other relevant local circumstances. The rate must be no less than the lowest effective discount rate and no greater than the highest effective discount rate for the current managed care contracts of the hospital. Uninsured patients may also qualify for an additional discount based upon financial need under the system financial assistance policy. All accounts due from the patient will receive a statement after discharge or after final adjudication from patient's insurance. Generally the patient will receive 4 months (120 days) of in-house collection efforts (including early out vendors) and 12 months of bad debt collection efforts. The hospital will make Reasonable Efforts to determine FAP eligibility including: 1. The financial assistance summary will be included with each billing statement. 2. Extraordinary Collection Activity (ECAs) may not occur until bad debt placement and only after 120 days. 3. ECAs must be suspended if a guarantor submits a FAP application during the application period. 4. Reasonable measures must be taken to reverse ECAs if the application is approved which may include refunding any payments made in excess of amounts owed as an FAP-eligible individual. 5. Bad Debt vendors will gain written approval from SSMH prior to engaging in ECAs. SSMH will review the accounts and verify satisfactory completion of reasonable efforts during the notification and application period. A waiver is not considered reasonable efforts. Obtaining a signed waiver that an individual does not wish to apply for FAP assistance or receive FAP application information will not meet the requirement to make ""reasonable efforts"" to determine whether the individual is FAP-eligible before engaging in ECAs. All outside collection agencies must comply with state and federal laws, comply with the association of credit and collection professional's code of ethics and professional responsibility and comply with SSM Health Care St. Louis' collection and financial assistance policies."

Schedule H, Part V, Section B, Line 16a FAP website
A - SSM Health DePaul Hospital - St. Louis: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; - SSM Health St. Clare Hospital - Fenton: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; - SSM Health Rehabilitation Hospital: Line 16a URL: https://www.ssm-rehab.com/patients-and-caregivers/admissions/financial-assistance/;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - SSM Health DePaul Hospital - St. Louis: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; - SSM Health St. Clare Hospital - Fenton: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; - SSM Health Rehabilitation Hospital: Line 16b URL: https://www.ssm-rehab.com/patients-and-caregivers/admissions/financial-assistance/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - SSM Health DePaul Hospital - St. Louis: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; - SSM Health St. Clare Hospital - Fenton: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; - SSM Health Rehabilitation Hospital: Line 16c URL: https://www.ssm-rehab.com/patients-and-caregivers/admissions/financial-assistance/;

Schedule H, Part VI, Line 2 Needs assessment
SSM Health (SSMH) participates in Community Benefit according to our vision. Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically, and socially marginalized, will experience improved health in mind, body, spirit and environment. In the tradition of our founders, the Franciscan Sisters of Mary, caring for those in greatest need remains our organizational priority. Today our System Board monitors Community Benefit efforts, and views achievement of our vision as a primary responsibility. The purpose of SSM's Community Benefit program is to assess and address community health needs. Making our communities healthier in measurable ways is always our goal. To fulfill this commitment, SSM's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). The CHNA is an assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conducted every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-health priorities: Establish strategies to address priorities; complete Strategic Implementation Plan; obtain Regional/Divisional Board approval; and integrate strategies into operational plan. * Make CHNA widely available to the public: Publish CHNA and summary document on hospital's website. * Monitor, track, and report progress on top health priorities: Collect data and evaluate progress; report to Regional/Divisional Board every six months and System Board every year; share findings with community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). System Office staff and leaders oversee and monitor SSMH's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, SSM Health Care Corporation also identifies needs based on assessments and research, and SSMH facilities also involve case managers and care team staff to pinpoint critical health issues in the community. All hospital CHNAs are completed, approved, and integrated into the organization's strategic plan. We continue to monitor and assess the progress of our local efforts in the spirit of caring for others and improving community health.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Each entity providing medical service shall provide information to the public regarding its charity care policies and the qualification requirements for each of its facilities. When standard system notices and communication regarding charity care are available, these must be used. Modifications to the standard may be made to comply with state and local laws, as well as reflect culturally sensitive terminology for the policy. All notices are easy to understand by the general public, culturally appropriate and available in those languages that are prevalent in the community. They provide information about: * The patient's responsibility for payment, * The availability of financial assistance from public programs and entity charity care and payment arrangements, * The entity's charity policy and application process, and * Who to contact to get additional information or financial counseling. The following types of notices to the public are provided: * Signs in the emergency department, website resources, and public waiting areas. * Brochures or fliers provided at time of registration and available in the financial counseling areas. * Notices sent with or on patient bills or communications sent to patients and guarantors related to medical services. * Applications provided to uninsured patients at the time of registration. The application for charity care, together with any instructions, must clearly state the policies regarding charity care, including excluded services, eligibility criteria and documentation requirements. Information about the entity's charity policies is also provided to public agencies.

Schedule H, Part VI, Line 6 Affiliated health care system
SSM Health Care St Louis is a 501(c)(3) organization and is a member of the integrated health care system know as SSM Health. SSM Health Care St Louis is one of the largest, full-service health care networks in the St Louis, Missouri area. SSM Health Care St Louis includes the following operating hospitals: SSM Health DePaul Hospital - St. Louis SSM Health St. Joseph Hospital - St. Charles SSM Health St. Joseph Hospital - Wentzville (remote location of St. Joseph Hospital) SSM Health St. Joseph Hospital - Lake Saint Louis SSM Health St. Mary's Hospital - St. Louis SSM Health St. Clare Hospital - Fenton.

Schedule H, Part VI, Line 7 State filing of community benefit report
MO

Schedule H, Part VI, Line 4 Community information
SSM Health Care St Louis defines its primary service area as the St Louis metropolitan statistical area (MSA), which includes the Missouri Counties of St. Louis, St. Charles, Jefferson, Franklin, Lincoln, and Warren and St. Louis City. Because we support a wide range of local markets and constituencies, demographics are also evaluated for our individual hospital service areas, service lines and clinical departments to ensure we focus on specific community health needs. The total population for the MSA is estimated at 2.8 million, making the area the 21st largest metropolitan area in the United States; however, it saw a decline from 2020 to 2021. About 41/3% of the population has a post-secondary degree. The poverty rate for the MSA was reported at 10.4% in 2020. More detailed statistics for each hospital's community is as follows: SSM Health St. Mary's Hospital is geographically located in Mid-St. Louis County, however, the primary and secondary service areas include zip codes in both St. Louis County and St. Louis City. There are 28 zip codes that are included within or overlap the service area. In 2020, the population of St. Louis county was approximately 980,000. SSM Health St. Joseph - St. Charles and SSM Health St. Joseph Hospital - Lake Saint Louis hospitals are located in St. Charles County, Missouri, and serve that region as well as parts of Lincoln and Warren Counties. This tri-county area makes up 80% of the hospitals' patients served and includes 19 zip codes. In addition to the locations in historic downtown St. Charles and Lake Saint Louis, the hospital has a location in Wentzville that provides emergency, outpatient, and behavioral medicine services. The service area had an estimated population of 500,000 persons in 2020 and is growing rapidly. Over 1/3 of households have children 18 or under. Median family income is just over $100,000, well above the State and National average. SSM Health St. Clare Hospital - Fenton serves Southwest St. Louis and Jefferson Counties. There are 10 zip codes contained within or overlapping the service area. As of 2020 data, the primary service area had an estimated population of 335,000 persons. Approximately 5.6% of the community population over 25 did not have a high school diploma, and over 23% of students in the area are eligible for free or reduced-price school lunches. Over 18.5% of the population is over the age of 64. SSM Health DePaul Hospital - St. Louis defines its service area as North St. Louis County, which includes 18 zip codes within or that overlap the service area. As of 2020 data, North St. Louis County had an estimated population of 405,000 persons. Approximately 26.6% of the population has at least a Bachelor's Degree, and there is a 73.9% high school graduation rate.

Schedule H, Part VI, Line 5 Promotion of community health
SSM Health Care St. Louis participates in a wide array of community programs throughout the area to further its exempt purpose of promoting the health of the community. The community initiatives build on the strengths of our communities and systems to improve the quality of life and to create a sense of hope. Community Benefit initiatives build community capacity and individual empowerment through community organizing, leadership development, partnerships, and coalition building. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. In response to the global coronavirus pandemic, SSM Health Care St. Louis worked relentlessly to respond to community needs by developing and implementing strategies to address social needs of those served, providing screening & testing services, personal protective equipment and education throughout the community, as well as treatment for those who presented with COVID-19. SSM Health Care St. Louis promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote community health. SSM Health Care St. Louis also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay, * Has an open medical staff with privileges available to all qualified physicians in the area, * Has a governing body in which independent persons representative of the community comprise a majority * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system.