4A (Expenses $ 547486968 including grants of $ 0) (Revenue $ 711782135)
BON SECOURS ST. FRANCIS HEALTH SYSTEM (BSSFHS) PRIMARILY SERVES GREENVILLE COUNTY, WHICH IS COMPRISED OF GREATER THAN 514,000 RESIDENTS AND HAS EXPERIENCED A GROWTH RATE DOUBLE THAT OF THE UNITED STATES AND SIGNIFICANTLY HIGHER THAN THAT OF SOUTH CAROLINA. ST. FRANCIS HOSPITAL PROVIDES MEDICAL CARE TO PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. ST. FRANCIS HOSPITAL PROVIDES SUPPORT FOR THE COMMUNITY SERVICES. DURING 2021 ST. FRANCIS HOSPITAL PROVIDED $36.75M IN NET COMMUNITY BENEFITS REPRESENTING 6.14% OF TOTAL OPERATING EXPENSES.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - St. Francis Hospital, Inc.. A community-based approach was taken to complete the Community Health Needs Assessment. Data was collected as outlined below from primary and secondary sources during the time period of April 2019 - July 2019. National, state, and county-specific data was collected from a broad set of reliable data sources. Additional attention was placed on assessing Healthy People 2020 Leading Indicators, review of the previous CHNA data, and gathering information from community residents, providers of health and human services, and other stakeholders and representatives of Greenville County. Efforts were made to ensure that the research was conducted in a manner that was representative of the communities within Bon Secours Mercy Health's service area. Collection of statistical (secondary, quantitative) data at national, state, regional and local levels - key data sources included Census Bureau American Fact Finder, Healthy People 2020, Robert Wood Johnson County Health Rankings, Centers for Disease Control, and South Carolina DHEC biostatistics, vital records, county health profiles and hospital discharge data. Collection and analysis of qualitative data was completed through a community survey, a town hall meeting and a stakeholder focus group. The community survey was completed by 1,014 individuals from January - March 2019. A Town Hall meeting was held in April 2019 to allow discussion among leaders of social service agencies, senior health groups, free medical clinics and others in tune with the needs of at-risk populations in Greenville County. Community Focus Group consisted of neighborhood leaders, organizers and advocates. This group represented the interests of urban and suburban residents, mostly from less affluent communities that are home to lower-income families, minority families and the elderly. Lastly, a Stakeholder Focus Group was held for small group discussion with additional health and social service providers. The meetings with stakeholders were facilitated to review the assessment findings and identify priorities and potential actions. The assessment was completed in partnership and with local public health professionals, health and human service agencies, the South Carolina Hospital Association and Bon Secours St. Francis Health System leaders and board. Additional detail can be found on the Bon Secours website at https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - St. Francis Hospital, Inc.. St. Francis Hospital, Inc. Affordable Housing Implementation Activities: Goal: Advocate for a comprehensive affordable housing strategy to address housing inequities in Greenville County and its municipalities; Partner with organizations to address the housing affordability gap in Greenville; Expand housing for women affected by domestic violence. 2021 Strategies and Outcomes: * Education and advocating for policies and practices that specifically address the preservation of affordable housing in Greenville was a focus for the hospital during the year. The hospital worked with the Greenville Housing Fund and local officials towards the creation of advocacy platform for housing affordability. * During 2021, the hospital continued their engagement with affordable housing partners, such as the Greenville Housing Fund, to increase funding to support affordable housing units. Bon Secours St. Francis' Community Health Director serves on the Housing Fund's board of directors and the advocacy committee. In Q3, the Housing Fund established an equity fund focusing on the preservation of affordable housing. The Housing Fund also benefitted from state, county, city and federal funding to address evictions and late rental payments due to the impact of COVID-19. * In collaboration with the Clemson University School of Architecture, the hospital helped design the affordable housing units for 6 parcels of land owned by the Sterling Land trust. Funding request will be completed by the hospital once 501(c)(3) status is attained. * The hospital entered into an agreement with Mercy Housing SE to build 46 affordable 1-, 2- and 3-bedroom apartments in Mauldin, SC. In 2021, Mercy Housing had begun the work on the construction of the housing units with the expected completion early 2022 and occupation by the end of the year. * In 2021, the hospital continued to work with Jasmine Road to expand additional housing units by identifying and leveraging funding resources to support the costs of expansion. * Due to the impact of COVID-19, several programs, and strategies that the hospital intended to implement to address this health need were delayed until 2022. The hospital plans to resume these programs in 2022. Behavioral Health Implementation Activities: Goal: Actively address behavioral health issues in the Upstate through community and partnership-based collaborative approaches; Increase education, early detection and easy access to behavioral health interventions through Bon Secours St. Francis Health System (BSSFHS) access points; Expand community addiction service resources. 2021 Strategies and Outcomes: * In 2021, the hospital completed a Resource Guide as part of its partnership with Greenville County Behavioral Health Coalition. The physical version of resource guide was delayed but the online guide was made available at findlocaltreatment.com. * During 2021, the hospital successfully implemented and rolled out the Columbia-Suicide Severity Rating Scales (C-SSRS) in combination with the already established Patient Health Questionnaire (PHQ-9) depression screening in ambulatory settings locally. * Providing behavioral health and early detection education and awareness to faith-based organizations was a goal for the hospital during 2021. This was achieved by having Dr. Felkel of the hospital offer several community events virtually throughout the year. * The hospital continues to seek opportunities to expand pathways to behavioral health education and training for providers to increase the behavioral health workforce. In 2021, one behavioral health nurse practitioner was hired, a recruitment plan is being developed to hire two psychiatrists and two therapists in 2022, and the hospital began developing a behavioral health system work group. * The hospital provides behavioral health and early detection education and awareness to faith-based organizations. In 2021, providers and nurses completed the Screening, Brief Intervention, and Referral to Treatment (SBIRT) training and the hospital extended Medication for Opioid Use Disorder (MOUD) to Jasmine Road. Additionally, the hospital continued its ongoing work to support MOUD introduction in the Emergency Department by hiring one new Nurse Practitioner with the ability to prescribe MOUD. * In 2021, the hospital continued to work with the Phoenix Center and the Greenville County opioid task force to provide behavioral health support for students and families at the legacy charter school. The hospital also opened a clinic at the Legacy Early College Health Center during 2021, which will provide an avenue for behavioral health discussion and elevated awareness.

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - CONTINUED DESCRIPTION: St. Francis Hospital, Inc.. Obesity and Chronic Conditions Implementation Activities: Goal: Reduce one or more modifiable risk factors associated with chronic disease in two identified adult populations; Increase knowledge and awareness of the prevention of childhood obesity. 2021 Strategies and Outcomes: * Throughout 2021 the hospital continued to provide education, programming and activities addressing nutrition, physical activity and behavioral health to underserved populations through a partnership with the Free Clinic. The hospital's exercise specialist taught 4 educational classes in 2021, 2 virtually and 2 in person. The virtual classes covered physical activity precautions, appropriate frequency and intensity, demonstrations of basic stretches, and resistance exercising. The in-person classes consisted of walking with clients outside. The hospital's dietician also taught 4 classes during the year included the basic nutrition of carbohydrates, the facts on proteins and fats, and finding health foods that are cost effective. * The hospital continued to implement educational programming and resource opportunities from the American Diabetes Association and LiveWell for service delivery at St. Sebastian. The hospital conducted 5 events that incorporated blood pressure awareness and screenings, with 3 of the 5 events also focusing on diabetes awareness and finding a medical home. These 5 events had the following impact on the community: - The May 2021 event, Take Care of Your Heart, provided AHA Blood Pressure Guidelines and what is high blood pressure handouts. 28 participants received information on finding/establishing a medical home and the participants received Food Share Fresh produce boxes. - The June 2021 event held at St. Sebastian Catholic Church, provided participants with hypertension awareness and prevention in both English and Spanish handouts. Additionally, this event offered blood pressure readings and permanent medical home information. - The July 2021 event, Chronic Condition Awareness, gave out flyers on heart disease, hypertension, diabetes, and colon cancer while also providing blood pressure checks, permanent medical home information and Food Share Fresh Produce boxes to 24 participants. - The October 2021 event, Chronic Condition Activity held at St. Sebastian provided 20 Food Share fresh produces boxes to participants. Participants were also provided prevention and management education obesity, hypertension, heart disease, diabetes, and colon cancer. Additionally, a total of 29 blood screenings were performed. * Continued work and discussion with the Furman University staff to discuss implementation of a wellness tracking and healthy outcomes program in 2021. * The hospital continues to partner with community organizations, such as LiveWell and their Build Trust/Build Health group as well as the Healthy Carolinas organization, Healthy People. During 2021, the hospital met with LiveWell once a month to help implement healthy eating strategies for families in the White Horse Rd corridor and by facilitating physical activity projects like soccer for Hispanic Youths. Parental involvement in the soccer clubs and other activities has promoted a healthier lifestyle for both parents and their children. Additionally, the hospital worked with Clemson University's SnapEd staff to offer Healthy Plate preservations at various locations in the White House Rd corridor. * The hospital continues to work in partnership with a Hispanic faith-based organizations to implement family-based obesity prevention strategies aimed at reversing the increasing trend of overweight Hispanic Children. During 2021, the hospital conducted health eating presentations at 7 Hispanic churches in the area and continued to hold a monthly zoom meeting with the Hispanic Pastor group to promote healthy eating. Additionally, due to Covid-19 Hispanic families have been facing food insecurity so the hospital has continued to work with Mill Village Farms and Loaves and Fishes to distribute healthy foods for these families. The distribution sites for this food have been at the partner Hispanic faith organizations. When distributing the food, the hospital also provides healthy recipes and educational flyers have been provided along with the food. All prioritized health needs identified in the hospital's most recent CHNA have been addressed.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - St. Francis HOspital, Inc.. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT OR FAMILY MEMBER TO COMPLETE AN APPLICATION INCLUDING GROSS INCOME FOR A MINIMUM OF 3 MONTHS (UP TO 12 MONTHS) PRIOR TO THE DATE OF APPLICATION OR DATE OF SERVICE. PROOF OF INCOME IS REQUIRED WITH THE EXCEPTIONS OF PATIENTS WHO QUALIFY FOR PRESUMPTIVE ELIGIBILITY. PROOF OF INCOME IS NOT REQUIRED IF A PATIENT OR FAMILY MEMEBER ATTESTS TO AN INCOME LEVEL THAT QUALIFIES THE APPLICANT FOR DISCOUNTED CARE UNDER OHIO'S HEALTHCARE ASSURANCE PROGRAM (HCAP). THIRD PARTY INCOME SCORING MAY BE USED TO VERIFY INCOME IN SITUATIONS WHERE INCOME VERIFICATION IS UNABLE TO BE OBTAINED THROUGH OTHER METHODS. Patients are presumed to be eligible for financial assistance based on individual life circumstances including but not limited to when the Patient's income is below 200% Federal Poverty Guidelines and considered self-pay, the Patient is discharged to a SNF, the Patient is deceased with no known estate and below 200% Federal Poverty Guidelines, the patient is supported by State-funded prescription programs, the patient is Homeless or received care from a homeless clinic, the patient has Participated in Women, Infants and Children programs (WIC), the patient is eligible for Food stamps, the patient is eligible for Subsidized school lunch program, the patient is eligible for other state or local assistance programs that are unfunded (e.g., Medicaid spend-down), the Patient is referred through the National Association of Free Clinics, the patient provides Low income/subsidized housing as a valid address, or Other significant barriers are present.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - St. Francis Hospital, Inc.. There are situations where individuals may not have reported income but have significant assets available to pay for healthcare services. In these situations, BON SECOURS MERCY HEALTH may evaluate and require documented proof of any assets that are categorized as convertible to cash and unnecessary for the patient's essential daily living expenses. PATIENTS WHO LIVE IN THE COMMUNITY SERVED BY A BON SECOURS MERCY HEALTH HOSPITAL WILL BE OFFERED HEALTHCARE FINANCIAL ASSISTANCE. FOR THOSE PATIENTS LIVING OUTSIDE OF THE COMMUNITY, EXTENUATING CIRCUMSTANCES MUST BE DOCUMENTED AND APPROVED BY THE PFS MANAGER AND BE MEDICALLY NECESSARY OR EMERGENT IN NATURE. A LIST OF THE ZIP CODES OF THE COMMUNITY SERVED FOR EACH BON SECOURS MERCY HEALTH HOSPITAL IS MAINTAINED IN A SEPARATE DOCUMENT AND READILY AVAILABLE VIA THE CONTACT LIST AT THE END OF THE POLICY LOCATED AT HTTPS://WWW.MERCY.COM/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE AND AT https://www.bonsecours.com/patient-resources/financial-assistance. BON SECOURS MERCY HEALTH'S FINANCIAL ASSISTANCE POLICY REQUIRES A PATIENT TO APPLY FOR HEALTH INSURANCE COVERAGE AND/OR ENTER THE MARKETPLACE/EXCHANGE BEFORE FINANCIAL ASSISTANCE MAY BE EXTENDED. EXCEPTIONS TO THIS POLICY INCLUDE PATIENTS DISCHARGED TO A SKILLED NURSING FACILITY, PATIENTS WHO ARE DECEASED WITH NO ESTATE, AND PATIENTS WHO HAVE DOCUMENTED HOMELESSNESS.

Schedule H, Part I, Line 7e Community Health Improvement Services
Bon Secours Mercy Health hospitals incurred significant additional costs in responding to the COVID-19 pandemic in 2021. Certain costs associated with health care support services, including executive and other employee time spent planning for and recovering from the public health emergency and for planning for community COVID-19 vaccine services were included as Community Health Improvement Services. These costs were not directly reimbursed by any provider relief funds or other government funding sources.

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
Bon Secours Mercy HEalth, Inc.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
82240133

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Cost of financial assistance at cost was calculated with a cost to charge ratio using worksheet 2. The cost related to Medicaid patients was determined using Bon Secours Mercy Health's cost accounting system and included both inpatients and outpatients for traditional Medicaid and Medicaid managed care plans. For subsidized services Bon Secours Mercy Health's cost accounting system used to determine cost related to the specific service excluding traditional Medicaid and Medicaid managed care patients. Costs for charity and bad debt accounts are deducted using a ration of cost to charge specific to that subsidized service. Costs for other programs reflect the direct and indirect costs of providing those programs.

Schedule H, Part II Community Building Activities
Bon Secours Mercy Health (BSMH) addresses various community concerns including health improvement, poverty, workforce development, and access to health care. BSMH hospitals conduct community health education and support groups, health fairs and screenings for the communities served. BSMH hospitals work with state and local leadership to address community needs and provide healthcare services to the poor and underserved. BSMH is committed to addressing the social determinants of health (SDOH) and social needs for patients and communities throughout our footprint. With a deep understanding of both areas, the team is working systematically across the ministry and in our local communities to ensure we respond holistically and impactfully. BSMH addresses SDOH through its Community Health Needs Assessment (CHNA), Community, investment strategy, advocacy/public policy partnerships, and cross sector solutions. BSMH addresses social needs through SDOH patient assessment, health education/promotion programs, capacity building of local community resources, and closed loop referral system. BSMH hospitals provide programs to improve the physical surroundings and housing in the communities served. Inadequate housing has a negative impact on the health of residents in the area by leading to violence in the neighborhoods. A robust economy positively impacts residents covered by health insurance and improves the capacity of the community to support health services. Additional detail regarding BSMH's community building activities and the promotion of health of its communities can be found in its 2021 Community Health Annual Report available at https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. NET PATIENT ACCOUNTS ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED UPON BON SECOURS MERCY HEALTH'S (BSMH) HISTORICAL COLLECTION EXPERIENCE ADJUSTED FOR CURRENT ENVIRONMENTAL RISKS AND TRENDS FOR EACH MAJOR PAYOR SOURCE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS IN THE PERIOD OF SERVICE BASED ON PAST COLLECTION EXPERIENCE. BSMH'S CONCENTRATION OF CREDIT RISK RELATED TO NET PATIENT ACCOUNTS IS LIMITED DUE TO THE DIVERSITY OF PATIENTS AND PAYORS. NET PATIENT ACCOUNTS CONSIST OF AMOUNTS DUE FROM GOVERNMENTAL PROGRAMS (PRIMARILY MEDICARE AND MEDICAID), PRIVATE INSURANCE COMPANIES, MANAGED CARE PROGRAMS AND PATIENTS THEMSELVES. NET PATIENT SERVICE REVENUE FOR SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE IS RECOGNIZED BASED ON CONTRACTUAL RATES FOR SERVICES RENDERED. BSMH RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). AMOUNTS RECOGNIZED ARE SUBJECT TO ADJUSTMENT UPON REVIEW BY THIRD-PARTY PAYORS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, BSMH RECOGNIZES REVENUE WHEN SERVICES ARE PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF BSMH'S ININSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, BSMH RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. ANY DISCOUNTS APPLIED TO SELF-PAY PATIENTS WOULD BE DEEMED EITHER CHARITY OR A CONTRACTUAL ADJUSTMENT. BAD DEBT WOULD BE BASED ON THE BALANCE AFTER THE CHARITY OR CONTRACTUAL ADJUSTMENT THAT IS DEEMED UNCOLLECTABLE FOLLOWING A REASONABLE COLLECTION EFFORT.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
"BON SECOURS MERCY HEALTH (BSMH) FOLLOWS THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY (""CHA GUIDELINES"") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE MEDICARE LOSSES AS COMMUNITY BENEFIT. BSMH'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE MEDICARE AMOUNTS IN PART III."

Schedule H, Part V, Section B, Line 16a FAP website
A - ST. FRANCIS HOSPITAL - DOWNTOWN: Line 16a URL: https://www.bonsecours.com/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - ST. FRANCIS HOSPITAL - DOWNTOWN: Line 16b URL: https://www.bonsecours.com/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - ST. FRANCIS HOSPITAL - DOWNTOWN: Line 16c URL: https://www.bonsecours.com/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE;

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
"BON SECOURS MERCY HEALTH'S (BSMH) FINANCIAL ASSISTANCE POLICY DOES NOT PERMIT THE COST OF PATIENTS WHO ARE UNCOOPERATIVE OR UNABLE TO BE LOCATED TO BE RECLASSIFIED FROM FINANCIAL ASSISTANCE TO BAD DEBT. BSMH'S FINANCIAL ASSISTANCE POLICY REQUIRES AN APPLICATION AND SUPPORTING DOCUMENTATION. THEREFORE, ZERO DOLLARS ARE BEING REPORTED ON PART III, LINE 3 AS AMOUNTS INCLUDED IN BAD DEBT THAT COULD BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER BSMH'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL FOLLOWS THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY (""CHA GUIDELINES"") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE BAD DEBT EXPENSE AS COMMUNITY BENEFIT."

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
BON SECOURS MERCY HEALTH'S (BSMH) AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. BSMH ELECTED TO EARLY ADOPT ASU 2011-07. ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AS AN OPERATING EXPENSE. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS, 2. SIGNIFICANT ACCOUNTING POLICIES, (d) NET PATIENT ACCOUNTS AND NET PATIENT SERVICE REVENUE (PAGE 10) STATES Patient receivables are recorded at net realizable value based on certain assumptions determined by payor class. For third party payors including Medicare, Medicaid, and commercial insurance, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. For self-pay receivables, which includes patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries and any anticipated changes in trends.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
PATIENTS KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE NOT SENT TO A COLLECTION AGENCY. THE ORGANIZATION REPEATEDLY OFFERS PATIENTS ACCESS TO FINANCIAL HELP DURING THEIR HOSPITAL STAYS AND AFTER, AS WELL AS WITH EACH BILLING NOTICE. BILLS ARE SENT TO A COLLECTION AGENCY AS A LAST RESORT AND ONLY: WHEN PATIENTS HAVE THE ABILITY TO PAY SOME PORTION OF THEIR HEALTHCARE EXPENSES BUT REFUSE TO DO SO; WHEN PATIENTS REFUSE TO WORK WITH THE ORGANIZATION TO DETERMINE IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE VIA FEDERAL, STATE, LOCAL OR HOSPITAL ASSISTANCE PROGRAMS; WHEN THE ORGANIZATION IS UNABLE TO LOCATE THE PATIENT OR PERSON RESPONSIBLE FOR THE BILL. Patients that are presumed to be eligible for financial assistance based on individual life circumstances will be provided 100% financial assistance. Patients determined to have presumptive financial assistance eligibility will not be required to meet income criteria, asset eligibility criteria, or fill out a financial assistance application. BSMH utilizes available resources (e.g. technology solutions, service organizations, etc.) to obtain information such as credit scores to assist in determining a patient's presumed eligibility.

Schedule H, Part VI, Line 2 Needs assessment
BON SECOURS MERCY HEALTH (BSMH) HOSPITALS ASSESS AND CONTINUALLY RESPOND TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. BSMH HOSPITALS JOIN AN EXISTING COMMUNITY-BASED NEEDS ASSESSMENT EVERY THREE YEARS AND UPDATES ARE PROVIDED BETWEEN ASSESSMENTS. BSMH HOSPITALS INCORPORATE PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. BSMH HOSPITALS RECOGNIZE THE HEALTH OF THE COMMUNITY IS INFLUENCED BY SOCIAL, ECONOMIC, AND ENVIRONMENTAL FACTORS, NOT JUST BY DISEASE AND ILLNESS. OUR COMMUNITY BENEFIT INCLUDES BOTH QUALITATIVE AND QUANTITATIVE DATA; DEMOGRAPHICS INCLUDING RACE, AGE, AND ETHNICITY; SOCIOECONOMIC DATA INCLUDING INCOME, EDUCATION, AND HEALTH INSURANCE RATES; PRIMARY CARE AND CHRONIC DISEASE NEEDS OF UNINSURED PERSONS; AND DATA ON HEALTH DISPARITIES IN HEALTH OUTCOMES AMONG MINORITY GROUPS. BSMH HAS A DEDICATED STAFF TO ASSIST IN THE COMMUNITY BENEFIT EFFORT. BSMH'S COMMUNITY BENEFITS COMMITTEES MEET TO PROVIDE OVERSIGHT TO THE ORGANIZATION'S COMMUNITY BENEFITS PROGRAM. BSMH HOSPITALS WORK CLOSELY WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS IN THE AREA, PARTNERING WITH SOME TO PROVIDE SERVICES TO AVOID DUPLICATION.

Schedule H, Part VI, Line 4 Community information
THE COMMUNITY FOR EACH HOSPITAL IN THE BON SECOURS MERCY HEALTH (BSMH) SYSTEM IS DEFINED BOTH BY MISSION AND GEOGRAPHY. THE GEOGRAPHIC COMMUNITY IS DEFINED BY EACH HOSPITAL'S IMMEDIATELY CONTIGUOUS AREAS AS WELL AS BY THE BROADER SURROUNDING COUNTIES/REGIONS WHERE THE MAJORITY OF DISCHARGED PATIENTS RESIDE. ADDITIONALLY, THE COMMUNITY INCLUDES PATIENTS WHO REQUIRE THE EXPERTISE AND SPECIALIZED SERVICES OF A BSMH HOSPITAL. Approximately 514,000 residents reside in Greenville County. Greenville County has experienced a growth rate double that of the United States and significantly higher than the growth rate of South Carolina. As of 2017, Greenville County is predominantly White (75.3%), with a large Black/African American population (18.2%). Compared to South Carolina, Greenville has a larger percentage of Hispanics/Latinos. There is a slow, but steady increase in minority populations in Greenville County. Greenville has a similar age distribution compared to South Carolina, with slightly more children (age <18) and fewer older adults (age >65). The unemployment rate is lower in Greenville County than in South Carolina and the U.S. Greenville has a higher median income and per capita income than South Carolina, but less than the nation. At 13.5%, Greenville has a lower percentage of people living below the poverty level than the state (16.6%); however, there are differences by race/ethnic group. Hispanic/Latinos, Black/African Americans, and those who identify as Other have twice the Greenville percentage. Similar to South Carolina and the U.S., 33.2% of Greenville County residents aged 25 or over have a Bachelor's degree or higher. ADDITIONAL DETAIL REGARDING THE COMMUNITY FOR EACH HOSPITAL IN THE BSMH SYSTEM CAN BE FOUND IN EACH HOSPITAL'S CHNA AT THE FOLLOWING LINKS: HTTPS://WWW.MERCY.COM/ABOUT-US/MISSION/GIVING-BACK/COMMUNITY-HEALTH-NEEDS-ASSESSMENT https://www.bonsecours.com/about-us/community-commitment/community-health-needs-assessment

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
ST. FRANCIS HOSPITAL, INC. POSTS THE BON SECOURS MERCY HEALTH (BSMH) CHARITY CARE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY DEPARTMENTS AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. BSMH HOSPITALS PROVIDE A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS. ADDITIONALLY, A COPY OF THE POLICY OR A SUMMARY ALONG WITH FINANCIAL ASSISTANCE CONTACT INFORMATION IS INCLUDED IN PATIENT BILLS. BSMH HOSPITALS DISCUSS WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. THE HOSPITAL ELIGIBILITY LINK PROGRAM (HELP) IS A FREE REFERRAL SERVICE PROVIDED BY BSMH HOSPITALS. THE PURPOSE OF HELP IS TO ASSIST PATIENTS IN OBTAINING MEDICAL BENEFITS THROUGH FEDERAL, STATE, AND HOSPITAL PROGRAMS. HELP REPRESENTATIVES WILL PROVIDE THE FOLLOWING SERVICES AT NO COST TO THE PATIENT: *EXPLORE ELIGIBILITY UNDER PUBLIC ASSISTANCE PROGRAMS *FILE APPLICATIONS ON PATIENT'S BEHALF *SCHEDULE AND ATTEND APPOINTMENTS *PROVIDE TRANSPORTATION WHEN NECESSARY *PROVIDE MEDICAL DOCUMENTATION TO SOCIAL SECURITY ADMINISTRATION FOR DISABILITY CLAIMS. THROUGH HELP, PATIENTS AND THEIR COUNSELORS LOOK AT WHAT OPTIONS ARE AVAILABLE. BSmh HOSPITALS UNDERSTAND THAT NOT EVERYONE CAN PAY FOR HEALTHCARE SERVICES. HELP IS HERE TO OFFER OPTIONS AND ASSISTANCE FOR THOSE WHO ARE UNINSURED OR UNDERINSURED. HELP IS AN EXTENSION OF BMH'S MISSION TO IMPROVE THE HEALTH OF OUR COMMUNITY WITH EMPHASIS ON THE POOR AND UNDERSERVED. MEETING THE NEEDS OF THOSE WITH LIMITED RESOURCES HAS ALWAYS BEEN THE HEART OF OUR MISSION. BSMH IS PROUD TO MAKE OUR FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO THE PUBLIC THROUGH OUR WEBSITE, WHICH CAN BE FOUND AT: https://www.bonsecours.com/patient-resources/financial-assistance OTHER PATIENT EDUCATION INFORMATION THAT IS PROVIDED FOR ELIGIBILITY OF ASSISTANCE IS AS FOLLOWS: *BILINGUAL REPRESENTATIVES ARE AVAILABLE IN OUR CUSTOMER SERVICE DEPARTMENTS. *STAFF TRAINING ON HOSPITAL CARE ASSURANCE PROGRAM (HCAP) AND HOSPITAL FINANCIAL ASSISTANCE (HFA) WAS PROVIDED. TRAINING INCLUDED A MANUAL AND IN-DEPTH INFORMATION REGARDING THE PREPARATION OF THE COST REPORT LOGS, ACCURATE COMPLETION OF THE HCAP APPLICATION AS WELL AS AN OVERVIEW OF THE FAQ'S PROVIDED BY THE OHIO HOSPITAL ASSOCIATION. *STAFF TRAINING PROVIDED BY SOCIAL SECURITY ADMINISTRATION TO ASSIST PATIENTS IN OBTAINING DISABILITY BENEFITS. *FINANCIAL ASSISTANCE COUNSELORS WORK WITH CASE MANAGERS TO EXPEDITE THE TRANSFER OF PATIENTS TO EXTENDED CARE FACILITIES. *FEDERAL POVERTY GUIDELINES ARE POSTED ON OUR WEBSITE AS WELL AS A COPY OF OUR CHARITY APPLICATION. *ALL THIRD PARTIES THAT WORK ON BEHALF OF THE ORGANIZATION TO COLLECT FEES (SUCH AS COLLECTION AGENCIES AND LAW FIRMS) ARE REQUIRED TO FOLLOW BSMH'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. *CONSISTENT REVIEW OF SELF PAY PATIENTS FOR RETROACTIVE MEDICAID COVERAGE. *SERVICES PROVIDED BY VENDOR TO REACH OUT TO PATIENTS IN BAD DEBT TO SCREEN FOR HCAP ELIGIBILITY.

Schedule H, Part VI, Line 5 Promotion of community health
BON SECOURS MERCY HEALTH (BSMH) HOSPITALS, INCLUDING ST. FRANCIS HOSPITAL, INC., OPERATE EMERGENCY ROOMS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, BSMH HOSPITALS ALSO PROVIDE MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. BSMH HOSPITALS OPERATE TRAUMA SERVICES, AIR AMBULANCE SERVICES, DISEASE MANAGEMENT, WOUND CARE, SPECIALTY CLINICS, DEVELOPMENTAL THERAPY, HOSPICE, HOME CARE, CRISIS INTERVENTION, BEHAVIORAL SERVICES AND SUBSTANCE ABUSE SERVICES. BSMH HOSPITALS HAVE OPEN MEDICAL STAFFS WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. THE MAJORITY OF THE GOVERNING BODY CONSISTS OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITIES SERVED BY BSMH HOSPITALS. THE BSMH BOARD AND ITS MARKET GOVERNING BOARDS ARE COMPOSED OF MEMBERS OF THE COMMUNITIES SERVED WHO DIRECT AND GUIDE MANAGEMENT IN CARRYING OUT THE MISSION OF BSMH. BOARD MEMBERS ARE SELECTED ON THE BASIS OF THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS BENEFICIAL TO BSMH AND ITS AFFILIATED HOSPITALS IN FULFILLING ITS MISSION OF PROVIDING HEALTHCARE SERVICES TO THE POOR AND UNDER SERVED. BSMH HOSPITALS ENGAGE IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS. BSMH HOSPITALS PROVIDE RESIDENCY PROGRAMS AND OTHER TRAINING PROGRAMS. BSMH HOSPITALS PARTICIPATE IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. BSMH HOSPITAL'S EMERGENCY DEPARTMENTS TREAT AN INCREASING NUMBER OF PATIENTS WHO USE THE FACILITY FOR PRIMARY CARE NEEDS. PATIENT DEMOGRAPHICS REFLECT THE CHANGING COMMUNITY. AS IN OTHER COMMUNITIES, SOME AREA PHYSICIANS PLACE LIMITS ON THEIR ACCEPTANCE OF MEDICAID PATIENTS. IN ADDITION, SOME PRIMARY CARE PHYSICIANS REFER PATIENTS WITH AFTER-HOURS NEEDS DIRECTLY TO AREA EMERGENCY ROOMS. COMMUNITY GROUPS AND INDIVIDUALS ARE VERY SUPPORTIVE OF BSMH. BSMH FORGES COLLABORATIVE RELATIONSHIPS WITH THE FEDERALLY QUALIFIED HEALTH CENTERS IN ITS COMMUNITIES.

Schedule H, Part VI, Line 6 Affiliated health care system
"BON SECOURS ST. FRANCIS HEALTH SYSTEM, INC. AND ST. FRANCIS HOSPITAL, INC. ARE MEMBERS of Bon Secours Mercy Health, Inc., a Maryland nonprofit, nonstock membership corporation (BSMH), and all of the other entities that are controlled directly or indirectly by BSMH are described collectively as the System. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of Ohio, New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSMH aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. As a member of the Catholic health ministry and a member of BSMH, this organization and its related entities are called to continue the healing ministry of Jesus. We exist to benefit the people living in the communities it serves. Through all of the services offered to the community, the mission is ""to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a System of caregivers, we commit ourselves to help bring people and communities to health and wholeness as part of the healing ministry of Jesus Christ and the Catholic Church."" This organization and related organizations share the BSMH Vision. BSMH's vision to partner with communities to create a more humane world, build social justice for all and provide exceptional value for those served is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2019-2021). - Co-Create Healthy Communities: We recognize that the factors which drive health outcomes extend well beyond the scope of traditional health care services. Thus, we commit to improve the health of communities through partnership and collaboration with a broad range of constituencies including committed community residents - Be Person Centric: We recognize that those whom we serve are increasingly engaged in their own care and are seeking convenience, affordability and reliability. Thus, we commit to anticipate and respond to the changing expectations of health care consumers, and to ensure that we engage each person in an individualized plan for health with a focus on prevention and wellness. - Serve Those Who Are Vulnerable: We recognize, by our Catholic identity, that the struggle for a more humane world is not an option, but an integral part of spreading the gospel. Thus, we commit to serve those who are vulnerable in many ways, addressing health disparities, sustaining global ministries, healing the environment and working to end violence and oppression. - Strengthen Our Culture and Capabilities: We recognize that the health care delivery system is undergoing rapid change with increasing complexity. Thus, we commit to liberate the potential of our people by strengthening individual and collective capabilities with respect to ministry leadership, knowledge, analytics, innovation and finances. Please see Schedule R for listings of the related organizations. Each of the reported entities play a role in achieving the vision of BSMH and the SQP (Strategic Quality Plan). System-wide community benefit for 2021 per the audit footnote is as follows: Total 2021 Community Benefit: $605.3 Million Benefits to the Broader Community: $138.9 million Unreimbursed Care for Those Who Are Poor and Qualify for Medicaid: $371.6 million Cost of Care for Those Who Could Not Afford to Pay: $94.8 million Community Benefit as Percent of Total Expense: 5.7 percent."