4A (Expenses $ 1725266837 including grants of $ 1606562) (Revenue $ 2028236134)
SEE SCHEDULE H

Schedule H, Part V, Section B, Line 3E
The significant health needs are a prioritized description of the significant health needs of the community and identified through the CHNA.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - ALL FACILITIES. In order to assess the needs of our community, we created a hospital subcommittee to solicit and take into account input from individuals representing the broad interest of our community. Our hospital subcommittee was made up of key stakeholder and individuals who represented the broader interests of our community. Public Health representatives attended every meeting and provided input into the process of narrowing the selection of health issues. Once health needs were prioritized, we determined groups and individuals appropriate for focus groups, being sure to solicit input from underserved or minority groups within the communities we serve. These focus groups helped identify particularly important needs as seen by our communities, help us identify gaps in knowledge, and understand current external efforts around health needs that could be improved by healthcare participation.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - PENROSE-ST FRANCIS HEALTH SERVICES, St. Anthony Hospital and Orthocolorado Hospital. St Anthony Hospital and OrthoColorado Hospital conducted a joint CHNA. In addition, St Francis Medical Center and Penrose Hospital conducted a joint CHNA.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - PENROSE-ST. FRANCIS. Penrose-St Francis and community stakeholders identified three significant needs in their community which they prioritized and focused on. The needs were Obesity, Intentional Injury-Youth Suicide and Access to Care. For Obesity, three goals were utilized and then implemented to use evidence-based practice approaches of breastfeeding and the incorporation of education and access for disparate communities to healthy eating active living. To achieve these goals, four activities were initiated regarding breastfeeding, and three activities for education and each healthy eating active living. The need of Intentional Injury-Youth Suicide had two goals to develop coordinated efforts to promote and implement programs to identify risk and early indicators of mental, emotional and behavioral problems among youth and ensure referral to appropriate resources. The second goal was to develop coordinated effort to implement and promote Penrose-St. Francis internal and external community trainings in Adverse Childhood Experiences (A.C.E), Mental Health First Aid (MHFA) and Youth MHFA trainings to identify signs of depression and suicide for early intervention and stigma reduction. Multiple activities were created and measured the progress. The last prioritized need, Access to Care had two goals of increasing the number of El Paso County residents who receive assistance in the enrollment process leading to an insurance product; and increase health insurance and health care literacy for newly enrolled residents needing assistance navigating the health care system. Two activities for each goal were used to implement changes toward Access to Care. All three prioritized needs were addressed by Penrose-St. Francis provided benefits related to improving the health of our community through multiple programs. Penrose provided medical education which equates to over 30,000 associate hours and $1.3Million into education for nurses, medical students, PT, pharmacy, etc. The PFS pharmacy discounted and provided prescription assistance for more than 920 uninsured and underinsured through working relationships in our community. Provided over 900 staff hours for community screenings, classes and services for the community for a value of over $42,000 of uncompensated care. SPSF committed staff and grants to two low income zip-codes to fund various programs. more than 920 and resources to the community for $1,303,808 and 817 people. Cancer programs also supported the community via community outreach programs such as education and counseling; screening events; self-help classes; women's services, and support groups; provided over 2,555 families with room nights and services equating to $262,988 at the John Zay Guest House for patient's families regardless of the ability to pay; dedicated over $89,000 in the areas of nutrition services, prescription pricing, and wellness activities. All needs have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - ST. ANTHONY HOSPITAL. St Anthony Hospital (SAH) and community stakeholders identified four significant needs in their community which they prioritized and focused on. The prioritized needs were Behavioral Health, Healthy Eating Active Living (HEAL), Access to Care and Injury Prevention. The process followed to address the needs, was to create several goals for each need, and then implementing specific activities and metrics to measure progress of address the need. Specifically, SAH's goal for Behavioral Health were to decrease rate of Mental Health Hospitalizations by 3% and percentage of adults with a lack of social or emotional support from 18% to 17% among people living in St. Anthony Hospital service area. This was to be done by building community and organizational capacity and care team skills to promote mental wellbeing, improving utilization of evidence-based practices in mental health screening, promote care team training, and increase awareness and referrals to appropriate mental health resources in partnership with the community. Three of the five goals were improve the detection and treatment of mental health needs through the utilization of evidence based screening tools in our SAH service area; increase awareness of and improve referral to mental health resources (leverage/ implement relationships so care systems can work with community partners); and build primary prevention strategies through providing positive protective factors for youth in partnership with community organization. HEAL's need was targeting to increase the percent of population at a healthy BMI and decrease incidence of Type 2 Diabetes by building community and organizational capacity and care team skills to promote healthy weight and lifestyles. Reduce obesity and improve utilization of evidence-based practices in screening; promote care team training; and increase awareness and referrals to appropriate resources in partnership with the community. Two of the five goals for HEAL were to increase utilization of evidence-based practices to screen for health factors and indicators for obesity and related conditions; and increase awareness of and improve referral to healthy eating active living resources at points of service. Access to Care need was to increase the percentage of adults with a regular doctor and percent people who are insured. One of the goals of the three created was to increase the number of people enrolled into Medicaid or Commercial Coverage. Injury Prevention need was addressed by decreasing the number of preventable injuries in the community and those which come into St. Anthony Hospital. The related goals to address were decrease the number of hospitalizations due to a preventable fall by increasing the number of people reached through evidence-based programming by 20%. And decrease the number of recreation/leisure activity-related traumatic brain injuries through safe biking practices. Two goals were created and the first one was to decrease the number of recreation/leisure activity-related traumatic brain injuries through safe biking practices. All needs were addressed. During FY18, SAH enrolled 1,045 people in to available health coverage; provided thirty injury prevention classes reaching 9,000 community members and 706 bicycle helmets to ensure safety while being physically active. Also, SAH partnered with Mental Health First Aid Jeffco Coalition to provide 1,200 people with mental health first aid training; provided 1,618 staff hours to address community health needs through direct support and partnerships; provided weight loss programming to community 275 community members, who lost 1,041 pounds collectively. All needs have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 3
Facility A, 3 - MERCY REGIONAL MEDICAL CENTER. Mercy Regional Medical Center (MRMC) and community stakeholders identified three significant needs in their community which they prioritized and focused on. The prioritized needs were Obesity, Mental Health/Substance Abuse and Access to Care. The process followed to address the needs, was to create several goals for each need, and then implementing specific activities and metrics to measure progress of address the need. Obesity: Although our obesity rates are not worse than the state average, we know the trends are going in the wrong direction. In our community, 16.5% of adults are obese and 31% are overweight. We also know that if we can reduce obesity rates, it will have a positive effect on some of the disease prevalence, such as heart disease, diabetes and cancer. Two goals of the four created were to increase screening of patients and associates for health factors and indicators for obesity and related conditions; and to implement continuing education for associates to increase knowledge of clinical tools, methods, and communication strategies for obese or at-risk patients. Mental Health and Substance Abuse: We have seen a dramatic increase in the number of patients with mental health and substance use diagnoses in our emergency room. Additionally, the suicide rate in our community is 18.3 per 100,000, which is higher than the state average of 17.2 per 100,000, and much higher than the Healthy People 2020 goal of 10.2 per 100,000. Roughly 14% of adults in our community report they do not get the social and emotional support they need. Three goals to address this need was to improve the utilization of mental/behavioral health screening tools through screening Mercy Family Medicine (MFM) patients for depression and substance use. Also, MRMC promoted care team training and education of associates in evidence-based practices; and supported partners in mental health by building protective factors within the community. Access to Care: In addition to the above prioritized health needs, Centura Health and Mercy recognize that access to care is a critical factor for assessing, screening, and providing treatment that improves and maintains health. We have a primary duty to ensure we address barriers to access, and link our communities to the care they need. Mercy's service area shows a 28% uninsured rate for residents between the age of 18-64 and 12% uninsured for children under the age of 19. There are 99 primary care physicians per 100,000 and 29% of adults report they do not have a regular doctor. All needs have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 4
Facility A, 4 - ST. MARY-CORWIN MEDICAL CENTER. St. Mary-Corwin Medical Center (SMC) and community stakeholders identified three significant needs in their community which they prioritized and focused on. The prioritized needs were Obesity/Diabetes, Chronic Lung/Respiratory Disease and Behavioral Health. The process followed to address the needs, was to create several goals for each need, and then implementing specific activities and metrics to measure progress of address the need. Obesity: This is a priority because of the prevalence of direct effects and indirect effects of obesity and diabetes on comorbidities such as cardiovascular, hypertension, and would care among the population in Pueblo. The CHNA sub-committee unanimously found that we have the capacity to effect change in the current adult population and upstream with resources currently available in the community. Addressing food insecurity by developing multiple sources of access to healthy food, particularly in zip codes 81004 and 81003, two local food deserts/swamps, along with an aggressive food prescription program supported and tracked by local providers, plus upstream education of school-aged children will be the primary initiatives for the next three years. Two of the goals, of four total, are to work upstream to prevent diabetes through expansion of existing community programs; and to provide short- and long-term education in best organic gardening practices and food safety protocols for the emerging interest groups who are organizing neighborhood, agency, school and church community gardens. Chronic Lung/Respiratory Disease: This is a new priority because the CHNA sub-committee determined that Pueblo has particular environmental factors emanating from the local steel mill and low health literacy regarding home hygiene related to healthy air throughout the community. The resources are readily available to influence a downward trend in COPD and asthma related illness among adults and children. Hospital initiatives will include foci on testing for the genetic Alpha marker that predetermines COPD and partnering with the local DOTS program sponsored by the Fire Department, EMS, police and code enforcement to help families find resources to make their home air quality safer. Two goals implemented are to identify older adolescents and young adults at genetic risk of COPD and to increase healthy home hygiene for individuals at risk for lung disease. Behavioral Health: This need is a priority because the prevalence of mental health issues due to generational poverty and increasing unemployment and disability rates. The CHNA sub-committee discerned that positively impacting mental health will satisfy the increasingly vocal demand for these services in the community and will also impact the work force and therefore economic development positively in the long-run. There are no legal barriers to providing better mental health options in Pueblo. To address this need, St. Mary-Corwin Medical Center will, over the next three years, work with local partners to bolster protective elements in our community: awareness of health consequences of early childhood trauma, provision of Mental Health First-Aid training throughout the community, and expanding a continuum of care consisting of complementary therapies that empower citizens to manage their own conditions through better coping mechanisms. Goals implemented were to use programs developed in the past three-year CHNA cycle to continue supporting mental resilience in adults with compromised health issues and resultant anxiety and stress levels; and to offer Mental Health Certification Courses and continue Adverse Childhood Experiences (ACES) screening and training. All needs have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 5
Facility A, 5 - ST. FRANCIS MEDICAL CENTER. Penrose-St Francis and community stakeholders identified three significant needs in their community which they prioritized and focused on. The needs were Obesity, Intentional Injury-Youth Suicide and Access to Care. For Obesity, three goals were utilized and then implemented to use evidence-based practice approaches of breastfeeding and the incorporation of education and access for disparate communities to healthy eating active living. To achieve these goals, four activities were initiated regarding breastfeeding, and three activities for education and each healthy eating active living. The need of Intentional Injury-Youth Suicide had two goals to develop coordinated efforts to promote and implement programs to identify risk and early indicators of mental, emotional and behavioral problems among youth and ensure referral to appropriate resources. The second goal was to develop coordinated effort to implement and promote Penrose-St. Francis internal and external community trainings in Adverse Childhood Experiences (A.C.E), Mental Health First Aid (MHFA) and Youth MHFA trainings to identify signs of depression and suicide for early intervention and stigma reduction. Multiple activities were created and measured the progress. The last prioritized need, Access to Care had two goals of increasing the number of El Paso County residents who receive assistance in the enrollment process leading to an insurance product; and increase health insurance and health care literacy for newly enrolled residents needing assistance navigating the health care system. Two activities for each goal were used to implement changes toward Access to Care. All three prioritized needs were addressed by Penrose-St. Francis provided benefits related to improving the health of our community through multiple programs. Penrose provided medical education which equates to over 30,000 associate hours and $1.3Million into education for nurses, medical students, PT, pharmacy, etc. The PFS pharmacy discounted and provided prescription assistance for more than 920 uninsured and underinsured through working relationships in our community. Provided over 900 staff hours for community screenings, classes and services for the community for a value of over $42,000 of uncompensated care. SPSF committed staff and grants to two low income zip-codes to fund various programs. more than 920 and resources to the community for $1,303,808 and 817 people. Cancer programs also supported the community via community outreach programs such as education and counseling; screening events; self-help classes; women's services, and support groups; provided over 2,555 families with room nights and services equating to $262,988 at the John Zayn Guest House for patient's families regardless of the ability to pay; dedicated over $89,000 in the areas of nutrition services, prescription pricing, and wellness activities. All needs have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 6
Facility A, 6 - ST. ANTHONY SUMMIT MEDICAL CENTER. St. Anthony Summit Medical Center (SUM) and community stakeholders identified two significant needs in their community which they prioritized and focused on. The prioritized needs were Behavioral Health and Intentional Injury Prevention. The process followed to address the needs, was to create several goals for each need, and then implementing specific activities and metrics to measure progress of address the need. Behavioral Health: Three of the goals were to increase people who are able to identify, understand and respond to those in mental health and substance abuse crisis through training about identification and resources through Mental Health First Aid (MHFA) and other resources; increase the percent of people screened for substance abuse and mental health issues in healthcare and other related community settings; and to increase the number of appropriate referrals to available resources within the community. Intentional Injury Prevention: The three goals for this need were to provide injury prevention education to 120 people. Decrease long-term effects of TBI and increase older adult independence and physical activities; to decrease long-term effects of Traumatic Brain Injuries (TBI's); and to increase older adult independence and physical activity/wellness through injury prevention strategies. All needs have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 7
Facility A, 7 - ST. THOMAS MORE HOSPITAL. St. Thomas More (STM) and community stakeholders identified three significant needs in their community which they prioritized and focused on. The prioritized needs were Heart Disease, Lung Disease and Obesity/Diabetes physical activity and nutrition. The process followed to address the needs, was to create several goals for each need, and then implementing specific activities and metrics to measure progress of address the need. Heart Disease: STM prioritized Heart Disease because in Fremont County, 5.1% of adults have heart disease, compared to 2.7% of adults in the state. This is roughly twice the percentage of adults with Heart Disease compared to the Colorado State average. One of our goals is to increase the amount of cardiology services not only at St. Thomas More but also throughout Fremont County. We have the cardiology clinic here at St. Thomas More, and we frequently refer patients to this program. Additionally, we provide free cardiovascular education at community events and health fairs throughout the year, and are recruiting for a full-time, non-invasive cardiologist. Lung Disease: St. Thomas More Hospital also prioritized lung disease. Lung Disease is a priority for St. Thomas More because Fremont County has almost double the amount of tobacco users than the Colorado State average, with almost half of our 25 to 34 year olds using tobacco products regularly. In our community, 29.1% of adults report that they currently smoke. The Colorado percentage of smokers is much lower, at 16.8%. The mortality rate for lung disease in our community is 60.5 per 100,000, higher than Colorado's rate of 49.8. This is likely due to the higher rates of smoking in our community. The goal was to decrease tobacco use in Fremont County by providing education regarding tobacco cessation and tobacco health risks at community events such as health fairs and partner with local businesses to make their facilities tobacco free. Obesity/Diabetes physical activity and nutrition: St. Thomas More also prioritized Obesity/Overweight, Physical Activity and Nutrition. In our community 23.1% of adults are obese and 41.8% are overweight. Together, almost 2/3 of our population is above a healthy weight. In the state, 20.2% of adults are obese and 35.3% are overweight. St. Thomas More is excited to lead the community by example. Through the Partnership for a Healthier America and the Colorado Healthy Hospital Compact, we will make sustainable environmental changes that models healthy lifestyles and provides our St. Thomas More associates and hospital visitors with the tools and resources to make healthy decisions while at work or visiting the hospital. We know that in our community, 18.7% of adults get no leisure time physical activity (15.2% in Colorado) and 79% of adults eat less than 5 fruits and vegetables per day (75% in Colorado). We recognize the importance of eating well and exercising, and we plan to educate the community on fitness and nutrition as a way to impact the overall health of Fremont County. One goal implemented is to provide support and education regarding obesity prevention and weight management to the St. Thomas More community in partnership with local organizations. All needs have been addressed.

Schedule H, Part V, Section B, Line 11 Facility A, 8
Facility A, 8 - OrthoColorado Hospital. Due tot the close proximity of OrthoColorado Hospital to St Anthony Hospital (SAH), both hospitals combined their resources and worked together and community stakeholders who identified four significant needs in their community which they prioritized and focused on. The prioritized needs were Behavioral Health, Healthy Eating Active Living (HEAL), Access to Care and Injury Prevention. The process followed to address the needs, was to create several goals for each need, and then implementing specific activities and metrics to measure progress of address the need. Specifically, SAH's goal for Behavioral Health were to decrease rate of Mental Health Hospitalizations by 3% and percentage of adults with a lack of social or emotional support from 18% to 17% among people living in St. Anthony Hospital service area. This was to be done by building community and organizational capacity and care team skills to promote mental wellbeing, improving utilization of evidence-based practices in mental health screening, promote care team training, and increase awareness and referrals to appropriate mental health resources in partnership with the community. Three of the five goals were improve the detection and treatment of mental health needs through the utilization of evidence based screening tools in our SAH service area; increase awareness of and improve referral to mental health resources (leverage/ implement relationships so care systems can work with community partners); and build primary prevention strategies through providing positive protective factors for youth in partnership with community organization. HEAL's need was targeting to increase the percent of population at a healthy BMI and decrease incidence of Type 2 Diabetes by building community and organizational capacity and care team skills to promote healthy weight and lifestyles. Reduce obesity and improve utilization of evidence-based practices in screening; promote care team training; and increase awareness and referrals to appropriate resources in partnership with the community. Two of the five goals for HEAL were to increase utilization of evidence-based practices to screen for health factors and indicators for obesity and related conditions; and increase awareness of and improve referral to healthy eating active living resources at points of service. Access to Care need was to increase the percentage of adults with a regular doctor and percent people who are insured. One of the goals of the three created was to increase the number of people enrolled into Medicaid or Commercial Coverage. Injury Prevention need was addressed by decreasing the number of preventable injuries in the community and those which come into St. Anthony Hospital. The related goals to address were decrease the number of hospitalizations due to a preventable fall by increasing the number of people reached through evidence-based programming by 20%. And decrease the number of recreation/leisure activity-related traumatic brain injuries through safe biking practices. Two goals were created and the first one was to decrease the number of recreation/leisure activity-related traumatic brain injuries through safe biking practices. All needs were addressed. During FY18, SAH enrolled 1,045 people in to available health coverage; provided thirty injury prevention classes reaching 9,000 community members and 706 bicycle helmets to ensure safety while being physically active. Also, SAH partnered with Mental Health First Aid Jeffco Coalition to provide 1,200 people with mental health first aid training; provided 1,618 staff hours to address community health needs through direct support and partnerships; provided weight loss programming to community 275 community members, who lost 1,041 pounds collectively. All needs have been addressed.

Schedule H, Part I, Line 3c Eligibility Criteria
CHI COLORADO HAS AN ESTABLISHED CHARITY CARE POLICY BASED ON THE FEDERAL POVERTY LEVEL. CHARITY IS PROVIDED TO PATIENTS BASED ON A SLIDING SCALE THAT CONSIDERS THE PATIENT'S FAMILY SIZE AND INCOME LEVEL. THE CHARITY PROVIDED RANGES FROM 100% OF THE PATIENT'S BILL FOR INDIVIDUALS WHOSE HOUSEHOLD INCOME IS AT 100% OR LESS OF THE FEDERAL POVERTY LEVEL, TO A 80% DEDUCTION FOR INDIVIDUALS WHOSE INCOME IS AT 400% OF THE FEDERAL POVERTY LEVEL. CHI COLORADO TAKES INTO ACCOUNT SPECIFIC FACTS AND CIRCUMSTANCES IN GRANTING CHARITY IN SITUATIONS SUCH AS A CATASTROPHIC ILLNESS WHERE THE PATIENT DOES NOT HAVE LIQUID ASSETS.

Schedule H, Part VI, Line 4 COMMUNITY INFORMATION (CONTINUED)
ST. ANTHONY SUMMIT MEDICAL CENTER To define our community for the CHNA and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that account for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 43,982: Race: White 89.6%; Black 1.2%; Asian 0.9%; Native American/Alaskan Native 1.0%; Native Hawaiian/Pacific Islander 0.2%; some other race 6.1%; Multiple races 1.1%. Ethnicity: 16.11% of the population in our service area reports as Hispanic or Latino. Education Level: In our community, 49.0% of the population has an Associate's Degree or higher; CO average is 44.7%. Unemployment Rate: 2.9%; CO average is 4.0%. Population with Limited English Proficiency: 7.1%; CO average is 6.7%. High School Graduation Rate: 82.6%; CO average is 77.6%. Population Living in Households with Income Below 200% of Federal Poverty level: 30.0%; CO average is 29.6%. ST. THOMAS MORE HOSPITAL To define our community for the CHNA and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that account for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 43,982: Race: 85.6% White, 5.8% Black, 1% Asian, 1.9% Native American/Alaska Native, 0.1% Native Hawaiian/Pacific Islander, 3.9% some other race, and 1.7% multiple races. Ethnicity: 12.3% Hispanic/Latino, Non-Hispanic: 87.7% Education Level: In our community, 23.1% of the population has an Associate's Degree or higher. CO average is 44.7% Unemployment Rate: 5.5%, CO average is 4.0% Population with Limited English Proficiency: 5.6%, CO average is 6.7% High School Graduation Rate: 74.8%, CO average is 77.6% Population Living in Households with Income Below 200% of Federal Poverty level: 36.5%, CO average is 29.6%. ORTHOCOLORADO HOSPITAL To define our community for the CHNA and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that accounts for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 1,143,793: Race and Ethnicity: The population is 85.3% white, 1.38% black, 3.11% Asian, 0.99% Native American/Alaskan Native, 0.06% native Hawaiian/Pacific Islander, 6.17% some other race, and 2.99% multiple races. Additionally, 33.1% are Hispanic or Latino. Education Level: In our communities, 48.5% of the population has an Associate's Degree or higher. CO average is 44.7% Unemployment Rate: 3.8%, CO average is 4.0% Population with Limited English Proficiency: 8.3%, CO average is 6.7% High School Graduation Rate: 67.6%, CO average is 77.6% Population Living in Households with Income Below 200% of Federal Poverty level: 28.2%, CO average is 29.6%.

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
Centura Health Corporation

Schedule H, Part I, Line 7g Subsidized Health Services
There are no physician clinics included in subsidized health services.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
72714101

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using the organization's cost-to-charge ratio. The cost-to-charge ratio covers all patient segments. The cost-to-charge ratio for the year ended 6/30/2018 was computed using the following formula: Operating expense (before restructuring, impairment and other losses) divided by gross patient revenue. Worksheet 2 was not used to derive the cost-to-charge ratio.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Gross charges, as recorded in the audited financial statements, are reported as bad debt.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
Catholic Health Initiatives Colorado does not include any portion of bad debt as community benefit.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
Cost for each hospital's cost report is pulled from year end trial balances. The cost is then evaluated and all non-allowable cost is removed via adjustments. The remaining allowable cost is then allocated to appropriate patient care and non-patient care cost centers based on Medicare allocation principles. Catholic Health Initiatives Colorado (CHIC) does not treat Medicare shortfalls as community benefit. CHIC's position is consistent with that of Catholic Health Initiatives (CHI), its Sponsor. Medicare is not a differentiating feature of tax-exempt health care organizations; for-profit hospitals treat and attempt to attract Medicare beneficiaries.

Schedule H, Part V, Section B, Line 16a FAP website
A - PENROSE-ST FRANCIS HEALTH SERVICES: Line 16a URL: www.centura.org/patients-and-families/billing-and-financial-services/financial-help;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - PENROSE-ST FRANCIS HEALTH SERVICES: Line 16b URL: www.centura.org/patients-and-families/billing-and-financial-services/financial-help;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - PENROSE-ST FRANCIS HEALTH SERVICES: Line 16c URL: www.centura.org/patients-and-families/billing-and-financial-services/financial-help;

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Catholic Health Initiatives Colorado (CHIC) is operated as part of Centura Health Corporation (Centura). Information concerning financial assistance is included on Centura's website. The website not only lists phone numbers for patients to call to discuss financial assistance, but also includes Centura's policy for charity care and its policies related to uninsured patients. In addition, at the time of registration, uninsured patients are screened to determine if the patients qualify for any Federal, State or County programs. Uninsured patients are also sent a letter requesting that the patient call to determine eligibility for various assistance programs, including charity.

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

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
CATHOLIC HEALTH INITIATIVES COLORADO (CHIC) DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, TAKING INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHI FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY. THE PROVISION FOR BAD DEBTS IS PRESENTED IN THE CONSOLIDATED STATEMENT OF OPERATIONS AS A DEDUCTION FROM PATIENT SERVICES REVENUES (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) SINCE CHI ACCEPTS AND TREATS ALL PATIENTS WITHOUT REGARD TO THE ABILITY TO PAY.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Catholic Health Initiatives Colorado's debt collection policy provides for the performance of a reasonable review of each patient's account prior to turning an account over to a third-party collection agent and prior to instituting any legal action for non-payment. The review of patient accounts is done to assure that the patient or their guarantor is not eligible for assistance through Catholic Health Initiatives Colorado's charity care policy, uninsured discount policy, or another financial assistance program (i.e. Medicaid). Catholic Health Initiatives Colorado requires the following of its third-party collection agencies: * Neither Catholic Health Initiatives Colorado hospitals or their collection agencies will request bench or arrest warrants as a result of non-payment; * Neither Catholic Health Initiatives Colorado hospitals or their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and * No Catholic Health Initiatives Colorado collection agency may seek court action without hospital approval. Once a patient is known to qualify for financial assistance, collection actions are then suspended.

Schedule H, Part VI, Line 2 Needs assessment
The Catholic Health Initiatives Colorado related hospitals provide several services and resources to the communities it serves beyond the prioritized needs specifically identified in the Community Health Needs Assessment. They sponsor wellness events such as breast feeding education, asthma screenings, and financially supports wellness initiatives of cities and public schools. They also provides transportation for low income patients and housing at no cost or very low cost for the families of low income patients of the hospital that are far from their residence. They also supports, financially and through volunteerism, initiatives such as soup kitchens and meals on wheels to provide food and nutrition education to address hunger issues. Hospital staff also volunteer to serve as preceptors for students of local health professional programs and serve on boards of local community organizations that provide social services to populations in need.

Schedule H, Part VI, Line 5 Promotion of community health
The organization's hospital facilities promote health for the benefit of the community. Medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The organization's hospital facilities have an open medical staff. Its board of trustees is composed of prominent citizens in the community. Excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. The facilities treat persons paying their bills with the aid of public programs like Medicare and Medicaid. All patients presenting at the hospital for emergency and other medically necessary care are treated regardless of their ability to pay for such treatment.

Schedule H, Part VI, Line 6 Affiliated health care system
Catholic Health Initiatives Colorado (CHIC) is operated as part of Centura Health Corporation (Centura). Centura and its affiliated organizations are dedicated to extending the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities. Specifically, Centura has launched a system-wide strategic plan to improve the quality, consistency, availability, and affordability of healthcare to communities throughout Colorado. The three main components of this strategy are (1) to continue investing in technology advancements that improve the quality, costs, and coordination of care including the establishment of electronic health records linking our physicians, clinics, hospitals, long-term facilities and home care services; (2) providing wellness care, thereby potentially reducing health care costs by helping patients to maintain good health, growing the level of support and outreach provided to rural communities, and increasing access, affordability and quality of health care; and (3) coordinate and develop systems of care, looking to each facility and entity in Centura to share best practices and improve overall efficiency and communication system-wide from birth to home care.

Schedule H, Part VI, Line 4 Community information
PENROSE-ST. FRANCIS HEALTH SERVICES To define our community for the CHNA and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that accounts for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 527,449: Race and Ethnicity: Native American/Alaskan Native .77%; Asian 5.54%; Black 6.34%; Hispanic or Latino 15.07%; White 81.11%; Native Hawaiian/Pacific Islander .32%; Some other race 4.99%; Multiple Races 5.18%. Education Level: The percentage of the population in the Pikes Peak region with an Associate degree or higher is 45.5%. This is comparable to the Colorado state average of 44.7%. Unemployment Rate: The 5.1% unemployment rate in our area is higher than the state average of 4.0%. Population with Limited English Proficiency: El Paso County has a lower level of residents with a limited English proficiency than the state average. Our service area is at 4.2% and the state average of 6.7% High School Graduation Rate: 78.4% of adolescents are graduating from high school which is a slightly higher rate than the Colorado state average of 77.6%. Population Living in Households with Income Below 200% of Federal Poverty level: 29% of our overall population is living at or below this poverty level, which is consistent with the state average of 29.5%. One of the zip-codes in our area has a poverty level of 50% and is targeted with community initiatives included in the PSF CHIP. ST. ANTHONY HOSPITAL AND ORTHOCOLORADO To define our community for the CHNA and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that accounts for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 1,143,793: Race and Ethnicity: The population is 85.3% white, 1.38% black, 3.11% Asian, 0.99% Native American/Alaskan Native, 0.06% native Hawaiian/Pacific Islander, 6.17% some other race, and 2.99% multiple races. Additionally, 33.1% are Hispanic or Latino. Education Level: In our communities, 48.5% of the population has an Associate's Degree or higher. CO average is 44.7% Unemployment Rate: 3.8%, CO average is 4.0% Population with Limited English Proficiency: 8.3%, CO average is 6.7% High School Graduation Rate: 67.6%, CO average is 77.6% Population Living in Households with Income Below 200% of Federal Poverty level: 28.2%, CO average is 29.6%. MERCY REGIONAL MEDICAL CENTER To define our community for the CHNA and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that accounts for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 197,281: Race and Ethnicity: Native American/Alaskan Native 15.68%; Asian .61%; Black .6%; Hispanic or Latino 13.02%; White 75.63%; Native Hawaiian/Pacific Islander .1%; Some other race 4.26%; Multiple Races 3.03%. Education Level: Population with associate's degree or higher: 47.6% Unemployment Rate: 4.0% Population with Limited English Proficiency: 3.7% High School Graduation Rate: 75.6% Population Living in Households with Income Below 200% of Federal Poverty level: 34.1%. ST. MARY-CORWIN MEDICAL CENTER To define our community for the Community Health Needs Assessment and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that accounts for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 188,587: Race: 82.85% White; 2.67% Black; 0.7% Asian; 1.87% Native American Ethnicity: 36.84% Hispanic/Latino, Non-Hispanic: 63.16% Education Level: In our community, 30.5% of the population has an Associate's Degree or higher. CO average is 44.7% Unemployment Rate: 5.6%, CO average is 4.0% Population with Limited English Proficiency: 4.5%, CO average is 6.7% High School Graduation Rate: 71.4%, CO average is 77.6% Population Living in Households with Income Below 200% of Federal Poverty level: 40.2%, CO average is 29.6%. ST. FRANCIS MEDICAL CENTER To define our community for the CHNA and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that accounts for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 527,449: Race and Ethnicity: Native American/Alaskan Native .77%; Asian 5.54%; Black 6.34%; Hispanic or Latino 15.07%; White 81.11%; Native Hawaiian/Pacific Islander .32%; Some other race 4.99%; Multiple Races 5.18%. Education Level: The percentage of the population in the Pikes Peak region with an Associate degree or higher is 45.5%. This is comparable to the Colorado state average of 44.7%. Unemployment Rate: The 5.1% unemployment rate in our area is higher than the state average of 4.0%. Population with Limited English Proficiency: El Paso County has a lower level of residents with a limited English proficiency than the state average. Our service area is at 4.2% and the state average of 6.7% High School Graduation Rate: 78.4% of adolescents are graduating from high school which is a slightly higher rate than the Colorado state average of 77.6%. Population Living in Households with Income Below 200% of Federal Poverty level: 29% of our overall population is living at or below this poverty level, which is consistent with the state average of 29.5%. One of the zip-codes in our area has a poverty level of 50% and is targeted with community initiatives included in the PSF CHIP. ST. ANTHONY NORTH HOSPITAL To define our community for the CHNA and to analyze demographic and health indicator data, we used the STARK-Law service areas. The STARK-Law service area is defined as the lowest number of contiguous ZIP codes that accounts for 75% of a hospital's inpatient admissions. These ZIP codes have a combined population of 218,151: Race and Ethnicity: White=85.8%; Black=1.4%; Asian=5.3%; Native American/Alaskan Native=0.5%; Native Hawaiian/Pacific Islander=<0.1%; some other race=3.2%; Multiple races=3.7% 16.9% of our community identifies as Hispanic or Latino Education Level: Population with Associates Level Degree or Higher=46.4%, CO average is 44.7% Unemployment Rate: 6.7%, CO average is 4.0% Population with Limited English Proficiency: 5.2%, CO average is 6.7% High School Graduation Rate: 72.7%, CO average is 77.6% Population Living in Households with Income Below 200% of Federal Poverty level: 18.3%, CO average is 29.6%.