4A (Expenses $ 186397335 including grants of $ 12450) (Revenue $ 199777265)
Please see Schedule O for a complete description of program service accomplishments.

Schedule H, Part V, Section B, Line 3E
THE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.

Schedule H, Part V, Section B, Line 5 Facility A, 1
"Facility A, 1 - Monroe Clinic. The GCHCC is co-chaired by representatives from SSM Health Monroe Hospital & Monroe Clinic Medical Group and Green County Public Health. The coalition is comprised of public health, healthcare leaders and representatives of the underserved population. The Coalition determined our community health priorities after collecting primary and secondary community health data. An online community health needs assessment survey in English and Spanish was available for community members to complete during February and March of 2021. This survey asked about people's personal health, their thoughts about the community's health, and gave space for people to provide suggestions. It took approximately 10 minutes to complete with 750 individuals fully completing the survey. Community members could submit a comment at the end of the survey. When these comments were analyzed we identified the 10 most frequent comment topics/suggestions. Five Community Conversations were held in several communities within Green County to learn about residents' concerns, solicit their ideas on healthcare and how it could be improved. These conversations gave us insight on what community perception was and opened-up the conversation for ideas on how to improve health care access and resources. Approximately 30 individuals contributed comments on a range of issues that affect population health and well-being, barriers for underserved populations and other community concerns. Eight ""key informant"" interviews were held with healthcare professionals from a variety of settings in Green County. During these interviews and conversations we asked questions and took notes. Afterwards those responses were analyzed to identify common themes. Secondary data was collected from multiple sources and analyzed and revealed health disparities and key issues impacting social determinants of health. Data collection included demographic information, chronic disease and morbidity/ mortality information, health status indicators, health behaviors and general environment information. This data is compared to state and national benchmarks. The community survey and secondary data were presented to the coalition. The committee identified and prioritized community health needs based on importance to community members and our ability to make a significant impact. The requirement that the hospital conducts a Community Health Needs Assessment (CHNA) under the Patient Protection and Affordable Care Act (PPACA) asks hospitals to pay specific attention to health care concerns that affect vulnerable populations. This prioritized list was then presented to SSM Health Monroe Hospital & Monroe Clinic Medical GroupBoard of Directors and Green County Public Health Board for approval."

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - Monroe Clinic. The facility conducted its 2021 CHNA with Green County (WI) Public Health.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - Monroe Clinic. The hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Adverse childhood experiences - Housing - Mental health Adverse childhood experiences What happens to people during their childhood impacts them throughout their life, and negative experiences at a young age can have detrimental consequences to a person's health. ACEs are traumatic events and unsafe or unstable environments experienced between the ages of 0 through 17. ACEs significantly affect childhood development, well-being, adult health, and social productivity. The more ACEs experienced as a child, the greater the individual's risk for chronic disease and mental illness throughout life. The hospital's vision is to break the cycle of adversity and trauma by building hope, resilience and growth for the children and families of Green County with the following goals and objectives: Goal #1: Develop a centralized website dedicated to building knowledge, prevention and resources towards adverse childhood experiences by October 2022. - Objective 1a: Develop easily understood information related to what adverse childhood experiences are and why it is important we prevent them (the buy in) by July 2022. - Objective 1b: Gather already available resources in Green County that promote the prevention of adverse experiences and develop prosocial behavior for children and families by April 2023. - Objective 1c: Developing a website through the Green County Healthy Community Coalition by October 2022. - Objective 1d: Provide content for the social media platform related to adverse childhood experiences and resources as an ongoing task. - Objective 1e: Monitor how frequently the webpage is accessed and the Facebook insights as to the number of people content reaches and webpage accessed as an ongoing task. Goal #2: Identify at least one evidence-based resource for community members that provides direct education related to parenting, helping parents and youth handle stress, manage emotions, and tackle everyday challenges by March 2023. - Objective 2a: Research available community evidence-based resources already available in Green County by July 2022. - Objective 2b: Determine what community intervention or model fits our mission and vision for the Resilient Children, Families, and Community committee by December 2022. - Objective 2c: Identify a steering committee interested in the development of the chosen model by January 2023. - Objective 2d: Develop action steps to carry out the implementation of the identified resource by February 2023. - Objective 2e: Determine a general budget to access training resource and carry out the action steps for implementation by March 2023. Goal #3: Increase public awareness by offering adverse childhood experiences education geared towards all levels of the community by April 2024. Objective 3a: Research available tool kits and prevention recommendations for communities for the prevention of ACES and Positive Childhood Experiences (PCES) by January 2023. Objective 3b: Develop goals and implementation steps for a public awareness campaign based on the tool kits and prevention recommendations by April 2023. Housing Safe, affordable housing is imperative to the health of an individual and for a thriving community. Evidence shows housing and health can be understood as supporting the existence of four pathways. First, the health impacts of not having a stable home (the stability pathway). Second, the health impacts of conditions inside the home (the safety and quality pathway), third, the health impacts of the financial burdens resulting from high-cost housing (the affordability pathway) and lastly, the health impacts of neighborhoods, including both the environmental and social characteristics of where people live (the neighborhood pathway). The committee plans to work to have available, affordable, accessible, and safe housing for all Green County residents, and to build awareness of housing issues through the following goals and objectives: Goal #1: Our group will create and distribute comprehensive resources for housing in Green County by December 2022. - Objective 1a: Determine best locations where resources need to be distributed. - Objective 1b: Will distribute 20 flyers/packets to determined locations. - Objective 1c: Determine how information should be published: Print, digital, social media and multilingual. Goal #2: Plan and host a Housing Summit with stakeholders by June 2023 in Green County. - Objective 2a: Determine format of summit and location by December 2022. - Objective 2b: Determine content and stakeholders by August 2022. - Objective 2c: Evaluate and create next steps after housing summit by August 2023. Mental Health Community education, prevention, access to care, addressing binge drinking and fighting stigma are important in sustaining a community that supports mental health. One in four Americans suffer from a mental health issue each year. Mental health includes our emotional, psychological and social well-being. It impacts general health and quality of life at every stage. The Pandemic has not helped with the isolation people have felt. Nationwide and locally, mental health professionals are challenged by a need for services that exceeds availability. The result is mental health care in Green County is largely focused on providing crisis intervention and follow-up services. Our focus is to build upon the existing foundations to expand and grow behavioral health resources in an inclusive and non-judgmental manner by educating, advocating for, and supporting everyone who lives, works, or learns in Green County. Goal #1: Mental Health Matters (MHM) will support and increase the awareness of the Substance Abuse and Mental Wellness Navigator position. - Objective 1a: MHM will share on many platforms the job posting to find a candidate. Upon hire, MHM will assist with the onboarding process for the candidate to be successful transitioning into the community. MHM will help the candidate connect with providers and resources. This will be measured by the candidate meeting 80% of identified providers and resources within four months of starting the position and consistently attending the MHM Committee Meetings. - Objective 1b: MHM will promote awareness in the community and increase with a grand re-opening and other media promotions. This will be measured by an increase in monthly data of those being connected and helped by the Navigator. Goal #2: MHM will increase mental health education, awareness, and outreach in Green County by June 2024. - Objective 2a: MHM has formed a subcommittee to develop a plan to increase awareness, resources, and issues to determine: a) the number of opportunities to develop, or b) the number of people we would like to reach in this goal. The subcommittee will complete this plan and present it at the July 2022 MHM Committee meeting. Goal #3: MHM will work on promotion and education to decrease binge drinking in Green County. - Objective 3a: MHM will formulate a subcommittee to work through a strategic framework process to identify the prevention priorities. This will be measured by the strategic process to be completed and presented at the September 2022 MHM Committee meeting. The hospital has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs.

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
SSM Health Care Corporation, 46-6029223

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
The amounts reported on Form 990, Schedule H, Part I, Line 7a, 7b, and 7c were determined using the cost to charge ratio derived from worksheet 2 in the schedule h instructions. Form 990, schedule h, part I, Lines 7e, 7f, 7g, 7h, and 7i are reported at cost as reported in the organization's financial statements. The calculation of Schedule H, Part I, Line 7, Column F utilizes 990, Part IX, Line 25, Column A, which does not include Bad Debt Expense.

Schedule H, Part II Community Building Activities
THE MONROE CLINIC INC PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: PHYSICAL IMPROVEMENTS/HOUSING: HABITAT FOR HUMANITY BUILDING; ECONOMIC DEVELOPMENT: HOSPITAL PRESIDENT VOLUNTEERS ON GREEN COUNTY DEVELOPMENT BOARD WORKING WITH 20+ COMMUNITY LEADERS; COMMUNITY SUPPORT: HOSPITAL PRESIDENT VOLUNTEERS WITH EXCELLENCE IN EDUCATION TO SUPPORT SPECIAL TEACHER/STUDENT PROJECTS ADVANCING EDUCATION; ENVIRONMENTAL IMPROVEMENTS: HOSPITAL STAFF ADOPTED PORTION OF HIGHWAY FOR ROUTINE CLEAN UP; COALITION BUILDING: HOSPITAL STAFF PARTICIPATION IN THE UNITED WAY; WORKFORCE DEVELOPMENT: ASSISTANCE WITH AREA HEALTH EDUCATION COLLEGE IN PRESENTATION VIDEO ON HEALTH CARE CAREERS.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
FOR FINANCIAL STATEMENT PURPOSES, SSM Health HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER NORTON HOSPITAL'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
The Monroe Clinic is part of the SSM Health consolidated audit. The footnote that references the treatment of uncollectible accounts and implicit price concessions in the December 31, 2021 consolidated audit is contained on page 13, 14 and 15 of the attached financial statements.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
MONROE CLINIC RECOGNIZES THE INHERENT VALUE OF ALL INDIVIDUALS. ALL INDIVIDUALS HAVE THE RIGHT TO BE TREATED WITH RESPECT AND DIGNITY. THOSE INDIVIDUALS INDICATING LACK OF FINANCIAL RESOURCES TO PAY FOR SERVICES WILL BE DIRECTED TO MONROE CLINIC'S COMMUNITY CARE PROGRAM TO ENSURE ALL INDIVIDUALS QUALIFYING FOR ASSISTANCE ARE INDEED GIVEN ASSISTANCE. INDIVIDUALS WITH THE FINANCIAL RESOURCES TO PAY FOR SERVICES ARE EXPECTED TO DO SO IN A TIMELY MANNER TO ENSURE MONROE CLINIC'S FINANCIAL HEALTH AND ABILITY TO MAINTAIN OPERATIONS AND CONTINUED COMMUNITY CARE. PATIENTS WITH FINANCIAL RESOURCES ARE ASKED TO PAY CO-PAYMENTS AT THE TIME OF SERVICE AND TO PAY BALANCES REMAINING DUE AFTER INSURANCE HAS PAID WITHIN 30 DAYS OR MAKE MUTUALLY AGREEABLE PAYMENT ARRANGEMENTS WITH PATIENT ACCOUNTING. COLLECTION AGENCIES USED BY MONROE CLINIC GUARANTEE COMPLIANCE WITH THE FAIR DEBT COLLECTION PRACTICES ACT AND THE ACA INTERNATIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY.

Schedule H, Part V, Section B, Line 16a FAP website
A - Monroe Clinic: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - Monroe Clinic: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - Monroe Clinic: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;

Schedule H, Part VI, Line 6 Affiliated health care system
The Monroe Clinic is a 501(c)(3) organization and is a member of the integrated health care system known as SSM Health.

Schedule H, Part VI, Line 7 State filing of community benefit report
IL, WI

Schedule H, Part VI, Line 2 Needs assessment
SSM Health (SSMH) participates in Community Benefit according to our vision, Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically, and socially marginalized, will experience improved health in mind, body, spirit and environment. In the tradition of our founders, the Franciscan Sisters of Mary, caring for those in greatest need remains our organizational priority. Today our System Board monitors Community Benefit efforts, and views achievement of our vision as a primary responsibility. The purpose of SSMH's Community Benefit program is to assess and address community health needs. Making our communities healthier in measurable ways is always our goal. To fulfill this commitment, SSMH's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). The CHNA is an assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conducted every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-health priorities: Establish strategies to address priorities; complete Strategic Implementation Plan; obtain Regional/Divisional Board approval; and integrate strategies into operational plan. * Make CHNA widely available to the public: Publish CHNA and summary document on hospital's website. * Monitor, track, and report progress on top health priorities: Collect data and evaluate progress; report to Regional/Divisional Board every six months and System Board every year; share findings with community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). System Office staff and leaders oversee and monitor SSMH's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, SSM Health Care Corporation also identifies needs based on assessments and research, and SSMH facilities also involve case managers and care team staff to pinpoint critical health issues in the community. All hospital CHNAs are completed, approved, and integrated into the organization's strategic plan. We continue to monitor and assess the progress of our local efforts in the spirit of caring for others and improving community health.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Each entity providing medical service shall provide information to the public regarding its charity care policies and the qualification requirements for each of its facilities. When standard system notices and communication regarding charity care are available, these must be used. Modifications to the standard may be made to comply with state and local laws, as well as reflect culturally sensitive terminology for the policy. All notices are easy to understand by the general public, culturally appropriate and available in those languages that are prevalent in the community. They provide information about: * The patient's responsibility for payment, * The availability of financial assistance from public programs and entity charity care and payment arrangements, * The entity's charity policy and application process, and * Who to contact to get additional information or financial counseling. The following types of notices to the public are provided: * Signs in the emergency department, website resources, and public waiting areas. * Brochures or fliers provided at time of registration and available in the financial counseling areas. * Notices sent with or on patient bills or communications sent to patients and guarantors related to medical services. * Applications provided to uninsured patients at the time of registration. The application for charity care, together with any instructions, must clearly state the policies regarding charity care, including excluded services, eligibility criteria and documentation requirements. Information about the entity's charity policies is also provided to public agencies.

Schedule H, Part VI, Line 4 Community information
The Monroe Clinic is located in Monroe, Wisconsin, in Green County. The county, as well as portions of Lafayette County, Wisconsin, accounts for 51% of Monroe Clinic's patients. The hospital also serves Stephenson County, Illinois, and Jo Daviess County, Illinois. The community is overwhelmingly white at 96.8% for Green County, and approximately 19.3% of residents are age 65 or older. Median household income is slightly above the State average, and rates of poverty are 6.4%, below the State rate of 10.4% and national rate of 10.5%. For those under 65, 5.4% of Green County residents are without health insurance, considerably lower than State and National percentages. While there is a higher percentage of County residents graduating high school than in Wisconsin and the U.S., there are lower rates for those with a Bachelor's degree. Additional demographic and statistical information on the hospital's community can be found throughout the 2021 CHNA.

Schedule H, Part VI, Line 5 Promotion of community health
The Monroe Clinic participates in a wide array of community programs throughout the area to further its exempt purpose of promoting the health of the community. The community initiatives build on the strengths of our communities and systems to improve the quality of life and to create a sense of hope. Community Benefit initiatives build community capacity and individual empowerment through community organizing, leadership development, partnerships, and coalition building. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. In response to the global coronavirus pandemic, The Monroe Clinic, INC worked relentlessly to respond to community needs by developing and implementing strategies to address social needs of those served, providing screening & testing services, personal protective equipment and education throughout the community, as well as treatment for those who presented with COVID-19. The Monroe Clinic promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote community health. The Monroe Clinic also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay, * Has an open medical staff with privileges available to all qualified physicians in the area, * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system.