4A (Expenses $ 204113931 including grants of $ 2895469) (Revenue $ 224830244)
"Montefiore St. Luke's Cornwall Hospital (""MSLC"") is a not-for-profit hospital dedicated to serving the healthcare needs of those in the Hudson Valley. Montefiore St. Luke Cornwall Hospital recently became a member of the Montefiore Health System, an integrated healthcare delivery system providing quality comprehensive healthcare services. This collaboration allows us to share clinical best practices, care management expertise and information technology platforms to enhance our patient care. With dedicated staff, modern facilities and state-of-the-art treatment, we are committed to meeting the needs of the community and continuing to aspire to excellence. Montefiore St. Luke's Cornwall Hospital with main campuses in Newburgh and Cornwall, and off-site facilities throughout the community, is a 345 bed acute care hospital dedicated to providing for the health care needs of the community. Montefiore St. Luke's Cornwall Hospital is the regional center for neonatology, thanks to its Elaine Kaplan Neonatal Intensive Care Unit. The Hospital offers other pediatric subspecialties, as well as a robust list of both inpatient and outpatient services including a cardiac catheterization lab, Intensive Care Unit, Birthing Center, Metabolic and Bariatric Surgery, Thoracic Surgery and much more. The Hospital offers centers of excellence in cancer service, cardiovascular care, angioplasty, cardiac rehabilitation, orthopedics, sport medicine, and metabolic and bariatric surgery. The Hospital's Cornwall campus is a thriving outpatient focused Center. This vital and growing community resource offers necessary healthcare access points to area residents for a variety of services including the Littman Center for Cancer Care which includes radiation oncology and infusion services. The Cornwall campus also provides cardiac and pulmonary rehabilitation, a center for sleep medicine, physical therapy, pain management, palliative care, a balance center and a speech and swallowing center. Montefiore St. Luke's hospital operates an active emergency department and verified level III Trauma Center at its Newburgh campus delivering high quality emergency and trauma care close to home. The center is opened 24 hours, 365 days of the year and is one of the newest and busiest emergency departments between New York City and Albany. With a recent $11 million renovation and expansion, our emergency department was designed with patient comfort and convenience in mind. General trauma and specialty treatments bays for cardiac, asthma, Women's Health and Pediatrics enable our highly skilled ER team to provide comprehensive, quality care in a Patient-centered environment. During the past few years, the newly rebranded Montefiore St. Luke's Cornwall Hospital has undergone significant transformation. This transformation has occurred on both campuses, including the expansion of our services as a result of our partnership with Montefiore Health System. In March 2018, St Luke's unveiled a $1.7 million chronic care center - Rehabilitation at Montefiore St. Luke's Cornwall Hospital - in Partnership with Burke Rehabilitation Hospital in White Plains, New York. This state-of-the-art facility offers physical and occupational therapy, cardiac and pulmonary rehabilitation and eventually cognitive medicine including dementia services and a memory clinic. The hospital recently broke grounds on a $8 million remodeling of the hospital's Newburgh Emergency Department. A new $24 million kidney center in Cornwall was recently opened in partnership with Fresenius Kidney Care to better serve the Cornwall's area growing dialysis community. Exceptional care is the center of all we do. This commitment is recognized by many outside organizations and includes, - Our designation as a New York Stroke Center; - Our top Performer Recognition from The Joint Commission on key quality measures for excellence in management of Heart Attack, Heart Failure, Stroke and Surgical Care; - Achievement of the Healthgrades Patient Safety Excellence Award, a designation that honors hospital performance in the prevention of serious, potentially preventable complications during hospital stays; - A recipient for multiple straight years of the ""Get With the Guidelines Gold Plus Achievement Award"" from the American Stroke Association for overall quality of care for stroke patients; - Inclusion on the list of Health Care's Most Wired hospitals, ranking among the nation's best in using information technology to improve patient care; - Designation as an Institute of Quality for Cardiac Medical Intervention by Aetna for its excellent in care, commitment to continuous improvement and exceptional value to our patients; - Awarded the Healthgrade five star recipient recognition in natural childbirth for consecutive years; - Designated as a Blue Distinction center for knee and Hip replacement and for Maternity Care by empire Blue Cross Blue Shield; - Accredited as a comprehensive Center under the Metabolic and Bariatric Surgery accreditation; - Verified as a Level III trauma center through 2022 by the verification Review Committee. During 2021, Montefiore St. Luke's Cornwall Hospital was again at the forefront of the fight against the resurgent waves of the COVID-19 virus that has continued relentlessly throughout 2021. Our Covid admissions grow as each new waves of the virus spread throughout the community causing immense suffering and volumes of deaths in its wake. St. Luke's outreach initiatives are based on our dedication and commitment to the community to provide excellent health care. We have our own community education program that reaches a wide variety of audiences on a number of relevant health care topics. Education is provided at a number of local senior groups, workplace wellness programs, local businesses, food pantries, soup kitchens, and public events. In the last year, we have provided many educational and screening events to the community as part of our mission to improve the lives and well-being of the people in the communities that we serve."

SCHEDULE H, PART V, Section B, Line 5
The process for preparing 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. The Montefiore St. Luke's Cornwall Community Health Needs Assessment was compiled using specific data provided from Mid-Hudson Region Community Health Assessment 2019-2021, and used as Montefiore St. Luke's Cornwall Hospital primary data collection source. The Mid-Hudson Region Community Health Assessment 2019-2021 was compiled and written by HealtheConnections and was inclusive of data pertaining to the seven counties within the Mid-Hudson Region. This assessment originated from a Collaborative that was formed in 2017 from the seven local Health Departments across the Mid-Hudson Region, with a goal of creating the first ever regional community health survey. The seven local Health Departments included Orange County Department of Health, Putnam County Department of Health, Rockland County Department of Health, Dutchess County Department of Behavioral & Community Health, Sullivan County Public Health Services, Ulster County Department of Health and Mental Health and Westchester Department of Health. There were 17 local hospitals who contributed funds for the Collaborative to contract with the Siena College Research Institute, to conduct a randomized digital dial community health survey between April and September 2018 to supplement the Regional Community Health Assessment. To further assess the broad interests of the community, following the Regional assessment, several focus groups were created to gain insight of the underrepresented populations in the community, including those who are seniors, low income, veterans, LGBTQ members, those experiencing homelessness, and residents with a mental health diagnosis. Twelve focus groups, with members of the providers who serve these populations were created collaboratively with Human Service providers throughout the region. Prior to the focus group, a survey was sent to providers in each county in an effort to supply additional background regarding local factors that influence community Health. Along with the primary data collected through the survey and focus groups, secondary data was compiled to further supplement the data collected and show health indicators for the Region. To capture an up-to-date high-level view of the health status of Orange County residents, there was an evaluation of temporal trends, differences between Orange County and other Mid-Hudson Region Counties, New York State excluding New York City and New York City for more than 20 measures, including: obesity, preterm births, teen pregnancy rates, poverty, access to primary care, insurance status, smoking, flu immunizations, cancer screening, HIV incidence, lung, colorectal, prostrate and breast cancer incidence rates, and hospitalization for asthma, diabetes, heart attacks and falls. Montefiore St. Luke's Cornwall Hospital participated in the Orange County Health Summit on June 4, 2019 that included more than 100 community partners, including hospitals, health care providers, community members, community health care providers, and those involved in academia. This summit was an active working session to review the data from the focus groups, along with the Sienna College Survey Data and untimely decide on the Priority areas for the 2019-2021 Community Health Improvement and Community service plan. Comments received on the most recently conducted Community Health Needs Assessment address areas of concern that Montefiore's St. Luke's Cornwall Hospital had when creating the document, specifically that Montefiore St. Luke's Cornwall's primary service area, inclusive of the City of Newburgh was not well reflective in this data. The final Mid-Hudson Regional Community Health Assessment 2019-2021, notes that while the results gives an extensive background of the health needs of the Mid-Hudson region, the final results are misleading and mask several of the disparities that exist in the Urban areas of Orange County. At first glance, Orange County appears to be an affluent suburban community that enjoys a median household income above the New York averages, a smaller percentage of individuals living below the poverty line, a smaller unemployment rate and boasts higher percentage of high school graduates as compared to New York State. However, aggregate county data are misleading and masks the disparities within the county. The urban areas of Orange County are characterized by severe socioeconomically and health inequities, with one-third of the population living below the poverty line and residing in the three major cities of Newburgh, Middletown and Port Jervis.

Schedule H, Part V, Section B, Line 7a
The direct website address where the St Luke's Cornwall Hospital's CHNA report can be accessed: https://www.MONTEFIORESLC.ORG/DOCUMENTS/mslc-2019-CHNA-W-Appendices-FINAL. pdf

Schedule H, Part V, Section B, Line 10a
The hospital's most recently adopted implementation strategy is posted on the direct website: https://www.MONTEFIORESLC.ORG/DOCUMENTS/mslc-2019-CHNA-W-Appendices-FINAL. pdf

Schedule H, Part V, Section B, Line 11
The two priority areas that Montefiore St. Luke's has identified as a result of the Community Health Needs Assessment and the discussion at the Health Summit are the same that was selected by Orange County as the two Prevention Agenda Priorities at the Summit: Prevent chronic Disease and Prevent Communicable Disease. According to the Mid-Hudson Regional community Health Assessment 2019-2021, in Orange County, Heart Disease and cancer are the leading causes of death and leading cause of premature death by a large margin. Obesity is a leading contributor to these top causes of death, as well as diabetes, stroke, and hypertension, all of which can lead to premature death. According to the 2016 BRFSS data, nearly 70% of Orange County adults are either overweight or obese. Data from 2016-2018 show that 36.8% of school aged children and adolescents are overweight or obese. Over the past ten years, the rate of obesity has continually grown, as well as subsequent morbidity of cardiovascular disease, prediabetes, and hypertension. STIs are also on the rise in Orange County. There has been a 75% increase in the average number of newly diagnosed HIV cases in Orange County. Chlamydia rates among both males and females from 2014-2016 are higher in Orange County than rates in the Mid-Hudson Region, and have steadily increased or remained the same from 2011-2013 to 2014-2016. Additionally, Orange County had its first fetal demise in 2019 from congenital syphilis in over 25 years. The significant needs to be addressed by Montefiore St. Luke's Cornwall, focusing on Orange County and specifically the hospital's primary service area inclusive of the City of Newburgh are as follows: - Prevent Chronic Disease - Montefiore St. Luke's Cornwall will focus on preventive care and management with an effort to promote evidence-based care to prevent and manage chronic diseases including Cardiovascular Disease, COPD, Diabetes and Prediabetes as well as asthma. The Montefiore St. Luke Cornwall team already has many systems in place to address these areas. Additionally, we will work to increase food security in Orange County by improving screening methods to identify patients with food insecurity, and further enhance the resources available within the hospital and amongst our community partners to connect the populations that we serve with a more available healthier food sources. Another focus area will be increasing cancer-screening rates. - Prevent Communicable Diseases - Montefiore St. Luke's Cornwall will be working with community partners to reduce the annual rate of growth for sexually transmitted infections. There has been a significant increase in STIs in Orange County and the hospital has seen this increase firsthand in both the presentations to the emergency department as well as the Labor and deliver unit. The New York State Prevention Agenda Health Improvement plan for 2019 established five prevention agenda priority areas from which the Orange County Department of Health has selected two of the five areas as a result of its collaboration with Montefiore St. Luke's Cornwall and several other community partners. The three areas that were not selected, as a focus area by the hospital were Promoting healthy women, infants and children, Prompting a healthy and safe environment and promoting well-being and preventing mental substance use disorders. Even though Promoting Healthy women, infants and Children was not a selected priority area of Montefiore St. Luke's for the 2019-2021 community service plan, there are many systems that are already in place for this area. In 2018, an OB Patient Navigator was added to the Hospital's Birthing Center staff. In addition, prenatal education and breastfeeding classes are offered and the course size has seen recent increases. In 2019, a patient navigator was hired to connect patients who struggle with substance abuse or opioid addition with the appropriate community resources. The second area not selected was promoting a healthy and safe environment by focusing on access to supermarket or grocery stores and lead screenings. Montefiore St. Luke's is indirectly addressing the first focus area in our realm of working to increase food security in the community that we serve. By our work with the community to enhance the availability of healthy food options, we may be ultimately addressing this disparity. Lead screening, the second focus area, is not a focal point at Montefiore St. Luke's Cornwall since this area is currently being addressed by the performance of lead screenings by the community-based pediatricians in the hospital's primary service area. The third and last area not selected was promoting well-being and preventing mental substance use disorders. While this area was not addressed in the hospital's three-year community service plan, this area remains a top focus throughout the hospital and Orange County as a whole. Since the community already has a large variety of resources invested in addressing the opioid epidemic, it was felt that our collective efforts would be better geared in other directions. Additionally, in 2019, the hospital launched the first Medication Assisted Treatment Program, within the walls of the hospital, engaging patients when they first arrive and working to get them connected to the proper community resources.

Schedule H, Part V, Section B, Line 13H
The hospital uses a credit assessment tool to help determine if certain patients can auto-qualify for a charity care discount based on presumption eligibility.

Schedule H, Part V, Section B, Line 16A
The organization's FAP is available on the Hospital's website: https://www.montefioreslc.org/documents/LD-1415-FINANCIAL-ASSISTANCE.501R- COMPLIANT).pdf

Schedule H, Part V, Section B, Line 16B
The organization's FAP application is available on the Hospital's website: https://www.montefioreslc.org/DOCUMENTS/2288-FINANCIAL-ASSISTANCE-APPLICAT ION.PDF

Schedule H, Part V, Section B, Line 16C
The Plain Language summary of the FAP is available on the Hospital's website: https://www.montefioreslc.org/documents/3357-SLCH-Plain-Language-Summary-F AP.pdf

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 ratio of patient care cost-to-charge. In calculating the patient care cost for the ratio, the organization reduced its operating expenses for its non-patient care costs and cost of its community benefits and 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. The organization further adjusted its patient care cost to exclude these expenses not adjusted in the prior year's cost to charge ratio calculation. 1. Part I, Line 7g The hospital has reported two 501(c)(3) physician's clinics, that includes its emergency physicians, as part of its subsidized health services. These two clinics are part of the integrated health care services provided by St. Luke's Cornwall Hospital, a safety net and vital access provider, serving a medically underserved population. These medical clinics provide much needed health care services to the Hospital large Medicare and Medicaid populations that are operated by the hospital at a substantial loss to the organization. For 2021, the cost included in Part I, Line 7G for theses medical services were $2,799,183.

1. PART III, Section A, LINE 2
"The cost of bad debt expense 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 organization's bad debt expense (at cost) attributed to under the organization's charity care policy was based on the 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. Part III, Section A, Line 4 As reported in St Luke's Cornwall Hospital and Subsidiaries audited 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 year ended December 31, 2021, changes in the Hospital'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 provision for bad debts. The provision for bad debt for the year ended December 31, 2021 and 2020, was not significant""."

1. PART III, Section B, LINE 8
The amount reported on Line 6 was derived using the Medicare allowable costs as reported on the Hospital's New York State Institutional Cost Report. The Medicare Shortfall should be considered a community benefit since these SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A whole AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE tax-exempt PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY healthcare SERVICES TO ALL INDIVIDUAL'S IN A NON-DISCRIMINATORY MANNER without REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ability TO PAY. Medicare, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF care. The Medicare reimbursement has not kept pace with the rising Medicare costs thus shifting the burden for the difference to the organization for services rendered mainly to a frail, elder population that has great health needs.

1. Part III, Section C, Line 9B
For patients who are known to qualify for Financial assistance, all collection activities are 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. Determination of eligibility for financial aid is made as early in the care planning and scheduling process as possible. A counselor will assist any patients who require assistance with completing the applications. Emergency services are never delayed pending financial determinations. Patients can apply for financial aid prior to services or after receipt of a bill. Certain patients can auto qualify for a full or partial charity care discount based on presumption eligibility.

3. Patient Education of Eligibility for Assistance
All intake, registration and collection agency staff is trained on the hospital's Financial Aid Policy and how to provide patients with assistance. When it is determined that a patient is having difficulty paying their bill, a referral is made to the Hospital's Financial Aid Office and a Financial counselor will help the patient apply for financial aid. The hospital makes its financial aid policy known to the public by providing written information at patient service areas, information posted on the internet and information sent out on patient's bills. A financial assistance package, with instructions and application, is available to all self-pay patients at the time of registration or financial counseling.

6. Affiliated Health Care Systems
Montefiore St. Luke's Cornwall Hospital is an affiliate of Montefiore Health System. Montefiore Health System, Inc. is a leader in community Health and has a long history of developing innovative approaches to care and creating 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 support the Health System well in its provision of service to the community.

7. State Filing of Community Benefits Report
Montefiore St. Luke's Cornwall Hospital files a COMMUNITY BENEFIT REPORT WITH the State of NEW YORK.

2. Needs Assessment
The organization assesses community needs by working jointly with a broad spectrum of community partners. St. Luke's leads the Population Health Coalition, a group that includes more than 30 local organization focused on improving the health of the population served. The group is comprised of disease specific advocacy, local health care providers, including primary and specialty care practices, rehabilitation centers, emergency medical services, and federally qualified Health Centers, as well as organizations that focus on housing, the aging population, employment, mental health and special needs. The Population Health Coalition strives to identify gaps in care, consolidate resources and information and collaborate on projects that serve the community. St. Luke's also uses Primary and secondary data collections to assess the health needs of the community. Patient survey data obtained and compiled by the Orange County Department of Health are used as a secondary data source to supplement input obtained directly at COMMUNITY AND TOWN council MEETINGS, MEDICAL EDUCATION SEMINARS, PHYSICIAN PRESENTATIONS AND various HEALTH screening EVENTS.

4. Community Information
Montefiore ST. LUKE'S CORNWALL HOSPITAL is a 242-bed acute care not-for-profit community hospital with campuses in Newburgh and Cornwall New York, as well as several off-site facilities, that provide care to more than 250,000 patients per year and serves a population of approximately 400,000 people. As a safety net and Vital access Provider, the hospital serves a population that has been designated as a medically underserved area (MUA), specifically in the City of Newburgh. THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES THE CITY OF NEWBURGH, the most densely populated portion of Montefiore St. Luke's primary SERVICE area, with more than 7,473.3 PEOPLE PER SQUARE MILE. THE hospital's MARKET IS defined BY 12 neighboring ZIP CODES mainly IN ORANGE county and INCLUDING ULSTER AND DUTCHESS COUNTIES. According to estimates from the United States Census Bureau, Orange county's: - Population grew by 2.4% (between 2010 and 2018) - Median household income (in 2017 dollars) 2013-2017 was $75,146 - Percentage of persons 65 and older was 13.6% and - 10.9% of the population lives in poverty. The latest Community Health Assessment Survey shows an increase from 2013 in the reported prevalence of certain chronic diseases, including diabetes, high blood pressure, reported overweight or obesity and heart disease. The survey also indicated the other most commonly reported chronic diseases as hyperlipidemia, depression or anxiety and chronic pain. Access to healthcare providers is another social determinant identified in the Mid-Hudson Region, and is specifically a challenge in the City of Newburgh due to limited access to transportation as well as the cost of care. The Mid-Hudson Region Community Health Assessment 2019-2021 notes that 11.1% of Orange County residents did not receive medical care due to cost in 2016. While Orange County may not be among the highest, the numbers are far higher in the City of Newburgh as compared to the county as a whole.

5. Promotion of Community Health
Montefiore St. Luke's Cornwall hospital promotes community health by working with a board spectrum of community Partners in order to address various community health issues. St. Luke's leads the Population Health Coalition, a group that includes more than 30 local organization focusing on improving the health of the population served. The Population Coalition strives to identify gaps in care, consolidates resources and information and collaborates on projects that serve the community. The Coalition has succeeded in compiling an interactive directory of local community resources that can be utilized to better connect the population to appropriate services that best fit their needs. Montefiore St. Luke's Cornwall Hospital has its own community education programs that reach a wide variety of audience on a number of community health issues. Education is provided at a number of local senior groups, workplace wellness programs, local businesses, food pantries, soup kitchens and public events. Future plans will build upon this existing model by identifying other audiences in need of educational programming, as well as utilizing digital outreach through the internet and social media.