4A (Expenses $ 63472509 including grants of $ 235000) (Revenue $ 74858841)
See Schedule O

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Swedish Covenant Hospital. Swedish Covenant Health (SCH) and members of the Alliance for Health Equity (AHE), a collaborative of over 30 hospitals, 7 health departments, and 100 community partners, used the Mobilizing for Action through Planning and Partnerships (MAPP) model for the CHNA to build a comprehensive Community Health Needs Assessment (CHNA) in Chicago and Cook County. AHE emphasized the importance of community engagement, partnership development, and the dynamic interplay of factors and forces within the public health system. AHE chose this inclusive, community-driven process to leverage and align with health department assessments and to actively engage stakeholders, including community members, in identifying and addressing strategic priorities to advance health equity. As part of the CHNA process, leaders from AHE met with SCH's Community Leader group to provide an overview of the CHNA and to welcome feedback. Additionally, numerous organizations from the SCH Community Leader group were active contributors to focus groups related to health care providers and social services, including immigrant and refugee-serving organizations. The Alliance for Health Equity's collaborative CHNA combined robust public health data, community input, existing research, existing plans, and existing assessments to document the health status of communities within Chicago and Suburban Cook County and to highlight systemic inequities that are negatively impacting health. The CHNA also provided insight into community-based assets and resources that should be supported and leveraged during the implementation of health improvement strategies. Swedish Covenant Hospital partnered with the Alliance for Health Equity (AHE), other hospitals, the Chicago Department of Public Health, and community organizations to complete this collaborative CHNA between March 2018 and March 2019. Primary and secondary data from a diverse range of sources were utilized for robust data analysis and to identify community health needs in Chicago and Suburban Cook County. IPHI worked with the CHNA committee and steering committee to design and facilitate a collaborative, community-engaged assessment. This 2019 CHNA process is adapted from the Mobilizing for Action through Planning and Partnerships (MAPP) framework, a community-engaged strategic planning framework that was developed by the National Association for County and City Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC). Both the Chicago and Cook County Departments of Public Health use the MAPP framework for community health assessment and planning. The MAPP framework promotes a system focus, emphasizing the importance of community engagement, partnership development, and the dynamic interplay of factors and forces within the public health system. Primary data for the CHNA was collected through four methods: Community input surveys, Community resident focus groups and learning map sessions, Health care and social service provider focus groups and two stakeholder assessments led by partner health departments-Forces of Change Assessment and Health Equity Capacity Assessment. Epidemiologists from the Chicago Department of Public Health (CDPH) and Cook County Department of Public Health (CCDPH) worked with IPHI and the steering committee to select a common set of indicators based on an adapted version of the County Health Rankings and Roadmaps Model. Secondary data used in the CHNA were compiled from a range of sources. In alignment with the purpose, vision, and values, the Alliance for Health Equity prioritizes engagement of community members and community-based organizations as a critical component of assessing and addressing community health needs. Community partners have been involved in the assessment and ongoing implementation process in several ways both in providing community input and in decision making processes. The community-based organizations engaged in the Alliance for Health Equity represent a broad range of sectors such as workforce development, housing services, food security, community safety, planning, community development, immigrant rights, primary and secondary education, faith communities, behavioral health services, advocacy, policy, transportation, older adult services, health care services, higher education, and many more. All community partners work with or represent communities that are disproportionately affected by health inequities such as communities of color, immigrants, youth, older adults and caregivers, LGBTQ+, individuals experiencing homelessness or housing instability, individuals living with mental illness or substance use disorders, individuals with disabilities, veterans, and unemployed youth and adults. SCH worked closely with the AHE and community based organizations that are members of the SCH Community Leader Program to collect in-depth community input data through a community input survey and focus groups. We collected 763 surveys and conducted 8 focus groups with residents from the SCH service area as well as 3 focus groups with healthcare and social service providers. The community input survey was a qualitative tool designed to understand community health needs and assets from community members, with a focus on hearing from community members most impacted by health inequities. The community input surveys, along with focus group data, informed the priority areas and strategies for community health improvement in Chicago and suburban Cook County. Between August 2018 and February 2019, the Illinois Public Health Institute (IPHI) worked with Alliance for Health Equity partners to hold a total of 57 focus groups with priority populations such as veterans, individuals living with mental illness, communities of color, older adults, caregivers, teens and young adults, LGBTQ+ community members, adults and teens experiencing homelessness, families with children, faith communities, adults with disabilities, and children and adults living with chronic conditions such as diabetes and asthma. In total, 12 focus groups were held with residents and service providers in SCH's service area. SCH values the community health needs assessment process as an opportunity to engage with community leaders and organizations through the Community Leader Engagement Program and Community Ambassador Program and with our colleagues from other healthcare institutions across the County through the Alliance for Health Equity. In partnership with communities, the Chicago Department of Public Health, the Illinois Public Health Institute, and the Alliance for Health Equity, we have taken an in-depth look at the needs and assets in the communities we serve, and we are committed to addressing those needs through implementation strategies in partnership with communities most impacted by health inequities. We undertake this collaborative approach to community health needs assessment and implementation in order to address the underlying root causes of health disparities and to support greater community health and well-being in the communities we serve. Swedish Covenant Hospital makes the Community Health Needs Assessment available at SwedishCovenant.org/community-benefit. It is also shared broadly with internal and external stakeholders, including employees, volunteers, physicians, elected officials and members of our community, including the Community Leader Engagement Program.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Alliance for Health Equity. Alliance for Health Equity (AHE) is a collaborative of over 30 hospitals, 7 health departments, and 100 community partners.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - Swedish Covenant Hospital. In acknowledging the wide range of priority health issues that emerged from the CHNA process, Swedish Covenant Health (SCH) determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence. The hospital focused on 8 of 12 identified needs. Listed below are the eight needs which are being addressed and highlights of how they are being addressed: Addressing Social and Structural Determinants of Health 1. Violence During FY21, Swedish Hospital served 74 patients who came to our Emergency Department (ED) for medical treatment following a sexual assault or disclosed a sexual assault in one of our inpatient or outpatient settings. We served 193 patients currently experiencing or showing signs of possible domestic violence. 14 patients exhibited red flags for human trafficking. Female washrooms in most public areas of the hospital display signage that asks ""Is Someone Hurting You?"" in 5 languages (English, Spanish, Arabic, Urdu and Korean) and provides cards with phone numbers to domestic violence hotlines. Over 512 cards were taken from these washrooms during FY21. 2. Conditions that Support Healthy Eating and Active Living In FY21 the Swedish Hospital Foundation continued to provide a grant to support the Food Connections Program at Swedish Hospital. In FY21, more than $95,000 in funding was utilized for program expenses and implementation. Swedish Hospital Foundation will continue to support this program with funding as well as collaborate to identify additional grant opportunities to support the growth and expansion of this program. Efforts have been focused in the following areas: Raising awareness of food insecurity as a health issue among Swedish staff, implementing the hunger vital sign food insecurity screening questions, piloting food access interventions and building relationships with community partners. Throughout FY21, the hospital hosted or participated in more than 15 community events which a supported healthy lifestyle. One key initiative focused on bike safety tips and free helmet giveaways/fittings. During FY21, more than 1,200 bike helmets were distributed (along with safe fittings and safe riding tips) at more than 10 community events including local farmers markets, summer camps and back to school fairs. The hospital supports the community gardening movement by hosting an edible community garden on campus for both employees and general community members, in partnership with Peterson Garden Project. 3. Housing and the Neighborhood Environment: Swedish Hospital remains committed to identifying, housing and providing support services to homeless individuals in our area. Ongoing updates about the program are sent to all employees to keep them informed and encourage their ongoing engagement. Swedish Hospital's ED noticed the patterns of recurring visits by the same chronically undomiciled patients. Seeking a more permanent solution, Swedish Hospital currently partners with Lutheran Social Services of Illinois (LSSI), to reduce hospital visits and improve the well-being of the homeless by providing permanent housing and support services. The ED Director of Nursing and staff continue to remain engaged in the process of identifying homeless patients who need assistance with food, shelter and clothing. With funds from the Swedish Foundation, Swedish developed a MOU with LSSI to provide housing and case management to 6 Swedish homeless patients and counting. Swedish Hospital Foundation provided more than $6,000 in funding to support the housing program, through partnerships with Center for Housing and Health and LSSI. In addition, Swedish's director of intergovernmental affairs has attended 27 meetings, with over 42 hours spent mentoring collaborations with outside agencies, including meetings with the Alliance for Health Equity Housing Committee. Addressing Chronic Conditions: Risk Factors, Prevention and Management Swedish's Nutrition and Diabetes Center (NDC) continues to provide free support groups and education sessions for ongoing lifestyle management. These free group options are available for individuals who cannot attend 1-1 sessions due to financial barriers or other limitations. A vital part of managing diabetes is having adequate support from others. The free support group is facilitated by a Certified Diabetes Care and Education Specialist (CDCES) and allows participants to share experiences with others and learn tips and information about healthy living. In FY21, due to COVID restrictions on in-person gathering, the support group was transitioned to a quarterly virtual option; 18 participants attended the virtual support group in FY21. In FY22, the support group is moving back to a monthly, in person option as possible. The free monthly education session, entitled Get Educated on Diabetes, is also led by a CDCES from the NDC and provides strategies regarding how to stay one step ahead of diabetes through healthy lifestyle habits, careful nutrition, exercise, glucose monitoring and medication. In FY21, 11 participants attended the free diabetes class. In total the NDC saw 728 participants for one on one or group education sessions in FY21. Swedish Hospital received $37,500 in funds from the American Hospital Association and BCBSIL to fund diabetes education for low-income racially diverse patients and community members through May 2021. This health disparity grant provided free individual diabetes education to uninsured/underinsured ethnic minorities in the Swedish Hospital community. As part of the program, multilingual fliers were created for partnering organizations (Spanish, Korean and Hindi) to assist in referring patients into this free service. The CDCES worked closely to identify these partner organizations and has remained in close contact with the organizations to streamline the referral process. In August of 2021, the NDC was also notified of an award from the G.A. Ackermann Memorial Fund, providing $96,250 to provide nutrition and diabetes education to uninsured or underinsured patients and community members. Under this grant, the NDC is also able to include several additional components, including physical fitness classes, food access resources and transportation assistance. Services via this grant will begin in FY22. In FY21, 109 visits were completed under the combination of these two grants, and 139.5 hours were spent providing education to patients who otherwise would not have been able to access nutrition and/or diabetes individual education. 5. Heart Disease & Hypertension: Due to COVID, the ability to provide education and outreach in this area has been significantly limited. The hospital's Stroke Coordinator hosted two presentations about Warning Signs of Stroke in FY21. Each February, the hospital places special emphasis on Heart Month and helps inform community members about the importance of cardiovascular health and prevention tips. Information is shared on campus media walls, on the hospital website and throughout the hospital's social media platforms. The hospital teaches community members about the importance of ""hands-only"" cardiopulmonary resuscitation (Bystander CPR) and how to respond in an emergency situation. The free training features interactive practice of ""hands-only"" CPR with a mannequin so individuals understand how to properly perform chest compressions. The class also demonstrates how to use an AED (Automated External Defibrillator). COVID has significantly limited the ability to offer these programs and in FY21 one Bystander CPR program was delivered to the community, with a total of 14 individuals attending the training session. In FY20, the hospital established a COVID Rehabilitation pilot program within the cardiac rehab department. For many people who suffer from COVID-19, the effects of the illness can be long term with serious issues lasting for months. Research indicates that up to 35 percent of patients experience symptoms ranging from fatigue to joint pain, headaches and heart abnormalities that can last for months. The COVID Rehabilitation pilot program was developed to help those who had ""recovered"" but were still experiencing chronic symptoms like shortness of breath, and were struggling to return to baseline functionality. The program is currently supported by a donation from the Swedish Hospital Foundation. In FY21, the program provided 460 visits supported by more than $55,000 in funding."

Schedule H, Part V, Section B, Line 11 Facility , 2
Facility , 2 - Swedish Covenant Hospital. 6. Obesity: As a certified medical fitness facility on Swedish Hospital's campus, GLC offers a wide variety of programs for all ability levels, to help prevent and manage obesity. Among many programs, GLC offers Fundamental Fitness and Eat-Move-Lose. Fundamental Fitness works with physician referrals to provide a comprehensive 8-week course on health, fitness and wellness topics in a supportive and encouraging environment. The program is reasonably priced, and scholarships for those unable to afford the program are also available. Fundamental Fitness resumed in FY21 after having paused during Covid and served 21 people between August - September 2021. GLC's Eat-Move-Lose program is a 12-week group weight loss program designed for people who are overweight or have medical conditions related to weight gain. In FY21, Eat-Move-Lose was offered 3 times to a total of 27 participants. One of the 3 classes was presented using a hybrid format where the nutrition class was done virtually and people had the option of attending the exercise portion in-person or virtually. GLC specialists provide fitness programming at various senior/community centers to enhance access to physical fitness. As GLC continues to adapt during the pandemic, the facility has continued to offer a wide assortment of virtual class options, allowing community members to continue accessing fitness classes remotely and safely from the comfort of their homes. This discounted membership option remains popular and will continue into FY22. Virtual personal training continues to be offered as well. There are over 220 virtual only members and virtual class visits average around 2,330 a month. There are currently 80 scholarship members (this number has decreased due to COVID), which provides discounted membership for individuals experiencing both financial and medical need, via an application process. 7. Cancer: The Swedish Hospital Community Breast Health Program (CBHP) serves women who face the greatest challenges accessing breast cancer detection and treatment due to financial, cultural, and language barriers. For our uninsured patients, grant support from The National Breast Cancer Foundation, Susan G. Komen Chicagoland and A Silver Lining is available. In FY21, more than $115,000 in annual funding was provided by external funders including Susan G. Komen, National Breast Cancer Foundation and A Silver Lining Foundation to support no-cost mammograms, ultrasounds and breast biopsies. Through the generous support of these organizations, the program was able to provide screening and diagnostic mammograms, ultrasounds, and biopsies to low-income women over the last year. In FY21, CBHP delivered 1,105 no-charge cancer detection services to 871 uninsured, low-income women. Improving Mental Health 8. Enhancing Access to Resources and Services: The hospital continues to seek ways to Provide appropriate resources for individuals presenting in the SCH Emergency Department (ED) with Substance Abuse (SA) or other mental health disorders. In acknowledging the wide range of priority health issues that emerged from the CHNA process, Swedish Hospital determined that it could only effectively focus on those which it deemed most pressing, most under-addressed, and most within its ability to influence. The following is a list of needs identified through the CHNA process which will not be actively addressed at this time: 1. Addressing structural racism and advancing racial equity. 2. Policies that advance equity and promote physical and mental well-being. 3. Reducing substance use disorders. 4. Improving maternal and child health including reducing maternal and infant mortality.

Schedule H, Part I, Line 7d
The PA tax benefit is not reimbursement for direct patient care and therefore we believe it shows for Schedule H, Line 7b, Column (c). The $24,952,736 in the community benefit expense includes the provider assessment tax of $4,255,689. Had the provider tax been excluded, the total community benefit expense would have been $20,697,047. On Schedule H, Line 7b, Column (d), the direct offsetting revenue of $26,773,524 includes the provider tax revenue of $12,272,300. Had the public aid provider revenue been excluded from Schedule H, the direct offsetting revenue would have been $14,501,224. Using an adjusted total community benefit expense of $20,697,047 noted above, minus an adjusted direct offsetting revenue amount of $14,501,224, also noted above, the resulting community benefit dollar amount on Schedule H, Line 7b, Column (e) would have been $6,195,823. On Schedule H, Line 7b, Column (f) percentage of total expense would have increased from 0% to 8.85%. The PA tax benefit is not reimbursement for direct patient care and therefore we believe it should be excluded from the Schedule H calculations.

Schedule H, Part V, Section B, Line 3 Explanation of CHNA Noncompliance Due to Change in Fiscal Year
"IRC Section 501(r)(3) requires a hospital organization to conduct a community health needs assessment (CHNA) every three years and adopt an implementation strategy to meet the community health needs identified through such assessment. With respect to any taxable year, a hospital organization meets the requirements of section 501(r)(3) with respect to a hospital facility it operates only if the hospital facility has conducted a CHNA in such taxable year or in either of the two taxable years immediately preceding such taxable year. Swedish Covenant Health previously conducted a CHNA before September 30, 2019. In connection with a system affiliation agreement between NorthShore University HealthSystem and Edward-Elmhurst Healthcare (EEH), effective January 1, 2022, the fiscal year of Swedish Covenant Health was changed from September 30 to December 31, resulting short tax year for the three-month period ended December 31, 2021. As a result of the short tax year, which was not contemplated prior to the affiliation with EEH, Swedish Covenant Health did not complete its most recent CHNA within the short tax year nor the two previous years. Swedish Covenant Health was in the process of completing the CHNA for Swedish Hospital as of December 31, 2021 and was fully expecting to have it completed by the historical September 30, 2022 deadline to comply with 501(r)(3). The failure to have the CHNA conducted before December 31, 2021 was discovered by Swedish Covenant Health during January 2022. Afterwards, Swedish Covenant Health communicated the error and the CHNA was expedited to be completed as soon as reasonably possible. Swedish Covenant Health made the CHNA report widely available to the public on its website and finished conducting the CHNA on September 7, 2022. The implementation strategy was adopted by the Board of Directors on November 2, 2022. As described in 26 CFR Section 1.501(r)-2(c), ...""a hospital facility's failure to meet one or more of the requirements described in 1.501(r)-3 that is neither willful nor egregious shall be excused... if the hospital facility corrects and makes disclosure in accordance with rules set forth by revenue procedure, notice, or other guidance published in the Internal Revenue Bulletin. A ""willful"" failure includes a failure due to gross negligence, reckless disregard, or willful neglect, and an ""egregious"" failure includes only a very serious failure, taking into account the severity of the impact and the number of affected persons. Whether a failure is willful or egregious will be determined based on all the facts and circumstances. A hospital facility's correction and disclosure of a failure in accordance with the relevant guidance is a factor tending to show that the failure was not willful."" The failure was not willful because the CHNA process began before the change in fiscal year and with the expectation to be conducted before the end of the third tax year following the previously conducted CHNA. Further, Swedish Covenant Health discovered the error and expedited to correct by finish conducting the CHNA as soon as reasonably possible. The failure is not egregious because the CHNA would have been timely conducted if the fiscal year had not changed. The previous CHNA was conducted during September 2019, which was within the last three years at the time failure occurred. Based on the facts and circumstances described above, Swedish Covenant Health did not willfully nor egregiously fail to comply with 501(r)(3). Further, Swedish Covenant Health corrected the failure by promptly completing the most recent CHNA following the unexpected change in fiscal year. Accordingly, Swedish Covenant Health has not filed an excise tax return or paid any related tax imposed under IRC section 4959. NorthShore has reviewed its procedures in place to address and monitor its compliance with the requirements of IRC section 501(r), including the timely adoption of future CHNA. The next CHNA will be adopted during tax year 2024, which will be the third consecutive tax year after the short tax year 2021."

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Each net community benefit expense is divided by total hospital expenses (excluding bad debt expense) to determine the percent of community benefits provided for the tax year. Costing Methodology - For all community benefits, we utilize the cost to charge ratio to calculate the benefit. The net operating costs are calculated by taking the total operating costs less the following: the PA tax and the non-patient care activity costs, the net gross charges are calculated as follows: gross charges less charges for community benefits, net operating costs divided by net gross charges provides the cost to charge ratio.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Bad debt expense was reported at cost using a cost-to-charge methodology. The Schedule H, Worksheet 2, Ratio of Patient Care Cost-to-Charges calculated to report charity care on Part I, Line 7a was multiplied by the bad debt expense to determine the bad debt expense at cost. Discounts and payments on patient accounts are excluded from bad debt expense in order to reflect the expected amount to be paid.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
There are no bad debt amounts included in community benefits.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
See pages 13-17 of the audited financial statements for footnotes describing accounts receivable and bad debt expense.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
The Schedule H, Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to determine the Medicare costs reported on Part III, Line 6.

Schedule H, Part V, Section B, Line 16a FAP website
- Swedish Covenant Hospital: Line 16a URL: swedishcovenant.org/for-patients-and-visitors/pay-your-bill/financial-assistance;

Schedule H, Part II Community Building Activities
Members of Swedish Covenant Hospital staff work with other organizations and participate in many activities to advocate for health improvement in our community. These include: involvement with the association for community safety net hospitals and the IHA advocacy outreach team, participation in the Medicaid rate reform tag group, community meetings, chambers of commerce, education, and seeking of resources to enhance health care services in the community. During the fiscal year, Swedish Covenant Hospital continued its active involvement in a collaborative of area hospitals entitled the alliance for health equity (AHE). AHE is a partnership between the Illinois public health institute, hospitals, health departments, and community organizations across Chicago and cook county. This initiative is one of the largest collaborative hospital-community partnerships in the country with the current involvement of over 30 hospitals, 7 health departments, and 100 community partners throughout Chicago and cook county serving on various action teams. AHE is a collaboration of Chicago and cook county-based hospitals that strives to promote a collective impact on health outcomes in the city of Chicago through an environment that fosters learning, sharing of resources, data and best practices. They are also the driving force to facilitate and execute the community health needs assessment (CHNA) for their hospital members. SCH has staff who participate in a variety of sub-groups via AHE including the following: AHE steering committee, social and structural determinants of health committee, housing and health workgroup, food security/food access workgroup, mental health and substance use disorders committee, CHNA committee, policy committee and trauma informed hospitals collaborative. Erie family health is a strong partner of Swedish Covenant Hospital, providing expanded health services for those in need through high-quality, low-cost medical care as a federally qualified health center (FQHC). The Erie Foster Avenue Health Center (one of 13 Erie locations in Chicago and the surrounding suburbs) is Erie's first location on a hospital campus, which allows for integrated care coordination along the health continuum. Through this partnership, numerous Erie providers have delivery privileges at Swedish Covenant Hospital, and Erie foster avenue patients have access to specialty care services provided by Swedish Covenant Hospital. One key element to this partnership is Erie's role as the clinical training site for SCH family medicine and internal medicine residency programs. This collaboration allows for great medical exposure and training, in part due to the nature of the diverse patient population. SCH partners with local schools and organizations to provide career days' science fair judging and other interactive tours with students. One example is a healthcare careers exploration panel which SCH hosted for students of Niles north and west high schools who were interested in health professions. Over the course of two hours, students heard candid stories from more than ten health professionals including a pediatric nurse practitioner, dietitian, nurse, physical therapist, violence prevention specialist, lab director and senior administrator from our medical group. Finally, SCH remains committed to identifying, housing and providing support services to homeless individuals in our area. Chicago ranks 3rd among cities in the U.S. for the most homeless residents, with a large encampment living under the viaducts less than two miles away from Swedish Hospital. The average life expectancy of a chronically homeless individual is much lower than the life expectancy for the general population. When Swedish Hospital's emergency department noticed the patterns of recurring visits by the same chronically homeless patients, they developed a more permanent solution. The hospital partners with Lutheran Social Services of Illinois (lSSI) to reduce hospital visits of the homeless by providing permanent housing and services, including intensive case management and managed healthcare services. Swedish hospital's commitment to the community is unique and patient care extends far beyond the walls of the hospital. In addition to the above mentioned activities, SCH regularly engages in conversation to advocate for community health improvement and support, including attending meetings with the local police districts on safety/community policing and meeting with organizations who serve disadvantaged populations within our community to develop relationships/partnerships to provide preventive health screenings (including mammograms), violence prevention resources, and other free health education offerings throughout the community.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Charity Care Patients: The organization has a policy of Presumptive Charity Care for health care services provided to uninsured patients who are presumed eligible for charity care based on criteria demonstrating financial need. Effective January 1, 2014, the regulations adopted by the Illinois Attorney General (77 Ill. Admin. Code Part 4500, Hospital Financial Assistance under the Fair Patient Billing Act), require that a presumptive charity determination take place as soon as possible after the receipt of health care services from the hospital and prior to the issuance of any bill for those health care services by the hospital. According to the regulations, a patient's financial need must be determined by use of presumptive charity criteria (which may be accomplished through software/screening) without further scrutiny by the hospital. Financial Assistance: Patients with a self-pay balance and without the resources to pay their obligations will be assessed for financial assistance by the Financial Service Center. The assessment involves an evaluation for eligibility for all appropriate levels of assistance, including governmental or partial reductions or complete charity care.

Schedule H, Part V, Section B, Line 16b FAP Application website
- Swedish Covenant Hospital: Line 16b URL: swedishcovenant.org/for-patients-and-visitors/pay-your-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Swedish Covenant Hospital: Line 16c URL: swedishcovenant.org/for-patients-and-visitors/pay-your-bill/financial-assistance;

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

Schedule H, Part VI, Line 2 Needs assessment
In the spring of 2018, Swedish Covenant Health (SCH) embarked on a comprehensive Community Health Needs Assessment (CHNA) process to identify and address the key issues for our community. SCH and members of the Alliance for Health Equity (AHE), a collaborative of over 30 hospitals, 7 health departments, and 100 community partners, worked together during Spring 2018-Fall 2019 to build a comprehensive CHNA in Chicago and Cook County. The CHNA was reviewed and approved by the hospital board of directors in September 2019. Using the Mobilizing for Action through Planning and Partnerships (MAPP) model for the CHNA, AHE emphasized the importance of community engagement, partnership development, and the dynamic interplay of factors and forces within the public health system. AHE chose this inclusive, community driven process to leverage and align with health department assessments and to actively engage stakeholders, including community members, in identifying and addressing strategic priorities to advance health equity. SCH will continue to partner with members of AHE and other key community partners within our service area to leverage existing resources and develop strategies which contribute to improving the most pressing health needs of our communities. This implementation plan describes programs SCH is undertaking over the next three years to address the prioritized health needs within our community. SCH has been serving Chicago's diverse north and northwest sides for more than 130 years, providing the full range of comprehensive health and wellness services including an acute care hospital, primary care and specialists in the medical group, strong community outreach programs and Chicago's only certified medical fitness center, Galter LifeCenter. SCH is a 312-bed nonprofit teaching hospital, with more than 600 board-certified doctors and advanced practice providers from top medical schools and residency/fellowship programs in the country. The hospital has continually evolved to offer more than 50 academic-level medical specialties, including advanced robotic and minimally invasive treatments. The hospital maintains a department dedicated to addressing its outreach objectives of serving the entire community, not only those who come through its doors. Building on a long tradition of service, the Community Relations Department utilizes hospital strengths alongside those of other well established community partners. This strategy allows the hospital to better understand and reach the most vulnerable sectors of the community, while meeting pressing healthcare needs. The goal is to improve the community's health status by empowering citizens to make healthy life choices. In consideration of the top health priorities identified through the CHNA process - and taking into account hospital resources and overall alignment with the hospital's mission, goals and strategic priorities - SCH is committed to developing and/or supporting strategies and initiatives for the following issues: Addressing Social and Structural Determinants of Health, Addressing Chronic Conditions: Risk Factors, Prevention and Management and Improving Mental Health. These health needs were prioritized due to the fact that they were supported by both primary and secondary data. Additionally, the hospital's relationships with community partners, clinical expertise, strategic priorities and ongoing commitment to community engagement creates an ideal opportunity to make an impact in the above priority needs, including focused attention within communities of greatest need. Some additional components of the above broad areas of need were highlighted by AHE as areas of opportunity, however due to various reasons they will not be focused on by Swedish Hospital. The CHNA which began in Spring 2018 and was reviewed and approved in 2019 to inform the activities for FY20-22. The priorities being addressed are: Addressing Social and Structural Determinants of Health 1. Violence, Trauma and Community Safety 2. Conditions that Support Healthy Eating and Active Living 3. Housing and the Neighborhood Environment Addressing Chronic Conditions: Risk Factors, Prevention and Management 1. Diabetes 2. Heart Disease & Hypertension 3. Obesity 4. Cancer Improving Mental Health 1. Enhancing Access to Resources and Services

Schedule H, Part VI, Line 5 Promotion of community health
In keeping with the Hospital's mission to provide a continuum of excellent healthcare services, any surplus funds are invested in capital improvements related to patient care or in community benefit programs. The hospital extends medical staff privileges to all qualified physicians in the communities it serves, in accordance with our medical staff development process. The hospital has an active Board of Directors who meet every two months. In addition to reviewing the hospital's financial results, they discuss the hospital's plans and programs in support of our efforts to enhance the health care environment for the entire community we service. The Hospital helps community members gain access to health care services by assisting low income families in applying for the Illinois Department of Public Aid's KidCare and FamilyCare programs. Information about these services is distributed to numerous community organizations, churches, health fairs and school events. It is also publicized throughout the hospital campus and on the hospital web site. Medicaid applications continue to be processed for all inpatients who qualify. The Senior Health Insurance Program (SHIP) counselor continues to provide information for seniors, including information on Medicare Part D. Information about this service is also publicized throughout the hospital campus.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Charity or discounted care is available for medically necessary services as defined by Medicare, to patients who meet the financial and documentation criteria defined below. Each situation is reviewed on an individual case-by-case basis. While not absolutely essential, the need for potential charity or discounted care should be established in advance of admission or rendering of service, or shortly thereafter. Notices in English, Arabic, Assyrian, Korean, Mongolian, Polish, Russian, Spanish, and Vietnamese about the availability of Charity or Discounted Care are posted in the Emergency Room registration area, and the inpatient and outpatient registration areas. The information is also contained in the Patient Handbook, given to all patients upon inpatient admission. Patients and families are encouraged to speak to a financial counselor for more information and assistance, The Guidelines, along with the financial questionnaire, are posted in English, Arabic, Assyrian, Korean, Mongolian, Polish, Russian, Spanish, and Vietnamese on the hospital's website. In order to be eligible for charity or discounted care, the patient must be willing to provide verification of income by filling out the Patient Financial Statement. The patient is responsible to voluntarily submit any and all documentation in order to be eligible to receive this discount. During the registration and information gathering process, the financial counselors determine if the patient qualifies for medical assistance from other existing financial resources such as Medicare, Medicaid, Kid Care, Family Care or other state or federal programs, If the patient refuses to apply for existing financial resources or to provide information necessary to the application process, charity or discounted care cannot be granted. If the application for existing financial resources is denied, or has been previously denied, consideration for charity or discounted care will then be given. Once the Financial Assistance Application form is received, the Financial Service Center determines the eligibility for charity or discount care. SCH suspends the collection process while the Financial Assistance Application is being reviewed. The only criteria considered for Financial Assistance is income and family size. Income is evaluated against the matrix of Federal Poverty Guidelines to determine whether full or partial discount can be approved, Documentation of income is submitted in the form of paycheck stubs, income tax returns, Social Security checks, and/or other documents that are indicative of income. If the information submitted is not perceived to be accurate or reliable, SCH reserves the right to request additional documentation to substantiate income or family size. Patients who are approved for financial assistance and earn a family income less than 200% of the federal poverty guidelines will receive care at no cost for their patient balance after $150 per inpatient stay or outpatient services. The insured patient with a large balance due to deductibles and/or co-payments may be eligible for charity or discounted care. In order to qualify, the patient must complete the Patient Financial Statement and return it to the financial counselors for evaluation and recommendation. No legal action is taken against uninsured patients for the first one hundred twenty (120) days after discharge. Patients who have a family income that is no more than 600% of the Federal Poverty Guidelines (as determined each year), and who do not have any health insurance (or coverage under workers' compensation, accident liability insurance, or other third party liability) as documented through SCH's insurance verification procedures, receive a discount in accordance with the Hospital Uninsured Patient Discount Act (210 ILCS 89/) (the Act).

Schedule H, Part VI, Line 4 Community information
SCH's community, as defined for the purposes of the hospital's Community Health Needs Assessment, includes each of the residential ZIP Codes that comprise the hospital's Primary Service Area (PSA) and Secondary Service Area (SSA), including: 60613, 60618, 60625, 60626, 60630, 60640, 60641, 60645, 60646, 60659, 60660 and 60712. This community definition was determined because the majority of SCH's patients originate from this area. The population of the hospital's service area is estimated at 721,937 people. It is predominantly non-Hispanic White, but also has substantial Hispanic (28%) and Asian (11 %) populations. As throughout the state and nation, our population is aging, with 11.0% currently age 65 and older. There is substantial variation in income across the SCH service area. The community areas with highest poverty rates are Albany Park, Rogers Park, Uptown, Edgewater, and Avondale. The hospital serves a very diverse multicultural community, with the Albany Park neighborhood serving as a key entry point for many new immigrants. To better address the needs of our highly diverse community, the hospital works regularly with dozens of community stakeholders including local ethnic groups, legislators, and community and business organizations, including: the Albany Park Community Center, Centro Romero, Erie Family Health, Heartland Health, Chicago Department of Public Health, HANA Center, Asian Human Services, Vietnamese Association of Illinois, Hamdard Center, Apna Ghar, and North River Commission. These organizations serve as a link between the hospital and the many surrounding niche communities, and the hospital's Community and Government Relations teams communicate regularly online and in-person to propose solutions to issues including Access to Care and health reform. The Spanish language represents the majority of interpretive assistance requested at the hospital. To meet this need on an inpatient and outpatient basis, the hospital employs a full time Spanish medical interpreter. The hospital additionally uses telephonic and video interpretive services to meet the needs in other languages, as well as for when the employed interpreter is not present. In FY21, 85 unique languages were accessed by our staff to communicate with our diverse patient base. To better serve the Korean community, the hospital partners each year with HANA Center, the Korean Medical Society and the Korean Nurses Association to host an annual Korean Health Fair at the hospital. This event provides discounted services for the uninsured and underinsured working population. More than 100 Koreans residing in the greater Chicago area attend this event to receive free or reduced cost screenings and services. HANA Center coordinates the event collaboratively with staff from SCH. In FY21, SCH collaborated with dozens of community organizations and local businesses to provide wellness and prevention programs prior to the pandemic. Additionally, the hospital is committed to educating the public about health and wellness online via social media. As the pandemic progressed, the hospital was tirelessly committed to providing resources and education via virtual programs for community leaders and general community members. As part of the hospital's community outreach efforts, two programs play a critical role: the Community Ambassador Program and the Community Leader Engagement Program. The Community Ambassador Program initiated in FY16 and consists of employees from various departments within the organization who live in the local community and are looking for ways to build bridges among neighbors. Ambassadors engage in dialogue with schools, churches, cultural groups and other local organizations to learn more directly about the community's needs. Feedback and insight is shared with the Community Relations staff which helps to develop appropriate programming and education for the community served by the hospital. The group meets in-person quarterly to discuss ways to better connect with the community; additionally, ambassadors are linked via a closed Facebook group to continue dialogue throughout the year, between meetings. In FY21, more than 30 employees served as Community Ambassadors. The Community Leader Engagement Program initiated in FY17 as an extension of the Ambassador Program. The community leader program has established the hospital as a local leader driving positive change. Two to three times each year, nearly 100 leaders gather to discuss issues impacting our local community. Attendees represent schools, faith communities, cultural organizations, neighborhood organizations and elected officials, as well as a range of internal hospital leaders. With a focus on health and wellness, the group dialogues about the hospital's Community Health Needs Assessment while exploring tangible efforts to impact key priorities, including the hospital's Violence Prevention Program and Housing Connections (housing for homeless individuals). Each year, the group makes a commitment to improve awareness about a specific community health issue and make a positive impact in the health of the community. In FY20 and FY21, based on needs identified in our CHNA as well as input from Community Leaders and clinical professionals, the group planned to host a Summer Social to promote healthy lifestyle habits (centered around wellness zones of Fitness, Nutrition, Mind/Body and Preventive Care). This one-day summer events were postponed due to COVID. Swedish Hospital continues to provide updates and resources to local leaders, stakeholders and elected officials to share with the community and their constituents. Swedish Hospital also prepared education on the COVID-19 vaccine. During the pandemic, Swedish Hospital had been dedicated to caring for COVID-19 patients, providing testing, educating the community, and supporting their employees. Our healthcare professionals have made daily sacrifices and we recognize the ongoing hard work, dedication, and resilience both within the hospital as well as throughout the community, in the face of a global pandemic.