4A (Expenses $ 149819306 including grants of $ 283093) (Revenue $ 154024281)
ST. FRANCIS HOSPITAL (SAINT FRANCIS) IS A COMMUNITY HOSPITAL LOCATED IN WILMINGTON, DELAWARE, IN OPERATION SINCE 1923. THE HOSPITAL PROVIDES A FULL SPECTRUM OF GENERAL MEDICAL SERVICES, INCLUDING EMERGENCY, DIAGNOSTIC TESTING, AND WOMEN'S HEALTH. SAINT FRANCIS ALSO OFFERS SPECIALIZED SURGICAL SERVICES, INCLUDING BARIATRIC SURGERY, AND IS THE ONLY HOSPITAL IN WILMINGTON TO OFFER PRECISION SURGERY VIA THE DA VINCI SURGICAL SYSTEM FOR MINIMALLY INVASIVE GYNECOLOGICAL AND PROSTATE SURGERIES. SAINT FRANCIS HAS ALSO BEEN OPERATING A SLEEP CENTER SINCE 1997, AND IS ONE OF THE FEW SLEEP CENTERS IN DELAWARE THAT IS ACCREDITED BY THE ACADEMY OF SLEEP MEDICINE. IN FY22 THE HOSPITAL PROVIDED OVER 17,000 PATIENT DAYS OF HEALTH CARE SERVICES TO INPATIENTS, SERVED OVER 186,000 OUTPATIENTS AND 29,000 EMERGENCY ROOM VISITS.PLEASE SEE SCHEDULE H AND VISIT OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT SERVICES, RECOGNITIONS AND AWARDS: WWW.TRINITYHEALTHMA.ORG/LOCATION/SAINT-FRANCIS-HEALTHCARE

ST. FRANCIS HOSPITAL
PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E:ST. FRANCIS HOSPITAL, ALSO KNOWN AS SAINT FRANCIS HEALTH CARE (SAINT FRANCIS), INCLUDED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED CHNA. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1. BEHAVIORAL HEALTH (SUBSTANCE USE AND MENTAL HEALTH DISORDERS)2. TRAUMA AND ADVERSE CHILDHOOD EXPERIENCES3. EQUITABLE ACCESS TO HEALTH CARE SERVICES4. AFFORDABLE HOUSING5. LACK OF EDUCATION6. POVERTY7. VIOLENCE/CRIME8. FOOD INSECURITY 9. CHRONIC DISEASES10. INFANT MORTALITY

ST. FRANCIS HOSPITAL
PART V, SECTION B, LINE 5: ON SEPTEMBER 19, 2019, SAINT FRANCIS OBTAINED INPUT FROM THE DELAWARE DIVISION OF PUBLIC HEALTH SENIOR LEADERSHIP GROUP (SLG). MEMBERS OF THE SLG INCLUDED THE PUBLIC HEALTH DIRECTOR, DEPUTY DIRECTOR, MEDICAL DIRECTOR, DENTAL DIRECTOR, AND SECTION CHIEFS WHO REPRESENTED COMMUNITY HEALTH, CHILD AND MATERNAL HEALTH, HEALTH PROMOTION AND DISEASE PREVENTION, EPIDEMIOLOGY, AND RURAL HEALTH. THE MEETING FORMAT INCLUDED A PRESENTATION OF THE CHNA DATA FOLLOWED BY A QUESTION AND ANSWER SESSION. ADDITIONALLY, SAINT FRANCIS PARTICIPATED IN A DAY-LONG STATE HEALTH IMPROVEMENT PLAN (SHIP) STAKEHOLDER MEETING ON OCTOBER 23, 2019 AT THE UNIVERSITY OF DELAWARE, WHICH WAS SPONSORED AND LED BY DELAWARE'S DEPARTMENT OF HEALTH AND SOCIAL SERVICES. PUBLIC HEALTH STAKEHOLDERS WERE UPDATED ON SHIP PROGRESS TO DATE AND WERE INCLUDED IN A DISCUSSION AROUND ALIGNMENT BETWEEN THE SHIP PRIORITIES AND THE PRIORITIES OF STAKEHOLDERS AND PARTNERS.SAINT FRANCIS OBTAINED INPUT FROM THE FOLLOWING ORGANIZATIONS DURING A COMMUNITY ENGAGEMENT MEETING AT SAINT FRANCIS HOSPITAL ON OCTOBER 30, 2019: LATIN AMERICAN COMMUNITY CENTER, CATHOLIC CHARITIES, SALVATION ARMY, MINISTRY OF CARING, SUNDAY BREAKFAST MISSION, BOYS & GIRLS CLUB, WESTSIDE FAMILY HEALTHCARE, DELAWARE COALITION AGAINST DOMESTIC VIOLENCE, AIDS DELAWARE, UNITED WAY DELAWARE, AMERICAN HEART ASSOCIATION, AMERICAN CANCER SOCIETY, DELAWARE BREAST CANCER COALITION, CHILDREN & FAMILIES FIRST, ST. ELIZABETH HIGH SCHOOL, NATIONAL ASSOCIATION OF MENTAL ILLNESS, CONNECTIONS COMMUNITY SUPPORT PROGRAMS, YWCA, CITY OF WILMINGTON, NEW CASTLE COUNTY, NEMOURS, AND CHRISTIANA CARE HEALTH SYSTEM.AN ONLINE COMMUNITY SURVEY CONDUCTED THROUGH SURVEY MONKEY WAS MADE AVAILABLE TO COMMUNITY RESIDENTS AND SAINT FRANCIS EMPLOYEES BETWEEN AUGUST 1 AND SEPTEMBER 30, 2019. AMONG GENERAL QUESTIONS ABOUT HEALTH STATUS AND SOCIAL DETERMINANTS OF HEALTH, THE ONLINE SURVEY INCLUDED TWO COMMUNITY HEALTH RELATED QUESTIONS. ONE HUNDRED THIRTEEN INDIVIDUALS RESPONDED TO THE SURVEY. THE INPUT GATHERED WAS REPRESENTATIVE OF THE WILMINGTON POPULATION, WHICH INCLUDES THOSE WHO ARE AT OR BELOW POVERTY LEVEL, UNINSURED OR UNDERINSURED, HOMELESS, MINORITIES, AND IMMIGRANTS. SAINT FRANCIS SERVES THESE POPULATIONS.

ST. FRANCIS HOSPITAL
PART V, SECTION B, LINE 11: SAINT FRANCIS' IMPLEMENTATION STRATEGY IS DESIGNED TO ADDRESS THE PRIORITY AREAS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). FOLLOWING ARE THE NEEDS THAT ARE ADDRESSED IN THE IMPLEMENTATION STRATEGY:1. BEHAVIORAL HEALTH 2. CHRONIC DISEASE PREVENTION AND MANAGEMENT3. FOOD INSECURITYBELOW ARE PROGRAM EXAMPLES OF HOW SAINT FRANCIS ADDRESSED EACH NEED WITHIN FISCAL YEAR 2022.BEHAVIORAL HEALTH SERVICES - SAINT FRANCIS CONTRACTED WITH CATHOLIC CHARITIES TO PROVIDE VIRTUAL BEHAVIORAL HEALTH ASSESSMENTS FOR UNINSURED AND UNDERINSURED PATIENTS OF THE ST. CLARE MEDICAL OUTREACH VAN. A LICENSED CLINICIAN WAS AVAILABLE 8 HOURS PER WEEK TO PATIENTS. PATIENTS WERE SCHEDULED FOR FOLLOW-UP CARE OR FURTHER EVALUATION AS NEEDED. CHRONIC DISEASE PREVENTION AND MANAGEMENT - THE ST. CLARE MEDICAL OUTREACH VAN PARTNERED WITH QUALITY INSIGHTS TO IMPROVE ACCESS TO MAMMOGRAMS, PAP SMEARS, COLONOSCOPIES AND OTHER SCREENINGS AT NO COST OR LOW COST TO ST. CLARE VAN PATIENTS. QUALITY INSIGHTS NAVIGATORS CONNECTED WITH ST. CLARE VAN PATIENTS AND PARTICIPANTS OF THE MONTHLY MOBILE FOOD BANK TO PROVIDE EDUCATION AND REFERRALS. THE ST. CLARE MEDICAL OUTREACH VAN OBTAINED TAKE HOME BLOOD PRESSURE KITS THROUGH A GRANT. PATIENTS WITH HIGH OR UNCONTROLLED BLOOD PRESSURE WERE IDENTIFIED AND KITS WERE DISTRIBUTED FREE OF CHARGE TO THE PATIENT. PATIENT EDUCATION ON USE OF THE KITS WAS PROVIDED AND BLOOD PRESSURE MONITORED FOR IMPROVEMENT. THE SAINT CLARE MEDICAL OUTREACH VAN REFERRED 35 PATIENTS TO DISPENSARY OF HOPE PHARMACY CHARITY CARE PROGRAMS FOR INSULIN AND OTHER MEDICATIONS.FOOD INSECURITY - SAINT FRANCIS CONTINUED AND EXPANDED ITS FOOD INSECURITY PROGRAM IN FISCAL YEAR 2022. IN PARTNERSHIP WITH THE FOOD BANK OF DELAWARE MOBILE FOOD PANTRY, SAINT FRANCIS OFFERED GROCERY STORE STAPLES TO MORE THAN 80 FOOD INSECURE FAMILIES OR INDIVIDUALS PER MONTH. ADDITIONALLY, SAINT FRANCIS CONTRACTED WITH LANCASTER FARM FRESH PROGRAM TO SUPPLEMENT THE MOBILE FOOD PANTRY WITH WEEKLY DELIVERY OF HEALTHY FRUITS AND VEGETABLES. 3,099 FARM BOXES WERE DISTRIBUTED IN FISCAL YEAR 2022 TO INDIVIDUALS AT NO COST TO THEM. THE INDIVIDUALS OR FAMILIES WHO RECEIVED PRODUCE WERE IDENTIFIED AS FOOD INSECURE AND WERE DIAGNOSED WITH EITHER DIABETES OR OBESITY. WEEKLY, TWO THIRDS OF THE PRODUCE BOXES WERE DIVIDED AMONG A LOW-INCOME SENIOR LIVING FACILITY AND LOW-INCOME FAMILIES SERVED BY THE LATIN AMERICAN COMMUNITY CENTER. IN FISCAL YEAR, 405 GROCERY STORE GIFT CARDS WERE PROVIDED THROUGHOUT THE YEAR AND ESPECIALLY DURING HOLIDAYS, TO FAMILIES WHO MET THE NEED OF FOOD INSECURE AND NEEDED EXTRA ASSISTANCE PURCHASING GROCERIES. SAINT FRANCIS PARTNERED WITH WILLIAM LEWIS ELEMENTARY AND LAS AMERICAS ASPIRA FOR THE BACKPACK MEAL PROGRAM. THERE WERE 2,908 BACKPACK MEALS PROVIDED WEEKEND FOR STUDENTS AND OTHERS WHO DID NOT HAVE ACCESS TO FOOD OUTSIDE THE NORMAL SCHOOL WEEK.SAINT FRANCIS ACKNOWLEDGES THE WIDE RANGE OF PRIORITY ISSUES THAT EMERGED FROM THE CHNA PROCESS AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. SAINT FRANCIS DID NOT ADDRESS THE FOLLOWING NEEDS DURING FISCAL YEAR 2022:TRAUMA/ADVERSE CHILDHOOD EXPERIENCES WAS NOT DIRECTLY ADDRESSED DUE TO LACK OF RESOURCES REQUIRED TO FULLY IMPLEMENT A TRAUMA-INFORMED CARE PROGRAM. AFFORDABLE HOUSING WAS NOT DIRECTLY ADDRESSED TO AVOID DUPLICATING EFFORTS ALREADY IN PROGRESS WITH CINNAIRE, A COMMUNITY REDEVELOPMENT CORPORATION. LACK OF EDUCATION WAS NOT DIRECTLY ADDRESSED BECAUSE THE HOSPITAL LACKS EXPERTISE OR RESOURCES REQUIRED TO EFFECTIVELY ADDRESS GAPS IN EDUCATIONAL ATTAINMENT. POVERTY WAS NOT DIRECTLY ADDRESSED BECAUSE OF RESOURCE CONSTRAINTS. HOWEVER, SAINT FRANCIS DOES ASSIST THOSE WHO ARE LIVING IN POVERTY THROUGH COMMUNITY BENEFIT PROGRAMS, INCLUDING FINANCIAL ASSISTANCE, THE SAINT CLARE MOBILE MEDICAL OUTREACH VAN, THE TINY STEPS PROGRAM, THE MOBILE FOOD PANTRY, AND THE CENTER OF HOPE.VIOLENCE/CRIME WAS NOT DIRECTLY ADDRESSED BECAUSE OF THE SYSTEM'S RELATIVE LACK OF EXPERTISE OR RESOURCES REQUIRED TO EFFECTIVELY REDUCE CRIME AND VIOLENCE WITHIN THE COMMUNITY.INFANT MORTALITY WAS NOT DIRECTLY ADDRESSED TO AVOID DUPLICATING EFFORTS CURRENTLY UNDERWAY THROUGH THE DELAWARE HEALTHY MOTHERS AND INFANT CONSORTIUM AND OTHER STATE-LED TASK FORCES; HOWEVER, SAINT FRANCIS' TINY STEPS PROGRAM PROVIDES A FULL SPECTRUM OF SERVICES TO WOMEN OF REPRODUCTIVE AGE WHO ARE CONSIDERED TO BE AT HIGH RISK FOR POOR BIRTH OUTCOMES.EQUITABLE ACCESS TO HEALTHCARE SERVICES WAS NOT DIRECTLY ADDRESSED DUE TO COMPETING PRIORITIES, HOWEVER SAINT FRANCIS CONTINUES TO OPERATE THE ST. CLARE MEDICAL OUTREACH VAN, WHICH IMPROVES ACCESS TO CARE FOR THOSE WITH BARRIERS TO ACCESSING CARE.

ST. FRANCIS HOSPITAL
PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.

PART V, SECTION B, LINE 7A:
WWW.TRINITYHEALTHMA.ORG/COMMUNITY-BENEFIT/CHNA/SAINT-FRANCIS

PART V, SECTION B, LINE 9:
AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC.

PART V, SECTION B, LINE 10A:
WWW.TRINITYHEALTHMA.ORG/COMMUNITY-BENEFIT/CHNA/SAINT-FRANCIS

PART V, SECTION B, LINE 16A:
WWW.TRINITYHEALTHMA.ORG/PATIENTS-VISITORS/PAY-YOUR-BILL/SAINT-FRANCIS/FINANCIAL-ASSISTANCE

PART V, SECTION B, LINE 16B:
WWW.TRINITYHEALTHMA.ORG/PATIENTS-VISITORS/PAY-YOUR-BILL/SAINT-FRANCIS/FINANCIAL-ASSISTANCE

PART V, SECTION B, LINE 16C:
WWW.TRINITYHEALTHMA.ORG/PATIENTS-VISITORS/PAY-YOUR-BILL/SAINT-FRANCIS/FINANCIAL-ASSISTANCE

PART I, LINE 3C:
IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS.

PART I, LINE 6A:
ST. FRANCIS HOSPITAL (SAINT FRANCIS) PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF DELAWARE. IN ADDITION, SAINT FRANCIS REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, SAINT FRANCIS INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE.

PART I, LINE 7:
THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM.

PART I, LN 7 COL(F):
THE FOLLOWING NUMBER, $7,466,335, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F).

PART III, LINE 2:
METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.

PART III, LINE 3:
SAINT FRANCIS USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, SAINT FRANCIS IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, SAINT FRANCIS IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL.

PART III, LINE 4:
"SAINT FRANCIS IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE PATIENT ACCOUNTS RECEIVABLE, ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS FOOTNOTE FROM PAGE 13 OF THOSE STATEMENTS: ""AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTABLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE.THE CORPORATION HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE CORPORATION'S HEALTH MINISTRIES AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS AND OTHER CHANGES IN ESTIMATES ARE INCLUDED IN NET PATIENT SERVICE REVENUE AND ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED.""PART III, LINE 5: TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE ONE PERCENT SEQUESTRATION REDUCTION FOR THE PERIOD APRIL 1, 2022 THROUGH JUNE 30, 2022."

PART III, LINE 8:
SAINT FRANCIS DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT.

PART III, LINE 9B:
THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS.

PART VI, LINE 2:
NEEDS ASSESSMENT - SAINT FRANCIS ASSESSES THE HEALTH STATUS OF ITS COMMUNITY, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. TO ASSESS THE HEALTH OF THE COMMUNITY, THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES, AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR WHO ARE UNINSURED.

PART VI, LINE 7, REPORTS FILED WITH STATES
DE

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SAINT FRANCIS COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES, FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS, AND OTHER COMMUNITY-BASED CHARITABLE PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. SAINT FRANCIS OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. SAINT FRANCIS HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SAINT FRANCIS MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER.

PART VI, LINE 4:
COMMUNITY INFORMATION - SAINT FRANCIS SERVES THE CITY OF WILMINGTON, WHICH HAS A POPULATION OF JUST OVER 70,000. WILMINGTON HAS SOME OF THE HIGHEST SOCIO-ECONOMIC NEEDS ZIP CODES IN THE STATE OF DELAWARE: 19801, 19802 AND 19805. SAINT FRANCIS HOSPITAL IS IN 19805, JUST BLOCKS FROM CENSUS TRACT 22, WHICH IS WESTSIDE WILMINGTON'S HIGHEST POVERTY AREA. ZIP CODES CONSIDERED HIGH NEED GENERALLY HAVE POORER HEALTH OUTCOMES THAN ZIP CODES IN MORE AFFLUENT NEIGHBORHOODS.WILMINGTON'S POPULATION IS RELATIVELY YOUNG WITH A MEDIAN AGE OF 36. CLOSE TO HALF OF THE CITY'S POPULATION IS BLACK; ANOTHER 34% IS NON-HISPANIC WHITE AND 11% IS HISPANIC. PROFOUND ECONOMIC DIFFERENCES EMERGE IN THE DEMOGRAPHICS WHEN COMPARING WILMINGTON TO NEW CASTLE COUNTY AND COMPARING CENSUS TRACT 22 TO BOTH THE COUNTY AND THE CITY. IT IS CLEAR FROM THE DEMOGRAPHICS THAT POCKETS OF POVERTY EXIST ALONGSIDE THE WEALTH GENERATED BY WILMINGTON'S BANKING AND CREDIT CARD INDUSTRIES. THE AVERAGE MEDIAN HOUSEHOLD INCOME FOR BLACK AND HISPANIC FAMILIES LIVING IN WILMINGTON IS ONE HALF THAT OF WHITE FAMILIES. NEARLY 65% OF HISPANIC HOUSEHOLDS LACK ENOUGH SAVINGS TO REPLACE INCOME AT THE POVERTY LEVEL FOR THREE MONTHS IF THEY WERE TO EXPERIENCE A SUDDEN JOB LOSS, MEDICAL EMERGENCY, OR OTHER FINANCIAL CRISIS. BLACK RESIDENTS LEAD IN INCOME POVERTY, WITH ROUGHLY 27% OF BLACK FAMILIES IN WILMINGTON EARNING BELOW THE FEDERAL POVERTY LEVEL FOR THE PAST 12 MONTHS. JUST OVER 40% OF WILMINGTON'S CHILDREN, AND OVER 60% OF CHILDREN LIVING IN CENSUS TRACT 22, LIVE BELOW POVERTY. WITH RESPECT TO EDUCATION, ALMOST 93% OF WHITE RESIDENTS HOLD A HIGH SCHOOL DEGREE OR HIGHER, COMPARED TO JUST OVER 81% OF BLACK RESIDENTS. MORE THAN 35% OF LATINOS IN WILMINGTON LACK A HIGH SCHOOL DEGREE.THE CITY'S HOMEOWNERSHIP RATE STANDS AT 58.2% FOR WHITE RESIDENTS, NEARLY 20% HIGHER THAN THAT FOR BLACK AND ASIAN RESIDENTS, AND ROUGHLY DOUBLE THAT FOR LATINO RESIDENTS. IN ADDITION TO SAINT FRANCIS, THE FOLLOWING HEALTH CENTERS ALSO SERVE THE CITY OF WILMINGTON: CHRISTIANA CARE HEALTH SYSTEM, WESTSIDE FAMILY HEALTHCARE, HENRIETTA JOHNSON MEDICAL CENTER, AND NEMOURS/A.I. DUPONT HOSPITAL FOR CHILDREN.

PART VI, LINE 5:
PROMOTION OF COMMUNITY HEALTH - SAINT FRANCIS RECEIVED A $65,000 IT STARTS HERE COVID-19 GRANT FROM TRINITY HEALTH TO SUPPORT THE LATIN AMERICAN COMMUNITY CENTER (LACC) FOR VACCINATION EFFORTS. LACC PARTNERED WITH THE LIFE HEALTH CENTER AND THE MOBILE DPH TO SERVE A MOSTLY BLACK & BROWN POPULATION IN WILMINGTON. LACC IS FOUNDED BY PUERTO RICAN IMMIGRANT COMMUNITY, BUT VACCINE DISTRIBUTION & EDUCATION WAS PROVIDED TO THE ENTIRE WEST SIDE COMMUNITY. THROUGH IT STARTS HERE, 3,753 INDIVIDUALS WERE VACCINATED AND 5,504 WERE EDUCATED THROUGH OUTREACH EVENTS.SAINT FRANCIS RECEIVED A $75,000 TRANSFORMING COMMUNITIES INITIATIVE GRANT FROM TRINITY HEALTH TO SUPPORT CORNERSTONE WEST CDC FOR DEVELOPMENT AND IMPLEMENTATION OF EVIDENCE-BASED STRATEGIES THAT ADVANCE HEALTH AND RACIAL EQUITY THROUGH ADDRESSING THE ROOT CAUSE OF HOUSING.

PART VI, LINE 6:
SAINT FRANCIS IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH'S COMMUNITY HEALTH AND WELL-BEING (CHWB) STRATEGY PROMOTES OPTIMAL HEALTH FOR PEOPLE EXPERIENCING POVERTY AND OTHER VULNERABILITIES IN THE COMMUNITIES WE SERVE BY CONNECTING SOCIAL AND CLINICAL CARE, ADDRESSING SOCIAL NEEDS, DISMANTLING SYSTEMIC RACISM, AND REDUCING HEALTH INEQUITIES. WE DO THIS BY: 1. INVESTING IN OUR COMMUNITIES, 2. ADVANCING SOCIAL CARE, AND 3. IMPACTING SOCIAL INFLUENCERS OF HEALTH.TO FURTHER OUR STRATEGY IN FISCAL YEAR 2022 (FY22), CHWB LAUNCHED TWO TRAINING SERIES TO ADVANCE HEALTH AND RACIAL EQUITY IN OUR COMMUNITIES.1. CHWB LEADER SERIES TO ADVANCE HEALTH AND RACIAL EQUITY: A YEAR-LONG PEER LEARNING SERIES TO BUILD THE CAPACITY OF OUR CHWB LEADERS TO DELIVER ON OUR CHWB STRATEGY WITH A FOCUS ON COMMUNITY LEADERSHIP AND ENGAGEMENT, AND THE USE OF A RACIAL EQUITY LENS IN ALL OF OUR DECISION MAKING. 2. COMMUNITY ENGAGEMENT TO ADVANCE RACIAL JUSTICE - PREPARING FOR IMPLEMENTATION STRATEGY: A FOUR-PART SERIES ON ENGAGING OUR COMMUNITIES IN MEANINGFUL WAYS USING A HEALTH EQUITY AND RACIAL EQUITY LENS TO BUILD LASTING PARTNERSHIPS AND IMPACTFUL IMPLEMENTATION STRATEGIES.INVESTING IN OUR COMMUNITIES - TRINITY HEALTH AND ITS MEMBER HOSPITALS ARE COMMITTED TO THE DELIVERY OF PEOPLE-CENTERED CARE AND SERVING AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN THE COMMUNITIES THEY SERVE. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITIES AND IS COMMITTED TO ADDRESSING THE UNIQUE NEEDS OF EACH COMMUNITY. IN FY22, TRINITY HEALTH CONTRIBUTED $1.37 BILLION IN COMMUNITY BENEFIT SPENDING TO AID THOSE WHO ARE VULNERABLE AND LIVING IN POVERTY, AND TO IMPROVE THE HEALTH STATUS OF THE COMMUNITIES IN WHICH WE SERVE. SOME EXAMPLES OF THESE INVESTMENTS INCLUDE: TRINITY HEALTH AWARDED OVER $1.6 MILLION IN COMMUNITY GRANTS THAT DIRECTLY ALIGN WITH INTERVENTIONS AND LOCAL PARTNERSHIPS IDENTIFIED IN ITS MEMBER HOSPITALS' COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IMPLEMENTATION STRATEGIES, INCLUDING ACCESS TO HEALTH CARE, MENTAL HEALTH, TRANSPORTATION, COMMUNITY ENGAGEMENT, FOOD ACCESS, AND HOUSING SUPPORTS. WITH A $1.2 MILLION INITIAL INVESTMENT, TRINITY HEALTH LAUNCHED ROUND 2 OF THE TRANSFORMING COMMUNITIES INITIATIVE (TCI), A FIVE-YEAR, INNOVATIVE FUNDING AND TECHNICAL ASSISTANCE INITIATIVE, PARTNERING WITH COMMUNITY-BASED ORGANIZATIONS AND RESIDENTS TO ADVANCE HEALTH AND RACIAL EQUITY IN NINE OF OUR COMMUNITIES EXPERIENCING HIGH POVERTY AND OTHER VULNERABILITIES. HEALTH MINISTRIES RECEIVING TCI FUNDING ARE COLLABORATING WITH A LOCAL MULTI-SECTOR COLLABORATIVE TO DEVELOP AND IMPLEMENT EVIDENCE-BASED STRATEGIES THAT ADVANCE HEALTH AND RACIAL EQUITY THROUGH ADDRESSING AT LEAST ONE ROOT CAUSE OF POOR HEALTH IDENTIFIED IN THE DEVELOPMENT OF THEIR MOST RECENT CHNA IMPLEMENTATION STRATEGY. TRINITY HEALTH AWARDED OVER $1 MILLION IN COVID-19 FUNDING TO SUPPORT NEW AND ONGOING COMMUNITY ENGAGEMENT AND MOBILIZATION EFFORTS AROUND MAKING THE COVID-19 VACCINATION ACCESSIBLE TO ALL ELIGIBLE POPULATIONS. THIS FUNDING WAS DESIGNED TO SUPPORT ALL COMMUNITIES TO ENSURE EASY AND EQUITABLE ACCESS TO THE VACCINE BY REMOVING BARRIERS FOR ALL PEOPLE TO RECEIVE THE VACCINE, ESPECIALLY COMMUNITIES THAT HAVE LESS THAN A 75% VACCINATION RATE. WITH THIS FUNDING, HEALTH MINISTRIES FACILITATED 3,200 COVID-19 VACCINE EVENTS, ADMINISTERED 80,000 COVID-19 VACCINE DOSES, AND REACHED 874,000 PEOPLE WITH EDUCATIONAL MATERIALS ON COVID-19 AND THE BENEFITS OF VACCINATION.IN ADDITION TO THE $1.37 BILLION IN COMMUNITY BENEFIT SPENDING, OUR COMMUNITY INVESTING PROGRAM HAD THE MOST ROBUST YEAR OF LENDING SINCE THE PROGRAM'S INCEPTION OVER 20 YEARS AGO: $17.8 MILLION IN NEW LOANS AND $8.3 MILLION IN LOAN RENEWALS WERE APPROVED, FOCUSING ON BUILDING AFFORDABLE HOUSING AND INCREASING ACCESS TO EDUCATION IN PARTNERSHIP WITH OUR HEALTH MINISTRIES. ADVANCING SOCIAL CARE - TRINITY HEALTH'S SOCIAL CARE PROGRAM WAS DEVELOPED TO ADDRESS SOCIAL NEEDS, SUCH AS ACCESS TO TRANSPORTATION, CHILDCARE, OR AFFORDABLE MEDICATIONS BY FACILITATING CONNECTIONS BETWEEN OUR PATIENTS, HEALTH CARE PROVIDERS AND COMMUNITY PARTNERS THAT PROMOTE HEALTHY BEHAVIORS. HIGHLIGHTS FROM FY22 INCLUDE THE FOLLOWING SUCCESSES:- LAUNCHED TRINITY HEALTH COMMUNITY HEALTH WORKER (CHW) CERTIFICATION PROGRAM, TRAINING 86 CHWS WITH 40+ HOURS OF TRAINING, AND INCREASED CHW STAFF ACROSS MOST HEALTH MINISTRIES- LAUNCHED A SYSTEM-WIDE ASSESSMENT OF LANGUAGE ACCESS SERVICES TO RECOMMEND SYSTEM STANDARDS THAT ENSURE CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES FOR ALL OF OUR PATIENTS, THEIR COMPANIONS, AND CAREGIVERS- ENGAGED OVER 1,100 PARTICIPANTS IN THE NATIONAL DIABETES PREVENTION PROGRAM, EXCEEDING OUR PROGRAM YEAR 5 GOAL- INCREASED THE NUMBER OF ACTIVE COMMUNITY PARTNER ORGANIZATIONS ON THE COMMUNITY RESOURCE DIRECTORY BY 120% FROM FISCAL YEAR 2021- ENGAGED 5,300+ PATIENTS WHO ARE DUALLY ENROLLED IN MEDICARE AND MEDICAID IN A SOCIAL CARE OR MEDICAL CARE ACTIVITY, IN SUPPORT OF REDUCING PREVENTABLE HOSPITALIZATIONS (SUCH AS DIABETES AND ASTHMA)IMPACTING SOCIAL INFLUENCERS OF HEALTH - LEVERAGING INVESTOR POWER TO CATALYZE CORPORATE SOCIAL RESPONSIBILITY, TRINITY HEALTH'S SHAREHOLDER ADVOCACY WORK FOCUSES ON DISMANTLING RACISM ACROSS FIVE STRATEGIC FOCUS AREAS BY HOLDING CORPORATIONS ACCOUNTABLE FOR THE HUMAN RIGHTS VIOLATIONS THOSE COMPANIES PERPETUATE IN THE U.S. AND BEYOND. IN FY22, TRINITY HEALTH FACILITATED OVER 135 SHAREHOLDER ADVOCACY ENGAGEMENTS, WITH GREAT SUCCESS:- FIVE BELOW COMMITTED TO ASSESS AND MANAGE THE RISKS/HAZARDS ASSOCIATED WITH CHEMICALS OF HIGH CONCERN CONTAINED IN THEIR PRIVATE LABEL PRODUCTS- UNILEVER AGREED TO STOP FOOD AND BEVERAGE MARKETING TO CHILDREN UNDER AGE 16, AND WILL ADOPT NEW TARGETS TO REDUCE SALT, ADDED SUGARS AND CALORIES, AND INCREASE SALES OF THEIR HEALTHIER PRODUCTS- PEPSICO SET GOALS TO INCREASE POSITIVE NUTRIENTS IN THEIR PRODUCTS- PDC ENERGY ACCELERATED ITS GOAL TO END ROUTINE FLARING OF METHANE, FROM 2030 TO 2025, THUS REDUCING ENVIRONMENTAL HEALTH RISKS AND GREENHOUSE GAS EMISSIONSADDITIONALLY, TRINITY HEALTH AND OTHER MEMBERS OF THE INTERFAITH CENTER ON CORPORATE RESPONSIBILITY GUN SAFETY GROUP SUBMITTED A SHAREHOLDER RESOLUTION ASKING STURM RUGER, ONE OF THE NATION'S LEADING MANUFACTURERS OF FIREARMS, TO CONDUCT AND PUBLISH AN INDEPENDENT HUMAN RIGHTS IMPACT ASSESSMENT OF ITS POLICIES, PRACTICES AND PRODUCTS, AND MAKE RECOMMENDATIONS FOR IMPROVEMENT. THE RESOLUTION RECEIVED A 68.5% VOTE IN FAVOR, WELL ABOVE THE THRESHOLD REQUIRED FOR THE RESOLUTION TO BE RESUBMITTED IN 2023, INDICATING A LARGE MAJORITY OF STURM RUGER INVESTORS BELIEVE THE COMPANY HAS TO ADDRESS ITS HUMAN RIGHTS IMPACTS. TRINITY HEALTH AND TRINITY HEALTH OF NEW ENGLAND ARE CITED AS PART OF THE GROUP WHO MOVED FORWARD THIS RESOLUTION.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG.