4A (Expenses $ 205171424 including grants of $ 1079902) (Revenue $ 249155328)
PROVIDENCE HOSPITAL is a 302-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2022, PROVIDENCE HOSPITAL treated 12,024 adults and children for a total of 65,445 patient days of service. The hospital also provided services for 130,519 outpatient visits, which included 7,683 outpatient surgeries and 42,032 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. As part of the Ascension Catholic health ministry, the filing organization served in support of Ascension's commitment to both care for patients and communities and support caregivers and other associates through the challenges of the COVID-19 global pandemic in FY22.

Schedule H, Part V, Section B, Line 3E
TO BETTER TARGET COMMUNITY RESOURCES ON THE SERVICE AREA'S MOST PRESSING HEALTH NEEDS, THE HOSPITAL PARTICIPATED IN A GROUP DISCUSSION WITH ORGANIZATIONAL DECISION MAKERS AND COMMUNITY LEADERS TO PRIORITIZE THE SIGNIFICANT COMMUNITY HEALTH NEEDS WHILE CONSIDERING SEVERAL CRITERIA: ALIGNMENT WITH ASCENSION HEALTH STRATEGIES OF HEALTHCARE THAT LEAVES NO ONE BEHIND; CARE FOR THE POOR AND VULNERABLE; OPPORTUNITIES FOR PARTNERSHIP; AVAILABILITY OF EXISTING PROGRAMS AND RESOURCES; ADDRESSING DISPARITIES OF SUBGROUPS; AVAILABILITY OF EVIDENCE-BASED PRACTICES; AND COMMUNITY INPUT. THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SEE SCHEDULE H, PART V, LINE 7 FOR THE LINK TO THE CHNA AND SCHEDULE H, PART V, LINE 11 FOR HOW THOSE NEEDS ARE BEING ADDRESSED.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Providence Hospital. In Providence Hospital's most recent CHNA, the assessment process included quantitative and qualitative components. Qualitative data, also known as community input, was obtained through the following methods: interviews of community representatives and leaders in 2021, a survey of community members, and several community focus groups. Some of the external organizations that assisted in providing input included: Feeding the Gulf Coast, McKemie Place Homeless Shelter, local YMCA, Mobile County Sheriff's Department, and United Way of Southwest AL among others (full list of community participants found in the CHNA on the hospital's website). The medically underserved, low-income and minority populations represented through these methods and/or organizations include: Mobile County Health Department, Area Agency on Aging, Catholic Social Services, Bureau of Disease Control, Franklin Primary Health Center, Guadalupe Center, Victory Health Partners among others (full list of community participants found in the CHNA on the hospital's website). Multiple methods were used to gather community input that provided additional perspectives on how to select and address top health issues facing Mobile County, Alabama. Prioritization of the community health issues was a multistep process that included: review and discussion of all of the top health concerns and associated indicator data, identification and discussion of consequences of not addressing the issue, consideration of key criteria for impacting change.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Providence Hospital. Infirmary Health and USA Health System, collaborated on data collection efforts from the community

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - Providence Hospital. During the most recently conducted CHNA, the following significant needs were identified for Providence Hospital. The top unmet health needs identified for Mobile County, AL, were Access to Healthcare, Alcohol/Drug Use, Chronic Disease, COVID-19, Mental/Behavioral Health and Social Determinants of Health. THE MOST RECENT CHNA FOR PROVIDENCE HOSPITAL WAS COMPLETED AND APPROVED BY ITS GOVERNING BOARD IN MARCH 2022. IN RESPONSE TO THE NEEDS IDENTIFIED IN THE 2021 CHNA, AN IMPLEMENTATION STRATEGY (I.S.) WAS DEVELOPED TO ADDRESS THE FOLLOWING: ACCESS TO CARE NEEDS THAT WILL NOT BE ADDRESSED Alcohol/Drug Use, Chronic Disease, COVID-19, Mental/Behavioral health, and Social Determinants of Health will not be addressed by an implementation plan DUE TO LIMITED RESOURCES BUT THE HEALTH SYSTEM CONTINUES TO SUPPORT OTHER INITIATIVES IMPROVING THESE NEEDS OUTSIDE OF THE I.S. FOR THE POOR AND VULNERABLE WITHIN OUR COMMUNITY. During the CHNA's transition year, the previous I.S. were reported as the final year of measurement. In response to the needs identified in the CHNA, an Implementation Strategy (I.S.) was developed to address the following: *Access to Healthcare *Mental Healthcare - Mental Health Disorders *Mental Healthcare - Substance Abuse *Healthy Living - Breast Cancer *Healthy Living - Diabetes *Healthy Living - Heart Health Through conversations with Ascension internal teams and leaders, Ascension Florida and Gulf Coast's Community Benefit team was able to identify and assess potential barriers - current and future - to implementing the strategies as approved by the respective governing regional Board of Directors. The most common barrier identified through Florida and Gulf Coast was the need to shift operational protocols given state executive orders as well as Ascension COVID-19 guidelines related to restriction of in-person interactions. The updates below summarize if and/or how Providence Hospital's I.S. were specifically impacted by the COVID-19 pandemic and current updates. Priority Need: Access to Healthcare Our goal to address access to healthcare is to increase the proportion of persons with a usual primary care provider. The I.S. has a strategy to implement a protocol to connect unattached individuals to a primary care provider. A system-wide alert system and protocol to notify staff of unattached patients interfacing with the hospital was enacted. Providence Hospital is currently working to connect patients to a primary care provider utilizing protocol from above. Unfortunately, due to the COVID-19 pandemic redirecting and limiting resources, this I.S. was never able to be fully implemented and was discontinued at the end of the 3 year CHNA cycle. Priority Need: Mental Healthcare Our goal to address mental healthcare is to increase the proportion of adults with mental health disorders who receive treatment. The I.S. has a strategy to connect adults with mental health disorders to treatment options. A Mental Health Resource guide was developed, produced and distributed to patients. Patients diagnosed with a mental health disorder (select ICD-10 codes were used) were tracked for referrals to Mental Health resources. Due to the COVID-19 Pandemic, Ascension Providence was not able to provide Mental Health First Aid Training to community members due to social distancing limitations. I.S. to track PHQ-9 of AMG patients to show improvement with treatment was also limited due to closure and social distancing limitations of AMG provider services, ending below goal. Priority Need: Mental Healthcare (substance abuse) Our goal to address mental healthcare for substance abuse is to increase access to alcohol and/or illicit drug treatment. The I.S. has a strategy to connect individuals with suspected or diagnosed substance abuse to treatment. Providence Hospital provided physician education (CME) on substance abuse. Substance abuse CME is a State of Alabama requirement for licensure. Patients with suspected or diagnosed substance abuse to treatment facilities are being referred to external local resources for substance abuse treatment for all payors using a newly developed and distributed Mental Health Resource guide. Priority Need: Healthy Living (Breast Cancer) Our goal to address healthy living (breast cancer) is to increase the proportion of women who receive breast cancer screening based on the most recent guidelines. The I.S. has a strategy to provide free or reduced cost mammograms to individuals at high risk or uninsured. Providence Hospital did achieve an increase in the number of breast cancer screenings/mammograms performed for minority populations, although it ended slightly below goal at Year End Close. Priority Need: Healthy Living (Diabetes) Our goal to address health living (diabetes) is to increase prevention behaviors in persons at high risk for diabetes with prediabetes. The I.S. has a strategy to increase enrollment in the DPP program while maintaining participation and success rates. Providence Hospital did achieve an increase in screenings for a prediabetes diagnosis, achieving the goal set. While Providence Health did increase referrals of prediabetes patients to DPP programs in Ascension Medical Group practices, it did not meet the goal at the Year End Close. Priority Need: Healthy Living (CPR) Our goal to address health living (CPR) is to increase the proportion of persons who are aware of the symptoms of and how to respond to a heart attack. The I.S. has a strategy to provide CPR training for community members, especially individuals who work in schools, at no or significantly reduced cost. Ascension Providence in partnership with the American Heart Association, has supported CPR training onsite at the Providence Hospital campus for community members. This action was suspended due to the COVID-19 Pandemic forcing campus closures to the public and social distancing limitations.

Schedule H, Part I, Line 3c FACTORS OTHER THAN FPG
"IN ADDITION TO FPG, THE ORGANIZATION USES MEDICAL INDIGENCY, ASSET TEST, INSURANCE STATUS AND RESIDENCY AS OTHER FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A Patient may not be eligible for the financial assistance if such Patient is deemed to have sufficient assets to pay pursuant to an ""Asset Test."" The Asset Test involves a substantive assessment of a Patient's ability to pay based on the categories of assets measured in the FAP Application. A Patient with such assets that exceed 250% of such Patient's FPL amount may not be eligible for financial assistance. AN ASSET TEST APPLIES IF A PATIENT HAS ELIGIBLE LIQUID ASSETS THAT EXCEED 250% OF THE PATIENT'S FPG LEVEL FOR CONSIDERATION OF FINANCIAL ASSISTANCE ELIGIBILITY. LIQUID ASSETS INCLUDE ASSETS THAT CAN BE CONVERTED TO CASH WITHIN 1 YEAR. THESE INCLUDE ITEMS SUCH AS CHECKING ACCOUNTS, SAVINGS ACCOUNTS, TRUST FUNDS AND LUXURY ITEMS SUCH AS RECREATIONAL VEHICLES, BOATS, A SECOND HOME, ETC."

Schedule H, Part I, Line 5a BUDGET AMOUNTS FOR FREE OR DISCOUNTED CARE
THE ORGANIZATION ADMINISTERS ITS FINANCIAL ASSISTANCE POLICY IN ACCORDANCE WITH THE TERMS OF THE POLICY.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
"THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (""CHA"") GUIDELINES. THE ORGANIZATION USES A COST 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 WAS CALCULATED AND APPLIED."

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2022 was $13,345,593 at charges, ($3,469,854 at cost).

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BASED ON THE ORGANIZATION'S ADMINISTRATION OF ITS FINANCIAL ASSISTANCE PROGRAM, NO ESTIMATE FOR BAD DEBT ATTRIBUTABLE TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS IS DEEMED APPLICABLE TO HOSPITAL OPERATIONS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE ORGANIZATION IS PART OFASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSESBAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 17-20, OF THE AUDITED FINANCIAL STATEMENTS.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE GROSS CHARGES TO CALCULATE MEDICARE COSTS, WHICH ARE THEN COMPARED TO MEDICARE PAYMENTS RECEIVED, TO DETERMINE A MEDICARE GAIN OR LOSS. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT A MEDICARE SHORTFALL (LOSS) IS NOT TREATED AS COMMUNITY BENEFIT, EVEN THOUGH THE HOSPITAL HAS INCURRED LOSSES IN PROVIDING CARE TO MEDICARE PATIENTS. THEREFORE, NONE OF THE AMOUNT ON LINE 7 IS TREATED AS COMMUNITY BENEFIT.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
ASCENSION PROVIDENCE FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED IF ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED FOR THE AMOUNTS FOR WHICH THE PATIENT QUALIFIES.

Schedule H, Part V, Section B, Line 16a FAP website
- PROVIDENCE HOSPITAL: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- PROVIDENCE HOSPITAL: Line 16b URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- PROVIDENCE HOSPITAL: Line 16c URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part VI, Line 4 Community information
Providence Hospital services Southwest Alabama with a 1 county primary service area. The total population of the county primary service area is estimated to be 421,255 residents in calendar 2022 and is expected to increase by approximately 3.5% to 435,922 residents in five years. The median household income of the primary service area is $49,625. Approximately 17.6% of the service area residents live below the poverty line. Within the primary service area, there are 7 federally designated medically underserved areas. There are 7 acute care hospitals located within the primary service area.

Schedule H, Part VI, Line 5 Promotion of community health
Providence Hospital's governing body is comprised of persons representing diverse aspects and interests of the community. Many members of Providence Hospital governing body reside in the organization's primary service area and who are neither employees nor independent contractors of the organization, nor family members thereof. Providence Hospital extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties. Providence Hospital applies surplus funds to fund improvements in patient care, medical education, and research.

Schedule H, Part VI, Line 2 Needs assessment
Providence Hospital uses internal and external data and reports from third parties, including government sources, to assess the healthcare needs of the communities we serve. These reports provide key information about health, socioeconomic, demographic factors that identify areas of need and inform our strategies that help to meet those needs of our community. These reports include, but are not limited to: Sg2 Healthcare Intelligence, Clarify for healthcare claims datasets, 3d Health, Alabama state health data, and internal data. Providence Hospital utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, Providence Hospital considers the health care needs of the overall community when evaluating internal financial and operational decisions.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Providence Hospital IS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL, IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, Providence HOSPITAL'S FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES; Providence HOSPITAL PROVIDES FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 400% OF THE FEDERAL POVERTY LEVEL. Providence Hospital WIDELY PUBLICIZES ITS: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY VIA THE HOSPITAL FACILITY'S WEBSITE - https://healthcare.ascension.org/Locations/Alabama/ALMOB/Mobile-Providence-Hospital/Financial-Assistance Providence Hospital MAKES PAPER COPIES OF THE: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION. THE PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. Providence Hospital INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION MAY BE FOUND. Providence Hospital INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 6 Affiliated health care system
Providence Hospital is a member of Ascension. 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 19 of the United States and the District of Columbia. Ascension is sponsored by Ascension Sponsor, a public juridical person. The participating entities of Ascension Sponsors 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. Providence Hospital operates a hospital facility in Mobile County Alabama and is part of Ascension Florida and Gulf Coast which also owns and operates other healthcare related entities, including St. Vincent's Medical Center and Sacred Heart Health System. The health system provides inpatient, outpatient, and emergency care services for residents of Southwest Alabama.