4A (Expenses $ 73548816 including grants of $ 0) (Revenue $ 107943187)
Roper St. Francis Hospital - Berkeley is an affiliate of Roper St. Francis Healthcare. Roper St. Francis Hospital - Berkeley is a full-service hospital with a wide range of services and an expert team dedicated to our mission of healing all people with compassion, faith and excellence. In 2021, Roper St. Francis Hospital - Berkeley contributed $3.2 million in community benefit.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Roper St. Francis Hospital - Berkeley Inc.. In an effort to create a greater impact on the community and address the greatest needs, Roper St. Francis Healthcare participated in and produced a joint Community Health Needs Assessment (CHNA) in collaboration with the Medical University of South Carolina and the Trident United Way. Data for the CHNA was collected from January - February 2019. To gather community input the Community Health Needs Assessment team disseminated a community survey with the purpose of identifying a general overview of the most concerning health topics. The surveys had 5,128 responses which greatly surpassed the number of responses from the previous CHNA of 905 survey responses. This level of engagement is an immediate benefit of collaborating with community partners. Furthermore, the team hosted 19 Interviews with community leaders, elected officials and health care professionals, held 12 focus groups with 57 participants from the community at large, and had 100 participants at the team's community input session. During the 2019 CHNA planning process, specific community groups and organizations, including area schools, churches, and clinics, were included to engage more members from African American, Latino, low socioeconomic and rural communities. Using feedback from the surveys, interviews, focus groups and the community input session a summary of community feedback was created. This summary would be used in the creation of team's priorities and ultimately the implementation strategy.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Roper St. Francis Hospital - Berkeley Inc.. Roper Hospital, Inc. Bon Secours St. Francis Xavier Hospital Roper St. Francis Mt. Pleasant Hospital Roper St. Francis Hospital - Berkeley Inc. Medical University of South Carolina

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - Roper St. Francis Hospital - Berkeley Inc.. Trident United Way

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - Roper St. Francis Hospital - Berkeley Inc.. The Roper St. Francis Healthcare (RSFH) is comprised of Roper Hospital, Bon Secours St. Francis Xavier Hospital, Roper St Francis Mount Pleasant Hospital, and Roper St. Francis Berkeley Hospital. These hospitals are collectively referred to as ""Roper St. Francis Healthcare"" or ""RSFH."" RSFH's Community Needs Assessment Team developed implementation strategies for each health issue identified as a strategic priority. This implementation plan was rolled out over 3 years. Some strategies may be addressed by more than one RSFH hospital or the system as a whole. The team developed a monitoring method at the conclusion of the implementation planning process to provide status updates to community partners, stakeholders, and the community-at-large. The following are the 2021 strategies and outcomes on the 5 issues identified as priorities in the 2020 Community Health Needs Assessment. Access to Care 2021 Strategies and Outcomes: Strategy (System-wide): Navigate high users of emergency departments to primary care medical homes, and to refer underinsured and uninsured patients to AccessHealth and/or the Transitions Clinic. * During 2021, the four local hospital systems actively participated in AccessHealth Tri-County Network in order to collaborate with local healthcare systems to identify Emergency Department (ED) ""super utilizers"". * RSFH coordinated with AccessHealth and the Transition Clinic to navigate uninsured ED ""super utilizers"" to these programs. During 2021, AccessHealth had 2,113 patients, including 668 new patients, and Transitions Clinic had 1,313 patients, including 350 new patients, which resulted in a reduction in ED visits for these patients by 83%. * RSFH implemented a team-based program to create a comprehensive, patient-centered care plan for ED ""super utilizers,"" engaging both RSFH and community resources called U-Turn. During 2021, RSFH enrolled 69 patients into the U-Turn program. Strategy (System-wide): Coordinate and collaborate with safety-net partners for delivery of services, including area Federally Qualified health Centers (FQHC), free clinics, and homeless shelters. * RSFH provides lab work, free supplies, and ancillaries to partner medical clinics and supportive agencies. During 2021, RSFH provided $2,211,126 of in-kind services to partnered clinics. * RSFH managed care coordination for eligible patients referred from local partners through the shared care navigation hub managed by AccessHealth. Those served are included in the 2,113 patients served by AccessHealth in 2021. Strategy (System-wide): Provide in-home care to patients with limited mobility through Home Health and Hospice Care. * RSFH provided high quality care for patients with transportation or mobility issues or those with end-of-life needs through in-home or inpatient Hospice or Home Health Services. During 2021, 6,986 patients received Home Health Services, while 636 patients received In-home Hospice care and 437 patients received Inpatient Hospice care. Clinical Preventative Services 2021 Strategies and Outcomes: Strategy (System-wide): Provide routine, primary care for low-income, uninsured adults. * RSFH provides lab work, free supplies, and ancillaries to partner medical clinics and supportive agencies. During 2021, RSFH provided $2,211,126 of in-kind services to partnered clinics. * RSFH provided $307,984 of financial support for clinical staff and infrastructure at Our Lady of Mercy Outreach during the year. Strategy (System-wide): Provide early intervention services for patients diagnosed with HIV/AIDS. * RSFH enrolled HIV positive patients into the federally funded Ryan White program. In 2021, The Ryan White Wellness Center provided comprehensive HIV and primary care for 802 HIV positive patients. * In 2021, RSFH worked with the Ryan White Wellness Center to ensure continued health insurance coverage for 325 HIV positive adult patients using federal and employer insurance programs. * Through the continued work with the Ryan White Wellness Center 802 total patients were served during 2021, including 112 patients who were enrolled in the Pre-Exposure Prophylaxis (PrEP) Program. * During 2021, RSFH continued to host community events to promote HIV awareness and prevention with the Ryan White Wellness Center attending 8 events. Due to COVID-19 restrictions HIV testing was not able to be performed at these events. Strategy (System-wide): Provide evidence-based outpatient care for diabetic patients and expand access to free annual breast health screenings for all women, particularly African-American women. * Through its affiliated physician entity, Roper St. Francis Physician Partners (RSFPP), RSFH tracked the number of patients diagnosed with diabetes who have a healthy A1c level to be considered having controlled diabetes. In 2021, 70.3% of RSFH's patients were considered to have controlled diabetes with the goal of reaching 78% of diabetes patients having controlled diabetes. RSFH is in the process of hiring additional diabetic educators to help improve these scores. * RSFH continued to host screening events for underserved men and women to get breast and colorectal screenings. During 2021, RSFH hosted a Breast Cancer Screening event in June with 15 participants and 11 same day mammograms performed. RSFH also hosted a Colorectal Screening in August with 22 participants and 5 completed colonoscopies. Behavioral Health 2021 Strategies and Outcomes: Strategy (System-wide): Coordinate services between Emergency Departments and regional mental health agencies. * During 2021, RSFH continued to participate and collaborate in the Charleston/Dorchester Mental Health Department's community task force. * During 2021, RSFH coordinated care of behavioral health patients, using local agencies and resources, such as Greer Transitions (LPC) and AccessHealth, for support. * RSFH continued their collaboration with mental health providers and other local agencies to engage community members in highest need areas to direct appropriate services. In 2021, RSFH and Lowcounty Food Bank prepared and distributed 1,962 nutritious, prepared meals that specifically targeted dietary needs of homebound food-insecure seniors in Charleston County. Additionally, RSFH distributed approximately 1,715 bags of fresh produce through the Farmacy. Strategy (System-wide): Provide services and education to combat the opioid epidemic. * RSFH has continued building relationships with local law enforcement to create an alliance for holding Drug Take Back events and to expand their initiative. Throughout 2021, 8 drug take back events were held, and a total of 238.6 lbs. collected, 166 attendees, and over 20 volunteers. Two events were held at Dorchester County/St. George Health Fair and Bethel AME Church and are considered rural facilities. Strategy (System-wide): Provide mental health screenings at wellness and postpartum OB/GYN visits. * RSFH incorporates depression screenings at primary care wellness visits and postpartum OB/GYN patient visits. In 2021, 55,343 patients or 81% of all patients received a depression screening during primary care wellness checks and 965 patients or 95.1% of all patients received a depression screening during the follow-up postpartum visit."

Schedule H, Part V, Section B, Line 11 Facility , 2
Facility , 2 - Roper St. Francis Hospital - Berkeley Inc.. Obesity, Nutrition, and Physical Activity 2021 Strategies and Outcomes: Strategy (System-wide): increase opportunities for comprehensive wellness. * RSFH continued to implement Wellness Works incentives to increase employee participation in wellness exams and PCP visits. During the year 3,914 teammate wellness exams were conducted. * RSFH promotes employee participation in disease-specific events to increase health awareness and advocacy. In 2021, RSFH employees recorded 3,478 hours of staff time supporting initiatives while serving 9,972 community residents. * During the year RSFH's Community Health team participated in 44 health fairs or screening events by hosting informative and interactive tables and booths to increase opportunities for comprehensive wellness. Strategy (System-wide): Collaborate with local partners to increase healthy food options in underprivileged communities. * RSFH collaborates with Lowcountry Food Bank and East Cooper Meals on Wheels to provide home-delivered meals in low-income communities. In 2021, RSFH and Lowcounty Food Bank prepared and distributed 1,962 nutritious, prepared meals that specifically targeted dietary needs of homebound food-insecure seniors in Charleston County. Additionally, RSFH distributed approximately 1,715 bags of fresh produce through the Farmacy. Strategy (System-wide): Host evidence-based health and wellness community programs for older adults. * RSFH continued to offer physical wellness classes specifically targeting older adults throughout the Tri-county. Maternal, Infant, and Child Health 2021 Strategies and Outcomes: Strategy (Bon Secours St. Francis Hospital): Offer specialized services for high-risk pregnancies. * Bon Secours St. Francis Xavier Hospital (BSSF) continued to offer specialized care teams for high-risk pregnant women to include a board-certified maternal fetal medicine specialist during 2021. * BSSF supported a Maternal Fetal Medicine program that includes medical management, counseling, biophysical profiles, diagnosis and management of birth defects as well as other highly specialized services. During 2021, this program had 5,166 patient visits with 1,504 total patients served. Strategy (Bon Secours St. Francis Hospital): Provide prenatal care for uninsured patients that are not eligible for Medicaid. * BSSF continued to support and promote prenatal care for eligible uninsured and immigrant patients of Our Lady of Mercy Outreach. * During 2021, BSSF continued partnerships that provide routine lab work, radiology services, prenatal education classes, and Maternal Fetal Medicine services for Spanish speaking patients. Strategy (Bon Secours St. Francis Hospital, Roper St. Francis Mt. Pleasant Hospital, and Roper St. Francis Berkeley Hospital): Host expectant parent education classes and tours, and Safe Sitter classes. * During 2021, BSSF, MPH and BH facilitated regularly scheduled expectant parent education classes and hospital tours as well as Safe Sitter classes. The classes facilitated during the year totaled 122 and had 694 participants. All prioritized needs identified in the hospital's CHNA have been addressed.

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - Roper St. Francis Hospital - Berkeley Inc.. Full charity care will be provided to patients with income 200% or less of FPG. Patients with an FPG of 201% - 400% will receive a discount based upon a sliding scale. Patients who qualify and are receiving benefits from the following programs may be presumed eligible for 100 percent financial assistance - food stamps, county and state relief programs, homelessness, deceased patients, and religious organizations. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the financial assistance application. In order to determine the appropriate level of financial assistance to apply to a patient's account, the facility will utilize a scoring mechanism, with the assistance of a third party vendor that provides a patient profile, or require the patient to complete a financial assistance application. Household income, as defined for federal tax guidelines, will be considered in determining whether a patient is eligible for financial assistance.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - Roper St. Francis Hospital - Berkeley Inc.. The patient handbook provided with registration references the Policy and includes contact information for patients who need assistance. In addition, signs are posted at all Hospital registration sites that reference our financial assistance policies and how they are accessed.

Schedule H, Part V, Section B, Line 23 Facility , 1
"Facility , 1 - Roper St. Francis Hospital - Berkeley Inc.. Roper St. Francis Healthcare (RSFH) hospitals implemented new policies and procedures in January 2016 to meet the financial assistance and billing and collection requirements outlined under the final IRC Section 501(r) regulations. RSFH offers financial assistance based on the current Federal Poverty Guidelines to uninsured and underinsured patients and guarantors with an outstanding balance owed for medically necessary services. Patients or guarantors may be determined to be Presumptively Eligible for financial assistance based on eligibility for other specific state or federal programs. Full charity care is provided to uninsured and underinsured patients earning 200% or less of the federal poverty level (FPL). Patients with an FPL of 201% - 400% will receive a discount based upon a sliding scale as outlined in RSFH's Financial Assistance Policy (FAP). Additionally, RSFH calculates each hospital's Amount Generally Billed (AGB) to patients who have insurance and to assure patients who qualify for the Financial Assistance Program are not charged more than the average amount reimbursable by insurance. RSFH hospitals use the ""Look Back Method"" described by the IRS in the 501(r) regulations. This method compares the charges for claims processed by insurance companies and Medicare with the ""amounts allowed"" for those services. The ""amounts allowed"" means the portion that insurance and Medicare pay or allocate to the patient to pay. The percentage is updated annually. Prior to 2019, RSFH applied first a self-pay discount to the patient's charges and then applied the sliding scale discount to the remaining balance, resulting in a discount of 90%. Both the self-pay discount and the sliding scale discount ensured that patients who qualified for financial assistance were not charged more than amounts generally billed (AGB). Beginning in February 2019, RSFH discontinued the practice of applying the self-pay discount prior to the application of the sliding scale discount outlined in RSFH's FAP. The sliding scale discount pursuant to the terms of the FAP was not adjusted to align with the hospitals' AGB. During 2019 -2021, patients with an FPL of 201%-300% received a discount of 50%, and patients with an FPL of 301%-400% received a discount of 75%. The majority of patients eligible for financial assistance during this time were eligible for a discount of 75%. The sliding scale discounts offered during these years were less than AGB. Due to this change, certain patients who qualified for financial assistance were inadvertently charged more than AGB during tax years 2019 - 2021. Immediately upon recognition of the minor oversight in December 2021, RSFH began taking steps to align the sliding scale discounts in the FAP with the annual AGB calculations to ensure that any patient who qualifies for a partial discount under the FAP is not charged more than AGB. RSFH approved an 83% discount effective January 1, 2022, for all patients at all RSFH hospitals who qualify for a partial discount. The discount will be adjusted on an annual basis to align with the annual AGB calculation for each hospital. At the time of identification of the minor oversight in December 2021, RSFH also reviewed all accounts for patients potentially charged more than AGB and ceased any ongoing collection actions for those patients until a thorough review of those patients' accounts could be completed in Q1 2022. In April of 2022, RSFH corrected all account balances for patients that were charged more than the AGB in from 2019-2021. This included preventing ECA where it hadn't yet occurred and rectifying ECA where it had occurred. RSFH processed adjustments to patients' accounts to reduce any charges that exceeded AGB for that episode of care and requested any accounts subject to collection actions be adjusted accordingly. Any ECAs that had been taken, including adverse credit reporting, were reversed. Patients with resulting credit balances were issued refunds. The below detail shows the year this occurred, the number of patients charged more than AGB, and the total amount charged more than AGB for Roper St. Francis Hospital - Berkeley Inc. 2019: 2 patients, $3,842.88 charged more than the AGB 2020: 29 patients, $3,752.83 charged more than the AGB 2021: 38 patients, $79,162.15 charged more than the AGB In 2022, RSFH will begin performing an internal audit on a regular and continuous basis to ensure compliance with IRS Section 501(r) regulations. We do not believe the minor oversight to be considered ""willful or egregious"" and RSFH has performed internal research to identify how the minor oversight occurred and taken additional steps, including changes to its FAP and operational procedures, to ensure compliance going forward."

Schedule H, Part I, Line 3c Roper St. Francis Hospital - Berkeley Inc.
In addition to using the FPG to determine eligibility for free or discounted care, the system offers a 35% discount for patients who are uninsured. A 10% prompt payment discount is offered to all self-pay or self-pay-after-insurance patients who pay the balance at one time. Medical indigency adjustments are available to those that meet the established guidelines.

Schedule H, Part V, Section B Line 16g
"Roper St. Francis Healthcare (RSFH) hospitals implemented new policies and procedures in January 2016 to meet the notification requirements outlined under the final IRS Section 501(r) regulations. Training materials were revised, new scripting was developed, and training sessions were held for applicable Revenue Cycle employees which required competency sign-off for those who completed the training. Procedures initially implemented included offering a copy of the plain language summary (PLS) to patients as part of the intake process. Individuals were notified about the FAP by receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or other measures reasonably calculated to attract patients' attention. As a result of an annual internal review, it was determined that the PLS of RSFH's Financial Assistance Policy (FAP) was not being offered to all patients at intake during 2020 through June 2021. Immediately upon recognition of the minor oversight, RSFH began taking steps to offer a copy of the PLS to all patients who visit the hospital facilities by adding scripting to notify patients of the availability of financial assistance and offering a copy of the PLS to the patient intake process. In June 2021, RSFH added new language to the Consent for Treatment, Payment, and Health Care Operations (Consent) form required to be signed by all patients, including a copy of the PLS attached as an addendum to the Consent to certify that the patient is aware of RSFH's FAP and a copy of the PLS was offered. Additional training has also been provided to all applicable staff. RSFH widely publicized its FAP, the FAP Application, and the PLS on the organization's website, includes a conspicuous written notice about the FAP on patients' billing statements, posts conspicuous public displays in the Emergency Department and Registration areas of the hospitals, and notifies members of the community about availability of the FAP. RSFH will continue to perform an internal audit on a regular and continuous basis at least once per year to ensure compliance. We do not believe the minor oversight to be considered ""willful or egregious"" and RSFH has performed internal research to identify how the minor oversight occurred and taken additional steps to ensure compliance going forward."

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Cost of financial assistance at cost was calculated with a cost to charge ratio using worksheet 2. The cost related to Medicaid patients was determined using Roper St. Francis Healthcare's cost accounting system and included both inpatients and outpatients for traditional Medicaid and Medicaid managed care plans. For subsidized services Roper St. Francis Healthcare's cost accounting system used to determine cost related to the specific service excluding traditional Medicaid and Medicaid managed care patients. Costs for charity and bad debt accounts are deducted using a ration of cost to charge specific to that subsidized service. Costs for other programs reflect the direct and indirect costs of providing those programs.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. NET PATIENT ACCOUNTS ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED UPON ROPER ST. FRANCIS HEALTHCARE'S HISTORICAL COLLECTION EXPERIENCE ADJUSTED FOR CURRENT ENVIRONMENTAL RISKS AND TRENDS FOR EACH MAJOR PAYOR SOURCE. SIGNIFICANT PROVISION IS MADE FOR SELF-PAY PATIENT ACCOUNTS IN THE PERIOD OF SERVICE BASED ON PAST COLLECTION EXPERIENCE. ROPER ST. FRANCIS HEALTHCARE'S CONCENTRATION OF CREDIT RISK RELATED TO NET PATIENT ACCOUNTS IS LIMITED DUE TO THE DIVERSITY OF PATIENTS AND PAYORS. NET PATIENT ACCOUNTS CONSIST OF AMOUNTS DUE FROM GOVERNMENTAL PROGRAMS (PRIMARILY MEDICARE AND MEDICAID), PRIVATE INSURANCE COMPANIES, MANAGED CARE PROGRAMS AND PATIENTS THEMSELVES. NET PATIENT SERVICE REVENUE FOR SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE IS RECOGNIZED BASED ON CONTRACTUAL RATES FOR SERVICES RENDERED. ROPER ST. FRANCIS HEALTHCARE RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME SERVICES ARE RENDERED EVEN THOUGH IT DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). AMOUNTS RECOGNIZED ARE SUBJECT TO ADJUSTMENT UPON REVIEW BY THIRD-PARTY PAYORS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, ROPER ST. FRANCIS HEALTHCARE RECOGNIZES REVENUE WHEN SERVICES ARE PROVIDED. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF ROPER ST. FRANCIS HEALTHCARE'S ININSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, ROPER ST. FRANCIS HEALTH RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. ANY DISCOUNTS APPLIED TO SELF-PAY PATIENTS WOULD BE DEEMED EITHER CHARITY OR A CONTRACTUAL ADJUSTMENT. BAD DEBT WOULD BE BASED ON THE BALANCE AFTER THE CHARITY OR CONTRACTUAL ADJUSTMENT THAT IS DEEMED UNCOLLECTABLE FOLLOWING A REASONABLE COLLECTION EFFORT.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
For patients who do not turn in a signed charity care application, after 120 days of collection efforts, Roper St. Francis Healthcare uses the Health Care Advisory Board's self pay compass program to automatically qualify patients for charity care through the use of an electronic scoring technique. The data received through this software is believed to err on the side of denying charity. The estimate of bad debt that could have been charity is based on the system error rate. Please note that patients who complete a full charity care application and qualify for charity under our policy are granted charity regardless of the score in the self-pay compass system.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
"BON SECOURS MERCY HEALTH AND ITS MEMBERS, INCLUDING ROPER ST. FRANCIS HEALTHCARE (RSFH), FOLLOW THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES POLICY DOCUMENT, COMMUNITY BENEFIT PROGRAM, A REVISED RESOURCE FOR SOCIAL ACCOUNTABILITY (""CHA GUIDELINES"") FOR DETERMINING COMMUNITY BENEFIT. THE CHA GUIDELINES RECOMMEND THAT HOSPITALS NOT INCLUDE MEDICARE LOSSES AS COMMUNITY BENEFIT. RSFH'S COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE MEDICARE AMOUNTS IN PART III."

Schedule H, Part V, Section B, Line 16a FAP website
- Roper St. Francis Hospital - Berkeley Inc.: Line 16a URL: https://www.rsfh.com/billing-financial-assistance/;

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
BON SECOURS MERCY HEALTH'S (BSMH) AUDITED FINANCIAL STATEMENTS, WHICH INCLUDES THE ACTIVITY OF ROPER ST. FRANCIS HEALTHCARE, DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. BSMH ELECTED TO EARLY ADOPT ASU 2011-07. ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AS AN OPERATING EXPENSE. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS, 2. SIGNIFICANT ACCOUNTING POLICIES, (d) NET PATIENT ACCOUNTS AND NET PATIENT SERVICE REVENUE (PAGE 17) STATES Patient receivables are recorded at net realizable value based on certain assumptions determined by payor class. For third party payors including Medicare, Medicaid, and commercial insurance, the net realizable value is based on the estimated contractual reimbursement percentage, which is based on current contract prices or historical paid claims data by payor. For self-pay receivables, which includes patients who are uninsured and the patient responsibility portion for patients with insurance, the net realizable value is determined using estimates of historical collection experience. These estimates are adjusted for estimated conversions of patient responsibility portions, expected recoveries and any anticipated changes in trends.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Roper St. Francis Healthcare (RSFH) uses the same reasonable efforts and follows the same reasonable process for collecting amounts due for services provided to all patients, including insured, underinsured or uninsured patients. Collection activities may occur during the pre-registration process and will continue until account resolution, a determination the account is uncollectible, or determination of eligibility for financial assistance. The collection process may include the use of deposits, the implementation of payment plans or discretionary settlements. The collection process may involve the use of outside collection agencies. The collection process is documented in the patient's account files accessible to the Hospital and its business associates involved in the collection process. Collection will not, however, be pursued against patients who fall within populations exempt from collection action by law.

Schedule H, Part V, Section B, Line 16b FAP Application website
- Roper St. Francis Hospital - Berkeley Inc.: Line 16b URL: https://www.rsfh.com/billing-financial-assistance/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Roper St. Francis Hospital - Berkeley Inc.: Line 16c URL: https://www.rsfh.com/billing-financial-assistance/;

Schedule H, Part VI, Line 2 Needs assessment
The CHNA team used surveys sent out to the community at large and asked respondents to rank the top 10 topics areas from Health People 2020 that impact the communities where they live and/or work from 1 (most concerning) to 10 (least concerning). The top five health topic areas prioritized by the community were then used as the focus of health improvement efforts going forward. Additionally, secondary sources of data in the assessment process came from interviews with community leaders, elected officials and health care professionals, health focus groups with the community at large, and feedback from participants at the CHNA team's community input session. Healthy People 2020 is consistently recognized as a national benchmark for healthcare goals and standards.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Statements to patients from the Hospital outline our charity care policy and our charity care policy is posted on our website. If patients indicate they are not able to pay their bill, we will provide the patient with a charity care application. The Hospital shall send anyone who requests information on the Hospital's financial assistance program a letter outlining required information and a financial assistance application form. Requests for financial assistance may be proposed by sources other than the patient, such as the patient's physician, family members, social service organizations, community or religious groups, or Hospital personnel. Patients can also meet with a member or our financial counseling department to learn about their financial assistance options. Brochures are printed in English and Spanish telling patients to contact the financial counseling department. The Hospital wants its patients focus to be on health and recovery and not financial worry. There is absolutely no additional cost for our financial counseling assistance. Additionally, patients can meet with staff of the Medicaid program. The program staff will meet with patients individually to help them apply for publicly supported programs such as Medicaid, Medicare, and disability. Counselors meet with patients in the Hospital as well as making home visits as appropriate. The staff can also help identify resources to help pay for medication. All of this information is posted on our website with the appropriate contact information.

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

Schedule H, Part VI, Line 4 Community information
The primary service area for Roper St. Francis Healthcare and its four hospitals (collectively referred to as RSFH) consists of Charleston, Berkeley, and Dorchester counties. These counties include the major municipalities of Charleston, North Charleston, Mount Pleasant, and Summerville. The tri-county area that makes up the primary service area has a population of approximately 750,000 residents and is expected to grow based on the results of the most recently completed Community Health Needs Assessment (CHNA). These residents are 47% Male and 53% Female with a majority between the ages of 18 and 64. The average annual household income of the tri-county area is between $50,000 - $75,000 with the average level of education being an Associates degree. The race/ethnicity of these residents is approximately 66% White (non-Hispanic), 27% African American, and 6% Hispanic/Latinx. Based on the respondents from the CHNA the average amount of individuals with no health insurance is between 6.8% in Dorchester County, 7.5% in Berkeley County, and 10.6% in Charleston County. Accordingly to national health rankings, South Carolina struggles with high rates of premature death, obesity, violent crime, poverty, and diabetes. However, County Health Rankings and Roadmaps ranks the Tri-County region high in overall health compared to the other 43 counties in South Carolina. Additional detail regarding the community served by RSFH can be found in the CHNA at the following link: https://www.rsfh.com/mission-department/

Schedule H, Part VI, Line 5 Promotion of community health
In keeping with our mission of healing all people with compassion, faith, and excellence, Roper St. Francis Healthcare strives to enrich the health of our community. We do this by offering charity care to those in need, reaching out to our neighbors with health fairs and educational materials, sponsoring organizations and events that promote wellness and community well-being, and marshaling our resources to advance the health and dignity of each person with whom we come in contact. We are the Low Country's only non-governmental, not for profit healthcare system. With this distinction, we believe it is our responsibility to advocate for and respond to our neighbors needs through community benefit. Surplus funds are returned to our community through the development of new facilities to serve population growth, the expansion of existing facilities, subsidizing care for those who are unable to pay, sponsorship of healthcare related activities including outreach clinics and programs for the uninsured, and investing in technology to improve the quality of patient care. The Organization is committed to the enrichment of healthcare in our community as evidenced by the composition of our Board of Directors and Open Medical Staff. Our governing body is comprised of a 13-member Board of Directors. At least nine directors must have their primary residence in a community served by the System. Five directors must be physicians actively engaged in the full time practice of medicine. The hospital extends medical staff privileges to all qualified physicians in the area for most of our departments.

Schedule H, Part VI, Line 6 Affiliated health care system
Roper St. Francis Healthcare (RSFH) is a charitable health care delivery system based in Charleston, South Carolina. The 657-bed health system provides services at 90 facilities and doctors' offices conveniently located throughout our region. On January 2, 2020, Bon Secours Mercy Health, Inc. (BSMH), through its affiliate HealthSpan Partners, completed an agreement with the Medical Society of South Carolina to restructure the RSFH joint venture. The restructuring increased BSMH's ownership interest in the joint venture from a noncontrolling 27% to a controlling 51%. Following the restructuring, RSFH is a member of Bon Secours Mercy Health, Inc., a Maryland nonprofit, nonstock membership corporation (BSMH), and all of the other entities that are controlled directly or indirectly by BSMH are described collectively as the System. The System was organized in June 1983 to fulfill the healthcare mission of the United States Province of the Congregation of the Sisters of Bon Secours of Paris, a congregation of religious women of the Roman Catholic Church founded in France in 1824. The System's activities are in the states of Ohio, New York, Pennsylvania, Maryland, Virginia, Kentucky, South Carolina, and Florida, each referred to as a local system. The Ministry of BSMH aids those in need, particularly those who are sick and dying, by offering services that include but are not limited to acute inpatient, outpatient, pastoral, palliative, home health, nursing home, rehabilitative, primary and secondary care and assisted living without regard to race, religion, color, gender, age, marital status, national origin, sexual orientation, or disability. BSMH's vision to partner with communities to create a more humane world, build social justice for all and provide exceptional value for those served is implemented through its Strategic Quality Plan which provides focus in four goal areas for the current three year period (2019-2021). - Co-Create Healthy Communities: We recognize that the factors which drive health outcomes extend well beyond the scope of traditional health care services. Thus, we commit to improve the health of communities through partnership and collaboration with a broad range of constituencies including committed community residents - Be Person Centric: We recognize that those whom we serve are increasingly engaged in their own care and are seeking convenience, affordability and reliability. Thus, we commit to anticipate and respond to the changing expectations of health care consumers, and to ensure that we engage each person in an individualized plan for health with a focus on prevention and wellness. - Serve Those Who Are Vulnerable: We recognize, that the struggle for a more humane world is not an option, but an integral part of spreading the gospel. Thus, we commit to serve those who are vulnerable in many ways, addressing health disparities, sustaining global ministries, healing the environment and working to end violence and oppression. - Strengthen Our Culture and Capabilities: We recognize that the health care delivery system is undergoing rapid change with increasing complexity. Thus, we commit to liberate the potential of our people by strengthening individual and collective capabilities with respect to ministry leadership, knowledge, analytics, innovation and finances. Please see Schedule R for listings of the related organizations. Each of the reported entities play a role in achieving the vision of BSMH and the SQP (Strategic Quality Plan). System-wide community benefit for 2021 per the audit footnote is as follows: Total 2021 Community Benefit: $605.3 Million Benefits to the Broader Community: $138.9 million Unreimbursed Care for Those Who Are Poor and Qualify for Medicaid: $371.6 million Cost of Care for Those Who Could Not Afford to Pay: $94.8 million Community Benefit as Percent of Total Expense: 5.7 percent.