2024-06-21T14:07:42-05:00 2023-06-30 PwC US Tax LLP 2001 MARKET ST SUITE 1800 PHILADELPHIA PA 19103 990 2022-07-01 510103684 CHRISTIANA CARE HEALTH SERVICES INC % SR VP'S OFFICE CHRI 3024282426 4000 NEXUS DRIVE NW3-100 WILMINGTON DE 19803 ROBERT MCMURRAY CFO 3026237202 2024-06-21 true ROBERT MCMURRAY 999009999 ANTONIO C RUSSO P00858539 2673303000 2024-06-21 2 2022 2023-04-26 12:10:37Z X JANICE NEVIN MD 4000 NEXUS DRIVE WILMINGTON DE 19803 3169010325 false X WWW.CHRISTIANACARE.ORG X 1965 DE OUR MISSION AS AN ORGANIZATION IS TO SERVE OUR NEIGHBORS AS EXPERT, CARING PARTNERS IN THEIR HEALTH. 14 11 12272 569 1680328 0 43095263 53965055 2339408720 2567645527 205839630 60054269 16410989 16332229 2604754602 2697997080 0 516250 0 0 1432780622 1555860667 0 0 0 986479046 1031979043 2419259668 2588355960 185494934 109641120 4231902873 4483979485 1096190099 1106827681 3135712774 3377151804 X WE SERVE OUR NEIGHBORS AS EXPERT, CARING PARTNERS IN THEIR HEALTH. WE DO THIS BY CREATING INNOVATIVE, EFFECTIVE, AFFORDABLE AND EQUITABLE SYSTEMS OF CARE THAT OUR NEIGHBORS VALUE. false false 2210804304 516250 2578197043 AS PART OF ITS MISSION OF SERVICE, THE HOSPITALS AND MEDICAL STAFF OF CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS") OFFER A FULL RANGE OF HEALTH SERVICES TO ADDRESS THE NEEDS OF ITS LOCAL COMMUNITIES. THIS INCLUDES THE PROVISION OF COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF THE STATE OF DELAWARE, NORTHERN MARYLAND, SOUTHEASTERN PENNSYLVANIA AND SOUTHERN NEW JERSEY, WITHOUT REGARD TO THE PATIENTS' RACE, GENDER, ETHNICITY, AGE, DISABILITY, RELIGION, OR ABILITY TO PAY. DURING FISCAL 2023, THE HOSPITALS OF CCHS RECORDED 402,555 PATIENT DAYS, 56,359 ADMISSIONS, 192,088 EMERGENCY DEPARTMENT VISITS, AND THE BIRTHS OF 6,325 BABIES. ADDITIONALLY, CCHS'S MEDICAL GROUP ENGAGED WITH PATIENTS DURING A TOTAL OF 292,658 PRIMARY CARE VISITS. DURING THE FISCAL YEAR, CCHS PROVIDED $52,130,184 OF UNCOMPENSATED AND UNREIMBURSED CARE, AND ENGAGED IN A VARIETY OF OTHER ACTIVITIES TO SUPPORT AND ASSIST THE LOCAL COMMUNITIES THAT ARE MORE FULLY DISCUSSED IN SCHEDULE H. 2210804304 true true false true false false false false false true true true false true true false false true false false true false false false false false true true true false true true false false false false false false false false false false true false false false true true true true false false true 352 0 true 12272 true true true false false false false false false false false false true false X 14 11 false false false false true true true true true false false true true true true true true true true true false PA X SR VP'S OFFICE 3024282441 4000 NEXUS DRIVE AVENUE NORTH WILMINGTON DE 19803 X JANICE E NEVIN MD PRESIDENT & CEO 43.0 2.0 X X 2944902 0 9778 KENNETH SILVERSTEIN MD CHIEF PHYS. EXEC- THRU 1/23 44.0 1.0 X 1177731 0 17648 RAY A BLACKWELL MD CHIEF OF CARDIAC SURGERY 45.0 0.0 X 1057088 0 20501 RANDALL GABORIAULT CHIEF DIGITAL & INFO. OFFICER 45.0 0.0 X 983750 0 90042 SHARON KURFUERST COO- THRU 1/23 0.0 0.0 X 967304 0 84880 KIRK N GARRATT MD MED. DIR. CTR FOR H/V HEALTH 45.0 0.0 X 967643 0 7085 NEIL JASANI MD CHIEF PEOPLE OFFICER 45.0 0.0 X 939001 0 20501 ROBERT MCMURRAY CFO, TREAS. & ASS'T SECRETARY 36.0 9.0 X 857940 0 86827 VINAY K GHEYI CHAIR DEPARTMENT RADIOLOGY 45.0 0.0 X 922721 0 13663 NICHOLAS J PETRELLI MD MED. DIR, CCHS CANCER PROGRAM 45.0 0.0 X 901292 0 12272 PAUL K DAVIS MD PHYSICIAN - CARDIAC SURGEON 45.0 0.0 X 873870 0 20501 RICHARD CUMING CHIEF OPERATING OFFICER 44.0 1.0 X 799573 0 68418 JENNIFER L SCHWARTZ ESQ CORPORATE SECRETARY 35.0 10.0 X 745416 0 78435 LISA MAXWELL MD PRESIDENT, CC MEDICAL GROUP 45.0 0.0 X 703655 0 71570 FREDERIC T HARAD MD DIRECTOR 45.0 0.0 X 761349 0 12272 BETTINA TWEARDY-RIVEROS CHIEF PUBLIC AFFAIRS OFFICER 45.0 0.0 X 653726 0 62382 VINAY MAHESHWARI MD DIRECTOR- AS OF 1/1/23 45.0 0.0 X 607271 0 91 DAVID B STRATTON ESQ CHAIR 44.0 1.0 X X 0 0 0 LOSSIE FREEMAN DIRECTOR 1.0 1.0 X 0 0 0 KATHY JANVIER DIRECTOR- AS OF 1/1/23 1.0 1.0 X 0 0 0 ERIC T JOHNSON MD DIRECTOR- THRU 12/31/22 1.0 0.0 X 0 0 0 LOLITA A LOPEZ VICE CHAIR 1.0 0.0 X X 0 0 0 TOM MOORE DIRECTOR 1.0 0.0 X 0 0 0 JULIE TOPKIS NASON DIRECTOR 1.0 0.0 X 0 0 0 BARRY NIZIOLEK DIRECTOR 1.0 0.0 X 0 0 0 PAWAN RASTOGI MD DIRECTOR 1.0 0.0 X 0 0 0 SALVATORE CHIP ROSSIE DIRECTOR 1.0 0.0 X 0 0 0 CHRISTINE SAUERS DIRECTOR 1.0 0.0 X 0 0 0 DWIGHT D THOMEY ESQ DIRECTOR 1.0 3.0 X 0 0 0 16864232 0 676866 3325 false true false GENERAL HEALTHCARE RESOURCES 2250 HICKORY ROAD SUITE 240 PLYMOUTH MEETING PA 19462 TEMPORARY STAFFING 94190860 CERNER CORPORATION PO BOX 959156 ST LOUIS MO 631959156 IT SERVICES 27015449 CONSTRUCTION SERVICES GROUP LLC 1630 WEST CHESTER PIKE WEST CHESTER PA 19382 CONSTRUCTION SRVCS 22524820 DELOITTE CONSULTING LLP PO BOX 844717 DALLAS TX 75284 CONSULTING SERVICES 8285423 MILESTONE CONSULTING COMPANY INC 4 MILL PARK COURT NEWARK DE 19713 CONSULTING SERVICES 7166396 334 8554 2702461 48131330 3122710 171862 53965055 NET PROGRAM SERVICE REVENUES 622110 2505720793 2505720793 0 0 OTHER REVENUES 900099 61924734 56535877 1680328 3708529 2567645527 50847682 50847682 0 0 4155639 0 4155639 0 4155639 4155639 474049765 6170067 471013245 3036520 6170067 9206587 9206587 0 0 0 0 0 0 0 0 0 MAINTENANCE FEES 531390 1625074 0 0 1625074 AFFILIATE REVENUES 900099 10551516 10551516 0 0 12176590 2697997080 2572808186 1680328 69543511 X 516250 516250 0 0 0 13854988 11802284 2052704 0 0 1207600869 1028687167 178913702 0 72859901 62065246 10794655 0 177399734 151116842 26282892 0 84145175 71678535 12466640 0 17464911 13278657 4186254 0 1679939 1277266 402673 0 567461 431443 136018 0 325798 251034 74764 0 5889729 0 5889729 0 69367073 52740125 16626948 0 5410127 4113346 1296781 0 7817528 5943705 1873823 0 72005540 54746164 17259376 0 45612 34679 10933 0 41493376 31547617 9945759 0 2412007 1833861 578146 0 0 4877538 3708416 1169122 0 5815440 4788426 1027014 0 0 116787364 85036341 31751023 0 24877551 18914524 5963027 0 MEDICAL SUPPLIES 451872980 451872980 0 0 OTHER SUPPLIES AND SERVICES 203269069 154419396 48849673 0 2588355960 2210804304 377551656 0 X 141444726 181844123 191567741 87857829 0 0 370268568 421401431 0 0 0 0 0 0 46112024 49504179 28837684 27951704 2796158166 1728880425 1047844303 1067277741 1522391684 1672961947 419786225 491444744 0 0 1015805 1015805 462634113 482719982 4231902873 4483979485 432548032 446857675 0 0 0 0 305985527 298936087 0 0 0 0 0 0 0 0 357656540 361033919 1096190099 1106827681 X 3078587122 3317366405 57125652 59785399 3135712774 3377151804 4231902873 4483979485 X 109641120 175474040 -43676130 X false true X true true true X 24577838 80735115 128076121 43095263 53965055 330449392 0 0 24577838 80735115 128076121 43095263 53965055 330449392 0 330449392 40934424 38348773 34285085 42693278 55003321 211264881 0 1481357 1515817 1583245 1524457 1625074 7729950 549444223 10986419663 0.60142 0.60381 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 325798 325798 325798 325798 2588030162 2644027194 2588355960 2644352992 1000000 1000000 250000 250000 1000000 1000000 1000000 1000000 4000000 6000000 230460 249926 249595 325798 1055779 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 58310687 732143 3560384 3375036 59228178 68569307 669502 -6744573 4183549 58310687 62232483 993569 9205113 3861858 68569307 67336850 1520182 2545562 9170111 62232483 69132135 518673 1845561 9170111 4159519 58166739 0.38110 0.42660 0.19230 true false 32739798 32739798 1775133156 966643543 808489613 36581801 11990592 24591209 911562797 720091126 191471671 40140614 30155164 9985450 1067277741 OTHER SECURITIES 491444744 F 491444744 CONSTRUCTION IN PROGRESS 49128727 DUE FROM AFFILIATES 131257960 OTHER ASSETS 173871029 OTHER RECEIVABLES 31776098 SUBSIDIARY INVESTMENT 96686168 482719982 0 PENSION & POST RETIREMENT BENEFIT 144094577 INSURANCE LIABILITIES 13831844 OTHER LIABILITIES 203107498 361033919 FORM 990, SCHEDULE D, PART V, LINE 3A & 4 DETAIL OF ENDOWMENT FUNDS THE ORGANIZATION'S BOARD DESIGNATED ENDOWMENTS ARE INTENDED TO COVER ANNUAL INCREMENTAL OPERATING EXPENSES OF THE HEALTH SERVICES' TRANSITIONAL CANCER RESEARCH, VALUE INSTITUTE, AND INFANT MORTALITY. THE ORGANIZATION'S PERMANENT ENDOWMENT CONSISTS OF APPROXIMATELY TWENTY SIX DONOR RESTRICTED ENDOWMENT FUNDS USED FOR A VARIETY OF PURPOSES, INCLUDING SALARY AND PROGRAM SUPPORT. THE ORGANIZATION'S PURPOSE AND TIME RESTRICTED NET ASSETS ARE RESTRICTED FOR INDIGENT CARE, BUILDING AND MAINTENANCE, AND PROGRAM SUPPORT. -------------------- Central America and the Caribbean Investments 152526933 152526933 152526933 true false true false false false FORM 990, SCHEDULE F, PART I, LINE 2 DETAIL OF SUB-CONTRACTS IN FURTHERANCE OF ITS RESEARCH ACTIVITIES, THE ORGANIZATION MAY MAKE SUB-CONTRACTS TO FOREIGN INSTITUTIONS THAT PERFORM RESEARCH IN CONNECTION WITH RESEARCH GRANTS AWARDED TO THE ORGANIZATION. THE ORGANIZATION DOES NOT CATEGORIZE ANY SUCH SUB-CONTRACTS AS GRANTS FOR FORM 990, SCHEDULE F, PARTS II AND III PURPOSES. true true X true X 400. false false false false 26 15959789 0 15959789 0.00620 369199405 345431411 23767994 0.00920 26 385159194 345431411 39727783 0.01540 42 31259 9798101 69808 9728293 0.00380 4 6 88619385 14687410 73931975 0.02860 1 30892 7459254 4048903 3410351 0.00130 1 21380857 18927053 2453804 0.00090 14 1111 289911 0 289911 0.00010 62 63268 127547508 37733174 89814334 0.03470 62 63294 512706702 383164585 129542117 0.05010 2 109634 0 109634 1 152130 0 152130 0.00010 1 1315 0 1315 1 7065 0 7065 1 833 0 833 1 223800 0 223800 0.00010 7 494777 0 494777 0.00020 true 63038043 762517 526982585 613284601 -86302016 X true true 2 1 CHRISTIANA HOSPITAL 4755 OGLETOWN-STANTON ROAD NEWARK DE 19718 www.christianacare.org LICENSE #HSPTL-002 X X X X X A 2 WILMINGTON HOSPITAL 501 WEST 14TH STREET WILMINGTON DE 19801 www.christianacare.org LICENSE #HSPTL-001 X X X X X A A-CHRISTIANA AND WILMINGTON HOSPITALS 12 false false true X X X X X X X X X 21 true true true true X SEE PART V, SECTION C X true 22 true SEE PART V, SECTION C false true X 400. 0. X X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X X true X false false PART V, SECTION B, LINE 5 (INPUT FROM COMMUNITY) AS DEMONSTRATED BY OUR MISSION: WE SERVE OUR NEIGHBORS AS RESPECTFUL, EXPERT, CARING PARTNERS IN THEIR HEALTH. WE DO THIS BY CREATING INNOVATIVE, EFFECTIVE, AFFORDABLE, AND EQUITABLE SYSTEMS OF CARE THAT OUR NEIGHBORS VALUE. CHRISTIANACARE IS GUIDED BY ITS COMMITMENT TO PARTNERING WITH THOSE WE SERVE AND PROVIDING THEM WITH WHAT THEY VALUE. BECAUSE OF THIS, WE WELCOME THE TASK OF UNDERTAKING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THAT RELIES UPON COMMUNITY INPUT AS ANOTHER OPPORTUNITY TO LEARN FROM OUR NEIGHBORS. IN 2022, CHRISTIANACARE ISSUED CRISIS STANDARDS OF CARE FOR THE FIRST TIME IN ITS HISTORY AS COVID-19 CASES WERE REACHING NEW PEAKS IN OUR STATE. DUE TO THIS ENVIRONMENT, WE DECIDED TO GATHER INPUT THROUGH VIRTUAL COMMUNITY MEETINGS. IN-PERSON MEETINGS HELD AT ACCESSIBLE COMMUNITY LOCATIONS IS OUR PREFERENCE AS THIS ENABLED THE PARTICIPATION OF NEARLY 100 COMMUNITY MEMBERS IN OUR PRIOR CHNA, BUT WE HAD TO PRIORITIZE SAFETY. 35 INDIVIDUALS WHO REPRESENTED ORGANIZATIONS INCLUDING DELAWARE HEALTH AND SOCIAL SERVICES, NON-PROFIT ORGANIZATIONS, LOCAL BUSINESSES, HEALTHCARE PROVIDERS, SCHOOL SYSTEMS, AND LOCAL POLICYMAKERS PARTICIPATED IN FOUR VIRTUAL COMMUNITY STAKEHOLDER MEETINGS. ALL COMMUNITY MEETINGS FOLLOWED THE SAME FORMAT. SECONDARY DATA WERE PRESENTED INCLUDING A SUMMARY OF UNFAVORABLE COMMUNITY HEALTH INDICATORS. PARTICIPANTS WERE ASKED TO PROVIDE FEEDBACK ON THE SECONDARY DATA ANALYSIS AND IDENTIFY COMMUNITY HEALTH ISSUES THAT WERE MISSING FROM THE DATA. TO CONCLUDE, ALL PARTICIPANTS WERE ASKED TO COMPLETE AN ONLINE SURVEY AND TO IDENTIFY THREE TO FIVE COMMUNITY HEALTH ISSUES THEY CONSIDERED TO BE MOST SIGNIFICANT. CHRISTIANACARE CAREGIVERS WHO PROVIDE REPRODUCTIVE HEALTH EDUCATION TO ADOLESCENTS IN SCHOOLS ALSO PROVIDED THE SECONDARY DATA PRESENTATION TO 110 STUDENTS AT WILLIAM PENN HIGH SCHOOL IN NEW CASTLE DURING THEIR HEALTH CLASSES. YOUNG PEOPLE ARE A SIGNIFICANT PART OF OUR COMMUNITY AND SO WE BELIEVE IT IS IMPORTANT TO HEAR FROM THEM TOO. IN ADDITION TO THE COMMUNITY MEETINGS, WE ALSO CONDUCTED INTERVIEWS WITH THE CABINET SECRETARY AND DEPUTY SECRETARY FOR DELAWARE HEALTH AND SOCIAL SERVICES AND THE DIRECTOR FOR THE DELAWARE DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH TO GAIN THEIR PERSPECTIVES ON THE HEALTH OF OUR COMMUNITIES. FINALLY, 45 CHRISTIANACARE CAREGIVERS FROM DIVERSE DEPARTMENTS PARTICIPATED IN TWO ADDITIONAL VIRTUAL MEETINGS SO THAT WE COULD GAIN THEIR PERSPECTIVE BASED ON THEIR EXPERIENCES SERVING OUR COMMUNITY. CHRISTIANACARE CONTRACTED WITH VERIT HEALTHCARE CONSULTING, LLC (VERIT) TO COMPLETE ITS 2022 CHNA. IN COOPERATION WITH CHRISTIANACARE'S OFFICE OF HEALTH EQUITY, VERIT CONDUCTED THE RESEARCH, PRIMARY AND SECONDARY DATA COLLECTION, REVIEW, AND ANALYSIS, TO DEVELOP THE CHNA. -------------------- PART V, SECTION B, LINE 6 (JOINT CHNA) CHRISTIANACARE'S TWO HOSPITAL FACILITIES IN DELAWARE, CHRISTIANA HOSPITAL AND WILMINGTON HOSPITAL, JOINTLY CONDUCTED THEIR CHNA. -------------------- PART V, SECTION B, LINE 7 (CHNA PUBLIC AVAILABILITY) CHRISTIANACARE'S CHNA IS AVAILABLE ON ITS WEBSITE AT: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY-HEALT H-NEEDS-ASSESSMENT/ A PAPER COPY OF THE CHNA IS ALSO AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST. -------------------- PART V, SECTION B, LINE 10 (IMP. PLAN PUBLIC AVAILABILITY) CHRISTIANACARE'S CHIP IS AVAILABLE ON ITS WEBSITE AT: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY-HEALT H-IMPLEMENTATION-PLAN/ A PAPER COPY OF THE CHIP IS ALSO AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST. -------------------- PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) CHRISTIANACARE IDENTIFIED THE FOLLOWING AS THE COMMUNITY'S MOST SIGNIFICANT NEEDS: . ACCESS TO HEALTH SERVICES . CHRONIC HEALTH CONDITIONS . MATERNAL AND CHILD HEALTH . MENTAL HEALTH AND SUBSTANCE USE DISORDERS . SOCIAL DETERMINANTS OF HEALTH . VIOLENT CRIME CHRISTIANACARE WILL ADDRESS ALL OF THESE SIGNIFICANT AREAS OF NEED. EXCEPT FOR THE NEWLY ADDED CHRONIC CONDITIONS AREA OF NEED, THESE NEEDS WERE ALSO PRIORITIZED IN 2019. WE WILL CONTINUE TO ADDRESS THESE NEEDS THROUGH PROGRAMMING WE HAVE CREATED, ADAPTED, AND EXPANDED SINCE OUR 2019 CHNA. TO COMPLETE THIS CHNA, WE WERE FORTUNATE TO LEARN FROM MANY HIGH SCHOOL STUDENTS ABOUT WHAT THEY CONSIDERED TO BE SIGNIFICANT AREAS OF NEED. THE SIGNIFICANT AREAS OF NEED THE STUDENTS IDENTIFIED MIRRORED THE SELECTIONS OF THE ADULTS WHO PARTICIPATED, BUT WITH TWO ADDITIONAL SIGNIFICANT AREAS OF NEED IDENTIFIED BY MANY OF THE STUDENTS: SEXUALLY TRANSMITTED INFECTIONS AND SMOKING, TOBACCO, AND VAPE PRODUCT USE. CHRISTIANACARE ADDRESSES BOTH THESE AREAS IN ITS SCHOOL-BASED HEALTH CENTERS AND ITS ALLIANCE FOR ADOLESCENT PREGNANCY PREVENTION (AAPP) PROGRAMMING. SINCE 1995 CHRISTIANACARE HAS BEEN THE RECIPIENT OF A STATE GRANT TO OPERATE AAPP WHICH PROVIDES EDUCATION TO STUDENTS THROUGHOUT DELAWARE TO REDUCE THE NUMBER OF TEENS WHO ARE SEXUALLY ACTIVE, CONTRACT AND SPREAD SEXUALLY TRANSMITTED INFECTIONS, BECOME PREGNANT AND BECOME TEEN PARENTS. CHRISTIANACARE WILL NOT PRIORITIZE THE TEEN-IDENTIFIED SIGNIFICANT AREAS OF NEED, BUT WE WILL CONTINUE TO ADDRESS THEM THROUGH DIRECT INTERACTION WITH STUDENTS IN THE SCHOOL-BASED HEALTH CENTERS AND THROUGH AAPP PROGRAMMING. ACCESS TO HEALTH SERVICES CHRISTIANACARE IS COMMITTED TO RADICALLY SIMPLIFYING ACCESS, THROUGH BOTH DIGITAL AND IN-PERSON MEANS. IN FY23, SUCCESSFUL EFFORTS WERE UNDERTAKEN TO PROVIDE PATIENTS WITH MEANINGFUL ACCESS TO THEIR CARE TEAM OUTSIDE OF A VISIT, THE ABILITY TO SCHEDULE THEIR APPOINTMENTS ONLINE IN MORE PRACTICES AND SPECIALTIES, AND THE OPPORTUNITY TO COMPLETE A PAPERLESS INTAKE PROCESS. THE TURNAROUND TIME FOR RESOLVING A CLINICAL CONSULT FOR A PATIENT REFERRAL ALSO IMPROVED DURING FY23. BY CONSULTING WITH THE PATIENT QUICKLY AFTER A REFERRAL AND UNDERSTANDING THEIR NEEDS, THIS PROCESS ENSURES PATIENTS GET THE RIGHT CARE, AVOIDING UNNECESSARY APPOINTMENTS. THESE ACTIVITIES DEMONSTRATE OUR COMMITMENT TO ENSURING BOTH CURRENT PATIENTS AND NEW PATIENTS HAVE INCREASED ACCESS TO THE CARE THEY NEED. WE ARE ALSO UTILIZING COMMUNITY PARTNERSHIPS AND INNOVATIVE PROGRAMS TO PROVIDE ACCESS TO CARE WITHIN OUR COMMUNITY. IN JUNE 2022, CHRISTIANACARE INTRODUCED ITS TWO MOBILE HEALTH SERVICES VANS IN A RIBBON CUTTING CEREMONY IN WILMINGTON'S SOUTHBRIDGE NEIGHBORHOOD. THESE VANS ARE SUPPORTED BY A $1 MILLION INVESTMENT FROM BARCLAYS AS PART OF ITS COVID-19 COMMUNITY AID PACKAGE. MOBILE HEALTH SERVICES ALLOW US TO BRING CARE TO OUR NEIGHBORS WHO MAY HAVE DIFFICULTY ACCESSING CARE OTHERWISE. AS WE REPORTED IN FY22, RECEIVING CARE ON THE VAN IS NOT A ONE-TIME EVENT, BUT THE START OF A PRIMARY AND SPECIALTY CARE RELATIONSHIP THAT WILL HELP EACH INDIVIDUAL IMPROVE THEIR HEALTH AND WELLNESS. IN SERVICE TO THAT EXPECTATION, TIME WAS SPENT IN FY23 DETERMINING HOW BEST TO UTILIZE THE VAN SERVING OUR COMMUNITY WITHIN NEW CASTLE COUNTY. CHRISTIANACARE'S COMPLEX CARE AND COMMUNITY MEDICINE DEPARTMENT WORKED WITH CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT TO IDENTIFY THE AREAS IN THE COMMUNITY WHERE MOBILE HEALTH SERVICES WERE NEEDED AND THE COMMUNITY ORGANIZATIONS THAT COULD BE PARTNERED WITH TO HOST AND PROMOTE THE VANS TO BEST SERVE THE COMMUNITY. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) BEGINNING IN 2023, A VAN IS PARKED ACROSS FROM THE WILMINGTON HOSPITAL EMERGENCY DEPARTMENT EVERY MONDAY MORNING. ON AN ALTERNATING SCHEDULE ON WEDNESDAYS, THE VAN IS STATIONED AT EZION FAIR BAPTIST CHURCH IN THE MORNING AND KINGSWOOD COMMUNITY CENTER IN THE AFTERNOON, AND THE EMPOWERMENT CENTER ON THE FOLLOWING WEDNESDAY MORNING AND THE ROSE HILL COMMUNITY CENTER IN THE AFTERNOON. IN FY23, THERE WERE 180 MOBILE VAN VISITS. THESE LOCATIONS ARE ALL WITHIN AREAS CHRISTIANACARE HIGHLIGHTED IN OUR CHNA AS HAVING CONSIDERABLE CHALLENGES IN COMPARISON TO THE REST OF OUR SERVICE AREA OF NEW CASTLE COUNTY. BRINGING CARE TO THESE COMMUNITIES IS A WAY IN WHICH WE CAN ADDRESS SOME OF THAT NEED. THE VANS SERVE CHRISTIANACARE PATIENTS WHO NEED SAME DAY CARE AND SERVE PATIENTS WHO DON'T HAVE A DOCTOR. THE VANS PROVIDE FULL-SERVICE MEDICINE INCLUDING ADULT CARE, WOMEN'S HEALTH, PEDIATRICS, VACCINES, AND MORE. IN THE SOUTHERN PORTION OF OUR STATE, OUR SECOND VAN IS LOCATED ONCE A MONTH AT THE FOLLOWING LOCATIONS: THE DELAWARE MARKET STREET PARK IN LAUREL, THE MODERN MATURITY CENTER IN DOVER, AND THE FRIENDSHIP HOUSE OF KENT COUNTY IN DOVER. OUR MOBILE PRESENCE AT THESE LOCATIONS PROVIDES ACCESS TO HEALTH SERVICES FOR COMMUNITIES THAT OTHERWISE MAY NOT BE ABLE TO ACCESS SUCH SERVICES. ANOTHER SIGNIFICANT POINT OF ACCESS FOR HEALTH CARE SERVICES CHRISTIANACARE PROVIDES TO OUR COMMUNITY IS THROUGH OUR SCHOOL-BASED HEALTH CENTERS (SBHCS). WE OPERATE 23 SCHOOL-BASED HEALTH CENTERS (SBHC) THROUGHOUT NEW CASTLE COUNTY IN ELEMENTARY, MIDDLE, AND HIGH SCHOOLS. SBHCS OFFER CONVENIENT ACCESS TO HEALTH CARE FOR STUDENTS AND PROVIDE THE OPPORTUNITY TO ADDRESS HEALTH ISSUES AT THE EARLIEST AND MOST PREVENTABLE STAGES. IN FY2023, OUR SBHCS HAD 30,892 STUDENT VISITS. FOR OVER A DECADE CHRISTIANACARE'S HEALTH GUIDES HAVE BEEN WORKING TO CONNECT PATIENTS TO HEALTH CARE SERVICES AND COMMUNITY RESOURCES AND ASSIST IN HEALTH INSURANCE ENROLLMENT AND PRESCRIPTION ASSISTANCE. LOCATED IN THE WILMINGTON HOSPITAL, IN FY2022, WE IDENTIFIED AN OPPORTUNITY TO EXPAND THE PROGRAM AND SERVE MORE PEOPLE BY HIRING TWO NEW BILINGUAL HEALTH GUIDES TO WORK ON-SITE AT TWO CHRISTIANACARE PRIMARY CARE PRACTICES. THIS EXPANSION ACHIEVED OUR GOAL OF SERVING MORE MEMBERS OF OUR COMMUNITY. IN FY23, 2,089 INDIVIDUALS WERE SERVED BY THE HEALTH GUIDES IN 4,848 PATIENT ENCOUNTERS, REPRESENTING AN INCREASE OF 656 PATIENTS FROM FY22. MANY PATIENTS HAD MULTIPLE NEEDS THAT THE HEALTH GUIDES WERE ABLE TO HELP THE PATIENT ADDRESS. IN FY23, THE HEALTH GUIDES PLAYED A CRUCIAL ROLE IN SERVING OUR COMMUNITY BY MAKING PATIENTS AWARE OF THE MEDICAID REDETERMINATION PROCESS, PROVIDING THEM WITH INFORMATION ON THE PROCESS, AND PROVIDING GUIDANCE ON HOW TO MAINTAIN THEIR COVERAGE. THE HEALTH GUIDES ALSO ASSISTED PATIENTS IN APPLYING FOR A TOTAL OF $2,652,177.68 IN FINANCIAL ASSISTANCE. ANOTHER STRATEGY CHRISTIANACARE EMPLOYS TO HELP PATIENTS OVERCOME BARRIERS TO GOOD HEALTH IS THE COMMUNITY HEALTH WORKER (CHW) PROGRAM. CHWS PROVIDE EMOTIONAL AND INSTRUMENTAL SUPPORT TO HELP PATIENTS OVERCOME HARDSHIPS IN THEIR LIVES OR CHALLENGES IN COORDINATING COMPLEX MEDICAL CARE THAT CAN DETER ACCESS. CHWS ARE LOCATED ON-SITE IN PRACTICES AND MEET PATIENTS IN THEIR HOMES AND AT OTHER COMMUNITY SITES TO PROVIDE THE MOST IMPACTFUL SUPPORT. ALL CHWS RECEIVE TRAINING THROUGH PENN MEDICINE'S IMPACT (INDIVIDUALIZED MANAGEMENT FOR PATIENT CENTERED TARGET) EVIDENCE-BASED MODEL. THE CHWS WORK TO IMPROVE HEALTH OUTCOMES BY ADDRESSING SOCIAL NEEDS, HELPING PATIENTS TO IDENTIFY AND ACHIEVE PATIENT CENTERED GOALS, AND CONNECTING PATIENTS TO CARE. CHWS SERVE OUR PATIENTS IN WAYS THAT ARE MORE FULLY DISCUSSED BELOW, BUT THE CHWS ADDRESS EACH OF OUR PRIORITIZED AREAS OF NEED AND ALSO WILL BE INCLUDED THROUGHOUT OUR DESCRIPTIONS OF HOW WE ARE ADDRESSING THOSE NEEDS. IN ADDITION, CHRISTIANACARE'S CHWS ARE REGULAR ATTENDEES AT COMMUNITY EVENTS TO PROVIDE INFORMATION ABOUT OUR PROGRAMS, COMPLETE SOCIAL DETERMINANTS OF HEALTH SCREENING, AND PROVIDE REFERRALS TO RESOURCES IN THE COMMUNITY. IN FY23, THE PRIMARY CARE AND EMERGENCY DEPARTMENT CHWS PROVIDED FURTHER SERVICE TO OUR COMMUNITY BY HOSTING A BACKPACK DRIVE THAT PROVIDED 30 BACKPACKS TO INDIVIDUALS WITHOUT HOUSING TO STORE THEIR BELONGINGS AND VOLUNTEERED AT THE KNOLLWOOD COMMUNITY CENTER IN CLAYMONT TO HELP CLEAN THE NEIGHBORHOOD. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) BEHAVIORAL HEALTH CHWS LAUNCHED IN OCTOBER 2021, THE BEHAVIORAL HEALTH CHWS SUPPORT PATIENTS RECEIVING OUTPATIENT BEHAVIORAL HEALTH AND SUBSTANCE USE SERVICES IN EFFORTS TO ASSIST PATIENTS IN INCREASING INDEPENDENCE AND RESILIENCE. THERE ARE 4 BEHAVIORAL HEALTH CHWS SERVING PATIENTS OF CHRISTIANACARE'S OUTPATIENT BEHAVIORAL HEALTH PRACTICES. THEY PROVIDE SERVICE DELIVERY TO CHILDREN/ADOLESCENTS AND ADULTS WITH MENTAL HEALTH AND/OR SUBSTANCE USE DIAGNOSES FOR UP TO 6 MONTHS. IN FY23, 141 PATIENTS WERE SERVED WITH 75% OF THOSE GRADUATING FROM THE PROGRAM. ADDITIONALLY, 96% OF THESE PATIENTS WERE SCREENED FOR SOCIAL DETERMINANTS OF HEALTH AND OFF THOSE, 88% HAD A POSITIVE SCREENING. EMERGENCY DEPARTMENT CHWS THE EMERGENCY DEPARTMENT (ED) CHW PROGRAM LAUNCHED IN FEBRUARY OF 2021. THIS 3-MONTH PROGRAM UTILIZES AN EVIDENCE-BASED APPROACH TO IMPROVE HEALTH OUTCOMES, INCREASE HEALTH LITERACY, AND DIRECT HIGH ED UTILIZERS (2 OR MORE VISITS TO THE ED IN 90 DAYS) TO PRIMARY CARE AND LONG-TERM SUPPORT. THERE ARE 2 CHWS SERVING PATIENTS OF WILMINGTON HOSPITAL'S ED. IN FY23, THE ED CHWS FOCUSED EFFORTS TO IMPROVE PATIENTS' TRANSITIONS TO CARE FROM THE ED TO CHRISTIANACARE'S CENTER FOR SPECIAL HEALTHCARE NEEDS (PARTICULARLY PATIENTS WITH SICKLE CELL DISEASE) AND PRIMARY CARE PRACTICES. THE ED CHW PROGRAM ALSO EXPANDED THE ELIGIBILITY CRITERIA TO ACCEPT PATIENTS WITH MEDICARE INSURANCE. IN FY23, THIS PROGRAM SERVED 70 PATIENTS WITH 56% OF THOSE GRADUATING. OF THE 81% OF PARTICIPATING PATIENTS WHO WERE SCREENED FOR SOCIAL DETERMINANTS OF HEALTH, 98% SCREENED POSITIVE. NEW CASTLE COUNTY HOPE CENTER CHWS IN MAY 2023, CHRISTIANACARE'S CHW SERVICES EXPANDED TO THE NEW CASTLE COUNTY HOPE CENTER TO SERVE CHRISTIANACARE PATIENTS THAT REQUIRE RESPITE BEDS. THERE IS ONE CHW SERVING THESE PATIENTS. THE CHW ASSISTS PATIENTS IN WORKING TOWARDS OPTIMAL HEALTH BY CLOSING CARE GAPS AND ADDRESSING THE SOCIAL DETERMINANTS OF HEALTH THAT IMPACT HEALTH AND WELL-BEING. DURING FY23, 20 PATIENTS WERE SERVED. MEDICAID ENGAGEMENT CHWS THE MEDICAID ENGAGEMENT TEAM CONSISTS OF FOUR CHWS THAT OUTREACH PATIENTS THAT HAVE BEEN NEWLY CONNECTED TO CHRISTIANACARE AND CONNECT THEM WITH PRIMARY CARE APPOINTMENTS. THESE CHWS EMPLOY MULTIPLE METHODS TO ATTEMPT TO ENGAGE PATIENTS, INCLUDING GOING TO THE PATIENTS' HOMES. IN FY23, 231 PATIENTS WERE SUCCESSFULLY ENGAGED. PRIMARY CARE CHWS THE PRIMARY CARE CHW PROGRAM WAS ONE OF THE FIRST CHW PROGRAMS CHRISTIANACARE DEPLOYED IN FY20. IT IS A 6-MONTH PROGRAM THAT UTILIZES AN EVIDENCE-BASED APPROACH TO IMPROVE HEALTH OUTCOMES, INCREASE HEALTH LITERACY, AND ENGAGE PATIENTS WITH DIABETES, HYPERTENSION, AND/OR HIGH EMERGENCY DEPARTMENT UTILIZATION IN PRIMARY CARE SERVICES. THE PRIMARY CARE CHW PROGRAM HAS 7 CHWS SERVING PATIENTS OF CHRISTIANACARE'S PRIMARY PRACTICES THROUGHOUT NEW CASTLE COUNTY AND KENT COUNTY TO DELIVER SERVICES TO ADULTS 18+ WITH MEDICAID, MEDICARE, AND NO INSURANCE. SERVICE DELIVERY OCCURS THROUGH THE SPAN OF 6-MONTHS. IN FY23, THE PRIMARY CARE CHW PROGRAM EXPANDED ITS ELIGIBILITY CRITERIA TO SERVE PATIENTS WITH MEDICARE INSURANCE. A PRIMARY CARE CHW ALSO BEGAN SERVING PATIENTS WITH SUBSTANCE USE DISORDERS AT CHRISTIANACARE'S FAMILY MEDICINE CENTER. THE PRIMARY CARE CHW PROGRAM ALSO IMPLEMENTED A SELF-MEASURED BLOOD PRESSURE READING (SMBP) PROGRAM FOR PATIENTS DIAGNOSED WITH HYPERTENSION. THE SMBP PROGRAM PROVIDES EDUCATION, TRAINING, AND RESOURCES ON BLOOD PRESSURE MONITORING AS WELL AS BLOOD PRESSURE CUFFS TO PATIENTS FOR AT-HOME MONITORING. IN FY23, THIS PROGRAM SERVED 298 PATIENTS WITH 69% OF THOSE GRADUATING. 95% OF THESE PATIENTS WERE SCREENED FOR SOCIAL DETERMINANTS OF HEALTH. OF THOSE, 77% SCREENED POSITIVE. SCHOOL BASED HEALTH CENTER CHWS IN ADDITION TO THE CLINICAL ACCESS PROVIDED AT SBHCS PREVIOUSLY DESCRIBED, CHRISTIANACARE HAS ALSO EMBEDDED EIGHT COMMUNITY HEALTH WORKERS (CHWS) WITHIN 21 OF CHRISTIANACARE'S SBHCS. JUST AS ALL THE OTHER CHWS DO, THESE CHWS ALSO WORK IN PARTNERSHIP WITH THE STUDENTS TO ADDRESS THEIR HEALTH AND SOCIAL NEEDS. THE SBHC CHWS SERVED 728 STUDENTS IN FY23 BY CONNECTING THEM AND THEIR FAMILIES TO NEEDED RESOURCES SUCH AS CLOTHING, FOOD, TRANSPORTATION, AND UTILITY ASSISTANCE. STUDENTS WERE ALSO CONNECTED TO PRIMARY CARE PRACTICES, DENTAL SERVICES, AND EYE CARE AND HELPED TO ENROLL THEM IN HEALTH INSURANCE. WOMEN'S HEALTH CHWS ONE OF THE INITIAL CHW PROGRAMS LAUNCHED IN FY20, THE WOMEN'S HEALTH CHW PROGRAM WAS DESIGNED TO TRANSFORM MATERNAL AND INFANT HEALTHCARE WITH A COMMITTED INVESTMENT TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH THAT NEGATIVELY IMPACT HEALTH AND WELL-BEING FOR MOTHERS AND THEIR FAMILIES. THE WOMEN'S HEALTH CHW PROGRAM HAS 5 CHWS SERVING PATIENTS OF CHRISTIANACARE'S WOMEN'S HEALTH SERVICES INCLUDING INPATIENT, OUTPATIENT, OB TRIAGE, AND THE NEONATAL INTENSIVE CARE UNIT (NICU). WOMEN'S HEALTH CHWS SERVE PATIENTS OF ALL AGES THROUGHOUT NEW CASTLE AND KENT COUNTY WITH MEDICAID OR THAT ARE UNINSURED WITH A CHRONIC DISEASE, MENTAL HEALTH AND/OR SUBSTANCE USE ISSUE(S), LATE/NO ENTRY TO PRENATAL CARE, HISTORY OF POOR BIRTH OUTCOMES, A BMI AT/ABOVE 30, AND/OR ARE AT-RISK FOR BIRTH DEFECTS. SERVICE DELIVERY CONSISTS OF EPISODIC AND LONGITUDINAL CARE DURING THE PERINATAL PERIOD. IN FY23, THE WOMEN'S HEALTH CHWS SERVED 140 PATIENTS WITH 84% OF THOSE GRADUATING. ADDITIONALLY, 73% OF PATIENTS WERE SCREENED FOR SOCIAL DETERMINANTS OF HEALTH AND OFF THOSE, 70% SCREENED POSITIVE. IN OCTOBER 2022, CHRISTIANACARE OPENED A 14 BED PEDIATRIC CARE CENTER ON THE NEWARK CAMPUS. THE CENTER PROVIDES 24/7 COMBINED SHORT-STAY INPATIENT AND EMERGENCY CARE FOR INFANTS TO 18-YEAR-OLDS. IN THE UNITED STATES, THERE IS ONLY 1 PEDIATRIC HOSPITAL FOR EVERY 20 ADULT HOSPITALS AND PEDIATRIC HOSPITALS SERVE ONLY 15-20% OF PEDIATRIC EMERGENCY PATIENTS. CHRISTIANACARE'S PEDIATRIC CARE CENTER PLAYS A PIVOTAL ROLE IN PROVIDING FAMILIES WITH AN OPTION TO RECEIVE PEDIATRIC-CENTERED CARE IN THEIR COMMUNITY. IN ITS FIRST YEAR OF OPERATION, THE PEDIATRIC CARE CENTER SERVED OVER 7,500 PATIENTS. FURTHER, THE FOCUS HAS BEEN ON CONTINUOUSLY WORKING TO IMPROVE PATIENTS' CARE WHICH HAS BEEN DEMONSTRATED BY THE LENGTH OF STAY FOR THE BEHAVIORAL HEALTH POPULATION GOING FROM 36% DISCHARGED WITHIN 48 HOURS IN FY22 TO 58% DISCHARGED WITHIN 48 HOURS IN FY23. FURTHERMORE, 95% OF ADMITTED PATIENTS WERE ALSO RETAINED WHICH MINIMIZED DIRECT AND INDIRECT COSTS FOR FAMILIES. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) DENTAL SERVICES ACCESSING DENTAL SERVICES IS ALSO CHALLENGING FOR MANY COMMUNITY MEMBERS AND CHRISTIANACARE HAS LONG WORKED TO ADDRESS THIS NEED FOR NOT ONLY OUR NEIGHBORS IN NEW CASTLE COUNTY, BUT FOR INDIVIDUALS THROUGHOUT THE STATE WHO CANNOT ACCESS AFFORDABLE DENTAL CARE. IN JANUARY 2021, CHRISTIANACARE COMPLETED A TWO-YEAR RENOVATION PROJECT THAT INCREASED THE CLINICAL CAPACITY OF OUR DENTISTRY AND ORAL-MAXILLOFACIAL SURGERY PRACTICES. IN FY23, THERE WERE 11,809 PATIENT VISITS TO OUR DENTAL CLINIC. FOR OVER 60 YEARS, OUR DENTAL CLINIC HAS PROVIDED COMPREHENSIVE CARE, INCLUDING ORAL SURGERY, FOR UNINSURED AND UNDERINSURED INDIVIDUALS. EVERY FRIDAY, THE DENTAL CLINIC SERVES UNINSURED PEDIATRIC PATIENTS. FEES AT THE CLINIC ARE KEPT AT A REDUCED LEVEL AND ONLY MEDICAID IS ACCEPTED. PATIENTS ARE SEEN AT THIS CLINIC BY DENTAL RESIDENTS AND VOLUNTEER AND EMPLOYED DOCTORS. THE RESIDENTS SERVING THE DENTAL CLINIC ALSO PROVIDE DENTAL SERVICE IN THE COMMUNITY THROUGH ROTATIONS AT AFFILIATED DENTAL CLINICS AT WESTSIDE FAMILY HEALTHCARE, A FEDERALLY QUALIFIED HEALTH CENTER, AND DELAWARE TECHNICAL COMMUNITY COLLEGE. NEW CASTLE COUNTY HOPE CENTER THE NEW CASTLE COUNTY HOPE CENTER, WHICH IS LOCATED IN A FORMER HOTEL PURCHASED BY NEW CASTLE COUNTY IN 2020, PROVIDES EMERGENCY SHELTER FOR FAMILIES AND INDIVIDUALS EXPERIENCING HOMELESSNESS. THE HOPE CENTER PROVIDES SHELTER, RESOURCES, AND SUPPORT FOR ITS RESIDENTS WITH THE GOAL OF TRANSITIONING THEM INTO PERMANENT HOUSING. CHRISTIANACARE HAS PARTNERED WITH NEW CASTLE COUNTY TO SHARE EXPERTISE ON HEALTH AND PROVIDE SERVICES AT THE HOPE CENTER. SINCE 2021, CHRISTIANACARE HAS OPERATED AN ON-SITE PRIMARY CARE OFFICE THAT SERVES PATIENTS RESIDING IN THE HOPE CENTER. SERVICES INCLUDE ACUTE ILLNESS MANAGEMENT, CHRONIC DISEASE MANAGEMENT, PRENATAL CARE, PEDIATRIC AND NEWBORN CARE, AND CONTRACEPTIVE MANAGEMENT. IN ADDITION TO THE PRIMARY CARE PRACTICE, IN JANUARY 2023, CHRISTIANACARE ALSO ESTABLISHED A MEDICAL RESPITE PROGRAM ENCOMPASSING 36 ROOMS AT THE HOPE CENTER FOR PATIENTS WHOSE COMPLEX ILLNESSES MAKE THEM INELIGIBLE FOR RESIDING AT A STANDARD HOUSING SHELTER. THESE PATIENTS ARE REFERRED THROUGH CHRISTIANACARE DEPARTMENTS/PROGRAMS AND COMMUNITY PARTNERS. THIS PROGRAM ALLOWS PATIENTS WITHOUT STABLE HOUSING TO RECEIVE CARE IN THE COMMUNITY INSTEAD OF REMAINING UNNECESSARILY IN THE HOSPITAL DUE TO THE LACK OF COMMUNITY OPTIONS FOR THEM. TO DATE, 72 PATIENTS HAVE BEEN ABLE TO RECEIVE RESPITE CARE IN THE COMMUNITY AT THE HOPE CENTER. FINALLY, RECEIVING QUALITY HEALTH CARE SERVICES IS FUNDAMENTAL TO ACHIEVING OPTIMAL HEALTH. HOWEVER, ACCESS TO QUALITY HEALTH SERVICES WILL ONLY LEAD TO QUALITY HEALTH OUTCOMES IF PATIENTS AND FAMILIES UNDERSTAND THEIR HEALTH INFORMATION. IN FY23, CHRISTIANACARE LED STATE EFFORTS TO STRENGTHEN HEALTH LITERACY FOR ALL DELAWAREANS. WITH STATE AND COMMUNITY PARTNERS, CHRISTIANACARE ORGANIZED COMMUNITY MEMBERS TO CREATE THE HEALTH LITERACY COUNCIL OF DELAWARE (HLCD) THAT WILL PROMOTE AND ENCULTURATE HEALTH LITERACY BEST PRACTICES TO BENEFIT POPULATION HEALTH IN OUR STATE. WE ALSO SUCCESSFULLY APPLIED FOR AN $80,000 GRANT FROM HIGHMARK BLUE CROSS BLUE SHIELD TO SUPPORT THE HLCD AND PROVIDE EDUCATION IN THE COMMUNITY TO SUPPORT INCREASED HEALTH LITERACY AND ENABLE INDIVIDUALS TO MAKE INFORMED HEALTHY CHOICES. THAT GRANT WORK WILL BEGIN IN FY24. AT CHRISTIANACARE, WE ARE WORKING TO REFINE OUR OPERATIONS TO IMPROVE HEALTH LITERACY AMONG OUR PATIENTS IN A VARIETY OF WAYS. AMONG OTHER EFFORTS, WE INTEGRATED HEALTH LITERATE MEDICATION PATIENT EDUCATION INTO THE ELECTRONIC HEALTH RECORD FOR A MORE CONSISTENT AND STREAMLINED APPROACH, AND WE CONDUCTED RESEARCH ON ENGAGING AND EMPOWERING PATIENTS AND CAREGIVERS TO BE ACTIVE PARTICIPANTS IN UNDERSTANDING THEIR HEALTH. WE WILL CONTINUE OUR EFFORTS TO PROMOTE HEALTH LITERACY AMONG OUR PATIENTS AND IN OUR COMMUNITY AS IT IS A BUILDING BLOCK FOR HEALTH EQUITY. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) CHRONIC HEALTH CONDITIONS IN OUR 5-YEAR STRATEGIC PLAN, CHRISTIANACARE ADOPTED THE ASPIRATION OF ENDING DISPARITIES IN ACCESS, EXPERIENCE, CARE DELIVERY, AND HEALTH OUTCOMES. IN THE AREA OF CHRONIC DISEASE, WE ARE FOCUSED ON REDUCING RACIAL DISPARITIES IN UNCONTROLLED HYPERTENSION. IN FY24, WE WILL DESIGN AND IMPLEMENT INTERVENTIONS TO REDUCE THOSE DISPARITIES. FOOD INSECURITY IS ONE OF THE MOST PREVALENT SOCIAL NEEDS NATIONWIDE AND IS ASSOCIATED WITH WORSENING CHRONIC DISEASE OUTCOMES AND DIFFICULTIES ADHERING TO A HEALTHY DIET. RESEARCH HAS SHOWN THAT CHWS ARE VITAL TO BRIDGING THE GAPS BETWEEN COMMUNITY MEMBERS AND HEALTH AND SOCIAL SERVICES, ULTIMATELY IMPROVING FOOD INSECURITY AND HEALTH OUTCOMES. IN 2021, CHRISTIANACARE LAUNCHED DELAWARE FOOD FARMACY (DFF), A 6-MONTH "FOOD AS MEDICINE" CHW PROGRAM, IN PARTNERSHIP WITH LUTHERAN COMMUNITY SERVICES FOR PATIENTS WITH CHRONIC CONDITIONS. PATIENTS RECEIVE WEEKLY MEDICALLY TAILORED GROCERIES, AND CHWS ASSIST PATIENTS WITH GOAL SETTING AND IMPROVING DIETARY KNOWLEDGE AND CULINARY SKILLS. SINCE PROGRAM LAUNCH, 396,710 MEALS HAVE BEEN PROVIDED. IN FY23, 98 PATIENTS PARTICIPATED, AND 240 COMMUNITY MEMBERS (PARTICIPANTS AND HOUSEHOLD) WERE FED THROUGH THE DFF. ENOUGH FOOD IS PROVIDED FOR THE ENTIRE FAMILY AS A FOOD INSECURE PARENT COULD NOT BE EXPECTED TO EAT THE FOOD PROVIDED FOR THEM WITHOUT SHARING WITH THEIR FAMILY. 80% OF THE PARTICIPANTS LIVED IN THE HIGH-RISK ZIP CODES CHRISTIANACARE IDENTIFIED IN ITS LAST TWO CHNAS. 48,700 MEALS WERE PROVIDED IN FY23. ON AVERAGE, PATIENTS DEVELOPED 2-3 PERSONAL GOALS AND 77% OF THE GOALS WERE COMPLETED UPON GRADUATION. PRELIMINARY OUTCOME ANALYSES DEMONSTRATE PERCENTAGE OF PATIENTS WHO IDENTIFIED AS FOOD INSECURE DECREASED 26%, HEMOGLOBIN A1C DECREASED 0.7 POINTS, BODY MASS INDEX DECREASED 3.6 KG/M2, AND ANXIETY AND DEPRESSION DECREASED 18% AND 11%, RESPECTIVELY. IN FY23, WE CONDUCTED AN ITERATIVE FORMATIVE EVALUATION TO ENSURE DFF IS CULTURALLY RESPONSIVE TO SPANISH SPEAKING PATIENTS. AS A RESULT, DFF MADE MENU CHANGES AND IS COLLABORATING WITH CHRISTIANACARE'S LANGUAGE SERVICES/LANGUAGE LINE TO HAVE DOCUMENTS AND RECIPES TRANSLATED, AS WELL AS TO HAVE DFF COOKING VIDEOS CLOSED CAPTIONED/DUBBED OVER TO SUPPORT OUR SPANISH SPEAKING COMMUNITY. IN PARTNERSHIP WITH URBAN ACRES, CHRISTIANACARE ALSO OPERATED A PRODUCE DELIVERY PROGRAM DESIGNED TO INCREASE PATIENT ACCESS TO THE FRESH PRODUCE NECESSARY TO LIVE A HEALTHIER LIFE. ADULT PATIENTS LIVING IN NEW CASTLE COUNTY WHO ARE ON MEDICAID OR ARE MEDICAID ELIGIBLE AND HAVE DIABETES, HYPERTENSION, AND/OR NEED FOOD ASSISTANCE ARE ELIGIBLE. THEY RECEIVE A $10 WHOLESALE BAG OF PRODUCE (50/50 FRUITS & VEGETABLES) DELIVERED TO THEIR HOMES EVERY WEEK FOR A MINIMUM OF 3 MONTHS. IN FY23, CHRISTIANACARE ENROLLED 137 PARTICIPANTS AND SERVED 376 COMMUNITY MEMBERS (INCLUDING PARTICIPANTS AND THEIR HOUSEHOLD MEMBERS). OF THE PARTICIPANTS, 67% LIVED IN THE HIGH-RISK ZIP CODES IDENTIFIED IN CHRISTIANACARE'S TWO PRIOR CHNAS. AS DESCRIBED PREVIOUSLY, THE PRIMARY CARE AND WOMEN'S HEALTH CHW PROGRAMS INCLUDE CHRONIC CONDITIONS AS AN ELIGIBILITY REQUIREMENT. CHWS WORK WITH THE PATIENTS TO IMPROVE SELF-MANAGEMENT OF THEIR CHRONIC CONDITIONS. WHILE CHRONIC CONDITIONS ARE NOT A REQUIREMENT TO PARTICIPATE IN THE OTHER CHW PROGRAMS, CHRONIC CONDITION MANAGEMENT WILL CERTAINLY BE ADDRESSED IF A PATIENT HAS THAT NEED. MATERNAL AND CHILD HEALTH IN 2010, DELAWARE HAD THE HIGHEST RATE OF UNINTENDED PREGNANCIES IN THE NATION AND BY 2017, THAT RATE WAS DOWN BY NEARLY 20%. THIS WAS THE RESULT OF STATEWIDE COLLABORATION AND PARTICIPATION BY STATE AND COMMUNITY AGENCIES AND PROVIDERS, INCLUDING CHRISTIANACARE, IN PROJECT UPSTREAM, AN EFFORT TO MAKE IUDS AND IMPLANTS IMMEDIATELY AVAILABLE IN ONE OFFICE VISIT OR AFTER A DELIVERY, MISCARRIAGE, OR ABORTION. IN 2015, DELAWARE'S INFANT MORTALITY RATE WAS THE SECOND WORST IN THE NATION AT 9.13 DEATHS PER 1,000 BIRTHS. IN 2021, OUR STATE'S INFANT MORTALITY RATE HAD DECREASED BY NEARLY HALF TO 4.77 PER 1,000 BIRTHS. AS WITH UNINTENDED PREGNANCIES, THIS DECREASE WAS THE RESULT OF CONCERTED EFFORT AMONG PROVIDERS AND STATE AND COMMUNITY AGENCIES. AS WILL BE DESCRIBED IN THIS SECTION, CHRISTIANACARE HAS CREATED, LED, AND PARTICIPATED IN MANY OF THE INITIATIVES THAT HAVE HELPED DECREASE INFANT MORTALITY. WHILE THE REDUCTION IN INFANT MORTALITY IS CERTAINLY AN ACCOMPLISHMENT TO BE CELEBRATED, UNFORTUNATELY, THOSE GAINS HAVE NOT BEEN EQUITABLE. RACIAL DISPARITIES IN MATERNAL AND INFANT MORTALITY PERSIST. IN 2020, DELAWARE'S 5-YEAR BLACK INFANT MORTALITY RATE WAS 3 TIMES THAT OF WHITE INFANT MORTALITY. DESPITE REPRESENTING ONLY 28% OF LIVE BIRTHS IN DELAWARE IN THE 2017 - 2021 PERIOD, BLACK WOMEN REPRESENTED 78% OF PREGNANCY-RELATED DEATHS. CHRISTIANACARE CONTINUES TO UNDERTAKE AND LEAD TARGETED EFFORTS TO IMPROVE THESE DISPARATE OUTCOMES IN BOTH CLINICAL AND COMMUNITY SETTINGS. AS WILL BE DEMONSTRATED THROUGH THE PROGRAMS AND INITIATIVES DESCRIBED BELOW, CHRISTIANACARE RECOGNIZES THAT REDUCING MATERNAL AND INFANT MORTALITY RATES, AND ESPECIALLY THE DISPARITIES WITHIN THOSE RATES, IS ONLY POSSIBLE WITH A HOLISTIC APPROACH THAT CONSIDERS ALL THE NEEDS OF THE INDIVIDUAL, WHETHER THOSE ARE HEALTH RELATED OR SOCIAL. CHRISTIANACARE CAREGIVERS HAVE LONG LED AND PARTICIPATED IN STATEWIDE COLLABORATIVE EFFORTS TO ADDRESS THE SYSTEMIC MATERNAL AND INFANT MORTALITY. FROM 2005 TO 2023, DR. DAVID PAUL, CHRISTIANACARE CHAIR OF PEDIATRICS HAS SERVED AS THE GOVERNOR APPOINTED CHAIR OF THE DELAWARE HEALTHY MOTHER AND INFANT CONSORTIUM (DHMIC). THE MISSION OF DHMIC IS TO PROVIDE STATEWIDE LEADERSHIP AND COORDINATION OF EFFORTS TO REDUCE INFANT MORTALITY, DECREASE PRETERM BIRTH, DECREASE THE MATERNAL MORTALITY RATE, AND DECREASE DISPARITY RATES. CHRISTIANACARE CAREGIVERS ALSO SERVE ON DELAWARE'S MATERNAL MORTALITY REVIEW PANEL AND THE FETAL & INFANT MORTALITY REVIEW (FIMR). BOTH PANELS SERVE TO EXAMINE INDIVIDUAL DEATHS TO CONSIDER THE PUBLIC HEALTH AND CLINICAL INTERVENTIONS AS WELL AS SYSTEMIC CHANGES THAT COULD REDUCE THE NUMBER OF DEATHS. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) AS REPORTED LAST YEAR, CHRISTIANACARE HAS ALSO UNDERTAKEN SEVERAL INITIATIVES TO ADDRESS DISPARITIES AMONG PREGNANT AND POSTPARTUM WOMEN. IMPLEMENTING A REMOTE PATIENT MONITORING PLATFORM SUCCESSFULLY REDUCED OVERALL POSTPARTUM PATIENT READMISSIONS FOR HIGH BLOOD PRESSURE BY 55% AND ELIMINATED A LONGSTANDING RACIAL DISPARITY. AMONG BLACK MOTHERS, THE READMISSION RATE DROPPED FROM 61% TO 31%. LIKEWISE, ENABLING PATIENTS TO UNDERTAKE FASTING BLOOD SUGAR TESTS AT HOME AND TEXT THEIR RESULTS ALSO LED TO IMPROVED COMPLIANCE RATES OVERALL AND A NARROWING OF THE RACIAL GAP IN CARE WITH A 180% HIGHER DIABETES DETECTION AMONG NON-BLACK WOMEN AND A 577% INCREASE AMONG BLACK WOMEN. THESE REDUCTIONS IN RACIAL DISPARITIES WERE MADE POSSIBLE BECAUSE IN BOTH EFFORTS, THE SOLUTION WAS ESSENTIALLY PROVIDED BY THE PATIENTS. THE RESEARCH TEAM CONSIDERED WHY COMPLIANCE WITH POSTPARTUM OFFICE VISITS AMONG BLACK WOMEN WAS LOW. BARRIERS SUCH AS LACK OF TRANSPORTATION AND THE TIME OF THE APPOINTMENT WERE SOME OF THE DIFFICULTIES REPORTED SO THOSE BARRIERS WERE REMOVED THROUGH THE IMPLEMENTATION OF HOME MONITORING AND TESTING. THE POSITIVE RESULTS EXEMPLIFY WHY PATIENTS MUST BE TREATED AS PARTNERS. CHRISTIANACARE HAS ALSO SET THE TARGET OF REDUCING RACIAL DISPARITIES IN PREECLAMPSIA AT 34 WEEKS. IN FY24, WE EXPECT TO DESIGN AND IMPLEMENT INTERVENTIONS, LEARNING FROM PRIOR EXPERIENCE, TO MEET THIS GOAL. AS DESCRIBED PREVIOUSLY, CHRISTIANACARE EMPLOYS WOMEN'S HEALTH CHWS WHO ARE EMBEDDED THROUGHOUT CHRISTIANACARE'S WOMEN'S HEALTH SERVICES INCLUDING INPATIENT, OUTPATIENT, OBSTETRICS (OB) TRIAGE, AND THE NEONATAL INTENSIVE CARE UNIT (NICU). THESE CHWS PARTNER WITH PATIENTS TO PROVIDE CONNECTION TO NEEDED SOCIAL AND HEALTH RESOURCES TO ULTIMATELY IMPROVE HEALTH. CHWS ARE VALUABLE MEMBERS OF A PATIENT'S CARE TEAM WHICH IS POSSIBLE BECAUSE OUR CAREGIVERS RECOGNIZE THE OUTSIZED ROLE A PATIENT'S SOCIAL NEEDS HAS ON THEIR HEALTH. IN PARTNERSHIP WITH THE DELAWARE DIVISION OF PUBLIC HEALTH, CHRISTIANACARE HAS OFFERED BOTH THE HEALTHY BEGINNINGS AND HEALTH AMBASSADORS PROGRAMS FOR OVER A DECADE. BOTH PROGRAMS WERE CREATED TO ADDRESS DELAWARE'S HIGH INFANT MORTALITY RATE. HEALTHY BEGINNINGS FOCUSES ON PRECONCEPTION CARE TO IDENTIFY AND ADDRESS RISKS TO FUTURE PREGNANCY, PREGNANCY PLANNING TO SET THE STAGE FOR A HEALTHY PREGNANCY, AND PRENATAL CARE FROM CONCEPTION TO CHILDBIRTH. THE GOAL IS TO REDUCE DISPARATE BIRTH OUTCOMES AND SAVE THE LIVES OF INFANTS AND THEIR MOTHERS. THE HEALTH AMBASSADORS PROGRAM SERVES PREGNANT WOMEN AND FAMILIES WITH CHILDREN AGED 0 TO 5 IN TARGETED HIGH-RISK ZIP CODES TO CONNECT WOMEN AND YOUNG FAMILIES TO HEALTH CARE, SOCIAL SERVICES, HOME VISITING, AND EDUCATIONAL PROGRAMS. THEY ALSO PROMOTE KEY MATERNAL AND CHILD HEALTH MESSAGES INCLUDING THE BENEFITS OF BREASTFEEDING AND THE IMPORTANCE OF SAFE SLEEP. IN FY23, HEALTHY BEGINNINGS ENROLLED 2,036 PATIENTS. OF THOSE PATIENTS, 1,249 (61.3%) WERE AFRICAN AMERICAN AND 1,201 (58.9%) LIVED IN A HIGH-RISK ZONE (19702, 19703, 19720, 19801, 19802, 19804, 19805, 19809, 19901, 19904, 19933, 19950, 19973). TO BETTER SERVE THEIR PATIENTS, HEALTHY BEGINNINGS PARTNERS WITH DELAWARE COALITION AGAINST DOMESTIC VIOLENCE, UNIVERSITY OF DELAWARE DEPARTMENT OF BEHAVIORAL HEALTH AND NUTRITION, DELAWARE COMMUNITY LEGAL AID SOCIETY, INC., CHILDREN & FAMILIES FIRST, QUALITY INSIGHTS, FOOD BANK OF DELAWARE, DELAWARE WOMEN, INFANT AND CHILDREN (WIC) AND DELAWARE CENTER FOR MATERNAL-FETAL MEDICINE. SERVICES PROVIDED TO PATIENTS INCLUDE PERSONAL HEALTH AND WELLNESS, WEIGHT MANAGEMENT, STRESS MANAGEMENT, EMOTIONAL HEALTH TREATMENT, FAMILY PLANNING, CONTRACEPTION, DOMESTIC ABUSE SCREENING, TOBACCO CESSATION SERVICES AND HYPERTENSION SCREENING AND TREATMENT. IN FY23, THE HEALTH AMBASSADORS SERVED 1,279 INDIVIDUALS BY PROVIDING THEM WITH A VARIETY OF ESSENTIAL ITEMS NEEDED FOR INFANTS AND CHILDREN SUCH AS CLOTHING, DIAPERS, CAR SEATS, STROLLERS, PACK & PLAYS, AND FORMULA AS WELL AS NEEDED RESOURCES LIKE FOOD AND BUS PASSES. EVERY DAY THE HEALTH AMBASSADORS ALSO CONNECTED INDIVIDUALS TO COMMUNITY RESOURCES TO ADDRESS FOOD AND HOUSING INSECURITY, DOMESTIC VIOLENCE, PARENTING EDUCATION NEEDS, AMONG OTHER SOCIAL NEEDS. THE HEALTH AMBASSADORS ALSO HOSTED SEVERAL COMMUNITY EVENTS THROUGHOUT THE YEAR. IN SEPTEMBER 2022, CHRISTIANACARE HELD A LATINX BABY SHOWER TO PROVIDE PREGNANT SPANISH SPEAKING MOTHERS WITH INFORMATION ABOUT HEALTHY DEVELOPMENT AND THE IMPORTANCE OF MATERNAL HEALTH FOR THEIR BABIES' HEALTH AND 120 FAMILIES ATTENDED. IN JANUARY 2023, WE ORGANIZED A WINTER WONDERLAND BABY SHOWER TO PROVIDE EDUCATION ON SAFE SLEEP PRACTICES AND 178 MOTHERS RECEIVED THIS EDUCATION. FINALLY, CHRISTIANACARE HELD A LATINX CHAT & CHEW IN JUNE 2023. THIS 4-SESSION WORKSHOP CONSISTED OF MINI EDUCATIONAL SESSIONS ON HEALTHY RELATIONSHIPS, BREASTFEEDING, NUTRITION DURING PREGNANCY, INFORMATION ON HOME VISITING PROGRAMS, AND HELP WITH INSURANCE NEEDS FOR FAMILIES. EACH SESSION HAD 10-15 WOMEN ATTENDING. WE ARE ALSO EXPANDING THE CHRISTIANACARE COMMUNITY HEALTH DEPARTMENT'S DELAWARE FOOD FARMACY (DFF) PROGRAM INTO WOMEN'S HEALTH. THE WOMEN'S HEALTH DFF IS A 6-TO-9-MONTH PROGRAM THAT WILL PROVIDE PREGNANT MOTHERS WITH THE HOLISTIC CARE NECESSARY KEEP BOTH MOM AND BABY HEALTHY. PARTICIPANTS WILL HAVE DELIVERED TO THEIR HOMES MEDICALLY TAILORED FOOD FOR THEM AND THEIR FAMILIES TO PREPARE 10 MEALS PER WEEK, PER PERSON IN THE HOME. LIKE OUR CURRENT SUCCESSFUL DFF PROGRAM DESCRIBED PREVIOUSLY, CHRISTIANACARE WILL PROVIDE CULINARY EQUIPMENT AND SKILLS TRAINING AND RECIPES, AND CHWS, REGISTERED DIETICIANS (RD'S), AND PROVIDERS WILL PROVIDE NUTRITION ASSESSMENT, EDUCATION AND ONGOING SUPPORT FOR DIETARY BEHAVIOR CHANGES AND ACHIEVING GOALS FOR A HEALTHIER PREGNANCY. ADDITIONALLY, EVIDENCE-BASED BEHAVIOR-CHANGE STRATEGIES SUCH AS MOTIVATIONAL INTERVIEWING, INCREMENTAL SMART GOAL SETTING, REMINDERS/CUES/PROMPTS, MOBILE TECHNOLOGY AND ONGOING SOCIAL SUPPORT WILL BE EMPLOYED IN THIS EXPANSION OF THE DFF PROGRAM TO WOMEN'S HEALTH. A COMMUNITY-ENGAGED APPROACH, INCLUDING AN ADVISORY BOARD OF LOCAL LEADERS AND ORGANIZATIONS, WILL BE USED TO IDENTIFY CULTURALLY RESPONSIVE FOODS AND RECIPES AND DEVELOP EDUCATIONAL MATERIALS APPROPRIATE FOR OUR LARGELY AFRICAN AMERICAN AND HISPANIC PARTICIPANTS AND THEIR FAMILY MEMBERS. TO GAUGE SUCCESS OF THE PROGRAM, WE WILL MEASURE CHANGES IN KEY PROJECT OUTCOMES, SUCH AS CHANGES IN DIETARY BEHAVIORS, FOOD SECURITY AS WELL AS OBSTETRICAL OUTCOMES (I.E., GESTATIONAL DIABETES, NICU DAYS AND CESAREAN DELIVERY). TO BE ELIGIBLE, INDIVIDUALS MUST BE A CHRISTIANACARE WOMEN'S HEALTH PATIENT WHO RESIDES IN NEW CASTLE COUNTY, HAVE MEDICAID OR BE MEDICAID ELIGIBLE, HAVE A BMI OF 30 OR HIGHER, HAVE A SINGLETON PREGNANCY, AND BE BETWEEN 4 AND 14 WEEKS PREGNANT. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) WE ARE AIMING TO LAUNCH THIS PROGRAM IN DECEMBER 2023 AND MUCH OF FY23 WAS SPENT APPLYING FOR THE FEDERAL FUNDING THAT WILL SUPPORT THIS EXPANSION AND PREPARING FOR LAUNCH. A SERIES OF COOKING AND PREGNANCY CARE VIDEOS WERE CREATED FOR THIS EXPANSION, AND TO ENSURE THEIR UTILITY, THE COMMUNITY HEALTH DEPARTMENT ALSO SURVEYED PATIENTS AND COLLECTED QUANTITATIVE AND QUALITATIVE DATA PERTAINING TO THE VIDEOS AND RECIPES THAT WILL BE USED. COMMUNITY HEALTH ALSO HELD FOCUS GROUPS WITH VARIOUS WOMEN'S HEALTH DEPARTMENTS AND PROGRAMS TO DETERMINE HOW BEST TO PROVIDE COLLABORATIVE CARE ON BEHALF OF THESE MOTHERS TO ENSURE THIS PROGRAM WILL SUCCESSFULLY SERVE PATIENTS. CHRISTIANACARE IS ALSO WORKING TO IMPROVE BIRTH OUTCOMES THROUGH ITS COLLABORATION WITH UNIVERSITY OF DELAWARE'S DIVISION OF PROFESSIONAL AND CONTINUING STUDIES AND SCHOOL OF NURSING TO OFFER A BIRTHING COMPANION CERTIFICATE. BIRTH COMPANIONS SUPPORT AND ADVOCATE FOR WOMEN DURING THEIR PREGNANCY, LABOR AND BIRTH, AND AFTER DELIVERY. NURSING STUDENTS PARTICIPATING IN THIS COURSE PROGRAM ARE PROVIDED WITH THE SKILLS NEEDED TO PURSUE THE REQUIREMENTS OF BECOMING A DOULA. THIS PROGRAM SERVES THE DUAL PURPOSE OF HELPING THE PATIENT AND PROVIDING THE NURSING STUDENT WITH CLINICAL EXPERIENCE ALONG WITH THE OPPORTUNITY TO WORK CLOSELY WITH PATIENTS WHO MAY BE IN VERY DIFFERENT CIRCUMSTANCES THAN THEIR OWN. AS A COMMUNITY-BASED TEACHING HOSPITAL, IT IS OUR DUTY TO ENSURE THE NEXT GENERATION OF HEALTH CARE WORKERS RECOGNIZE AND CAN ADDRESS POTENTIAL BARRIERS TO HEALTH THAT MAY RESULT IN HEALTH DISPARITIES. IT IS ALSO OUR COMMITMENT TO ENSURE THE NEXT GENERATION OF HEALTH CARE WORKERS RECOGNIZE AND RESPECT PATIENTS AS WHOLE PEOPLE WHO MAY HAVE VERY DIFFERENT PERSPECTIVES AND EXPERIENCES. FINALLY, SINCE 1995, THE STATE OF DELAWARE HAS ALSO PROVIDED CHRISTIANACARE WITH A GRANT TO OPERATE THE ALLIANCE FOR ADOLESCENTS PREGNANCY PREVENTION (AAPP). AAPP PROVIDES DELAWARE YOUTH WITH SKILLS AND INFORMATION TO HELP AVOID OR REDUCE INVOLVEMENT IN HIGH-RISK BEHAVIORS, PARTICULARLY HIGH-RISK SEXUAL BEHAVIORS, AND TO PROMOTE POSITIVE YOUTH DEVELOPMENT. IN FY23, CHRISTIANACARE'S 536 STUDENTS PARTICIPATED IN ONE OF THE THREE CORE COURSES AAPP OFFERS: 1. BE PROUD! BE RESPONSIBLE: A SIX-MODULE CURRICULUM THAT PROVIDES ADOLESCENTS, AGES 13 TO 18, WITH THE KNOWLEDGE, MOTIVATION, AND SKILLS NECESSARY TO CHANGE THEIR BEHAVIORS IN WAYS THAT WILL REDUCE THEIR RISK OF CONTRACTING HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS. 2. MAKING PROUD CHOICES: AN EIGHT-MODULE CURRICULUM THAT PROVIDES YOUNG ADOLESCENTS, AGES 11 TO 13, WITH THE KNOWLEDGE, CONFIDENCE, AND SKILLS NECESSARY TO REDUCE THEIR RISK OF SEXUALLY TRANSMITTED INFECTIONS (STIS), HIV, AND PREGNANCY. 3. WISE GUYS: A TEN-MODULE PROGRAM DESIGNED TO PREVENT ADOLESCENT PREGNANCY, EMPOWER YOUNG MEN TO RECOGNIZE CHALLENGES THEY MAY FACE IN LIFE, AND GIVE THEM THE TOOLS TO OVERCOME THESE CHALLENGES. IN EACH OF THE 3 CORE COURSES, SELF-REPORTED PRE-TEST AND POST-TEST KNOWLEDGE, ATTITUDE, AND BEHAVIOR MEASURES BETWEEN SEPTEMBER 2022 AND JUNE 2023 DEMONSTRATED STUDENTS' INCREASED KNOWLEDGE AFTER THEIR PARTICIPATION. AT THE END OF THE COURSE, EVERY STUDENT WAS PROVIDED A SATISFACTION SURVEY AND WAS ASKED TO RATE THE AAPP SERIES THEY ATTENDED. 97% RATED THE AAPP SERIES AS "EXCELLENT"GOOD," 2% RATED IT AS "FAIR,1% RATED IT AS "POOR." IN FY23, THE AAPP TEAM ALSO WORKED TO DEVELOPED WISE GUYS FOR KIDS, A PROGRAM FOR 9-11-YEAR-OLDS. THIS PROGRAM WILL BE PILOTED DURING THE 2023-2024 SCHOOL YEAR. AAPP ALSO OFFERED WISE GUYS: MALE RESPONSIBILITY NEXT LEVEL FOR PARTICIPANTS OVER THE AGE OF 18. IN FY23, 28 INDIVIDUALS RECEIVED THIS EDUCATION. IMPORTANTLY, DESPITE OFFERING THESE COURSES FOR OVER 30 YEARS, THE AAPP TEAM CONTINUALLY LOOKS FOR WAYS TO ENSURE THEIR LESSONS ARE EFFECTIVE AND RESONATE WITH THE STUDENTS. MENTAL HEALTH AND SUBSTANCE USE DISORDERS OUR COMMUNITY HAS LONG IDENTIFIED MENTAL HEALTH AND SUBSTANCE USE DISORDERS AS A SIGNIFICANT AREA OF NEED. OVER THE PAST SEVERAL YEARS, CHRISTIANACARE HAS UNDERTAKEN A VARIETY OF INITIATIVES TO EXPAND ACCESS TO BEHAVIORAL HEALTH SERVICES IN CLINICAL AND COMMUNITY SETTINGS INCLUDING EMBEDDED BEHAVIORAL HEALTH CARE MODELS. EMBEDDING BEHAVIORAL HEALTH SERVICES INCREASES ACCESS AND EARLY PREVENTION AS WELL AS ENABLES US TO SERVE THE PATIENT HOLISTICALLY BY ADDRESSING THE CONNECTION BETWEEN PHYSICAL AND MENTAL HEALTH. CHRISTIANACARE'S BEHAVIORAL HEALTH TEAM SET THE GOAL OF HIRING 71 NEW CAREGIVERS IN BOTH CLINICAL AND NON-CLINICAL ROLES TO ADDRESS BEHAVIORAL HEALTH BY THE END OF FISCAL YEAR 2023. ULTIMATELY, DESPITE A CHALLENGING WORKFORCE ENVIRONMENT, 65 CAREGIVERS WERE HIRED TO ADDRESS BEHAVIORAL HEALTH NEEDS. IN FY23, PSYCHOLOGISTS WERE ALSO EMBEDDED IN CHRISTIANACARE'S PAIN CENTER, PALLIATIVE CARE, AND THE SLEEP CENTER. AS DESCRIBED PREVIOUSLY, CHRISTIANACARE EMPLOYS BEHAVIORAL HEALTH CHWS WHO ARE EMBEDDED IN CHRISTIANACARE'S OUTPATIENT BEHAVIORAL HEALTH SERVICES TO SUPPORT CHILDREN, ADOLESCENTS, AND ADULTS WITH MENTAL HEALTH AND/OR SUBSTANCE USE DIAGNOSES FOR UP TO 6 MONTHS. THESE CHWS ALSO PARTICIPATE IN COMMUNITY EVENTS AND CAN TRAIN COMMUNITY MEMBERS ON THE USE OF NARCAN, AN OPIOID ANTAGONIST DESIGNED TO REVERSE OVERDOSE. IN FY23, DUE TO THE DEMONSTRATED NEED AT THE WILMINGTON FAMILY CENTER PRACTICE, THE EMBEDDED CHW NOW SERVES PATIENTS WITH SUBSTANCE USE DISORDER AS WELL. FOR 15 YEARS, CHRISTIANACARE HAS OPERATED PROJECT ENGAGE, AN EARLY INTERVENTION AND REFERRAL TO SUBSTANCE USE DISORDER TREATMENT PROGRAM. PEERS IN RECOVERY ENGAGE WITH INPATIENTS AND PATIENTS IN THE EMERGENCY DEPARTMENT WHO ARE STRUGGLING WITH SUBSTANCE USE DISORDER. THE PEERS USE MOTIVATIONAL INTERVIEWING TO EMPOWER EACH PATIENT IN THE DECISION-MAKING PROCESS, ASSISTING THEM TO TAKE THE CRITICAL FIRST STEP TO SEEK HELP FOR THE SUBSTANCE USE DISORDER. PEERS WILL CONNECT THESE PATIENTS TO TREATMENT PROGRAMS AND OTHER COMMUNITY RESOURCES. IN FY23, PROJECT ENGAGE PEERS HAD A TOTAL OF 2,468 ENGAGEMENTS WITH PATIENTS AND MADE 1,323 REFERRALS TO TREATMENT. IN APRIL 2023, CHRISTIANACARE'S EMERGENCY DEPARTMENT ALSO BEGAN PRESCRIBING MEDICATIONS FOR OPIOID USE DISORDER (MOUD) TO ELIGIBLE PATIENTS WITH OPIOID USE DISORDER (OUD) SO THAT PATIENTS WHO WANT TO TREAT THEIR OUD CAN TAKE THAT STEP IMMEDIATELY. PROJECT ENGAGE ASSISTS THESE PATIENTS IN MAKING REFERRALS TO TREATMENT TO ENSURE THEY CONTINUE TO RECEIVE MOUD IN THE COMMUNITY AFTER DISCHARGE. AS OVERDOSE DEATHS CONTINUE TO RISE IN DELAWARE, PROVIDING IMMEDIATE ACCESS TO TREATMENT IS CRUCIAL PARTICULARLY AS THE 2021 ANNUAL REPORT ON DELAWARE'S OVERDOSE FATALITIES FOUND THAT 4 OUT OF 5 OF THOSE WHO DIED FROM AN OVERDOSE INTERACTED WITH A HEALTH SYSTEM IN THE YEAR PRIOR TO THEIR DEATH. CHRISTIANACARE ALSO OPERATES SEVERAL BEHAVIORAL HEALTH PROGRAMS IN THE COMMUNITY TO ENSURE OUR NEIGHBORS HAVE ACCESS. IN 2021, CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT RECEIVED STATE AND FEDERAL FUNDING TO PARTNER WITH THE NEW CASTLE COUNTY POLICE DEPARTMENT TO DIVERT INDIVIDUALS AWAY FROM THE CRIMINAL JUSTICE SYSTEM AND EMERGENCY DEPARTMENTS WHEN APPROPRIATE AND WORK TO CONNECT INDIVIDUALS TO CARE IN THE COMMUNITY. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) THREE CHRISTIANACARE CAREGIVERS, TWO MENTAL HEALTH PROFESSIONALS AND A CASE MANAGER, ARE EMBEDDED IN THE POLICE DEPARTMENT'S BEHAVIORAL HEALTH UNIT (BHU) TO ADDRESS MENTAL HEALTH NEEDS IN THE COMMUNITY. SERVING WITH THE POLICE IN A CO-RESPONDER MODEL, THE MENTAL HEALTH PROFESSIONALS RESPOND TO 911 CALLS AND OFFICER REFERRALS WHEN MENTAL ILLNESS IS BELIEVED TO BE A PRIMARY FACTOR FOR POLICE INVOLVEMENT. THEY PROVIDE SUPPORT TO THE COMMUNITY MEMBER AT A TIME OF CRISIS AS WELL AS EDUCATION TO THE OFFICERS ON HOW TO IDENTIFY MENTAL ILLNESS AND PROVIDE ESSENTIAL DE-ESCALATION TACTICS. ONCE THE INITIAL CRISIS HAS BEEN ABATED, THE CASE MANAGER CONTINUES TO WORK TO CONNECT THESE INDIVIDUALS TO THE APPROPRIATE COMMUNITY TREATMENT AND TO ADDRESS ANY SOCIAL NEEDS. SIX ADDITIONAL CHRISTIANACARE CAREGIVERS SUPPORT THE NCCPD'S HERO HELP PROGRAM WHICH ADDRESSES SUBSTANCE USE DISORDER BY SUPPORTING THOSE SEEKING TREATMENT. THESE CAREGIVERS RESPOND TO NON-FATAL OVERDOSES, PROVIDE OUTREACH IN THE COMMUNITY, WORK WITH INDIVIDUALS TO DEVISE A TREATMENT PLAN, OBTAIN TREATMENT, PROVIDE ONGOING MANAGEMENT, AND ADDRESS ANY NEEDS INDIVIDUALS MAY HAVE THAT SERVE AS BARRIERS TO OBTAINING TREATMENT. IN FY23, CHRISTIANACARE AND THE NCCPD SUCCESSFULLY APPLIED FOR FEDERAL FUNDING TO DOUBLE THE NUMBER OF CAREGIVERS SERVING THE HERO HELP PROGRAM INCLUDING THE HIRING OF TWO POSITIONS SERVED BY PEERS. THIS PARTNERSHIP ALLOWS FOR EFFECTIVE INTERVENTIONS FOR COMMUNITY MEMBERS WHO MAY OTHERWISE NOT HAVE ACCESS TO THE BEHAVIORAL HEALTH SERVICES THEY NEED. IT ALSO PROVIDES MUCH NEEDED SUPPORT TO THE POLICE WHO ARE ROUTINELY CONFRONTED WITH BEHAVIORAL HEALTH NEEDS OF THE COMMUNITY MEMBERS. CHRISTIANACARE'S COMMUNITY SUBSTANCE OVERDOSE SUPPORT (SOS), CREATED IN PARTNERSHIP WITH NEW CASTLE COUNTY, PROVIDES OUTREACH TO INDIVIDUALS WITH SUBSTANCE USE DISORDER (SUD) LIVING IN NEW CASTLE COUNTY. SOS ACCEPTS SELF-REFERRALS, INTERNAL REFERRALS FOR CHRISTIANACARE PATIENTS, AND NEW CASTLE COUNTY EMS REFERRALS OF INDIVIDUALS THEY HAVE REVIVED WITH NALOXONE, THE OPIOID OVERDOSE REVERSING MEDICATION, AND TAKEN TO ONE OF CHRISTIANACARE'S EMERGENCY DEPARTMENTS. SOS GOES TO INDIVIDUALS' HOMES OR OTHER COMMUNITY LOCATIONS AND USES MOTIVATIONAL INTERVIEWING TECHNIQUES TO ENCOURAGE THE INDIVIDUAL TO ENTER SUBSTANCE USE DISORDER TREATMENT. IF NEEDED, SOS WILL HELP THE PATIENT ADDRESS ANY BARRIERS TO TREATMENT AND ASSIST THEM WITH ENROLLING IN TREATMENT. SOS ALSO PROVIDES NALOXONE AND TRAINING ON ITS USE AS WELL AS OTHER HARM REDUCTION EDUCATION IN THE COMMUNITY. IN FY23, SOS DISTRIBUTED 314 NALOXONE KITS IN THE ZIP CODES WE IDENTIFIED AS HIGH NEED IN OUR 2 MOST RECENT CHNAS. SOS ALSO RECEIVED A TOTAL OF 797 REFERRALS. THEY WERE ABLE TO SUCCESSFULLY CONTACT 45% OF THOSE REFERRALS, AND OF THOSE, 12% AGREED TO TREATMENT WHICH IS A STRONG RESULT FOR THIS POPULATION. IF AN INDIVIDUAL WAS UNWILLING TO GO TO TREATMENT, THEY WERE OFFERED HARM REDUCTION EDUCATION AND NALOXONE AND ENCOURAGED TO CONTACT SOS ONCE THEY WERE READY TO PURSUE TREATMENT. IN FY23, SOS ALSO BEGAN WORKING WITH THE WILMINGTON POLICE DEPARTMENT (WPD) TO DEVELOP A PARTNERSHIP THAT WOULD ALLOW THE SOS TEAM TO SERVE THOSE WITH SUBSTANCE USE DISORDER REFERRED BY THE WPD. THIS IS ANOTHER EFFORT AIMED AT PROVIDING EFFECTIVE SUPPORT TO THE POLICE IN ADDRESSING THESE PATIENT NEEDS AND CRITICAL RESOURCES TO OUR COMMUNITY. FINALLY, IN RESPONSE TO SPECIFIC COMMUNITY CONCERNS ABOUT ADOLESCENT MENTAL HEALTH IN EARLY 2023, CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT COLLABORATED WITH NEW CASTLE COUNTY'S POLICE DEPARTMENT TO ORGANIZE TWO YOUTH MENTAL HEALTH FAIRS. THE 68 ATTENDEES WERE ABLE TO RECEIVE INFORMATION FROM COMMUNITY BASED MENTAL HEALTH SERVICES AND RESOURCES FROM OVER 25 PROVIDERS. THESE EVENTS WERE HELD IN FEBRUARY 2023 AT THE POLICE ATHLETIC LEAGUE OF WILMINGTON AND THE GREATER NEWARK BOYS & GIRLS CLUB. VIOLENCE IN RECOGNITION OF VIOLENCE AS A PUBLIC HEALTH ISSUE, CHRISTIANACARE LAUNCHED A HOSPITAL BASED VIOLENCE INTERVENTION PROGRAM (HVIP), EMPOWERING VICTIMS OF LIVED VIOLENCE (EVOLV), IN FEBRUARY 2021. EVOLV IS A COLLABORATION OF CHRISTIANACARE'S TRAUMA AND COMMUNITY HEALTH DEPARTMENTS TO CREATE A SINGLE CARE TEAM USING EVIDENCE-BASED SYNERGISTIC STRATEGIES. EVOLV AIMS TO ADDRESS VIOLENCE AND PROVIDE CARE NAVIGATION AND SUPPORT TO PATIENTS IMPACTED BY COMMUNITY VIOLENCE POST-DISCHARGE TO REDUCE RECIDIVISM OF NEW AND RECURRING INJURIES. EVOLV EMPLOYS TWO CHWS WHO ACTIVELY FOLLOW PATIENTS AND ASSIST IN A MAGNITUDE OF SERVICES POST-DISCHARGE INCLUDING FOLLOW-UP CARE, CONNECTION TO COMMUNITY RESOURCES, ADDRESSING SOCIAL CARE NEEDS, AND IDENTIFYING AND ACHIEVING PATIENT CENTERED GOALS AND OUTCOMES. THE EVOLV PROGRAM HAS A DIRECT CONNECTION TO CHRISTIANACARE'S MISSION AND GOALS TO END DISPARITIES AND RADICALLY SIMPLIFY ACCESS TO CARE. ELIGIBLE PATIENTS ARE THOSE AGES 13+ THROUGHOUT THE STATE OF DELAWARE WHO ARE TREATED AT CHRISTIANACARE'S TRAUMA DEPARTMENT OR EMERGENCY DEPARTMENT FOR A GUNSHOT WOUND, STAB WOUND, AND/OR VIOLENT BLUNT ASSAULT FROM COMMUNITY VIOLENCE. SERVICES ARE EPISODIC AND UP TO 6-MONTHS. IN FY23, THE EVOLV PROGRAM SUCCESSFULLY APPLIED FOR A 2-YEAR GRANT OF $200,000 FROM DELAWARE'S CRIMINAL JUSTICE COUNCIL (CJC). WITH THIS FUNDING, AN ADDITIONAL FRONT-LINE WORKER (CHW) WAS HIRED IN AUGUST OF 2023. EVOLV CONTINUES TO DEVELOP PARTNERSHIPS WITH COMMUNITY AGENCIES SUCH AS THE CENTER FOR STRUCTURAL EQUITY (CFSE), DEPARTMENT OF HEALTH AND SOCIAL SERVICES (DHSS)/GROUP VIOLENCE INTERVENTION (GVI), AND THE OFFICE OF VICTIM'S SERVICES (OVS). THE PARTNERSHIP WITH OVS WILL ALLOW EVOLV TO BETTER ASSIST PATIENTS AND FAMILIES WITH ACCESS TO SERVICES INCLUDING THE VICTIM'S COMPENSATION ASSISTANCE PROGRAM. IN FY23, 39 PATIENTS WERE SERVED WITH 64% OF THOSE GRADUATING. 95% OF PARTICIPATING PATIENTS WERE SCREENED FOR SOCIAL DETERMINANTS OF HEALTH. OF THOSE, 98% SCREENED POSITIVE. THE TRAUMA DEPARTMENT IS ALSO ADDRESSING VIOLENCE THROUGH EDUCATION. IN FY23, THE TRAUMA DEPARTMENT CAREGIVERS PROVIDED 101 STOP THE BLEED TRAININGS TO 1,236 INDIVIDUALS AT CHRISTIANACARE CAMPUSES, SCHOOLS, AND COMMUNITY CENTERS THROUGHOUT DELAWARE. STOP THE BLEED IS A NATIONAL AWARENESS CAMPAIGN THAT EMPOWERS BYSTANDERS WITH THE KNOWLEDGE AND TOOLS THEY NEED TO RECOGNIZE AND STOP LIFE-THREATENING BLEEDING. THE TRAUMA DEPARTMENT ALSO OFFERED EDUCATION FOR STUDENTS THAT REFRAMES GUN VIOLENCE AS A PUBLIC HEALTH ISSUE. STUDENTS DISCUSS THE INDIVIDUAL AND COMMUNITY FACTORS THAT PUT PEOPLE AT RISK FOR GUN VIOLENCE AS WELL AS THE PHYSICAL AND EMOTIONAL IMPACTS OF GUN VIOLENCE. STUDENTS ARE EMPOWERED WITH INFORMATION TO HELP THEM IDENTIFY THE WARNING SIGNS OF GUN VIOLENCE. IN FY23, 60 STUDENTS FROM LAS AMERICAS ASPIRA ACADEMY IN NEWARK PARTICIPATED IN THIS PROGRAM. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) SOCIAL DETERMINANTS OF HEALTH CHRISTIANACARE IS COMMITTED TO THE STRATEGY OF ADDRESSING SOCIAL DETERMINANTS OF HEALTH (SDOH) TO IMPROVE HEALTH OUTCOMES. EVERY PROGRAM PREVIOUSLY DESCRIBED ADDRESSES INDIVIDUALS' SOCIAL NEEDS AND WE ARE ALSO ADDRESSING SDOH ON A SYSTEMWIDE SCALE. CHRISTIANACARE DESIGNED AND IMPLEMENTED ONE SDOH SCREENING INSTRUMENT TO ADMINISTER TO PATIENTS AND IN FY22, INTRODUCED PATIENT SELF-ADMINISTRATION OF THE SDOH SCREENING INSTRUMENT TO INCREASE THE NUMBER OF SDOH SCREENS COMPLETED, IMPROVE EFFICIENCY, AND PROVIDE A BETTER PATIENT EXPERIENCE. THE SDOH SCREEN IS NOT JUST AN EXERCISE TO COLLECT DATA. KNOWING THE CHALLENGES OUR PATIENTS FACE ENABLES US TO BETTER DESIGN CLINICAL AND COMMUNITY INTERVENTIONS TO ADDRESS THEM, AND WE ALSO STRIVE TO ADDRESS THOSE NEEDS THROUGH INTERNAL RESOURCES AND REFERRALS TO COMMUNITY RESOURCES. IN LATE FY23, CHRISTIANACARE LAUNCHED THE SOCIAL CARE CONNECTION CENTER WHICH ESSENTIALLY SERVES AS A HUB TO ADDRESS POSITIVE RESPONSES ON PATIENTS' SDOH SCREENS. DEPENDING ON THE LEVEL OF NEED, A CHW OR SOCIAL WORKER WILL WORK WITH THE PATIENT TO ADDRESS THEIR NEEDS. IN APRIL 2023, CHRISTIANACARE ALSO DEPLOYED TWO ACUTE CARE CONNECTORS (ACCS) TO TWO FLOORS AT WILMINGTON HOSPITAL. THE ACCS PERFORM SDOH SCREENING AT THE BEDSIDE AND SEEK TO ADDRESS SOCIAL CARE NEEDS THAT MAY INCREASE THE POSSIBILITY FOR READMISSION. ACCS ARE HIGHLY COLLABORATIVE AND BRIDGE THE CARE PATIENTS RECEIVE IN THE HOSPITAL WITH COMMUNITY SUPPORT AND RESOURCES. A SIGNIFICANT WAY IN WHICH CHRISTIANACARE ADDRESSES SOCIAL NEED IS THROUGH UNITE DELAWARE. IN 2019, CHRISTIANACARE PARTNERED WITH UNITE US TO LAUNCH AN ELECTRONIC CARE COORDINATION NETWORK, UNITE DELAWARE. THE UNITE DELAWARE NETWORK CONNECTS SOCIAL SERVICES AND CLINICAL CARE PROVIDERS ACROSS THE STATE. WITH THIS NETWORK, ANY HEALTHCARE PROVIDER OR SOCIAL SERVICE AGENCY CAN HELP AN INDIVIDUAL ADDRESS THE DIVERSE ARRAY OF NEEDS THEY MAY HAVE BY SENDING AN ELECTRONIC REFERRAL ON BEHALF OF THE PATIENT TO THE APPROPRIATE ORGANIZATION. THE SENDER OF THAT REFERRAL WILL BE ABLE TO TRACK WHETHER THAT NEED WAS MET OR NOT AND TAKE ADDITIONAL ACTION IF NEEDED TO HELP THE PATIENT MEET THEIR NEED. UNITE DELAWARE NOW INCLUDES TWO OTHER DELAWARE HOSPITALS AND OVER 200 COMMUNITY-BASED ORGANIZATIONS. CHRISTIANACARE FUNDS THE UNITE DELAWARE PLATFORM BECAUSE WE BELIEVE IT CAN HELP DELAWAREANS THROUGHOUT THE STATE ADDRESS THEIR NEEDS. THERE IS ALSO NO COST TO THE COMMUNITY-BASED ORGANIZATIONS THAT PARTICIPATE IN THE NETWORK AND SO OUR HOPE IS THAT THE NETWORK ALSO PROVIDES BENEFIT TO THEM. IN MAY 2022, UNITE DELAWARE WAS INTEGRATED INTO CHRISTIANACARE'S MEDICAL HEALTH RECORD TO ENABLE EASIER OPERABILITY FOR PROVIDERS TO SEND A REFERRAL IN A CLINICAL SETTING, AND SO THE PATIENT'S ENTIRE CARE TEAM CAN HAVE INSIGHT INTO THEIR SOCIAL NEEDS. IN OUR FY2023 ANNUAL OPERATING PLAN, IN SERVICE TO CHRISTIANACARE'S ASPIRATION OF ENDING DISPARITIES, WE SET THE GOAL OF INCREASING BY 25% THE PERCENTAGE OF PATIENTS WITH COMPLETE SDOH SCREENS FROM HIGH-RISK COMMUNITIES AS DEFINED IN THE CHNA AND INCREASING BY 25% THE NUMBER OF REFERRALS CAREGIVERS SEND THROUGH THE UNITE DELAWARE NETWORK ON BEHALF OF PATIENTS IN THE CHNA DEFINED HIGH-RISK ZIP CODES. WE FAR EXCEEDED THESE TARGETS IN FY23. IN FY23, CHRISTIANACARE'S PROGRAMS AND DEPARTMENTS THAT PARTICIPATE ON UNITE US CONNECTED 972 INDIVIDUALS TO THE UNITE DELAWARE PLATFORM AND SENT 2,194 REFERRALS TO PARTICIPATING COMMUNITY ORGANIZATIONS ON THEIR BEHALF. SOME OF CHRISTIANACARE'S PARTICIPATING DEPARTMENTS AND PROGRAMS ALSO ACCEPT REFERRALS THROUGH THE PLATFORM, AND IN FY23, WE MANAGED 1,201 REFERRALS FROM COMMUNITY PARTNERS. IN 2020, CHRISTIANACARE PARTNERED WITH ROUNDTRIP TO PROVIDE TRANSPORTATION TO MEDICAL SERVICES FOR ELIGIBLE PATIENTS WHO HAVE A TRANSPORTATION BARRIER. INITIALLY PILOTED IN TWO DEPARTMENTS, IN FY22, WE UNDERTOOK A CONSIDERABLE EXPANSION AND THERE ARE NOW MORE THAN 20 PARTICIPATING PROGRAMS AND DEPARTMENTS USING ROUNDTRIP TO SERVE PATIENTS WITH TRANSPORTATION BARRIERS. OUR EXPECTATION IS THAT PATIENTS' HEALTH WILL IMPROVE WHEN THE TRANSPORTATION BARRIER IS REMOVED. IN FY23, 19,552 RIDES WERE PROVIDED TO PATIENTS WHICH IS MORE THAN DOUBLE THE NUMBER OF RIDES PROVIDED IN FY22. THE HEALTH GUIDES ALSO CONTINUED TO CONNECT PATIENTS TO THE MEDICAL LEGAL PARTNERSHIP (MLP), CHRISTIANACARE'S COLLABORATION WITH THE DELAWARE COMMUNITY LEGAL AID SOCIETY, INC. (CLASI). THE MLP ASSISTS PRIMARY CARE PATIENTS WHO ARE AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL WITH THE MITIGATION OF CIVIL LEGAL HARDSHIPS. CHRISTIANACARE HAS CONTRACTED WITH CLASI SINCE 2015 TO PROVIDE THIS SERVICE. IN FY23, LEGAL SERVICES WERE PROVIDED TO 123 PATIENTS ON A TOTAL OF 146 NEW OPEN LEGAL CASES. SOME PATIENTS HAD MULTIPLE CIVIL LEGAL NEEDS AND SO COMPANION CASES WERE OPENED WHEN NEEDED. IN FY23, THE FOLLOWING LEGAL MATTERS WERE ADDRESSED ON BEHALF OF THE PATIENTS: . 36% HOUSING AND UTILITIES . 35% PERSONAL AND FAMILY STABILITY . 19% INCOME AND INSURANCE . 5% EDUCATION AND EMPLOYMENT . 5% LEGAL IMMIGRATION STATUS MOST OF THE PATIENTS (86) IDENTIFIED AS FEMALE AND 63% REPORTED AN INCOME AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL. FOR THE 2ND YEAR, CHRISTIANACARE'S HEALTH DEPARTMENT ALSO PROVIDED SHADOWING OPPORTUNITIES FOR UNIVERSITY OF DELAWARE NURSING STUDENTS. THIS EXPERIENCE PROVIDES EXPOSURE TO THE CHALLENGES PATIENTS MAY FACE AND HOW CHRISTIANACARE PARTNERS WITH PATIENTS TO ADDRESS THEM. IT IS ANOTHER OPPORTUNITY FOR THE NEXT GENERATION OF HEALTHCARE WORKERS TO RECOGNIZE THE IMPORTANCE OF HOLISTIC CARE. DURING THE 2022-2023 SCHOOL YEAR, 40 NURSING STUDENTS FROM THE UNIVERSITY OF DELAWARE MET AND SHADOWED CAREGIVERS IN THE COMMUNITY HEALTH DEPARTMENT. PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA) TO SUCCESSFULLY ADDRESS SOCIAL NEEDS, PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS ARE VITAL. THROUGHOUT THIS SECTION WE HAVE DESCRIBED SOME OF THE PARTNERSHIPS WE HAVE DEVELOPED TO BETTER SERVE OUR COMMUNITY. WE ARE ALSO COMMITTED TO SUPPORTING COMMUNITY-BASED ORGANIZATIONS THROUGH FUNDING. IN DECEMBER 2019, WE LAUNCHED CHRISTIANACARE'S COMMUNITY INVESTMENT FUND WITH THE AWARD OF OVER $2 MILLION IN FUNDING TO 32 COMMUNITY-BASED ORGANIZATIONS TO ADDRESS THE AREAS OF NEED PRIORITIZED IN THE 2019 CHNA. DUE TO THE FINANCIAL UNCERTAINLY CAUSED BY THE PANDEMIC, WE WERE UNABLE TO AWARD ANY FUNDS IN FY21. IN FY22, WE PROVIDED 13 ORGANIZATIONS WITH OVER $1 MILLION IN FUNDING TO ADDRESS FOOD INSECURITY AND HOUSING. IN MAY 2023, WE ANNOUNCED A NEW ROUND OF THE COMMUNITY INVESTMENT FUND THAT WOULD AWARD COMMUNITY-BASED ORGANIZATIONS WITH UP TO $75,000 TO ADDRESS FOOD INSECURITY, HOUSING, AND/OR ENVIRONMENTAL HEALTH. 17 ORGANIZATIONS WERE SELECTED TO RECEIVE A TOTAL OF JUST OVER $1 MILLION IN EARLY FY24. IN FY23, CHRISTIANACARE PROVIDED FUNDING TO THE FOLLOWING ORGANIZATIONS: . FRIENDSHIP HOUSE' TRANSITIONAL HOUSING PROGRAM TO SUPPORT THEIR CASE MANAGEMENT AND OTHER EFFORTS TO HELP RESIDENTS GAIN LONG TERM HOUSING. . THE DELAWARE COLLEGE SCHOLARS PROGRAM WHICH PREPARES HIGH-ACHIEVING UNDER-RESOURCED DELAWARE PUBLIC HIGH SCHOOL STUDENTS ACADEMICALLY AND SOCIALLY FOR SUCCESSFULLY APPLYING TO, SUCCEEDING IN, AND GRADUATING FROM FOUR-YEAR COLLEGES AND UNIVERSITIES. . THE RYSHEEMA J. DIXON FOUNDATION TO SUPPORT WILMINGTON PLAYSTREETS SUMMER 2023. THE PRIMARY GOAL OF WHICH IS TO PROMOTE HEALTHY COMMUNITIES BY PROVIDING GREATER ACCESS TO COMMUNITY RESOURCES AND CLOSE 1-2 NEIGHBORHOOD BLOCKS TO ALLOW TIME FOR PLAY IN AN ENCLOSED AND SAFE ENVIRONMENT, ENCOURAGING INTERACTIONS WITH COMMUNITIES. THE ABOVE IS NOT AN EXHAUSTIVE LIST OF THE FUNDING CONTRIBUTED TO COMMUNITY ORGANIZATIONS IN FY23, BUT IT DEMONSTRATES OUR COMMITMENT TO SUPPORTING THE DIVERSE EFFORTS OF OUR COMMUNITY PARTNERS TO MEET THE NEED OF OUR COMMUNITIES. IN ADDITION TO PROVIDING FUNDING TO COMMUNITY ORGANIZATIONS, CHRISTIANACARE ALSO PROVIDES IN-KIND DONATIONS TO ASSIST COMMUNITY ORGANIZATIONS AND REDUCE WASTE. IN FY23, THE WILMINGTON CAMPUS CAFETERIA DONATED 34,095 POUNDS OF FOOD TO THE SUNDAY BREAKFAST MISSION. THE SUNDAY BREAKFAST MISSION IN WILMINGTON PROVIDES EMERGENCY SHELTER AND MEALS TO MEN, WOMEN, AND CHILDREN. -------------------- PART V, SECTION B, LINE 13 (ELIGIBILITY FOR PROVIDING DISCOUNTED CARE) FEDERAL POVERTY GUIDELINES ARE NOT USED TO DETERMINE DISCOUNTED CARE. A SELF-PAY DISCOUNT OF 15% IS APPLIED TO ALL UNINSURED PATIENT ACCOUNTS REGARDLESS OF INCOME. PATIENTS WITH INCOME IN EXCESS OF 200% OF THE FEDERAL POVERTY LEVEL WILL RECEIVE A 15% DISCOUNT. -------------------- PART V, SECTION B, LINE 16 (FINANCIAL ASSISTANCE POLICY AVAILABILITY) A COPY OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY CAN BE ACCESSED AT: https://christianacare.org/US/EN/VISIT-US/FOR-PATIENTS/FINANCIAL-ASSISTANC E-PROGRAM-SUMMARY/FINANCIAL-ASSISTANCE-PROGRAM -------------------- PART V, SECTION B, LINE 20 (ADDITIONAL EFFORTS MADE BEFORE AN ECA) CHRISTIANA CARE HEALTH SERVICES COMMUNICATES IN WRITING ABOUT COLLECTION PLACEMENT AND THE FINANCIAL ASSISTANCE POLICY. -------------------- PART V, SECTION B, LINE 22 (CHARGES FOR FAP-ELIGIBLE INDIVIDUALS) FAP-ELIGIBLE INDIVIDUALS (THOSE WITH INCOME LESS THAN 200% OF FEDERAL POVERTY GUIDELINES) ARE NOT RESPONSIBLE FOR ANY CHARGES. -------------------- PART I, LINE 3C (DES. OF ELIGIBILITY CRITERIA FOR FREE OR DISCOUNTED CARE) CHRISTIANA CARE HEALTH SERVICES, INC.("CHRISTIANACARE") HAS A SELF PAY DISCOUNT PERCENTAGE OF 15% THAT IS APPLIED TO ALL UNINSURED PATIENTS' ACCOUNTS, REGARDLESS OF THE PERSON'S ABILITY TO PAY. THIS DISCOUNT PERCENTAGE IS COMPARABLE TO THAT WHICH IS EXTENDED TO OUR MANAGED CARE COMPANIES. -------------------- PART I, LINE 6A (COMMUNITY BENEFIT ANNUAL REPORT INFORMATION) CHRISTIANACARE HEALTH PREPARED A COMMUNITY HEALTH NEEDS ASSESSMENT AND A COMMUNITY HEALTH IMPLEMENTATION PLAN DURING THE FY2022 TAX YEAR. BOTH DOCUMENTS ARE AVAILABLE AT THE FOLLOWING LINK ON THE CCHS WEBSITE: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY- HEALTH-IMPLEMENTATION-PLAN/ -------------------- PART I, LINE 7 (BAD DEBT EXPENSE, COSTING METHODOLOGY USED) IMPLICIT PRICE CONCESSIONS ARE TREATED AS A CONTRA-REVENUE ITEM ON THE STATEMENT OF REVENUE. AS A RESULT, THERE ARE NO BAD DEBT EXPENSES INCLUDED ON FORM 990, PART IX THAT NEED TO BE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES LISTED. THE COSTING METHODOLOGY USED IN CALCULATING THE AMOUNTS REPORTED ON THE LINE 7 TABLE ARE BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. -------------------- PART II (COMMUNITY BUILDING ACTIVITIES) IN FY23, THE ECONOMIC DEVELOPMENT ACTIVITIES CHRISTIANACARE UNDERTOOK WERE PARTICIPATION ON THE FOLLOWING COMMUNITY ORGANIZATION BOARDS AND LEADERSHIP TEAMS: VISION COALITION OF DELAWARE: A PUBLIC PRIVATE PARTNERSHIP COMPOSED OF A BROAD RANGE OF DELAWARE WORKING TOGETHER TO IMPROVE DELAWARE PUBLIC EDUCATION. CHRISTIANACARE'S CHIEF HEALTH EQUITY AND PUBLIC AFFAIRS OFFICER SERVES AS CHAIR OF THE VISION COALITION. SENIOR LEADERSHIP SERVES ON THE DELAWARE BUSINESS ROUNDTABLE EDUCATION COMMITTEE: A NONPROFIT ORGANIZATION THAT AIMS TO IMPROVE PUBLIC EDUCATION BY AGGREGATING AND ALIGNING THE RESOURCES OF ROUNDTABLE MEMBERS AND OTHER BUSINESS LEADERS. WILMINGTON ALLIANCE: A NONPROFIT ORGANIZATION THAT PARTNERS WITH COMMUNITY, CIVIC, AND BUSINESS LEADERS TO PRIORITIZE THE CITY'S HIGHEST NEEDS TO DRIVE ECONOMIC OPPORTUNITY AND SOCIAL VITALITY. IN ADDITION TO OUR WILMINGTON HOSPITAL'S CAMPUS EXECUTIVE DIRECTOR'S PARTICIPATION ON THE WILMINGTON ALLIANCE EXECUTIVE BOARD, AS VICE CHAIR, CHRISTIANACARE ALSO PROVIDED WILMINGTON ALLIANCE WITH $90,000 IN FUNDING TO SUPPORT THEIR MISSION. OUR PARTICIPATION IN THE HEALTHCARE ANCHOR NETWORK, AN ORGANIZATION DEVOTED TO HELPING HEALTHCARE SYSTEMS BUILD MORE INCLUSIVE AND SUSTAINABLE LOCAL COMMUNITIES, IS ALSO INCLUDED IN THIS CATEGORY. IN THE COMMUNITY BUILDING CATEGORY OF COMMUNITY SUPPORT, WE REPORTED CHRISTIANACARE'S $150,000 CONTRIBUTION TO DELAWARE COLLEGE SCHOLARS WHICH SERVES TO ACADEMICALLY AND SOCIALLY PREPARE HIGH-ACHIEVING, UNDER-RESOURCED DELAWARE PUBLIC HIGH SCHOOL STUDENTS FOR SUCCESSFULLY APPLYING TO, SUCCEEDING IN, AND GRADUATING FROM FOUR-YEAR COLLEGES AND UNIVERSITIES. IN THE COMMUNITY BUILDING CATEGORY OF COALITION BUILDING, WE REPORTED THE TIME SPENT BY OUR CHIEF PUBLIC AFFAIRS AND CHIEF HEALTH EQUITY OFFICER PARTICIPATING ON THE PURPOSE-BUILT COMMUNITIES' REACH RIVERSIDE COMMUNITY DEVELOPMENT INITIATIVE BOARD OF DIRECTORS. IN 2019, CHRISTIANACARE CONTRIBUTED $1 MILLION TO THIS INITIATIVE TO REVITALIZE THE RIVERSIDE NEIGHBORHOOD IN WILMINGTON AND OUR CHIEF PUBLIC AFFAIRS OFFICER AND CHIEF HEALTH EQUITY OFFICER HAS CONTINUED TO SUPPORT THIS INITIATIVE. IN THE COMMUNITY BUILDING CATEGORY OF ENVIRONMENTAL IMPROVEMENTS, WE REPORTED EXPENSES RELATED TO THE ENVIRONMENTAL HEALTH ROUNDTABLE WE ORGANIZED IN MAY 2023. THE SMALL, BUT MEANINGFUL, EVENT WAS HELD AT THE TEEN WAREHOUSE LOCATED IN A NEIGHBORHOOD THAT HAS SUFFERED FROM THE IMPACT OF FLOODING RECENTLY AND THROUGHOUT ITS HISTORY. COMMUNITY STAKEHOLDERS SUCH AS THE CHIEF EXECUTIVE OFFICER OF REACH RIVERSIDE, DELAWARE NATURAL RESOURCES AND ENVIRONMENTAL CONTROL SECRETARY, CHIEF EXECUTIVE OFFICER OF THE DELAWARE NATURE SOCIETY CEO, AND STATE REPRESENTATIVES CONVENED TO DISCUSS WITH CHRISTIANACARE LEADERS ENVIRONMENTAL EFFORTS THEY ARE UNDERTAKING AND OPPORTUNITIES FOR COLLABORATION. THIS WORK WILL BE ONGOING AS CHRISTIANACARE STRIVES TO BE A LEADER IN ENVIRONMENTAL STEWARDSHIP. FINALLY, CHRISTIANACARE INVESTS CONSIDERABLY IN WORKFORCE DEVELOPMENT. OUR WORKFORCE DEVELOPMENT INITIATIVES SERVE TO BOTH INFLUENCE THE NEXT GENERATION OF HEALTHCARE WORKERS TO UNDERSTAND THE BARRIERS TO GOOD HEALTH PATIENTS MAY FACE AND DEVELOP A WORKFORCE THAT REFLECTS OUR COMMUNITY. CHRISTIANACARE IS IN THE 2ND YEAR OF ITS 5-YEAR COMMITMENT OF $500,000 TO AWARD MERIT-BASED SCHOLARSHIPS OF $12,500 TO TEN STUDENTS PER YEAR, PER STUDENT, TO ATTEND AN HBCU. THE FOCUS OF THE SCHOLARSHIP PROGRAM ARE MINORITY STUDENTS WHO ARE PURSUING A FIELD OF STUDY IN HEALTH CARE. THESE STUDENTS ALSO PARTICIPATED IN AN INTERNSHIP PROGRAM AT CHRISTIANACARE. CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT ALSO OFFERS YOUTH PROGRAMMING THAT EXPOSES THE PARTICIPANTS, OR SCHOLARS AS WE REFER TO THEM, TO POTENTIAL CAREERS IN THE HEALTH FIELD AND PROVIDES THEM WITH THE SKILLS AND EXPERIENCE TO SUPPORT THEIR DEVELOPMENT INTO YOUNG ADULTS EVEN IF THEY CHOOSE TO TAKE A DIFFERENT PATH. IN FY23, THE FOLLOWING PROGRAMS WERE OFFERED: BACK 2 BASICS 2.0: THIS PROGRAM, OFFERED IN PARTNERSHIP WITH JOBS FOR DELAWARE GRADS, A SCHOOL-TO-WORK TRANSITIONAL PROGRAM DEDICATED TO HELPING YOUTH REACH ACADEMIC AND ECONOMIC SUCCESS, WAS CREATED IN RESPONSE TO THE CORONAVIRUS PANDEMIC. IT PROVIDES HIGH SCHOOL SCHOLARS WITH THE OPPORTUNITY TO PARTICIPATE IN 12 IMMERSIVE SESSIONS THROUGH A CASE STUDY APPROACH. IN FY23, 64 SCHOLARS PARTICIPATED IN THIS PROGRAM. WORK BASED LEARNING (NURSING/SURGICAL SERVICES): THIS PROGRAM, INTRODUCED IN FY23, IS DESIGNED TO INCREASE SCHOLAR AWARENESS OF POTENTIAL SURGICAL SERVICE CAREERS, THROUGH REAL WORLD WORKPLACE OBSERVATION AND ENGAGEMENT WITH HEALTHCARE PROFESSIONALS. SCHOLARS EXPLORE A VARIETY OF OCCUPATIONS WITHIN THE SURGICAL SETTING, SCOPE OF ROLE/RESPONSIBILITIES, ESSENTIAL SKILLS, AND EDUCATIONAL REQUIREMENTS AND PATHWAYS. PARTICIPANTS ARE SENIORS AT APPOQUINIMINK HIGH SCHOOL OR MIDDLETOWN HIGH SCHOOL AND ENROLLED IN THE SCHOOL OF HEALTH SCIENCE PATHWAY. SCHOLARS PARTICIPATING IN CHRISTIANACARE'S SURGICAL SERVICE WORK BASED LEARNING EXPERIENCE MUST ATTEND ALL HOSPITAL PROGRAM DATES AND BACK 2 BASICS VIRTUAL SESSIONS. IN FY23, 5 SCHOLARS COMPLETED THIS PROGRAM. NURSING CAREER COLLABORATIVE: THIS PROGRAM WAS DEVELOPED TO SERVE AS A PATHWAY TO NURSING FOR HIGH SCHOOL SCHOLARS FROM WILLIAM PENN HIGH SCHOOL AND FREIRE CHARTER SCHOOL. THROUGH THE NURSING CAREER COLLABORATIVE, SCHOLARS ARE EDUCATED AND EXPOSED TO THE FIELD AND FUNDAMENTALS OF NURSING. ON THEIR LAST DAY OF THE PROGRAM, SCHOLARS ALSO HAD AN OPPORTUNITY TO SHADOW ON A UNIT WITH A NURSE. IN FY23, 20 SCHOLARS PARTICIPATED. MEDICAL ASSISTANT CO-OP: IN FY 23, 9 MEDICAL ASSISTANT TRACT SCHOLARS FROM DELCASTLE AND ST. GEORGES TECHNICAL HIGH SCHOOLS CAME TO CHRISTIANACARE FOR THE CO-OP EXPERIENCE. UPON COMPLETION OF THE ACADEMIC SCHOOL YEAR IN JUNE 2023, 2 OF THE SCHOLARS WERE HIRED ON AS MEDICAL ASSISTANCES. BRANDYWINE LIFESAVERS PROGRAM: IN FY23, CHRISTIANACARE AGAIN PARTNERED WITH THE BRANDYWINE LIFESAVERS PROGRAM WHICH WAS DEVELOPED BY BRANDYWINE SCHOOL DISTRICT NURSES TO CREATE A PIPELINE FOR YOUNGER STUDENTS TO BE INTRODUCED TO POSSIBLE CAREERS IN HEALTH CARE. THE PROGRAM ALSO FOCUSES ITS ATTENTION ON STUDENTS FROM BACKGROUNDS NOT REPRESENTED IN THE NURSING PROFESSION. 60 MIDDLE AND HIGH SCHOOL SCHOLARS FROM THE BRANDYWINE SCHOOL DISTRICT VISITED CHRISTIANACARE'S NEWARK CAMPUS IN MARCH AND APRIL 2023 TO LEARN ABOUT DIFFERENT SPECIALTY STATIONS AND TOUR A PATIENT CARE UNIT. THE TOPICS OF MENTAL HEALTH AND THE IMPORTANCE OF SELF-CARE AND MENTORSHIP WERE ALSO DISCUSSED WITH THE SCHOLARS. -------------------- PART III, SECTION A, LINE 2 (IMPLICIT PRICE CONCESSIONS/BAD DEBT EXPENSE) THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 ARE BASED ON ACTUAL CHARGES WRITTEN OFF (AMOUNTS THAT ARE DEEMED TO BE UNCOLLECTIBLE AND RECORDED AS IMPLICIT PRICE CONCESSIONS UNDER ACCOUNTING PRONOUNCEMENT ASC 606). -------------------- PART III, SECTION A, LINE 3 (IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY) THE AMOUNT OF BAD DEBTS (IMPLICIT PRICE CONCESSIONS) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ITS FINANCIAL ASSISTANCE POLICY WAS CALCULATED BASED UPON THE NUMBER OF PRESUMED CHARITY-CARE ELIGIBLE PATIENTS WHO DID NOT COMPLETE THE FAP PAPERWORK DURING THE YEAR. -------------------- PART III, SECTION A, LINE 4 (IMPLICIT PRICE CONCESSION FOOTNOTE) THE TEXT OF THE IMPLICIT PRICE CONCESSION (BAD DEBT EXPENSE) FOOTNOTE CAN BE FOUND ON PAGE 13 OF THE ELECTRONICALLY ATTACHED AUDITED FINANCIAL STATEMENTS. -------------------- PART III, SECTION B, LINE 8 (COSTING METHODOLOGY, MEDICARE SHORTFALL) THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 6 IS BASED ON A COST TO CHARGE RATIO. CONSISTENT WITH THE CHARITABLE HEALTHCARE MISSION OF CHRISTIANACARE AND THE COMMUNITY BENEFIT STANDARD SET FORTH IN IRS REVENUE RULING 69-545, CHRISTIANACARE PROVIDES CARE FOR ALL PATIENTS COVERED BY MEDICARE SEEKING MEDICAL CARE. SUCH CARE IS PROVIDED REGARDLESS OF WHETHER THE REIMBURSEMENT PROVIDED FOR SUCH SERVICES MEETS OR EXCEEDS THE COSTS INCURRED BY CHRISTIANACARE TO PROVIDE SUCH SERVICES. AS A RESULT, CHRISTIANA CARE VIEWS ANY SHORTFALL REPORTED IN LINE 7 AS AN ADDITIONAL ITEM OF COMMUNITY BENEFIT PROVIDED BY THE ORGANIZATION. -------------------- PART III, SECTION B, LINE 9B (COLLECTION PRACTICES) CHRISTIANACARE HAS A FINANCIAL ASSISTANCE POLICY THAT IDENTIFIES THE CIRCUMSTANCES FOR WHICH A RESPONSIBLE PARTY WOULD BE EXTENDED A 100% ADJUSTMENT ON ALL MEDICAL BILLS. THE GROSS INCOME THRESHOLD FOR THIS CHARITABLE ADJUSTMENT IS 200% OF THE FEDERAL POVERTY LEVEL AND IT IS BASED ON THE NUMBER OF DEPENDENTS IN THE HOUSEHOLD. THE FINANCIAL ASSISTANCE POLICY FURTHER EXPLAINS THAT ANY UNINSURED PATIENT WHO FAILS TO QUALIFY FOR FINANCIAL ASSISTANCE WOULD BE GRANTED A 15% SELF PAY DISCOUNT. PATIENTS MAY ALSO ESTABLISH INTEREST-FREE MONTHLY PAYMENT ARRANGEMENTS FOR ANY OUTSTANDING BALANCE THAT IS NOT COVERED BY A THIRD PARTY PAYER. AS PART OF THE SELF PAY DUNNING PROCESS, CHRISTIANA CARE MAKES UNINSURED PATIENTS AWARE OF THE FINANCIAL ASSISTANCE PROGRAM WITH THE RELEASE OF OUR FIRST STATEMENT. FOR ALL SUBSEQUENT STATEMENTS, PATIENTS HAVE AN OPPORTUNITY TO CALL OUR CUSTOMER SERVICES DEPARTMENT IF THEY ARE UNABLE TO MAKE PAYMENT IN FULL. IF A PATIENT QUALIFIES FOR A CHARITABLE ADJUSTMENT, THEY ARE EXTENDED THE COURTESY OF AN AUTOMATIC ADJUSTMENT TO THEIR BILLS FOR THE NEXT YEAR AND FOR ONE YEAR PRIOR TO THE DATE A PATIENT'S APPLICATION IS APPROVED. PATIENTS WOULD NEED TO REAPPLY FOR CHARITABLE CONSIDERATION AFTER THE ONE YEAR HAS LAPSED. ALL COLLECTION ACTIONS WOULD CEASE ONCE A PATIENT IS DEEMED ELIGIBLE FOR CHARITY OR ONCE A PATIENT ESTABLISHES AND MAINTAINS A MONTHLY PAYMENT ARRANGEMENT. -------------------- PART VI, LINE 2 (NEEDS ASSESSMENT) AT CHRISTIANACARE, WE PARTNER WITH OUR NEIGHBORS TO PROVIDE THEM WITH SYSTEMS OF CARE THAT THEY VALUE. KNOWING WHAT OUR NEIGHBORS VALUE IS ONLY POSSIBLE THROUGH COMMUNICATION. TWO OF THE BEHAVIORS THAT GUIDE CHRISTIANACARE CAREGIVERS ARE A WILLINGNESS TO LISTEN ACTIVELY AND SEEK NEW KNOWLEDGE AND IT IS WITH THIS MINDSET THAT WE APPROACH OUR PARTNERSHIPS IN THE COMMUNITY AND OUR SERVICE TO OUR PATIENTS. MANY OF THE WAYS IN WHICH CHRISTIANACARE ASSESSES THE HEALTH NEEDS OF OUR COMMUNITY HAVE BEEN DESCRIBED. A SYSTEM WIDE SDOH SCREENING INSTRUMENT WAS IMPLEMENTED TO LEARN DIRECTLY FROM OUR PATIENTS ABOUT THEIR CHALLENGES, AND WE PARTNERED WITH UNITE US TO LAUNCH UNITE DELAWARE IN THE STATE TO PROVIDE A TOOL TO ADDRESS OUR PATIENTS' NEEDS AS WELL AS INSIGHT INTO THE NEEDS OF DELAWAREANS. IN FY23, THE TOP NEEDS REFERRED TO IN UNITE DELAWARE WERE HOUSING & SHELTER, UTILITIES, FOOD ASSISTANCE, CLOTHING & HOUSEHOLD GOODS, AND INCOME SUPPORT. THE COMMUNITY INVESTMENT FUND ALSO PROVIDES US WITH THE OPPORTUNITY TO LEARN FROM COMMUNITY-BASED ORGANIZATIONS ABOUT THE CHALLENGES THEIR COMMUNITIES FACE AND HOW THEY THINK BEST TO ADDRESS THEM. 72 ORGANIZATIONS APPLIED FOR OUR MOST RECENT ROUND OF FUNDING. DIRECTLY PARTNERING WITH COMMUNITY ORGANIZATIONS ALSO PROVIDES INSIGHT INTO OUR COMMUNITY. THE GREATER WILMINGTON COMMUNITY PARTNERSHIP WAS FORMED WITH COMMUNITY PARTNERS IN 2012 TO ADDRESS THE NEEDS OF HOMELESS INDIVIDUALS. THE FOCUS HAS SINCE EXPANDED TO SOCIAL DETERMINANTS OF HEALTH BROADLY, AND IT CONTINUES TO BE HOSTED BY CHRISTIANACARE. MONTHLY MEETINGS PROVIDE INFORMATION AND RESOURCE SHARING AND THE OPPORTUNITY TO DISCUSS COMMUNITY CHALLENGES. PARTICIPANTS INCLUDE THOSE FROM FAITH-BASED, NON-PROFIT, AND GOVERNMENT ORGANIZATIONS. CHAIRED BY A CHRISTIANACARE PROVIDER, THE WILMINGTON CONSORTIUM SERVES TO EDUCATE PROFESSIONALS WORKING WITH FAMILIES WITH CHILDREN FROM BIRTH TO AGE 5. LIKE THE GREATER WILMINGTON COMMUNITY PARTNERSHIP, THE PURPOSE OF THE GROUP IS TO SHARE RESOURCES AND DISCUSS COMMUNITY ISSUES AS THEY RELATE TO FAMILIES WITH YOUNG CHILDREN. MEMBERS ARE ALSO ABLE TO SHARE COMMUNITY EVENTS AND RESOURCES WHICH ARE EMAILED TO ALL MEMBERS. THE COMMUNITY ENGAGEMENT ADVISORY COUNCIL, CO-CHAIRED BY CHRISTIANACARE'S CHIEF HEALTH EQUITY OFFICER, WAS FORMED TO PROVIDE CHRISTIANACARE WITH A DIRECT CONNECTION TO COMMUNITY LEADERS AND STAKEHOLDERS TO GAIN THEIR PERSPECTIVE ON COMMUNITY NEEDS AND IDENTIFY OPPORTUNITIES IN WHICH BOTH THE COMMUNITY AND CHRISTIANACARE CAN BENEFIT FROM WORKING TOGETHER TOWARDS MUTUAL GOALS. CHRISTIANACARE'S PATIENT & FAMILY HEALTH EDUCATION TEAM HAS ALSO PARTNERED WITH THE UNIVERSITY OF DELAWARE PARTNERSHIP FOR HEALTHY COMMUNITIES AND THE DELAWARE DIVISION OF PUBLIC HEALTH TO IMPROVE HEALTH LITERACY IN OUR STATE. SOME OF THEIR SUCCESSFUL EFFORTS, WHICH INCLUDED THE DEVELOPMENT OF AND PARTICIPATION ON THE HEALTH LITERACY COUNCIL OF DELAWARE, WERE DESCRIBED PREVIOUSLY AS A WAY IN WHICH WE ARE ALSO PROMOTING ACCESS TO CARE. PARTICIPATION BY CHRISTIANACARE LEADERS ON COMMUNITY BOARDS AND COMMITTEES ALSO PROVIDES INSIGHT INTO COMMUNITY NEEDS. THE DELAWARE HEALTHY MOTHER AND INFANT CONSORTIUM, THE VISION COALITION OF DELAWARE, THE REACH RIVERSIDE BOARD, THE DELAWARE BUSINESS ROUNDTABLE, THE WILMINGTON ALLIANCE, AND AIDS DELAWARE, AMONG OTHER ORGANIZATIONS, ARE ALL SERVED BY CHRISTIANACARE CAREGIVERS. -------------------- PART VI, LINE 3 (PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE) ON FEBRUARY 1, 2023, CHRISTIANACARE MADE SEVERAL CHANGES TO ITS FINANCIAL ASSISTANCE POLICY TO MAKE IT AVAILABLE TO MORE OF OUR NEIGHBORS. THE FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLD WAS RAISED FROM 200% TO 400% OF THE FEDERAL POVERTY LEVEL AND PATIENTS FACING CATASTROPHIC COSTS, WHERE THE MEDICAL EXPENSES FOR AN EPISODE OF CARE EXCEED 20% OF THEIR ANNUAL INCOME, CAN NOW APPLY FOR FINANCIAL ASSISTANCE AS WELL. CHRISTIANACARE'S PRESUMPTIVE ELIGIBILITY PROCESS WAS ALSO UPDATED AND CLARIFIED IN THE FINANCIAL ASSISTANCE POLICY TO REDUCE THE BURDEN ON PATIENTS TO SUPPLY SUPPORTING DOCUMENTATION. THE PROCESS FOR CHRISTIANACARE REPRESENTATIVES TO MAKE IMMEDIATE CASE-BY-CASE DETERMINATIONS OF INDIVIDUAL ELIGIBILITY AND ACCEPT ALTERNATIVE QUALIFYING DOCUMENTATION FOR FINANCIAL ASSISTANCE WAS ALSO UPDATED AND STREAMLINED. THOSE WHO ARE UNINSURED WITH HOUSEHOLD INCOMES GREATER THAN 400% OF THE FPL ARE ELIGIBLE FOR A STANDARD DISCOUNT OF 15%. CHRISTIANACARE'S FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON OUR WEBSITE: FINANCIAL ASSISTANCE PROGRAM SUMMARY - CHRISTIANACARE ALONG WITH THE FOLLOWING MATERIALS IN ENGLISH, SPANISH, CANTONESE, AND MANDARIN WHICH ARE THE MOST SPOKEN LANGUAGES BESIDES ENGLISH: . A PLAIN LANGUAGE SUMMARY, . THE FINANCIAL ASSISTANCE APPLICATION, . A DESCRIPTION OF THE APPLICATION PROCESS, . THE INCOME SCALES, . THE FINANCIAL ASSISTANCE SERVICE AREA, AND . A LIST OF PARTICIPATING AND NON-PARTICIPATING PROVIDERS. THE FINANCIAL ASSISTANCE PROGRAM IS PUBLICIZED THROUGH PAMPHLETS, SIGNAGE, ONLINE NOTICES ON THE CHRISTIANACARE WEBSITE, AND IN-PATIENT SERVICE AREAS. THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PROVIDED TO PATIENTS WHO ARE UNINSURED OR UNDERINSURED AND WHO INDICATE THEIR INABILITY TO PAY FOR MEDICALLY NECESSARY SERVICES AT INTAKE OR DISCHARGE. TRANSLATION ASSISTANCE BY PHONE TO COMPLETE NECESSARY FORMS FOR ANYONE NOT PROFICIENT IN READING, WRITING, OR SPEAKING ENGLISH IS ALSO AVAILABLE MONDAY THROUGH FRIDAY FROM 9 A.M. TO 4 P.M. PATIENTS MAY ALSO CALL PATIENT FINANCIAL SERVICES TO REQUEST INFORMATION AND AN APPLICATION AND TO TALK CONFIDENTIALLY ABOUT THEIR SITUATION. IF CHRISTIANACARE DETERMINES THAT THE PATIENT MAY QUALIFY FOR OTHER COVERAGE, FINANCIAL COUNSELING IS PROVIDED TO ASSIST PATIENTS TO APPLY FOR THE AVAILABLE COVERAGE. CHRISTIANACARE'S FINANCIAL ASSISTANCE POLICY WEBPAGE AND PLAIN LANGUAGE SUMMARY ALSO INCLUDES CONTACT INFORMATION OF STATE AND FEDERAL HEALTH INSURANCE RESOURCES FOR THOSE WHO ARE UNINSURED. AS DESCRIBED PREVIOUSLY, CHRISTIANACARE'S HEALTH GUIDES ARE ALSO AVAILABLE TO HELP PATIENTS OVERCOME FINANCIAL BARRIERS. THEY ASSIST PATIENTS IN COMPLETING THE CHRISTIANACARE APPLICATION FOR FINANCIAL ASSISTANCE AS WELL AS ENROLL IN HEALTH INSURANCE OR APPLY FOR PRESCRIPTION ASSISTANCE OR MEDICAID, TO NAME JUST A FEW EXAMPLES. IN FY23, THE HEALTH GUIDES ASSISTED PATIENTS IN APPLYING FOR $2,652.177.67 IN CHRISTIANACARE FINANCIAL ASSISTANCE. -------------------- PART VI, LINE 4 (COMMUNITY INFORMATION) CHRISTIANACARE PROVIDES SERVICES IN FOUR STATES, BUT DUE TO THE HIGH PERCENTAGE OF NEW CASTLE COUNTY RESIDENTS AMONG THOSE DISCHARGED FROM CHRISTIANACARE'S TWO DELAWARE HOSPITALS, WE IDENTIFIED NEW CASTLE COUNTY AS OUR SERVICE AREA. IN FY2021, 77% OF CHRISTIANA HOSPITAL'S DISCHARGES AND 91% OF WILMINGTON HOSPITAL'S DISCHARGES WERE FOR NEW CASTLE COUNTY RESIDENTS. THE TOTAL POPULATION OF NEW CASTLE COUNTY IN 2021 WAS APPROXIMATELY 553,500 PERSONS. THIS POPULATION IS EXPECTED TO GROW 2.6% FROM 2020 TO 2030. THE POPULATION 65 YEARS OF AGE AND OLDER IS ANTICIPATED TO GROW BY 30.5% DURING THAT TIME. DUE TO THE CONSIDERABLE VARIATION AMONG SOCIOECONOMIC CONDITIONS IN NEW CASTLE COUNTY, THE 2022 CHNA ASSESSED COMMUNITY HEALTH NEEDS IN TWO GEOGRAPHIC AREAS OF NEW CASTLE COUNTY: "COMMUNITY 1" (ZIP CODES 19801, 19802, 19804, 19805, AND 19720) AND "COMMUNITY 2" (ALL OTHER NEW CASTLE COUNTY ZIP CODES). COMMUNITY 1 ACCOUNTED FOR 28% OF CHRISTIANACARE DISCHARGES IN 2021 AND COMMUNITY 2 ACCOUNTED FOR 52% OF CHRISTIANACARE DISCHARGES. THE OVERALL POVERTY RATE IN NEW CASTLE COUNTY HAS BEEN BELOW DELAWARE AND U.S. AVERAGES; HOWEVER, RATES FOR BLACK AND FOR HISPANIC COUNTY RESIDENTS HAVE BEEN SUBSTANTIALLY HIGHER THAN RATES FOR WHITE RESIDENTS. THE POVERTY RATE IN COMMUNITY 1 HAS BEEN MORE THAN DOUBLE THE RATE FOR COMMUNITY 2 (16.8% COMPARED TO 8.3%). IN COMMUNITY 1, APPROXIMATELY 48% OF THE POPULATION IDENTIFIES AS BLACK; IN COMMUNITY 2, THIS STATISTIC IS 17%. APPROXIMATELY 15% OF THE OVERALL POPULATION IN COMMUNITY 1 IDENTIFIES AS HISPANIC; IN COMMUNITY 2, THIS STATISTIC IS ABOUT 8%. LOW-INCOME CENSUS TRACTS ARE MOST PREVALENT IN NEWARK, WILMINGTON AND THROUGHOUT COMMUNITY 1. IN MANY OF THESE CENSUS TRACTS, MORE THAN ONE-HALF OF HOUSEHOLDS ARE "RENT BURDENED,CATEGORIZED AS "HIGH NEED" BY THE DIGNITY HEALTH COMMUNITY NEED INDEXTM (CNI) AND ARE IN THE TOP QUARTILE NATIONALLY FOR "SOCIAL VULNERABILITY" ACCORDING TO THE CENTERS FOR DISEASE CONTROL'S SOCIAL VULNERABILITY INDEX. BECAUSE OF THESE DISPARITIES AMONG NEW CASTLE COUNTY COMMUNITIES, WE SET THE FY23 AOP GOALS OF INCREASED SDOH SCREENING AND RESOURCE REFERRALS THROUGH UNITE DELAWARE FOR PATIENTS LIVING IN COMMUNITY 1. OUR COMMITMENT TO SDOH SCREENING AMONG ALL PATIENTS WILL ENSURE PATIENTS OUTSIDE OF COMMUNITY 1 ARE ALSO RECOGNIZED THROUGH OUR UNIVERSAL SCREENING. -------------------- PART VI, LINE 5 (INFORMATION REGARDING PROMOTION OF COMMUNITY HEALTH) CHRISTIANACARE IS CENTERED ON IMPROVING HEALTH OUTCOMES, MAKING HIGH-QUALITY CARE MORE ACCESSIBLE, AND LOWERING HEALTH CARE COSTS. GUIDED BY OUR VALUES, LOVE AND EXCELLENCE, CHRISTIANACARE IS FOCUSED ON MEETING THE NEEDS OF OUR COMMUNITY. CHRISTIANACARE HAS AN EXTENSIVE NETWORK OF PRIMARY CARE AND OUTPATIENT SERVICES, HOME HEALTH CARE, URGENT CARE CENTERS, THREE HOSPITALS (1,200 BEDS), A FREESTANDING EMERGENCY DEPARTMENT, A 24/7 PEDIATRIC CARE CENTER, THE ONLY LEVEL I TRAUMA CENTER AND THE ONLY HIGH-RISK DELIVERING HOSPITAL IN DELAWARE OFFERING A LEVEL III NEONATAL INTENSIVE CARE UNIT, A COMPREHENSIVE STROKE CENTER, REGIONAL CENTERS OF EXCELLENCE IN HEART AND VASCULAR CARE, CANCER CARE, AND WOMEN'S HEALTH, AND THE GENE EDITING INSTITUTE. CHRISTIANACARE IS ALSO ONE OF THE LARGEST COMMUNITY-BASED TEACHING HOSPITALS CONDUCTING RESEARCH IN THE UNITED STATES. AS DEMONSTRATED THROUGHOUT OUR RESPONSES, WE ARE COMMITTED TO ENSURING OUR NEXT GENERATION OF HEALTHCARE PROFESSIONALS ARE PREPARED TO SERVE OUR COMMUNITY. CHRISTIANACARE WAS ONE OF THE FIRST HOSPITALS IN THE NATION TO ESTABLISH AN EMBEDDED RESEARCH INSTITUTE, THE INSTITUTE FOR RESEARCH ON EQUITY AND COMMUNITY HEALTH. THIS EMBEDDED RESEARCH INSTITUTE CONDUCTS APPLIED RESEARCH FOCUSED ON ISSUES OF EQUITY AND COMMUNITY HEALTH, POPULATION HEALTH, AND VIRTUAL HEALTH, AS WELL AS TRAINING THE NEXT GENERATION OF CLINICAL SCIENTISTS WITH THE GOAL TO BRIDGE THE GAP BETWEEN CLINICAL AND TRANSLATIONAL RESEARCH, ADVANCEMENTS IN THE QUALITY OF CARE, AND IMPROVED HEALTH OUTCOMES FOR ALL. AN EXAMPLE OF THEIR WORK IS A 2021 STUDY THAT SHOWED DISPROPORTIONATELY HIGHER COUNTS OF CONVENIENCE STORE TOBACCO RETAILERS LOCATED IN MEDIUM AND HIGH-DENSITY RESIDENTIAL ZONES IN PREDOMINATELY AFRICAN AMERICAN AND LATINX NEIGHBORHOODS WITHIN THE CITY OF WILMINGTON RELATIVE TO THE SURROUNDING COUNTY. THE AUTHORS PROPOSED ZONING SOLUTIONS AS A TOOL TO FIGHT TOBACCO USE. CHRISTIANACARE IS ALSO COMMITTED TO PROVIDING AFFORDABLE AND VALUE-BASED CARE. CHRISTIANACARE IS A FOUNDING PARTNER IN EBRIGHTHEALTH ACO, AN ACCOUNTABLE CARE ORGANIZATION THAT SERVES APPROXIMATELY 30,000 REGIONAL MEDICARE BENEFICIARIES FROM DELAWARE, PENNSYLVANIA, AND MARYLAND. CHRISTIANACARE'S CAREVIO PROVIDES THE CARE COORDINATION FOR THIS INITIATIVE. CAREVIO HARNESSES AN INFORMATION TECHNOLOGY PLATFORM THAT IDENTIFIES THE PATIENTS WHO ARE AT HIGHEST RISK AND WHO HAVE SIGNIFICANT CARE NEEDS, INCLUDING THOSE WHO DO NOT REGULARLY ACCESS PRIMARY CARE AND PREVENTIVE SERVICES. UNDERSTANDING WHO IS AT RISK FOR POOR HEALTH ENABLES CLINICIANS TO PROACTIVELY CONTACT THE INDIVIDUAL TO CONNECT THEM TO THE HEALTH SERVICES THEY NEED. IN PERFORMANCE YEAR 2022, THE EBRIGHTHEALTH ACO REDUCED HEALTH CARE SPENDING BY APPROXIMATELY $9.5 MILLION AND EARNED A QUALITY SCORE OF 86.7%. THIS IS THE THIRD CONSECUTIVE YEAR THE ACO HAS ACHIEVED SHARED SAVINGS AND THE SEVENTH CONSECUTIVE YEAR THAT EBRIGHTHEALTH ACO HAS REDUCED HEALTH CARE COSTS FOR ITS ATTRIBUTED BENEFICIARIES. THE CUMULATIVE AMOUNT SAVED IS $54 MILLION. IN 2021, CHRISTIANACARE ALSO LAUNCHED ONE OF THE FIRST MEDICAID ACOS IN THE STATE, DELAWARE MEDICAID QUALITY PARTNERS ACO. THIS ACO SERVES MORE THAN 18,000 MEDICAID PATIENTS AND IS ALSO SUPPORTED BY CAREVIO. THIS ACO WILL FOCUS ON HEALTH EQUITY, CARE STANDARDIZATION, AND SOCIAL DETERMINANTS OF HEALTH TO ENSURE PATIENTS ARE SET UP FOR SUCCESS IN ACHIEVING POSITIVE HEALTH OUTCOMES. CHRISTIANACARE ALSO STRIVES TO BE A LEADER AMONG OTHER BUSINESSES AND ORGANIZATIONS. . IN 2022, CHRISTIANACARE PLEDGED COMMITMENT TO THE WHITE HOUSE/HHS HEALTH SECTOR CLIMATE PLEDGE. CHRISTIANACARE IS TAKING ACTION TO REDUCE ITS GREENHOUSE GAS EMISSIONS BY 50% BY 2030 AND ACHIEVE NET ZERO EMISSIONS BY 2050. . CHRISTIANACARE HAS INSTITUTED A SUPPLIER DIVERSITY PROGRAM TO PROVIDE EQUAL ACCESS TO PROCUREMENT OPPORTUNITIES FOR DIVERSE AND SMALL BUSINESSES TO ASSIST AND MEET OUR HEALTHCARE SYSTEM GOALS. WE PROVIDE RESOURCES AND MENTORSHIP, ASSIST WITH CAPACITY BUILDING, AND OFFER OUTREACH PROGRAMS SO THAT WE CAN WORK WITH COMPANIES THAT HELP CONTRIBUTE TO THE ECONOMY AND COMMUNITIES WE SERVE. . IN 2020, CHRISTIANACARE BEGAN OFFERING 12 WEEKS OF PAID PARENTAL LEAVE FOR ITS CAREGIVERS. . IN 2019, CHRISTIANACARE INCREASED ITS MINIMUM WAGE TO $15 AN HOUR. . IN 2019, CHRISTIANACARE INSTITUTED A COMMUNITY SERVICE BENEFIT TO ITS CAREGIVERS THAT PROVIDES PAID COMMUNITY SERVICE TIME, IN ADDITION TO THEIR PAID TIME OFF, TO VOLUNTEER AT CHARITABLE, NON-PROFIT ORGANIZATIONS. IN FY23, 1,325 HOURS WERE SPENT IN COMMUNITY SERVICE AT A COST OF OVER $64,000 TO CHRISTIANACARE. AS CHRISTIANACARE CONTINUES TO ADAPT, INNOVATE, AND GROW, WE WILL ALWAYS BE GUIDED BY OUR MISSION OF SERVICE AND OUR VALUES OF EXCELLENCE AND LOVE. OUR MOST IMPORTANT PARTNERSHIP IS WITH THE PEOPLE IN ALL THE COMMUNITIES WE SERVE. PART VI, LINE 6 (AFFILIATED HEALTHCARE SYSTEM INFORMATION) CHRISTIANACARE IS CENTERED ON IMPROVING HEALTH OUTCOMES, MAKING HIGH-QUALITY CARE MORE ACCESSIBLE, AND LOWERING HEALTH CARE COSTS. GUIDED BY OUR VALUES, LOVE AND EXCELLENCE, CHRISTIANACARE HAS GROWN, AND CONTINUES TO GROW, TO MEET THE NEEDS OF OUR COMMUNITY. CHRISTIANACARE HAS AN EXTENSIVE NETWORK OF PRIMARY CARE AND OUTPATIENT SERVICES, HOME HEALTH CARE, URGENT CARE CENTERS, THREE HOSPITALS (1,435 LICENSED BEDS), A FREESTANDING EMERGENCY DEPARTMENT, A LEVEL I TRAUMA CENTER AND A LEVEL III NEONATAL INTENSIVE CARE UNIT, A COMPREHENSIVE STROKE CENTER, AND REGIONAL CENTERS OF EXCELLENCE IN HEART AND VASCULAR CARE, CANCER CARE, AND WOMEN'S HEALTH. CHRISTIANACARE PROVIDES SERVICES THAT DELAWAREANS CANNOT FIND ELSEWHERE IN THE STATE SUCH AS AN EPILEPSY MONITORING UNIT, A COMPREHENSIVE PAIN CENTER, WHICH OFFERS EFFECTIVE, NON-OPIOID PAIN TREATMENT STRATEGIES FOR INDIVIDUALS WITH ACUTE AND CHRONIC PAIN, ADULT KIDNEY TRANSPLANT, AND A LEVEL 2 PEDIATRIC EMERGENCY CARE FACILITY. CHRISTIANACARE IS ALSO ONE OF THE LARGEST COMMUNITY-BASED TEACHING HOSPITALS CONDUCTING RESEARCH IN THE UNITED STATES. WE ARE COMMITTED TO ADVANCING HEALTH AND HEALTH EQUITY THROUGH RESEARCH AND INNOVATION AS DEMONSTRATED THROUGHOUT THIS NARRATIVE AND AS SHOWN BY OUR INSTITUTE FOR RESEARCH ON EQUITY AND COMMUNITY HEALTH. THIS EMBEDDED RESEARCH INSTITUTE CONDUCTS APPLIED RESEARCH FOCUSED ON ISSUES OF EQUITY AND COMMUNITY HEALTH, POPULATION HEALTH, AND VIRTUAL HEALTH, AS WELL AS TRAINING THE NEXT GENERATION OF CLINICAL SCIENTISTS WITH THE GOAL TO BRIDGE THE GAP BETWEEN CLINICAL AND TRANSLATIONAL RESEARCH, ADVANCEMENTS IN THE QUALITY OF CARE, AND IMPROVED HEALTH OUTCOMES FOR ALL. ALONG WITH SERVING OUR PATIENTS AND COMMUNITY THROUGH EXCEPTIONAL CLINICAL SERVICES, TRAINING THE NEXT GENERATION OF HEALTHCARE WORKERS, CONDUCTING ROBUST RESEARCH TO ADVANCE HEALTH OUTCOMES, AND AN UNWAVERING COMMITMENT TO EQUITY, WE ARE ALSO COMMITTED TO PROVIDING AFFORDABLE AND VALUE-BASED CARE. CHRISTIANACARE IS A FOUNDING PARTNER IN EBRIGHTHEALTH ACO, AN ACCOUNTABLE CARE ORGANIZATION THAT SERVES APPROXIMATELY 30,000 REGIONAL MEDICARE BENEFICIARIES FROM DELAWARE, PENNSYLVANIA, AND MARYLAND. CHRISTIANACARE'S CAREVIO PROVIDES THE CARE COORDINATION FOR THIS INITIATIVE. CAREVIO IS ANOTHER EXAMPLE OF CHRISTIANACARE'S AWARD WINNING INNOVATION TO BETTER SERVE INDIVIDUALS. CAREVIO HARNESSES AN INFORMATION TECHNOLOGY PLATFORM THAT IDENTIFIES THE PATIENTS WHO ARE AT HIGHEST RISK AND WHO HAVE SIGNIFICANT CARE NEEDS, INCLUDING THOSE WHO DO NOT REGULARLY ACCESS PRIMARY CARE AND PREVENTIVE SERVICES. UNDERSTANDING WHO IS AT RISK FOR POOR HEALTH ENABLES CLINICIANS TO PROACTIVELY CONTACT THE INDIVIDUAL TO CONNECT THEM TO THE HEALTH SERVICES THEY NEED. IN PERFORMANCE YEAR 2021, THE EBRIGHTHEALTH ACO REDUCED HEALTH CARE SPENDING BY $7 MILLION AND EARNED A QUALITY SCORE OF 82.1%. THIS MARKS THE SIXTH CONSECUTIVE YEAR THAT EBRIGHTHEALTH ACO HAS REDUCED HEALTH CARE COSTS FOR ITS ATTRIBUTED BENEFICIARIES, BRINGING THE CUMULATIVE AMOUNT SAVED TO MORE THAN $44.5 MILLION. CHRISTIANACARE ALSO LAUNCHED ONE OF THE FIRST MEDICAID ACOS IN THE STATE, DELAWARE MEDICAID QUALITY PARTNERS ACO ON JULY 1, 2021. THIS ACO SERVES MORE THAN 18,000 MEDICAID PATIENTS AND LIKE THE EBRIGHTHEALTH ACO, IT WILL ALSO BE SUPPORTED BY CAREVIO. HEALTH EQUITY, CARE STANDARDIZATION, AND SOCIAL DETERMINANTS OF HEALTH ARE AREAS OF FOCUS FOR THIS ACO TO ENSURE PATIENTS ARE SET UP FOR SUCCESS IN ACHIEVING POSITIVE HEALTH OUTCOMES. CHRISTIANACARE'S LEADERSHIP IN THE AREAS OF CLINICAL CARE, INNOVATION, AND RESEARCH CONTRIBUTE TO NATIONAL RECOGNITION. THE FOLLOWING ARE TWO AWARDS WE RECENTLY RECEIVED AMONG MANY. FOR THE 7TH YEAR IN A ROW, THE COLLEGE OF HEALTHCARE INFORMATION MANAGEMENT EXECUTIVES (CHIME) HAS GIVEN CHRISTIANACARE THE "MOST WIRED" DESIGNATION. AMONG THE MORE THAN 38,000 ORGANIZATIONS SURVEYED BY CHIME, CHRISTIANACARE RANKED ABOVE ITS PEERS IN THE CATEGORIES OF ANALYTICS AND DATA MANAGEMENT, POPULATION HEALTH, INFRASTRUCTURE, AND PATIENT ENGAGEMENT. FOR THE 3RD YEAR IN A ROW, HEALTHGRADES NAMED CHRISTIANACARE AS ONE OF AMERICA'S 50 BEST HOSPITALS. CHRISTIANACARE IS AMONG THE TOP 1% OF MORE THAN 4,500 HOSPITALS ASSESSED NATIONWIDE FOR CONSISTENT, YEAR-OVER-YEAR SUPERIOR CLINICAL PERFORMANCE. AS THE LARGEST PRIVATE EMPLOYER IN THE STATE OF DELAWARE, CHRISTIANACARE ALSO STRIVES TO BE A LEADER AMONG OTHER BUSINESSES AND ORGANIZATIONS. IN EARLY 2019, CHRISTIANACARE INCREASED ITS MINIMUM WAGE TO $15 AN HOUR, AND BEGINNING IN JULY 2020, CHRISTIANACARE BEGAN OFFERING 12 WEEKS OF PAID PARENTAL LEAVE FOR ITS CAREGIVERS. IN HONOR OF MARTIN LUTHER KING DAY IN JANUARY 2019, CHRISTIANACARE ALSO PROVIDED A COMMUNITY SERVICE BENEFIT TO ITS CAREGIVERS WHICH PROVIDES THEM WITH PAID COMMUNITY SERVICE TIME, IN ADDITION TO THEIR PAID TIME OFF, TO VOLUNTEER AT CHARITABLE, NON-PROFIT ORGANIZATIONS. IN FY2022, 425 HOURS WERE SPENT IN COMMUNITY SERVICE AT A COST OF OVER $24,000 TO CHRISTIANACARE. FINALLY, CHRISTIANACARE HAS ALSO COMMITTED TO BEING AN ANTI-RACISM ORGANIZATION. THAT COMMITMENT CAN BE FOUND HERE: ANTI-RACISM COMMITMENT - CHRISTIANACARE. CHRISTIANACARE'S CONTINUED GROWTH, ADAPTATION, AND INNOVATION WILL ALWAYS BE DRIVEN BY OUR FOUNDATION OF SERVICE TO OUR COMMUNITY AND ADDRESSING THE NEEDS THEY IDENTIFY. OUR MOST IMPORTANT PARTNERSHIP WILL ALWAYS BE WITH OUR NEIGHBORS. -------------------- PART VI, LINE 7 (STATES FILING OF COMMUNITY BENEFIT REPORT) THERE IS NO PRESENT STATE OF DELAWARE REQUIREMENT FOR CHRISTIANACARE TO FILE A COMMUNITY BENEFIT REPORT. CHRISTIANACARE HAS ESTABLISHED A COMMUNITY BENEFIT DEDICATED SECTION ON ITS WEBSITE WHERE THE CHNA AND CHIP CAN BE FOUND, ALONG WITH ARTICLES ABOUT CHRISTIANACARE'S COMMUNITY BENEFIT INITIATIVES AND STORIES. THIS CAN BE ACCESSED AT: https://christianacare.org/us/en/about-us/who-we-are/community-benefit -------------------- true DELAWARE COLLEGE SCHOLARS PO BOX 392 WILMINGTON DE 19801 824608572 501(C)(3) 150000 GENERAL SUPPORT HBCU WEEK FOUNDATION INC 1022 COLEMAN STREET WILMINGTON DE 19805 851276996 501(C)(3) 136250 GENERAL SUPPORT FRIENDSHIP HOUSE INC PO BOX 1517 WILMINGTON DE 19899 510306759 501(C)(3) 100000 GENERAL SUPPORT WILMINGTON ALLIANCE INC 100 W 10TH ST SUITE 206 WILMINGTON DE 19801 510347680 501(C)(3) 90000 GENERAL SUPPORT RYSHEEMA J DIXON FOUNDATION 903 RUE MADORA BEAR DE 19701 921122189 501(C)(3) 40000 GENERAL SUPPORT 5 0 FORM 990, SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS ALL FUNDING REQUIRES APPROVAL. PRIOR TO PROVIDING ANY FUNDS, CCHS CONFIRMS THAT THE RECIPIENT ORGANIZATION IS TAX EXEMPT AND REQUIRES THE SUBMISSION OF A PROPOSAL FOR HOW THE FUNDING WILL BE UTILIZED. CCHS RETAINS THE RIGHT TO REQUEST DETAIL REGARDING THE ORGANIZATION'S UTILIZATION OF THE FUNDING. X true true true true false false false false false true false RAY A BLACKWELL MD CHIEF OF CARDIAC SURGERY 892906 0 155636 0 8546 0 0 0 20501 0 1077589 0 0 0 RICHARD CUMING CHIEF OPERATING OFFICER 514222 0 185622 0 99729 0 56146 0 12272 0 867991 0 40000 0 PAUL K DAVIS MD PHYSICIAN - CARDIAC SURGEON 745228 0 112651 0 15991 0 0 0 20501 0 894371 0 0 0 RANDALL GABORIAULT CHIEF DIGITAL & INFO. OFFICER 672226 0 244128 0 67396 0 69541 0 20501 0 1073792 0 0 0 KIRK N GARRATT MD MED. DIR. CTR FOR H/V HEALTH 785789 0 171222 0 10632 0 0 0 7085 0 974728 0 0 0 VINAY K GHEYI CHAIR DEPARTMENT RADIOLOGY 752758 0 164024 0 5939 0 0 0 13663 0 936384 0 0 0 NEIL JASANI MD CHIEF PEOPLE OFFICER 515438 0 184394 0 239169 0 0 0 20501 0 959502 0 159456 0 SHARON KURFUERST COO- THRU 1/23 691616 0 248907 0 26781 0 71217 0 13663 0 1052184 0 0 0 LISA MAXWELL MD PRESIDENT, CC MEDICAL GROUP 515436 0 184371 0 3848 0 51069 0 20501 0 775225 0 0 0 ROBERT MCMURRAY CFO, TREAS. & ASS'T SECRETARY 624494 0 226794 0 6652 0 66326 0 20501 0 944767 0 0 0 JANICE E NEVIN MD PRESIDENT & CEO 1347992 0 742346 0 854564 0 0 0 9778 0 2954680 0 564176 0 NICHOLAS J PETRELLI MD MED. DIR, CCHS CANCER PROGRAM 734231 0 159979 0 7082 0 0 0 12272 0 913564 0 0 0 JENNIFER L SCHWARTZ ESQ CORPORATE SECRETARY 543248 0 197288 0 4880 0 57934 0 20501 0 823851 0 0 0 KENNETH SILVERSTEIN MD CHIEF PHYS. EXEC- THRU 1/23 725662 0 263534 0 188535 0 0 0 17648 0 1195379 0 0 0 BETTINA TWEARDY-RIVEROS CHIEF PUBLIC AFFAIRS OFFICER 461660 0 151168 0 40898 0 41881 0 20501 0 716108 0 0 0 FREDERIC T HARAD MD DIRECTOR 599122 0 78318 0 83909 0 0 0 12272 0 773621 0 0 0 VINAY MAHESHWARI MD DIRECTOR- AS OF 1/1/23 498145 0 105211 0 3915 0 0 0 91 0 607362 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 1A DETAIL REGARDING BENEFITS PROVIDED SOCIAL CLUB DUES CCHS PROVIDES A SOCIAL CLUB MEMBERSHIP TO BE USED BY THE PRESIDENT IN CONNECTION WITH THEIR DUTIES. THE PRESIDENT IS RESPONSIBLE FOR AND TAXED ON ANY PERSONAL USE OF SUCH CLUB MEMBERSHIP. -------------------- FORM 990, SCHEDULE J, PART I, LINE 3 TOP MANAGEMENT COMPENSATION AS PROVIDED IN THE FORM 990, SCHEDULE J INSTRUCTIONS, SINCE THE ORGANIZATION RELIES ON A RELATED ORGANIZATION WHICH USES ONE OR MORE OF THE METHOD DESCRIBED IN LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIALS' COMPENSATION, THIS QUESTION HAS BEEN LEFT UNANSWERED. REFER TO SCHEDULE O FOR A DESCRIPTION OF THE COMPENSATION REVIEW AND APPROVAL PROCESS. -------------------- FORM 990, SCHEDULE J, PART I, LINE 4A DETAIL OF SEVERANCE PAYMENTS SHARON KURFUERST (FORMER CHIEF OPERATING OFFICER) RECEIVED A SEVERANCE PAYMENT OF $168,230 DURING THE YEAR. KENNETH SILVERSTEIN (FORMER PRESIDENT, CC MEDICAL GROUP) RECEIVED A SEVERANCE PAYMENT OF $173,170 DURING THE YEAR. --------------- FORM 990, SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED PLAN PARTICIPATION CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS") MAINTAINS AN IRC SECTION 457(F) DEFERRED COMPENSATION PLAN. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED AND/OR RECEIVED DISTRIBUTIONS FROM THE 457(F) PLAN DURING THE YEAR: RICHARD CUMING, RN- $58,402 RANDALL GABORIAULT- $61,829 NEIL JASANI, MD- $232,282 SHARON T. KURFUERST- $21,575 LISA C. MAXWELL, MD- NO DISTRIBUTION ROBERT MCMURRAY- NO DISTRIBUTION JANICE E. NEVIN, MD- $843,088 JENNIFER L. SCHWARTZ, ESQ.- NO DISTRIBUTION KENNETH SILVERSTEIN, MD- $82,817 BETTINA TWEARDY-RIVEROS- $36,502 -------------------- FORM 990, SCHEDULE J, PART I, LINE 7 PROVISION OF NON-FIXED PAYMENTS CHRISTIANA CARE HEALTH SYSTEM, INC. ("SYSTEM") IS THE SOLE MEMBER OF THIS ORGANIZATION. ALL OFFICER/TRUSTEE COMPENSATION ARRANGEMENTS, INCLUDING THE PAYMENT OF DISCRETIONARY BONUS AND/OR INCENTIVE COMPENSATION PAYMENTS TO ELIGIBLE EMPLOYEES, ARE DETERMINED BY THE SYSTEM BOARD. PAYMENTS MADE TO ANY DISQUALIFIED PERSON ARE APPROVED BY THE COMPENSATION COMMITTEE OF SYSTEM THROUGH THE PROCESS DESCRIBED IN FORM 990, PART VI, SECTION B, LINE 15. -------------------- A DELAWARE HLTH FACILITIES AUTHORITY SERIES 2020A 510272458 246388TQ5 2020-02-11 247255000 REFUND SERIES 2008 & 2010 false false false A 0 0 305483000 0 0 0 2324976 0 0 145360019 157798005 0 2021 true false true true A false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true A false false true false false false 0 false 0 false true A true FORM 990, SCHEDULE K, PART I ADDITIONAL INFORMATION REGARDING TAX-EXEMPT BONDS THE DELAWARE HEALTH FACILITIES AUTHORITY SERIES 2020A BOND WAS ISSUED TO CHRISTIANA CARE HEALTH SYSTEM, INC. (EIN:52-1479538), A RELATED IRC SECTION 501(C)(3) ORGANIZATION. SINCE ALL BOND PROCEEDS WERE ALLOCATED TO CHRISTIANA CARE HEALTH SERVICES, INC., THIS BOND HAS BEEN REPORTED ON THIS ORGANIZATION'S FORM 990, SCHEDULE K. HOWEVER, CHRISTIANA CARE HEALTH SYSTEM, INC. REMAINS AS THE PRIMARY OBLIGOR OF THE BOND. -------------------- FORM 990, SCHEDULE K, PART II, LINE 3 ADDITIONAL INFORMATION REGARDING PROCEEDS OF ISSUE FOR DELAWARE HLTH FACILITIES AUTHORITY SERIES 2020A, THE TOTAL PROCEEDS OF THE ISSUE REPORTED INCLUDES INVESTMENT EARNINGS. -------------------- FORM 990, SCHEDULE K, PART II, LINE 5 ADDITIONAL INFORMATION REGARDING CAPITALIZED INTEREST FROM PROCEEDS ALTHOUGH CCHS CAPITALIZES INTEREST FOR BOOK PURPOSES, BOND PROCEEDS ARE NOT USED TO PAY INTEREST AND ARE THEREFORE NOT REPORTED ON PART II, LINE 5. -------------------- X 8 171862 FMV false true false SCHEDULE M, PART I, COLUMN (B) ADDITIONAL INFORMATION REGARDING SECURITIES REPORTED CHRISTIANA CARE HEALTH SERVICES, INC. REPORTS THE NUMBER OF CONTRIBUTIONS IN PART I, COLUMN (B). FORM 990, HEADER, ITEM B AMENDED FORM 990 THE ORGANIZATION'S JUNE 30, 2023 FORM 990 IS BEING AMENDED IN ORDER TO CORRECT CERTAIN COMPENSATION INFORMATION THAT WAS PREVIOUSLY INADVERTENTLY REPORTED AS A COMPONENT OF FORM 990, PART VII, SECTION A, COLUMN (F) AND FORM 990, SCHEDULE J, PART II, COLUMN (C) COMPENSATION. THIS INFORMATION HAS NOW BEEN MORE PROPERLY REPORTED AS A COMPONENT OF FORM 990, SCHEDULE J, PART II, COLUMN (F) COMPENSATION FOR THE AFFECTED INDIVIDUALS. THE SUPPLEMENTAL DISCLOSURE FOR FORM 990, SCHEDULE J, PART I, LINE 4B HAS ALSO BEEN REVISED. -------------------- FORM 990, PART VI, SECTION A, LINES 6 & 7A,7B GOVERNING BODY AND MANAGEMENT CHRISTIANA CARE HEALTH SYSTEM, INC. ("SYSTEM"), A TAX-EXEMPT ORGANIZATION, IS THE SOLE MEMBER OF CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS"). THE SYSTEM BOARD ELECTS DIRECTORS OF CCHS AT ITS ANNUAL MEETING. THE ANNUAL OPERATING BUDGET OF CCHS IS APPROVED BY THE CCHS BOARD, THE SYSTEM FINANCE COMMITTEE, AND THE SYSTEM BOARD. -------------------- FORM 990, PART VI, SECTION B, LINE 11 FORM 990 REVIEW PROCESS INFORMATION RELATED TO CHRISTIANA CARE'S FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO PWC US TAX LLP FOR REVIEW. THE FINAL 2022 FORM 990 FOR THE FISCAL YEAR ENDING JUNE 30, 2023 WAS REVIEWED AND APPROVED BY VARIOUS SENIOR MANAGEMENT OFFICIALS. THE ORGANIZATION'S GOVERNING BOARD WAS ALSO PROVIDED ACCESS TO THE APPROVED 2022 FORM 990 VIA ITS BOARD OF DIRECTOR'S PORTAL. -------------------- FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY OUR CONFLICT OF INTEREST ("COI") POLICY IS LOCATED IN THE CAREGIVER RESOURCE CENTER ON THE EMPLOYEE PORTAL. THERE IS AN ANNUAL MANDATORY EDUCATION FOR MANAGERS WHICH INCLUDES AN ELECTRONIC SIGN OFF ACKNOWLEDGING COMPLETION OF THE EDUCATION, REPORTING OF A REAL OR PERCEIVED CONFLICT OR THAT NO CONFLICTS OF INTEREST EXISTS. THE HR/EMPLOYEE RELATIONS TEAM FOLLOWS UP WITH ANYONE WHO HAS A CONFLICT OR PERCEIVED CONFLICT OR DOES NOT COMPLETE THE EDUCATION IN ORDER TO RESOLVE. SEVERAL REPORTING MECHANISMS ALSO EXIST FOR EMPLOYEES TO REPORT CONCERNS. THE BOARD OF DIRECTORS HAS THEIR OWN COI POLICY. COI IS A STANDING AGENDA ITEM ON EACH BOARD OR BOARD COMMITTEE MEETING. BOARD MEMBERS EXPECTATIONS FOR COI ARE CLEARLY COMMUNICATED. -------------------- FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW AND APPROVAL PROCESS THE BOARD OF DIRECTORS OF CHRISTIANA CARE HEALTH SYSTEM, INC. ("SYSTEM"), THE SOLE MEMBER OF CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS") ESTABLISHES CCHS'S COMPETITIVE TOTAL COMPENSATION POLICY AND PRACTICE. THE EXECUTIVE COMPENSATION COMMITTEE ("ECC") OF THE SYSTEM BOARD ENGAGES AN INDEPENDENT THIRD PARTY ANNUALLY WHO ASSESSES DATA FROM SEVERAL MAJOR SURVEYS TO ENSURE TOTAL REMUNERATION IS MARKET COMPETITIVE AND QUALIFIES FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTIONS RULE, SECTION 4958 OF THE INTERNAL REVENUE CODE. AFTER DELIBERATION, THE ECC DOCUMENTS THEIR DECISIONS IN MEETING MINUTES. -------------------- FORM 990, PART VI, SECTION B, LINE 16B JOINT VENTURE ARRANGEMENTS ALTHOUGH THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY IN PLACE REGARDING PARTICIPATION IN JOINT VENTURE RELATIONSHIPS, WHEN ANY SUCH RELATIONSHIPS ARE CONSIDERED, THEY ARE FIRST REVIEWED AND EVALUATED BY MANAGEMENT OFFICIALS IN CONJUNCTION WITH PWC US TAX LLP. -------------------- FORM 990, PART VI, SECTION C, LINE 19 GOVERNANCE, MANAGEMENT, & DISCLOSURE THE GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. -------------------- FORM 990, PART X BALANCE SHEET CERTAIN PRIOR YEAR BALANCES HAVE BEEN RESTATED TO CONFORM TO THE CURRENT YEAR PRESENTATION. -------------------- FORM 990, PART XI, LINE 9 DETAIL OF OTHER CHANGES IN NET ASSETS CHANGE IN PENSION AND POST RETIREMENT LIABILITIES $(43,856,239) CHANGE IN NET ASSET OF SYSTEM 230,334 OTHER CHANGES (50,225) ----------- TOTAL $(43,676,130) CHRISTIANA CARE CAMPUS REALTY LLC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 510103684 SUPPORT SRVCS DE 0 0 CCH SERVICES CHRISTIANA CARE QUALITY PARTNERS LLC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 844061485 SUPPORT SRVCS DE -227515 3723127 CCH SERVICES CHRISTIANA CARE QUALITY PARTNERS ACOLLC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 474102953 SUPPORT SRVCS DE -1383606 101994 CCH SERVICES CHRISTIANA CARE CARE LINK LLC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 510103684 SUPPORT SRVCS DE -10934575 3050461 CCH SERVICES CHRISTIANA CARE CTR FOR VIRTUAL HLTH LLC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 862155365 SUPPORT SRVCS DE -4782702 4996050 CCH SERVICES CHRISTIANA CARE HEALTH SYSTEM 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 521479538 FUNDRAISING DE 501(C)(3) 7 NA false CHRISTIANA CARE HEALTH INITIATIVES 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 510295186 OUTPATIENT SV DE 501(C)(3) 10 CCH SYSTEM false CHRISTIANA CARE HOME HEALTH & COM SRVCS 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 510064334 HOME HLTHCARE DE 501(C)(3) 7 CCH SYSTEM false UNION HOSPITAL OF CECIL COUNTY FDN 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 521794552 FUNDRAISING MD 501(C)(3) 7 AFFINITY false UNION HOSPITAL OF CECIL COUNTY INC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 520607945 HLTHCARE SVCS MD 501(C)(3) 3 AFFINITY false UNION HOSPITAL OF CECIL COUNTY HLTH SVCS 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 521794553 PROPERTY MGMT MD 501(C)(3) 10 AFFINITY false UNION HOSPITAL OF CECIL COUNTY ONCOLOGY 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 812662359 HEALTHCARE MD 501(C)(3) 3 AFFINITY false AFFINITY HEALTH ALLIANCE INC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 521794697 MANAGEMENT DE 501(C)(3) 12B, II CCH SERVICES true CHRISTIANA CARE WEST GROVE INC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 883155785 HEALTHCARE PA 501(C)(3) PENDING CCH SERVICES true CHRISTIANA CAREGENE EDITING INSTITUTE 40000 NEXUS DR NW3-100 WILMINGTON DE 19803 883110655 HEALTHCARE DE 501(C)(3) PENDING CCH SYSTEM true CHRISTIANA CARE GO HEALTH URGENT CARE L 5555 GLENRIDGE CONNECTOR SUITE 700 ATLANTA GA 30342 843657727 URGENT CARE SRVCS DE CCH SERVICES RELATED 0 0 false 0 false 0.50100 CHRISTIANACARE VALUE HEALTH JV LLC 11221 ROE AVENUE LEAWOOD KS 66211 851100149 AMBULATORY SRVCS DE CCH SERVICES RELATED 0 25500 false 0 true 0.51000 CLINERGY LLC 4755 OGLETOWN STANTON RD NEWARK DE 19718 852698063 GROUP PURCHASING DE CCH SERVICES RELATED -41020 428997 false 0 false 0.79800 LEEWARD HEALTH LLC 4000 NEXUS DRIVE STE C3-300 WILMINGTON DE 19803 883132477 MED ADV RISK DE CCH SYSTEM false false THE DE CTR FOR MAT FETAL MED OF CC INC 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 205891272 HEALTHCARE DE CCH SERVICES C CORP 35582 5971632 1.00000 true CHRISTIANA CARE HEALTH PLANS 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 510352728 INSURANCE DE CCH SYSTEM C CORP false CHRISTIANA CARE DEFERRED COMP PLAN 4755 OGLETOWN STANTON RD NEWARK DE 19718 816359549 DEF COMP PLAN DE CCH SERVICES TRUST 0 0 1.00000 true CHRISTIANA CARE EXEC DEFERRED COMP PLAN 4755 OGLETOWN STANTON RD NEWARK DE 19718 357048822 DEF COMP PLAN DE CCH SERVICES TRUST 0 0 1.00000 true CARE ASSOCIATES DEFERRED COMP PLAN 4755 OGLETWON STANTON RD NEWARK DE 19718 357048714 DEF COMP PLAN DE CCH SERVICES TRUST 0 0 1.00000 true CHRISTIANA CARE INSURANCE CO LTD PO BOX 1159 878 W BAY RD GRAND CAYMAN CJ KY1-1102 981489490 SELF-INSURANCE CJ CCH SERVICES C CORP 2009422 75736485 1.00000 true CHRISTIANA CARE STRATEGIC INVESTMENTS 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 853348300 STRATEGY DE CCH SYSTEM C CORP false UNION HOSPITAL OF CECIL COUNTY VENTURES 4000 NEXUS DR NW3-100 WILMINGTON DE 19803 521793691 MEDICAL SERVICES MD AFFINITY C CORP false true true false true false false false false false true true true false true true true true true true UNION HOSPITAL OF CECIL COUNTY INC ADOQR 38223329 FMV CHRISTIANA CARE GO HEALTH URGENT CARE LLC ADJPR 34661291 FMV THE DE CTR FOR MAT FETAL MED OF CC INC J,K,O 1134931 FMV CHRISTIANA CARE INSURANCE CO LTD Q,R 41304662 FMV AFFINITY HEALTH ALLIANCE INC R,S 2556997 FMV CLINERGY LLC O 890297 FMV CHRISTIANA CARE HOME HEALTH & COMM SERVICES ADOQR 9575854 FMV UNION HOSPITAL OF CECIL COUNTY ONCOLOGY INC J,K,O 665802 FMV DIRECT OTHER LOBBYING EXEMPT PURPOSE NAME OF ELECTING ORGANIZATION EXPENDITURES EXPENDITURES __________________________________ ____________ _______________ CHRISTIANA CARE HEALTH SYSTEM $ NONE $ 2,870,161 CHRISTIANA CARE HEALTH SERVICES 325,798 2,588,030,162 CHRISTIANA CARE HOME HEALTH AND COMMUNITY SERVICES NONE 42,543,018 CHRISTIANA CARE HEALTH INITIATIVES NONE 10,583,853 ----------- -------------- TOTAL $ 325,798 $2,644,027,194 THE ORGANIZATION HAS MADE THE LOBBYING ELECTION UNDER I.R.C. SECTION 501(H) FOR THE TAX YEAR ENDED JUNE 30, 2023. THIS ELECTION HAS NOT BEEN REVOKED BEFORE THE START OF THE ORGANIZATION'S TAX YEAR THAT BEGAN IN 2022.