4A (Expenses $ 1073816204 including grants of $ 4205046) (Revenue $ 1526953895)
St. Vincent Hospital and Health Care Center is a 830-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2022, St. Vincent Hospital and Health Care Center treated 31,489 adults and children for a total of 206,363 patient days of service. The hospital also provided services for 888,078 outpatient visits, which included 11,786 outpatient surgeries and 109,912 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. As part of the Ascension Catholic health ministry, the filing organization served in support of Ascension's commitment to both care for patients and communities and support caregivers and other associates through the challenges of the COVID-19 global pandemic in FY22.

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

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - Facility Group A. Ascension St. Vincent Hospital and Health Care Center, Line 1 Ascension St. Vincent Women's Hospital, Line 2 Ascension St. Vincent Stress Center, Line 3 Ascension St. Vincent Hospital - Peyton Manning Children's Hospital, Line 4 Recognizing its vital importance to understanding the health needs and assets of the community, Ascension St. Vincent Indianapolis consulted with a range of public health and social service providers that represent the broad interests of residents of Marion County. Multiple methods were used to gather community input, including community input meetings, a hospital input meeting with hospital staff, and key informant interviews. A summary of the process and results is outlined below. Four community input meetings were conducted by Verite Healthcare Consulting in May and June 2021 to gather feedback on the health needs and assets of Marion County. Fifty-three (53) individuals participated in the Marion County community meetings. These individuals represented organizations including local health departments, non-profit organizations, faith-based organizations, health care providers, and local policymakers. The organizations that participated in the community input meetings are the following: Allen Chapel A.M.E. Church, Indianapolis City Council, Anthem Medicaid, Indianapolis City-County Council, Broadway United Methodist Church, Indianapolis Neighborhood Housing Partnership, City of Indianapolis (Division of Community Nutrition and Food Policy), Indianapolis Public Transportation Corporation (IndyGo), Coalition for Our Immigrant Neighbors, Indianapolis Urban League, Concerned Clergy of Indianapolis, Indy Hunger Network, Connections IN Health, Jump IN for Healthy Kids, Connections IN Health - IU School of Medicine, Managed Health Services (MHS), Covering Kids & Families of Indiana, Marian University, Crossroads A.M.E. Church, Marian University - College of Osteopathic Medicine, First Baptist Church North Indianapolis, Marion County Public Health Department, Gennesaret Free Clinic, Neighborhood Christian Legal Clinic, Gleaners Food Bank of Indiana, Nine13sports, Habitat for Humanity of Greater Indianapolis, Nurse Family Partnership - Goodwill of Central and Southern Indiana, Health by Design, Office of Representative Andre Carson, Horizon House Pathway to Recovery, Immigrant Welcome Center, Playworks Indiana, Indiana Civil Rights Commission (American Indian and Asian), Raphael Health Center, Clinical and Translational Sciences Institute (CTSI), Richard M. Fairbanks Foundation, Indiana Legal Services, The Julian Center, Indiana Public Health Association, Top 10 Coalition, Indiana State Department of Health, University of Indianapolis, Indiana University Richard M. Fairbanks School of Public Health, and YMCA of Greater Indianapolis. Two meetings also were conducted in November 2021 and January 2022 to gather feedback from hospital staff on the health needs and assets of Marion County. Twenty-four individuals participated. These staff included physician residents, discharge planners, community navigators, social workers, primary care providers, and administrators. Finally, an interview was conducted with a local public health department representative to obtain subject-matter expertise regarding health needs in Marion County. Questions focused, first, on identifying and discussing health issues in the community before the COVID-19 pandemic began. Questions then focused on the pandemic's impacts and on what has been learned about the community's health given those impacts. The organizations that participated represented a variety of vulnerable populations, which included individuals who are medically underserved (census tracts in Indianapolis and central Marion County are designated as a medically underserved area and the Indiana Hemophilia & Thrombosis Center and the lower income population of the Indianapolis Northwest Side have been designated as MUPs), living in poverty, struggling to meet basic needs (including housing and food insecurity), experiencing addiction, seeking government assistance, victims of domestic violence and/or neglect, senior citizens, and/or experiencing racial/ethnic health disparities. Additionally, the Marion County Public Health Department represented the needs of these vulnerable populations via their public health expertise.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - Facility Group A. Ascension St. Vincent Hospital and Health Care Center, Line 1 Ascension St. Vincent Women's Hospital, Line 2 Ascension St. Vincent Stress Center, Line 3 Ascension St. Vincent Hospital - Peyton Manning Children's Hospital, Line 4 During its most recent CHNA, The Hospital collaborated with other Indiana health systems to collect primary data through online community input meetings and key stakeholder interviews. These health systems include IU Health, Community Health Network, Riverview Health, and the Rehabilitation Hospital of Indiana. Ascension St. Vincent Indianapolis also collaborated with other hospitals that are members of Ascension St. Vincent.

Schedule H, Part V, Section B, Line 11 Facility A, 1
"Facility A, 1 - Facility Group A - Part 1. Ascension St. Vincent Hospital and Health Care Center, Line 1 Ascension St. Vincent Women's Hospital, Line 2 Ascension St. Vincent Stress Center, Line 3 Ascension St. Vincent Hospital - Peyton Manning Children's Hospital, Line 4 Addressed Significant Needs of FY20-22 CHNA Cycle (FY22 Summary) 1) Access to Health Services - The goal of the initiative is to increase the number of people enrolled in Medicare or Medicare Savings programs. This will be accomplished through an evidence-based strategy called Pathways, which is utilized by the hospital's health advocates, who educate people interested in these programs about their options and assist with the application and submission process. The SMART objective is as follows: By June 30, 2022, the hospital will increase its FY20 baseline number of enrollments for the Medicare and Medicare Savings Program by 2.5%. During FY22, the hospital dedicated $160,008 in community benefit to this initiative and assisted 43 people with obtaining Medicare and/or Medicare Savings insurance (FY20 baseline = 16, FY22 goal = 17, FY22 goal attainment = achieved). 2) Food Security - The goal of the initiative aligns with the Healthy People 2020 goal to eliminate very low food security among children. The strategy focuses on encouraging schools and/or school districts to adopt a school-wide or district wide policy designed to increase student availability and participation in the scientifically supported school breakfast program. The target population are schools with less than 70% of students who eat free or reduced-price lunch also eating breakfast at school. To accomplish this, the system partnered with the national organization, No Kid Hungry, and other local organizations to launch the initiative. The hospital works with a food service director of a school and/or districts to support breakfast after the bell models and/or universal free school meal options. The SMART objective is as follows: The hospital will partner with a school and/or a school district to increase the percentage of students who eat free/reduced-priced lunch also eating breakfast in the School Breakfast Program by 2% from the baseline established at the beginning of FY21 until the end of FY22 (June 30, 2022). However, due to the unanticipated, significant impact COVID-19 had on schools, the scope of the initiative was expanded to include all school nutrition programs, in addition to the school breakfast program. Consequently, during FY22, Ascension St. Vincent Indianapolis dedicated $10,000 in community benefit to this initiative by supporting St. Monica's purchase of a new steamer for the school cafeteria. 3) Mental Health - The goal of the initiative is to increase the number of community members that are trained in the evidence-based Mental Health First Aid (MHFA) curriculum to identify individuals who are experiencing mental health /substance issues. The strategy consists of the hospital offering at least one MHFA training to the community at no charge during the reporting year. The target population is community members who want to be trained as MFHA ""first aiders"". To accomplish this, the hospital works with certified MHFA instructors and local community mental health and service organizations. The SMART objective is as follows: By June 30, 2022, the hospital will increase the number of community members trained to identify individuals experiencing mental health /substance issues by the end of FY 2022. During FY22, Ascension St. Vincent Indianapolis Hospital did offer a MHFA training for 11 individuals. However, it was reported after the deadline and therefore, not included in the community benefit dollars reported. Addressing Needs in Current CHNA Cycle (FY23-25) In Ascension St. Vincent Indianapolis most recent CHNA, the following were identified as significant needs in the community: Access to Care; Communicable Diseases/STDs; COVID-19 Pandemic; Food Security; Maternal, Infant, and Child Health; Mental Health Status and Access to Mental Health Services; Obesity; Racial and Ethnic Health Disparities; Social Determinants of Health, including: Poverty, Affordable Housing, Food Insecurity, and Transportation; Smoking and Tobacco Use; Substance Use Disorders and Overdoses; Violence and Crime The FY2023-2025 Implementation Strategy specifically addresses Access to Care, Mental Health, and Maternal, Infant, and Child Health, in following ways: 1) Access to Care - The goal of the initiative is to increase access to comprehensive, high-quality health care services (Healthy People 2030). The hospital will do this through various strategies, which includes the evidence-based approach called Pathways, utilized by the hospital's health advocates, to assist individuals access various health, human, and social services. Specifically, the hospital will focus on increasing the proportion of people with a usual primary care provider by doing the following: 1) increasing the number of patients established with a medical home by 2.0% each year, amongst individuals who complete a Medical Home Pathway, from baseline established in FY2023, and 2) increasing the number of self-pay/charity Emergency Department patients connected with a provider by 5.0%, from baseline established in FY2023. Also, the hospital will focus on increasing the proportion of people with health insurance by 5.0% each year, amongst individuals who complete an enrollment pathway, from baseline established in FY2023. Finally, in an effort to work collaboratively with community groups and organizations, the hospital will strengthen community engagement by supporting coalitions and implementing partners to improve access to care. 2) Mental Health - The goal of the initiative is to improve mental health (Healthy People 2030). The strategy is based on the HP2030 Mental Health and Mental Disorders objective: Reduce the suicide rate (MHMD-01). The hospital will collaborate with the Ascension St. Vincent Stress Center, to offer at least one QPR (Question, Persuade, Refer) training to the community at no charge by the end of the implementation strategy cycle. The target population will include community members, first responders, educators, students, and faith-based organizations. Additionally, this initiative includes a community engagement objective. The hospital will strengthen community engagement to expand the reach of evidence-based programs, advocacy, and/or services through financial support, facilitation, and/or promotion to improve mental health. 3) Maternal, Infant, and Child Health (through the lens of poverty) - The goal of this initiative is to improve the health of the mother-baby dyad before, during, and after pregnancy and prevent maternal and infant deaths. The first strategy is based on the HP2030 Maternal, Infant, Child Health objective: Increase the proportion of pregnant women who receive early and adequate prenatal care (MICH-08). The hospital will increase the number of women who receive prenatal care within the first trimester (12 weeks and six days of conception) by 5.0%, amongst the Primary Care Center (PCC) and select Ascension Medical Group (AMG) OB practices, from baseline established in FY2023. The second strategy aims to increase the proportion of women who receive perinatal mental health care and adequate postpartum care via the following two methods: 1) implement a pilot program to standardize perinatal mood and anxiety disorder (PMAD) screening and referrals, amongst the Primary Care Center (PCC) and select Ascension Medical Group (AMG) OB practices and 2) increase the number of women who receive postpartum care within 56 days of delivery by 5.0% amongst the Primary Care Center (PCC) and select Ascension Medical Group (AMG) OB practices, from baseline established in FY2023. The third strategy will increase the number of babies born weighing more than 5 lbs. 8 oz. by 5.0%, each year, amongst the individuals who complete a Pregnancy Pathway, from baseline established in FY2023. Finally, the hospital will strengthen community engagement to expand the reach of evidence-based programs, advocacy, and/or services through financial support, facilitation, and/or promotion to maternal and infant health."

Schedule H, Part V, Section B, Line 11 Facility A, 2
"Facility A, 2 - Facility Group A - Part 2. Ascension St. Vincent Indianapolis is committed to improving community health by directly, and indirectly, addressing community needs. However, certain factors impact the hospital's ability to fully address all of the identified needs. The needs listed below are not included in the Ascension St. Vincent Indianapolis's implementation strategy for the following reasons: Communicable Diseases/STDs - The hospital, together with Ascension Medical Group (AMG), a physician-led provider organization, provides diagnoses, treatments, and counseling for community members with communicable diseases and STDs. Additionally, the hospital remains committed to partnering with community groups to address this identified health need and will continue to seek opportunities to do so. As federal, state, and local authorities, as well as community-based organizations, are working to reduce communicable diseases/STDs, the hospital will not directly address this need in the current Implementation Strategy. COVID-19 Pandemic - The hospital, together with AMG, continues to provide treatment for community members diagnosed with COVID-19, as it has done since the beginning of the pandemic. As federal, state, and local authorities are providing leadership for prevention and surveillance activities, the hospital will not directly address the COVID-19 pandemic in the current Implementation Strategy. Food Security - The hospital works to improve food security of community members through a variety of means, such as continuation of partnerships with schools to support weekend feeding programs or school nutrition programs, financial donations to charitable organizations, and/or food drives. Moreover, the hospital, together with AMG, screens patients for food insecurity and provides referrals to community resources and/or hospital-based local resources. Additionally, the hospital remains committed to partnering with community groups to address this identified health need and will continue to seek opportunities to do so. As federal, state, and local authorities, as well as community-based organizations, are working to improve food security, the hospital will not directly address this need in the current Implementation Strategy. Obesity, Physical Inactivity, and Associated Chronic Disease - The hospital, together with AMG, provides education on various health topics related to obesity, physical inactivity, and associated chronic disease through health fairs and screenings, health education, wellness programs, lectures, school health education programs, and/or community support groups. Additionally, the hospital remains committed to partnering with community groups to address these identified health needs and will continue to seek opportunities to do so. As federal, state, and local authorities, as well as community-based organizations, are working to reduce this need, the hospital will not directly address this need in their current Implementation Strategy. Racial and Ethnic Health Disparities - The hospital is a ministry of Ascension St. Vincent, which is committed to serving all individuals, with special attention to those living in poverty and who are most vulnerable. In 2020, this commitment was reinforced with the launch of a system-wide initiative to advance health equity and social justice through the ABIDE (Appreciation, Belongingness, Inclusivity, Diversity, and Equity) Framework. Moreover, the use of Community Health Workers across the market is a strategy that is deemed, ""likely to decrease disparities'', per County Health Rankings and Roadmaps. Additionally, the hospital remains committed to partnering with community groups to address the issue of health disparities and will continue to seek opportunities to do so. As federal, state, and local authorities, as well as community-based organizations, are working to reduce this need, the hospital will not directly address this need in the current Implementation Strategy. Smoking and Tobacco Use - The hospital, together with AMG, screens patients for tobacco use and promotes the use of the evidence-based state tobacco cessation quitline (1-800-Quit-Now). Additionally, the hospital remains committed to partnering with community groups to address this identified health issue and will continue to seek opportunities to do so. As federal, state, and local authorities, as well as community-based organizations, are working to reduce smoking and tobacco use, the hospital will not directly address this need in the current Implementation Strategy. Substance Use Disorders and Overdoses - The hospital, together with AMG, does provide diagnoses, treatment, and counseling for community members with substance use disorders and overdoses, most notably through emergency services. Additionally, the hospital remains committed to partnering with community groups to address this identified health need and will continue to seek opportunities to do so. As federal, state, and local authorities, as well as community-based organizations, have focused efforts to reduce substance use disorders and overdoses, the hospital will not directly address this need in the current Implementation Strategy. Violence and Crime - The hospital, together with AMG, screens patients to identify safety concerns as well as for social determinants of health factors related to violence and crime. Moreover, supporting services and referrals are provided by Community Health Workers in the Ascension St. Vincent Health Access Department, to respond to violence and crime encountered by patients. Additionally, the hospital remains committed to partnering with community groups to address these identified health needs and will continue to seek opportunities to do so. As federal, state, and local authorities, as well as community-based organizations, are working to reduce violence and crime, the hospital will not directly address this need in the current Implementation Strategy. While these needs are not the focus of this Implementation Strategy, Ascension St. Vincent Indianapolis may consider investing resources in these areas as appropriate, depending on opportunities to leverage organizational assets in partnership with local communities and organizations. Also, this report does not encompass a complete inventory of everything Ascension St. Vincent Indianapolis does to support health within the community."

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

Schedule H, Part V, Section B, Line 5 Facility B, 1
Facility B, 1 - OrthoIndy. AS FEDERALLY REQUIRED BY THE AFFORDABLE CARE ACT, THE FOLLOWING IS AN OVERVIEW OF THE METHODS AND PROCESS USED TO IDENTIFY AND PRIORITIZE SIGNIFICANT HEALTH NEEDS IN THE FOLLOWING COUNTIES IN INDIANA: HAMIILTON, HENDRICKS, JOHNSON AND MARION. The 2021 CHNA was conducted with contracted assistance from Verite Healthcare Consulting from June 2021 to April 2022 and utilized a process that incorporated data from both primary and secondary sources. Primary data sources included information provided by groups/individuals, e.g., representatives of public health departments, community residents, health care consumers, health care professionals, community stakeholders, and multi-sector representatives. A community input meeting was held in June 2021. Numerous individuals representing organizations across Marion County were invited. A key stakeholder interview was conducted with a representative of the Marion County Health Department. A hospital input meeting was held with hospital staff members. Special attention was given to the needs of individuals and communities who are more vulnerable and to unmet health needs or gaps in services. Sessions were conducted using virtual meeting platforms and online polls to assess community priorities of significant needs in Marion County. Secondary data were compiled and reviewed to understand the health status of the community. Measures reviewed included chronic disease, social and economic factors, and healthcare access and utilization trends in the community and were gathered from reputable and reliable sources. Four community input meetings were conducted in April and May 2021 to gather feedback on the health needs and assets of Marion County. Individuals from a wide variety of organizations and communities participated in community meetings and surveys. These individuals represented organizations including local health departments, non-profit organizations, faith-based organizations, health care providers, and local policymakers. Community organizations participating in the community input meetings are presented below. ALLEN CHAPEL A.M.E. CHURCH ANTHEM MEDICAID BROADWAY UNITED METHODIST CHURCH CITY OF INDIANAPOLIS, DIVISION OF COMMUNITY NUTRITION AND FOOD POLICY COALITION OF OUR IMMIGRANT NEIGHBORS CONCERNED CLERGY OF INDIANAPOLIS CONNECTIONS IN HEALTH - IU SCHOOL OF MEDICINE CONNECTIONS IN HEALTH COVERING KIDS AND FAMILIES OF INDIANA CROSSROADS A.M.E. CHURCH FIRST BAPTIST CHURCH NORTH INDIANAPOLIS GENNESARET FREE CLINIC GLEANERS FOOD BANK OF INDIANA HABITAT OF HUMANITY OF GREATER INDIANAPOLIS HEALTH BY DESIGN HORIZON HOUSE IMMIGRANT WELCOME CNETER INDIANA CIVIL RIGHTS COMMISSION (AMERICAN INDIAN AND ASIAN) INDIANA CLINICAL AND TRANSLATIONAL SCIENCES INSTITUTES (CTSI) INDIANA LEGAL SERVICES INDIANA PUBLIC HEALTH ASSOCIATION INDIANA STATE DEPARTMENT OF HEALTH INDIANA UNIVERSITY FICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH INDIANAPOLIS CITY COUNTY INDIANAPOLIS NEIGHBORHOOD HOUSING PARNERSHIP INDIANAPOLIS URBAN LEAGUE INDIANAPOLIS CITY-COUNTY COUNCIL INDIANAPOLIS PUBLIC TRANSPORTATION CORPORATION (INDYGO) INDY HUNGER NETWORK JUMP IN FOR HEALTH KIDS MANAGED HEALTH SERVICE (MHS) MARIAN UNIVERSITY - COLLEGE OF OSTEOPHATHIC MEDICINE MARIAN UNIVERSITY MARION COUNTY PUBLIC HEATLH DEPARTMENT NEIGHBORHOOD CHRISTIAN LEGAL CLINIC NINE13SPORTS NURSING FAMILY PARTNERSHIP - GOODWILL OF CENTRAL AND SOUTHERN INDIANA OFFICE OF REPRESENTATIVE ANDRE CARSON PATHWAY TO RECOVERY PLAYWORKS INDIANA RAPHAEL HEALTH CENTER RICHARD M. FAIRBANKS FOUNDATION THE JULIAN CENTER TOP 10 COALITION UNIVERISTY OF INDIANAPOLIS YMCA OF GREATER INDIANAPOLIS A hospital input meeting also was conducted in January 2022 to gather feedback from hospital staff on the health need priorities and assets of Marion County. Two individuals participated. These staff represented the perspectives of discharge planners, community navigators, social workers, primary care providers, and administrators.

Schedule H, Part V, Section B, Line 6a Facility B, 1
Facility B, 1 - OrthoIndy. THE HOSPITAL CONDUCTED ITS CHNA IN CONJUNCTION WITH THE FOLLOWING HOSPITAL FACILITIES: ASCENSION ST. VINCENT IU HEALTH COMMUNITY HEALTH NETWORK RIVERVIEW HEALTH REHABILITATION HOSPITAL OF INDIANA

Schedule H, Part V, Section B, Line 11 Facility B, 1
"Facility B, 1 - OrthoIndy. As a result of OrthoIndy's most recent CHNA, the following needs were identified as significant in the community: substance abuse, mental health, chronic health conditions, youth services, and homelessness. The hospital's FY20-22 implementation strategy addresses the prioritized health needs of mental health, with the addition of the system-wide health improvement priorities of access to health services through the following system-wide health improvement priority strategies: 1) Access to Health Services - The goal of the initiative is to increase the number of people enrolled in Medicare or Medicare Savings programs. This will be accomplished through an evidence-based strategy called Pathways, which is utilized by the hospital's health advocates, who educate people interested in these programs about their options and assist with the application and submission process. The SMART objective is as follows: By June 30, 2022 the hospital will increase its FY20 baseline number of enrollments for the Medicare and Medicare Savings Program by 2.5%. During FY21, the hospital dedicated $160,008 in community benefit to this initiative and assisted 36 people with obtaining Medicare and/or Medicare Savings insurance (FY20 baseline = 16, FY21 goal = 17, FY21 goal attainment =211%). 2) Mental Health - The goal of the initiative is to increase the number of community members that are trained in the evidence-based Mental Health First Aid (MHFA) curriculum to identify individuals who are experiencing mental health /substance issues. The strategy consists of the hospital offering at least one MHFA training to the community at no charge during the reporting year. The target population is community members who want to be trained as MFHA ""first aiders"". To accomplish this, the hospital works with certified MHFA instructors and local community mental health and service organizations. The SMART objective is as follows: By June 30, 2022 the hospital will increase the number of community members trained to identify individuals experiencing mental health /substance issues by the end of FY 2022. Please note, a specific target will be set for FY 2022, after the baseline is determined in FY 2021. During FY21, OrthoIndy scheduled a virtual MHFA but had to cancel the training session due to a lack of participation. The hospital is committed to improving community health by directly, and indirectly, addressing prioritized health needs. However, certain factors impact the hospital's ability to fully address all priority health needs. The significant needs and explanations listed below are not being addressed in the hospital's implementation strategy plan for the following reasons: Nutrition & Weight Status - Food Security - This identified health need is not being addressed in the Implementation Strategy due to limitations within the hospital's human capital and financial resources. Substance Abuse - This issue is being addressed through the Mental Health priority. Homelessness - This identified health need is not being addressed in the Implementation Strategy due to limitations within the hospital's human capital and financial resources. However, the hospital provides support through the community-based care coordination department of St. Vincent Rural and Urban Access to Health (RUAH). Chronic Health Conditions - This identified health need is not being addressed in the Implementation Strategy due to limitations within the hospital's financials and human resources. However, the hospital may provide education on various health needs facing the local community through the following: health fairs, health promotion, wellness programs, lectures, school health education programs, and support groups. Youth Services - This identified health need is not being addressed in the Implementation Strategy due to limitations within the hospital's human capital and financial resources. Following the completion of the current CHNA, OrthoIndy has selected the prioritized needs outlined below for its FY2023 - FY2025 Implementation Strategy. Ascension has defined ""prioritized needs'' as the significant needs which have been prioritized by the hospital to address through the three-year CHNA cycle: Access to Care - This need was selected because access to care indicators such as adults reporting fair or poor health, low birthweight babies, per capita supply of healthcare providers, preventable hospital stays, and/or core preventive services compared unfavorably to peer counties or U.S. averages and because community meeting participants identified access to care (including preventive services) as a priority. Mental Health - This need was selected because mental health indicators such as number of mentally unhealthy days, number of mental health providers per population, depression rate and/or suicide rate compared unfavorably to peer counties or U.S. averages and because community meeting participants identified mental health and adverse childhood experiences (ACEs) as a priority. OrthoIndy understands the importance of all the health needs of the community and is committed to playing an active role in improving the health of the people in the communities it serves. For the purposes of this Implementation Strategy, OrthoIndy has chosen to focus its efforts on the priorities listed above. OrthoIndy is a specialty orthopedic hospital with expertise in providing the highest quality, comprehensive bone, joint, spine and muscle care. The hospital is committed to improving community health by directly, and indirectly, addressing prioritized health needs. However, certain factors impact the hospital's ability to fully address all prioritized health needs. The needs listed below are not included in the hospital's Implementation Strategy plan for the following reasons: COVID-19 Pandemic - This need was not selected because other facilities or organizations in the community are addressing the need. Food Security - This need was not selected because a relatively low priority was assigned to the need and because other organizations are addressing this need. Obesity, Physical Inactivity, and Associated Chronic Disease - This need was not selected because of resource constraints and because other facilities or organizations in the community are addressing the need. Social Determinants of Health, including poverty, affordable housing, food insecurity, and transportation - This need was not selected because of a relative lack of expertise or competencies to effectively address the need. Smoking and Tobacco Use - This need was not selected because a relatively low priority was assigned to the need and other organizations in the community are addressing the need. While these needs are not the focus of this Implementation Strategy, OrthoIndy may consider investing resources in these areas as appropriate, depending on opportunities to leverage organizational assets in partnership with local communities and organizations. Also, this report does not encompass a complete inventory of everything OrthoIndy does to support health within the community."

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

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

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

Schedule H, Part II Community Building Activities
Research shows that social determinants and quality of life play a major role in the health status of individuals and communities. Community building activities, which focus on the root causes of health problems, ultimately influence, and improve health status. Examples of community building activities include physical improvement and housing, economic development, community support, environmental improvements, leadership development and leadership training for community members, coalition building, advocacy for community health improvements and safety, and workforce development. During FY22, the community building dollars reported for Ascension St. Vincent Indianapolis Hospital focused on empowering youth through education via support of Junior Achievement and advocacy for college and career opportunities within the Hispanic community.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2022 was $70,795,198 at charges, ($24,505,658 at cost).

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

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

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

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

Schedule H, Part V, Section B, Line 16a FAP website
A - Ascension St. Vincent Hospital: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance; B - OrthoIndy Hospital: Line 16a URL: https://www.orthoindy.com/pay-bill;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - Ascension St. Vincent Hospital: Line 16b URL: https://healthcare.ascension.org/Financial-Assistance; B - OrthoIndy Hospital: Line 16b URL: https://www.orthoindy.com/pay-bill;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - Ascension St. Vincent Hospital: Line 16c URL: https://healthcare.ascension.org/Financial-Assistance; B - OrthoIndy Hospital: Line 16c URL: https://www.orthoindy.com/pay-bill;

Schedule H, Part VI, Line 4 Community information
St. Vincent Hospital and Health Care Center, Inc. services Central Indiana with a 12-county primary service area. The total population of the 12-county primary service area is estimated to be 2,060,357 residents in calendar 2022 and is expected to increase by approximately 3.7% to 2,135,970 residents in five years. The median household income of the primary service area is $64,916. Approximately 10.7% of the service area residents live below the poverty line. Within the primary service area, there are 13 federally designated medically underserved areas. There are 25 acute care hospitals located within the primary service area.

Schedule H, Part VI, Line 5 Promotion of community health
St. Vincent Hospital and Health Care Center's governing body is comprised of persons representing diverse aspects and interests of the community. Many members of St. Vincent Hospital and Health Care Center's governing body reside in the organization's primary service area and who are neither employees nor independent contractors of the organization, nor family members thereof. St. Vincent Hospital and Health Care Center, Inc. extends medical staff privileges to all qualified physicians in its community for some or all its departments or specialties. St. Vincent Hospital and Health Care Center, Inc. applies surplus funds to fund improvements in patient care, medical education, and research.

Schedule H, Part VI, Line 2 Needs assessment
St. Vincent Hospital and Health Care Center, Inc. uses internal and external data and reports from third parties, including government sources, to assess the healthcare needs of the communities we serve. These reports provide key information about health, socioeconomic, demographic factors that identify areas of need and inform our strategies that help to meet those needs of our community. These reports include, but are not limited to: Sg2 Healthcare Intelligence, The Advisory Board, IQVIA for healthcare claims datasets, 3d Health, Indiana Hospital Association, and internal data. St. Vincent Hospital and Health Care Center, Inc. utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, The Heart Center considers the health care needs of the overall community when evaluating internal financial and operational decisions.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
St. Vincent Hospital and Health Care Center, Inc. IS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL, IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES; St. Vincent Hospital and Health Care Center, Inc. PROVIDES FULL FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 250% OF THE FEDERAL POVERTY LEVEL AND SLIDING SCALE ASSISTANCE UP TO 400% OF THE FEDERAL POVERTY LEVEL. St. Vincent Hospital and Health Care Center, Inc. WIDELY PUBLICIZES ITS: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY VIA THE HOSPITAL FACILITY'S WEBSITE - https://healthcare.ascension.org/financial-assistance/indiana St. Vincent Hospital and Health Care Center, Inc. MAKES PAPER COPIES OF THE: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION. THE PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. St. Vincent Hospital and Health Care Center, Inc. INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION MAY BE FOUND. St. Vincent Hospital and Health Care Center, Inc. INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 6 Affiliated health care system
St. Vincent Hospital and Health Care Center, Inc. is a member of Ascension. Ascension Health Alliance, D/B/A Ascension (Ascension), is a Missouri nonprofit corporation formed on September 13, 2011. Ascension is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or health ministries, located in 19 of the United States and the District of Columbia. Ascension is sponsored by Ascension Sponsor, a public juridic person. The participating entities of Ascension Sponsors are the Daughters of Charity of St. Vincent De Paul, St. Louise Province; The Congregation of St. Joseph; The Congregation of The Sisters of St. Joseph of Carondelet; The Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province. St. Vincent Hospital and Health Care Center, Inc. operates a hospital facility in Marion County Indiana and is part of Ascension St. Vincent which also owns and operates other healthcare related entities, including St. Mary's Health, St. Joseph Hospital and Health Care Center, and St. Vincent Anderson Regional Hospital. The health system provides inpatient, outpatient, and emergency care services for residents of Indiana.