4A (Expenses $ 113980599 including grants of $ 0) (Revenue $ 155056344)
ST. ANTHONY'S MEMORIAL HOSPITAL, EFFINGHAM OF THE HOSPITAL SISTERS HEALTH SYSTEM PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED,SEX, NATIONAL ORIGIN, HANDICAP, AGE, RELIGION, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES IS CRITICAL TO THE CONTINUED OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE NECESSARY MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY WITH THE BEST QUALITY HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. INHERENT TO OUR MISSION, WE PROVIDE CARE TO THE POOR, THE ELDERLY, AND THE NEEDY OF THE COMMUNITY THROUGH VARIOUS PROGRAMS AND SERVICES. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. DURING FISCAL YEAR 2022, ST. ANTHONY'S MEMORIAL HOSPITAL PROVIDED SERVICES TO 3,164 INPATIENTS UTILIZING 11,831 ADULT AND PEDIATRIC DAYS OF CARE. IN ADDITION, ST. ANTHONY'S MEMORIAL HOSPITAL PROVIDED SERVICES TO 139,362 OUTPATIENTS. ST. ANTHONY'S MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL CARE TO THE POOR AT FREE OR REDUCED COST THROUGH OUR CHRISTIAN CARE PROGRAM. CHARITY CARE PROVIDED AT COST WAS $455,919. IN ADDITION, THE HOSPITAL PARTICIPATES IN THE ILLINOIS MEDICAID PROGRAM, WHICH REIMBURSES THE HOSPITAL AT RATES SUBSTANTIALLY BELOW THE COST OF PROVIDING THE SERVICES. FULFILLING OUR MISSION TO THE COMMUNITY, SERVICES WERE PROVIDED TO MEDICAID INPATIENTS UTILIZING 1,194 DAYS OF CARE. THE UNPAID COST OF MEDICAID WAS $8,610,204. OTHER BENEFITS INCLUDED IN-KIND DONATIONS IN THE AMOUNT OF $202,500. ST. ANTHONY'S MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL CARE TO MEMBERS OF THE BROADER COMMUNITY THROUGH OUR PARTICIPATION IN THE MEDICARE PROGRAM, PROVIDING MANY PROGRAMS AND SERVICES FREE OR AT A REDUCED PRICE, PROVIDING SERVICES THAT BENEFIT THE COMMUNITY BUT HAVE A NEGATIVE MARGIN, AND THROUGH EDUCATIONAL PROGRAMS AT NO COST. THE UNPAID AND UNREIMBURSED COST OF PARTICIPATING IN THE MEDICARE PROGRAM WAS $4,017,582 DURING FISCAL YEAR 2022.

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

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - HSHS St. Anthony's Memorial Hospital. St. Anthony's Memorial Hospital undertook an eight-month planning and implementation effort to develop the CHNA, identify and prioritize community health needs for its service area and formulate an implementation plan to guide ongoing population health initiatives with like-missioned partners and collaborators. These planning and development activities included the following internal and external steps: 1. Identified the CHNA core group comprised of St. Anthony's Memorial Hospital, Effingham County Health Department and Jasper County Health Department. 2. Convened a community advisory committee to solicit input and help narrow identified priorities. 3. Conducted a community survey to get input from community members around the priorities identified. 4. Convened an internal advisory committee respective to each organization to force rank the final priorities and select the FY2022-FY2024 CHNA priorities. External St. Anthony's Memorial Hospital worked with core group partners to leverage existing relationships and provide diverse input for a comprehensive review and analysis of community health needs in Effingham and Jasper counties. Representation on the community advisory council (CAC) was sought from health and social service organizations that: 1. Serve low-income populations 2. Serve at-risk populations 3. Serve minority members of the community 4. Represent the general community The following community stakeholders were invited to serve on the CAC: * Denotes groups representing the under resourced in our community including low-income seniors, children living in poverty and families who struggle with shelter and food. * Effingham County Health Department* * Jasper County Health Department* * HSHS St. Anthony's Memorial Hospital* * Effingham Catholic Charities * * Jasper County Sheriff's Department * Effingham City Police Department * University of Illinois Extension Center* * Effingham Unit 40 Schools* * Effingham County Chamber of Commerce * Heartland Human Services* * Premier Broadcasting * Rides Mass Transit District * Jasper Unit 1 Schools* * Crisis Nursery of Effingham

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - HSHS St. Anthony's Memorial Hospital. The hospital conducted the FY2021 CHNA with Effingham County Health Department and * Jasper County Health Department* * HSHS St. Anthony's Memorial Hospital* * Effingham Catholic Charities * * Jasper County Sheriff's Department * Effingham City Police Department * University of Illinois Extension Center* * Effingham Unit 40 Schools* * Effingham County Chamber of Commerce * Heartland Human Services* * Premier Broadcasting * Rides Mass Transit District * Jasper Unit 1 Schools* * Crisis Nursery of Effingham

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - HSHS St. Anthony's Memorial Hospital. In FY2021, HSHS St. Anthony's Hospital conducted a CHNA. The hospital partnered with other agencies and reviewed primary and secondary data. Then the internal work group gathered and based on the data and the prioritization process, the following priority community health needs were selected: 1. Access to Mental Health and Behavioral Health Services 2. Chronic Conditions 3. Workforce Development FY2022 Highlights and Outcomes: A partnership with Gateway Foundation launched in FY2022 to identify, connect, screen and develop a treatment plan for persons presenting in the ED with substance use disorder. This initiative employs an engagement specialist who works with the provider to identify referral and linkages to address the patients addiction. The recovery coach helps the patient transition back in the community when exiting residential treatment. St. Anthony's Hospital along with three others in southern Illinois engaged in an 18-month planning process to identify solutions to crisis screening gaps in the emergency department. In FY2023, the plan will be presented to strategy and finance teams with the goal of deploying in January 2023. As part of this plan, SAE will have 365-day psychiatric coverage in the emergency department. SAE has used the better part of FY2022 to vet and operationalize the use of a determinants of health screening tool for every patient entering the hospital. The goal is to expand this to Primary care physician settings as well. This tool will allow us to make referrals to social service agencies in direct response to our patient's social needs. HSHS launched a DEI committee in FY2022. SAE participates in the Workforce Subcommittee to explore internal and external gaps in workforce readiness, obtainment, and success. As an outcome of the prioritization process, the following community health needs were also identified, but will not be addressed directly by the hospital for reasons indicated. * Child Care: While not a direct priority issue, child care availability will be explored within the strategic plan of maternal and child health. * Human Trafficking: This is an ever-growing issue in all communities across Illinois and the nation. St. Anthony's will be represented on the Illinois Human Trafficking Task Force by the HSHS Illinois division. While not a direct priority area, HSHS and St. Anthony's Memorial Hospital will continue to raise awareness in HSHS facilities and the community on identification and response to human trafficking. * Cancer * Food Insecurity: While not a direct priority issue, food insecurity will be addressed within the strategic plan of chronic conditions. * Senior Health: Effingham Senior Services and Effingham County Committee on Aging provide services and assistance for senior health. St. Anthony's will continue to partner with community organizations in addressing senior health issues. * Homelessness: The Southern Illinois Continuum of Care reports homeless numbers trending down for all populations. In 2019, homeless was discussed during a community town hall. St. Anthony's participated in this discussion and will continue to participate in discussions as the need arises.

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - St. Anthony's Memorial Hospital. Presumptive eligibility is presumed under certain circumstances for uninsured patients based on their enrollment in other means-tested programs or other sources of information, not provided directly by the patient. Once determined, presumptive eligibility provides individuals participating in one of the following categories with a 100% write off. These programs are granted by outside organizations based on screening criteria of less than 200% of the FPG. 1. Homelessness 2. Deceased with no estate 3. Mental incapacitation with no one to act on patient's behalf 4. Medicaid eligibility, but not on date of service or for non-covered services 5. Incarceration in a penal institution 6. Enrollment in the following assistance programs for low-income individuals: 6a. Temporary Assistance for Needy Families (TANF) 6b. Illinois Housing Development Authority's Rental Housing Support Program 6c. Wisconsin Department of Health Services Housing Assistance Program 7. Participation in Women, Infants and Children programs (WIC); 8. Supplemental Nutrition Assistance Program (SNAP) eligibility; 9. Low Income Home Energy Assistance Program (LIHEAP); 10. Wisconsin Home Energy Assistance Program (WHEAP); 11. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria; 12. Receipt of grant assistance for medical services

Schedule H, Part I, Line 7g Subsidized Health Services
NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC ARE INCLUDED ON LINE 7G.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET 3 TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE COMMUNITY HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH PROGRAM, AND DONATIONS ARE STATED AT ACTUAL COST (when applicable). THE COST OF THESE ITEMS ARE TRACKED THROUGH THE GENERAL LEDGER PROCESS AND THROUGH OTHER ACCOUNTING SOFTWARE.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
FOR FINANCIAL STATEMENT PURPOSES, HOSPITAL SISTERS HEALTH SYSTEM HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE.

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 pages 16-17 in the HSHS Consolidated Audit Report.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Every effort is made prior to, during and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and provide adequate documentation. If the patient qualified for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualified for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. The hospital will make reasonable efforts to determine whether a patient is eligible under the financial assistance policy before it engages in an ECA. To the extent a patient is determined to be eligible for financial assistance under the FAP, the hospital will take all reasonably available measures to reverse any ECA taken against the patient to obtain payment for the care.

Schedule H, Part V, Section B, Line 16a FAP website
- ST. ANTHONY'S MEMORIAL HOSPITAL: Line 16a URL: http://www.hshs.org/FAP;

Schedule H, Part V, Section B, Line 16b FAP Application website
- ST. ANTHONY'S MEMORIAL HOSPITAL: Line 16b URL: http://www.hshs.org/FAP;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- ST. ANTHONY'S MEMORIAL HOSPITAL: Line 16c URL: http://www.hshs.org/FAP;

Schedule H, Part VI, Line 2 Needs assessment
HSHS St. Anthony's Hospital has a systematic and comprehensive strategic planning process that starts with a reaffirmation of the mission, vision and values. The first step of the process is the compilation of the Environmental Strategic Assessment. The Environmental Strategic Assessment helps to identify the potential need for transformational change as it encompasses major market challenges, community health needs assessment, growth strategies/keys to success, physician alignment strategy, and future state (one to three years out). Key participants in the strategic planning process include leadership team, Administrative Team, physicians, Board of Directors, and Southern Illinois Division colleagues. Patients participate in the strategic planning process through comments on surveys, letters, phone calls, real-time and social media feedback. In addition, former patients and community members sit on key committees including the Quality & Patient Safety Council, the Quality Care Committee, and the Board of Directors itself. In addition to conducting a triennial CHNA, the hospital routinely asses the health care needs of the communities it serves in a variety of ways, including: reviewing the health needs assessment of other health care organizations in our service area, reviewing the local health department IPLANS, reviewing the united way health assessment. We continually review primary data such as hospital and emergency department utilization data. We also review patient surveys and secondary data from county and state public health departments, the center for disease control and prevention, county health rankings and the behavioral risk and surveillance system survey.

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

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
The Registration Department provides brochures to patients upon registration regarding the Financial Assistance Program available to them at the Hospital. The brochures are also supplied in waiting and ancillary areas for easy access by the patient. To better serve our patient population, the Hospital offers information on our financial assistance program in Spanish. This includes the Financial Assistance Policy, Brochure and Application, which allows the hospital to serve populations in its county and the surrounding area for whom Spanish is their primary language. 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 customer service representative or cashier, or other qualified staff, 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 third-party vendor also assists individuals in determining their eligibility for state health plans or insurance on the open health insurance marketplace. They can also assist with the application process.

Schedule H, Part VI, Line 4 Community information
Located in rural central Illinois, the hospital defines its primary service area and populations as Effingham and Jasper counties with a combined population of approximately 43,618. HSHS St. Anthony's Memorial Hospital is the only hospital located in its primary service area. The hospital's total service area is Effingham and Jasper counties along with portions of the counties of Clark, Clay, Coles, Crawford, Cumberland, Fayette, Marion, Richland, Shelby and Wayne. The hospital's patient population includes all who receive care without regard to insurance coverage or eligibility of assistance. The hospital does not exclude Medically Underserved Areas (MUAs), low income or minority populations from its service area. There are two MUAs in St. Anthony's primary service area of Effingham and Jasper Counties, and six MUAs in its secondary service area. Per the 2019 estimates of the US Census Bureau QuickFacts, the demographic make-up of Effingham County is 97.5 percent white (non-Hispanic), 1.9 percent of Hispanic or Latino origin, and 0.7 percent Black or African American. The demographic make-up of Jasper County is 98.3 percent white (non-Hispanic), 1.8 percent of Hispanic or Latino origin, and 0.3 Black or African American. The Community Health Needs Assessment (CHNA), using data from the US Census Bureau's American Community Survey: 2011 to 2015, indicated that 20.55 percent of Effingham County and 16.6 percent of Jasper County of those insured have health insurance coverage through Medicaid (or other means-tested public health insurance). US Census Bureau data showed 6.99 percent of Effingham County and 7.97 percent of Jasper County residents have no insurance coverage for health care expenses. Within the primary service area, 9.8 percent of Effingham County residents and 12 percent of Jasper County residents are living in households with income below the Federal Poverty Level (FPL) according to the US Census Bureau, Small Area Income and Poverty Estimates. According the US Census Bureau, American Community Survey (2019) the median household income for Effingham County is $56,685 and Jasper County is $54,878.

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. Anthony's Memorial Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1875, the hospital brings a healing presence and improves the health of our community, especially those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Effingham and Jasper Counties and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that St. Anthony's is responding to community need. In FY2020, the Schedule H (Form 990) community benefit narrative was shared with the Board members and community benefit programs offered by the hospital are discussed as needed with the group. Community leaders serve on the Foundation Leadership Council, which ensure the continuing growth, stability and future of health care in the region, by accepting and acknowledging charitable contributions to the hospital. St. Anthony's Auxiliary Executive Committee is a board of volunteers who direct the Auxiliary volunteer program which promotes and advances the welfare of the hospital through services for patients and their families and fundraising for hospital needs. St. Anthony's also connects with the community through the Patient Family Advisory Council. This council gathers input from patients and their family members on how to improve patient care. Consistent with its exempt purpose, St. Anthony's 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, St. Anthony's reinvests surplus funds to support the mission of the organization and promote the 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. St. Anthony's partnership with the Liberty University College of Osteopathic Medicine (LUCOM) provides clinical education for their osteopathic medical students. These third-year medical students learn alongside hospital colleagues and Medical Staff during their clinical rotations. St. Anthony's partners with the Eastern Illinois Education for Employment System (EIEFES) to provide classroom space for their Health Occupations program. During this year-long course, students also participate in the direct care of patients, work alongside medical and administrative staff in the hospital as well as in several local nursing homes. The Health Occupations program is a Health Science Technology program designed primarily for high school seniors who are interested in pursuing a career in a health care field. Students who successfully complete this course are eligible to take the Basic Nurse Assistant Competency Exam. In addition, the hospital offers a job shadowing program to high school and college students. This program gives students the opportunity to shadow hospital colleagues in their various roles. Students obtain firsthand knowledge about their future career path. Through these programs, St. Anthony's gives young adults in the community access to educational and job opportunities. To offer advanced specialty care to area residents close to home, St. Anthony's acquired a second telemedicine ""robot"" to provide direct access to intensivists, board certified physicians who specialize in the care of critically ill patients, most often in the intensive care unit. The remote intensivist can examine a patient using sophisticated videoconference and other medical equipment, speak with clinicians and family members, review any imaging scans and other tests and support treatment decisions with documentation in the medical record. Telemedicine solutions allow improved access to health care, especially in rural areas. St. Anthony's also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2022, St. Anthony's provided more than $1.7 million in Community Benefit, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health."

Schedule H, Part VI, Line 6 Affiliated health care system
Headquartered in Springfield, Illinois, Hospital Sisters Health System (HSHS) is a highly integrated, multi-institutional health care system comprised of 15 hospitals and more than 200 physician practice sites in Illinois and Wisconsin. HSHS is sponsored by Hospital Sisters Ministries (HSM), which is a public juridic person of the Roman Catholic Church. HSHS continues the health care ministries begun by its founders, the Hospital Sisters of St. Francis, more than 140 years ago, in rural and midsized communities throughout Illinois and Wisconsin. HSHS provides compassionate, holistic, high quality, and cost-effective health care through its acute care hospitals, physician practices, home health programs, palliative and hospice programs, and community outreach services. In addition, HSHS affiliated hospitals include critical access facilities that offer essential health services that otherwise would not be available in many communities. Our mission calls us to reveal and embody Christ's healing love for all people, and we extend our high quality Franciscan health care ministry beyond the walls of our hospitals by providing community health improvement services with special emphasis on the poor and vulnerable. In addition to providing community health improvement services to the broader community, HSHS cares for everyone who comes to its facilities, regardless of their ability to pay. In tandem with a variety of cross sector community partners, HSHS's Community Benefit initiatives are strategically planned and professionally implemented to improve access to health care services; enhance the health of the community; advance medical or general health care knowledge; and relieve or reduce the burden of government to improve health. The COVID-19 pandemic caused an unprecedented disruption in healthcare services across the United States. HSHS responded with services that benefited our communities, including free telehealth screenings, free testing, and coordination with other healthcare providers in the communities we serve to best ensure access to needed care. In FY2022, HSHS collectively provided $218.9 million in Community Benefit (8.3% of total hospital expenses). Of the total Community Benefit provided, HSHS spent $11.6 million provided for Financial Assistance (aka Charity Care) and $146.1 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 $23.2 million. HSHS hospitals also recorded $68.7 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.