4A (Expenses $ 7378476 including grants of $ 0) (Revenue $ 6419776)
Medical inpatient services encompass over 1,050 patient admissions and over 4,220 patient days. St. Mary's Medical Center provides diagnostic services and high quality care to patients admitted with a wide range of diagnoses. Services includes radiology disciplines such as MRI, CT-Scans, and Ultrasound as well as laboratory tests; respiratory procedures; therapy treatments; pharmacy services and bedside nursing care.

4B (Expenses $ 5104468 including grants of $ 0) (Revenue $ 6163082)
Emergency services includes over 14,800 patient visits in the 24-hour emergency department. These patients are diagnosed, treated and discharged by our highly qualified clinicians and emergency physicians.

4C (Expenses $ 4410445 including grants of $ 0) (Revenue $ 3501198)
Surgical Services includes over 200 inpatient admissions,1,000 patient days and 200 outpatient surgeries. St. Mary's Medical Center offers a wide range of both invasive and non-invasive surgical procedures and is equipped with the latest diagnostic and surgical equipment operated by our highly qualified nursing staff and physicians. Our medical center embraces major disciplines of care ranging from minimally invasive procedures to complex multi-disciplinary surgical interventions. We offer a wide range of outpatient and inpatient surgical interventions including vascular surgery, surgical management of breast disease, surgical oncology, orthopedic surgery, gynecological surgery, and ENT procedures.

4D (Expenses $ 15655145 including grants of $ 0) (Revenue $ 25940048)
ALL OTHER PROGRAM SERVICES INCLUDE CARDIOLOGY, ORTHOPEDICS, NEUROLOGY, ONCOLOGY, REHAB SERVICES, WOMEN'S SERVICES, RADIOLOGY, SLEEP LAB, PAIN CENTER, WOUND CARE AND OTHER OUTPATIENT AREAS. THESE SERVICES REPRESENT 1,195 INPATIENT ADMISSIONS WITH 5,082 PATIENT DAYS AND 25,852 OUTPATIENT VISITS.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - St. Mary's Medical Center. Interviews with key stakeholders within Jackson County, MO were conducted between January and February 2013. Attachment A of CHNA lists the names titles and organizations of those participating in the 3D-minute interviews. In total 50 interviews were completed. Physicians from the St. Mary's Medical Executive Committee and members of the St. Mary's Patient Advisory Committee also participated in this research by providing feedback on the consumer health needs in Jackson County. The individuals who participated in the community stakeholders' interviews represent the broad interests of the community served by St. Mary's Medical Center and included members of organizations serving low-income minority populations and populations with chronic disease needs. Representatives from the three public health departments serving Jackson County, MO were also included in this research. These Community leaders assisted our hospital in ranking the health needs that were determined to be a priority in the community. For a full list of organizations represented by the community stakeholders reference A of CHNA.,Appendix For a copy of the key stakeholder interview guide, including a ranking worksheet of top priorities in Jackson County, MO reference Appendix B of CHNA.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - St. Mary's Medical Center. Needs Not Being Addressed as a Priority: - Access to Quality Healthcare: This need will not be addressed as priority. Our mission is to improve the health and lives of our patients and community. We take great pride in putting our patients first and that is the reason we have our charity and financial assistance programs available to offer assistance. St. Mary's also works with the Shared Free Clinic and several Stand Up! Blue Springs projects that provide dental care for children. However, due to resource restraints there are other organizations, some non-hospital settings, more equipped to deal with this issue. There are various community organizations and programs addressing this need. - Addiction/Substance Abuse: This need will not be addressed as a priority. St. Mary's does not have a behavioral health program but collaborates with many organizations that focus on addiction and/or substance abuse to ensure our patients have continuity of care in te appropriate setting. This need is being addressed by a variety of organizations in Jackson Country and throughout the Kansas City area. - Infectious Diseases: This need will not be addressed as a priority. Jackson County Health Department manages this issue. - Maternal, Infant, and Child Health: This is a need we were addressing until the close of our Birthing Center in July of 2013. This is not a need we will be addressing going forward. Pregnant women in Jackson County are significantly more likely to receive no or inadequate prenatal care when compared to the statewide average; the percentage of low birth weight infants and infant mortality rates in Jackson County are also significantly higher. Teenage pregnancy is still very taboo and an issue in the community. St. Mary's Medical Center was awarded the Mader Family Foundation grant and created the St. Mary's Healthy Beginnings Program to address these issues. The St. Mary's Medical Center Foundation, with the support of local community agencies, made it possible to offer a unique prenatal program free of charge. Healthy Beginnings was for young mothers who were socially at risk. That included those who were on Medicaid, teens and those dealing with other social situations that could benefit from additional support. Members of this group received three to five individual visits with an RN for one-on-one education. Participants also receive a free car seat, childbirth classes, a breast pump, a breast-feeding class, prenatal education, referral to community resources (WIC, Healthy Families and Hope House), infant and maternity clothing, and much more. With the close of the Birthing Center, it was very important to keep the intent of the grant intact. The remaining $16,000 was given to Children's Mercy East ,the Boy Scouts (obesity program) and Rainbow Center to support children in Eastern Jackson County. - Mental Health and Mental Disorders: This need will not be addressed as a priority. St. Mary's does not have a behavioral health program and lacks the resources needed to combat this monumental problem. We do, however, collaborate with many organizations that focus on mental health to ensure our patients have continuity of care in the appropriate setting. This need is being addressed by a variety of organizations in Jackson County and throughout the Kansas City area. - Violence Prevention: This need will not be addressed as a priority. St. Mary's has an ongoing relationship with Hope House and helps promote awareness among our patients and employees to ensure they are receiving the care and support they need. However, there are other organizations in the community better served to address this need.

Schedule H, Part V, Section B, Line 22 Facility , 1
Facility , 1 - St. Mary's Medical Center. For cases that apply for our charity care program, upon receipt of a completed application, collection activity will cease until a determination has been made. For presumptive charity cases (cases where an application is not necessarily completed), collection activity may continue while the due diligence is being completed or until the patient's account is reviewed. Additionally, for all patients identified as full charity care patients, Carondelet Health: - Will not place a lien on a charity care patient's primary residence or include the primary residence in the asset calculation unless the value of the property clearly indicates an ability to assume the financial obligation and subject to senior management approval. - Will not execute a lien or force the sale or foreclosure of a charity care patient's primary residence/property to pay for an outstanding medical bill. - Will not use forced court appearance to require the charity care patient or responsible party to appear in court. - Will not garnish wages. Hospital charity policy has a yearly maximum to be charged for medical care for catastrophic medical cases where patient/guarantor medical bills exceed 20% of their gross income plus assets for the year. Uninsured Patient Discount Eligibility Criteria: An uninsured patient who does not qualify as financially or medically indigent shall receive a discount. Effective 7/1/10, the uninsured discount will be 30%. Prompt Pay: Prompt payment discounts are extended to all self-pay balances in return for immediate payment of patient/guarantor's. The prompt pay discount provides patients with balances due an alternative method of payment, as well as expedites the resolution of self-pay receivables. A prompt pay discount of 10% of charges is applicable for patients who meet the terms as stated in Carondelet Health Business Office Discretionary Discount Policy.

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
The annual community benefit report is completed for Carondelet Health, the parent organization for St. Mary's Medical Center.

Schedule H, Part I, Line 7g Subsidized Health Services
St. Mary's Medical Center provides several clinical services that result in a financial loss. These services include Nursery Intensive Care Unit (NICU), Cardiac Rehab and the Obstetric/Newborn program. These services are hospital programs and do not include physician clinic services.

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

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
From the consolidated audited financial statements of Ascension Health Alliance (which includes the activity of St. Mary's Medical Center): The provision for doubtful accounts is BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, INCLUDING THOSE AMOUNTS NOT COVERED BY INSURANCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE SYSTEM. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEM'S POLICIES. THE METHODOLOGY FOR DETERMINING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND RELATED WRITE-OFFS ON UNINSURED PATIENT ACCOUNTS HAS REMAINED CONSISTENT WITH THE PRIOR YEAR.

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

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply.

Schedule H, Part VI, Line 2 Needs assessment
The health care needs of our community are assessed every year by the Mid-America Regional Council. The assessment is based on data collected through surveys of safety net clinics and information provided by the Missouri and Kansas Hospital Associations and public health records. A committee comprised of representatives from medical data to develop recommendations for improving access to health care in the community. Carondelet Health implemented a new process that will comply with the Patient Protection and Affordable Care Act of 2010 requirement for a community health needs assessment including both qualitative and quantitative research.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
"For uninsured patients, at time of service we interview the patient looking for "" found"" insurance (Medicaid, Cobra automobile insurance or local government programs). If no insurance coverage is discovered we discuss payment arrangements and the hospital's financial assistance/charity programs. After time of service when patients contact the business office regarding their patient care liability and the patients indicate a financial hardship in making payment, we discuss payment arrangements and the hospital's financial assistance/charity program."

Schedule H, Part VI, Line 4 Community information
Carondelet Health is comprised of two acute care hospitals, St. Joseph Medical Center and St. Mary's Medical Center, along with Carondelet Horne Care Services a home health agency. Carondelet Health primarily serves the southern and eastern areas of metropolitan Kansas City, which comprise approximately two-thirds of the entire Kansas City population or 2.4 million people. 13.8% of households live at or below federal poverty guidelines, and uninsured and underinsured persons represent 25% of the population. 22% of the population are minority and 7% speak a language other than English, predominantly Spanish.

Schedule H, Part VI, Line 5 Promotion of community health
Carondelet Health's board is comprised of individuals from throughout the community. Medical staff privileges are extended to all physicians who apply and meet qualifications. Carondelet Health provides a wide variety of resources to help improve the health of the community. Our web site provides a free comprehensive health library with information on general wellness and specific health conditions with additional direct links to other health care , along support organizations. Meeting space is offered on the campuses of St. Joseph and St. Mary's Medical Centers for use by community groups. A wide range of support groups provide counseling for patients and their families coping with health concerns. In addition Carondelet Health's, community outreach efforts provide health and wellness resources that otherwise may be unavailable to many community members including free health screenings and health educational materials.

Schedule H, Part VI, Line 6 Affiliated health care system
Carondelet Health is a member of Ascension Health. Ascension Health Alliance d/b/a Ascension (Ascension), is a Missouri nonprofit corporation formed on September 13, 2011. Ascension is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia. SPONSORSHIP ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. MISSION THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING, AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTHCARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS. - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF EACH ENTITY'S TOTAL OPERATING EXPENSES TO THE ENTITY'S BILLED CHARGES FOR PATIENT CARE.