4A (Expenses $ 47472175 including grants of $ 0) (Revenue $ 15441139)
SEE SCHEDULE O - COMMUNITY BENEFIT REPORT

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - ST. MARY'S HOSPITAL STREATOR. In order to gain community input for the FY2015 Community Health Needs Assessment, a variety of stakeholders were asked to participate in engagement sessions. These individuals included HSHS St. Mary's partners, individuals from other health care organizations, local school districts, community organizations, business members, public administrators, and local religious organizations. Participants for the 2015 CHNA were identified by researchers at the University of Illinois Springfield's Survey Research Office (SRO) and approved by HSHS St. Mary's Hospital. The CHNA Steering Committee included: Father Jacob Rose, Parochial Vicar, St. Michael the Archangel Parish Stephen Jonland, Economic Development Director, Streator Chamber of Commerce Robert Turner, Deputy Chief of Police, Streator Police Department Julia K. Kerestes, B.S., L.E.H.P., Public Health Administrator, LaSalle County Health Department Julie Ramza, Pharmacist, Streator Drugs Margaret Morrison, Director, ADV & SAS Bradley Solberg, Director, OSF St. James-John W. Albrecht Medical Center Jackie Dever, Director of Nursing Livingston County Health Department Janette Strabala, Administrator, Heritage Health/Evergreen Place Christine Kohut, Director, North Central Behavioral Systems Dr. Mark Wargo, Family Practice Physician, HSHS Medical Group Family Medicine Judy Booze, Director, Salvation Army Scot Wrighton, City Manager, City of Streator Deb Derby, Principal, Woodland High School Jack Dzuris, Executive Director, Streator Chamber of Commerce Bonnie Campbell, Dean of Health Professions, Illinois Valley Community College Josh Biros, Executive Director, Streator YMCA Sister Ana Pia Corduca, Community Services, Catholic Charities of the Diocese of Peoria Suzie Meisner, Community Services Coordinator, Catholic Charities of the Diocese of Peoria Karen Brodbeck, Community Benefit, OSF St. Elizabeth Medical Center Becky Tirevold, Director, Community Outreach, HSHS St. Mary's Hospital.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - St. Mary's Hospital Streator. University of Illinois at Springfield Survey Research Office, Southern Illinois University School of Medicine Office of Community Health and Service, St. Michael the Archangel Parish, Streator Chamber of Commerce, Streator Police Department, LaSalle County Health Department, Livingston County Health Department, Streator Drugs, Against Domestic Violence/Sexual Assault Services, North Central Behavioral Systems, HSHS Medical Group Family Medicine, Heritage Health/Evergreen Place Long-term care Facilities, Salvation Army, City of Streator, Woodland High School, Streator Chamber of Commerce, Illinois Valley Community College, Streator YMCA, and Catholic Charities of the Diocese of Peoria.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - St. Mary's Hospital Streator. It is important to note that one of the major findings of the FY2015 Community Health Needs Assessment is the pervasiveness of poverty within HSHS St. Mary's Hospital's service area. In fact, more than 17,000 of the individuals living in HSHS St. Mary's Hospital's service area live below the poverty level. Research indicates that poverty and poor health are inseparably correlated. In other words, poverty is both a cause and a consequence of poor health. Poverty increases the likelihood of poor health among residents, while poor health, in return, keeps communities in poverty. It can be asserted that the health priority areas identified by the engagement session participants are directly connected to the rate of poverty within the region. Based on the analysis of the two engagement sessions as well as additional stakeholder feedback, four health priority areas were identified for the area served by HSHS St. Mary's Hospital. The engagement groups applied individual power rankings to the needs. Four Priority Areas: 1. Access to Mental Health Care Services 2. Overweight/Obesity 3. Tobacco Use 4. Domestic Abuse HSHS St. Mary's Hospital will partner with North Central Behavioral Systems, North Central Area Transit, LaSalle County Health Department, Livingston County Health Department, Local Food Pantry, Salvation Army, YMCA, Catholic Charities, Streator Substance Abuse Prevention Coalition, ADV/SAS, and OSF St. Elizabeth Medical Center - CHOICES, to develop, implement, monitor and evaluate both new and ongoing initiatives that address the identified priority community health needs. The implementation strategies and interventions are contained in the Implementation Plan, which was approved and adopted by the Hospital Board of Directors. The implementation strategies and interventions will include, but are not limited to, the following initiatives in each of the categories. 1. Access to Mental Health Care - Collaborate and explore the following efforts to improve access to care. * Partner with local agencies and schools to increase awareness of the cause and effect of mental illness. * Partner with local mental health resources to improve access to care via referral, recognizing this will be challenging due to the limited availability of services and governmental downsizing. * Continue to support the North Central Area Transit for transportation of mental health clients to access outpatient mental health care. 2. Obesity - HSHS St. Mary's Hospital will continue to lead the following efforts to address obesity. * Healthy You annual weight loss competition/healthy lifestyle promotion in partnership with the local YMCA. * Community gardening in local schools and hospital grounds. * Healthy eating & gardening classes in the area schools. * Zumba exercise sponsorship in schools. 3. Tobacco Use - HSHS St. Mary's Hospital will support efforts to address tobacco use in the younger population. * Nurse education in the local school system, in partnership with Streator Substance Abuse Prevention Coalition, since tobacco is a gateway drug to the use of more illicit drugs. 4. Domestic Violence - HSHS St. Mary's Hospital will support the following efforts to address violence and/or abuse. * Continue ADV/SAS partnership for patient advocates through the Emergency Department. * Increase awareness regarding other types of abuse and/or violence

Schedule H, Part VI, Line 5 Promotion of community health (continued A)
Other Community Benefit Activities and Programs HSHS St. Mary's Hospital coordinated with Bureau and Putnam county health department (BPHD) to provide onsite enrollment counselors during the ACA enrollment period. BPHD was on site 13 times for a total of 67 hours and enrolled 49 community members in Medicaid and Health Insurance Exchange the previous year. Due to pending closure, providing space this year was not an option. The Streator community suffers from rising poverty level. This is relevant because poverty creates barriers to access to health services, nutritional food and other necessities that contribute to poor health status. HSHS St. Mary's Hospital hosted a Salvation Army Angel Tree again this year providing Christmas community area teens in need. The Salvation Army is extremely grateful to receive support through Christmas giving and Fresh Garden produce. HSHS St. Mary's Hospital Chaplain serves as a board member for the LaSalle County Emergency Food and Shelter Program. The program has disperses funds to assist community members in need.

Schedule H, Part VI, Line 6 Description of affiliated group (continued A)
"In southwest Illinois, HSHS St. Joseph's Hospital in Highland enhanced their offerings to their senior population based on their CHNA. ""Senior Renewal"" is an outpatient counseling program for senior adults who may be facing emotional and physical problems unique to the aging process such as feelings of loneliness, isolation and anxiety. Clients receive a comprehensive level of treatment without inpatient hospitalization through counseling strategies and education. In addition, St. Joseph's Hospital in collaboration with the Illinois Department of Insurance participates in the Senior Health Insurance Program (SHIP), a free health insurance counseling service for Medicare beneficiaries and their caregivers. In addition to programs designed to increase access to care, HSHS makes sure that those who need financial assistance receive it. HSHS's Financial Assistance (Charity Care) policy was modified effective January 1, 2014 to offer a 25 percent self-pay discount to all patients who register without insurance. HSHS Financial Assistance programs have a sliding scale, in some instances providing up to a 55 percent reduction off billed charges if an uninsured patient's family income level is determined to be above 500 percent but equal to our less than 600 percent of the current Federal Poverty Guidelines. HSHS hospitals waive all charges for patients below 200 percent of the Federal Poverty Levels. Counselors are available in our hospitals to explain our financial assistance policy to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Enhance community health As part of our mission to embody Christ's healing love for all people, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. To ensure the health care needs of all are being met, HSHS hospitals also understand we need to listen closely to the residents of the communities we serve. In turn, 13 of our 15 hospitals completed Community Health Needs Assessments (CHNAs) in FY2015. HSHS St. Clare Memorial Hospital in Oconto Falls, Wisconsin, who affiliated with HSHS in September 2015, and HSHS Holy Family Hospital in Greenville, Illinois, who affiliated with HSHS in May 2016, both completed their CHNAs in FY2014. HSHS hospitals are using the information gathered from their most recent CHNAs to develop new, and enhance existing, programs and services that best address the needs of the community. Several priority areas were identified in the FY2015 CHNAs including access to health care services; alcohol, tobacco, and other drug abuse; chronic disease prevention and management; nutrition/wellness; mental health; and oral health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. In many cases, the hospitals collaborate with other hospital facilities, local departments of public health and community organizations to address identified needs. In western Wisconsin, HSHS Sacred Heart Hospital in Eau Claire and HSHS St. Joseph's Hospital in Chippewa Falls are taking the lead on programming to educate the public about mental health issues and treatment, the stigma associated with mental health, and the recognition of mental health issues. To combat the rising rate of suicides in the area, both hospitals under the umbrella of 3D Community Health are providing community education on QPR (Question, Persuade and Refer), an evidence-based suicide prevention program. In FY2016, 3D Community Health provided 37 adult QPR programs for 1,046 persons and 44 youth QPR programs for 1,161 high school students. In addition, 3D Community Health hosted a community forum to discuss the CHNA results and introduce QPR to 192 community members. HSHS St. Vincent Hospital in Green Bay collaborated with Prevea Health to implement the TIPS program, a program for non-violent opioid abusers that provides treatment and deferred/dismissed prosecution upon successful completion of the treatment program. St. Vincent Hospital also subsidized scholarships for a residential treatment program and arranged to have the first dose of Vivitrol donated; Vivitrol prevents relapse to opioid dependence after opioid detox by attaching to opioid receptors and blocking feelings of pain relief and wellbeing. HSHS St. Mary's Hospital in Decatur, Illinois joined the Macon County Mental Health Board to collaborate on existing programs and to provide resources to meet identified gaps. While other communities are cutting back on mental health services, St. Mary's Hospital remains committed to providing a full spectrum of behavioral health services for adolescents, adults and senior. For example, the hospital collaborates with the Decatur Public School District to provide school teachers for two hours per day for children in the adolescent behavioral health unit. The partnership limits the amount of schoolwork missed during hospitalization. The hospital also has substance abuse counselors who provide educational programs on alcohol and other drug abuse in county schools for students and faculty. HSHS St. Nicholas Hospital in Sheboygan identified nutrition and physical activity as a priority health need in its FY2015 CHNA. In response, St. Nicholas Hospital coordinated and supported the development of the ""Double Your Bucks"" program at the Sheboygan Farmers Market in FY2016 to enable EBT recipients to double the amount of fresh fruits and vegetables they can purchase. The hospital is also a sponsor of the Sheboygan Farmers Market to promote healthy eating in the community. Additionally, St. Nicholas subsidized the cost of additional bike helmets at the Early Learning Center to increase the physical activity levels of Head Start students and purchased culinary equipment for South High School nutrition and fitness classes to increase opportunities for students to learn how to prepare healthy food. HSHS St. Mary's Hospital in Streator, Illinois collaborated with two local schools to establish community gardens on each of their campuses to address childhood obesity in addition to the community garden on the hospital campus. Students, their families, and hospital colleagues planted, tended and harvested the gardens. Math and science teachers incorporated the gardens into their curricula. Neither school offered Home Economics classes, so St. Mary's Hospital provided the produce and colleagues to offer cooking demonstrations in the classrooms to encourage students to prepare fresh fruit and vegetables snacks. The three gardens produced more than 1,713 pounds of produce in three years, which was donated to the local food pantry, Salvation Army, students and local churches providing healthy food to the poor and vulnerable. Advance medical knowledge HSHS works to advance medical knowledge by supporting research initiatives and educational opportunities. In FY2016, HSHS hospitals and affiliated physician groups contributed more than $19.1 million toward research and education. Highlights of this commitment include subsidizing medical school residency programs, offering ongoing medical education to physicians and clinicians, and providing job shadowing programs for high school students. In southern Illinois, HSHS St. Joseph's Hospital in Breese, hosted members of the Health Occupations Students of America onsite to learn about job opportunities in health care from health care professionals. St. Joseph's also provided clinical experience for Kaskaskia College students enrolled in nursing, physical therapy and radiology programs. Pharmacy students have also completed their clinical training at St. Joseph's Hospital. In FY2016, the program served more than 100 students. In FY2016, HSHS St. Mary's Hospital Medical Center and HSHS St. Vincent Hospital in Green Bay invested more than $311,000 to provide onsite training and education of nurses and allied health professionals. In addition, the hospitals have been collaborating with the Medical College of Wisconsin to establish a community medical education program in Green Bay and to provide financial support to offset operating costs in FY2016. Also in eastern Wisconsin, HSHS St. Clare Memorial Hospital in Oconto Falls provided training for local paramedics and emergency response personnel through the hospital's EMS liaison program."

Schedule H, Part VI, Line 6 Description of affiliated group (continued B)
Mission-driven and strategically implemented Community Benefit is an integral part of Hospital Sisters Health System's Mission. Our commitment to Community Benefit arises from our Catholic identity, Mission and Core Values shared by 14,000 colleagues across Illinois and Wisconsin. Through our work to improve access to health care services, enhance community health, advance medical knowledge, and relieve or reduce the burden of government, we believe we have made a positive difference in the quality of lives of tens of thousands of people in Illinois and Wisconsin in FY2016. As a Catholic health care ministry, HSHS is concerned with the dignity of all persons, the common good, and the stewardship of resources. We advocate for health care for all and work to improve social conditions that lead to improved health and well-being. We engage partners in our communities to improve health and quality of life and to reduce duplication. Working side by side with many faith communities, HSHS remains dedicated to our common purpose of compassionate care for all people.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
0

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
TO DETERMINE THE ACTUAL COST OF THESE SERVICES, THE HOSPITAL USES A COST-TO CHARGE RATIO BASED ON OUR AUDITED FINANCIAL STATEMENTS TO CALCULATE THE AMOUNTS REPORTED ON LINES 7A THROUGH 7I. ST. MARY'S HOSPITAL USES LYON SOFTWARE (CBISA) WHICH FOLLOWS THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES ON REPORTING CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS. Bad debt expense was not included in the calculation of the percentage in Part I, Line 7, column (f).

Schedule H, Part II Community Building Activities
The Director of Community Outreach works closely with key community partners to coordinate strategies and reports directly to the President/CEO. Executive team members utilize a discernment process to strategically and appropriately contribute funds and/or resource that will support the needs of the community. Community Building through community support, health improvement advocacy, and workforce development is an important part of HSHS St. Mary's Hospital's commitment to enhancing community-wide health and well-being. St. Mary's is engaged in community building by developing support groups and through coalition building with community outreach events. As part of our commitment to provide our community with the highest quality of care, St. Mary's Hospital participated in a number of health fairs providing educational information. In FY2016, St. Mary's colleagues donated their time to travel to several health fairs throughout the Illinois Valley, offering healthy eating education. Health fairs are just one way that our hospital educates the community and encourages a healthy lifestyle. St. Mary's Hospital also partners with the United Way, Salvation Army, and Streator YMCA to promote healthy eating and activities that support a healthier lifestyle. This includes but is not limited to personal hygiene products, coat and blanket drive, and food drives. St. Mary's Hospital is also a proud supporter of the American Cancer Society's Relay for Life. In addition to the event sponsorship, St. Mary's Hospital donates office space for the American Cancer Society's local resource office. St. Mary's Hospital strives to promote and improve the health of the communities it serves by providing a teaching environment for nursing and technical clinical expertise for the regional workforce, recruiting and retaining the professional medical staff to meet the area need, and by providing care through a collaborative approach. St. Mary's Hospital also supports North Central Area Transit (NCAT) to improve access to healthcare. NCAT provides public transportation which allows mobility to those who are transportation disadvantaged which includes but not limited to seniors, persons with disabilities, and low income residents who reside independently within our rural community. North Central Area Transit provides curb-to-curb service. All vehicles are lift equipped. Transportation is provided to all ages. Consistent with its exempt purpose, St. Mary's serves as a clinical site for students in the fields of nursing, laboratory, diagnostic imaging, physical therapy, speech and pharmacy. St. Mary's hospital is a community partner with Illinois Valley Community College to provide a clinical training site, professional oversight, and a supportive entrance to the nursing field. By providing this medical education, the hospital is contributing to the regional and national workforce in a way that will continue to ensure access and high quality care for the families St. Mary's serves.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Self-pay patients are screened for verification of no insurance coverage. Once verification of no coverage has been completed, the guarantors will be screened for charity or uninsured discounts based on income levels. Those guarantors who do not qualify for charity through the screening process will be asked to provide proof of income in the form of a recent pay stub and/or recent tax return to determine the level of uninsured discounting. If no proof of income is provided or a guarantor's income is greater than 201% of the federal poverty level, the appropriate discount according to the established criteria up to 600% of the federal poverty level will be applied. The amount of money not collected from those self-pay patients who are not eligible for charity care is reported as bad debt. Allowances for Doubtful Accounts have been recorded based on an historical matrix, using collectability percentages by payor and aging category in accordance with HSHS Executive Policy #F-23, Valuation of Net Accounts Receivable. Percentages are based on historical experience at the hospital and adjusted for known limitations.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
HSHS St. Mary's Hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients who potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity because of missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Currently, the hospital is implementing processes, procedures and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the hospital.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
The text of the footnote to the organization's financial statements that describes bad debt expense can be found on page 21 of the HSHS Consolidated Audit Report.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
HSHS St. Mary's Hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for charity care or other means-tested government programs. Further, by absorbing this payment shortfall and providing care below cost to these individuals, HSHS St. Mary's Hospital is relieving the burdens of the government. Accordingly, this shortfall restricts St. Mary's Hospital's ability to make funds available to provide for charity care and other community benefits. The hospital Medicare shortfall at cost for fiscal year 2016 was $4,205,954.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
"Prior to an account being sent to collection, the patient predictability for a 'no response' patient will be checked through Pay Nav. ""no response"" for this purpose is described as no response for at least sixty (60) days, during which at least three (3) contact attempts have been made. Attempts include mailing an application, sending patient statements, and/or making telephone calls. If the result of the payment predictability comes back as low or undetermined, the Pay Nav result is stored and retrievable through the system and the account written off to charity. If an indication of the inability to pay is apparent, the patient will be given the option to complete Illinois Public Aid - form 450, if appropriate. The final option would then be to ask the patient to cooperate with the charity care & uninsured program determination process to determine the patient's ability to pay."

Schedule H, Part V, Section B, Line 16b FAP Application website
- ST. MARY'S HOSPITAL: Line 16b URL: https://www.stmaryshospital.org/Patient-Guest/Patient-Financial-Services.aspx;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- ST. MARY'S HOSPITAL: Line 16c URL: https://www.stmaryshospital.org/Patient-Guest/Patient-Financial-Services.aspx;

Schedule H, Part VI, Line 2 Needs assessment
As indicated in Part V, Section C, HSHS St. Mary's Hospital conducted a Community Health Needs Assessment in FY2015 (July 1, 2014 through June 30, 2015). In FY2012, the hospital assessed community health needs in cooperation with Leede Research, a research firm specializing in health care information programs and tools. In addition to the primary data provided by Leede, the hospital's CHNA Steering Committee also reviewed secondary data from the Illinois Behavioral Risk Factor Surveillance System (IBRFSS) and the Illinois Department of Public Health (IDPH). The committee also considered the County Health Rankings which synthesizes health information from a variety of national data sources to create the rankings. Measures based on vital statistics data are calculated by the National Center for Health Statistics and other units of the Centers for Disease Control and Prevention (CDC). In FY2012, St. Mary's CHNA Steering Committee was comprised of a diverse group of community leaders and stakeholders from throughout LaSalle, Livingston and Marshall Counties. Provisions in the Affordable Care Act require charitable hospitals to conduct a CHNA and adopt implementation strategies to meet the needs identified. To comply with these requirements, HSHS St. Mary's Hospital led a collaborative approach to conduct its CHNA and adopt an Implementation Plan in FY2015 (July 1, 2014 through June 30, 2015), a process we undertake every three years.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
The patient accounts department provides brochures to patients who have health care needs and are uninsured, underinsured, ineligible for government programs, or otherwise unable to pay for urgent or emergent medical care based on the individual financial situation. The patient accounts department will discuss the application and help the patient complete the application, if needed. The charity care & uninsured program brochures are also supplied in waiting and ancillary areas, as well as on the hospital's website at www.stmaryshospital.org. Information outlining the program is also available. The organization has a representative on site to assist patients who may be eligible for Medicaid assistance through the Illinois Department of Public Assistance. They work with patients to determine if they may be eligible, and if so, assist in pulling together the necessary application for submission. Patients are also provided a Fair Billing Act notification at the point of registration regarding separate physician billing they can expect to receive, plus information about the patient's financial responsibility if their insurance plan is out of network. One-on-one conversations to educate patients about financial assistance often stem from patients receiving a statement or a pre-collection letter. At that point, the patient accounts representative will inform/educate the caller about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's charity care program. The letter provides direct contact information to begin the application process for charity care and lists the Internet address where the policy can be obtained. A system called Pay Nav is now being utilized after failed attempts made by the hospital and our law firm to work out payment arrangements. That system accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a determination whether to grant charity care or continue collection efforts.

Schedule H, Part VI, Line 4 Community information
HSHS St. Mary's Hospital service area is a three county area - LaSalle, Livingston and Marshall Counties - approximately 2,566 square miles with a population of approximately 164,000 and an average population density of 56.8 per square mile. According to the US Census Bureau, LaSalle County is 95.2% Caucasian and 2.3% African-American; Livingston County is 92.2% Caucasian and 5.5% African-American; and Marshall County is 97.5% Caucasian and 0.5% African-American. The service area consists of the following rural communities: Streator, Toluca, Wenona, Ottawa, Cornell, and Grand Ridge. The U.S. Census Bureau data reports the average household income at $52,919. According to the U.S. Census data, the population in the region rose from 164,367 to 165,514 between 2000 and 2010, a 0.7% increase. Within the report area 11.0% or 17,458 individuals are living in households with income below the Federal Poverty Level (FPL). This is lower than the statewide poverty levels (13.7%). Poverty is considered a key driver of health status, so this indicator is relevant because poverty creates barriers to access including health services, nutritional food and other necessities that contribute to poor health status. Approximately 11% of the communities served are uninsured and 21.6% of our hospital's patients are uninsured and/or Medicaid recipients. Other hospitals serving the area include: Illinois Valley Community Hospital, OSF Saint Elizabeth Medical Center, OSF Saint Paul Medical Center, Mendota, and OSF Saint James-John W. Albrecht Medical Center, Pontiac. St. Mary's Hospital does not exclude Medically Underserved Areas, low income or minority populations from its service area.

Schedule H, Part VI, Line 5 Promotion of community health
As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), HSHS St. Mary's Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded more than 125 years ago to bring a healing presence and improve the health of our community, especially for those persons who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Streator and surrounding areas. The hospital is governed by a Board of Directors, at least a majority of whom reside in the hospital's primary service area and who are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St. Mary's Hospital is responding to community need. In FY2015, for example, the Board reviewed the Community Health Needs Assessment and approved an Implementation Plan for addressing selected health focus areas Also consistent with its exempt purpose, HSHS St. Mary's Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS St. Mary's Hospital reinvests surplus funds to support the mission of the organization and health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. HSHS St. Mary's Hospital also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2016, HSHS St. Mary's Hospital provided more than $1.8 million in Community Benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, in fiscal year 2016, HSHS St. Mary's Hospital provided more than $4.2 million (at cost) in excess of Medicare payment for health care services. HSHS St. Mary's Hospital provides a range of Community Benefit activities and programs that furthers our mission and long-standing commitment to our community. In many cases, these Community Benefit initiatives would not exist without the leadership role played by HSHS St. Mary's Hospital and they often relieve a burden that would otherwise be carried by government. Programs to address the needs identified in the CHNA 2015 are overseen at the operational level by the Director of Community Outreach, reporting directly to the hospital's President/CEO. The Director of Community Outreach works closely with key community partners to coordinate strategies. Executive team members utilize a discernment process to strategically and appropriately contribute funds and/or resource that will support the needs of the community. ACCESS TO MENTAL HEALTH CARE - St. Mary's Hospital collaborated with North Central Behavioral Health (NCBH). Attempts were made to donate a building for office space to keep services in the local community. When NCBH declined the donation, St. Mary's Hospital assisted in coordinating transportation to appointments 15 miles away via North Central Area Transit (NCAT). OBESITY Collaborate with other community organizations to enhance community gardens: A community garden was established in the spring of 2013 and continued to be cared for by hospital colleagues and community volunteers through the last 3 yrs. Ongoing financial support of all 3 gardens is provided by St. Mary's Hospital. The Community Benefit team was inspired by our hospital's lead gardener. He shared the Ron Finley story about food deserts in Los Angeles. He describes his efforts for addressing obesity by getting children involved in gardening and they are more likely to eat what they grow. The team reached out to many schools and two local schools communicated an interest in bringing gardening and healthy eating into the class rooms. A team of colleagues and volunteers met with the local junior high and St. Michael's elementary schools. Teachers were so excited with what we were offering, they decided to each host a community garden at their schools. Their gardens will be taken care of by their students, families, and hospital colleagues. Math teachers would use the garden as education to figure square footage, how many people the garden could feed, and depth of seeds. Science teachers integrated gardening into their curriculum through the study of plants. St. Mary's Hospital conducted a garden design and naming contest to engage the children in the garden project. Lacking Home Economics in schools, St. Mary's provided the produce and employees to assist with demonstrations in the classroom to over 50 students each fall and spring. Each class prepared fresh vegetable and fruit snacks during the after school program which the more vulnerable children participate in. The education provided opportunity to learn to make their own healthy snacks, try new foods, and have fun preparing the food. St. Mary's Hospital provided each student participating with their own tools to prepare the recipes, an apple peeler, a tomato corer, and a healthy kid's cookbook to take home. In addition, education was provided to the students regarding the 5-2-1-0 program; eating 5 fruits or vegetables, 2 hours of physical activity, 1 hour or less screen time, and 0 sugary drinks/drink more water every day. In addition to in person education, St. Mary's provided nearly 4,000 handouts on 5-2-1-0 for use throughout the school year. The three gardens have produced over 1,713 lbs. of fresh produce in 3 yrs. and was donated and used by the local Food Pantry, Salvation Army, students and local churches providing healthy food to the poor and vulnerable. St. Mary's Hospital is the monetary sponsor through the YMCA for Zumba exercise dancing in local schools for three years. Over 100 students each year participated. An additional school was added for school year 2015-16. The educators provided feedback on the program stating that the students thoroughly enjoyed it and that Zumba is an excellent and fun way to get kids moving. They also stated that students showed an improved awareness of practicing healthier lifestyles. In addition to community gardens and education in schools, St. Mary's provided food and monetary donations to the Salvation Army for perishables during food shortages. St. Mary's also provided monetary donations to Blessing in a Back Pack. TOBACCO USE St. Mary's Hospital Nurse Educator collaborates with the coalition and provides a program in the school during last year around tobacco use and how it is a gate way to substance abuse. The program mirrors the school's Six Pillars of Character; Trustworthiness, Responsibility, Respect, Caring, Fairness, and Citizenship. Due to pending closure, classes were not pursued school year 2015-16. DOMESTIC VIOLENCE Enhance the Medical Advocate Program: St. Mary's Hospital has engaged in a process with other community organizations to assess how the hospital could support local resources already in place for domestic violence. In particular, the hospital is collaborating with ADV/SAS (A Domestic Violence & Sexual Assault Service) to help strengthen their medical advocate program throughout LaSalle and Livingston counties. Medical Advocates provide support and information to survivors of domestic or sexual violence, advocate for the victim with the medical staff and law enforcement personnel, explain the medical evidence collection and criminal justice procedures, and arrange transportation and shelter if the victim wishes. St. Mary's Hospital was also a proud monetary sponsor of ADV/SAS to support their advocacy efforts as government funding has been unreliable. A St. Mary's Hospital colleague proudly serves on the ADV/SAS board. In addition, ADV/SAS provided six educational sessions and received nine referrals from the Emergency Department in the first year of strengthening the relationship with ADV/SAS compared to no referrals in the three years prior. Between 2013 and 2015, twenty referrals were made to ADV/SAS through the Emergency Department.

Schedule H, Part VI, Line 6 Affiliated health care system
"HSHS St. Mary's Hospital in Streator is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 15 hospitals, numerous community-based health centers and clinics, and hundreds of physician partners across Illinois and Wisconsin. The mission of HSHS is ""to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry."" We live our mission by providing holistic healing to all who seek our care, as well as through Community Benefit. In tandem with others in the communities we serve, our Community Benefit initiatives are strategically increasing access to care, improving the health status of residents, and increasing medical education and knowledge. In FY2016, our hospitals responded to the top needs identified in each of their most recent Community Health Needs Assessments (CHNAs). The information gathered from these assessments was used to develop or enhance Community Benefit programs and services to best address community health needs. Among the priority needs identified in the most recent CHNA process were access to care; alcohol, tobacco, and other drug abuse; chronic disease prevention and management; nutrition/wellness; mental health; and oral health. HSHS hospitals are proactively addressing these and other needs through patient, provider and community education, preventative screenings, self-management classes, and new or enhanced clinical services. In FY2016, HSHS collectively provided $203.8 million in Community Benefit (10.0% of total hospital expenses). This amount included $28.1 million provided for Financial Assistance (i.e. Charity Care) and $134.3 million for unreimbursed care provided as part of the Medicaid program. In addition, HSHS hospitals committed significant resources to treat Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $221.3 million. HSHS hospitals also recorded $31.4 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to serving all persons in need of care. In addition to the dollars invested in our Community Benefit programs, HSHS continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing so, we ensure our ability to meet the ongoing demand for high quality, efficient and easily accessible health care. Improve access to health services As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need with a special focus on the poor and vulnerable. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for those in our communities. Our efforts to ensure residents in the communities we serve receive the right care, at the right time, and in the right setting involve collaborating with others to achieve this goal. Across our two-state System, there are numerous examples of partnerships with departments of public health, other health care facilities and community and social service organizations to enhance access to care for those in need. In FY2016, HSHS and our 15 hospitals invested Community Benefit resources to educate the uninsured about new enrollment opportunities in affordable health care coverage and to facilitate the process. Studies have shown that people without insurance are more likely to postpone care and develop more severe and expensive conditions than their insured counterparts. It is for this reason that the Catholic Church, Catholic health care and HSHS have long promoted ""coverage and access for all."" HSHS and our 15 hospitals in partnership with local health departments, social service agencies and other health care providers played a vital role in educating eligible people in their local communities, by referring people to Certified Application Counselors and/or in enrolling them in the health insurance exchanges, or in securing coverage through Medicaid expansion. In southern Illinois, HSHS St. Elizabeth's Hospital in Belleville identified an education gap among newly insured patients. Although these patients now had health insurance, they did not know how to use insurance nor did they understand the many benefits that come with different plans. To bridge the gap, St. Elizabeth's Hospital hosted quarterly resource fairs in collaboration with other social service agencies in the community to not only educate the public about their health insurance benefits but also about other resources in the community that can improve their overall health and quality of life. More than 100 persons participated in the resource fairs and each received a healthy snack or hygiene kit. In response to its FY2015 CHNA, HSHS St. John's Hospital in Springfield, Illinois established a community health worker program to increase access to health care and coordination of care for residents of the Enos Park Neighborhood. The hospital also helped establish an Enos Park Neighborhood Advisory Council and Providers Alliance as part of the access collaborative to drive behavior changes and improve health outcomes. In the first year of the program, 103 clients were 100% engaged. Services provided included basic needs (70%) and health care access (30%). The access collaborative also placed 12 homeless individuals or families in affordable, safe housing in Enos Park. Of the 27 parolees we worked with, we realized an 18% recidivism rate compared to the national rate of 60% due to lack of housing or employment. One hundred percent of our clients visited a primary care provider and 84% connected to a medical home. Due to the program's initial success, it is being replicated in Sangamon County's eastside where our most poor and vulnerable populations live. HSHS St. Mary's Hospital Medical Center in Green Bay led the activities of the community Oral Health Task Force, which focuses on prevention, intervention and policy modification strategies to improve oral health in Brown County. In FY2016, St. Mary's Hospital helped to expand the services at NEW Community Clinic dental clinic by supporting their efforts to secure a HRSA grant for expansion by subsidizing the rent guarantee necessary and by assisting with the design cost for the center. The hospital also subsidized the cost of a staff person to obtain the necessary medical clearances and consent forms for patients, many of whom are elderly and/or disabled and need consent from guardians - thus supporting the oral surgeons who are providing their services free of charge. St. Mary's Hospital expanded oral health services for children by covering the costs of a dental hygienist employed by the Brown County Oral Health Partnership to offer oral health services in the Ashwaubenon school district. Through this new alliance, 79 students received oral health care that otherwise would have been difficult to obtain, including care for dental caries and abscesses. HSHS St. Francis Hospital in Litchfield, Illinois collaborated with Lewis & Clark Community College and local dental providers to bring the College's mobile dental health unit to the Litchfield area; the unit provides free or low cost dental exams and screenings, x-rays and hygiene services. In addition, three local dental providers also participated by opening their offices and donating time, staff and supplies to provide either a free filling, extraction or hygiene services. Beginning in 2015, the hospital collaborated with Catholic Charities to launch a dental voucher program. Five dentists in Macoupin and Montgomery counties participate in the program, which covers an initial exam and x-rays, one tooth extraction and up to three fillings per year per individual. The percentage of total emergency department visits related to dental issues decreased from 2.2 percent in 2011 to 1.27 percent in 2014 because of this collaboration. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between HSHS St. Anthony's Memorial Hospital in Effingham and Catholic Charities. In FY2016, St. Anthony's Memorial Hospital helped to underwrite the cost of prescription medications for 518 residents. St. Anthony's Memorial Hospital and Catholic Charities believe no one should be without prescriptions because of the inability to pay."

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