4A (Expenses $ 176865186 including grants of $ 101885) (Revenue $ 181271883)
"CARLE BROMENN MEDICAL CENTER (""CBMC"") IS A TAX-EXEMPT ILLINOIS NOT-FOR-PROFIT CORPORATION ESTABLISHED FOR THE PURPOSE OF OPERATING A HOSPITAL AND CONDUCTING PATIENT CARE RELATED ACTIVITIES. THE HEALTHCARE LEADER IN MCLEAN COUNTY, ILLINOIS, CBMC PROVIDES WORLD-CLASS CARE IN NEUROLOGY, CARDIOLOGY, ORTHOPEDICS, OBSTETRICS, BEHAVORIAL HEALTH SERVICES, AND MORE. CBMC IS ALSO A TEACHING FACILITY OFFERING RESIDENCY PROGRAMS IN NEUROSURGERY, NEUROLOGY, FAMILY MEDICINE, AND CLINICL PASTORAL EDUCATION. CBMC IS A 221 BED HOSPITAL LOCATED AT 1304 FRANKLIN AVENUE, NORMAL, IL PROVIDING A RANGE OF ANCILLARY AND SUPPORT SERVICES. CBMC IS ACCREDITED BY DNV GL HEALTHCARE AND HAS ACHIEVED MAGNET DESIGNATION, THE NATION'S HIGHEST DESIGNATION FOR NURSING CARE. CBMC MAINTAINS ACCREDITATIONS AS A LEVEL II TRAUMA CENTER, CHEST PAIN CENTER, PRIMARY STROKE CENTER AND LEVEL II PERINATAL CENTER, AND IS IPDH EMERGENCY DEPARTMENT APPROVED FOR PEDIATRICS. CBMC CONTINUES A NEARLY 125-YEAR HISTORY OF PROVIDING CHARITABLE, NOT-FOR-PROFIT HOSPITAL CARE FOR BLOOMINGTON-NORMAL, AND THEIR SURROUNDING COMMUNITY. THIS HISTORY BEGAN WITH DEACONESS HOSPITAL, WHICH WAS FORMED IN 1896 AND WHICH LATER CHANGED ITS NAME TO BROKAW HOSPITAL, AND THEN TO BROMENN MEDICAL CENTER AFTER A MERGER WITH MENNONITE HEALTH CARE ASSOCIATION. IN 2010, THE HOSPITAL AND ITS SISTER HOSPITAL, EUREKA HOSPITAL, MERGED INTO ADVOCATE HEALTH AND HOSPITAL CORPORATION (ADVOCATE) AND WAS OPERATED AS A DIVISION OF ADVOCATE, UNTIL JULY 1, 2020 WHEN ACQUIRED BY CARLE HEALTH. FOR 2021, CBMC HAD APPROXIMATELY 110,813 INPATIENT AND OUTPATIENT VISITS WITH APPROXIMATELY 26,111 EMERGENCY DEPARTMENT VISITS AND 1,287 BIRTHS."

COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 5)
Carle BroMenn Medical Center, Chestnut Health Systems (a Federally Qualified Health Center), the McLean County Health Department and OSF St. Joseph Medical Center collaborated with representatives from 39 other organizations on the McLean County Community Health Council to conduct a joint 2019 McLean County Community Health Needs Assessment (CHNA) and adopt a joint 2020-2022 McLean County Community Health Improvement Plan (CHIP). Participants included a broad cross-sector of representatives from 39 organizations including healthcare, county and city government, public health, social services, housing, education, faith and others. Eleven of these organizations are social services organizations representing the underserved, including the Baby Fold, Bloomington Normal Girls and Boys Club, Children's Home and Aid, East Central Illinois Area Agency on Aging, Heartland Head Start, Home Sweet Home Ministries (homeless), Marcfirst SPICE, McLean County Center for Human Services, Mid Central Community Action, Project Oz (youth) and United Way of McLean County. There were also representatives from two health care clinics-Chestnut Health Systems and the Community Health Care Clinic-serving low-income and underserved residents of McLean County. Conducting a joint CHNA is possible as all four entities define their service area as McLean County. The process of collecting and analyzing data and prioritizing significant needs was overseen by an Executive Steering Committee of the council comprised of one representative from both hospitals, Chestnut Health Systems and the McLean County Health Department. In the fall/winter of 2018-2019, the committee analyzed data from a variety of sources, including existing secondary data sources and primary data from a survey administered to McLean County residents in July-September 2018. Of the 675 residents that responded, 102 were from the low-income population. The Executive Steering Committee identified the significant health needs to present to the McLean County Community Health Council for prioritization by utilizing the following criteria: size of issue, rates worse than other counties in Illinois or the state rate; disparities by race/ethnicity, age, gender or ZIP code; and not meeting the Healthy People 2020 target. The six significant health needs identified by the executive steering committee for prioritization by the council were access to care; behavioral health (mental health and substance use); healthy eating and active living (exercise, nutrition, obesity, food access/insecurity); heart disease; oral health; and respiratory disease. The Executive Steering Committee facilitated three meetings of the McLean County Community Health Council from January through February 2019. The purpose of the meetings was to review outcomes from the McLean County 2017-2019 CHIP, to present data for the six significant health needs identified by the Executive Steering Committee and to prioritize the needs, using the Hanlon Method, in order to select the three significant health needs for the 2019 McLean County CHNA and the 2020-2022 Mclean County CHIP. Carle BroMenn Medical Center -Eureka Hospital Governing Council approved the 2019 McLean County CHNA Report on July 23, 2019, followed by approval of the 2020-2022 McLean County CHIP on January 28, 2020. The McLean County 2019 CHNA was posted in August 2019 and included a mechanism for the community to provide feedback either by a form or via email. Posting of the McLean County 2020-2022 CHIP occurred in February 2020. As of December 31, 2021, there was no additional feedback from the community related to the 2019 McLean County CHNA, the 2020-2022 McLean County CHIP, or the previous 2016 McLean County CHNA or the 2017-2019 McLean County CHIP

COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 6A)
OSF HEALTHCARE ST. JOSEPH MEDICAL CENTER, BLOOMINGTON, ILLINOIS

COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 6B)
CHESTNUT HEALTH SYSTEMS, CHESTNUT FAMILY HEALTH CENTER, BLOOMINGTON, ILLINOIS, AND MCLEAN COUNTY HEALTH DEPARTMENT, BLOOMINGTON, ILLINOIS

COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 7A)
https://carle.org/chna

COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 7B)
MCLEAN COUNTY HEALTH DEPARTMENT: http://health.mcleancountyil.gov OSF ST JOSEPH MEDICAL CENTER: http://www.osfhealthcare.org/st-joseph/ CHESTNUT HEALTH SYSTEMS: https://www.chestnutfamilyhealth.org/about-us/data-reports/

COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 7D)
An overview of the process and results of the 2019 McLean County CHNA were given to the John M. Scott Health Care Commission, City of Bloomington Planning Commission, McLean County Board of Health, Chestnut Health Systems Board of Directors, Advocate BroMenn Delegate Church Association (Carle BroMenn and Eureka Delegate Church Association as of July 1, 2020), Advocate BroMenn-Eureka Governing Council (Carle BroMenn-Eureka Governing Council as of July 1, 2020); OSF Healthcare Systems Board of Directors and Advocate BroMenn Nursing Leadership. CHNA presentations were also given to students at Illinois Wesleyan University and to Leadership McLean County participants in 2021.

COMMUNITY HEALTH NEEDS ASSESSMENT (PART V, SECT B, LINE 11)
"2017-2019 CHNA and 2020 - 2022 CHIP The 2020-2022 McLean County CHIP is a joint plan for the entire county and consists of interventions and resources to be provided by the hospitals, health department, family health center and numerous social service or other community organizations. Priority Action Teams met during 2019 and into 2020 to coordinate efforts. Advocate BroMenn Medical Center Transition Carle Health acquired Advocate BroMenn Medical Center on July 1, 2020. The implementation plan efforts for each health need below refers to the time of January 1 -December 31, 2021, when Carle BroMenn Medical Center was a part of Carle Health. HEALTH NEEDS SELECTED Access to care was selected as a significant health need to address given there are significant geographic and racial/ethnic disparities in McLean County that may be related to access to care, and improving access in certain areas and for certain populations can have a widespread impact on a variety of health outcomes ranging from oral health to respiratory disease. Highlights for steps taken from January 1 - December 31, 2021, as a part of the 2020-2022 McLean County CHIP to address access to care are as follows: - Carle BroMenn Medical Center and OSF Healthcare St. Joseph Medical Center collaborated with The Community Health Care Clinic for Coordinating Appropriate Access to Comprehensive Care (CAATCH). CAATCH is an emergency room navigation program for navigators and/or care coordinators to engage those without a primary care home. In 2021, there were 358 CAATCH patients served. Outcomes include a zero percent 30-day hospital readmission rate for CAATCH patients, an 89% reduction in emergency department visits post involvement in CAATCH and a $1,116,000 yearly estimated cost savings. - Carle BroMenn Medical Center and Carle West Behavioral Health continued to offer telepsychiatry consults to increase access to mental health services for patients in 2021. In 2021, there were 128 hours of telepsychiatry consults at Carle BroMenn Medical Center (number of patients not available). Carle West BroMenn Behavioral Health provided 2,992 consults for 892 unique patients in 2021. - The Carle BroMenn Medical Center Community Health Director served on the City of Bloomington's John M. Scott Health Care Commission Grants Committee in 2021. The John M. Scott Health Care Trust provides approximately $500,000 - $950,000 a year in grants to organizations with services that address one or more of the health priorities outlined in the 2019 McLean County Community Health Needs Assessment. John M. Scott Trust funds are for McLean County residents with annual household incomes at or below 185% of the Federal Poverty Line. - In August 2021, Carle BroMenn Medical Center behavioral health therapists began hosting a weekly stroke support group at the Carle Health and Fitness Center. The curriculum is created around a holistic approach, with the addition of hosting medical and community experts on a scheduled basis. Direct referrals are made for all patients with a stroke diagnosis discharged from the hospital. - Carle BroMenn Medical Center Addiction Recovery began offering Partial Hospitalization Programming (PHP) again in 2021 at the hospital in conjunction with Intensive Outpatient Programming (IOP) and After Care Programming. This is a group-based outpatient treatment that meets Monday through Friday for five hours per day. While programming is individualized, typical length of stay is 10 to 15 days. Patients learn core recovery principles, relapse prevention strategies and coping skills to implement into a recovery lifestyle. Licensed therapists, dietitians, chaplains and members of the recovery community are available to assist patients with their recovery plans following partial hospitalization treatment. - Beginning on June 7, 2021, Carle BroMenn Medical Center staff began meeting with community members, the American Cancer Society, and Carle Cancer Institute staff for a Commission on Cancer standard with a focus on increasing mammograms in the African American and Black community. - In 2021, Carle BroMenn Medical Center, UnityPoint Health and Prairie Pride Coalition helped bring Central Illinois Friends to the Community Health Care Clinic, expanding access to HIV and sexual health services. - McLean County Orthopedics joined Carle Health on August 29, 2021. This expanded access to care to orthopedics, pain, podiatry and sports medicine care for Medicaid patients. - From April to December 2021, Carle BroMenn Medical Center partnered with Carle Foundation Hospital's Community Health Initiatives department to bring the Carle Mobile Health Clinic to Bloomington once a month. The clinic was held in the parking lot of Woodhill Towers. A total of 148 patients received services at the clinic. Collaborative partners also joined the clinic. OSF HealthCare St. Joseph Medical Center provided nutrition information and distributed 166 Smart Meals. The McLean County Health Department provided Diabetes Prevention Program information and The Tinervin Foundation distributed food boxes. The Carle Mobile Health Clinic also provided school physicals at Normal West High School for 89 students and at Bloomington Junior High School for 108 students. - In 2021, the Carle Cancer Institute created a multidisciplinary clinic and tumor board. This allowed patients to see a breast surgeon, medical oncologist, radiation oncologist and nurse navigator on the same day at Carle Cancer Institute Normal. Patients also receive tumor board recommendations for treatment within a week of their appointment. This clinic shortened the wait time for patients newly diagnosed with breast cancer to begin treatment. - On April 20, 2021, Carle West Physician Group partnered with the McLean County Health Department for the first Spanish language virtual town hall to address COVID -19 vaccine hesitancy offered to community members. A Carle West physician was one of the speakers for the event for Spanish speaking community members. - On February 25, 2021, two Carle West physicians were presenters at the virtual town hall for the Black or African American community to address COVID-19 vaccine hesitancy. - In 2021, Carle launched an interactive chatbot to assist patients and community members in determining when and where they can get the COVID-19 vaccine. - In 2021, The Chief Nursing Officer for Carle BroMenn Medical Center and Carle Eureka Hospital was a speaker for an International Seminar Series event titled, ""COVID-19: Managing Locally a Global Pandemic. - Carle BroMenn Medical Center continued leading the monthly LGBTQ+ Advisory Council meetings, which began in December 2019 and continued in 2020 and 2021. The council fosters increased access to care by giving a voice to the LGBTQ+ community and allies to provide sensitive and respectful care. The 2020-2022 McLean County CHIP was posted in February 2020. Interventions for access to care outlined in the plan can be viewed at: https://carle.org/chn Behavioral health was selected as a significant health need to address given there are numerous health disparities in Bloomington ZIP code 61701 for both mental health and substance abuse. There has also been a great deal of public support and momentum behind mental health and the county is well situated to continue to collaborate on mental health due to the on-going efforts of numerous organizations and the McLean County Government. Mental health had also been selected as a significant health need for the 2016 McLean County CHNA giving further momentum to the efforts of improving mental health for county residents. Highlights for steps taken from January 1 - December 31, 2021, as a part of the 2020-2022 McLean County CHIP to address behavioral health are as follows: - The hospital continues to have the only inpatient mental health unit and the only hospital-based substance use program in McLean County, which addresses both the behavioral health and access to care significant health needs. The inpatient mental health unit and the addiction and recovery unit provide critical services to those adults needing inpatient psychiatric or addiction and recovery services. The inpatient mental health unit operated at a loss of $ 2,174,259 and the addiction and recovery unit operated at a loss $1,396,498 from January 1 - December 31, 2021. - The Manager of Behavioral Health, Carle BroMenn Medical Center Chemical Dependency, served on the McLean County Recovery Oriented System of Care Council - In 2021, Carle BroMenn Medical Center sponsored three Mental Health First Aid (MHFA) courses for 46 community members. One of the classes was the first Older Adults MHFA class held in McLean County. - The Community Health Director for Carle BroMenn Medical Center served on the McLean County Trauma and Resilience Collaborative, led by the McLean County Government, in 2021. In 2021, Carle BroMenn Medical Center Addiction Recovery began offering Partial Hospitalizat"

SCHEDULE H, PART VI, LINE 2
Needs Assessment Carle Bromenn Medical Center primarily assesses healthcare needs in our community by being a part of the aforementioned joint CHNA in partnership with OSF Healthcare St. Joseph Medical Center, McLean County Health Department and Chestnut Health Systems - Family Health Center. In addition to the highlights for access to care outlined in Part 5 line 11, Carle BroMenn Medical Center has a strong financial assistance program based on a philosophy of doing the right thing for the community and patients, balanced by a careful stewardship of the community's resources. As a tax-exempt organization, Carle BroMenn Medical Center provides care to patients regardless of their ability to pay. Carle Health's generous financial assistance program has resulted in our ability to reach many people over the years. To ensure we are addressing the needs of the community, the finance and quality committees of Carle Health's board of trustees reviews and evaluates charity care figures annually. We do not limit the amount of financial assistance we provide, at this time. In addition to charity care, Carle BroMenn Medical Center supports a wide range of programs and services to increase community capacity, health care work force expansion, and social services that provide complementary healthcare-related services. Carle BroMenn Medical Center will continue with these Initiatives to improve access to care: 1. Offer a charity care program 2. Communicate the availability of the charity care program 3. Recruit more providers into the Carle Health system, thereby expanding access/capacity 4. Support the local Community Health Care Clinic to ensure added local capacity for health and dental care 5. Participate in population health initiatives that actively manage the health of members 6. Enhance access-related initiatives that will improve patient access and ability to interface more efficiently for needed services, i.e; virtual visits 7. Continue access to care through subsidized services, including mental health services, heart failure clinic, palliative care and acute rehabilitation to name a few.

SCHEDULE H, PART VI, LINE 3
Patient education of eligibility for assistance. Carle Health's practice is to look at each patient's financial status in relation to the Carle Financial Assistance Program and the criteria of the Uninsured Patient Discount Act and to provide the patient with the deepest discount available. By expanding the presumptive eligibility screening processes and determining the financial status of patients up-front, Carle Health has been able to pinpoint those needing assistance early in the process, minimizing bad debt and optimizing our ability to help. Staff is also diligent in following up with patients during hospitalization and after discharge if there's any reason to believe the patient could benefit from financial assistance, and we auto-qualify certain patient populations for Carle Financial Assistance Program, such as the homeless, WIC, SNAP (Supplemental Nutrition Assistance Program), Medicaid, Low Income Home Energy Assistance Program (LIHEAP), and Township Assistance recipients. Communicating that Financial Assistance is Available Carle Health has made a concerted, continuous effort to be sure that people have access to information that will help them with their medical bills. These include: - Advertising Carle Financial Assistance Program using print, billboards and web; continued presence in appropriate community publications; and on-site via displays throughout the hospital and clinics. - Simplified application form, including a version in Spanish, that contains information regarding the Carle Financial Assistance Program. - Publication of a Plain Language Summary and all other financial assistance-related information on Carle.org/FinancialAssistance. - Information about the Carle Financial Assistance Program on all statements, collection letters and hospital admission packets. - Carle Financial Assistance Program information and applications at all registration points, hospital main lobby and carle.org. - Meetings with local legislators to help them assist constituents with healthcare needs, including financial assistance.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM The Hospital and its associated business units under The Carle Foundation umbrella all participate in carrying out the same annual community benefit plan, participating in programs that fit their specific missions.

SCHEDULE H, PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT ILLINOIS

FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA (PART I, LINE 3C)
PATIENTS MAY REQUEST AND COMPLETE A FINANCIAL ASSISTANCE APPLICATION AT ANY TIME, INCLUDING BEFORE CARE IS RECEIVED. PATIENTS ARE INFORMED ABOUT FINANCIAL ASSISTANCE ON MULTIPLE OCCASIONS THROUGHOUT THE COLLECTION PROCESS. IN ADDITION TO PATIENTS COMPLETING APPLICATIONS FOR CARLE'S FINANCIAL ASSISTANCE PROGRAM, ROBUST PRESUMPTIVE ELIGIBILITY PROCESSES ARE IN PLACE. CARLE HAS PARTNERED WITH EXPERIAN INFORMATION SOLUTIONS, INC. TO HELP IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BASED ON KEY FINANCIAL INDICATORS. THESE PATIENTS MAY BE APPROVED WITHOUT EVER COMPLETING AN APPLICATION OR EXPRESSING A NEED FOR FINANCIAL ASSISTANCE. IN ADDITION, CARLE PRESUMES ELIGIBILITY FOR PATIENTS WHO ARE VERIFIED HOMELESS, DECEASED WITH NO ESTATE, MENTALLY INCAPACITATED, ELIGIBLE FOR SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) OR WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC), TOWNSHIP ASSISTANCE, LOW INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP), ILLINOIS FREE LUNCH AND BREAKFAST PROGRAM OR COVERED BY ILLINOIS MEDICAID.

BAD DEBT, MEDICARE, & COLLECTION PRACTICES (PART III, LINE 3)
CARLE BROMENN MEDICAL CENTER USES 50% AS A GENERAL ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.

BAD DEBT FOOTNOTE (PART III, LINE 4)
THE FOOTNOTES PERTAINING TO BAD DEBT EXPENSE CAN BE FOUND ON PAGE 28 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENTS.

SCHEDULE H, PART VI, LINE 4
Community Information. Description of the Community/Population The McLean County Community Health Council defined the community as McLean County, the primary service area for Advocate BroMenn Medical Center (Carle BroMenn Medical Center as of July 1, 2020), the McLean County Health Department, OSF St. Joseph Medical Center and Chestnut Family Health Center. This area includes the following cities and towns: Anchor, Arrowsmith, Bellflower, Bloomington, Carlock, Chenoa, Colfax, Cooksville, Danvers, Downs, Ellsworth, Gridley, Heyworth, Hudson, Le Roy, Lexington, McLean, Merna, Normal, Saybrook, Stanford and Towanda. The total population of McLean County is 172,052 with Bloomington having the largest population in the county with 78,368 and Normal the second largest population with 54,534. The population in McLean County increased by 1.46 percent from 2010 to 2019 (Conduent Healthy Communities Institute, 2019). Social Determinants of Health (SDOH) The SocioNeeds Index is a Conduent Healthy Communities Institute tool that is a measure of socioeconomic need, which is correlated with poor health outcomes. The index is calculated from six indicators, one each from the following topics: poverty, income, unemployment, occupation, education and language. The indicators are weighted to maximize the correlation of the index with premature death rates and preventable hospitalization rates. All ZIP codes, counties and county equivalents in the U.S. are given an index value from zero (low need) to 100 (high need). To help identify the areas of highest need within a defined geographic area, the selected ZIP codes are ranked from 1 (low need) to 5 (high need) based on their index value. These values are sorted from low to high and divided into five ranks using natural breaks. McLean County has several communities that have greater socioeconomic needs compared to other communities in the county. One ZIP code with a ranking of 5, Bloomington 61701, and eight ZIP codes with a ranking of 4, represent the areas with the highest socioeconomic need in McLean County. The eight communities with a ranking of 4 are Normal, Colfax, Funks Grove/McLean, Saybrook, Stanford, Bellflower and Cooksville. Demographics The median age in McLean County is 33.7 years of age, which is less than the median age in Illinois at 38.5. Twenty-two percent of persons in McLean County are less than 18 years of age and 24 percent are 45 to 64 years of age. Thirteen percent of persons are over the age of 65. Forty-nine percent of the population in McLean County is male and 51 percent is female. The race/ethnicity of the county's population is 81.7 percent White, 7.7 percent Black or African American, 5.8 percent Asian, 5.1 percent Hispanic or Latino, 0.25 percent American Indian and Alaska Native, and .05 percent Native Hawaiian or Pacific Islander. There are 66,336 households in McLean County. The average household size is 2.43. Approximately 25 percent of the households in McLean County are single parent households compared to 32.4 percent for Illinois (Conduent Healthy Communities Institute, 2019). The median household income for McLean County is $67,065. This is higher than the median household income for Illinois of $66,487. In McLean County, the percent of people living below the federal poverty line (FPL) is 14.5 percent. Within McLean County, the median household income varies with Native Hawaiian/Pacific Islanders having the highest median household income of $114,583 and Blacks/African Americans having the lowest at $34,463. However, Native Hawaiian/Pacific Islanders represent only .05 percent of the population in McLean County. Therefore, small changes can greatly affect the data. The percentage of the civilian labor force ages 16 years and over that is unemployed in McLean County is 3.73 percent, lower than Illinois at 6.7 percent. The three common industries of employment are the financial or insurance industry at 18.2 percent, educational services at 13.9 percent and healthcare at 13.1 percent. As far as level of education, ninety-six percent of the population ages 25 and over in McLean County possesses a high school diploma or higher and 44.7 percent have a bachelor's degree or higher. The state percentage for a bachelor's degree or higher is 33.4 percent. Illinois State University, Illinois Wesleyan University, Heartland Community College and Lincoln College are all located in McLean County. The four-year high school graduation rate for McLean County is 88.1 percent. This is higher than the graduation rate for Illinois of 85.6 percent. One-hundred-and-one percent of respondents of the 2018 McLean County Community Health Survey reported having either private insurance, Medicare or Medicaid, while ten percent reported not having any insurance. This percentage is greater than 100 percent because respondents could choose more than one answer. The Index of Medical Underservice (IMU) score for the McLean County Service Area is 49.2. The lowest score (highest need) is 0; the highest score (lowest need) is 100. To qualify for designation, the IMU score must be less than or equal to 62.0. This score applies to the Medically Underserved Area (MUA) or Medically Underserved Populations (MUP) as a whole, and not to individual portions of it. Healthcare Resources in the Defined Community McLean County has two hospitals, Carle BroMenn Medical Center located in Normal and OSF Healthcare St. Joseph Medical Center located in Bloomington. There is also a federally qualified health center (FQHC), the Chestnut Family Health Center, located in Bloomington. In addition, there are two community clinics. The Community Health Care Clinic is located in Normal and McLean County Center for Human Services is located in Bloomington. Two additional health care resources in McLean County are the clinic within the McLean County Health Department and a crisis stabilization unit, which is a part of Chestnut Health Systems. In the 2019 County Health Rankings, McLean County ranked 2nd out of 102 Illinois counties for Clinical Care, which compares seven indicators: percent uninsured; ratio of primary care physicians, dentists, and mental health providers to the population; preventable hospital stays; percent completing mammogram screenings; and percent of flu vaccinations.

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH Carle BroMenn Medical Center's dedication to promoting the health of the community is exemplified in numerous ways. The Carle BroMenn Medical Center and Eureka Hospital Governing Council is comprised of local community leaders and physicians. Governing Council members support hospital leadership in their pursuit of the hospital's goals, represent the community's interest to the hospital and serve as ambassadors in the community. Seventy-one percent of the current Governing Council members represent the community. In addition, the organization extends medical staff privileges to all qualified physicians in its community for some or all of its departments and specialties. A vast majority of the hospital's executive and leadership team serve on multiple community boards that help either directly or indirectly improve the health of the community, such as the Community Health Care Clinic, Faith in Action, Habitat for Humanity, McLean County Interfaith Alliance, Mennonite College of Nursing, Not in Our Town, Economic Development Council, Recovery Court and Promise Council boards. In addition, Carle BroMenn Medical Center's president is involved in many other boards impacting the community, such as the Commerce Bank Advisory Board, Illinois Wesleyan University Board, Central Illinois Regional Airport Board, Illinois State University Foundation and Development Advisory Boards, McLean County Chamber of Commerce and the Pandemic Advisory Council. As briefly mentioned earlier, the Community Health Care Clinic also contributes to the health of the community and furthers the medical center's charitable, tax-exempt status. In 1993, Carle BroMenn Medical Center (BroMenn Medical Center at the time) collaborated with OSF Healthcare St. Joseph Medical Center to open the clinic. The clinic provides services to the medically underserved population of McLean County to ensure all populations in the community have access to healthcare. Emergency room visits, diagnostic testing and medical center services are provided free-of-charge by Carle BroMenn Medical Center and OSF Healthcare St. Joseph Medical Center. In 2021, the Community Health Care Clinic served 1,294 patients for 4,648 patient visits and dispensed 31,441 prescription medications at no charge to uninsured individuals. During the same period, the CHCC saw 665 dental patients for 1,551 visits. The clinic is in a building owned by Carle BroMenn Medical Center for which the hospital paid $89,793 for upkeep and maintenance of the facility in 2021. In addition to the above, Carle BroMenn Medical Center offers several services to patients and the community which operate at a loss to the hospital. A sampling of these services is outlined below. - Carle BroMenn Medical Center is an American Heart Association (AHA) Training Center. The American Heart Association (AHA) Training Center offers Friends & Family CPR/AED, BLS (Basic Life Support), Heartsaver First Aid/CPR/AED, Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS, to staff, as well as the community. In 2021, 6,116 individuals were trained through the training center at a cost of $41,223 to the medical center. - Carle BroMenn Medical Center's Acute Rehab Services treats patients who require inpatient rehabilitation services resulting from a variety of conditions including stroke, traumatic and non-traumatic brain and spinal cord injury, neurological disorders, hip fracture, amputation, burns, arthritis, joint replacement and other conditions. The goal of treatment, provided by a care team, is to help individuals regain their independence and reach their rehabilitation goals. Depending on the customized care plan, a care team may include nurses, physical therapists, occupational therapists, speech therapists, social workers/case managers and dietitians. Carle BroMenn Medical Center operated Acute Rehab Services in 2021 at a loss of $2,051,737. - In 2021, Carle BroMenn Medical Center operated a heart failure clinic at a loss of $285,689 and cardiopulmonary rehab at a loss of $749,066 in 2021. Other services offered by the medical center that benefit the health of the community include clinical pastoral education programs and being a teaching hospital for both family practice, neurology and neurosurgery residents.

EXPLINATION OF COSTING METHODOLOGY (PART I, LINE 7 AND PART III, LINE )2
TO COMPUTE AND CONVERT FINANCIAL ASSISTANCE, UNREIMBURSED MEDICAID, MEANS-TESTED PROGRAMS AND BAD DEBT CHARGES TO COST; A CONSISTENT GAAP (GENERALLY ACCEPTED ACCOUNTING PRINCIPLES) BASED COST-TO-CHARGE RATIO WAS USED ACROSS ALL PAYERS. ALTHOUGH THE METHODOLOGY WAS SIMILAR TO WORKSHEET #2, FOR SIMPLICITY PURPOSES CERTAIN IMMATERIAL VALUES WERE OMITTED. OTHER COMMUNITY BENEFITS COSTS WERE REPORTED AT THE ACTUAL EXPENSE INCURRED. PATIENT RECEIVABLE PAYMENTS AND RELATED DISCOUNTS WERE RECORDED AT ACTUAL AMOUNTS AT THE TIME OF PAYMENT RECEIPT. A SEPARATE GAAP BASED PROVISION FOR ESTIMATED BAD DEBTS AND DISCOUNTS WAS RECOGNIZED FOR ACCOUNTS IN PROCESS AND PENDING ADJUDICATION AND PAYMENT. THE ESTIMATED PORTION WAS BASED ON HISTORICAL TRENDS AND ADJUSTED TO ACTUAL WHEN ADJUDICATION AND PAYMENT OCCUR. ACCOUNTS DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE WERE PROCESSED IMMEDIATELY FOR FINANCIAL ASSISTANCE DISCOUNT WITH NO COLLECTION EFFORT. FOR ACCOUNTS WITH INSUFFICIENT INFORMATION AND DOCUMENTATION TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY, THE HOSPITAL CONSULTED WITH A VARIETY OF ALTERNATIVE SOURCES TO HELP DETERMINE AN INDIVIDUAL'S FINANCIAL MEANS (OR LACK OF MEANS) TO PAY. BASED ON RELATED TRENDS, THE HOSPITAL FURTHER DEVELOPED A GENERAL ESTIMATE OF FINANCIAL ASSISTANCE WHICH CONTINUED TO BE RECORDED WITHIN BAD DEBTS.

COMMUNITY BUILDING ACTIVITIES (PART VI AND PART II)
Education Through a variety of activities including significant donations and physician, nurse and allied-health education, more than $1 million was invested in programs that address community-wide workforce and education issues, strengthening the training and availability of professionals to care for our communities' healthcare needs now and in the future. Community-Building Although community-building items are not counted as community benefit, this support is an important aspect of contributing to the economic viability of the community. Total, Carle BroMenn Medical Center contributed more than $58,000 in community building activities in 2021. The contributions are outlined below. Economic Development: A portion of Carle BroMenn Medical Center's community-building activities focused on economic development cash donations and in-kind donations. The hospital provided funding to many community building associations in 2021, including the Bloomington-Normal Economic Development Council, the McLean County Chamber of Commerce, the McLean County Museum of History and more. Leadership also provided in-kind support by serving on the board for the Bloomington-Normal Economic Development Council. Disaster Readiness: Carle BroMenn Medical Center, like many other health organizations across the country, focused efforts and resources to serve our community against the COVID-19 pandemic. While it is challenging to equate the numerous hours leaders and staff spent preparing, communicating and treating for COVID-19, Carle Health conservatively reported only a very small number of public information items- in which Carle BroMenn Medical Center staff worked to educate the community on COVID-19, with no expectation of any business in return.

EXPLINATION OF MEDICARE COST REPORT COSTING METHODOLOGY (PART III, LINE 8)
THE NUMERATOR (TOTAL EXPENSE) AND DENOMINATOR (TOTAL GROSS CHARGES) OF THE SIMPLE RATIO OF PATIENT CARE COST TO CHARGES IS ADJUSTED BY ELIMINATING NON-PATIENT CARE THAT GENERATES OTHER REVENUE, BAD DEBT EXPENSE, MEDICAID AND OTHER PROVIDER TAXES AND THE TOTAL COST OF COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS. ALSO, ANY GROSS PATIENT CHARGES FOR PROGRAMS NOT RELYING ON THE RATIO ARE ELIMINATED FROM BOTH THE NUMERATOR AND DENOMINATOR OF THE RATIO. THESE ADJUSTMENTS ARE INTENDED TO ELIMINATE ANY POTENTIAL DOUBLE COUNTING OF COMMUNITY BENEFIT EXPENSES. THE RESULTANT RATIO ALIGNS WITH SCHEDULE H REQUIREMENTS. ILLINOIS LAW DEFINES GOVERNMENTAL-SPONSORED INDIGENT HEALTH CARE AS THE INDIGENT CARE PROGRAMS. WHEN THERE IS A SHORTFALL, MANAGEMENT BELIEVES THIS IS A COMMUNITY BENEFIT BECAUSE, AS A HOSPITAL, CARLE IS STEPPING UP TO CARRY THE BURDEN OF THE GOVERNMENT, ASSURING CARE TO SENIORS, AND THOSE WITHIN LESS FORTUNATE DEMOGRAPHICS THAT HAVE EXPERIENCED INCREASING COSTS OVER THE PAST DECADE WHILE LIVING ON FIXED INCOMES.

COLLECTION PRACTICES (PART III, LINE 9B)
"THE CARLE FINANCIAL ASSISTANCE PROGRAM (CFAP) PROVIDES DISCOUNTED OR FREE CARE TO THOSE WHO NEED IT WITHIN THE CARLE HEALTH SYSTEM, INCLUDING CARLE BROMENN MEDICAL CENTER. NOT ONLY DOES THIS RESULT IN A MORE TIMELY APPLICATION PROCESS, BUT MOST IMPORTANTLY, IT MEANS PATIENTS RECEIVE THE SAME DISCOUNT AT THE HOSPITAL AND CLINICS IF THEY MIGHT NEED AN ADDITIONAL SPECIALTY OR HIGHER ACUITY HOSPITAL CARE AT THE CARLE FOUNDATION HOSPITAL IN URBANA, ILLINOIS. WITH THIS PROGRAM, CARLE BROMENN MEDICAL CENTER HAS A ROBUST PRESUMPTIVE ELIGIBILITY PROCESS. CARLE PRESUMES ELIGIBILITY FOR VERIFIED HOMELESS, DECEASED WITH NO ESTATE, MENTAL INCAPACITATION, RECIPIENTS OF WIC (WOMEN, INFANTS AND CHILDREN NUTRITION PROGRAM), SNAP (SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM), LIHEAP (LOW INCOME HOME ENERGY ASSISTANCE PROGRAM), ILLINOIS FREE LUNCH AND BREAKFAST PROGRAM, RECEIPT OF GRANT ASSISTANCE FOR MEDICAL SERVICE, FEDERALLY QUALIFIED HEALTH CLINIC (FQHC) DISCOUNT REFERRALS, MEDICAID TITLE XIX, XXI, AND IN-NETWORK MEDICAID MANAGED CARE PLANS. IN ADDITION, CARLE UTILIZES A VENDOR, EXPERIAN INFORMATION SOLUTIONS, INC., TO PROACTIVELY IDENTIFY PATIENTS WHO MAY BE PRESUMPTIVELY-QUALIFIED FOR ASSISTANCE - NOT ONLY FOR PUBLIC PROGRAMS LIKE MEDICAID, BUT ALSO BASED ON A NUMBER OF KEY FINANCIAL INDICATORS, INCLUDING CREDIT HISTORY, DEMOGRAPHICS AND GROSS INCOME. IDENTIFIED PATIENTS MAY BE PRESUMED ELIGIBLE AND AUTOMATICALLY ENROLLED IN THE PROGRAM, OR THEY MAY BE CONTACTED AND ENCOURAGED TO APPLY FOR ASSISTANCE. PATIENTS WHO ARE NOT DEEMED PRESUMPTIVELY-ELIGIBLE WOULD NEED TO REQUEST AND COMPLETE AN APPLICATION. IF THE PATIENT DOES NOT REQUEST OR COMPLETE AND RETURN THE APPLICATION, THEN THE BALANCE IS DEEMED THAT INDIVIDUAL'S RESPONSIBILITY TO PAY. FOR PATIENTS WHO DO NOT QUALIFY FOR CARLE FINANCIAL ASSISTANCE AND WHO MAY BE UNINSURED OR UNDERINSURED, CARLE BROMENN MEDICAL CENTER HAS OTHER DISCOUNT OPTIONS AVAILABLE, SUCH AS PROMPT PAY, ILLINOIS UNINSURED DISCOUNT, AND CAPPED DISCOUNT - WHERE PATIENTS' OUT-OF-POCKET MEDICAL EXPENSES ARE LIMITED TO 40% OF THEIR ANNUAL GROSS INCOME IF THEY EARN AT OR BELOW 400% OF THE FEDERAL POVERTY LEVEL. ONCE ALL APPLICABLE DISCOUNTS HAVE BEEN APPLIED, MANAGEMENT MAKES EVERY ATTEMPT TO WORK WITH PATIENTS AND SET UP PAYMENT ARRANGEMENTS ON THE REMAINING BALANCES DUE. THE CURRENT MINIMUM IS 5% OF THE TOTAL BALANCE DUE OR $25.00 A MONTH. IF THEY CANNOT MEET THESE GUIDELINES, OUR IN-HOUSE BILLING STAFF MEMBERS WORK WITH THEM TO SET UP A TEMPORARY/SHORT TERM PAYMENT ARRANGEMENT UNTIL THEY CAN MAKE THE MINIMUM PAYMENT. IF THEY ARE UNABLE TO MAKE PAYMENTS ON THE BALANCE DUE, THEN THAT BALANCE MAY BE LISTED WITH AN OUTSIDE COLLECTION AGENCY. WHEN THE ACCOUNT IS STILL IN-HOUSE, THE MINIMUM NOTIFICATION IS MONTHLY ITEMIZED STATEMENTS. IF A PATIENT DOES NOT RESPOND, THE ACCOUNT IS GIVEN A FINAL NOTICE, EITHER BY LETTER OR PHONE, AND SENT TO AN OUTSIDE COLLECTION AGENCY. CARLE BROMENN MEDICAL CENTER WILL NOT FILE COLLECTION SUIT LIENS ON A PRIMARY RESIDENCE, NOR DOES CARLE AUTHORIZE AN AGENCY TO USE SO-CALLED ""BODY ATTACHMENTS."" THE CONTRACTED AGENCIES ARE AWARE OF OUR CFAP AND HAVE BEEN ADVISED TO REFER THE PATIENTS BACK TO CARLE IF THEY DEEM THE PATIENT IS UNABLE TO PAY. BILLING STAFF WILL THEN MAKE ONE MORE ATTEMPT TO WORK WITH THE PATIENT TO DETERMINE IF HELP IS AVAILABLE. IF STAFF DETERMINES THE PATIENT MIGHT QUALIFY, CARLE SENDS THE PATIENT A CFAP APPLICATION AND INSTRUCTS THE AGENCY TO PUT A HOLD ON THE ACCOUNT; THE AVERAGE HOLD IS 60 DAYS. IF THE PATIENT IS THEN APPROVED FOR DISCOUNTS AT 100% FOR FINANCIAL ASSISTANCE, THE BALANCE IS ADJUSTED AND THE ACCOUNT IS CLOSED WITH THE AGENCY. IF THE PATIENT IS APPROVED FOR LESS THAN 100%, THE ADJUSTMENTS ARE REPORTED TO THE AGENCY AND THE AGENCY WILL BEGIN COLLECTION EFFORTS ON ANY REMAINING BALANCE."