4A (Expenses $ 288192606 including grants of $ 34181178) (Revenue $ 367749531)
SAINT LUKE'S EAST HOSPITAL (SLEH) IS A FULL SERVICE, 236 BED HOSPITAL AND OUTPATIENT CAMPUS PROVIDING ACUTE AND GENERAL HEALTH CARE TO THE COMMUNITY. 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. THE HOSPITAL HAD 60,300 INPATIENT DAYS AND PROVIDED APPROXIMATELY 150,200 OUTPATIENT AND EMERGENCY SERVICES. EMERGENCY SERVICES ARE PROVIDED 24 HOURS A DAY, 7 DAYS A WEEK AND ARE STAFFED BY BOARD-CERTIFIED EMERGENCY PHYSICIANS. THE HOSPITAL ALSO PROVIDES HEALTH RELATED ACTIVITIES AND SERVICES IN SUPPORT OF THE COMMUNITY, INCLUDING BUT NOT LIMITED TO SOCIAL WORK SERVICES, SPIRITUAL SERVICES, AND COMMUNITY EDUCATION / HEALTH FAIRS. 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 , 1
Facility , 1 - SAINT LUKES EAST HOSPITAL. Input from persons representing the broad interests of the community was taken into account through key informant interviews (16 participants) and community meetings (44 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, City of Kansas City Department of Health, Crittenton Children's Center, Harvesters Community Food Network, Saint Luke's East Hospital, Saint Luke's Health System, Saint Luke's Hospital of Kansas City, Saint Luke's Physician Group, and Samuel U. Rodgers Health Center.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - SAINT LUKES EAST HOSPITAL. The hospital is addressing the following three significant health needs as identified in its CHNA, in addition to an overarching focus on advancing racial and ethnic health equity: *Access to Care To address this need, the hospital will implement the following initiatives: 1. Provide access for new and existing patients at Urgent Care, Convenient Care Clinics, and the Emergency Department. 2. Support SLHS advocacy efforts to assure successful implementation of Medicaid expansion in advance of July 1, 2021. 3. Support SLHS efforts to expand access to Medicaid recipients at Saint Luke's East locations. 4. Continue active efforts to recruit new services including vascular, thoracic, and spine. 5. Expand Telehealth services to victims of domestic violence at Hope House. 6. Continue providing education and training for the community through the following programs: a. Breastfeeding education b. Women's Health Community Champions c. Diabetes education d. Stroke support and education e. Heart attack support and education f. Other community-based health education and support groups. 7. Continue to support SLHS efforts to provide Covid-19 vaccination events at the hospital retail pharmacy. 8. 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, as opportunities arise. 9. Continue to reach the public by providing community education about Covid-19 via Saint Luke's social media platforms. *Needs of Growing Senior Population To address this need, the hospital will implement the following initiatives: 1. Continue to evaluate partnership opportunities with John Knox Village to support growing senior population. 2. Continue providing outreach services and health screenings for low-income and disabled seniors living in identified buildings and communities. 3. Continue providing out-bound transportation to vulnerable seniors. 4. Continue helping patients apply for Medicare, Medicaid, and insurance benefits to support needed medical and home-based services. 5. Expand the Meds-to-Beds program, which provides patients with access to medications prior to discharge. 6. Implement Phase I of the Saint Luke's at Home program to provide primary care and acute care to qualified SLHS patients. 7. Evaluate opportunities for community health education. *Poverty and Social Determinants of Health To address this need, the hospital 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 developing and utilizing the Care-Companion Platform, a mySaintLuke's resource to support chronic disease management. 5. Continue supporting the Compassionate Care Fund and Medication Assistance Program that support access to health services and medications for those adversely impacted by health disparities and social determinants of health. 6. Participate in SLHS Anchor Institution Strategies to be included in the SLHS Destination 2025 Strategic Plan: a. Expand hiring programs that build pipelines for people of color and local hiring and workforce development programs. b. Hold on-site (and participate off-site) job fairs. 7. Expand programs to introduce high-school aged students to the health professions. 8. Continue providing rideshare vouchers for low-income patients who need transportation post discharge. No hospital organization can address all the health needs present in its community. The hospital is committed 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. The hospital does not intend to address three of the six significant community health needs identified through its CHNA, as follows. 1. COVID-19 pandemic and effects. SLE recognizes the significant challenges of the COVID-19 pandemic and its effects. SLE 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. Mental health. While the hospital's CHNA identified Mental Health as a significant community health need, SLE does not provide psychiatric or behavioral health care and thus does not have the expertise or dedicated resources to address this need. The committee charged with developing the 2022-2024 SLE Implementation Strategy identified three other needs as higher priorities. 3. Unhealthy behaviors. While SLE's 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 SLE Implementation Strategy.

Schedule H, Part I, Line 3c ASSISTANCE ELIGIBILITY
THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. IN ADDITION, MEDICAL INDIGENCY MAY BE DETERMINED ON AN INDIVIDUAL BASIS FOR INCOME ABOVE THE FEDERAL POVERTY LEVEL WHEN A SINGLE ILLNESS OR INJURY CAUSES HARDSHIP.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
17447966

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
COSTS OF CHARITY CARE AND UNREIMBURSED HEALTH SERVICES WERE CALCULATED USING THE APPROPRIATE COST TO CHARGE RATIO FROM THE HOSPITAL'S COST REPORT.

Schedule H, Part II Community Building Activities
OUR HOSPITAL SPONSORS OR PARTICIPATES IN MANY COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF OUR COMMUNITY. THESE ACTIVITIES INCLUDE FREE FLU SHOTS AVAILABLE TO THE PUBLIC, CHILD CAR SEAT SAFETY CHECKS, AND COLLECTING CLOTHING ARTICLES AND FOOD DONATIONS FOR LEE'S SUMMIT CARES AND FOR OTHER SPONSORSHIPS AND COMMUNITY EVENTS. SAINT LUKE'S EAST ALSO PROVIDES CAREER SHADOWING AND PARTICIPATES IN A HIGH SCHOOL CAREER ADVISORY PROGRAM. THE HOSPITAL ENCOURAGES ITS EMPLOYEES TO SERVE ON COMMUNITY BOARDS AND TO VOLUNTEER FOR ACTIVITIES THAT PROMOTE WELLNESS IN THE COMMUNITY.

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 9b Collection practices for patients eligible for financial assistance
THE 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
- SAINT LUKES EAST HOSPITAL: Line 16a URL: www.saintlukeskc.org/financial-assistance;

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

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

Schedule H, Part VI, Line 2 Needs assessment
IN ADDITION TO ITS CHNA, THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING ITS COMPREHENSIVE DATA DRIVEN, ANNUAL STRATEGIC PLANNING PROCESS. THE HOSPITAL OBTAINS HIDI MARKET DATA AND OTHER OUTPATIENT MARKET DATA. WITH THIS DATA, THE HOSPITAL IDENTIFIES SERVICES RECEIVED BY THE RESIDENTS OF OUR COMMUNITY (DEFINED BY OUR PRIMARY AND SECONDARY SERVICE AREAS). ANY PREDOMINANT SERVICES NOT CURRENTLY OFFERED BY THE HOSPITAL ARE CONSIDERED AT THIS TIME. ANOTHER ELEMENT OF THE COMMUNITY ASSESSMENT CONSISTS OF QUARTERLY MEETINGS OF SENIOR ADVISORY COMMITTEE AND BUSINESS ADVISORY COMMITTEE OF BOARD OF DIRECTORS. THROUGH FEEDBACK FROM THESE MEETINGS, COMMUNITY NEEDS ARE COMMUNICATED TO THE HOSPITAL AND CONSIDERED.

Schedule H, Part VI, Line 4 Community information
SAINT LUKE'S EAST HOSPITAL IS LOCATED IN JACKSON COUNTY, MISSOURI, A SUBURB OF THE KANSAS CITY METROPOLITAN AREA. THE COMMUNITY IS DESCRIBED AS A 26 ZIP CODE SERVICE AREA.

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 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 5 Promotion of community health
THE BOARD OF DIRECTORS CONSISTS OF MEDICAL PROFESSIONALS, BUSINESS PROFESSIONALS AND ACTIVE COMMUNITY MEMBERS, NEARLY ALL OF WHOM RESIDE OR WORK IN THE COMMUNITY. THE BOARD IS INVOLVED IN THE PLANNING AND COMMUNITY ASSESSMENT PROCESSES. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.

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.