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Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
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ST. ELIZABETH HEALTHCARE RECOGNIZES PATIENT SERVICE REVENUE AT THE TIME SERVICES ARE RENDERED FOR, EVEN THOUGH ST. ELIZABETH HEALTHCARE DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY. AS A RESULT, THE PROVISION FOR BAD DEBTS AND CHARITY CARE ARE PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). ST. ELIZABETH HEALTHCARE RECOGNIZES REVENUE WHEN SERVICES ARE RENDERED FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE. BASED ON HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF ST. ELIZABETH HEALTHCARE'S UNINSURED AND UNDERINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES RENDERED. AS A RESULT, ST. ELIZABETH HEALTHCARE RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED AND UNDERINSURED PATIENTS IN THE PERIOD THE SERVICES ARE RENDERED. FOR FINANCIAL STATEMENT PURPOSES, ST. ELIZABETH HEALTHCARE HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ST. ELIZABETH HEALTHCARE'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.
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Schedule H, Part III, Line 3 Bad Debt Expense Methodology
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THE ESTIMATED AMOUNT OF ST. ELIZABETH HEALTHCARE'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ST. ELIZABETH HEALTHCARE'S FINANCIAL ASSISTANCE POLICY IS $4,356,840. THE PERCENTAGE OF BAD DEBTS THAT LIKELY COULD BE CHARITY CARE, IF ENOUGH INFORMATION WAS OBTAINED UP FRONT, WAS DEVELOPED WITH THE HELP OF OUR LARGEST COLLECTION AGENCY WHO HAS DETERMINED, BASED ON ACCOUNTS REVIEWED, WHO MAY NOT HAVE HAD THE FINANCIAL ABILITY TO PAY. ST. ELIZABETH HEALTHCARE ALSO BELIEVES THAT MANY PATIENTS FALL INTO THE CATEGORY WHERE THEY DO NOT MEET THE FEDERAL POVERTY GUIDELINES BUT YET CANNOT AFFORD THE COST OF THE SERVICES RENDERED, OR HAVE INSURANCE THAT MAY NOT COVER THE COST OF SERVICES. THEREFORE, ST. ELIZABETH HEALTHCARE BELIEVES THESE NON REIMBURSED COSTS SHOULD BE COUNTED AS A BENEFIT TO THE COMMUNITY WE SERVE. THE AMERICAN HOSPITAL ASSOCIATION'S POSITION IS THAT BAD DEBTS SHOULD BE COUNTED AS A COMMUNITY BENEFIT.
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Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
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Patient accounts are reported at the net consideration in which St. Elizabeth Healthcare expects to be entitled to in exchange for providing patient care. The portfolio approach is used to determine the reduction to accounts receivables based upon the historical collection experience of St. Elizabeth Healthcare adjusted for current environmental risks and trends for each major payor source. Amounts recognized are subject to adjustment upon review by third-party payors. Significant price concessions are made for self-pay patient accounts in the period of service based on past collection experience and are reported at the net amount St. Elizabeth Healthcare expects to collect. St. Elizabeth Healthcare recognizes patient service revenue at the time in which performance obligations are satisfied. These amounts are due from patient, third-party payers, (including managed care and governmental programs), and others are subject to contractual adjustments, discounts and implicit price concessions. Patient service revenue is reported at the net consideration in which St. Elizabeth Healthcare expects to be entitled to in exchange for providing patient care. Settlements are recorded on an estimated basis in the period the related services are rendered and adjusted in future periods based upon additional information, filed cost reports, interim settlements, and final settlements. St. Elizabeth Healthcare recognizes patient service revenue at the time services are rendered even though they do not assess the patient's ability to pay. As a result, implicit price concessions are presented as a deduction from patient service revenue (net of contractual provisions and discounts). Amounts determined to qualify as charity care are not reported as patient service revenue. For uninsured and underinsured patients that do not qualify for charity care, St. Elizabeth Healthcare recognizes revenue when services are provided. Based on historical experience, a significant portion of St. Elizabeth Healthcare's uninsured and underinsured patients will be unable or unwilling to pay for the services provided. Thus, St. Elizabeth Healthcare records significant implicit price concessions related to uninsured and underinsured patients in the period the services are provided.
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Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
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ST. ELIZABETH HEALTHCARE USES THE STEP DOWN METHODOLOGY TO DETERMINE COSTS FOR MEDICARE. THE REPORTS WERE THEN COMPLETED BY FOLLOWING THE GUIDANCE PROVIDED IN THE INSTRUCTIONS FOR PART III. ST. ELIZABETH HEALTHCARE BELIEVES MEDICARE LOSSES SHOULD BE AN ALLOWABLE COMMUNITY BENEFIT. ST. ELIZABETH HEALTHCARE PROVIDES NEEDED SERVICES TO THE ELDERLY AND DISABLED MEDICARE POPULATION AT A FINANCIAL LOSS TO ST. ELIZABETH HEALTHCARE TO HELP THOSE INDIVIDUALS GET THE CARE THEY NEED IN THE COMMUNITY WE SERVE. THE AMERICAN HOSPITAL ASSOCIATION'S POSITION IS ALSO THAT MEDICARE LOSSES SHOULD BE COUNTED AS COMMUNITY BENEFIT.
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Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
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ST. ELIZABETH HEALTHCARE HAS A WRITTEN DEBT COLLECTION POLICY THAT ALSO INCLUDES A PROVISION ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IF A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, CERTAIN COLLECTION PRACTICES DO NOT APPLY.
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Schedule H, Part V, Section B, Line 16a FAP website
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A - ST. ELIZABETH FLORENCE: Line 16a URL: https://www.stelizabeth.com/care/pay-my-bill/;
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Schedule H, Part V, Section B, Line 16b FAP Application website
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A - ST. ELIZABETH FLORENCE: Line 16b URL: https://www.stelizabeth.com/care/pay-my-bill/;
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Schedule H, Part V, Section B, Line 16c FAP plain language summary website
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A - ST. ELIZABETH FLORENCE: Line 16c URL: https://www.stelizabeth.com/care/pay-my-bill/;
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Schedule H, Part VI, Line 2 Needs assessment
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In 2022, St. Elizabeth Healthcare continued to work with the Northern Kentucky Office of Drug Control Policy and other community partners to address the issue of behavioral health (mental health and substance use) including the provision of financial support to the Northern Kentucky Addiction Helpline, providing data and support to community partners and local/state legislators to advocate for policies and funding that support treatment and recovery of substance use disorders, working with community partners to provide recovery support focused on employment/financial stability for people with substance use disorder, working with Safety Net Alliance and other partners to address the social determinants of health, and working with community mental health agencies in the promotion of mental health among youth and suicide prevention for all ages. In 2022, St. Elizabeth continued its support of Faith Community Pharmacy's Prescription Medication Programs. These programs provide life-sustaining prescriptions medications, free of charge, to those unable to pay, ensuring our Northern Kentucky community does not go without needed medications due to affordability. IN 2022, ST. ELIZABETH HEALTHCARE CONTINUED TO PROVIDE THE PATIENT AND FAMILY ADVISORY COUNCIL (PAFAC), WHICH MEETS EVERY TWO (2) MONTHS TO IDENTIFY NEEDS OF THE COMMUNITY BASED ON THE FEEDBACK OBTAINED FROM OUR PATIENTS AND FAMILY MEMBERS. CONTINUOUSLY, ST. ELIZABETH EVALUATES DATA FROM SOURCES SUCH AS OUR PATIENT SATISFACTION AND COMMUNITY HEALTH SURVEYS TO IDENTIFY THE NEEDS OF OUR COMMUNITY FOR THE PEOPLE WE SERVE.
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Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
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PATIENT FINANCIAL ASSISTANCE PROGRAM INFORMATION IS POSTED AT EACH SITE (THERE IS A FRAMED SIGN POSTED IN SPANISH AND ENGLISH). IN ADDITION, THERE IS A 1-PAGE DESCRIPTION OF OUR FINANCIAL ASSISTANCE PROGRAM THAT IS ATTACHED TO THE "PATIENT RIGHTS AND RESPONSIBILITIES" DOCUMENT, AND ALL PATIENTS ARE GIVEN THESE DOCUMENTS UPON REGISTRATION. IF A PATIENT DOES NOT HAVE INSURANCE, THEY ARE ALSO OFFERED AN APPLICATION PACKET FOR FINANCIAL ASSISTANCE. PATIENTS ARE NOTIFIED OF THEIR FINANCIAL RESPONSIBILITY, THE PATIENT RIGHTS AND RESPONSIBILITIES DOCUMENT GIVEN TO ALL PATIENTS STATES THEY HAVE A RESPONSIBILITY TO "PROVIDE NECESSARY FINANCIAL INFORMATION TO ASSURE ACCURATE BILLING AND MEET FINANCIAL COMMITMENTS." THE FINANCIAL ASSISTANCE PLAN DOCUMENT THEY ARE GIVEN PROVIDES DETAILED INFORMATION ON ELIGIBLE FINANCIAL AID SERVICES, AND ALSO STATES THAT "FINANCIAL ASSISTANCE IS NOT CONSIDERED AN ALTERNATIVE OPTION TO PAYMENT, AND PATIENTS MAY BE ASSISTED IN FINDING OTHER MEANS OF PAYMENT FOR FINANCIAL ASSISTANCE BEFORE APPROVAL FOR ST. ELIZABETH FINANCIAL ASSISTANCE PROGRAM." THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED ON ST. ELIZABETH HEALTHCARE'S WEB SITE. A WRITTEN COPY IS ALSO INCLUDED IN THE PATIENT HANDBOOK PROVIDED TO INPATIENT ADMISSIONS. A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR QUALIFYING INDIVIDUALS ON THE PATIENT BILLS. FINANCIAL COUNSELORS ARE AVAILABLE TO ASSIST PATIENTS TO DETERMINE QUALIFICATION AND A COPY OF THE POLICY IS AVAILABLE TO PATIENTS UPON REQUEST.
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Schedule H, Part VI, Line 4 Community information
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ST. ELIZABETH HEALTHCARE SERVES THE NORTHERN KENTUCKY COUNTIES, WHICH INCLUDE: BOONE, BRACKEN, CAMPBELL, CARROLL, GALLATIN, GRANT, HARRISON, KENTON, MASON, OWEN, PENDLETON, ROBERTSON, AND SOUTHEASTERN INDIANA COUNTIES: DEARBORN, FRANKLIN, RIPLEY, OHIO, AND SWITZERLAND. THESE SERVICE AREAS INCLUDE URBAN, SUBURBAN, AND RURAL AREAS. THE TOTAL POPULATION OF THE SERVICE AREAS IS OVER 639,000. ST. ELIZABETH HEALTHCARE'S PRIMARY SERVICE AREAS DURING 2022 WAS DETERMINED BY IDENTIFYING WHERE 90% OF ITS PATIENT POPULATION ORIGINATES. THIS APPROACH ENSURES THAT THE ASSESSMENT WAS NOT LIMITED TO CERTAIN GEOGRAPHIC AREAS BUT INCLUDED THE MAJORITY OF THE POPULATION SERVED. THE DATA REVEALED THAT 94% OF THE PATIENT POPULATION RESIDES IN THE COUNTIES THAT MAKE UP THE NORTHERN KENTUCKY AREA DEVELOPMENT DISTRICT (NKADD). THE NKADD ENCOMPASSES THE COUNTIES OF BOONE, CAMPBELL, CARROLL, GALLATIN, GRANT, KENTON, OWEN AND PENDLETON, AND REPRESENTS OVER 473,000 RESIDENTS. WITH THE EXCEPTION OF ST. ELIZABETH DEARBORN, ALL OTHER HOSPITALS IN THE ST. ELIZABETH HEALTHCARE SYSTEM ARE LOCATED IN THIS REGION. THE PRIMARY SERVICE AREAS ARE PREDOMINANTLY NORTHERN KENTUCKY AND SOUTHEAST INDIANA. POPULATION BY ORIGIN: 89.98% WHITE, 3.44% BLACK, 3.33% HISPANIC, 1.31% ASIAN, 0.14% NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER, 0.28% AMERICAN INDIAN AND ALASKA NATIVE, 1.51 % OTHER. POPULATION BY AGE: UNDER 5; 6.03%; UNDER 18; 23.07%; 19-64; 53.98 %; 65+; 16.92%. PERSONS BELOW POVERTY LEVEL IN NKY, ALL AGES: 11.21% DUE TO THE ENACTMENT OF THE AFFORDABLE CARE ACT, IT IS ESTIMATED THAT APPROXIMATELY 6% OF THE NORTHERN KENTUCKY AND SOUTHEASTERN INDIANA POPULATION UNDER AGE 65 REMAINS UNINSURED. THE POVERTY LEVEL OF THE REGION IS AS FOLLOWS: CARROLL COUNTY - 17.9%, OWEN COUNTY - 15.20%, GRANT COUNTY - 12.7%, CAMPBELL COUNTY - 11.1%, KENTON COUNTY - 12.6%, BOONE COUNTY - 6.4%, GALLATIN COUNTY - 14.7%, PENDLETON COUNTY - 14.8%, DEARBORN COUNTY - 7.6%, FRANKLIN COUNTY - 8.6%, RIPLEY COUNTY - 8.9%, SWITZERLAND COUNTY - 13.9%, OHIO COUNTY - 9.1%. THERE ARE SIX (6) OTHER HOSPITALS THAT SERVE THE NORTHERN KENTUCKY COMMUNITY. 1. GATEWAY REHABILITATION HOSPITAL IN BOONE COUNTY, 2. CARROLL COUNTY MEMORIAL HOSPITAL IN CARROLL COUNTY, 3. HARRISON MEMORIAL HOSPITAL IN HARRISON COUNTY, 4. ENCOMPASS REHABILITATION HOSPITAL IN KENTON COUNTY, 5. MEADOWVIEW REGIONAL MEDICAL CENTER IN MASON COUNTY, AND 6. SUN BEHAVORIAL HEALTH IN KENTON COUNTY. THERE IS ONE (1) OTHER HOSPITAL THAT SERVES THE SOUTHERN INDIANA COMMUNITY - MARGARET MARY HEALTH HOSPITAL IN RIPLEY COUNTY. THERE ARE A NUMBER OF HOSPITALS THAT SERVE THE SOUTHERN OHIO COMMUNITY, INCLUDING: THE CHRIST HOSPITAL, TRIHEALTH, MERCY HEALTH, AND THE UNIVERSITY OF CINCINNATI MEDICAL CENTER. THERE ARE A FEW FEDERALLY DESIGNATED - MEDICALLY UNDERSERVED AREAS OR POPULATIONS IN THE COMMUNITIES.
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Schedule H, Part VI, Line 5 Promotion of community health
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ST. ELIZABETH HEALTHCARE FURTHERS ITS EXEMPT PURPOSES IN IMPROVING COMMUNITY HEALTH STATUS BY: 1) ENCOURAGING AND SUPPORTING STAFF TO PARTICIPATE ON VARIOUS COMMUNITY BOARDS/ACTIVITIES THAT SUPPORT AND/OR DEVELOP PROGRAMS THAT ADDRESS COMMUNITY HEALTH NEEDS AND WORKFORCE DEVELOPMENT. 2) ST. ELIZABETH HEALTHCARE'S BOARD OF TRUSTEES IS MADE UP OF COMMUNITY REPRESENTATIVES TO ENSURE THAT ST. ELIZABETH HEALTHCARE ADHERES TO ITS MISSION TO IMPROVE THE HEALTH OF THE PEOPLE WE SERVE. THE MAJORITY OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE WITHIN ST. ELIZABETH'S PRIMARY SERVICE AREA. ST. ELIZABETH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. 3) Through its PrimeWise network, St. Elizabeth Healthcare connects adults 50+ to programs including low impact exercise, health education and screenings, community events, wellness programs, and driver's safety. 4) Each year, St. Elizabeth Healthcare produces and distributes more than 600,000 different pieces of health-related information or invitations to health-related educational events throughout the community - which is an average of nearly 4 pieces of information per Northern Kentucky household. 5) PERIODICALLY, ST. ELIZABETH HEALTHCARE WILL PARTNER WITH COMMUNITY ORGANIZATIONS AND BUSINESS AGENCIES TO PRESENT HEALTH RELATED PROGRAMS AND HEALTH SCREENINGS. 6) ST. ELIZABETH APPLIES SURPLUS FUNDS TO IMPROVE PATIENT CARE BY IMPROVING FACILITIES, ACCESS TO CARE, TECHNOLOGY, RECRUITING AND RETAINING TOP TALENT, AND CONTINUING EDUCATION OF OUR STAFF THROUGH EITHER RESIDENCY OR COLLEGE EDUCATIONAL PROGRAMS. EXAMPLES OF HOW SURPLUS FUNDS WERE APPLIED IN 2022 ARE AS FOLLOWS: a. ST. ELIZABETH HEALTHCARE PROVIDED OUTREACH TO THE COMMUNITIES THROUGH THE MOBILE MAMMOGRAPHY AND MOBILE HEART PROGRAMS. b. ST. ELIZABETH HEALTHCARE PROVIDED COHORT EDUCATIONAL PROGRAMS WITH THE NORTHERN KENTUCKY UNIVERSITY (NKU), THOMAS MORE UNIVERSITY (TMU), AND MT. SAINT JOSEPH UNIVERSITY (MSJU) TO PROVIDE FOR CONTINUING AND/OR ADDITIONAL EDUCATION FOR OUR STAFF. c. THE CONTINUED FINANCIAL ASSISTANCE AND SUPPORT FOR THE FAMILY PRACTICE RESIDENCY PROGRAM WHICH IS COMPRISED OF THIRTY (30) FAMILY PRACTICE RESIDENTS WHO LIVE AND STAY IN THE COMMUNITY TO IMPROVE AND ENHANCE THE ACCESS TO PRIMARY CARE FOR THE PEOPLE WE SERVE. d. ST. ELIZABETH HEALTHCARE CONTINUES FINANCIAL SUPPORT FOR OUR PARISH NURSING PROGRAM WHICH PROVIDES OUTREACH, EDUCATION, AND PREVENTION INFORMATION TO OVER EIGHTY-ONE (81) CHURCHES AND NINE (9) COMMUNITY SITES. e. ST. ELIZABETH HEALTHCARE CONTINUES FINANCIAL SUPPORT FOR PREVENTION AND INJURY TREATMENT FOR ATHLETES ATTENDING SCHOOLS IN OUR COMMUNITIES. f. ST. ELIZABETH HEALTHCARE SPONSORS COMMUNITY BENEFITS TO ADDRESS THE HEALTHCARE NEEDS FOR DISEASES SUCH AS OBESITY, DIABETES, AND HEART DISEASE FOR THE PEOPLE WE SERVE. g. ST. ELIZABETH PHYSICIANS PRIMARY CARE PROVIDED ENHANCED SERVICES FOR EDUCATION AND RESOURCES TO THOSE IN THE COMMUNITY WE SERVE WHO STRUGGLE WITH OBESITY AND ENSUING CO-MORBIDITIES.
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Schedule H, Part VI, Line 6 Affiliated health care system
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ST. ELIZABETH HEALTHCARE IS A SYSTEM THAT FEATURES FIVE (5) FACILITIES THROUGHOUT NORTHERN KENTUCKY WHICH ARE: (I) ST. ELIZABETH - EDGEWOOD; (II) ST. ELIZABETH - FLORENCE; (III) ST. ELIZABETH - FORT THOMAS; (IV) ST. ELIZABETH - GRANT (V) ST. ELIZABETH - COVINGTON; PLUS ST. ELIZABETH - DEARBORN IN SOUTHEAST INDIANA. EACH OF THESE FACILITIES ADDRESSES THE SPECIFIC NEEDS OF ITS LOCALE AS IDENTIFIED BY THE PATIENTS IN THE COMMUNITY. THE SERVICE AREAS VARY FROM RURAL AREAS TO SUBURBAN AREAS TO URBAN AREAS. ST. ELIZABETH HEALTHCARE OFFERS OVER 1,190 LICENSED BEDS, OVER 10,100 EMPLOYEES, 815 PHYSICIAN PROVIDERS WITH FULL ADMITTING PRIVILEGES AND A WHOLLY OWNED PHYSICIAN ORGANIZATION (SEP) WHICH INCLUDES OVER 241 PRIMARY CARE AND SPECIALTY OFFICE LOCATIONS. ST. ELIZABETH HEALTHCARE IS SPONSORED BY THE DIOCESE OF COVINGTON.
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Schedule H, Part VI, Line 7 State filing of community benefit report
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KY
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