4A (Expenses $ 46759127 including grants of $ 60718) (Revenue $ 58952239)
ASCENSION ST. JOSEPH HOSPITAL is a 47-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2021, ASCENSION ST. JOSEPH HOSPITAL treated 1,368 adults and children for a total of 4,616 patient days of service. The hospital also provided services for 180,026 outpatient visits, which included 1,210 outpatient surgeries and 16,498 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. JOSEPH HOSPITAL. Recognizing its vital importance in understanding the health needs and assets of the community, Mary Kushion Consulting, LLC. on behalf of ASCENSION ST. JOSEPH HOSPITAL assisted with the TAX YEAR 2021 CHNA AND consulted with a range of public health and social service providers that represent the broad interests of Iosco County. A concerted effort was made to ensure that the individuals and organizations represented the needs and perspectives of: 1) public health practice and research; 2) individuals who are medically underserved, are low-income, or considered among the minority populations served by the hospital; and 3) the broader community at large and those who represent the broad interests and needs of Iosco County. Multiple methods were used to gather community input. To avoid duplication of effort and ""survey fatigue"", Ascension St. Joseph Hospital promoted the community pulse surveys and provider surveys developed and disseminated by the MiTHRIVE assessment process. A large community forum was held to share the data generated at both the regional (MiTHRIVE) and county-specific level. The draft of the CHNA was sent to the participants of the community forum and other stakeholders within Iosco County with a feedback survey to gather the community's input prior to finalizing the CHNA for board approval. *Community Forum - In addition to the MiTHRIVE ""data walk"" to review and provide input on a regional level, Ascension St. Joseph Hospital also hosted a public forum in February 2022 to gather feedback from community members on the health needs and assets of Iosco County. Over 20 community members participated and represented populations of note, such as medically underserved and low-income and minority groups. In addition, faith-based, government, healthcare, mental health, public health, substance use, transportation/community mobility as well as the broader community were represented at the forum. *Surveys - A survey was conducted by Ascension St. Joseph Hospital to gather the perceptions, thoughts, opinions, and concerns of the community regarding the preliminary draft report for Iosco County. The survey was distributed to 32 individuals and four participated in the survey, held between March 2022 and April 2022. The data gathered and analyzed provides valuable insight into the issues of importance to the community. The survey contained five questions and was distributed to the stakeholder and partners who were invited to the community forum and other interested identified persons through a Google Form (survey) link. The following list represents the TAX YEAR 2021 CHNA participating organizations: *AuSable Valley Community Mental Health *Catholic Human Services *District Health Department #2 *Iosco County Medical Care Facility *Michigan Department of Health and Human Services *Northern Michigan Children's Assessment Center *Oscoda Area Schools *Sacred Heart Catholic Church"

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - ASCENSION ST. JOSEPH HOSPITAL. THE NON-HOSPITAL ORGANIZATIONS WITH WHICH ASCENSION ST. JOSEPH HOSPITAL CONDUCTED ITS tax year 2021 CHNA IS: -Northern Michigan Community Health Innovation Region -Central Michigan District Health Department

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - ASCENSION ST. JOSEPH HOSPITAL. Ascension St. Joseph's Fiscal Year 2020-2022 CHNA implementation strategy completed in June 2022 and addressed the following priority health needs: Healthcare Access, Obesity Related Adverse Health Conditions, Adverse Childhood Experiences (ACEs), and Human Trafficking. Highlights from the Ascension St. Joseph Hospital's TAX YEAR 2018 (fy2019) CHNA implementation strategy include: *Healthcare Access - Ascension St. Joseph Hospital exceeded its goal to increase access to healthcare in Iosco County. In October 2019, Ascension St. Joseph Hospital launched a tele-behavioral health program in the Emergency Department. A Rheumatology telehealth clinic was launched in August 2020 followed by the launch of a Neurology telehealth clinic in February 2021. Additionally, Ascension St. Joseph Hospital partnered with Catholic Health Services for Project ASSERT (Alcohol & Substance Abuse Services, Education, and Referral to Treatment), a program that helps Emergency Department patients who demonstrate risky alcohol and drug use behavior with access to treatment and the appropriate level of care. Additional information on the actions taken include: Implement a Tele-Behavioral Health Clinic - Launched clinic in November 2020; Rheumatology telehealth clinic launched in August 2020; Neurology telehealth clinic launched in February 2021 Partner with community organizations to increase mental health awareness by expanding mental health education, training capacity and support for community-driven initiative - Partnered with Catholic Human Services to provide Project ASSERT, a program that helps Emergency Department patients who demonstrate risky alcohol and drug use behavior with access to treatment and the appropriate level of care *Adverse Childhood Experiences (ACES) - Ascension St. Joseph Hospital has made significant progress on providing trauma informed care awareness, education and training to hospital staff. Through a collaboration with the Ascension Clinical Professional Development department, a standardized ACEs module for internal education was developed; over 91% of staff has completed the annual module following its launch in 2020. Additionally, five (5) Ascension Medical Group practices have been identified to pilot ACES screening, an age-specific questionnaire that provides a score that can be an indicator to the care team that further mental health services may be needed based on current or past experience An ACES workgroup has been implemented which is focused on developing best practices and workflows. Additional information on the actions taken include: Provide trauma informed care / ACEs educational module to internal staff - Co-developed standardized ACEs module for internal education; 91% of staff completed the annual module following launch in 2020 *Human Trafficking - Due to delays caused by the COVID-19 pandemic, Ascension St. Joseph Hospital and Ascension Standish collaborated to host a human trafficking awareness event for Arenac and Iosco Counties residents in spring 2022. The event aimed to increase awareness and encourage action with special focus on parents, school staff, as well as the general community. Ascension St. Joseph Hospital continues to utilize an established protocol to identify, assess, treat and refer victims of Human Trafficking (HT) to supportive community services who present for care in the Emergency Department or who are identified while receiving inpatient services. Additionally, Ascension St. Joseph Hospital has combined efforts with Ascension Southwest Michigan Community Health and other Ascension hospitals throughout Michigan to offer hospital-wide associate education with an Ascension internal MyLearning education module to increase awareness and recognition of the signs and symptoms of Human Trafficking via the lens of Trauma Informed Care, and community resources to support victims. Additional information on the actions taken include: Provide human trafficking awareness education to staff - Internal MyLearning education module available focused on the signs and symptoms of Human Trafficking via the lens of Trauma Informed Care; 91% of staff have completed module *Obesity Related Adverse Health Conditions - Ascension St. Joseph Hospital set forth to address obesity related adverse health conditions by implementing a virtual diabetes prevention program (DPP) to reduce A1C levels for individuals at risk of developing Type 2 diabetes. To offer the virtual DPP at no-cost to Iosco County residents, Ascension St. Joseph Hospital partnered with the Michigan Health Improvement Alliance, Inc. (MiHIA) and Canary Health, and thereafter began educating clinical teams on patient eligibility and establishing referral protocols. Through March 2020, Ascension Medical Group providers referred patients to virtual DPP during in-person clinical visits; however, awareness and referral efforts were halted per transition from predominantly in-person clinical visits to virtual due to an operational shift caused by the COVID-19 pandemic. Unfortunately, notification was received by Canary Health that it was closing its DPP arm of the company; no new registrations were accepted after October 8, 2021, and current participants would be supported through January 31, 2022.Additional information on the actions taken include: Provide education to clinical teams on virtual Diabetes Prevention Program - Training session(s) held to teach about the program and how to refer patients Implement virtual Diabetes Prevention Program referral protocol - Referral protocol implemented; however, referral and awareness efforts were halted per transition from predominantly in-person clinical visits to virtual due to an operational shift caused by the COVID-19 pandemic. The FY2023-FY2025 Ascension St. Joseph Hospital Implementation Strategy for the TAX YEAR 2021 CHNA will address the following prioritized needs: *Mental and Behavioral Health, including substance use disorder (SUD) Strategy 1.1: Increase awareness, access, and referrals to Project ASSERT (Alcohol & Substance Abuse Services, Education, and Referral to Treatment) for individuals who present to Ascension St. Joseph Hospital. Strategy 1.2: Through a coordinated and transformational approach, Ascension Michigan hospitals will improve access to mental and behavioral health for vulnerable populations. Strategy 1.3: Increase involvement in and support of community health activities to address mental and behavioral health needs. *Chronic Disease Strategy 2.1: Improve collaboration and coordination between Ascension St. Joseph Hospital providers, including Ascension Medical Group outpatient clinics, and Ascension St. Mary's Diabetes Education Center through a diabetic & prediabetic referral protocol. Strategy 2.2: Participate in/on chronic disease-focused community-based forums and coalitions to increase involvement in community health activities and assure awareness of the services offered by Ascension St. Joseph Hospital. *Healthcare Providers & Services Strategy 3.1: Provide cancer (lung, breast, and colorectal) and neurovascular (stroke and concussion) preventative screenings for underserved populations to improve early detection rates in Iosco County Strategy 3.2: Participate in/on healthcare access-focused community-based forums and coalitions to increase involvement in grassroots community health activities and assure awareness of the services offered by Ascension St. Joseph Hospital.

Schedule H, Part I, Line 3c actors 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 III, Line 2 Bad debt expense - methodology used to estimate amount
AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES. AFTER APPLYING THE COST-TO-CHARGE RATIO, THE SHARE OF THE BAD DEBT EXPENSE IN FISCAL YEAR 2022 WAS $2,486,584 CHARGES, ($1,212,391 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. JOSEPH 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. JOSEPH HOSPITAL: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance;

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

Schedule H, Part VI, Line 5 Promotion of community health
ASCENSION ST. JOSEPH 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 JOSEPH HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. ASCENSION ST JOSEPH HOSPITAL APPLIES SURPLUS FUNDS TO FUND IMPROVEMENTS IN PATIENT CARE.

Schedule H, Part VI, Line 2 Needs assessment
Ascension St. Joseph 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. Joseph Hospital utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, Ascension St. Joseph 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. JOSEPH 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. JOSEPH 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. JOSEPH 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. JOSEPH 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/midet/detroit-ascension-st-john-hospital/financial-assistance ASCENSION ST. JOSEPH 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. JOSEPH 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. JOSEPH 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. Joseph Hospital is located in Iosco County but also serves portions of surrounding counties (Alcona, Oscoda, Ogemaw). The total population of Iosco county is estimated to be 26,422 residents in calendar year 2023 and is estimated to decrease by 93 residents or -0.35% over the next five years (Sg2/Claritas Pop-Facts 2023). There are an estimated 11,772 households. The county is rural and Ascension St. Joseph Hospital is a rural hospital and sole community provider. There are federally designated medically underserved areas in Iosco County and all the counties surrounding Iosco County. The median household income in Iosco county is $42,628, based on the United States Census Bureau (in 2020 dollars, 2016-2020). Approximately 13.8% of the service area persons live below the poverty line. There are no other acute care hospitals located within Ascension St. Joseph Hospital's service area.

Schedule H, Part VI, Line 6 Affiliated health care system
ASCENSION ST. JOSEPH 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 JOSEPH HOSPITAL OPERATES A HOSPITAL FACILITY IN IOSCO 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 ST. MARY'S HOSPITAL, ASCENSION STANDISH HOSPITAL, ASCENSION GENESYS 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. JOSEPH HOSPITAL'S SERVICE AREA IN NORTHERN/MID-MICHIGAN.