4A (Expenses $ 260791276 including grants of $ 591421) (Revenue $ 376340396)
ASCENSION NE WISCONSIN, INC. HAS TWO HOSPITAL CAMPUSES: ST. ELIZABETH HOSPITAL, A 172-BED CAMPUS AND MERCY MEDICAL CENTER, A 120-BED CAMPUS. THESE LOCATIONS PROVIDE SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2022, ASCENSION NE WISCONSIN, INC. TREATED 11,225 ADULTS AND CHILDREN FOR A TOTAL OF 55,214 PATIENT DAYS OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES FOR 440,824 OUTPATIENT VISITS, WHICH INCLUDED 17,266 OUTPATIENT SURGERIES AND 45,009 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. AS PART OF THE ASCENSION CATHOLIC HEALTH MINISTRY, THE FILING ORGANIZATION SERVED IN SUPPORT OF ASCENSION'S COMMITMENT TO BOTH CARE FOR PATIENTS AND COMMUNITIES AND SUPPORT CAREGIVERS AND OTHER ASSOCIATES THROUGH THE CHALLENGES OF THE COVID-19 GLOBAL PANDEMIC IN FY22.

Schedule H, Part V, Section B, Line 3E
TO BETTER TARGET COMMUNITY RESOURCES ON THE SERVICE AREA'S MOST PRESSING HEALTH NEEDS, THE HOSPITAL PARTICIPATED IN A GROUP DISCUSSION WITH ORGANIZATIONAL DECISION MAKERS AND COMMUNITY LEADERS TO PRIORITIZE THE SIGNIFICANT COMMUNITY HEALTH NEEDS WHILE CONSIDERING SEVERAL CRITERIA: ALIGNMENT WITH ASCENSION HEALTH STRATEGIES OF HEALTHCARE THAT LEAVES NO ONE BEHIND; CARE FOR THE POOR AND VULNERABLE; OPPORTUNITIES FOR PARTNERSHIP; AVAILABILITY OF EXISTING PROGRAMS AND RESOURCES; ADDRESSING DISPARITIES OF SUBGROUPS; AVAILABILITY OF EVIDENCE-BASED PRACTICES; AND COMMUNITY INPUT. THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SEE SCHEDULE H, PART V, LINE 7 FOR THE LINK TO THE CHNA AND SCHEDULE H, PART V, LINE 11 FOR HOW THOSE NEEDS ARE BEING ADDRESSED.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - ASCENSION NE WISCONSIN - ST. ELIZABETH CAMPUS and ASCENSION NE WISCONSIN - MERCY CAMPUS. THE MOST RECENT ASCENSION NE WISCONSIN - ST. ELIZABETH AND MERCY CAMPUSES' COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH OTHER HEALTH SYSTEMS AND THE PUBLIC HEALTH AGENCIES IN THE FOX VALLEY REGION, WHICH INCLUDES OUTAGAMIE AND WINNEBAGO COUNTIES, TO TAKE INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. SPECIAL ATTENTION WAS GIVEN TO THE NEEDS OF INDIVIDUALS AND COMMUNITIES WHO ARE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. COMMUNITY INPUT WAS OBTAINED THROUGH THE FOLLOWING METHODS: --KEY STAKEHOLDER INTERVIEWS: CONDUCTED BETWEEN JULY 2021 AND AUGUST 2021, A SERIES OF 56 ONE-ON-ONE INTERVIEWS WERE CONDUCTED BY THE PARTNER HEALTH SYSTEMS AND HEALTH DEPARTMENTS TO GATHER FEEDBACK FROM KEY STAKEHOLDERS ON THE HEALTH NEEDS AND ASSETS OF OUTAGAMIE AND WINNEBAGO COUNTIES. THESE REPRESENTATIVES FROM DIFFERENT ORGANIZATIONS AND AGENCIES INCLUDED PARTICIPANTS FROM LOCAL HEALTH DEPARTMENTS AND REPRESENTATIVES OF ORGANIZATIONS THAT SERVE MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY AND RURAL POPULATIONS. A LIST OF THE ORGANIZATIONS THAT PROVIDED INPUT ARE LISTED BELOW: 211 UNITED WAY APPLETON PUBLIC LIBRARY APRICITY ASCENSION WISCONSIN ASCENSION CALUMET HOSPITAL AURORA MEDICAL CENTER OSHKOSH B3 WINNEBAGO & OUTAGAMIE BE WELL FOX VALLEY/UNITED WAY CALUMET COUNTY CATALPA HEALTH CHILD CARE RESOURCE AND REFERRAL CHILDREN'S WISCONSIN - FOX VALLEY CHILTON POLICE DEPARTMENT CITY OF APPLETON FIRE DEPARTMENT CITY OF APPLETON HEALTH DEPARTMENT CITY OF MENASHA HEALTH DEPARTMENT COMMON GROUNDS DAY BY DAY WARMING SHELTER DIVERSE AND RESILIENT ESTHER EVERGREEN RETIREMENT COMMUNITY FAMILY SERVICES FATHER CARR'S PLACE 2B FOX VALLEY LITERACY HMONG AMERICAN PARTNERSHIP IMAGINE FOX CITIES LEAVEN MENASHA SENIOR CENTER MULTI-CULTURAL COMMUNICATION TEAM NEW HOLSTEIN CITY NEW MENTAL HEALTH COALITION OSHKOSH AREA FOOD PANTRY OSHKOSH AREA SCHOOL DISTRICT OUTAGAMIE COUNTY DISTRICT ATTORNEY OUTAGAMIE COUNTY ADRC AND AGING DIVISION OUTAGAMIE COUNTY HEALTH AND HUMAN SERVICES OUTAGAMIE COUNTY PUBLIC HEALTH OUTAGAMIE COUNTY SHERIFF PEOPLE OF PROGRESSION PILLARS REACH ROCK LEDGE INTERMEDIATE SCHOOL, SEYMOUR SCHOOL DISTRICT RURAL HEALTH INITIATIVE SALVATION ARMY-CALUMET COUNTY SCHOOL DISTRICT OF HILBERT SOAR FOX CITIES, INC. THEDACARE THEDACARE, MENTAL HEALTH THOMPSON (SENIOR) CENTER ON LOURDES US2 BEHAVIORAL HEALTH UW OSHKOSH HEAD START WINNEBAGO COUNTY HEALTH DEPARTMENT, COMMUNITY HEALTH WINNEBAGO COUNTY HEALTH DEPARTMENT, WI WELL WOMAN WINNEBAGO COUNTY HEALTH DEPARTMENT, HEALTH OFFICER WORLD RELIEF FOX VALLEY YMCA OF THE FOX CITIES

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - ASCENSION NE WISCONSIN - ST. ELIZABETH CAMPUS and ASCENSION NE WISCONSIN - MERCY CAMPUS. THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES ADVOCATE AURORA HEALTH CARE, ASCENSION CALUMET HOSPITAL, CHILDREN'S WISCONSIN, THEDACARE

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - ASCENSION NE WISCONSIN - ST. ELIZABETH CAMPUS and ASCENSION NE WISCONSIN - MERCY CAMPUS. THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITIES APPLETON HEALTH DEPARTMENT, CALUMET COUNTY PUBLIC HEALTH, MENASHA HEALTH DEPARTMENT, OUTAGAMIE COUNTY PUBLIC HEALTH DEPARTMENT, WINNEBAGO COUNTY PUBLIC HEALTH DEPARTMENT

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - ASCENSION NE WISCONSIN - ST. ELIZABETH CAMPUS and ASCENSION NE WISCONSIN - MERCY CAMPUS. USING THE CHNA COMPLETED IN JUNE 2019, THE HOSPITAL FINISHED A THREE-YEAR IMPLEMENTATION STRATEGY TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. IN FISCAL YEAR 2022 (TAX YEAR 2021), THE HOSPITAL IMPLEMENTED THE FOLLOWING PLAN TO ADDRESS THE PRIORITY NEEDS: HEALTHY WEIGHT: INCREASE THE PROPORTION OF RESIDENTS WHO HAVE A HEALTHY DIET AND REGULAR PHYSICAL ACTIVITY -- INCREASED AWARENESS, EDUCATION AND TRAINING BY PARTICIPATING IN AND FUNDING REGIONAL COALITIONS, INCLUDING THE BE WELL FOX VALLEY COALITION (FORMERLY WEIGHT OF THE FOX VALLEY), WHICH OFFERED EVENTS, NEWSLETTERS AND SOCIAL MEDIA POSTS. THE FOX VALLEY COALITION IS COORDINATING A FOOD AS MEDICINE PROGRAM AND HOSTED AMERICORPS MEMBERS TO DELIVER EDUCATION PROGRAMS. -- CONTINUED HEALTHY EATING/LIFESTYLE EDUCATION FOR YOUTH AND ADULTS AT VARIOUS COMMUNITY EVENTS -- IMPLEMENTED ROUTINE BODY MASS INDEX SCREENING, RESOURCES AND REFERRALS IN PRIMARY CARE SETTINGS MENTAL HEALTH: REDUCE SUICIDES IN OUTAGAMIE AND WINNEBAGO COUNTIES -- INCREASED AWARENESS, EDUCATION AND TRAINING AROUND MENTAL HEALTH AND SUICIDE PREVENTION THROUGH PARTICIPATION IN REGIONAL COALITIONS. THOSE COALITIONS CONDUCTED VARIOUS TRAININGS, INCLUDING QUESTION, PERSUADE, REFER (QPR) FOR INDIVIDUAL COMMUNITY MEMBERS AND ZERO SUICIDE FOR ORGANIZATIONS SEEKING TO CHANGE THEIR INTERNAL SYSTEMS TO REDUCE SUICIDE. -- THE HOSPITAL HELPED FUND A NUMBER OF MENTAL HEALTH PROGRAMS AND SUPPORTED SCREENINGS WITHIN THE COMMUNITY -- CONTINUED THE IMPLEMENTATION OF DEPRESSION SCREENING IN PRIMARY CARE SETTINGS AND IMPROVED PROCESSES FOR INCREASED SCREENING RATES **WHILE ALL PRIORITIZED SIGNIFICANT NEEDS WERE ADDRESSED, COVID-19 DISRUPTED SOME ORIGINAL IMPLEMENTATION STRATEGIES. THE HOSPITALS NEEDED TO MODIFY OR ADD TO CURRENT STRATEGIES TO PROTECT THE HEALTH AND WELLBEING OF STAFF, PATIENTS AND COMMUNITY MEMBERS. THE DESCRIPTION BELOW INCLUDES THE NEEDS NOT BEING ADDRESSED IN THE 2019-2022 CHNA AS WELL AS THE REASON WHY THE NEEDS ARE NOT BEING ADDRESSED. -ALCOHOL MISUSE/SUBSTANCE ABUSE WAS NOT SELECTED IN THIS CHNA CYCLE. ADDRESSING ALCOHOL AND SUBSTANCE ABUSE AT THE COMMUNITY LEVEL IS A COLLABORATIVE UNDERTAKING. AT THIS TIME, COMMUNITY MOMENTUM AND PARTNERSHIPS ON THIS ISSUE ARE LIMITED. AS OPPORTUNITIES ARISE TO SUBSTANTIVELY AND COLLABORATIVELY ADDRESS SUBSTANCE ABUSE IN OUTAGAMIE AND WINNEBAGO COUNTIES, THE HOSPITAL CAMPUSES WILL PARTICIPATE. ADDITIONALLY, THE CAMPUSES WILL SEEK INTERNAL OPPORTUNITIES TO ADDRESS ALCOHOL MISUSE/SUBSTANCE ABUSE. ********** BASED ON THE CHNA COMPLETED IN JUNE 2022, THE HOSPITAL WILL WORK ON EXECUTING A 2022-2025 IMPLEMENTATION STRATEGY TO ADDRESS THE FOLLOWING PRIORITY NEEDS: ALCOHOL AND DRUG USE: -INCREASE COMMUNITY INITIATIVES FOR ALCOHOL AND DRUG MISUSE TREATMENT -PARTNER ON PREVENTION IN THE COMMUNITY -INCREASE ACCESS TO ALCOHOL AND DRUG MISUSE SERVICES FOR ASCENSION WISCONSIN PATIENTS -PROVIDE HOLISTIC SUPPORT SERVICES FOR ASCENSION WISCONSIN PATIENTS IN RECOVERY DIET AND EXERCISE: -ENGAGE AND EDUCATE COMMUNITY MEMBERS ABOUT HEALTH AND PREVENTION -EXPAND OPPORTUNITIES FOR COMMUNITY MEMBERS TO BE ENGAGED IN HEALTHY LIVING ACTIVITIES -PROMOTE SCREENINGS AND INTERVENTIONS FOR CHRONIC DISEASE PREVENTION -EDUCATE PATIENTS AND ASSOCIATES ABOUT HEALTHY FOODS AND PHYSICAL ACTIVITY MENTAL HEALTH: -SUPPORT COMMUNITY-BASED INITIATIVES THAT CREATE AN ENVIRONMENT FOR MENTAL WELLBEING -INCREASE COMMUNITY INITIATIVES FOR MENTAL HEALTH ACCESS -PROMOTE EARLY DETECTION AND TREATMENT FOR MENTAL HEALTH CONDITIONS -DELIVER COMPREHENSIVE, COMPASSIONATE CARE TO THOSE THAT HAVE EXPERIENCED TRAUMA ********** ASCENSION NE WISCONSIN UNDERSTANDS THE IMPORTANCE OF ALL THE HEALTH NEEDS OF THE COMMUNITY AND IS COMMITTED TO PLAYING AN ACTIVE ROLE IN IMPROVING THE HEALTH OF THE PEOPLE IN THE COMMUNITIES WE SERVE. FOR THE PURPOSES OF THIS CHNA, WE HAVE CHOSEN TO FOCUS OUR EFFORTS ON THE PRIORITIES LISTED ABOVE. THE FOLLOWING HEALTH NEEDS WERE NOT SELECTED TO BE INCLUDED IN THIS PLAN FOR THE REASONS DESCRIBED BELOW. --SAFE AND AFFORDABLE HOUSING, SOCIAL CONNECTEDNESS AND BELONGING AND ECONOMIC STABILITY AND EMPLOYMENT: THESE SOCIAL DETERMINANTS OF HEALTH WERE NOT PRIORITIZED DUE TO HOSPITAL AND STAFF CAPACITY. HOWEVER, ASCENSION ST. ELIZABETH IS COMMITTED TO PARTICIPATING WITH PARTNERS IN ADDRESSING THESE NEEDS AND WILL CONTINUE TO LOOK FOR OPPORTUNITIES TO DO SO. THESE ARE INDEED IMPORTANT ISSUES FOR OUTAGAMIE COUNTY, BUT REQUIRE A SYSTEM APPROACH TO BE LED BY RESPECTIVE SUBJECT EXPERTS. ASCENSION ST. ELIZABETH WILL CONSIDER THE SOCIAL DETERMINANTS OF HEALTH AS A LENS IN CONDUCTING ITS IMPLEMENTATION STRATEGY AND WILL SUPPORT COMMUNITY EFFORTS AS AVAILABLE.

Schedule H, Part I, Line 3c FACTORS OTHER THAN FPG
"IN ADDITION TO FPG, THE ORGANIZATION USES MEDICAL INDIGENCY, ASSET TEST, INSURANCE STATUS AND RESIDENCY AS OTHER FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A PATIENT MAY NOT BE ELIGIBLE FOR THE FINANCIAL ASSISTANCE IF SUCH PATIENT IS DEEMED TO HAVE SUFFICIENT ASSETS TO PAY PURSUANT TO AN ""ASSET TEST."" THE ASSET TEST INVOLVES A SUBSTANTIVE ASSESSMENT OF A PATIENT'S ABILITY TO PAY BASED ON THE CATEGORIES OF ASSETS MEASURED IN THE FAP APPLICATION. A PATIENT WITH SUCH ASSETS THAT EXCEED 250% OF SUCH PATIENT'S FPL AMOUNT MAY NOT BE ELIGIBLE FOR FINANCIAL ASSISTANCE. AN ASSET TEST APPLIES IF A PATIENT HAS ELIGIBLE LIQUID ASSETS THAT EXCEED 250% OF THE PATIENT'S FPG LEVEL FOR CONSIDERATION OF FINANCIAL ASSISTANCE ELIGIBILITY. LIQUID ASSETS INCLUDE ASSETS THAT CAN BE CONVERTED TO CASH WITHIN 1 YEAR. THESE INCLUDE ITEMS SUCH AS CHECKING ACCOUNTS, SAVINGS ACCOUNTS, TRUST FUNDS AND LUXURY ITEMS SUCH AS RECREATIONAL VEHICLES, BOATS, A SECOND HOME, ETC."

Schedule H, Part I, Line 5a BUDGET AMOUNTS FOR FREE OR DISCOUNTED CARE
THE ORGANIZATION ADMINISTERS ITS FINANCIAL ASSISTANCE POLICY IN ACCORDANCE WITH THE TERMS OF THE POLICY.

Schedule H, Part I, Line 7g Subsidized Health Services
ST. ELIZABETH HOSPITAL - CATALPA HEALTH IS A PEDIATRIC OUTPATIENT MENTAL HEALTH AND WELLNESS ORGANIZATION. COMPREHENSIVE MENTAL HEALTH SERVICES ARE PROVIDED THROUGHOUT THE REGION AND IN MORE THAN 50 SCHOOL-BASED THERAPY SITES. SERVICES INCLUDE THERAPY, PSYCHOLOGY AND PSYCHIATRY SERVICES, AS WELL AS SUPPORT FOR CHILDREN AND THEIR FAMILIES IN COPING WITH PEDIATRIC MENTAL HEALTH CONDITIONS AND ENSURING CHILDREN ARE ABLE TO CONTINUE THEIR EDUCATION.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
"THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (""CHA"") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED."

Schedule H, Part II Community Building Activities
THERE WERE NO COMMUNITY BUILDING ACTIVITIES TO REPORT THIS YEAR. ALL REPORTED ACTIVITIES QUALIFY AS COMMUNITY BENEFIT AND ARE DESCRIBED IN THE NARRATIVE UNDER SCH H PART I LINE 7.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES. AFTER APPLYING THE COST-TO-CHARGE RATIO, THE SHARE OF THE BAD DEBT EXPENSE IN FISCAL YEAR 2022 WAS $13,001,041 AT CHARGES, ($4,393,631 AT COST).

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BASED ON THE ORGANIZATION'S ADMINISTRATION OF ITS FINANCIAL ASSISTANCE PROGRAM, NO ESTIMATE FOR BAD DEBT ATTRIBUTABLE TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS IS DEEMED APPLICABLE TO HOSPITAL OPERATIONS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE ORGANIZATION IS PART OFASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSESBAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 17-20, OF THE AUDITED FINANCIAL STATEMENTS.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE GROSS CHARGES TO CALCULATE MEDICARE COSTS, WHICH ARE THEN COMPARED TO MEDICARE PAYMENTS RECEIVED, TO DETERMINE A MEDICARE GAIN OR LOSS. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT A MEDICARE SHORTFALL (LOSS) IS NOT TREATED AS COMMUNITY BENEFIT, EVEN THOUGH THE HOSPITAL HAS INCURRED LOSSES IN PROVIDING CARE TO MEDICARE PATIENTS. THEREFORE, NONE OF THE AMOUNT ON LINE 7 IS TREATED AS COMMUNITY BENEFIT.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
THE FILING ORGANIZATION FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED IF ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED FOR THE AMOUNTS FOR WHICH THE PATIENT QUALIFIES.

Schedule H, Part V, Section B, Line 16a FAP website
A - ASCENSION NE WISCONSIN - ST. ELIZABETH CAMPUS: Line 16a URL: https://healthcare.ascension.org/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - ASCENSION NE WISCONSIN - ST. ELIZABETH CAMPUS: Line 16b URL: https://healthcare.ascension.org/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - ASCENSION NE WISCONSIN - ST. ELIZABETH CAMPUS: Line 16c URL: https://healthcare.ascension.org/financial-assistance;

Schedule H, Part VI, Line 2 Needs assessment
IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, ASCENSION NE WISCONSIN, INC. USE BOTH HOSPITAL DATA AND RELIABLE, THIRD PARTY REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THESE REPORTS PROVIDE INFORMATION ABOUT KEY HEALTH, SOCIOECONOMIC, AND DEMOGRAPHIC INDICATORS THAT POINT TO AREAS OF NEED. ASCENSION NE WISCONSIN (F/K/A ST. ELIZABETH HOSPITAL, INC.) UTILIZES THIS INFORMATION TO DETERMINE DEVELOP PROGRAMS AND SERVICES TO BE PROVIDED FOR THE COMMUNITY. THESE NEEDS AND INITIATIVES ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE CONSIDERED IN DEVELOPING THE ORGANIZATION'S STRATEGY, POLICY DEVELOPMENT, AND INTERNAL FINANCIAL AND OPERATIONAL DECISIONS.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
ASCENSION NE WISCONSIN, INC. IS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL, IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, ASCENSION NE HOSPITAL'S FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES; ASCENSION NE HOSPITAL'S PROVIDES FULL FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 250% OF THE FEDERAL POVERTY LEVEL AND SLIDING SCALE ASSISTANCE UP TO 400% OF THE FEDERAL POVERTY LEVEL. ASCENSION NE WISCONSIN, INC. WIDELY PUBLICIZES ITS: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY VIA THE HOSPITAL FACILITY'S WEBSITE - https://healthcare.ascension.org/Locations/Wisconsin/WIAPA/Appleton-Ascension-NE-Wisconsin-St-Elizabeth-Campus/Financial-Assistance https://healthcare.ascension.org/Locations/Wisconsin/WIAPA/Oshkosh-Ascension-NE-Wisconsin-Mercy-Campus/Financial-Assistance ASCENSION NE WISCONSIN, INC. MAKES PAPER COPIES OF THE: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION. THE PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. ASCENSION NE WISCONSIN, INC. INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION MAY BE FOUND. ASCENSION NE WISCONSIN, INC. INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 4 Community information
ASCENSION NE WISCONSIN, INC. -- MERCY CAMPUS AND ASCENSION NE WISCONSIN, INC. -- ST. ELIZABETH CAMPUS PRIMARILY SERVE THE RESIDENTS OF WINNEBAGO AND OUTAGAMIE COUNTIES AND THE SURROUNDING COUNTIES IN AN URBAN AREA OF EAST CENTRAL WISCONSIN. THE POPULATION OF WINNEBAGO COUNTY IS APPROXIMATELY 171,000, WITH 12% OF RESIDENTS LIVING AT OR BELOW THE FEDERAL POVERTY THRESHOLD. THE MEDIAN HOUSEHOLD INCOME IS OVER $58,000. APPROXIMATELY 5% OF THE INDIVIDUALS LIVING IN THE COUNTY ARE UNINSURED AND 18% RECEIVE MEDICAID. WINNEBAGO COUNTY INCLUDES DESIGNATED MENTAL HEALTH CARE AND DENTAL HEALTH CARE SHORTAGE AREAS. THERE ARE 4 HOSPITALS IN WINNEBAGO COUNTY (ASCENSION NE WISCONSIN - MERCY CAMPUS, AURORA MEDICAL CENTER IN OSHKOSH, CHILDREN'S HOSPITAL OF WISCONSIN -- FOX VALLEY AND AN INPATIENT MENTAL HEALTH CENTER). THE POPULATION OF OUTAGAMIE COUNTY IS APPROXIMATELY 186,000, WITH 7% OF RESIDENTS LIVING AT OR BELOW THE FEDERAL POVERTY THRESHOLD. THE MEDIAN HOUSEHOLD INCOME IS OVER $61,000. APPROXIMATELY 6% OF THE INDIVIDUALS LIVING IN THE COUNTY ARE UNINSURED AND 17% RECEIVE MEDICAID. OUTAGAMIE COUNTY INCLUDES DESIGNATED PRIMARY CARE, MENTAL HEALTH CARE AND DENTAL HEALTH CARE SHORTAGE AREAS. THERE ARE 2 HOSPITALS IN OUTAGAMIE COUNTY (ASCENSION NE WISCONSIN -- ST. ELIZABETH CAMPUS AND THEDACARE REGIONAL MEDICAL CENTER -- APPLETON). BOTH CAMPUSES ARE DISPROPORTIONATE SHARE HOSPITALS. (DISPROPORTIONATE SHARE HOSPITALS SERVE A SIGNIFICANTLY DISPROPORTIONATE NUMBER OF LOW-INCOME PATIENTS AND RECEIVE PAYMENTS FROM THE CENTERS FOR MEDICAID AND MEDICARE SERVICES TO COVER THE COSTS OF PROVIDING CARE TO UNINSURED PATIENTS.)

Schedule H, Part VI, Line 5 Promotion of community health
THE ORGANIZATION STRIVES TO FURTHER ITS EXEMPT PURPOSES BY THE FOLLOWING: (1) THE ORGANIZATION'S GOVERNING BOARD CONSISTS PRIMARILY OF PERSONS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA WHO ARE NOT EMPLOYEES OF THE ORGANIZATION. (2) AS MENTIONED, THE ORGANIZATION PROVIDES SEVERAL SERVICES WHICH ARE NOT OTHERWISE AVAILABLE BEING IN A RURAL SETTING. (3) BASED ON THE ORGANIZATION'S MISSION, EMERGENCY ROOMS ARE MADE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY. (4) THE ORGANIZATION ALSO PARTICIPATES IN THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS THROUGH INTERNSHIP PROGRAMS. CERTAIN SPECIALIZED SERVICES AVAILABLE INCLUDE: DENTAL SERVICES TO PRIMARILY THE INDIGENT, FERTILITY CLINIC SERVICES AND WIC HOME VISITS TO NEW MOTHERS AND INFANTS.

Schedule H, Part VI, Line 6 Affiliated health care system
ASCENSION NE WISCONSIN, INC. IS A MEMBER OF ASCENSION. ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 19 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. ASCENSION NE WISCONSIN, INC. IS AN AFFILIATE OF MINISTRY HEALTH, INC. AND ASCENSION HEALTH. THE HOSPITAL'S AFFILIATES ARE LARGE MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT MINISTRIES INCLUDING HOSPITAL AND NON-HOSPITAL MINISTRIES (PHYSICIAN GROUP PRACTICES, HOSPITAL ORGANIZATIONS, RESEARCH, HOME HEALTH, DURABLE MEDICAL EQUIPMENT AND SENIOR FACILITIES). THESE MINISTRIES WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF SERVING AS A HEALING PRESENCE WITH SPECIAL CONCERN FOR OUR NEIGHBORS ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION AND RESEARCH. THE ORGANIZATIONS WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, STATE AND NATIONAL LEVEL. THE ORGANIZATION PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING HEALTHCARE SERVICES IN THE SOUTHEAST WISCONSIN AREA, REGARDLESS OF THE PERSON'S ABILITY TO PAY, BECAUSE IT IS OUR MISSION TO IMPROVE THE LIVES OF THOSE IN THE COMMUNITIES WE SERVE.