4A (Expenses $ 155791639 including grants of $ 81222) (Revenue $ 143627141)
PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

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 A, 1
Facility A, 1 - SSM Health St. Mary's Hospital - Jefferson City. To complete the 2022 -2024 Community Health Needs Assessment, leadership from SSM Health St. Mary's Hospital -Jefferson City conducted a comprehensive community health assessment using multiple methodologies: secondary data analysis, conversations with community groups, and surveys completed by community members, community leaders and local health and human service providers, which allowed us to measure perception, health risks, health factors, health outcomes and characteristics specific to the communities in these five central Missouri counties. Primary Data SSM Health St. Mary's Hospital -Jefferson City sought and received input from a number of community members and the leaders from numerous community organizations.Community perspectives and data gathered during this endeavor were incorporated into the SSM Health St. Mary's Hospital -Jefferson City's Community Health Needs Assessment.Community perspectives were gathered from multiple agencies, including a key informant survey. *Community and Key Informant Survey -In addition to the review of demographics and secondary data, and the aforementioned conversations with community groups, a community perception survey was conducted to assess the perception of health care and health status across the five-county region in the analysis. The survey was made available via email, yielding a total of 59 responses from residents. Analysis of the survey responses helped inform the secondary data and fueled the prioritization process. This input provided perspective on the health status of the community and enlightened the analysis of the secondary data relative to the most important health issues and challenges, key resources and advice on how to address the issues identified. Secondary Data Existing data previously collected for other purposes, called secondary data, was used from a variety of credible public local, state and federal sources to provide a context for analysis and interpretation. Data is key to diagnosing and addressing some of our region's most pressing health issues, and by analyzing the information available to the public, furthers our missions to improve health and the well-being of our communities. The availability of new datasets enabled a more detailed level of analysis such as health and social factors at a county and zip code level. We gathered and reviewed data from broad sources to set the initial direction and priorities of the community health needs assessment. The secondary data was derived from a variety of unbiased sources including the U.S. Census, Centers for Disease Control and Prevention, Robert Wood Johnson Foundation, Community Commons, Missouri Hospital Association, and the Missouri Department of Health and Human Services.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - SSM Health St. Mary's Hospital - Jefferson City. The hospital identified various health needs in the 2021 CHNA. To make a meaningful impact, and use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Mental Health - Access to Care - Health Literacy Mental Health Mental health needs in Central Missouri may include, but are not limited to needs, barriers and challenges that relate to provider availability, affordability, insurance, stigma, substance use, stress, and suicide. Substance abuse needs in Central Missouri may include, but are not limited to needs, barriers and challenges that relate tobacco, vaping, drugs (narcotics, marijuana, etc.), prescription medications, and alcohol use, mental health treatment services and access to care. Many community perception survey participants and steering team members expressed concern about mental health issues in the community. Mental health issues, such as anxiety, depression and risk of suicide, are prevalent concerns. There are limited mental health providers in the area in general but especially noted was the gap in providers for youth and families in distress. Long wait lists for treatment or counseling were often noted. Additionally, many feel that mental health is intertwined with other key health issues such as substance abuse, addiction, and overall good physical health. Regarding substance abuse, it was noted that individuals may be using drugs/alcohol as a mechanism to cope with mental health issues stemming from toxic stress they have experienced. Poor mental or behavioral health frequently contributes to or exacerbates problems with physical health and illness. An additional concern reported was related to connecting patients with services needed, especially coordination of care for patients with co co-occurring or dual diagnosis conditions. A concern that social stigmas around mental health are widespread in our communities and may play a key role in whether an individual seeks care. The hospital has outlined the following action plan in order to improve mental health through prevention and by ensuring access to appropriate, quality mental health services: * Participate in Emergency Room Enhancement (ERE) Program and evaluate implementation of Peer Support for mental health patients in the ER * Collaborate with and support Catholic Charities of Central and Northern to evolve mental health screenings and therapy services at the Catholic Charities Center in Jefferson City * Enhance partnership with Council for Drug Free Youth to expand school school-based education and increase availability of substance use prevention and early identification/intervention initiatives in the region * Sustain SSM Health Outpatient Brief Treatment Program for Adults and the Outpatient Transitional Care Program for Adults and Seniors * Increase access by working to enhance mental health resources and or teletherapy services in the clinical and community-based settings Community partners & supporting resources include: Catholic Charities of Central and Northern Missouri; Compass Health; Council for Drug Free Youth; SSM Medical Group; SSM Health Behavioral Services; Compass Health; Catholic Charities; Missouri Mental Health Foundation; and Missouri Coalition of Behavioral Health Centers. Access to Care Access to specialty health care services through a doctor's office, clinic or other appropriate provider is an important element of a community's health care system and is vital for helping the community's residents to be healthy. The ability to access specialty care is influenced by many factors, including: * insurance coverage and the ability to afford services; * long waits for appointments or treatments; * the availability and hours of operation; * an understanding of where to find services when needed; * a lack of specialty; and * a lack of reliable personal or public transportation. The hospital's action plan to increase the proportion of persons of all ages who have a specific source of ongoing care includes: * Collaboration with area health care providers, United Way and social service agencies to establish a community community-based solution to health health-related transportation, i.e., HealthTran * Continuing to evolve partnership with Catholic Charities of Central and Northern Missouri to expand health and human service outreach programs, including integration with Catholic Charities Health and Nutrition services to coordinate health screenings, wellness and chronic disease self-management programs, and on on-line food ordering for at at-risk patients at discharge to address social determinants of health. * Increasing number and capacity of health care professionals to improve access in primary and specialty care providers in identified shortage areas * Evaluate expansion and implementation of telehealth/telemedicine offerings in region Community partners & supporting resources will be: Catholic Charities of Central and Northern Missouri; Missouri Rural Health Association; United Way of Central Missouri; Community Health Center of Central Missouri; Jefferson City Medical Group; SSM Health Medical Group; United Way of Central Missouri. Health Literacy Chronic disease needs in Central Missouri may include, but are not limited to needs, barriers and challenges that relate to diabetes, cardiovascular disease, obesity, hypertension, food accessibility, health behaviors and access to care. Heart disease, cancer, cerebrovascular diseases, respiratory diseases are in the top ten leading causes of death in Central Missouri. Health literacy, including chronic disease self-management, preventative care, and life skills education, stress management and coping are needed to improve health and wellness decisions. Primary data suggests that health education, preventative screenings, and social and emotional support services should be delivered differently throughout communities rather than in the traditional class offerings or group settings. Expanding the opportunities for education of consumers through digital media, health kiosks, providing more mobile health care options, and using community health workers and case managers in a variety of settings, including churches, schools and colleges, to encourage and link individuals to health care or support services. In addition, it was noted that health literacy is a concern that cuts across the other priority areas as well, income and educational disparities, language barriers, lack of insurance and/or understanding of how to use the health care system are some of the issues that undermine health and wellness. The hospital has outlined the following initiatives to increase the proportion of persons who report their health care provider always gives them easy-to-understand instructions about what to do to take care of their illness or health condition: * Provide community health education, health risk and prevention screenings, chronic disease self-management and life skills education to improve health and wellness decision such as, blood pressure self-monitoring program * Provide community and workplace health resource fairs and screenings * Evaluate implementation of evidenced evidenced-based Diabetes Prevention Program (DPP) with key partners, YMCA, Catholic Charities, and SSM Health Medical Group Community partners & supporting resources will include: Catholic Charities self-monitoring blood pressure program, Central Missouri SMBP Task Force, Aging Best, Jefferson City YMCA. The hospital has no plans to discontinue other programs addressing the remaining CHNA-identified needs and additional community needs within its efforts.

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 REGIONAL HEALTH SERVICES 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: COMMUNITY SUPPORT: PARTNERS IN EDUCATION PROGRAM, WHICH PRODUCES VIDEOS FOR LOCAL SCHOOLS, FINANCIAL SUPPORT FOR THE AMERICAN HEART ASSOCIATION, COUNCIL FOR A DRUG-FREE YOUTH, YMCA, AND AMERICAN CANCER SOCIETY; COALITION BUILDING: HOSPITAL STAFF PARTICIPATE IN CASA EDUCATION, TRAINING, AND FAMILY SUPPORT SERVICES.

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 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. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER NORTON HOSPITAL'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
SSM Regional Health Services 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 Regional Health Services 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, The Health Center embraces its responsibility to serve the communities in which it participates by establishing sound business practices. The Health Center's 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 SSM prior to engaging in ECAs. SSM 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 Regional Health Services' collection and financial assistance policies."

Schedule H, Part V, Section B, Line 16a FAP website
A - SSM Health St. Mary's Hospital - Jefferson City: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - SSM Health St. Mary's Hospital - Jefferson City: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - SSM Health St. Mary's Hospital - Jefferson City: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill;

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 SSMH'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, SSMH'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 REGIONAL HEALTH SERVICES IS A HEALTH CARE NETWORK THAT OPERATES SSM HEALTH ST MARY'S HOSPITAL - JEFFERSON CITY IN JEFFERSON CITY, MISSOURI. SSM REGIONAL HEALTH SERVICES IS PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. SSM HEALTH IS A 501(C)(3) ORGANIZATION HEADQUARTED IN ST LOUIS, MISSOURI.

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

Schedule H, Part VI, Line 4 Community information
The community we serve is defined as Central Missouri, including Callaway, Cole, Miller, Moniteau, and Osage Counties, which covers the primary service area served by the hospital. There are 51 zip codes that are contained within or overlap the service area. The hospital is located in Jefferson City (65109), Cole County Missouri. In 2019, Callaway, Cole, Miller, Moniteau, and Osage Counties had an estimated population of 176,474 persons. Between 2000 and 2010 the population in the report area grew by 12,829 persons, a change of 7.93%. When compared to Missouri and the United States, the population of our report area is less diverse with 90.1% of the population being white and 9.9% of the population being persons of color. All five counties in the report area have a median age that is at or above the Missouri state average of 38.6 years and all five counties have a median age that is above the national average of 38.1 years. In addition, an estimated 29,001 persons are adults aged 65 and older, representing 16.43% of the population. This percentage is consistent with the aging of the population across the rest of the state but is higher than what is being seen across the United Sates (15.64%). The Hispanic population in the report area grew by 75.1% or 1,508 persons. This finding is consistent with Hispanic population growth of 79.5% in the state of Missouri during the same period. Median household income and per capita income are less for the region than Missouri and the U.S. as a whole. The report area includes people who are at high risk of not receiving adequate medical care due to being uninsured/underinsured or facing barriers related to geography, language, financial circumstances, transportation, stigma, accessibility to technology, access to healthy and affordable foods and low-income housing. Additional demographic and community information can be found throughout the 2021 CHNA.

Schedule H, Part VI, Line 5 Promotion of community health
SSM REGIONAL HEALTH SERVICES 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 Regional Health Services 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 REGIONAL HEALTH SERVICES PROMOTES GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE BOTH COMMUNITY HEALTH AND HEALTHY COMMUNITIES. SSM REGIONAL HEALTH SERVICES 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, *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.