4A (Expenses $ 453732247 including grants of $ 746180) (Revenue $ 512489949)
Medical and surgical services provided to 12,592 inpatients and 444,461 outpatients during the year.

4B (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
Various other services. Please see Schedule H.Catholic Medical Center (CMC), as an agency of the Roman Catholic Church, shall provide health care in a manner consistent with the ethical and religious directives for Catholic health care services as interpreted by the Roman Catholic Bishop of Manchester. CMC shall employ the highest quality health care professionals and the most appropriate technology to deliver an array of services either directly or through strategic alliances with compatible health care providers. With dignity and compassion, CMC shall treat the body, mind, and spirit of all who seek or provide care and comfort. Additional details provided in Schedule H.

Catholic Medical Center
Part V, Section B, Line 5: A variety of different secondary data sources were accessed. They included but were not limited to the Centers for Disease Control and Prevention (CDC), New Hampshire Department of Health and Human Services (NHDHHS), Youth Behavioral Risk Factor Surveillance Survey, City of Manchester, Census data, and local town data. Representatives from CMC, Elliot Health System (EHS) and Manchester Health Department interviewed key leaders from towns in our service area to ascertain the key health related issues that they were facing and dealing with in their local communities. The towns that were included in the interview process were Auburn, Bedford, Candia, Hooksett, Goffstown, Deerfield, and New Boston. Though the overall needs were similar the priority of them varies between the towns. Overall, the common themes were substance use, the availability of behavioral health services, transportation (especially in the elderly populations and the more rural areas of New Boston and Deerfield), self-care and management of chronic disease, and access to health care for the low income populations and communities. Communications on community needs were collected via discussions with local leaders in the health care field. These leaders consisted of individuals from: Catholic Medical Center, Dartmouth-Hitchcock Clinic, Public Health Department - City of Manchester, NH, Elliot Health System, and Community Health & Mission.

Catholic Medical Center
Part V, Section B, Line 6a: Elliot Health System in Manchester, NH.

Catholic Medical Center
Part V, Section B, Line 6b: Manchester Health Department.

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"Part V, Section B, Line 7d: The Catholic Medical Center ""Healthy Living News"", the Medical Center's community newsletter, provides a summary report of the community benefits that the Medical Center provides. The Healthy Living News is distributed to our primary and secondary service areas, approximately 120,000 people."

Catholic Medical Center
Part V, Section B, Line 11: Catholic Medical Center has addressed the needs identified in the June 30, 2022 CHNA through the implementation of programs and services throughout the Manchester health service area (HSA). Mental illness and violence are often intrinsically intertwined. CMC has increased services within our Behavioral Health Department and developed the Opioid Use/Misuse Resource. This is an online tool available to all CMC staff to create consistency of care in the treatment and recovery of this public health epidemic. Health Care for the Homeless (HCH) of CMC provides behavioral health services and substance abuse counseling to the homeless throughout the Manchester HSA. CMC has improved the mental health assessment tool in Primary Care, a key component in the early identification and treatment of mental illness. The Doorway of Greater Manchester: In May 2020, CMC, assumed leadership of The Doorway Program of Greater Manchester. The NH Doorway system was launched in January 2019 with funding from the State Opioid Response grant from the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA) and is designed to be an access point for those seeking services for substance use disorder (SUD). A 2018 study from SAMHSA found that 20.3 million people aged 12 or older, or 7.4% of this population had a SUD. SUD continues to be an area of concern identified in the Greater Manchester Community Health Needs Assessment. Of those with an addiction-related condition, only 11% received treatment. By operating the Doorway, CMC is committed to assisting those with SUD by connecting them with clinical treatment and wrap-around services to break the cycle of addiction. Wilson Street Integrated Health: Continuing its mission of caring for the region's most vulnerable neighbors, CMC opened Wilson Street Integrated Health (WSIH), located within the Manchester Recovery and Treatment Center (MRTC). Wilson Street Integrated Health is a service of the Health Care for the Homeless Program of Manchester, a collaboration between CMC and the City of Manchester Health Department. The new practice offers primary care, social work, counseling and medication assisted treatment to our most vulnerable patients, as well as providing our patients with easy access to our MRTC partners: Hope for New Hampshire Recovery, The Willows Substance Use Treatment Center, and the Mental Health Center of Greater Manchester's Mobile Crisis Response Team. Ambulatory care, chronic disease, including asthma and aging issues have all been addressed through various means. Catholic Medical Center's Primary Care has implemented The Patient-Centered Medical Home (PCMH) Model, a proactive approach to preventative medicine through the introduction of care coordinators to the primary care practices. All care managers work with the practices' most high risk patients (asthma, diabetes, COPD, etc) to ensure they understand their medications and follow-up care. The PCMH Model encourages patients to become involved and educated in their personal care plan. CMC offers free health screenings, chronic disease, and self-management classes to the community. These programs provide the opportunity for early detection of chronic disease; referral based follow-up care and education on adopting healthy lifestyle behaviors, communicating with the healthcare team, problem solving, and goal setting. To aid with aging issues, CMC's Parish Nurse program provides nurse consultations, education, referrals, and screenings at Parishes throughout the Greater Manchester Area.In order to address the barriers to access of health care services related to poverty (lack of insurance, cost, transportation and education on accessing care, and lack of medical home) CMC provides comprehensive care to Manchester's underserved and refugee populations. Health Care for the Homeless provides primary medicine and behavioral health care to over 1,700 homeless patients. CMC's Certified Application Counselors (CAC) provide outreach and enrollment services to the communities' uninsured. CACs provide information on a full range of qualified health plan (QHP) options and assist individuals in applying for coverage through a QHP in the ACA's Marketplace Exchange. CMC provides shuttle support at no cost to patients with offsite appointments such as primary care, outpatient PT, and other services that are not available at the Hospital. CMC assists patients through the Medication Assistance program to obtain medications they would otherwise not be able to afford and has developed a prescription delivery program with Rite Aid Pharmacy to assist patients with filling their medications upon discharge.CMC's Poisson Dental Facility has expanded access to oral health services to patients of the Pregnancy Care Center and Manchester Community Health Center (MCHC). The Poisson Dental Facility provides access to exams and treatment planning for women from the Pregnancy Care Center and access to oral health care during the first post-partum year until their treatment plan has been completed. CMC's Poisson Dental facility provides oral health services to not-for-profit agencies in our community including Mental Health Center of Greater Manchester, Moore Center Services, Manchester Health Department, and Health Care for the Homeless (HCH). The majority of HCH patients often arrive with very poor oral health. In an effort to meet the growing need for oral health services, CMC's Poisson Dental expanded services to include school-based dental care for children in need attending Manchester elementary, middle, and high schools. This school-based program is made possible through collaboration with the City of Manchester Health Department and Easter Seals NH. Poisson Dental also provides onsite dentistry at Dartmouth Hitchcock Manchester by integrating these services within their pediatric practice. This allows for ease of access for the patients and direct communication amongst the providers of care.CMC's Fertility Education provides teens at local schools and parishes educational opportunities such as The Cradle Within, Ideal Dating, Sexual Risk Behavior, and Conflict Resolution. The goal is to equip adolescents with the tools to identify healthy relationships and the benefits of choosing sexual risk avoidance behaviors. The Pregnancy Care Center provides supportive prenatal care to all women, including teens, regardless of their ability to pay. Their mission is to improve pregnancy outcomes by serving those most in need and unable to access services in a traditional prenatal setting. The Pregnancy Care Center expanded services, adding Centering Group Prenatal Care; this program is a multifaceted model of group care that integrates the three major components of care: health assessment, education, and support. Visits promote greater patient engagement, personal empowerment, and community-building. Veteran's Support: In June of 2018, Easter Seals and Catholic Medical Center launched a pilot program to provide Easter Seals' Military & Veteran Services (MVS) care coordination services onsite to veterans, service members, and their immediate family members (including CMC staff members). Easter Seals MVS provides care coordination services to veterans of all eras, regardless of branch, active duty status, length of service, or discharge status. Among other things, Easter Seals MVS can help patients (and staff members who are veterans) to determine eligibility for and connect to military and civilian benefits and resources, stabilize housing, and find employment support.Breast & Cervical Cancer Screening: Regular screenings and follow-up care can help prevent or more effectively treat breast and cervical cancers. The Let No Woman Be Overlooked Breast and Cervical Cancer Program allows women throughout New Hampshire who do not have access to essential, basic, preventive care access free screenings.(Explanation is continued later in Part V, Facility Information)

Catholic Medical Center
Part V, Section B, Line 16j: Signs are posted throughout the hospital facility and physician practices that list the financial programs available and contact information for assistance.

Part V, Line 7a & 7b:
Hospital's Website URL for Community Health Needs Assessment: https://www.catholicmedicalcenter.org/CatholicMedicalCenter/media/CMCE-Media-Library/AboutUs/Manchester-Community-Health-Needs-Assessment-2022.pdf The CHNA can also be found at:https://www.elliothospital.org/website/downloads/Manchester-Community-Health-Needs-Assessment-2022.pdf

Part V, Line 10a:
Hospital's Website URL for Community Health Implementation Plan:www.catholicmedicalcenter.org/about-cmc/in-the-community/community-health-implementation

Schedule H, Part V, Section B, Line 16a-16c:
The financial assistance policy, application, and plain language summary are available online: https://www.catholicmedicalcenter.org/patients-visitors/financial-assistance

Part I, Line 7, Column (f):
The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 16,187,697.

Part II, Community Building Activities:
Catholic Medical Center participates in a wide range of community building activities, committees, boards, and partnerships to promote the health of the communities it serves, including City Year, Granite United Way, and New Hampshire Charities, among others. The Medical Center sponsors emergency service efforts through planning hours for emergency preparedness and bioterrorism preparedness safety management.COVID-19: During the unprecedented COVID-19 pandemic, CMC was an integral part of the community's response activities. Early on in the pandemic, CMC partnered with the City of Manchester at the City's first COVID testing center located at the NH State Armory. Shortly thereafter, CMC collaborated with the City of Manchester, NH National Guard, and other healthcare partners to stand up the Greater Manchester Alternative Care Site (GMACS), a 250-bed field hospital located at Southern New Hampshire University (SNHU). CMC's Incident Command Center held weekly calls with the City's Emergency Operations Center, ensuring constant communication and updated information sharing. Finally, CMC has provided clinical and non-clinical staff to support the State's fixed Covid Vaccine site at SNHU as well as super clinics held at the New Hampshire Motor Speedway.

Part III, Line 2:
Costing methodology ratio of cost to charge is used to arrive at cost of bad debt expense.

Part III, Line 3:
Patients deemed eligible for financial asssistance follow CMC's charity care policies. Therefore, no bad debt expense related to patients eligible under the Hospital's financial assistance policy is included as a community benefit.

Part III, Line 4:
See Footnote 2 on Page 11 of the attached audited financial statements.

Part III, Line 8:
The entire Medicare shortfall is reported in our Community Benefit Report to the State of New Hampshire. The Medicare shortfall represents costs incured by the Hospital for providing care to Medicare patients in the Hospital's service area that were not reimbursed by the federal government. The Hospital considers this amount to be a significant shortfall for providing healthcare-related services to these patients which ultimately benefits the community it serves.

Part III, Line 9b:
CMC is a charitable healthcare organization that treats patients for emergency or medically necessary care regardless of their financial status. CMC's Collections Policy and Procedures addresses the procedures for patients who choose not to make payment or work with CMC to make payment arrangements for their bill. The policy contains specific language that applies to those patients who may qualify for financial assistance. CMC will hold collection activities where the patient has submitted a completed financial assistance application. CMC makes reasonable efforts to determine whether an individual is eligible for financial assistance under our Financial Assistance Policy (FAP). In order to determine whether a patient is eligible for financial assistance, CMC provides written notice that indicates the availability of financial assistance, provides a plain-language summary of the FAP, and attempts to notify the individual orally about the FAP and how the patient may get assistance with the application process. CMC also publishes the policy on our website, at patient registration locations, and provides notice to the community.

Part VI, Line 2:
In collaboration with the city of Manchester and other health care and social service agencies, Catholic Medical Center participates in a community needs assessment as required by the New Hampshire Attorney General's Office Division of Charitable Trusts.Since hospitals are required to assess the needs of their community every three years, CMC has completed a 2022 (tax year 2021) Needs Assessment and approved by the board and made widely available to the public during the fiscal year covered by the Hospital's 2021 Form 990. The previous Needs Assessment was completed in fiscal year 2019 (tax year 2018) by CMC and the Elliot Hospital of the City of Manchester. Additional information is obtained on an ongoing basis to assist the Organization in evaluating progress towards meeting our goals and the identification of new areas of need. This information is collected through community surveys, focus groups and discussions with community leaders, program evaluations and communication with those in the community who interact with our vulnerable populations.

Part VI, Line 3:
Patients are notified of CMC's FAP via notices upon registration, discharge, postings to our website, in the hospital, and physician practices. Signage is posted throughout the Hospital and physician practices highlighting Catholic Medical Center's financial assistance. CMC also communicates the policy to the community via mailings and other postings in relevant local support organizations. CMC also contacts patients verbally to inform them of the programs available.

Part VI, Line 4:
Catholic Medical Center's primary service area consists of the following towns and cities: Allenstown, Auburn, Bedford, Goffstown, Hooksett, Manchester, and New Boston. Our secondary service area is made up of Amherst, Concord, Derry, Litchfield, Londonderry, Merrimack, Milford, Nashua, Peterborough, Raymond, Salem and Weare.

Part VI, Line 7, Reports Filed With States
NH

Part VI, Line 5:
Catholic Medical Center is involved in numerous community initiatives to improve the health outcomes of our community, including, but not limited to the following: DSRIP 1115 Waiver, N4H a federally funded program with the state of New Hampshire to transform care by integrating primary and behavioral health care to improve health outcomes; a collaboration with The Manchester Health Department, Easter Seals, and Catholic Medical Center to provide school-based dental care to school-aged children in need. Services are provided at all Manchester elementary and middle schools along with one of the high schools; partnership with Dartmouth Hitchcock Clinic for the integration of dental care within a pediatric clinic setting, improving oral health and overall health and a partnership with Amoskeag Health Center to provide oral health exams and hygiene and a referral to a dental home for children ages 1-5; 500 Cities initiative with CMC's Parish Nurse Program and Manchester Health Department to offer assessments and services to high risk populations located within neighborhoods; primary care, specialty care and care coordination the homeless population via the HRSA grant; Medication Assistance Program offering free or reduced cost medication through the pharmaceutical companies and other low cost resources; emergency bioterrorism preparedness safety management.

Part VI, Line 6:
Catholic Medical Center operates as part of CMC Healthcare System. Under the System, CMC offers a range of healthcare services to the community. The System includes CMC as a licensed, 330 bed full-service, acute care hospital, physician practices, general care surgical capabilities, and advanced care for cardiac needs. Catholic Medical Center offers full medical-surgical care with more than 25 subspecialties, comprehensive orthopedic care, inpatient and outpatient rehabilitation services, a 24-hour emergency department, outpatient behavioral health services, and diagnostic imaging. In addition, Catholic Medical Center has the Special Care Nursery which is a state-of-the-art neonatal facility designed to meet the distinct needs of our babies and their families. Catholic Medical Center is also home to the nationally recognized New England Heart and Vascular Institute (NEHVI), which provides a full-range of cardiac services, and is a pioneer in offering innovative surgical procedures. The Institute is also a national center for advanced clinical trials and cardiovascular rehabilitation and wellness education to help patients recover in a multi-step program of exercise, education, risk factor management, and the development of healthy lifestyles. The System also participates in two joint ventures, Bedford Ambulatory Surgical Center and Alliance Urgent Care Services, through its wholly-owned entity, and Alliance Ambulatory Services through the Granite Health Network.CMC has a deeply rooted history of providing care to those most in need through the Community Health and Mission department. CMC reaches beyond the walls of the hospital and into the community, assisting underserved individuals with health information and access to care. Community Health and Mission provides a wide variety of education, clinical services and resources for those in our primary and secondary markets. It is the home of the Pregnancy Care Center, the Poisson Dental Facility, the Health Care for the Homeless program, and the Parish Nurse program. We provide medication assistance, breast and cervical cancer screenings, and health screenings.