4A (Expenses $ 18471119 including grants of $ 5136) (Revenue $ 22540558)
St. Vincent Williamsport Hospital is a 16-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 Williamsport Hospital treated 391 adults and children for a total of 1,909 patient days of service. The hospital also provided services for 57,348 outpatient visits, which included 631 outpatient surgeries and 7,057 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 , 1
Facility , 1 - Ascension St. Vincent Williamsport. Recognizing its vital importance to understanding the health needs and assets of the community, Ascension St. Vincent Williamsport consulted with a range of public health and social service providers that represent the broad interests of residents of Fountain and Warren counties. 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. During the hospital's most recent CHNA, community input was obtained through a community input meeting, which was conducted by Verite Healthcare Consulting in October 2021, to gather feedback on the health needs and assets of Fountain and Warren counties. Organizations that have a fundamental understanding of Warren and Fountain Counties' health needs, specifically among those who are medically underserved, low-income and minority populations, were invited to attend. Of the thirteen individuals invited to participate in the community input meeting, four both attended and completed a post-meeting survey to identify significant community needs. The organizations invited included the following: Community Action Program, Fountain & Warren County Public Health Department, Fountain County Ambulance and Rescue Service, Lafayette Urban Ministries, Warren County Community Foundation, Warren County Government, Warren County Local Economic Development Organization, Warren County Sheriff Department, Western Indiana Community Foundation, and Williamsport Indiana Fire Department. Additionally, a hospital input meeting was conducted by Verite Healthcare Consulting in November 2021 to gather feedback from hospital staff on the health needs and assets of Fountain and Warren counties. Two individuals participated. These staff included perspectives related to discharge planners, community navigators, social workers, primary care providers, administrators, and others. Finally, an interview was conducted with a local public health department representative to obtain subject-matter expertise regarding health needs in Fountain and Warren counties. 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 individuals and organizations invited to participate represent a variety of vulnerable populations, including the medically underserved (both Fountain and Warren counties are designated as medically underserved populations), those living in poverty, individuals struggling to meet basic needs, the elderly, and those seeking government assistance. Although there did not appear to be organizations focused specifically on minority populations, possibly due to the populations of Fountain and Warren counties being 95.0 percent and 95.3 non-Hispanic White, respectively, the Fountain & Warren County Public Health Department represented the needs of all vulnerable populations via their public health expertise.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Ascension St. Vincent Williamsport. During its most recent CHNA, Ascension St. Vincent Williamsport 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 Williamsport also collaborated with other hospitals that are members of Ascension St. Vincent.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - Ascension St. Vincent Williamsport - Part 1. As a result of Ascension St. Vincent Williamsport's most recent CHNA, the following needs were identified as significant in the community: substance abuse, mental health, transportation, poverty, and obesity. 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 and nutrition & weight status - food security 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 FY22, the hospital dedicated $2,988 in community benefit to this initiative and assisted 27 people with obtaining Medicare and/or Medicare Savings insurance (FY20 baseline = 11, FY22 goal =12, FY22 goal = 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 Williamsport dedicated $5,069 in community benefit to this initiative through their work with Warren County Schools to support their weekend feeding program and cafeteria supplies. 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. However, during FY21, Ascension St. Vincent Williamsport Hospital was unable to complete the goal due to competing demands, including the increased demands resulting from the COVID-19 pandemic. During FY22, Ascension St. Vincent Williamsport contributed $1,065 towards this initiative by hosting a virtual MHFA training session for 15 individuals. Addressing Needs in Current CHNA Cycle (FY23-25) In Ascension St. Vincent Williamsport most recent CHNA, the following were identified as significant needs in the community: Access to Care; COVID-19 Pandemic; Maternal, Infant, and Child Health; Mental Health Status and Access to Mental Health Services; Obesity, Physical Inactivity, and Associated Chronic Disease; Services for Seniors; Social Determinants of Health, including Poverty, Affordable Housing, Food Insecurity, and Transportation; Smoking and Tobacco Use; and Substance Use Disorders and Overdoses. The FY2023-2025 Implementation Strategy specifically addresses Access to Care, Mental Health, and Senior Services, in following ways: 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 focus on three strategies. The first two strategies use an evidence-based approach called Pathways, which is utilized by the hospital's health advocates, to assist individuals access various health, human, and social services. Specifically, the first strategy is to increase the proportion of people with a usual primary care provider, and the SMART objective is, ""By June 30, 2025, Ascension St. Vincent Williamsport will increase 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."" The second strategy is to increase the proportion of people with health insurance and the SMART objective is, ""By June 30, 2025, Ascension St. Vincent Williamsport will increase the number of people enrolled in a health insurance plan 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 third strategy is to strengthen community engagement by supporting coalitions and implementing partners. The SMART objective is, ""By June 30, 2025, Ascension St. Vincent Williamsport will strengthen community engagement to expand the reach of evidence-based programs, advocacy, and/or services through financial support, facilitation, and/or promotion."" 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. Senior Services - The goal of the initiative is to improve health and well-being for older adults (Healthy People 2030). The strategy is based on the HP2030 Access to Health Services objective: Increase the proportion of adults who get recommended evidence-based preventive health care (AHS-08). The hospital will collaborate with community partners to offer at least one community outreach event focused on education and promotion of recommended, evidence-based preventive health care for older adults. The target population will be adults aged 50 and older and their caregivers. Additionally, this initiative will include 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 senior services."

Schedule H, Part V, Section B, Line 11 Facility , 2
Facility , 2 - Ascension St. Vincent Williamsport - Part 2. Ascension St. Vincent Williamsport 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 Williamsport's implementation strategy for the following reasons: COVID-19 Pandemic - The hospital, together with Ascension Medical Group (AMG), a physician-led provider organization, 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. Maternal, Infant, and Child Health - The hospital, together with AMG, provides health care services to pregnant women, infants, and children. Additionally, the hospital does address this need in various ways including participation in statewide committees and local community coalitions, offering support groups, and/or providing community education. The hospital will remain committed to partnering with community groups to address maternal, infant, and child health -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 improve maternal, infant, and child health, 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. Social Determinants of Health, including poverty, affordable housing, food insecurity, and transportation - The hospital, together with AMG, screens patients for needs related to social determinants of health. Moreover, supporting services and referrals are provided by Community Health Workers in the Ascension St. Vincent Health Access Department, to meet needs, such as transportation and housing. Additionally, the hospital remains committed to partnering with community groups to address needs related social determinants of health 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. While these needs are not the focus of this Implementation Strategy, Ascension St. Vincent Williamsport 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 Williamsport 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 Williamsport Hospital focused on community support through their nurse manager conducting interviews with local high school seniors who were interested in pursuing a career in health care and practice time preparing for a health careers scholarship interview.

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 $2,433,444 at charges, ($646,650 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
ST. VINCENT WILLIAMSPORT HOSPITAL, INC. 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
- ASCENSION ST. VINCENT WILLIAMSPORT: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- ASCENSION ST. VINCENT WILLIAMSPORT: Line 16b URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- ASCENSION ST. VINCENT WILLIAMSPORT: Line 16c URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part VI, Line 4 Community information
St. Vincent Williamsport Hospital has a 2-county primary service area: Fountain and Warren Counties Indiana. The total population of the 2-county primary service area is estimated to be 24,436 residents in calendar 2022 and is expected to increase by approximately 0.2% to 24,489 residents in five years. The median household income of the primary service area is $55,247. Approximately 10.3% of the service area residents live below the poverty line. Within the primary service area, there are 2 federally designated medically underserved areas. There are no other acute care hospitals located within the primary service area.

Schedule H, Part VI, Line 5 Promotion of community health
St. Vincent Williamsport Hospital's governing body is comprised of persons representing diverse aspects and interests of the community. Many members of St. Vincent Williamsport Hospital'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 Williamsport Hospital extends medical staff privileges to all qualified physicians in its community for some or all of its departments or specialties. St. Vincent Williamsport Hospital applies surplus funds to fund improvements in patient care.

Schedule H, Part VI, Line 2 Needs assessment
St. Vincent Williamsport Hospital, 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 Williamsport Hospital, Inc. utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, St. Vincent Williamsport Hospital, Inc. 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 Williamsport Hospital, 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 Williamsport Hospital, 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 Williamsport Hospital, 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 Williamsport Hospital, 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 Williamsport Hospital, 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 Williamsport Hospital, 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 Williamsport Hospital, 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 Williamsport Hospital, Inc. operates a hospital facility in Fountain County Indiana and is part of Ascension St. Vincent which also owns and operates other healthcare related entities, including Ascension St. Vincent Indianapolis Hospital. The health system provides inpatient, outpatient, and emergency care services for residents of Indiana.