4A (Expenses $ 585189017 including grants of $ 300073) (Revenue $ 667311644)
PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

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

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - SSM Health St. Mary's Hospital - Madison. THE HOSPITAL, THROUGH THE HEALTHY DANE COLLABORATIVE, ASSESSED INPUT FROM THE COMMUNITY AND DATA RELATED TO HEALTH FACTORS PRESENTED BY THE COUNTY HEALTH RANKINGS TO UNDERSTAND WHAT IMPACTS THE HEALTH OF THE COMMUNITY. PARTICULAR ATTENTION WAS GIVEN TO SOCIAL, ECONOMIC, AND ENVIRONMENTAL DISADVANTAGED POPULATIONS. THE HOSPITAL UTILIZED KEY INFORMANT INTERVIEWS, COMMUNITY INPUT SESSIONS AND SURVEYS, PROVIDER SURVEYS, AND A YOUTH ASSESSMENT.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - SSM Health St. Mary's Hospital - Madison. THE 2021 CHNA WAS COLLABORATIVELY COMPLETED WITH THE FOLLOWING OTHER HOSPITALS THROUGH THE HEALTHY DANE COLLABORATIVE: UW HEALTH, UNITYPOINT HEALTH-MERITER, AND STOUGHTON HOSPITAL.

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - SSM Health St. Mary's Hospital - Madison. THE 2021 CHNA WAS COLLABORATIVELY COMPLETED WITH THE FOLLOWING OTHER COMMUNITY PARTNERS THROUGH THE HEALTHY DANE COLLABORATIVE: GROUP HEALTH COOPERATIVE AND PUBLIC HEALTH MADISON DANE COUNTY.

Schedule H, Part V, Section B, Line 11 Facility A, 1
"Facility A, 1 - SSM Health St. Mary's Hospital - Madison. The Hospital identified various health needs in the 2021 CHNA, which was done in conjunction with the Healthy Dane Collaborative. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Reproductive justice - Chronic conditions - Behavioral health - Injury prevention Reproductive justice In Dane County, maternal and child health has continually been identified as a top health priority. Mother and baby wellbeing plays a large role in the health of the next generation. There are also significant disparities within the county between races and ethnicities. Our vision is for all Dane County residents to have an optimal health and wellbeing. Our mission Is to eliminate gaps and barriers to optimal health and reduce disparities In health outcomes. Our #1 priority is maternal and child health for the following reasons: - The Dane County Black-White disparity in severe maternal mortality is similar to statewide and national benchmarks. Structural racism is associated with these disparities and may affect the quality of care Black women and birthing persons receive before and during pregnancy, during delivery hospitalization, and postpartum. - In Dane County, 82.7% of women accessed early prenatal care. Rates were lower for mothers 15-24 years old. - African American babies are more likely to be born with low birth weight (less than 5 pounds, 8 ounces) or very low birth weight (less than 3 pounds, 5 ounces) than White babies. - The birth of a healthy baby is not only the result of 9 months of pregnancy, but the entire span of a woman's life leading up to pregnancy. Chronic stress over the life course (e.g. in the community, social relationships, discrimination, finances, trauma) causes wear and tear on the body and can impact health outcomes. The Hospital has the following action plan in place to improve reproductive justice: - Employ a community healthcare approach to identify low, medium, and high-risk pregnant women by gathering social determinants of health (SDOH) information. - All pregnant women will be screened for SDOH and have access to the 211 Community support directory. Medium and high-risk patients will be referred to Community Health workers or an OB RN navigator. - Host the Black Maternal and Child health community advisory board (CAB) monthly to provide input and recommendation for improving culturally competent healthcare. - Institute process, programming and policy changes in response to CAB recommendations. - Provide financial stipends to participants for their time and expertise. We expect the outcomes outlined below as a result of the action plan: - Black and African American women that are identified as medium to high risk will be referred to Compass Rose program at UW Health. - Reduce black infant mortality rates in Dane County from 10.5 deaths per 1000 live births to 5.6 deaths per 1000 live births which is equivalent to the mortality rate for white infants. - Reduce black pre-term deliveries from 15% to 10% which is equivalent to other populations. - Participation in the community advisory board to assist in the efforts for process change, program development, and policy efforts. - Build trust between the black and African American community and healthcare in Dane County. Chronic conditions Significant racial and ethnic health inequities exist in the Madison community and the broader Dane County area. Disparities in equity of care also persist within healthcare institutions. St. Mary's Hospital Madison has a sincere interest in working closely with community partners to provide health education, health promotion and disease prevention activities and resources. - The age adjusted hospitalization rate due to pediatric asthma in Dane County is higher than state rate (6.8) at 11.0 hospitalizations per 100,000, the rate for Black pediatric Dane residents is almost 6 times that of Whites. - 88.2% of high school students report being physically active for 60 minutes at least one or more days per week, slightly lower than 2018 at 91. - In Dane County there are 0.15 grocery stores per 1,000 population. - 25.3% of adults living in Dane County are obese and 32.6% of adults in Dane County are overweight. - The age adjusted hospitalization rate due to Hypertension for Black and African American individuals is 55.2 compared to 4.0 for White individuals in Dane County. The Hospital has implemented the following steps to address chronic conditions in the community: - Regularly provide subject matter experts (SMEs) for health education, health promotion and disease prevention events with a Rebalanced-Life Wellness Association (RLWA) group. - Provide a meeting space and refreshments at SSM Health for the group to converse. - Launch pre- and post-surveys to track knowledge enhancement and areas of need. - Provide funding to RLWA. - Host the Black Men's Health Community Advisory Board (CAB) quarterly to provide input and recommendation for improving culturally competent healthcare. - Institute process, programming and policy changes in response to CAB recommendations. - Promote physical activity events such as Black Men Run and Black Men Cycle Madison. With the steps above put in place, outcomes associated with chronic conditions include: - More black men in Dane County will have access to health education on chronic disease. - Participating black men will have increased knowledge on chronic disease prevention and management. - Reduce the heart disease death rate in black, Dane County residents from 175.2 per 100,000 to 150.0 per 100,000. - Reduce hospitalizations in black, Dane County residents from 55.2 to 40.0. - Black men will assist in the community advisory board (CAB) to assist in the efforts for process change, program development, and policy development. - Black men will share satisfaction with CAB process and SSM response to change. - Black community members will share there is improved communication and cultural humility in healthcare services. Behavioral Health In 2021, Behavioral Health came to the top of the identified priority needs in Dane County. Our children need to learn that talking about feelings in an effort to get better is the right thing to do. No one should suffer in silence. - The overall age adjusted death rate due to Alzheimer's Disease in Dane County is higher than state and national rates at 33.3 deaths per 100,000. - 13.8% of high school seniors report binge drinking. 60.1% of the binge drinkers were girls. - Lower income high school youth report a higher rate of suicidal thoughts (41.9%) than their more affluent peers (16.3%). - Although responses varied by race, ethnicity and language preference, ""Substance abuse"" was consistently seen as the second most critical health need among survey respondents. - Between 2015 and 2019, the rate of opioid related overdose deaths in Dane County increased by almost 50%. The Hospital's action plan on behavioral health involves: - Educate and provide information to local schools and colleges. - Campaign for the Jakob's SWAG Foundation and its Got Your Back app. - Educate youth on mental health resources and prevention through clubs, athletics and/or health classes. - Educate school staff through in-services or staff meetings. - Ensure every patient seeking Behavioral health services has a collaborative safety plan completed. - Continue collaborative efforts as a key member of the Dane County zero suicide to implement the initiative. - Be the healthcare representative on the WI Coalition for Senior Isolation and Loneliness. The hospital intentionally plans the below results: - students will have access to an app with prevention tools to ensure support though mental health crises. - decrease in students reporting suicidal thoughts in the last 30 days. - decrease of low-income students reporting a high rate of suicidal thoughts. - patients seeking behavioral health services will receive a collaborative action plan. - St. Mary's Hospital will be a key stakeholder in the Zero Suicide Team and Coalition for Senior Isolation. - Seniors in Dane County will have more education on the impact of isolation on mental health. - Reduce the age-adjusted suicide rate from Dane County men from 18.1 to 15.0. - Reduce the suicide rate for the senior population from 18.9 to 15.0."

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - SSM Health St. Mary's Hospital - Madison (continued). Injury Prevention In the State of Wisconsin, the top five causes for hospitalization due to injury from 2016-2019 include: fall, poisoning, motor vehicle, non-traffic transportation and struck by/or against an object or person. In 2019 2,242 Dane County residents were hospitalized due to an injury, of those hospitalizations 1,095 were due to an unintentional fall related injury. 65% (710) of those hospitalizations were for patients 65+. Falls are the number one leading cause of injury in Wisconsin and Dane County; this is also reflected in the St. Mary's Hospital Madison trauma registry. It is important to note that geriatric falls make up the majority of the trauma patients seen at St. Mary's Hospital Madison. Therefore, it was easily determined a fall prevention program needs to be an area of focus. The SSM Health Trauma Program collaborates with the SSM Health SAFE at Home program which provides comprehensive care for patients who are high risk for falling. The goal is to reduce falls and help participants live as safely and independently in their own homes for as long as possible. Recommendations are made in the following categories: medication, adaptive equipment, basic maintenance, community agency referral, decluttering, and home modification. - 17.2% of 9th 12th and 17.7% of 7th 8th grade youth report they had intentionally harmed themselves in the past 12 months compared to 15.5% and 14.9% respectively in 2018. - Poisoning was the leading cause of injury related hospitalization (from 2017 2019), followed by falls, then motor vehicle crashes. - Suffocation was the leading cause of injury related death, followed by motor vehicle crashes during this same time period. - Alcohol is involved in 34.3% of motor vehicle crash deaths in Dane County. - The age group with the highest suicide rate in Dane County was ages 65+. This age group (18.9) and ages 45 64 (15.3) had higher rates than Wisconsin rates (14.9). The Hospital's plans the following initiatives to assist with injury prevention: - Promote and support health and wellness events and classes around Fall Prevention such as Stepping On, Tai Chi, and the Only Leave Should Fall Prevention Conference. - Provide Fall prevention kids to seniors 65+ and support other initiatives of the SAFE at Home Initiative. - Support the work and efforts of the Focused Interruption's Community Safety Workers, Support Groups for families impacted by gun violence, and the outreach team. - Provide education to healthcare staff on Trauma-informed care. - Support SAFE Communities gun shop project. Results of the initiatives are predicted to be: - Dane County seniors will have access to fall prevention education. - Dane County seniors will receive fall prevention kits and community facing events focusing on fall prevention. - Reduce the number of falls in Dane County for the senior population. - Reduce the age-adjusted death rate from falls from 28.4 to 20.6 to be equivalent with Wisconsin as a whole. - Increase support for individuals seeking emergency medical services from gun violence through community safety workers or support groups. - Increase number of healthcare workers educated on trauma-informed care. - Increase number of gun shops and owners who are trained and practice lawful gun compliance. - Reduce gun violence in Dane County and deaths due to unintentional injuries from 58.6 to 50.0. The hospital has no plans to discontinue other community benefit efforts addressing additional health needs as outlined in its CHNA.

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

Schedule H, Part V, Section B, Line 5 Facility B, 1
Facility B, 1 - SSM Health St. Clare Hospital - Baraboo. SSM Health St. Clare Hospital -Baraboo sought and received input from the Sauk County Public Health Department. The hospital also worked closely with the Health & Wellness Steering Committee to develop the 2021 Sauk County Community Health Assessment (CHA).Community perspectives and data gathered during this endeavor were incorporated into the SSM Health St. Clare Hospital -Baraboo Community Health Needs Assessment. Community perspectives were gathered from multiple activities, including a community survey, key informant interviews, and focus groups (community conversations). In addition to a review of demographics, we gathered and reviewed data from broad sources to set the initial direction and priorities of the community health needs assessment. The secondary data was derived from a variety of unbiased sources including the County Health Rankings, 211 Count data from Sauk County, Community Commons, Wisconsin Hospital Association CHNA Dashboard and the Wisconsin Department of Health Service.

Schedule H, Part V, Section B, Line 11 Facility B, 1
"Facility B, 1 - SSM Health St. Clare Hospital - Baraboo. The Hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Mental Health - Affordable housing - Substance use Mental Health In 2021, Mental Health came to the top of the identified priority needs in Sauk County. Our children and seniors need to learn that talking about feelings in an effort to get better is the right thing to do. No one should suffer in silence. - 31% of survey residents said mental services are a challenge to obtain. - 15% of adults reporting fair or poor health. - 12% of survey residents said everyone in their household could get the Health services they needed only sometimes, rarely or never. - 13% of adults reporting 14 or more days of poor mental health per month The Hospital's action plan on mental health involves: - Educate and provide information to local schools and colleges. - Campaign for the Jakob's SWAG Foundation and its Got Your Back app. - Educate youth on mental health resources and prevention through clubs, athletics and/or health classes. - Educate school staff through in-services or staff meetings. - Provide access to healthy social activities through ""What's Your New Purpose"" for a healthy retirement - Wisconsin Institute for Healthy Aging (WIHA) evidence-based classes such as Living Well with Chronic Conditions and Stepping On Senior Exercise Classes at Civic Center - Service on WI Coalition to end Social Isolation - Utilize the ""Make It Okay"" campaign toolkit to reduce stigma around mental health in Sauk County. - Members of the Sauk County Health and Wellness Coalition and Prevention for Change along with other community members will become ""Make it Okay"" ambassadors. - Promote use of Pledge Cards in the community. Planned results of the hospital's strategies include the following: - students will have access to an app with prevention tools to ensure support though mental health crises. - increase of students having access to emotional support for mental health needs. - decrease of students reporting serious consideration of suicide. - increase of seniors enrolled in health-related classes to enhance both physical and mental health. - SSM Health will join the Coalition of Social Isolation as healthcare leaders in this work. - 33% of older adults in WI will report feeling lonely on a regular basis (decrease from 43%). - Sauk County organizations and community members will be a part of reducing stigma around mental health in Sauk County by becoming ""Make it okay"" ambassadors. - Reduce poor mental health days from 4.3 to 4.0 to be equivalent to the state of WI overall. - 5% increase in people who feel comfortable talking to someone about their mental health. Affordable Housing Safe, affordable housing is imperative to the health of an individual and for a thriving community. Evidence shows housing and health can be understood as supporting the existence of four pathways. First, the health impacts of not having a stable home (the stability pathway). Second, the health impacts of conditions inside the home (the safety and quality pathway), third, the health impacts of the financial burdens resulting from high cost housing (the affordability pathway) and lastly, the health impacts of neighborhoods, including both the environmental and social characteristics of where people live (the neighborhood pathway). - 28% Of the population live in cost burdened households (housing cost are 30% or more of total household income). - 8% of the population lack adequate access to foods. - 40% of children enrolled in public schools are eligible for free lunch or reduce price lunch. - 2.45% of occupied housing units are lacking complete kitchen facilities. The hospital has organized the following activities to improve affordable housing measures: - Provide financial support to Baraboo Area Homeless Shelter to do the following: initiate the purchase of shelter facility, begin a fund to supplement state-funded client grants for affordable rental housing, provide support towards salary of shelter staff. - Provide community education on health issues related to housing issues such as asthma and black mold. - Create pamphlet and educational materials on what to watch for in your home for health. - Share at local libraries, schools, WIC clinics and other community events. - Collaborate with key stakeholders in Sauk County focused on housing issues including quality and affordability. - Establish a workgroup to address Housing concerns in Sauk County. - Identify strategies as a county task force to better meet the needs of residents. Outcomes anticipated include: - Baraboo Area Homeless Shelter will own a facility building with SSM Health financial support. - Supplemental financial support will be provided to clients for affordable rental housing - Increase of homeless clients accessing the shelter who get permanent placement in stable housing. - Decreased number of homeless individuals in Sauk County. - Increase of individuals who access the shelter being placed in permanent housing (from 65% to 75% goal). - Sauk County residents will have increase knowledge of how housing impacts health through education. - 22% of county residents will report living in substandard living conditions (which would be a decrease from 27.55% currently). - Housing workgroup will be established and made up of multi-disciplinary organizations. - Decrease of county residents requesting rent and shelter assistance, and living in cost-burdened households. Substance Use Substance misuse is a serious concern in the community. Underage drinking, the use of vaping products, and misuse of prescription drugs and opioids are all issues. - 28% Of adults self-reported excessive drinking in the last 30 days. - 26.6 per 1,000 people were diagnosis with Drug/Substance abuse. - As of 2019 there were 21 reported drug poising deaths per 100,000. - Within the Sauk county area there are 18.7% adults who have smoked or are currently smoking. The hospital is involved in the following initiatives to help substance use in the community served: - Educate middle school students on dangers of vaping for prevention efforts. - Serve as the healthcare representative on the Tobacco Restorative Justice team. - Distribute Lock Boxes during discharge process with pharmacy team. - Distribute bottle locks and lock boxes at community-based events. - Create sample script and educate safe storage/disposal practices. - Promote ""Not In My House"" campaign throughout Sauk County. - Promote access to Satori House through referrals at ED when a patient presents with an opioid addiction. - Education provided regarding Satori House peer counselors. Goals of these initiatives are listed below: - middle and high school students will be more knowledgeable about dangers of vaping in Sauk County. - Decrease of youth vaping in Sauk County middle schoolers from 13% to 10%. - parents will have access to bottle locks and lock boxes to prevent youth access to alcohol. - increase public knowledge about the WI Social Host Law. - decrease in the percentage of youth accessing alcohol and unnecessary prescription drugs. - Provide resources to those seeking recovery in Sauk County. - Decrease the number of overdoses in Sauk County and related ER admissions. - increase recovery support for those with addiction. - decrease rate of opioid deaths from 25.3 to 20.0 per 100,000. The hospital has no plans to discontinue other community benefit efforts addressing additional health needs as outlined in its CHNA."

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

Schedule H, Part V, Section B, Line 5 Facility C, 1
Facility C, 1 - SSM Health St. Mary's Hospital - Janesville. SSM Health St. Mary's Hospital -Janesville sought and received input from the Rock County Public Health Department. The hospital also worked closely with the Health Equity Alliance of Rock County to develop the 2021 Rock County Community Health Assessment (CHA).Community perspectives and data gathered during this endeavor were incorporated into the SSM Health St. Mary's Hospital -Janesville's Community Health Needs Assessment. Community perspectives were gathered from multiple activities, including a community survey, key informant interviews, and focus groups (community conversations). In addition to a review of demographics, we gathered and reviewed data from broad sources to set the initial direction and priorities of the community health needs assessment. The secondary data was derived from a variety of unbiased sources including the Wisconsin Hospital Association's CHNA Dashboard, County Health Rankings, Youth Behavioral Risk Survey, Community Commons, Area Deprivation Index and Opportunity Atlas, and the Wisconsin Department of Health Services.

Schedule H, Part V, Section B, Line 6b Facility C, 1
Facility C, 1 - SSM Health St. Mary's Hospital - Janesville. The hospital partnered with Health Equity Alliance of Rock County to complete its 2021 Community Health Needs Assessment.

Schedule H, Part V, Section B, Line 11 Facility C, 1
"Facility C, 1 - SSM Health St. Mary's Hospital - Janesville. The Hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Mental health - Access to care Mental health Mental health is an essential part of overall health that includes emotional, psychological, and social wellbeing. Mental health can be determined by a range of factors and often affects how individuals cope with stress, relate to others, and make choices. Mental health was a primary topic of concern among Rock County residents through every mode of data collection. Specifically: - 17% of Rock County Youth reported they were seriously considering suicide in the past 12 months, with 8% actually attempting it. - In Rock County, 17% of adults aged 18 and older report they receive insufficient social and emotional support. - 18% of Rock County adults have a mental health diagnosis and Rock County residents averaged 4.3 poor mental health days compared to 4.0 for Wisconsin overall. The hospital is involved in the following initiatives to improve mental health measures in the community served: - Educate and provide information to local schools and colleges. - Campaign for the Jakob's SWAG Foundation and its Got Your Back app. - Educate youth on mental health resources and prevention through clubs, athletics and/or health classes. - Educate school staff through in-services or staff meetings. - Sponsor and provide space for the Strong Bodies program. - Serve as the healthcare leader on the coalition for social isolation and loneliness. - provide health related educational series geared toward seniors. - consider developing an Adopt a Senior program in Rock County. - Utilize the ""Make It Okay"" campaign toolkit to reduce stigma around mental health in Sauk County. - Members of the Sauk County Health and Wellness Coalition and Prevention for Change along with other community members will become ""Make it Okay"" ambassadors. - Promote use of Pledge Cards in the community. - distribute bottle locks and lock boxes as part of outreach events. - provide the Catch My Breath curriculum to middle and high school students in Rock County. - identify evidence-based workplace assessment and score card to offer local businesses. - provide education and tools to local businesses to make changes in the workplace culture around mental health. - adopt the Mental Health Friendly Workplace Initiative. Outcomes related to mental health are anticipated to be: - students will have access to an app with prevention tools to ensure support though mental health crises. - increase of students having access to emotional support for mental health needs. - decrease of students reporting serious consideration of suicide. - increase of seniors enrolled in health-related classes to enhance both physical and mental health. - SSM Health will join the Coalition of Social Isolation as healthcare leaders in this work. - 33% of older adults in WI will report feeling lonely on a regular basis (decrease from 43%). - Sauk County organizations and community members will be a part of reducing stigma around mental health in Sauk County by becoming ""Make it okay"" ambassadors. - Reduce poor mental health days from 4.3 to 4.0 to be equivalent to the state of WI overall. - 5% increase in people who feel comfortable talking to someone about their mental health. - Education to youth in Rock County on vaping prevention and distribution of lock boxes for prescription drugs and alcohol. - Reduction in youth vaping, youth drinking, and youth misuse of pain medications. - Assessment, education, and tools provided to local businesses, with these businesses adopting new mental health initiatives within their organization. - Rock County employees will report a reduction of stress and burnout in the workplace. Access to Care Access to healthcare generally means an individual is able to access timely health services to achieve the best health outcomes possible. Healthcare access is determined by healthcare coverage, timeliness of the available services, and the availability of the workforce providing healthcare services. These key components of healthcare access impact many of the factors that can promote good health such as service affordability, and receiving quality or routine care. Additional facts and figures that relate to access to care are below. - There were 991 preventable oral health visits in 2019. When compared to WI, Rock County averages 20 more ER visits / 10,000 people related to non-traumatic oral health issues. - The lack of health insurance is considered a key driver of health status.5.93% of Rock County residents are uninsured and 20.59% of Rock County Latinos are uninsured. - Health literacy is not simply a reflection of an individual's skills and abilities, but on how well health systems provide information and services. The hospital is implementing the following measures to improve access to care: - develop a partnership with HealthNet Dental to create an Emergency Room diversion program for uninsured and under-insured patients. - Train SSM Health emergency department staff in workflow for referring oral health patients to HealthNet Dental to establish a dental home. - establish a Maternal and Child Health Task Force in Rock County. - Identify and train black women from Rock County as birth doulas through Harambee Village. - Promote doula services in Rock County to improve black birth outcomes. - Teach Living Well with Chronic Conditions class for seniors on advocating for themselves. - Research and conduct a health literacy assessment at St. Mary's Hospital - Janesville. - MyChart education sessions for patient navigation at local libraries, churches, community centers and senior apartments. - Discuss opportunities for healthcare career pipelines for diverse students at Blackhawk Technical Collage. - Provide scholarship opportunities to culturally-diverse healthcare students. - Engage with Fresh Start students in pursuing healthcare careers. - Provide financial support for patients needing transportation services to access healthcare services. - Sponsor and enhance the Janesville Jets literacy program for area schools. - Sponsor Healthnet of Rock County to provide free healthcare services for low-income residents. - Sponsor local farmers markets and expand on existing SNAP benefits. The hospital attempts the following progress: - reduction of the number of ED visits related to an oral health concern at the hospital and increase referrals to HealthNet for dental services. - increase the number of uninsured and under-insured residents in Rock County with an established dental home. - Black women from within Rock County will be trained as birth doulas for low-income Rock County pregnant women. - Maternal and Child Health Task Force made up of local healthcare partners and nonprofits to address infant mortality in Rock County. - Reduce Blank Infant mortality from 16.8 per 1,000 births to 9.4 per 1,000 births, which is still two times the rate of white infants in Rock County. - seniors will learn new skills in advocating for themselves and navigating healthcare. - SMHJ will learn what changes to implement from an assessment to improve health literacy. - More Spanish language health education provided in Rock County. - No Rock County census tracts will be in the bottom quartile related to health literacy. - Seniors in Rock County will report improved health outcomes due to improved health literacy. - more Rock County diverse students will be interested in and receive financial assistance for healthcare careers. - Increased number of healthcare professionals in Rock County that represent diverse cultures, resulting in black patients feeling more welcome. - provide free transportation for residents to access healthcare. - sponsor HealthNet of Rock County. - Janesville students will increase time ready to improve literacy. - sponsor farmers' markets and other programs improving access to healthy food. - increase of Latino Rock County families with health insurance from 79% to 90%. - Decrease in percentage of households that are food insecure from 10.4% to 5%. The hospital has no plans to discontinue other community benefit efforts addressing additional health needs as outlined in its CHNA."

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

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

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

Schedule H, Part II Community Building Activities
SSM HEALTH CARE OF WISCONSIN PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: COMMUNITY SUPPORT: IN-KIND DONATIONS RELATED TO COVID, BELOIT AREA COMMUNITY HEALTH CENTER TRUCK OR TREAT EVENT SUPPORT; ENVIRONMENTAL IMPROVEMENTS: SAFE SHARPS DISPOSAL, HIGHWAY CLEANUP; LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS: BOYS AND GIRLS CLUB'S TODAY'S DREAMERS TOMORROW'S LEADERS EVENT SPONSORSHIP; WORKFORCE DEVELOPMENT: JOB SHADOWING PROGRAMS AND HEALTH CARE INDUSTRY DAY.

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

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

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

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

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

Schedule H, Part V, Section B, Line 16a FAP website
A - SSM Health St. Mary's Hospital - Madison: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; B - SSM Health St. Clare Hospital - Baraboo: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; C - SSM Health St. Mary's Hospital - Janesville: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - SSM Health St. Mary's Hospital - Madison: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; B - SSM Health St. Clare Hospital - Baraboo: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; C - SSM Health St. Mary's Hospital - Janesville: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - SSM Health St. Mary's Hospital - Madison: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; B - SSM Health St. Clare Hospital - Baraboo: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance; C - SSM Health St. Mary's Hospital - Janesville: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

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

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

Schedule H, Part VI, Line 6 Affiliated health care system
SSM HEALTH CARE OF WISCONSIN (SSMHC/WI) IS A COMPREHENSIVE NOT-FOR- PROFIT CATHOLIC HEALTH CARE ORGANIZATION PROVIDING HEALTH CARE SERVICES TO AN 18- COUNTY AREA IN SOUTH- CENTRAL WISCONSIN. SSMHC/WI, WITH HEADQUARTERS IN MADISON, WI, IS SPONSORED BY SSM HEALTH MINISTRIES AND IS OWNED AND OPERATED BY SSM HEALTH (SSMH) BASED IN ST. LOUIS, MISSOURI. SSMHC/WI PROVIDES HEALTH CARE SERVICES AT THREE WHOLLY-OWNED ACUTE CARE HOSPITALS, SSM HEALTH ST. MARY'S HOSPITAL - MADISON, SSM HEALTH ST. CLARE HOSPITAL - BARABOO AND SSM HEALTH ST. MARY'S HOSPITAL - JANESVILLE, AS WELL AS AT TWO NURSING HOMES - SSM HEALTH ST. MARY'S CARE CENTER IN MADISON AND SSM HEALTH ST. CLARE MEADOWS CARE CENTER IN BARABOO.

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

Schedule H, Part VI, Line 4 Community information
SSM Health St. Mary's Hospital - Madison St. Mary's Hospital serves Dane County in south-central Wisconsin, which is home to Wisconsin's state capitol, Madison, and Wisconsin's flagship public university, the University of Wisconsin-Madison. Dane County is the second most densely populated county in Wisconsin and Madison is the second largest city in the state. The population of Dane County grew 2.8% between 2016 and 2019 bringing the population to 546,695. Dane County's diversity is concentrated in the City of Madison, but the County as a whole has minority population around 20%. The percent of the population that has at least a bachelor's degree around 70% and is much higher in Dane County than in Wisconsin and the US. Approximately 17% of the area population is over 65 years old. Additional detailed information on the St Mary's Hospital service area can be found in its 2021CHNA. SSM Health St. Clare Hospital - Baraboo St. Clare Hospital serves the primarily serves Sauk County in Wisconsin, along with portions of adjacent Adams, Columbia and Juneau counties. This primary service area covers about 75% of the hospital's total patients. Sauk County's population is less diverse and slightly older than the populations of Wisconsin and the United States, as a whole. White individuals represent 90.4% of the populations, and 19.1% are 65 or older. The most recent total population estimate of the service area is 109,298. Sauk County and the St. Clare Hospital service areas includes people who are at high risk of not receiving adequate medical care due to being uninsured/underinsured, have limitations in housing, education, language, or geography, or are experiencing other health disparities. People with disabilities may also be a more vulnerable or under-served population within the community and occur at a rate of about 8%. Additional detailed information on the St. Clare Hospital service area can be found on in its 2021 CHNA. SSM Health St. Mary's Hospital - Janesville St. Mary's Janesville defines its community as Rock County, Wisconsin. Approximately 87% of the hospital's patient population live in the county. The hospital is located in Janesville, Wisconsin, the county seat of Rock County and the county's largest city. In 2019, Janesville had an estimated population of 64,575 with a population for all of Rock County of 163,354 persons. Rock County includes people who are at high risk of not receiving adequate medical care due to being uninsured/underinsured, have limitations in housing, education, language, or geography, or are experiencing other health disparities. Poverty rates are higher in the county, at 12.3%, than in Wisconsin and the U.S. as a whole. Also, disability rates are higher at 13.7% of the county's population. Additional detailed information on the St. Mary's Janesville Hospital service area can be found in its 2021 CHNA.

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