4A (Expenses $ 40502740 including grants of $ 0) (Revenue $ 58018534)
HSHS St. Francis (SFL) provides comprehensive health care services with the latest technology to the Litchfield area 24 hours a day, 7 days a week. SFL offers a full range of services including emergency care, cancer care, heart care, orthopedics, radiology, rehabilitation, surgery, women and infants services and more -all in one convenient location. SFL's specialists work with health care professionals across our health system to ensure each patient has seamless access to care. St. Francis Hospital is dedicated to providing the highest level of local care, 24/7. the community benefit contribution of St. Francis hospital includes programs and activities that improve access to health care and improve health in our communities. in order to portray the full breadth of our contribution, our community benefit information is described below: the fiscal year ended June 30, 2022 St. Francis hospital operated as a critical access hospital. the hospital provided 1,032 total admissions and accommodated 64,484 outpatient visits during the fiscal year, including 11,092 emergency department visits, 167 babies born and 909 surgical cases. quality medical services were provided to all patients regardless of race, creed, sex, national origin, handicap, age or financial status. Although reimbursement for services rendered is critical to the operation and stability of the hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. St. Francis hospital's mission is to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry. to accomplish the mission, the hospital provides care to the poor, elderly, and the needy of the community through various programs and services. these activities include wellness programs, community education, community support activities, and programs specifically designed for the elderly, handicapped and medically underserved. benefits for the poor include services provided to persons who cannot afford health care because of inadequate resources and who are uninsured or underinsured. these benefits are provided in the form of charity care for those who cannot afford to pay through the hospital's uninsured discount program and through public programs such as Medicaid. St. Francis provides charity care through its Christian care program. The Christian care program is designed to ensure that the resources used to assist patients are provided for those who are unable to pay for their medical care. Financial assistance is determined by comparing the applicant's gross family income to the most recent federal poverty guidelines. In order to qualify for assistance applicants must complete an application form, provide documentation of current family income, documentation of medical expenses and available assets, and provide evidence of investigation of all other means of assistance. Applications are reviewed by the hospital's Christian care committee and selection for assistance is determined by the hospital's available funds and the eligibility of the applicant. All uninsured patients are allowed a discount of at least 10% from the charges billed for the patients' hospital services. In accordance with the state of Illinois public act 095-0965, St. Francis provides uninsured patients the ability to apply for further discounts. Under the hospital uninsured patient discount act, uninsured patients may be eligible for discounts ensuring that they pay no more than 135% of the cost of the services provided. Benefits for the broader community include services provided to needy populations that may not qualify as poor but need special services and support. St. Francis provides these benefits through the provision of unbilled services for community members. non-billed community services include the cost of health education and community health clinics and screenings. specific services provided by St. Francis include: -assistance with community blood drives, kidney mobile, dental care, and fresh fruit program -employee speakers at health fairs, schools, and other community organizations -nutritional management consulting services and educational materials -educational seminars for the general public on senior fitness programs, breast cancer awareness, diabetes, cardiac rehabilitation, congestive heart failure, elder abuse, stroke, and drug prevention -screenings for colorectal cancer, hypertension, cholesterol, and obesity -donation of medical supplies and used equipment to missions in underdeveloped countries -donation of cash and supplies to local agencies -educational sessions for healthcare providers on blood borne pathogens, stress management, and CPR

Schedule H, Part V, Section B, Line 3E
Yes, the significant health needs are a prioritized description of the significant health needs of the community and were identified through the CHNA process.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - HSHS St. Francis Hospital. SFL, HAH and CAH&C are committed to address community health needs in collaboration with local organizations and other area health care institutions. The FY2021 assessment sought input from a broad section of community stakeholders. Input from Community Stakeholders The FY2021 assessment was designed to better document community inclusion. PSP created an electronic demographic survey for the community advisory council (CAC) and focus group participants to document these inclusion efforts. This survey documented basic information such as gender, age, and profession. In total, 33 individuals completed the survey. While the CAC was mostly male and the focus groups were majority female, the gender dispersion was nearly even (45.5% male; 54.5% female). No participants identified as transgender or nonconforming. The age range across all participants was from 15 years old to 71 years old, with an average age of 50.4 years old and a median age of 51 years old. Almost 67% of CAC members worked outside of health care (e.g., hospitals, clinics, public health departments) and 100% of the focus group participants worked outside of health care. In addition to the nine retirees, participants worked in ministry, law enforcement, public education, farm bureau, social work, public housing and economic development. This information demonstrates the majority of the stakeholders were not employed by the hospitals. Input from Members of Medically Underserved, Low Income and Minority Populations To best understand the reasons for and solutions to the greatest health priorities concerning the community, the hospitals invited a diverse group of individuals who would be directly impacted to be part of the CAC and focus groups. Youth were included for the first time in FY2021 to better learn about their health concerns first hand. Out of the 33 participants, 15.5% were youth. FY2021 was also the first year demographic data was collected from CAC and focus group participants to capture how it provides a good representation of the population. All participants had voting power and time to discuss their thoughts and opinions on the priority areas and the data associated with it. Across adult and youth participants, both racial/ethnic minorities and sexual minorities were represented: 3.03% identified as Native American and 3.03% identified as African American/Black. Additionally, 9.10% reported being a member of the LGBTQ2+ community. A combined assessment of HSHS St. Francis, Hillsboro Area, and Carlinville Area Hospital Community Health Needs Assessment 12 All participants reported having medical insurance; however, there was also some differences in socioeconomic status as indicated by income, employment, and education. Among all participants, 18.20% reported a household income level less than $49,999, but only 3.03% reported their household income fell below the federal poverty line. Out of the adult participants, 10.71% reported their employment status as disabled. In addition, 7.14% indicated they were not homeowners. Finally, while adult education was higher on average than the general population, 7.14% of adult participants had completed some high school and 17.9% had completed some college, thus indicating that not all participants were from positions of power or privilege. Input from Communities on Past CHNAs No written comments were received regarding the SFL FY2021 CHNA, the HAH FY2021 or the CAH&C FY2021.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - HSHS St. Francis Hospital. Yes. Hillsboro Area Hospital and Carlinville Area Hospital and Clinics.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - HSHS St. Francis Hospital. Montgomery County Economic Development, Locust Street Clinic, Litchfield Chamber of Commerce, Carlinville Catholic Charities, Macoupin County Health Department, Vine Street Clinic - Federally Qualified Health Clinic, Litchfield Police Department, CEFS Economic Opportunity Corporation, Community Action Agency, Farm Bureau, City of Nokomis, Hillsboro Sources of Strength - CUSD, Village of Fillmore, Hillsboro School District, Montgomery County Health Department, David A. Emler Youth Assessment Project, Staunton Hospital, Carlinville Area Hospital and Clinics, Hillsboro Area Hospital, Hillsboro Chamber of Commerce, St. Francis Hospital.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - HSHS St. Francis Hospital. Based on the CHNA planning and development process described the following community health needs were identified: 1. Access to Mental and Behavioral Health Treatment 2. Workforce Development 3. Food Insecurity In FY2022, HSHS Illinois ministries engaged in an 18-month planning process to identify solutions to crisis screening gaps in the emergency department. In FY2023, the plan will be presented to strategy and finance teams with the goal of deploying a pilot in January 2023. As part of this plan, local ministries will have 365-day psychiatric coverage in the emergency department. We will analyze the initiative and explore expansion across HSHS Illinois ministries in FY2025. In FY2022, HSHS launched the DEI steering committee including the cultural competence and workforce equity subcommittees. Under the workforce equity subcommittee, we conducted a gap analysis of our recruiting, hiring and employee policies to ensure best DEI practices were being deployed. At the end of FY2021, we presented a strategic plan proposal to increase diversity in the workforce and address any barriers to career obtainment. This plan will be implemented in FY2022 and expand to work with local schools and community colleges in developing pipeline programs from school to healthcare career. SFL continues to own and operate the St. Clare's Food Pantry. Montgomery County contains areas known as ""food deserts,"" where residents do not have easy access to healthy food. In FY2022, SFL contributed $104,780 to the food pantry and served 4,021 Litchfield residents. As an outcome of the prioritization process, the following community health needs were also identified but will not be addressed directly by the hospital for the reasons indicated: * Access to Dental Care * Access to Exercise * Affordable Health Care * Child Abuse and Neglect * Cost Burdened Renters * Diabetes and Obesity * Future Water Issues in Rural Areas * Human Trafficking * Student Mobility * Unmanaged Chronic Conditions"

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - St. Francis Hospital. Presumptive eligibility is presumed under certain circumstances for uninsured patients based on their enrollment in other means-tested programs or other sources of information, not provided directly by the patient. Once determined, presumptive eligibility provides individuals participating in one of the following categories with a 100% write off. These programs are granted by outside organizations based on screening criteria of less than 200% of the FPG. 1. Homelessness 2. Deceased with no estate 3. Mental incapacitation with no one to act on patient's behalf 4. Medicaid eligibility, but not on date of service or for non-covered services 5. Incarceration in a penal institution 6. Enrollment in the following assistance programs for low-income individuals: 6a. Temporary Assistance for Needy Families (TANF) 6b. Illinois Housing Development Authority's Rental Housing Support Program 6c. Wisconsin Department of Health Services Housing Assistance Program 7. Participation in Women, Infants and Children programs (WIC); 8. Supplemental Nutrition Assistance Program (SNAP) eligibility; 9. Low Income Home Energy Assistance Program (LIHEAP); 10. Wisconsin Home Energy Assistance Program (WHEAP); 11. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria; 12. Receipt of grant assistance for medical services

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET 3 TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE COMMUNITY HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH PROGRAM, AND DONATIONS ARE STATED AT ACTUAL COST (when applicable). THE COST OF THESE ITEMS ARE TRACKED THROUGH THE GENERAL LEDGER PROCESS AND THROUGH OTHER ACCOUNTING SOFTWARE.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
FOR FINANCIAL STATEMENT PURPOSES, HOSPITAL SISTERS HEALTH SYSTEM HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
The text of the footnote to the organization's financial statements that describes bad debt expense can be found on pages 16-17 in the HSHS Consolidated Audit Report.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
The Hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital leadership continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. The IRS does not classify this shortfall in Medicare payments as Community Benefit. However, we believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for financial assistance or other means-tested government programs. Further, by absorbing this shortfall and providing care below cost to these individuals, the Hospital is relieving the burden of the government. Accordingly, this shortfall restricts the Hospital's ability to make funds available to provide for financial assistance and other Community Benefit. The hospital's Medicare shortfall at cost for fiscal year 2022 was $243,299

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Every effort is made prior to, during and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and provide adequate documentation. If the patient qualified for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualified for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. The hospital will make reasonable efforts to determine whether a patient is eligible under the financial assistance policy before it engages in an ECA. To the extent a patient is determined to be eligible for financial assistance under the FAP, the hospital will take all reasonably available measures to reverse any ECA taken against the patient to obtain payment for the care.

Schedule H, Part V, Section B, Line 16a FAP website
- St. Francis Hospital: Line 16a URL: http://www.hshs.org/fap;

Schedule H, Part V, Section B, Line 16b FAP Application website
- St. Francis Hospital: Line 16b URL: http://www.hshs.org/fap;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- St. Francis Hospital: Line 16c URL: http://www.hshs.org/fap;

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

Schedule H, Part VI, Line 2 Needs assessment
As indicated in Part V, Section C, HSHS St. Francis Hospital conducted a Community Health Needs Assessment in FY2021 (July 1, 2020 through June 30, 2021). Throughout the three-year CHNA cycle, the hospital continuously reviews updated local and state data, Illinois Comp Data, patient surveys and feedback, and local needs assessments conducted by community groups. Additionally, the hospital received input from public health officials, community groups and community boards on an ongoing basis. The information received and reviewed is used to inform ongoing strategic initiatives developed to meet CHNA health priorities and new areas of need that are going unmet. Sources of data included the U.S. Census and subsequent updates and estimates from the U.S. Census Bureau, the Illinois Behavioral Risk Factor Surveillance System (IBRFSS), official websites of the City of Litchfield and Macoupin and Montgomery counties health departments, and a statewide report on poverty in Illinois. County Health Rankings obtained from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute were utilized as well as information from Community Commons, the Illinois Department of Employment Security, and the National Cancer Institute. Other data sources include the U.S. Health Resources and Services Administration data, the Illinois State Board of Education, and the U.S. Department of Agriculture. The hospital's awareness of the health care needs of our community continues through phone calls, inquiries, and requests received by the Community Outreach Facilitator from the community for health-related services. Program evaluations of community outreach programs also provide a mechanism for feedback from the community regarding health care and health related education needs.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
The Registration Department provides brochures to patients upon registration regarding the Financial Assistance Program available to them at the Hospital. The brochures are also supplied in waiting and ancillary areas for easy access by the patient. To better serve our patient population, the Hospital offers information on our financial assistance program in Spanish. This includes the Financial Assistance Policy, Brochure and Application, which allows the hospital to serve populations in its county and the surrounding area for whom Spanish is their primary language. Patients are also provided a Fair Billing Act notification at the point of registration regarding separate physician billing they can expect to receive, plus information about the patient's financial responsibility if their insurance plan is out of network. One-on-one conversations to educate patients about financial assistance often stem from patients receiving a statement or a pre-collection letter. At that point, the customer service representative or cashier, or other qualified staff, will inform/educate the caller about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's charity care program. The letter provides direct contact information to begin the application process for charity care and lists the Internet address where the policy can be obtained. A third-party vendor also assists individuals in determining their eligibility for state health plans or insurance on the open health insurance marketplace. They can also assist with the application process.

Schedule H, Part VI, Line 4 Community information
Combined population is 74,291 and the median household income is around $53,953 per year. The percentage of people living below the poverty level averages 13% in Macoupin County and 15.4% in Montgomery County and the current unemployment rate is 5.7% and 6.7% respectively. Based on the 2018 population estimates derived from the 2010 census data, 98% of Macoupin County and 89% of Montgomery County is Caucasian. Two percent of the population in Macoupin County is African Americans, Native American, Asian and Hispanic or Latino. In Montgomery County, 8% of the residents are African American. Less than 3% are Native American, Asian and Hispanic or Latino. The female population in Macoupin County is 22,543 and the male population is 22,939. The female population in Montgomery County is 13,993 while 15,308 males live in the county. The age of individuals living in Macoupin County under five years is 2,846; under 18 years, 10,071 and 65 years and over is 8,127. The age range for Montgomery County is: under five years: 1,461; under 18 years: 5,785 and 65 years and over: 5,435. Persons eligible for Medicare account for 49% of the patient revenue generated at the hospital and Medicaid-eligible patients generate 18%. Likewise, 29% of the revenue is derived from patients who have managed care/commercial insurance coverage. The remaining 3% of patient revenue comes from patients with no insurance. Most of the Medicaid revenue originates in the Maternity unit. More than 67.0% of the Maternity unit revenue was from treating patients eligible for Medicaid. Provision of maternity services is a financial burden for the hospital, a Critical Access Hospital (CAH) and is reimbursed by Medicare based on the Medicare-eligible costs incurred. Maintaining a Maternity unit limits the number of Medicare patients that can be admitted to the hospital, since a CAH is allowed only 25 inpatients at a time, including maternity patients.

Schedule H, Part VI, Line 5 Promotion of community health
As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System, HSHS St. Francis Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1857, the hospital brings a healing presence and improves the health of our community, especially those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Macoupin and Montgomery County, IL and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St. Francis Hospital is responding to community need. Consistent with its exempt purpose, HSHS St. Francis Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS St. Francis Hospital reinvests surplus funds to support the mission of the organization and promote the health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. HSHS St. Francis Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2022, HSHS St. Francis Hospital provided more than $900,000 in Community Benefit, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. HSHS St. Francis Hospital provides a range of Community Benefit initiatives and programs that further our mission and long-standing commitment to our community. In many cases, these Community Benefits would not exist without the leadership role played by HSHS St. Francis Hospital and they often relieve a burden that would otherwise be carried by government.

Schedule H, Part VI, Line 6 Affiliated health care system
Headquartered in Springfield, Illinois, Hospital Sisters Health System (HSHS) is a highly integrated, multi-institutional health care system comprised of 15 hospitals and more than 200 physician practice sites in Illinois and Wisconsin. HSHS is sponsored by Hospital Sisters Ministries (HSM), which is a public juridic person of the Roman Catholic Church. HSHS continues the health care ministries begun by its founders, the Hospital Sisters of St. Francis, more than 140 years ago, in rural and midsized communities throughout Illinois and Wisconsin. HSHS provides compassionate, holistic, high quality, and cost-effective health care through its acute care hospitals, physician practices, home health programs, palliative and hospice programs, and community outreach services. In addition, HSHS affiliated hospitals include critical access facilities that offer essential health services that otherwise would not be available in many communities. Our mission calls us to reveal and embody Christ's healing love for all people, and we extend our high quality Franciscan health care ministry beyond the walls of our hospitals by providing community health improvement services with special emphasis on the poor and vulnerable. In addition to providing community health improvement services to the broader community, HSHS cares for everyone who comes to its facilities, regardless of their ability to pay. In tandem with a variety of cross sector community partners, HSHS's Community Benefit initiatives are strategically planned and professionally implemented to improve access to health care services; enhance the health of the community; advance medical or general health care knowledge; and relieve or reduce the burden of government to improve health. The COVID-19 pandemic caused an unprecedented disruption in healthcare services across the United States. HSHS responded with services that benefited our communities, including free telehealth screenings, free testing, and coordination with other healthcare providers in the communities we serve to best ensure access to needed care. In FY2022, HSHS collectively provided $218.9 million in Community Benefit (8.3% of total hospital expenses). Of the total Community Benefit provided, HSHS spent $11.6 million provided for Financial Assistance (aka Charity Care) and $146.1 million for unreimbursed care provided as part of the Medicaid program. In addition, HSHS hospitals committed significant resources to treat Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $23.2 million. HSHS hospitals also recorded $68.7 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to serving all persons in need of care. In addition to the dollars invested in our Community Benefit programs, HSHS continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing so, we ensure our ability to meet the ongoing demand for high quality, efficient and easily accessible health care.