4A (Expenses $ 269935288 including grants of $ 917624) (Revenue $ 291058112)
ASCENSION ST. MARY'S HOSPITAL is a 232-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2022, ASCENSION ST. MARY'S HOSPITAL treated 8,566 adults and children for a total of 44,453 patient days of service. The hospital also provided services for 475,863 outpatient visits, which included 2,372 outpatient surgeries and 38,352 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. MARY'S HOSPITAL. THE FY2020 (TAX YEAR 2019) COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED COLLABORATIVELY WITH A NUMBER OF COMMUNITY ORGANIZATIONS WHO ARE MEMBERS OF THE COMMUNITY HEALTH ASSESSMENT/ COMMUNITY HEALTH IMPROVEMENT PLAN (CHA/CHIP) COMMITTEE. THESE AGENCIES DEDICATED DIRECT FUNDING AND STAFF TIME TO THE COMPLETION OF THE MAPP ASSESSMENT. THESE COMMUNITY ORGANIZATIONS ARE LISTED BELOW. *SAGINAW COMMUNITY FOUNDATION *UNITED WAY OF SAGINAW COUNTY *SAGINAW COUNTY HEALTH DEPARTMENT *ASCENSION ST. MARY'S HOSPITAL *SAGINAW COUNTY COMMUNITY MENTAL HEALTH (SCCMHA) *SAGINAW INTERMEDIATE SCHOOL DISTRICT (SISD) *COVENANT HEALTHCARE *GREAT LAKES BAY HEALTH CENTERS (GLBHC) *ALIGNMENT SAGINAW IN ADDITION TO THESE CORE AGENCIES, THE CHA/CHIP STEERING COMMITTEE ALSO HAD REPRESENTATION FROM AGENCIES THAT REPRESENTED KEY AREAS IN SAGINAW COUNTY. THESE AGENCIES ARE LISTED BELOW. *EZEKIEL PROJECT *MICHIGAN HEALTH IMPROVEMENT ALLIANCE (MIHIA) *SAGINAW COUNTY BOARD OF COMMISSIONERS *SAGINAW COUNTY BUSINESS AND EDUCATION PARTNERSHIP *SAGINAW COMMUNITY ACTION CENTER *SAGINAW COUNTY HOUSING COMMISSION *SAGINAW COUNTY DRUG TREATMENT COURT *SAGINAW VALLEY STATE UNIVERSITY IN ADDITION TO INPUT FROM COMMUNITY AGENCIES THROUGH THE CHA/CHIP STEERING COMMITTEE - INPUT WAS PROVIDED FROM COMMUNITY MEMBERS THROUGH THE COMMUNITY ADVISORY COMMITTEE. THIS COMMITTEE WAS MADE UP OF SAGINAW COUNTY RESIDENTS WHO WERE PASSIONATE ABOUT MAKING CHANGE IN THEIR COMMUNITY AND CAME FROM A VARIETY OF BACKGROUNDS IN SAGINAW COUNTY. COMMITTEE MEMBERS WERE COMPENSATED FOR THEIR TIME AND EXPERTISE ON COMMUNITY ACTIVITIES FOR THE CHA. THE COMMUNITY ADVISORY COMMITTEE MET MONTHLY DURING THE MAPP PROCESS TO GIVE INPUT ON THE DESIGN, IMPLEMENTATION, AND EVALUATION OF THE SAGINAW COUNTY COMMUNITY HEALTH ASSESSMENT. THEIR DECISIONS HELPED INFORM THE DESIGN OF THE LOGO, THE FORMAT OF THE ASSET MAPPING TOWN HALLS, THE DESIGN AND IMPLEMENTATION OF THE STRATEGIC ISSUES MEETING, AND MORE. IN AN ATTEMPT TO ACQUIRE BROAD COMMUNITY INPUT REGARDING THE HEALTH NEEDS OF SAGINAW COUNTY, INDIVIDUALS WHO LIVE, WORK, AND/OR ATTEND SCHOOL IN SAGINAW COUNTY, INCLUDING RESIDENTS, HEALTH CARE CONSUMERS, COMMUNITY LEADERS, HEALTH CARE PROFESSIONALS, AND MULTI-SECTOR REPRESENTATIVES, PARTICIPATED IN MEETINGS OF CHIP'S NETWORK OF COMMUNITY PARTNERS, AND/OR RESPONDED TO THE SHARE YOUR STORY SAGINAW SURVEY. MORE THAN 3400 COMMUNITY MEMBERS COMPLETED THIS SURVEY WHICH ACTED AS A TOUCHPOINT FOR NEEDS IMPORTANT TO COMMUNITY MEMBERS AND CAPTURED INFORMATION ON SOCIAL DETERMINANTS OF HEALTH IN SAGINAW COUNTY.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - ASCENSION ST. MARY'S HOSPITAL. ASCENSION ST. MARY'S HOSPITAL COLLABORATED WITH THE FOLLOWING HOSPITAL ORGANIZATIONS IN CONDUCTING ITS MOST RECENT CHNA: COVENANT HEALTHCARE

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - ASCENSION ST. MARY'S HOSPITAL. ASCENSION ST. MARY'S HOSPITAL COLLABORATED WITH THE FOLLOWING ORGANIZATIONS IN CONDUCTING ITS TAX YEAR 2019 MOST RECENT CHNA: - SAGINAW COUNTY DEPARTMENT OF PUBLIC HEALTH - SAGINAW COUNTY COMMUNITY MENTAL HEALTH AUTHORITY - HEALTH DELIVERY INC. - FEDERALLY QUALIFIED HEALTH CENTERS - Saginaw Community Foundation - Great Lakes Bay Health - SAGINAW INTERMEDIATE SCHOOL DISTRICT - ALIGNMENT SAGINAW

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - ASCENSION ST. MARY'S HOSPITAL. In Ascension St. Mary's Hospital's tax year 2019 CHNA, the following were identified as significant needs in the community: 1) Mental Health; 2) Obesity Related Chronic Disease; 3) Infant Mortality. The FY 2021-FY 2023 Implementation Strategy specifically addressed the needs in the following ways: Priority Need 1: Mental Health STRATEGY: Increase awareness of Adverse Childhood Experiences (ACEs) by providing trauma informed care education and training to community members at-large, including Ascension St. Mary's Hospital associates. - Ascension St. Mary's associate has been identified to maintain representation with MiHIA and THRIVE as a linkage to the region-wide ACEs focus. One (1) Ascension Medical Group (AMG) outpatient primary care provider office has been identified to pilot implementation of ACEs screening; work continues to identify the second office. STRATEGY: Expand access to mental health services for hospital-based patients through community outpatient primary care provider offices by integrating behavioral health strategies - AMG recently hired a MSW that is taking the lead on behavioral health. AMG will have two (2) MSW's to support patients with behavioral health needs in six primary care offices; these team members are also going to work within the community to identify BH partners and form relationships to ensure continuity between PCP offices and BH offices. - After much consideration, the decision has been made to not form a Behavioral Health Task Force (TF) at this time as conversations are happening in smaller groups. Priority Need 2: Obesity Related Chronic Disease: STRATEGY: Improve health behaviors and outcomes of individuals at-risk of developing or who have Type 2 diabetes through Ascension St. Mary's Diabetes Education Center outpatient programs, Ascension Medical Group (AMG) Care Management, and MiHIA virtual Diabetes Prevention Program (DPP). - Diabetes Self-Management Training (DSMT) Program activities continue, including group classes and marketing monthly to various providers' offices. - The Wound Care & Diabetes Education Center have also added an Administrative Assistant to the program to allow for ease of patient scheduling and insurance verifications; there are now two Certified Diabetes Educators (CDEs), a RN and RD, which allows for the program to see and treat a wider variety of patient care needs. - AMG is no longer pursuing virtual DPP as program sunsets in October 2021. AMG team is currently developing a pre-diabetic and diabetic patient referral protocol. STRATEGY: Increase awareness & knowledge, and influence attitudes & beliefs about healthy lifestyle changes through Ascension St. Mary's Center of HOPE (COH) programs and community partnerships. - Monthly newsletters (723 HOPE) include healthy lifestyle information and tips, based on monthly - national health observances. Community listserv consists of community partners, associates at AMG offices, faith-based organizations and COH members. - CoH Coordinator met with a new masonry/professional gardener to receive an estimate for projects. Pending follow up from MedExcel to schedule a date for ground leveling (follow up with advisory committee once complete). - Developed Garden of HOPE sponsorship packet for potential sponsors. New process for the master gardener program is underway. Priority Need 3: Violence and Neighborhood Safety STRATEGY: Increase awareness and community involvement in SLive, a hospital-based, community-focused violence intervention initiative, through protocol, training, and education to community members at-large including Ascension St. Mary's Hospital associates. - The first SLIVE program field day was Friday, April 9, 2021, with two Saginaw Police Officers and the Violence Interventionist. - The program had its first two clients, and continues to reach out to the community to fill their needs. - SLIVE flyers will be distributed to the ED Nursing Supervisor directing ED associates to call the chaplain whenever there is a victim of violence. Ascension St. Mary's will not directly address the following prioritized needs within its FY 2021-23 CHNA Implementation Strategies: Infant Mortality, Transportation, Lack Of Job Opportunities, Drug & Alcohol Addiction, or Housing & Homelessness. While critically important to overall community health, these specific priorities did not meet internally determined criteria that prioritized needs by either continuing or expanding current programs, services and initiatives to steward resources and achieve the greatest community impact. For the areas not chosen, there are other service providers in the community better resourced to address these priorities. Ascension St. Mary's will work collaboratively with these organizations as appropriate to ensure optimal service coordination and utilization.

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 the social determinants and quality of life play a major role in the health status of individuals and communities. Community building activities, which focus on improving the quality of life within a community, ultimately influence and improve health status. The Community Building dollars reported for FY22 were related to Economic Development, one of the social determinants of health.

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 $9,890,850 at charges, ($3,310,197 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
ASCENSION ST. MARY'S HOSPITAL FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED IF ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED FOR THE AMOUNTS FOR WHICH THE PATIENT QUALIFIES.

Schedule H, Part V, Section B, Line 16a FAP website
- ASCENSION ST. MARY'S HOSPITAL: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance;

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

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

Schedule H, Part VI, Line 5 Promotion of community health
ASCENSION ST. MARY'S HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSONS REPRESENTING ASCENSION MICHIGAN'S SERVICE AREAS AND INCLUDES MEMBERS WITH DIVERSE ASPECTS AND INTERESTS OF THE SERVICE AREA. MEMBERS OF THE GOVERNING BODY RESIDE IN THE ORGANIZATION'S SERVICE AREA AND ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. ASCENSION ST. MARY'S HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. ASCENSION ST. MARY'S HOSPITAL APPLIES SURPLUS FUNDS TO FUND IMPROVEMENTS IN PATIENT CARE.

Schedule H, Part VI, Line 2 Needs assessment
Ascension St. Mary's Hospital 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 -State Datasets -Internal Data Sets Ascension St. Mary's Hospital utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, Ascension St. Mary's Hospital 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
ASCENSION ST. MARY'S HOSPITAL 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, ASCENSION ST. MARY'S 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; ASCENSION ST. MARY'S HOSPITAL PROVIDES FULL FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 250% OF THE FEDERAL POVERTY LEVEL AND SLIDING SCALE ASSISTANCE FOR THOSE UP TO 400% OF THE FEDERAL POVERTY LEVEL. ASCENSION ST. MARY'S HOSPITAL 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/locations/michigan/misag/saginaw-ascension-st-marys-hospital/financial-assistance ASCENSION ST. MARY'S HOSPITAL 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. ASCENSION ST. MARY'S HOSPITAL 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. ASCENSION ST. MARY'S HOSPITAL INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 4 Community information
Ascension St. Mary's Hospital is located in Saginaw County. The total population of Saginaw County is estimated to be 187,419 residents in calendar year 2023 and is estimated to decrease by 3,090 residents or -1.65% over the next five years (Sg2/Claritas Pop-Facts 2023). There are an estimated 78,980 households. The county includes the city of Saginaw and is considered urban. There is a federally designated medically underserved area in Saginaw. The median household income in Saginaw county is $49,565, based on the United States Census Bureau (in 2020 dollars, 2016-2020). Approximately 15.9% of the service area persons live below the poverty line. There are 3 acute care hospitals located in Saginaw County including Ascension St. Mary's Hospital.

Schedule H, Part VI, Line 6 Affiliated health care system
ASCENSION ST. MARY'S HOSPITAL 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 SPONSOR 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. ASCENSION ST. MARY'S HOSPITAL OPERATES A HOSPITAL FACILITY IN SAGINAW COUNTY MICHIGAN AND IS PART OF ASCENSION HEALTH. ASCENSION ALSO OPERATES HOSPITALS IN THE EASTERN PORTION OF THE STATE INCLUDING ASCENSION ST. JOHN HOSPITAL, ASCENSION RIVER DISTRICT HOSPITAL, ASCENSION MACOMB OAKLAND HOSPITAL WARREN CAMPUS, ASCENSION MACOMB OAKLAND HOSPITAL MADISON HEIGHTS CAMPUS, ASCENSION PROVIDENCE HOSPITAL SOUTHFIELD CAMPUS, ASCENSION PROVIDENCE HOSPITAL NOVI CAMPUS, ASCENSION PROVIDENCE ROCHESTER HOSPITAL, ASCENSION GENESYS HOSPITAL, ASCENSION STANDISH HOSPITAL, ASCENSION ST. JOSEPH HOSPITAL AND ASCENSION BRIGHTON CENTER FOR RECOVERY. ASCENSION ALSO OWNS AND OPERATES OTHER HEALTH CARE RELATED ENTITIES IN SOUTHWEST MICHIGAN INCLUDING ASCENSION BORGESS ALLEGAN HOSPITAL, ASCENSION BORGESS PIPP HOSPITAL, ASCENSION BORGESS LEE HOSPITAL AND ASCENSION BORGESS HOSPITAL. THE HEALTH SYSTEM PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF ASCENSION ST. MARY'S HOSPITAL'S SERVICE AREA IN MICHIGAN.