4A (Expenses $ 585401491 including grants of $ 2000000) (Revenue $ 733372004)
KEY OPERATING STATISTICS FOR THE YEAR ENDED 9/30/2022 INCLUDE: ADULT AND PEDIATRIC INPATIENTS CARED FOR AND DISCHARGED 15,104; BABIES BORN 2,336; TOTAL INPATIENT DAYS OF CARE PROVIDED 78,258; PATIENTS SEEKING CARE IN THE STAMFORD HOSPITAL EMERGENCY ROOM: ADMITTED FOR INPATIENT TREATMENT 7,745; TREATED AND RELEASED 52,356; TREATED AT TULLY IMMEDIATE CARE CENTER 27,873; SURGERIES PERFORMED AT THE HOSPITAL AND TULLY CENTER 13,711; RADIATION THERAPY PROCEDURES PERFORMED 236,396.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - THE STAMFORD HOSPITAL. For its 2022 CHNA which was adopted by the Stamford Health Board in July 2022, Stamford Health took into account input from persons who represent the community. Many individuals providing input represent medically underserved, low-income, and minority populations. Input was obtained through a quantitative survey instrument to which 404 Stamford residents responded and 74 Darien residents responded. Qualitative responses were obtained through individual, small group and focus group interviews. Below are organizations from which feedback was gathered in the form of either an interview, small group or focus group interviews: Americares, Boys & Girls Club, Building One Community, Children's Health Collaborative, City of Stamford, Community Health Center, Inc., Connecticut Department of Children and Families, Darien Post 53, Darien Public Schools, Darien Senior Center, Domestic Violence Crisis Center, Faith Tabernacle Missionary Baptist Church, Family Centers, Charter Oak Communities, Independent Physician, Inspirica, Kids in Crisis, OPTIMUS Health Care, Person to Person, Shop Rite / Wakefern, SilverSource, Stamford EMS, Stamford Health, Stamford Health Commission, Stamford Public Schools, Stamford Senior Center, The Child Guidance Center of Southern Connecticut, The Community Fund of Darien, The Depot, Thriving Youth Taskforce, Town of Darien. After the quantitative and qualitative surveys were completed, Stamford Hospital identified a working group that was responsible for developing a community health improvement plan (CHIP) to address health strategic priorities. The task force included representatives from quality, nursing, case management, ambulatory, finance, and service line teams. Additionally, several physicians were asked to participate on the committee as well as leaders from the community. As the task force built the CHIP, it considered the programs, organizations, and facilities available in the community to help address the identified health priorities.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - THE STAMFORD HOSPITAL. Stamford Health's 2022 CHNA was reviewed and adopted by the Hospital's leadership team and Board of Directors in July 2022. For Stamford Health's 2022 Fiscal Year, the hospital was still addressing 2019 CHIP priorities. Stamford Health's 2023 CHIP activities began in Fiscal Year 2023. The top three needs identified in Stamford Health's 2022 CHNA were (1) behavioral health, (2) access to health and social services, and (3) access to nutrition. Specific strategies in which Stamford engaged in included: developing a behavioral health strategic plan and hosting community-wide discussions to determine service gaps and identify steps Stamford Health and the community can take to address them; initiating a pilot with Liberation Programs to embed behavioral health services in select medical group offices; successfully advocating for the expansion of behavioral health services in our region; securing funding for Stamford Health's behavioral health expansion; completing an ambulatory network plan with the goal of increasing capacity to Stamford Health's outpatient services. The Stamford Health Medical Group grew and added a new service; expanding access to the COVID-19 vaccine, by working with community partners to create and implement the No Barriers Program which vaccinated thousands of socially-vulnerable residents at Stamford Health without prior registration or other barriers such as insurance, or in some cases such as undocumented individuals, identification; developing a Medical Weight Loss Program; supporting Fairgate Farms' program of free vegetables and fruit to economically distressed West Side residents; leading KIDS' FANS, which teaches nutrition education to third graders in the Stamford Public schools. This program was expanded to include personalized nutrition counseling at the Cohen Children's Specialty Center at the Tully Health Center.

Schedule H, Part V, Section B, Line 20d FORM 990, SCHEDULE H, PART V, SECTION B, LINE 20D
FOR AN INDIVIDUAL WHOSE INCOME IS BETWEEN 200% AND 400% OF THE FPG, STAMFORD HOSPITAL SHALL DETERMINE THE LEVEL OF DISCOUNT FOR THE SERVICE IF THE PATIENT'S HOUSEHOLD GROSS YEARLY INCOME MEETS OR DOES NOT EXCEED FOUR TIMES THE MOST RECENT FPG, ACCORDING TO STAMFORD HOSPITAL'S FINANCIAL ASSISTANCE CALCULATION TABLE. THE DISCOUNT WILL BE APPLIED TO THE PATIENT'S OBLIGATION, WHICH, FOR UNINSURED PATIENTS, IS THE AGB BASED ON THE LOOK-BACK METHOD. FOR INSURED PATIENTS, THE DEDUCTIBLE, COPAYMENT OR COINSURANCE OBLIGATION WILL BE DETERMINED USING THE FPG FOR THE PATIENT'S GROSS HOUSEHOLD YEARLY INCOME AND THE STAMFORD HOSPITAL FINANCIAL ASSISTANCE CALCULATION TABLE.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE COST OF BAD DEBT EXPENSE IS ESTIMATED BASED ON THE BAD DEBT PROVISION AT CHARGE, APPLIED TO THE RATIO OF TOTAL PATIENT CARE EXPENSES TO TOTAL CHARGES FOR ALL SERVICES RENDERED. ANY PAYMENTS OR DISCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTYCOVERAGE, TSH ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), TSH RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
TREATMENT OF MEDICARE SHORTFALL AS COMMUNITY BENEFIT TO THE EXTENT THERE IS A MEDICARE 'SHORTFALL', THE HOSPITAL HAS PROVIDED SERVICES AND IS REIMBURSED LESS THAN THE COST OF THOSE SERVICES. THIS TRANSFER OF VALUE BENEFITS THE PATIENT AND ARGUABLY (DIRECTLY AND INDIRECTLY) THE COMMUNITY IN WHICH THEY LIVE.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
COLLECTION PRACTICES APPLICATION OF COLLECTION PRACTICES QUALIFYING FOR FINANCIAL ASSISTANCE ALL COLLECTION EFFORTS CEASE AT ANY POINT IN THE PROCESS IF THE PATIENT APPLIES FOR FREE BED FUNDS OR FINANCIAL ASSISTANCE.

Schedule H, Part V, Section B, Line 16a FAP website
- THE STAMFORD HOSPITAL: Line 16a URL: https://www.stamfordhealth.org/patients/fap/;

Schedule H, Part V, Section B, Line 16b FAP Application website
- THE STAMFORD HOSPITAL: Line 16b URL: https://www.stamfordhealth.org/patients/fap/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- THE STAMFORD HOSPITAL: Line 16c URL: https://www.stamfordhealth.org/patients/fap/;

Schedule H, Part VI, Line 2 Needs assessment
In addition to assessments performed in the CHNA, Stamford Health continuously assesses the needs of the community through numerous means. First, Stamford Health participates in community-wide collaborations at which the needs of residents, particularly those experiencing challenges are discussed and addressed. Examples of these collaborations include the following collaborations: Vita, which is a Stamford-based collaboration of about 50 organizations which meet on an at least monthly basis to discuss community challenges and approaches to addressing those challenges. Stamford Health co-leads this collaboration with the City's public housing authority, known as Charter Oak Community. Participants include food pantries and soup kitchens, Stamford's four FQHCs, the City of Stamford's Public Health and Social Services Department, school system, and Police Department, local clergy, Kids in Crisis, Building One Community (an immigrant organization), Domus, Boys & Girls Club, homeless shelters, St. Joseph's Parenting Initiative, the United Way of Western CT. Cradle to Career, a Stamford-based collaboration whose mission is to align community resources to measurably improve outcomes for Stamford's youth so they may succeed in education, careers and life. Community Care Team (CCT) which provides intensive services to help to stabilize members of the community who experience very substantial difficulties which often include homelessness, mental health issues and substance use disorder. Youth Mental Health Alliance which aligns services and information to prevent, provide early intervention and access to resources to promote mental wellness throughout the community. KIDS' FANS (Fitness and Nutrition Services) which promotes childhood wellness, obesity prevention, and physical activity using a hands-on curriculum that is designed to make learning about healthy eating and regular exercise engaging and interactive for children ages pre-K to high school. It is a behavioral modification and lifestyle intervention program which empowers children to make healthy behavior choices by giving them the tools and skills they need to best navigate their food and physical activity environments. In addition to collaborations, Stamford Health assesses the needs of the community by, among other ways, participation in local, regional and statewide economic development boards and workforce development initiatives; periodic meetings between Stamford Health leadership and community organization leaders; service on boards of local nonprofits serving the underserved such as Building One Community, Pacific House, Greenwich YWCA, and Liberation Programs, and meetings with the Patient and Families Advisory Council; and receiving requests from community organizations for physician education lectures.

Schedule H, Part VI, Line 5 Promotion of community health
Other ways in which Stamford Health promotes health in the community is through its partnership with Optimus, an FQHC that Stamford Health supports with an annual grant and through the services of medical students; numerous public educational programs by Stamford Health physicians including information about harms caused by vaping and smoking and programs for area seniors and libraries; research conducted by Stamford Health's research department; and participation in equity programs such as the City of Stamford's Vaccine Equity Program and promotion of diversity, equity and inclusion principals for its employees, patients and community.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
"PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE STAMFORD HOSPITAL USES SEVERAL VENUES TO NOTIFY OUR PATIENTS OF THE AVAILABLE FINANCIAL OPTIONS. 1) SIGNAGE IS DISPLAYED IN ENGLISH AND SPANISH IN THE FOLLOWING AREAS: * EMERGENCY ROOM WAITING ROOMS AND REGISTRATION WORKSTATIONS * IMMEDIATE CARE CENTER WAITING ROOM * PATIENT REGISTRATION AREAS ON THE MAIN CAMPUS AND TULLY CAMPUS * CASHIER'S OFFICE, OFFICES OF THE FINANCIAL COUNSELORS, RECEPTION AREA OF THE PATIENT BUSINESS SERVICES DEPARTMENT * ANCILLARY DEPARTMENTS *THE FAP POLICIES ARE LOCATED ON OUR INTRANET PAGE AND INCLUDE THE PLAIN LANGUAGE SUMMARY ALONG WITH A FAP Application. * BROCHURES ARE ALSO AVAILABLE IN CREOLE AND POLISH. 2) THE HOSPITAL'S BILLING STATEMENTS INCLUDE AN INFORMATIONAL PAGE THAT IS PRINTED ON THE REVERSE SIDE OF THE STATEMENT OUTLINING THE FINANCIAL OPTIONS. 3) THE ""ARE YOU UNINSURED NOTICE"" IN ENGLISH AND SPANISH IS ATTACHED TO THE TRUE SELF PAY STATEMENTS. 4) STAFFING: * SOCIAL SERVICES DEPARTMENT * CASE MANAGEMENT DEPARTMENT * PATIENT REGISTRATION HAS THREE FULL TIME BILINGUAL FINANCIAL COUNSELOR * PATIENT BUSINESS SERVICES HAS TWO FULL TIME BILINGUAL FINANCIAL COUNSELORS. * A TSH FINANCIAL COUNSELOR HOLDS EDUCATIONAL AND COUNSELING SESSIONS IN THE OPTIMUS AND STAMFORD HOSPITAL CLINICS ONCE PER WEEK. * HAND-OUTS ARE PROVIDED TO PATIENTS BY THE FINANCIAL COUNSELORS AT THE CLINICS AND THE COMMUNITY HEALTH CENTERS. * PATIENTS ARE SCREENED FOR FEDERAL OR STATE PROGRAMS, AND THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM (FAP) BY FINANCIAL ASSISTANCE COUNSELORS. 5) NOTIFICATIONS: PATIENTS RECEIVE APPROVAL OR DENIAL LETTERS AND, IF ELIGIBLE, FINANCIAL ASSISTANCE PROGRAM IDENTIFICATION CARDS."

Schedule H, Part VI, Line 4 Community information
COMMUNITY INFORMATION STAMFORD HEALTH PROVIDES A BROAD RANGE OF COMMUNITY OUTREACH AND EDUCATIONAL SERVICES TO RESIDENTS OF PREDOMINANTLY ITS PRIMARY SERVICE AREA (PSA) AND SECONDARY SERVICE AREA (SSA) THAT INCLUDE 12 COMMUNITIES IN SOUTHERN FAIRFIELD COUNTY, CT. THE HOSPITAL'S SERVICE AREA WAS DEVELOPED THROUGH THE STRATEGIC PLANNING PROCESS AND IS DEFINED IN STAMFORD HEALTH'S STRATEGIC PLAN. THE HOSPITAL'S COMBINED PSA AND SSA INCLUDE AN ESTIMATED 127,644 HOUSEHOLDS WITH A TOTAL POPULATION OF 376,161 RESIDENTS. THE PSA INCLUDES THE COMMUNITIES OF STAMFORD, DARIEN, AND ROWAYTON, WITH AN ESTIMATED 55,775 HOUSEHOLDS AND A TOTAL POPULATION OF 152,587. STAMFORD COMPRISES AN ESTIMATED 47,675 HOUSEHOLDS WITH A TOTAL POPULATION OF 127,289. THE SSA INCLUDES THE COMMUNITIES OF GREENWICH, COS COB, RIVERSIDE, OLD GREENWICH, NEW CANAAN, NORWALK, WESTPORT, WESTON, AND WILTON, WITH AN ESTIMATED 79,969 HOUSEHOLDS AND A TOTAL POPULATION OF 223,574. FOR THE PSA, 25.2% OF THE POPULATION IS ESTIMATED TO BE 19 YEARS OF AGE OR LESS; 35.8% IS 20 - 44; 26.0% IS 45-64; AND 13.0% IS 65 YEARS OF AGE AND OLDER. THE SSA HAS A SLIGHTLY OLDER AGE DISTRIBUTION WITH AN ESTIMATED 27.3% OF ITS POPULATION 19 YEARS OF AGE OR LESS; 27.5% IS 20-44; 30.3% IS 45-64; AND 14.9% 65 YEARS OF AGE AND OLDER. REGARDING RACE/ETHNICITY, OF THE ESTIMATED POPULATION IN THE PSA, 56.2% OF RESIDENTS ARE WHITE; 23.8% ARE HISPANIC; 11.8% BLACK; 7.5% ASIAN; AND THE REMAINING PORTION OF THE POPULATION IS MULTI-RACIAL, NATIVE AMERICAN, PACIFIC ISLANDER, OR OTHER. STAMFORD IS ESTIMATED TO HAVE A MORE RACIALLY DIVERSE POPULATION THAN THE PSA AND SSA WITH THE BLACK POPULATION REPRESENTING 14.0%, HISPANIC POPULATION REPRESENTING 26.6% AND ASIAN POPULATION REPRESENTING 8.1% OF ITS TOTAL POPULATION. FOR THE SSA, 70.1% OF THE TOTAL ESTIMATED POPULATION IS WHITE; 6.9% BLACK; 14.7% HISPANIC; 6.1% ASIAN; AND THE REMAINING PORTION OF THE POPULATION IS MULTI-RACIAL, NATIVE AMERICAN, PACIFIC ISLANDER, OR OTHER. ALTHOUGH IN THE PSA AN ESTIMATED 22.5% OF TOTAL HOUSEHOLDS HAVE HOUSEHOLD INCOMES EXCEEDING $200,000, STAMFORD HAS AREAS WITH SIGNIFICANT POVERTY. IN COMPARISON TO THE PSA, STAMFORD HAS ONLY AN ESTIMATED 17.8% OF TOTAL HOUSEHOLDS WITH HOUSEHOLD INCOMES EXCEEDING $200,000, AND 20.8% WITH HOUSEHOLD INCOMES LESS THAN $35,000, 30.0% WITH LESS THAN $45,000. IN THE SSA, AN ESTIMATED 30.8% OF THE TOTAL HOUSEHOLDS HAVE HOUSEHOLD INCOMES EXCEEDING $200,000, WHILE AN ESTIMATED 16.1% HAVE HOUSEHOLD INCOMES LESS THAN $35,000 AND 20.9% LESS THAN $45,000. THE ESTIMATED PAYOR MIX, BASED ON HOSPITAL UTILIZATION, OF THE PSA IS PREDOMINANTLY COMMERCIAL/PRIVATE INSURANCE (35.2%), FOLLOWED BY MEDICAID (29.2%); MEDICARE (26.8%); AND SELF-PAY/OTHER (8.8%). COMPARED TO THE PSA, STAMFORD HAS A HIGHER ESTIMATED PERCENTAGE OF MEDICAID AT 31.7% AND SELF-PAY/OTHER AT 9.5%. FOR THE SSA, THE ESTIMATED PAYOR MIX IS ALSO PRIMARILY COMMERCIAL/PRIVATE INSURANCE (40.7%), FOLLOWED BY MEDICARE (29.0%); MEDICAID (22.8%); AND SELF-PAY/OTHER (7.5%).