4A (Expenses $ 396905427 including grants of $ 98925) (Revenue $ 506000117)
EXPENSES INCURRED IN PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY MEDICALLY NECESSARY SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT (STATEMENT OF PROGRAM SERVICES) WHICH INCLUDES DETAILED INFORMATION REGARDING THE VARIOUS SERVICES PROVIDED BY THIS ORGANIZATION.

SCHEDULE H, PART V; SECTION B, QUESTIONS 3I
"THE IMPACT OF ANY ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE HOSPITAL'S PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"") CAN BE FOUND WITHIN APPENDIX A OF THE ORGANIZATION'S 2019 CHNA."

SCHEDULE H, PART V, SECTION B, QUESTION 5
IN ITS MOST RECENTLY CONDUCTED CHNA THIS ORGANIZATION TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED. THE ORGANIZATION DEVELOPED AN EVIDENCED-BASED PROCESS TO DETERMINE THE HEALTH NEEDS OF MIDDLESEX COUNTY RESIDENTS. CHNA DATA SOURCES INCLUDE BOTH PRIMARY AND SECONDARY DATA TO PROVIDE QUALITATIVE AND QUANTITATIVE INFORMATION ABOUT THE COMMUNITIES. THE CHNA UTILIZED DETAILED PRIMARY AND SECONDARY PUBLIC HEALTH DATA AT THE STATE, COUNTY, AND COMMUNITY LEVELS, FROM VARIOUS SOURCES INCLUDING: THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, CENTERS FOR DISEASE CONTROL AND PREVENTION, CENSUS BUREAU, HEALTHY PEOPLE 2020, THE COUNTY HEALTH RANKINGS, HOSPITAL DISCHARGE DATA AND COMMUNITY NEEDS SURVEYS. DATA FROM THESE SOURCES WERE REVIEWED BY THE STEERING COMMITTEE TO IDENTIFY AND PRIORITIZE THE TOP ISSUES FACING RESIDENTS IN OUR SERVICE AREA. IN REVIEWING THE INFORMATION THAT FOLLOWS, IT IS IMPORTANT TO NOTE THAT THE QUANTITATIVE DATA UTILIZED PRECEDES THE ACTIVITIES OF THE CURRENT COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP), WHILE THE QUALITATIVE WORK COINCIDES WITH THE CHIP WORK FROM 2016-2020. THE TIME DELAY OF THE QUANTITATIVE DATA IS DUE TO THE REPORTING PROCEDURES OF THE DATA SOURCES USED, WHICH ARE STANDARD AMONG RESEARCH AGENCIES. THE DELAY DOES NOT DISRUPT OR NEGATIVELY INFLUENCE THE VALUE OF THE INFORMATION, AS IT ALLOWS ANALYSIS OF THE HEALTH TRENDS THAT ARE PREVALENT IN THE HOSPITAL SERVICE AREA OVER A PERIOD OF FOUR YEARS, DEFINING THOSE AREAS THAT ARE THE MOST IMPACTFUL IN THE COMMUNITY. IDENTIFYING PERVASIVE TRENDS AND ALIGNING THEM WITH THE 2016 CHIP FOCUS AREAS WILL LEAD TO THE CREATION OF A MORE ROBUST AND EVIDENCE-BASED 2020 CHIP. DURING THIS PROCESS THE NEW AND EMERGING TRENDS THAT OCCUR THROUGHOUT BOTH THE QUALITATIVE AND QUANTITATIVE MEASURES WILL BE HIGHLIGHTED. IN ADDITION TO THE ABOVE, THERE WAS A PURPOSEFUL DECISION TO FOCUS ON AN UPDATE, RATHER THAN A DUPLICATION OF THE PREVIOUS CHNA. CONSISTENCY THROUGHOUT THE ASSESSMENT WAS OF PARAMOUNT IMPORTANCE, LEADING TO A FOCUS ON THE QUANTITATIVE MEASURES, COMMUNITY HEALTH NEEDS SURVEYS AND FOCUS GROUP DISCUSSIONS, ALLOWING PERVASIVE TRENDS TO EMERGE MORE READILY. THESE DECISIONS REPRESENT THE CORRECT APPROACH TO NOT ONLY EFFECTIVELY EVALUATE THE COMMUNITY, BUT THE RIGHT STRATEGIC APPROACH TO PROVIDING THE ACTUAL IMPLEMENTATION OF THE PROGRAMS AND POLICIES THAT AFFECT THE HEALTH OF THE COMMUNITY IN MIDDLESEX AND SOMERSET COUNTIES. PRIMARY DATA SOURCES -------------------- COMMUNITY HEALTH NEEDS SURVEYS: IN ORDER TO OBTAIN A SERVICE AREA-SPECIFIC ANALYSIS FOR THE ORGANIZATION'S SERVICE AREA, ON-LINE SURVEY INTERVIEWS WERE CONDUCTED AMONG 1,185 RESIDENTS. INTERVIEWS WERE CONDUCTED ONLINE AND BY TELEPHONE. A LINK TO THE ONLINE SURVEY WAS DISPLAYED ON HOSPITAL WEB PAGES AND SOCIAL MEDIA SITES. ADDITIONALLY, POSTCARDS WERE HANDED OUT AT AREA BUSINESSES AND LIBRARIES, DIRECTING RESIDENTS TO THE ONLINE SURVEY LINK. A TELEPHONE AUGMENT WAS CONDUCTED TO CAPTURE ADDITIONAL INTERVIEWS IN SPECIFIC AREAS AND AMONG SPECIFIC ETHNIC GROUPS. FOCUS GROUP DISCUSSIONS: TWO FOCUS GROUPS WERE UNDERTAKEN TO UNCOVER ADDITIONAL INFORMATION FROM KEY COMMUNITY GROUPS AND INDIVIDUALS WITH RESPECT TO HEALTH NEEDS, CHALLENGES AND BARRIERS, AND SUGGESTIONS FOR IMPROVING ACCESS TO HEALTH CARE SERVICES. ONE FOCUS GROUP WAS MADE UP OF YOUTH COUNSELORS, INDIVIDUALS, AND REPRESENTATIVES FROM COMMUNITY ORGANIZATIONS PROVIDING SERVICES TO YOUTH AND ADOLESCENTS. THIS GROUP WAS DESIGNED TO UNCOVER MAJOR ISSUES ABOUT CONCERNS FACING MIDDLE AND HIGH SCHOOL AGED ADOLESCENTS. ANOTHER FOCUS GROUP WAS MADE UP OF UNDOCUMENTED HISPANIC/LATINA WOMEN TO DISCUSS THEIR HEALTH NEEDS AND THE BARRIERS THEY FACED IN ACCESSING CARE, AND IN LEADING HEALTHY LIFESTYLES. FOCUS GROUP MEETINGS WERE CONDUCTED ON AUGUST 27TH AND 30TH, 2019 BY NEW SOLUTIONS, INC. SECONDARY DATA SOURCES ---------------------- OVER 100 SECONDARY DATA SOURCES WERE UTILIZED IN COMPILING OUR CHNA, PRESENTING DATA BY INDICATOR BY COUNTY AND STATE. SOURCES INCLUDE: THE UNITED STATES CENSUS BUREAU, CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), NEW JERSEY DEPARTMENT OF HEALTH (NJDOH), AND BEHAVIORAL RISK FACTOR APPENDIX C CONTAINS A DETAILED REPORT OF CANCER INCIDENCE AND MORTALITY BY CANCER SITE FOR MIDDLESEX COUNTY FOR THE YEARS 2010-2017. IN ADDITION, HOSPITAL TUMOR REGISTRY DATA IS UTILIZED TO UNDERSTAND STAGE OF CANCER AT TIME OF DIAGNOSIS. HEALTH PROFILE: SECTION 5 OF THE ORGANIZATION'S CHNA PROVIDES A COMPREHENSIVE PRESENTATION OF HEALTH OUTCOMES AS WELL AS THE SOCIAL DETERMINANTS OF HEALTH AND OTHER HEALTH FACTORS THAT CONTRIBUTE TO THE HEALTH AND WELL-BEING OF MIDDLESEX COUNTY RESIDENTS. COLOR INDICATOR TABLES: THROUGHOUT THE HEALTH PROFILE SECTION OF THIS CHNA, THE COLOR INDICATOR TABLES COMPARE COUNTY LEVEL DATA TO HEALTHY PEOPLE 2020 TARGETS, COUNTY HEALTH RANKINGS BENCHMARKS, AND NEW JERSEY STATE DATA. DATA BY RACE/ETHNICITY ARE COMPARED TO DATA FOR ALL RACES IN THE COUNTY, UNLESS OTHERWISE INDICATED. MIDDLESEX COUNTY WAS THE MIDPOINT VALUE COMPARED TO A RANGE 20% HIGHER THAN THE VALUE FOR NEW JERSEY, HEALTHY PEOPLE 2020, OR COUNTY HEALTH RANKINGS BENCHMARKS, OR 20% LOWER THAN THE VALUE FOR NEW JERSEY, HEALTHY PEOPLE 2020, OR COUNTY HEALTH RANKINGS BENCHMARKS. IF THE COUNTY VALUE WAS WITHIN THE RANGE 20% LOWER OR 20% HIGHER THAN THE COMPARISON INDICATOR, OR CONSIDERED WITHIN REASONABLE RANGE, THE INDICATOR WILL BE YELLOW. THE TABLE WILL BE RED IF THE MIDDLESEX COUNTY VALUE IS MORE THAN 20% WORSE OR LOWER THAN THE INDICATOR VALUE. IF THE MIDDLESEX COUNTY VALUE IS 20% BETTER OR HIGHER THAN THE INDICATOR VALUE, THE TABLE WILL BE GREEN. COMPARATIVE COUNTIES ARE ALSO PRESENTED PROVIDING ADDITIONAL CONTEXT FOR SELECT HEALTH INDICATORS. ASSETS AND GAPS: SECTION 6 OF THE ORGANIZATION'S CHNA, ASSETS AND GAPS, SUMMARIZES THE PRECEDING COMPONENTS OF THE CHNA. ASSETS HIGHLIGHT COUNTY INFORMATION INDICATING IMPROVEMENT OVER TIME, IN COMPARISON TO OTHER COUNTIES AND THE STATE, OR IN COMPARISON TO OTHER RACES OR GENDERS. GAPS FOCUS ON DISPARITIES IN MIDDLESEX COUNTY OR THE ORGANIZATION'S SERVICE AREA THAT HAVE A NEGATIVE TREND, IN COMPARISON TO OTHER COUNTIES IN THE STATE OR TO OTHER RACES OR GENDERS.

SCHEDULE H, PART V, SECTION B, QUESTION 6A & 6B
"UNDER THE 2010 PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA), NON-PROFIT HOSPITALS MUST CONDUCT A CHNA AND IDENTIFY AN IMPLEMENTATION STRATEGY TO ADDRESS THOSE NEEDS EVERY THREE YEARS. IN ORDER TO CONTINUE COMPLIANCE WITH THIS REQUIREMENT, SAINT PETER'S UNIVERSITY HOSPITAL AND ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL AGAIN TEAMED TOGETHER AND ENGAGED WITH NEW SOLUTIONS, INC., TO COMPLETE A SERIES OF MULTI-METHOD ANALYTIC ACTIVITIES TO PERFORM THE THIRD ROUND OF THE HEALTHIER MIDDLESEX COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY. HEALTHIER MIDDLESEX IS A DIVERSE, MULTI-SECTOR, COMMUNITY-FOCUSED CONSORTIUM COMPRISED OF A WIDE VARIETY OF STAKEHOLDERS INCLUDING COMMUNITY-BASED ORGANIZATIONS, HOSPITALS, ACADEMIC INSTITUTIONS, AND HEALTH DEPARTMENTS. THROUGH THIS PARTNERSHIP, HEALTHIER MIDDLESEX IS ABLE TO PROVIDE ITS COMMUNITY WITH THE BEST PROGRAMS AND POLICIES AVAILABLE. HEALTHIER MIDDLESEX CONSTANTLY STRIVES TO DEVELOP MORE EFFECTIVE STRATEGIES TO POSITIVELY IMPACT THE HEALTH OF THE COMMUNITY. THE CONSORTIUM IS FOCUSED ON IDENTIFYING THE STRENGTHS AND OPPORTUNITIES WITHIN THE COMMUNITY, ALIGNING THE EFFORTS AND RESOURCES OF ITS PARTNERS, WHILE DEVELOPING STRUCTURE AND SUSTAINABLE STRATEGIES THAT INTEGRATE HEALTH AND WELLNESS INTO ALL ASPECTS OF ITS COMMUNITY. RWJUH AND SPUH ARE FOUNDING MEMBERS OF THE CONSORTIUM AND PROVIDE SPONSORSHIP FOR THE DEVELOPMENT OF THE CHNA. THE CHNA IS DESIGNED TO ENSURE THAT THE HOSPITALS AND OTHER COMMUNITY STAKEHOLDERS CONTINUE TO SERVE THE HEALTH NEEDS OF ITS SERVICE AREA EFFECTIVELY AND EFFICIENTLY. THE CHNA'S DEVELOPMENT CONSULTANTS, NEW SOLUTIONS, INC.(""NSI""), HAVE PLANNED AND CONDUCTED NUMEROUS COMMUNITY NEEDS ASSESSMENTS AND IMPLEMENTATION PLANS WITH MULTIPLE ORGANIZATIONS INCLUDING INDIVIDUAL HOSPITALS, HEALTH SYSTEMS, OTHER HEALTH CARE AND COMMUNITY ORGANIZATIONS SUCH AS CONSORTIA COMPRISED OF A WIDE RANGE OF PARTICIPANT ORGANIZATIONS. THE NSI TEAM INCLUDES: PLANNING CONSULTANTS, MARKET RESEARCHERS, EPIDEMIOLOGISTS, COMPUTER PROGRAMMERS AND DATA ANALYSTS. NSI HAS EXTENSIVE REGIONAL AND LOCAL COMMUNITY KNOWLEDGE OF HEALTH ISSUES, COMMUNITY SERVICES AND PROVIDER RESOURCES. THIS EXPERTISE, AS WELL AS THE METHODOLOGICAL AND TECHNICAL SKILLS OF THE ENTIRE STAFF, WAS BROUGHT TO BEAR IN CONDUCTING THIS NEEDS ASSESSMENT AND HEALTH IMPROVEMENT PLAN."

SCHEDULE H, PART V; SECTION B, QUESTION 7A
"THE ORGANIZATION IS AN AFFILIATE WITHIN SAINT PETER'S HEALTHCARE SYSTEM, INC. AND AFFILIATES (""SYSTEM""); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN PART V, SECTION B, QUESTION 7A, IS THE HOME PAGE FOR THE SYSTEM. THE CHNA CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: HTTPS://WWW.SAINTPETERSHCS.COM/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASS ESSMENT"

SCHEDULE H, PART V; SECTION B, QUESTION 10A
"THE ORGANIZATION IS AN AFFILIATE WITHIN SAINT PETER'S HEALTHCARE SYSTEM, INC. AND AFFILIATES (""SYSTEM""); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN PART V, SECTION B, QUESTION 10A, IS THE HOME PAGE FOR THE SYSTEM. THE ORGANIZATION'S IMPLEMENTATION STRATEGY CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: HTTPS://WWW.SAINTPETERSHCS.COM/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASS ESSMENT"

SCHEDULE H, PART V, SECTION B, QUESTION 11
HEALTHIER MIDDLESEX USED THE DATA COLLECTED THROUGH THE CHNA TO DETERMINE THE COUNTIES' TOP HEALTH ISSUES. AFTER OBTAINING FEEDBACK FROM THE MEMBERSHIP, CONSULTANTS DEVELOPED A LIST OF 17 ISSUES IDENTIFIED AS COMMON THEMES OF THE RESEARCH. THE ISSUES IDENTIFIED WERE PRESENTED TO THE COMMITTEE AND REVIEWED TO ENSURE AGREEMENT ON MAJOR THEMES. ON JULY 31, 2019, MEMBERS MET TO RANK THE MAJOR THEMES INTO PRIORITY AREAS FOR ACTIONS USING A VOTING PROCESS THAT ASKED MEMBERS TO RANK EACH OF THE MAJOR THEMES IDENTIFIED IN THE CHNA USING THE FOLLOWING CRITERIA. - NUMBER OF PEOPLE IMPACTED - RISK OF MORTALITY AND MORBIDITY ASSOCIATED WITH THE PROBLEM - IMPACT OF THE PROBLEM ON VULNERABLE POPULATIONS - MEANINGFUL PROGRESS CAN BE MADE WITHIN A THREE-YEAR TIMEFRAME - COMMUNITY'S CAPABILITY AND COMPETENCY TO IMPACT THE STEERING COMMITTEE REVIEWED THE RESULTS OF THE PRIORITIZATION PROCESS AND THROUGH DISCUSSION DETERMINED THAT THE TOP THREE PRIORITY ISSUES OF THE PLAN WOULD ADDRESS INCLUDED: ACCESS TO CARE AND SERVICES, PREVENTIVE CARE AND VACCINE USE, AND NUTRITION AND PHYSICAL ACTIVITY. SPECIFIC AREAS OF CONCERN WITHIN THE MAJOR AREAS INCLUDED: 1) ACCESS TO CARE AND SERVICES - TRANSPORTATION, INSURANCE, AVAILABILITY OF SERVICES, HEALTH LITERACY - BEHAVIORAL/MENTAL HEALTH/SUBSTANCE ABUSE USE FOR ADULTS AND CHILDREN 2) PREVENTATIVE CARE AND VACCINATION USE - CHRONIC DISEASES PREVENTION AND MANAGEMENT (VARIOUS, HEART DISEASE, DIABETES, CANCER) - STI PREVENTION/SCREENING - VACCINATION USE - MATERNAL CHILD HEALTH/PRENATAL CARE AND WELL BABY 3) NUTRITION AND PHYSICAL ACTIVITY - FOOD SECURITY - OBESITY THE ORGANIZATION PLANS TO ADDRESS THE ABOVE HEALTH NEEDS BY DOING THE FOLLOWING AS INDICATED WITHIN ITS COMMUNITY HEALTH IMPROVEMENT PLAN. PRIORITY AREA I: ACCESS TO CARE/PRIORITY GROUP I - TRANSPORTATION ----------------------------------------------------------------- GOAL: UTILIZING A TECHNOLOGY PLATFORM, INCREASE ACCESSIBILITY OF TRANSPORT SERVICES THROUGH COORDINATION OF EXISTING SERVICES. OBJECTIVE: DEVELOP A COMPREHENSIVE ELECTRONIC DATABASE OF AVAILABLE TRANSPORTATION SERVICES BY 2021. ACTION ITEMS: (1) FORM DATA COMMITTEE TO COLLECT INFORMATION ON EXISTING TRANSPORTATION RESOURCES IN MIDDLESEX/SOMERSET COUNTY; (2) REVIEW NATIONWIDE BEST PRACTICES ON HOW TO COORDINATE TRANSPORTATION RESOURCE INFORMATION; (3) BEGIN DATA COLLECTION; (4) SET MEETING WITH MCDOT TO OBTAIN BUY-IN FOR ASSISTANCE IN DEVELOPING ELECTRONIC DATABASE OF RESOURCES; (5) WORK WITH MCDOT TO DEVELOP AND TEST THE ELECTRONIC DATA PLATFORM. OBJECTIVE: BY 2022, ENSURE THAT ACCESS TO TRANSPORTATION RESOURCES ARE WIDELY AVAILABLE TO THE COMMUNITY VIA HEALTHIER MIDDLESEX WEBSITE AND VIA DISSEMINATION TO COMMUNITY PARTNERS. ACTION ITEMS: (1) COMMUNITY PARTNERS WITH ACCESS TO THE ELECTRONIC DATABASE WILL BE RESPONSIBLE FOR TRAINING OF THEIR FRONT LINE/OUTREACH STAFF; (2) PRINTED INFORMATION WILL BE TRANSLATED INTO TOP 3 LANGUAGES SPOKEN IN THE COMMUNITY. PRIORITY AREA I: ACCESS TO CARE/PRIORITY GROUP II - BEHAVIORAL HEALTH/TRAUMA INFORMED CARE --------------------------------------------------------------------- GOAL: INCREASE ACCESS TO BEHAVIORAL HEALTH CARE AND BEHAVIORAL HEALTH EDUCATION FOR ADULTS AND CHILDREN. OBJECTIVE: BY 2022, TRAIN 200 PEOPLE IN MENTAL HEALTH FIRST AID AND MENTAL HEALTH FIRST AID FOR YOUTH. ACTION ITEMS: (1) A IDENTIFY MENTAL HEALTH FIRST AID AND YOUTH MENTAL HEALTH FIRST AID TRAINERS: (2) IDENTIFY LOCATIONS THROUGHOUT MIDDLESEX COUNTY TO HOST TRAININGS; (3) IDENTIFY ORGANIZATIONS AND POPULATIONS WITHIN EACH MUNICIPALITY WHO SERVE YOUTH TO MARKET YMHFA TRAINING; (4) HOLD TRAININGS AND CERTIFY 100 PEOPLE IN MENTAL HEALTH AND YOUTH MENTAL HEALTH FIRST AID. OBJECTIVE: BY 2022, DEVELOP A HOSPITAL-BASED PROGRAM TO IDENTIFY, REFER AND SERVICE VICTIMS OF VIOLENCE AND BUILD A CRIME VICTIM SURVIVORS CONSORTIUM OF COMMUNITY-BASED ORGANIZATIONS TO PROVIDE EDUCATION, RESOURCES AND REFERRALS FOR VICTIMS AND SURVIVORS OF VIOLENT CRIMES AND THEIR FAMILIES. ACTION ITEMS: (1) BY THE END OF 2020, TRAIN AND ON BOARD RWJUH AND PRAB STAFF AND IMPLEMENT PROGRAM; (2) BY THE END OF 2020, CREATE AND IMPLEMENT AN ALGORITHM IN THE RWJUH ELECTRONIC MEDICAL RECORDS (EMR) SYSTEM TO SCREEN 100% OF IN-PATIENT IN THE TRAUMA DEPARTMENT AND IDENTIFY VIOLENTLY-INJURED PATIENTS FOR REFERRAL TO THE HVIP; (3) BY THE END OF 4Q - 2020, COLLECT DATA TO CREATE BASELINE OF PROGRAM EVALUATION MEASURES (E.G. NUMBERS OF VIOLENTLY INJURED PATIENTS IDENTIFIED, REFERRED, CONSENTED, AND ENROLLED); (4) RECRUIT COMMUNITY-BASED ORGANIZATION (CBOS) TO CREATE A HOSPITAL-BASED VIOLENCE COMMUNITY CONSORTIUM (HVCC) TO SUPPORT THE PATIENT CASE CONFERENCING INTERVENTION MODEL FOR THE RWJUH HVIP; (5) BY THE END OF Q4 - 2020, EXPAND NUMBER OF CBO PARTNERS TO INCLUDE ORGANIZATIONS IN UNION, MIDDLESEX AND SOMERSET COUNTIES; (6) BY THE END OF Q4 - 2020, CREATE A PATIENT GUN SAFETY INTERVENTION; (7) BY THE END OF Q4 - 2020, GUN SAFETY HANDOUTS WILL BE CREATED, AND TRAUMA NAVIGATORS TRAINED TO PROVIDE GUN SAFETY EDUCATION AND DISTRIBUTE GUN LOCKS; (8) BY 2020, DEVELOP PROGRAM EVALUATION TOOLS AND RECRUIT TRAINERS FOR HVIP COMMUNITY CONSORTIUM (HVCC) MEMBER PROGRAMS; (9) BY THE END OF Q3 - 2020, IMPLEMENT EVALUATIONS TOOLS. OBJECTIVE: BY 2022, INCREASE PROVIDERSCOMMUNITY MEMBERS' KNOWLEDGE OF ADVERSE CHILDHOOD EXPERIENCES (ACES). ACTION ITEMS: (1) PARTNER WITH FAMILY SUCCESS CENTERS TO PROVIDE AND IMPLEMENT ACES TRAINING; (2) IMPLEMENT 20 PRESENTATIONS YEARLY WITH A MINIMUM OF 10 MUNICIPALITIES REPRESENTED, UNTIL 2022; (3) IDENTIFY AND TRAIN A MINIMUM OF 5 COMMUNITY HEALTH AMBASSADORS (CHA) TO BECOME ACES EXPERTS AND PROVIDE TRAININGS TO THE COMMUNITY (JULY 2020); (4) IMPLEMENT 10 ACES WORKSHOPS TARGETING 75 RESIDENTS FACILITATED BY CHA IN THE COMMUNITY (DECEMBER 2020). OBJECTIVE: DURING 2020 TO 2022 ADVOCATE FOR THE NEED, AND GARNER SUPPORT FOR THE DEVELOPMENT OF A YOUTH DETOX CENTER IN MIDDLESEX COUNTY. ACTION ITEMS: (1) A GATHER DATA TO DEMONSTRATE NEED FOR YOUTH DETOX CENTER IN MIDDLESEX COUNTY AND PROCESS TO DEVELOP CENTER, 2020; (2) BY 2021, CONTACT LOCAL OFFICIALS AND SEND LETTERS WITH CHNA DATA AND INFORMATION REGARDING YOUTH OPIOID CASES IN THE COUNTY; (3) PRESENT DATA TO STATE, COUNTY OF LOCAL OFFICIALS, 2021; (4) SUPPORT COMMUNITY EFFORTS FOR THE CREATION OF A YOUTH DETOX CENTER IN MIDDLESEX COUNTY, 2022. OBJECTIVE: BY 2022, UPDATE, EXPAND, AND INCREASE UTILIZATION OF THE BEHAVIORAL HEALTH REFERRAL AND RESOURCE GUIDE (BHRRG). ACTION ITEMS: (1) UPDATE, DISTRIBUTE AND TRAIN COMMUNITY PROVIDERS ON THE BHRRG; (2) TRANSLATE PRESENTATION AND HOLD BHHRG TRAINING IN SPANISH, 2021; (3) MARKET TRAININGS AND BHRRG TO APPROPRIATE COMMUNITY PROVIDERS, ANNUALLY; (4) ADD BHRRG TO THE HEALTHIER MIDDLESEX WEBSITE AND TRACK UTILIZATION. OBJECTIVE: BY 2022, ENCOURAGE SCHOOLS, CAMPS, AFTER SCHOOL PROGRAMS AND FAITH-BASED ORGANIZATIONS TO OFFER PROGRAMS DESIGNED TO PROVIDE CHILDREN AND FAMILIES WITH THE TOOLS AND RESOURCES THEY NEED TO NAVIGATE THE CHALLENGES THEY FACE ON A DAILY BASIS. ACTION ITEMS: (1) UTILIZE FAMILY SUCCESS CENTER'S ACES TRAINING FOR PROVIDERS AND MAKE AVAILABLE FOR HEALTHY KIDS CAMP STAFF; (2) B IMPLEMENT THE FOOTPRINTS FOR LIFE PROGRAM IN 5 SCHOOLS THROUGHOUT THE COUNTY (ANNUALLY). PRIORITY AREA I: ACCESS TO CARE/PRIORITY GROUP III - HEALTH LITERACY -------------------------------------------------------------------- GOAL: TO CREATE HEALTHY COMMUNITIES THROUGHOUT MIDDLESEX COUNTY BY MOBILIZING LIBRARIANS TO DISSEMINATE UNDERSTANDABLE AND ACTIONABLE HEALTH INFORMATION TO EMPOWER INDIVIDUALS TO ACHIEVE AND MAINTAIN A HEALTHY QUALITY OF LIFE. OBJECTIVE: BY 2020, INCREASE THE NUMBER OF LIBRARIANS IN THE GREATER MIDDLESEX REGION TRAINED IN CONSUMER HEALTH INFORMATION SCIENCE (CHIS) BY THE NATIONAL NETWORK OF LIBRARIES OF MEDICINE (NNLM) BY 10%. ACTION ITEMS: (1) RECRUIT AND PROVIDE FUNDING FOR LIBRARIANS TO RECEIVE CHIS TRAINING. OBJECTIVE: BY 2021, INCREASE THE NUMBER OF LIBRARIES IN THE GREATER MIDDLESEX REGION THAT OFFER HEALTH INFORMATION AS PART OF THE HILOW INITIATIVE BY 10%. ACTION ITEMS: (1) RECRUIT LIBRARIANS IN MIDDLESEX COUNTY TO PARTICIPATE IN THE HILOW INITIATIVE. OBJECTIVE: BY 2021, DEPLOY LIBRARIANS TO COMMUNITY SITES TO DISSEMINATE HEALTH INFORMATION AND PROMOTE HEALTH LITERACY. ACTION ITEMS: (1) BY 2020, DEVELOP A LIST OF TOPICS MOST OFTEN REQUESTED BY COMMUNITY MEMBERS FOR LECTURES/WORKSHOPS; (2) BY 2021, CONDUCT 5 LECTURES, WORKSHOPS, AND/OR SCREENING EVENTS IN COLLABORATION WITH HEALTHIER MIDDLESEX PARTNERS. PRIORITY AREA II: PREVENTIVE CARE AND VACCINE USE - PRIORITY GROUP IV - CHRONIC DISEASE PREVENTION & MANAGEMENT GOAL: INCREASE UTILIZATION OF COMMUNITY RESOURCES FOR PREVENTION AND MANAGEMENT OF CHRONIC DISEASES. OBJECTIVE: INCREASE THE NUMBER OF CHRONIC DISEASE SELF-MANAGEMENT PEER LEADERS BY TRAINING 10 NEW PEER EDUCATORS EACH YEAR. ACTION ITEMS: (1) RECRUIT TRAINING VOLUNTEERS THROUGH EXISTING COMMUNITY PARTNERSHIPS; (2) BY 2022, IDENTIFY MECHANISMS TO ENHANCE CONTINUED PARTICIPATION IN

SCHEDULE H, PART V; SECTION B, QUESTION 16
"THE ORGANIZATION IS AN AFFILIATE WITHIN SAINT PETER'S HEALTHCARE SYSTEM, INC. AND AFFILIATES (""SYSTEM""); A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN PART V, SECTION B, QUESTION 16, IS THE HOME PAGE FOR THE SYSTEM. THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: HTTP://WWW.SAINTPETERSHCS.COM/PATIENTS/BILLING-AND-PAYMENT/FINANCIAL-ASSIS TANCE-PROGRAM"

SCHEDULE H, PART I, LINE 3C
"IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, SAINT PETER'S UNIVERSITY HOSPITAL (""SPUH"") USES OTHER FACTORS IN DETERMINING ELIGIBILITY CRITERIA FOR FREE AND DISCOUNTED CARE. OTHER FACTORS TO DETERMINE ELIGIBILITY INCLUDE: - ASSET LEVEL; - MEDICAL INDIGENCY; - INSURANCE STATUS; - UNDERINSURANCE STATUS; AND - RESIDENCY. ADDITIONAL INFORMATION WITH RESPECT TO SPUH'S ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE IS OUTLINED BELOW. NEW JERSEY CHARITY CARE ----------------------- NJ CHARITY CARE IS FREE OR REDUCED CHARGE CARE WHICH IS PROVIDED TO PATIENTS WHO RECEIVE INPATIENT AND OUTPATIENT SERVICES AT ACUTE CARE HOSPITALS THROUGHOUT THE STATE OF NEW JERSEY. CHARITY CARE IS AVAILABLE ONLY FOR EMERGENT OR MEDICALLY NECESSARY HOSPITAL CARE. SOME SERVICES SUCH AS PHYSICIAN FEES, ANESTHESIOLOGY FEES, RADIOLOGY INTERPRETATION, AND OUTPATIENT PRESCRIPTIONS ARE SEPARATE FROM HOSPITAL CHARGES AND MAY NOT BE ELIGIBLE FOR REDUCTION. IN ACCORDANCE WITH CHARITY CARE GUIDELINES, PAYMENT ASSISTANCE IS AVAILABLE TO NEW JERSEY RESIDENT PATIENTS WHOSE HOUSEHOLD GROSS INCOME IS AT OR BELOW 300% OF THE FEDERAL POVERTY GUIDELINES AND WHO: 1. HAVE NO HEALTH COVERAGE OR HAVE COVERAGE THAT PAYS ONLY PART OF THE BILL; 2. ARE INELIGIBLE FOR ANY PRIVATE OR GOVERNMENTAL SPONSORED COVERAGE (SUCH AS MEDICAID): AND 3. MEET THE INCOME AND ASSETS CRITERIA DESCRIBED BELOW. CHARITY CARE IS AVAILABLE TO THOSE THAT DO NOT QUALIFY FOR STATE OR FEDERAL PROGRAMS. INCOME CRITERIA - PATIENTS WITH FAMILY GROSS INCOME LESS THAN OR EQUAL TO 200% OF THE FEDERAL POVERTY GUIDELINES (""FPG"") ARE ELIGIBLE FOR 100% CHARITY CARE COVERAGE. PATIENTS WITH FAMILY GROSS INCOME GREATER THAN 200% BUT LESS THAN OR EQUAL TO 300% OF FPG ARE ELIGIBLE FOR DISCOUNTED CARE UNDER THE CHARITY CARE PROGRAM. ASSETS CRITERIA - INDIVIDUAL ASSETS CANNOT EXCEED $7,500 AND FAMILY ASSETS CANNOT EXCEED $15,000. SHOULD AN APPLICANT'S ASSETS EXCEED THESE LIMITS, HE/SHE MAY ""SPEND DOWN"" THE ASSETS TO THE ELIGIBLE LIMITS THROUGH PAYMENT OF THE EXCESS TOWARD THE HOSPITAL BILL AND OTHER APPROVED OUT-OF-POCKET MEDICAL EXPENSES. CHARITY CARE MAY BE AVAILABLE TO NON-NEW JERSEY RESIDENTS, SUBJECT TO SPECIFIC PROVISIONS (SUCH AS EMERGENCY MEDICAL CONDITIONS). ALL EMPLOYED PHYSICIANS OF SAINT PETER'S UNIVERSITY HOSPITAL AND AFFILIATED ENTITIES (OVER 200 PROVIDERS) ACCEPT CHARITY CARE PATIENTS AND DO NOT BILL FOR THEIR SERVICES. NEW JERSEY UNINSURED DISCOUNT CARE RATE --------------------------------------- UNINSURED NEW JERSEY STATE RESIDENT PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE AND WHOSE INCOME FALLS LESS THAN OR EQUAL TO 500% OF THE FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR A DISCOUNT BASED UPON MEDICARE RATES AS PER THE NJ STATE STATUTE P.L. 2008, CHAPTER 60, APPROVED ON AUGUST 8, 2008, ASSEMBLY, NO. 2609, AS ENACTED BY THE SENATE AND GENERAL ASSEMBLY OF THE STATE OF NEW JERSEY. AMOUNT GENERALLY BILLED (""AGB"") ------------------------------- PER INTERNAL REVENUE CODE 501(R)(5) CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE FOR FAP-ELIGIBLE INDIVIDUALS UNDER SPUH'S FAP WILL BE LIMITED TO BUT NOT BILLED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE."

SCHEDULE H, PART I; QUESTION 6A
NOT APPLICABLE.

SCHEDULE H, PART I; QUESTION 7G
NO COSTS RELATING TO SUBSIDIZED HEALTHCARE SERVICES ARE ATTRIBUTABLE TO ANY PHYSICIAN CLINICS.

SCHEDULE H, PART I, QUESTION 7
THE ORGANIZATION'S COST ACCOUNTING SYSTEM WAS UTILIZED.

SCHEDULE H, PART I, QUESTION 7B
Saint Peter's University Hospital partnered with Middlesex County and the State of New Jersey through a provider assessment mechanism to make the state of New Jersey Medicaid program healthier for all. The program increases financial resources provided to hospital using the State of New Jersey's Medicaid program and certain federal matching funds in order to better serve the needs in the community. These additional funds received from the program are included in Schedule H, Part I; Line 7b; Direct offsetting revenue. during calendar year 2021, Saint Peter's University Hospital also experienced a Medicaid cost per case increase for Medicaid patients which the costs are included in Schedule H, Part I; Line 7b; Total community benefit expense.

SCHEDULE H, PART II
COMMUNITY BUILDING ACTIVITIES UNDERTAKEN BY THIS ORGANIZATION IMPROVE THE MEDICAL AND SOCIOECONOMIC WELL-BEING OF THE COMMUNITIES IN OUR CARE. THIS IS ACCOMPLISHED THROUGH SERVICE ON STATE AND REGIONAL ADVOCACY COMMITTEES AND BOARDS, VOLUNTEERISM WITH LOCAL COMMUNITY-BASED NON-PROFIT ADVOCACY GROUPS, AND PARTICIPATION IN CONFERENCES AND OTHER EDUCATIONAL ACTIVITIES TO PROMOTE UNDERSTANDING OF THE ROOT CAUSES OF HEALTH CONCERNS. THIS ORGANIZATION PROVIDES EDUCATIONAL MATERIALS, CONDUCTS COMMUNITY HEALTH FAIRS AND HOLDS HEALTH EDUCATION SEMINARS AND OUTREACH SESSIONS FOR ITS PATIENTS AND FOR COMMUNITY PROVIDERS. PRESENTATIONS ARE PROVIDED BY PHYSICIANS, NURSES AND OTHER HEALTHCARE PROFESSIONALS.

SCHEDULE H, PART III, SECTION B; QUESTION 8
"MEDICARE COSTS WERE DERIVED FROM THE 2021 MEDICARE COST REPORT. THE ORGANIZATION BELIEVES THAT MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS SHOULD BE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUAL'S IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE (""IRC"") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM ""CHARITABLE"" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT ""[T]HE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE,PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM ""CHARITABLE"" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE ""CHARITY CARE STANDARD."" UNDER THE STANDARD, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY, AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH ""REMOVE[D]"" FROM REVENUE RULING 56-185 ""THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST."" UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE ""COMMUNITY BENEFIT STANDARD,"" HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE ""GENERALLY ACCEPTED LEGAL SENSE"" OF THE TERM ""CHARITABLE,"" AS REQUIRED BY TREAS. REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS ""PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY"" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. MEDICARE UNDERPAYMENTS AND BAD DEBT ARE COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THE AMERICAN HOSPITAL ASSOCIATION (""AHA"") BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA POSITION. AS OUTLINED IN THE AHA LETTER TO THE IRS DATED AUGUST 21, 2007, WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA BELIEVED THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES HOSPITALS ONLY 85 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION (""MEDPAC"") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10-YEAR LOW AT NEGATIVE 5.4 PERCENT. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED ELIGIBLES."" THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO BELIEVE THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR FINANCIAL ASSISTANCE PROGRAMS. A 2006 CONGRESSIONAL BUDGET OFFICE (""CBO"") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT ""THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE."" - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40 PERCENT OF BAD DEBT IS PENDING CHARITY CARE. - THE CBO CONCLUDED THAT ITS FINDINGS ""SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFITS"" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES THAT THEY ARE GENERALIZABLE. - AS OUTLINED BY THE AHA, DESP"

SCHEDULE H, PART VI; QUESTION 5
THIS ORGANIZATION HOLDS AN ANNUAL COMMUNITY PUBLIC MEETING WHERE THE BOARD MEMBERS ARE INVITED AS WELL AS SENIOR MANAGEMENT TEAM AND STAFF MEMBERS. THE MAJORITY OF THE BOARD OF TRUSTEES ARE INDIVIDUALS WITH LOCAL BUSINESSES OR WHO RESIDE IN THE COMMUNITY. HOSPITAL STAFF MEMBERS SERVE ON THE BOARDS OF MANY LOCAL NOT-FOR-PROFIT ORGANIZATIONS AND PROVIDE OTHER FORMS OF SUPPORT (FUNDRAISING, ACTIVITY PARTICIPATION). ALL QUALIFIED PHYSICIANS ARE EXTENDED PRIVILEGES BY THEIR RESPECTIVE DEPARTMENTS. UNDER THE DIRECTIVE OF THE ORGANIZATION'S CORPORATE FINANCE OFFICE, SURPLUS FUNDS ARE USED FOR CAPITAL PROJECTS TO IMPROVE SERVICES OR PURCHASE EQUIPMENT, WHICH IN TURN, BENEFIT THE COMMUNITY.

SCHEDULE H, PART VI; QUESTION 7
THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN NEW JERSEY. THE STATE OF NEW JERSEY DOES NOT REQUIRE HOSPITALS TO ANNUALLY FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW JERSEY.

SCHEDULE H, PART III, SECTION A; QUESTIONS 2, 3 & 4
BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM ITS AUDITED FINANCIAL STATEMENTS. SAINT PETER'S HEALTHCARE SYSTEM, INCLUDING ITS HOSPITALS AND SUBSIDIARIES, PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. THE BELOW WAS OBTAINED FROM THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENTS OF THE SYSTEM AND SUBSIDIARIES. ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE --------------------------------------------------- NET PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE SYSTEM EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS AND INCLUDES PROVISIONS FOR VARIABLE CONSIDERATION (REDUCTIONS TO REVENUE) FOR RETROACTIVE REVENUE ADJUSTMENTS, INCLUDING ADJUSTMENTS DUE TO THE SETTLEMENT OF ONGOING AND FUTURE AUDITS, REVIEWS, AND INVESTIGATIONS. THE SYSTEM USES A PORTFOLIO APPROACH TO ACCOUNT FOR CATEGORIES OF PATIENT CONTRACTS AS A COLLECTIVE GROUP RATHER THAN RECOGNIZING REVENUE ON AN INDIVIDUAL CONTRACT BASIS. THE PORTFOLIOS CONSIST OF MAJOR PAYOR CLASSES FOR INPATIENT REVENUE AND MAJOR PAYOR CLASSES AND TYPES OF SERVICES PROVIDED FOR OUTPATIENT REVENUE. BASED ON HISTORICAL COLLECTION TRENDS AND OTHER ANALYSES, THE SYSTEM BELIEVES THAT REVENUE RECOGNIZED BY UTILIZING THE PORTFOLIO APPROACH APPROXIMATES THE REVENUE THAT WOULD HAVE BEEN RECOGNIZED IF AN INDIVIDUAL CONTRACT APPROACH WERE USED. THE SYSTEM'S INITIAL ESTIMATE OF THE TRANSACTION PRICE FOR SERVICES PROVIDED TO PATIENTS IS DETERMINED BY REDUCING THE TOTAL STANDARD CHARGES RELATED TO THE PATIENT SERVICES PROVIDED BY VARIOUS ELEMENTS OF VARIABLE CONSIDERATION, INCLUDING CONTRACTUAL ADJUSTMENTS, DISCOUNTS, IMPLICIT PRICE CONCESSIONS, AND OTHER REDUCTIONS TO THE SYSTEM'S STANDARD CHARGES. THE SYSTEM DETERMINES THE TRANSACTION PRICE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL OR FORMULA-DRIVEN RATES FOR THE SERVICES RENDERED (SEE DESCRIPTION OF THIRD-PARTY PAYOR PAYMENT PROGRAMS BELOW). THE ESTIMATES FOR CONTRACTUAL ALLOWANCES AND DISCOUNTS ARE BASED ON CONTRACTUAL AGREEMENTS, THE SYSTEM'S DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. FOR UNINSURED AND UNDER-INSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, THE SYSTEM DETERMINES THE TRANSACTION PRICE ASSOCIATED WITH SERVICES ON THE BASIS OF CHARGES REDUCED BY IMPLICIT PRICE CONCESSIONS. IMPLICIT PRICE CONCESSIONS INCLUDED IN THE ESTIMATE OF THE TRANSACTION PRICE ARE BASED ON THE SYSTEM'S HISTORICAL COLLECTION EXPERIENCE FOR APPLICABLE PATIENT PORTFOLIOS. UNDER THE SYSTEM'S POLICY FOR SELF-PAY PATIENTS, A PATIENT WHO HAS NO INSURANCE AND IS INELIGIBLE FOR ANY GOVERNMENT ASSISTANCE PROGRAM HAS HIS OR HER BILL REDUCED TO THE AMOUNT WHICH WOULD BE BILLED TO A COMMERCIALLY INSURED PATIENT. GENERALLY, THE SYSTEM BILLS PATIENTS AND THIRD-PARTY PAYORS SEVERAL DAYS AFTER THE SERVICES ARE PERFORMED AND/OR THE PATIENT IS DISCHARGED. NET PATIENT SERVICE REVENUE IS RECOGNIZED AS PERFORMANCE OBLIGATIONS ARE SATISFIED. PERFORMANCE OBLIGATIONS ARE DETERMINED BASED ON THE NATURE OF THE SERVICES PROVIDED BY THE SYSTEM. NET PATIENT SERVICE REVENUE FOR PERFORMANCE OBLIGATIONS SATISFIED OVER TIME IS RECOGNIZED BASED ON ACTUAL CHARGES INCURRED IN RELATION TO TOTAL CHARGES. THE SYSTEM BELIEVES THAT THIS METHOD PROVIDES A REASONABLE DEPICTION OF THE TRANSFER OF SERVICES OVER THE TERM OF THE PERFORMANCE OBLIGATION BASED ON THE SERVICES NEEDED TO SATISFY THE OBLIGATION. GENERALLY, PERFORMANCE OBLIGATIONS SATISFIED OVER TIME RELATE TO PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES OR PATIENTS RECEIVING SERVICES IN THE SYSTEM'S OUTPATIENT AND AMBULATORY CARE CENTERS. THE SYSTEM MEASURES THE PERFORMANCE OBLIGATION FROM ADMISSION INTO THE HOSPITAL OR THE COMMENCEMENT OF AN OUTPATIENT SERVICE TO THE POINT WHEN IT IS NO LONGER REQUIRED TO PROVIDE SERVICES TO THAT PATIENT, WHICH IS GENERALLY AT THE TIME OF DISCHARGE OR THE COMPLETION OF THE OUTPATIENT SERVICE. SUBSTANTIALLY ALL OF ITS PERFORMANCE OBLIGATIONS RELATE TO CONTRACTS WITH A DURATION OF LESS THAN ONE YEAR. THE UNSATISFIED OR PARTIALLY UNSATISFIED PERFORMANCE OBLIGATIONS PRIMARILY RELATE TO INPATIENT ACUTE CARE SERVICES AT THE END OF THE REPORTING PERIOD FOR PATIENTS WHO REMAIN ADMITTED AT THAT TIME (IN-HOUSE PATIENTS). THE PERFORMANCE OBLIGATIONS FOR IN-HOUSE PATIENTS ARE GENERALLY COMPLETED WHEN THE PATIENTS ARE DISCHARGED, WHICH FOR THE MAJORITY OF THE SYSTEM'S IN-HOUSE PATIENTS OCCURS WITHIN DAYS OR WEEKS AFTER THE END OF THE REPORTING PERIOD. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE (DETERMINED ON A PORTFOLIO BASIS WHEN APPLICABLE) ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019, CHANGES IN THE SYSTEM'S ESTIMATES OF IMPLICIT PRICE CONCESSIONS, DISCOUNTS, CONTRACTUAL ADJUSTMENTS OR OTHER REDUCTIONS TO EXPECTED PAYMENTS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR PERIODS WERE NOT SIGNIFICANT. PORTFOLIO COLLECTION ESTIMATES ARE UPDATED QUARTERLY BASED ON COLLECTION TRENDS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY (DETERMINED ON A PORTFOLIO BASIS WHEN APPLICABLE) ARE RECORDED AS BAD DEBT EXPENSE.

SCHEDULE H, PART III, SECTION B; QUESTION 9B
"ACCOUNTS CONSIDERED TO BE CHARITY CARE ARE NOT INCLUDED IN THE BAD DEBT EXPENSE, BUT RATHER, ACCOUNTED FOR AS AN ALLOWANCE. IT IS THE POLICY OF THE SAINT PETER'S UNIVERSITY HOSPITAL'S BUSINESS OFFICE, AND ALL ITS HOSPITAL AFFILIATES, TO TREAT ALL PATIENTS EQUALLY REGARDLESS OF INSURANCE AND THEIR ABILITY TO PAY. THE FOLLOWING CRITERIA HAS BEEN ESTABLISHED TO ENSURE THAT ALL EFFORTS HAVE BEEN EXHAUSTED TO ENSURE THAT THE PATIENT IS NOT ELIGIBLE FOR A GOVERNMENTAL PROGRAM, THEY DO HAVE ACCESS OR MEANS TO OBTAIN THIRD-PARTY HEALTH INSURANCE COVERAGE, AND WE HAVE EXHAUSTED ALL REASONABLE EFFORTS TO COLLECT THE OUTSTANDING PAYMENT OBLIGATION - INCLUDING FAP-ELIGIBILITY STATUS (AND IF ELIGIBLE, ENSURE THAT FEES/CHARGES HAVE BEEN ADJUSTED TO THE APPLICABLE LEVELS). THE CRITERIA ARE INCLUSIVE OF THE FOLLOWING: 1) THE ACCOUNTS RECEIVABLE BALANCE MUST BE CONFIRMED AS A PATIENT (OR GUARANTOR) RESPONSIBILITY AMOUNT. IF THE ACCOUNT HAS A PRIOR HISTORY OF MEDICAID OR CHARITY CARE ELIGIBILITY, WE WILL MAKE ALL EFFORTS TO REVIEW CURRENT DOCUMENTATION AND CHECK FOR POTENTIAL ELIGIBILITY. 2) THERE MUST BE DOCUMENTATION IN ACCOUNT NOTES THAT AT LEAST FOUR (4) POST-DISCHARGE BILLING STATEMENTS WITH THE CONFIRMED PATIENT BALANCE HAVE BEEN SENT TO THE CURRENT ADDRESS ON FILE. THE MESSAGES ON THE STATEMENT ARE PROGRESSIVE IN NATURE - WITH THE LAST ONE PROVIDING A CLEAR MESSAGE THAT, AFTER 30 DAYS FROM THE DATE OF THIS NOTICE, IF THE BALANCE IS NOT SATISFIED IN FULL, OR A PAYMENT PLAN ESTABLISHED, THE ACCOUNT QUALIFIES FOR PLACEMENT WITH ONE OF OUR EXTERNAL COLLECTION AGENCIES. PLEASE NOTE THAT THIS ""30-DAY"" NOTICE MUST ALSO: - PROVIDE THE INDIVIDUAL WITH WRITTEN NOTICE THAT STATES FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS; - INCLUDE A DESCRIPTION OF ANY OTHER ECAS THAT SPUH INTENDS ON UNDERTAKING IN ADDITION TO SENDING TO AN EXTERNAL COLLECTION AGENCY (PLEASE REFER TO NUMBER 5 BELOW); AND - INCLUDE A COPY OF THE PLS. IN ADDITION, SPUH MUST MAKE A REASONABLE EFFORT TO ORALLY NOTIFY THE INDIVIDUAL ABOUT THE FAP. 3) THERE MUST BE A MINIMUM SPAN OF 120 DAYS, FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT, PRIOR TO ANY BAD DEBT WRITE-OFF AND POTENTIAL REFERRAL TO ONE OF OUR EXTERNAL COLLECTION AGENCIES. 4) IF AT ANY TIME OUR EXTERNAL COLLECTION AGENCY IS NOTIFIED THAT THE PATIENT/GUARANTOR IS FAP-ELIGIBLE THE HOSPITAL RETAINS THE OPTION TO: - RECALL THE ACCOUNT FROM THE COLLECTION AGENCY AND RE-START THE COLLECTION PROCESS WITH THE BALANCE ADJUSTED SUCH THAT THE PATIENT/GUARANTOR IS PAYING NO MORE THAN THEY ARE RESPONSIBLE FOR AS A FAP-ELIGIBLE INDIVIDUAL AND REFUND ANY PAYMENTS ALREADY MADE IN EXCESS OF THE ADJUSTED BALANCE (IF GREATER THAN $5); OR - HAVE THE COLLECTION AGENCY RETAIN THE ACCOUNT AND RE-START THE COLLECTION PROCESS WITH THE BALANCE ADJUSTED SUCH THAT THE PATIENT/GUARANTOR IS PAYING NO MORE THAN THEY ARE RESPONSIBLE FOR AS A FAP-ELIGIBLE INDIVIDUAL AND REFUND ANY PAYMENTS ALREADY MADE IN EXCESS OF THE ADJUSTED BALANCE (IF GREATER THAN $5). 5) IN ADDITION TO NUMBER FOUR (DETAILED ABOVE - ""4""), AFTER DETERMINING FAP-ELIGIBILITY SPUH CAN UNDERTAKE ADDITIONAL ECAS INCLUDING, BUT NOT LIMITED TO: - TAKING ACTIONS THAT REQUIRE LEGAL OR JUDICIAL PROCESS - INCLUDING LIENS, FORECLOSURES, CIVIL ACTIONS; - REPORTING ADVERSE INFORMATION TO CREDIT AGENCIES OR BUREAUS; AND - DEFERRING, DENYING, OR REQUIRING A PAYMENT BEFORE REQUIRING NON-MEDICALLY NECESSARY OR EMERGENT CARE BECAUSE OF NON-PAYMENT FOR PREVIOUSLY PROVIDED CARE THAT IS COVERED UNDER THE FAP."

SCHEDULE H, PART VI; QUESTION 2
IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS OUTLINED IN SCHEDULE H, SECTION B, QUESTIONS 1-12 AND SECTION C, THIS ORGANIZATION CONDUCTS A REVIEW OF KEY FACTOR INFORMATION ANNUALLY WHICH INCLUDES: A REVIEW OF HEALTHCARE UTILIZATION OF ITS SERVICE AREA POPULATION BY SERVICES (UROLOGY, CARDIOLOGY, OBSTETRICS, ETC.) FOR DETERMINING INCREASED OR DECREASED HEALTH NEEDS; HEALTHCARE SERVICE ESTIMATES AND FORECASTS (BOTH INPATIENT AND OUTPATIENT); ASSESSMENTS OF LOCAL DEMOGRAPHIC AND SOCIOECONOMIC INFORMATION; AND, A REVIEW OF HEALTH STATUS/NEEDS ASSESSMENTS AND STUDIES CONDUCTED BY EXTERNAL PARTIES (HEALTH RESEARCH AND EDUCATION TRUST OF RUTGERS). THIS ORGANIZATION CONDUCTS AN EXTENSIVE SERVICE AREA POPULATION PHYSICIAN NEED STUDY (BY PRIMARY AND SPECIALTY) EVERY THREE TO FIVE YEARS. SPECIFIC SPECIALTY NEEDS ARE CONDUCTED FOR IDENTIFIED GAPS IN SERVICE. THESE REVIEWS INFORM MEDICAL STAFF DEVELOPMENT AT THE MEDICAL CENTER TO ASSURE RESPONSIVENESS TO IDENTIFIED COMMUNITY NEEDS. IN ADDITION, THIS ORGANIZATION WORKS WITH LOCAL PROVIDERS TO PLAN AND DISCUSS HEALTH NEEDS OF THE POPULATION. ONE FORUM IS A PERINATAL CONSORTIUM FOR THE GREATER MIDDLESEX AREA WITH REPRESENTATION FROM LOCAL COMMUNITY HEALTH CENTERS, OTHER HEALTH PROVIDERS AND OTHER COMMUNITY HEALTH LEADERS.

SCHEDULE H, PART VI; QUESTION 3
"IN ACCORDANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(4) SPUH INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BY WIDELY PUBLICIZING THE AVAILABILITY OF FINANCIAL ASSISTANCE. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS WIDELY PUBLICIZED IN THE FOLLOWING WAYS: A) SPUH'S FAP AND A PLAIN LANGUAGE SUMMARY (""PLS"") OF THE FAP ARE ALL AVAILABLE VIA OUR WEBSITE -- WWW.SAINTPETERSHCS.COM. B) PAPER COPIES OF THE FAP AND PLS ARE AVAILABLE UPON REQUEST WITHOUT CHARGE BY MAIL AS WELL AS PROVIDED IN VARIOUS AREAS THROUGHOUT THE HOSPITAL FACILITIES - INCLUDING ADMISSIONS, PATIENT REGISTRATION, EMERGENCY ROOM DEPARTMENT, RESOURCE SERVICES, AND PATIENT DISCHARGE. ALL WRITTEN REQUESTS SHOULD BE SENT TO: SAINT PETER'S UNIVERSITY HOSPITAL ATTN: RESOURCE SERVICES 254 EASTON AVENUE NEW BRUNSWICK, NJ 08901 C) VERBAL REQUESTS FOR PAPER COPIES OF THE FAP AND PLS WILL BE AVAILABLE BY CONTACTING: SAINT PETER'S UNIVERSITY HOSPITAL DEPARTMENT: RESOURCE SERVICES TELEPHONE #: 732.745.8600 EXTENSION: 5019 D) SPUH IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, SPUH, AND ALL SUBSTANTIALLY RELATED ENTITIES, WILL WIDELY PUBLICIZE THIS FAP AND THE PLS IN THE COMMUNITIES THAT WE SERVE. E) THE FAP AND THE PLS ARE AVAILABLE IN ENGLISH AND OTHER LANGUAGES THAT CONSTITUTE THE LESSER OF 5% OR 1,000 INDIVIDUALS WITHIN SPUH'S PRIMARY SERVICE AREA. F) SIGNAGE NOTIFYING PATIENTS/GUARANTORS OF OUR FAP WILL BE PLACED IN CONSPICUOUS LOCATIONS, INCLUDING THE ADMISSION DEPARTMENT, AMBULATORY SERVICES, AND EMERGENCY ROOM AREAS, AND WILL PROVIDE A TELEPHONE NUMBER AND OFFICE LOCATIONS THAT CAN PROVIDE INFORMATION ON APPLYING FOR OUR FAP."

SCHEDULE H, PART VI; QUESTION 4
THIS ORGANIZATION IS IN A DIVERSE SUBURBAN LOCATION SERVING DIVERSE COMMUNITIES RANGING FROM INNER CITY COMMUNITIES IN NEW BRUNSWICK TO MORE AFFLUENT SUBURBAN AREAS. THIS ORGANIZATION IS LOCATED IN NEW BRUNSWICK, IN MIDDLESEX COUNTY. MIDDLESEX COUNTY ENCOMPASSES A LAND MASS OF 323 SQUARE MILES COMPRISED OF 25 URBAN AND SUBURBAN MUNICIPALITIES. THE COUNTY'S MUNICIPALITIES ARE DIVERSE, ENCOMPASSING INNER-CITY COMMUNITIES, SUCH AS NEW BRUNSWICK AND PERTH AMBOY, AND THE SUBURBAN COMMUNITIES OF PLAINSBORO, CRANBURY AND MONROE TOWNSHIP. ECONOMIC WEALTH IS NOT UNIFORMLY DISTRIBUTED ACROSS MUNICIPALITIES; URBAN AREAS INCLUDE A HIGH NUMBER OF POOR AND MINORITY POPULATIONS. IN 2016, 8.9% OF PEOPLE AND 6.5% OF MIDDLESEX COUNTY FAMILIES WERE LIVING IN POVERTY COMPARED TO 10.9% OF PEOPLE AND 8.1% OF FAMILIES STATEWIDE. - IN 2016, 36.0% OF PEOPLE AND 28.9% OF FAMILIES WERE LIVING IN POVERTY IN NEW BRUNSWICK. - IN 2016, 8.4% OF FAMILIES WERE LIVING IN POVERTY IN THE HIGHLAND PARK ZIP CODE. IN 2016, 4.6% OF MIDDLESEX COUNTY RESIDENTS WERE UNEMPLOYED, LOWER THAN THE STATE (5.2%). - THE UNEMPLOYMENT RATE IN NEW BRUNSWICK (5.4%) EXCEEDED THE COUNTY RATE (4.6%) AND WAS HIGHER THAN THE STATE RATE (5.2%). - THE MONROE UNEMPLOYMENT RATE WAS 3.4%, THE LOWEST IN THE SERVICE AREA AND LOWER THAN THE MIDDLESEX COUNTY RATE OF 4.6%. IN 2016, THE MIDDLESEX COUNTY MEDIAN HOUSEHOLD INCOME WAS $80,716, MORE THAN $7,000 ABOVE THE STATE AVERAGE. - THE 2016 MEDIAN HOUSEHOLD INCOME OF NEW BRUNSWICK RESIDENTS ($40,428) WAS A LITTLE MORE THAN HALF THE STATEWIDE FIGURE ($73,702). - EAST BRUNSWICK HAD THE HIGHEST MEDIAN HOUSEHOLD INCOME IN THE RWJUH/SPUH SERVICE AREA AT $101,245. - BETWEEN 2014-2016, INCOME LEVELS ACROSS THE COUNTY AND THE RWJUH/SPUH SERVICE AREA SHOWED LITTLE INCREASE OR DECLINE.

SCHEDULE H, PART VI; QUESTION 6
"OUTLINED BELOW IS A SUMMARY OF THE ENTITIES THAT COMPRISE SAINT PETER'S HEALTHCARE SYSTEM, INC. AND AFFILIATES. SAINT PETER'S HEALTHCARE SYSTEM, INC. ------------------------------------- SAINT PETER'S HEALTHCARE SYSTEM, INC. (""SYSTEM"") IS THE TAX-EXEMPT PARENT OF THE SAINT PETER'S HEALTHCARE SYSTEM; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM (""SYSTEM""). THIS INTEGRATED HEALTHCARE DELIVERY SYSTEM CONSISTS OF A GROUP OF AFFILIATED HEALTHCARE ORGANIZATIONS. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY IS EITHER SYSTEM OR ANOTHER SYSTEM AFFILIATE CONTROLLED BY SAINT PETER'S HEALTHCARE SYSTEM. THE SYSTEM IS AN INTEGRATED NETWORK OF HEALTHCARE PROVIDERS IN THE STATE OF NEW JERSEY. SAINT PETER'S HEALTHCARE SYSTEM, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). SAINT PETER'S UNIVERSITY HOSPITAL --------------------------------- SAINT PETER'S UNIVERSITY HOSPITAL (""SPUH"") IS A 478-BED ACUTE CARE AND TEACHING HOSPITAL LOCATED IN NEW BRUNSWICK, MIDDLESEX COUNTY, NEW JERSEY. SPUH IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, SPUH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. MOREOVER, SPUH OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. 1. SPUH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF- PAY, MEDICARE AND MEDICAID PATIENTS; 2. SPUH OPERATES AN ACTIVE EMERGENCY DEPARTMENT FOR ALL PERSONS; WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. SPUH MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF SPUH RESTS WITH ITS BOARD OF GOVERNORS WHICH IS COMPRISED OF INDEPENDENT CIVIC LEADERS, MEMBERS OF THE COMMUNITY AND MEDICAL STAFF REPRESENTATION; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE; PROGRAMS AND ACTIVITIES. ST. PETER'S FOUNDATION ---------------------- ST. PETER'S FOUNDATION IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THROUGH FUNDRAISING ACTIVITIES, THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF SPUH; A RELATED INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION, THAT PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. SAINT PETER'S HEALTH AND MANAGEMENT SERVICES CORPORATION -------------------------------------------------------- SAINT PETER'S HEALTH AND MANAGEMENT SERVICES CORPORATION IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THE ORGANIZATION IS A SUPPORTING ORGANIZATION OF SPUH; A RELATED INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION, THAT PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. SAINT PETER'S PROPERTIES CORPORATION ------------------------------------ SAINT PETER'S PROPERTIES CORPORATION IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(2). NEW BRUNSWICK AFFILIATED HOSPITALS, INC. ---------------------------------------- NEW BRUNSWICK AFFILIATED HOSPITALS, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). SAINT PETER'S HEALTHCARE SYSTEM PHYSICIAN ASSOCIATES, P.C. ---------------------------------------------------------- SAINT PETER'S HEALTHCARE SYSTEM PHYSICIAN ASSOCIATES, P.C. IS A PROFESSIONAL CORPORATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). DUE TO STATE OF NEW JERSEY CORPORATE PRACTICE OF MEDICINE PROHIBITION RULES, THE ORGANIZATION IS OWNED THROUGH A NOMINEE RELATIONSHIP BY A LICENSED PROFESSIONAL FOR THE BENEFIT OF SAINT PETER'S UNIVERSITY HOSPITAL. THE ORGANIZATION COMPRISES A COMPONENT OF THE CLINICAL SERVICE PHYSICIAN PRACTICE PLANS AND IS AN INTEGRAL PART OF SAINT PETER'S UNIVERSITY HOSPITAL. SAINT PETER'S SOLAR ENERGY SOLUTIONS, INC. ------------------------------------------ AN ENTITY WHOSE SOLE SHAREHOLDER IS SAINT PETER'S HEALTH AND MANAGEMENT SERVICES. THE ORGANIZATION IS LOCATED IN NEW BRUNSWICK, MIDDLESEX COUNTY, NEW JERSEY. THE ORGANIZATION PROVIDES SOLAR GENERATED ELECTRICITY TO THE HOSPITAL AND ONE OTHER NON-PROFIT ORGANIZATION. PARK AVENUE COLLECTIONS CORPORATION ----------------------------------- AN INACTIVE ORGANIZATION. RISK ASSURANCE COMPANY OF SAINT PETER'S UNIVERSITY HOSPITAL ----------------------------------------------------------- A CONTROLLED FOREIGN CORPORATION BY SPUH. THE ORGANIZATION WAS FORMED AND OPERATES SOLELY IN THE CAYMAN ISLANDS. SAINT PETER'S SPECIALTY PHYSICIANS, P.C. ---------------------------------------- DUE TO STATE OF NEW JERSEY CORPORATE PRACTICE OF MEDICINE PROHIBITION RULES, THE ORGANIZATION IS OWNED THROUGH A NOMINEE RELATIONSHIP BY A LICENSED PROFESSIONAL FOR THE BENEFIT OF SAINT PETER'S UNIVERSITY HOSPITAL. THE ORGANIZATION COMPRISES A COMPONENT OF THE CLINICAL SERVICE PHYSICIAN PRACTICE PLANS AND IS AN INTEGRAL PART OF SAINT PETER'S UNIVERSITY HOSPITAL. AN INACTIVE PROFESSIONAL CORPORATION LOCATED IN NEW BRUNSWICK, MIDDLESEX COUNTY, NEW JERSEY. SAINT PETER'S ADVANCED CARE, P.C. --------------------------------- AN INACTIVE ORGANIZATION."