4A (Expenses $ 24388982 including grants of $ 0) (Revenue $ 36977923)
MENDOTA COMMUNITY HOSPITAL is licensed to operate 25 patient beds. The hospital provided $1,887,326 in financial assistance to the community during FISCAL YEAR 2022. The Hospital's services provided during fiscal year 2022 are as follows: Patient days of 2,556, Outpatient visits of 35,699, Patient visits to the emergency room of 6,058.

Schedule H, Part V, Section B, Line 3E
The significant health needs were prioritized as significant health needs of the community and identified through the CHNA. See CHNA for further information.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - MENDOTA COMMUNITY HOSPITAL. FOR THE 2022 CHNA, MENDOTA COMMUNITY HOSPITAL d/b/a SAINT PAUL MEDICAL CENTER SOLICITED AND TOOK INTO ACCOUNT INPUT FROM THE FOLLOWING SOURCES: 1) CURRENT PUBLIC HEALTH ADMINISTRATOR AT THE LASALLE COUNTY HEALTH DEPT. and CURRENT HEALTH EDUCATOR AND PUBLIC INFORMATION FROM THE LASALLE COUNTY HEALTH DEPT. 2) PRIMARY DATA WAS COLLECTED FROM THE AT-RISK AND ECONOMICALLY DISADVANTAGED POPULATION BY COLLECTING A STRATIFIED SAMPLE OF SURVEYS DISTRIBUTED IN ENGLISH AND SPANISH AT ALL HOMELESS SHELTERS, FOOD PANTRIES AND SOUP KITCHENS. 3) THE PRIOR AND NEW 2022 CHNA WAS MADE WIDELY AVAILABLE TO THE COMMUNITY AND FEEDBACK RECEIVED FROM COMMUNITY SERVICE ORGANIZATIONS WAS TAKEN INTO ACCOUNT. 4) ADDITIONAL SOURCES OF INPUT WAS RECEIVED FROM A COLLABORATIVE TEAM CREATED TO CONDUCT THE CHNA, WHICH INCLUDED CONSUMER ADVOCATES, REPRESENTATIVES FROM NONPROFIT AND COMMUNITY-BASED ORGANIZATIONS, ACADEMIC EXPERTS AND HEALTH EDUCATORS, LOCAL GOVERNMENT OFFICIALS, ADMINISTRATORS FROM LOCAL SCHOOL DISTRICTS, HEALTH CARE PROVIDERS AND COMMUNITY HEALTH CENTERS, EXECUTIVE DIRECTOR OF IL VALLEY PADS HOMELESS SHELTER PROGRAM, PROGRAM COORDINATOR FOR THE YOUTH SERVICE BUREAU OF IL VALLEY SERVING THE LATINO POPULATION ENROLLED IN PUBLIC BENEFITS, EXECUTIVE DIRECTOR OF UNITED WAY, AND EXECUTIVE DIRECTOR OF MENDOTA AREA SENIOR SERVICES. MEMBERS OF THE COLLABORATIVE TEAM BY NAME, AFFILIATIONS, TITLE AND EXPERTISE ARE LISTED IN APPENDIX 1 TO THE 2022 CHNA.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER - MENDOTA, IL. THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR 2022 FOR LASALLE COUNTY WAS A COLLABORATIVE UNDERTAKING BY OTTAWA REGIONAL HOSPITAL AND HEALTHCARE CENTER DBA OSF SAINT ELIZABETH MEDICAL CENTER AND MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER. THE CHNA HIGHLIGHTS THE HEALTH NEEDS AND WELL-BEING OF RESIDENTS IN LASALLE COUNTY.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - MENDOTA COMMUNITY HOSPITAL. MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"") DURING FISCAL YEAR 2019 AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R)(3). THE FINAL CHNA FOR THE HOSPITAL WAS APPROVED AND ADOPTED BY THE SYSTEM'S BOARD OF DIRECTORS ON JULY 29, 2019. THIS CHNA IS EFFECTIVE FOR FISCAL YEARS 2020, 2021 AND 2022. THE LASALLE COUNTY CHNA WAS DONE AS A COLLABORATIVE UNDERTAKING BY OSF SAINT ELIZABETH AND OSF SAINT PAUL MEDICAL CENTERS TO HIGHLIGHT THE HEALTH NEEDS AND WELL BEING OF RESIDENTS IN LASALLE COUNTY. THE COLLABORATIVE TEAM IDENTIFIED THE FOLLOWING SIGNIFICANT COMMUNITY HEALTH NEEDS AS A PRIORITY: HEALTHY BEHAVIORS AND BEHAVIORAL HEALTH. IN RESPONSE TO THESE PRIORITY HEALTH NEEDS, THE HOSPITALS DEVELOPED AN IMPLEMENTATION STRATEGY DESCRIBING THE ACTIONS THE HOSPITALS INTEND TO TAKE TO ADDRESS BOTH PRIORITY HEALTH NEEDS, THE RESOURCES THE HOSPITALS PLAN TO COMMIT TO ADDRESS THE HEALTH NEEDS, AND ANY PLANNED COLLABORATIONS WITH OTHER ORGANIZATIONS TO ADDRESS THE HEALTH NEEDS. THE HOSPITALS REVIEW THEIR IMPLEMENTATION STRATEGY AT LEAST ANNUALLY AND MAKE REVISIONS AS NEEDED TO MAXIMIZE THE IMPACT ON IDENTIFIED PRIORITY HEALTH NEEDS. A SUMMARY OF HOW THE HOSPITALS HAVE ADDRESSED THE PRIORITY HEALTH NEEDS IS PROVIDED BELOW. HEALTHY BEHAVIORS DEFINED AS - ACTIVE LIVING, HEALTHY EATING AND OBESITY GOALS. ACTIVE LIVING - A HEALTHY LIFESTYLE, COMPRISED OF REGULAR PHYSICAL ACTIVITY, HAS BEEN SHOWN TO INCREASE PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING. GOAL 1: INCREASE ACTIVE LIVING IN LASALLE COUNTY OVER THE NEXT THREE YEARS AS EVIDENCED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY. OUTCOME METRIC: INCREASE ACTIVE LIVING IN LASALLE COUNTY BY INCREASING THE NUMBER OF RESPONDENTS EXERCISING (HEALTHY ACTIVITY) 1 - 5 TIMES PER WEEK FROM 60% TO 62% AND DECREASING THOSE REPORTING THEY DO NOT EXERCISE AT ALL FROM 28% TO 25%. TACTICS AND PROGRESS FOR FY 2022 (1) Promoted the University of Illinois walking guide for Ottawa, Streator, and Mendota virtually in Live Well Streator's 20 in 21 social media campaign, daily on the OSF Center for Health Streator's waiting room digital screens, on April 13 at Illinois Valley Community College Student Wellness Fair, April 29 at Streator YMCA Healthy Kids Day, and May 7 at Mendota YMCA Healthy Kids Day. In addition, Live Well Streator partnered with the Streator Chamber for a Poker Walk on October 1 (2) INCREASE OFFERING OF THE HEALTHY KIDS U PROGRAM: PROGRESS FY 2022 HKU to launch in May 2022. Due to low enrollment class cancelled. Participated in April 29 Streator YMCA's Healthy Kids Day, May 7 Mendota YMCA's Healthy Kids Day, July 2 Streator 4th of July Celebration's Kids Korner and July 14-15 LaSalle County 4-H Fair. Co-sponsored and participated in the University of Illinois Extension's Illinois Junior Chef program in Streator June 20-24. (3) IMPLEMENT JOURNEY TO HEALTH - REDESIGNED PROGRAM. PROGRESS FY 2022 - Reset Program - locally 350 people participate LaSalle County. 90% complete all 6 weeks. July 12 - Summer Out Loud - 3 week summer family program. Fall Session - 9 participants HEALTHY EATING - A HEALTHY LIFESTYLE, COMPRISED OF A PROPER DIET, HAS BEEN SHOWN TO INCREASE PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING. OBESITY - A HEALTH OUTCOME, WHICH IS DIRECTLY RELATED TO HEALTHY BEHAVIORS. GOAL 2: INCREASE COMMUNITY CONSUMPTION OF FRUITS/VEGETABLES TO MORE THAN 2 SERVINGS PER DAY. OUTCOME METRIC 2: INCREASE THE RATE FROM 44% TO 48% OF THE COMMUNITY THAT REPORTED THAT THEY CONSUME MORE THAN 2 SERVINGS OF FRUITS/VEGETABLES PER DAY ON THE 2022 CHNA SURVEY. BASELINE: PER THE 2019 CHNA, 44% OF THE COMMUNITY REPORTED THAT THEY CONSUME MORE THAN 2 SERVICES OF FRUITS/VEGETABLES PER DAY. TACTICS AND PROGRESS FOR FY 2022 (1) PROMOTE AWARENESS OF COMMUNITY GARDENS AT OSF HEALTHCARE, OTTAWA COMMUNITY GARDENS, SHS EDIBLE GARDEN, NORTHLAWN JR. HIGH SCHOOL GARDEN AND THE DISTRIBUTION LOCATIONS TO ADDRESS LOCAL FOOD DISPARITIES AND ACCESS TO HEALTHY FOODS. PROGRESS FY2022 Micropantry installed at Reading Township Hall, Streator. Ottawa - 12 beds and herbs planted. Mendota - 26 beds. Streator - 3 garden bed areas, south lot garden divided into 4 sections, transportation center 12 raised beds. The Ottawa Community Garden harvested 640 pounds and donated the produce to A Servant's Heart. Streator donated 713.75 pounds to the Streatorland Food Pantry, Grace Community Church Food Pantry, New Beginnings Baptist Church Food Pantry and the Streator Salvation Army Food Pantry. The Mendota garden donated 1,175 pounds to the OSF Saint Paul Cafe, Mission Partners, and the Mendota Area Christian Food Pantry. Total of 2,528.75 pounds of produce this season. PROGRESS FY2022 - HKU to launch in May 2022. Due to low enrollment class cancelled. Participated in April 29 Streator YMCA's Healthy Kids Day, May 7 Mendota YMCA's Healthy Kids Day, July 2 Streator 4th of July Celebration's Kids Korner and July 14-15 LaSalle County 4-H Fair. Co-sponsored and participated in the University of Illinois Extension's Illinois Junior Chef program in Streator June 20-24. (2) Develop and Promote Live Well Streator Health Eating Restaurant Menu Guide PROGRESS FY2022: 1 restaurant, due to COVID, supplier and staffing challenges. Content on Live Well Streator Facebook page highlighted 12 restaurants with healthy options, 4 posts with 100-calorie swap outs and 20 fruit/vegetable features. (3) Conduct the Illinois Jr. Chef's Cooking School in three communities PROGRESS FY2022: 30 students participated in Streator June 20-24. (4) Promote healthier school lunchroom environments PROGRESS FY2022: Due to COVID restrictions with limited access for visitors at schools, community implementation was identified including Illinois Junior Chef at Northlawn Junior High School in Streator, Safety Town at Central Elementary School in Ottawa, Illinois Valley Community College Student Wellness Fair. (5) King Care-A-Van client nutrition education and food demonstrations within OSF Service area through mobile King Care-A-Van service PROGRESS FY2022: Nutrition education - Habitat Restore Peru, Streator Salvation Army, Ottawa Homeless Shelter/IV PADS MENTAL HEALTH - THE CHNA SURVEY ASKED RESPONDENTS TO INDICATE PREVALENCE OF SPECIFIC MENTAL-HEALTH ISSUES, NAMELY DEPARESSION AND STRESS/ANXIETY. OF RESPONDENTS, 41% INDICATED THEY FELT DEPRESSED IN THE LAST 30 DAYS AND 39% INDICATED THEY FELT ANXIOUS OR STRESSED. GOAL1: INCREASE THE OVERALL COMMUNITY UNDERSTANDING OF MENTAL HEALTH NEEDS AND ACCESS TO MENTAL HEALTH SERVICES. OUTCOME METRIC 1: DECREASE SELF-REPORTS OF DEPRESSION AND ANXIETY TO SEE A REDUCTION OF INDIVIDUALS REPORTING DEPRESSION AND ANXIETY WITHIN THE LAST 30 DAYS FROM 35% TO 32% BY 2022. (PER CHNA SURVEY, 2019) TACTICS FOR PROGRESS IN 2022 (1) North Central trained 12 participants at Park Presbyterian Church/Streator March 12th and 14 staff from Peru & Ottawa homeless shelters (IV PADS) July 19th (2) EMBED BILINGUAL BEHAVIORAL HEALTH PROVIDER AT OSF MULTI-SPECIALTY GROUP MENDOTA, BILINGUAL PROGRAMMING'S AND COMMUNICATIONS. PROGRESS FY2022: Implementation delayed due to staff turnover. Currently using Globo for translation services. (3) ENGAGE FAITH COMMUNITY NURSE TO WORK WITH SCHOOL NURSES REGARDING STUDENTS NOT HAVING MEDICATIONS NEEDED PROGRESS FY2022 - DELAYED DUE TO STAFF TURNOVER. (4) PROVIDE FREE ACCESS TO DIGITAL BEHAVIORAL HEALTH SOLUTION - SILVERCLOUD PROGRESS FY2022 - 64 UTILIZING APP. (5) PROVIDE FREE BEHAVIORAL HEALTH NAVIGATION SERVICE PROGRESS FY2022 - 231 USING SERVICE. GOAL 2: USE SOCIAL DETERMINATES OF HEALTH (SDOH) TO IDENTIFY PATIENTS AT INCREASED RISK OF POOR MENTAL HEALTH AND CONNECT THEM TO COMMUNITY ORGANIZATIONS IN ORDER TO IMPROVE MENTAL HEALTH OUTCOMES. OUTCOME MEASURE 2: DECREASE THE PERCENTAGE OF RESPONDENTS STATING THEY HAVE POOR OVERALL MENTAL HEALTH BY 1%. BASELINE: PER THE 2019 CHNA SURVEY, 8% OF RESPONDENTS STATED THEY HAVE POOR OVERALL MENTAL HEALTH. NOT HAVING BASIC HUMAN NEEDS IS LIKELY LINKED TO POOR MENTAL HEALTH. IF A SURVEY RESPONDENT DOES NOT HAVE HOUSING, FOOD, TRANSPORTATION (ETC.), THEIR OVERALL STATE OF MENTAL HEALTH WOULD LIKELY BE RATED LOWER. TACTICS FOR PROGRESS IN 2022 (1) IMPLEMENT SCREENING OF PATIENTS FOR SDOH. SCREEN AND CONNECT. NUMBER OF PATIENTS SCREENED. PROGRESS FY2022 - 8,047 (2) TRACK NUMBER OF PATIENTS REFERRED TO COMMUNITY BASED ORGANIZATIONS (CBO) PROGRESS FY2022 - 273 (3) TRACK NUMBER OF MISSION PARTNERS EDUCATED FOR CONTINUED ROLL-OUT - PROGRESS FY2022 - completed (4) TRACK NUMBER OF PATIENT REFERRALS TO OSF CARE MANAGEMENT AND SOCIAL WORKERS PROGRESS FY2022 - 22"

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - MENDOTA COMMUNITY HOSPITAL. CATASTROPHIC FINANCIAL ASSISTANCE IS AVAILABLE WHEN CHARGES EXCEED 25% OF ANNUAL FAMILY INCOME. THE AMOUNT BILLED IS ADJUSTED TO 25% OF FAMILY INCOME WHEN OSF DETERMINES THIS ADJUSTMENT IS THE MOST GENERAL ASSISTANCE.

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - MENDOTA COMMUNITY HOSPITAL. PRESUMPTIVE FINANCIAL ASSISTANCE IS AVAILABLE AND PROVIDES FOR A DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO A PATIENT WITH NO INSURANCE BENEFITS, WHEN THE PATIENT ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA: HOMELESSNESS; DECEASED WITH NO ESTATE; MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF; AND CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE.

Schedule H, Part V, Section B, Line 15 Facility , 1
Facility , 1 - MENDOTA COMMUNITY HOSPITAL. THE FINANCIAL ASSISTANCE POLICY IS AVAIABLE BY WEBSITE, FAX, POSTAL ADDRESS AND PATIENTS ARE DIRECTED TO STAFF IN THE PATIENT FINANCIAL SERVICES AND ADMITTING AREAS AT OSF HOSPITALS FOR ASSISTANCE IN OBTAINING ANSWERS TO QUESTIONS REGARDING THE POLICY.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - MENDOTA COMMUNITY HOSPITAL. A PLAIN LANGUAGE SUMMARY OF THE FAP IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS, INFORMATION ABOUT FINANCIAL ASSISTANCE AND THE APPLICATION PROCESS IS INCLUDED ON OR WITH THE OSF PATIENT BILLING STATEMENT, AND OSF PROVIDES COPIES OF THE PLAIN LANGUAGE SUMMARY AND THE FAP APPLICATION FORM TO REFERRING STAFF PHYSICIANS.

Schedule H, Part I, Line 3c Criteria for Free or Discounted Care
CATASTROPHIC CHARITY ASSISTANCE REGARDLESS OF INCOME OR ASSET LEVELS FOR MEDICALLY NECESSARY SERVICES WHICH EXCEED 25% OF ANNUAL FAMILY INCOME. THE AMOUNT DUE IS ADJUSTED TO 25% OF FAMILY INCOME WHEN OSF DETERMINES CATASTROPHIC CHARITY IS MORE GENEROUS. PRESUMPTIVE CHARITY: CHARGES MAY BE ADJUSTED TO PROVIDE FOR A CHARITY DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO AN UNINSURED PATIENT WHO ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA. PRESUMPTIVE CHARITY CATEGORIES FOR ALL OSF HOSPITALS: -HOMELESSNESS; - DECEASED WITH NO ESTATE; - MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF; OR - CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. ALL PATIENTS RECEIVE THE GREATEST REQUESTED DISCOUNT AVAILABLE UNDER ANY OF THE OSF PROGRAMS. NO ASSET TESTS ARE USED. EXCEPT AS OTHERWISE NOTED, THESE POLICIES APPLY BOTH TO UNINSURED PATIENTS AND TO INSURED PATIENTS WITH RESPECT TO THE PATIENT RESPONSIBILITY AMOUNT.

Schedule H, Part I Coronavirus Pandemic
On March 11, 2020, the World Health Organization designated COVID-19 as a global pandemic. Patient activity and related revenues for most services were significantly impacted starting in mid-March 2020, as various policies were implemented by federal, state, and local governments in response to the COVID-19 pandemic. In March 2020, the CARES Act was signed into law, providing temporary and limited relief to hospitals during the COVID-19 outbreak. Under the CARES Act, appropriations were made for hospitals to cover expenses and lost revenue associated with the treatment of COVID-19 patients, the Medicare Accelerated and Advanced payment program was expanded, employee retention tax credits to employers affected by COVID-19 were provided, the 2% reduction in Medicare payments from sequestration through December 2021 has been eliminated, add-on payments for inpatient hospitals treating COVID-19 patients were created, and a reduction in Medicaid funding for Medicare disproportionate share hospitals was delayed.

Schedule H, Part I, Line 7g Subsidized Health Services
NET COSTS (TOTAL EXPENSE LESS REVENUE) OF PHYSICIAN CLINICS ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES ON PART 1, LINE 7G.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Medicare cost to charge ratio

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
IN GENERAL, AND IN ACCORDANCE WITH MEDICARE REGULATIONS, PATIENT ACCOUNT BALANCES ARE WRITTEN OFF TO BAD DEBT EXPENSE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED AND THE ACCOUNT HAS BEEN SENT TO A COLLECTION AGENCY OR LAW FIRM. PATIENTS' ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, OSF ANALYZES PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, OSF ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH PATIENT RESPONSIBILITY (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE PATIENTS ARE SCREENED AGAINST THE OSF FINANCIAL ASSISTANCE POLICY AND UNINSURED DISCOUNT POLICY. FOR ANY REMAINING PATIENT RESPONSIBILITY BALANCE, OSF RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. BAD DEBT EXPENSE OF 396,385 ON FORM 990, PART IX, LINE 24B IS BASED UPON ACCRUAL ACCOUNTING REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THIS AMOUNT CONSEQUENTLY DIFFERS FROM THE BAD DEBT EXPENSE OF 290,097 ON SCHEDULE H, PART III, LINE 2 WHICH REQUIRES THE ORGANIZATION TO REPORT AGGREGATE BAD DEBT AT COST. BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS THEREFORE CALCULATED BY MULTIPLYING GROSS CHARGES WRITTEN OFF TO BAD DEBT EXPENSE TIMES THE MEDICARE COST-TO-CHARGE RATIO DERIVED FROM THE MEDICARE COST REPORT.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
PLEASE SEE PAGE 22 OF NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
OSF IS COMMITTED TO SERVING PATIENTS, REGARDLESS OF ABILITY TO PAY OR IF THE PAYMENTS TO BE RECEIVED WILL BE LESS THAN THE COST TO PROVIDE THE SERVICE, WHICH IS THE CASE FOR MEDICARE AND MEDICAID PATIENTS. THE MEDICARE ALLOWABLE COSTS ON LINE 6 PART III HAVE BEEN CALCULATED BY USING THE MEDICARE COST TO CHARGE RATIO. THE AMOUNT IS COMPARED TO TOTAL MEDICARE PAYMENTS RECEIVED INCLUDING DSH AND IME PAYMENTS. SHOULD THERE BE A SHORTFALL, IT WOULD BE TREATED AS A COMMUNITY BENEFIT SINCE IT REFLECTS UN-REIMBURSED COSTS FOR PROVIDING MEDICAL SERVICES TO THE MEDICARE RESIDENTS OF THE COMMUNITY.

Schedule H, Part V, Section B, Line 16a FAP website
- MENDOTA COMMUNITY HOSPITAL: Line 16a URL: https://www.osfhealthcare.org/billing/financial-assistance/;

Schedule H, Part V, Section B, Line 16b FAP Application website
- MENDOTA COMMUNITY HOSPITAL: Line 16b URL: https://www.osfhealthcare.org/billing/financial-assistance/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- MENDOTA COMMUNITY HOSPITAL: Line 16c URL: https://www.osfhealthcare.org/billing/financial-assistance/;

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

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
DISCOUNTS, INCLUDING ANY APPLICABLE THIRD PARTY PAYER CONTRACTUAL ALLOWANCES AND ANY FINANCIAL ASSISTANCE DISCOUNTS (VALUED AT GROSS CHARGES), ARE APPLIED TO PATIENT ACCOUNT GROSS CHARGES TO DETERMINE THE ACCOUNT BALANCE BEFORE PATIENT PAYMENTS. THE AGGREGATE AMOUNT OF ALL PATIENT PAYMENTS IS THEN APPLIED TO THE ACCOUNT BALANCE. WHEN DETERMINATION IS MADE THAT NO FURTHER AMOUNTS CAN BE COLLECTED IN ACCORDANCE WITH THE CORPORATION'S BAD DEBT POLICY, THE REMAINING BALANCE IS WRITTEN OFF TO BAD DEBT EXPENSE. PRESUMPTIVE CHARITY: CHARGES MAY BE ADJUSTED TO PROVIDE FOR A CHARITY DISCOUNT OF 100% OF BILLED CHARGES FOR MEDICALLY NECESSARY SERVICES PROVIDED TO AN UNINSURED PATIENT WHO ESTABLISHES FINANCIAL NEED AT TIME OF REGISTRATION BY SATISFYING ONE OF THE FOLLOWING CATEGORIES OF PRESUMPTIVE ELIGIBILITY CRITERIA. PRESUMPTIVE CHARITY CATEGORIES FOR ALL OSF HOSPITALS: -HOMELESSNESS; -DECEASED WITH NO ESTATE; -MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF; OR -CURRENT MEDICAID ELIGIBILITY, BUT NOT ON DATE OF SERVICE OR FOR NON-COVERED SERVICE. THEREFORE, THE CORPORATION DOES NOT BELIEVE THAT BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 INCLUDES ANY AMOUNTS THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY UNDER THE CORPORATION'S FINANCIAL ASSISTANCE POLICY.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
THE CORPORATION HAS A self-pay BILLING COLLECTION POLICY WHICH APPLIES FOR ALL PATIENTS. THE POLICY INCLUDES: -REQUIRED INFORMATION PROVIDED IN BILLS TO PATIENTS (INCLUDING A REQUIREMENT THAT INFORMATION BE PROVIDED ON HOW THE PATIENT MAY APPLY FOR FINANCIAL ASSISTANCE). -PROCESS FOR PATIENTS TO INQUIRE ABOUT OR DISPUTE A BILL, INCLUDING TOLL-FREE TELEPHONE NUMBER, ADDRESS, CONTACT NAME AND E-MAIL ADDRESS. -REQUIREMENTS FOR TIMELY RESPONSE TO PATIENT INQUIRIES. -CONDITIONS WHICH MUST BE SATISFIED BEFORE PATIENT MAY BE SENT TO A COLLECTION AGENCY OR ATTORNEY. -LEGAL ACTION FOR NON-PAYMENT OF A PATIENT BILL MAY NOT BE INITIATED UNTIL AN AUTHORIZED HOSPITAL OFFICIAL HAS DETERMINED THAT ALL CONDITIONS IN THE CORPORATION'S POLICY (INCLUDING ALL THE FOREGOING POLICY PROVISIONS) HAVE BEEN SATISFIED FOR INITIATING LEGAL ACTION. -LEGAL ACTION MAY NOT BE PURSUED AGAINST UNINSURED PATIENTS WHO HAVE CLEARLY DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS - EVEN IF SUCH PATIENTS DO NOT APPLY FOR FINANCIAL ASSISTANCE. -THE CORPORATION SHALL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS, SUCH AS SUBMITTING REPORTS TO CREDIT AGENCIES BEFORE REASONABLE ATTEMPTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE HAVE BEEN COMPLETED. -IF A PATIENT RECEIVES AN APPLICATION FOR FINANCIAL ASSISTANCE BUT FAILS TO RETURN IT, OSF WILL TRY TO USE SECONDARY SOURCES TO DETERMINE THE PATIENT'S ELIGIBILITY FOR NON COMPLIANT CHARITY BEFORE PURSUING LEGAL ACTION FOR NONPAYMENT. IF A COMPLETE APPLICATION IS RECEIVED DURING THE APPLICATION PERIOD, OSF WILL SUSPEND EXTRAORDINARY COLLECTION ACTIONS AND MAKE A DETERMINATION OF ELIGIBILITY FOR ASSISTANCE. IF THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, OSF WILL ISSUE APPROPRIATE REFUNDS AND REVERSE ANY EXTRAORDINARY COLLECTION ACTIONS TAKEN, AS MORE FULLY DESCRIBED IN THE OSF FAIR BILLING - COLLECTION POLICY.

Schedule H, Part VI, Line 2 Needs assessment
"MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"") DURING FISCAL YEAR 2019 AS PREVIOUSLY STATED. THE CHNA IS UPDATED EVERY 3 YEARS AND CORRESPONDING IMPLEMENTATION STRATEGY IS REFRESHED YEARLY. NOT ONLY DOES THE PLAN GET REFRESHED YEARLY, BUT EACH ACTION ITEM HAS A RESPONSIBLE PARTY INVOLVED TO GET THE WORK ASSOCIATED WITH THE NEED ACCOMPLISHED. THE 2021 TAX YEAR REPRESENTS THE FINAL YEAR OF THE NEEDS ASSESSMENT ADOPTED AS PART OF THE 2019 CHNA. THE NEW CHNA WAS APPROVED AND ADOPTED BY THE OSF BOARD OF DIRECTORS ON JULY 29, 2019 AND THE CORRESPONDING IMPLEMENTATION STRATEGY WAS APPROVED JANUARY 27, 2020. THE ASSOCIATED PLAN GOALS AND ACCOMPLISHMENTS ARE LISTED IN THIS YEARS FILING. LEADERSHIP WITHIN OSF SIT ON VARIOUS COMMUNITY ADVISORY BOARDS TO STAY CONNECTED TO THE OTHER AGENCIES WITHIN THE COMMUNITY. THIS WORK ALIGNS WITH OUR MISSION STATEMENT TO SERVE PERSONS WITH THE GREATEST CARE AND LOVE IN A COMMUNITY THAT CELEBRATES THE GIFT OF LIFE."

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
THE CORPORATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO ARE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE CORPORATION'S FINANCIAL ASSISTANCE POLICY, IN ENGLISH AND IN ANY OTHER LANGUAGE SPOKEN BY POPULATIONS WITH LIMITED ENGLISH PROFICIENCY THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY OF THE HOSPITAL, IN THE FOLLOWING WAYS: -SIGNS ARE POSTED IN PATIENT REGISTRATION AREAS (INCLUDING EMERGENCY DEPARTMENT REGISTRATION) INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, THE AVAILABILITY OF FINANCIAL ASSISTANCE COUNSELORS, AND HOW TO OBTAIN A COPY OF THE OSF FINANCIAL ASSISTANCE POLICY AND APPLICATION. -A PLAIN LANGUAGE SUMMARY OF THE OSF FINANCIAL ASSISTANCE POLICY IS OFFERED TO PATIENTS AS PART OF THE INTAKE OR DISCHARGE PROCESS AND INCLUDED IN THE BILLING STATEMENT MAILED PRIOR TO INITIATING EXTRAORDINARY COLLECTION ACTIONS. IN ADDITION, THE PLAIN LANGUAGE SUMMARY AND APPLICATION ARE PROVIDED TO REFERRING STAFF PHYSICIANS. -OSF MAKES REASONABLE EFFORTS TO ORALLY NOTIFY PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY AND HOW TO OBTAIN ASSISTANCE IN APPLYING. -A NOTICE OF AVAILABILITY OF THE CORPORATION'S FINANCIAL ASSISTANCE AND UNINSURED PATIENT DISCOUNT POLICIES IS PROMINENTLY AVAILABLE ON THE CORPORATION'S WEBSITE. THE APPLICATION FORM WITH INSTRUCTIONS AND THE PLAIN LANGUAGE SUMMARY IS AVAILABLE FOR DOWNLOAD. -A NOTE REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE (TOGETHER WITH CONTACT PHONE NUMBERS) APPEARS ON EVERY PATIENT BILLING STATEMENT AS WELL AS THE WEBSITE WHERE COPIES OF THE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY MAY BE OBTAINED. -FINANCIAL ASSISTANCE COUNSELORS ARE AVAILABLE IN PERSON AND BY PHONE TO ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AND IN DETERMINING ELIGIBILITY AND APPLYING FOR GOVERNMENT PROGRAM BENEFITS, INCLUDING MEDICAID. -THE CORPORATION'S FINANCIAL ASSISTANCE POLICY IS FILED WITH THE ILLINOIS ATTORNEY GENERAL AND IS AVAILABLE TO THE PUBLIC.

Schedule H, Part VI, Line 4 Community information
MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER IS LOCATED IN LASALLE COUNTY. THE OSF SAINT PAUL MEDICAL CENTER SERVICE COMMUNITY IS LOCATED PRIMARILY IN LASALLE COUNTY BUT EXTENDS INTO PORTIONS OF LEE, BUREAU, AND DEKALB COUNTIES. THE RACE AND ETHNICITY MAKEUP OF THE SERVICE AREA INDICATES THAT MORE THAN 12.6% OF THE POPULATION IS OF HISPANIC ORIGIN. OTHER RACE AND ETHNICITY NUMBERS ARE TYPICAL OF RURAL ILLINOIS. THERE ARE NO LARGE CHANGES IN THE PROFILE OVER THE PAST FIVE YEARS. THE POVERTY RATE FOR LASALLE COUNTY WAS 13.6 PERCENT IN 2017. THE POPULATION USED FOR THE CALCULATION WAS 110,067 YIELDING 14,969 RESIDENTS LIVING IN POVERTY IN THE LASALLE COUNTY AREA. DATA FROM THE LAST CENSUS INDICATE THE POPULATION OF LASALLE COUNTY HAS SLIGHTLY DECREASED (2.1%) BETWEEN 2013 AND 2017. THE POPULATION IN LASALLE COUNTY HAS DECREASED FROM 112,424 IN 2013 TO 110,067 IN 2017.

Schedule H, Part VI, Line 5 Promotion of community health
MENDOTA COMMUNITY HOSPITAL DBA OSF SAINT PAUL MEDICAL CENTER SPONSORING ORGANIZATION IS A RELIGIOUS CONGREGATION OF THE ROMAN CATHOLIC CHURCH KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS. IN ACCORDANCE WITH CANON LAW OF THE ROMAN CATHOLIC CHURCH AND FEDERAL TAX LAW APPLICABLE TO SUPPORTING ORGANIZATIONS, A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION ARE PROFESSED MEMBERS OF THE SPONSORING RELIGIOUS CONGREGATION. THEY HAVE A COMMUNITY ADVISORY BOARD CONSISTING OF MEMBERS OF THE COMMUNITY WHO ARE NOT DIRECTORS, OFFICERS, OR CONTRACTORS OF MENDOTA. EXCEPT FOR HOSPITAL DEPARTMENTS WHICH HAVE BEEN CLOSED, OR IN WHICH CLINICAL PRIVILEGES HAVE BEEN RESTRICTED, FOR CLINICAL OR QUALITY OF CARE REASONS BY ACTIONS OF THE HOSPITAL'S MEDICAL STAFF AND THE BOARD OF DIRECTORS, MENDOTA EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE MENDOTA SURPLUS FUNDS WERE USED DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2021 FOR IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH. MENDOTA HOSPITAL MEETS THE REQUIREMENTS OF REVENUE RULING 69-545 BY: -OPERATING AN EMERGENCY DEPARTMENT WHICH IS STAFFED 24 HOURS PER DAY BY QUALIFIED PHYSICIANS AND OTHER MEDICAL PERSONNEL AND WHICH IS OPEN TO ALL PERSONS WITHOUT REGARD TO ABILITY TO PAY. -HAVING MEDICAL STAFFS WHICH ARE OPEN TO ALL QUALIFIED PHYSICIANS, MID-LEVEL PROVIDERS, PODIATRISTS, AND DENTISTS IN THE COMMUNITY (EXCEPT WHERE RESTRICTED IN RARE CASES FOR CLINICAL QUALITY REASONS BY ACTION OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS). -ACCEPTING MEDICARE, MEDICAID AND OTHER GOVERNMENT PROGRAM PATIENTS. -ACCEPTING ALL PATIENTS, INCLUDING UNINSURED PATIENTS, WITHOUT REGARD TO THEIR ABILITY TO PAY. -USING SURPLUS FUNDS TO IMPROVE THEIR FACILITIES, EQUIPMENT, PATIENT CARE, MEDICAL TRAINING, EDUCATION, AND RESEARCH AS DESCRIBED ABOVE. MENDOTA HOSPITAL PARTNERS WITH OTHER LOCAL SERVICE AGENCIES TO ENSURE ACCESS FOR RURAL HEALTHCARE INCLUDING OFFERING SPACE TO OTHER AGENCIES TO CO-LOCATE UNDER ONE ROOF. OSF ON CALL OFFERS A 24/7 ONLINE ACCESS TO MEDICAL CARE VIA SMARTPHONE, TABLET OR COMPUTER. THE HOSPITAL FORMED A TRANSIT PARTNERSHIP UNDER THE CITY OF OTTAWA AND NORTH CENTRAL AREA TRANSIT (NCAT).

Schedule H, Part VI, Line 6 Affiliated health care system
"The Corporation is part of an affiliated health care system (the ""OSF System""), which is an integrated health system that operates acute care hospitals, home health care services, two colleges of nursing, a medical training simulation center, and other health care facilities in Illinois and Michigan. The OSF System includes many other entities which are controlled, directly or indirectly by the Sisters of the Third Order of St. Francis (the ""Congregation""). All affiliated entities apply and follow the financial assistance policies of the Corporation and are operated in furtherance of the mission to provide comprehensive, durable medical equipment, integrated quality care to the communities served by the Corporation. The OSF System's corporate office in Peoria, Illinois (the ""Corporate Office""), provides corporate management services as well as direction, consultation and assistance to the administration of the OSF System's health care facilities and subsidiary corporations. The primary affiliated corporations of the OSF System are the following: The Congregation, which works exclusively in the health care apostolate, holds the assets of the religious congregation and directs all other corporations in the affiliated health care system through board representation and the exercise of reserved powers. OSF Multi-Specialty Group was incorporated in 2011. Virtually all physicians and advance practice providers providing professional services through the OSF System's acute care hospital facilities and ambulatory practice settings (with a few limited exceptions) provide services pursuant to employment agreements or professional service agreements with the Multi-Specialty Group. OSF Medical Group is a d/b/a of Multi-Specialty Group. Pointcore, Inc., formerly known as OSF Saint Francis, Inc., was originally incorporated in 1986 and is engaged in the following lines of business: retail pharmacies, retail shops, a mobile medical system, emergency medical transportation, home therapeutics, real estate, equipment technology services, telecommunications, electronic health records, telehealth services, and consulting services. Pointcore, Inc. also participates in various health related joint ventures. OSF Healthcare Foundation was incorporated in 1989 to conduct fundraising and other activities for the benefit of OSF Healthcare System and in support of the mission of the Congregation. Ottawa Regional Hospital & Healthcare Center, formerly known as Community Hospital of Ottawa was incorporated in 1964. OSF Healthcare System became the sole member of Ottawa Regional Hospital & Healthcare Center in 2012, and the hospital was renamed as d/b/a/ OSF Saint Elizabeth Medical Center. Mendota Community Hospital, formerly known as Mendota Hospital Foundation, was incorporated in 1944. OSF Healthcare System became the sole member of Mendota Community Hospital in 2015, and the hospital was renamed as d/b/a/ OSF Saint Paul Medical Center"