Hospitals. Complete if the organization answered "Yes" to Form 990, Part IV, question 20.

Transcription

1 SCHEDULE H (Form 990) 2 If "Ys," was it a writtn poliy? If th organization ha multipl hospital failitis, iniat whih of th following st sris appliation of th finanial assistan poliy to its various hospital failitis uring th tax yar. 3 Answr th following as on th finanial assistan ligiility ritria that appli to th largst numr of th organization's patints uring th tax yar. a Di th organization us Fral Povrty Guilins (FPG) as a fator in trmining ligiility for proviing fr ar? If th organization us fators othr than FPG in trmining ligiility, sri in Part VI th inom as ritria for trmining ligiility for fr or isount ar. Inlu in th sription whthr th organization us an asst tst or othr thrshol, rgarlss of inom, as a fator in trmining ligiility for fr or isount ar. 4 Di th organization's finanial assistan poliy that appli to th largst numr of its patints uring th tax yar provi for fr or isount ar to th "mially inignt"? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5a Di th organization ugt amounts for fr or isount ar provi unr its finanial assistan poliy uring th tax yar? ~~~~ Complt th following tal using th workshts provi in th Shul H instrutions. Do not sumit ths workshts with th Shul H. OMB No Finanial Assistan an Crtain Othr Community Bnfits at Cost Numr of Prsons Total Dirt Nt Prnt of Finanial Assistan an (a) () () () () (f) ativitis or srv ommunity offstting ommunity total xpns programs (optional) (optional) nfit xpns rvnu nfit xpns Mans-Tst Govrnmnt Programs a Total Finanial Assistan an Mans-Tst Govrnmnt Programs f g h i j k Appli uniformly to all hospital failitis Gnrally tailor to iniviual hospital failitis If "Ys," iniat whih of th following was th FPG family inom limit for ligiility for fr ar: ~~~~~~~~~~~~~ 100% 150% 200% Othr % Di th organization us FPG as a fator in trmining ligiility for proviing isount ar? If "Ys," iniat whih Othr Bnfits Total. Othr Bnfits ~~~~~~ Total. A lins 7 an 7j Appli uniformly to most hospital failitis of th following was th family inom limit for ligiility for isount ar: ~~~~~~~~~~~~~~~~~~~~~~~~ 200% 250% 300% 350% 400% Othr % If "Ys," i th organization's finanial assistan xpnss x th ugt amount? ~~~~~~~~~~~~~~~~ If "Ys" to lin 5, as a rsult of ugt onsirations, was th organization unal to provi fr or isount ar to a patint who was ligil for fr or isount ar? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6a Di th organization prpar a ommunity nfit rport uring th tax yar? ~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," i th organization mak it availal to th puli? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Finanial Assistan at ost (from Worksht 1) ~~~~~~~~~~ Miai (from Worksht 3, olumn a) ~~~~~~~~~~~ Costs of othr mans-tst govrnmnt programs (from Worksht 3, olumn ) ~~~~~ Community halth improvmnt srvis an ommunity nfit oprations (from Worksht 4) ~~~~~~~ Halth profssions uation (from Worksht 5) ~~~~~~~ Susiiz halth srvis (from Worksht 6) ~~~~~~~ Rsarh (from Worksht 7) ~~ Cash an in-kin ontriutions for ommunity nfit (from Worksht 8) ~~~~~~~~~ Hospitals 2013 Complt if th organization answr "Ys" to Form 990, Part IV, qustion 20. Dpartmnt of th Trasury Intrnal Rvnu Srvi Attah to Form 990. S sparat instrutions. Information aout Shul H (Form 990) an its instrutions is at Opn to Puli Insption Nam of th organization Mry Catholi Mial Cntr Employr intifiation numr of Southastrn Pnnsylvania Part I Finanial Assistan an Crtain Othr Community Bnfits at Cost Ys No 1a Di th organization hav a finanial assistan poliy uring th tax yar? If "No," skip to qustion 6a ~~~~~~~~~~~ 1a % % % 495, , , % LHA For Paprwork Rution At Noti, s th Instrutions for Form 990. Shul H (Form 990) FINAL 5/13/ a 3 4 5a 5 5 6a 6 1,472. 1, % % 46, , % , % %

2 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Pag 2 Part II Community Builing Ativitis Complt this tal if th organization onut any ommunity uiling ativitis uring th tax yar, an sri in Part VI how its ommunity uiling ativitis promot th halth of th ommunitis it srvs. (a) Numr of ativitis or programs (optional) () Prsons srv (optional) () Total ommunity uiling xpns () Dirt offstting rvnu () Nt ommunity uiling xpns (f) Prnt of total xpns 1 Physial improvmnts an housing.00% 2 Eonomi vlopmnt.00% 3 Community support.00% 4 Environmntal improvmnts.00% Total Part III Ba Dt, Miar, & Colltion Pratis Stion A. Ba Dt Expns Stion B. Miar Larship vlopmnt an training for ommunity mmrs Coalition uiling Community halth improvmnt avoay Workfor vlopmnt Othr Di th organization rport a t xpns in aoran with Halthar Finanial Managmnt Assoiation Statmnt No. 15? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Entr th amount of th organization's a t xpns. Explain in Part VI th mthoology us y th organization to stimat this amount Entr th stimat amount of th organization's a t xpns attriutal to patints ligil unr th organization's finanial assistan poliy. Explain in Part VI th mthoology us y th organization to stimat this amount an th rational, if any, for inluing this portion of a t as ommunity nfit ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~ Provi in Part VI th txt of th footnot to th organization's finanial statmnts that sris a t xpns or th pag numr on whih this footnot is ontain in th attah finanial statmnts. Entr total rvnu riv from Miar (inluing DSH an IME) Entr Miar allowal osts of ar rlating to paymnts on lin 5 ~~~~~~~~~~~~ ~~~~~~~~~~~~ Sutrat lin 6 from lin 5. This is th surplus (or shortfall) ~~~~~~~~~~~~~~~~~~ Dsri in Part VI th xtnt to whih any shortfall rport in lin 7 shoul trat as ommunity nfit. Also sri in Part VI th osting mthoology or sour us to trmin th amount rport on lin 6. Chk th ox that sris th mtho us: Cost aounting systm Cost to harg ratio Othr Stion C. Colltion Pratis 9a Di th organization hav a writtn t olltion poliy uring th tax yar? ~~~~~~~~~~~~~~~~~~~~~~~ 9a If "Ys," i th organization's olltion poliy that appli to th largst numr of its patints uring th tax yar ontain provisions on th olltion pratis to follow for patints who ar known to qualify for finanial assistan? Dsri in Part VI 9 Part IV Managmnt Companis an Joint Vnturs (own 10% or mor y offirs, irtors, trusts, ky mploys, an physiians - s instrutions) ,084,709. (a) Nam of ntity () Dsription of primary () Organization's () Offirs, irt- () Physiians' ativity of ntity profit % or stok ownrship % ors, trusts, or ky mploys' profit % or stok ownrship % 0. 69,611, ,843,182. 5,768, %.00%.00%.00%.00% Ys profit % or stok ownrship % No Shul H (Form 990) FINAL 5/13/15 36

3 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information Stion A. Hospital Failitis (list in orr of siz, from largst to smallst) How many hospital failitis i th organization oprat uring th tax yar? 2 Nam, arss, primary wsit arss, an stat lins numr 1 Mry Fitzgral Hospital 1500 Lansown Av Dary, PA Mry Philalphia Hospital 501 S 54th Strt Philalphia, PA Lins hospital Gn. mial & surgial Chilrn's hospital Tahing hospital Critial ass hospital Rsarh faility ER-24 hours ER-othr Othr (sri) Pag 3 Faility rporting group Shul H (Form 990) FINAL 5/13/15 37

4 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion B. Faility Poliis an Pratis (Complt a sparat Stion B for ah of th hospital failitis or faility rporting groups list in Part V, Stion A) Pag 4 Nam of hospital faility or faility rporting groupmry Fitzgral Hospital If rporting on Part V, Stion B for a singl hospital faility only: lin numr of hospital faility (from Shul H, Part V, Stion A) Community Halth Ns Assssmnt (Lins 1 through 8 ar optional for tax yars ginning on or for Marh 23, 2012) f g h i j f g h i During th tax yar or ithr of th two immiatly pring tax yars, i th hospital faility onut a ommunity halth ns assssmnt (CHNA)? If "No," skip to lin 9~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," iniat what th CHNA rport sris (hk all that apply): a A finition of th ommunity srv y th hospital faility Dmographis of th ommunity Existing halth ar failitis an rsours within th ommunity that ar availal to rspon to th halth ns 8a Di th organization inur an xis tax unr stion 4959 for th hospital faility's failur to onut a CHNA If "Ys" to lin 8, what is th total amount of stion 4959 xis tax th organization rport on Form of th ommunity How ata was otain Th halth ns of th ommunity Primary an hroni isas ns an othr halth issus of uninsur prsons, low-inom prsons, an minority groups Th pross for intifying an prioritizing ommunity halth ns an srvis to mt th ommunity halth ns Th pross for onsulting with prsons rprsnting th ommunity's intrsts Information gaps that limit th hospital faility's aility to assss th ommunity's halth ns Othr (sri in Stion C) Iniat th tax yar th hospital faility last onut a CHNA: 20 In onuting its most rnt CHNA, i th hospital faility tak into aount input from prsons who rprsnt th roa intrsts of th ommunity srv y th hospital faility, inluing thos with spial knowlg of or xprtis in puli halth? If "Ys," sri in Stion C how th hospital faility took into aount input from prsons who rprsnt th ommunity, an intify th prsons th hospital faility onsult ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was th hospital faility's CHNA onut with on or mor othr hospital failitis? If "Ys," list th othr hospital failitis in Stion C ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th hospital faility mak its CHNA rport wily availal to th puli? If "Ys," iniat how th CHNA rport was ma wily availal (hk all that apply): a Hospital faility's wsit (list url): Othr wsit (list url): Availal upon rqust from th hospital faility Othr (sri in Stion C) $ ~~~~~~~~~~~~~~~~~~~~~~~~ If th hospital faility arss ns intifi in its most rntly onut CHNA, iniat how (hk all that apply as of th n of th tax yar): a Aoption of an implmntation stratgy that arsss ah of th ommunity halth ns intifi through th CHNA Exution of th implmntation stratgy Partiipation in th vlopmnt of a ommunity-wi plan Partiipation in th xution of a ommunity-wi plan Inlusion of a ommunity nfit stion in oprational plans Aoption of a ugt for provision of srvis that arss th ns intifi in th CHNA Prioritization of halth ns in its ommunity Prioritization of srvis that th hospital faility will unrtak to mt halth ns in its ommunity Othr (sri in Stion C) Di th hospital faility arss all of th ns intifi in its most rntly onut CHNA? If "No," xplain in Stion C whih ns it has not arss an th rasons why it has not arss suh ns ~~~~~~~~~~~ as rquir y stion 501(r)(3)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys" to lin 8a, i th organization fil Form 4720 to rport th stion 4959 xis tax? ~~~~~~~~~~~~~~~~ for all of its hospital failitis? a 8 Ys No Shul H (Form 990) FINAL 5/13/15 38

5 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Pag 5 Part V Faility Information(ontinu) Mry Fitzgral Hospital Finanial Assistan Poliy Ys No f g h i a f g Billing an Colltions a a Di th hospital faility hav in pla uring th tax yar a writtn finanial assistan poliy that: Explain ligiility ritria for finanial assistan, an whthr suh assistan inlus fr or isount ar? ~~~~~ Us fral povrty guilins (FPG) to trmin ligiility for proviing fr ar? ~~~~~~~~~~~~~~~~~~~~ If "Ys," iniat th FPG family inom limit for ligiility for fr ar: 200 % If "No," xplain in Stion C th ritria th hospital faility us. Us FPG to trmin ligiility for proviing isount ar? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," iniat th FPG family inom limit for ligiility for isount ar: 400 % If "No," xplain in Stion C th ritria th hospital faility us. Explain th asis for alulating amounts harg to patints? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," iniat th fators us in trmining suh amounts (hk all that apply): a Inom lvl Asst lvl Mial inigny Insuran status Uninsur isount Miai/Miar Stat rgulation Rsiny Othr (sri in Stion C) Explain th mtho for applying for finanial assistan? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Inlu masurs to puliiz th poliy within th ommunity srv y th hospital faility? ~~~~~~~~~~~~~~~ If "Ys," iniat how th hospital faility puliiz th poliy (hk all that apply): Th poliy was post on th hospital faility's wsit Th poliy was attah to illing invois Th poliy was post in th hospital faility's mrgny rooms or waiting rooms Th poliy was post in th hospital faility's amissions offis Th poliy was provi, in writing, to patints on amission to th hospital faility Th poliy was availal on rqust Othr (sri in Stion C) Di th hospital faility hav in pla uring th tax yar a sparat illing an olltions poliy, or a writtn finanial assistan poliy (FAP) that xplain ations th hospital faility may tak upon non-paymnt? Chk all of th following ations against an iniviual that wr prmitt unr th hospital faility's poliis uring th tax yar for making rasonal fforts to trmin th iniviual's ligiility unr th faility's FAP: Rporting to rit agny Lawsuits Lins on rsins Boy attahmnts Othr similar ations (sri in Stion C) ~~~~~~~~~~~~~~ Di th hospital faility or an authoriz thir party prform any of th following ations uring th tax yar for making rasonal fforts to trmin th iniviual's ligiility unr th faility's FAP? ~~~~~~~~~~~~~~~~~~~~~~ If "Ys," hk all ations in whih th hospital faility or a thir party ngag: Rporting to rit agny Lawsuits Lins on rsins Boy attahmnts Othr similar ations (sri in Stion C) Shul H (Form 990) FINAL 5/13/15 39

6 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Mry Fitzgral Hospital 18 Iniat whih fforts th hospital faility ma for initiating any of th ations list in lin 17 (hk all that 19 a apply): ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Notifi iniviuals of th finanial assistan poliy on amission Notifi iniviuals of th finanial assistan poliy prior to isharg Notifi iniviuals of th finanial assistan poliy in ommuniations with th iniviuals rgaring th iniviuals' ills Doumnt its trmination of whthr iniviuals wr ligil for finanial assistan unr th hospital faility's finanial assistan poliy Othr (sri in Stion C) Poliy Rlating to Emrgny Mial Car Di th hospital faility hav in pla uring th tax yar a writtn poliy rlating to mrgny mial ar that rquirs th hospital faility to provi, without isrimination, ar for mrgny mial onitions to iniviuals rgarlss of thir ligiility unr th hospital faility's finanial assistan poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 19 Ys Pag 6 No If "No," iniat why: a Th hospital faility i not provi ar for any mrgny mial onitions Th hospital faility's poliy was not in writing Th hospital faility limit who was ligil to riv ar for mrgny mial onitions (sri in Stion C) Othr (sri in Stion C) Chargs to Iniviuals Eligil for Assistan unr th FAP (FAP-Eligil Iniviuals) 20 Iniat how th hospital faility trmin, uring th tax yar, th maximum amounts that an harg to FAP-ligil iniviuals for mrgny or othr mially nssary ar. a Th hospital faility us its lowst ngotiat ommrial insuran rat whn alulating th maximum amounts that an harg Th hospital faility us th avrag of its thr lowst ngotiat ommrial insuran rats whn alulating th maximum amounts that an harg Th hospital faility us th Miar rats whn alulating th maximum amounts that an harg Othr (sri in Stion C) 21 During th tax yar, i th hospital faility harg any FAP-ligil iniviual to whom th hospital faility provi mrgny or othr mially nssary srvis mor than th amounts gnrally ill to iniviuals who ha insuran ovring suh ar? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 21 If "Ys," xplain in Stion C. 22 During th tax yar, i th hospital faility harg any FAP-ligil iniviual an amount qual to th gross harg for any srvi provi to that iniviual? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 22 If "Ys," xplain in Stion C. Shul H (Form 990) FINAL 5/13/15 40

7 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion B. Faility Poliis an Pratis (Complt a sparat Stion B for ah of th hospital failitis or faility rporting groups list in Part V, Stion A) Pag 4 Nam of hospital faility or faility rporting groupmry Philalphia Hospital If rporting on Part V, Stion B for a singl hospital faility only: lin numr of hospital faility (from Shul H, Part V, Stion A) Community Halth Ns Assssmnt (Lins 1 through 8 ar optional for tax yars ginning on or for Marh 23, 2012) f g h i j f g h i During th tax yar or ithr of th two immiatly pring tax yars, i th hospital faility onut a ommunity halth ns assssmnt (CHNA)? If "No," skip to lin 9~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," iniat what th CHNA rport sris (hk all that apply): a A finition of th ommunity srv y th hospital faility Dmographis of th ommunity Existing halth ar failitis an rsours within th ommunity that ar availal to rspon to th halth ns 8a Di th organization inur an xis tax unr stion 4959 for th hospital faility's failur to onut a CHNA If "Ys" to lin 8, what is th total amount of stion 4959 xis tax th organization rport on Form of th ommunity How ata was otain Th halth ns of th ommunity Primary an hroni isas ns an othr halth issus of uninsur prsons, low-inom prsons, an minority groups Th pross for intifying an prioritizing ommunity halth ns an srvis to mt th ommunity halth ns Th pross for onsulting with prsons rprsnting th ommunity's intrsts Information gaps that limit th hospital faility's aility to assss th ommunity's halth ns Othr (sri in Stion C) Iniat th tax yar th hospital faility last onut a CHNA: 20 In onuting its most rnt CHNA, i th hospital faility tak into aount input from prsons who rprsnt th roa intrsts of th ommunity srv y th hospital faility, inluing thos with spial knowlg of or xprtis in puli halth? If "Ys," sri in Stion C how th hospital faility took into aount input from prsons who rprsnt th ommunity, an intify th prsons th hospital faility onsult ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was th hospital faility's CHNA onut with on or mor othr hospital failitis? If "Ys," list th othr hospital failitis in Stion C ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di th hospital faility mak its CHNA rport wily availal to th puli? If "Ys," iniat how th CHNA rport was ma wily availal (hk all that apply): a Hospital faility's wsit (list url): Othr wsit (list url): Availal upon rqust from th hospital faility Othr (sri in Stion C) $ ~~~~~~~~~~~~~~~~~~~~~~~~ If th hospital faility arss ns intifi in its most rntly onut CHNA, iniat how (hk all that apply as of th n of th tax yar): a Aoption of an implmntation stratgy that arsss ah of th ommunity halth ns intifi through th CHNA Exution of th implmntation stratgy Partiipation in th vlopmnt of a ommunity-wi plan Partiipation in th xution of a ommunity-wi plan Inlusion of a ommunity nfit stion in oprational plans Aoption of a ugt for provision of srvis that arss th ns intifi in th CHNA Prioritization of halth ns in its ommunity Prioritization of srvis that th hospital faility will unrtak to mt halth ns in its ommunity Othr (sri in Stion C) Di th hospital faility arss all of th ns intifi in its most rntly onut CHNA? If "No," xplain in Stion C whih ns it has not arss an th rasons why it has not arss suh ns ~~~~~~~~~~~ as rquir y stion 501(r)(3)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys" to lin 8a, i th organization fil Form 4720 to rport th stion 4959 xis tax? ~~~~~~~~~~~~~~~~ for all of its hospital failitis? a 8 Ys No Shul H (Form 990) FINAL 5/13/15 41

8 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Pag 5 Part V Faility Information(ontinu) Mry Philalphia Hospital Finanial Assistan Poliy Ys No f g h i a f g Billing an Colltions a a Di th hospital faility hav in pla uring th tax yar a writtn finanial assistan poliy that: Explain ligiility ritria for finanial assistan, an whthr suh assistan inlus fr or isount ar? ~~~~~ Us fral povrty guilins (FPG) to trmin ligiility for proviing fr ar? ~~~~~~~~~~~~~~~~~~~~ If "Ys," iniat th FPG family inom limit for ligiility for fr ar: 200 % If "No," xplain in Stion C th ritria th hospital faility us. Us FPG to trmin ligiility for proviing isount ar? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," iniat th FPG family inom limit for ligiility for isount ar: 400 % If "No," xplain in Stion C th ritria th hospital faility us. Explain th asis for alulating amounts harg to patints? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Ys," iniat th fators us in trmining suh amounts (hk all that apply): a Inom lvl Asst lvl Mial inigny Insuran status Uninsur isount Miai/Miar Stat rgulation Rsiny Othr (sri in Stion C) Explain th mtho for applying for finanial assistan? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Inlu masurs to puliiz th poliy within th ommunity srv y th hospital faility? ~~~~~~~~~~~~~~~ If "Ys," iniat how th hospital faility puliiz th poliy (hk all that apply): Th poliy was post on th hospital faility's wsit Th poliy was attah to illing invois Th poliy was post in th hospital faility's mrgny rooms or waiting rooms Th poliy was post in th hospital faility's amissions offis Th poliy was provi, in writing, to patints on amission to th hospital faility Th poliy was availal on rqust Othr (sri in Stion C) Di th hospital faility hav in pla uring th tax yar a sparat illing an olltions poliy, or a writtn finanial assistan poliy (FAP) that xplain ations th hospital faility may tak upon non-paymnt? Chk all of th following ations against an iniviual that wr prmitt unr th hospital faility's poliis uring th tax yar for making rasonal fforts to trmin th iniviual's ligiility unr th faility's FAP: Rporting to rit agny Lawsuits Lins on rsins Boy attahmnts Othr similar ations (sri in Stion C) ~~~~~~~~~~~~~~ Di th hospital faility or an authoriz thir party prform any of th following ations uring th tax yar for making rasonal fforts to trmin th iniviual's ligiility unr th faility's FAP? ~~~~~~~~~~~~~~~~~~~~~~ If "Ys," hk all ations in whih th hospital faility or a thir party ngag: Rporting to rit agny Lawsuits Lins on rsins Boy attahmnts Othr similar ations (sri in Stion C) Shul H (Form 990) FINAL 5/13/15 42

9 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Mry Philalphia Hospital 18 Iniat whih fforts th hospital faility ma for initiating any of th ations list in lin 17 (hk all that 19 a apply): ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Notifi iniviuals of th finanial assistan poliy on amission Notifi iniviuals of th finanial assistan poliy prior to isharg Notifi iniviuals of th finanial assistan poliy in ommuniations with th iniviuals rgaring th iniviuals' ills Doumnt its trmination of whthr iniviuals wr ligil for finanial assistan unr th hospital faility's finanial assistan poliy Othr (sri in Stion C) Poliy Rlating to Emrgny Mial Car Di th hospital faility hav in pla uring th tax yar a writtn poliy rlating to mrgny mial ar that rquirs th hospital faility to provi, without isrimination, ar for mrgny mial onitions to iniviuals rgarlss of thir ligiility unr th hospital faility's finanial assistan poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 19 Ys Pag 6 No If "No," iniat why: a Th hospital faility i not provi ar for any mrgny mial onitions Th hospital faility's poliy was not in writing Th hospital faility limit who was ligil to riv ar for mrgny mial onitions (sri in Stion C) Othr (sri in Stion C) Chargs to Iniviuals Eligil for Assistan unr th FAP (FAP-Eligil Iniviuals) 20 Iniat how th hospital faility trmin, uring th tax yar, th maximum amounts that an harg to FAP-ligil iniviuals for mrgny or othr mially nssary ar. a Th hospital faility us its lowst ngotiat ommrial insuran rat whn alulating th maximum amounts that an harg Th hospital faility us th avrag of its thr lowst ngotiat ommrial insuran rats whn alulating th maximum amounts that an harg Th hospital faility us th Miar rats whn alulating th maximum amounts that an harg Othr (sri in Stion C) 21 During th tax yar, i th hospital faility harg any FAP-ligil iniviual to whom th hospital faility provi mrgny or othr mially nssary srvis mor than th amounts gnrally ill to iniviuals who ha insuran ovring suh ar? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 21 If "Ys," xplain in Stion C. 22 During th tax yar, i th hospital faility harg any FAP-ligil iniviual an amount qual to th gross harg for any srvi provi to that iniviual? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 22 If "Ys," xplain in Stion C. Shul H (Form 990) FINAL 5/13/15 43

10 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion C. Supplmntal Information for Part V, Stion B. Provi sriptions rquir for Part V, Stion B, lins 1j, 3, 4, 5, 6i, 7, 10, 11, 12i, 14g, 16, 17, 18, 19, 19, 20, 21, an 22. If applial, provi sparat sriptions for ah faility in a faility rporting group, signat y "Faility A, " "Faility B," t. Pag 7 Mry Fitzgral Hospital: Part V, Stion B, Lin 3: Information on th halth status an halth ar ns of Mry Fitzgral Hospital's srvi ara rsints was ollt from th ommunity through four ommunity mtings with rsints, puli halth rprsntativs, srvi provirs, an avoats knowlgal aout ommunity halth. Fifty-nin ommunity lars, provirs, puli halth rprsntativs, an rsints partiipat. Th partiipating groups, organizations, an iniviuals inlu 52n Strt Businss Assoiation, AIDS Car Group, Blss Virgin Mary Churh, Chapl of Goo Shphr, Chsspnn Halth Srvis, Chstr City, Chstr NAACP, Crozr-Kyston Halth Systm, Dary Fr Lirary, Dlawar County, Dlawar County Dpartmnt of Intrommunity Halth, Dlawar County Intrmiat Unit, Dlawar County Mial Soity, Dlawar County Offi of Housing an Community Dvlopmnt/Dary CDC, Dlawar County Offi of Srvis for th Aging, Dlawar County Rorr of Ds, Dlmar Pharmay, Domsti Aus Projt, Primary Car Physiian, Family Prati an Counsling Ntwork - Halth Annx, Frinship Cirl Snior Cntr, Goo Nighor Snior Car, Gra-Community Unit Mthoist Churh, Halth Partnrs, Intrultural Family Srvis Halthy Start, Matrnity Car Coalition, Mry Halth Systm SEPA, Mry Philalphia Hospital, PathWaysPA, PBS Consulting, Philalphia Corporation for Aging, Philalphia Halth Cntr 3, Philalphia Halth Cntr 4, Snior Community Srvis, Sikl Cll Disas Assoiation of Amrian, Philalphia Dlawar Vally Chaptr, St. Cyprian Roman Catholi Churh, Th Entrpris Cntr CDC, Unit Halthar Community Plan, Unit Way of Gratr Philalphia an Southrn Nw Jrsy, Uppr Dary Snior Cntr, Shul H (Form 990) FINAL 5/13/15 44

11 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion C. Supplmntal Information for Part V, Stion B. Provi sriptions rquir for Part V, Stion B, lins 1j, 3, 4, 5, 6i, 7, 10, 11, 12i, 14g, 16, 17, 18, 19, 19, 20, 21, an 22. If applial, provi sparat sriptions for ah faility in a faility rporting group, signat y "Faility A, " "Faility B," t. VITAS Hospi, Wal-Mart of Glnoln PA, Winr Shool of Nursing, an Youth Srvi, In. Pag 7 Mry Philalphia Hospital: Part V, Stion B, Lin 3: Information on th halth status an halth ar ns of Mry Philalphia Hospital's srvi ara rsints was ollt from th ommunity through ommunity mtings with rsints, puli halth rprsntativs, srvi provirs, an avoats knowlgal aout ommunity halth. Thirty-on ommunity lars, provirs, puli halth rprsntativs, an rsints partiipat. Th partiipating groups, organizations, an iniviuals inlu 52n Strt Businss Assoiation, AtionAIDS, Ai for Frins, Communitis in Shools of Philalphia In., Dlawar Vally Halthar Counil of HAP, Family Prati an Counsling Ntwork - Halth Annx, Halth Promotion Counil of SEPA, Intrultural Family Srvis Halthy Start, Matrnity Car Coalition, Mntal Halth Assoiation of Southastrn Pnnsylvania, Mry Halth Systm SEPA, Mtropolitan Ara Nighorhoo Nutrition Allian (MANNA), PBS Consulting, Philalphia Corporation for Aging, Philalphia Halth Cntr #10, Philalphia Halth Cntr 3, Philalphia Halth Cntr 4, Svnth Snatorial Distrit, Sikl Cll Disas Assoiation of Amrian Philalphia Dlawar Vally Chaptr, St. Cyprian Roman Catholi Churh, Th Entrpris Cntr CDC, Youth Srvi In., PATH In., Philalphia Fir Dpt/EMS, Philalphia Poli Dpt. 15th Distrit, Philalphia Poli Dpt. 7th Distrit, Rhawnhurst NORC at Jwish Fration of Gratr Philalphia, Snior Car Partnrs, St. Jrom Parish, Tmpl Bth Ami, an VITAS Hospi Shul H (Form 990) FINAL 5/13/15 45

12 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion C. Supplmntal Information for Part V, Stion B. Provi sriptions rquir for Part V, Stion B, lins 1j, 3, 4, 5, 6i, 7, 10, 11, 12i, 14g, 16, 17, 18, 19, 19, 20, 21, an 22. If applial, provi sparat sriptions for ah faility in a faility rporting group, signat y "Faility A, " "Faility B," t. Pag 7 Mry Fitzgral Hospital: Part V, Stion B, Lin 7: Mry Fitzgral Hospital intifi twnty-on iffrnt signifiant halth ns an implmntation stratgis wr vlop for fiftn of thos ns, laving six that wr not arss. Th six unarss ns rlat to: 1. Dntal ar for olr aults an low inom populations. 2. Early prnatal ar. 3. Programs that ru infant mortality among all rsints an low irth wight irths, spially among Afrian-Amrian womn. 4. Tn prgnany. 5. Prsriptions for olr aults an low inom populations. 6. Unrstaning an trust in th pulily fun halth ar an insuran systm among low inom rsints, partiularly City Halth Cntrs an Frally Qualifi Halth Cntrs in Philalphia. Mry Fitzgral Hospital i not arss ths ns aus thy lak th xprtis an omptnis n to arss th issu fftivly. Mry Philalphia Hospital: Part V, Stion B, Lin 7: Mry Philalphia Hospital intifi nintn iffrnt signifiant halth ns an implmntation stratgis wr vlop for twlv of thos ns, laving svn that wr not arss. Th svn unarss ns rlat to: 1. Dntal ar for olr aults an low inom populations. 2. Halth insuran ovrag. 3. Prsriptions for olr aults an low inom populations. 4. OB/GYN ar, inluing pr-natal ar an livry for prgnant womn. 5. Infant mortality rat. 6. Infants orn at low irth wight. 7. Tn prgnany. Mry Philalphia Hospital i not arss ths ns aus thy lak th xprtis an omptnis n to arss th issu Shul H (Form 990) FINAL 5/13/15 46

13 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion C. Supplmntal Information for Part V, Stion B. Provi sriptions rquir for Part V, Stion B, lins 1j, 3, 4, 5, 6i, 7, 10, 11, 12i, 14g, 16, 17, 18, 19, 19, 20, 21, an 22. If applial, provi sparat sriptions for ah faility in a faility rporting group, signat y "Faility A, " "Faility B," t. fftivly. Pag 7 Mry Fitzgral Hospital: Part V, Stion B, Lin 12i: Th Hospital rognizs that not all patints ar al to provi omplt finanial an/or soial information. Thrfor, approval for finanial support may trmin as on availal information. Exampls of prsumptiv ass inlu: as patints with no known stat, th homlss, unmploy patints, non-ovr mially nssary srvis provi to patints qualifying for puli assistan programs, patint ankruptis, an mmrs of rligious organizations who hav takn a vow of povrty an hav no rsours iniviually or through th rligious orr. For th purpos of hlping finanially ny patints, a thir-party is utiliz to onut a rviw of patint information to assss finanial n. This rviw utilizs a halthar inustry-rogniz, pritiv mol that is as on puli ror ataass. Ths puli rors nal th Hospital to assss whthr th patint is haratristi of othr patints who hav historially qualifi for finanial assistan unr th traitional appliation pross. In ass whr thr is an asn of information provi irtly y th patint, an aftr fforts to onfirm ovrag availaility, th pritiv mol provis a systmati mtho to grant prsumptiv ligiility to finanially ny patints. Mry Philalphia Hospital: Shul H (Form 990) FINAL 5/13/15 47

14 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion C. Supplmntal Information for Part V, Stion B. Provi sriptions rquir for Part V, Stion B, lins 1j, 3, 4, 5, 6i, 7, 10, 11, 12i, 14g, 16, 17, 18, 19, 19, 20, 21, an 22. If applial, provi sparat sriptions for ah faility in a faility rporting group, signat y "Faility A, " "Faility B," t. Part V, Stion B, Lin 12i: Th Hospital rognizs that not all patints ar al to provi omplt finanial an/or soial information. Thrfor, approval for finanial support may trmin as on availal information. Exampls of prsumptiv ass inlu: as patints with no known stat, th homlss, unmploy patints, non-ovr mially nssary srvis provi to patints qualifying for puli assistan programs, patint ankruptis, an mmrs of rligious organizations who hav takn a vow of povrty an hav no rsours iniviually or through th rligious orr. Pag 7 For th purpos of hlping finanially ny patints, a thir-party is utiliz to onut a rviw of patint information to assss finanial n. This rviw utilizs a halthar inustry-rogniz, pritiv mol that is as on puli ror ataass. Ths puli rors nal th Hospital to assss whthr th patint is haratristi of othr patints who hav historially qualifi for finanial assistan unr th traitional appliation pross. In ass whr thr is an asn of information provi irtly y th patint, an aftr fforts to onfirm ovrag availaility, th pritiv mol provis a systmati mtho to grant prsumptiv ligiility to finanially ny patints. Mry Fitzgral Hospital: Part V, Stion B, Lin 18: Th organization os not tak any of th ations list on Lin 17 with rspt to patints ligil for assistan unr th organization's FAP Shul H (Form 990) FINAL 5/13/15 48

15 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion C. Supplmntal Information for Part V, Stion B. Provi sriptions rquir for Part V, Stion B, lins 1j, 3, 4, 5, 6i, 7, 10, 11, 12i, 14g, 16, 17, 18, 19, 19, 20, 21, an 22. If applial, provi sparat sriptions for ah faility in a faility rporting group, signat y "Faility A, " "Faility B," t. Pag 7 Mry Philalphia Hospital: Part V, Stion B, Lin 18: Th organization os not tak any of th ations list on Lin 17 with rspt to patints ligil for assistan unr th organization's FAP. Mry Fitzgral Hospital: Part V, Stion B, Lin 20: Th hospital faility us Miai rats whn alulating th maximum amounts that an harg. Mry Philalphia Hospital: Part V, Stion B, Lin 20: Th hospital faility us Miai rats whn alulating th maximum amounts that an harg Shul H (Form 990) FINAL 5/13/15 49

16 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part V Faility Information (ontinu) Stion D. Othr Halth Car Failitis That Ar Not Lins, Rgistr, or Similarly Rogniz as a Hospital Faility Pag 8 (list in orr of siz, from largst to smallst) How many non-hospital halth ar failitis i th organization oprat uring th tax yar? 0 Nam an arss Typ of Faility (sri) Shul H (Form 990) FINAL 5/13/15 50

17 Shul H (Form 990) 2013 of Southastrn Pnnsylvania Part VI Supplmntal Information Pag 9 Provi th following information Rquir sriptions. Provi th sriptions rquir for Part I, lins 3, 6a, an 7; Part II an Part III, lins 2, 3, 4, 8 an 9. Ns assssmnt. Dsri how th organization asssss th halth ar ns of th ommunitis it srvs, in aition to any CHNAs rport in Part V, Stion B. Patint uation of ligiility for assistan. Dsri how th organization informs an uats patints an prsons who may ill for patint ar aout thir ligiility for assistan unr fral, stat, or loal govrnmnt programs or unr th organization's finanial assistan poliy. Community information. Dsri th ommunity th organization srvs, taking into aount th gographi ara an mographi onstitunts it srvs. Promotion of ommunity halth. Provi any othr information important to sriing how th organization's hospital failitis or othr halth ar failitis furthr its xmpt purpos y promoting th halth of th ommunity (.g., opn mial staff, ommunity oar, us of surplus funs, t.). Affiliat halth ar systm. If th organization is part of an affiliat halth ar systm, sri th rsptiv rols of th organization an its affiliats in promoting th halth of th ommunitis srv. Stat filing of ommunity nfit rport. If applial, intify all stats with whih th organization, or a rlat organization, fils a ommunity nfit rport. Part I, Lin 6a: Mry Catholi Mial Cntr rports its ommunity nfit information as part of th onsoliat ommunity nfit information rport y Trinity Halth (EIN ) in its auit finanial statmnts, availal at In aition, Mry Catholi Mial Cntr inlus a opy of its most rntly fil Shul H on oth its own wsit an Trinity Halth's wsit. Part I, Lin 7: Th st availal ata was us to alulat th ost amounts rport in itm 7. For rtain atgoris, primarily total harity ar an mans-tst govrnmnt programs, spifi ost-to-harg ratios wr alulat an appli to thos atgoris. Th ost-to-harg ratio was riv from worksht 2, ratio of patint ar ost-to-hargs. In othr atgoris, th st availal ata was riv from th Hospital's ost aounting systm. Part I, Lin 7g: Shul H (Form 990) FINAL 5/13/15 51

18 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 Of th amount on Shul H, Part I, Lin 7(g), Column (), $8,111,890 was spnt fraying th ost of physiian srvis rnr at th hospital an failitis own y rlat organizations. Part III, Lin 2: Th figurs wr alulat as on th ost-to-harg ratio. Th ost-to-harg ratio was riv y iviing total oprating xpnss y total gross patint hargs. Th ost-to-harg ratio was appli to total a t writ-offs to alulat th osts for lin 2. Any isounts provi or paymnts ma to a partiular patint aount ar appli to that patint aount prior to any a t writ-off an ar thus not inlu in a t xpns. As a rsult of th paymnt an ajustmnt ativity ing post to a t aounts, w ar al to rport a t xpns nt of ths transations. Part III, Lin 3: Mry Catholi Mial Cntr uss a pritiv mol that inorporats thr istint varials in omination to prit whthr a patint qualifis for harity: (1) Soio-onomi sor, (2) Estimat Fral Povrty Lvl (FPL), an (3) Homownrship. Bas on th mol, harity ar an still xtn to patints vn if thy hav not rspon to finanial ounsling fforts an all othr funing sours hav n xhaust. Mry Catholi Mial Cntr is roring amounts as harity ar (insta of a t xpns) as on th rsults of th pritiv mol. Thrfor, Mry Catholi Mial Cntr is rporting zro on lin 3, sin thortially any potntial harity ar shoul hav n intifi through th pritiv mol Shul H (Form 990) 52 FINAL 5/13/15 52

19 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 Part III, Lin 4: Mry Catholi Mial Cntr is inlu in th onsoliat finanial statmnts of Trinity Halth. Th following is th txt of th allowan for outful aounts footnot from pag 14 of thos statmnts: "Th Corporation rognizs a signifiant amount of patint srvi rvnu at th tim th srvis ar rnr vn though th Corporation os not assss th patint's aility to pay at that tim. As a rsult, th provision for a ts is prsnt as a ution from patint srvi rvnu (nt of ontratual provisions an isounts). For uninsur an unrinsur patints that o not qualify for harity ar, th Corporation stalishs an allowan to ru th arrying valu of suh rivals to thir stimat nt ralizal valu. This allowan is stalish as on th aging of aounts rival an th historial olltion xprin y Rgional Halth Ministry an for ah typ of payor. A signifiant portion of th Corporation's provision for outful aounts rlats to slf-pay patints, as wll as o-paymnts an utils ow to th Corporation y patints with insuran." Part III, Lin 8: Mry Catholi Mial Cntr has rport a surplus on proviing Miar srvis of $5,768,330 on Part III, Lin 7 on Shul H. This surplus agrs to th amount islos in th Miar Cost Rport for th fisal yar n Jun 30, Mry Catholi Mial Cntr also inurr unpai osts of Miar programs of $7,303,422 for th prio ning Jun 30, Ths unpai osts rlat to th following: 1) Th ost an rimursmnt for f-shul rimurs srvis ar not onsir in th Miar ost rport. 2) Th ost-to-harg ratio mthoology us in th ost rport iffrs from th mthoology that Shul H (Form 990) 53 FINAL 5/13/15 53

20 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 Mry Catholi Mial Cntr uss to alulat th unpai ost of Miar srvis. 3) Th ost rport os not inlu unpai osts of Miar Avantag plans. 4) Th ost rport numrs o not inlu rvnus an osts of grauat irt mial uation. This $7,303,422 amount rprsnts th osts of srvis provi to Miar patints y th Hospital for whih no paymnt is xpt or riv. Miar srvis ar provi to ligil patints rgarlss of thir aility to pay, an thrfor any shortfall is onsir to a ommunity nfit provi y th Hospital. Whn onsiring th total unpai ost of Miar for th Hospital for all srvis, inluing thos whih ar not rport on th 2014 ost rport, th total unpai ost of Miar srvis for Mry Catholi Mial Cntr is $1,535,092. Costing mthoology for lin 6 - Miar osts wr otain from th fil Miar ost rport. Th osts ar as on Miar allowal osts as rport on worksht B, olumn 27, whih xlu irt mial uation osts. Inpatint Miar osts ar alulat as on a omination of allowal ost pr ay tims Miar ays for routin srvis an ost-to-harg ratio tims Miar hargs for anillary srvis. Outpatint Miar osts ar alulat as on ost-to-harg ratio tims Miar hargs y anillary partmnt. Part III, Lin 9: Th Hospital's olltion poliy ontains provisions on th olltion pratis to follow for patints who ar known to qualify for finanial assistan. Charity isounts ar appli to th amounts that qualify for finanial assistan. Colltion pratis for th rmaining alans ar larly outlin in th organization's olltion Shul H (Form 990) 54 FINAL 5/13/15 54

21 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 poliy. Th Hospital has implmnt illing an olltion pratis for patint paymnt oligations that ar fair, onsistnt an ompliant with stat an fral rgulations. Part VI, Lin 2: Mry Fitzgral Hospital asssss th halth status of its ommunity in th normal ours of oprations an in th ontinuous fforts to improv patint ar an th halth of th ovrall ommunity. Th Hospital may us patint ata, puli halth ata, annual County Halth Rankings, markt stuis, an gographial maps showing aras of high utilization for mrgny srvis an inpatint ar, whih may iniat populations of iniviuals who o not hav ass to prvntativ srvis or ar uninsur, in th assssmnt of th ommunity. Part VI, Lin 2: Mry Philalphia Hospital asssss th halth status of its ommunity in th normal ours of oprations an in th ontinuous fforts to improv patint ar an th halth of th ovrall ommunity. Th Hospital may us patint ata, puli halth ata, annual County Halth Rankings, markt stuis, an gographial maps showing aras of high utilization for mrgny srvis an inpatint ar, whih may iniat populations of iniviuals who o not hav ass to prvntativ srvis or ar uninsur, in th assssmnt of th ommunity. Part VI, Lin 3: Mry Fitzgral Hospital is ommitt to: - Proviing ass to quality halthar srvis with ompassion, ignity an rspt for thos w srv, partiularly th poor an th unrsrv in our ommunitis Shul H (Form 990) 55 FINAL 5/13/15 55

22 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 - Caring for all prsons, rgarlss of thir aility to pay for srvis - Assisting patints who annot pay for part or all of th ar thy riv - Balaning n finanial assistan for som patints with roar fisal rsponsiilitis in orr to sustain viaility an provi th quality an quantity of srvis for all who may n ar in a ommunity In aoran with Amrian Hospital Assoiation rommnations, Mry Fitzgral Hospital has aopt th following guiing prinipls whn hanling th illing, olltion an finanial support funtions for our patints: - Provi fftiv ommuniations with patints rgaring hospital ills - Mak affirmativ fforts to hlp patints apply for puli an privat finanial support programs - Offr finanial support to patints with limit mans - Implmnt poliis for assisting low-inom patints in a onsistnt mannr - Implmnt fair an onsistnt illing an olltion pratis for all patints with patint paymnt oligations Mry Fitzgral Hospital ommuniats fftivly with patints rgaring patint paymnt oligations. Finanial ounsling is provi to patints aout thir paymnt oligations an hospital ills. Information on hospital-as finanial support poliis an xtrnal programs that provi ovrag for srvis ar ma availal to patints uring th pr-rgistration an rgistration prosss an/or through ommuniations with patints sking finanial assistan Shul H (Form 990) 56 FINAL 5/13/15 56

23 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 Finanial ounslors mak affirmativ fforts to hlp patints apply for puli an privat programs for whih thy may qualify an that may assist thm in otaining an paying for halthar srvis. Evry ffort is ma to trmin a patint's ligiility prior to, or at th tim of, amission or srvi. Howvr, trmination for finanial support an ma uring any stag of th patint's stay aftr stailization or olltion yl. Mry Fitzgral Hospital offrs finanial support to patints with limit mans. This support is availal to uninsur an unrinsur patints who o not qualify for puli programs or othr assistan. Notifiation aout finanial assistan, inluing ontat information, is availal through patint rohurs, mssags on patint ills, post notis in puli rgistration aras inluing mrgny rooms, amitting an rgistration partmnts, an othr patint finanial srvis offis. Summaris of hospital programs ar ma availal to appropriat ommunity halth an human srvis agnis an othr organizations that assist popl in n. Information rgaring finanial assistan programs is also availal on hospital wsits. In aition to English, this information is also availal in Spanish or othr languags, rflting othr primary languags spokn y th population srvi y our hospital. Part VI, Lin 3: Mry Philalphia Hospital is ommitt to: - Proviing ass to quality halthar srvis with ompassion, ignity an rspt for thos w srv, partiularly th poor an th unrsrv in our ommunitis - Caring for all prsons, rgarlss of thir aility to pay for srvis - Assisting patints who annot pay for part or all of th ar thy Shul H (Form 990) 57 FINAL 5/13/15 57

24 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 riv - Balaning n finanial assistan for som patints with roar fisal rsponsiilitis in orr to sustain viaility an provi th quality an quantity of srvis for all who may n ar in a ommunity In aoran with Amrian Hospital Assoiation rommnations, Mry Philalphia Hospital has aopt th following guiing prinipls whn hanling th illing, olltion an finanial support funtions for our patints: - Provi fftiv ommuniations with patints rgaring hospital ills - Mak affirmativ fforts to hlp patints apply for puli an privat finanial support programs - Offr finanial support to patints with limit mans - Implmnt poliis for assisting low-inom patints in a onsistnt mannr - Implmnt fair an onsistnt illing an olltion pratis for all patints with patint paymnt oligations Mry Philalphia Hospital ommuniats fftivly with patints rgaring patint paymnt oligations. Finanial ounsling is provi to patints aout thir paymnt oligations an hospital ills. Information on hospital-as finanial support poliis an xtrnal programs that provi ovrag for srvis ar ma availal to patints uring th pr-rgistration an rgistration prosss an/or through ommuniations with patints sking finanial assistan. Finanial ounslors mak affirmativ fforts to hlp patints apply for puli an privat programs for whih thy may qualify an that may assist Shul H (Form 990) 58 FINAL 5/13/15 58

25 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 thm in otaining an paying for halthar srvis. Evry ffort is ma to trmin a patint's ligiility prior to, or at th tim of, amission or srvi. Howvr, trmination for finanial support an ma uring any stag of th patint's stay aftr stailization or olltion yl. Mry Philalphia Hospital offrs finanial support to patints with limit mans. This support is availal to uninsur an unrinsur patints who o not qualify for puli programs or othr assistan. Notifiation aout finanial assistan, inluing ontat information, is availal through patint rohurs, mssags on patint ills, post notis in puli rgistration aras inluing mrgny rooms, amitting an rgistration partmnts, an othr patint finanial srvis offis. Summaris of hospital programs ar ma availal to appropriat ommunity halth an human srvis agnis an othr organizations that assist popl in n. Information rgaring finanial assistan programs is also availal on hospital wsits. In aition to English, this information is also availal in Spanish or othr languags, rflting othr primary languags spokn y th population srvi y our hospital. Part VI, Lin 4: Mry Fitzgral Hospital (MFH) is loat in Dary (19023), Dlawar County. Its primary an sonary srvi ara ompriss 11 zip os aross Southastrn Dlawar County an Wst/Southwst Philalphia. This is a ivrs srvi ara whr 71% of total population is a minority. Th ovrall population is xpt to inras y 1% twn 2014 an 2019 whil th minority population is projt to inras 3.1%. A ras of 2.3% is projt in th fmal population hil aring ag Shul H (Form 990) 59 FINAL 5/13/15 59

26 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 group. With an avrag houshol inom of $52,513 an unmploymnt at 9.7%, thr ar pokts of nighorhoos that ar onomially istrss an aras that hav n signat as mially unrsrv an primary ar halth profssional shortag aras. Part VI, Lin 4: Mry Philalphia Hospital (MPH) is loat in Kingsssing (19143), Wst Philalphia. Its primary an sonary srvi ara ompriss fiv zip os aross wst an southwst Philalphia. Stions of th srvi ara hav n signat y th stat an fral govrnmnt as a mially unrsrv (MUA) an/or primary ar halth profssional shortag (HPSA) aras an ar also onomially istrss. Th srvi ara has a high minority population, 83% of th total population. Th ovrall population is xpt to inras y 1.7% whil th fmal population of hil aring ag is projt to ras y 0.9% twn 2014 an Th avrag houshol inom is $39,098 an th unmploymnt rat is 9.3%. Part VI, Lin 5: Our ommunity nfit ativitis inlu going irtly into unrsrv ommunitis/populations an proviing halth srnings, immunizations an halth ar uation. Our ommunity nfit programs also nsur stalishing primary ar physiian offis in mially unrsrv aras. In aition, w maintain a 24-hour mrgny room, an opn mial staff an a oar ompris largly of inpnnt mmrs of th ommunity. Part VI, Lin 6: Mry Catholi Mial Cntr is a mmr of Trinity Halth, Shul H (Form 990) 60 FINAL 5/13/15 60

27 Shul H (Form 990) of Southastrn Pnnsylvania Part VI Supplmntal Information (Continuation) Pag 9 on of th largst Catholi halth ar livry systms in th ountry. Trinity Halth annually rquirs that all mmr organizations fin - an ahiv - ommunity nfit goals that inlu implmnting n srvis or xpaning ass to srvis for low-inom iniviuals. As a not-for-profit halth systm, Trinity Halth rinvsts its profits ak into th ommunity through programs srving thos who ar poor an uninsur, hlping manag hroni onitions lik iats, proviing halth uation, promoting wllnss an rahing out to unrsrv populations. Ovrall, th organization invsts mor than $800 million in suh ommunity nfits an works to nsur that its mmr hospitals an othr ntitis/affiliats nhan th ovrall halth of th ommunitis thy srv y arssing ah ommunity's spifi ns. For mor information aout Trinity Halth, visit Shul H (Form 990) 61 FINAL 5/13/15 61