4A (Expenses $ 88694962 including grants of $ 12617) (Revenue $ 113041526)
PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

Schedule H, Part V, Section B, Line 3E
THE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. In conducting this assessment, the SSM Health Community Health team sought input from the community through a community wide health survey, hosted focus groups, and conducted key informant interviews. No groups in the community were excluded from participating in the assessment. Secondary data was collected from various organizations, such as the U.S. Census, Centers for Disease Control and Prevention, County Health Rankings, SparkMap, broadstreet.io, and the Illinois Department of Public Health. Each of these sources of primary data (community input) was analyzed along aside secondary data. No written comments were received on the SSM Health Southern Illinois 2019- 2021 Community Health Needs Assessment. Community Health Survey From March 15, 2021, to May 24, 2021, individuals within the community were invited to complete a thirty nine question community health survey. The online survey was promoted through social media, press releases, county and city chambers of commerce, e mail invitations to SSM Health physicians, staff, and volunteer boards as well as email invitations to public officials, community organizations, and churches. Paper surveys were available at the hospital entrances and local public libraries. 577 residents of the 23 zip codes of the defined communities completed surveys; 3 of the 577 surveys were completed using a paper survey. Focus Groups Focus groups were moderated, conducted, and analyzed by the company, Stefanie Santos McLeese: PR and Brand Strategy. As part of the broader Community Health Needs Assessment (CHNA) data gathering process, three audiences were identified as priorities for further investigation, either due to statistical under representation in the 2021 CHNA survey or general urgency as indicated in survey results. One group was assigned to represent each of these audiences. When possible, CHNA initiatives focus on the collection of health needs from a representative mix of first person perspectives. However, certain groups may be more reluctant or simply less likely to share their direct feedback for a variety of reasons. In cases like these, it can be appropriate to engage individuals with direct contact with these populations to provide the necessary story, point of view, and context, helping to ensure the CHNA incorporates the needs of these groups. The SSM Health community health team conducted a rigorous, best practice network recruit for each of the three groups, beginning with known stakeholders with appropriate context before branching out to recruit stakeholders suggested as ideal for representing the populations in question by those known stakeholders. Group Emphasis and Participant Summary -Individuals experiencing housing instability or homelessness : seven participants representing local community services organizations; two of these participants had personally experienced housing instability -Black community members : three church leaders serving predominantly Black congregations -Individuals experiencing mental health difficulties: nine participants representing local community service organizations which on focus mental health services Key Informant Interviews The Community Health team interviewed 28 key community members health care administrations, social service organization leaders, law enforcement, educational leaders, civic organizational leaders, and key community leaders to gather input on the health needs, strengths, concerns, and areas of improvement needed in our community. Several of the interviews involved more than one person from the organization. Interviews were conducted in person or via virtual video meeting software depending on the individual's preferences. All interviews were recorded and transcribed via auto transcription software.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. SSM Health St. Mary's Hospital - Centralia conducted its 2021 CHNA in cooperation with SSM Health Good Samaritan Hospital - Mt. Vernon.

Schedule H, Part V, Section B, Line 11 Facility A, 1
"Facility A, 1 - SSM Health St. Mary's Hospital - Centralia. The hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Substance abuse - Mental health - Nutrition, weight, and exercise Substance abuse According to the CDC's National Center for Health Statistics provisional, drug overdose deaths have increased from 78,056 in 2019/2020 to 100,306 in 2020/2021. In Illinois, the overall age adjusted drug overdose mortality rate in 2019 was 21.9 per 100,000 population. Illinois has also been ranked 24 th in the country for overall drug overdose fatality rate. According to the CDC's Center for Vitals statistics, mortality rates due to poisoning were 26 per 100,000 population for Marion County and 22 per 100,000 for Jefferson County. Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Cigarette smoking causes more than 480,000 deaths annually, including 41,000 deaths from secondhand smoke. For every American who dies because of smoking, at least 30 are living with a serious smoking related illness. According to CDC's Behavioral Risk Factor Surveillance Survey, over 15% of residents in Illinois were current smokers in 2019. Additionally, in 2019, 22.7% of Illinois high school youth reported currently using any tobacco product, including e cigarettes. Among Illinois high school youth, 4.7% reported currently smoking cigarettes. The percent of adults who regularly smoke in both Marion and Jefferson County is approximately 20%, higher than the state average. The hospital has the following strategies addressing Substance abuse in its community: - Provide opportunities for proper drug disposal for OTC and controlled substances - install comprehensive medication collection kiosks, pending DEA approval, at each hospital - create and distribute education regarding at home drug disposal best practices - distribute ""at-home"" disposal kids to high risk populations - Provide education on opioid misuse and provide naloxone to community members - apply for a State of Illinois naloxone standing order for SSM Health pharmacy and ensure listing on state and national websites - Identify eligible organizations willing to participate in the Illinois Drug Overdose Prevention Program (DOPP) - Promote Narcan pick-up availability at specified community-based locations - Provide education opportunities on Narcan administration and disperse Narcan for households to have on-hand in an emergency - Provide prevention and cessation education on tobacco and vaping use - Initiate the implementation of CATCH my Breath program in local schools - Provide resources and educational opportunities for tobacco and vaping cessation in the community - Provide incentive opportunities for local schools to participate in smoking prevention education Goals for the substance abuse health priority are: - decrease incidence of improper drug use - decrease incidence of prescription drug dependence - reduce emergency hospital visits due to drug-related incidents - decrease rate of opioid overdose - reduce prevalence of tobacco related health disparities Mental health Marion and Jefferson Counties are ranked among the lowest quartile of adults reporting poor mental health days, with an average of over 5 poor mental health days per month. According to United Health Foundation's US Health Rankings, over 14% of Illinois residents have been diagnosed with a depressive disorder. The rate of suicide in Illinois is 11.3 per 100,000 population. Additionally, the rate of suicide in Marion county is 26 per 100,000 population, and Jefferson county is 15 per 100,000 population. Both rates of suicide are higher than the average rate of suicide in the state. The hospital's action plan includes the following initiatives to address mental health in the region served: - Provide educational opportunities for community members - Offer Question, Persuade, Refer (QPR) Gatekeeper Training - Implement Adult and Youth Mental Health First Aid trainings - Provide resources to increase knowledge of accessible mental health services - Increase distribution of community Mental Health Resource Guide - Begin distributing the National Suicide Prevention Lifeline to community members and partnering organizations - Enhance collaborative efforts with community partners - Develop relationships with new and existing community partners - Sponsor community events and initiatives hosted by partners - Provide educational opportunities on trauma informed care - Provide CME opportunities to SSM Health and community clinicians on trauma informed care - Provide general education workshops on trauma informed community building and resilience Expected outcomes of these strategies include the following: - reduce number of reported mentally unhealthy days - increase percentage of individuals receiving treatment for chronic mental illness - reduce prevalence of untreated depression/anxiety - decrease suicide rate - decrease emergency department visits for nonfatal intentional injury Nutrition, weight and exercise Obesity is a serious chronic disease that continues to increase in the United States and can lead to other serious illnesses like type II diabetes, heart disease, and cancer. In Jefferson and Marion counties, over 30% of adults living in the community are obese (BMI=30+), which is slightly lower than the state average percentage of adults with obesity, at 32%. Community representatives who participated in the Community Health Needs Assessment have identified obesity as a significant need to be addressed in the area. Access to nutritious food and opportunities for physical activity plays a vital role in reducing the prevalence of obesity and chronic disease. Within the Jefferson and Marion county areas, 14% of the population experience food insecurity, or a lack of resources to feed all members of their household. Additionally, the rate of available fitness and recreation facilities per 100,000 population is approximately 15 in both Jefferson and Marion County. The rate in Illinois for Recreation and Fitness facilities is only 12.5 per 100,000 population. Many times, these facilities have a cost for membership, which can also pose a barrier to many community members. Costs for fitness center memberships typically range from $10 to $100 each month. The hospital has outlined the strategies below to improve community health related to nutrition, weight and exercise: - promote access to nutritious food for those experiencing food insecurity - provide support for mobile markets and to local community food pantries - identify locations for little food pantry box installation - support existing and establish additional community gardens and the training of master gardeners - provide opportunities for education and engagement regarding nutrition, weight and exercise - fund scholarships for identified vulnerable populations to participate in Felician wellness centers' next (nutrition, exercise, and physical activity) program - provide evidence-based chronic disease/diabetes self-management cources - provide support in offering accessible community fitness courses - build partnerships with outside organizations to build community programs - partner with local schools to promote the USDA's team nutrition program - develop relationships with new and existing community partners - sponsor community events and initiatives hosted by partners Long-term, the hospital hopes for these outcomes: - reduce percentage of adults with obesity - reduce percentage of individuals with Type II diabetes - reduce percentage of individuals with chronic disease - decrease population who experience food insecurity - reduce obesity-related disability - improve quality of life The hospital has no plans to discontinue other community benefit efforts to address other needs noted in its 2021 CHNA."

Schedule H, Part I, Line 3c Discounted Care Exceptions
"Patients whose family income exceeds 400% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the hospital; however the discounted rates shall not be greater than the amounts generally billed to commercially insured [or Medicare] patients. In such cases, other factors may be considered in determining their eligibility for discounted or free services, including: * Bank accounts, investments and other assets * Employment status and earning capacity * Amount and frequency of bills for health care services * Other financial obligations and expenses * Generally, financial responsibility will be no more than 25% of gross family income. The hospital may utilize predictive analytical software or other criteria to assist in making a determination of financial assistance eligibility in situations where the patient qualifies for financial assistance but has not provided the necessary documentation to make a determination. This process is called ""presumptive eligibility."""

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
SSM Health Care Corporation, 46-6029223

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
The amounts reported on Form 990, Schedule H, Part I, Line 7a, 7b, and 7c were determined using the cost to charge ratio derived from worksheet 2 in the schedule h instructions. Form 990, schedule h, part I, Lines 7e, 7f, 7g, 7h, and 7i are reported at cost as reported in the organization's financial statements. The calculation of Schedule H, Part I, Line 7, Column F utilizes 990, Part IX, Line 25, Column A, which does not include Bad Debt Expense.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
FOR FINANCIAL STATEMENT PURPOSES, SSM Health 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. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER NORTON HOSPITAL'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
SSM Health St. Mary's Hospital - Centralia is part of the SSM Health consolidated audit. THE FOOTNOTE THAT REFERENCES THE TREATMENT OF UNCOLLECTIBLE ACCOUNTS AND IMPLICIT PRICE CONCESSIONS IN THE DECEMBER 31, 2021 CONSOLIDATED AUDIT IS CONTAINED ON PAGE 13, 14 AND 15 OF THE ATTACHED FINANCIAL STATEMENTS.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
"SSM Health St. Mary's Hospital - Centralia has established a written credit and collection policy and procedures. The billing and collection policies and practices reflect the mission and values of SSM Health, including our special concern for people who are poor and vulnerable, The Health Center embraces its responsibility to serve the communities in which it participates by establishing sound business practices. The Health Center's billing and collection practices will be fairly and consistently applied. All staff and vendors are expected to treat all patients consistently and fairly regardless of their ability to pay. They respond to patients in a prompt and courteous manner regarding any questions about their bills and provide notification of the availability of financial assistance. All uninsured patients will be provided a standard discount for medically necessary inpatient and outpatient services, including services provided at off-campus outpatient sites. The hospital determined the amount of the discount based on the local managed care market, applicable statutory requirements and other relevant local circumstances. The rate must be no less than the lowest effective discount rate and no greater than the highest effective discount rate for the current managed care contracts of the hospital. Uninsured patients may also qualify for an additional discount based upon financial need under the system financial assistance policy. All accounts due from the patient will receive a statement after discharge or after final adjudication from patient's insurance. Generally the patient will receive 4 months (120 days) of in-house collection efforts (including early out vendors) and 12 months of bad debt collection efforts. The hospital will make Reasonable Efforts to determine FAP eligibility including: 1. The financial assistance summary will be included with each billing statement 2. Extraordinary Collection Activity (ECAs) may not occur until bad debt placement and only after 120 days. 3. ECAs must be suspended if a guarantor submits a FAP application during the application period. 4. Reasonable measures must be taken to reverse ECAs if the application is approved which may include refunding any payments made in excess of amounts owed as an FAP-eligible individual. 5. Bad Debt vendors will gain written approval from SSM prior to engaging in ECAs. SSM will review the accounts and verify satisfactory completion of reasonable efforts during the notification and application period. A waiver is not considered reasonable efforts. Obtaining a signed waiver that an individual does not wish to apply for FAP assistance or receive FAP application information will not meet the requirement to make ""reasonable efforts"" to determine whether the individual is FAP-eligible before engaging in ECAs. All outside collection agencies must comply with state and federal laws, comply with the association of credit and collection professional's code of ethics and professional responsibility and comply with SSM Health St. Mary's Hospital - Centralia's collection and financial assistance policies."

Schedule H, Part V, Section B, Line 16a FAP website
A - SSM Health St. Mary's Hospital - Centralia: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - SSM Health St. Mary's Hospital - Centralia: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - SSM Health St. Mary's Hospital - Centralia: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part VI, Line 2 Needs assessment
SSM Health (SSMH) participates in Community Benefit according to our vision, Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically, and socially marginalized, will experience improved health in mind, body, spirit and environment. In the tradition of our founders, the Franciscan Sisters of Mary, caring for those in greatest need remains our organizational priority. Today our System Board monitors Community Benefit efforts, and views achievement of our vision as a primary responsibility. The purpose of SSMH's Community Benefit program is to assess and address community health needs. Making our communities healthier in measurable ways is always our goal. To fulfill this commitment, SSMH's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). The CHNA is an assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conducted every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-health priorities: Establish strategies to address priorities; complete Strategic Implementation Plan; obtain Regional/Divisional Board approval; and integrate strategies into operational plan. * Make CHNA widely available to the public: Publish CHNA and summary document on hospital's website. * Monitor, track, and report progress on top health priorities: Collect data and evaluate progress; report to Regional/Divisional Board every six months and System Board every year; share findings with community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). System Office staff and leaders oversee and monitor SSMH's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, SSM Health Care Corporation also identifies needs based on assessments and research, and SSMH facilities also involve case managers and care team staff to pinpoint critical health issues in the community. All hospital CHNAs are completed, approved, and integrated into the organization's strategic plan. We continue to monitor and assess the progress of our local efforts in the spirit of caring for others and improving community health.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Each entity providing medical service shall provide information to the public regarding its charity care policies and the qualification requirements for each of its facilities. When standard system notices and communication regarding charity care are available, these must be used. Modifications to the standard may be made to comply with state and local laws, as well as reflect culturally sensitive terminology for the policy. All notices are easy to understand by the general public, culturally appropriate and available in those languages that are prevalent in the community. They provide information about: * The patient's responsibility for payment, * The availability of financial assistance from public programs and entity charity care and payment arrangements, * The entity's charity policy and application process, and * Who to contact to get additional information or financial counseling. The following types of notices to the public are provided: * Signs in the emergency department, outpatient and inpatient registration and public waiting areas. * Brochures or fliers provided at time of registration and available in the financial counseling areas. * Notices sent with or on patient bills or communications sent to patients and guarantors related to medical services. * Applications provided to uninsured patients at the time of registration. The application for charity care, together with any instructions, must clearly state the policies regarding charity care, including excluded services, eligibility criteria and documentation requirements. Information about the entity's charity policies is also provided to public agencies.

Schedule H, Part VI, Line 4 Community information
SSM Health St. Mary's Hospital - Centralia, in partnership with SSM Health Good Samaritan Hospital - Mount Vernon, defines its primary service area as Marion and Jefferson Counties in Illinois. There are 23 zip codes that are located within or partially within the community. This area had an estimated population of 81,171 people in 2020 and accounts for 54% of the total patients served by the hospitals. The secondary service area is another 84,000 people and 17% of inpatient-care patients served. The median age in the community is 41.0 years old, which is older than the U.S. median age of 38.1 years. The population has also decreased about 3.7% in the last 10 years. In the area served, the poverty level is 18.0%, significantly more than the 13% rates for both Illinois and the U.S. as a whole. Median family income is $60,361, compared to $83,279 for Illinois and $77,263 for the nation. Life expectancy also falls behind State and U.S. rates for this area. Additional information concerning the service area can be found starting on page 6 of the 2021 CHNA.

Schedule H, Part VI, Line 6 Affiliated health care system
St. Mary's Hospital, Centralia, Illinois is a 501(c)(3) organization and is a member of the integrated health care system known as SSM Health. Along with Good Samaritan Regional Health Center, it is part of a joint operating agreement between SSM Health based in St Louis, Missouri, and Felician Sisters, Inc. of Chicago. Together the hospitals are pursuing a vision to create a comprehensive, regional health care enterprise covering a nine county area in South Central Illinois.

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

Schedule H, Part VI, Line 5 Promotion of community health
SSM Health St. Mary's Hospital - Centralia participates in a wide array of community programs throughout the area to further its exempt purpose of promoting the health of the community. The community initiatives build on the strengths of our communities and systems to improve the quality of life and to create a sense of hope. Community Benefit initiatives build community capacity and individual empowerment through community organizing, leadership development, partnerships, and coalition building. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. In response to the global coronavirus pandemic, St. Mary's Hospital, Centralia, Illinois worked relentlessly to respond to community needs by developing and implementing strategies to address social needs of those served, providing screening & testing services, personal protective equipment and education throughout the community, as well as treatment for those who presented with COVID-19. SSM Health St. Mary's Hospital - Centralia advocates for vulnerable populations by developing relationships with policy makers and through targeted education efforts. All projects include measurable objectives with a specific time frame and have activities that will favorably affect health status indicators. Projects to accomplish health status objectives may include: disease prevention programs; health education programs; health care programs for individuals with special health concerns; and other projects that improve community health status. Projects to address the health problems of minorities, the poor, and other medically underserved populations may include: improving accessibility and continuity of care; working to reduce disparities in health status; and sponsoring efforts to increase the number of minorities, the poor, and underserved who enter health professions and work in medically underserved communities. Projects designed to contain the growth of community health care costs may include: improving efficiency of services; improving case management and continuity of care; sponsoring health promotion, disease prevention, and self- care activities; containing health care costs; and reducing redundancies. St. Mary's Hospital, Centralia, Illinois also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay, * Has an open medical staff with privileges available to all qualified physicians in the area, * Has a governing body in which independent persons representative of the community comprise a majority * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system.