4A (Expenses $ 57216810 including grants of $ 15614) (Revenue $ 72523524)
SAINT JOSEPH REGIONAL MEDICAL CENTER-PLYMOUTH (SJRMC-PLYMOUTH), LOCATED IN PLYMOUTH, INDIANA, HAS BEEN SERVING THE MARSHALL COUNTY AREA SINCE 1983. SJRMC-PLYMOUTH IS AN ACUTE CARE HOSPITAL, WHICH IS LICENSED FOR 58 BEDS, AND OFFERS A WIDE RANGE OF SPECIALTY SERVICES AND AN EMERGENCY DEPARTMENT. ATTACHED TO THE HOSPITAL IS A MEDICAL OFFICE BUILDING THAT HOUSES PHYSICIAN OFFICES AND OTHER MEDICAL AND ANCILLARY SERVICES.IN FY22, THE HOSPITAL PROVIDED 5,920 PATIENT DAYS OF HEALTH CARE SERVICES TO THE COMMUNITY.PLEASE SEE SCHEDULE H AND VISIT OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT OUR SERVICES, RECOGNITIONS AND AWARDS: WWW.SJMED.COM/PATIENTS-VISITORS/PLYMOUTH-MEDICAL-CENTER/

SJRMC - PLYMOUTH CAMPUS
PART V, SECTION B, LINE 3J: N/APART V, SECTION B LINE 3E:SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH (SJRMC-PLYMOUTH) INCLUDED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS, WHICH WERE IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED CHNA. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1. ACCESS TO MENTAL HEALTH CARE2. IMPROVE NUTRITION AND EATING HABITS3. ACCESS TO WELLNESS RESOURCES (FRESH FOODS, NUTRITION CLASSES, GYMS, ETC.)4. ACCESS/AFFORDABILITY OF MEDICATION5. INCREASE PARTICIPATION IN PHYSICAL ACTIVITIES AND EXERCISE PROGRAMS

SJRMC - PLYMOUTH CAMPUS
PART V, SECTION B, LINE 5: DURING THE MONTHS OF AUGUST THROUGH NOVEMBER OF 2020, SURVEYS WERE USED TO GATHER INPUT FROM PEOPLE REPRESENTING THE COMMUNITY SERVED FOR THE RECENT CHNA. SURVEYS WERE DISTRIBUTED IN BOTH ONLINE AND PRINTED FORMATS IN ENGLISH AND SPANISH, WHICH ENSURED A WIDE DISTRIBUTION OF THE SURVEY. THIS SURVEY WAS DELIVERED VIA INVITATION BASED ON A STRATIFIED RANDOM SAMPLING OF THE COMMUNITY AT LARGE USING A THIRD-PARTY DATABASE. TO ENSURE THE SURVEY SAMPLE REFLECTED A WIDE VARIETY OF SOCIOECONOMIC LEVELS, AGE AND RACE/ETHNICITY, IT WAS OFFERED TO COMMUNITY GROUPS VIA ORGANIZATIONS SUCH AS LA CASA DE AMISTAD, THE CENTER FOR THE HOMELESS, UNITED WAY OF ST. JOSEPH COUNTY, AND AT LOCAL FOOD PANTRIES. THESE GROUPS REPRESENT THE MEDICALLY UNDERSERVED, MINORITIES, LOW-INCOME INDIVIDUALS, ENTREPRENEUR GROUPS, HEALTH CARE WORKERS, ETC. THE COVID-19 PANDEMIC PREVENTED THE USE OF COMMUNITY EVENTS TO REACH MORE SURVEY PARTICIPANTS OR TO GAIN ADDITIONAL INSIGHT FROM INDIVIDUALS AS WAS DONE IN THE PAST. THIS RESULTED IN A LOWER SURVEY VOLUME THAN WAS SEEN IN PREVIOUS YEARS. THE PRINTED COPY OF THE SURVEY WAS ALSO USED WITH COMMUNITY GROUPS TO FACILITATE BROAD-BASED REPRESENTATION OF THE SENIOR 65+ AND UNDERSERVED POPULATIONS. THE SURVEY PARTICIPANTS WERE ASKED A SERIES OF QUESTIONS ABOUT TOPICS CRITICAL TO THE HEALTH OF THE COMMUNITY. A TOTAL OF 2,683 SURVEYS WERE COLLECTED, 586 OF WHICH WERE FROM MARSHALL COUNTY.COMMUNITY HEALTH ADVISORY COMMITTEE MET ON FEBRUARY 25, 2021 TO DISCUSS HOW TO IMPROVE THE TOP FIVE IDENTIFIED NEEDS. MEMBERS OF THE COMMUNITY HEALTH ADVISORY COMMITTEE INCLUDED: YOUNG PROFESSIONALS, HEALTH EDUCATORS, PARKS DEPARTMENT EMPLOYEES, SENIORS, CLINICS, BUSINESS LEADERS, VETERANS, AND LATINO COMMUNITY LEADERS. THE FOCUS GROUPS WERE ASKED TO DISCUSS ISSUES THAT HAD BEEN IDENTIFIED AS IMPORTANT BY SAINT JOSEPH HEALTH SYSTEM.SAINT JOSEPH HEALTH SYSTEM (SJHS) COMPLETED A COMPREHENSIVE CHNA THAT WAS ADOPTED BY THE BOARD OF DIRECTORS ON MAY 28, 2021. SJHS PERFORMED THE CHNA IN ADHERENCE WITH FEDERAL REQUIREMENTS FOR NOT-FOR-PROFIT HOSPITALS SET FORTH IN THE AFFORDABLE CARE ACT AND BY THE INTERNAL REVENUE SERVICE. THE ASSESSMENT TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY, COMMUNITY MEMBERS, AND VARIOUS COMMUNITY ORGANIZATIONS.

SJRMC - PLYMOUTH CAMPUS
PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN COLLABORATION WITH SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS, INC.

SJRMC - PLYMOUTH CAMPUS
PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING COLLABORATING ORGANIZATIONS: BETHEL UNIVERSITY, BOYS AND GIRLS CLUBS OF ST. JOSEPH COUNTY, BOYS AND GIRLS CLUBS OF MARSHALL COUNTY, BOWEN CENTER, FOOD BANK OF NORTHERN INDIANA, INDIANA HEALTH INFORMATION EXCHANGE, LA CASA DE AMISTAD, MISHAWAKA PARKS DEPARTMENT, MARSHALL COUNTY BOARD OF HEALTH, MARSHALL COUNTY COUNCIL ON AGING, MARSHALL COUNTY NEIGHBORHOOD CENTER, OAKLAWN PSYCHIATRIC CENTER, PLYMOUTH SCHOOL BOARD, POOR HANDMAIDS, PURDUE EXTENSION, ST. JOSEPH COUNTY HEALTH DEPARTMENT, UNITED RELIGIOUS COMMUNITY OF ST. JOSEPH COUNTY, UNITY GARDENS, UNITED WAY OF MARSHALL COUNTY, UNITED WAY OF ST. JOSEPH COUNTY, AND UNIVERSITY OF NOTRE DAME.

SJRMC - PLYMOUTH CAMPUS
PART V, SECTION B, LINE 7D: ALL COMMUNITY HEALTH ADVISORY BOARD MEMBERS RECEIVED A PRINTED OR E-MAILED COPY OF THE COMPLETE CHNA.

SJRMC - PLYMOUTH CAMPUS
PART V, SECTION B, LINE 11: ON SEPTEMBER 15, 2021, THE BOARD APPROVED THE 2022 THROUGH 2024 THREE-YEAR IMPLEMENTATION STRATEGY BASED ON THE MAY 2021 CHNA. THE PLAN WAS DEVELOPED TO ADDRESS THE TOP FOUR OF FIVE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA: ACCESS TO MENTAL HEALTH CARE, IMPROVE NUTRITION AND EATING HABITS, ACCESS TO WELLNESS RESOURCES, AND INCREASE PARTICIPATION IN PHYSICAL ACTIVITIES AND EXERCISE PROGRAMS. SIGNIFICANT NEEDS 'IMPROVE NUTRITION AND EATING HABITS AND 'ACCESS TO WELLNESS RESOURCES (FRESH FOODS, NUTRITION CLASSES, GYMS, ETC.)' HAVE BEEN COMBINED INTO ONE IMPLEMENTATION STRATEGY CATEGORY DUE TO THEIR SIMILAR NATURE.ACTIVITIES CARRIED OUT TO ADDRESS THE NEEDS IN FY22 INCLUDED:TO IMPROVE ACCESS TO MENTAL HEALTH, HEALTH AND WELLNESS EDUCATOR'S HOURS CONTINUED TO ADDRESS MULTIPLE CONCERNS FOR OUR LATINO COMMUNITY, INCLUDING MENTAL HEALTH AS IT RELATES TO THE PHYSICAL FEAR OF CONTRACTING THE COVID-19 VIRUS, THE RAMIFICATIONS OF ONE OF THEIR FRIENDS AND FAMILY MEMBERS CONTRACTING IT, AND THE STRESS ASSOCIATED WITH THE DECREASED SOCIAL CONNECTIONS AND CONCERNS FOR SAFETY DUE TO THE PANDEMIC. ADDITIONAL FACTORS AFFECTING THE MENTAL HEALTH OF OUR COMMUNITY, SUCH AS FOOD ACCESS, HOMELESSNESS, LANGUAGE BARRIERS, AND INADEQUATE HEALTH CARE WERE ADDRESSED THROUGH THE HIRING OF A SPANISH SPEAKING COMMUNITY HEALTH WORKER IN MARSHALL COUNTY. FURTHERMORE, TO INCREASE THE COMPETENCE OF OUR SCHOOL HEALTH STAFF TO RESPOND TO THE MENTAL HEALTH NEEDS IN THEIR SCHOOLS, ALL SJRMC EMPLOYED SCHOOL HEALTH STAFF IN MARSHALL COUNTY WERE INVITED TO ATTEND A YOUTH MENTAL HEALTH FIRST AID TRAINING.TO IMPROVE NUTRITION, EATING HABITS AND ACCESS TO WELLNESS RESOURCES, SJRMC-PLYMOUTH DIABETES PREVENTION PROGRAM CLASSES CONTINUED FOR COUNTY MEMBERS, VETERANS, VULNERABLE POPULATIONS, AND SJHS COLLEAGUES IN AN ONLINE FORMAT IN BOTH ENGLISH AND SPANISH. FOOD INSECURITY, WHICH SAW AN INCREASE OF OVER 30% IN MARSHALL COUNTY DURING FY22, WAS COMBATED BY BRINGING FRESH PRODUCE, WHOLE GRAINS, AND REDUCED SODIUM OPTIONS TO OUR SERVICE AREA THROUGH ONE MOBILE FOOD PANTRY, SERVING 250+ INDIVIDUALS, IN COLLABORATION WITH THE NORTHERN FOOD BANK OF INDIANA; FUNDING FOR THIS WAS MADE POSSIBLE THROUGH TRINITY HEALTH. SJRMC-PLYMOUTH PARTNERED WITH THE POOR HANDMAIDS OF JESUS CHRIST TO COMBAT POOR EATING HABITS AMONG INDIVIDUALS EXPERIENCING HOMELESSNESS BY PROVIDING CROCKPOTS TO THEM FOR USE IN THEIR TEMPORARY RESIDENCE. SUPPORT FOR THE HEALTH AND WELLNESS EFFORTS OF THE LATINO COMMUNITY WAS UPHELD THROUGH THE PROVISION OF RESOURCES SPECIFIC TO COVID-19 SYMPTOMS, TESTING, AND MASKS BY OUR LATINO OUTREACH COORDINATOR AND SPANISH SPEAKING COMMUNITY HEALTH WORKER. TOBACCO RISK ASSESSMENTS WERE ALSO ADMINISTERED DURING COVID-19 THROUGH FOLLOW-UP CALLS MADE BY STAFF TO COMMUNITY MEMBERS, AND QUIT LINE NUMBER DISTRIBUTION AND INVITATIONS TO JOIN A VIRTUAL CESSATION CLASS WERE EXTENDED TO THOSE WHO QUALIFIED.TO ACHIEVE INCREASED PARTICIPATION IN PHYSICAL ACTIVITIES AND EXERCISE PROGRAMS, SJRMC-PLYMOUTH PARTNERED WITH SJRMC-SOUTH BEND TO ENGAGE 15 MISHAWAKA, PLYMOUTH AND DIOCESE OF FORT WAYNE/SOUTH BEND SCHOOLS IN SAINT JOSEPH AND MARSHALL COUNTIES IN A WELLNESS CHALLENGE; 688 KIDS PARTICIPATED, WITH AN AVERAGE OF 1,597 EXTRA MINUTES OF ACTIVITY DURING THE MONTH OF FEBRUARY. INFRASTRUCTURE DEVELOPMENT FOR PHYSICAL FITNESS WAS SUPPORTED THROUGH MONETARY SUPPORT OF THE TOWN OF BOURBON'S SPORT COURT REVITALIZATION PROJECT. ADDITIONALLY, BI-LINGUAL QR CODES AND WINDOW CLINGS LINKING THE COMMUNITY TO VARIOUS RESOURCES AND PROGRAMS WERE DISTRIBUTED AT COMMUNITY ORGANIZATIONS IN PLYMOUTH TO REENGAGE THE COMMUNITY IN A NEW WAY SINCE THE ONSET OF THE COVID-19 PANDEMIC. TO FURTHER SUPPORT HEALTHY LIVING THROUGH MOVEMENT, SJRMC-PLYMOUTH CONTRIBUTED STAFF TIME AND FUNDS TOWARD THE MARSHALL COUNTY COMMUNITY FOUNDATION'S ENDEAVOR TO WORK WITH THE BLUE ZONES PROJECT TO CHAMPION CHANGE THROUGH POLICY, SYSTEMS, AND ENVIRONMENTAL INITIATIVES SURROUNDING WELLNESS. SJRMC-PLYMOUTH DID NOT DIRECTLY ADDRESS ACCESS/AFFORDABILITY OF MEDICATION DUE TO COMPETING PRIORITIES. THE NEED FOR AFFORDABLE MEDICATION IS ALREADY BEING ADDRESSED AT A LOW-COST HEALTH CLINIC THE HOSPITAL CURRENTLY OPERATES, SAINT JOSEPH HEALTH CENTER IN MARSHALL COUNTY. THIS CENTER PROVIDES PRIMARY HEALTH CARE SERVICES AND MEDICATION TO INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED AND WHO FALL BELOW 200% OF THE FEDERALLY DESIGNATED POVERTY LEVEL. THIS HEALTH CENTER ADDRESSES PREVENTION OF DISEASE AND ILLNESS AND FOCUSES ON THE OVERALL HEALTH AND WELL-BEING OF EACH PATIENT. IN ADDITION TO PRIMARY AND PREVENTATIVE HEALTH CARE SERVICES, THE CLINIC OFFERS SPECIALTY CARE TO OUR PATIENTS, WHICH IS PROVIDED BY VOLUNTEER PHYSICIANS.

SJRMC - PLYMOUTH CAMPUS
PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS.

FORM 990 PART V, SECTION B, LINE 7A - HOSPITAL FACILITY'S WEBSITE URL:
WWW.SJMED.COM/ABOUT-US/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2021

FORM 990 PART V, SECTION B, LINE 10 - HOSPITAL FACILITY'S WEBSITE URL:
WWW.SJMED.COM/CHNA2020

FORM 990 PART V, LINE 16A, FINANCIAL ASSISTANCE POLICY WEBSITE:
WWW.SJMED.COM/PATIENTS-VISITORS/BILLING-AND-ASSISTANCE/FINANCIAL-ASSISTANCE

FORM 990 PART V, LINE 16B, FAP PLAIN LANGUAGE SUMMARY WEBSITE:
WWW.SJMED.COM/PATIENTS-VISITORS/BILLING-AND-ASSISTANCE/FINANCIAL-ASSISTANCE

FORM 990 PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:
WWW.SJMED.COM/PATIENTS-VISITORS/BILLING-AND-ASSISTANCE/FINANCIAL-ASSISTANCE

SJRMC - PLYMOUTH - PART V, SECTION B, LINE 9:
AS PERMITTED IN THE FINAL SECTION 501(R) REGULATIONS, THE HOSPITAL'S IMPLEMENTATION STRATEGY WAS ADOPTED WITHIN 4 1/2 MONTHS AFTER THE FISCAL YEAR END THAT THE CHNA WAS COMPLETED AND MADE WIDELY AVAILABLE TO THE PUBLIC.

PART I, LINE 3C:
IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS.

PART I, LINE 6A:
SJRMC-PLYMOUTH PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF INDIANA. IN ADDITION, SJRMC-PLYMOUTH REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, SJRMC-PLYMOUTH INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE.

PART I, LINE 7:
THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM.

PART I, LN 7 COL(F):
THE FOLLOWING NUMBER, $5,464,044, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F).

PART II, COMMUNITY BUILDING ACTIVITIES:
SJRMC-PLYMOUTH STRIVES TO LIVE ITS MISSION OF SERVING THOSE WHO ARE POOR AND UNDERSERVED BY ASSISTING LOCAL ORGANIZATIONS IN CREATING PROGRAMS AIMED AT HELPING THE CITIZENS OF OUR COMMUNITY BECOME MORE PRODUCTIVE, HEALTHY MEMBERS OF SOCIETY AND IMPROVING THE OVERALL HEALTH STATUS OF THE COMMUNITY. IN FISCAL YEAR 2022, SJRMC-PLYMOUTH PROVIDED COMMUNITY SUPPORT THROUGH IN-KIND PRINTING FOR THE UNITED WAY OF MARSHALL COUNTY'S ANNUAL CAMPAIGN. THE UNITED WAY OF MARSHALL COUNTY IMPACTS EDUCATION WITH THE IMPLEMENTATION OF FINANCIAL LITERACY CLASSES, INCOME BY PROVIDING ASSISTANCE WITH PRESCRIPTION COSTS, AND HEALTH AND NUTRITION BY SUPPORTING THE OPERATIONS OF LOCAL FOOD PANTRIES FOR THE COMMUNITY. SJRMC-PLYMOUTH ALSO SUPPORTED COALITION BUILDING BY HAVING AN EMPLOYEE OF SJHS SERVE ON THE MARSHALL COUNTY BOARD OF HEALTH, WHICH IS A PART OF STATE AND LOCAL PUBLIC HEALTH SYSTEMS AND IS CHARGED WITH ADDRESSING HEALTH PROMOTION, DISEASE PREVENTION, AND PUBLIC PROTECTION. THIS APPOINTMENT PROVIDED THE NECESSARY GUIDANCE AND OVERSIGHT TO SUPPORT THE COMMUNITY'S HEALTH BY SETTING POLICIES, HIRING AND MONITORING HEALTH OFFICERS, REVIEWING OPERATIONAL DATA AND CHALLENGING ORGANIZATIONAL ACTIVITIES, AND EXERCISING FINANCIAL OVERSIGHT OF THE LOCAL HEALTH DEPARTMENT, A CRITICAL ROLE AMIDST THE COVID-19 PANDEMIC.

PART III, LINE 2:
METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.

PART III, LINE 3:
SJRMC-PLYMOUTH USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, SJRMC-PLYMOUTH IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, SJRMC-PLYMOUTH IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL.

PART III, LINE 4:
"SJRMC-PLYMOUTH IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE PATIENT ACCOUNTS RECEIVABLE, ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS FOOTNOTE FROM PAGE 13 OF THOSE STATEMENTS: ""AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTABLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE.THE CORPORATION HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE CORPORATION'S HEALTH MINISTRIES AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS AND OTHER CHANGES IN ESTIMATES ARE INCLUDED IN NET PATIENT SERVICE REVENUE AND ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED.""PART III, LINE 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE ONE PERCENT SEQUESTRATION REDUCTION FOR THE PERIOD APRIL 1, 2022 THROUGH JUNE 30, 2022."

PART III, LINE 9B:
THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS.

PART VI, LINE 7, REPORTS FILED WITH STATES
IN

PART III, LINE 8:
SJRMC-PLYMOUTH DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT.

PART VI, LINE 2:
NEEDS ASSESSMENT: SJRMC-PLYMOUTH ASSESSES THE HEALTH STATUS OF ITS COMMUNITY, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. TO ASSESS THE HEALTH OF THE COMMUNITY, THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES, AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTIVE SERVICES OR ARE UNINSURED. TO INVESTIGATE NEW HEALTH TRENDS, QUESTIONS REGARDING COVID-19 WERE ADDED TO THE ASSESSMENT CONDUCTED IN FY21 TO GAUGE THE PANDEMIC'S IMPACT ON COMMUNITY MEMBERS. DATA GATHERED ON THIS TOPIC ALSO GUIDED SJRMC-PLYMOUTH AS IT BEGAN VACCINATING THE COMMUNITY AND ENGAGING IN VACCINATION CAMPAIGNS AND EDUCATION.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SJRMC-PLYMOUTH COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES, FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS, AND OTHER COMMUNITY-BASED CHARITABLE PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. SJRMC-PLYMOUTH OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. SJRMC-PLYMOUTH HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SJRMC-PLYMOUTH MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER.

PART VI, LINE 4:
COMMUNITY INFORMATION: SRMC-PLYMOUTH, ALONG WITH SJRMC-SOUTH BEND, SERVES 902,902 PEOPLE IN A DIVERSE NINE-COUNTY AREA IN INDIANA AND MICHIGAN THROUGH ITS CONTINUUM OF CARE. THE PRIMARY SERVICE AREA INCLUDES ST. JOSEPH, ELKHART AND MARSHALL COUNTIES IN INDIANA. THE SECONDARY SERVICE AREA ENCOMPASSES FULTON, LA PORTE, PULASKI AND STARKE COUNTIES IN INDIANA AS WELL AS BERRIEN AND CASS COUNTIES IN MICHIGAN. SRMC-PLYMOUTH'S SURVEYED COUNTIES ARE GENERALLY RURAL IN NATURE, WITH THE EXCEPTION OF LIGHT INDUSTRY CENTERED IN THE TOWNS OF PLYMOUTH AND BREMEN. THE REGION OFFERS DIVERSITY, A STABLE ECONOMY AND A FAMILY-FRIENDLY ENVIRONMENT, ALL WITHIN CLOSE PROXIMITY TO CHICAGO. NEARBY CULVER IS THE HOME OF CULVER ACADEMIES, WHICH ATTRACTS STUDENTS TO INDIANA FROM ALL OVER THE WORLD. THERE ARE ALSO THREE CRITICAL ACCESS HOSPITALS (CAH) IN THIS AREA: COMMUNITY HOSPITAL OF BREMEN, PULASKI MEMORIAL HOSPITAL, AND WOODLAWN HOSPITAL, WHERE PRIMARY CARE PROFESSIONALS WITH PRESCRIPTIVE PRIVILEGES FURNISH OUTPATIENT PRIMARY-CARE SERVICES.AS IN MOST RURAL MIDWESTERN COMMUNITIES, THE POPULATION IS ALMOST EXCLUSIVELY (86%) MADE UP OF WHITE NON-HISPANIC INDIVIDUALS OF NORTHERN EUROPEAN DESCENT, ALTHOUGH THERE HAS BEEN AN INCREASE IN THE HISPANIC POPULATION (CURRENTLY 11%) OVER THE PAST TEN YEARS. AN ABOVE-AVERAGE PERCENTAGE OF MARSHALL COUNTY'S POPULATION IDENTIFIES AS HISPANIC AND THERE IS A MUCH SMALLER AFRICAN AMERICAN POPULATION IN COMPARISON TO THE INDIANA AVERAGE.THE TOTAL POPULATION WITHIN THE SYSTEM SERVICE AREA IS EXPECTED TO GROW ONE PERCENT THROUGH 2025. COMPARED TO THE STATE OF INDIANA, THERE IS A LOWER PROJECTED POPULATION GROWTH, A HIGHER MEDIAN AGE, AND A LOWER PERCENTAGE OF PEOPLE WITH A BACHELOR'S DEGREE OR HIGHER. THE POPULATION AGED 65 AND OLDER IS EXPECTED TO GROW TO FROM 18 PERCENT TO 19.6 PERCENT OVER THE NEXT FIVE YEARS. APPROXIMATELY 20 PERCENT OF THE POPULATION WITHIN THE SYSTEM SERVICE AREA EARNS AN ANNUAL SALARY OF $25,000 OR BELOW. HOUSEHOLD INCOME IS FAIRLY STABLE ACROSS THE PRIMARY SERVICE AREA, WITH AREAS OF HIGHEST AFFLUENCE IN THE GRANGER ZIP CODE AND PORTIONS OF ELKHART COUNTY. IN MARSHALL COUNTY, THE AVERAGE HOUSEHOLD INCOME ($59,672) IS BELOW THAT FOR THE STATES OF INDIANA, MICHIGAN AND OHIO, AS WELL AS THE U.S., AND AS OF DECEMBER 2020, THE UNEMPLOYMENT RATE WAS 3.4 PERCENT, WHICH WAS SLIGHTLY LOWER THAN THE INDIANA RATE AND LOWER THAN THE NATIONAL AVERAGE. HEALTH CARE, MANUFACTURING, SERVICE AND FARMING ARE THE MAJOR EMPLOYERS IN THE LOCAL ECONOMY.IN 2018, 11% OF INDIVIDUALS IN MARSHALL COUNTY LIVED IN POVERTY. THIS IS DOWN FROM 12% REPORTED IN 2016 AND IS COMPARED TO AN INDIANA POVERTY RATE OF 7% FOR 2018. [U.S. CENSUS BUREAU, SMALL AREA INCOME AND POVERTY ESTIMATES (SAIPE) PROGRAM, DECEMBER 2018]ESTIMATES OF UNINSURED INDIVIDUALS ARE 10.3 PERCENT IN ST. JOSEPH COUNTY AND 12.7 PERCENT IN MARSHALL COUNTY, TOTALING APPROXIMATELY 27,000 INDIVIDUALS COMBINED. THIS IS COMPARED TO AN INDIANA RATE OF 9.7 PERCENT. THE SYSTEM SERVICE AREA INCLUDES SEVERAL MEDICALLY UNDERSERVED AREAS (MUA) AND MEDICALLY UNDERSERVED POPULATIONS (MUP). [U.S. CENSUS BUREAU, SMALL AREA HEALTH INSURANCE (SAHIE) PROGRAM, MARCH 2018]

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"OTHER INFORMATION: SJRMC-PLYMOUTH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS. BY DOING SO, IT IS ABLE TO ENSURE THAT HIGH QUALITY AND ACCESSIBLE CARE IS AVAILABLE IN THE COMMUNITY IN A VARIETY OF PRIMARY AND SPECIALTY CARE AREAS. REFERRALS FOR NEEDED SERVICES NOT AVAILABLE IN PLYMOUTH ARE EASILY MADE WITH SJRMC-SOUTH BEND IN MISHAWAKA OR OTHER LOCAL HOSPITALS.SJRMC-PLYMOUTH PRIDES ITSELF ON ITS RELATIONSHIP WITH SJRMC-SOUTH BEND, A STATE-OF-THE-ART MEDICAL CENTER THAT UTILIZES THE LATEST TECHNOLOGY, ELECTRONIC MEDICAL RECORDS, FULLY INTEGRATED MEDICAL TEAMS, AND HIGHLY TRAINED STAFF TO PROVIDE CARE THAT IS SECOND TO NONE. INTERACTION OF THE MEDICAL STAFFS, ASSOCIATES, AND ANCILLARY SERVICES ALLOWS SJRMC-PLYMOUTH TO PROVIDE ITS PATIENTS WITH THE SAME LEVEL OF CARE OFFERED THE RESIDENTS OF THE CITIES OF SOUTH BEND AND MISHAWAKA.SJRMC-PLYMOUTH BOASTS A STATE-OF-THE-ART EMERGENCY ROOM WHICH HAS AN OUTSTANDING GROUP OF EMERGENCY DEPARTMENT PHYSICIANS AND STAFF TRAINED IN TREATING PERSONS SUFFERING FROM EMERGENT AND NON-EMERGENT CONDITIONS. SJRMC-PLYMOUTH SERVES ALL PEOPLE REGARDLESS OF ETHNICITY, GENDER, RELIGION, ABILITY TO PAY, ETC.SJRMC-PLYMOUTH IS A CERTIFIED ""BABY-FRIENDLY"" HOSPITAL. BABY-FRIENDLY HOSPITALS ARE HOSPITALS THAT ARE RECOGNIZED FOR ENCOURAGING BREASTFEEDING AND MOTHER/BABY BONDING, WHICH IS KNOWN TO PROVIDE HEALTH BENEFITS FOR INFANTS, CHILDREN, AND MOTHERS.SJRMC-PLYMOUTH PARTICIPATES IN MEDICARE, MEDICAID, TRICARE AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. THE HOSPITAL ALSO OFFERS CHARITY CARE AND CARE ON A SLIDING FEE SCALE. IN KEEPING WITH ITS MISSION STATEMENT AND VALUES, SJRMC-PLYMOUTH ASSURES UNINSURED PATIENTS THAT THEY RECEIVE THE SAME HIGH-QUALITY MEDICAL CARE AS THOSE WHO ARE INSURED AND ABLE TO PAY. FINANCIAL ASSISTANCE IS PROVIDED TO ALL WHO ARE ELIGIBLE TO RECEIVE IT. POLICIES GOVERNING SUCH ASSISTANCE ARE READILY AVAILABLE FOR STAFF AND PATIENTS ALIKE. SJRMC-PLYMOUTH SPONSORS A HEALTH CENTER THAT PROVIDES CARE FOR THE UNINSURED. STAFFED PRIMARILY BY A MID-LEVEL PRACTITIONER IN A COLLABORATIVE AGREEMENT WITH LOCAL DOCTORS, THIS HEALTH CENTER SEES A HIGHLY DIVERSE POPULATION AND OFFERS SPECIALIZED CLINICS IN CHRONIC DISEASE MANAGEMENT, COUMADIN CARE, SMOKING CESSATION, HIV/AIDS, AND SUBSTANCE ABUSE. ADVOCACY FOR VARIOUS HEALTH-RELATED ISSUES IS AT THE FOREFRONT AT SJRMC-PLYMOUTH, INCLUDING EFFORTS RELATED TO OBTAINING HEALTH CARE FOR ALL, ELIMINATING THE HEALTH CARE DISPARITIES AMONG DIVERSE POPULATIONS, AND OBTAINING AFFORDABLE PHARMACEUTICALS. SJRMC-PLYMOUTH CONTINUES TO BE A LEADER IN FOUNDING AND FUNDING PROGRAMS THAT IMPACT THE HEALTH OF ITS COMMUNITIES, SUCH AS PROVIDING LOCAL SCHOOLS WITH ATHLETIC TRAINERS.AS A FAITH-BASED HEALTH INSTITUTION, SJRMC-PLYMOUTH OFFERS PATIENTS, THEIR FAMILIES, AND THE BROADER COMMUNITY THE OPPORTUNITY TO ADDRESS THE SPIRITUAL NEEDS THAT ARISE AS ONE EXPERIENCES ILLNESS, CHRONIC HEALTH CONDITIONS, OR THE DYING PROCESS. THIS EXPERIENCE OF FAITH, THE PRESENCE OF A REFLECTION/PRAYER ROOM, AND A FULL-TIME CHAPLAIN AFFORD EVERYONE THE CERTITUDE THAT THE WHOLE PERSON AND HIS/HER CARE ARE ADDRESSED.SJRMC-PLYMOUTH AND SJRMC-SOUTH BEND ARE THE LEAD AGENCIES FOR LOCAL TOBACCO CONTROL IN OUR COUNTIES. IN MARSHALL COUNTY, THE BREATHE EASY MARSHALL COUNTY ALLIANCE INCLUDES THE PROGRAM COORDINATOR, COALITION CHAIR, KAREN RICHEY WITH PURDUE EXTENSION AND 21 COALITION PARTNERS. THE PROGRAM COORDINATOR PROVIDES MEETING AGENDA, MINUTES AND ARRANGES GUEST SPEAKERS. ON AVERAGE, THERE ARE 8-10 ACTIVE COALITION PARTNERS THAT ATTEND MONTHLY COALITION MEETINGS. ADVOCACY EFFORTS FOR FY22 INCLUDED SMOKE-FREE WORKPLACES, TOBACCO-FREE SCHOOLS, AND TOBACCO/VAPING EDUCATION AND CESSATION, ESPECIALLY AMONG THE YOUTH POPULATION. SCREENING FOR SOCIAL INFLUENCERS OF HEALTH (SIOHS) FOR ALL SJRMC-PLYMOUTH PATIENTS OCCURS ANNUALLY DURING A REGULAR ROUTINE OFFICE VISIT. THE SIOH HAS BEEN EMBEDDED INTO OUR ELECTRONIC HEALTH RECORD, AND IF A PATIENT HAS MYCHART, QUESTIONS ARE PUSHED OUT TO THEM PRIOR TO AN OFFICE VISIT. FINDHELP.ORG IS LINKED WITH OUR ELECTRONIC HEALTH RECORD. IF RESOURCES WERE INDICATED AS BEING NEEDED, THEY WERE MADE AVAILABLE TO THE PATIENT THROUGH THE END OF VISIT SUMMARY PROVIDED. CLINICAL STAFF ALSO HAVE THE ABILITY TO REFER PATIENTS TO OUR COMMUNITY HEALTH WORKER PROGRAM. SJRMC-PLYMOUTH HAS ESTABLISHED RELATIONSHIPS WITH THE AGENCY ON AGING CENTER AND FOOD BANKS TO HELP ASSIST WITH NEEDS. IN ADDITION TO WORKING WITH PATIENTS OF SJRMC-PLYMOUTH, OUR COMMUNITY HEALTH WORKERS RECEIVE AND RESPOND TO REFERRALS FROM COMMUNITY PARTNERS TO HELP ADDRESS THE SIOH NEEDS FACED IN OUR SERVICE AREA. SJRMC-PLYMOUTH CONTINUED RESPONDING TO THE COVID-19 PANDEMIC THROUGH OUR COVID-19 HOTLINE TO PROVIDE COVID-19 RELATED INFORMATION AND RESOURCES TO LOCAL RESIDENTS. BY CALLING THE LINE, RESIDENTS COULD SCHEDULE COVID-19 TESTING AND VACCINATION SERVICES, ASK BASIC QUESTIONS REGARDING COVID-19, AND/OR INDICATE THEY NEEDED ASSISTANCE WITH SOCIAL NEEDS SUCH AS FOOD, TRANSPORTATION AND CLEANING SUPPLIES/MASKS, WHICH WOULD BE ADDRESSED BY OUR COMMUNITY HEALTH WORKERS. ADDITIONALLY, SJRMC-PLYMOUTH CONTINUED TO OPERATE FEVER AND UPPER RESPIRATORY INFECTION (FURI) CLINICS TO PROVIDE ADEQUATE TRIAGE AND TESTING AT THE MEDICAL PRACTICES. IT STARTS HERE: SJRMC-PLYMOUTH'S ""IT STARTS HERE"" CAMPAIGN IS A COVID-19 VACCINE EDUCATION OUTREACH CAMPAIGN PRIMARILY FOCUSING ON COMMUNITIES OF COLOR AND VULNERABLE POPULATIONS AND WAS FUNDED BY TRINITY HEALTH. SJRMC-PLYMOUTH PARTNERED WITH THE FOLLOWING LOCAL COMMUNITY-BASED ORGANIZATIONS TO SERVE POPULATIONS WITH LOW COVID-19 VACCINATION RATES IN MARSHALL COUNTY: THE MARSHALL COUNTY COUNCIL ON AGING, THE BREAD OF LIFE FOOD PANTRY, CULVER LAKEFEST, LLC, AND THE MARSHALL COUNTY FAIR ASSOCIATION. SJHS PROVIDED DOOR-TO-DOOR OUTREACH WITH RESOURCE BAGS CONTAINING COVID-19 EDUCATION, MASKS, HAND SANITIZER AND HEALTH EDUCATION IN NEIGHBORHOODS AND ZIP-CODES WITH A HIGH PERCENTAGE OF MINORITY RESIDENTS AND LOW SOCIOECONOMIC STATUS POPULATIONS."

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SJRMC-PLYMOUTH IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH'S COMMUNITY HEALTH AND WELL-BEING (CHWB) STRATEGY PROMOTES OPTIMAL HEALTH FOR PEOPLE EXPERIENCING POVERTY AND OTHER VULNERABILITIES IN THE COMMUNITIES WE SERVE BY CONNECTING SOCIAL AND CLINICAL CARE, ADDRESSING SOCIAL NEEDS, DISMANTLING SYSTEMIC RACISM, AND REDUCING HEALTH INEQUITIES. WE DO THIS BY: 1. INVESTING IN OUR COMMUNITIES, 2. ADVANCING SOCIAL CARE, AND 3. IMPACTING SOCIAL INFLUENCERS OF HEALTH.TO FURTHER OUR STRATEGY IN FISCAL YEAR 2022 (FY22), CHWB LAUNCHED TWO TRAINING SERIES TO ADVANCE HEALTH AND RACIAL EQUITY IN OUR COMMUNITIES.1. CHWB LEADER SERIES TO ADVANCE HEALTH AND RACIAL EQUITY: A YEAR-LONG PEER LEARNING SERIES TO BUILD THE CAPACITY OF OUR CHWB LEADERS TO DELIVER ON OUR CHWB STRATEGY WITH A FOCUS ON COMMUNITY LEADERSHIP AND ENGAGEMENT, AND THE USE OF A RACIAL EQUITY LENS IN ALL OF OUR DECISION MAKING. 2. COMMUNITY ENGAGEMENT TO ADVANCE RACIAL JUSTICE - PREPARING FOR IMPLEMENTATION STRATEGY: A FOUR-PART SERIES ON ENGAGING OUR COMMUNITIES IN MEANINGFUL WAYS USING A HEALTH EQUITY AND RACIAL EQUITY LENS TO BUILD LASTING PARTNERSHIPS AND IMPACTFUL IMPLEMENTATION STRATEGIES.INVESTING IN OUR COMMUNITIES - TRINITY HEALTH AND ITS MEMBER HOSPITALS ARE COMMITTED TO THE DELIVERY OF PEOPLE-CENTERED CARE AND SERVING AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN THE COMMUNITIES THEY SERVE. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITIES AND IS COMMITTED TO ADDRESSING THE UNIQUE NEEDS OF EACH COMMUNITY. IN FY22, TRINITY HEALTH CONTRIBUTED $1.37 BILLION IN COMMUNITY BENEFIT SPENDING TO AID THOSE WHO ARE VULNERABLE AND LIVING IN POVERTY, AND TO IMPROVE THE HEALTH STATUS OF THE COMMUNITIES IN WHICH WE SERVE. SOME EXAMPLES OF THESE INVESTMENTS INCLUDE: TRINITY HEALTH AWARDED OVER $1.6 MILLION IN COMMUNITY GRANTS THAT DIRECTLY ALIGN WITH INTERVENTIONS AND LOCAL PARTNERSHIPS IDENTIFIED IN ITS MEMBER HOSPITALS' COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IMPLEMENTATION STRATEGIES, INCLUDING ACCESS TO HEALTH CARE, MENTAL HEALTH, TRANSPORTATION, COMMUNITY ENGAGEMENT, FOOD ACCESS, AND HOUSING SUPPORTS. WITH A $1.2 MILLION INITIAL INVESTMENT, TRINITY HEALTH LAUNCHED ROUND 2 OF THE TRANSFORMING COMMUNITIES INITIATIVE (TCI), A FIVE-YEAR, INNOVATIVE FUNDING AND TECHNICAL ASSISTANCE INITIATIVE, PARTNERING WITH COMMUNITY-BASED ORGANIZATIONS AND RESIDENTS TO ADVANCE HEALTH AND RACIAL EQUITY IN NINE OF OUR COMMUNITIES EXPERIENCING HIGH POVERTY AND OTHER VULNERABILITIES. HEALTH MINISTRIES RECEIVING TCI FUNDING ARE COLLABORATING WITH A LOCAL MULTI-SECTOR COLLABORATIVE TO DEVELOP AND IMPLEMENT EVIDENCE-BASED STRATEGIES THAT ADVANCE HEALTH AND RACIAL EQUITY THROUGH ADDRESSING AT LEAST ONE ROOT CAUSE OF POOR HEALTH IDENTIFIED IN THE DEVELOPMENT OF THEIR MOST RECENT CHNA IMPLEMENTATION STRATEGY. TRINITY HEALTH AWARDED OVER $1 MILLION IN COVID-19 FUNDING TO SUPPORT NEW AND ONGOING COMMUNITY ENGAGEMENT AND MOBILIZATION EFFORTS AROUND MAKING THE COVID-19 VACCINATION ACCESSIBLE TO ALL ELIGIBLE POPULATIONS. THIS FUNDING WAS DESIGNED TO SUPPORT ALL COMMUNITIES TO ENSURE EASY AND EQUITABLE ACCESS TO THE VACCINE BY REMOVING BARRIERS FOR ALL PEOPLE TO RECEIVE THE VACCINE, ESPECIALLY COMMUNITIES THAT HAVE LESS THAN A 75% VACCINATION RATE. WITH THIS FUNDING, HEALTH MINISTRIES FACILITATED 3,200 COVID-19 VACCINE EVENTS, ADMINISTERED 80,000 COVID-19 VACCINE DOSES, AND REACHED 874,000 PEOPLE WITH EDUCATIONAL MATERIALS ON COVID-19 AND THE BENEFITS OF VACCINATION.IN ADDITION TO THE $1.37 BILLION IN COMMUNITY BENEFIT SPENDING, OUR COMMUNITY INVESTING PROGRAM HAD THE MOST ROBUST YEAR OF LENDING SINCE THE PROGRAM'S INCEPTION OVER 20 YEARS AGO: $17.8 MILLION IN NEW LOANS AND $8.3 MILLION IN LOAN RENEWALS WERE APPROVED, FOCUSING ON BUILDING AFFORDABLE HOUSING AND INCREASING ACCESS TO EDUCATION IN PARTNERSHIP WITH OUR HEALTH MINISTRIES. ADVANCING SOCIAL CARE - TRINITY HEALTH'S SOCIAL CARE PROGRAM WAS DEVELOPED TO ADDRESS SOCIAL NEEDS, SUCH AS ACCESS TO TRANSPORTATION, CHILDCARE, OR AFFORDABLE MEDICATIONS BY FACILITATING CONNECTIONS BETWEEN OUR PATIENTS, HEALTH CARE PROVIDERS AND COMMUNITY PARTNERS THAT PROMOTE HEALTHY BEHAVIORS. HIGHLIGHTS FROM FY22 INCLUDE THE FOLLOWING SUCCESSES:- LAUNCHED TRINITY HEALTH COMMUNITY HEALTH WORKER (CHW) CERTIFICATION PROGRAM, TRAINING 86 CHWS WITH 40+ HOURS OF TRAINING, AND INCREASED CHW STAFF ACROSS MOST HEALTH MINISTRIES- LAUNCHED A SYSTEM-WIDE ASSESSMENT OF LANGUAGE ACCESS SERVICES TO RECOMMEND SYSTEM STANDARDS THAT ENSURE CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES FOR ALL OF OUR PATIENTS, THEIR COMPANIONS, AND CAREGIVERS- ENGAGED OVER 1,100 PARTICIPANTS IN THE NATIONAL DIABETES PREVENTION PROGRAM, EXCEEDING OUR PROGRAM YEAR 5 GOAL- INCREASED THE NUMBER OF ACTIVE COMMUNITY PARTNER ORGANIZATIONS ON THE COMMUNITY RESOURCE DIRECTORY BY 120% FROM FISCAL YEAR 2021- ENGAGED 5,300+ PATIENTS WHO ARE DUALLY ENROLLED IN MEDICARE AND MEDICAID IN A SOCIAL CARE OR MEDICAL CARE ACTIVITY, IN SUPPORT OF REDUCING PREVENTABLE HOSPITALIZATIONS (SUCH AS DIABETES AND ASTHMA)IMPACTING SOCIAL INFLUENCERS OF HEALTH - LEVERAGING INVESTOR POWER TO CATALYZE CORPORATE SOCIAL RESPONSIBILITY, TRINITY HEALTH'S SHAREHOLDER ADVOCACY WORK FOCUSES ON DISMANTLING RACISM ACROSS FIVE STRATEGIC FOCUS AREAS BY HOLDING CORPORATIONS ACCOUNTABLE FOR THE HUMAN RIGHTS VIOLATIONS THOSE COMPANIES PERPETUATE IN THE U.S. AND BEYOND. IN FY22, TRINITY HEALTH FACILITATED OVER 135 SHAREHOLDER ADVOCACY ENGAGEMENTS, WITH GREAT SUCCESS:- FIVE BELOW COMMITTED TO ASSESS AND MANAGE THE RISKS/HAZARDS ASSOCIATED WITH CHEMICALS OF HIGH CONCERN CONTAINED IN THEIR PRIVATE LABEL PRODUCTS- UNILEVER AGREED TO STOP FOOD AND BEVERAGE MARKETING TO CHILDREN UNDER AGE 16, AND WILL ADOPT NEW TARGETS TO REDUCE SALT, ADDED SUGARS AND CALORIES, AND INCREASE SALES OF THEIR HEALTHIER PRODUCTS- PEPSICO SET GOALS TO INCREASE POSITIVE NUTRIENTS IN THEIR PRODUCTS- PDC ENERGY ACCELERATED ITS GOAL TO END ROUTINE FLARING OF METHANE, FROM 2030 TO 2025, THUS REDUCING ENVIRONMENTAL HEALTH RISKS AND GREENHOUSE GAS EMISSIONSADDITIONALLY, TRINITY HEALTH AND OTHER MEMBERS OF THE INTERFAITH CENTER ON CORPORATE RESPONSIBILITY GUN SAFETY GROUP SUBMITTED A SHAREHOLDER RESOLUTION ASKING STURM RUGER, ONE OF THE NATION'S LEADING MANUFACTURERS OF FIREARMS, TO CONDUCT AND PUBLISH AN INDEPENDENT HUMAN RIGHTS IMPACT ASSESSMENT OF ITS POLICIES, PRACTICES AND PRODUCTS, AND MAKE RECOMMENDATIONS FOR IMPROVEMENT. THE RESOLUTION RECEIVED A 68.5% VOTE IN FAVOR, WELL ABOVE THE THRESHOLD REQUIRED FOR THE RESOLUTION TO BE RESUBMITTED IN 2023, INDICATING A LARGE MAJORITY OF STURM RUGER INVESTORS BELIEVE THE COMPANY HAS TO ADDRESS ITS HUMAN RIGHTS IMPACTS. TRINITY HEALTH AND TRINITY HEALTH OF NEW ENGLAND ARE CITED AS PART OF THE GROUP WHO MOVED FORWARD THIS RESOLUTION.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG.