4A (Expenses $ 131473196 including grants of $ 0) (Revenue $ 130937345)
Inpatient Services:42,677 Acute Care Patient Days13,438 Newborn Patient Days28,115 Skilled Nursing Patient Days2,990 I/P Surgeries

4B (Expenses $ 177210059 including grants of $ 0) (Revenue $ 169651184)
Outpatient Services:43,502 ED Visits net of Admits200,455 Referred Ambulatory Visits9,456 Operating Room5,528 G.I. Laboratory283 Interventional Radiology (IXR)

4C (Expenses $ 30984557 including grants of $ 0) (Revenue $ 30132911)
Primary Care Clinics:74,118 Clinic/Primary Care Center Visits469,158 Substance Abuse Visits

Part V, Section A:
"Sisters of Charity Hospital continuedAudiology O/P Chemical Dependence - Rehabilitation O/PClinic Part Time Services Clinical Laboratory ServiceCoronary Care Dental O/P Emergency Department Intensive CareLevel III Perinatal Care MaternityMedical Services - Other Medical SpecialtiesMedical Services - Primary Care Medical Social Services Medical/Surgical Neonatal Continuing Care Neonatal Intensive Care Neonatal Intermediate Care Nuclear Medicine - Diagnostic Nuclear Medicine - Therapeutic Physical Medical Rehabilitation Podiatry O/P Primary Stroke Center Radiology - Diagnostic Renal Dialysis - AcuteTherapy - Occupational O/P Therapy - Physical O/P Therapy - Speech Language PathologyTherapy - Vocational Rehabilitation O/P ""Sisters of Charity Hospital - St. Joseph Campus continued Clinic Part Time ServicesClinical Laboratory ServicesCoronary Care Emergency Department Intensive CareMedical Services - Other Medical SpecialtiesMedical Services - Primary Care Medical Social Services Medical/Surgical Nuclear Medicine - Diagnostic Radiology - Diagnostic Renal Dialysis - Acute Therapy - Speech Language Pathology"

Part V, Section B
Facility Reporting Group A

Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 5:
- Erie County Health Department - Assessed resources and determined that they would extend the 2019-2021Priorities for the 2022-2024 cycle due to the COVID-19 pandemic.- CHNA/CHIP Steering Committee - Monthly meetings held starting in December of 2021. Delayed start due to resource allocation resulting from the global COVID-19 pandemic.- Consumer survey December 2021 through April 2022 - 1394 respondents, reviewed by zip code to ensure equitable geographic input.- Focus Groups - March 2022- Professional Key Stakeholder Conversations - Three held with total of 16 participants.- Community Conversations - Five held, two of which were face-to-face with social distancing, facilitated by Erie County Health Department Staff as part of existing community groups.- Findings of surveys and focus groups were compiled and reviewed by the Steering Committee which is comprised of hospitals, county representatives and other community organizations, each of which disseminated results to their networks, county contacts, and other organizations. The results continue to be shared with county and community leaders as the county works to support residents during this unprecedented time.- Catholic Health CHNA Summit - June 13, 2022. Health system clinical and non-clinical leaders were invited to review and approve priorities identified through above processes.- Catholic Health Board Strategic Planning Committee Meeting - July 11, 2022. The overall CHNA/CHIP process was highlighted and the selected health priorities were presented.- Catholic Health Mission Integration Committee - September 7, 2022. The 2022-2024 health priorities and initiatives were presented and the reporting dashboard was discussed.- Catholic Health Ministry Services Board Meeting - November 17, 2022. The CHNA reports and CHIP for each of the hospitals were presented and approved by the board members.- Catholic Health Board of Directors were informed of the Ministry Services Board's approval of the 2022-2024 CHNA reports and CHIP during the December 1, 2022 Board of Directors meeting.- All reports have been published electronically on the Catholic Health website (chsbuffalo.org) with hard copies available upon request from the Catholic Health Mission Integration office.

Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 6a:
Lauri McCoy Catholic Health lmccoy1@chsbuffalo.orgBernadette Franjoine Catholic Health bfranjoine@chsbuffalo.orgKathleen Tompkins Kaleida Health ktompkins@kaleidahealth.orgBrian Meade Kaleida Health bmeade@kaleidahealth.org

Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 6b:
Kelly Asher Smalt Erie County Health Department kelly.asher@erie.govLisa Neff American Heart Association lisa.neff@heart.orgKarl Wende Buffalo State College wendeke@buffalostate.eduCheryll Moore Erie County Health Department cheryll.moore@erie.ogvLaurene Tumiel Behalter University at Buffalo tumiel@buffalo.eduRenee Cadzow D'Youville College cadzowr@dyc.eduMary K. Comtois United Way of Buffalo & Erie County mary.k.comtois@uwbec.orgAlessandra Duarte Population Health Collaborative of WNY aduarte@phcwny.orgKelly Wofford Erie County Health Department kelly.wofford@erie.govArica Rouse Erie County Health Department aricayrouse@gmai.comMargaret Barbalato Erie County Health Department margaret.barbalato@erie.goveAlan Delmerico Buffalo State University delmeram@buffalostate.eduJohn Gaeddert Erie County Health Department john.gaeddert@erie.govKaren Hall Population Health Collaborative of WNY khall@phcwny.org

Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 11:
Catholic Health 2022-2024 Prevention Agenda Priorities and Disparity:In collaboration with the Erie County Department of Health and other community partners, the following priorities, goals, focus areas and interventions were selected for the Catholic Health Community Health Improvement Plans. Priority Area #1 and Priority Area #2 were priorities identified by the Erie County Department of Health and selected for our community collaboration. Catholic Health is required to align with at least two county Priority Areas as part of the CHNA process. Of note, the Niagara County Department of Health identified the same priorities.Priority Area #1: Prevent Chronic Diseases:Disparity: SocioeconomicFocus Area 1: Healthy Eating and Food SecurityOverarching Goal: Reduce obesity and the risk of chronic diseaseGoal 1.13: Increase the percentage of adults with perceived food securityPriority Area #2: Promote Well-Being and Prevent Mental and Substance Use Disorders:Disparity: SocioeconomicFocus Area 1: Promote Well-BeingGoal 1.2: Facilitate supportive environments that promote respect and dignity for people of all agesGoal 2.2: Prevent opioid and other substance misuse and deathsFocus Area 2: Prevent Mental and Substance Use DisordersGoal 2.2: Prevent opioid and other substance misuse and deathsPriority Area #3: Promote Healthy Women, Infants, and Children:Disparity: EthnicityFocus Area 1: Maternal and Women's HealthGoal 1.2: Reduce maternal mortality and morbidityFocus Area 2: Perinatal and Infant HealthGoal 2.2: Increase breastfeedingA comprehensive review of outcome data from a variety of state and national resources were reviewed as part of the CHNA process. Primary resources utilized included the New York Prevention Agenda Dashboard, data from the United States census reporting, the University of Wisconsin's Population Health Institute's County Health Rankings and Roadmaps, as well as others. Due to the proximity and nature of the interrelationships between Erie and Niagara counties, as well as the reach of the Catholic Health service area and goal for high level of inclusivity for community health, data from both counties is represented in the following report. This provides a more comprehensive view of the overall service area while still allowing county specific needs to be identified.The overall assessment process is a collaborative effort between Catholic Health, Erie County Department of Health, and other local organizations and hospitals. More than 15 organizations directly participated in planning meetings and feedback sessions and over 1,300 residents responded to the CHNA survey. Input was also solicited from a broad range of other community organizations, individuals, and groups. This input helped validate and bring focus to areas of specific need and disparity, as well as helped prioritize interventions to address the needs of those we serve. The completed assessment and analysis of the data provided a framework for the health system's overall implementation plan to support priority needs that were identified for the community over the next three years.The progress and overall improvement related to the Prevention Agenda priorities in the Catholic Health improvement plan will be monitored by the internal leaders who are coordinating the interventions identified by the teams to support the priorities identified and as outlined on the CHIP template provided by the New York State Department of Health. Catholic Health will submit updates on progress towards each intervention annually, or as requested. The county's steering committee representatives will also continue to meet at least annually and review progress as well as explore new opportunities to collaborate on to support the priority areas. The Prevention Agenda Dashboard will continue to serve as the primary resource to track latest available trending details and monitor outcome data. While Catholic Health is committed to serving the community through the CHNA priorities in this report, there are a number of needs that were not incorporated into Catholic Health's individual 2022-2024 Community Health Improvement Plan at this time for one or more of the following reasons:*Requires resources that Catholic Health does not currently have available without compromising other important initiatives.*Is being targeted or addressed by other entities within the community.*Was deemed not as impactful on the overall health of the community as compared to other identified needs.Should community circumstances change or additional resources become available, Catholic Health will consider incorporating other initiatives into its plan.The Community Health Needs Assessment and Community Health Improvement Plan processes are linked directly to requirements specified by the Federal Internal Revenue Service and the New York State Department of Health. Under the Patient Protection and Affordable Care Act of 2010, the Internal Revenue Service requires all state-licensed, tax-exempt hospitals to develop a Community Health Needs Assessment and Community Health Improvement Plan to maintain their Internal Revenue Code Section 501(c)(3) tax-exempt status. Similarly, New York State requires hospitals and local health departments to collaborate within their community to identify local health priorities and to plan and implement a strategy for local health improvement focused on the Prevention Agenda 2022-2024: New York State Health Improvement Plan.Part V, line 7a page 8: https://www.chsbuffalo.org/mission/social-responsibility-community-benefitPart V, line 10a page 8: https://www.chsbuffalo.org/mission/social-responsibility-community-benefit

Group A-Facility 2 -- Sisters of Charity Hospital - St. Joseph Part V, Section B, line 16j:
Includes information in both English and Spanish on all signage and brochures for financial assistance.

Part I, Line 6a:
Sisters Hospital Community Benefit Report is contained in the annual report prepared by the Catholic Health System.

Part I, Line 7:
Costing is a full step down methodology of cost from non-revenue producing departments to revenue producing departments', with assignment of cost to individual charge items based on volume and charge amount. All patient accounts are cost with the same methodology regardless of patient type (inpatient, outpatient, emergency room, etc.) or insurance coverage (Medicare, Medicaid, private insurance, uninsured, etc.).

Part II, Community Building Activities:
Community Building Activities for Sisters Hospital included Community Support - for $13,220 and Environmental improvements - for $2,926

Part III, Line 2:
The Hospital did not report bad debt on their financial statements, as they adopted ASU 2014-09 Revenue from Contracts with Customers in 2018. Upon adoption, the majority of what was previously classified as provision for bad debts and presented as a reduction to net patient service revenue on the statement of operations and changes in net assets is treated as an implicit price concession that reduces the transacton price, which is reported as net patient service revenue.

Part III, Line 3:
The Hospital did not report bad debt on their financial statements, as they adopted ASU 2014-09 Revenue from Contracts with Customers in 2018. Upon adoption, the majority of what was previously classified as provision for bad debts and presented as a reduction to net patient service revenue on the statement of operations and changes in net assets is treated as an implicit price concession that reduces the transacton price, which is reported as net patient service revenue.

Part III, Line 4:
The hospital does not have a footnote that describes bad debt in the financial statements.

Part III, Line 8:
Sisters Hospital does not treat Medicare shortfall as a community benefit, as serving Medicare patients is not a differentiating feature of tax-exempt healthcare organizations. The existing community benefit framework allows community benefit programs that serve the Medicare population to be counted in other community benefit categories.

Part III, Line 9b:
The hospital's collection policies contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance. The hospital has implemented billing and collection practices for patient payment obligations that are fair, consistent, and compliant with state and federal regulations and no extraordinary collection practices are followed.

Part VI, Line 2:
In addition to its CHNA, Sisters Hospital as part of Catholic Health utilizes multiple methods to assess the health care needs of the communities it serves, including:* Evaluations administered by Sisters Hospital in coordination with the Catholic Health Community Education Department after each class, workshop, or program it sponsors seeking input on other programs or topics ofinterest participants would like to see. Based on this feedback, program planners meet with leadership to develop programs or workshops that match community interest/need;* Information management obtains from administrative data and payer mix to assist in evaluating the health needs and trends of the community * Evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors;* Patient, resident and caregiver satisfaction surveys;* Physician and leadership participation in community boards and forums to define health needs of patient populations; and*Catholic Health acute facilities have Patient Family Advisory Councils to provide opportunity for engagement and input into programs and services.* Participation in regional and state planning initiatives.

Part VI, Line 3:
"Catholic Health's Sisters Hospital inform and educate patients and persons who may be billed for medical services about their eligibility for assistance under federal, state, or local government programs or our own Healthcare Assistance Program (HAP) in a variety of ways. For example, Sisters Hospital, like our other Catholic Health facilities, has posters and brochures available, which include eligibility and contact information for the Patient Financial Services Team. This information is available in admissions areas, emergency rooms, primary care and outpatient rehabilitation centers, the Administrative and Regional Training Center (ARTC) and other areas throughout Catholic Health where eligible patients and family members are likely to be present. This information is also on the website https://www.chsbuffalo.org/billing-insurance/financial-assistance and includes general information, our policy and application and is translated in Spanish and Arabic. In addition, information on financial assistance is included on our website.Sisters Hospital also provides information about financial assistance and Healthcare Assistance program (HAP) contact information to patients as part of the intake process and during or within 90 days of their discharge from the hospital via patient statements or outreach. To further assist patients, all patient bills include the following language: ""If you need financial assistance: Catholic Health offers a healthcare assistance program to help those in need. For more details please visit www.chsbuffalo.org/financial assistance, or call our Patient Financial Services Team at (716) 601-3600. For free, confidential assistance in applying for financial assistance, patients can also call our Patient Financial Services team at 716-601-3600. A counselor will work with them to see if they qualify for free or low-cost insurance or other financial assistance. For patients who do not have insurance and need care at a Catholic Health hospital, a registration clerk can put the patient in touch with one of our Certified Application Counselors. Interpreting services are also available for patients who do not speak English. We offer case management services, and our Certified Application Counselors who discuss with patients the availability of various government benefits, such as Medicaid or other state and federal programs, and assist patients and families with eligibility and applications when necessary."

Part VI, Line 7, Reports Filed With States
NY

Part VI, Line 4:
Sisters Hospital is located in Erie County. Catholic Health is a not-for-profit integrated healthcare delivery system that operates four acute care operations in Erie County (two facilities located within the City of Buffalo). Two facilities are in the first-ring suburban communities of Kenmore and Cheektowaga, and one is in neighboring Niagara County. In addition, Catholic Health has Home and Community Based Care, Primary Care Centers, as well as Diagnostic and Testing Centers. The target populations include our general community population including those who may be at risk or disadvantaged.Catholic Health serves eight counties of Western New York. Erie County, Catholic Health System's primary service area, consists of a mix of urban, suburban, and rural populations. It includes the City of Buffalo, New York State's second largest city, surrounded by a ring of older suburbs, further encompassed by a ring of newly developed suburbs, with rural communities on the outskirts.Erie County is a metropolitan center located on the western border of New York State covering 1,058 square miles and consisting of three cities and 25 town governments. Buffalo serves as the county seat of Erie County. The population of Erie County, New York in 2020 was 917,241, down 0.2% from 918,992 in 2016. For comparison, the US population grew 2% and New York state's population shrank by 1.5% during that 4 year period.The largest ethnic groups in Erie County are White (Non-Hispanic) 74.5% and Black or African American (Non-Hispanic) 12.8%. White (Hispanic) accounts for 1.78% of the population and Asian (Non-Hispanic) accounts for 1.1%. The largest minority populations reside in 11 zip codes within the city of Buffalo.Erie County residents account for approximately 80% of the health system's inpatient volume.

Part VI, Line 5:
"One of the fundamental reasons for the creation of Catholic Health was to ensure the continued viability of faith-based health care to meet the needs of residents in Erie County, Niagara County and the surrounding communities. The Mission statement of Sisters Hospital, as part of Catholic Health - We are called to reveal the healing love of Jesus to those in need further articulates why we exist. Integral to this effort is caring for the needs of those who are poor and disadvantaged. The services provided by Sisters Hospital are in response to identified community needs, and reflect the Hospitals's emphasis on caring for the underserved. The Hospital collaborates with other charitable organizations and social service agencies (i.e. Catholic Charities, Spectrum Human Services, Evergreen Health Services, Erie County Department of Health, etc.), to maximize its ability to provide needed services to the residents of our region.The governing Board of Directors of Sisters Hospital is comprised of community representatives from universities, legal communities, and business leaders. Religious orders are represented, as well as active andretired medical staff members. The Sisters Hospital medical staff is considered an ""open"" medical staff, as any physician can apply for privileges. Each application is reviewed by a vigorous credentialing verification process. The hospitals have robust health professional education programs. Mercy Hospital and Sisters Hospital are physician teaching facilities. All sites participate in teaching programs for other allied health professionals.Our six emergency departments are open to all people regardless of their ability to pay. Our primary care centers are strategically located in areas deemed economically disadvantaged or where other medical services are lacking.Each year, Sisters Hospital, as part of Catholic Health touches thousands of area residents through its community health education programs, health screenings, clinical and support services, and communityservice activities. Most of these program are free to encourage participation by people from all walks of life. Programs offered also include those that are in alignment with state prevention priorities. Catholic Health continues to meet community needs by making charity care a priority and available to the uninsured and underinsured, traditional Medicaid services, and community benefit programs, including collaborative community health improvement initiatives, health professional education programs, volunteering and community service activities, and cash and in-kind contributions to community organizations that serve the poor and disadvantaged. In 2022, the Catholic Health System provided more than $210 million in charity care and community benefit activities to help make our WNY community a healthier place, especially for the poor and underserved. These activities included: -Supporting Project Homeless Connect An outreach initiative to link homeless individuals and families with medical and other support services;-Offering a Healthcare Assistance Program to ensure that people without insurance or financial means get the care they need; -Providing health and wellness information in places of worship through our Faith Community Nursing program; -Supporting nationally recognized ""green"" initiatives to remain good stewards of our natural resources and protect the environment."