4A (Expenses $ 1654574594 including grants of $ 68533167) (Revenue $ 1936994074)
"See Schedule OTemple University Hospital was founded in 1892 as ""Samaritan Hospital,"" with the mission of caring for patients with limited incomes and ensuring access to medical care in its surrounding neighborhoods. As the chief academic teaching hospital of the Lewis Katz School of Medicine at Temple University, Temple University Hospital (TUH) is an 879-bed non-profit acute care hospital that provides a comprehensive range of medical services to its low-income communities, and a broad spectrum of secondary, tertiary, and quaternary care to patients throughout Southeastern Pennsylvania and beyond. TUH is accredited as an Adult Level 1 Trauma Center by the Pennsylvania Trauma Systems Foundation.TUH is an indispensable provider of health care in the largest city in America without a public hospital. Within our immediate service area, about 40% of individuals live below the federal poverty level. Among Pennsylvania's full-service safety-net providers, Temple University Hospital serves the greatest volume and highest percentage of patients covered by Medicaid.In addition to its main campus in North Philadelphia, TUH includes its Episcopal, Jeanes and Northeastern campuses, which all serve economically and socially disadvantaged communities.As our chief clinical teaching site, TUH is staffed by over 400 physicians of Temple Faculty Physicians as well as physician scientists from our affiliated Fox Chase Cancer Center and our community-based Temple Physicians, Inc. The Temple Faculty Practice Plan represents about 20 academic departments including subspecialties in emergency medicine, oncology, gastroenterology, obstetrics, gynecology, orthopedics, neurosurgery, neurology, general and specialty surgery, and psychiatry. Temple University Hospital's Episcopal Campus provides a recovery oriented behavioral health treatment program, offering a welcoming approach and hope for those whose lives have been affected by mental illness and/or co-occurring disorders. It serves adults, age 18 or older, experiencing severe psychiatric symptoms that markedly impair their capacity to function adequately within the community. Many of its patients are diagnosed with psychiatric plus one or more substance/alcohol disorders. Almost half have one or both diagnosis of hypertension and or diabetes. Many have multiple co-existing medical illnesses. Temple physicians also staff important clinics that address major public health concerns, such as the Comprehensive Neuroaids Center at Temple University, which is dedicated to improving the public health impact of bench-to-clinic research associated with HIV-induced neurological diseases and cognitive disorders.Among our distinctions is the achievement of Magnet status from the American Nurses Credentialing Center, a prestigious recognition of quality nursing care, community commitment and staff dedication bestowed upon only 8% of U.S. healthcare organizations.Temple's nationally renowned physicians offer state of the art treatment options for patients with complex medical problems, some of whom were previously considered untreatable. Using sophisticated technologies and personalized treatments, Temple physicians are working to alter the course of serious disease. In over a dozen research centers, our faculty is speeding the transformation of fundamental scientific discoveries into practical therapies with the potential to dramatically improve human health.As a premier transplant center, Temple University Hospital performed 346 transplants last year, including 122 lung transplants and 163 bone marrow transplants. We also participate in countless research studies to promote life-saving treatment modalities. Our affiliated Temple Center for Population Health, LLC, (TCPH) promotes and manages our population health efforts. Its mission is to attain a sustainable model of health care delivery through clinical and business integration, community engagement, and academic distinction to promote healthy populations. The TCPH includes an extensive network of Patient Centered Medical Homes; chronic disease management programs for high risk populations utilizing nurse navigators; an extensive inpatient and outpatient community health worker program, peer coaching, and a central access center for appointment scheduling and acute care follow-up. The TCPH ambulatory performance improvement platform provides the infrastructure on which outpatient clinics can continue to achieve better care, smarter spending and healthier communities. The TCPH collaborates closely with TUH to assure smooth transitions of care, access to community resources and management of value-based purchasing. Virtually all Temple physicians, whether faculty or community-based, care for patients covered by Medicaid in both the inpatient and outpatient setting. About 86% of Temple University Hospital's inpatients are covered by government programs: 41% by Medicare and 45% by Medicaid. Patients dually eligible for both Medicare and Medicaid comprise about half of our Medicare inpatient base. Approximately 49% of our total inpatient cases include a behavioral health diagnosis.TUH serves as a critical access point for vital public health services. Last year we handled about 155,000 patients in our Emergency Department; 12,000 patients in our Psychiatric Crisis Response Center; and 1,500 discharges from our inpatient Behavioral Health unit. We delivered about 2,100 babies, of whom nearly 90% were covered by Medicaid. During our FYE June 30, 2022, Temple University Hospital engaged in numerous programs and events serving thousands of community members. Below are selected highlights.(1) Pandemic Response: Temple University Hospital offered 24/7 COVID-19 hotline to provide community members with questions on COVID-19 prevention, infection, and recovery. We operate free COVID-19 testing on our hospital campuses. We also partner with community organizations to provide on-site testing in difficult-to-reach neighborhoods. Our Regional Health Collaborative, in partnership with University of Pennsylvania, covers over 300 assisted living, personal care homes, and skilled nursing facilities in Philadelphia, Bucks, Chester, and Lancaster counties with consulting services on COVID-19 care, PPE use and sourcing, testing, infection control, and palliative care. We partner with the Philadelphia Housing Authority (PHA) to provide its residents with COVID-19 education and assistance with food insecurity, prescription delivery, financial assistance, and other social challenges. This program is staffed by a dedicated team of community health workers, all public housing beneficiaries, who we trained and hired.(2) Addressing the Opioid Epidemic: Temple University is on the front line addressing this public health crisis: 25% of our inpatients have a substance use disorder; our service area's drug overdose mortality rate is seven-times the national rate and has the highest opioid mortality rate in the City of Philadelphia. Our Temple Recovery Using Scientific Treatment (TRUST) Clinic, which is integrated into our family medicine and general internal medicine practices, provides low-barrier substance use disorder treatment with on-site peer recovery and case management services. The TRUST Clinic supports community based primary care providers and Temple University Hospital's Emergency Departments at its Main, Episcopal and Jeanes campuses. Our Begin the Turn street side multidisciplinary unit is staffed by a behavioral health professional, case manager, medical practitioner, and outreach workers. This team provides pharmacologic treatment for opioid use disorder and acute care services with a bridge to primary care and social services.(3) Addressing Public Health Impact of Gun Violence: Temple University Hospital's prevention and intervention programs provide a comprehensive approach to addressing this public health crisis. The homicide mortality rate in our immediate service area is 700% higher than the national rate. With the addition of a full-time psychologist, Turning Point offers cognitive-based and trauma-informed mental health services to patients. Cradle to Grave is our collaborative program with the Juvenile Justice Department and local schools that works with at-risk youth to break the cycle of gun violence. Our Fighting Chance program is one of the nation's few initiatives that teach community members how to provide basic first aid to gunshot wound victims."

4B (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
"(4) Healing Through Work: Our partnership with the Pennsylvania Commission on Crime and Delinquency and Philadelphia Works connects victims of gun violence with gainful employment to disrupt the cycle of interpersonal violence, open pathways, and bring stability to lives. A full-time workforce development specialist on our trauma team enrolls participants, help set career goals, creates access to career pathways, and provides ongoing training and mentorship. (5) Trauma Victim Advocate Program: We provide social, emotional, and material support to patients and families from their time of entry into our hospital through discharge. Our 24/7 advocate team offers counseling and facilitates access to victim's services that aid with post-traumatic recovery and community reintegration. We provide referrals to crime agencies to assist with relocation, recovery of lost wages, unpaid medical bills, and mental health services. In FY22, we linked 1,800 patients and family members with crime victim service agencies through TUH's 24-hour Trauma Advocate Program.(6) Cure Violence Philadelphia (CVP): This structured violence intervention program is based on the premise that violence is a public health issue. The program is designed to reduce the spread of violence through interrupting its transmission, concentrating on those at highest risk, and changing social norms that propagate violence. As a replication site of the global Cure Violence model created in Chicago, our adapted model works to reduce the level of violence, particularly shootings and homicides, in Philadelphia. Trained outreach workers identify and mediate conflicts in the community. They work with high-risk individuals -- meeting them where they are and helping them obtain the social services they need -- making them less likely to commit violence.(7) Maternal Health Equity: Geared toward prevention and treatment, this program advances and nurtures the health, wellbeing, and agency of Black, Latinx, and Indigenous birthing families in Philadelphia and beyond. A multidisciplinary team of clinicians, birth workers, and researchers cultivate impactful and sustainable solutions that support health equity at individual, family, health system, and societal levels. This program addresses substance misuse in pregnancy in a trauma-informed, evidence-based way that supports the entire birthing family throughout the pregnancy and one-year post birth. (8) Philadelphia Healthy and Safe Schools (PHASeS): Trauma-informed schools have been shown to protect children who have been traumatized from suffering from substance misuse. A team of trauma specialists use educational coaching, parenting guidance, and social work values to empower the school community. A principal endeavor of the program is to transform two nearby public K-8 schools into urban trauma sensitive beacons. Providing safe and welcoming trauma-informed schools for children to learn, teachers to educate, and a community to grow will elicit openings to achieve educational milestones, generate a climate of sustainability, and engender greater academic and social equity. (9) Transformative Emotional Academic Community Healing (TEACH): This program is designed to create stronger interpersonal relationships and improve the mental health of youth in North Philadelphia through mindfulness and trauma-informed programming. TEACH is an innovative, trauma-informed, community-driven model designed for children in K-8 grade levels who lack substantive and supportive out-of-school-time programming. It fosters development of strong, cohesive, independent family systems and communities through the creation of hyper-local, high-quality, informal learning spaces. TEACH focuses on enhancing and affirming children's social and emotional literacy, physical and psychological safety, interpersonal support, and community connection -- critical developmental building blocks for success, self-determination, and wellbeing.(10) COVID-19 Vaccination Collaborative: This program addresses vaccine hesitancy in North Philadelphia and provides community-based access to COVID-19 vaccination. (11) Care Transitions & Community Health Workers Programs: We developed a cohesive and robust series of programs that address social determinants and link patients to appropriate services. Our Community Health Worker (CHW) team serves as a critical resource for our surrounding neighborhoods. After identifying patients with complex social and medical health issues, CHWs conduct home visits, schedule and attend doctor appointments, coordinate transportation, and connect with other social supports to improve quality of life and treatment outcomes. We also developed a social determinants of health survey tool embedded in EPIC that is utilized to identify gaps in basic needs for patients such as housing, food, access to internet, transportation, utility assistance, and general health literacy. This has been implemented in our Emergency Departments and physician practices. When patients are identified with a gap, the CHW team coordinates access to community-based programs. In addition, we invested in a web software that identifies community based resources. This site supports our CHWs work and is available to the community as a free service. (12) Multi-Visit Patient Clinic: Provides a full continuum of care for patients with high emergency department use and frequent inpatient admissions. Upon discharge, Community Health Workers link patients with follow-up healthcare, provide meals and transportation, conduct home visits, and connect with other social supports. Patients enrolled in the clinic show a 37% reduction in emergency department use, 37% reduction in inpatient utilization and over 33% increase in outpatient services use, demonstrating they are seeking more appropriate care in effective settings.(13) Certified Peer Recovery Specialist Team: We hired a team with lived experience and specialized training that link overdose patients and families with needed social services after treatment in our Emergency Departments and Crisis Response Center. (14) Food Insecurity & Nutrition: Given the limited access to fresh food in North Philadelphia, our Farm to Families program brings fresh, low-cost produce to North Philadelphia families through home delivery and neighborhood distribution to address obesity, food insecurity, cardiovascular disease, and diabetes related to poor diet and lifestyle. Families can use SNAP benefits and a ""prescription"" from a Temple doctor to purchase local fruits and vegetables - helping them build capacity for healthier eating habits. In partnership with the Lewis Katz School of Medicine, St. Christopher's Foundation for Children and the Lancaster Farm Fresh Cooperative, food is sourced, packaged, and delivered to community food hubs. Our Jeanes Campus offers a seasonal fresh farm market, nutritional cooking demonstrations, and community access to its walking trail. (15) Community Health Outreach: Temple University Hospital participated in numerous health fairs serving our immediate community to build trust and break down barriers to care. We often collaborate with Temple University's Schools of Medicine, Public Health, Dentistry, and Pharmacy to provide health screenings and education on a variety of health issues affecting residents, including diabetes, obesity, cancer, depression, anxiety, addiction, and PTSD. Health professionals from across Temple University Hospital's departments engaged in numerous outreach activities with government offices and community-based organizations. These include free health screenings and education on cancer, behavioral health, substance abuse, burn prevention, childbirth education and yoga instruction for expecting moms, diabetes care, smoking cessation, LGBTQ health, stroke prevention, and other topics.(16) Housing Smart: In collaboration with Health Partners Plan, Keystone First and Resources for Human Development launched a two-year program to help 25 homeless Medicaid patients who frequently use hospital emergency departments. Patients are provided free housing and caseworkers to connect them with health and social services. Caseworkers assist patients by furnishing apartments, connecting with healthy meals, and helping with applications for income assistance such as Social Security."

4C (Expenses $ 0 including grants of $ 0) (Revenue $ 0)
(17) Social Supports: Our Social workers connected thousands of people with community-based social services, including free transportation, legal services, clothing, pharmaceuticals, co-pays and medical supplies. We provide these supports for our vulnerable patient population to ease their transition to home after discharge or outpatient treatment.(18) Behavioral Health Community Education. Our physicians and staff provide community-based education on seeking help for depression, suicidal behavior, and other mental health issues. In addition to the above, Temple University Hospital offers a number of culturally competent services to augment our ability to provide access to high quality care and improve outcomes for our patients and their caregivers. Below are selected highlights.(1) Financial Services: Temple employs Financial Counselors dedicated to helping uninsured and under-insured patients obtain medical coverage as well as providing assistance with out-of-pocket medical expense. Our team of knowledgeable and caring professionals help patients understand their insurance coverage, limitation, and out-of-pocket obligations. They assist patients and their families by answering their questions regarding the cost of healthcare services, providing information and guidance in comparing health plans, and enrolling them in government funded insurance plans such as Medicaid, Medicare and ACA Marketplace plans. All of our counselors are CMS Certified Application Counselors. In addition, they assist patients in applying for Temple Hospitals' Charity Care and Sliding-Scale Financial Assistance program and setting up payment plans. The financial counselors also assist patients in qualifying for patient assistance programs to cover most of the out-of-pocket costs for expensive medications. (2) Linguistic and Cultural Services: Our language proficient bilingual staff, who we train and credential, performed thousands of interpretations this year. This unique program, known for its excellence, is one of many resources we provide to non-English speaking patients and families. We also assist other area hospitals that call on us to adapt our linguistic services module to their patient populations.(3) Patient Family Advisory Councils (PFACS): Under the leadership of Temple University Hospital's Office of Patient Experience, we continued the six (6) Temple Physician Incorporated (TPI), Temple Heart and Vascular Institute (THVI), and Temple Trauma Unit Injury PFACs for a total of 8 PFACs. These committees engage and encourage the participation of patients, their families, and members of the community in evaluating patient satisfaction. Our PFACs are currently setting priorities as well as developing recommendations for improving Temple University Hospital's services, programs, communications, and policies to better meet the needs of patients and families with the full support of Temple Health leadership. (4) Workforce Development. The purpose of our labor-management workforce development and education programs are to build local workforce and improve skills sets needed to deliver quality healthcare. This involves comprehensive training and education to help workers living in our community adapt and improve skills to enable them to participate in a changing healthcare workplace. Career pathways include nursing, behavioral health, allied health, childcare, and health IT. Education services include GED classes and testing as well as ESL and safety instruction. In addition to our partnership with Temple University's Center for Social Policy, District Council 1199c Training and Upgrade Fund, and Philadelphia Workforce Development Corporation, our Community Health Worker program helps local residents develop valuable job skills while also achieving national goals of improving healthcare quality, outcomes, and cost.(5) Health Professions Education. Temple provides a significant investment in the education and training of the next professional healthcare workforce to benefit the broader community. This includes part of the cost of training nearly 700 residents and fellows in 46 teaching programs. The exposure that our residents receive caring for our diverse, low-income community helps Temple address health disparities while developing our nation's future physicians. (6) Emergency Preparedness and Research. This program helps ensure that our staff and hospital facilities are prepared to continue to provide safe, quality patient care under the most austere conditions. This program is a critical link in federal, state, and local disaster response plans. Our Emergency Preparedness Department is involved in three local committees including the North Philadelphia Emergency Healthcare Support Zone, the Regional Hospital Subcommittee, and the Emergency Support Function-8 Work Group. These committees focus on creation of drills, policy development, and continuing education.A summary of our community health improvement and other community benefit activities is also provided in our Community Benefit Report posted in plain view on our hospital's website at https://www.templehealth.org/locations/temple-university-hospital/about/community-health

Part V, Section B
Facility Reporting Group A

Facility Reporting Group A consists of:
- Facility 1: Temple University Hospital, Inc, - Facility 3: Temple Univ. Hosp @ Episcopal Campus, - Facility 4: Northeastern Ambulatory Care Center, - Facility 5: Temple Univ Hosp Infusion Rm @Fox Chase Cancer, - Facility 2: Temple University Hospital @ Jeanes Campus

Group A-Facility 1 -- Temple University Hospital, Inc Part V, Section B, line 5:
In conducting its Community Health Needs Assessment (CHNA), Temple University Hospital took into account input from representatives of the community served by its facility, including those with special knowledge or expertise in public health. Our processes, as well as the persons with whom Temple University Hospital consulted are set forth on pages 19-32 of its CHNA posted in plain view on the hospital's website at https://www.templehealth.org/locations/temple-university-hospital/about/community-health .

Group A-Facility 1 -- Temple University Hospital, Inc Part V, Section B, line 11:
Temple University Hospital is addressing most needs identified in our CHNA. Our approach to addressing additional needs is identified in our CHNA Implementation strategy on pages 23-25 , which is posted in plain view on the hospital's websites at https://www.templehealth.org/locations/temple-university-hospital/about/community-health .

Group A-Facility 2 -- Temple University Hospital @ Jeanes Camp Part V, Section B, line 5:
Refer to Facility 1 description.

Group A-Facility 2 -- Temple University Hospital @ Jeanes Camp Part V, Section B, line 11:
Refer to Facility 1 description.

Group A-Facility 3 -- Temple Univ. Hosp @ Episcopal Campus Part V, Section B, line 5:
Refer to Facility 1 description.

Group A-Facility 3 -- Temple Univ. Hosp @ Episcopal Campus Part V, Section B, line 11:
Refer to Facility 1 description.

Group A-Facility 4 -- Northeastern Ambulatory Care Center Part V, Section B, line 5:
Refer to Facility 1 description.

Group A-Facility 4 -- Northeastern Ambulatory Care Center Part V, Section B, line 11:
Refer to Facility 1 desription.

Group A-Facility 5 -- Temple Univ. Hosp Infusion Rm @Fox Chase Part V, Section B, line 5:
Refer to Facility 1 description.

Group A-Facility 5 -- Temple Univ. Hosp Infusion Rm @Fox Chase Part V, Section B, line 11:
Refer to Facility 1 description.

Part I, Line 7:
As set forth in the Temple University Hospital Emergency Care, Charity Care, Financial Assistance, and Uninsured Discount Policy, it is the policy of Temple University Health System to provide all necessary urgent and emergent care to patients without regard to their ability to pay for such care. Given this mission and within the guidelines of prudent business management, it is further the policy of Temple University Health System (TUHS) that an orderly and controlled system for the write-off of all types of Bad Debt and Charity Care balances is in effect to insure maximum collections. All patients have the option to apply for the TUHS Charity Care Program. The guiding principles behind this policy are to treat all patients equally, with dignity and respect, to serve the emergency healthcare needs of everyone in the community, to assist patients who cannot pay and to balance appropriate financial assistance for patients with fiscal responsibility. Patients and their families have a responsibility to assist TUHS in qualifying them for financial assistance. TUH Inc.'s cost to charge ratio for Part 1, lines 7a through 7d is derived by total expenses divided by the total gross charges.

Part I, Line 7g:
Temple University Hospital invested about $29 million to subsidize critical health care services needed in our community. This includes support for our outpatient emergency, acute care and psychiatric services, as well the inpatient psychiatric services on our Episcopal Campus. These physical and mental health services are critical to the health and welfare of our vulnerable communities.

Part II, Community Building Activities:
"Temple University Hospital engages in numerous community building activities throughout the year. These activities, separate from our ""community health improvement"" activities, advance the health or safety of the neighborhoods we serve.A summary of our community building and other community benefit activities is provided in our Community Benefit Report posted in plain view on our hospital's website at https://www.templehealth.org/locations/temple-university-hospital/about/community-healthCOMMUNITY SUPPORT.(1) Emergency Preparedness and Research: This program helps ensure that our staff and hospital facilities are prepared to continue to provide safe, quality patient care under the most austere conditions. This program is a critical link in federal, state and local disaster response plans. Our Emergency Preparedness Department is involved in three local committees, including the North Philadelphia Emergency Healthcare Support Zone, the Regional Hospital Subcommittee, and the Emergency Support Function-8 Work Group. These committees focus on creation of drills, policy development, and continuing education.(2) Employee Community Engagement: Temple University Hospital conducts numerous engagement activities throughout the year, including collections for new coats and clothing, holiday gifts, food, and school supplies to benefit low income families living in our communities. We are particularly proud of the support that we provide to local public schools, where many families have limited resources to purchase cold weather clothing and school supplies for young children. (3) At Your Service: Temple University Hospital's volunteer intern program connected undergraduate students who engage in pro-active non-clinical rounding on inpatient and outpatient units and interact with patients and families. Volunteer interns gain familiarity with hospital settings while enhancing the experience of patients and visitors. (4) Support for Early Learning: Temple University Hospital's Episcopal Campus provides facility use for the charitable purpose of providing early learning education for low-income children with autism and disabilities.(5) Housing Smart: In collaboration with Health Partners Plan, Keystone First and Resources for Human Development launched a two-year program to help 25 homeless Medicaid patients who frequently use hospital emergency departments. Patients are provided free housing and caseworkers to connect them with health and social services. Caseworkers assist patients by furnishing apartments, connecting with healthy meals, and helping with applications for income assistance such as Social Security.(6) Southeast Pennsylvania Collaborative Opportunities to Advance Community Health (COACH) initiative: In partnership with the U.S. Department of Health & Human Services, Philadelphia Department of Health and the Healthcare Improvement Foundation, Temple helps address food insecurity. (7) Public Safety: Partnership with Temple University to improve public safety on and around North Philadelphia campuses, including indoor and outdoor spaces open to community. WORKFORCE DEVELOPMENT(1) Investment in Community's Healthcare Workforce: The purpose of this program is to build local workforce and improve skills sets needed to deliver quality healthcare. This involves comprehensive training and education for workers living in our community, which helps to adapt and improve skills that enable them to participate in a changing healthcare workplace. About half the students are union members and half from the general community, including laid-off workers and those receiving public assistance. Career pathways include nursing, behavioral health, allied health, childcare, and health IT. Education services include GED classes and testing as well as ESL and safety instruction.(2) Community Health Worker Program: In partnership with Temple University's Center for Social Policy, District Council 1199c Training and Upgrade Fund and Philadelphia Workforce Development Corporation, this program trains unemployed members of our community to become Community Health Workers. Through this program, we are helping residents develop valuable job skills while also achieving national goals of improving healthcare quality, outcomes and cost."

Part III, Line 2:
Effective July, 1, 2018, the Health System adopted a new revenue recognition accounting standard that resulted in significant changes to the methodology for reporting bad debt expense. Under the previous standard, estimates for amounts not expected to be collected based on historical experience were recorded within net patient service revenue and then recognized as bad debt expense. Under the new standard, estimates for unrealizable amounts are recognized as implicit price concessions that are a direct reduction to net patient service revenues. As a result, the amount of bad debt expense reported in the Health System's financial statements has been greatly reduced, despite the fact that overall collection rates have not changed.

Part III, Line 8:
Community Benefit as in Charity Care is when estimated cost of providing services is in excess of payments received. In 2022, the cost of providing services to the Medicare population was $28,859,460, higher than revenue. Medicare allowable cost was based on cost apportionment derived from the Medicare Cost Report. The Medicare shortfall carried by TUH provides a community benefit because it benefits a charitable class, the elderly.

Part III, Line 9b:
Temple University Hospital's collection policy contains provisions on the collection practices to be followed for patients who are known to qualify for charity care. If a patient does not qualify for charity care or qualifies for only a charity care discount, the normal billing process of four (4) statements over a span of at least 120 days will occur. If no patient response is received, a write-off request form will be completed by the collection specialist and submitted for proper signature authority for agency referral. Once approved, the account will be transferred to the Bad Debt Financial Class. The account will be forwarded to the collection agency for additional collection effort. Collection vendors are required to include in their collection notifications notice that TUH provides free and/or reduced price care to persons who qualify, that TUH provides assistance in applying for and obtaining government funded insurance, and that patients can contact TUH's Financial Services Department for assistance.

Part VI, Line 2:
In addition to our Community Health Needs Assessment described in Part V Section B, Temple University Hospital (TUH) further assesses community health needs using comprehensive sets of internal and external data sources. Externally, we rely largely on health data compiled by federal, state, city, and community-based health organizations, including the following:*United States Center for Disease Control: https://www.cdc.gov/DataStatistics/Pennsylvania Department of Health -http://www.statistics.health.pa.gov/Pages/default.aspx#.WoIMY1Qo6Un*Pennsylvania and County Health Profiles- http://www.statistics.health.pa.gov/HealthStatistics/VitalStatistics/CountyHealthProfiles/Documents/County_Health_Profiles_2015.pdf*Pennsylvania Health Care Cost Containment Council (PHC4) - http://www.phc4.org/reports/utilization/inpatient/Philadelphia Department of Public Health, including the Philadelphia Vital Statistics Report, the Philadelphia Vital Statistics Report by Census Tract and Zip Code Report; the annual Health Center Service Area Report; the Maternal and Child Family Health Data Watch, the Report on Selected Maternal & Child Health Indicators for the City of Philadelphia, 1995-2005 and the Taking Philadelphia's Temperature report. http://www.phila.gov/health/Commissioner/DataResearch.html*County Health rankings: http://www.countyhealthrankings.org/app/pennsylvania/2017/overview*City Data: http://www.city-data.com/Centers for Medicare and Medicaid Services (CMS) Medpar data. https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/MEDPARLDSHospitalNational.html*Maternity Care Coalition - http://maternitycarecoalition.org/research/#publications-and-reports*Vizient (University Healthcare Consortium) Clinical Database*Current literature on evolving health care delivery issues and care delivery models.*Participation in the Southeast Pennsylvania Collaborative Opportunities to Advance Community Health (COACH) initiative in partnership with the U.S. Department of Health & Human Services, Philadelphia Department of Health and the Healthcare Improvement Foundation. Internally, we rely on the following sources:*Feedback from the Temple University Hospital Community Advisory Council. The purpose of the Community Advisory Council is to help Temple University Hospital achieve its mission, including its responsibility to Medicare and Medicaid to achieve equitable and high quality care, with a focus on the following community health goals: To promote equity in health and healthcare delivery for all, with emphasis on those residing in the communities served by the Temple University Hospital; To advise Temple University Hospital clinical and administrative leadership on community health needs and barriers to care; To develop innovative approaches for reducing racial and ethnic health disparities; for enhancing care quality and affordability; and for promoting access to clinical and social services. *Feedback from our various Patient and Family Advisory Councils (PFAC), including the separate Temple Physicians, Inc. PFACs connected with six separate practice locations in our community and Temple University Hospital's Injury PFAC of our Trauma Unit and the PFAC of our Heart and Vascular Institute. These groups are organized under Temple University Hospital's Department of Patient Experience.*Collaboration of Medical School and Hospital leadership*Consensus discussion with key clinical providers and community service organizations*Performance Improvement, Risk Management and Patient Safety outcomes.*Feedback from community members of our board of directors and routine interaction with neighborhood community organizations.*Historic, service line specific utilization data*Organizational community risk assessments (Infection Control, Environment of Care, Emergency Management, Fire Safety Management, Disaster Response).*In addition to assessing data sources, we work closely with the City of Philadelphia Department of Public Health's Health Centers, other local Federally Qualified Health Centers (FQHCs), the City's Police and Fire Departments and other community-based health and social services organizations to address specific needs of vulnerable populations. These partnerships enable us to coordinate care delivery in both inpatient and outpatient settings and address social determinants of health affecting health outcomes for the communities we serve.To support moms and newborns, we collaborate with Esperanza Community Health Center (Esperanza), Maria de los Santos Health Center, and Greater Philadelphia Health Action to provide a full range of obstetrical services. Temple University Hospital also works closely with our community partners to provide adult health services. Esperanza Physicians maintain staff privileges and provide continuity of care for their patients at our hospital. Additionally, Esperanza participates in our Internal Medicine Residency Programs. Maria de los Santos Health Center and the Greater Philadelphia Health Action also refer their patients to Temple University Hospital for inpatient care.Representatives of Temple University Hospital serve on several health-and safety related boards and committees of the City of Philadelphia, including the Health Department, Task Force to Combat the Opioid Epidemic, and the Fire Commissioner's Medical Advisory Board.

Part VI, Line 3:
34 Financial Counselors assigned to Temple University Hospital screen all uninsured and underinsured patients (including those with high deductibles and co-pays) who are hospitalized or require elective outpatient hospital services to determine their eligibility for government funded medical insurance coverage such as Medicaid and CHIP. *Patients that meet the qualifications for these programs are assisted by financial counseling staff throughout each step of the application process. Medicaid applications are submitted by TUH on the patient's behalf and tracked until final determination. *Patients who do not qualify for government-funded programs are screened for Temple University Health System's Charity Care program to determine their eligibility for free or reduced cost care. *Temple's Charity Care discounting policy is not restricted to Emergency Department patients, but is available to inpatients and outpatients as well.*Patients who contact the Hospital's Business Office concerning bills they have received that they cannot afford to pay are also screened for Charity Care eligibility. *The Financial Counseling Staff at Temple University Hospital also offers assistance in obtaining supplemental coverage as well as prescription drug benefits. *Patients are informed of Temple's Financial Services, and direction on how to access these services, through the following means:*Posters in plain view at inpatient, outpatient and emergency registration areas and billing offices;*Patient discharge summaries, billing invoices and vendor collection notices; and *Hospital website.

Part VI, Line 4:
As indicated in Temple University Hospital's Community Health Needs Assessment available at https://www.templehealth.org/locations/temple-university-hospital/about/community-health and https://www.templehealth.org/locations/jeanes-campus-tuh/about/community-health, our primary service area (TUH Service Area) is comprised of the following zip codes: 19111, 19120; 19121;19122; 19124; 19125; 19132; 19133; 19134; 19135; 19140; 19144 and 19149. These zip codes represent about 70% of where our patients reside seen on an inpatient and observation basis. Our service area's population has a disproportionally high percentage of non-college educated residents living in poverty compared to the city, state, and nation.The following data is current as of the time of conducting our most recent 3-year Community Health Needs Assessment referenced above.A. Population and Population GrowthThe TUH Service Area's includes a population of about 550,000, which is about one-third of Philadelphia's population of about 1.5 million.B. Age DistributionThe TUH Service Area's age distribution reveals an overall younger population with 25.8% under the age of 18; 27.1% age 18-34; 34.8% age 35-64; and 12.3% age 65 and up.C. Education LevelThe population in the TUH service area consisted of 61.6% with a high school education or less compared with national average of 61.5%%. The TUH service area population consists of 38.4% with education beyond high school, compared with national average of 61.5%. D. Unemployment and Household IncomeUnemploymentPhiladelphia's unemployment rate is 9.2% compared with 3.4% national average. (Source: Bureau of Labor Statistics, Local Area Unemployment Statistics, CY 2022)Household Income 59.5% of households in the TUH service area earn less than $50,000 per year, compared with the national rate of 34.8%. E. Population Below Federal Poverty LevelApproximately 30% of the population living within TUH's service area lives at or below the federal poverty level. F. Race/EthnicityIn TUH's service area, 35.4% of the population identifies as Black; 31.5% as Hispanic, non-black; 21.4% as White Non-Hispanic; 7.7% as Asian& Pacific; and, 4.0% as others.G. Payer Mix Approximately 79% of TUH service area's residents were covered by either Medicaid or Medicare: 49.1% for Medicaid, and 29.9% for Medicare.

Part VI, Line 6:
Temple University Hospital is a member of the Temple University Health System, Inc. It is the chief clinical teaching site for the Temple University School of Medicine. Consistent with its mission to provide access to the highest quality of health care in community and academic settings, Temple University Hospital supports Temple University's Health Sciences Center academic programs by providing a clinical environment and research programs that offers high quality education and training for health care professionals. The missions of other members of the Temple University Health System similarly advance the health systems goals, as follows: the hospital of the Fox Chase Cancer Center is devoted solely to cancer treatment, research, and prevention; the Temple Health System Transport Team, Inc. mission is to provide the highest level of critical care transport services available in the mid-Atlantic region; the Institute for Cancer Research, Fox Chase Cancer Center Medical Group and Fox Chase Network's mission is to prevail over cancer, marshalling heart and mind in bold scientific discovery, pioneering prevention and compassionate care; the Temple Physicians, Inc., mission is to provide the highest quality of clinical care as well as to support the clinical, administrative and corporate activities of the Temple University Health System; and the mission of Temple Faculty Practice Plan, Inc. is to provide access to the highest quality of clinical care to the patients of North and Northeast Philadelphia and surrounding areas, and to support the clinical, administrative, and corporate activities of Temple University Health System while continuing to support the academic and research mission of Temple University's Lewis Katz School of Medicine.

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In addition to the Community Building activities described in Section V above, Temple University Hospital organized or participated as a key partner in a number of community health improvement activities. These activities are free to the community, subsidized by Temple University Hospital, do not generate a patient bill, and are carried out for the sole purpose of improving community health.TUH is an indispensable provider of health care in the largest city in America without a public hospital. Among Pennsylvania's full-service safety-net providers, Temple University Hospital serves the greatest volume and highest percentage of patients covered by Medicaid. About 86% of our inpatients are covered by government programs: 41% by Medicare and 45% by Medicaid. Temple University Hospital is located in a medically underserved area. During our FYE June 30, 2022, Temple University Hospital engaged in numerous programs and events serving thousands of community members. Below are selected highlights.(1) Pandemic Response: Temple University Hospital offered 24/7 COVID-19 hotline to provide community members with questions on COVID-19 prevention, infection and recovery. We operate free COVID-19 testing on our hospital campuses. We also partner with community organizations to provide on-site testing in difficult-to-reach neighborhoods. Our Regional Health Collaborative, in partnership with University of Pennsylvania, covers over 300 assisted living, personal care homes, and skilled nursing facilities in Philadelphia, Bucks, Chester, and Lancaster counties with consulting services on COVID-19 care, PPE use and sourcing, testing, infection control, and palliative care. We partner with the Philadelphia Housing Authority (PHA) to provide its residents with COVID-19 education and assistance with food insecurity, prescription delivery, financial assistance, and other social challenges. This program is staffed by a dedicated team of community health workers, all public housing beneficiaries, who we trained and hired.(2) Addressing the Opioid Epidemic: Temple University is on the front line addressing this public health crisis: 25% of our inpatients have a substance use disorder; our service area's drug overdose mortality rate is seven-times the national rate and has the highest opioid mortality rate in the City of Philadelphia. Our Temple Recovery Using Scientific Treatment (TRUST) Clinic, which is integrated into our family medicine and general internal medicine practices, provides low-barrier substance use disorder treatment with on-site peer recovery and case management services. The TRUST Clinic supports community based primary care providers and Temple University Hospital's Emergency Departments at its Main, Episcopal and Jeanes campuses. Our Begin the Turn street side multidisciplinary unit is staffed by a behavioral health professional, case manager, medical practitioner, and outreach workers. This team provides pharmacologic treatment for opioid use disorder and acute care services with a bridge to primary care and social services.(3) Addressing Public Health Impact of Gun Violence: Temple University Hospital's prevention and intervention programs provide a comprehensive approach to addressing this public health crisis. The homicide mortality rate in our immediate service area is 700% higher than the national rate. With the addition of a full-time psychologist, Turning Point offers cognitive-based and trauma-informed mental health services to patients. Cradle to Grave is our collaborative program with the Juvenile Justice Department and local schools that works with at-risk youth to break the cycle of gun violence. Our Fighting Chance program is one of the nation's few initiatives that teach community members how to provide basic first aid to gunshot wound victims. (4) Healing Through Work: Our partnership with the Pennsylvania Commission on Crime and Delinquency and Philadelphia Works connects victims of gun violence with gainful employment to disrupt the cycle of interpersonal violence, open pathways, and bring stability to lives. A full-time workforce development specialist on our trauma team enrolls participants, help set career goals, creates access to career pathways, and provides ongoing training and mentorship. (5) Trauma Victim Advocate Program: We provide social, emotional, and material support to patients and families from their time of entry into our hospital through discharge. Our 24/7 advocate team offers counseling and facilitates access to victim's services that aid with post-traumatic recovery and community re-integration. We provide referrals to crime agencies to assist with relocation, recovery of lost wages, unpaid medical bills, and mental health services. In FY22, we linked 1,800 patients and family members to crime victim service agencies through TUH's 24-hour Trauma Advocate Program.(6) Cure Violence Philadelphia (CVP): This structured violence intervention program is based on the premise that violence is a public health issue. The program is designed to reduce the spread of violence through interrupting its transmission, concentrating on those at highest risk, and changing social norms that propagate violence. As a replication site of the global Cure Violence model created in Chicago, our adapted model works to reduce the level of violence, particularly shootings and homicides, in Philadelphia. Trained outreach workers identify and mediate conflicts in the community. They work with high-risk individuals -- meeting them where they are and helping them obtain the social services they need -- making them less likely to commit violence.(7) Maternal Health Equity: Geared toward prevention and treatment, this program advances and nurtures the health, wellbeing, and agency of Black, Latinx, and Indigenous birthing families in Philadelphia and beyond. A multidisciplinary team of clinicians, birth workers, and researchers cultivate impactful and sustainable solutions that support health equity at individual, family, health system, and societal levels. This program addresses substance misuse in pregnancy in a trauma-informed, evidence-based way that supports the entire birthing family throughout the pregnancy and one-year post birth. (8) Philadelphia Healthy and Safe Schools (PHASeS): Trauma-informed schools have been shown to protect children who have been traumatized from suffering from substance misuse. A team of trauma specialists use educational coaching, parenting guidance, and social work values to empower the school community. A principal endeavor of the program is to transform two nearby public K-8 schools into urban trauma sensitive beacons. Providing safe and welcoming trauma-informed schools for children to learn, teachers to educate, and a community to grow will elicit openings to achieve educational milestones, generate a climate of sustainability, and engender greater academic and social equity. (9) Transformative Emotional Academic Community Healing (TEACH): This program is designed to create stronger interpersonal relationships and improve the mental health of youth in north Philadelphia through mindfulness and trauma informed programming. TEACH is an innovative, trauma-informed, community-driven model designed for children in K-8th grade levels who lack substantive and supportive out-of-school-time programming. It fosters development of strong, cohesive, independent family systems and communities through the creation of hyper-local, high-quality informal learning spaces. TEACH focuses on enhancing and affirming children's social and emotional literacy, physical and psychological safety, interpersonal support, and community connection -- critical developmental building blocks for success, self-determination, and wellbeing.(10) COVID-19 Vaccination Collaborative: This program addresses vaccine hesitancy in North Philadelphia and provides community-based access to COVID-19 vaccination. NOTE: Part VI, Line 5 continues after Part VI, Line 6

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"(11) Care Transitions & Community Health Workers Programs: We developed a cohesive and robust series of programs that address social determinants and link patients to appropriate services. Our Community Health Worker (CHW) team serves as a critical resource for our surrounding neighborhoods. After identifying patients with complex social and medical health issues, CHWs conduct home visits, schedule and attend doctor appointments, coordinate transportation, and connect with other social supports to improve quality of life and treatment outcomes. We also developed a social determinants of health survey tool embedded in EPIC that is utilized to identify gaps in basic needs for patients such as housing, food, access to internet, transportation, utility assistance, and general health literacy. This has been implemented in our Emergency Departments and physician practices. When patients are identified with a gap, the CHW team coordinates access to community based programs. In addition, we invested in a web software that identifies community based resources. This site supports our CHWs work and is available to the community as a free service. (12) Multi-Visit Patient Clinic: Provides a full continuum of care for patients with high emergency department use and frequent inpatient admissions. Upon discharge, Community Health Workers link patients with follow-up healthcare, provide meals and transportation, conduct home visits, and connect with other social supports. Patients enrolled in the clinic show a 37% reduction in emergency department use, 37% reduction in inpatient utilization and over 33% increase in outpatient services use, demonstrating they are seeking more appropriate care in effective settings.(13) Certified Peer Recovery Specialist Team: We hired a team with lived experience and specialized training that links overdose patients and families with needed social services after treatment in our Emergency Departments and Crisis Response Center. (14) Food Insecurity & Nutrition: Given the limited access to fresh food in North Philadelphia, our Farm to Families program brings fresh, low-cost produce to North Philadelphia families through home delivery and neighborhood distribution to address obesity, food insecurity, cardiovascular disease, and diabetes related to poor diet and lifestyle. Families can use SNAP benefits and a ""prescription"" from a Temple doctor to purchase local fruits and vegetables - helping them build capacity for healthier eating habits. In partnership with the Lewis Katz School of Medicine, St. Christopher's Foundation for Children and the Lancaster Farm Fresh Cooperative, food is sourced, packaged, and delivered to community food hubs. Our Jeanes Campus offers a seasonal fresh farm market, nutritional cooking demonstrations, and community access to its walking trail. (15) Community Health Outreach: Temple University Hospital participated in numerous health fairs serving our immediate community to build trust and break down barriers to care. We often collaborate with Temple University's Schools of Medicine, Public Health, Dentistry, and Pharmacy to provide health screenings and education on a variety of health issues affecting residents, including diabetes, obesity, cancer, depression, anxiety, addiction, and PTSD. Health professionals from across Temple University Hospital's departments engaged in numerous outreach activities with government offices and community-based organizations. These include free health screenings and education on cancer, behavioral health, substance abuse, burn prevention, childbirth education and yoga instruction for expecting moms, diabetes care, smoking cessation, LGBTQ health, stroke prevention, and other topics.(16) Social Supports: Our Social workers connected thousands of people with community-based social services, including free transportation, legal services, clothing, pharmaceuticals, co-pays, and medical supplies. We provide these supports for our vulnerable patient population to ease their transition to home after discharge or outpatient treatment.(17) Behavioral Health Community Education. Our physicians and staff provide community-based education on seeking help for depression, suicidal behavior, and other mental health issues. In addition to the above, Temple University Hospital offers a number of culturally competent services to augment our ability to provide access to high quality care and improve outcomes for our patients and their caregivers. Below are selected highlights.(1) Financial Services: Temple employs Financial Counselors dedicated to helping uninsured and under-insured patients obtain medical coverage as well as providing assistance with out of pocket medical expense. Our team of knowledgeable and caring professionals help patients understand their insurance coverage, limitation and out of pocket obligations. They assist patients and their families by answering their questions regarding the cost of healthcare services, providing information and guidance in comparing health plans, and enrolling them in government funded insurance plans such as Medicaid, Medicare and ACA Marketplace plans. All of our counselors are CMS Certified Application Counselors. In addition, they assist patients in applying for Temple Hospitals' Charity Care and Sliding-Scale Financial Assistance program and setting up payment plans. The financial counselors also assist patients in qualifying for patient assistance programs to cover most of the out of pocket costs for expensive medications. (2) Linguistic and Cultural Services: Our language proficient bilingual staff, who we train and credential, performed thousands of interpretations this year. This unique program, known for its excellence, is one of many resources we provide to non-English speaking patients and families. We also assist other area hospitals that call on us to adapt our linguistic services module to their patient populations.(3) Patient Family Advisory Councils (PFACS): Under the leadership of Temple University Hospital's Office of Patient Experience, we continued the six (6) Temple Physician Incorporated (TPI), Temple Heart and Vascular Institute (THVI), and Temple Trauma Unit Injury PFACs for a total of 8 PFACs. The goal of these committees is to engage and encourage the participation of patients, their families, and members of the community in evaluating patient satisfaction. Our PFACs are currently setting priorities as well as developing recommendations for improving Temple University Hospital's services, programs, communications, and policies to better meet the needs of patients and families with the full support of Temple Health leadership. A summary of our community health improvement and other community benefit activities is also provided in our Community Benefit Report posted in plain view on our hospital's website athttps://www.templehealth.org/locations/temple-university-hospital/about/community-health"