4A (Expenses $ 3559116799 including grants of $ 0) (Revenue $ 3765797405)
"Patient Care DOING MORE - It's how we created our history of firsts. It's why we developed the world's first transvenous cardiac pacemaker and performed the world's first coronary bypass. Doing more put us at the forefront of treating cancer with highly targeted therapies. It made us one of only a few hospitals in the U.S. performing surgeries on babies before they're born. It built one of the most active and successful transplant centers in the country. Doing more - It's how we are creating the future of healthcare. Established in 1884 as a hospital for patients with chronic illnesses, Montefiore is a full-service integrated healthcare delivery system serving a large and complex urban population, a distinguished academic medical center with renowned faculty, an innovative research center pioneering scientific breakthroughs and medical ""firstsan exceptionally dedicated community partner with an unparalleled roster of innovative programs and services that address needs ranging far beyond medical care. Montefiore's mission is to heal, to teach, to discover and to advance the health of the communities it serves. To this mission Montefiore brings a unique synergy of strengths and resources. The Montefiore delivery system offers a full range of healthcare services (preventive, primary, specialty, acute and post acute) to the nearly 2 million residents of the Bronx, New York and nearby Westchester County. Montefiore also serves as a tertiary care referral center for patients across the metropolitan area, the nation and the world, and is known for advanced care in numerous specialties, including cardiology and cardiac surgery, cancer care, children's health, tissue and organ transplantation, women's health, surgery and surgical subspecialties. Montefiore combines its deep commitment to the community with nationally-renowned expertise to reach people at convenient locations. Through the Montefiore School Health Program (the largest and most comprehensive school-based health program in the country), Primary Care at Home programs, mobile medical and dental health vans and health education initiatives, Montefiore provides primary care services in non-traditional settings. Montefiore is increasingly recognized for success in delivering high-quality care to a large urban community, harnessing the power of health information technology and using care management tools to improve quality, safety and outcomes while controlling costs. To help patients, especially those with chronic diseases, achieve a better quality of life and reduced hospitalizations, Montefiore goes beyond the fragmented fee-for-service payment system, assuming total responsibility for the quality and costs of care for some of its sickest patients. Through the Montefiore IPA, Inc. (MIPA), The Care Management Company, LLC (CMO) and Bronx Accountable Healthcare Network IPA, Inc., dba Montefiore Accountable Care Organization IPA (ACO), a global prepayment strategy is used to manage care over the continuum, including hospital care, rehabilitation, outpatient care, professional services, remote patient monitoring and other programs. At the center of the Medical system are six main campuses with a total of 1,558 licensed beds that provided over 78,971 inpatient admissions in 2021, including over 3,763 births and multiple ambulatory services: - The 680 bed Henry and Lucy Moses Division; - the 421 bed Jack D. Weiler Hospital of Albert Einstein College of Medicine; - the 136 bed Children's Hospital at Montefiore, recognized as one of ""America's Best Children's Hospitals"" in U.S. News & World Report's rankings; - the 321 bed Wakefield Division (formerly the North Division renamed to reflect its anchor role in the community); - Montefiore Westchester Square (The former New York Westchester Square Hospital) operating as a Free standing Emergency Department and Ambulatory Surgery Facility; - The Montefiore Hutchinson Campus - The innovative ""hospital without beds"" providing world-class treatment with the latest technology and the best of multidisciplinary approach to care, enabling patients to be treated effectively and safely without hospitalization. Montefiore also operates extensive ambulatory care services connected by a robust health information technology system through a network of more than 175 locations - from community-based ambulatory care centers to school-based health centers to mobile clinics: - Montefiore's Emergency Departments, among the busiest in the nation, treats more than 320,000 patients annually (down to 258,399 in 2021 as a result of the COVID pandemic); - The hospital based clinics provides over 423,000 visits a year; - The Physician practices provides more than 1.5 million office visits annually; - Montefiore Medical Group, a network with over 350 distinguished physicians supported by a dedicated team of nurses, health educators and other highly-qualified medical professionals, working at more than 20 community based locations throughout the Bronx and Westchester provides over 650,000 visits a year; - Montefiore Home Care Program provides over 205,000 visits each year to homebound patients; - The Montefiore School Health Program, the largest in the nation, with 32 school-based health centers serves more than 15,000 children annually; - The Montefiore Substance Abuse and Treatment Program operating multiple substance abuse treatment sites offering drug treatment and rehabilitation services and comprehensive primary care to recovering abusers in communities across the Bronx; - Targeted outreach services to at-risk populations including programs serving the homeless and victims of domestic violence, mothers at risk of premature birth, as well as services to homebound and/or fragile seniors in community-based settings throughout the Bronx. At the intersection of Albert Einstein College of Medicine and Montefiore are Centers of Excellence in Cancer Care, Cardiovascular services, the Children's hospital, transplantation and neurosciences. In these centers, renowned investigators and multidisciplinary clinical teams collaborate to develop and deliver the advanced, innovative care available only at premier academic medical centers and the seamless continuum of services that ensures an ideal patient experience. In 2021, Montefiore Medical Center was again at the forefront of the fight against the resurgent waves of the COVID-19 virus that continued relentlessly throughout 2021. The Hospital continued to provide life-saving treatments and therapies to the community along with newfound hope with the advent of the COVID Vaccine. New York State was first hit hardest in early 2020 by the novel coronavirus spreading across the U.S., with more cases and more related deaths per capita than any other state. The Bronx, the main service area of the Medical Center, was the epicenter of this pandemic. In response to the COVID-19 pandemic, the Medical Center quickly and comprehensively integrated telehealth into our service programs to meet the needs of our patients who are largely from high-risk and low-income communities. Telehealth capabilities were rollout to triage patients with COVID-19 symptoms, safely conduct video and voice visits with patients in our ambulatory sites and hospitals and expand ICU communications with physicians who were serving patients with COVID-19 in other parts of the Medical Center. Telehealth has made it possible for medical staff in Montefiore's three hospitals to communicate safely with our ICU command center, staffed by board-certified Critical Care and Pulmonary Physicians at all times, effectively enabling all beds involved in the treatment of COVID-19 to be ICU beds. This technology has ensured remote monitoring of vital signs, ultrasounds, and electrocardiograms for all patients throughout the system, and for consults with other physicians in the role of hospitalists. In addition, the telehealth capabilities in our Psychiatry Department have been beneficial in providing consultations for our physicians and associates in need of assistance in coping with the immense suffering and volume of death they have been facing on a daily basis, and their concerns about exposure for themselves and their families. Montefiore Medical Center is guided by a mission to provide high quality care for all its patients, including those in our service area who lack health insurance coverage and who cannot pay for all or part of the essential care they receive. The Medical Center is committed to maintaining charity care policies that are consistent with its mission and values of advancing the health of the communities that it serves in providing one standard of excellent care to all patients regardless of their background or ability to pay. For more than 100 years, Montefiore has been a leader in innovations, new treatments, new procedures and new approaches to patient care that has produced stellar outcomes and helped to raise the bar for medical centers in the re"

4B (Expenses $ 443718754 including grants of $ 22581794) (Revenue $ 208323855)
Medical Education & Research Medical Education Montefiore is the University Hospital for Albert Einstein College of Medicine, one of the nation's premier institutions for medical education, basic research and clinical investigations. This strong alignment enables Montefiore to advance clinical and translational research results more rapidly to the bedside and to the medical community, and educate the next generation of physicians, healthcare leaders and investigators. In place are extensive training programs for medical students, residents and fellows. Through the second-largest medical residency program in the country, Montefiore provides postgraduate clinical training to more than 1,250 residents across 89 accredited residency and fellowship programs. Our progressive focus on comprehensive rather than fragmented care provides the ideal training ground for healthcare leaders of the future. To remain on the cutting-edge of training, we develop and expand programs that advance teamwork, communication and decision-making providing the doctors of tomorrow a unique opportunity for education and training in one of the most diverse urban areas in the country caring for a global population where the disease burden is high and the need for quality care is great. These programs, coupled with Montefiore's mission and vision draw residents from top medical schools who are particularly committed to increasing access to excellent care in an underserved population. Montefiore is dedicated to cultivating the ethical and professional development of all of its trainees. Montefiore's physicians are at the forefront of their fields, actively mentoring and cultivating a new generation of physicians and scientists committed to our mission and values of advancing the front line of health and leading the way in twenty-first century medicine and patient care. Montefiore training experience - clinically advanced and grounded in our organizational values of humanity, innovation, teamwork and equity - extends to all disciplines. On an average over 1,750 undergraduate and graduate nursing staff train at Montefiore (down to 202 in 2021 due to the pandemic) as did hundreds of social workers, nutritionists and pharmacists. Montefiore training also extends beyond the graduate level. The Center for Continuing Medical Education (CCME) at Montefiore Medical Center and Albert Einstein College of Medicine, founded in 1976, is accredited by the Accreditation Council for Continuing Medical Education (ACCME). The Center has provided hundreds of CME activities and CME credits to thousands of practitioners. Recognizing the vital importance of developing and embracing innovative techniques and treatments, Montefiore is committed to the utilization of resources for the advancement of physicians' education and delivery of care. Research Montefiore's large biomedical and clinical research initiatives include inquiry into a range of medical and health care delivery issues, including basic research into the fundamental process of disease and its treatment in humans, clinical trials and related clinical research and research into the organization and management of health care services. Montefiore is among 38 academic medical centers nationwide, at that time, to be awarded the Prestigious clinical and translational science award (CTSA) by the National Institutes of Health (NIH). The National Institutes of Health, along with other Federal, State and other funding, supports research in such areas as Aids, Oncology, Pediatrics, Anesthesiology, Emergency Medicine, Neurology, Pathology, Social Medicine and other clinical programs. Montefiore and Einstein are aligned around shared goals, with special emphasis on advancing clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies of today. At the heart of Montefiore Medical Center's pioneering research initiatives is its unique partnership with Albeert Einstein College of Medicine. Since 1963, Montefiore has served as the University Hospital of Albert Einstein College of Medicine (Einstein), a powerful collaboration between two of the nation's preeminent medical institutions that fosters the creation of knowledge by attracting world-renowned leaders in their fields and promoting opportunities for basic translational and clinical research. This bond was strengthen further in 2015 when Montefiore assumed operational and financial control of the College and, more recently, when Montefiore Medicine Academic Health System, Inc., the parent organization of the Montefiore Health System, Inc., became the sole member of the College. Montefiore and Einstein together have successfully collaborated to secure a National Institute of Health funded $22.5 million clinical and translational Science award to create a research infrastructure to support and promote clinical and translational research. Montefiore researchers are currently involved in more than 500 clinical trials and research studies, helping to translate scientific breakthroughs into cutting edge diagnostics and innovative treatments.

4C (Expenses $ 118080409 including grants of $ 15700527) (Revenue $ 6815471)
"Community Services Services to the community are an explicit and essential component of Montefiore's mission and one of its most valued traditions. The Medical Center has a long history of reaching beyond the walls of its hospitals to identify and meet the needs of its community and has been a national leader in organizing and expanding community-based services. Montefiore's commitment to the community has required a multifaceted, continually evolving response, in which the unique capacities of the academic medical center are mobilized to improve the lives of the people and the communities served-not just medically, but socially, economically and environmentally, wherever and whenever resources can make a difference. The Medical Center has maintained and expanded its range of community services, reaching out to and serving un-met health needs, including those with poor access to comprehensive primary care, at-risk and hard to reach children and their families, underserved and at-risk senior citizens, those affected by cancer, those affected by the continuing HIV epidemic in the Bronx, persons with or at-risk for tuberculosis infection, persons affected with problems of substance abuse, the homeless, adults and children with limited access to primary dental care and those affected by chronic health care diseases such as congestive heart failure, diabetes and asthma. Embracing its social responsibility to the community, Montefiore is nationally known as a pioneer in programs that are tailored to the specific needs of the community. Montefiore has been in the vanguard of intervention to combat such conditions as HIV disease, tuberculosis and lead poisoning prevention. Montefiore has sharpened the focus on such issues as childhood obesity, diabetes, improving community access to fresh, healthy foods at green markets and reducing healthcare disparities. Montefiore is aligning components of the delivery system to help improve public outcomes and building behavioral and population-based research to identify best practices. The community served by Montefiore, by several measures, faces many challenges. It is ranked the poorest urban county in the country, leads the nation in rates of diabetes and obesity and other chronic conditions and leads New York City in a host of significant markers: people in ""fair or poor health"", low birth weight, teen pregnancy, children in poverty, disabled individuals and families living below the poverty line. Montefiore is continuously working to help the community maintain a sense of security and economic stability, as well as to improve such quality-of-life fundamentals as education and affordable housing. Montefiore seeks to advance life in the Bronx beyond the traditional bounds of healthcare, by leading development efforts, promoting safe and productive neighborhoods and taking a leadership role in community business development. Montefiore is an advocate and partner with our neighbors in the Bronx, helping to sustain the community that sustains us."

Schedule H, Part V, Section B, Line 5
In conducting its most recent CHNA, the hospital facility took into account input from persons who represented the broad interests of the community served by the hospital facility including those with special knowledge of or expertise in public health. Montefiore Medical Center, in partnership with multiple Bronx hospitals and healthcare providers, community stakeholders including the New York City Department of Health and Mental Hygiene's Bronx Bureau, community organizations and community residents conducted its 2019-2021 Community Health Needs Assessment to identify the significant health concerns of the Bronx County. Montefiore Medical Center facilitated strong relationships with community groups. The Montefiore Community Advisory Boards, which serve the Montefiore Medical Center Acute Care campuses in the Bronx consist of membership serving the twelve Bronx Community Boards and represent key constituencies in those communities including local police precinct councils, large faith based organizations and major social service providers. The staff of Montefiore's Office of Community and Population Health and Montefiore's Office of Government and Community Relations also engages with the Bronx Borough President's duly appointed representatives of the official twelve Bronx Community Boards. In addition to receiving input from these regional boards and their community membership, the staff also solicits information from elected leaders through health focused legislative breakfasts which allow the sharing of secondary data with the local elected officials to receive confirmation or alternate opinion on the impacts felt by their constituencies. In addition, Montefiore also participates with a number of coalitions, most notably the #Not 62 Coalition-The Campaign for a Healthy Bronx in obtaining information representing broad interest of the community. The preparation of the 2019-2021 Community Health Needs Assessment was an inter-organizational and community collaborative process, initiated with the goal of developing an assessment that was reflective of the needs of the community including the clinical and social determinants of health. Given the complexity and diversity of the populations of the Bronx, a collection of secondary and primary data was used to identify the significant Health concerns of the Bronx community. The collection of primary data was made from a representative sample of Bronx residents. To capture the voices of various sectors of Bronx community residents and workers from various perspectives, a multi-lingual electronic survey directed through partnering Bronx organizations was used in the spring and early summer of 2019. The NYCDOHMH's provision of comprehensive borough specific data assisted the process of interpreting areas of need across the borough. In addition to data provided from New York City sources, multiple additional secondary data sources were used to support the identification and selection of the priority items that were selected and reviewed with the partners and enhanced through the input from the New York City Department of Health and Mental Hygiene's Bureau of Bronx Neighborhood Health. Through the process of completing and reviewing data obtained through the primary and secondary sources, engaging with community stakeholders and key partners and a review of resources available within the Medical Center and through its partnerships, an implementation Strategy was developed to address the significant needs identified. With the previous community health assessments, Montefiore did not receive any written feedback; however, Montefiore was invited to explain its Community Benefit spending to a group of key community stakeholders led by the North West Bronx Community and Clergy Coalition (NWBCC). The NWBCC directly questioned the allocation of resources and recommended that resources be directed towards addressing the social determinants of health, specifically violence prevention efforts in the communities along the Jerome Avenue Corridor. This meeting led to an evaluation of available data on local violence, including shootings, and has resulted in a financial resource being identified from DSRIP and other budgeted sources to support a St. Barnabas Hospital Health System led violence prevention effort which is a part of St. Barnabas Hospital's Prevention Agenda efforts and in which Montefiore is a partner. Schedule H, Part V, Section B, Line 6a Montefiore Medical Center consists of the Montefiore Health System facilities within the Bronx County. The Community Health Needs Assessment conducted included the three hospital campuses (Moses, Weiler/Einstein and Wakefield), the Children's Hospital at Montefiore (CHAM), the off campus hospital based Emergency Department at Montefiore - Westchester Square, the Montefiore Hutchinson Campus and the sites of the Montefiore Medical Group and the Montefiore School Health Program.

Schedule H, Part V, Section B, Line 7a
The CHNA is available on the hospital facility's website: URL: https://www.montefiore.org/documents/communityservices/MMC-Community-Healt h-Needs-Report-2019-2021.pdf

Schedule H, Part V, Section B, Line 10a
The hospital facility's most recent adopted implementation strategy is posted on the website: URL: https://www.montefiore.org/documents/communityservices/MMC-Community-H ealth-Needs-Report-2019-2021.pdf

Schedule H, Part V, Section B, Line 11
Based on the reported and documented health needs that were important across the populations surveyed and reflected in the data as critical and in alignment with the New York State Prevention Agenda, two priority areas were identified for the 2019-2021 report. One of the Priority Areas selected in 2016 have been re-selected in 2019, though the focus areas have expanded to include food security. This cycle's Priority Areas also includes work on mental and substance use disorders that is in alignment with the DSRIP work at Montefiore. DSRIP has a very strong focus on both the prevention and management of chronic diseases and behavioral health issues including substance abuse. Given that these priorities represent significant risk factors for the residents of the Bronx, we believe that it is important to continue our chronic disease prevention work in our clinics and extending our reach into the community. The first of the two priority areas identified is to prevent chronic disease with the focus on healthy eating and food security and preventive care and management. The goals for the first focus area are to increase access to healthy and affordable foods and beverages, increase the skills and knowledge to support healthy food and beverage choices and increase food security. The Montefiore Healthy Store Initiative (MHSI) is engaging bodega owners in increasing the supply and promotion of healthier food and beverage options, engaging local groups around advocacy for improved food access and nutrition education and technical assistance to drive demand for healthier food and beverage options. The Medical Center will also implement social determinants of health screener in outpatient and inpatient settings to screen for social needs, including food insecurity, and use community resource directory/referral tool to connect patients to appropriate resources. The goals of the second focus area are to increase early detection of cardiovascular disease, diabetes, pre-diabetes and obesity and to promote evidence-based care to prevent and manage chronic diseases including asthma, arthritis, cardiovascular disease, diabetes and pre diabetes and obesity. The Medical Center serves an ethnically diverse and income challenged community where the risk for diabetes is greater than in any other NYC boroughs and targets a higher percentage of Hispanic and non-Hispanic blacks. The Medical Center is engaging its clinical partners in the HbA1c screening protocol, aligning clinical and community-based resources to address the level of patient health status, increasing screening and intervention across the ambulatory settings and expanding the opportunities for clinical evaluation of diabetes Bronx residents. Providers will screen patients for diabetes and refer patients who identify as pre-diabetes into the Montefiore Diabetes Prevention program to help those at high risk of developing diabetes make lifestyle changes in order to delay the disease onset. The second of the two Priority Areas selected is to Promote Well-Being and Prevent Mental and Substance Use Disorders with the goal of preventing opioid overdose deaths. The Medical Center intervention will include training medical providers and staff on opioid overdose prevention education and naloxone distribution for at-risk patients at Montefiore Medical Group primary care clinics, providing free opioid overdose prevention education and naloxone take-home kits for community based organizations, and integrating opioid prevention education and naloxone distribution in Montefiore's mental health and substance use treatment programs. Montefiore is also partnering with community based organizations, emergency rooms and hospitals to accept patient referrals and to provide training and support to providers and community groups. Obesity and its related behaviors are important contributors to the substantial rise in premature deaths and illness among the residents in the Bronx. These issues also contribute directly to such varied health problems as diabetes, hypertension, asthma and cardiovascular disease. Montefiore has a number of existing efforts under way to help tackle these health issues, starting with education. The Medical Center has longstanding and effective partnerships and partner support for plans to expand on what has already been successfully done to date. The Medical Center is also improving Bronx resident's access to healthy food by sponsoring and supporting a weekly farmers market and green carts throughout the borough and partnering with the City on its healthy Bodega initiative. In addition, we are participating in the Academy of nutrition and Dietetics annual nutrition education and information campaign designed to focus attention on the importance of making informed food choices and developing sound eating and physical activity habits. Montefiore's well-being promotion and mental health and substance use prevention strategy includes several prongs. The first is Montefiore's opioid overdose prevention education that targets medical providers, at-risk patients, community members and community-based organizations to increase access to information and resources. These activities will be implemented with the goal of reducing overdose deaths in the Bronx. The second prong of our strategy is provider education and support for providers through opioid management trainings, electronic consults, assessments for patients prescribed long-term opioids, and integration of opioid use disorder treatment programs into primary care clinics. Montefiore will partner with community-based organizations, emergency rooms, and hospitals for referrals. In addition to the multiple resources that have been developed at Montefiore independently and through partnership with other organizations, there continues to be a need for community-based programs and resources that can augment Montefiore's programs and services. Multiple free and low cost internet databases have entered the public sphere such as www.auntbertha.com, www.hitesite.org, www.nowpow.com, among others, that have reduced the need for quickly obsolete and expensive-to-produce information and community resources referral guides. Since the previous version of this report in 2016, Montefiore has begun using the internet database platform www.nowpow.com, to connect patients to needed resources, which has been a challenge for the health care sector in the past. This online tool is a much more comprehensive and practical alternative to the hard to keep up-to-date and difficult to search homegrown referral guides that many health care providers have had to use in the past. Many Montefiore sites have been introduced to this new online resource and work is underway to more seamlessly integrate this kind of solution into the various workflows across the ambulatory, ED and inpatient settings. The use of an internet database will allow Montefiore to connect patients to important community resources provided outside of the health system by many of our community partners to address community needs such as housing (quality and affordability), transportation, employment, and education. We at Montefiore are more than aware of the importance of addressing the social determinants of health in our mission of advancing the health of the communities that we serve.

Schedule H, Part V, Section B, Line 13H
Family size is factored into the eligibility criteria for financial assistance. Schedule H, Part V, Section B, Lines 15d & 15e The Medical Center has internal resources available for assistance with the FAP application process. The Medical Center's FAP provides addresses, locations and phone numbers for offices within Montefiore to assist with completing applications. The financial aid and Medicaid staff at these locations are also certified application counselors that assist with Market place and Medicaid applications.

Schedule H, Part V, Section B, Lines 16a-16c
The FAP information can be found on the website: https://www.Montefiore.org/financial-aid-policy

PART I, LINE 7 TABLE:
THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST table IS BASED ON THE MEDICAL CENTER'S ACTIVITIES ONLY. Since the activities of the disregarded entities are quite unique and not representative of a hospital facility, the activities from these entities were excluded from consideration in the table. THE MEDICAL CENTER'S TOTAL OPERATING EXPENSES WERE ADJUSTED FOR AN UNBUDGETED $74.8 MILLION OPERATING SUBSIDIES PAID TO AN AFFILIATE MEDICAL COLLEGE INCLUDED IN PART XI, LINE 9 RECONCILIATION OF NET ASSETS AS WELL AS AN ADJUSTMENT FOR AFFILIATES COSTS. FORM 990, PART IX, LINE 25, COLUMN A EXPENSES USED TO CALCULATE THE BENEFIT PERCENTAGES WAS ADJUSTED ACCORDINGLY.

1. PART I, LINE 7:
THE COST-TO-CHARGE RATIO METHODOLOGY WAS UTILIZED TO CALCULATE THE AMOUNT included IN THE TABLE. THE CALCULATION OF THIS RATIO WAS DERIVED FROM the ratio OF PATIENT CARE COST-TO-CHARGES (RCC factor). In calculating the patient care cost for the ratio, the organization reduced its operating expenses for its non-patient care costs and the cost of its community benefits & building activities not relying on the RCC factor for costing purposes. In 2021, the organization received additional funding from the Cares Act Provider Relief Fund and FEMA for direct reimbursement of COVID-19 expenses and loss revenue. The organization further adjusted its patient care cost to exclude these COVID-19 expenses not adjusted in the prior year's cost to charge ratio calculation.

1. PART II - COMMUNITY BUILDING ACTIVITIES:
THE MEDICAL CENTER IS ACTIVELY INVOLVED WITH COMMUNITY-BASED ORGANIZATIONS AND SPECIAL COMMUNITY HEALTH PROGRAMS AS PART OF ITS MISSION TO ADVANCE THE HEALTH OF THE COMMUNITIES IT SERVES. THE MEDICAL CENTER'S COMMUNITY BUILDING activities INCLUDE COMMUNITY SUPPORT OF THE BRONX AIDS VOLUNTEERS organization, THE LEAD POISONING PREVENTION PROGRAM AND RECRUITMENT OF MUCH NEEDED MEDICAL PROFESSIONALS TO THE HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA) of the Bronx, among other INITIATIVES. MONTEFIORE'S LEAD POISONING PREVENTION Program is a designated NEW YORK State Resource Center for Lead poisoning prevention, and consists of a multidisciplinary team in medicine, research, social services, environmental investigation and public advocacy. It serves as a referral center for the medical management of lead poisoning, links families to safe housing during home abatement procedures, provides bilingual educational workshops, advocates for lead poisoned children during local and state legislative reviews and collaborates with city and private agencies in environmental intervention. PROJECT BRAVO is a hospital-based volunteer program managed by Montefiore's Aids Center that provides support to HIV and Aids patients. The program renders outreach services in the community, provides friendly visits to hospitalized patients and staffs the BRAVO food pantry.

1. PART III, Section A, LINE 2:
"The cost of bad debt expense included in the transaction price is estimated based on the bad debt provision at charge, applied to the ratio of total patient care expenses to total charges for all services rendered. Any payments or discounts are excluded from bad debt expense. 1. Part III, Section A., Line 3 THE ESTIMATED AMOUNT OF THE ORGANIZATIONS'S BAD DEBT EXPENSE (AT COST) attributed to PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAs based ON RESULTS OF PREDICTIVE ANALYSIS. BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE organization PROVIDES MUCH NEEDED HEALTH CARE SERVICES INDISCRIMINATELY to the COMMUNITY-AT-LARGE WITHOUT REGARD TO WHETHER OR NOT THE PATIENT has insurance or if THE BILL WILL EVER BE PAID. 1. Part III, Section A., Line 4 AS REPORTED IN MONTEFIORE HEALTH SYSTEM'S AUDITED CONSOLIDATED FINANCIAL statements, BAD DEBT EXPENSE IS DESCRIBED AS FOLLOWS: ""Subsequent changes to the estimate of the transaction price (determined on a portfolio basis when applicable) are generally recorded as adjustments to patient service revenue in the period of the change. For the years ended December 31, 2021 and 2020, changes in the Medical Center's estimates of expected payments for performance obligations satisfied in prior years were not significant. Portfolio collection estimates are updated based on collection trends. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (determined on a portfolio basis when applicable) are recorded as bad debt expense. Bad debt expense for the years ended December 31, 2021 and 2020 was not significant""."

3. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:
ALL INTAKE, REGISTRATION, AND COLLECTION AGENCY STAFF IS TRAINED ON THE Medical CENTER'S FINANCIAL AID POLICY AND HOW TO PROVIDE PATIENTS WITH assistance. MONTEFIORE MEDICAL CENTER HAS A POLICY THAT ESTABLISHES guidelines for THE BILLING OFFICE TO FOLLOW WHEN WORKING WITH INDIVIDUALS WHO are HAVING DIFFICULTY PAYING THEIR MEDICAL BILLS. A REFERRAL IS MADE TO THE MEDICAL CENTER'S FINANCIAL AID OFFICE AND A Financial COUNSELOR WILL HELP THE PATIENT APPLY FOR FREE OR LOW-COST insurance. IF THE FINANCIAL COUNSELOR DETERMINES THAT THE PATIENT DOES not qualify FOR LOW-COST INSURANCE, the counselor WILL HELP THE patient APPLY FOR A FINANCIAL AID DISCOUNT BASED ON INCOME LEVEL. THE MEDICAL CENTER MAKES ITS FINANCIAL AID POLICY KNOWN TO THE PUBLIC BY providing WRITTEN INFORMATION AVAILABLE IN multiple languages (English, Spanish, Albanian, Arabic, Bengali, Chinese, French, Russian & Vietnamese) including brochures AT all patient service areas, information posted on the intranet and internet, and information sent out on patient's bills. THERE ARE ALSO SIGNS POSTED AT entranceways, in the Emergency Department, Admitting Office, Billing and Medicaid offices and other registration and waiting area ADVISING PATIENTS OF THE availability of Financial aid.

5. PROMOTION OF COMMUNITY HEALTH:
"MONTEFIORE IS A LEADER IN COMMUNITY HEALTH AND HAS A LONG HISTORY OF DEVELOPING INNOVATIVE APPROACHES TO CARE AND TAILORING PROGRAMS TO BEST SERVE THE CHANGING NEEDS OF ITS COMMUNITY. MONTEFIORE EMBRACES ITS SOCIAL responsibility AND DEFINES ITS ROLE BROADLY, PROMOTING WELLNESS IN ADDITION TO TREATING DISEASE AND ADDRESSING NEEDS RANGING FAR BEYOND MEDICAL CARE. MONTEFIORE EXTENDS THIS RESPONSIBILITY TO THE CARE OF ITS EMPLOYEES AND MEDICAL STAFF, many WHOM LIVE IN THE SURROUNDING COMMUNITY. THE POPULATION MONTEFIORE SERVES IS ONE OF THE MOST DIVERSE IN THE NATION. MONTEFIORE HAS BEEN AN INCUBATOR FOR PROGRAMS THAT IMPROVE PATIENTS' ACCESS TO CULTURALLY APPROPRIATE SERVICES, AND ITS PROGRESSIVE FINANCIAL AID POLICY AND ROBUST ENTITLEMENT ENROLLMENT PROGRAM SUPPORT ACCESS TO CARE FOR THOSE IN NEED. HISTORICALLY, MONTEFIORE HAS EMBRACED COMMUNITY SERVICE AND COMMUNITY HEALTH IMPROVEMENT AS A DELIVERY SYSTEM CHALLENGE, REACHING OUT TO SERVE THE UNDER-RESOURCED THROUGH ITS EXTENSIVE PRIMARY CARE DELIVERY SYSTEM, INCLUDING A NUMBER OF FEDERALLY-QUALIFIED COMMUNITY HEALTH CENTERS (FQHC). IN ADDITION, MONTEFIORE HAS DEVELOPED A WIDE RANGE OF SERVICES TARGETED TO SPECIFIC GROUPS IN NEED: THE YOUNG, THE ELDERLY, THE HIV INFECTED AND AFFECTED, THE MENTALLY ILL, THOSE STRUGGLING WITH SUBSTANCE USE, HOMELESSNESS AND VIOLENCE AND THOSE LIVING WITH CHRONIC DISEASES. THE MEDICAL CENTER HAS MAINTAINED AND EXPANDED ITS RANGE OF COMMUNITY SERVICES, REACHING OUT TO AND SERVING POPULATIONS WITH UNMET HEALTH CARE NEEDS, INCLUDING: - THOSE WITH POOR ACCESS TO COMPREHENSIVE CARE - UNDERSERVED, AT-RISK AND HARD TO REACH CHILDREN & THEIR FAMILIES - UNDERSERVED AND AT-RISK SENIOR CITIZENS - THOSE AFFECTED BY CANCER - THOSE AFFECTED BY THE CONTINUING HIV EPIDEMIC IN THE BRONX - PERSONS WITH OR AT-RISK FOR TUBERCULOSIS INFECTION - PERSONS AFFECTED WITH PROBLEMS OF SUBSTANCE ABUSE - THE HOMELESS - ADULTS AND CHILDREN WITH LIMITED ACCESS TO PRIMARY DENTAL CARE - THOSE AFFECTED BY CHRONIC HEALTH CARE DISEASE SUCH AS CONGESTIVE HEART FAILURE, DIABETES AND ASTHMA. THE MEDICAL CENTER RUNS PROGRAMS for COMMUNITY HEALTH SERVICES THAT ARE AMONG THE NATION'S MOST EXTENSIVE PROVIDING PRIMARY CARE TO UNDERSERVED POPULATIONS including: - MONTEFIORE'S NETWORK OF PRIMARY CARE CENTERS IN THE BRONX INCLUDING SEVERAL FEDERALLY-QUALIFIED HEALTH CARE CENTERS (FQHC) PROVIDES ACCESS TO high QUALITY PRIMARY HEALTH CARE SERVICES AND A VARIETY OF PRACTICE-BASED AND COMMUNITY OUTREACH PROGRAMS TO SOME OF THE NATION'S POOREST AND MOST underserved COMMUNITIES. - MONTEFIORE OPERATES ONE OF THE NATION'S LARGEST PROGRAMS OF SCHOOL-BASED PRIMARY CARE, SERVING over 15,000 STUDENTS AT 32 ELEMENTARY, middle AND HIGH SCHOOLS IN THE BRONX, PROVIDING OVER 42,900 MEDICAL, MENTAL HEALTH, DENTAL, REPRODUCTIVE AND HEALTH PROMOTION SERVICES. THIS MODEL PROGRAM IS ABLE TO PROVIDE SERVICES TO ALL STUDENTS IN THESE SCHOOLS, INCLUDING THE ROUGHLY HALF OF ALL STUDENTS WITHOUT INSURANCE. - MONTEFIORE PROVIDES much NEEDED HEALTH CARE SERVICES TO HOMELESS CHILDREN AND FAMILIES IN VARIOUS LOCATIONS IN THE BRONX AND THROUGHOUT NEW YORK CITY USING A FLEET OF MOBILE MEDICAL UNITS AND A MOBILE DENTAL UNIT AND USING TEAMS OF PROFESSIONALS PROVIDING SERVICES WITHIN HOMELESS AND DOMESTIC VIOLENCE SHELTERS. MONTEFIORE PROVIDES COMPREHENSIVE CARE AND A RANGE OF INNOVATIVE PROGRAMS for HIGH-RISK CHILDREN IN THE BRONX, INCLUDING: - A HIGHLY REGARDED PREVENTION, COUNSELING AND TREATMENT PROGRAM FOR ABUSED CHILDREN AND THEIR FAMILIES, BASED IN MONTEFIORE'S CHILD ADVOCACY CENTER. - A NATIONALLY RECOGNIZED LEAD POISONING PREVENTION, SCREENING AND TREATMENT PROGRAM SERVING POPULATIONS AT HIGHEST RISK FOR LEAD POISONING. Its SAFE HOUSE IS A MODEL HOUSING PROGRAM TO SHELTER FAMILIES OF CHILDREN WITH HIGH LEAD LEVELS WHILE THEIR DWELLINGS ARE MADE LEAD FREE. - AN INNOVATIVE, MULTI-LEVEL PROGRAM OF CARE FOR CHILDREN WITH AND AT-RISK FOR OBESITY AND DIABETES, INCLUDING INITIATIVES IN THE SCHOOL-BASED HEALTH CENTERS, IN THE COMMUNITY-BASED PRIMARY CARE SITES AND AT THE CHILDREN'S HOSPITAL division AT MONTEFIORE (CHAM). - HEALTH PROFESSIONS EDUCATION PROGRAMS FOR HIGH SCHOOL STUDENTS CONDUCTED IN COLLABORATION WITH AREA HIGH SCHOOLS. THE MEDICAL CENTER OPERATES ONE OF THE NATION'S LARGEST AND MOST COMPREHENSIVE PROGRAMS FOR THE DIAGNOSIS, CARE AND ONGOING MANAGEMENT OF POPULATIONS WITH AND AT-RISK FOR HIV INFECTION, INCLUDING: - A HOSPITAL-BASED, STATE-DESIGNATED COMPREHENSIVE AIDS CENTER THAT SERVES INDIVIDUALS WITH HIV/AIDS WITH A BROAD PROGRAM OF AMBULATORY AND INPATIENT CARE. - A COMMUNITY-BASED PROGRAM THAT SERVES INDIVIDUALS WITH HIV/AIDS, OPERATING IN THE MEDICAL CENTER'S PRIMARY CARE SITES. - LONGSTANDING PROGRAMS FOCUSED ON THE PREVENTION, EARLY IDENTIFICATION AND ONGOING CARE AND MANAGEMENT OF CHILDREN AND ADOLESCENTS WITH OR AT RISK FOR HIV INFECTION. - AN INNOVATIVE PROGRAM OF OUTREACH HIV PRIMARY AND SPECIALTY CARE SERVICES, THAT ARE LOCATED IN MONTEFIORE'S SUBSTANCE ABUSE TREATMENT PROGRAM, WHICH SERVES OPIATE-ADDICTED INDIVIDUALS, HALF OF WHOM ARE HIV-INFECTED, IN SEVERAL DRUG TREATMENT CENTERS LOCATED THROUGHOUT THE BRONX. THIS SERVICE INFRASTRUCTURE HAS PROVEN INVALUABLE IN MOUNTING EFFECTIVE PUBLIC HEALTH, DIAGNOSIS AND CARE PROGRAMS RESPONDING TO THE TWO OTHER INFECTIOUS DISEASE EPIDEMICS THAT HAVE ALSO AFFLICTED THE BRONX: TUBERCULOSIS AND HEPATITIS-C infection. MONTEFIORE PROVIDES A WIDE RANGE OF ON-SITE AND OUTREACH PROGRAMS TO SERVE THE BOROUGH'S FRAIL AND AT-RISK ELDERLY, INCLULDING: - A COMPRHENSIVE, MULTIDISCIPLINARY GERIATRIC AMBULATORY PRACTICE, INCLUDING GERIATRIC MEDICINE AND GERIATRIC PSYCHIATRY, SOCIAL SERVICES, PHARMACY AND NUTRITIONAL COUNSELING, WITH SERVICE SITES IN THE EAST AND WEST BRONX; - AN AGING AND MEMORY CENTER THAT PROVIDES ASSESSMENTS, AMBULATORY CARE AND HOME VISITS BY GERIATRIC PSYCHIATRISTS; - ONE OF THE NATION'S LARGEST HOSPITAL-BASED HOMECARE PROGRAMS, PROVIDING IN-HOME SERVICES TO INNER CITY SENIORS LIVING IN NEIGHBORHOODS THAT ARE AMONG THE COUNTRY'S MOST DISADVANTAGED; - AN EXTENSIVE PROGRAM TO IDENTIFY, PREVENT AND RESPOND TO SUSPECTED ELDER ABUSE; - PHYSICIAN HOME VISIT PROGRAMS SERVING THE ELDERLY LIVING IN PUBLICLY SUBSIDIZED HOUSING PROJECTS ACROSS THE BRONX, A PROGRAM MOUNTED IN PARTNERSHIP WITH THE NYC HOUSING AUTHORITY AND LOCAL COMMUNITY AND SOCIAL services AGENCIES IN ""NATURALLY OCCURRING RETIREMENT COMMUNITIES - AN INNOVATIVE FEDERALLY-FUNDED DEMONSTRATION PROGRAM THAT USES A COMBINATION OF CARE AND CASE MANAGEMENT, A PHYSICIAN HOME VISITING PROGRAM, HOME-BASED TELEMONITORING AND PATIENT/FAMILY SUPPORT TO MANAGE AND IMPROVE THE CARE AND HEALTH OF SENIORS IDENTIFIED BY CMS AS THEIR ""HIGH-COST BENEFICIARIES"" (MEDICARE BENEFICIARIES WITH COMPLEX MEDICAL AND PSYCHOSOCIAL NEEDS). THE DEPARTMENT OF OB-GYN AND WOMEN'S HEALTH IS INVOLVED IN A RANGE OF PROGRAMS FOCUSED ON THE HEALTH NEEDS OF WOMEN IN THE BRONX AND SURRROUNDING COMMUNITIES that INCLUDES PARTNERING WITH NY STATE, NY CITY AND LOCAL PROVIDERS in THE DEVELOPMENT OF A REGIONAL PERINATAL SYSTEM IN THE BRONX, WHICH HAS one of THE COUNTRY'S HIGHEST RATES OF INFANT MORTALITY AND DISABILITY AND LOW BIRTH WEIGHT. MONTEFIORE AS A COMMUNITY LEADER IS RESPONDING TO THE UNIQUE AND PRESSING needs OF ITS COMMUNITY reflected in various outreach programs: - THE MONTEFIORE-EINSTEIN CANCER CARE OPERATES THE COMMUNITY OUTREACH PROGRAM, A RESEARCH BASED CANCER PREVENTION, EDUCATION, AND SUPPORT PROGRAM THAT PROVIDES SUPPORT AND EDUCATIONAL SERVICES TO PATIENTS, FAMILIES, STAFF, AND COMMUNITY MEMBERS FACING THE CHALLENGES OF CANCER. THE CENTER ALSO PARTICIPATES IN CANCER SCREENING, CANCER EDUCATION AND AWARENESS, AND SUPPORT PROGRAMS. - MONTEFIORE'S COMMUNITY DENTISTRY PROGRAM PROVIDES DENTAL SERVICES TO A multitude OF UNDERSERVED AND MEDICALLY COMPROMISED PATIENTS AT ON-SITE DENTAL FACILITIES, ONE COMMUNITY SITE, AND THE INFECTIOUS DISEASE CLINIC AT THE MOSES DIVISION. A MOBILE DENTAL VAN PROVIDES MOBILE DENTAL SERVICES TO THE UNDERSERVED AT A VARIETY OF MONTEFIORE PRIMARY CARE SITES ACROSS THE BRONX. - MONTEFIORE has been DESIGNATED BY NY STATE AS ONE OF FOUR DIABETES CENTERS OF EXCELLENCE IN THE STATE. MONTEFIORE HAS IMPLEMENTED A COMPREHENSIVE ARRAY OF PROGRAMS RESPONDING TO THE ""NEXT EPIDEMIC"" IN THE BRONX: THE EXTRAORDINARILY HIGH AND INCREASING RATES OF DIABETES AND OBESITY AND THE COMMON CARDIOVASCULAR COMPLICATIONS AND COMORBIDITIES. MONTEFIORE IS TAKING A NETWORK-WIDE QUALITY IMPROVEMENT APPROACH TO ORGANIZING AND IMPROVING THE PREVENTION, CARE AND MANAGEMENT OF THIS DISEASE CLUSTER, IN ITS PRIMARY CARE AND SCHOOL-BASED SITES, IN ITS SPECIALTY SERVICES AND HOSPITAL divisions. Montefiore has taken a leadership position in neighborhood and community development, creating and supporting the Mosholu Preservation Corporation (MPC). MPC is a community redevelopment corporation that has successfully rehabilitated housing stock in the depressed neighborhoods in the northwest Bronx and has been involved in a number of economic de"

6. AFFILIATED HEALTH CARE SYSTEM:
Montefiore Medical Center IS AN AFFILIATE OF MONTEFIORE HEALTH SYSTEM, INC. The Health System is a leader in community and population health and has a long history of developing innovative approaches to care and tailoring programs to best serve the changing needs of its community. These include, but are not limited to the following: Community service plan, Community Service Strategy, Accountable Care Organization, Patient-centered medical home, disease management programs and community outreach. The integration of these innovative approaches supports Montefiore well in its provision of service to the community. See line 5, Promotion of Community Health, for how the Health System along with Montefiore Medical Center promotes community Health.

7. STATE FILING OF COMMUNITY BENEFIT REPORT:
Montefiore Medical Center files a Community Service Plan with the State of New York.

1. PART III, Section B, LINE 8:
The MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED IN PART III, SECTION B, were based on the allowable costs and Medicare reimbursements that were reported in the organization's 2021 Medicare Cost Report reduced for the Medicare subsidized services already reported in Part I, line 7G of Schedule H and direct graduate medical education reported in Part 1, line 7H. The MEDICARE ALLOWABLE COSTS WERE DERIVED using THE Medicare COST REPORT COST-FINDING METHODOLOGY, WHICH APPORTIONS ROUTINE costs TO MEDICARE USING DAYS AND ANCILLARY COSTS TO MEDICARE USING departmental RATIOS OF COSTS TO CHARGES. The following table represents a reconciliation of Medicare revenue and costs included on Lines 5, 6 and 7 in part III to the total actual Medicare revenue and costs of the Medical Center. In past years, the Medical Center has typically showed a Medicare surplus in Part III that reconciled to a shortfall after other Medicare programs and the DME and Medicare subsidized health service losses were added back. For 2020 and again in 2021, because of the additional costs related to the Medical Center's rapid response to the COVID-19 pandemic, the cost of establishing seven COVID-19 testing sites throughout the Bronx and Westchester and the additional cost from procuring personal protective equipment, we are again reporting a shortfall for Part III Medicare. This shortfall was increased to $134,635,473 when reconciled to our actual Medicare costs as highlighted in the table below. REVENUE Allowable SURPLUS COSTS (SHORTFALL) Part 111, LINES 5-7: $370,129,224 $394,304,935 ($24,175,711) ADD: COSTS NOT INCLUDED IN MEDICARE COST REPORT: - 26,513,330 (26,513,330) ADD: MEDICARE DME: 32,500,844 64,909,025 (32,408,181) ADD: EMP PHYS SERV: 46,607,162 86,625,487 (40,018,325) ADD: MED SUBSID HLTH SERV: 6,248,132 17,768,058 (11,519,926) MEDICARE Shortfall: $455,485,362 $590,120,835 ($134,635,473) MEDICARE REVENUE AND ALLOWABLE COSTS REPORTED IN PART III, SECTION B, were derived FROM THE MEDICARE COST REPORT. HOWEVER, LINES 5, 6, AND 7 IN Part III DO NOT INCLUDE CERTAIN MEDICARE REVENUE AND COSTS, AND does NOT present the ENTIRE FINANCIAL impact OF THE MEDICAL CENTER'S PARTICIPATION in the MEDICARE PROGRAM. IN ADDITION, THE MEDICARE COST REPORT cost-finding methodology IS INCONSISTENT WITH THE REST OF SCHEDULE h, whereby costs ARE calculated USING THE MEDICAL CENTER'S OVERALL RATIO OF COSTs TO charges (RCC) FROM WORKSHEET 2. ACCORDINGLY, THE MEDICARE Shortfall reflected IN PART III, LINE 7 BEFORE THE reconciling ADJUSTMENTS described in the table is significantly understated. FOR EXAMPLE, PART III EXCLUDES CERTAIN MEDICAL center EXPENSES THAT ARE NOT PART OF THE MEDICARE COST FINDING process. These COSTS INCLUDE CERTAIN CONSULTING AND MARKETING EXPENSES, COSTS related TO NURSE PRACTITIONERS, NURSE MIDWIVES, PHYSICIAN assistants, and Hospitalists WHO BILL THE MEDICARE PROGRAM FOR PART B SERVICES AND physician COSTS EXCEEDING THE MEDICARE REASONABLE compensation equivalent (RCE) LIMITS. INCLUDING THE MEDICARE SHARE OF these COSTS WOULD HAVE increased THE MEDICARE Shortfall ON LINE 7 BY $26,513,330. PART III ALSO EXCLUDES MEDICARE REVENUE AND ALLOWABLE COSTS FROM THE MEDICARE COST REPORT RELATED TO DIRECT MEDICAL EDUCATION (DME), WHICH WERE REPORTED IN PART I, LINE 7F AS REQUIRED BY THE SCHEDULE H INSTRUCTIONS. IF THE MEDICARE SHARE OF DME LOSSES HAD BEEN REPORTED IN PART III, THE MEDICARE Shortfall ON LINE 7 WOULD HAVE BEEN increased BY $32,408,181. (SEE ABOVE RECONCILIATION TABLE) ADDITIONALLY, PART III EXCLUDES MEDICARE REVENUE AND COSTS FOR SERVICES BILLED FOR THE MEDICAL CENTER'S EMPLOYED PHYSICIANS THAT ARE PART OF THE RCC CALCULATION IN WORKSHEET 2 BUT ARE NOT REFLECTED IN THE MEDICAL CENTER'S MEDICARE COST REPORT. INCLUDING THE MEDICARE LOSSES FROM THE MEDICAL CENTER'S EMPLOYED PHYSICIAN SERVICES WOULD HAVE increased THE MEDICARE Shortfall ON LINE 7 BY AN ADDITIONAL $40,018,325. (SEE ABOVE RECONCILIATION TABLE) PART III ALSO EXCLUDED MEDICARE REVENUE AND COSTS FROM THE MEDICARE COST REPORT ASSOCIATED WITH SUBSIDIZED HEALTH SERVICES WHICH WERE REPORTED IN PART I, LINE 7G AS REQUIRED BY THE SCHEDULE H INSTRUCTIONS. IF THE MEDICARE LOSSES FROM THE MEDICAL CENTER'S SUBSIDIZED HEALTH SERVICES HAD BEEN REPORTED IN PART III, THE MEDICARE Shortfall IN LINE 7 WOULD HAVE BEEN increased BY AN ADDITIONAL $11,519,926. (SEE ABOVE RECONCILIATION TABLE) The Medicare Shortfall should be included as a community benefit, since the organization is rendering much needed health care services mainly to a frail elderly population living on a fixed income with great health needs. 1. Part III, Section C, line 9b FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS HALTED AND THE PATIENT IS REFERRED FOR FINANCIAL AID. IF AN ACCOUNT IS IN COLLECTION AND THE PATIENT REQUESTS FINANCIAL AID OR IF THE AGENCY DETERMINES THAT THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ACCOUNT IS REFERRED BACK TO THE HOSPITAL WHERE THE PATIENT IS PROVIDED ASSISTANCE WITH COMPLETING AN APPLICATION FOR ASSISTANCE. The organization also uses predictive analysis to assist in charity care determinations in the absence of completed financial aid applications. Financial screening/Presumption Charity uses financial information that is contained in a patient's credit report and other patient specific attributes to estimate a patient's income level and where they are in relation to the Federal Poverty Level to qualify under the Hospital's Charity Care Policy. Presumptive eligibility may also be based on prior FAP eligibility or enrollment in certain specified means-tested public programs to presumptively determine if an individual is FAP eligible. Full Financial aid is also granted to patients with outstanding self-pay bills and current Medicaid coverage, patients who are homeless and uninsured and underinsured minors receiving care in the Medical center's school health clinic.

2. NEEDS ASSESSMENT:
MONTEFIORE ASSESSES COMMUNITY NEEDS BY: A) COMMUNITY ADVISORY BOARDS THE PRIMARY APPROACH USED TO GAIN INPUT AND COMMUNITY INVOLVEMENT IS THROUGH A VARIETY OF COMMUNITY ADVISORY BOARDS (CABS). MONTEFIORE MEDICAL CENTER works EXTENSIVELY WITH REPRESENTATIVES OF THE COMMUNITIES THROUGH THE CABS TO IDENTIFY HEALTH CARE NEEDS AND DETERMINE THE APPROPRIATE CONFIGURATION OF SERVICES. ON A REGULAR BASIS, MONTEFIORE REPORTS TO THESE VARIOUS COMMUNITY GROUPS ON THE Medical Center's performance and services, the status of programs, financial and utilization statistics, and the plans for and implementation of community services, and plans for the future. B) COMMUNITY SERVICES COMMMITTEE MONTEFIORE HEALTH SYSTEM HAS A BOARD COMMITTEE, THAT IS FOCUSED ON COMMUNITY SERVICES. IT IS RESPONSIBLE FOR OVERSEEING MONTEFIORE'S COMMUNITY SERVICES AND COMMUNITY BENEFIT ACTIVITIES TO ENSURE THEY ARE FORMULATED TO FACILITATE THE FULFILLMENT OF THE MEDICAL CENTER'S MISSION AND MEET THE NEEDS OF THE COMMUNITY. THE COMMITTEE MEETS REGULARY TO BECOME FAMILIAR WITH AND ASSESS MONTEFIORE'S community service programs AND THE EXTENT TO WHICH THEY ADDRESS AND MAKE A MEANINGFUL IMPACT ON PRESSING COMMUNITY NEEDS. THE COMMITTEE WORKS CLOSELY WITH MONTEFIORE LEADERSHIP AND/OR RELEVANT BOARD COMMITTEES THAT ARE RESPONSIBLE FOR OVERSEEING THE MEDICAL CENTER'S MISSION TO ASSESS AND IMPROVE THE HEALTH OF THE COMMUNITIES SERVED. C) PARTNERSHIPS AND COLLABORATIONS BEYOND THE FORMAL STRUCTURE THAT MONTEFIORE HAS ESTABLISHED TO GAIN INPUT from THE COMMUNITIES IT SERVES, THE MEDICAL CENTER PARTICIPATES IN A VARIETY OF ORGANIZED PARTNERSHIPS AND COLLABORATIVES, WORKING WITH OTHER PROVIDERS IN THE BRONX, THE NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE, COMMUNITY-BASED ORGANIZATIONS IN THE BRONX AND MEMBERS OF THE COMMUNITY IN PLANNING AND DEVELOPING INITIATIVES AIMED AT IMPROVING THE HEALTH OF PEOPLE IN THE BRONX. EXAMPLES OF SUCH Partnerships INCLUDES: - THE BRONX HEALTH LINK - THE BRONX RHIO - THE BRONX COLLABORATIVE - THE BRONX BREATHES INITIATIVE - THE BRONX HIV PLANNING COUNCIL - SOUTH BRONX ENVIRONMENTAL JUSTICE PARTNERSHIP (SBEJP) - CITIWIDE HARM REDUCTION PROGRAM - BRONX COMMUNITY PALLIATIVE CARE INITIATIVE - BRONX SCIENCE AND HEALTH OPPORTUNITIES PARTNERSHIP - HISPANIC CENTER OF EXCELLENCE - BRONX CENTER TO REDUCE AND ELIMINATE ETHNIC AND RACIAL HEALTH DISPARITIES (BRONX CREED). D) The office of community and population health Montefiore continues to partner with a variety of community-based organizations to work to advance the health of the community. The Montefiore Office of Community and Population Health was set up to maximize the impact of the Medical Center's community services and helps to assess community needs by its various initiatives, including, - supporting and coordinating Montefiore's diverse portfolio of community health improvement programs and activities; - enhancing Montefiore's capacity to assess and measure the health needs of the communities it serves; - Identifying and selecting a limited number of top-priority health needs in the communities Montefiore serves for specific focus; - Leading and coordinating Montefiore-wide efforts and working with community partners to measurably improve the health of the communities served; - The to your Health! Program, a community and worksite wellness initiative seeking to reduce the growing burden of chronic disease in the community through a number of public health programs to educate patients, visitors, staff and local residents on how to live healthier lives. Through collaborations with local community based organizations, the Office of Community Health will identify specific interventions that can be worked on both collaboratively and independently to transform the community health. Using data collected through Montefiore, the District Public Health Office and other sources, the impact on the community health by the particular intervention can than be measured and analyzed.

4. COMMUNITY INFORMATION:
"THE MEDICAL CENTER HAS OUTREACH SERVICES RESPONDING TO THE HEALTH CARE and social NEEDS THROUGHOUT THE BRONX AND SOUTHERN WESTCHESTER. IT HAS become a MAJOR COMMUNITY RESOURCE TO A POPULATION WHICH IS AMONG THE country's most ECONOMICALLY AND SOCIALLY DISADVANTAGED and to a community that is full of great challenges. The Bronx, with its 1.43 million residents, is ranked the poorest urban county in the country, leads the nation in rates of diabetes and obesity and other chronic conditions, and leads New York City in a list of significant markers: people in ""fair or poor health"", low birth weight, teen pregnancy, children in poverty, disabled individuals and families living below the poverty level. The Bronx has a poverty rate of 28% (compared to 15.9% city-wide), household median income of $37,397 (compared to $56,942 in Brooklyn, $64,509 in Queens, $79,201 in Staten Island and $85,071 in Manhattan) and one of the highest child poverty rates in the United States with 40% of Bronx children living below poverty; the eight highest proportion for any county in the United States, and the highest for any urban county. THE BRONX IS ALSO THE YOUNGEST county IN NEW YORK STATE WITH a median age of 33.6 and 25.3% of its population under the age of 18. The Bronx has the 4th highest proportion of single-parent headed households with children (59.5%) among US counties. The Bronx is one of the most diverse counties in the nation; 56.2% are Hispanic/Latino, 29.0% are non-Hispanic Black, 9.1% are non-Hispanic white, and 3.8% are non-Hispanic Asian. More than one-third (36.4%) of Bronx residents were born outside of the U.S. The Bronx was NYC's first borough to have a majority of people of color and is the only borough with a Latino majority. COMMUNITY HEALTH PROFILES OF THE BRONX SHOW POOR HEALTH STATUS, HIGHER than AVERAGE INCIDENCE AND PREVALENCE OF HIV AND TUBERCULOSIS, POORER than average BIRTH OUTCOMES, WORSE THAN AVERAGE ACCESS TO PRIMARY CARE, and high HOSPITAL ADMISSION RATES FOR DIABETES, CARDIOVASCULAR, cerebrovascular, PERIPHERAL VASCULAR AND RENAL DISEASES. The Bronx has been an epicenter of the asthma, HIC/Aids and drug epidemics and also has excess mortality rates from heart disease, stroke, and diabetes compared to city-wide and national averages. As Bronx mortality rates remain significantly high, the number of physicians practicing in the Bronx continues to decrease earning the county a federal health professional shortage area (HPSA) designation."