4A (Expenses $ 172162728 including grants of $ 20610275) (Revenue $ 209298041)
ALL PROGRAM SERVICE EXPENSES WERE INCURRED IN FURTHERANCE OF OUR MISSION, WHICH IS TO ENSURE THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE SERVICES TO ALL PATIENTS IN A CARING ENVIRONMENT. IN 2021, THERE WERE 32,400 PATIENT DAYS AND 970 NEWBORN DAYS. IN ADDITION, THE HOSPITAL PROVIDED 95,500 OUTPATIENT AND EMERGENCY SERVICES. AS A VOLUNTARY, NONPROFIT, COMPREHENSIVE ORGANIZATION, SAINT LUKE'S NORTH HOSPITAL IS COMMITTED TO SERVING ALL WHO SEEK OUR SERVICES REGARDLESS OF THEIR SOCIOECONOMIC STATUS. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS A FINANCIAL ASSISTANCE POLICY FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. BETWEEN OUR BARRY ROAD AND SMITHVILLE CAMPUSES, SAINT LUKE'S NORTHLAND HOSPITAL HAS 161 LICENSED PATIENT BEDS. BOTH CAMPUSES SERVE THE NORTHERN KANSAS CITY AREA. The hospital collaborated with other Saint Luke's Health System entities, the Missouri and Kansas Hospital Associations, and Mid-America Regional council to implement initiatives for establishing COVID testing sites, vaccine distribution, expanding virtual visits, and post-discharge follow-up for COVID-19 patients in addition to expanding coverage for the increase in hospitalized patients. The health system realigned its care and services to continue to treat and care for COVID-19 patients while protecting its employees.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - FACILITY GROUP A - SAINT LUKES NORTH HOSPITAL-BARRY AND SAINT LUKES NORTH HOSPITAL-SMV. Input from persons representing the broad interests of the community was taken into account through key informant interviews (16 participants) and community meetings (36 participants). Stakeholders included: individuals with special knowledge of or expertise in public health; local public health departments; hospital staff and providers; representatives of social service organizations; and leaders, representatives, and members of medically underserved, low-income, and minority populations. Individuals from the following organizations were interviewed: Boys & Girls Club of Greater Kansas City, Clay County Public Health Center, Crittenton Children's Center, Harvesters Community Food Network, Platte County Health Department, Saint Luke's Health System, Saint Luke's Hospital of Kansas City, Saint Luke's North Hospital, Saint Luke's Physician Group, Samuel U. Rodgers Health Center, and Tri-County Mental Health Services.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - SAINT LUKES NORTH HOSPITAL-SMV. SAINT LUKES NORTH HOSPITAL- BARRY AND SAINT LUKES NORTH HOSPITAL-SMV CONDUCTED THE CHNA TOGETHER.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - FACILITY GROUP A - SAINT LUKES NORTH HOSPITAL-BARRY AND SAINT LUKES NORTH HOSPITAL-SMV. THE HOSPITAL PLANS TO ADDRESS THE SIGNIFICANT NEEDS AS IDENTIFIED IN ITS CHNA AS FOLLOWS: *Access to Care To address this need, the hospital will implement the following initiatives: 1. Support SLHS initiatives to expand access to Telehealth services across the Northland for specialists, primary care physicians, critical care, ICU, NICU, social workers, and qualified mental health professionals. 2. Support SLHS advocacy efforts to assure successful implementation of Medicaid expansion in advance of July 1, 2021. 3. Assist patients with enrollment in Medicaid during hospital episodes of care (utilizing HumanArc). 4. Continue Medical Program Interventional Cardiology Fellows Program with UMKC School of Medicine. 5. Continue providing Allied Health Professions (RT, US, PT, ST, Sterilization Tech) training programs which contribute to the supply of health professionals across the region. 6. Continue active efforts to recruit new services including oncology, neurology, GI, ENT, and an advanced practice provider for OB/GYN. 7. Expand access through the addition of a walk-in clinic for existing and new patients at SLN-Smithville. 8. Continue collaborations between SLN and Federally Qualified Health Centers that serve the Northland. 9. Support SLHS efforts to expand access to Medicaid recipients at Saint Luke's North locations. 10.Continue providing education and training for the community through the following programs: a. Breastfeeding support group, b. Mental health support groups, c. Behavioral health education addressing the impact of Covid-19, d. Primary Stroke Center and Acute Myocardial Infarction programs, e. Healthcare provider education, and f. Other community-based health education and support groups. 11. Provide access to clinicians and staff for outreach and community health education on Covid-19, vaccine benefits and safety, social distancing, masking, testing, safety of hospitals and clinics, and more. 12.Continue to reach the public by providing community education about Covid-19 on Saint Luke's social media platforms. 13.Continue to support SLHS efforts to provide Covid-19 vaccination events. 14.Evaluate opportunities to partner with the Access to Care Task Force of the Northland Health Alliance. *Mental Health To address this need, the hospital will implement the following initiatives: 1. Evaluate the opportunity to implement new mental health programs at SLN-Smithville. 2. Expand access to medication management services to patients in the Northland via Telehealth clinics. 3. Continue providing qualified mental health professionals at all SLHS Emergency Departments (with the exception of Saint Luke's Hospital of Kansas City), plus several non-SLHS Emergency Departments. 4. Continue providing access to a variety of on-site clinical programs for children and adolescents at Crittenton via: a. Inpatient hospitalizations, b. Residential programs, c. Outpatient clinic, d. Foster care, and e. Intensive outpatient substance abuse. 5. Continue providing in-home services for children and adolescents via Crittenton: a. Multiple individual and family therapy sessions and b. Case management 6. Continue providing the nationally recognized Crittenton Trauma Smart program designed to help children heal from complex or repetitive trauma. 7. Evaluate adding intensive outpatient therapy (IOP) for adults with mental illness in the Northland. 8. Provide access for children and adolescents through in-home therapy via Crittenton and Tri-County Mental Health Services. 9. Evaluate the opportunity to expand behavioral health services for SLN employees and their families. 10.Continue active efforts to expand psychiatry, psychology, and therapy services. 11.Continue utilizing Telehealth Behavioral Health Assessment resources expanding access to Primary Care and Women's Health & Maternal Fetal Medicine High-Risk OB patients to identify at-risk patients for suicide, homicide, and severe depression in order to escalate referrals. 12. Expand opportunities to provide the following programs in partnership with community organizations. Offerings available for chambers of commerce, faith-based organizations, schools, nonprofits, and other organizations as appropriate. a. Crisis Intervention Training (CIT) b. Suicide prevention programs c. QPR mental health trainings d. Mental health education 13.Evaluate opportunities to collaborate with the Behavioral Health Task Force of the Northland Health Alliance. *Poverty and Social Determinants of Health To address this need, SLN will implement the following initiatives: 1. Implement a base living wage of $15 per hour for SLHS employees. 2. Continue offering the Saint Luke's Community Resource Hub to expand patient, employee, and community awareness of available health and social services. 3. Continue screening all patients for social determinants of health issues. a. Document needs in EPIC based on Health Leads screening toolkit. b. Place consults in Care Progression for interventions. c. Refer patients to information available on the Saint Luke's Community Resource Hub. 4. Continue providing taxicab and Uber/Lyft vouchers for low-income patients who need transportation post-discharge. 5. Partner with Park Hill School District and the Northland Center for Advanced Professional Studies (CAPS) Program to have students interested in healthcare shadow at the hospital. 6. Continue the hospital's Medication Assistance Program for patients who are underinsured and/or uninsured. 7. Continue developing and utilizing the Care Companion Platform, a mySaintLuke's resource to support chronic disease management. No hospital organization can address all the health needs present in its community. SLN iscommitted to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a wide range of community benefits. SLN does not intend to address three of the six significant community health needs identified through its 2021 CHNA, as follows. 1. COVID-19 pandemic and effects. SLN recognizes the significant challenges of the COVID-19 pandemic and its effects. SLN addresses the needs of COVID-19 patients by providing access to care. The hospital also supports community focused SLHS initiatives in the Kansas City region. 2. Needs of growing senior population. SLN and SLHS recognize the significant growth projected for the population aged 65 years and older. SLN already offers a wide array of acute and continuing care services for this growing population and anticipates continuing to meet its health care needs. Based on the criteria described above, the committee charged with developing this plan determined that the hospital's implementation strategy should focus on other, higher priority types of community health needs. 3. Unhealthy behaviors. While SLN's 2020 CHNA identified the prevalence of unhealthy behaviors (e.g., physical inactivity, smoking, and others) as a significant community health need, the committee charged with developing this plan identified three other needs as higher priorities for the 2022-2024 SLN implementation strategy.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
18564848

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: Performance obligations are identified based on the nature of the services provided. Revenue associated with performance obligations satisfied over time is recognized based on actual charges incurred in relation to total expected (or actual) charges. Performance obligations satisfied over time relate to patients receiving inpatient acute care services. The System measures the performance obligation from admission into the hospital to the point when there are no further services required for the patient, which is generally the time of discharge. For outpatient services, the performance obligation is satisfied as the patient simultaneously receives and consumes the benefits provided as the services are performed. In the case of these outpatient services, recognition of the obligation over time yields the same result as recognizing the obligation at a point in time. Management believes this method provides a faithful depiction of the transfer of services over the term of performance obligations based on the inputs needed to satisfy the obligations. As the System's performance obligations relate to contracts with a duration of less than one year, the System has applied the optional exemption provided in the guidance and, therefore, is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when the patients are discharged, which generally occurs within days or weeks of the end of the reporting period. The System uses a portfolio approach to account for categories of patient contracts as a collective group rather than recognizing revenue on an individual contract basis. The portfolios consist of major payor classes for inpatient revenue and major payor classes and types of services provided for outpatient revenue. Based on the historical collection trends and other analyzes, the System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. The System determines the transaction price, which involves significant estimates and judgment, based on standard charges for goods and services provided, reduced by explicit and implicit price concessions, including contractual adjustments provided to third-party payors, discounts provided to uninsured and underinsured patients in accordance with policy and/or implicit price concessions based on the historical collection experience of patient accounts. The System determines the transaction price associated with services provided to patients who have third-party payor coverage based on reimbursement terms per contractual agreements, discount policies and historical experience. For uninsured patients who do not qualify for charity care, the System determines the transaction price associated with services on the basis of charges, reduced by implicit price concessions. Implicit price concessions included in the estimate of the transaction price are based on historical collection experience for applicable patient portfolios. Patients who meet the System's criteria for charity care are provided care without charge; such amounts are not reported as revenue. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. PATIENT RELATED BAD DEBT IS REPORTED CONSISTENT WITH THE FINANCIAL STATEMENTS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
SEE FOOTNOTE PROVIDED ABOVE IN THE EXPLANATION FOR PART III, LINE 2

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO DIRECTLY FROM THE MEDICARE COST REPORT. SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN WHAT IT COSTS TO PROVIDE THE CARE AND SERVICES. WE ACCEPT ALL MEDICARE PATIENTS KNOWING THE COST OF PROVIDING THE CARE MAY EXCEED THE FUNDS WE RECEIVE FROM MEDICARE FOR THE SERVICE. OUR SHORTFALL IS CONSIDERED TO BE COMMUNITY BENEFIT. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS, INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
OUR DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF THE PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FOR ANY REMAINING BALANCES DUE, THE SAME COLLECTION POLICY AND PROCEDURES ARE APPLIED EQUALLY TO ALL PATIENT TYPES. ALTHOUGH WE ARE NOT LEGALLY BOUND BY THE FAIR DEBT COLLECTION PRACTICES ACT, THE PRINCIPLES ADDRESSED ARE GENERALLY FOLLOWED.

Schedule H, Part V, Section B, Line 16a FAP website
A - SAINT LUKES NORTH HOSPITAL-BARRY: Line 16a URL: www.saintlukeskc.org/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - SAINT LUKES NORTH HOSPITAL-BARRY: Line 16b URL: www.saintlukeskc.org/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - SAINT LUKES NORTH HOSPITAL-BARRY: Line 16c URL: www.saintlukeskc.org/financial-assistance;

Schedule H, Part VI, Line 2 Needs assessment
THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, AND ANNUAL STRATEGIC PLANNING PROCESS. THE HOSPITAL MEETS WITH STAFF, VOLUNTEERS, PATIENTS, BOARD MEMBERS AND PHYSICIANS. THE FEEDBACK PROVIDED BY THESE GROUPS IS COMMUNICATED TO HOSPITAL MANAGEMENT AND CONSIDERED WHEN DETERMINING THE NEEDS OF THE COMMUNITY.

Schedule H, Part VI, Line 4 Community information
BETWEEN OUR BARRY ROAD AND SMITHVILLE HOSPITALS, SAINT LUKE'S NORTH HOSPITAL HAS 161 LICENSED PATIENT BEDS AND MORE THAN 20 SPECIALIZED HEALTH CARE SERVICES. BOTH CAMPUSES SERVE THE NORTHERN KANSAS CITY AREA.

Schedule H, Part VI, Line 5 Promotion of community health
THE BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROFESSIONALS, ALMOST ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, AND IN GENERAL STEWARDSHIP. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
THE HOSPITAL FOLLOWS THE SAINT LUKE'S HEALTH SYSTEM POLICIES FOR FINANCIAL ASSISTANCE, PATIENT BILLING AND COLLECTION. IN ADDITION TO THESE POLICIES, THE HOSPITAL PROVIDES EDUCATION ON FINANCIAL ASSISTANCE ELIGIBILITY TO PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES THROUGH MANY SOURCES INCLUDING THE SLHS WEBSITE, INFORMATION ON BILLING STATEMENTS, INFORMATION UPON CHECK-IN LOCATED IN THE ADMITTING PATIENT PACKETS, ON OUR B-131 RELEASE TO TREAT FORMS SIGNED BY ALL PATIENTS REQUESTING SERVICES, VISITS WITH INPATIENTS BY SOCIAL WORKER TEAMS, AND FOLLOW-UP CALLS TO PATIENTS AFTER DISCHARGE. FINANCIAL ASSISTANCE APPLICATIONS OR MEDICAID APPLICATIONS ARE REQUESTED ON ALL UNINSURED INPATIENTS PRIOR TO DISCHARGE. THE HOSPITAL ALSO CONTRACTS WITH ELIGIBILITY ENROLLMENT COMPANIES TO SCREEN ALL UNINSURED PATIENTS, ANY PATIENTS IDENTIFIED BY OUR SOCIAL WORKER OR CASE MANAGEMENT TEAMS, AND ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR MEDICAID OR OTHER GOVERNMENT COVERAGE. THE ELIGIBILITY ENROLLMENT SERVICE ALSO PROVIDES PATIENTS WITH INFORMATION ON FINANCIAL ASSISTANCE.

Schedule H, Part VI, Line 6 Affiliated health care system
THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSIST OF 16 AREA HOSPITAL FACILITIES, AND SEVERAL PRIMARY AND SPECIALTY CARE PRACTICES, AND PROVIDES A RANGE OF INPATIENT, OUTPATIENT, AND HOME CARE SERVICES. FOUNDED AS A FAITH-BASED, NOT-FOR-PROFIT ORGANIZATION, OUR MISSION INCLUDES A COMMITMENT TO THE HIGHEST LEVELS OF EXCELLENCE IN HEALTH CARE AND THE ADVANCEMENT OF MEDICAL RESEARCH AND EDUCATION. THE HEALTH SYSTEM IS AN ALIGNED ORGANIZATION IN WHICH THE PHYSICIANS AND HOSPITALS ASSUME RESPONSIBILITY FOR ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF PEOPLE IN THE METROPOLITAN KANSAS CITY AREA AND THE SURROUNDING REGION.