4A (Expenses $ 382367858 including grants of $ 2231435) (Revenue $ 494843251)
Alexian Brothers Medical Center is a 376-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2022, Alexian Brothers Medical Center treated 16,175 adults and children for a total of 95,536 patient days of service. The hospital also provided services for 122,785 outpatient visits, which included 5,387 outpatient surgeries and 41,576 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. As part of the Ascension Catholic health ministry, the filing organization served in support of Ascension's commitment to both care for patients and communities and support caregivers and other associates through the challenges of the COVID-19 global pandemic in FY22.

Schedule H, Part V, Section B, Line 3E
TO BETTER TARGET COMMUNITY RESOURCES ON THE SERVICE AREA'S MOST PRESSING HEALTH NEEDS, THE HOSPITAL PARTICIPATED IN A GROUP DISCUSSION WITH ORGANIZATIONAL DECISION MAKERS AND COMMUNITY LEADERS TO PRIORITIZE THE SIGNIFICANT COMMUNITY HEALTH NEEDS WHILE CONSIDERING SEVERAL CRITERIA: ALIGNMENT WITH ASCENSION HEALTH STRATEGIES OF HEALTHCARE THAT LEAVES NO ONE BEHIND; CARE FOR THE POOR AND VULNERABLE; OPPORTUNITIES FOR PARTNERSHIP; AVAILABILITY OF EXISTING PROGRAMS AND RESOURCES; ADDRESSING DISPARITIES OF SUBGROUPS; AVAILABILITY OF EVIDENCE-BASED PRACTICES; AND COMMUNITY INPUT. THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SEE SCHEDULE H, PART V, LINE 7 FOR THE LINK TO THE CHNA AND SCHEDULE H, PART V, LINE 11 FOR HOW THOSE NEEDS ARE BEING ADDRESSED.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - ALEXIAN BROTHERS MEDICAL CENTER. In Alexian Brothers most recent CHNA, community input was obtained through the following methods. Ascension Illinois partnered with the Alliance for Health Equity on the TY2021 Community Health Needs Assessment (CHNA) for its Cook County hospitals. This collaborative CHNA for Cook County, Illinois was conducted by the Alliance for Health Equity, a collaborative of 35 hospitals working with health departments and community-based organizations to improve health equity, wellness, and quality of life across Chicago and Suburban Cook County. Recognizing its vital importance in understanding the health needs and assets of the community, Alliance for Health Equity consulted with a range of public health and social service providers that represent the broad interest of Cook County. A concerted effort was made to ensure that the individuals and organizations represented the needs and perspectives of: 1) public health practice and research; 2) individuals who are medically underserved, are low-income, or considered among the minority populations served by the hospital; and 3) the broader community at large and those who represent the broad interests and needs of the community served. Multiple methods were used to gather community input, including key stakeholder focus groups, community focus groups and community surveys for the TY21 CHNA. Community focus groups A series of 43 focus groups were conducted by Alliance for Health Equity & its hospital collaborators to gather feedback from the community on the health needs and assets of Cook County. Held between September 2021 and January 2022, most focus groups were 90 minutes in duration with an average of 10 participants. Thirteen sessions were conducted virtually via Zoom and 30 groups were conducted in-person. Populations represented by participants included: - Individuals living with mental health conditions and/or substance use disorders - Older adults - Youth and young adults - Justice involved - Faith communities - LGBTQ+ community members - Individuals living with chronic conditions - Immigrants and refugees - Community Health Workers - Homeless and housing unstable - Low-income families Community surveys A survey was conducted by the Alliance for Health Equity to gather the perceptions, thoughts, opinions, and concerns of the community regarding health outcomes, health behaviors, social determinants of health, and clinical care for Cook County. Over 5,200 individuals participated in the survey, held between September 2021 and December 2021. The data gathered and analyzed provides valuable insight into the issues of importance to the community. The survey contained 24 questions and was available online in English and Spanish. In addition, surveys were collected in paper format at focus groups and at select in-person events. Populations represented by participants included: - Non-English speaking - LGBTQ+ community members - Households with individual(s) with a disability - Youth - Families with children - Low-income persons Key stakeholder focus groups A series of focus groups and listening sessions were conducted by Alliance for Health Equity to gather feedback from key stakeholders on the health needs and assets of Cook County. The Alliance for Health Equity compiled key issues and themes from Forces of Change assessments led by the Chicago Department of Public Health (CDPH), Cook County Department of Public Health (CCDPH) and the Illinois Department of Public Health (IDPH) then discussed opportunities and barriers related to these key issues with members of the collaborative (both healthcare and community organizations). Sectors represented by participants are noted below for this input that was collected between July 2021 and December 2021. Populations represented by participants included: - Healthcare - Public health - Social Services - Education - Community Organizers Organizations participating in providing or collecting community input for the most recent CHNA include: Partners for Our Community, NAMI, Asian Human Services, Greater Chicago Food Depository, St. Thomas Villanova-Palatine, St. Emily Catholic Church-Mt Prospect, St. Colette Catholic Church, Children's Advocacy Center, Kenneth Young Center, Cook County Department of Public Health, Metopio, Alliance for Health Equity.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - ALEXIAN BROTHERS MEDICAL CENTER. FOR THE FY2022 (tax year 2021) COLLABORATIVE COOK COUNTY CHNA, ALEXIAN BROTHERS MEDICAL CENTER PARTNERED WITH THE FOLLOWING HOSPITALS AND HEALTH SYSTEMS: NONPROFIT HOSPITAL MEMBERS: AdventHealth La Grange Advocate Aurora Children's Hospital Advocate Aurora Christ Medical Center Advocate Aurora Illinois Masonic Medical Center Advocate Aurora Lutheran General Hospital Advocate Aurora South Suburban Hospital Advocate Aurora Trinity Hospital Ann & Robert H. Lurie Children's Hospital of Chicago Ascension Alexian Brothers Ascension Alexian Brothers Behavioral Health Hospital Ascension Holy Family Ascension Resurrection Ascension Saint Alexius Ascension Saint Francis Ascension Saint Joseph - Chicago Ascension Saints Mary and Elizabeth Cook County Health Humboldt Park Health Jackson Park Hospital The Loretto Hospital Loyola Medicine- Gottlieb Memorial Hospital Loyola Medicine- Loyola University Medical Center Loyola Medicine- MacNeal Hospital Northwestern Memorial Hospital Northwestern Palos Community Hospital OSF Little Company of Mary Medical Center Roseland Community Hospital Rush Oak Park Rush University Medical Center Sinai Health System- Holy Cross Hospital Sinai Health System- Mount Sinai Hospital Sinai Health System- Schwab Rehabilitation Hospital South Shore Hospital Swedish Hospital University of Illinois Hospital and Health Sciences System

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - ALEXIAN BROTHERS MEDICAL CENTER. FOR THE FY2022 (tax year 2021) COLLABORATIVE COOK COUNTY CHNA, ALEXIAN BROTHERS MEDICAL CENTER PARTNERED WITH THE FOLLOWING HEALTH DEPARTMENTS: Chicago Department of Public Health Cook County Department of Public Health Illinois Public Health Institute

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - ALEXIAN BROTHERS MEDICAL CENTER. Alexian Brothers and its collaborative partners and stakeholders have identified the following prioritized health needs in our community on the FY2019/TY2018 Community Health Needs Assessment: Social and Structural Determinants of Health, including policies that advance equity and promote physical and mental well-being, and conditions that support healthy eating and active living. Access to Care, Community Resources, and Systems Improvements, consisting of timely linkage to appropriate care, and resources, referrals, coordination, and connection to community-based services. Mental Health and Substance Use Disorders, especially reducing stigma, increasing the reach and coordination of behavioral health services, and addressing the opioid epidemic. Chronic Condition Prevention and Management, focusing especially on metabolic diseases such as diabetes, heart disease, and hypertension, and on asthma, cancer, and complex chronic conditions. However, certain factors impact the hospital's ability to fully address all of the identified needs. Alexian Brothers will not directly address the following focus areas/priorities identified in the 2019 CHNA: - Economic Vitality and Workforce Development - Education and Youth Development - Housing, Transportation, and Neighborhood Environment - Maternal and Child Health - Violence and Community Safety, Injury - Trauma-Informed Care While critically important to overall community health, these specific priorities did not meet internal criteria that further prioritized how to achieve the greatest community impact. For these areas not chosen, there are service providers in the community better resourced to address these priorities. Alexian Brothers will work collaboratively with and support these organizations as appropriate to ensure service coordination and utilization. The information below describes actions taken in the reporting period from the Alexian Brothers FY 2019-2022 Implementation Strategy and other priority programs designed to address each priority need including any indicators for improvement. In 2020 & 2021, due to the continued COVID-19 pandemic, Alexian Brothers shifted some of its community priorities to meet the immediate needs of hospitalized patients and also COVID-19 vaccination efforts for associates and the community. In 2021, Alexian Brothers continued to reserve the right to redirect resources to help address emerging public health threats even if doing so slowed the ability to implement plans for addressing key priorities selected through the CHNA process. Alexian Brothers remained focused on continued re-emergence of implementation strategy plans while addressing other key issues exacerbated by the pandemic, such as food insecurity, COVID-19 vaccination efforts and connecting people to vital resources in the community. Social & Structural Determinants of Health Strategy: Community Resource Directory (Aunt Bertha/Findhelp.org) Progress: Alexian Brothers associates utilized the social determinant of health software, Aunt Bertha, to connect and refer patients to local resources such as food pantry, health clinics, utilities support and more. Additionally, an external website is hosted for the community as a community benefit to search for their own resources. In FY22, additional community partners were added to the resource portal and training held for Community Based Organizations as well as internal associates. There are on average 3,197 resources available in the directory for the hospital community. A total of 307 persons were assisted by the directory in FY22. Access to Care, Community Resources & Systems Improvement Strategy: Community Resource Directory (Aunt Bertha/Findhelp.org) Progress: Alexian Brothers associates utilized the social determinant of health software, Aunt Bertha, to connect and refer patients to local resources such as food pantry, health clinics, utilities support and more. Additionally, an external website is hosted for the community as a community benefit to search for their own resources. In FY22, additional community partners were added to the resource portal and training held for Community Based Organizations as well as internal associates. There are on average 3,197 resources available in the directory for the hospital community. A total of 307 persons were assisted by the directory in FY22. Mental Health & Substance Use Disorder Strategy: Mental Health First Aid Trainings Progress: In FY22, Alexian Brothers continued reaching out to external partners to host trainings. Ten virtual trainings were held serving 29 individuals in FY22. 100% of participants reported increased knowledge of signs, symptoms and risk factors of mental illnesses and addictions. 100% of participants reported improvement in mental health literacy and anti-stigma levels following the training. Chronic Condition Prevention & Management Strategy: Diabetes Prevention Program Progress: Due to the pandemic, the Diabetes Prevention Program was converted to a virtual format. In FY22, 9 virtual trainings were offered in both English & Spanish. Additionally, beginning in 2021, Ascension Illinois partnered with the Alliance for Health Equity on the TY2021 Community Health Needs Assessment (CHNA) for its Cook County hospitals. This collaborative CHNA for Cook County, Illinois was conducted by the Alliance for Health Equity, a collaborative of 35 hospitals working with health departments and community-based organizations to improve health equity, wellness, and quality of life across Chicago and Suburban Cook County. The following are the significant needs that were determined from the tax year 2021 assessment: - Social and Structural Determinants of Health - Access to Care and Community Resources - Prevention and Treatment of Priority Health Conditions: Chronic Conditions, COVID-19, Injury (including violence related), Maternal and Child Health, Mental Health, Substance Use Disorders Alexian Brothers intends to prioritize these significant needs to address in the next implementation strategy plan. As the TY2021 Community Health Needs Assessment was approved at the end of the fiscal year, no actions have yet been taken during the tax year. AMITA Health Alexian Brothers Medical Center Elk Grove Village will not directly address the following focus areas/priorities identified in the 2019 CHNA: - Economic Vitality and Workforce Development - Education and Youth Development - Housing, Transportation, and Neighborhood Environment - Violence and Community Safety, Injury, including Violence-related injury - Trauma-Informed Care - Maternal and Child Health While critically important to overall community health, these specific priorities did not meet internally determined criteria that prioritized addressing needs by either continuing or expanding current programs, services, and initiatives to steward resources and achieve the greatest community impact. For these areas not chosen, there are service providers in the community better resourced to address these priorities. AMITA Health will work collaboratively with these organizations as appropriate to ensure optimal service coordination and utilization.

Schedule H, Part V, Section B, Line 16 Facility , 1
"Facility , 1 - ALEXIAN BROTHERS MEDICAL CENTER. ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING CHARITY. THE FRONT OF OUR STATEMENT INCLUDES THIS MESSAGE: ""IF YOU ARE AN UNINSURED ILLINOIS RESIDENT AND MEET CERTAIN INCOME REQUIREMENTS, YOU MAY QUALIFY FOR A DISCOUNT THROUGH OUR ALEXIAN ASSISTANCE PROGRAM IN ACCORDANCE WITH THE STATE OF ILLINOIS, HOSPITAL UNINSURED PATIENT DISCOUNT ACT (EFFECTIVE APRIL 1, 2009). Additional information on the financial assistance policy is available on Organization's website, by calling 888-693-2252, by email atamitafinancialassistance@amitahealth.org, or in writing at: AMITA Health PFS Attention: Financial Assistance Department 1000 Remington Blvd., Suite 110 Bolingbrook, IL 60440"" . THE BACK OF OUR STATEMENT INCLUDES THIS MESSAGE: ""IF PAYING THIS BILL PRESENTS A FINANCIAL HARDSHIP, YOU MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ALEXIAN BROTHERS HOSPITAL NETWORK PROVIDES ASSISTANCE TO PATIENTS IN NEED OF FINANCIAL AID TO HELP PAY FOR HIS/HER HOSPITAL BILLS. YOU MAY OBTAIN AN APPLICATION BY CALLING OUR STAFF AT THE NUMBER BELOW OR YOU MAY DOWNLOAD THE FORMS FROM THE INTERNET AT https://www.amitahealth.org/patient-resources/pay-your-bill/financial-assistance/"". IN ADDITION, ALL UNINSURED PATIENTS RECEIVE A LETTER FROM OUR PATIENT FINANCIAL SERVICES DEPARTMENT ONCE WE COMPLETE A PROCESS OF ATTEMPTING TO IDENTIFY ALTERNATIVE COVERAGE FOR UNINSURED PATIENTS. THIS LETTER IS SENT AT THE BEGINNING OF OUR STATEMENT CYCLE FOR EACH UNINSURED PATIENT. THE TEXT OF THE LETTER IS: ""THANK YOU FOR CHOOSING [HOSPITAL NAME] AS YOUR HEALTHCARE PROVIDER. YOUR ACCOUNT CURRENTLY HAS A BALANCE OF $XX; ADDITIONAL CHARGES MAY BE PENDING. WE HAVE NO RECORD THAT YOU HAVE HEALTH INSURANCE TO HELP IN PAYING YOUR BILL. IF YOU HAVE INSURANCE, PLEASE PROVIDE THE NECESSARY INFORMATION BY FILLING OUT THE STUB ABOVE AND FAXING A COPY OF YOUR INSURANCE CARD TO 847-483-7058, ATTN: CORRESPONDENCE TEAM. IF YOU HAD INSURANCE THAT ENDED WITHIN THE LAST 60 DAYS, YOU MAY BE ELIGIBLE FOR COBRA COVERAGE FROM A FORMER EMPLOYER. PLEASE CONTACT YOUR FORMER EMPLOYER TO DETERMINE IF YOU ARE ELIGIBLE."" ALEXIAN BROTHERS HEALTH SYSTEM USES MULTIPLE METHODS OF COMMUNICATING ITS MISSION OF PROVIDING CARE TO ALL WHO NEED IT REGARDLESS OF ABILITY TO PAY. SIGNS POSTED AT REGISTRATION CLEARLY POINT OUT THAT CHARITY CARE OR FINANCIAL ASSISTANCE IS AVAILABLE. ALEXIAN BROTHERS HEALTH SYSTEM'S WEBSITE, THE MAIN WEBSITE FOR ALL SYSTEM HOSPITALS, FEATURES INFORMATION ON HOW TO APPLY FOR CHARITY CARE ON-LINE. IN THE HOSPITAL SETTING, WE EMPLOY TWO FINANCIAL COUNSELORS WHO ARE AVAILABLE TO WORK WITH PATIENTS AND WE ALSO HAVE MEDICAID APPLICATION SPECIALISTS TO ASSIST PATIENTS THAT MAY QUALIFY. IN ADDITION, ALL BILLS AND STATEMENTS INCLUDE INFORMATION REGARDING CHARITY."

Schedule H, Part I, Line 3c FACTORS OTHER THAN FPG
"IN ADDITION TO FPG, THE ORGANIZATION USES MEDICAL INDIGENCY, ASSET TEST, INSURANCE STATUS AND RESIDENCY AS OTHER FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A Patient may not be eligible for the financial assistance if such Patient is deemed to have sufficient assets to pay pursuant to an ""Asset Test."" The Asset Test involves a substantive assessment of a Patient's ability to pay based on the categories of assets measured in the FAP Application. A Patient with such assets that exceed 250% of such Patient's FPL amount may not be eligible for financial assistance. AN ASSET TEST APPLIES IF A PATIENT HAS ELIGIBLE LIQUID ASSETS THAT EXCEED 250% OF THE PATIENT'S FPG LEVEL FOR CONSIDERATION OF FINANCIAL ASSISTANCE ELIGIBILITY. LIQUID ASSETS INCLUDE ASSETS THAT CAN BE CONVERTED TO CASH WITHIN 1 YEAR. THESE INCLUDE ITEMS SUCH AS CHECKING ACCOUNTS, SAVINGS ACCOUNTS, TRUST FUNDS AND LUXURY ITEMS SUCH AS RECREATIONAL VEHICLES, BOATS, A SECOND HOME, ETC."

Schedule H, Part VI, Line 7 State of Filing for Community Benefit
"Alexian Brothers Hospital Network (""ABHN"") prepares and files the Annual Non-Profit Hospital Community Benefit Plan Report with the Attorney General's Office of the State of Illinois. This report is prepared on a consolidated basis and includes data for Alexian Brothers Medical Center (""ABMC""), St. Alexius Medical Center (""SAMC"") and Alexian Brothers Behavioral Health Hospital (""ABBHH"")."

Schedule H, Part I, Line 5a BUDGET AMOUNTS FOR FREE OR DISCOUNTED CARE
THE ORGANIZATION ADMINISTERS ITS FINANCIAL ASSISTANCE POLICY IN ACCORDANCE WITH THE TERMS OF THE POLICY.

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
ALEXIAN BROTHERS MEDICAL CENTER REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE FOLLOWING RELATED ORGANIZATION'S ANNUAL COMMUNITY BENEFIT REPORT: ALEXIAN BROTHERS HOSPITAL NETWORK 36-3276552

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
"THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (""CHA"") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED."

Schedule H, Part II Community Building Activities
There were no community building activities to report this year. All reported activities qualify as community benefit and are described in the narrative under Schedule H Part Part I Line 7.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES. AFTER APPLYING THE COST-TO-CHARGE RATIO, THE SHARE OF THE BAD DEBT EXPENSE IN FISCAL YEAR 2022 WAS $1,050,333 AT CHARGES, ($220,570 AT COST).

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BASED ON THE ORGANIZATION'S ADMINISTRATION OF ITS FINANCIAL ASSISTANCE PROGRAM, NO ESTIMATE FOR BAD DEBT ATTRIBUTABLE TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS IS DEEMED APPLICABLE TO HOSPITAL OPERATIONS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE ORGANIZATION IS PART OFASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSESBAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 17-20, OF THE AUDITED FINANCIAL STATEMENTS.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE GROSS CHARGES TO CALCULATE MEDICARE COSTS, WHICH ARE THEN COMPARED TO MEDICARE PAYMENTS RECEIVED, TO DETERMINE A MEDICARE GAIN OR LOSS. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT A MEDICARE SHORTFALL (LOSS) IS NOT TREATED AS COMMUNITY BENEFIT, EVEN THOUGH THE HOSPITAL HAS INCURRED LOSSES IN PROVIDING CARE TO MEDICARE PATIENTS. THEREFORE, NONE OF THE AMOUNT ON LINE 7 IS TREATED AS COMMUNITY BENEFIT.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Alexian Brothers Medical Center FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED IF ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED FOR THE AMOUNTS FOR WHICH THE PATIENT QUALIFIES.

Schedule H, Part V, Section B, Line 16a FAP website
- Alexian Brothers Medical Center: Line 16a URL: https://www.amitahealth.org/pay-your-bill/financial-assistance/financial-assistance-forms-and-policy;

Schedule H, Part V, Section B, Line 16b FAP Application website
- Alexian Brothers Medical Center: Line 16b URL: https://www.amitahealth.org/pay-your-bill/financial-assistance/financial-assistance-forms-and-policy;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Alexian Brothers Medical Center: Line 16c URL: https://www.amitahealth.org/pay-your-bill/financial-assistance/financial-assistance-forms-and-policy;

Schedule H, Part VI, Line 4 Community information
The total population of the 30 zip codes that comprise the ABMC primary service area is estimated to be 904,905 residents in calendar year 2023 and is expected to decrease by approximately 1.17% to 894,281 residents in five years. The average income of the primary service area is $123,532, based on Sg2 for 2023. Approximately 5.1% of the service area households live below the poverty line, with 17.2% uninsured or Medicaid patients. Within the ABMC PSA there are 6 federally designated medically underserved areas. There are 5 acute care hospitals located within the ABMC primary service area.

Schedule H, Part VI, Line 5 Promotion of community health
ALEXIAN BROTHERS MEDICAL CENTER GOVERNING BODY IS COMPRISED OF PERSONS REPRESENTING DIVERSE ASPECTS AND INTERESTS OF THE COMMUNITY. MANY MEMBERS OF ALEXIAN BROTHERS MEDICAL CENTER GOVERNING BODY RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. ALEXIAN BROTHERS MEDICAL CENTER EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. ALEXIAN BROTHERS MEDICAL CENTER APPLIES SURPLUS FUNDS TO FUND IMPROVEMENTS IN PATIENT CARE (AND/OR) MEDICAL EDUCATION (AND/OR) RESEARCH BY DONATIONS.

Schedule H, Part VI, Line 2 Needs assessment
Alexian Brothers Medical Center uses internal and external data and reports from third parties, including government sources, to assess the healthcare needs of the communities we serve. These reports provide key information about health, socioeconomic, demographic factors that identify areas of need and inform our strategies that help to meet those needs of our community. These reports include but are not limited to the above resource table. Alexian Brothers Medical Center utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, Alexian Brothers Medical Center considers the health care needs of the overall community when evaluating internal financial and operational decisions.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Alexian Brothers Medical Center IS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL, IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, Alexian Brothers Medical Center FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES; Alexian Brothers Medical Center PROVIDES FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 250% OF THE FEDERAL POVERTY LEVEL. Alexian Brothers Medical Center WIDELY PUBLICIZES ITS: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY VIA THE HOSPITAL FACILITY'S WEBSITE - https://www.amitahealth.org/pay-your-bill/financial-assistance/financial-assistance-forms-and-policy Alexian Brothers Medical Center] MAKES PAPER COPIES OF THE: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION. THE PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. Alexian Brothers Medical Center INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION MAY BE FOUND. Alexian Brothers Medical Center INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 6 Affiliated health care system
ALEXIAN BROTHERS MEDICAL CENTER IS A MEMBER OF ASCENSION. ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 19 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. ALEXIAN BROTHERS MEDICAL CENTER OPERATES HOSPITAL FACILITIES IN THE ABMC PSA AND IS PART OF THE ASCENSION ILLINOIS MARKET WHICH ALSO OWNS AND OPERATES OTHER HEALTH CARE RELATED ENTITIES. THE HEALTH SYSTEM PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF THE ABMC PSA.

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