4A (Expenses $ 159180055 including grants of $ 38264) (Revenue $ 151716876)
ST. MARY'S HEALTHCARE IS A 290-BED HOSPITAL CAMPUS PROVIDING SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2022, ST. MARY'S HEALTHCARE TREATED 4,585 ADULTS AND CHILDREN FOR A TOTAL OF 62,983 PATIENT DAYS OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES FOR 401,199 OUTPATIENT VISITS, WHICH INCLUDED 5,124 OUTPATIENT SURGERIES AND 24,787 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS.

PART V, SECTION A:
ST. MARY'S HEALTHCARE CONSISTS OF TWO LICENSED FACILITIES, NAMELY, THE HOSPITAL AND THE WILKINSON RESIDENTIAL HEALTH CARE FACILITY, WHICH IS A SKILLED NURSING FACILITY. THE HOSPITAL HAS SEVERAL LOCATIONS, INCLUDING TWO OUTPATIENT ALCOHOL REHABILITATION CLINICS, ONE DIAGNOSTIC SERVICE CENTER, AND SEVEN PRIMARY CARE CENTERS.

ST. MARY'S HEALTHCARE
PART V, SECTION B, LINE 5: (FROM 2021 COMMUNITY SERVICE PLAN & COMMUNITY HEALTH IMPROVEMENT PLAN) AS PART OF THE COMMUNITY HEALTH ASSESSMENT, A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN THE SUMMER OF 2021 FOR THE REPORTING PERIOD OF 2022-2025. A RANDOM SURVEY OF 757 INDIVIDUALS 18 AND OLDER IN ST. MARY'S HEALTHCARE SERVICE AREA, INCLUDING 401 IN FULTON COUNTY AND 356 IN MONTGOMERY COUNTY. ALL ADMINISTRATION OF THE SURVEYS, DATA COLLECTION AND DATA ANALYSIS WERE CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). AN ONLINE SURVEY WAS ALSO CONDUCTED TO SOLICIT INPUT FROM KEY INFORMANTS. ST. MARY'S HEALTHCARE SUPPLIED A LIST OF RECOMMENDED PARTICIPANTS INCLUDING PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF COMMUNITY LEADERS. THE COMMUNITY LEADERS INCLUDE THOSE WHO WORK WITH LOW-INCOME MINORITY POPULATIONS AND MEDICALLY UNDERSERVED POPULATIONS.ST. MARY'S HEALTHCARE USES RELIABLE, THIRD-PARTY RESOURCES, INCLUDING DATA FROM GOVERNMENT SOURCES TO ASSESS THE HEALTHCARE NEEDS FOR THE COMMUNITY IT SERVES: FULTON AND MONTGOMERY COUNTIES IN NEW YORK STATE. THESE REPORTS INCLUDE VITAL INFORMATION REGARDING KEY HEALTH STATUS, SOCIOECONOMIC AND DEMOGRAPHIC INDICATORS THAT POINT TO AREAS OF NEED AND INCLUDE, BUT ARE NOT LIMITED TO, REPORTS FROM: CATHOLIC CHARITIES OF FULTON AND MONTGOMERY COUNTIES, FULMONT COMMUNITY ACTION AGENCY, FULTON COUNTY DEPARTMENT OF PUBLIC HEALTH, FULTON COUNTY OFFICE FOR THE AGING, FULTON COUNTY YMCA, HFM (HAMILTON, FULTON AND MONTGOMERY) PREVENTION COUNCIL, MONTGOMERY COUNTY DEPARTMENT OF PUBLIC HEALTH, MONTGOMERY COUNTY OFFICE FOR THE AGING, US CENSUS BUREAU, ETC. TO ACCESS A COMPLETE LISTING OF RESOURCES, PLEASE REFER TO THE ST. MARY'S HEALTHCARE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT.ST. MARY'S HEALTHCARE UTILIZES THESE RESOURCES TO HELP GUIDE COMMUNITY EDUCATION PROGRAMS AND PROVIDE SERVICES THROUGHOUT THE REGION. IN ADDITION, ST. MARY'S HEALTHCARE CONSIDERS THE HEALTHCARE NEEDS OF THE OVERALL COMMUNITY WHEN EVALUATING INTERNAL FINANCIAL AND OPERATIONAL DECISIONS. INPUT FROM PERSONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY AND POPULATIONS WHICH ARE UNDERSERVED, LOW-INCOME, MINORITY AND/OR WITH CHRONIC DISEASE NEEDS WERE INCLUDED THROUGH RANDOMIZED PHONE SURVEYS AND AN EMAILED KEY INFORMANT SURVEY.

ST. MARY'S HEALTHCARE
PART V, SECTION B, LINE 6A: ST. MARY'S HEALTHCARE CONDUCTED ITS CHNA WITH THE FOLLOWING OTHER HOSPITAL FACILITY: ST. MARY'S HOSPITAL.

ST. MARY'S HEALTHCARE
"PART V, SECTION B, LINE 11: THE CHNA STEERING COMMITTEE MET IN JANUARY 2022 TO DETERMINE THE HEALTH NEEDS TO BE PRIORITIZED FOR ACTION. THE AREAS OF OPPORTUNITY WERE PRIORITIZED BY THE COMMITTEE AS FOLLOWS: NUTRITION/PHYSICAL ACTIVITY/WEIGHT MANAGEMENT AND MENTAL HEALTH AND SUBSTANCE ABUSE. ST. MARY'S HEALTHCARE IS CONTINUALLY WORKING TO MEET THE GOALS SET FORTH IN THEIR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IMPLEMENTATION STRATEGY FY 2022-2025. NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT: ST. MARY'S HAS ESTABLISHED A TEACHING KITCHEN TO HOST COOKING CLASSES AND DEMONSTRATIONS FOR PATIENTS IN TARGETED POPULATIONS. PRIMARY CARE PROVIDERS AND THEIR STAFF DISCUSS NUTRITIONAL CONCERNS WITH PATIENTS AND PROVIDE REFERRALS FOR NUTRITIONAL COUNSELING AS NECESSARY. ST. MARY'S HAS A DIABETES AND NUTRITION EDUCATION CENTER TO PROVIDE NUTRITIONAL COUNSELING TO THE COMMUNITY, AND THE PREGNANCY CARE CENTER. ST. MARY'S HAS ESTABLISHED 6 OFF-SITE AND ON CAMPUS ""MISSION CUPBOARDS,"" WHICH SERVE AS EMERGENCY FOOD PANTRIES FOR PATIENTS IN NEED. A DOCUMENT LISTING ALL COMMUNITY MEALS AND FOOD PANTRIES HAS BEEN CREATED AND SHARED AS A RESOURCE FOR PROVIDERS AND STAFF. A TASK FORCE HAS BEEN ESTABLISHED TO INCLUDE COMMUNITY PARTNERS. ST. MARY'S HAS ESTABLISHED A REFERRAL PROCESS TO INCREASE ENROLLMENT IN AN EVIDENCE-BASED DIABETES PREVENTION LIFESTYLE CHANGE PROGRAM (DIABETES PREVENTION PROGRAM-DPP) THE CLASS IS OFFERED TO PEOPLE WHO ARE AT HIGH RISK FOR TYPE 2 DIABETES THAT CAN PREVENT OR DELAY THE DISEASE BY LOSING A MODEST AMOUNT OF WEIGHT THROUGH LIFESTYLE CHANGES (DIETARY CHANGES AND INCREASED PHYSICAL ACTIVITY) THE CANCER PEER EDUCATION TEAM HAS DEVELOPED AN INDOOR ""FUN AND FREE WALKING PROGRAM"" FOR THE COMMUNITY TO EXERCISE DURING THE WINTER MONTHS. HEALTHY FOOD AND BEVERAGE CHOICES ARE ALSO DISCUSSED AT THIS WEEKLY PROGRAM. ST. MARY'S HAS PARTNERED WITH CATHOLIC CHARITIES TO ESTABLISH A FOOD FARMACY AT THE MEMORIAL CAMPUS TO PROVIDE LOW-INCOME, FOOD INSECURE PATIENTS WITH CHRONIC HEALTH CONDITIONS, TEMPORARY ACCESS TO HEALTHY FOODS AND NUTRITION EDUCATION WITH AN ON-SITE DIETITIAN. MENTAL HEALTH/SUBSTANCE ABUSE: ST. MARY'S HEALTHCARE HAS JOINED WITH COMMUNITY PARTNERS, PUBLIC HEALTH, AND PROVIDERS TO FORM AN OVERDOSE TASK FORCE. THE TASK FORCE WILL INCREASE AVAILABILITY AND ACCESS TO MEDICATION-ASSISTED TREATMENT AND OVERDOSE REVERSAL. ST. MARY'S HEALTHCARE ALSO CONTINUES TO PARTICIPATE AS A MEMBER OF THE FULTON MONTGOMERY SUICIDE PREVENTION TASK FORCE. THE HOSPITAL IS AVAILABLE TO PROVIDE EDUCATIONAL MATERIALS AND RESOURCES TO SCHOOLS IN FULTON AND MONTGOMERY COUNTIES. ST. MARY'S HAS EXPANDED COLLABORATION TO BECOME A TRAUMA-INFORMED COMMUNITY TO PROVIDE CARE TO THOSE AFFECTED BY MENTAL, EMOTIONAL, AND BEHAVIORAL DISORDERS. THIS WILL ALSO EXPAND CRISIS TRAINING TO CLINICAL CAREGIVERS. ST. MARY'S HAS ADOPTED A COLLABORATIVE CARE APPROACH FOR BEHAVIORAL HEALTH AT THE AMSTERDAM AND JOHNSTOWN FAMILY HEALTH CENTERS. BEHAVIOR HEALTH CARE MANAGERS HELP TO COORDINATE BEHAVIORAL HEALTH APPOINTMENTS AND COMMUNICATE PATIENT NEEDS TO PRIMARY CARE PROVIDERS TO ENSURE THAT PATIENTS' PHYSICAL AND BEHAVIORAL HEALTH NEEDS ARE BEING MET. THE SOCIAL DETERMINANTS OF HEALTH (SDOH), PHQ-2 AND PHQ-9 SCREENING TOOLS HAVE BEEN INCORPORATED INTO PRIMARY CARE CLINICS WORKFLOW TO BETTER ADDRESS PATIENTS' MENTAL HEALTH NEEDS. PATIENTS ARE ASKED THE SDOH QUESTIONNAIRE AT INITIAL APPOINTMENTS, WHEREAS PH-2 AND PHQ-9 SCREENING OCCURRING AT EVERY VISIT. ST. MARY'S WALK-IN OUTPATIENT DETOX PROGRAM LOCATED IN THE MEMORIAL CAMPUS HAS HELPED TO INCREASE THE ACCESS TO MEDICATION-ASSISTED TREATMENT (MAT) AND OVERDOSE REVERSAL (NALOXONE). THIS OUTPATIENT DETOX PROGRAM HAS ALSO INCREASED THE AVAILABILITY OF/ACCESS TO OVERDOSE REVERSAL TRAINING TO PRESCRIBERS, PHARMACISTS, AND CONSUMERS. OTHER NEEDS: PRENATAL NUTRITION COUNSELING IS OFFERED TO PROVIDE PATIENTS WITHIN THE OB CLINIC WITH INFORMATION RELATED TO HEALTHY EATING AND HEALTHY WEIGHT GAIN THROUGHOUT THEIR PREGNANCY. MEDICAL PROVIDERS AT PRIMARY CARE CENTERS ASSESS PATIENTS FOR TOBACCO USE AND PROVIDE COUNSELING. PATIENTS ARE ALSO OFFERED ""BUTT STOPS HERE"" CLASSES TO ENCOURAGE SMOKING CESSATION. ST. MARY'S PROVIDES FREE FLU SHOTS TO THE LOCAL COLLEGE AND BOCES'S STUDENTS IN THE CNA, LPN, AND RN NURSING CLASSES AND TO OUR MIGRANT FARM WORKERS IN THE RURAL SECTIONS OF MONTGOMERY COUNTY. THE HOSPITAL PARTNERS WITH LOCAL PHYSICIANS AND MEDICAL PROVIDERS TO OFFER EDUCATIONAL PROGRAMS ON JOINT, BONE AND BACK HEALTH. WE HAVE A PARTNERSHIP WITH A LOCAL ORTHOPEDIC PRACTICE TO OFFER ""JOINT SCHOOL"" WHICH EDUCATES CANDIDATES FOR JOINT REPLACEMENT ON SURGERY, TREATMENT, CARE, AND MANAGEMENT OF BONE AND JOINT TISSUES. ST. MARY'S CURRENTLY AUDITS PATIENT RECORDS TO ENSURE THAT ALL DIABETICS ARE RECEIVING THE CARE THEY NEED TO PREVENT RENAL DISEASE AS A RESULT OF COMPLICATIONS FROM THEIR DIABETES. IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, ST. MARY'S HEALTHCARE DETERMINED THAT IT COULD ONLY EFFECTIVELY FOCUS ON THOSE WHICH IT DEEMED MOST PRESSING, MOST UNDER-ADDRESSED, AND MOST WITHIN ITS ABILITY TO INFLUENCE. THE FOLLOWING IDENTIFIED NEEDS ARE NOT BEING ADDRESSED BY CHNA: *CANCER: ACCORDING TO THE CHNA, BREAST AND CERVICAL CANCER SCREENINGS FALL BELOW STATEWIDE PERCENTAGES. HOWEVER, COLORECTAL CANCER SCREENINGS EXCEED THE NYS AVERAGE. SMH CANCER SERVICES PROGRAM (CSP) OFFERS FREE BREAST, CERVICAL AND COLORECTAL CANCER SCREENINGS, AND DIAGNOSTIC FOLLOW- UP SERVICES. IN ADDITION TO CSP, THE CANCER PREVENTION IN ACTION PROGRAM (CPIA) HELPS TO INCREASE THE ADOPTION OF WORKSITE POLICIES THAT ESTABLISH PAID TIME OFF BENEFITS FOR EMPLOYEES TO OBTAIN CANCER SCREENINGS. *ACCESS TO HEALTHCARE SERVICES: AS EVIDENCED BY THE CHNA, WE HAVE FEWER PRIMARY CARE PROVIDERS THAN MOST OF NYS. HOWEVER, WE ARE OUTPERFORMING MOST AREAS WHEN IT COMES TO ADULTS AND CHILDREN ATTENDING WELLNESS VISITS. ONLY 7.8% OF PEOPLE IN OUR SERVICE AREA UNINSURED. SMH EMPLOYS A FULL-TIME HEALTH INSURANCE ENROLLER TO PROVIDE INDIVIDUALS WITH APPROPRIATE HEALTH INSURANCE. IN ADDITION, WE HAVE A FULL-TIME PHYSICIAN RECRUITER WHO IS FOCUSING ON INCREASING PROVIDERS IN OUR AREA. *RESPIRATORY DISEASES: PRIMARY CARE PATIENTS ARE SCREENED FOR TOBACCO USE USING THE ""5 A'S"" MODEL. IF A PATIENT IDENTIFIES USING TOBACCO PRODUCTS, A REFERRAL TO THE NYS SMOKER'S QUITLINE CAN BE MADE. SMH ALSO EMPLOYS A BSH FACILITATOR TO PROVIDE EDUCATION AND SUPPORT TO THOSE WHO ARE CURRENT SMOKERS. VIRTUAL BSH CLASSES ARE ALSO OFFERED. *INFANT HEALTH/FAMILY PLANNING: TEEN BIRTH RATES IN SMH SERVICE AREA WERE ABOVE BOTH STATES AND NATIONAL RATES, HOWEVER, SMH SERVICE AREA SHOWED A LOWER PERCENTAGE OF LOW BIRTH WEIGHTS WHICH OUTPERFORMED BOTH STATE AND NATIONAL FINDINGS. THE ANNUAL AVERAGE OF INFANT DEATHS IN THE SMH SERVICE AREA WAS ALSO LOWER THAN THE NATIONAL AVERAGE. ST. MARY'S HEALTHCARE CONTINUES TO OFFER WOMEN'S REPRODUCTIVE CARE AT BOTH THE AMSTERDAM AND JOHNSTOWN OB/GYN CLINICS. *KIDNEY DISEASE: THE ANNUAL AVERAGE AGE-ADJUSTED KIDNEY DISEASE MORTALITY RATE AND PREVALENCE OF KIDNEY DISEASE IN SMH SERVICE AREA WAS MUCH HIGHER THAN STATE AND NATIONAL RATES. PRIMARY CARE HAS ADOPTED THE HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET (HEDIS) MEASUREMENT WHICH AIMS TO IMPROVE KIDNEY DISEASE TESTING IN PEOPLE WITH DIABETES, WHICH IS A KEY RISK FACTOR FOR DEVELOPING KIDNEY DISEASE. SMH HAS TWO UROLOGY HEALTH CENTER LOCATIONS FOCUSING ON CONDITIONS RELATED TO THE BLADDER, KIDNEYS, AND OTHER UROLOGICAL CONCERNS FOR BOTH MEN AND WOMEN. *POTENTIALLY DISABLING CONDITIONS: SMH HAS PARTNERED WITH LOCAL PHYSICIANS AND MEDICAL PROVIDERS TO OFFER FREE OF CHARGE EDUCATIONAL PROGRAMS ON JOINT, BONE AND BACK HEALTH. SMH HAS AN INTER-DISCIPLINARY TEAM THAT PARTNERED WITH A LOCAL ORTHOPEDIC PRACTICE TO OFFER A ""JOINT SCHOOL"" WHICH EDUCATES CANDIDATES FOR JOINT REPLACEMENT ON SURGERY, TREATMENT, CARE AND MANAGEMENT OF BONE AND JOINT ISSUES. ""JOINT SCHOOL"" HAS BEEN TEMPORARILY PUT ON HOLD DUE TO THE COVID-19 PUBLIC HEALTH EMERGENCY BUT PLANS TO RESUME SESSIONS ARE IN PLACE. *INJURY: ACCORDING TO THE CHNA, OUR SERVICE AREA'S AGE ADJUSTED UNINTENTIONAL INJURY DEATHS FALL BELOW THE NATIONAL RATE AND ARE SIMILAR TO THE HEALTHY PEOPLE 2030 GOAL. THE RATE OF VIOLENT CRIMES IN OUR SERVICE AREA HAS REMAINED STATISTICALLY UNCHANGED AND REMAINS BELOW THE NYS RATES."

ST. MARY'S HEALTHCARE
PART V, SECTION B, LINE 16J: INDIVIDUAL LETTERS ARE MAILED TO ALL UNINSURED PATIENTS INFORMING THEM OF THE FINANCIAL ASSISTANCE PROGRAMS AVAILABLE.

ST. MARY'S HEALTHCARE
PART V, SECTION B, LINE 20E: THE BILLING AND COLLECTIONS POLICY OF ST. MARY'S HEALTHCARE DOES NOT ALLOW A HOSPITAL TO ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE THE ORGANIZATION MADE REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS TAKEN INCLUDE BUT ARE NOT LIMITED TO:- NOTIFYING INDIVIDUALS OF THE FINANCIAL ASSISTANCE POLICY ON ADMISSION.- NOTIFYING INDIVIDUALS OF THE FINANCIAL ASSISTANCE POLICY ON BILLING STATEMENTS THROUGHOUT THE BILLING CYCLE.

FORM 990, SCHEDULE H, PART V, SECTION B, LINE 3E
THE SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED IN OUR 2021 COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS WERE VOTED ON AND PRIORITIZED BY A COMMITTEE OF APPROXIMATELY 60 COMMUNITY STAKEHOLDERS, CONSISTING OF CLINICIANS, BUSINESS LEADERS, HEALTH EDUCATORS, SOCIAL WORKERS, ETC. THE PRIORITIZED HEALTH NEEDS ARE AS FOLLOWS: NUTRITION/PHYSICAL ACTIVITY/WEIGHT, MENTAL HEALTH, AND SUBSTANCE ABUSE. THE IMPLEMENTATION STRATEGY WAS DEVELOPED AFTER THE NEEDS WERE IDENTIFIED AND PRIORITIZED BASED ON SCOPE AND SEVERITY, AND THE PROGRAMS/SERVICES OF THE IMPLEMENTATION PLAN REFLECT THOSE TOP HEALTH PRIORITIES.

FORM 990, SCHEDULE H, PART V, SECTION B, LINE 22D
THE MAXIMUM AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS IS BASED ON THE UNINSURED DISCOUNT, WHICH IS REVIEWED AND UPDATED ANNUALLY, AS APPLICABLE. UNINSURED PATIENTS WITH THE ABILITY TO PAY WILL BE PROVIDED A DISCOUNT BASED ON THE DISCOUNT PROVIDED TO THE HIGHEST-PAYING PAYER THAT ACCOUNTS FOR AT LEAST THREE PERCENT OF THE HOSPITAL'S VOLUME OR GROSS PATIENT REVENUES. IN FY22, THE HOSPITAL PROVIDED DISCOUNTS TO THE UNINSURED EQUAL TO 38% OF CHARGES FOR INPATIENTS AND 47% OF CHARGES FOR OUTPATIENTS.

PART I, LINE 3C:
"PATIENTS WITH DEMONSTRATED FINANCIAL NEEDS WITH INCOME GREATER THAN 400% OF THE FPL MAY BE ELIGIBLE FOR CONSIDERATION UNDER A ""MEANS TEST"" FOR SOME DISCOUNT OF THEIR CHARGES FOR SERVICES FROM THE ORGANIZATION BASED ON A SUBSTANTIVE ASSESSMENT OF THEIR ABILITY TO PAY. PATIENTS WILL BE REQUIRED TO COMPLETE THE ORGANIZATIONS MEANS TEST APPLICATION WHICH REQUIRES DISCLOSURE OF DETAILED INFORMATION REGARDING DEBT AND INCOME TO DETERMINE ELIGIBILITY FOR A MEANS TEST DISCOUNT. A PATIENT ELIGIBLE FOR THE ""MEANS TEST"" DISCOUNT WILL NOT BE CHARGED MORE THAN THE CALCULATED AGB CHARGES."

PART III, LINE 2:
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 COLLECTIONS EFFORTS. 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 $3,024,799 AT CHARGES.

PART III, LINE 3:
ST. MARY'S HEALTHCARE FOLLOWS THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT.

PART III, LINE 4:
THE FOOTNOTE THAT DISCUSSES BAD DEBT EXPENSE IS LOCATED ON PAGE 15 OF THE AUDITED FINANCIAL STATEMENTS.

FORM 990, SCHEDULE I, PART III, LINE 3
ST. MARY'S HEALTHCARE HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTABLE TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS.

FORM 990, SCHEDULE H, PART III, LINE 2
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 COLLECTIONS EFFORTS. 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 $7,717,801 AT CHARGES ($3,024,799 AT COST).

PART VI, LINE 2:
IN ADDITION TO THE CHNA PROCESS DESCRIBED IN SCHEDULE H PART V, THE HOSPITAL SOUGHT INPUT FROM ITS BOARD OF TRUSTEES, MEDICAL EXECUTIVE COMMITTEE, LEADERSHIP STAFF AND COMMUNITY PARTNERS WHEN COMPLETING ITS ANNUAL INTEGRATED STRATEGIC, OPERATIONAL, AND FINANCIAL PLAN (ISOFP). THE ISOFP USES PERTINENT DATA AND COMPREHENSIVE FEEDBACK TO OUTLINE CURRENT AND FUTURE CRITICAL HEALTHCARE NEEDS FOR THE HOSPITAL'S SERVICE AREA, AS WELL AS THE RESOURCES NEEDED TO ADDRESS THE IDENTIFIED ISSUES.

PART VI, LINE 3:
ST. MARY'S HEALTHCARE STRIVES TO MAINTAIN A BALANCE BETWEEN PROVIDING CARE OF THE POOR WITH THE ABILITY OF THE HOSPITAL TO MAINTAIN QUALITY HEALTH CARE FOR THE COMMUNITY IT SERVES. AS PART OF ITS FINANCIAL ASSISTANCE POLICIES, THE HOSPITAL OFFERS A SELF-PAY DISCOUNT TO ALL UNINSURED PATIENTS AS A PERCENTAGE OFF THE STANDARD CHARGE; THE DISCOUNTS WERE SET AT 38% FOR INPATIENT SERVICES AND 47% FOR OUTPATIENT SERVICES. FOR THE TWELVE-MONTH PERIOD (JULY 2021-JUNE 2022), THE DISCOUNTS PROVIDED TO THE UNINSURED WERE $2,422,129. THE CARONDELET CARE ASSISTANCE PROGRAM IS THE NEXT LEVEL OF FINANCIAL ASSISTANCE AVAILABLE TO THE HOSPITAL'S PATIENTS. THIS PROGRAM IS AVAILABLE TO ALL PATIENTS WHO CAN DEMONSTRATE A FINANCIAL BURDEN ASSOCIATED WITH THEIR PATIENT RESPONSIBILITY. FINANCIAL ASSISTANCE IS PROVIDED THROUGH COLLABORATION BETWEEN THE HEALTH INSURANCE ENROLLMENT AND FINANCIAL ASSISTANCE STAFF. ALTHOUGH THE TWO DEPARTMENTS OFFER DIFFERENT FINANCIAL ASSISTANCE SERVICES, THE ENROLLMENT STAFF IS TRAINED TO HELP THOSE INDIVIDUALS WHO DO NOT QUALIFY FOR ANY GOVERNMENT SPONSORED PROGRAMS TO ACCESS THE CARONDELET CARE ASSISTANCE PROGRAM. SIMILARLY, THE FINANCIAL COUNSELORS OFTEN REFER PATIENTS IN NEED OF INSURANCE TO OUR ENROLLMENT SPECIALIST. THE ENROLLMENT STAFF IS AVAILABLE TO MEET WITH COMMUNITY MEMBERS AT THE MAIN HOSPITAL, THE MEMORIAL CAMPUS AND AT ALL SEVEN OF THE OFF-SITE FAMILY HEALTH CENTERS. STAFF IS ALSO TRAINED TO REFER INDIVIDUALS TO FREE OR LOW-COST HEALTH CARE PROGRAMS WITHIN THE COMMUNITY IF NO OTHER OPTIONS ARE IMMEDIATELY AVAILABLE. THE HOSPITAL ENROLLER WORKS COLLABORATIVELY WITH COMMUNITY AGENCIES TO FURTHER EXPAND ITS OUTREACH. LARGE POSTERS DESCRIBING THE HOSPITAL'S WILLINGNESS TO HELP PATIENTS WITH FINANCIAL ASSISTANCE ARE DISPLAYED IN ALL MAIN ENTRANCES TO THE HOSPITAL AND THE OFF-SITE LOCATIONS, AS WELL AS IN OUR MULTIPLE REGISTRATION SITES AND WAITING ROOMS. THE INFORMATIONAL POSTERS ARE IN ENGLISH AND SPANISH AND URGE PATIENTS TO CALL IF THEY ARE CONCERNED ABOUT BILL PAYMENT. TRANSLATION SERVICES ARE ALSO AVAILABLE AS NEEDED VIA LANGUAGE LINE TELEPHONES AND IPAD VIDEO APPLICATION.BROCHURES IN ENGLISH AND SPANISH ARE AVAILABLE AT ALL SERVICE SITES AND OFFER DETAILED INFORMATION ABOUT THE VARIOUS LEVELS OF ASSISTANCE. IN ADDITION TO OFFERING DISCOUNTS, ST. MARY'S OFFERS OPTIONS FOR PAYMENT PLANS AND PAYMENT SCHEDULES. THE ENGLISH AND SPANISH BROCHURES ARE ALSO AVAILABLE ON THE HOSPITAL WEB SITE. INFORMATION ON FINANCIAL ASSISTANCE IS ALSO CONTAINED IN THE PATIENT INFORMATION GUIDE GIVEN TO ALL INPATIENTS AT ST. MARY'S HEALTHCARE.

PART VI, LINE 7, REPORTS FILED WITH STATES
NY

PART VI, LINE 4:
THE PSA REPRESENTS ONE OF THE OLDEST REGIONS IN NYS. ESTIMATES INDICATE THAT THE 65 AND OLDER POPULATION WILL CONTINUE TO GROW. ACCORDING TO SG2 HEALTHCARE ANALYTICS, THE LARGEST PROJECTED SEGMENT OF OUR POPULATION SHOWING GROWTH OVER THE NEXT 5 YEARS IS THE 60+, WITH AN AVERAGE GROWTH RATE OF 11.8%. IN FACT, WITHIN THIS SEGMENT, 67-69+ SHOWS AN 18.3% PROJECTED INCREASE. THERE ARE MANY FACTORS THAT CONTRIBUTE TO THE COMMUNITY'S POVERTY LEVELS, INCLUDING THE HIGH SCHOOL DROPOUT RATE IN BOTH COUNTIES. REPORTS INDICATE AN AVERAGE DROPOUT RATE OF 10% IN FULTON COUNTY AND 9% IN MONTGOMERY COUNTY WITH OUR TWO LARGEST SCHOOL DISTRICTS AVERAGING AN 11.5% DROPOUT RATE. THE LACK OF EDUCATION AFFECTS THE WORKFORCE, CONTRIBUTES TO HIGHER UNEMPLOYMENT AND GREATER RISK OF WORKING WITHOUT HEALTH INSURANCE. IN THE PSA OF FULTON AND MONTGOMERY COUNTIES THE MEDIAN POVERTY RATE IS 17.2% WHICH IS 2.7% HIGHER THAN THE STATE AVERAGE. RESEARCH INDICATES A DECLINE IN THE CAUCASIAN POPULATION, WHICH IS A CONSISTENT TREND OVER SEVERAL YEARS. THE HISPANIC COMMUNITY IS OUR LARGEST MINORITY COMMUNITY, WITH THE LARGEST CONCENTRATION WITHIN THE CITY OF AMSTERDAM. US CENSUS 2017 ESTIMATES INDICATE THAT 30.2% OF THE RESIDENTS OF AMSTERDAM ARE IDENTIFIED AS HISPANIC WHICH IS MORE THAN 11.7% HIGHER THAN THE NATIONAL AVERAGE. THE HOSPITAL EMPLOYS BILINGUAL AND BICULTURAL HEALTHCARE PROFESSIONALS TO MEET THE NEEDS OF THE HISPANIC COMMUNITY.HEALTH STATISTICS RELEVANT TO THE COMMUNITY'S HEALTH STATUS ARE AS FOLLOWS: OVER 71.3% OF THE ST. MARY'S HEALTHCARE SERVICE AREA ADULTS ARE OVERWEIGHT. ESPECIALLY ALARMING IS THAT 37.2% OF OUR CHILDREN ARE OVERWEIGHT. THE RELATIONSHIP OF BEING OVERWEIGHT WITH OTHER HEALTH ISSUES SUCH AS HIGH BLOOD PRESSURE, CHRONIC DEPRESSION, ARTHRITIS AND DIABETES ARE SIGNIFICANT. POOR NUTRITIONAL HABITS AND LACK OF PHYSICAL ACTIVITY ARE SIGNIFICANT CONTRIBUTING FACTORS TO THE OVERWEIGHT STATUS OF OUR COMMUNITY. ACCESS TO QUALITY HEALTH CARE SERVICES IS IMPORTANT FOR INCREASING THE QUALITY OF LIFE FOR EVERYONE. IT IMPACTS OVERALL PHYSICAL, SOCIAL AND MENTAL HEALTH STATUS; THE PREVENTION OF DISEASE AND DISABILITY; QUALITY OF LIFE; PREVENTABLE DEATH AND LIFE EXPECTANCY. UNINSURED INDIVIDUALS COMPRISE 5.5% OF THE POPULATION IN FULTON AND MONTGOMERY COUNTIES. OF THE TOTAL RESPONDENTS, 4% OF THOSE WITH LOW-INCOME WENT WITHOUT SOME TYPE OF COVERAGE THE PAST YEAR. THE LARGEST SEGMENT IN OUR SERVICE AREA REPORTING A LACK OF HEALTHCARE INSURANCE COVERAGE ARE MEN AND WOMEN AGED 18 TO 39. ADDITIONALLY, OVER 43% OF RESPONDENTS REPORTED SOME TYPE OF DIFFICULTY OR DELAYS IN RECEIVING NEEDED HEALTH CARE IN THE PAST YEAR, WITH THOSE WHO ARE UNINSURED MUCH MORE LIKELY TO REPORT BARRIERS WHEN COMPARED TO THE INSURED POPULATION.

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THROUGH AUGUST 31, 2021, ST. MARY'S HEALTHCARE (THE HOSPITAL) WAS A MEMBER OF ASCENSION HEALTH. IN SEPTEMBER 2021, ST. MARY'S HEALTHCARE SEPARATED FROM ASCENSION HEALTH.THE HOSPITAL, LOCATED IN AMSTERDAM, NEW YORK, IS A NONPROFIT ACUTE CARE HOSPITAL. THE CONSOLIDATED FINANCIAL STATEMENTS INCLUDE THE HOSPITAL, MEDICAL SERVICES ENHANCEMENT, INC. (MSE), CARONDELET REGIONAL MEDICAL, P.C., AND THE FOUNDATION OF ST. MARY'S HEALTHCARE, INC. (FOUNDATION). MSE OPERATES A MEDICAL OFFICE BUILDING TO RETAIN AND ATTRACT PHYSICIAN SPECIALISTS TO BETTER SERVE THE HEALTHCARE NEEDS OF THE COMMUNITY. CARONDELET REGIONAL MEDICAL, P.C IS A MULTISPECIALTY PHYSICIAN PRACTICE. THE FOUNDATION'S PRIMARY PURPOSE IS TO ASSIST THE HOSPITAL TO DEVELOP AND EXPAND ITS SERVICES TO THE COMMUNITY BY PROVIDING A FOCAL POINT AS THE RECIPIENT FOR PHILANTHROPIC SUPPORT AND BY TRANSFERRING FUNDS TO THE HOSPITAL.THE HOSPITAL PROVIDES ACUTE INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF MONTGOMERY, FULTON, AND HAMILTON COUNTIES. THE HOSPITAL ALSO PROVIDES AN ARRAY OF BEHAVIORAL HEALTH SERVICES INCLUDING INPATIENT MENTAL HEALTH AND ALCOHOL REHABILITATION PLUS OUTPATIENT MENTAL HEALTH AND ALCOHOL RELATED SERVICES. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. ADDITIONALLY, THE HOSPITAL OPERATES A 160-BED SKILLED NURSING FACILITY WHICH PROVIDES HOUSING, HEALTHCARE AND OTHER RELATED SERVICES TO RESIDENTS WHO ARE SEVERELY LIMITED IN THEIR ABILITY TO CARE FOR THEMSELVES DUE TO ILLNESS AND/OR DISABILITY, AND A MEDICAL ADULT DAY CARE PROGRAM. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS IN THE ACUTE CARE FACILITY, 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 COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA AND IS CALCULATED IN COMPLIANCE WITH GUIDELINES ESTABLISHED BY BOTH THE CATHOLIC HEALTH ASSOCIATION (CHA) AND THE INTERNAL REVENUE SERVICE (IRS).THE AMOUNT OF TRADITIONAL CHARITY CARE PROVIDED, DETERMINED ON THE BASIS OF COST, EXCLUDING THE PROVISION FOR BAD DEBT EXPENSE WAS APPROXIMATELY $688,000 FOR THE TWELVE MONTHS ENDED JUNE 30, 2022 AND $740,000 FOR THE TWELVE MONTHS ENDED JUNE 30, 2021. THE AMOUNT OF UNPAID COST OF PUBLIC PROGRAMS, COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS, AND COMMUNITY BENEFIT COST ARE REPORTED IN THE ACCOMPANYING OTHER FINANCIAL INFORMATION.

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ST. MARY'S HEALTHCARE'S GOVERNING BODY CONSISTS OF PERSONS REPRESENTING DIVERSE ASPECTS AND INTERESTS OF THE COMMUNITY. MANY MEMBERS OF ST. MARY'S HEALTHCARE'S GOVERNING BODY RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA; WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL ITS DEPARTMENTS OR SPECIALTIES AND APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH. MANY SURPLUS FUNDS FIND THEIR WAY TO MISSION TRIPS IN THIRD WORLD COUNTRIES OR STAY HERE FOR THE MEDICAL MISSION AT HOME EVENTS. ST. MARY'S HEALTHCARE PROMOTES THE HEALTH OF ITS COMMUNITY THROUGH VARIOUS ACTIVITIES, INCLUDING THE FOLLOWING: - DURING JULY 2021-JUNE 2022, COMMUNITY EDUCATION WAS PROVIDED ON TOPICS SUCH AS DIABETES EDUCATION, NUTRITION AND PHYSICAL ACTIVITY, BREAST, CERVICAL AND COLORECTAL CANCER SCREENINGS, HEALTH INSURANCE, BREASTFEEDING, DIABETES PREVENTION, HEART HEALTH, INFANT CPR, LACTATION SUPPORT, SUICIDE PREVENTION, HEALTH CARE PROXYS, GENERAL MENTAL WELL-BEING, SKIN CANCER PREVENTION, AND OTHER WELLNESS AREAS. - HOSTED SEVEN AMERICAN RED CROSS BLOOD DRIVES TO ADDRESS THE CRITICAL NEED FOR BLOOD IN OUR SERVICE AREA. - FROM JULY 2020 JUNE 2021, ST. MARY'S ASSOCIATES GAVE OVER 1,100 HOURS BACK TO THEIR COMMUNITY SERVING ON VARIOUS BOARDS INCLUDING MINORITY HEALTH TASK FORCE, ROTARY, DANIELLE'S HOUSE, COMMUNITY HEALTH CENTER (CHC) , GREATER AMSTERDAM VOLUNTEER AMBULANCE CORP (GAVAC), NEW DIMENSIONS IN HEALTH CARE, HEALTHY ALLIANCE IPA, HABITAT FOR HUMANITY, MONTGOMERY COUNTY EMS, ALBANY MEDICAL CENTER TRAUMA, ADIRONDACK - APPALACHIAN REGIONAL EMERGENCY MEDICAL SERVICES (AAERMS), FULTON MONTGOMERY CHAMBER OF COMMERCE, LEXINGTON FINANCE, FULTON MONTGOMERY COMMUNITY COLLEGE (FMCC), INNOVATIVE HEALTH ALLIANCE OF NEW YORK (IHANY), CATHOLIC CHARITIES OF FULTON AND MONTGOMERY COUNTIES, COMMUNITY FOOD ASSISTANCE NETWORK, TRI COUNTY CHEMPACK BOARD, FMCC NURSE ADVISORY BOARD, FAMILY SELECTIONS COMMITTEE, RESOURCE AND DEVELOPMENT COMMITTEE, HABITAT FOR HUMANITY - FROM JULY 2021 THROUGH JUNE 2022, THE HOSPITAL SUPPORTED THE WORK OF MANY COMMUNITY GROUPS INCLUDING THE LIBERTY FOUNDATION, MAKE A WISH FOUNDATION, MONTGOMERY COUNTY OFFICE FOR AGING, CITY OF AMSTERDAM, FULTON MONTGOMERY COMMUNITY COLLEGE, DANIELLE'S HOUSE, INTERFAITH PARTNERSHIP FOR THE HOMELESS, FULTON MONTGOMERY REGIONAL CHAMBER OF COMMERCE, CHARLTON HERITAGE, KNIGHT OF COLUMBUS, CATHOLIC CHARITIES. - ST. MARY'S CONTINUED TO BE A LEADER AND COLLABORATOR WITH A GROUP OF PARTNERS FROM LOCAL HEALTH CARE ENTITIES AND COMMUNITY AGENCIES WHOSE MISSION IS TO IMPROVE THE HEALTH STATUS FOR ALL WE SERVE. DURING 2021-2022, WE CONTINUED TO CARRY OUT THE WORK WE COMMITTED TO IN OUR IMPLEMENTATION STRATEGY AND COMMUNITY SERVICE PLAN. - ENROLLED 734 INDIVIDUALS IN STATE-SPONSORED INSURANCE PROGRAMS AND PROGRAMS THROUGH THE NEW YORK STATE OF HEALTH MARKETPLACE. - PROVIDED 24/7 LIFE-SAVING CANCER SCREENINGS TO UNINSURED INDIVIDUALS THROUGH THE CANCER SERVICES PROGRAM. - SUPPORTED A PROMOTOR WHO PROVIDED OUTREACH EDUCATION, REFERRAL, FOLLOW-UP, CASE MANAGEMENT AND ADVOCACY SERVICES TO OUR LATINO AND MIGRANT COMMUNITY. THE GOAL OF THE PROGRAM IS TO PROMOTE NEEDED PRIMARY HEALTH SERVICES AND PREVENTION EFFORTS IN A CULTURALLY APPROPRIATE MANNER. - MAINTAINED THE IMPORTANCE OF CULTURALLY SENSITIVE AND ACCURATE COMMUNICATION WITH LATINO PATIENTS AND PATIENTS WITH LIMITED ENGLISH PROFICIENCY THROUGH THE USE OF TRANSLATION SERVICES WHICH INCLUDE PROFESSIONAL PHONE AND VIDEO TRANSLATION SERVICES AND THE TRANSLATION OF KEY DOCUMENTS. ENGLISH AND SPANISH ARE THE MOST PROMINENT LANGUAGES SPOKEN IN THE COMMUNITY, AND ALL SIGNAGE IS POSTED IN BOTH ENGLISH AND SPANISH THROUGHOUT THE ORGANIZATION. THE IPAD VIDEO SERVICES ALSO SERVE THOSE IN NEED OF SIGN LANGUAGE SERVICES. - A MAJORITY OF THE HOSPITAL'S BOARD OF TRUSTEES IS COMPRISED OF PEOPLE WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS THEREOF. - THE HOSPITAL ESTABLISHED THE CARONDELET COMMUNITY FUND, WHICH PROVIDES MODEST ASSISTANCE TO LOCAL PROGRAMS AND AGENCIES WHOSE VALUES AND MISSION ALIGN WITH THE VALUES OF ST. MARY'S HEALTHCARE. GRANTS FROM THE FUND ARE MADE TO ELIGIBLE NON-PROFIT COMMUNITY AGENCIES WHICH ARE LOCATED WITHIN THE SERVICE AREA OF ST. MARY'S HEALTHCARE AND WHICH SHARE THE VALUES OF ST. MARY'S WITH AN EMPHASIS ON SERVICE TO THE POOR AND VULNERABLE, AND HOLISTIC CARE. ELEVEN LOCAL NOT-FOR-PROFIT AGENCIES SERVING OUR COMMUNITY WERE ONCE AGAIN AWARDED GRANT FUNDING AS PART OF ST. MARY'S CARONDELET COMMUNITY FUND PROGRAM OF 2022. FUNDS WERE ALLOCATED TO MONTGOMERY COUNTY OFFICE FOR AGING, NEW DIMENSIONS IN HEALTH CARE, HFM PREVENTION COUNCIL- CREATIVE CONNECTIONS CLUBHOUSE, MONTGOMERY COUNTY SPCA, COMFORT ZONE- TRINITY LUTHERAN CHURCH, SARAH JANE SANFORD HOME, HOLY TRINITY CHURCH, BROADALBIN-PERTH LIONS FOUNDATION, GROW AMSTERDAM, HABITAT FOR HUMANITY, HAVE OF HOPE.