4A (Expenses $ 2387098083 including grants of $ 0) (Revenue $ 2955959031)
"FOR OVER 140 YEARS, FRANCISCAN ALLIANCE, INC. (""FRANCISCAN"") HAS ENDEAVORED TO STAY TRUE TO OUR FOUNDING MISSION OF CARING FOR PATIENTS WHO COME THROUGH OUR DOORS AND WE CONTINUE TO LOOK FOR OPPORTUNITIES TO SERVE OUR COMMUNITIES THROUGH THE VERY BEST IN MEDICAL CARE AND SERVICE TO THE LESS FORTUNATE AMONG US. FRANCISCAN'S PURPOSE IS TO CONTINUE THE HEALING MINISTRY OF CHRIST IN ACCORDANCE WITH THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH AND IN PARTNERSHIP WITH OTHERS TO PROVIDE A FULL CONTINUUM OF HEALTH CARE SERVICES; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO THE PROMOTION OF HEALTH; TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO HEALTH CARE; AND TO PARTICIPATE IN ACTIVITIES DESIGNED AND CONDUCTED TO PROMOTE THE GENERAL HEALTH OF THOSE SERVED BY FRANCISCAN. FRANCISCAN DIRECTLY OR INDIRECTLY OPERATES 12 HOSPITAL CAMPUSES (ONE IN ILLINOIS AND ELEVEN IN INDIANA) ALONG WITH NUMEROUS PHYSICIAN CLINICS AND ANCILLARY SERVICES CENTERS AND OFFERS NUMEROUS COMMUNITY HEALTH IMPROVEMENT PROGRAMS THAT ARE FURTHER DESCRIBED BELOW. IN 2018, FRANCISCAN SERVED OVER 2.3 MILLION PERSONS AND PROVIDED OVER $721 MILLION IN CHARITY CARE AND OTHER COMMUNITY BENEFITS. FRANCISCAN PROVIDES SIGNIFICANT BENEFITS THAT REFLECT THE ORGANIZATION'S COMMITMENT TO HEALTHCARE AND THE COMMUNITIES IT IS PRIVILEGED TO SERVE. IN 2018, FRANCISCAN PROVIDED COMMUNITY BENEFITS WHICH INCLUDED: UNREIMBURSED COSTS OF MEDICAID AND OTHER INDIGENT CARE PROGRAMS $131,803,000 COST OF CHARITY CARE PROVIDED $ 96,426,000 OTHER BENEFITS FOR THE POOR AND UNDERSERVED $ 6,256,000 SUBSIDIZED HEALTH SERVICES $ 40,091,000 HEALTH PROFESSIONS EDUCATION $ 14,657,000 COMMUNITY HEALTH IMPROVEMENT SERVICES $ 5,508,000 FINANCIAL AND IN-KIND CONTRIBUTIONS $ 1,408,000 RESEARCH $ 1,639,000 COMMUNITY BUILDING ACTIVITIES $ 1,783,000 COMMUNITY BENEFIT OPERATIONS $ 315,000 UNREIMBURSED COSTS OF MEDICARE $421,646,000 _______________ TOTAL $721,532,000 WWW.FRANCISCANHEALTH.ORG/COMMUNITYHEALTH REFLECTS FRANCISCAN'S MISSION OF ""CONTINUING CHRIST'S MINISTRY IN OUR FRANCISCAN TRADITION."" ALTHOUGH IT IS NOT ALL INCLUSIVE OF THE MANY BENEFITS PROVIDED BY FRANCISCAN IT DOES PORTRAY THE SIGNIFICANT BENEFITS THAT REFLECT OUR COMMITMENT TO HEALTHCARE AND THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. WWW.FRANCISCANHEALTH.ORG/COMMUNITYHEALTH REFLECTS FRANCISCAN'S MISSION OF ""CONTINUING CHRIST'S MINISTRY IN OUR FRANCISCAN TRADITION."" ALTHOUGH IT IS NOT ALL INCLUSIVE OF THE MANY BENEFITS PROVIDED BY FRANCISCAN IT DOES PORTRAY THE SIGNIFICANT BENEFITS THAT REFLECT OUR COMMITMENT TO HEALTHCARE AND THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. THE FOLLOWING IS A SUBSET OF THE MANY CLINICAL SERVICES AS WELL AS POPULATION HEALTH IMPROVEMENT AND COMMUNITY OUTREACH ACTIVITIES OFFERED BY ONE OR MORE OF FRANCISCAN'S HEALTHCARE FACILITIES: - INPATIENT HOSPITAL SERVICES INCLUDING: MEDICAL SERVICES, SURGICAL SERVICES, INTENSIVE CARE SERVICES, TELEMETRY SERVICES, OBSTETRICS SERVICES, PEDIATRICS SERVICES, NEONATAL INTENSIVE CARE SERVICES, ACUTE REHABILITATION SERVICES, ONCOLOGY SERVICES, BONE MARROW TRANSPLANT SERVICES, GENERAL SURGERY SERVICES, CARDIAC SURGERY SERVICES, VASCULAR SERVICES, PULMONARY SERVICES, INTERVENTIONAL RADIOLOGY, ORTHOPEDICS, JOINT AND SPINE CARE, GASTROINTESTINAL CARE, NEUROSCIENCES SERVICES, COLON AND RECTAL SERVICES, ANESTHESIA SERVICES, HOSPICE SERVICES, INPATIENT PSYCHIATRIC CARE, RESIDENTIAL TREATMENT PROGRAM FOR ADOLESCENTS, ETC. - EMERGENCY SERVICES INCLUDING: 24 HOUR EMERGENCY ROOM SERVICES, AMBULANCE SERVICES, IMMEDIATE CARE SERVICES, ADVANCED LIFE SUPPORT SERVICES, BASIC LIFE SUPPORT SERVICES, BEHAVIORAL HEALTH EMERGENCY CONSULTATION SERVICES, 24-HOUR CRISIS AND REFERRAL HOTLINE, TRAUMA SERVICES, ETC. - OUTPATIENT SERVICES INCLUDING: LABORATORY SERVICES, PHYSICAL THERAPY SERVICES, OCCUPATIONAL THERAPY SERVICES, SPEECH THERAPY SERVICES, GENERAL RADIOLOGY SERVICES, COMPUTED TOMOGRAPHY SERVICES, MAGNETIC RESONANCE IMAGING (MRI), NUCLEAR MEDICINE SERVICES, MAMMOGRAPHY SERVICES, ANGIOGRAPHY SERVICES, NEURODIAGNOSTICS SERVICES, GASTRO/INTESTINAL SERVICES, SLEEP LABORATORY, PULMONARY SERVICES, OUTPATIENT SURGERY, CARDIAC TESTING, ELECTROCARDIOGRAM (EKG) SERVICES, MEDICAL ONCOLOGY SERVICES, RADIATION ONCOLOGY SERVICES, PHARMACY, OCCUPATIONAL MEDICINE SERVICES, CARDIAC/PULMONARY REHABILITATION SERVICES, CONGESTIVE HEART FAILURE CLINIC, WOUND HEALING AND PREVENTION, NUTRITIONAL COUNSELING, DIABETES MANAGEMENT, BARIATRIC SERVICES, PAIN MANAGEMENT, SOCIAL SERVICES, PALLIATIVE CARE, SPORTS MEDICINE, BEHAVIORAL HEALTH, STROKE SERVICES, HOME HEALTH SERVICES, SKILLED NURSING SERVICES, SOCIAL SERVICES, DURABLE MEDICAL EQUIPMENT. - PRIMARY CARE AND SPECIALTY CARE PHYSICIAN CLINICS. SUBSIDIZED HEALTHCARE SERVICES OFFERED BY FRANCISCAN: - FRANCISCAN HAS NEIGHBORHOOD HEALTH CLINICS THAT OFFER FAMILY PRACTICE SERVICES DESIGNED FOR FAMILIES WITHOUT ACCESS TO AFFORDABLE HEALTH CARE. THE FOCUS IS ON PROVIDING PRIMARY AND PREVENTIVE CARE AS WELL AS HEALTH EDUCATION. THESE CLINICS OFFER FREE IMMUNIZATIONS. - FRANCISCAN'S SEXUAL ASSAULT CLINICS THAT PROVIDE MEDICAL AND FORENSIC ASSISTANCE THAT IS SENSITIVE TO THE SPECIAL NEEDS OF THE VICTIM AS WELL AS A VICTIM ADVOCATE PROGRAM AND CRISIS INTERVENTION COUNSELORS. - FRANCISCAN'S BLOOD AND MARROW TRANSPLANT PROGRAM IS ONLY ONE OF TWO PROGRAMS IN INDIANA OFFERING FULL SERVICE TRANSPLANT CARE AND SPECIALIZES IN THE TREATMENT OF PATIENTS WITH LEUKEMIA, HODGKIN'S OR NON-HODGKIN'S LYMPHOMA, MULTIPLE MYELOMA, AND MANY OTHER MALIGNANCIES AND BLOOD DISORDERS. - FRANCISCAN'S DIABETES EDUCATION CENTERS OFFER A NUMBER OF DIABETES CLASSES AND INDIVIDUALIZED SESSIONS TO HELP PATIENTS TAKE CONTROL OF THEIR HEALTH WITH A FOCUS ON NUTRITIONAL, EXERCISE, MEDICATIONS, CHRONIC CONDITIONS, PRECONCEPTION AND PREGNANCY, BLOOD GLUCOSE MONITORING, GOAL SETTING, PROBLEM SOLVING, PSYCHOSOCIAL ADJUSTMENT, DETECTION/TREATMENT OF HIGH AND LOW BLOOD SUGAR, AND INSULIN ADMINISTRATION. - FRANCISCAN'S WOMEN'S AND CHILDREN'S SERVICES INCLUDE PREVENTIVE MEDICAL CARE AND HEALTH SCREENINGS TO GYNECOLOGICAL CARE, MATERNITY, LACTATION CONSULTATION SERVICES, AND BEYOND WITH A FOCUS ON KEEPING WOMEN HEALTHY. - FRANCISCAN'S HOSPICE CARE SERVICES PROVIDE A SENSE OF DIGNITY AND COMPASSION TO BOTH THE PATIENT AND THEIR FAMILY IN CARING FOR PATIENTS WITH A LIFE EXPECTANCY OF SIX MONTHS OR LESS. OUR PROGRAMS AFFIRM AND CELEBRATE LIFE AND REGARD DYING AS A NATURAL PROCESS, RECOGNIZING THAT EVERY PERSON HAS THE RIGHT TO DIE WITH DIGNITY, PEACE, AND COMFORT REGARDLESS OF THEIR ETHNICITY, FAITH BACKGROUND, OR ABILITY TO PAY. - LEVEL III NICU - AMBULANCE SERVICE - PHYSICIAN SERVICES - INPATIENT PSYCHIATRIC UNITS - HEALTH AND WELLNESS CENTERS AND HEALTHY LIVING EDUCATION CENTERS - CLINICAL CARE COORDINATORS TO SUPPORT FRANCISCAN'S VARIOUS ACCOUNTABLE CARE ORGANIZATIONS WHICH ARE DESIGNED TO IMPROVE QUALITY AND REDUCE COST. - FRANCISCAN SENIOR HEALTH & WELLNESS IS A COMPLETE HEALTH CARE SOLUTION FOR SENIORS WHO WANT TO REMAIN AT HOME. OUR PROGRAM ENABLES SENIORS TO LIVE AS INDEPENDENTLY AS POSSIBLE BY PROVIDING TRULY ALL-INCLUSIVE SERVICES. FRANCISCAN SENIOR HEALTH & WELLNESS IS A PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE), A COMMUNITY-BASED HEALTHCARE PROGRAM CREATED FOR PEOPLE 55 OR OLDER WHO ARE ELIGIBLE FOR NURSING-HOME LEVEL CARE BUT PREFER TO RECEIVE THEIR CARE IN THEIR OWN FAMILIAR SURROUNDINGS. THE FRANCISCAN SENIOR HEALTH & WELLNESS - PACE PROGRAM DELIVERS ALL THE SERVICES NEEDED TO KEEP PEOPLE HEALTHY, SAFE AND COMFORTABLE IN THE PLACE THEY CALL HOME. COVERED BENEFITS INCLUDE: - PRIMARY MEDICAL AND NURSING CARE - OCCUPATIONAL, PHYSICAL, AND SPEECH THERAPY - MEDICATIONS AND DURABLE MEDICAL EQUIPMENT - LABORATORY AND DIAGNOSTIC SERVICES - ALL NECESSARY PRESCRIPTION DRUGS - SKILLED HOME CARE AND PERSONAL CARE AIDES - HOSPITALIZATION AND SKILLED NURSING FACILITY CARE - CARE FROM MEDICAL SPECIALISTS IN CARDIOLOGY, NEPHROLOGY, OPHTHALMOLOGY, DERMATOLOGY, ORTHOPEDICS, SURGERY, PODIATRY, AND MORE - MEDICALLY NECESSARY TRANSPORTATION OUR BROAD RANGE OF SERVICE PROVIDERS, INCLUDING DOCTORS, NURSES, PHARMACISTS, THERAPISTS AND PERSONAL CARE AIDES ARE READILY ACCESSIBLE. THROUGH THESE MEDICAL SERVICES, WE CAN MANAGE THE CARE OF AN AGING LOVED ONE, AND HELP AVOID THE ILLNESSES AND HOSPITALIZATIONS THAT SENIORS OFTEN FACE. IN ADDITION TO ADDRESSING EACH PARTICIPANT'S UNIQUE MEDICAL NEEDS, FRANCISCAN SENIOR HEALTH & WELLNESS ALSO HELPS WITH THE SOCIAL, EMOTIONAL, AND PRACTICAL CHALLENGES THAT OLDER ADULTS OFTEN FACE. THROUGH INTERACTIONS WITH PEERS, STIMULATIVE ACTIVITIES AND OTHER SUPPORTIVE SERVICES, PARTICIPANTS WILL ENJOY A BETTER QUALITY OF LIFE. - BEHAVIORAL HEALTH SERVICES AT FRANCISCAN HEALTH DYER TOUCHES ALL FACETS OF EMOTIONAL, MENTAL HEALTH, BEHAVIORAL HEALTH AND CHEMICAL DEPENDENCY PROBLEMS. WE OFFER TREATMENTS IN PSYCHIATRIC DISORDERS, SUBSTANCE ABUSE AND ADDICTION, FAMILY CONFLICTS, AND EMOTIONAL DISORDERS, INCLUDING TESTING FOR PSYCHOLOGICAL DISORDERS AND CONSULTATIONS. OUR BEHAVIORAL HEALTH SERVICES AND P"

SCHEDULE H, PART V, SECTION B - SUPPLEMENTAL INFORMATION
"LINE 3E: PLEASE SEE THE RESPONSE TO SCHEDULE H, PART V, LINE 11 BELOW FOR AN EXPLANATION OF HOW THE HEALTH NEEDS IDENTIFIED IN THE CHNA WERE PRIORITIZED. LINE 5: INPUT FROM INDIVIDUALS IN THE COMMUNITY IN INDIANA, A STATEWIDE FOCUS GROUP WAS HELD TO DISCUSS REGIONAL ISSUES WITH STATE PUBLIC HEALTH LEADERS. THE FOCUS GROUP WAS CO-SPONSORED BY INDIANA UNIVERSITY HEALTH, ST. VINCENT HEALTH, COMMUNITY HEALTH NETWORK, AND FRANCISCAN ALLIANCE ATTENDEES INCLUDED: - FRANCISCAN ALLIANCE, INC. - KATE HILL-JOHNSON, ADMINISTRATIVE DIRECTOR, COMMUNITY HEALTH IMPROVEMENT - HEALTH BY DESIGN/ALLIANCE FOR HEALTH PROMOTION KIM IRWIN, EXECUTIVE DIRECTOR - HEALTH OCCUPATION STUDENT ASSOCIATION (INDIANA) EDDIE ERICKSON, STATE COORDINATOR; HOLLI FRODGE, STATE PRESIDENT - HOOSIER ENVIRONMENTAL COUNCIL INDRA FRANK, ENVIRONMENTAL HEALTH PROJECT DIRECTOR - INDIANA AREA HEALTH EDUCATION CENTERS DR. JENNIFER TAYLOR, DIRECTOR OF EVALUATION - INDIANA ASSOCIATION OF AREA AGENCIES ON AGING KRISTEN LAEACE, CEO; DAWNE LYON; ELVA JAMES, EXECUTIVE DIRECTOR, AREA 4 AGENCY OF AGING - LEADING AGE INDIANA JIM LEICH, EXECUTIVE DIRECTOR; KATHY JOHNSON, DIRECTOR OF TRAINING - INDIANA CARDIOVASCULAR AND DIABETES COALITION SHARA WESLEY, COALITION MANAGER; JENNIFER PFERRER, CHAIRPERSON - INDIANA COALITION AGAINST DOMESTIC VIOLENCE COLLEEN YEAKLE, COORDINATOR OF PREVENTION INITIATIVES - INDIANA CANCER CONSORTIUM KEYLEE WRIGHT, CANCER CONTROL SECTION DIRECTOR - INDIANA JOINT ASTHMA COALITION - KELLI MCCRARY, COALITION COORDINATOR - IU HEALTH - JOYCE HERTKO - INDIANA HEALTHY WEIGHT INITIATIVE - ERIC BEERS, COALITION COORDINATOR - INDIANA HOSPITAL ASSOCIATION - BERNIE ULRICH, VICE PRESIDENT - INDIANA IMMUNIZATION COALITION - LISA ROBERSON, DIRECTOR - INDIANA MINORITY HEALTH COALITION - ANITA OHMIT, DIRECTOR OF RESEARCH; CALVIN ROBERSON, VP OF PLANNING AND PROGRAM DEVELOPMENT - INDIANA NURSES ASSOCIATION - BLAYNE MILEY, DIRECTOR OF POLICY AND ADVOCACY - INDIANA PSYCHOLOGICAL ASSOCIATION - DR. KATHLEEN VOGLER, PAST PRESIDENT; TABITHA ARNETTE, EXECUTIVE DIRECTOR - INDIANA PRIMARY HEALTH CARE ASSOCIATION - PHIL MORPHEW, CEO; ELAINE WILLIAMS, RESOURCE DEVELOPMENT PROGRAM DIRECTOR - INDIANA SCHOOL NURSES ASSOCIATION - CAROLYN SNYDER, EXECUTIVE DIRECTOR - INDIANA STATE DEPARTMENT OF HEALTH - DR. JOAN DUWVE, CHIEF MEDICAL OFFICER; KATELIN RYAN, DIRECTOR OF PROGRAM EVALUATION; J. DAVID HOPPER, DIRECTOR, LOCAL HEALTH DEPARTMENT OUTREACH DIVISION - INDIANA SOCIETY FOR PUBLIC HEALTH EDUCATION - HEIDI HANCHER-RAUCH, ADVOCACY CHAIR; JENNIFER CONNER, PRESIDENT - IUPUI FAIRBANKS SCHOOL OF PUBLIC HEALTH - SULA HOOD; CYNTHIA STONE - IUPUI POLIS CENTER - KAREN COMER - YMCA OF GREATER INDIANA - CHELSY WINTERS, ASSOCIATE DIRECTOR OF HEALTH PARTNERSHIPS PROGRAMS; ANN GRAVES, DIRECTOR OF HEALTH INITIATIVES AND PARTNERSHIPS IN ADDITION, LOCAL PUBLIC HEALTH AND SOCIAL LEADERS WERE CONSULTED ON THE COMMUNITY HEALTH ISSUES, PRIORITIZATION OF NEEDS, AND COMMUNITY STRENGTHS. THE ASSESSMENT TASK FORCE FOR FRANCISCAN HEALTH CARMEL, FRANCISCAN HEALTH INDIANAPOLIS, AND FRANCISCAN HEALTH MOORESVILLE INCLUDED: - DAN HODGKINS, VICE PRESIDENT OF HEALTH PROMOTION AND COMMUNITY BENEFIT, COMMUNITY HEALTH NETWORK - ANN YEAKLE, COMMUNITY BENEFIT COORDINATOR, COMMUNITY HEALTH NETWORK - JOHN WHITCOMB, CONSULTANT, FRANCISCAN ALLIANCE - KATE HILL-JOHNSON, COMMUNITY BENEFIT AND ENGAGEMENT, FRANCISCAN HEALTH INDIANAPOLIS - PAYGE LIGGETT, COMMUNITY BENEFIT ASSISTANT, FRANCISCAN HEALTH INDIANAPOLIS - MANDI EGGERT, SERVICE EXCELLENCE, FRANCISCAN HEALTH CROWN POINT - RACHEL BUCKMAN, HEALTH EDUCATOR, HENDRICKS COUNTY HEALTH DEPARTMENT - STEPHANIE BERRY, COMMUNITY OUTREACH AND ENGAGEMENT, INDIANA UNIVERSITY HEALTH - ANYAH LAND, COMMUNITY OUTREACH AND ENGAGEMENT, INDIANA UNIVERSITY HEALTH - REBECCA YORK, DIRECTOR OF NURSING, MORGAN COUNTY HEALTH DEPARTMENT - KELLY PEISKLER, COMMUNITY BENEFIT, ST. VINCENT HEALTH - STEPHANIE ULLIANA, COMMUNITY BENEFIT, ST. VINCENT HEALTH - AMBER BLACKMON, INDIANA UNIVERSITY SCHOOL OF PUBLIC HEALTH BLOOMINGTON - HEATHER DOLNE, INDIANA UNIVERSITY SCHOOL OF PUBLIC HEALTH BLOOMINGTON - VIDHI JOSHI, INDIANA UNIVERSITY SCHOOL OF PUBLIC HEALTH BLOOMINGTON - ASHLEY WEISHAAR, INDIANA UNIVERSITY SCHOOL OF PUBLIC HEALTH BLOOMINGTON - JACOB HARTMEISTER, INDIANA UNIVERSITY SCHOOL OF PUBLIC AND ENVIRONMENTAL AFFAIRS BLOOMINGTON - ZACH LOTFALION, INDIANA UNIVERSITY SCHOOL OF PUBLIC AND ENVIRONMENTAL AFFAIRS BLOOMINGTON - LAYNIE MASON, MARION UNIVERSITY SCHOOL OF MEDICINE - H705 PUBLIC HEALTH CAPSTONE COURSE SPRING 2015 STUDENTS, INDIANA UNIVERSITY, RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AT IUPUI, DR. CINDY STONE, CLINICAL ASSOCIATE PROFESSOR - HEALTHIER MORGAN COUNTY INITIATIVE - HENDRICKS COUNTY HEALTH PARTNERSHIP - PARTNERSHIP FOR HEALTHY HAMILTON COUNTY - JERRY KING, INDIANA PUBLIC HEALTH ASSOCIATION - CAROLYN M. MUEGGE, INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AT IUPUI - JOE GIBSON, MARION COUNTY HEALTH DEPARTMENT - TAMMY NELSON, MARION COUNTY HEALTH DEPARTMENT - KAREN COMER-FREDRICKSON, THE POLIS CENTER AT IUPUI THE ASSESSMENT TASK FORCE FOR FRANCISCAN HEALTH CRAWFORDSVILLE INCLUDED: - MAYOR TODD BARTON, CITY OF CRAWFORDSVILLE, MAYORS OFFICE - FAWN JOHNSON, DIRECTOR, CITY OF CRAWFORDSVILLE PARKS & RECREATION - STEVE HOUSE, DIRECTOR, CHAMBER OF COMMERCE - REX RYKER, ASSISTANT SUPERINTENDENT, CRAWFORDSVILLE SCHOOL CORPORATION - TERRY KLEIN, VP/COO, FRANCISCAN HEALTH CRAWFORDSVILLE - SISTER M. RUTH LUTHMAN OSF, DIRECTOR OF MISSION INTEGRATION, FRANCISCAN HEALTH CRAWFORDSVILLE - MATT OATES, MARKETING SPECIALIST, FRANCISCAN HEALTH CRAWFORDSVILLE - JOBETH MCCARTHY-JEAN, MPH, DIRECTOR, CENTER FOR PUBLIC HEALTH PRACTICE, - INDIANA PUBLIC HEALTH TRAINING CENTER, AND LIAISON, PUBLIC HEALTH CORPS - DR. CYNTHIA STONE, DRPH, RN, CLINICAL ASSOCIATE PROFESSOR, HEALTH POLICY AND MANAGEMENT CONCENTRATION DIRECTOR, INDIANA UNIVERSITY INDIANAPOLIS - RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH - ZACH CHURNEY, DEPUTY DIRECTOR, INDIANA WEST ADVANTAGE - JILL ROGERS, PRESIDENT OF THE BOARD OF MCT (MEDICAL CARE TRUST) - NANCY SENNETT, PRESIDENT, MONTGOMERY COUNTY HEALTH BOARD - DR. SCOTT DOUGLAS, VICE-PRESIDENT, MONTGOMERY COUNTY HEALTH BOARD - MONICA NAGELE, DIRECTOR, MONTGOMERY COUNTY PURDUE EXTENSION - AMBER REED, ADMINISTRATOR, MONTGOMERY COUNTY HEALTH DEPARTMENT - LUKE WREN, ACCREDITATION COORDINATOR, MONTGOMERY COUNTY HEALTH DEPARTMENT - SAMANTHA SWEARINGEN, HEALTH EDUCATOR, MONTGOMERY COUNTY HEALTH DEPARTMENT - REBECCA LANG, PUBLIC HEALTH NURSE, MONTGOMERY COUNTY HEALTH DEPARTMENT - MARK DAVIDSON, MONTGOMERY COUNTY COUNCIL - LEAH SINNET, NUCOR STEEL - DAVID JOHNSON, EXECUTIVE DIRECTOR, MUFFY - DR. SARA DRURY, STRATEGIC PLANNING FACILITATOR, WABASH COLLEGE - KYLE STUCKER, WABASH STUDENT - KATE HILL-JOHNSON, ADMINISTRATIVE DIRECTOR OF COMMUNITY HEALTH IMPROVEMENT, FRANCISCAN HEALTH - JESS CORBIN, DIRECTOR, ACO CARE MANAGEMENT, FRANCISCAN HEALTH CRAWFORDSVILLE - RAYMOND P. MILLER, DIVISION CHIEF OF EMS CRAWFORDSVILLE FIRE DEPARTMENT - JOSHUA S. KRUMENACKER, M.D., MEDICAL DIRECTOR FOR PARAMEDICINE AND FRANCISCAN PHYSICIAN NETWORK (""FPN"") PHYSICIAN THE ASSESSMENT TASK FORCE FOR FRANCISCAN HEALTH LAFAYETTE INCLUDED REPRESENTATIVES FROM: - ACTION FOR HEALTHY KIDS - AMERICAN HEALTH NETWORK - AREA IV ON AGING AND COMMUNITY ACTION PROGRAMS - CITY OF LAFAYETTE - CITY OF WEST LAFAYETTE - COMMUNITY VOLUNTEERS - DRUG FREE COALITION OF TIPPECANOE COUNTY - EMPLOYEE BENEFITS SOLUTIONS - EMPLOYERS HEALTH NETWORK - FRANCISCAN HEALTH LAFAYETTE - GREATER LAFAYETTE COMMERCE - GREATER LAFAYETTE PARISH NURSE - GROUP HOMES FOR CHILDREN - HANNA/MINORITY HEALTH COALITION - HENRIOTT GROUP - KATHRYN WEIL CENTER - PHOENIX GROUP - IU HEALTH ARNETT - KIRBY RISK - LAFAYETTE SCHOOL CORPORATION WELLNESS COMMITTEE - LAFAYETTE FAMILY YMCA - LAFAYETTE YWCA - LAFAYETTE URBAN MINISTRY - MENTAL HEALTH AMERICA - MISSION COMMITTEE OF THE WESTERN INDIANA BOARD OF FRANCISCAN HEALTH LAFAYETTE - NUTRIPLEDGE - PARISH NURSES - PURDUE EXTENSION - PURDUE DEPARTMENT OF HEALTH & KINESIOLOGY - RIGGS COMMUNITY HEALTH CENTER - TIPPECANOE COUNTY HEALTH DEPARTMENT - TOBACCO FREE PARTNERSHIP - UNITED WAY OF GREATER LAFAYETTE - UNITY HEALTHCARE - WOMEN, INFANT, CHILDREN (WIC) PROGRAM THE ASSESSMENT TASK FORCE FOR FRANCISCAN HEALTH DYER, FRANCISCAN HEALTH HAMMOND, FRANCISCAN HEALTH MUNSTER, AND FRANCISCAN HEALTH CROWN POINT INCLUDED REPRESENTATIVES FROM: - 411 NEWSPAPER - COMMUNITY CARE NETWORK, INC. (CCNI) - CITY OF EAST CHICAGO HEALTH DEPARTMENT - CITY OF EAST CHICAGO - CITY OF GARY COMMUNITY DEVELOPMENT DEPARTMENT - COMMUNITY HEALTHNET INC. - EDGEWATER BEHAVIORAL HEALTH SERVICES - FRANCISCAN ALLIANCE - FRANCISCAN HEALTH - DYER, HAMMOND, MUNSTER, AND CROWN POINT - GARY HEALTH AND HUMAN SERVICES DEPARTMENT - GARY MENTAL HEALTH - GEMINUS CORPORATION - GREATER PORTAGE CHAMBER OF COMMERCE - HEALTHLINC - HOOSIER ENVIRONMENTAL COUNCIL - HOBART FAMILY YMCA - IVY TECH COMMUNITY COLLEGE - JASPER COUNTY HEALTH DEPARTMENT - LAKE AREA UNITED WAY - LAKESHORE CHAMBER OF"

LINES 6A AND 6B: ALL FACILITIES
IN INDIANA, ALL FRANCISCAN ALLIANCE HOSPITAL FACILITIES COLLABORATED IN A STATEWIDE PARTNERSHIP WITH ST. VINCENT HEALTH, INDIANA UNIVERSITY HEALTH, COMMUNITY HEALTH NETWORK, INDIANA UNIVERSITY RICHARD M. FAIRBANKS SCHOOL OF PUBLIC HEALTH AT INDIANAPOLIS, AND WITH EACH FACILITY WITHIN THE FRANCISCAN HEALTH SYSTEM. LINES 6A AND 6B: FRANCISCAN HEALTH DYER, FRANCISCAN HEALTH HAMMOND, FRANCISCAN HEALTH MUNSTER, AND FRANCISCAN HEALTH CROWN POINT ALSO COLLABORATED WITH METHODIST HEALTH SYSTEMS AND COMMUNITY HEALTH SYSTEM. A THIRD PARTY, PROFESSIONAL RESOURCE CONSULTANT, WAS USED FOR KEY LEADER SURVEYS AND INTERVIEWS. LINES 6A AND 6B: FRANCISCAN HEALTH CHICAGO HEIGHTS AND FRANCISCAN HEALTH OLYMPIA FIELDS ALSO PARTNERED WITH THE COOK COUNTY COLLABORATIVE, WHICH INCLUDES THE HEALTH DEPARTMENTS AND HOSPITALS SYSTEMS IN CHICAGO AND CHICAGO SUBURBS. LINE 6B: FRANCISCAN HEALTH MOORESVILLE PARTNERED WITH THE HENDRICKS COUNTY HEALTH DEPARTMENT AND THE MORGAN COUNTY HEALTH DEPARTMENT TO MEET THE LOCAL HEALTH DEPARTMENT ACCREDITATION STANDARDS AND THE COMMUNITY BENEFIT REQUIREMENTS. LINE 6B: FRANCISCAN HEALTH CRAWFORDSVILLE PARTNERED WITH THE MONTGOMERY COUNTY HEALTH DEPARTMENT TO MEET THE LOCAL HEALTH DEPARTMENT ACCREDITATION STANDARDS AND THE COMMUNITY BENEFIT REQUIREMENTS. LINE 6B: FRANCISCAN HEALTH LAFAYETTE PARTNERED WITH THE TIPPECANOE HEALTH DEPARTMENT TO MEET THE LOCAL HEALTH DEPARTMENT ACCREDITATION STANDARDS AND THE COMMUNITY BENEFIT REQUIREMENTS.

LINE 7: ALL FACILITIES
ALL CHNA REPORTS ARE AVAILABLE ON FRANCISCAN ALLIANCES WEBSITE AT HTTPS://WWW.FRANCISCANHEALTH.ORG/COMMUNITYHEALTH LINE 10: ALL FACILITIES ALL IMPLEMENTATION PLANS ARE AVAILABLE ON FRANCISCAN ALLIANCES WEBSITE AT HTTPS://WWW.FRANCISCANHEALTH.ORG/COMMUNITYHEALTH

LINE 11: COMMUNITY HEALTH NEEDS ASSESSMENT
"FRANCISCAN ALLIANCE PARTNERED WITH MULTIPLE COMMUNITY PARTNERSHIPS AND ADDITIONAL HEALTH SYSTEMS TO COMPLETE THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE PARTNERSHIP WITH THE LARGEST HEALTH SYSTEMS IN INDIANA AND THE COMMUNITY PARTNERSHIPS ALLOWED FOR BETTER DATA COLLECTION, REDUCED BURDEN ON RESIDENTS TO COMPLETE SURVEYS, AND A PLATFORM TO COMBINE EFFORTS ON VARIOUS COMMUNITY HEALTH NEEDS THROUGHOUT THE STATE. READERS WILL FIND THAT CHNAS FROM THESE SYSTEMS ARE ALIGNED, THOUGH EACH MAY HAVE PARTICULAR AREAS OF EMPHASIS DEPENDING ON THE SPECIFIC POPULATION SERVED AND THE GEOGRAPHIC LOCATION OF HOSPITALS. BECAUSE INDIANA OPERATES AS A HOME RULE STATE (THE INDIANA STATE CONSTITUTION ALLOWS FOR MUNICIPALITIES TO PASS LAWS TO GOVERN THEMSELVES AS THEY SEE FIT, WHICH LEADS TO A DECENTRALIZED GOVERNMENT), EACH COUNTY HAS A DIFFERENT PUBLIC HEALTH INFRASTRUCTURE AND RESOURCES IN ADDITION TO THE VARIATIONS BASED ON URBAN/RURAL STATUS, POPULATION, AND ECONOMIC MIX. DATA ON ZIP CODE OR CENSUS TRACK IS HIGHLY LACKING; THEREFORE THE DESIGN WAS BUILT ON A COUNTY BASIS. ELEVEN COUNTIES OF 28 INCLUDED IN THE ASSESSMENT ARE HOME TO MORE THAN ONE OF THE HEALTH SYSTEMS IN THE COLLABORATIVE. IN THESE COUNTIES, A COUNTY 'CAPTAIN' WAS ELECTED TO COORDINATE THE CHNA PROCESS ON BEHALF OF THE PARTNERSHIP. IN THE REMAINING COUNTIES WHERE ONLY ONE HEALTH SYSTEM WAS REPRESENTED, THE HEALTH SYSTEM IN THE COUNTY USED THE COLLABORATIVE MATERIALS AND RESOURCES, BUT COMPLETED THE WORK INDEPENDENTLY. THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP)MODEL, DEVELOPED BY THE NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH OFFICIALS (NACCHO), GUIDED THE ASSESSMENT PROCESS IN HENDRICKS AND MORGAN COUNTIES, AS BOTH COUNTY HEALTH DEPARTMENTS ARE WORKING ON ACCREDITATION THROUGH THE PUBLIC HEALTH ACCREDITATION BOARD (PHAB). THE MAPP MODEL INCLUDES SEVERAL COMPONENTS FOR COMMUNITY ASSESSMENT. FRANCISCAN PARTICIPATED IN ALL OF THE ASSESSMENT ACTIVITIES THAT WERE IN PROCESS DURING THE PERIOD OF THE HOSPITAL PARTNERSHIPS TIME FRAME. MARION COUNTY IS SEEKING ACCREDITATION, BUT HAD ALREADY COMPLETED THEIR COMMUNITY HEALTH ASSESSMENT PRIOR TO THE COLLABORATIVES TIME FRAME. INDIANA DOES NOT REQUIRE PHAB ACCREDITATION BY COUNTY HEALTH DEPARTMENTS AND A VAST MAJORITY OF HEALTH DEPARTMENTS ARE NOT SEEKING ACCREDITATION. IN THE REMAINING COUNTIES IDENTIFIED IN THIS ASSESSMENT, THE PRECEDE PROCEDE METHOD WAS UTILIZED. THIS ASSESSMENT REFLECTS PHASES 1 THROUGH 5. COMMUNITY BENEFIT PROFESSIONALS FROM EACH HEALTH SYSTEM WORKED TOGETHER ON DATA COLLECTED IN FOUR WAYS: 1. COMMUNITY HEALTH SURVEY: A CORE OF 20 MANDATORY QUESTIONS BASED ON PERCEPTION OF COMMUNITY AND PERSONAL NEEDS WAS CREATED. IN ADDITION, PROFESSIONALS ASSIGNED TO EACH COUNTY WORKED WITH ESTABLISHED COMMUNITY HEALTH COLLABORATIVES, LOCAL HOSPITALS, AND THE LOCAL HEALTH DEPARTMENT TO DEVELOP VOLUNTARY QUESTIONS SPECIFIC TO THE COUNTY. THIS RESULTED IN A SURVEY WITH 20 TO 29 QUESTIONS, DEPENDENT ON THE RESPONDENTS COUNTY OF RESIDENCE. 2. THE SURVEY WAS DISTRIBUTED ELECTRONICALLY AND ON PAPER. THE GOAL WAS TO ATTAIN A SAMPLE SIZE WITH A 95% CONFIDENCE LEVEL AND + OR 5% MARGIN OF ERROR. IN MOST COUNTIES, THE SAMPLE SIZE MET THIS GOAL; HOWEVER, PARTICULAR EMPHASIS ON VULNERABLE POPULATIONS MEANS THE SURVEY RESULTS ARE NOT A TRUE REPRESENTATION OF THE ENTIRE COUNTY POPULATION; BUT SKEWED TO REPRESENT THE MOST IN NEED. IN ADDITION TO THE QUANTITATIVE DATA, FREE TEXT RESPONSES WERE CODED AND CALCULATED TO PROVIDE FURTHER CLARIFICATION OF THE QUANTITATIVE DATA. 3. FOCUS GROUPS: BECAUSE FOCUS GROUPS ARE FACILITATED BASED ON THE CONVERSATION OF THE PARTICIPANTS, THE COLLABORATIVE DETERMINED OUTCOMES TO BE ACHIEVED DURING THE TWO-HOUR SESSIONS. MOST FOCUS GROUPS INCLUDED 15-60 COMMUNITY LEADERS FROM GOVERNMENTAL PUBLIC HEALTH, HEALTH CARE, SOCIAL SERVICE AGENCIES, RELATED NON-PROFITS, AND GRASSROOTS/NEIGHBORHOOD ORGANIZATIONS. IN LARGER FOCUS GROUPS, SUB- GROUPS WERE UTILIZED TO GIVE ALL PARTICIPANTS A VOICE. EACH FOCUS GROUP DETERMINED THE TOP FOUR TO SIX HEALTH NEEDS IN THE COMMUNITY; POTENTIAL RESOURCES OR PARTNERS; AND SOME ACTIONS/INTERVENTIONS THAT MIGHT WORK BEST. 4. SECONDARY DATA COLLECTION: WITH THE ASSISTANCE OF PUBLIC HEALTH UNDERGRADUATE AND GRADUATE STUDENTS, DATA ON HEALTH AND WELLNESS ISSUES WAS COLLECTED. SOURCES INCLUDE COUNTY HEALTH RANKINGS, CENSUS BUREAU DATA, VARIOUS REPORTS FROM THE INDIANA STATE DEPARTMENT OF HEALTH, AND OTHER NATIONAL REPORTS. INDIANA INDICATORS, COMMUNITY COMMONS, AND HEALTHY COMMUNITIES INSTITUTE DATA MANAGEMENT SYSTEMS ALSO CONTRIBUTED TO THE SECONDARY DATA USED. SOURCES OF THE SECONDARY DATA ARE IDENTIFIED THROUGHOUT THIS REPORT. IN ADVANCE OF THE FOCUS GROUPS, A FOCUS GROUP FOR STATE-WIDE ORGANIZATIONS WAS HELD FOR INDIANA. LEADERS FROM ORGANIZATIONS THAT SERVE THE ENTIRE STATE OF INDIANA GATHERED TO DISCUSS TRENDS AND GROWING CONCERNS BY PREPAREDNESS DISTRICT AND BY AGE OF THE POPULATION. THE RESULTS WERE USED AS A PROBE IN THE REMAINING FOCUS GROUPS AND AS AREAS FOR FURTHER STUDY IN SECONDARY DATA. A FOCUS GROUP OF HIGH SCHOOL STUDENTS CONVENED BY THE INDIANA CHAPTER OF HEALTH OCCUPATION STUDENT ASSOCIATION DURING THEIR ANNUAL CONFERENCE ALSO OFFERED SOME INSIGHT. THIS FOCUS GROUP YIELDED SOME INTERESTING INSIGHTS FROM THE TEEN PERSPECTIVE. IN DETERMINING COMMUNITY HEALTH INTERVENTIONS FOR THE SELECTED PRIORITY HEALTH NEEDS, HEALTH EQUITY, SUSTAINABILITY, AND CONSIDERATION OF THE SOCIAL DETERMINANTS OF HEALTH ARE KEY PRINICIPLES. WHILE MOST INTERVENTIONS FOCUS ON THE INDIVIDUAL LIFESTYLE FACTORS, KNOWLEDGE, SKILLS, AND BEHAVIORS, CONSIDERATION OF THE CULTURAL AND ENVIRONMENTAL CONTEXTS ARE JUST AS IMPORTANT. FRANCISCAN ALLIANCE ACKNOWLEDGES THAT TRUE CHANGE COMES WITH MAJOR SHIFTS IN ALL AREAS. THE FIRST CRITERIA USED TO DETERMINE IMPLEMENTATION STRATEGIES IS THE CONNECTION TO THE SOCIO-ECOLOGICAL MODEL AND SOCIAL DETERMINENTS OF HEALTH. INTERVENTIONS IMPLEMENTED BY FRANCISCAN ALLIANCE ARE PERSON-CENTERED AND DESIGNED TO CREATE LASTING CHANGE. MALCOLM KNOWLES PRINCIPLES OF ANDRAGOGY PROVIDED THE FRAMEWORK. WHILE THIS MODEL IS BASED ON EDUCATIONAL PROGRAMMING, IT APPLIES TO ALL TYPES OF INTERVENTIONS. FOR EXAMPLE, IN THE PROVISION OF CLINICAL CARE OR MEDICATION ASSISTANCE, PARTICIPANTS NOT ONLY RECEIVE THE CARE OR MEDICATION, THEY ALSO LEARN TO BETTER MANAGE THEIR OWN HEALTH OR ACCESS COMPONENTS OF THE HEALTH SYSTEM OR ASSISTANCE PROGRAM. REFLECTION, TEACH-BACK, AND COMMUNICATION TECHNIQUES ARE UTILIZED TO EMPOWER THE PARTICIPANT TO MOVE BEYOND A ONE-TIME INTERACTION OR ASSISTANCE. FRANCISCAN ALLIANCE USES EVIDENCE-BASED PRACTICES IN PLANNING INTERVENTIONS WHENEVER POSSIBLE, AS THESE PROGRAMS HAVE BEEN THOROUGHLY TESTED AND HAVE PROVEN EFFICACY. WHEN EVIDENCE-BASED PROGRAMS ARE NOT AVAILABLE, BEST PRACTICES AND DOCUMENTED RESEARCH GUIDES THE DEVELOPMENT AND IMPLEMENTATION OF THE INTERVENTION. IMPLEMENTATION ACTIVITIES WILL BE EVALUATED TO THE FULLEST EXTENT. USING THE KIRKPATRICK MODEL (A STANDARDIZED EVALUATION SYSTEM BASED ON REACTION, LEARNING, BEHAVIOR, AND RESULTS) AS A GUIDE, EVALUATION OF NOT ONLY THE PROGRAM, BUT ITS IMPACT AND RESULTS WILL BE REVIEWED. THIS PROCESS ALLOWS FOR CHANGES TO BE MADE TO IMPROVE THE PROGRAM ON AN ONGOING BASIS. WHILE IT CAN BE DIFFICULT TO DETERMINE THE EXACT CAUSE OF INDIVIDUAL BEHAVIORAL CHANGE, BIOMETRICS, POST-FOLLOW UP SURVEYS, AND OTHER METHODS WERE USED TO CAPTURE QUALITATIVE AND QUANTITATIVE DATA. THE FRANCISCAN ALLIANCE HOSPITALS MADE THE FOLLOWING PROGRESS DURING 2018 IN ADDRESSING THE IDENTIFIED COMMUNITY HEALTH NEEDS FROM ITS MOST RECENT CHNA: FRANCISCAN HEALTH CARMEL: - PHYSICAL ACTIVITY - COMPLETED AS INDICATED. PROGRAM WILL END DUE TO TAX ID/STRUCTURE AT THIS HOSPITAL. - ACCESS TO HEALTH CARE - COMPLETED AND EXCEEDED DETERMINED GOALS. FRANCISCAN HEALTH CRAWFORDSVILLE: - PARAMEDICINE - COMPLETED AND EXCEEDED DETERMINED GOALS. DUE TO SUCCESS OF THIS PROGRAM, IT HAS BEEN EXPANDED AND WILL CONTINUE THROUGH A HOSPITAL-CITY PARTNERSHIP AND SUPPORT. - PHYSICAL ACTIVITY - COMPLETED AS INDICATED. THIS PROGRAM WILL END REDIRECTING RESOURCES TO OTHER PROGRAMS. FRANCISCAN HEALTH CROWN POINT: - STEPPING ON FALL PREVENTION - UNMET. ONLY 13 PEOPLE ATTENDED THE PROGRAM. HAD DIFFICULTY RECRUITING PARTICIPANTS. - DIABETES PREVENTION PROGRAM (""DPP"") - COMPLETED. PROGRAM WILL CONTINUE AS A ONE-ON-ONE PRORGAM INSTEAD OF GROUP FORMAT TO BETTER MEET THE NEEDS OF THE PARTICIPANTS. - ACCESS TO HEALTH CARE FOR UNINSURED - COMPLETED, WITH SOME STRUCTURAL CHANGES DUE TO MOVING PROGRAMS TO FRANCISCAN PHYSICIAN NETWORK. NOW INTEGRATED AS STANDARD PRACTICE. FRANCISCAN HEALTH HAMMOND AND FRANCISCAN HEALTH DYER: - ADOLESCENTS COPING WITH DEPRESSION - COMPLETED AS INDICATED. PROGRAM WILL NOT CONTINUE. - ASTHMA SCHOOL PROGRAM - COMPLETED AS INDICATED. PROGRAM WILL NOT CONTINUE. - PERIOD OF PURPLE CRYING - COMPLETED AS INDICATED AND NOW INTEGRATED AS STANDARD PRACTICE. FRANCSICAN HEALTH INDIANAPOLIS AND MOORESVILLE: - MEDICATION ASSISTANCE - SHIFTED TO MEDI"

LINES 15 AND 16: ALL FACILITIES
"THROUGH FRANCISCAN ALLIANCE, INC. (""FRANCISCAN""), WE CONTINUE THE HEALING MINISTRY OF CHRIST IN A CATHOLIC HEALTH CARE SYSTEM THAT UPHOLDS THE MORAL VALUES AND TEACHINGS OF THE CATHOLIC CHURCH. CENTRAL CONCERNS OF THIS CORPORATE MINISTRY INCLUDE COMPASSION FOR THOSE IN NEED, RESPECT FOR LIFE AND THE DIGNITY OF PERSONS. FRANCISCAN BELIEVES IN THE DIGNITY, UNIQUENESS, AND WORTH OF EACH INDIVIDUAL AND, WITHIN THE LIMITS OF OUR RESOURCES, FRANCISCAN OFFERS A COMPREHENSIVE RANGE OF HEALTH CARE SERVICES TO ALL REGARDLESS OF RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, HANDICAP OR AN INDIVIDUAL'S FINANCIAL CAPABILITY. IN LIGHT OF THIS BELIEF, WE CONSIDER OUR HEALTH CARE SERVICES TO BE REACHING OUT AND RESPONDING, IN A CHRIST-LIKE MANNER, TO THOSE WHO ARE PHYSICALLY, MATERIALLY, OR SPIRITUALLY IN NEED. FRANCISCAN IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE, IN THE FORM OF CHARITY CARE OR UNINSURED DISCOUNTS, TO PERSONS WHO ARE UNINSURED OR UNDERINSURED, WHO ARE INELIGIBLE FOR GOVERNMENTAL OR SOCIAL SERVICE PROGRAMS, AND WHO OTHERWISE ARE UNABLE TO PAY FOR EMERGENCY SERVICES OR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. CONSISTENT WITH OUR MISSION TO DELIVER COMPASSIONATE, HIGH QUALITY, AFFORDABLE HEALTH CARE AND TO ADVOCATE FOR THOSE WHO ARE POOR AND DISENFRANCHISED, FRANCISCAN STRIVES TO ENSURE THE FINANCIAL CAPACITY OF PEOPLE WHO NEED MEDICALLY NECESSARY HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING THAT CARE. FRANCISCAN'S FINANCIAL ASSISTANCE POLICY IS DESIGNED TO ALLOW RELIEF FROM ALL OR PART OF THE CHARGES RELATED TO EMERGENCY OR MEDICALLY NECESSARY HEALTH CARE SERVICES THAT EXCEED A PATIENT'S REASONABLE ABILITY TO PAY. IN ORDER TO ENSURE TRANSPARENCY, CONSISTENCY AND FAIRNESS, WE ASK PATIENTS TO COOPERATE BY PROVIDING NECESSARY INFORMATION TO DETERMINE THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. FOR PATIENTS NOT INITIALLY IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, FRANCISCAN COMMUNICATES THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE IN THE APPLICABLE LANGUAGES OF THE HOSPITAL COMMUNITY THROUGH THE FOLLOWING MEANS: 1. FRANCISCAN COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE IN APPROPRIATE CARE SETTINGS SUCH AS EMERGENCY DEPARTMENTS, ADMITTING/REGISTRATION AREAS, BILLING OFFICES, OUTPATIENT SERVICE SETTINGS, AND ON OUR HOSPITALS' WEBSITES. SIGNS/POSTINGS INFORM PATIENTS THAT FREE OR REDUCED COST CARE MAY BE AVAILABLE TO QUALIFYING PATIENTS WHO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. 2. BROCHURES SUMMARIZING OUR FINANCIAL ASSISTANCE PROGRAMS ARE AVAILABLE THROUGHOUT EACH FRANCISCAN HOSPITAL. 3. FINANCIAL COUNSELORS AND BUSINESS OFFICE PERSONNEL ARE AVAILABLE TO HELP PATIENTS UNDERSTAND AND APPLY FOR LOCAL, STATE, FEDERAL HEALTH CARE, AND HEALTH INSURANCE EXCHANGE PROGRAMS AND FRANCISCAN'S FINANCIAL ASSISTANCE PROGRAMS. 4. ALL BILLS AND STATEMENTS FOR SERVICES INFORM UNINSURED PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. 5. PATIENTS/GUARANTORS MAY REQUEST A COPY OF THE FINANCIAL ASSISTANCE APPLICATION BY CALLING THE FRANCISCAN BILLING OFFICE OR DOWNLOADING A COPY AT NO COST FROM FRANCISCAN HOSPITAL'S WEBSITES. 6. PATIENTS/GUARANTORS CAN REQUEST FINANCIAL ASSISTANCE INFORMATION BY CALLING FRANCISCAN'S BILLING OFFICE PHONE LINE ON A 24-HOUR BASIS. 7. INDIVIDUALS OTHER THAN THE PATIENT, SUCH AS THE PATIENT'S PHYSICIAN, FAMILY MEMBERS, COMMUNITY OR RELIGIOUS GROUPS, SOCIAL SERVICES, OR HOSPITAL PERSONNEL MAY MAKE REQUESTS FOR FINANCIAL ASSISTANCE ON THE PATIENT'S BEHALF, SUBJECT TO APPLICABLE PRIVACY LAWS. 8. PRIOR TO TRANSFER TO A COLLECTION AGENCY, FRANCISCAN SENDS A MINIMUM OF 4 STATEMENTS AND MAKES 6 PHONE CALL ATTEMPTS TO CONTACT THE PATIENT/GUARANTOR AT THE ADDRESS AND PHONE NUMBER PROVIDED BY THE PATIENT/GUARANTOR. STATEMENTS AND COMMUNICATIONS INFORM THE PATIENT OF THE AMOUNT DUE AND IF THEY CANNOT PAY THEIR BALANCE THE AVAILABILITY OF FINANCIAL ASSISTANCE. A PATIENT'S QUALIFICATION FOR CHARITY CARE IS DETERMINED THROUGH A FINANCIAL ASSISTANCE APPLICATION AND SCREENING PROCESS. PATIENTS WHO MAY QUALIFY FOR MEDICAID OR ANY OTHER GOVERNMENTAL ASSISTANCE MUST BE DENIED COVERAGE OR ASSISTANCE FROM THOSE GOVERNMENTAL PROGRAMS PRIOR TO RECEIVING APPROVAL FOR CHARITY CARE. AS SUCH, FRANCISCAN OFFERS PATIENTS ASSISTANCE IN APPLYING OR ENROLLING IN SUCH PROGRAMS. A PATIENT WILL NEED TO FILL OUT, SIGN, AND SUBMIT THE FINANCIAL ASSISTANCE APPLICATION ALONG WITH ALL REQUESTED DOCUMENTATION OF INCOME, EXPENSES, ASSETS, AND LIABILITIES. FRANCISCAN'S BILLING OFFICE WILL PLACE THE PATIENT'S ACCOUNT ON HOLD ONCE A FINANCIAL ASSISTANCE APPLICATION HAS BEEN REQUESTED AND UNTIL A FINANCIAL ASSISTANCE DETERMINATION IS MADE. APPLICANTS ARE TREATED WITH DIGNITY AND RESPECT THROUGHOUT THE FINANCIAL ASSISTANCE PROCESS AND ALL INFORMATION/MATERIALS RECEIVED ARE CONFIDENTIALLY MAINTAINED. FRANCISCAN ALSO UTILIZES AN EXTERNAL VENDOR, SERVICE, OR DATA SOURCE THAT PROVIDES INFORMATION ON A PATIENT'S OR GUARANTOR'S ABILITY TO PAY (I.E. CREDIT SCORING). ELIGIBILITY FOR CHARITY CARE MAY BE DETERMINED AT ANY POINT IN THE COLLECTIONS CYCLE (I.E. PRIOR TO THE PROVISION OF SERVICES, DURING THE NORMAL COLLECTIONS CYCLE, OR MAY BE USED TO RE-CLASSIFY ACCOUNTS AFTER THEY HAVE BEEN DEEMED UNCOLLECTIBLE AND SUBSEQUENTLY RETURNED FROM A THIRD PARTY COLLECTION AGENCY). ONCE APPROVED, THE PATIENT WILL REMAIN ELIGIBLE FOR CHARITY CARE FOR A MAXIMUM OF FOUR MONTHS. THE ELIGIBILITY PERIOD WILL BEGIN FROM THE DATE OF THE PATIENT'S APPROVAL OF CHARITY CARE. CHARITY CARE DISCOUNTS WILL BE GIVEN FOR CURRENT OPEN ACCOUNTS AND THE FOLLOWING FOUR MONTHS OF EMERGENCY SERVICES OR MEDICALLY NECESSARY CARE. AFTER THE ELIGIBILITY PERIOD HAS ELAPSED, THE PATIENT MUST REAPPLY FOR FINANCIAL ASSISTANCE. LINES 16A, 16B, AND 16C: ALL FACILITIES THE FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY OF THE FAP ARE AVAILABLE AT THE FOLLOWING ADDRESS: HTTPS://FRANCISCANHEALTH.ORG/PATIENTS-AND-VISITORS/BILLING-INSURANCE/FINAN CIAL-ASSISTANCE-AND-COUNSELING LINE 22: FRANCISCAN HEALTH CHICAGO HEIGHTS, FRANCISCAN HEALTH OLYMPIA FIELDS FRANCISCAN HEALTH CHICAGO HEIGHTS AND FRANCISCAN HEALTH OLYMPIA FIELDS COMPUTE THE MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS BASED ON THE ILLINOIS UNINSURED DISCOUNT ACT. UNDER THIS ACT, ILLINOIS FACILITIES CANNOT CHARGE GREATER THAN 135% OF COST. THIS METHOD RESULTS IN A LARGER DISCOUNT THAN THAT DETERMINED BY THE FEDERAL CALCULATION."

SUPPLEMENTAL INFORMATION
"SCHEDULE H, PART VI, ITEM 2 NEEDS ASSESSMENT FRANCISCAN ALLIANCE, INC. (""FRANCISCAN"") HOSPITALS ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE BY COLLABORATING WITH PUBLIC AND PRIVATE AGENCIES TO DETERMINE COMMUNITY HEALTH NEEDS AND HOW BEST TO ADDRESS THEM. FRANCISCAN'S CORPORATE COMMUNITY BENEFIT COMMITTEE, AS WELL AS COMMITTEES IN THE LOCAL FACILITIES, COMMITTED TO AN ONGOING ASSESSMENT OF COMMUNITY HEALTH NEEDS AND PRIORITIES BASED UPON HEALTH INITIATIVES OF THE MUNICIPAL, COUNTY, AND STATE HEALTH DEPARTMENTS, COMMUNITY-BASED ASSESSMENTS BY OTHER PUBLIC SECTOR PARTNERS, PROFESSIONAL RESEARCH CONSULTANT REPORTS, AND FAITH-BASED PARTNERS WITHIN THE COMMUNITIES SERVED. IN ADDITION, OUR HOSPITALS ADDRESS PUBLIC AGENCY AND COMMUNITY GROUP REQUESTS TO PROVIDE COMMUNITY BENEFIT ACTIVITIES AND PROGRAMS THAT MEET CERTAIN SPECIALTY OR HYBRID NEEDS OR POPULATIONS. THE DETAILED CHNA ACTIVITIES FOR EACH OF FRANCISCAN'S HOSPITALS CAN BE FOUND IN PART V OF THIS SCHEDULE H. ------------------------------------------------------------------- SCHEDULE H, PART VI, ITEM 3 FINANCIAL ASSISTANCE POLICY FRANCISCAN'S HOSPITALS INFORM AND EDUCATE PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER FRANCISCAN'S FINANCIAL ASSISTANCE AND CHARITY CARE POLICY. FOR PATIENTS NOT INITIALLY IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE, FRANCISCAN COMMUNICATES THE AVAILABILITY OF CHARITY CARE AND FINANCIAL ASSISTANCE IN THE APPLICABLE LANGUAGES OF THE HOSPITAL COMMUNITY THROUGH THE FOLLOWING MEANS: 1. FRANCISCAN COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE IN APPROPRIATE CARE SETTINGS SUCH AS EMERGENCY DEPARTMENTS, ADMITTING/REGISTRATION AREAS, BILLING OFFICES, OUTPATIENT SERVICE SETTINGS, AND ON OUR HOSPITALS' WEBSITES. SIGNS/POSTINGS INFORM PATIENTS THAT FREE OR REDUCED COST CARE MAY BE AVAILABLE TO QUALIFYING PATIENTS WHO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. 2. BROCHURES SUMMARIZING OUR FINANCIAL ASSISTANCE PROGRAMS ARE AVAILABLE THROUGHOUT EACH FRANCISCAN HOSPITAL. 3. FINANCIAL COUNSELORS AND BUSINESS OFFICE PERSONNEL ARE AVAILABLE TO HELP PATIENTS UNDERSTAND AND APPLY FOR LOCAL, STATE, FEDERAL HEALTH CARE PROGRAMS; HEALTH INSURANCE EXCHANGES; AND FRANCISCAN'S FINANCIAL ASSISTANCE PROGRAMS. 4. ALL BILLS AND STATEMENTS FOR SERVICES INFORM UNINSURED PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. 5. PATIENTS/GUARANTORS MAY REQUEST A COPY OF THE FINANCIAL ASSISTANCE APPLICATION BY CALLING THE FRANCISCAN BILLING OFFICE OR DOWNLOADING A COPY AT NO COST FROM FRANCISCAN HOSPITAL'S WEBSITES. 6. INDIVIDUALS OTHER THAN THE PATIENT, SUCH AS THE PATIENT'S PHYSICIAN, FAMILY MEMBERS, COMMUNITY OR RELIGIOUS GROUPS, SOCIAL SERVICES, OR HOSPITAL PERSONNEL MAY MAKE REQUESTS FOR FINANCIAL ASSISTANCE ON THE PATIENT'S BEHALF, SUBJECT TO APPLICABLE PRIVACY LAWS. 7. FRANCISCAN SENDS 4 STATEMENTS AND MAKES 6 PHONE CALL ATTEMPTS TO CONTACT THE PATIENT/GUARANTOR AT THE ADDRESS AND PHONE NUMBER PROVIDED BY THE PATIENT/GUARANTOR. STATEMENTS AND COMMUNICATIONS INFORM THE PATIENT OF THE AMOUNT DUE AND IF THEY CANNOT PAY THEIR BALANCE THE AVAILABILITY OF FINANCIAL ASSISTANCE. ------------------------------------------------ SCHEDULE H, PART VI, ITEM 4 COMMUNITY INFORMATION THE FRANCISCAN ALLIANCE SERVES A LARGE GEOGRAPHIC AREA WHICH INCLUDES 18 COUNTIES IN INDIANA (BENTON, CARROLL, FOUNTAIN, HAMILTON, JASPER, JOHNSON, LAKE, LAPORTE, MARION, MONTGOMERY, MORGAN, NEWTON, PORTER, SHELBY, STARKE, TIPPACANOE, WARREN, AND WHITE) AND 3 COUNTIES IN ILLINOIS (COOK, KANKAKEE, AND WILL). THE POPULATION OF THE COMMUNITIES THAT WE SERVE WAS ESTIMATED CLOSE TO 3.9 MILLION PEOPLE WITH AN AVERAGE HOUSEHOLD INCOME ABOVE $59,000 IN 2018. FOR THESE COMMUNITIES, THE PERCENTAGE OF RESIDENTS BELOW THE FEDERAL POVERTY LEVEL WAS ESTIMATED AT 13.8%. THE PERCENTAGE OF INPATIENTS FROM THESE COMMUNITIES WHO WERE SERVED BY MEDICAID WAS 21.6%. AND THE PERCENTAGE OF INPATIENTS FROM THESE COMMUNITIES WHO WERE UNINSURED WAS APPROXIMATELY 3.1%. IN COMPARISON, THE PERCENTAGES OF MEDICAID AND UNINSURED INPATIENTS TREATED BY THE HOSPITALS OF THE FRANCISCAN ALLIANCE WERE 19.4% AND 2.1% RESPECTIVELY IN 2018. THERE ARE 58 OTHER HOSPITALS THAT SERVE WITHIN THESE COMMUNITIES AS WELL. ------------------------------------------------ SCHEDULE H, PART VI, ITEM 5 & PART I, LINE 6A OTHER INFORMATION WWW.FRANCISCANHEALTH.ORG/COMMUNITYHEALTH REFLECTS FRANCISCAN'S MISSION OF ""CONTINUING CHRIST'S MINISTRY IN OUR FRANCISCAN TRADITION."" ALTHOUGH IT IS NOT ALL INCLUSIVE OF THE MANY BENEFITS PROVIDED BY FRANCISCAN IT DOES PORTRAY THE SIGNIFICANT BENEFITS THAT REFLECT OUR COMMITMENT TO HEALTHCARE AND THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. THE FOLLOWING IS A SUBSET OF THE MANY CLINICAL SERVICES AS WELL AS POPULATION HEALTH IMPROVEMENT AND COMMUNITY OUTREACH ACTIVITIES OFFERED BY ONE OR MORE OF FRANCISCAN'S HEALTHCARE FACILITIES: - INPATIENT HOSPITAL SERVICES INCLUDING: MEDICAL SERVICES, SURGICAL SERVICES, INTENSIVE CARE SERVICES, TELEMETRY SERVICES, OBSTETRICS SERVICES, PEDIATRICS SERVICES, NEONATAL INTENSIVE CARE SERVICES, ACUTE REHABILITATION SERVICES, ONCOLOGY SERVICES, BONE MARROW TRANSPLANT SERVICES, GENERAL SURGERY SERVICES, CARDIAC SURGERY SERVICES, VASCULAR SERVICES, PULMONARY SERVICES, INTERVENTIONAL RADIOLOGY, ORTHOPEDICS, JOINT AND SPINE CARE, GASTROINTESTINAL CARE, NEUROSCIENCES SERVICES, COLON AND RECTAL SERVICES, ANESTHESIA SERVICES, HOSPICE SERVICES, INPATIENT PSYCHIATRIC CARE, RESIDENTIAL TREATMENT PROGRAM FOR ADOLESCENTS, ETC. - EMERGENCY SERVICES INCLUDING: 24 HOUR EMERGENCY ROOM SERVICES, AMBULANCE SERVICES, IMMEDIATE CARE SERVICES, ADVANCED LIFE SUPPORT SERVICES, BASIC LIFE SUPPORT SERVICES, BEHAVIORAL HEALTH EMERGENCY CONSULTATION SERVICES, 24-HOUR CRISIS AND REFERRAL HOTLINE, TRAUMA SERVICES, ETC. - OUTPATIENT SERVICES INCLUDING: LABORATORY SERVICES, PHYSICAL THERAPY SERVICES, OCCUPATIONAL THERAPY SERVICES, SPEECH THERAPY SERVICES, GENERAL RADIOLOGY SERVICES, COMPUTED TOMOGRAPHY SERVICES, MAGNETIC RESONANCE IMAGING (MRI), NUCLEAR MEDICINE SERVICES, MAMMOGRAPHY SERVICES, ANGIOGRAPHY SERVICES, NEURODIAGNOSTICS SERVICES, GASTRO/INTESTINAL SERVICES, SLEEP LABORATORY, PULMONARY SERVICES, OUTPATIENT SURGERY, CARDIAC TESTING, ELECTROCARDIOGRAM (EKG) SERVICES, MEDICAL ONCOLOGY SERVICES, RADIATION ONCOLOGY SERVICES, PHARMACY, OCCUPATIONAL MEDICINE SERVICES, CARDIAC/PULMONARY REHABILITATION SERVICES, CONGESTIVE HEART FAILURE CLINIC, WOUND HEALING AND PREVENTION, NUTRITIONAL COUNSELING, DIABETES MANAGEMENT, BARIATRIC SERVICES, PAIN MANAGEMENT, SOCIAL SERVICES, PALLIATIVE CARE, SPORTS MEDICINE, BEHAVIORAL HEALTH, STROKE SERVICES, HOME HEALTH SERVICES, SKILLED NURSING SERVICES, SOCIAL SERVICES, DURABLE MEDICAL EQUIPMENT. - PRIMARY CARE AND SPECIALTY CARE PHYSICIAN CLINICS. SUBSIDIZED HEALTHCARE SERVICES OFFERED BY FRANCISCAN: - FRANCISCAN HAS NEIGHBORHOOD HEALTH CLINICS THAT OFFER FAMILY PRACTICE SERVICES DESIGNED FOR FAMILIES WITHOUT ACCESS TO AFFORDABLE HEALTH CARE. THE FOCUS IS ON PROVIDING PRIMARY AND PREVENTIVE CARE AS WELL AS HEALTH EDUCATION. THESE CLINICS OFFER FREE IMMUNIZATIONS. - FRANCISCAN'S SEXUAL ASSAULT CLINICS THAT PROVIDE MEDICAL AND FORENSIC ASSISTANCE THAT IS SENSITIVE TO THE SPECIAL NEEDS OF THE VICTIM AS WELL AS A VICTIM ADVOCATE PROGRAM AND CRISIS INTERVENTION COUNSELORS. - FRANCISCAN'S BLOOD AND MARROW TRANSPLANT PROGRAM IS ONLY ONE OF TWO PROGRAMS IN INDIANA OFFERING FULL SERVICE TRANSPLANT CARE AND SPECIALIZES IN THE TREATMENT OF PATIENTS WITH LEUKEMIA, HODGKIN'S OR NON-HODGKIN'S LYMPHOMA, MULTIPLE MYELOMA, AND MANY OTHER MALIGNANCIES AND BLOOD DISORDERS. - FRANCISCAN'S DIABETES EDUCATION CENTERS OFFER A NUMBER OF DIABETES CLASSES AND INDIVIDUALIZED SESSIONS TO HELP PATIENTS TAKE CONTROL OF THEIR HEALTH WITH A FOCUS ON NUTRITIONAL, EXERCISE, MEDICATIONS, CHRONIC CONDITIONS, PRECONCEPTION AND PREGNANCY, BLOOD GLUCOSE MONITORING, GOAL SETTING, PROBLEM SOLVING, PSYCHOSOCIAL ADJUSTMENT, DETECTION/TREATMENT OF HIGH AND LOW BLOOD SUGAR, AND INSULIN ADMINISTRATION. - FRANCISCAN'S WOMEN'S AND CHILDREN'S SERVICES INCLUDE PREVENTIVE MEDICAL CARE AND HEALTH SCREENINGS TO GYNECOLOGICAL CARE, MATERNITY, LACTATION CONSULTATION SERVICES, AND BEYOND WITH A FOCUS ON KEEPING WOMEN HEALTHY. - FRANCISCAN'S HOSPICE CARE SERVICES PROVIDE A SENSE OF DIGNITY AND COMPASSION TO BOTH THE PATIENT AND THEIR FAMILY IN CARING FOR PATIENTS WITH A LIFE EXPECTANCY OF SIX MONTHS OR LESS. OUR PROGRAMS AFFIRM AND CELEBRATE LIFE AND REGARD DYING AS A NATURAL PROCESS, RECOGNIZING THAT EVERY PERSON HAS THE RIGHT TO DIE WITH DIGNITY, PEACE, AND COMFORT REGARDLESS OF THEIR ETHNICITY, FAITH BACKGROUND, OR ABILITY TO PAY. - LEVEL III NICU - AMBULANCE SERVICE - PHYSICIAN SERVICES - INPATIENT PSYCHIATRIC UNITS - HEALTH AND WELLNESS CENTERS AND HEALTHY LIVING EDUCATION CENTERS - CLINICAL CARE COORDINATORS TO SUPPORT FRANCISCAN'S VARIOUS ACCOUNTABLE CARE ORGANIZATIONS WHICH ARE DESIGNED TO IMPROVE QUALITY AND REDUCE CO"

SCHEDULE H, PART II
"COMMUNITY BUILDING ACTIVITIES FOLLOWING NATIONAL GUIDANCE ON COMMUNITY BUILDING AS A CATEGORY REPRESENTING INVESTMENTS IN SOCIAL DETERMINANTS IN THE COMMUNITY, FRANCISCAN ALLIANCE REPORTS ACCURATE DOLLARS IN THIS CATEGORY. FRANCISCAN ALLIANCE HAS ENGAGED IN COMMUNITY BUILDING THROUGH SUPPORTING LOCAL PARTNERS IN THEIR WORK. FRANCISCAN ALLIANCE DOES ENGAGE IN REDUCING BARRIERS TO HEALTH CARE ACCESS. MOST ACTIVITIES IN THIS AREA ARE INCLUDED IN THE FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT CATEGORIES. EXAMPLES INCLUDE: FREE OR LOW COST HEALTH SCREENING IN SPECIFIC NEIGHBORHOODS, IMMUNIZATION SERVICES, PRESCRIPTION MEDICATION ASSISTANCE PROGRAMS, ENROLLMENT ASSISTANCE IN MEDICAID, FOOD ASSISTANCE, TRANSPORTATION ASSISTANCE, AND REFERRAL ASSISTANCE. ADDITIONALLY, SEVERAL OF OUR HOSPITALS HAVE BEEN IDENTIFIED BY THE FEDERAL GOVERNMENT AS DESIGNATED REGIONAL MEDICATION DISTRIBUTION SITES IN THE EVENT OF A NATIONAL DISASTER OR EPIDEMIC/PANDEMIC. RESPONDING TO FEDERAL, STATE, AND LOCAL NEEDS IN THE EVENT OF NATIONAL OR LOCAL DISASTERS OR EPIDEMIC/PANDEMICS, WE COLLABORATE AND COORDINATE OUR EFFORTS WITH MANY CIVIC AND OTHER AGENCIES TO ENSURE THAT THOSE NEEDS WILL BE MET SHOULD DISASTER STRIKE. ----------------------------------------- SCHEDULE H, PART III, LINE 2 THROUGHOUT THE YEAR, THE CORPORATION ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ITS PATIENT ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE, AND OTHER RELEVANT FACTORS. THESE FACTORS INCLUDE CHANGES IN THE ECONOMY AND UNEMPLOYMENT RATES, WHICH HAS AN IMPACT ON THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, AS WELL AS TRENDS IN HEALTH CARE COVERAGE, SUCH AS THE INCREASED BURDEN OF DEDUCTIBLES, COPAYMENTS, AND COINSURANCE PAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED PROCEDURES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS AND CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE CORPORATION. ----------------------------------------- SCHEDULE H, PART III, LINE 3 THE CORPORATION HAS A SYSTEM-WIDE CHARITY CARE AND UNINSURED DISCOUNT POLICY; HAS DETAILED ADMINISTRATIVE PROCEDURES ESTABLISHED FOR QUALIFYING AND ENROLLING PATIENTS FOR CHARITY CARE OR UNINSURED/UNDERINSURED DISCOUNTS; USES VARIOUS ANALYTICAL PROGRAMS INCLUDING SOFT CREDIT INQUIRIES THAT DO NOT AFFECT CREDIT SCORES TO HELP ASSESS A PATIENT'S ABILITY TO PAY; AND UTILIZES NUMEROUS MECHANISMS TO INFORM AND EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE WHICH ARE DETAILED UNDER SCHEDULE H, PART VI, ITEM 3. DESPITE THESE RIGOROUS EFFORTS, PATIENTS WHO NEED SUBSIDIZED CARE MAY NOT SEEK THIS ASSISTANCE NOR CHOOSE TO ENROLL IN THE STATE'S MEDICAID PROGRAM. ALSO, AS FURTHER DESCRIBED IN HFMA STATEMENT NO. 15, THE APPROPRIATE CLASSIFICATION OF CHARITY CARE AND BAD DEBT IS OFTEN DIFFICULT. THE URGENCY OF SOME TREATMENTS, AS WELL AS CERTAIN FEDERAL REGULATIONS, OFTEN REQUIRES THE PROVISION OF SERVICE WITHOUT CONSIDERATION OF THE PATIENT'S ABILITY TO PAY. SOME PATIENTS HAVE COMPLEX MEDICAL CONDITIONS WITH UNPREDICTABLE TREATMENT NEEDS. FOR THESE AND OTHER REASONS, FRANCISCAN BELIEVES, A PORTION OF ITS BAD DEBT EXPENSE AS REPORTED ON LINE 2 OF PART III REPRESENTS CHARITY CARE DELIVERED TO INDIVIDUALS IN THE COMMUNITIES IT SERVES CONSISTENT WITH ITS CHARITABLE HEALTHCARE MISSION. -------------------------------------- SCHEDULE H, PART III, LINE 4 THE CORPORATION'S UNCOLLECTIBLE AMOUNTS DUE FROM PATIENTS FOOTNOTE FROM ITS AUDITED FINANCIAL STATEMENTS IS AS FOLLOWS: THE CORPORATION ALSO PROVIDES A SIGNIFICANT AMOUNT OF UNCOMPENSATED CARE TO PATIENTS WHICH IS NOT REPORTED IN THE SUMMARY OF QUANTIFIABLE COMMUNITY BENEFITS. EFFECTIVE JANUARY 1, 2018, THE CORPORATION ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD (""FASB"") ACCOUNTING STANDARD UPDATE (""ASU"") 2014-9, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606) WHICH REQUIRES REVENUE TO BE RECOGNIZED IN AN AMOUNT THAT REFLECTS THE CONSIDERATION THE ENTITY EXPECTS TO BE ENTITLED TO IN AN EXCHANGE FOR GOODS OR SERVICES. ADOPTION OF THIS ASU DOES NOT ALLOW THE SEPARATE REPORTING OF THE UNCOLLECTIBLE AMOUNTS DUE FROM PATIENTS; HOWEVER, THE IDENTIFICATION OF THIS AMOUNT IS NEEDED FOR OTHER PURPOSES INCLUDING GOVERNMENTAL REPORTING AND REIMBURSEMENT CALCULATIONS. THE CORPORATION HAS A SYSTEM-WIDE CHARITY CARE AND UNINSURED DISCOUNT POLICY THAT INCLUDES ADMINISTRATIVE PROCEDURES FOR QUALIFYING AND ENROLLING PATIENTS FOR CHARITY CARE OR UNINSURED/UNDERINSURED DISCOUNTS. THE CORPORATION ALSO USES VARIOUS ANALYTICAL PROGRAMS TO ASSESS A PATIENTS ABILITY TO PAY AND IT UTILIZES NUMEROUS MECHANISMS TO INFORM AND EDUCATE PATIENTS ABOUT FINANCIAL ASSISTANCE. DESPITE THESE RIGOROUS EFFORTS, PATIENTS WHO NEED SUBSIDIZED CARE MAY NOT SEEK THIS ASSISTANCE NOR CHOOSE TO ENROLL IN MEDICAID OR OTHER FINANCIAL ASSISTANCE PROGRAMS. FOR THESE AND OTHER REASONS, THE CORPORATION BELIEVES A PORTION OF ITS UNCOLLECTIBLE AMOUNTS DUE FROM PATIENTS REPRESENTS CHARITY CARE DELIVERED TO INDIVIDUALS IN THE COMMUNITIES IT SERVES CONSISTENT WITH ITS CHARITABLE HEALTH CARE MISSION. DURING THE YEARS ENDED DECEMBER 31, 2018 AND 2017, THE CORPORATION INCURRED APPROXIMATELY $50.4 MILLION AND $34.6 MILLION, RESPECTIVELY, AS UNCOLLECTIBLE AMOUNTS DUE FROM PATIENTS BASED ON ACCUMULATED CHARGES. ------------------------------------------------ SCHEDULE H, PART III, LINE 8 CONSISTENT WITH THE CHARITABLE HEALTHCARE MISSION OF FRANCISCAN AND THE COMMUNITY BENEFIT STANDARD SET FORTH IN IRS REVENUE RULING 69-545 AND THE REQUIREMENTS OF IRC SECTION 501(R), FRANCISCAN PROVIDES CARE FOR ALL PATIENTS COVERED BY MEDICARE SEEKING MEDICAL CARE AT FRANCISCAN. SUCH CARE IS PROVIDED REGARDLESS OF WHETHER THE REIMBURSEMENT PROVIDED FOR SUCH SERVICES MEETS OR EXCEEDS THE COSTS INCURRED BY FRANCISCAN TO PROVIDE SUCH SERVICES. LIKE MEDICAID, PAYMENT RATES FOR MEDICARE ARE SET BY LAW RATHER THAN THROUGH A NEGOTIATION PROCESS AS WITH PRIVATE INSURERS. THESE PAYMENT RATES ARE CURRENTLY SET BELOW THE COSTS OF PROVIDING CARE RESULTING IN UNDERPAYMENTS. MEDICARE RATES ARE DETERMINED WITHIN THE CONTEXT OF ALL THE BUDGETARY NEEDS OF THE FEDERAL GOVERNMENT AND MEDICARE PAYMENTS HAVE HISTORICALLY BEEN SET BELOW THE COSTS OF PROVIDING CARE TO MEDICARE PATIENTS THOUGH HOW FAR BELOW VARIES OVER TIME AND BY SERVICE. EACH YEAR MEDICARE IS SUPPOSED TO PROVIDE HOSPITALS AN INCREASE IN BOTH INPATIENT AND OUTPATIENT PAYMENTS TO ACCOUNT FOR INFLATION IN THE PRICES FOR GOODS AND SERVICES HOSPITALS MUST PURCHASE IN ORDER TO PROVIDE PATIENT CARE. HOWEVER INPATIENT UPDATES HAVE BEEN SET BELOW THE RATE OF INFLATION AND ACTUALLY NEGATIVE IN RECENT YEARS RESULTING IN A SHORTFALL THAT HAS GROWN OVER TIME. THE COMPOUNDING ISSUE THAT OCCURS IS THAT THIS SHORTFALL JEOPARDIZES HOSPITALS' ABILITY TO SERVE THEIR COMMUNITIES BECAUSE THEY ARE NOT REIMBURSED THEIR INCURRED COSTS. PROVIDERS MAKE THE DECISION TO ELIMINATE OR SIGNIFICANTLY REDUCE NECESSARY CLINICAL SERVICES WITHIN THE MARKETPLACE PLACING THE MEDICARE SHORTFALL BURDEN ON OTHERS THAT DO, SUCH AS FRANCISCAN. GIVEN THAT FRANCISCAN PROVIDES SUCH SERVICES TO MEDICARE PATIENTS KNOWING THAT THEY WILL RESULT IN A LOSS, AND GIVEN THAT FRANCISCAN BELIEVES THAT IT PROVIDES THESE SERVICES IN AN EFFICIENT AND COST EFFECTIVE MANNER, THE SHORTFALL REPORTED ON LINE 7 OF PART III SHOULD BE VIEWED AS COMMUNITY BENEFIT PROVIDED BY FRANCISCAN. ------------------------------------------------ SCHEDULE H, PART III, LINE 9B FRANCISCAN ALLIANCE, INC.'S WRITTEN CHARITY CARE AND UNINSURED PATIENT DISCOUNT POLICY AND PATIENT COLLECTION PROCEDURE INCLUDE VARIOUS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY OR FINANCIAL ASSISTANCE. IF A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE CERTAIN COLLECTION PRACTICES DO NOT APPLY. ------------------------------------------------ SCHEDULE H, PART IV NAME OF ENTITY: MOORESVILLE ENDOSCOPY CENTER LLC DESCRIPTION OF PRIMARY ACTIVITY OF ENTITY: ENDOSCOPY SERVICES ORGANIZATION'S PROFIT % OR STOCK OWNERSHIP %: 50.00000 OFFICERS, DIRECTORS, TRUSTEES. ETC. PROFIT % OR STOCK OWNERSHIP %: 0 PHYSICIANS' PROFIT % OR STOCK OWNERSHIP %: 50.00000 NAME OF ENTITY: INDIANA SLEEP CENTER LLC DESCRIPTION OF PRIMARY ACTIVITY OF ENTITY: SLEEP CENTER ORGANIZATION'S PROFIT % OR STOCK OWNERSHIP %: 50.00000 OFFICERS, DIRECTORS, TRUSTEES. ETC. PROFIT % OR STOCK OWNERSHIP %: 0 PHYSICIANS' PROFIT % OR STOCK OWNERSHIP %: 50.00000 NAME OF ENTITY: FRANCISCAN SURGERY CENTER LLC DESCRIPTION OF PRIMARY ACTIVITY OF ENTITY: SURGICAL SERVICES ORGANIZATION'S PROFIT % OR STOCK OWNERSHIP %: 50.44000 OFFICERS, DIRECTORS, TRUSTEES. ETC. PROFIT % OR STOCK OWNERSHIP %: 0 PHYSICIANS' PROFIT % OR STOCK OWNERSHIP %: 49.56000 NAME OF ENTITY: SOUTH EMERSON SURGERY CENTER LLC DESCRIPTION OF PRIMARY ACTIVITY OF ENTITY: SURGICAL SERVICES ORGANIZATION'S PRO"