4A (Expenses $ 141156615 including grants of $ 197351) (Revenue $ 158614043)
Please see Schedule O for a complete description of program service accomplishments.

Schedule H, Part V, Section B, Line 3E
THE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility A, 1
"Facility A, 1 - St. Anthony Shawnee Hospital. Primary/qualitative data was gathered from residents of Pottawatomie County through a Community health survey, Community chats/focus groups, Key informant interviews. Each of these data collection tactics was designed with our focus on health equity in mind. This was done to ensure that the voices of the most vulnerable members of the community and the voices of those who care for them were heard in the primary data collection process. Primary data collection instruments were also designed to help identify assets in the community that are making a positive impact on the health of the community. This health asset data was used to help prioritize the health needs identified in this assessment and will be used in the creation of the hospital's 2022 2024 Community Health Improvement Plan. Furthermore: A 28- question community health survey was designed to collect primary data on the health needs of Pottawatomie County. The survey questions were based on the themes of access to healthcare, food, education, and employment. The survey was distributed electronically, and hard copies were made available to community partners such as the public library. Language options for the survey included English and Spanish, and it was available for completion from June 10, 2021 through August 31, 2021. Four ""community chats"" were arranged by a coordinating task force made up of representatives from the Avedis Foundation, Blue Zones Project of Pottawatomie County, Gateway to Prevention and Recovery, and SSM Health St. Anthony. The task force designed the community chats to gather input from throughout the county, with a special focus on health equity and identifying community assets. 11 community leaders were interviewed, representing healthcare, nonprofits, and government entities in Pottawatomie County. Leaders were asked to share their insights into changes and trends they have recently seen in the county, their concerns about health in the community, assets that already exist in the county, and possible interventions that could improve the community's health, especially for the poor and vulnerable. Secondary data was also used and include information published by the CDC, County Health Rankings, the Center for Applied Research and Engagement Systems (CARES), the State of the State Report, and the United States Department of Agriculture (USDA)."

Schedule H, Part V, Section B, Line 11 Facility A, 1
"Facility A, 1 - St. Anthony Shawnee Hospital. The hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Food insecurity - Behavioral health - Primary care access Food insecurity Over 16% of Pottawatomie County residents are food insecure. In our 2021 CHNA survey, residents reported that the most significant challenge to accessing healthy foods was cost. Increasing access to healthy foods decreases the rate of chronic diseases and life expectancy. The hospital has implemented the following action plan to assist with food insecurity: - Continue to ensure VeggieRx's long-term sustainability - Create a VeggieRx guide that can be shared with community partners - Continue to promote VeggieRx amongst vulnerable community members - Continue quarterly cohorts with a minimum of 30 participants per cohort - Work with Hunger Free Oklahoma and community partners to establish 2-3 ""Double Up Oklahoma"" (DUO) sites in Pottawatomie County, allowing SNAP beneficiaries to double the amount of produce they can purchase using their SNAP benefits at participating grocery stores, farmers' markets, and other food vendors - SSM Health's support will include partnering with Hunger Free Oklahoma to secure grant support to sustain the DUO program for the first 2-3 years at participating food vendors - Establish a Food Pharmacy to serve hospital inpatients - The Food Pharmacy program is a partnership with Regional Food Bank of Oklahoma, where the hospital provides a food box with enough nonperishable food to prepare 16 meals for patients who are identified as food insecure - The hospital's Case Management team will conduct these food insecurity screenings, with a goal of offering a food box to 75% of patients who are identified as food insecure - Provide community-based organizations with financial support towards their work in addressing food insecurity in Pottawatomie County Outcome goals of the implementation plan include: - Decreasing the percentage of adults that are food insecure in Pottawatomie County from the current rate of 15% - Increase the consumption of fresh produce in Pottawatomie County - Reduce the burden of disease associated with malnutrition in vulnerable Pottawatomie communities - 60% of VeggieRx patients will lower their BMI on average by 2 points or more Behavioral Health Nearly 20% of adults in Oklahoma had a mental illness from 2013-2014, according to the Oklahoma State Department of Health. Unfortunately, the lack of mental health resources for low-income and uninsured persons in Pottawatomie County is a barrier to seeking life-changing treatment. Intervention and prevention are key steps in combating this multifaceted health indicator. The initiatives below have been adopted by the hospital to improve behavioral health: - Integrate behavioral health into the primary care setting in SSM Health Medical Group practices, with a goal of behavioral health integration across 50% of adult primary care providers in Pottawatomie County by 2024 - Establish a community coalition to identify specific behavioral health needs in the county and address the barriers to meeting those needs - While behavioral health was identified as a general need in the community during the CHNA process, the hospital leadership team and community partners have determined that further work needs to be done to identify which specific types of behavioral health providers and services are needed - This community coalition will identify which providers and services are currently available - both for the insured and the uninsured - and then develop a strategy to meet these specific needs. This strategy may include increasing access to specific kinds of providers through recruitment, partnership, and/or investment in telehealth - Provide community-based organizations with financial support towards their work in addressing behavioral health in Pottawatomie County. As a result of the initiatives, the following goals are set: - Improve the population to provider ratio for mental health providers in Pottawatomie County from the current ratio of 330:1 - Reduce the number of residents who report struggling to access mental health services - Reduce the prevalence of ""mental health not good for >=14 days"" in census tract 5002 (south Shawnee) from 24.7 per 100,000 (see page 17 of 2021 CHNA) - Reduce the annual suicide rate in Pottawatomie County from 22 per 100,000 (see page 17 of 2021 CHNA) Primary care access In 2018, it was estimated that the population to primary care provider ratio in Pottawatomie County was 2,600:1. In the 2021 CHNA, county residents reported that vulnerable community members frequently delay necessary medical care because of the lack of primary care providers in their neighborhoods or towns. This leads to a high utilization of emergency services for preventable health challenges, decreased life expectancy, and poor overall health outcomes throughout the county. The hospital will take the steps below to increase access to primary care: - Bring a new primary care provider (open to all payors) to the community, working with community partners to address the trust and transportation challenges that have historically prevented vulnerable populations in south Shawnee and southern Pottawatomie County from accessing primary care - Provide in-kind services (such as lab and imaging) to support area clinics that offer primary care to the uninsured and underinsured - Continue to provide support the Pottawatomie County Free Health Clinic and the clinic at Aydelotte Baptist Church and identify additional opportunities to support these and other mission-aligned primary care clinics - Work with the City of Shawnee to identify areas of collaboration to support the health needs of people experiencing homelessness - Provide community-based organizations with financial support towards their work in addressing primary care access in Pottawatomie County Health goals for primary care access are: - Decrease the adult prevalence rates for the diseases in which Pottawatomie County received a rating of ""F"" in the most recent State of the State Health Report (Diabetes: 13.3%, High blood pressure (ever): 41.6%, High cholesterol: 38.8%) - Improve the population to provider ratio for primary care providers in Pottawatomie County from the current ratio of 2600:1 The hospital has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs."

Schedule H, Part I, Line 3c DISCOUNTED CARE EXCEPTIONS
"Patients whose family income exceeds 400% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the hospital; however the discounted rates shall not be greater than the amounts generally billed to commercially insured [or Medicare] patients. In such cases, other factors may be considered in determining their eligibility for discounted or free services, including: * Bank accounts, investments and other assets * Employment status and earning capacity * Amount and frequency of bills for health care services * Other financial obligations and expenses * Generally, financial responsibility will be no more than 25% of gross family income. The hospital may utilize predictive analytical software or other criteria to assist in making a determination of financial assistance eligibility in situations where the patient qualifies for financial assistance but has not provided the necessary documentation to make a determination. This process is called ""presumptive eligibility."""

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
SSM Health Care Corporation, 46-6029223

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
The amounts reported on Form 990, Schedule H, Part I, Line 7a, 7b, and 7c were determined using the cost to charge ratio derived from worksheet 2 in the schedule h instructions. Form 990, schedule h, part I, Lines 7e, 7f, 7g, 7h, and 7i are reported at cost as reported in the organization's financial statements. The calculation of Schedule H, Part I, Line 7, Column F utilizes 990, Part IX, Line 25, Column A, which does not include Bad Debt Expense.

Schedule H, Part II Community Building Activities
ST. ANTHONY SHAWNEE HOSPITAL PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: ECONOMIC DEVELOPMENT: Shawnee Forward (the combination of Shawnee Area Chamber of Commerce and Economic Development Foundation), an organization leading Shawnee and the surrounding region in both community and economic development efforts; COMMUNITY SUPPORT: ACTIVE IN THE Blue Zones Project Pottawatomie County, a community-wide well-being improvement initiative to help make healthy choices easier for everyone in our community; COALITION BUILDING: INVOLVEMENT WITH THE UNITED WAY BOARD AND INITIATIVES.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
FOR FINANCIAL STATEMENT PURPOSES, SSM Health HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER NORTON HOSPITAL'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
St. Anthony Shawnee Hospital, Inc. is part of the SSM Health consolidated audit. The footnote that references the treatment of uncollectible accounts and implicit price concessions in the December 31, 2021 consolidated audit is contained on page 13, 14 and 15 of the attached financial statements.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
"St. Anthony Shawnee Hospital has established a written credit and collection policy and procedures. The billing and collection policies and practices reflect the mission and values of SSM Health, including our special concern for people who are poor and vulnerable, The Health Center embraces its responsibility to serve the communities in which it participates by establishing sound business practices. The Health Center's billing and collection practices will be fairly and consistently applied. All staff and vendors are expected to treat all patients consistently and fairly regardless of their ability to pay. They respond to patients in a prompt and courteous manner regarding any questions about their bills and provide notification of the availability of financial assistance. All uninsured patients will be provided a standard discount for medically necessary inpatient and outpatient services, including services provided at off-campus outpatient sites. The hospital determined the amount of the discount based on the local managed care market, applicable statutory requirements and other relevant local circumstances. The rate must be no less than the lowest effective discount rate and no greater than the highest effective discount rate for the current managed care contracts of the hospital. Uninsured patients may also qualify for an additional discount based upon financial need under the system financial assistance policy. All accounts due from the patient will receive a statement after discharge or after final adjudication from patient's insurance. Generally the patient will receive 4 months (120 days) of in-house collection efforts (including early out vendors) and 12 months of bad debt collection efforts. The hospital will make Reasonable Efforts to determine FAP eligibility including: 1. The financial assistance summary will be included with each billing statement 2. Extraordinary Collection Activity (ECAs) may not occur until bad debt placement and only after 120 days. 3. ECAs must be suspended if a guarantor submits a FAP application during the application period. 4. Reasonable measures must be taken to reverse ECAs if the application is approved which may include refunding any payments made in excess of amounts owed as an FAP-eligible individual. 5. Bad Debt vendors will gain written approval from SSM prior to engaging in ECAs. SSM will review the accounts and verify satisfactory completion of reasonable efforts during the notification and application period. A waiver is not considered reasonable efforts. Obtaining a signed waiver that an individual does not wish to apply for FAP assistance or receive FAP application information will not meet the requirement to make ""reasonable efforts"" to determine whether the individual is FAP-eligible before engaging in ECAs. All outside collection agencies must comply with state and federal laws, comply with the association of credit and collection professional's code of ethics and professional responsibility and comply with St. Anthony Shawnee Hospital collection and financial assistance policies."

Schedule H, Part V, Section B, Line 16a FAP website
A - ST ANTHONY SHAWNEE HOSPITAL: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - ST ANTHONY SHAWNEE HOSPITAL: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - ST ANTHONY SHAWNEE HOSPITAL: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part VI, Line 2 Needs assessment
SSM Health (SSMH) participates in Community Benefit according to our vision. Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically, and socially marginalized, will experience improved health in mind, body, spirit and environment. In the tradition of our founders, the Franciscan Sisters of Mary, caring for those in greatest need remains our organizational priority. Today our System Board monitors Community Benefit efforts, and views achievement of our vision as a primary responsibility. The purpose of SSM's Community Benefit program is to assess and address community health needs. Making our communities healthier in measurable ways is always our goal. To fulfill this commitment, SSM's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). The CHNA is an assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conducted every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-health priorities: Establish strategies to address priorities; complete Strategic Implementation Plan; obtain Regional/Divisional Board approval; and integrate strategies into operational plan. * Make CHNA widely available to the public: Publish CHNA and summary document on hospital's website. * Monitor, track, and report progress on top health priorities: Collect data and evaluate progress; report to Regional/Divisional Board every six months and System Board every year; share findings with community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). System Office staff and leaders oversee and monitor SSMH's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, SSM Health Care Corporation also identifies needs based on assessments and research, and SSMH facilities also involve case managers and care team staff to pinpoint critical health issues in the community. All hospital CHNAs are completed, approved, and integrated into the organization's strategic plan. We continue to monitor and assess the progress of our local efforts in the spirit of caring for others and improving community health.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Each entity providing medical service shall provide information to the public regarding its charity care policies and the qualification requirements for each of its facilities. When standard system notices and communication regarding charity care are available, these must be used. Modifications to the standard may be made to comply with state and local laws, as well as reflect culturally sensitive terminology for the policy. All notices are easy to understand by the general public, culturally appropriate and available in those languages that are prevalent in the community. They provide information about: * The patient's responsibility for payment, * The availability of financial assistance from public programs and entity charity care and payment arrangements, * The entity's charity policy and application process, and * Who to contact to get additional information or financial counseling. The following types of notices to the public are provided: * Signs in the emergency department, website resources, and public waiting areas. * Brochures or fliers provided at time of registration and available in the financial counseling areas. * Notices sent with or on patient bills or communications sent to patients and guarantors related to medical services. * Applications provided to uninsured patients at the time of registration. The application for charity care, together with any instructions, must clearly state the policies regarding charity care, including excluded services, eligibility criteria and documentation requirements. Information about the entity's charity policies is also provided to public agencies.

Schedule H, Part VI, Line 6 Affiliated health care system
ST. ANTHONY SHAWNEE HOSPITAL IS A 501(C) (3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. ALONG WITH SSM HEALTH CARE OF OKLAHOMA, INC. THE HOSPITAL IS PURSUING A VISION TO CREATE A COMPREHENSIVE, REGIONAL HEALTH CARE ENTERPRISE FOR THE CENTRAL OKLAHOMA REGION.

Schedule H, Part VI, Line 7 State filing of community benefit report
OK

Schedule H, Part VI, Line 4 Community information
SSM Health St. Anthony Hospital - Shawnee is located in Shawnee, Oklahoma and defines its primary service area as in Pottawatomie County, which according to 2020 population estimates, had a population of 7,454 persons. Residents of the county account for nearly 72% of the total patients served by the hospital. The hospital is on the north side of Shawnee, the 14th largest city in Oklahoma with a population of 31,476. Of the hospital's community, only 20% have at least a Bachelor's degree and 11% do not have a High School diploma. The south side of Shawnee is one of the most vulnerable areas in the state, with a CDC Social Vulnerability Score of 0.9502 (0 being lowest vulnerability, 1 highest vulnerability. The average household income for this area is only $20,038. For Pottawatomie County and Oklahoma, 15% of the population report food insecurity. Smoking prevalence for those 18 and older was 36.6% for the county and state, and 36.6% for the south Shawnee area. More information and statistical data on the SSM Health St Anthony Hospital - Shawnee service area can be found in the 2021 CHNA.

Schedule H, Part VI, Line 5 Promotion of community health
St. Anthony Shawnee Hospital, Inc. participates in a wide array of community programs throughout the area to further its exempt purpose of promoting the health of the community. The community initiatives build on the strengths of our communities and systems to improve the quality of life and to create a sense of hope. Community Benefit initiatives build community capacity and individual empowerment through community organizing, leadership development, partnerships, and coalition building. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. In response to the global coronavirus pandemic, St. Anthony Shawnee Hospital, Inc. worked relentlessly to respond to community needs by developing and implementing strategies to address social needs of those served, providing screening & testing services, personal protective equipment and education throughout the community, as well as treatment for those who presented with COVID-19. St. Anthony Hospital Shawnee, Inc. promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote both community health and healthy communities. St. Anthony Shawnee Hospital, Inc. also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay, * Has an open medical staff with privileges available to all qualified physicians in the area, * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system.