4A (Expenses $ 725617703 including grants of $ 536323) (Revenue $ 917649973)
THE 364 CERTIFIED BED HOSPITAL PROVIDES CARDIOVASCULAR TESTING AND OTHER GENERAL MEDICAL SERVICES NECESSARY TO SUPPORT CARDIOVASCULAR PATIENTS AND ALSO PROVIDES NON-CARDIOVASCULAR SERVICES IN RESPONSE TO THE GENERAL NEEDS OF THE COMMUNITY. DURING 2021, THE HOSPITAL ADMITTED 19,647 PATIENTS, PERFORMED 1,348 OPEN HEART OPERATIONS AND 11,632 CATHETERIZATIONS. FURTHER, THE HOSPITAL PERFORMED 3,596 PTCA'S AND 3,065 CARDIAC ARRYTHMIA PROCEDURES. IN ADDITION, THERE WERE 55,718 EMERGENCY ROOM VISITS AND DURING THE YEAR THE HOSPITAL SERVICED 228,771 OUTPATIENTS.

PART V, SECTION B, LINE 3E
IN 2019, MEMBERS OF THE LONG ISLAND HEALTH COLLABORATIVE REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM HEALTH NEEDS PRIORITIES FOR THE 2019-2021 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM (PHIP), WITH THE PHIP SERVING AS THE CENTRALIZED DATA RETURN AND ANALYSIS HUB. COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION.

PART V, SECTION B, LINE 5
ST. FRANCIS HOSPITAL & HEART CENTER CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ASSOCIATION WITH LONG ISLAND HEALTH COLLABORATIVE (LIHC) MEMBERS. THE LIHC IS A PARTNERSHIP OF LONG ISLAND'S HOSPITALS, COUNTY HEALTH DEPARTMENTS, HEALTH PROVIDERS, COMMUNITY-BASED SOCIAL AND HUMAN SERVICE ORGANIZATIONS, ACADEMIC INSTITUTIONS, HEALTH PLANS, LOCAL GOVERNMENT, AND THE BUSINESS SECTOR, ALL ENGAGED IN IMPROVING THE HEALTH OF LONG ISLANDERS. THE LIHC IS THE MAIN WORKING GROUP ASSOCIATED WITH CARRYING OUT THE GOALS OF THE LONG ISLAND POPULATION HEALTH IMPROVEMENT PROGRAM. IN 2019, MEMBERS OF THE LIHC REVIEWED EXTENSIVE DATA SETS SELECTED FROM BOTH PRIMARY AND SECONDARY DATA SOURCES TO IDENTIFY AND CONFIRM PREVENTION AGENDA PRIORITIES FOR THE 2019-2021 COMMUNITY HEALTH NEEDS ASSESSMENT CYCLE. DATA ANALYSIS EFFORTS WERE COORDINATED THROUGH THE LIHC, WHICH SERVED AS THE CENTRALIZED DATA RETURN AND ANALYSIS HUB. PRIMARY DATA SOURCES INCLUDE THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT SURVEY (CHAS) AND THE RESULTS FROM FOCUS GROUPS AND KEY COMMUNITY-BASED ORGANIZATION LEADER INTERVIEWS. SECONDARY DATA SOURCES COMPRISED PUBLICALLY-AVAILABLE DATA SETS WHICH WERE REVIEWED TO DETERMINE CHANGE IN HEALTH STATUS AND EMERGING ISSUES WITHIN NASSAU COUNTY. SOURCES OF SECONDARY DATA INCLUDED STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM (SPARCS), NEW YORK STATE PREVENTION AGENDA DASHBOARD, PREVENTION QUALITY INDICATORS (PQI), BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), EXTENDED BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (EBRFSS), NEW YORK STATE COMMUNITY HEALTH INDICATOR REPORTS (CHIRS) AND NEW YORK STATE VITAL STATISTICS. THE ENGAGEMENT OF THE BROADER COMMUNITY, FOR ASSESSMENT PROCESSES, IS ACHIEVED THROUGH THE LIHC AND ITS PARTNERS' ONGOING DISTRIBUTION OF THE LONG ISLAND AND EASTERN QUEENS COMMUNITY HEALTH ASSESSMENT (CHAS) SURVEY. THIS SURVEY IS OFFERED ONLINE VIA A SURVEYMONKEY LINK AND IS AVAILABLE TO RESIDENTS AT PUBLIC EVENTS, WORKSHOPS, EDUCATIONAL PROGRAMS, INTERVENTIONS, ETC., WHICH ARE OFFERED BY LIHC PARTNERS. IT IS ALSO DISTRIBUTED AMONG PHYSICIAN OFFICES, HOSPITAL WAITING AREAS, LIBRARIES, SCHOOLS, FEDERALLY-QUALIFIED HEALTH CLINICS, INSURANCE ENROLLMENT SITES, AMONG OTHER PUBLIC VENUES. THE LIHC AGGRESSIVELY PROMOTES THE SURVEY THROUGH SOCIAL MEDIA AND A LINK TO THE SURVEY IS ALSO AVAILABLE ON THE ST. FRANCIS HOSPITAL WEBSITE. RESULTS FROM THE CHAS ARE ANALYZED TWICE A YEAR. FINDINGS ARE SHARED WITH ALL LIHC PARTICIPANTS, WITH THE MEDIA AND POSTED ON THE LIHC WEBSITE. SURVEYS WERE DISTRIBUTED BY PAPER AND ELECTRONICALLY, THROUGH SURVEY MONKEY, TO COMMUNITY MEMBERS FROM JANUARY 1, 2018 THROUGH DECEMBER 31, 2018 WITH 1,664 SURVEYS COLLECTED IN NASSAU COUNTY. A CERTIFIED TRANSLATION OF THE SURVEY IS AVAILABLE IN THE FOLLOWING LANGUAGES: SPANISH, POLISH AND HAITIAN CREOLE. LARGE PRINT COPIES ARE ALSO AVAILABLE TO THOSE LIVING WITH VISION IMPAIRMENT. FOR THIS ASSESSMENT CYCLE, THE LIHC ALSO ENGAGED THE COMMUNITY THROUGH FOCUS GROUPS AND KEY INFORMANT INTERVIEWS WITH LEADERS OF COMMUNITY-BASED ORGANIZATIONS (CBO). THE RESEARCH FIRM EUREKAFACTS, LLC CONDUCTED THE FOCUS GROUPS AND CBO INTERVIEWS, INTERPRETED THE RESULTS, AND PRODUCED THE REPORT. FOCUS GROUPS WERE HELD IN LOW-INCOME COMMUNITIES, BELMONT AND HEMPSTEAD.

PART V, SECTION B, LINE 6A
ST. JOSEPH HOSPITAL, MERCY HOSPITAL, NORTHWELL HEALTH SYSTEM (GLEN COVE HOSPITAL, LONG ISLAND JEWISH VALLEY STREAM, LONG ISLAND JEWISH MEDICAL CENTER, NORTH SHORE UNIVERSITY HOSPITAL, PLAINVIEW HOSPITAL, SOUTH OAKS HOSPITAL, SYOSSET HOSPITAL), NASSAU UNIVERSITY MEDICAL CENTER, MOUNT SINAI SOUTH NASSAU HOSPITAL AND NYU WINTHROP HOSPITAL.

PART V, SECTION B, LINE 6B
THE HOSPITAL'S CHNA WAS ALSO CONDUCTED WITH NASSAU AND SUFFOLK HEALTH DEPARTMENTS, STONY BROOK UNIVERSITY AND MORE THAN 40 COMMUNITY-BASED ORGANIZATIONS, COLLECTIVELY KNOWN AS THE LONG ISLAND HEALTH COLLABORATIVE (LIHC).

PART V, SECTION B, LINE 11
"COMMUNITY PARTNERS SELECTED THE FOLLOWING AREAS OF FOCUS FOR LONG ISLAND FROM THE NEW YORK STATE PREVENTION AGENDA PRIORITIES: (1) PREVENT CHRONIC DISEASE, FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT, AND (2) PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS PREVENTION. THE WORK PLAN FOR ADDRESSING THE IDENTIFIED NEEDS CAN BE FOUND IN THE CHNA APPENDIX E, PUBLICLY AVAILABLE ON THE HOSPITAL WEBSITE, HTTPS://STFRANCISHEARTCENTER.CHSLI.ORG/. PRIORITY 1: PREVENT CHRONIC DISEASE, INTERVENTIONS INCLUDE: ST. FRANCIS OFFERS REGULARLY SCHEDULED PREVENTIVE HEALTH SCREENINGS IN LOCAL COMMUNITIES, PARTICULARLY THOSE IN MEDICALLY-UNDERSERVED COMMUNITIES, INCLUDING, BODY MASS INDEX (BMI), GLUCOSE, CHOLESTEROL, AND PROSTATE CANCER. IN 2021, 1,078 INDIVIDUALS RECEIVED BLOOD PRESSURE, TOTAL CHOLESTEROL, HDL AND BMI FROM JANUARY THROUGH SEPTEMBER. NINETY-NINE PATIENTS WERE REFERRED FOR FOLLOW-UP CARE. HEALTHY SUNDAYS COMMUNITY OUTREACH EVENTS ARE HELD IN COLLABORATION WITH CHURCHES, HOUSES OF WORSHIP, AND COMMUNITIES. EVENTS ARE HELD THREE TO FIVE TIMES PER YEAR AND INCLUDE HEALTH SCREENINGS, FLU VACCINATIONS, EDUCATION AND REFERRALS TO CARE ALONG WITH SELECT PARTNERS OFFERING FREE OR DISCOUNTED SERVICES. THE HEALTHY SUNDAYS PROGRAM RESUMED IN MARCH. FOUR EVENTS WERE HELD AND 445 PATIENTS WERE SEEN. FREE FLU IMMUNIZATIONS WERE OFFERED TO FAMILIES. IN SEPTEMBER, 144 FLU VACCINES WERE GIVEN VIA THIS VENUE. FROM JANUARY TO JUNE 2021 ST. FRANCIS HOSPITAL PROVIDED 956 COVID VACCINES TO COMMUNITY MEMBERS. DURING THE SUMMER, POP-UP COVID VACCINE CLINICS WERE SET UP IN AREA PARISHES FOR MEDICALLY UNDERSERVED POPULATIONS; 748 COVID VACCINES WERE ADMINISTERED AT THESE SITES. ST. FRANCIS HOSTS REGULARLY SCHEDULED SPEECHES, SYMPOSIUMS, AND EDUCATION EVENTS TO PREVENT DISEASE, IMPROVE HEALTH, AND ENHANCE QUALITY OF LIFE. THE ST. FRANCIS HEALTH EDUCATOR OFFERS VIRTUAL LECTURES ON HEALTH TOPICS. THE EDUCATOR WORKS WITH THE GLEN COVE LIBRARY, WHO THEN SHARES A LINK TO THE VIRTUAL EVENT WITH LIBRARIES IN NASSAU COUNTY, SO MORE PATRONS CAN TAKE ADVANTAGE OF THE EDUCATION PROGRAMS. ST. FRANCIS OFFERS STUDENT SCREENINGS TO HIGH SCHOOL ATHLETES TO DETECT CARDIAC ISSUES AND PREVENT POSSIBLE ADVERSE EVENTS DURING ATHLETIC EVENTS, AND INCLUDES FREE CPR/AED INSTRUCTION TO FAMILIES WHO ATTEND. FROM JANUARY THROUGH SEPTEMBER, 79 STUDENTS; 8 WERE REFERRED FOR FOLLOW-UP CARE. ST. FRANCIS OFFERS THE AMERICAN LUNG ASSOCIATION'S FREEDOM FROM SMOKING PROGRAM. TWENTY-ONE INDIVIDUALS WERE COUNSELED IN SMOKING CESSATION FROM JANUARY THROUGH SEPTEMBER. ST. FRANCIS OFFERED THE CENTER FOR DISEASE CONTROL (CDC) DIABETES PREVENTION PROGRAM (DPP), A LIFESTYLE CHANGE PROGRAM THAT CAN HELP AT- RISK INDIVIDUALS REDUCE THEIR RISK OF DEVELOPING TYPE 2 DIABETES. DIABETES PREVENTION PROGRAM SESSIONS WERE HELD FROM JANUARY THROUGH SEPTEMBER. A COHORT STARTED IN LATE NOVEMBER. TEN PATIENTS ENROLLED. THE ST. FRANCIS HOSPITAL WEIGHT MANAGEMENT PROGRAM ASSISTS INDIVIDUALS IN NEED OF WEIGHT LOSS. INDIVIDUAL SESSIONS AND GROUP CLASSES ARE AVAILABLE FOR BOTH A TRADITIONAL OR LOW CALORIE DIET. FROM JANUARY THROUGH SEPTEMBER, 2,060 PATIENT NUTRITIONAL SESSIONS WERE HELD. PRIORITY 2: PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERS, INTERVENTIONS INCLUDE: PROMOTION OF ALL PROGRAMS, EVENTS, AND EDUCATION OFFERED BY LIHC MEMBERS THAT SPEAK TO THE PREVENTION OF MENTAL AND SUBSTANCE USE DISORDERS. ST. FRANCIS HOSPITAL OFFERS FREE SUPPORT GROUPS AND WELLNESS CLASSES OPEN TO ALL COMMUNITY MEMBERS, INCLUDING THE BRAVE HEARTS FOR THOSE RECOVERING FROM OPEN HEART SURGERY, STROKE SUPPORT GROUP, HEALTHY BACK WELLNESS, MOVEMENT AND RELAXATION FOR WEIGHT MANAGEMENT, STRETCH AND TONE, RENEW/RELAX/RESTORE, CHAIR EXERCISE FOR ALL AGES, AND STRESS MANAGEMENT. -THE STROKE SUPPORT GROUP MET FROM JANUARY THROUGH SEPTEMBER WITH 95 PATIENT VISITS RECORDED. -THE DIABETES SUPPORT GROUP HAD IN-PERSON MEETINGS FROM JANUARY THROUGH JUNE. A TOTAL OF 41 PATIENT SESSIONS WERE HELD. -THE STRESS MANAGEMENT PROGRAM WAS CONDUCTED FROM JANUARY THROUGH SEPTEMBER WITH 170 PATIENT SESSIONS RECORDED. -THE SPIRIT, MIND, BODY MEDITATION PROGRAM WAS CONDUCTED FROM JANUARY THROUGH SEPTEMBER; 233 PATIENT SESSIONS WERE HELD. -THE CANCER INSTITUTE AT ST. FRANCIS HOSPITAL & HEART CENTER ALSO HOSTED AN ART THERAPY PAINTING SESSION AND VIRTUAL COOKING CLASSES FOR 36 PATIENTS. -THE CANCER INSTITUTE AT ST. FRANCIS HOSPITAL & HEART CENTER SUPPORT SESSIONS REMAINED ON HOLD THROUGH 2021 DUE TO COVID-RELATED CONCERNS. -RENEW/RELAX/RESTORE WORKSHOP WAS AVAILABLE TO ONCOLOGY PATIENTS AND OTHER COMMUNITY MEMBERS. IN THE SPRING 2021 SERIES, 70 PATIENT VISITS WERE RECORDED. THE FALL SERIES RESUMED IN OCTOBER. -DURING CPR CLASSES, EDUCATION ON HOW TO RECOGNIZE AN OPIOID OVERDOSE WITH NARCAN INTERVENTION WAS DISCUSSED. ALSO, ""STOP THE BLEED"" FIRST AID BASICS WERE COVERED. THE CATHOLIC HEALTH MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES GUIDEIS AVAILABLE FOR DOWNLOAD ON THE ST. FRANCIS WEBSITE. IN ADDITION TO THE TWO SELECTED NEW YORK STATE PRIORITY AND FOCUS AREAS, ST. FRANCIS HOSPITAL ALSO PARTICIPATES IN COMMUNITY OUTREACH ACTIVITIES THAT ADDRESS OTHER NEW YORK STATE PREVENTION AGENDA PRIORITIES. ST. FRANCIS OFFERS FREE, EVIDENCE-BASED FALL PREVENTION PROGRAMS DESIGNED TO IMPROVE BALANCE AND STRENGTH AND HELP REDUCE FALLS AND BUILD CONFIDENCE IN OLDER ADULTS. FACILITATORS WERE TRAINED TO CONDUCT ""STEPPING ON"" FALLS PREVENTION WORKSHOPS FOR SENIORS. CLASSES WERE SCHEDULED FOLLOWING THE TRAINING. ST. FRANCIS HOSPITAL ALSO OFFERS A MOVING FOR BALANCE CLASS THAT INCLUDES GENTLE MOVEMENTS FOR POSTURE, FLEXIBILITY, STRENGTH AND BALANCE TO HELP WITH FALLS PREVENTION. SPRING IN-PERSON CLASSES WERE HELD WITH 27 PATIENT SESSIONS RECORDED. FALL CLASSES WERE SCHEDULED WITH 13 PATIENT SESSIONS COMPLETED IN SEPTEMBER. ST. FRANCIS HOSPITAL OFFERS A CHAIR EXERCISE WORKSHOP FOR SENIORS WHICH ALSO HELPS THEM TO DEVELOP STRENGTH AND BALANCE. SEVENTY-THREE PATIENT SESSIONS WERE RECORDED IN SPRING 2021. SIXTY-SIX PATIENT VISITS WERE HELD IN THE FALL. AS A MEMBER OF CATHOLIC HEALTH, THE HOSPITAL OFFERS OUTREACH SERVICES AS PART OF THE CH MISSION AND SOCIAL DETERMINANTS OF HEALTH. ST. FRANCIS STAFF PARTICIPATED IN THE AMERICAN HEART ASSOCIATION LONG ISLAND IN-PERSON HEART WALK MOVE MORE CHALLENGE ON SEPTEMBER 12. STAFF ALSO PARTICIPATED IN THE AMERICAN CANCER SOCIETY MAKING STRIDES AGAINST BREAST CANCER WALK ON OCTOBER 17 AT JONES BEACH. -THE OUTREACH BUS WAS PRESENT AT THE EMPIRE STATE RIDE-LONG ISLAND WHERE BLOOD PRESSURE SCREENINGS WERE OFFERED. THE OUTREACH BUS WAS ALSO PRESENT AT THE LONG ISLAND CAR SHOW WHERE BLOOD PRESSURE SCREENINGS WERE AVAILABLE. FREE PSA SCREENING WAS OFFERED AT THE DEMATTEIS CENTER IN SEPTEMBER FOR PROSTATE AWARENESS MONTH. ELEVEN PATIENTS WERE SCREENED, AND TWO WERE REFERRED TO FOLLOW UP. ST. FRANCIS HOSTED 4 BLOOD DRIVES COLLECTED 286 PINTS OF BLOOD IN SUPPORT OF LONG ISLAND BLOOD SERVICES. THE HOSPITAL ALSO CONDUCTS COLLECTION DRIVES FOR FOOD, CLOTHING AND SCHOOL SUPPLIES, AND ADOPT-A-FAMILY COLLECTIONS AT CHRISTMAS."

PART V, SECTION B, LINE 20E
ST. FRANCIS HOSPITAL HAS POSTED MULTILINGUAL NOTICES ABOUT ITS CHARITY CARE POLICIES IN SEVERAL PROMINENT LOCATIONS WITHIN ST. FRANCIS HOSPITAL, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREAS. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH AND ARE CLEARLY VISIBLE TO THE PUBLIC. ST. FRANCIS HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE.

PART I, LINE 7 - RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET
RATIO OF PATIENT CARE COST TO CHARGES WORKSHEET (WORKSHEET 2 ) AS PRESCRIBED BY THE IRS INSTRUCTIONS TO SCHEDULE H FORM 990 WAS THE METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7 CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST LINES 7A, 7B AND 7C AND 7D. ALL OTHER LINES INCLUDE COSTS THAT WERE DERIVED BASED ON THE RCC METHODOLOGY OR ACTUAL COSTS FOR THE SERVICES AS TRACKED BY HOSPITAL PERSONNEL UTILIZING DIRECT HOURLY LABOR COSTS, FRINGES AND SUPPLY COSTS.

PART I, LINE 7A, COLUMN (D)
"DIRECT OFFSETTING REVENUES REPRESENT DISTRIBUTIONS FROM THE NEW YORK STATE (NYS) INDIGENT CARE POOL (ICP) WHICH IS SHOWN NET OF HOSPITAL CONTRIBUTIONS TO THE STATEWIDE POOL. THE FORMULA EMPLOYED BY NYS TO DETERMINE DISTRIBUTIONS TO HOSPITALS FROM THE ICP IS COMPLEX AND IS DERIVED FROM A HOSPITAL'S ""NEED"" CALCULATION. THIS CALCULATION CONSIDERS 100% OF A HOSPITAL'S ""NEED"" BASED ON A ""UNITS OF SERVICE"" METHODOLOGY FOR UNINSURED PATIENTS. THE CALCULATION ALSO MAKES ADJUSTMENTS BASED ON THE PROPORTION OF MEDICAID ELIGIBLE PATIENTS TREATED AT THE FACILITY. THE HOSPITAL HAS APPORTIONED THE ICP REVENUE BETWEEN BAD DEBT AND CHARITY CARE FOR REPORTING ON LINE 7A BASED ON THE PROPORTION OF EACH TO THE TOTAL OF ACTUAL BAD DEBT AND CHARITY CARE FOR 2021."

PART I, LINE 7H - RESEARCH
ST. FRANCIS HOSPITAL & HEART CENTER, THROUGH THE ST. FRANCIS HOSPITAL FOUNDATION, SUBSIDIZES THE OPERATING LOSSES OF ST. FRANCIS RESEARCH & EDUCATIONAL CORPORATION, INC. (R&E), A RELATED ENTITY. R&E IS FOCUSED ON CLINICALLY-BASED RESEARCH IN THE AREAS OF ADVANCED DIAGNOSTIC IMAGING AND CUTTING-EDGE THERAPEUTICS. R&E COLLABORATES ACROSS SEVERAL SUB-SPECIALTIES AND DISCIPLINES, WHICH GIVES THEM UNIQUE PERSPECTIVES AND ALLOWS THEM TO SUPPORT AND SERVE THE ST. FRANCIS COMMUNITY.

PART III, LINE 2,3 - BAD DEBT AS COMMUNITY BENEFIT
AS PART OF ITS TAX EXEMPT PURPOSE, THE HOSPITAL PROVIDES ACCESS TO MEDICALLY NECESSARY CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, OR CULTURAL BACKGROUND. THE HOSPITAL TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF WHETHER THEY HAVE THIRD-PARTY COVERAGE OR THE ABILITY TO PAY. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE HOSPITAL IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE FROM THE HOSPITAL SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT SINCE CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR TAX EXEMPT PURPOSE, WHICH IS MEETING THE NEED FOR EMERGENCY AND NON-ELECTIVE MEDICAL CARE SERVICES IN THE COMMUNITY.

PART III, LINES 2 AND 4 - TEXT OF FOOTNOTE DISCUSSING BAD DEBT
PAGES 19 TO 24 OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON PATIENT ACCOUNTS RECEIVABLE. THE FINANCIAL STATEMENTS ARE ATTACHED TO THIS RETURN.

PART III, LINE 8 - COSTING METHODOLOGY
THE MEDICARE REVENUE AND ALLOWABLE COSTS SHOWN ON PART III SECTION B LINE 5 WERE DERIVED FROM THE AS FILED 2021 CMS-2552 (MEDICARE COST REPORT). MEDICARE REVENUE IS BASED ON THE MEDICARE PROVIDER STATISTICAL AND REIMBURSEMENT REPORT AND MEDICARE COSTS ARE DEVELOPED UTILIZING A RATIO OF MEDICARE ALLOWABLE COSTS TO CHARGES METHODOLOGY. AMOUNTS SHOWN FOR TOTAL REVENUE RECEIVED AND MEDICARE ALLOWABLE COSTS ARE NET OF ANY AMOUNTS ALREADY INCLUDED WITHIN PART I, LINE 7, PRIMARILY IN SUBSIDIZED HEALTH SERVICES.

PART III, LINE 8 - MEDICARE SHORTFALL AS COMMUNITY BENEFIT
LOSSES ON TREATING MEDICARE BENEFICIARIES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT IN THEIR ENTIRETY. THIS REPRESENTS THE AMOUNT BY WHICH COSTS TO DELIVER CARE TO MEDICARE RECIPIENTS EXCEEDS THE LEVEL OF PAYMENT. ST. FRANCIS BEARS THE BURDEN OF NOT ONLY PROVIDING THE BEST AND MOST ADVANCED MEDICAL CARE POSSIBLE TO THE COMMUNITY BUT ALSO DOING SO WITH NO RECOURSE IN OBTAINING PAYMENT FOR THE COST OF PROVIDING CARE IN EXCESS OF THE MEDICARE PAYMENT. AS MEDICARE REVENUE DECLINES AND THE COST TO PROVIDE CUTTING-EDGE CARE TO THE COMMUNITY INCREASES, THE HOSPITAL WILL CARRY THE BURDEN. AS A PARTICIPATING PROVIDER AND A CHARITABLE ORGANIZATION, MEDICARE PATIENTS, THE MAJORITY OF WHOM ARE ELDERLY AND DISABLED ARE NOT TURNED AWAY, SO ST. FRANCIS WILL CONTINUE TO BEAR THE LOSS IN PROVIDING THE BEST CARE POSSIBLE TO THE LOCAL COMMUNITY.

PART III, LINE 9B
THE HOSPITAL'S CHARITY CARE POLICY DESCRIBES THE POLICIES AND PROCEDURES RELATING TO THE PROVISION OF CHARITY CARE TO PERSONS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR BILL. NO INDIVIDUAL WILL BE DENIED MEDICALLY NECESSARY HOSPITAL SERVICES BASED ON A DEMONSTRATED INABILITY TO PAY FOR THOSE SERVICES. IN ADDITION, UPON APPLYING FOR CHARITY CARE, EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY WILL BE ASSESSED. ELIGIBILITY FOR ASSISTANCE: A REASONABLE REVIEW SHALL BE PERFORMED PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (I.E. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE CH CHARITY CARE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO MEET THE CHARITY CARE CRITERIA SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT FOR APPROPRIATE FOLLOW-UP. THE THIRD-PARTY COLLECTION AGENT SHALL ADVISE THE PATIENT/GUARANTOR OF THE HOSPITAL'S CHARITY CARE POLICY AND RETURN THE ACCOUNT IMMEDIATELY IF IT IS DETERMINED THAT THE QUALIFICATIONS ARE MET.

PART VI, LINE 2 - ASSESSMENT OF COMMUNITY NEEDS AND GOALS
COMMUNITY HEALTH NEEDS ARE ASSESSED ON A CONTINUAL BASIS, DURING MEETINGS OF THE HOSPITAL'S BOARD OF TRUSTEES AND EXECUTIVE LEADERSHIP COUNCIL, COMMUNITY HEALTH AND EDUCATION DEPARTMENT MEETINGS, AT COLLABORATIVE SESSIONS WITH MEMBER HOSPITALS OF CATHOLIC HEALTH (CH), AND WITH PARTNERS AT COMMUNITY AGENCIES AND ORGANIZATIONS THAT ARE PART OF THE LONG ISLAND HEALTH COLLABORATIVE (LIHC). THE LIHC COMMUNITY HEALTH ASSESSMENT SURVEYS ARE OFFERED YEAR-ROUND AT MULTIPLE OUTREACH SITES IN THE COMMUNITY AND IS ALSO AVAILABLE VIA A LINK ON THE HOSPITAL'S WEBSITE. BY DISTRIBUTING COMMUNITY NEEDS SURVEYS (AVAILABLE IN ENGLISH, SPANISH, POLISH, HAITIAN CREOLE AND LARGE PRINT) TO PARTICIPANTS AT SCREENING SITES, EVERY POINT OF CONTACT SERVES AS AN OPPORTUNITY TO REQUEST FEEDBACK ON HOW THE HOSPITAL CAN BETTER MEET THE NEEDS OF THE COMMUNITY. THESE EVENTS ARE PROMOTED IN THE COMMUNITY SURROUNDING THE OUTREACH SITE AND ON CH'S WEBSITE. ST. FRANCIS CONTINUES TO COLLABORATE WITH OTHER HOSPITALS, LOCAL HEALTH DEPARTMENTS, HEALTH CARE PROVIDERS, PUBLIC HEALTH SPECIALISTS FROM ACADEMIC INSTITUTIONS AND COMMUNITY-BASED ORGANIZATIONS AT LIHC EVENTS. LIHC'S WEBSITE OFFERS COMPREHENSIVE INFORMATION TO PROMOTE GOOD HEALTH AND PREVENT CHRONIC DISEASE. IN ADDITION TO PROVIDING NUMEROUS RESOURCES SUCH AS HEALTH PROGRAM INVENTORIES, HEALTH INSURANCE INFORMATION AND EDUCATIONAL VIDEOS, LIHC AND ITS MEMBERS HAVE ORGANIZED WALKING PROGRAMS AND DEVELOPED A UNIVERSAL SCREENING TOOL TO HELP MEASURE THE EFFECTIVENESS OF COMMUNITY HEALTH EFFORTS. MORE INFORMATION CAN BE FOUND AT WWW.LIHEALTHCOLLAB.ORG.

PART VI, LINE 3 - COMMUNICATION OF FINANCIAL ASSISTANCE POLICY
1. SINCE IT IS THE DUTY OF THE HOSPITAL TO ENSURE THAT EVERY PATIENT IS MADE AWARE OF THE EXISTENCE OF THE HOSPITAL'S CHARITY CARE POLICY, ALL EMPLOYEES IN THE SCHEDULING, PATIENT ACCESS, PATIENT FINANCIAL SERVICES AND EMERGENCY DEPARTMENTS HAVE BEEN FULLY VERSED IN THE HOSPITAL'S CHARITY CARE POLICY, HAVE ACCESS TO THE CHARITY CARE APPLICATION FORMS, AND ARE ABLE TO DIRECT QUESTIONS TO THE APPROPRIATE HOSPITAL REPRESENTATIVES. 2. THE HOSPITAL HAS POSTED MULTILINGUAL NOTICES AS TO ANY POLICIES ON CHARITY CARE IN SEVERAL PROMINENT LOCATIONS WITHIN THE HOSPITAL INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY DEPARTMENT, BILLING OFFICE, WAITING ROOMS FOR PURPOSES OF ADMISSIONS, AND THE INPATIENT AND OUTPATIENT REGISTRATION AREA. SAID NOTICES ARE PUBLISHED IN ENGLISH AND SPANISH, AND ARE CLEARLY VISIBLE TO THE PUBLIC FROM THE LOCATION AT WHICH THEY ARE POSTED. 3. THE HOSPITAL PROVIDES PATIENTS, IN A TIMELY MANNER, A SUMMARY OF ITS CHARITY CARE POLICY UPON REQUEST. THE SUMMARY, AT A MINIMUM, PROVIDES SPECIFIC INFORMATION AS TO INCOME LEVELS USED TO DETERMINE ELIGIBILITY AND THE MEANS OF APPLYING FOR ASSISTANCE. THIS SUMMARY IS WRITTEN AT OR BELOW A SIXTH GRADE READING LEVEL. 4. THE HOSPITAL HAS POSTED ITS CHARITY CARE POLICY SUMMARY ON ITS WEBSITE. 5. THE HOSPITAL PROVIDES ALL PATIENTS ACCESS TO INTERPRETERS TO ASSIST THEM IN UNDERSTANDING THE MEDICAL CENTER'S CHARITY CARE PROGRAM IN THE LANGUAGE SPOKEN BY THE PATIENT DURING ANY PRE-ADMISSION, ADMISSION, AND DISCHARGE PROCESS. 6. ON ALL BILLS AND STATEMENTS SENT TO PATIENTS, INFORMATION IS INCLUDED REGARDING THE AVAILABILITY OF VARIOUS FINANCIAL ASSISTANCE PROGRAMS, INCLUDING CHARITY CARE, AND A CONTACT NUMBER TO CALL TO OBTAIN FURTHER DETAILS. THIS INFORMATION IS AVAILABLE AT OR BELOW A SIXTH GRADE READING LEVEL.

PART VI, LINE 4 - COMMUNITY INFORMATION
ST. FRANCIS HOSPITAL, THE HEART CENTER IS A NOT-FOR-PROFIT HOSPITAL LOCATED IN ROSLYN, NEW YORK, ON THE NORTH SHORE OF NASSAU COUNTY IN THE TOWN OF NORTH HEMPSTEAD. IT IS A MEMBER OF CATHOLIC HEALTH (CH). THE HOSPITAL'S PRIMARY SERVICE AREA IS NASSAU COUNTY, BUT IT ALSO SERVES PATIENTS FROM EASTERN QUEENS AND WESTERN SUFFOLK. ST. FRANCIS'S HOSPITAL DISCHARGE DATA INDICATES THAT ST. FRANCIS IS SERVING AN EVER-INCREASING OLDER POPULATION. THE HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREAS INCLUDE 96 PERCENT OF HOSPITAL DISCHARGES. IN 2019, 58.3 PERCENT OF ST. FRANCIS HOSPITAL'S DISCHARGES WERE FROM ITS PRIMARY SERVICE AREA, NASSAU COUNTY. THE SECONDARY SERVICE AREA COMPRISES TWO AREAS, WEST AND EAST. THE WESTERN AREA CONSISTS OF 33 ZIP CODES FROM QUEENS COUNTY AND PROVIDED 21.3 PERCENT OF DISCHARGES. THE EASTERN AREA CONSISTS OF 22 ZIP CODES IN SUFFOLK COUNTY AND PROVIDED 16.1 PERCENT OF DISCHARGES.

PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH
ST. FRANCIS HOSPITAL CONTINUES TO PARTNER WITH OTHER COMMUNITY ORGANIZATIONS TO ADDRESS THE DIVERSE NEEDS OF UNDERINSURED AND UNINSURED INDIVIDUALS ACROSS LONG ISLAND. FOLLOWING ARE SEVERAL PROGRAMS REPRESENTATIVE OF THESE EFFORTS IN 2021: ST. FRANCIS HOSPITAL OPERATES THE BISHOP MCHUGH HEALTH CENTER IN HICKSVILLE WITH A FOCUS ON PROVIDING PRIMARY CARE TO THE UNINSURED AND UNDERINSURED. THE CENTER'S MEDICAL STAFF OFFERS FREE PHYSICAL EXAMINATIONS, LAB WORK, FLU SHOTS, IMMUNIZATIONS, AND SPECIALTY REFERRALS AS NEEDED. IN 2021, THERE WERE MORE THAN 1,139 PATIENT VISITS AT THE CENTER, INCLUDING REFERRALS FOR SPECIALTY CARE. CH'S HEALTHY SUNDAYS PROGRAM OFFERED FREE HEALTH SCREENINGS FOLLOWING WEEKEND SERVICES AT LOCAL HOUSES OF WORSHIP, TO INDIVIDUALS WHO WOULD OTHERWISE HAVE DIFFICULTY ACCESSING HEALTH CARE. HEALTHY SUNDAYS CONTINUES TO PROVIDE A VITAL LINK TO PRIMARY CARE REFERRALS FOR THE MEDICALLY UNDERSERVED. ST. FRANCIS HOSPITAL'S MOBILE HEALTH SCREENING UNIT PROVIDED CARE TO THOUSANDS OF INDIVIDUALS WHO DID NOT HAVE ACCESS TO A TRADITIONAL HEALTH CARE FACILITY. THE SELF-CONTAINED MOBILE UNIT WAS ONSITE AT LOCATIONS IN QUEENS AND NASSAU AND SUFFOLK COUNTIES IN 2021. DURING THESE OUTREACH VISITS, ST. FRANCIS HOSPITAL NURSES PROVIDED 1,358 HEALTH SCREENINGS AND/OR FLU SHOTS, INCLUDING THOSE FOR PATIENTS IN COMMUNITIES IDENTIFIED AS PARTICULARLY IN NEED: FLORAL PARK, FREEPORT, HEMPSTEAD, INWOOD, LONG BEACH, MINEOLA, WESTBURY, ROOSEVELT, UNIONDALE, BELMONT AND GLEN COVE.

PART VI, LINE 6 - AFFILIATED HEALTHCARE SYSTEM
ST. FRANCIS HOSPITAL (ST. FRANCIS) IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH IS LOCATED ON A SINGLE CAMPUS IN ROSLYN, NEW YORK. ALONG WITH THE AFOREMENTIONED COMMUNITY PROGRAMS, ST. FRANCIS THROUGH ITS DAILY OPERATIONS, PROVIDES ACUTE, EMERGENT, AND OUTPATIENT CARE. ST. FRANCIS IS A MEMBER OF CATHOLIC HEALTH SYSTEM OF LONG ISLAND (D/B/A/ CATHOLIC HEALTH)(CH), A NEW YORK, NOT FOR PROFIT CORPORATION ORGANIZED TO SERVE AS THE COORDINATING BODY OF AN INTEGRATED NETWORK OF PROVIDERS SERVING NASSAU AND SUFFOLK COUNTIES. CH IS SPONSORED BY THE ROMAN CATHOLIC DIOCESE OF ROCKVILLE CENTRE. AS OF DECEMBER 31, 2021, CH COMPRISED SIX HOSPITALS (MERCY HOSPITAL, ST. FRANCIS HOSPITAL & HEART CENTER, AND ST. JOSEPH HOSPITAL IN NASSAU COUNTY, AND GOOD SAMARITAN HOSPITAL, ST. CHARLES HOSPITAL, AND ST. CATHERINE OF SIENA HOSPITAL IN SUFFOLK COUNTY), AS WELL AS THREE NURSING HOMES (ST. CATHERINE OF SIENA NURSING & REHABILITATION, GOOD SAMARITAN NURSING & REHABILITATION AND OUR LADY OF CONSOLATION NURSING & REHABILITATION, ALL IN SUFFOLK COUNTY), GOOD SHEPHERD HOSPICE, AND A COMMUNITY-BASED AGENCY FOR PERSONS WITH SPECIAL NEEDS. WITH MORE THAN 16,000 EMPLOYEES AND 4,600 MEDICAL STAFF WORKING THROUGHOUT THE SYSTEM, CH PROVIDES THE REGION'S FINEST HEALTH AND HUMAN SERVICES. OUR MISSION STATES: WE AT CATHOLIC HEALTH, HUMBLY JOIN TOGETHER TO BRING CHRIST'S HEALING MISSION AND THE MISSION OF MERCY OF THE CATHOLIC CHURCH EXPRESSED IN CATHOLIC HEALTH CARE TO OUR COMMUNITIES. MEMBER ORGANIZATIONS OF CH OFFER VIRTUALLY EVERY MEDICAL SPECIALTY AND CLINICAL SERVICE, AND SHARE A DEDICATION TO CONTINUOUSLY UPGRADE THE SCOPE, QUALITY AND ACCESSIBILITY OF CARE. ALL OF CH'S MEMBER ORGANIZATIONS HAVE RETAINED THEIR INDIVIDUAL LINKS TO THEIR HISTORY AND THEIR DISTINCTIVE PERSONALITIES, AS WELL AS THE SERVICE SPECIALTIES WHICH THEY ARE KNOWN FOR, THUS EMBEDDING THE ORGANIZATION IN THE COMMUNITY AND SERVING IT EFFECTIVELY. CH ENTITIES PROVIDE AN ABUNDANCE OF EDUCATION AND SUPPORT GROUPS AS WELL AS FREE HEALTH SCREENINGS THROUGH ITS HEALTHY SUNDAYS PROGRAMS, HEALTH FAIRS AND OTHER PROGRAMS. SINCE 1907, CATHOLIC HEALTH HAS BUILT A DISTINGUISHED TRADITION OF OPERATING COMMUNITY-BASED HOSPITALS AND HUMAN SERVICE ORGANIZATIONS WITH THE PRIMARY OBJECTIVE OF IMPROVING THE COMMUNITY'S HEALTH.