2017 Stewardship Report

COVENANT HEALTH SYSTEMS ANNUAL STEWARDSHIP REPORT 2017

Submitted to the Congregation for Institutes of Consecrated Life and Societies of Apostolic Life Vatican City, Rome 2018 Public Juridic Resolution

Covenant Health Systems Meeting of the Public Juridic Person Friday, June 22, 2018

A meeting of the Members of the Public Juridic Person of Covenant Health Systems was held on June 22, 2018 and the following Resolution was ADOPTED:

WHEREAS Covenant Health Systems is a Public Juridic Person of Pontifical Right and is accountable to the Congregation for Institutes of Consecrated Life and Societies of Apostolic Life (CICLSAL}; and

STEWARDSHIP REPORT WHEREAS CICLSAL requires Covenant Health Systems to submit an annual report detailing how Covenant Health Systems has overseen At Covenant Health, we believe that God has called us to be more than its sponsored ministry with regard to the obligations of faith and just a health care provider. We are called to be a faithful partner to our administration and; communities, a good steward of the resources we’ve been entrusted with and an advocate for those who are most vulnerable among us—and in doing so, a light unto our world. We joyfully live out this calling through the WHEREAS Covenant Health Systems has reviewed and discussed the care we provide our patients and residents, by encouraging our employees Covenant Health Systems’ 2017 Annual Report. to be part of this work and in helping meet the needs of others. NOW, THEREFORE, BE IT RESOLVED that the Covenant Health As a health system made up of many different organizations that each Systems’ Public Juridic Persons ACCEPTS the 2017 Annual Report reflect their own rich heritage and legacy, we are making a difference in many different ways – meeting needs that would not be met without our and that said report be submitted to CICLSAL by the Chair of Covenant support and involvement. Our Annual Stewardship Report provides an Health Systems. opportunity to reflect on all that has been accomplished and all that God is accomplishing through us.

We hope the following report serves as a testament to the profound impact we can have when we work together to bring light into the world and hope to those who are in need. Louise Trottier, Chair Covenant Health Systems Public Juridic Person

2018 | Stewardship Report 1 Table of Contents

Mission, Values and Heritage 4 Members of the Public Juridic Person 5 Election of Officers 8 Covenant Health Systems Ministry 9 Sponsorship Report 10 Catholic Health Association Annual Assembly Ministerial Juridic Person Meetings CHA Sponsor Formation Program Mission 11 Mission and Spiritual Care 11 Ethics 12 Ministry Formation Programs 14 St. Marguerite d’Youville Grants 16 “Mission Moments” 17 Our Response to the Changing Health Care Environment 19 Quality 21 Physician Practices 21 Hospitals and Operations 22 Community Benefit Reports 23 Fanny Allen Corporation, Colchester, VT 24 Maristhill Nursing and Rehabilitation Center, Waltham, MA 26 Mary Immaculate Health/Care Services, Inc., Lawrence, MA 28 Mount St. Rita Health Centre, Cumberland, RI 31 Penacook Place, Haverhill, MA 32 St. André Health Care, Biddeford, ME 34 St. Joseph Healthcare, Bangor, ME 37 St. Joseph Hospital, Nashua, NH 41 St. Joseph Manor, Brockton, MA 47 St. Mary Health Care Center, Worcester, MA 51 St. Mary’s Health System, Lewiston, ME 53 St. Mary’s Villa Campus, Elmhurst Township, PA 61 Youville House Assisted Living Residence, Cambridge, MA 64 Youville Place Assisted Living Residence, Lexington, MA 66 Environmental Stewardship 68 Mary Immaculate Health/Care Services Mount St. Rita Health Centre Penacook Place, Inc. Appendices 70 Covenant Health Systems Annual Report

2018 | Stewardship Report 2 MISSION We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.

VALUES Our Judeo-Christian tradition compels us to promote Gospel values in Members of the Public Juridic Person all of our endeavors. We commit to honor these core values: Covenant Health is guided by highly qualified community leaders as its Public Juridic Person, who give generously of their time, talent and leadership. The members of the Public Juridic Person also serve as COMPASSION We show respect, caring and sensitivity towards directors of Covenant Health, Inc. all, honoring the dignity of each person, especially the poor, vulnerable and suffering. Lesley Adkison, PhD, RN Bruce Bonnell, MD, MBA, MPH Lesley Adkison received her undergraduate degree from Dr. Bruce Bonnell is a geriatrician, internist and medical INTEGRITY We promote justice and ethical behavior, and Maryville College, a master’s degree in nursing from University educator. He serves as chief of geriatric medicine at Spaulding of Tennessee, Knoxville, and a nursing doctorate from Boston Hospital for Continuing Medical Care in Cambridge, MA and is responsibly steward our human, financial and College. She also holds specialty certifications in both an instructor in medicine at Harvard Medical School. Prior to environmental resources. gerontological nursing and psychiatric mental health nursing. joining Spaulding, Bruce served as a primary care geriatrician Lesley is currently on the board of directors for Youville Assisted at Mount Auburn Hospital in Cambridge and hospitalist at Living in both Cambridge and Lexington. Her professional Massachusetts General Hospital. He is also a member of the COLLABORATION We work in partnership, dialogue and shared background includes roles in program development and Massachusetts Board of Registration in Podiatry. Bruce earned purpose to create healthy communities. coordination, nursing administration, nursing education, his medical degree from New Jersey Medical School and holds research and biotechnology. Her professional interests include an MPH from Harvard’s T.H. Chan School of Public Health and organizational ethics and provider-patient interactions in an MBA from Boston University’s Questrom School of Business. EXCELLENCE We deliver all services with the highest level of healthcare. quality, while seeking creative innovation. Aisha Bonny, MSW Kenneth E. Arnold Aisha Bonny, MSW, is senior director of operations for Child Kenneth E. Arnold is retired and previously held the position of Family and Community Services at the Brockton Area Multi- senior vice president, general counsel and secretary of Lifespan Services, Inc. (BAMSI), a private, non-profit human services Corporation. He came to Rhode Island Hospital in 1992 and organization providing services to adults and children with was part of the group that created Lifespan. Ken has a master’s developmental disabilities, mental illness, behavioral health degree in health systems management and a law degree from and public health needs. She was named the Brockton 2011 OUR HERITAGE Tulane University. At Lifespan, he had responsibility for legal Woman of the Year. Aisha serves on the MSW advisory board affairs and served as a special advisor to the board of directors at Bridgewater State College, the Haitian Organization for Covenant Health, influenced by the Spirit of St. Marguerite d’Youville and and to senior management. From early 1999 to 2003, he had Advancement of Petit Goäve and the board of St. Joseph executive responsibility for development. He has also overseen Manor, Brockton, MA. that of all related sponsors, was founded by the “Grey Nuns,” the Sisters human resources on an interim basis. Prior to coming to Rhode of Charity of Montreal, and is committed, as an innovative Catholic health Island, he worked in several healthcare organizations, including organization, to advancing the healing ministry of Jesus. the University Medical Center of his alma mater, Tulane.

2018 | Stewardship Report 5 John A. Isaacson William P. Lucy Thomas L. Mortimer John Pallone, CPA John A. Isaacson is the chief executive officer and partner of William P. Lucy serves as senior vice president of commercial Thomas L. Mortimer’s 40-year banking career began as an John M. Pallone, CPA, is a founder and partner of Shaheen, Lee Auto Malls and Maine Auto Credit in Auburn, ME. John is services for Katahdin Trust Company in Bangor, ME. Bill began undergraduate at Northeastern University, where he pursued Pallone & Associates, P.C., a full-service certified public the former board chair of the Sisters of Charity Health System, his banking career in 1981 following his graduation from his degree in finance. He would later earn his MBA in finance accounting firm located in North Andover, MA, which provides which includes St. Mary’s Health System and d’Youville Pavilion. the University of Maine. Bill is chairman of the board of St. at the University of Massachusetts in Lowell, and in 1998, he accounting, auditing, tax and business advisory services to a He also serves on the board of directors for Greater Atlantic Joseph Healthcare, a member of Covenant Health. His prior was appointed executive vice president and chief credit officer diverse clientele. John is very involved in community affairs Insurance Company headquartered in Hamilton, Bermuda. community involvement includes service as board president of of Pentucket Bank in Haverhill. Since 2010, Tom has served as and has served as chairperson of the board of directors John graduated cum laude from Dartmouth College and is a Katahdin Area Council Boy Scouts of America, board member president and CEO of the Haverhill Bank. of Mary Immaculate Health/Care Services, a member of Rufus Choate Scholar. of Penobscot Community Health Center, board president of Covenant Health. the YMCA, campaign chair for United Way and director of the In addition to his professional responsibilities, Tom has also Bangor Symphony Orchestra. lent his time and talent to several community organizations. He Thomas L. Kelly is co-chairman of the finance committee of All Saints Parish Louise Trottier, Chair in Haverhill; past chairman of the Greater Haverhill Chamber Thomas L. Kelly is retired and formally held the position of Louise Trottier chairs the Covenant Health Board of Directors. of Commerce; president of the Greater Haverhill Foundation the chief executive officer at HealthSmart in Irving, TX. His Dan Mingle, MD She serves as vice chair of the board for Hunt Community and Haverhill Day Care; chairman of the finance committee previous experience includes serving as president and CEO of As a board-certified family physician, Dr. Dan Mingle has served Senior Living in Nashua. She serves as past chair of the St. for the Northern Essex Community College Foundation; and Schaller Anderson Inc., executive vice president at Davita, Inc. as private practitioner, group practice owner/leader, medical Joseph Hospital Board in Nashua, is a member of their finance is a member of the board of directors of the Massachusetts and founder of Mercy Health Plans, Inc. Tom has a master’s in educator, EMR director and lead physician and regional health committee and also serves on Covenant Health’s Finance Bankers Association. Tom is also the chairman of the board accounting from New York University and serves on the boards system executive. He has developed a national reputation Committee. Louise is retired and previously held the position of of Penacook Place, a 160-licensed bed not-for-profit skilled of Fidelis Care in New York, FOCoS Innovations and Welvie. for promoting healthcare reform, productive use of electronic senior vice president of retail banking at TD Bank. Louise has nursing and rehabilitation center located in Haverhill. medical records and practice improvement using healthcare experience serving on many non-profit local community boards data analytics. Dan was the founder, owner and lead physician and is currently on the Hunt Community Board of Trustees, a David R. Lincoln, FACHE of Western Maine Family Practice in Norway, ME, where he John D. Oliverio, Vice Chair non-profit senior living residence in Nashua. David R. Lincoln serves as president and chief executive practiced for 14 years. He was an early adopter of electronic John D. Oliverio is the former president and chief executive officer of Covenant Health. Prior to joining Covenant, David practice management systems and a pioneer, integrating officer of Wheaton Franciscan Healthcare, a Catholic, non- held several senior administrative positions at Memorial Health behavioral health into a primary care practice. profit organization with 14 hospital sites, more than 1,500 System and Memorial Hospital in South Bend, IN. David serves Dan spent five years on the faculty and as assistant medical staffed beds, more than 17,000 associates, over 500 medical on many boards, including the First Initiatives Insurance, LTD. director of the Maine-Dartmouth Family Practice Residency group physicians and a housing ministry with 2,620 units in He is a member of the finance committee at Catholic Health Program and held a faculty appointment in the Department Wisconsin, Iowa, Colorado and Illinois. Serving the organization Initiatives. He is the vice chairperson of Yankee Alliance, Inc. of Community and Family Medicine of the Dartmouth Medical for more than 31 years in various capacities with the last 15 and vice chairperson of Yankee Alliance, LLC. David is past vice School. He received a master’s degree from Dartmouth’s years as president and CEO, John has a deep commitment chairperson of the board of Stewardship Trustees of Catholic Center for Evaluative Clinical Sciences in 2003, a program to Wheaton’s mission, vision and values. He has led the Health Initiatives. He is a trustee emeritus of Catholic Healthcare emphasizing healthcare improvement, change management organization’s move to integrate delivery systems across Partners and served as the first lay chairperson of the Corporate and quality measurement. For his work in community-wide EHR markets, expand physician services and create innovative Member. He has served as past chairperson and president of implementation, he was recognized as Innovator of the Year by physician partnerships to efficiently and effectively support the the American Hospital Association’s Society for Health Care Healthcare Informatics Magazine in 2008. needs of patients, associates, physicians and communities. He Planning and Marketing, and he has served as the chairperson has also been committed to various civic organizations over of the American Hospital Association’s Governing Council for Dan is founder and chief executive officer of Mingle Analytics, his career in addition to serving as chair of his parish finance Health Care Systems. David has served as a member of the Inc. The company enables ambulatory clinicians to become committee and local school board. National Advisory Board of the American Hospital Association more patient-centered by making data-driven decisions Center for Healthcare Governance. for improved practice efficiency. Dan has provided quality reporting submissions to Medicare since 2011 through the Mingle Analytics PQRS Solutions™ registry (MIPS Solutions™ James F. Loftus, IV in 2017). James F. Loftus is the president and chief executive officer of 101.1 More FM/WBEB Radio-Philadelphia. A career broadcaster, he served as a vice president with CBS/Philadelphia from 2005 to 2015, and before that was chief operating officer at Times- Shamrock Communications, in Scranton, PA. He is a member of the board of directors of St. Mary’s Villa Nursing Home and St. Mary’s Villa Residence in Elmhurst Township, PA, and past board chairman. James is also a board member of the Archdiocese of Philadelphia’s Catholic Charities Appeal and the Pennsylvania Association of Broadcasters.

2018 | Stewardship Report 6 2018 | Stewardship Report 7 Election of PJP Members Covenant Health Systems Ministry On June 23, 2017, the members of the PJP voted on the following actions: Covenant Health Systems is a sponsor of 12 acute and post-acute care (PAC) organizations located in Maine, Massachusetts, New Hampshire, Pennsylvania and Rhode Island. It also serves as the sponsor of a foundation in Vermont. Covenant Health Systems has sponsorship, governance and management responsibility for these entities. These organizations are providing various levels of care including:

That Louise Trottier be and she hereby is elected as Chairperson of the Public Juridic Person of Covenant Health Systems for a one-year term, 2017-2018.

3 8 3 3 Acute Care Skilled Nursing Assisted Living Independent That the following individuals be and they hereby are re-elected as Kenneth Arnold Hospitals Facilities Facilities Living Facilities Directors of the Public Juridic Person of Covenant Health Systems, James Loftus for a three-year term, 2017-2020: William Lucy John Oliverio John Pallone 1 System Foundation 3 Hospital Foundations

That the following individuals be and they hereby are re-elected as John Ahle, Treasurer Officers of the Public Juridic Person of Covenant Health Systems, John Newman, Clerk for a one-year term, 2017-2018: David Lincoln, President John Oliverio, Vice Chair Louise Trottier, Chair

That the following individuals be and they hereby are new members Thomas Mortimer In addition, Covenant holds management of the Public Juridic Person and to the Covenant Health Systems contracts with three elder care facilities: one Board of Directors for a two-year term, 2017-2019. in Massachusetts and two in Maine. Covenant Health has affiliation agreements with another 12 facilities located in Massachusetts, two facilities in New Hampshire and one in Connecticut. These ministries are comprised of assisted living and long-term care facilities.

Sponsored/Member

Managed/Management Services

Affiliated

2018 | Stewardship Report 8 2018 | Stewardship Report 9 SPONSORSHIP REPORT

CATHOLIC HEALTH ASSOCIATION ANNUAL ASSEMBLY

Sr. Catherine O’Connor transitioned out of her role as mission leader at Covenant in early 2017 and was replaced by Deacon Reynold Spadoni, who began in September. Covenant Health was represented at the June CHA Annual Assembly meeting by David Lincoln, president/ceo and Louise Trottier, board chair. At last year’s meeting, Covenant attendees were impressed by Fr. Gregory Boyle, who is scheduled to present at the Covenant Health Systems Leadership Forum later this year.

Deacon Spadoni and other Covenant representatives have connected with staff at CHA and have begun collaborating with them on several initiatives. Covenant was represented Deacon Reynold Spadoni at the June 2018 Assembly meeting in San Diego, California.

MINISTERIAL JURIDIC PERSON MEETINGS

Louise Trottier, chair of the Covenant Health Board of Directors and Public Juridic Person, MISSION AND SPIRITUAL CARE and David Lincoln, president/ceo, attended the June meetings of the Ministerial Juridic Persons. Ms. Trottier and Deacon Spadoni attended the annual MJP meeting held on During 2017, Covenant Health transitioned from a decentralized health November 28, 2017. The fall meetings included representatives from the 16 MJPs in system to an integrated model, resulting in a reorganization of its the United States. Participants heard from Fr. Michael Fuller, Executive Director and approach to Mission Integration across the organization. During the Fall Secretariat of Doctrine and Canonical Affairs for the United States Conference of Catholic and early Winter of 2017, the scope of Mission Integration was revised to Bishops. He discussed several issues related to the forthcoming revision to the Ethical and include responsibility for interpreter services, development of a Covenant Religious Directives, including healthcare partnerships and care of transgender individuals. Health palliative care program, roll out of an initiative to improve employee This elicited a thoughtful discussion among all present. engagement and facilitation of efforts to enhance the patient experience for all patients and families served. This decision was guided by the The next meeting of this group will take place during the annual Assembly in June of 2018. belief that more directly infusing our mission and Catholic identity into efforts to enhance employee engagement and patient experience will be CHA SPONSOR FORMATION PROGRAM most impactful.

Covenant has four participants in the 2017-2019 CHA Sponsor Formation Program. These changes are being implemented during 2018, and as such, we look Themes of the formation program include: forward to reporting on our progress in our 2018 Stewardship Report. • The Call to Serve • To Serve Within the Church • Living Our Tradition • Sponsorship Today

The initial modules of the CHA Sponsor Formation Program were offered in October 2017.

2018 | Stewardship Report 10 with area agencies and within the system to improve families can be present with their loved one. Attention Ethics care of critically ill and dying. is given to the process by providing a sign to others using a special quilt on the bed, special lighting which The orientation of the system ethicist included a site indicates the time of transition and by allowing families The Role of Ethicist visit to 10 of the owned or managed post-acute facilities extended courtesies, such as food and drink. within the system, including facilities in Maine, New In July of 2017, Covenant hired its ethics consultant, Susan Belanger, PhD, MA, RN, into a Hampshire, Rhode Island and Pennsylvania. The residents of the Catholic faith are offered the part-time position to give ethics greater visibility within the system. The ethicist reports directly sacraments to prepare for death. At the time of death, to the senior vice president of mission integration and works closely with the mission leaders Ethics in Post-Acute Facilities prayers are offered, the families are supported, and the throughout the system. In general, the ethical decision-making in Covenant’s body of the resident is escorted by staff as the final act post-acute facilities is handled by a small group of of caring and presence. individuals which include the nursing and administrative leadership, mission leaders and clinicians skilled in Looking Ahead: The Role of the Ethicist deliberating ethical challenges. All facilities abide in 2018 by the ERDs, which was confirmed by the mission THE ROLE OF THE ETHICIST IS TO: In the coming year, the ethicist will continue with leaders and administrators. The two largest facilities, key functions within the system including, providing Mary Immaculate and d’Youville Pavilion have ethics 1 Provide ethics education to the staff at all levels of the Covenant organization education on the ERDs and ethical decision-making, committees, while the smaller facilities utilize leadership evaluating policies that impact ethical decisions, 2 Provide consultation for challenging ethical situations “huddles” and meetings to discuss ethical issues. offering forums for discussion of ethical challenges, guiding decision-making processes which consider 3 Assist with policy development in ethics The ethical challenges the facilities face most often the ERDs and assisting with challenging cases through relate to patient/family decision-making. Given the frailty 4 Assure ethics-related activities include and reflect the Ethical & Religious Directives for Catholic Health Care Services consultation. of human nature and the complexity of family dynamics, (ERDs) the issues encountered in post-acute facilities often Looking outward from the system into the communities 5 Provide and guide a process for organizational decision making related to ethical challenges include concerns surrounding patient self-harm, we serve, the goals of the ethicist and system potentially harmful family decisions, lack of family leadership are to advocate for and assist the decision-making in the situation of an incapacitated marginalized and vulnerable within our communities, resident, or conflict within the family which impacts including those with mental health and chemical decisions for the resident and others. The best care of dependency issues, refugees, victims of human Ethics in the Hospital Setting the resident is at the heart of every challenge, and the trafficking, the unborn, the underinsured/uninsured, the staff of each entity recognize their responsibilities in The work of the ethicist began with participation on the Association (CHA) literature or may be drawn from the poor and most especially, our frail elders. resolving the challenges and preventing the occurrence ethics committees of the three Covenant hospitals. In secular publications. The committees meet at least of new ones. general, each ethics committee has representation from quarterly throughout the year. Finally, the ethicist continued her own education and all areas of the hospital it serves, including clinicians, development by attending the CHA Ethics Colloquium These facilities take seriously the care they provide clergy, as well as administration and community Each hospital has an ethics consultation process, which in St. Louis in March 2018. Additional opportunities to their residents and families, especially at the members. At the meetings, recent ethics consultations includes trained members of the ethics committee. are provided through participation in the Schwartz time of death. Each facility is attentive to providing are discussed and if required, policy changes and/or Ethics consultation themes are consistent with those Center Rounds, The American Society for Bioethics and individualized spiritual care, adequate pain control and a recommendations are made to the administration. In found in the bioethics literature. These include issues Humanities and educational materials provided through good and dignified death. When a resident is dying, the addition, each committee provides education to the of patient self-determination – specifically patients who CHA. She assumed the system ethicist role on a full- resident is given a private room, when possible, so the members and considers topics for staff education. make decisions seen as harmful to self, challenges with time basis in the spring of 2018. Topics discussed at each facility include, but are family decision-making and surrogate decision makers; not limited to, the ERDs and contemporary issues in issues of aggressive end-of-life treatments in situations practice. of non-medically beneficial treatment; and challenges in treatment and discharge planning for the poor and Meetings may include a review of policies with an ethics vulnerable. component. Commonly, the meeting will also include an article for discussion about any number of ethics-related To provide good end-of-life care, Covenant hospitals topics. These are typically found in the Catholic Health embrace and support palliative care and work closely

2018 | Stewardship Report 12 2018 | Stewardship Report 13 Faculty for these sessions included mission leaders from within the system and from another Catholic health system’s Ministry Formation Programs ministry formation program. Their academic and professional preparation included Master’s Degrees in Pastoral Ministry, Master of Divinity degrees and Doctor of Theology/Philosophy in Systematic Theology, Ethics and Religious Studies. In addition, in 2017 Covenant Health also added a Ph.D.-trained system ethicist who is also a nurse; she served as faculty “In order to ensure a vibrant ministry in the coming years, ongoing formation of senior for ethics components of some of these programs. Responses from the ministry formation participants’ evaluations leaders involved with the ministry must be a high priority wherever the ministry extends included: THE SESSION ALLOWED ME TO… its mission. This formation is not an option - it is a necessity.”

- Catholic Health Association Reflect on the Know history about Gain an appreciation of values I hold close Covenant and the driving influences at home and at understand more underlying Catholic work. about our values. health care. The Covenant Public Juridic Person and Senior Leadership of Covenant Health view ministry formation as a priority. The formation programs focus on grounding our leaders in the foundational values of Catholic health care and help leaders apply the principles of Catholic identity and inspire personal and leadership growth.

Refocus on the values and importance of my job and why we work here.

The programs offered in 2017 included a continuation of established programs and one new program:

A Spirit of Caring was initiated for front-line staff, such as secretaries and medical assistants. This focused, lunchtime Understand the work Understand the I do and why I do it, conversation highlighted Catholic Social Teaching themes and Covenant values in connection with their daily work. Think outside my Catholic influence of remember my Catholic comfort zone. Ministry Concepts is a one-day program for managers. Content includes the history of religious congregations whose Covenant Health. teachings and bring it ministries are sponsored by Covenant Health, how Covenant Health became a Public Juridic Person of the Church, and to my everyday work. one’s call to ministry and ethics.

Foundations is a two-day program focused on the foundational elements of Catholic Health Care. Programing includes scripture, health care as ministry, Catholic social teaching, church and sponsorship, moral instincts and the ethical and religious directives for Catholic health care. This program is required for any director level or above and is also a pre- Realize more fully the mission-driven purpose of Covenant. requisite for senior leadership to begin their formation program.

Heritage and Horizon for senior leadership includes 12 days of formation offered over two years for each cohort of leaders (there are six, two-day modules in the program.) The third module - Catholic Health Care as Ministry - of the fifth cohort was held in June 2017. Revisit the Catholic Better understand the Better understand how beliefs of caring for Catholic health care the Catholic Church is community, co-workers, system’s stance and part of our work. self and poor. my place within it. In 2017, there was a focus on on-going formation for Covenant Health senior leadership. Every other month, more than 100 senior leaders of the system gathered for two days. Each gathering began with prayer, then transitioned to ministry formation using Covenant Health’s new values: compassion, integrity, collaboration and excellence. The sessions incorporated some of the formats used in Heritage and Horizon, such as theological reflection and scripture. An additional session, led by mission leaders from acute care hospitals and post-acute facilities, closed the second day of each gathering. Covenant Health collaborates with other internal departments, initiatives and external partners, such as Bon Secours and the Catholic Health Association (CHA), to provide resources and support for preparing governance, leadership and staff. In 2017, CHA shared results of a survey measuring the impact of senior leadership formation; Covenant participated in the survey. CHA is in the process of developing a reliable and valid measurement tool for leadership formation, and we look forward to the results to inform our future ministry formation efforts.

2018 | Stewardship Report 14 2018 | Stewardship Report 15 St. Marguerite d’Youville Grants Mission Moments

The St. Marguerite d’Youville Grant was established in 2008 when the Sisters of Charity of Montreal donated funds to At all the Covenant Health ministries, staff members provide medical care to those in need. What sets support specific projects which “assist the needy through education and/or projects for the poor.” Grant applications are them apart is the compassion and love with which it is delivered. These Mission Moments are but a few of encouraged from all member organizations. In December 2017, the Grant Committee awarded the following: the many, many examples of our staff’s exceptional work in service to those in their care.

Mary Immaculate Health/Care Services Lawrence, MA $10,000 Working with a local food and sheltering program, this grant will allow residents of Mary Immaculate to prepare Lawrence, MA food for homeless individuals and families in the local community. This will provide meaning and purpose for those Mary Immaculate Health/Care Services who are preparing the meals and will help meet a significant community need in an area where 28% of residents At Mary Immaculate, care extends not only to the whole person but also to the family. Recently, as a woman on our live in poverty. memory unit was nearing death, her husband of 68 years was unexpectedly hospitalized. Fearing that his wife would die without him by her side, he signed himself out of the hospital, insisting that his family bring him to his wife. When the staff at Mary Immaculate learned of the circumstances, they went to work immediately. They arranged for him to St. André Health Care Facility Biddeford, ME $10,000 be admitted to our rehab unit, so he could be cared for and close to his wife. The social worker and admission director St. André will refine and expand a program funded by the St. Marguerite Grant, that offers an educational opportunity spoke with the hospitalist and explained the situation, medical orders were obtained and staff worked with his insurance for current employees who seek professional certification as a certified nursing assistant (CNA) – a position often company to get him covered. The team then made all the arrangements so that he and his family were able to sit by the difficult to recruit at the facility. This program will also be offered to members of the local community who wish to bedside to usher his wife into the next life. enter the healthcare field. Sharing this sacred time with this family was a gift to all involved. As the family sat vigil, one son wrote:

St. Joseph Healthcare Bangor, ME $5,500 St. Joseph Healthcare is launching a program in partnership with a local food bank to screen inpatients and “I don’t have enough words to describe the love, care, passion and gentle, delicate care- emergency department patients for food insecurity and to provide pre-packaged food bags to those in need. In taking and understanding that has been given to my mother and my family at this facility.” Penobscot County, 17% of residents live in poverty, and hospital personnel frequently encounter patients receiving care who consistently have difficulty securing meals for themselves and family members.

St. Mary’s Health System Lewiston, ME $10,000 St. Joseph Healthcare Bangor, ME St. Mary’s is expanding its Nutrition Center community gardening program in Auburn, ME. Based on its highly successful and impactful community garden strategy, the Nutrition Center’s program ensures that fresh food is One day in November, the mission leader at St. Joseph Healthcare in Bangor received a call from one of the SAFE more available and affordable to residents with limited income, while helping create strong community connections (Sexual Assault Forensic Examiner) nurses in the Emergency Department asking for help with a patient who needed to fly among its members. Additionally, these funds will assist HIV/AIDS patients with transportation needs by providing to Southern California to rejoin her family. It was an unusual request. bus passes. Bella (not her real name) had a failed marriage. She had been job hunting for some time, eventually answering an ad for a construction apprentice job in Bangor. She applied for the job, and after a telephone interview, she was hired. She St. Mary’s Villa Elmhurst Township, PA $8,000 traveled to Bangor and was picked up by a man who kidnapped her. She was stripped of her phone and any kind of St. Mary’s is supporting a community program through the local volunteer fire department to provide a branded identification. For three months she was abused, mistreated and lived a life of a slave. trailer that offers aid to victims in times of natural disaster. The fire department will bring the trailer to St. Mary’s and will hold safety training for St. Mary’s staff as well as others in the community, including local schools, youth One day, her predator left the house, and she was able to find a deactivated iPhone. She called 911 and requested camps and eldercare facilities. help for chest pain and shortness of breath. First responders brought her to St. Joe’s ED, where the charge nurse knew there was more to Bella’s story. The nurse referred the case to a SAFE nurse who identified Bella as a victim of human trafficking.

The grant committee was pleased with the level of interest in the 2017 grant program and is confident that these The St. Joe’s staff provided Bella more than medical care. They reached out to several community partners, and upon programs will help meet important community demands, particularly for those who are vulnerable and in need. The discharge, Bella had in hand a plane ticket, new clothes and even a travel cage for her cat. One of the SAFE nurses nature of the funded projects is testimony to the positive impact that Covenant Health’s mission is having on the escorted her to the gate of the airplane to be sure her predator would not find her. This essential support truly made the communities it serves. difference between life and possibly death for Bella.

2018 | Stewardship Report 16 2018 | Stewardship Report 17 St. Joseph Hospital Nashua, NH

A patient came in through the Emergency Department with a broken hand. After being treated for the injury, she came to the pharmacy to pick up prescriptions for swelling and pain. The pharmacist recommended taking the medication with food, and the patient quietly responded that it might be an issue as she had fallen on difficult times and food was scarce at home. Through the d’Youville Fund, the hospital staff was able to immediately help the patient with a $25 food voucher. The next day, this patient called to say that it was the first time she had eaten a full meal in her home in over two weeks. It was also her birthday. She was so incredibly grateful and expressed that she felt a part of her faith had been restored.

Youville House Cambridge, MA

Living the mission in the workplace is a priority for staff. A good example of this comes from Youville House. Because HEALTH CARE ENVIRONMENT we are in the Northeast, inclement weather is a fact of life for those who live and work at most Covenant Health facilities. During one particularly severe snow storm, two staff members at Youville House insisted on driving employees home. Perhaps more than ever, we are experiencing great change in health The volunteer drivers wanted to offer meaningful thanks to their coworkers, especially those who walked or rode buses care delivery in the United States. Patients no longer accept directives to work, and help keep them safe. It is gratifying to see our mission and values in action. without discussion from their providers; they are demanding to be active and informed participants in the decisions that impact their health and wellness. Health organizations offering operational solutions that are convenient and clinically sound are becoming the providers of choice. Same-day appointments, walk-in clinics with extended hours, convenient community-based locations and virtual visits are quickly becoming the norm instead of the exception, with positive patient experience as the main driver of this transition.

Covenant Health’s CareLink project is integral to positioning our organization for the future. This powerful tool will streamline our operations and standardize our workflow. The patient portal, MyChart, encourages interaction outside of the exam room between providers and patients. We are also expanding our Virtual Health program based on a very successful initiative piloted during 2017 that expands neurology consultations to the underserved in Maine.

What has not and will not change is our commitment to those in our care. Our Strategic Plan (graphic on next page) makes that clear. The basis for all that we do is built on the foundation of our Catholic identity. Every day, we chart our course using the compass of our ministry.

2018 | Stewardship Report 18 Quality STRATEGIC PLAN Commitment to quality remained at the forefront during 2017. Highlights include: PYRAMID PHYSICIAN PRACTICES

PATIENTS Quality Restructuring & RESIDENTS As health care continues the shift from a hospital focus to ambulatory care, health systems are challenged with making access to care easier, streamlining services to enhance the patient experience, while improving the efficiency and quality of services provided by their physician practices. During 2017, Covenant continued the redesign and restructuring of its MISSION quality program across the system, focusing on the development of dedicated quality roles for the physician practices. A System Director of Physician Network Quality position was created, with Physician Network Quality Manager positions in We are a Catholic health each acute care location. ministry, providing healing and care for the whole person, in service to all in our communities. Notable quality achievements for the physician practices during 2017: The implementation and rollout of the NRC Health Connect Experience, real-time patient telephone survey program, to our physician practice patients, provides regular patient satisfaction feedback to providers, as well as to the local VISION and system physician operating committees. We will be a growing Catholic, integrated, community-centered health partner. The administration of the Maslach Burnout Inventory (MBI) survey to Covenant health care providers to assess the current level of provider burnout and the development of ongoing interventions with the Wellness Committee.

VALUES Successful submission of ambulatory quality performance metrics required for regulatory and recognition programs COMPASSION COLLABORATION for each of Covenant’s physician markets, including system-wide planning, education and completion of the Merit- INTEGRITY EXCELLENCE based Incentive Payment System (MIPS) Year 1 submission.

Other Significant Physician Practice Quality Achievements include: COVENANT MANAGEMENT METHOD ST. MARY’S HEALTH SYSTEM Lewiston, ME • St. Mary’s physician practices met all of their 2017 Accountable Care Organizations quality goals. OUR GOALS • Medicaid Meaningful Use was met by 71 out of 84 eligible providers. • All primary care practices received Patient Centered Medical Home (PCMH) recognition (2016 through 2019). PEOPLE QUALITY PERFORMANCE GROWTH & » We attract, develop We are a premier provider » We relentlessly TRANSFORMATION ST. JOSEPH’S HOSPITAL Nashua, NH & retain superior of care achieving the pursue operational » We offer innovative, teams quadruple aim: excellence • St. Joseph Hospital Nashua is participating in the Northern New England Practice Transformation Network, working relevant consumer » Patient experience » Best place to work/ » We promote a culture experiences on Patient Centered Medical Home (PCMH) readiness. » Provider engagement high engagement of fiscal responsibility • Current Merit-based Incentive Payment System (MIPS) group composite score above the exceptional performance » Population health » We provide seamless » Affordable healthcare integrated care threshold.

ST. JOSEPH’S HEALTHCARE Bangor, ME EXPANDING THE MINISTRY • All primary care practices received Patient Centered Medical Home (PCMH) recognition (2016 through 2019). The Catholic identity of Covenant Health will serve as our foundation and compass to guide and grow our mission and ministry of healing and health. 2018 | Stewardship Report 21 Quality Commitment to quality remained at the forefront during 2017. Highlights include:

HOSPITALS AND OPERATIONS

Accreditation for Acute Care Hospitals • During 2017, all of Covenant’s hospitals moved to the same accreditation platform. DNV-GL (Det Norske Veritas) began providing health care accreditation and clinical excellence certifications in the United States in 2008. They have deeming authority for hospitals from the Centers for Medicare and Medicaid (CMS). Hospitals accredited by DNV GL- Healthcare are deemed to be in compliance with the Medicare Conditions of Participation. DNV-GL accreditation integrates two sets of standards, their own National Integrated Accreditation for Healthcare Organization (NIAHO) standards based on the CMS Conditions of Participation, and the internationally recognized ISO 9001 (Quality Management System) standards. They survey annually, with the goal of hospitals achieving ISO 9001:2015 certification during year 4.

• St. Joseph Hospital, Nashua is in their fourth year of DNV accreditation and will undergo their ISO 9001:2015 certification survey during 2018. St. Mary’s Regional Medical Center, Lewiston and St. Joseph Healthcare, Bangor had their first successful DNV surveys during Q1 2017. DNV-GL. H ISO 9001 provides the framework for the sustainable implementation of the Conditions of Participation. It is also a framework within which methodologies such as LEAN COMMUNITY BENEFIT are better understood and utilized. The combined result drives quality transformation into the organization’s core processes. “To live charitably means not looking out for our own interests, but carrying the burdens of the weakest and poorest among us.” - Pope Francis Covenant Management Method Covenant completed its LEAN Transformation work with the Virginia Mason Institute (VMI) in 2017. The Covenant Office of LEAN Transformation (COLT) has developed a tiered educational program for the Covenant Management Method that will be rolled out over the course of 2018. During the spring and summer of 2017, Covenant’s Corporate Leadership Team (CLT) completed LEAN training and began twice weekly huddles and other effective strategic planning tools. Covenant’s Value Stream work focused on post-acute care and the redesign of the new-hire process.

CareLink Q-Hub Covenant Health went live with CareLink, our new electronic medical record (EMR), at St. Joseph’s in Bangor in January 2018. St. Mary’s in Lewiston and St. Joseph’s Nashua went live in May 2018. During the first two weeks of the EMR implementation, the Quality department ran a QHub program to review charts and provide real-time feedback to clinicians on the effectiveness of documentation of the key processes – and ensured that correct workflows are being followed. Training was adjusted based on the findings.

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Colchester Food Shelf: Matching donation to support the Our Community Care Camp, Inc: Summer meals Fanny Allen Corporation Food Shelf. Value: $421 and summer enrichment programs for economically Burlington, VT disadvantaged children. Value: $5,000 Colchester Food Shelf: Donation to support the work of OUR LEGACY the Food Shelf. Value: $100 Pathways Vermont: Supports Housing First program to find homes for homeless individuals with mental health, Committee on Temporary Shelter (COTS): Support Fanny Allen Holdings continues the ministry of the Religious Hospitallers of Saint Joseph by substance abuse or other issues. Value: $5,000 the COTS Housing Resource Center efforts to prevent stewarding resources to support activities that reflect the compassion of Christ in service to homelessness and increase housing retention. Value: Richmond Food Shelf: Donation to support the people who are sick and poor in body, mind or spirit. $10,000 Richmond Food Shelf. Value: $300

Community Health Centers of Burlington (CHCB): Rutland Community Cupboard: Donation to support the Support for sliding-fee scale dental program for residents Community Cupboard. Value: $300 lacking access to dental services. Value: $20,000 This past fiscal year, the Fanny Allen Corporation contributed $299,321 in grants and sponsorship to support nonprofit Samaritan House: Supportive Housing Project. organizations in Vermont that reflect the compassion of Christ in their service to people who are sick and poor. We Elderly Services, Inc.: Supports purchase of two Value $10,000 actualize the long-standing mission of the Religious Hospitallers of St. Joseph by partnering with other agencies and handicapped accessible vans serving a medical elderly Spectrum Youth & Family Services: Shelters and organizations that share our mission to serve the most vulnerable people among us and promote our values, thereby day care program. Value: $13,000 housing programs for homeless and marginally-housed improving the quality of life and building healthier communities. Faith in Action: Community support for volunteer youth. Value: $8,000 programs offering meals, transportation and other services to help vulnerable residents of Vermont’s St. Ann’s Shrine: Donation to support continued care of Northeast Kingdom remain independent. Value: $12,000 the Shrine. Value: $500 Addison County Community Action Group doing Burlington Dismas House: Donation made in support of business as HOPE: Supports low income residents of Dismas House Community Celebration. Value $1,000. Greater Burlington YMCA: Donation to support the early Vermont Catholic Charities, Inc.: Annual Advent Appeal Addison County with basic needs such as food, clothing, childhood education program. Value: $10,000 for emergency support to Vermonters. Value: $3,000 and shelter. Value: $10,500 Camp Agape Vermont: Reduced-fee summer camp for 70 children whose parent or other significant caregiver is Green Mountain Habitat for Humanity: Supported Vermont Catholic Charities, Inc.: Vermont Catholic ANEW Place: Helps foster long-term personal growth in incarcerated. Value: $7,500 construction of four perpetually affordable and energy- Charities Emergency Aid Program. Value: $20,000 homeless individuals. Value: $10,000. efficient homes in Essex and Burlington in 2017. Camp Exclamation Point, Inc.: Week long summer camp Vermont Foodbank: Supports Community Kitchen Value: $6,000 Boys and Girls Club of Burlington: Ensures that the for economically disadvantaged children. Value $6,000 Academy, which trains unemployed and unemployed socially and economically disadvantaged young people Hinesburg Community Resource Center: Donation to Vermonters for careers in food service. Value: $10,000 Cancer Patient Support Foundation: Provides free we serve have their most basic needs met, including support the center. Value: $300 1) reliable and cost-free access to healthy meals, 2) lodging to local cancer patients and their caregivers while Vermont Works for Women: Supports Step into Work reliable and cost-free access to a place after school undergoing cancer treatment away from their community. John Graham Shelter: Supports rapid re-housing for Employment Readiness for Women with Barriers. where they can be safe and free from harmful influences, Value: $10,000 families with children. Value: $18,000 Value: $8,000 especially drug use and violence, and 3) dedicated and Champlain Valley Office of Economic Opportunity: Vermont Youth Conservation Corps: Employment & individualized support for the Club’s entire population Joint Urban Ministry Project – also known as JUMP: Provides nutritious food to 1,800 individuals though the training for youth through the Food & Farm Program. of young people who have experienced severe abuse, Support for JUMP Drop-in Center. Value: $10,000 Addison Community Action Food Shelf. Value $5,000 Value: $7,500 neglect and trauma. Value: $6,000 King Street Center: After school and vacation program Champlain Valley Office of Economic Opportunity: Washington County Mental Health Services (WCMHS): Burlington Children’s Space: Offers take home meal kits for low income children in Burlington, Vermont. Value: Provides food assistance to low-income residents of Children’s Grief & Loss Project donation. Value $5,000 to food-insecure families, providing resources to support $10,000 Franklin and Grand Isle counties. Value: $5,000 and encourage the development of cooking skills and Lund: Supports early childhood education program for reinforce healthy attitudes around food by encouraging Charter House Coalition: Support for food and housing economically disadvantaged children. Value: $12,000 families to cook and eat together. Value: $6,000 programs for homeless individuals and expands the Day Station pilot program to provide guest support for Martha’s Kitchen: Sustains expanded hours of Burlington Dismas House: Increases the level of stability education, job search, social services and other needs. operations of nutrition center and offer workshops in our residential communities, which offer a structured Value: $10,000 teaching clients how to buy, store and prepare healthy family-type living situation to college students and former foods. Value: $5,000 prisoners and provides a greater degree of individual support to residents. Value: $6,500

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• Served as a clinical site for a ministry student from January – April.

Maristhill Nursing and Rehabilitation Center • President/CEO is a member of the Waltham Rotary, which is a very active civic organization involved in undertaking Waltham, MA multiple fund-raising projects and donations to designated programs and charities, including the Salvation Army. Value: $2,099. OUR LEGACY • HR Director administered the United Way campaign, time and materials. Value: $160. Maristhill was begun as an extension of the commitment of the Marist Missionary Sisters to MISSION/SPIRITUAL CARE respond to the needs of the communities they serve throughout the world. This concept of Maristhill’s Director of Mission and Spiritual Care participated in the following community benefit activities: unconditional caring has been foundational for Maristhill’s continuing dedication to building a • In January, spent 15 hours mentoring St. John’s Seminary student. Value: $300 kind and loving community for individuals, families and staff. • In February, 12 hours participating as an CPE program accreditation team member; February - 6 hours mentoring St. John’s Seminary student; March - 13 hours mentoring St. John’s Seminary student; April - 7 hours mentoring St. John’s Seminary student; May - 1-hour mentoring St. John’s Seminary student. Value: $825

Keeping with the mission and vision of our founding congregation, the Missionary Sisters of the Society of • In November and December, mentored 6 visiting Marist Missionary Sisters as volunteers in the Pastoral Ministry Mary and Covenant Health’s founding order, the Sisters of Charity of Montreal (Grey Nuns), Maristhill Nursing Department by helping with Sunday Mass or visiting residents at Maristhill. Value: $450 and Rehabilitation Center continues to respond to the needs of our patients, residents and the greater • In December, began to volunteer each Friday morning at the Waltham Community Day Center as part of the “Chaplains Waltham community with particular focus on the elderly and underserved. on the Way” team by ministering to the homeless. Value: $162.

Loss on Medicaid: $2,118,090 In addition to the above-mentioned activities, Maristhill continues to offer community support in ways Community Benefit Categories: $5,928 that are difficult to assign a dollar value to: Total Community Benefit: $2,124,018 • A ‘Circle of Friends’ fund continues through voluntary payroll deductions to assist fellow staff in crisis, whether from sudden illness, loss or financial difficulties. Community Benefit Categories • There is a basket in Maristhill’s lobby that collects food for the food pantry of our neighboring parish, Sacred Heart.

EDUCATION AND SUPERVISION • Maristhill has a formal commitment with the Marist Missionary Sisters, our founding order and neighbor, to grant priority admission for those Sisters needing skilled nursing care. Collaborated with the Marist Missionary Sisters to offer a computer learning course that was open to staff, free of charge and at hours complementary to employees’ schedules. • Maristhill provides Mass six days a week that is open to relatives and friends of residents, and members of the community, including the Marist Missionary Sisters. COMMUNITY OUTREACH • In November, Maristhill annually offers an interfaith memorial service to remember all those who have passed away • Partnered with the Prospect Hill Community Foundation and the Chesterbrook Learning Center to support after school in the previous year. Invitations are sent to the loved ones of former patients and residents and also to staff who are programs for underprivileged youth in Waltham. Through April: Bake sale, Tickets Silent Auction, Team for trivia, welcomed to attend to remember those they have cared for or someone they have personally lost. Backpacks for 50 children night. Value: $2018 • The facility collaborates with the Marist Missionary Sisters to offer a computer learning course open to staff free of • Partnered with Newton Center in sponsoring “Barn Babies.” Value: $325 charge and at hours complementary to their schedule.

• Director of Admissions and Care Transitions Nurse conducted monthly blood pressure clinics at the Waltham Senior • Maristhill offers its chapel and Pastoral Care support for residents and their families who wish to hold a funeral or Center. Value of Time: Value: $500. Memorial service for their loved ones at the facility. Maristhill encourages and supports staff who wish to attend services of residents they have cared for. • Delivered weekly Meals on Wheels meals to 10 seniors in Waltham. Value: $1551

• Donated a stationary recumbent bike ($2000) to Leland Home. Maintenance Director and Assistant spent 1 hour. Value: $150.

• Activities Department hosted and mentored numerous students and volunteers seeking to complete community service projects. Participants came from Brandeis University, St. Jude’s School and Bentley University. Maristhill’s Activities Director also volunteered work time at St Jude’s School for a fundraising project. Value: $276.

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educational opportunities for those who are planning to continue in the health field. We host local student clinical Mary Immaculate Health/Care Services placements in nursing, certified nursing aide, social work and chaplain training programs. As a host site we offer students the opportunity for hands on, real life situational training to enhance their education. Working hand in hand Lawrence, MA with our staff, these students are exposed not only to excellent clinical experiences but also to the mission and values of our organization. This exposure helps foster a deeper understanding of what it means to integrate such values into OUR LEGACY the practice of their respective disciplines. Our hope is to foster not only clinically strong medical professionals but also those committed to the values of compassion, integrity, collaboration and excellence. Trusting in the Providence of God, the Sisters of Charity of Montreal “Grey Nuns” founded Mary Immaculate in Lawrence, MA in 1868. We provide dignified, compassionate care within a Career Development Education: Through job shadowing and internship programs, we partner with Valleyworks, a not- diverse, loving family community and respond to the changing needs of society in the spirit of St. for-profit organization with a mission to build and promote workforce potential to support regional business growth and economic prosperity. As a corporate sponsor, students work side by side with our staff to learn job skills that will help Marguerite d’Youville. them secure permanent employment. This year, participants worked in our memory care unit, learning skills related to working with the memory impaired.

Dietary Education: In partnership with Lazarus House Ministries, a not- Mary Immaculate Health/Care Services (MIHCS), a member of Covenant Health, is a continuum of care for-profit organization working to break the cycle of poverty through a hand community comprised of low income independent senior housing, assisted living, adult day health programs, up rather than a hand out, Mary Immaculate staff trains interns from their transportation company with handicap accessible buses, short term rehabilitation and a skilled nursing culinary arts program. In hands on learning, students spend their intern facility. MIHCS continues to respond with compassionate care and dignity to the health, social and spiritual hours working side by side with our staff in our kitchen preparing meals for needs of those in and around our community of care in the spirit of St. Marguerite d’Youville, Mother of the residents of Mary Immaculate. They develop culinary job skills along Universal Charity. with a better understanding of business etiquette and expectations as an employee. In addition, one of our dietary directors teaches classes on-site Founded by the Sisters of Charity of Montreal (the Grey Nuns) in 1868, Mary Immaculate remains today an integral part to the full student body. He shares both his culinary skills and practical of our local community. The Grey Nuns began their legacy in the City of Lawrence when they were called to begin a information about working in the culinary field. mission then known as the “Protectory of Mary Immaculate.” As we prepare to celebrate our 150th Anniversary in 2018, we are committed to continuing the good works of St. Marguerite and the Grey Nuns through outreach to help meet the needs of the community, with special attention to the most vulnerable. While the organization focuses its services COMMUNITY OUTREACH Community Benefit: $26,182 on older adults, particularly those in need of some form of governmental assistance, our outreach extends to a broader Recognizing that we are created as a communal people and are called to gather together to live the Gospel message, spectrum of the local population. MI works with many organizations, both Catholic and secular, for the benefit of those in our communities. Some of our partnerships are detailed below. Mary Immaculate Health/Care Services, Inc. (MIHCS) follows the methodology recommended by the Catholic Health Association for calculating the cost of support. In that methodology, the cost of providing services is reduced by Financial Coaching Program: Aware that many of our staff live paycheck to payments received for services resulting in a net cost. It is the net cost that MIHCS reports as its commitment to the paycheck and struggle with financial issues, Mary Immaculate searched for broader community benefit. a program that could help staff learn how to better manage their finances. This search led to a program developed by Merrimack College and Arlington Loss on Medicaid: $3,463,790 | Community Benefit Categories:$161,130 Community Trabajando, that gives those struggling with financial stability the skills to make better economic choices. Business students from Merrimack College Total Community Benefit: $3,624,920 are paired up as coaches with participants of the program. The original plan was for Mary Immaculate, through a grant, to provide funding for 20 employees to Community Benefit Categories participate in the program. What developed was a true community partnership.

EDUCATION AND SUPERVISION Community Benefit: $125,105 Mary Immaculate became the host site for the entire program, welcoming Mary Immaculate staff and more than 100 Educational opportunities are an important benefit we provide to our local community. As one of the poorest cities in participants from multiple social programs throughout the city, students and educators for three workshops where topics Massachusetts, offering educational opportunities to local residents and community programs provides ways to improve such as budgeting, credit establishment and other financial issues were discussed and evaluated. The program also their lives and that of their families. Some of our educational programs include the following: provided for one on one coaching throughout the 12-week program.

Although the grant was exhausted in 2017, Mary Immaculate will remain a host site and support the efforts of this Medical Professionals Education: As one of the largest employers in the City of Lawrence, Mary Immaculate takes seriously its responsibility to help supplement the education of future generations. MI is committed to promoting nationally acclaimed program to support those looking to find better ways to provide for their families.

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Austin Scholars/City of God Program: In collaboration with the local Augustinian sponsored Merrimack College, MI became a host site for this experiential learning program that brings first and second year college student into our Mount St. Rita Health Centre Report community. This year, 25 students came weekly for two hours to interact with our residents in roles of service. As part Cumberland, RI of the program, they worked alongside our staff, sharing activities and serving meals. The students were then asked to apply the principles they learned in their philosophy or theology class to their experiences serving in the community. OUR LEGACY As a result, we have seen meaningful relationships developed, and students have gone beyond their required hours. In addition, two students requested to share their musical talents with our residents and have returned several times to sing Mount St. Rita Health Centre draws its inspiration and mission from the vision of Catherine and play the guitar. Staff serve as mentors and co-workers with these students, offering support and an opportunity for McAuley, who founded the Sisters of Mercy in Dublin, Ireland, in 1831. Since 1971, we have further discussion and reflection. In addition to all that the students gain, our residents benefit from the vibrancy that the youth bring to what they do each week. faithfully expressed Catherine’s call to serve the poor and the sick by providing exceptional health care with mercy, compassion and hospitality. We steward this great legacy in the tradition UNITAS Program: St. Augustine Parish, a local parish in a nearby affluent community, offers a week-long youth ministry of Mercy and daily renew our commitment to honor and fulfill it through each person we serve. service opportunity during the summer. High school students spend a week in Lawrence rotating amongst social service programs in the city, offering support and learning what each program offers to those in the community. During 2017, Mary Immaculate was approached to become a host site. In June, 48 high school students came to Mary Immaculate to learn what it means to live in a nursing home and the ways volunteers can serve in this environment. Students spent four hours each interacting with residents, helping with social activities and inviting one-on-one conversation. They then Community Benefit Categories returned to share and discuss the experience with their peers. COMMUNITY PARTNERSHIP

Neither students nor residents wanted the program to end. The youth minister coordinated with MI to put together a Student Volunteer Program: Provides opportunities for students to volunteer to interact with our elderly population and program where students would continue this ministry on Sunday mornings. Each week, between 5 and 10 high school develop skills. Value: $1,662 students come to learn more about what elder life is like. They share laughs, play cards, help with crafts and hold hands with those who can do nothing more. The program continues to grow, with 97 people participating in the last three Service through Sandwiches: Residents make 180 sandwiches a week for the homeless in our community. months of 2017 alone. This benefits both our residents and those who are in need.

Advisory Programs: Members of our staff continue to support local organizations Total Donations: Lend a hand ~ receive a hand: Non-billable services for the poor. Value: $10,456 by sharing their expertise with local boards and advisory groups. Amongst these $9,843 groups are The Lawrence Partnership, Massachusetts Catholic Conference Healthcare Subcommittee, Holy Family Hospital Community Collaborative, Holy Family Hospital DONATIONS Clinical Pastoral Education Program and the Home Health Foundation. Volunteer Appreciation: Provides education and practical experience with our elderly population. Value: $1115 Monetary contributions to other organizations, while difficult at times, are another important way to show support for our neighbor organizations. Included in this category are donations to Lazarus House Ministries, Greater Lawrence Family Health Center, Elder Services of the Merrimack Valley, and Family Services of the Merrimack Valley. CHARITY CARE

Charity Care: Care provided for the poor that is non-billable. Value: $737,249 In addition to cash donations, we continue to donate excess medical equipment to IMEC for repurposing to third world countries. This year we also donated more than 250 pieces of used and usable bedroom furniture to Mission of Deeds, a local not-for profit that provides furniture to those in need, and another 10 dressers to Habitat for Humanity for its EDUCATION residents. Nursing Program: Provides student nurses educational opportunities and practical experience with our elderly population. Value: $800 As we prepare for our 150th Anniversary Celebration we are mindful always of our responsibility to, like the Grey Nuns, seek where God is calling us to serve the poor and underserved in order to bring Christ to those we encounter.

2018 | Stewardship Report 30 2018 | Stewardship Report 31 COMMUNITY BENEFIT Penacook Place, Inc. COMMUNITY OUTREACH Community Benefit: $3325 Haverhill, MA Board Participation The CEO of Penacook Place, as a founding member, sits on the Board of Sarah’s Place Adult Day Health. This not-for- profit program provides services to the greater Haverhill area and works in conjunction with Penacook Place to continue OUR LEGACY our similar missions. The newest member of the Covenant Health family, Penacook Place (formerly Union Mission Local Groups Nursing Home) is a 160-licensed bed nursing and rehabilitation center founded in 1969 by a Penacook Place also is a continuing sponsor of many local senior and indigent programs designed to promote access group of citizens to provide senior health care services for the Greater Haverhill community. to healthcare, education, and services to those in need. These include The Council on Aging, the Haverhill Life Long Journey program, Senior luncheon and education programs, and Senior Center activities. Penacook provides food, entertainment, giveaway prizes, and educational speakers at these events throughout the year.

Penacook Place, Inc., a member of Covenant Health, is a skilled nursing facility. Penacook continues to respond with compassionate care and dignity to the health, social and spiritual needs of those in and around our community. Penacook Place follows the methodology recommended by the Catholic Health Association for calculating the cost of support. In that methodology, the cost of providing services is reduced by payments received for services resulting in a net cost. It is the net cost that Penacook Place reports as its commitment to the broader community benefit.

Loss on Medicaid: $1,482,018 Community Benefit Categories: $3325 Total Community Benefit: $1,485,343

Penacook Place was founded in 1969 by local clergy of Haverhill, MA. The clergy were concerned that there was no place for the aging and sick of their community to reside where dignity and respect would always be the cornerstone of their care. Since then, Penacook Place has strived to continue its mission to take care of those within its community with that same dignity and respect.

Today, as a fully owned member facility of Covenant Health, Penacook Place is well-positioned to continue to meet that mission. Sharing the vision of St. Patrick, Penacook Place will now add the community services of Catholic-based care to strengthen its original mission.

Community Benefit Categories

EDUCATION AND SUPERVISION Community Benefit: $114,785

As a member of Catholic healthcare, we understand the importance of educating our community on matters of good health. With that in mind Penacook Place has undertaken several education projects during 2017.

Mentor and Training Site Penacook Place is happy to be the premier site for Whittier Regional Vocational Technical High School students to complete their training and hands on clinical experience to prepare them to become certified nursing assistants. During 2017, over 20 students completed their training, with many gaining employment at Penacook Place. Additionally, several of those students have begun training to further their education as LPN and RN students.

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• An appreciation breakfast was served in gratitude to 12 spiritual care volunteers and their spouses from around York St. André Health Care County. Biddeford, ME • A Sisters Sundae honored 12 Good Shepherd Sisters of the founding community, and 12 residents enjoyed the afternoon with the sisters. OUR LEGACY • A reception followed the annual evening Ecumenical Prayer Service conducted in memory of loved ones who passed away during 2017 including, 42 residents, three sisters of the founding community, six family members of staff and one “Communicate love and goodness as God wills” through the ministry of mercy and faith spiritual care minister who served St. André for 25 years. education is the enduring heritage of St. André Health Care, founded in 1976. It is inspired by the charism of Venerable Marie Fitzbach-Roy, Mother Mary of the Sacred Heart, founder, Servants of COMMUNITY/PROFESSIONAL HEALTH EDUCATION Community Benefit: $6,525 the Immaculate Heart of Mary, the Good Shepherd Sisters of Quebec, Canada. St. André provided opportunities and classroom space conducive to learning for young people in pursuit of professional credentials that are required to serve residents in need of long-term care.

Classroom space was provided for 36 hours in support of 14 Osteopathic Medicine students in the University of New England’s geriatric program, and for 32 hours for 12 nursing students from Southern Maine Community College. At St. André Health Care, we are inspired by the spirit of Venerable Marie Fitzbach, Mother Mary of the Sacred Staff assumed the following teaching experiences: Heaii, founder, Servants of the Immaculate Heart of Mary, and the Good Shepherd of Sisters of Quebec, Canada. We aim to awaken in our hearts her legacy: to communicate love and goodness as God wills. • The director of nursing coordinated and prepared two CNA courses. Two nurse educators taught the courses - one in the spring and one in the fall. • The director of admissions, when St. André was filled to capacity, extended instruction to several callers on how to Community Benefit Reporting for 2017 proceed in accessing the appropriate level of care. • The director of recreation therapy guided a student of the University of New Hampshire’s recreational therapy program. Medicaid Losses: $996,118 | Veteran’s Losses: $53,911 | Community Benefit: $21,159 • The director of food and nutrition services prepared and facilitated an educational program for the Association of Total Community Benefit: $1,071,188 Nutrition and Food Service’s Professional Committee of Maine. • Administrative and clinical staff supported the Learning by Living immersion program of the New England University’s Osteopathic Medical Program. In 2017, we partnered with 13 sponsored Covenant organizations committed to providing healing and care for the • The directors of social work and nursing presented an educational in-service to the Wardwell management staff. whole person, in service to all in our communities while promoting values of compassion, integrity, collaboration and excellence. More can be accomplished together than alone. COMMUNITY-BASED CLINICAL SERVICE Community Benefit: $345 Throughout 2017, our staff and leadership team united in mission and values, then engaged in a variety of ministry-wide In a spirit of collaboration, St. André provided space for the American Red Cross spring and fall blood drives. Ten of our initiatives that were of benefit to individuals, groups and communities within York County. staff members contributed blood.

Community Benefit Categories PROFESSIONAL COLLABORATIONS Community Benefit: $5,576 Our staff shared their time and professional skills with other professionals, advancing community health among SPIRITUAL MINISTRIES Community Benefit: $1,876 individuals, groups and organizations. Examples include: Although not calculable, in the spirit of our Judeo-Christian tradition, spiritual services were made available for residents, • The CEO/administrator served on the board of Maine Mental Health for Men. families, friends and the local community, regardless of faith traditions and orientations. The Sunday Catholic Mass was • The director of food and nutrition services served as the volunteer president of the Maine chapter of the Association organized for all residents and welcomed their family members, friends and members of the local community to the of Nutrition and Food Service Professionals and was a member of the Southern Maine Community College Advisory celebration. Anywhere from 40 to 65 worshippers attend on a given Sunday or holy day. The offering of Communion Board (Dietetics). and/or blessings during the week was extended to visiting family members and friends. The Sacrament of the Sick was • The director of recreation therapy attended meetings of the Maine Recreation Therapy Association, the Maine Culture administered to residents as requested by the residents or by family members. The Sacrament was also offered during a Change Coalition and the Maine Health Care Association Activity Professionals Committee. Mass by the Chaplain in the fall and by Maine Bishop Deeley in the spring. • The director of social services served on the Wardwell Board of Directors and its steering committee. • The education/infection control coordinator volunteered for the Elder Life Program at Maine Medical Center Hospital. A comfort room was available for family members of dying residents. Pastoral care accommodations, snacks and meals were offered. Acknowledgement of sympathy was expressed by staff gathering to lend their signatures and condolences COMMUNITY BUILDING ACTIVITIES Community Benefit: $5,907 on a single card. The director of spiritual care attended many wakes and funerals. • St. André collaborated with the St. Louis Alumni Band in the entertainment of residents and the local community of Mission Week activities in October aimed to inspire and renew the acceptance of the common mission statement and Biddeford with an outdoor summer concert and ice cream treats. values. The special activities were enriched by the Department of Food and Nutrition Services:

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• St. André hosted the New England Parkinson’s Ride, and the director of recreation therapy rode 50 kilometers. • St. André hosted the Bike Rodeo Biddeford Cub Scout Pac 308. St. Joseph Healthcare • St. André hosted a Veterans Day celebration in honor of veterans who attended with their loved ones. The celebration St. Joseph Hospital, Bangor, ME was led by our CEO/administrator and director of recreation therapy, in collaboration with leaders of a local long-term care facility. OUR LEGACY • An assistant clinical nursing coordinator led a local Girl Scout troop as a team in earning badges. With a calling from God and the vision of Blessed Mary Angela, the Felician Sisters extended • Staff members supported activities of the Wardwell Retirement Neighborhood, and one volunteered at the lunch outing. • Our CEO/administrator hosted a meeting of the Biddeford/Saco Rotary Club. their ministry of care to St. Joseph Hospital, Bangor, Maine, in 1947. To all those in need, we • A physical therapist coached basketball and caroling for the Saco Parks and Recreation. provide compassionate, high-quality holistic healthcare. We pledge to continue our mission as • Our CEO/administrator honored a request to plan, prepare and host a memorial service for a local family. the leader of compassionate service, remaining a pillar of healing, while responding to the ever- • The director of spiritual care worked with a grieving man to plan, prepare materials and lead a memorial service for his changing needs of our communities. mother. • The director of spiritual care worked with a grieving family to plan and prepare materials for the planting of a tree on the St. André property in memory of a deceased loved one. • St. André hosted Books are Fun and a book fair. St. Joseph Healthcare continues to be the community hospital, providing compassionate • St. André hosted Toys for Tots. care to people from the greater Bangor area and its neighboring communities. Our “I love St. Joe’s. ministry continues to focus on the poor and vulnerable, never hesitating to provide them CASH DONATIONS AND IN-KIND CONTRIBUTIONS Community Benefit: $938 That is my favorite with whatever assistance is needed. Currently, this commitment to caring for the whole • In response to the call of the Episcopalian community’s In a Pinch Soup program, the Department of Food and Hospital. They take person manifests itself through community outreach programs, activities and services Nutrition Services responded generously. Value: $838. good care of me designed to support community members’ health and wellness needs. It also supports the growth and sustainability of a healthy and productive community. By partnering with • Staff members contributed three Thanksgiving baskets to families of staff members in need, two collections of Toys for when I need some and supporting agencies with similar mission goals, St. Joseph Healthcare is not only Tots at Christmas time and Christmas gifts to residents in the name of Santa. medical care.” able to provide persons and communities with a higher level of service, but also is able • St. André made cash donations in memory of residents who passed away to Catholic and other parishes and who to lead the way in addressing some of the social issues facing us today. desired non-profit organizations or charities to receive these donations as noted in their obituaries. Value: $100. Through this ministry, St. Joseph Healthcare has provided cash and in-kind donations for total of $1,400,925 to ST. ANDRÉ’S BENEFITS TO STAFF the greater Bangor Community. Although not calculated for this report, St. André contributed to the appreciation and well-being of its staff. The break room was continually supplied with bread, milk, peanut butter and jelly. Every Wednesday, September Community Benefit Reporting for 2017 through April, a plentiful supply of hot nutritious soup was available. During the summer months, staff participated in complimentary BBQ luncheons. Daily lunch was made available at a discounted price and free for some staff. Traditional Charity Care: $1,893,620 Appreciation Gathering, Thanksgiving and Christmas gifts were presented to all staff. Value: $29,366. Loss on Medicaid: $3,002,655 SUMMARY Community Benefit Categories: $883,819 Total Community Benefit: $5,780,094 As the only Catholic nursing home in York County, ME, St. André offers many elders within our community healing and care. We are strong in the empowerment of members within the community making decisions about the care needs of their loved ones. Our interdisciplinary approach, smart partnerships and incorporated planning help to bring about COMMUNITY HEALTH IMPROVEMENT SERVICES Community Benefit: $10,646 healthier and happier residents, families, staff and members of the local community. • Supported the American Heart Association through fundraising assistance, community leadership and in-kind activities All of the 2017 contributions for community benefit were in keeping with the principles of Catholic Social Teaching. to enable increased education regarding cardiovascular health risks and wellness opportunities within the greater Shared expertise and time may have helped to influence the economy of the local community in some small way, but Bangor community. Value: $164. more importantly, St. André touched many lives. The staff of St. André Health Care, in keeping with the values of Covenant Health, has heeded the message – what we • Nurses provided health care screening to our homeless population through blood pressure clinics, benefiting 98 can do together is better than what we can do alone. In our reflection on the compassion reflected in the parable of the persons. Value: amounting to a value of $722. Good Samaritan and in the legacy of Venerable Marie Fitzbach, to communicate love and goodness, we “saw,” “had • The greater Bangor community hosts the Harvest Festival in which locally sourced food vendors provide access to compassion” and provided help in “our small corner of the world.” produce and specialty products. This event also incorporates healthy living information. Value: $5,065.

2018 | Stewardship Report 36 2018 | Stewardship Report 37 • Supported a pulmonary support group the Better Breathers’ Club to support individuals with chronic lung disease to • Conducted Advance Directives Workshops with the screening of “Being Mortal: End of Life Care Workshops,” enhance lifestyle through education and community support. Value: $783. benefiting 50 individuals in the community. Value: $65

• Provided support to the Crohn’s & Colitis Foundation, raising awareness in the broader society regarding Crohn’s and EDUCATION AND SUPERVISION Community Benefit: $768,941 Colitis. Value: $826. St. Joseph Healthcare provided educational opportunities for: • Employees provided services to the Ostomy Group with information regarding colostomy, ileostomy or urostomy to share, learn and talk about ostomy issues with each other. Family members and caregivers were also included. 28 Physician Assistants Value: $152,744 23 Medical Assistant Students Value: $15,708 Provided community benefit by recording the services and keeping track of the beneficiaries and effects of the 4 Physicians Value: 9,385 1 Medical Laboratory Science Student Value: $34 programs. Value: $258. 25 Nurse Practitioners Value: $64,404 3 Nutrition Education Students Value: $7,654 • The community health needs assessment identified a need to educate the public on health and wellness opportunities. 93 Nursing Students Value: $56,123 57 Pharmacy Students Value: $176,115 St. Joseph Healthcare created an extensive media presence with Choosing Wisely. This program provided educational 147 Partnership Students (Seniors) Value: $139,136 29 Medical Imaging Students Value: $26,405 materials relative to weight loss, healthy living, exercise, etc., and included TV programs, heavy social media presence and printed literature, all through the health system. Value: $686. 102 EMS students Value: $39,663 52 PT/OT/Speech Students Value: $80,013 2 HR, PR, HIM Students Value: $1,557 • Food insecurity was identified as a need through our patient survey. In response to this need, we partnered with the Eastern Area Agency on Aging and Good Shepherd Food Pantry to provide food to patients identified with food insecurity. Value: $137. ADDITIONAL COMMUNITY SUPPORT Community Benefit: $80,066

• A group of students from the local community school was provided general awareness of a hospital setting as being a • Supported the American Red Cross through the coordination of community blood drives. Value: $293 friendly, safe place through the “Teddy Bear Clinic.” Value: $392. • Provided laundry services for the Greater Bangor Area Homeless Shelter to ensure the shelter had fresh linens daily for • St. Joseph Healthcare Nutrition Services provided community benefit through education on healthy eating habits and clients. Value: $5,448 meals. Value: $ 1,500. • Provided community service hours to various not-for-profit organizations to support health, wellness and community • The Spiritual Care Department at St. Joseph Healthcare offers a 12-month bereavement outreach program in which betterment activities. This included support for activities such as: suicide prevention, support of youths at a teen family members are provided consistent bereavement support materials and opportunities for spiritual support through homeless shelter (Shaw House), Bangor Region Chamber of Commerce, American Folk Festival, Community Health the grieving process. Value: $113. Leadership Board, Choosing Wisely Initiatives, Notary services for patients, Sex Trafficking Area Response Team, Being Mortal: End of Life Care Workshops, Circle Of Caring, Bangor Area Homeless Shelter, Food & Medicine Group, several community health and safety fairs, Hospital Week (Teddy Bear Clinic), Boy Scouts of America, Bangor Salvation Army, Community Outreach United Way and The American Red Cross. Value: $9,696

• St. Joseph Healthcare recognizes the value and importance of access to affordable health care services. As such, we • St. Joseph Healthcare’s president/CEO provided executive leadership on several community initiatives including the took an active role in providing community support through accessibility to certified application counselors to assist in Community Health Leadership Board and service on the following community boards: Penquis CAP, Bangor Nursing enrollment with the Healthcare Insurance Exchange. Value: $6,385. and Rehab and Maine Hospital Association, etc. Value: $30,118

• St. Joseph Healthcare’s patient service representative has provided support to 118 individuals in the application • St. Joseph Healthcare executives provided leadership on initiatives to educate the community on diversity and process for state and federal assistance programs such as Maine Care, etc., including a donation to the Eastern Maine in the formation of the Maine Multicultural Center. This agency helps ease integration of people of diverse ethnic Community Insurance Group. Value: $3,225. backgrounds by welcoming them into our community and facilitating essential services through partnerships. Value: $1,154. • Provided services for Hope Rising, a safe house and residential rehabilitation program for victims of human trafficking. Value: $1,207. • Employees provided hours of services to the Kiwanis Club and their community initiatives. Value: $1,153

• St. Joseph Healthcare is located in a rural area of Maine, which often leads to transportation challenges for patients. To • Donated pharmaceuticals to Partners for World Health, a regional partner which supports the distribution of supplies help patients overcome this challenge, St. Joe’s offers taxi vouchers to allow patients to be discharged from the facility and equipment to developing countries and local not-for-profit organizations. Value: $2,231 in a timely manner. 57 persons were assisted. Value: $1,953. • Employees supported the Eastern Area Agency on Aging program, Furry Friends Project, in which pet supplies (food, litter, etc.) are donated to support seniors. EAAA has noted that food insecure seniors will share food with beloved pets SOCIAL AND ENVIRONMENTAL IMPROVEMENT Community Benefit: $5,653 when financially challenged to provide pet food. Value: $404

• The employees of St. Joseph Healthcare provided hours of service to start and maintain the St. Joseph Closet, St. • Provided executive leadership to support the Maine Breast Cancer Coalition which focuses on breast health education Joseph Food Pantry and St. Joseph Cupboard – benefiting patients, employees and the community. Value: $568. and financial support to assist women in receiving breast cancer screenings. Services provided by MBCC impacted • Provided community benefit with service hours, cash and in-kind donations to benefit the patients and visitors and the 259 individuals. Value: $1,019 greater community. Value: $5,020.

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• Provided and served an evening meal once per month to the Greater Bangor Area Homeless Shelter, resulting in 330 nutritious meals. Value: $4,894. St. Joseph Hospital Nashua, NH • Established a supportive partnership with Kingman Elementary School to ensure food security, enhanced educational opportunities, improved educational tools and connectivity relative to health and wellness education. Value: $362. OUR LEGACY • Provided and served a noon-time meal once per month at the Bangor Salvation Army Dorothy Day Soup Kitchen. This provided 648 nutritious meals to individuals struggling with food insecurity. Value: $10,201. In 1908, St. Joseph Hospital was founded by Monsignor Henri Milette under the sponsorship of the Sisters of Charity of Montreal, “Grey Nuns,” to primarily serve Nashua’s French-Canadian • St. Joseph Healthcare Nutrition Services provides complimentary food and beverages to family members who sit vigil with loved ones who are nearing the end of life. Nutrition Services also provided 1,080 healthy meals for the residents community. With reverence for the poor and vulnerable, we continue our commitment of hope of Hope House. Value: $13,093. and healing in the spirit of the Grey Nuns and their foundress, St. Marguerite d’Youville, in spreading the good news of God’s intrinsic love for every human being. St. Joseph Healthcare collaborates with area agencies to address food insecurity in this community and provides food and grocery items for anyone in need. Value: $12,128. • Supports a Vegetable Exchange Stand in which excess produce from St. Joseph Hospital is a Catholic health ministry, providing healing and care for the whole person, in service home gardeners is donated to the stand, and community members to all in our communities. We commit to honor our core values in all our endeavors; compassion, integrity, are invited to enjoy this produce at no charge. This program provided collaboration and excellence. As such, we have implemented a broad spectrum of programs and services low-income individuals with the opportunity to access fresh fruits and which combine outreach, education, support and financial assistance to respond directly to the health care vegetables. Value: $81. needs of the Greater Nashua community. • With the donated food at St. Joseph Food Pantry, St. Joseph Healthcare provided nutrition for individuals struggling with food insecurity by making prepared meals available through the St. Joseph Pantry refrigerator. Value: $10,904. In this spirit, St. Joseph Hospital was actively engaged in the development of the most recent community health needs assessment (CHNA) for the greater Nashua region. The CHNA was published in the fall of 2017, in partnership with • Provides health and wellness educational programming for seniors, Senior Wise Meal/ Education Program providing the City of Nashua, Division of Public Health and other area healthcare providers and local agencies. The top three important health information and discounted pricing for nutritious meals. Value: $1,143. community-wide health care needs and priority areas identified in the CHNA are: Mental Health and Substance Abuse, Access to Care and Obesity rates.

Over the past year, St. Joseph Hospital has aimed to positively effect change in these areas through its comprehensive community benefits initiatives totaling $8,213,914. Community Benefit Categories

TRADITIONAL CHARITY CARE/UNPAID COST OF MEDICAID Community Benefit: $7,238,064

St. Joseph Hospital cares for all of its community members regardless of their ability to pay and offers a generous free care policy to patients who qualify. Our dedicated financial counselors assist patients with the free/reduced care application process to improve access to health care within our community and the state of New Hampshire. Financial counselors also offer counseling to assist those enrolling in the Healthcare Insurance Exchange.

In 2017… • There were 3439 outpatient cases and 138 inpatient cases with over 673 patient days which qualified for traditional charity/free care, totaling $705,712. • There were 9553 Medicaid outpatient cases and 284 Medicaid inpatients with over 1550 Medicaid inpatient days served. The total unpaid cost of providing services to the Medicaid population totaled $6,532,352. • In addition, there was $975,850 of other attributable community benefit activities which occurred in 2017, as described in this report.

2018 | Stewardship Report 40 2018 | Stewardship Report 41 CASH AND IN-KIND DONATIONS Community Benefit: $128,474 fuel, utilities assistance or rent assistance. This fund has also helped those who have suffered a crisis, such as a house fire or a flood, in order to replace necessary household items and/or secure temporary housing. The funds have helped St. Joseph Hospital provided a total of $128,474 in cash and in-kind donations to support our partners, social service many individuals get through personal difficulties in times of crisis or despair. Donations are received into this fund from agencies throughout the greater Nashua community. Examples of financial donations to agencies include: The Front employees, community members and through specific philanthropic donations which equaled $24,930 in 2017. Of that Door Agency, Gateways Community Services, Marguerite’s Place, Girls Incorporated and the St. Joseph Community amount, $23,134 was distributed to those in need. These funds were reflected in the Mission Effectiveness budget. Services Meals on Wheels program. Two specific examples of the programs and services for which our cash & in- Value: $23,134 kind contributions help to support are included in the narrative below: The Greater Nashua Dental Connection and the Prescription Assistance Program of Southern NH. Facilities/Land/Conference Room Space: St. Joseph Hospital donates its facilities, land and conference room space throughout the year—free of charge—to various local non-profit agencies. New Hampshire Catholic Charities operates its These two long standing community programs help to increase access to affordable dental care and affordable/free Nashua, New Hampshire office from St. Joseph’s 261 Lake Street building. Additionally, agencies such as Marguerite’s medication prescriptions for our most vulnerable population. Lastly, in-kind donations are made to area EMS/Fire Place, Greater Nashua Dental Connection, City of Nashua Public Health department, Alcoholics Anonymous, Emotions Departments through the St. Joseph Hospital pharmacy. Medications and supplies are restocked on ambulances from Anonymous, AAA Defensive Driving and the American Red Cross utilize the hospital’s conference room space for events, outreaching communities including Brookline, Hollis, Hudson and Merrimack Fire & Rescue. board/committee meetings and public meetings.

GROW-NASHUA Partnership: St. Joseph Hospital partnered with GROW-NASHUA, a local non-profit organization that supports empower people to strengthen their The Greater Nashua Dental Connection: The Greater Nashua Dental Connection (GNDC) is a non-profit agency own community relationships through the development of urban vegetable farms providing access to affordable high quality dental care to the uninsured and underinsured throughout Greater Nashua. throughout the city and at area schools. Farmers build their own plot on a common The clinic has been in operation for nearly 20 years and operates a three-chair dental clinic, referral service and a site where they learn the skills to grow, harvest, preserve, and cook fresh produce. comprehensive preventative school program with the Nashua School district. The GNDC serves people of all ages, In the true spirit of community, a plot of land on St. Joseph Hospital’s Lake Street regardless of financial, linguistic, cultural or geographic barriers. They service approximately 3,000 dental patients property was donated to GROW-NASHUA. The program focuses on families that annually. Most patients seen at the clinic are in distress, suffering from pain and infection when they arrive for their may not have the land and/or financial means to have farm space of their own. first visit or appointment. Many have gone months or even years without proper dental care, including children. The GROW-NASHUA is a resource to local families providing land space, plants, water, supplies and education to support GNDC helps to provide people with a dental home and aims to prevent unnecessary utilization of hospital emergency their efforts. This program helps to improve awareness and access, as well as better nutrition and exercise, and may help departments. The GNDC also serves Nashua’s children through their school-based program. Students are screened to make an impact on the rising rates of obesity within our community. Value: $18,480. at school and those identified with dental issues are transported from school to the clinic via the dental clinic van for treatment. St. Joseph Hospital assists this non-profit agency with a representative on the board of directors and through Christmas Basket Project: One of St. Joseph Hospital’s most financial support. Value: $20,000 touching annual community giving projects began 58 years ago with the St. Joseph School of Nursing. In 2017, St. Joseph Prescription Assistance Program of Southern NH: The Prescription Assistance Program of Southern New Hampshire employees and volunteers donated hundreds of Christmas gifts, is a community partnership between Southern NH Medical Center (SNHMC) and St. Joseph Hospital. This program including bicycles, clothes, toys and food items to 61 area families, helps uninsured or underinsured patients receive free medications through pharmaceutical companies. Pharmaceutical which included 100 adults and 161 children. A team of three companies supply medications at reduced or no cost to patients in need, and the program assists qualified patients dedicated staff members plan and execute this annual community of both healthcare systems. Patients complete the application process, and the program coordinator works with the giving event. Pre-planning efforts include meetings with area patient and his/her provider office to access medications. The program served over 600 people and filled over 2500 school nurses who help identify needy families, organizing drop off prescriptions, which were valued at approximately $2.0 million. Value: $25,000 location times, organizing volunteer delivery teams, wrapping gifts and more. Approximately 50 volunteers personally deliver baskets Joseph’s Closet & the St. Joseph Hospital Employee Food Pantry: Joseph’s Closet was created in 2015 to provide to the families in their homes. Value: $5,750. free gently used durable medical equipment to community members in need. Many items such as walkers, crutches, wheelchairs or commodes are either not covered by insurance or simply too expensive for many people to afford. Medical equipment is collected from community members at Joseph’s Closet, then it is cleaned, inventoried and COMMUNITY HEALTH IMPROVEMENT stocked – and then distributed to anyone in need. Since its opening in April 2015, Joseph’s Closet has served over 2500 members of the community. Joseph’s Closet operates with a few dedicated community volunteers, however, some staff Community Health Education: Each year hundreds of classes and programs are offered though St. time is dedicated to operations, as the mission coordinator staffs Joseph’s Closet weekly. Joseph Hospital Community Health Education. Class offerings range from Super Sitters education classes to stress management techniques, nutrition education, and various exercise classes to help The St. Marguerite d’Youville Fund: The St. Marguerite d’Youville fund was established at St. Joseph Hospital over combat community obesity rates. A wide variety of exercise classes are offered and include: Fit & Young 25 years ago to help community members who are most in need. Administered by the mission activities coordinator, for Life (strength training program offered to seniors in three communities), Low Impact Aerobics, Yoga, this emergency assistance fund helps people from the Greater Nashua community who have emergent financial needs and Zumba. The popular Dinner with the Doctors series allows community members to learn the latest and who are unable to receive help from other community resources. The coordinator meets with each prospective information around certain diagnoses and treatments. The series is presented by physicians, nurses, therapists, and/or recipient and reviews their case on an individual basis. Qualified recipients receive assistance for things like emergency other members of the medical staff.

2018 | Stewardship Report 42 2018 | Stewardship Report 43 Health & Wellness Fairs: Staff nurses, including Caring Beyond Our Borders committee members, nursing instructors COMMUNITY BUILDING ACTIVITIES and students from the St. Joseph School of Nursing, conducted several community health & wellness fairs and other outreach throughout the year. In May 2017, the St. Joseph Community Wellness Fair, in partnership with the Souhegan Time on Boards/Committees: St. Joseph Hospital leaders serve on many different non-profit boards and social service Valley Chamber wellness event, was held in Milford. Nurses provided blood pressure screenings, height & weight agencies throughout Greater Nashua, providing their time and talent to help fulfill the mission of each organization and measurements, hand massages and a foot care clinic. Wellness screenings were also conducted at Oracle, Inc. for to improve community building efforts. Most of the local nonprofit agencies work to help address the communities top their employees in June. For the fourth year, St. Joseph Hospital presented a community wide program/CME for identified health care needs (mental health/substance abuse, obesity and access to care). A sampling of the agencies area healthcare professionals and community members on the topic of “human trafficking”. The program presented our leaders partner with include: St. Joseph Community Services (Meals on Wheels), Greater Nashua Dental Connection, staggering facts and figures highlighting the impact of human trafficking on society – noting that these types of crimes Home Health & Hospice Care, the American Cancer Society NH Chapter, Making Strides against Breast Cancer NH occur within our own communities. In total, there were over 3000 total class registrations by community members Chapter, American Heart Association NH Chapter and the American Red Cross NH Chapter. Value: $17,695. participating in community health programs and services. Value: $142,468. Project Search: St. Joseph Hospital is one of the founding members and Support Groups: There are approximately 15+ different support groups offered at St. Joseph Hospital. Examples largest host site for Project SEARCH, a community-based initiative to assist include: disabled workers in finding meaningful employment. The program is a collaborative effort between St. Joseph Hospital, the Nashua School District, • Brain Injury Support Group • Cardiac Rehab Support Group New Hampshire Vocational Rehabilitation, the PLUS Company, Inc., and • Still Remembered Support Group: Designed for parents who • New Mothers Support Group Gateways Community Services. have lost a baby through miscarriage, birth or shortly after birth • Emotions Anonymous, Alcoholics Anonymous and Narcotics • Alzheimer’s & Dementia Support Group for Caregivers Anonymous groups A school-to-work program for students with disabilities, Project SEARCH provides real-life work experience combined with training in employability and independent living skills. The goal for each student is competitive employment within • Alzheimer’s Early-Stage Support Group: Bereavement support • FASTER: An addiction support group for caregivers the community, due in part to the skills they acquire during their Project SEARCH internship at St. Joseph Hospital. By group • Parenting After Loss Support Group providing classroom space, a hands-on learning environment, and executive level board support, this program provides • Breast and Ovarian Cancer Support Group • Power Up for PCOS: Parkinson’s support group excellent worksite experience for students and adults with disabilities.

Staff time dedicated to support groups in 2017 was valued at $22,670. In June 2017, St. Joseph Hospital graduated 11 Project Search students from the program. This was the ninth class to graduate since the program began. Students gain valuable work skills in various departments of the hospital including Alzheimer’s & Dementia Resource Center/Mission Effectiveness & Spiritual Care: The Alzheimer’s & Dementia the mail room, the cafeteria, environmental services, materials management and the stock room. Resource Center provides Alzheimer’s education and support services for patients, families, caregivers concerned about Value: $13,880 or living with Alzheimer’s disease. Programs and services include but are not limited to: Alzheimer’s Early-Stage Support Group, Alzheimer’s Education Series, the Day Away Respite Care Program, One-on-One Visits, Our Place Pregnancy Patient Navigators and Genetics Counselors: St. Joseph Hospital employs patient navigator roles in both the Breast /Parenting Program, Soul Prints Visitation Program, referrals and socialization for hundreds of older adults in the Care Center and in the Emergency Department (ED). In the ED, the navigator assists patients after medical screening community. In 2017, there were over 5000 encounters at the Resource Center. Value: $90,013 to help them obtain a regular source of primary care. The goal of the program is to assist the medically compromised indigent population in obtaining and using a Primary Care Provider (PCP) for primary care, instead of the ED. The Spiritual Care Department: The ministry of the Spiritual Care Department is critical to the mission of St. Joseph navigator identifies barriers that may prevent a patient from accessing services with a PCP, and the navigator assists Hospital. Spiritual Care chaplains advocate for all community members and provide a mind-body-spirit, holistic approach them in making their first or follow-up appointment—often securing public transportation as needed. This helps increase to healthcare. Chaplains serve patients and their families, medical staff, hospital employees, volunteers and community access to primary and preventive health services, which were identified as a priority in the needs assessment. service providers. They seek to promote holistic service partnerships between the hospital and the wider-community of spiritual, mental, and physical healthcare providers. Value: $396,107 The Breast Care Center employs a nurse navigator who acts as a primary point of contact for patients after a new diagnosis of breast or gynecological cancer. The navigator monitors, coordinates care and educates patients by Free Health Screenings: A variety of free health screenings are offered to the public throughout the year through the establishing an individual and customized plan of care. She also makes appropriate referrals, both within and outside St. Cardiovascular & Diabetes Center, the Breast Care Center, the Cancer Center, Laboratory Services and Diagnostic Joseph Hospital, and empowers patients to be self-advocates for the best outcomes. Genetic screening and genetic Imaging. Hundreds of Greater Nashua area residents received the free health screenings in 2017, including: blood counseling services are offered through the Breast Care Center to help identify patients with family history or genetic pressure screenings, BMI screening, diabetic foot clinics, stroke risk assessment screenings, diabetes screenings, predisposition for cancer. Genetic counseling and nurse navigator services provide a great benefit to patients, especially memory screenings, breast/cervical cancer screenings and prostate cancer screenings. Value: $16,183 the vulnerable population of patients newly diagnosed or living with cancer. Value: $35,000

Clinical Trials: Clinical trials include cancer research studies that test new techniques and medicines to treat, control or prevent cancer. These studies may also show which medical approaches work best for certain illnesses or groups of people. Many people being treated for cancer are now living longer because of progress made through clinical trials. St. Joseph Hospital’s mission to explore clinical trials and search for preventative care and improved quality of life for our patients always remains in compliance with the principles and ethics set by the Catholic Archdiocese. We collaborate with leading cancer centers, including the Lahey Health Cancer Institute, to provide local access to advanced clinical

2018 | Stewardship Report 44 2018 | Stewardship Report 45 trials. There are many resources available through our clinical trials nurse, a research professional involved in managing Back to School Supply/Backpack Drive: During difficult economic times it can be difficult for parents to provide even our clinical trials as an administrator, coordinator, and educator. She plays a critical role in planning, establishing and the most basic of essential school supplies. In 2017, St. Joseph Hospital employees donated 85 backpacks filled with providing clinical trials at the St. Joseph Hospital Cancer Center. Value: $35,000. new school supplies for needy children to start the school year. The backpacks were then distributed by Nashua Soup Kitchen and the Nashua Boys and Girls Club as part of a community wide project. Professional & Continuing Medical Education: St. Joseph Hospital’s professional education & training team coordinates the professional education programs and CME’s offered to physicians and nurses, not only within St. Joseph Title 1 School Snack Drive: The drive is conducted every October to provide snacks to Title 1 elementary schools. A Hospital, but throughout our entire community. The hospital provides a clinical setting for nurse training and nursing Title 1 school has 40% or more of the student population at or below the poverty line. Nashua has six Title 1 elementary internships, as well as allied health professional training, such as therapists or technicians. In addition, St. Joseph schools. Often, teachers provide the majority of their students with snacks on a daily basis in order to ensure the children Hospital School of Nursing instructors volunteer their time overseeing many of our nursing students as they volunteer have the nutrition they need to get through the day. This puts a strain on teachers’ already limited resources. This year, their time at community health clinics in various communities throughout the year. As nursing students, they can screen with the help of Mondelez International, three carloads of snacks were delivered to elementary schools throughout patients’ blood pressure, BMI measurements, and can perform bone density screenings. Value: $45,130. Nashua.

Community Benefits Preparation/Foundation for Healthy Communities: The cost of community benefits planning Operation Sweet Tooth: St. Joseph collected Halloween candy in November from employees, families and children. and preparation for 2017 includes staff time dedicated towards the Community Health Needs Assessment planning Over 400 pounds of candy was donated to Moore Mart, who ships candy and other items to US troops stationed execution and reporting, and the development of the community benefits report. Value: $9,000 overseas.

UNPAID COST OF MEDICARE

Unpaid Cost of Medicare is the shortfall created when payments received from Medicare are less than the cost of caring for patients. In 2017, the unpaid cost of Medicare totaled $27,755,261. There were 3,325 Medicare inpatients with 17,800 inpatient days, and 71,252 outpatients served in 2017. This amount is NOT accounted for in the total community benefit, as per the Catholic Health Association (CHA) guidelines.

ADDITIONAL COMMUNITY BENEFIT PROJECTS

Note: The following stories are not individually quantified in the community benefits financials, but they reflect the generosity of St. Joseph Hospital’s staff and physicians in supporting the general community in which they work and live. The Mission Activities Coordinator, with help from the St Joseph Mission Activities Committee, coordinates several drives throughout the year. Through the combined efforts and generosity of many St. Joseph staff, we have positively impacted the health & social wellbeing of our neighbors.

Sock Drive: The Sock Drive, held in January in conjunction with Immaculate Conception Church, collected over 1,500 pairs of new socks for men, woman, and children. Socks were distributed to local area shelters, food pantries, community centers, and others in need.

Lenten Drive: The Lenten Drive, held during the six weeks of Lent, focuses on collecting non-food related items and is aptly named “you need it but you can’t eat it”. St. Joseph Hospital employees donated 130 boxes of diapers and 15 boxes of paper goods, household cleaning products, personal care items, and feminine hygiene products. All collected items were donated to local area agencies such as Marguerite’s Place, Corpus Christi Food Pantry, Front Door Agency, and the Nashua Soup Kitchen.

Belle of the Ball Event: The event, held each April, provides local area high school girls the opportunity to receive a prom dress when they may not have been able to afford one otherwise. Fifty-two (52) prom dresses were donated to Anton’s Cleaners, who cleans the dresses free of charge, and then coordinates the set up for this touching event.

Summer Food Drive: The drive, which has been a tradition for over 20 years, helps to restock the shelves of local food pantries. With schools closed in the summer, local food pantries often see their stock diminish, right at a time that their needs increase. This year over 800 pounds of nonperishable food items were donated to the Nashua Soup Kitchen and other local area food pantries.

2018 | Stewardship Report 46 2018 | Stewardship Report 47 COMMUNITY BENEFIT

COMMUNITY OUTREACH

St. Joseph Manor Community Boy Scouts of America: The director of recreational services supervised and mentored members of (Brockton, MA) Boy Scout Troop 199 from Kingston, MA, as they provided our residents with an indoor summer camp experience over the course of two days in August 2017. Value: $576 OUR LEGACY Brockton Hospital Fundraiser: The director of mission services created and provided a gift basket to this annual event The legacy of the Congregation of the Poor Sisters of Jesus Crucified and the Sorrowful Mother, that raises funds to support community members with no insurance or limited means for medical care. Value: $344 founded by Rev. Alphonsus Maria, C.P., in 1924 to serve the poor, elderly and dying of all faith Brockton Housing Authority Outreach: The director of mission services, Mater Dei Adult Day Health and the Manor’s traditions, continues to inspire the healing ministry of St. Joseph Manor. administrator organized and served a pasta upper to residents at several of the Brockton Elder Housing sites in the months of June, August and November 2017. These suppers offered elders a good meal, socialization and fellowship. Value: $1,467

Keeping with the mission and vision of Rev. Alphonsus Maria, the Sisters of Jesus Crucified and Covenant Catholic Charities: The director of mission services continues to work with the Catholic Charities Elder Outreach Health, St. Joseph Manor continues to respond to the needs of our residents, clients and external community Program assisting in developing programs and training for the volunteers who participate in this vital program that members with a particular focus on the elderly and underserved. assists low-income elders in the community. Value: $1,049

Chamber of Commerce Taste of Metro South: The director of dietary services Community Benefit Reporting for 2017 and other dietary team members donated their time and a meal to the Chamber of Commerce Taste of Metro South event. This event brings various community Subsidies for low-income residents: $1,477,769 | Community Benefit: $27,512 organizations together to heighten public awareness of services and programs available to members of the community. Value: $488

Community Benefit Categories: Community Clean Up Project: The director of environmental services provided yard work services to members of our community who needed assistance as their EDUCATION spouses were military members deployed overseas. Value: $288

Brockton High School: The director of recreational services supervised and mentored a group of high school students Community Pastoral Outreach: During 2017, the Manor remained committed to the St. Joseph Manor Pastoral who were completing the community service portion of their curriculum at St. Joseph Manor. These students assisted Community Outreach Program initiated by one of our sisters over 20 years ago. Manor volunteers are coordinated and with the transport of residents to and from activities as well as joining in group activities. Value: $1,152 supported by the director of mission services who oversees the donation of food products by vendors to elders at Brockton Housing Authority sites, as well as clients of Stairway-To-Recovery, a substance abuse recovery program that Fontbonne Academy: The director of mission services supervised and mentored a National Honor Society student from provides support, education and job training for clients in the Brockton community. Approximately 78-14”x14” boxes Fontbonne Academy completing the community service portion of her high school curriculum. Fontbonne Academy is a were filled with food items and distributed throughout the community in 2017. Value: $288 private Roman Catholic college preparatory high school for girls located in Milton, Massachusetts started by the Sisters of St. Joseph in the Archdiocese of Boston. This student transported our residents to Sunday Mass and served in our Elder Community Outreach: The director of mission services assisted elders in the community in several areas in 2017. dining room weekly. Value: $576 These included end-of-life support and education, planning, preparing and facilitating funeral services and assisting with housing and daily living support such as shopping, meal preparation as well as other errands. Value: $8,441 Pope St. John XXIII Seminary Field Education Supervision: The director of mission services mentored and supervised two second year Pope St. John XXIII seminarians from January to May and an additional two beginning in September Hospital Blanket Outreach: The staff development coordinator organized and participated in an outreach effort that 2017 who will remain at the Manor until May 2018. These men visited with our residents weekly, providing support and resulted in 144 homemade blankets being donated to infants and cancer patients at area hospitals. Value: $864 spiritual care. Value: $3,067 Mass of Remembrance: Our Annual Mass of Remembrance was held to honor deceased residents, staff, volunteers TOPS Organization: This non-profit organization dedicated to weight-loss support and education rented meeting space and other community members. Approximately 200 people from the community attended this special celebration. The at the Mater Dei Adult Day Health Center every Tuesday from January through July 2017. Value: $350 director of mission services along with the spiritual care team donated their time to organize and host this event and reception. The directors of social and dietary services also volunteered their time at this event. Value $1,833

Salvation Army Food Drive: The director of recreational services coordinated and facilitated a Manor Food Drive for the local Salvation Army food pantry delivering several large boxes of non-perishable food items. Value: $288

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Toys for Tots Program: The director of recreational services coordinated and facilitated a toy drive to benefit the United States Marine Corps Toys for Tots program. This program distributes toys to underprivileged children across the country. St. Mary Health Care Center The Manor donated and delivered two large boxes of toys. Value: $576 (Worcester, MA) DONATIONS OUR LEGACY American Lung Association: St. Joseph Manor donated in memory of a deceased family member of one of our employees. This association provides lung health education and support, lung disease research and lung health St. Mary Health Care Center, sponsored by Covenant Health since 1998, is a place of welcome advocacy. Value: $100 and a home for the sick, the elderly and the poor. We live the compassionate healing of Jesus as

Equipment/Clothing Donations: Medical equipment such as electric wheelchairs, standard and adjustable wheelchairs, reflected in the life and legacy of St. Marguerite d’Youville, foundress of the Sisters of Charity of walkers and clothing were donated to Catholic Charities Elder Outreach Program clients, Salvation Army and others in Montreal, “Grey Nuns.” “We shall continue to love and serve.” —St. Marguerite d’Youville need in the community. Value: $ 5,725

Fontbonne Academy Annual Fundraiser: A donation was made to Fontbonne Academy’s Annual Fundraiser. Fontbonne Academy is a private Roman Catholic college preparatory high school for girls located in Milton, Massachusetts started by the Sisters of St. Joseph in the Archdiocese of Boston. Value: $40 St. Mary Health Care Center provides skilled nursing care, rehabilitation and palliative care in the heart of the city of Worcester. Ever mindful of our mission, the facility generously contributes to the surrounding community through its financial commitment and various outreach projects to the marginalized, to those made poor and to those in need.

The orientation of new employees and the constant reminders to all staff of the reason for the existence of this facility is to promote the vision, the compassion and the legacy of St. Marguerite d’Youville. Embracing this legacy is what gives meaning and purpose to this ministry of caring for the sick, frail and often the very poor elderly. The fact that St. Mary Health Care Center is located in an extremely poor area of the city inspires the staff to reach out in charity to one another and to the needs of the community. The following information is a glimpse into the heart of who we are and why we do what we do.

Community Benefit Reporting 2017

Cash and In-Kind Donations: $8,982 | Community Outreach Programs: $5,210 | Community Benefit: $14,192.50

Community Benefit Categories

COMMUNITY OUTREACH

Back to School Packs: Residents and staff gather Animal Rescue League: Residents together each August to prepare backpacks for the area and staff all have a deep love and children in need of school supplies. Value: $300 appreciation of God’s precious animals, especially dogs. We sponsor a periodic The Giving Tree: The annual custom of setting up and collection of food and monetary organizing the Giving Tree is a time-honored tradition donations, blankets and other supplies a which is supported by our staff, residents and their weekly post of animals in need is put on families. This year, our focus for giving was on our in- our Facebook page. Value: $800 house staff and their family needs. The individual needs are placed on tags which are then are placed on our Senior Center Visits - Blood Pressure Clinics: Our Christmas tree located in the front lobby. In addition, nursing staff volunteered and provided staffing at the local Christmas food gifts were given using grant monies. senior center blood pressure clinics. Value: $1,533

2018 | Stewardship Report 50 2018 | Stewardship Report 51 COMMUNITY BENEFIT St. Mary’s Health System Lewiston, ME

OUR LEGACY Worcester Food Bank: Our monthly food collection is Alzheimer’s Walk: In support of all people who live an on-going program to assist in meeting the needs of with Alzheimer’s disease, several staff supported by our In 1888, the Sisters of Charity of Saint-Hyacinthe established a healing ministry to meet the needs the homeless and hungry of our city. Proceeds from the Alzheimer’s activity director participate in the community of this community. In the spirit of the Sisters and their foundress, St. Marguerite d’Youville, St. purchase of snacks by our residents, staff and visitors go walk. Staff members also provide fundraising luncheons Mary’s Health System will continue its unwavering commitment to provide holistic care, offered to the outreach program for the hungry. Value: $435 and raffles. Value: $1,690 with respect and compassion, for all in our community. Autism Resource Central: As part of our mission, we Mentoring/Orientation of Students: The program reach out to those in our community who raise and teach director supervised, orientated and mentored students children who are autistic. Value: $5,000 from Holy Cross College to enanble them to: be present one-on-one with a resident providing them time to This legacy compels us to continue their vision of serving the most vulnerable of our community. Our goals for reminisce about the past, to relate stories of the present, 2017 were to address identified community-health needs by providing programs and services related to these to write letters and to assist in phone calls and other needs—caring for the poor and vulnerable in Androscoggin County, providing education to community groups personal needs they may have. and health care professionals and facilitating community partnerships to deepen the impact of our efforts.

St. Mary’s Health System

ST. MARY’S REGIONAL MEDICAL CENTER COMMUNITY PROGRAMS A 233-bed acute care facility, a primary care provider network, urgent care and emergency department, behavioral and mental health services, and outpatient specialty practices that combine talented and compassionate caregivers Various Staff Persons Serve as Board Members on a Variety of Area Concerns the City: Organizations include with state-of-the-art medical technology to meet the healthcare needs in the Androscoggin County area and beyond Worcester Elder Services, Shepard King Neighborhood Association, Worcester Community Foundation and Friends of Worcester. Value: $400 ST. MARY’S d’YOUVILLE PAVILION The state of Maine’s largest nursing home with skilled and nursing services Planning and Participation in the Opening of Castle Park: Value: $150 ST. MARY’S RESIDENCES 128 private, non-smoking apartments reserved exclusively for the independent elderly and handicapped Opening St. Mary Health Care Center to the Neighborhood: This effort includes Morning Coffee’ N and the children’s Halloween party. Value: $75

Spiritual Outreach: Mercy Chapel welcomes a prayer group each month to share a prepared prayer ritual with the Community Benefit Overview residents. After the prayer, all are invited to the main dining area for refreshments. St. Mary’s Health System (Regional Medical Center and Community Clinical Services) Traditional Charity Care: $5,647,558 Loss on Medicaid: $2,131,968 OUTREACH TO STAFF Community Benefit Categories: $2,871,726 Staff Time: $250 TOTAL: $10,651,252 Grants: $1,500 from St. Vincent’s Outreach COMMUNITY HEALTH IMPROVEMENT SERVICES Community Benefit: $1,056,533 $500 from Srs. of the Presentation St. Mary’s provided many community health improvement services to address the public health needs identified in Disaster Relief: Monetary donations to Haiti and Puerto Rico. Value: $175.00 the most recent Androscoggin County Community Health Needs Assessment. The most significant public health issues continue to be chronic diseases, mental health, substance use, obesity and tobacco use. Community health improvement services focused on chronic diseases and substance use. They included health screenings for skin cancer, lung cancer, and breast cancer, as well as self-help programs for smoking cessation and weight loss. St. Mary’s also focused on access to care for underserved populations.

2018 | Stewardship Report 52 2018 | Stewardship Report 53 Community Education: St. Mary’s offered community education to address the prioritized health needs in Androscoggin St. Mary’s Nutrition Center: Strengthening Cooking Skills with Adults: For the past 10 years, St. Mary’s Nutrition County. St. Mary’s also hosted and/or facilitated community support groups for health services, as well as exercise Center has hosted an adult cooking class on the last Tuesday evening of every month. In 2017, we added a new twist! programs targeted for wellness and prevention. Each month, a guest cook is invited to lead the group in preparing a dish from their native land for “Eat the World.” This • Given the fact that Maine has one of the highest cancer incidence rates in the country, St. Mary’s focused on cancer community has a rich and wonderful diversity to celebrate, and the kitchen is the perfect place to meet new faces and prevention: lung screenings were held to detect cancer in high risk patients; special Saturday hours were held to offer share stories. Participants have so far shared food and recipes from Congo, Angola, Puerto Rico, Cameroon and Iraq. colonoscopies and mammograms. Congolese food included chicken piri-piri, fufu and greens with sauce. On Angola night, guests enjoyed feijoada. Puerto Rican night featured arroz con gandules and Puerto Rican tostones. Iraqi chicken curry was a favorite and most recently, • In November 2017, St. Mary’s became a completely smoke-free campus to highlight the significance of tobacco use on “soul food” night included fried chicken, collard greens, and rice with black-eyed peas. Since switching to this new health. format, participation in the class has increased. Nearly 100 people have joined the Nutrition Center during these classes • Maine is in the midst of the opioid crisis. In 2016, 378 people died from opiate overdoses. St. Mary’s is a partner in in 2017 to share in this cuisine together. a major community grant for the CommUNITY in Recovery program. The program’s goal is to create a community response and safe pathway to recovery that provides full access, reduces stigma and encourages the possibility of In addition to the monthly class at the Nutrition Center, we continue to collaborate on a monthly program at the Center successful overall well-being and participation. Most of 2017 was spent planning the program, including access to for Wisdom’s Women and with residents of d’Youville Pavilion. We also hold bi-monthly classes with participants from medication assisted therapy. A free training was held for local providers in the first quarter of 2018 so that they can Creative Work Systems, Personal Onsite Development, Alternative Services and Tri-County Mental Health. become certified to provide the medication. Other aspects of the community response being planned are a peer recovery community program and a community resource guide. Finally, we were proud to have cooks from many countries using our kitchen for L/A World Refugee Day celebration preparations in June, and we are excited to collaborate on the event in 2018. In all, 1,150 class seats were filled, and 360 HIV Case Management Program: The HIV/AIDS Case Management Program, started in 1998 when St. Mary’s was adults participated in cooking programs in 2017. awarded the Ryan White grant/contract under the Maine CDC, is now the second largest AIDS Service Organization (ASO) in the state of Maine. The program serves 95 clients between Portland and Ellsworth, Maine. Services provided Commit to Get Fit Challenge: St. Mary’s Health System successfully completed its 4th annual Commit to Get Fit include: medical, dental and eye care linkages; ongoing monitoring of client health status including treatment and care, Challenge on Saturday, May 6, 2017. The wet and chilly weather did not stop the dedicated 350+ walkers and runners lab results and helping to ensure ongoing treatment adherence on all levels; access to vital medications, linkages to who participated in our 3K, 5K, 10K and 15K events. Through generous community sponsors and event registrations, healthcare, substance abuse and mental health services; and access to food, assistance for finances, housing and our Commit to Get Fit Challenge generated more than $25,000 for our St. Marguerite d’Youville Fund for the Needy. Our transportation assistance. The program also offers client support groups, holiday luncheons and much needed personal event saw walkers and runners of all levels. For some, our race would be “first race of the season.” For others, this was care supplies. their first 5K. The joy and satisfaction of crossing the finish line was evident on our walkers’ and runners’ faces--smiles for completing a personal goal, laughter for betting their running partner and smiles for doing something they have never Sadly, in the late summer and fall of 2017, there were several client deaths attributed to drug overdoses, suicides and co- done before. occurring health conditions that ended in hospice care. As a result, we are currently exploring additional mental health resources/programming that may be of benefit to our clients. During the last quarter of 2017, there was a 20 percent increase in clients due to new infections, people relocating from out of state, returning clients and asylum seekers from HEALTH PROFESSIONS EDUCATION Community Benefit: $1,048,936 Africa. Despite this influx of new clients and staffing challenges, we have not instituted a wait list (unlike other ograms).pr We continue to be committed to serving all who are in need of services. Helping prepare future healthcare professionals is an important aspect of not-for-profit health care. St. Mary’s is proud to serve as a clinical setting for undergraduate training and internships for many healthcare disciplines. The time employees Physician Recruitment: Since St. Mary’s service area is a medically underserved area, our physician recruitment efforts spend mentoring these students is included in this category. are part of our plan to increase healthcare access and improve community health. Recruitment efforts for primary care and our Emergency Department/Urgent Care Clinic include signing bonuses, income guarantees and travel expenses for Tufts Medical School: The third year of medical school typically requires students to complete six six-to-eight week interviews. rotation blocks in specialties like family medicine, surgery, OB/GYN, pediatrics, internal medicine and psychiatry. The Tufts University School of Medicine - Maine Medical Center program allows students to complete a longitudinal program REACH Grant: In 2014, the local public health agency, Healthy Androscoggin, received a three year Racial and Ethnic over a period of nine months at more rural hospitals, including St. Mary’s Regional Medical Center in Lewiston. Here are Approaches to Community Health (REACH) grant from the Centers for Disease Control (CDC). The goal was to improve comments from one of the students placed at St. Mary’s in 2017: cultural competency and increase access to care and included training, data collection, resources and materials to eight mainstream health and wellness partners in the community, including St. Mary’s. Part of the action plan at St. Mary’s “The third year of medical school is a foundational experience in transitioning from textbook knowledge to clinical was to review the “Culturally and Linguistically Appropriate Services for Health Care” (CLAS standards from the Office of medicine, and I cannot imagine a more formative and enjoyable place to do so than St. Mary’s in Lewiston. Minority Health) and implement ways to increase adherence to the standards. In 2017, this included training staff and a Throughout my year here, I have not only learned vast quantities of information about how to practice medicine, presentation to the board of directors about health disparities, health equity and CLAS standards. After three years of the but more importantly how to interact with patients, understand the many factors that go into their healthcare, grant, more than 2000 people in our community have received training on cultural competency. In addition, some videos and most importantly felt like I was truly becoming involved in the care of my patients with my mentors. Because were produced for providers and patients about culturally competent care and chronic health conditions. Click here to of St. Mary’s devotion to education, teaching, and learning I have truly had a unique experience here of having view the video. world class teaching with a community feel. This combination has been the primary reason of why my third year of medical school has been so formative and why it will remain with me throughout my career how integral St. Mary’s was in transitioning me from student to physician.”

2018 | Stewardship Report 54 2018 | Stewardship Report 55 CASH AND IN-KIND CONTRIBUTIONS Community Benefit: $390,136 St. Mary’s Food Pantry: This was a record year for St. Mary’s Food Pantry. We provided more Average Number of People Supported Each Week This category includes funds and in-kind services donated to individuals, community groups and other not-for- than 21,000 boxes of food for 60,817 people in (includes all members of a family visiting the pantry) profit organizations not affiliated with the organization. In-kind contributions include hours contributed by staff to the 2017. This figure is double the amount served community while on healthcare organization work time; overhead expenses of space donated to not-for-profit community in 2016 and a 378% increase from 2014. We 1170 groups; and the donation of food, equipment and supplies. provided over 446,000 pounds of fresh produce, a 197% increase from 2016. Members of St. Mary’s leadership serve on many community health boards such as United Way, the local hospice and Healthy Androscoggin, the local public-health organization. St. Mary’s is also generous in offering hospitality for local Maine saw a 24% drop in the number of people community groups by providing meeting rooms at no charge for other not-for-profit organizations. receiving SNAP (food stamps) from FY 2013 to 583 FY 2016 due to policy changes that removed Neonatal Abstinence Syndrome Program: Since the Perinatal Substance Use Support Group was established at 433 people who previously qualified and reduced 378 St. Mary’s Regional Medical Center, a total of 37 women have attended at various stages of their pregnancy and the benefit levels of those still receiving SNAP. postpartum experience. Weekly meetings last two hours and include support from a variety of professionals, including: As a result, people are likely relying more heavily an experienced nurse-midwife who is the current medical provider and addresses medication and medical needs of the on food from food pantries to make up the participants, an experienced counselor who brings her expertise to the team for support and guidance in recovery, and difference according to our food pantry guests. a social worker who assists in coordinating services that are needed for this special population. A nurse works with the patients providing education on healthy pregnancy behaviors and pregnancy education. Although not every pregnant New Mainers (our immigrant and refugee community), especially recent arrivals, face barriers to accessing food woman with a substance diagnosis is a candidate for this program, the program provides a unique service to those assistance. Our pantry works to remove barriers, for example, by translating information, providing culturally relevant women who are committed to a healthy perinatal experience and recovery guidance. food when able and by creating a welcoming atmosphere. This has resulted in the pantry becoming a trusted community resource. We have been told multiple times that we are the first place people come when they arrive in Lewiston. Recently, a mother in the program who returned for the second pregnancy said the program provides her with support and the guidance needed to assist in her recovery and journey through the perinatal process. She has diligently attended We rely very heavily on distributing fresh produce, which we can typically access for free from Good Shepherd Food the program consistently and has shown complete success in her commitment toward a healthy lifestyle. Bank or local farms. In 2014 we distributed roughly 30,000 pounds of produce, and that has increased each year. In 2017 we distributed nearly 450,000 pounds of produce—nearly a 200% increase over the previous year. We also started Our goal in the program is to work with each patient, recognizing their unique family and medical needs while respecting adding eggs as a low-cost regular, protein source. We grew from 2,000 pounds of eggs in 2014 to more than 13,000 their dignity and showing compassion. Through collaboration the team is committed to providing excellence in care with pounds distributed in 2017. integrity. We've engaged more volunteers in the work to help ease the load. In 2015, 34 volunteers performed about 2,435 Sophia’s House: St. Mary’s staff serves on the steering committee for volunteer hours. In 2017, 119 volunteers performed 5,575 hours of service in the pantry. Many of these volunteers Sophia’s House, a new program of The Center for Wisdom’s Women are also community members who benefit from the pantry services. Several are from our immigrant and refugee (CWW). It is modeled after the Nashville-based Magdalene Community communities and speak multiple languages, which also adds to our capacity. Over the last two years, we’ve also started at Thistle Farms, a comprehensive, two-year, “housing first”, community- to engage youth from our youth programs in pantry work and have dedicated Fellow support (training program for young based model with 20 years of success. The belief is that holistic healing adults and community members) to the pantry. - of the mind, body, spirit and soul - occurs in community. Healing occurs in many ways, through horticulture, healthy food, art, meaningful work, stable community life, spirituality, appropriate therapy and good COMMUNITY-BUILDING ACTIVITIES Community Benefit: $252,598 medical care. St. Mary’s is very active in programs that address the root causes of health problems, such as poverty, homelessness The proposal is to create an interfaith community house to provide two-year housing and recovery services for women and environmental concerns. Leadership is involved in local economic development and coalition building to address who are survivors of sex trafficking, addiction, prison, abuse or other traumas. The program will include support services these issues. for therapy, addiction recovery, medical care, GED completion, job training and other needs in collaboration with local partner agencies. Poverty and poor nutrition are also significant public health issues in the area we serve. St. Mary’s subsidizes the Nutrition Center to address these needs. This includes our farmers’ markets, community gardens and cooking classes. Sophia’s House will include a core permanent resident community that will sustain the basic operating costs of the house while providing a stable community life. Permanent residents, some of whom may serve as mentors, and those in the long-term program, will share the first-floor community spaces and regular meals. Hospitality will be offered to neighbors through simple meals and programs. The program will develop social enterprise, income-generating projects for transitional guests to gain work experience while earning some income.

2018 | Stewardship Report 56 2018 | Stewardship Report 57 The Good Food Bus and Maine Harvest Bucks “What the St. Mary’s Nutrition Center provides overall helps in many, many ways and this community needs that. There have been times in my life that I wanted to die. Now I don’t want to die; I want to be happy and to grow.”

unique stops, up from nine the 13 previous season We provided nearly 130 gardeners with space, seedlings and technical assistance for their gardening plot. This season the Nutrition Center worked alongside organizations, businesses and residents from both Lewiston and Auburn to 2,700 transactions support the creation of three more neighborhood-centered gardens.

of transactions were from As part of its continuing leadership role in the Auburn Community Garden Initiative (ACGI) coordinating team, the 42% communities at risk for food Nutrition Center collaborated with other ACGI members including the City of Auburn, Androscoggin Land Trust (ALT), St. Mary’s Nutrition Center made several exciting changes insecurity the University of Maine Cooperative Extension and City residents to secure a former house lot at 88 Newbury Street for the Good Food Bus (mobile farmer’s market) that for a second community garden in Auburn. Members of the ACGI knocked on neighborhood doors to gather feedback translated into positive growth and success in 2017. Most worth of local food purchased $22,000 and met with city officials to better understand the history of the site as well as its future as part of the revitalization of notably were improvements to the mobile market set- from farmers the city’s downtown. A groundbreaking and information gathering session was held on October 24, 2017. The ACGI will up, staff structure and schedule. Exchanging the 30-foot increase of sales from 2016 spent winter planning and continuing to collect input from community members. school bus for a truck and trailer, hiring a coordinator and 40% assistant coordinator and including more stops allowed us as many Anchor Meals (healthy Another collaboratively-birthed garden on the horizon will be located at 80 Birch Street, on the corner of Birch and to bring more good food to more people and more easily. 2X dinner meal bags) sold Pierce Street in Lewiston. After purchasing the vacant lot next to their headquarters, staff and members of the Raise-Op Housing Cooperative partnered with the Somali Bantu Community Association, the Root Cellar and the Maine People’s Resource Center to talk with more than 70 people in the neighborhood. When asked what should happen at 80 Birch Street, a majority of residents said they wanted a community vegetable garden. A ground-moving celebration was held Community Gardens and Youth Programs on Thursday, October 26th. Partners and community came together even amidst the rain to spread loam and share ideas for the garden name. The Nutrition Center is excited to continue to partner by overseeing coordination of garden development, gardener sign up and support. Other partners involved in the project include Goodwill, Take 2, Community Concepts, Community Partnerships for Protecting Children and the multi-sector Healthy Neighborhoods Planning Council.

“I liked growing my own vegetables and “It’s nice because this “We have cilantro and tomatoes. In anticipation of the new Nutrition Center Learning Garden, a sunflower-planting party, ground blessing and information growing my own food. I’m a heart patient past winter I bought no I got a lot of cucumbers. We can gathering session was held at the beginning of June. The event allowed those in attendance to share their intentions and and the one thing that really helps me vegetables because I put walk down, get food and eat! When is that I eat healthy, so I don’t have any so much in my freezer. I I cut the tomatoes and the carrots good will for the space and ideas on different garden components and infrastructure. Community faith leaders blessed heart disease problems. So it was nice to froze lots, so I don’t have the taste was sooo fresh! The taste the site and everyone came together to plant sunflower seeds to help remediate the lead from the soil. The Nutrition grow food and have it fresh. I especially to buy greens. I also have is different from the store. Now that Center garden will better integrate gardening components into our cooking, food pantry and youth programming. It will liked how I’d see families there, and I lots of beans and I’m I know how to plant, next year will be built specifically for learning and for all ages. Many aspects will be open for anyone to visit, learn, pick and eat and for brought my grandkids a few times.” saving some for seeds.” be even better”. community members to gather and relax with plots to grow food, for 540 members of their households. - Pine Street gardener - Hillview gardener - First-time Knox Street gardener. Youth Campaign Crew: Our youth program not only I am unique, curious and playful teaches youth about gardening, but also provides formation I dream of becoming someone full of love for personal and leadership development as well. Here Among the dozens of beds and hundreds of plants craning their necks for sun and burying their feet to find water, in I worry about my health is a poem compiled by statements from the 2017 Youth each of the Nutrition Center’s community gardens, there are countless stories being cultivated alongside one another. I try to have good grades in school Campaign Crew: Sometimes these stories can be difficult to find, just like the first ripe tomato of the season hiding beneath the cover of I am a sophisticated black woman hundreds of leaves. Others stand out tall and proud like the Mammoth Sunflower in August. I cry when I see people suffering I say “don’t let your mistakes hold you back” Such is the story of Charles, a long-time community gardener. Charles, like more than half of our gardeners, returned for I want justice and peace around the world another season of gardening. As in the season before, his growth did not stop at the edges of the garden but found its I am intelligent way out into the world and into his everyday life. We are grateful that Charles has been both unabashed in sharing his I want justice and peace in my community growth and struggle, and he’s been consistent in reminding us of the sustaining role the gardens play in peoples’ lives. We are all perfect in our own way Charles tells us that the garden gives him not only good food to eat, but an outlet and something beautiful. A recovering We are the YCC addict, clean for more than five years, he says the garden is his new “positive addiction.”

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Good Food in the Schools Nutrition Center programming with kids continues to expand. This season, the Nutrition Center staff gardened and St. Mary’s Villa cooked with more than 2,000 kids in 60+ classrooms and afterschool sites, with plans to increase that number in 2018. Elmhurst Township, PA Staff continued to work with students and teachers at Longley, Montello and McMahon Elementary Schools through classroom-based lessons, after school cooking and gardening clubs and summer school programming. OUR LEGACY

In fall 2017, we cultivated an additional partnership with Martel Elementary School. Children also had the opportunity St. Mary’s Villa was created in 1924 by a Passionist priest, Rev. Alphonsus Maria, who emigrated from to get dirty and make good food outside of the classroom at the Knox Street and Hillview Kids Gardens. These Lithuania and, with the fervor of the missionary spirit, answered the call of his fellow countrymen, women neighborhood gardens allow children to explore and help grow their own food, often right outside their front door. Teens in our fall gardener job training program designed and led hands-on and interactive activities as part of these fun and and their children in the area of Scranton, Pennsylvania. Rev. Alphonsus and the religious order that he educational garden times. This opportunity not only paired younger kids with older mentors, but also allowed the teens founded, the Poor Sisters of Jesus Crucified and the Sorrowful Mother, established an orphanage and a to build valuable leadership and teaching skills. home for the elderly. Their loving care for the elderly continues today.

We also worked in 2017 to help more teachers and adults work with kids in gardens. This year we engaged 43 area teachers and garden educators in farm to school training opportunities offered by NC staff and other state wide organizations, such as the five-day Maine Agriculture in the Classroom Summer Teachers Institute and Maine School Garden Day. In the spirit of the Covenant Health System and the Poor Sisters of Jesus Crucified, and in keeping with our mission, St. Mary’s Villa continues to respond to the needs of the poor and underserved in our community. Some of our in-school programming this year was supported in part through a collaborative agreement with the Auburn St. Mary’s Villa has a very active Mission Committee that works diligently throughout the year to provide their and Lewiston school districts as part of Auburn’s USDA Farm to School planning grant that wrapped up in September. services, talent and fundraising for our local community organizations and individuals in need. We look forward to continued collaboration with all area educators through the Androscoggin Farm to School Network and Wellness Committees in each district. Community Benefit Reporting for 2017 Medicaid Losses: $596,260 Community Benefit:$15,319 COMMUNITY BENEFIT OPERATIONS Community Benefit: $123,523

Community benefit operations include costs associated with assigned staff and community health needs, community Community Benefit Categories benefit strategy and operations. St. Mary’s uses Lyons software -- the software system recommended by the Catholic OUTREACH & DONATIONS Health Association -- to record and report community benefit efforts. Costs for fundraising aimed at hospital-sponsored community benefit programs (such as our Nutrition Center) are included in this category. Non-Perishable Food Drive: The St. Mary’s Villa Community conducted a non-perishable food drive leading up to our Super Bowl festivities. A total of 163 non-perishable food items were collected and dispersed to the St. Mary’s Villa Little Creating a Culture of Health: In 2016 St. Mary’s and the community of Lewiston were selected to participate in Food Pantry Project, and the North Pocono Community Food Pantry. Value: $21 “Building a Culture of Health,” a learning collaborative through the Robert Wood Johnson Foundation and the American Hospital Association. This included a site visit from the American Hospital Association to learn about our community’s COMMUNITY PARTNERSHIPS & OUTREACH effort to improve public health, as well as national meetings with the other nine communities selected to participate in St. Mary’s Villa Little Pantry Project: St. Mary’s Villa spearheaded a Little Pantry the collaborative. In March 2017, St. Mary’s participated in a site visit to Denver to for the second site meeting. The focus Project in 2016, and it continues today. Each week, the pantry is stocked full of was on social determinants of health. In August 2017, St. Mary’s presented in a national webinar about the work and non-perishable food items and is available to our immediate community. It provides learnings of the collaborative. nourishing meals to needy families to help them get by until payday. It is heavily-utilized and has been a well-received by our community. Value: $592 In 2012, St. Mary’s and the other local hospital established a group of community health-care related agencies to review the community health needs assessment. The group has continued monthly meetings to analyze community health St. Eulalia’s Breakfast Set-up and Assistance: St. Eulalia’s Parish is a local parish that holds a breakfast fundraiser needs assessment data, collaborate on appropriate initiatives and network about existing community resources. In 2017, every month. They rely on volunteers from the parish and local outreach groups, such as St. Mary’s Villa, to help with the the coalition focused on the three priority areas identified in the 2018 community health needs assessment: substance set-up and staffing of the breakfast event. Value: $103 use, mental health and physical activity/obesity/nutrition.

St. Mary’s is committed to improving the health of our community through staff leadership, strategic partnerships, EDUCATION & PLANNING community and health care professional’s education and community building. These efforts are one way we use our Mission Committee Meetings: St. Mary’s Villa holds monthly Mission Committee meetings with directors and staff “expert minds and caring hands” to turn hurt into hope. who are involved in the planning and implementation of all of our Community Benefit activities throughout the year. This committee also votes on the Employee of the Month Award and assists with our Gift of Time Policy. Value: $2,213

2018 | Stewardship Report 60 2018 | Stewardship Report 61 COMMUNITY PARTNERSHIPS community partnerships and neighborhood camaraderie to make our neighborhoods safer and more caring places to live. National Night Out enhances the relationship between neighbors and law enforcement while bringing back a true North Pocono Ministerium: In an effort to build community partnerships, St. Mary’s Villa has become a member of sense of community. Furthermore, it provides a great opportunity to bring police and neighbors together under positive the North Pocono Ministerium. This is a group of churches from our local North Pocono region that provide ecumenical circumstances. Value: $62 services to the community during Lent and Advent. St. Mary’s Villa has hosted these meetings on our campus, and our mission director has become an integral part of this group, participating in the meetings and ecumenical services. Value: EDUCATION, COMMUNITY OUTREACH & DONATIONS $322 Liam’s Lighthouse Foundation T-shirt Fundraiser: Liam’s Lighthouse Foundation (LLF), EDUCATION & OUTREACH a non-profit, tax-exempt organization, was established to create and provide educational material and awareness about Hemophagocytic Lymphohistiocytosis (HLH). Our focus is also Health Fairs and Blood Pressure Screenings: St. Mary’s Villa frequently participates in our local area’s health fairs, to bring families affected by HLH/Histiocytosis together and offer support through a variety of conducts blood pressure screenings and hosts educational programs on our campus for the community. Value: $566 resources. We aim at raising much-needed funds for continued education of physicians and research to develop safer and more effective treatment methods – and ultimately a cure. LLF COMMUNITY PARTNERSHIPS OR OUTREACH is also dedicated to bringing awareness to the community about the importance of becoming Volunteering Assistance to Organizations: Our Mission Committee members a blood and bone marrow donor. St. Mary’s Villa held a T-shirt fundraiser to benefit the Liam’s truly exemplify the mission and service leadership model of Covenant Health by Lighthouse Foundation this year. Value: $100 volunteering in our community on behalf of St. Mary’s Villa. Some of these activities include: The Lions Club, Historical Society, Jefferson Township Elementary School Scarecrow Decorating Contest with Canned Food Donations: St. Mary’s Villa held our scarecrow decorating contest PTA and field trip chaperones, as well as fundraising events for local parishes and this fall. This is a contest where each nursing unit and community decorates their own scarecrow. Families, friends and community organizations. Value: $2,285 staff vote for their favorite scarecrow by filling bins with non-perishable food donations. This year we collected 357 non- perishable food items and they were donated to our local North Pocono Food Pantry. Value: $156 St. Patrick’s Day Float: St. Mary’s Villa created a float and helped to support Scranton’s St. Patrick’s Day festivities by walking in the parade and promoting the area’s ethnic heritage. Value: $4,650 Community Trick or Trunk Event: St. Mary’s Villa hosted a free Trick or Trunk event in October which was open to our local community of Elmhurst and Roaring Brook Townships. More than 200 children attended and were given treats by Easter Eggstravaganza: St. Mary’s Villa held an Easter Eggstravaganza party for our our residents in both the nursing home and the personal care home. Many community members were very appreciative local community’s families. The event attracted more than 75 local children and their due to our local area being unsafe to trick-or-treat because it is rural and lacks street lights and sidewalks. Value: $526 families. Activities included pictures with the Easter Bunny, games, goodie bags and free ice cream. Value: $491 Moffat Estate Hall of Trees Project & Angel Tree Project: St. Mary’s Villa’s Mission Committee and our residents participated in the Hall of Trees project for the community of Covington Township this December. All of the tree's Earth Day Clean Up: St. Mary’s Villa held an Earth Clean Up of our neighborhood in conjunction with Earth Day. We ornaments were made by our residents. The tree, as well as all of its beautiful decorations, was donated to a family who cleaned garbage and debris from our local roadways. Value: $164 lost their home due to fire this year. This was a new program, and we enjoyed bringing joy during the holiday season. Also, St. Mary’s Villa provided toys and clothing to over 75 children in need through the Angel Tree Project organized by Elmhurst Township Fire Parade Float and Walkers: St. Mary’s Villa supports our local fire department. We hold the Salvation Army in our local area. Value: $706 fundraisers for the Elmhurst Township Fire Department and walked in their fire parade with floats this year. Value: $329 Spaghetti Benefit for Samantha: One of the best aspects of St. Mary’s Villa is the sense of family and how we stick St. Joseph’s Center Benefit and Telethon: For the past 12 years, St. Mary’s Villa has held fundraisers for St. Joseph’s together to help our family members. One of our CNA’s had a baby and a stroke preceding the pregnancy that left her Center in Scranton, Pennsylvania. St. Joseph’s Center is a non-profit organization that serves the community through completely paralyzed on her left side. A fundraiser was held for Samantha and her family in December. St. Mary’s Villa pregnancy, family and adoption services, outpatient therapy and extensive residential and community-based programs employees made raffle baskets and volunteered for the fundraiser. Value: $53 for children and adults diagnosed with intellectual disabilities. St. Joseph’s serves hundreds of people throughout Northeastern Pennsylvania on a daily basis. Value: $721 DONATIONS Book Donation: St. Mary’s Villa went through our libraries and found books that were duplicates or older books. We Alzheimer’s Seminar, Seminar on Drug Disposal ans Alzheimer’s Walk & Bingo: St. Mary’s Villa hosts numerous collected more than 150 books totaling in value of $500. St. Mary’s Villa donated these books to the Valley Public Library. events on our campus for the education of our community. Many topics benefit our elderly population, especially through Value: $526 our education and outreach regarding the warning signs and care of Alzheimer’s disease patients. We held a seminar on the proper methods of drug disposal for our community. We also had a team participate in this year’s Alzheimer’s Walk. Value: $732

National Night Out: St. Mary’s Villa has been a part of the National Night Out Program for the past three years. This year, St. Mary’s Villa had information tables and crafts for children at the National Night Out safety fair in conjunction with the City of Scranton. National Night Out is an annual community-building campaign that promotes police-

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its impact. This includes those affected directly, as well as family members and friends of those with the disease. It is Youville House Assisted Living Residences currently the only Parkinson’s support group offered in the Cambridge area. No ongoing commitment is necessary, and participants may attend meetings at their convenience. Value: $3,040 Cambridge, MA Dance with Parkinson’s: The Dance with Parkinson’s program provides classes to liberate movement through the joyful medium of dance. Classes are taught by a trained instructor and are open to the local Cambridge community every OUR LEGACY Thursday from 10:30 a.m. to 12 p.m. Value: $10,875 Youville Assisted Living Residences are communities grounded in the spirit of St. Marguerite Parkinson’s Presentation: Youville House invited the community to a Parkinson’s presentation. The presentation helped d’Youville, foundress of the Sisters of Charity of Montreal, “Grey Nuns.” Trusting in God’s love, clarify the ongoing challenges faced by people affected by Parkinson’s disease, offering general information about each community serves all those in need with compassion and respect. symptoms, progression and suggestions for living with the disease. Value: $1,751

Tai Chi for Parkinson’s: A Tai Chi for Arthritis course was offered free of charge to the community by Youville House. This Tai Chi course targeted those who struggle with joint pain and the reduction of movement. Value: $2090

Inspired by the life and work of Marguerite d'Youville, Youville House continues to respond to the needs of the Neuroscience Talk: Dr. Herrington from Massachusetts General Hospital discussed recent advances in the management resident and external communities, with particular focus on the elderly and underserved. of Parkinson’s disease. Dr. Herrington shared the newest understandings about how Parkinson’s disease develops. He also discussed new medications and surgical therapies, including deep-brain stimulation. Value $120 Community Benefit Reporting 2017 Hospice Presentation: Mary Crowe, director of education at Care Dimensions, presented information regarding Subsidized Units: In 2017, Youville House subsidized low-income seniors. Value: $266,376 palliative care and hospice to the Cambridge Community, as well as residents of Youville House. A continental breakfast Cash In-Kind Donations: Donations of space, staff hours, supplies and cash. Value: $62,207 was served. Value: $525.

Brown Bag Lunches: Youville House provided brown-bag lunches to the Salvation Army this year. Staff and residents Community Benefit Categories participated in the preparation of the bags. Value: $445

COMMUNITY BOARDS & ORGANIZATIONS Mentoring students: Throughout the year, students from colleges such as Tufts, MIT, Berklee School of Music, Salem The Art Connection Board: The community life coordinator serves on the Board of the Art Connection, an organization State, Buckingham, Brown and Nichols came to Youville to complete their practicums with our staff and residents. This that places art in nonprofits. year, Youville House welcomed five interns. The director of programs supervised three interns from Lesley College. These interns are studying to be expressive therapists. The director of mission supervised a pastoral care intern from Harvard The Cambridge First Wednesday of the Month Group: The Community Life Coordinator attends meetings monthly Divinity School who concentrated on the spiritual care of our residents. to reach out to the local community. This group is dedicated to improving services in Cambridge and supports organizations that serve the homeless, elderly, children and other underserved populations. Youville House was involved DONATIONS OF MEETING SPACE AND GOODS FOR NOT-FOR-PROFIT ORGANIZATIONS: in planning the fourth annual day of service on Martin Luther King Day in Cambridge. Neighborhood Tai Chi: Every Thursday, space is provided for one hour each week. Value: $4180 CRLS Reception space: Value: $25 OUTREACH TO THE COMMUNITY Oriana Orchestra: Youville House provided rehearsal space. Value: $3,750 St. Paul’s “Feed the Homeless Program”: Four times a year, we make more than 150 sandwiches, and our kitchen staff St. Paul’s Spiritual Group Meeting: Space was provided. Value: $1,950 prepares hot foods and bakes cookies for St. Paul’s “Feed the Homeless Program.” Some Wednesdays during Advent and Lent, residents and staff go to the church to help serve and eat with the guests. In March, meals were delivered by St. Paul’s Prayer Group Meetings: Space was provided throughout the year on a weekly basis. Value: $1,320 our van driver. Value: $1,859 Art Bingo-Space: Value: $75

MLK Day of Service: Two members of the Youville House participated in a day of service held at the Cambridge City OTHER Hall. Cards were brought back to Youville House for the residents and staff to address and send to nursing homes and hospitals. Our van driver delivered clothing, food and supplies to shelters and food pantries. Youville House provided 30 Staff Hours: Youville House staff participated in each one of the outreach projects, as well as the time spent with bagged lunches for the volunteers. Value: $660 the community that we invite into our building. Space, prepared food and hospitality is extended to the Cambridge community and is provided by all departments working together. Value: $29,317 Parkinson’s Support Group Meeting: Beginning in September, we started holding a Parkinson’s support group at Youville House, every third Tuesday of the month. This group is open to individuals coping with Parkinson’s disease or

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COMMUNITY PROGRAMS

Youville Place Assisted Living Residences Alzheimer’s Education: A program was offered to the Lexington community. Value $200 Lexington, MA Community Series: Dr. Karen O’Brien, director of the palliative program at Massachusetts General Hospital offered a presentation to the Lexington Community about the benefits of palliative care in the treatment of chronic and end-of-life Keeping with the mission and vision of Marguerite d'Youville, Youville Place continues to respond care. to the needs of the residents and external communities, with particular focus on the elderly and Value: $210 underserved. MENTORING STUDENTS:

The director of programs supervised three Lesley College expressive therapy graduate students as they worked with the residents doing programs to enhance their motor skills for activities of daily living. The director met with the students Community Benefit Reporting for 2017 on a regular basis, helping them plan and execute the programs. The mission director also supervised and met weekly with a seminarian from Pope John XXIII Seminary in Weston who worked on spiritual care programs for the residents. Subsidized Units: In 2017, Youville Place’s subsidy for income seniors totaled: $729,245 Donations of meeting space and goods for not-for-profit organizations Cash in-kind Donations: Donations of space, staff hours, supplies and cash in 2017 totaled: $20,862 Girl Scout Troops: During the school year, Youville Place offers space to Lexington Girl Scout troops for two hours each month. Value: $4,150 Community Benefit Categories Brownie Troop: During the school year, Youville Place offers space to Lexington Brownie troops for two hours each OUTREACH TO THE COMMUNITY month. Value: $550

Lexington Interfaith Clergy Association: The director of mission and pastoral care joins with the clergy in the town to Be a Santa for a Senior: In December, seniors wrapped gifts provided by Home Instead to give to seniors in the provide support for Lex Eat, Bridges and the MLK Day of service. This group supports the local food pantry and is very community. Staff members assisted residents. active in promoting an understanding of the diversity of cultures and religions through conversation and dialogue. The director of mission meets monthly with the group. Sock Drive for Women Place: Value: $22

Neighbors Who Care: In April 2017, Youville Place hosted a tea for seniors served by Neighbors Who Care. The Women Shelter Outreach: Value $150 volunteers and staff at Neighbors Who Care provide transportation, food and bill-paying for seniors. Youville Place invited residents and seniors to an afternoon of tea and conversation, along with some tasty desserts. Many staff members Food Drive: Value $25 joined, served and socialized with the group. This year, Youville Place hosted a second event with Neighbors. Value: $150. OTHER Lexington Interfaith Food Pantry: In August, Youville Place sponsored a canned-food drive. Residents and staff contributed canned goods, packed and delivered the food to the pantry. Staff Hours: Youville House staff participate in each one of the outreach projects, as well as time spent with the community. With all departments working together, hospitality is extended to the community through the donation of Lexington Interfaith Food Pantry: In December, the staff and residents collected and donated toiletries for the food meeting space and prepared food. pantry to distribute to the homeless community. Soap, Kleenex, powder and hand lotion were collected. • Staff hours donated in 2017 are equivalent to $15,005.

Meals for Homeless: Residents and staff prepared 200 bag lunches for a local homeless shelter. Each bag contained a • Supplies and donations in 2017 totaled $ 5,857. sandwich, drink, fruit and cookies. Value: $200 • The grand total for the year 2017 in supplies, donations and staff time totaled $20,862.

Lex Fun Baby Sitter Social: Youville House provided space and food to the Lexington Mother’s Group Value: $200

2018 | Stewardship Report 66 2018 | Stewardship Report 67 Environmental Stewardship Reports Mount St. Rita Health Centre Environmental Stewardship Initiatives As a member of Covenant Health, Mount St. Rita actively addresses our responsibility to be good stewards of our As an organization deeply rooted in the Catholic faith, we feel a deep responsibility to be good stewards of the planet environment in the following recycling initiatives in 2017: with which God has entrusted us. Covenant Health Systems member organizations have been recognized numerous • Florescent bulbs, dry cell batteries and lighting ballasts recycled on a regular basis times over the years for the steps we are taking towards sustainability. In 2017, we made even more progress in this area, and we will continue to invest in strategies that will leave the planet better for those who come behind us. The • Fluorescent lamps – a combination of sizes. Picked up by a company twice a year following is a summary of some of our 2017 efforts: • Dry cell batteries are picked up twice a year by a recycling company • 350 lbs. aluminum cans and plastic bottles • 400 lbs. corrugated boxes • 50 lbs. glass Mary Immaculate Environmental Stewardship Initiatives • 250 lbs. office paper shredded by company twice a month Mary Immaculate continues to care for our environment responsibly while being good stewards of our resources. • 250 lbs. e-waste Our efforts in 2017 included the following in our residential community: • Approximately 240 recycled ink cartridges a year • Added insulation to all apartment air conditioner wall sleeves to reduce air infiltration • Instead of buying bottle water, purchasing water filters for the faucets • Distributed LED light bulbs, LED night lights and thermometer to all apartments, free of charge • Started and completed the replacement of two of four building envelope systems (a.k.a. Curtain Walls). Penacook Place, Inc. Environmental Stewardship Initiatives » The objective of this project was to make the buildings water-tight and eliminate air filtration As a member of Catholic Healthcare since March of 2017, Penacook Place continues its tradition of caring for the • Upgraded the radiators in Building 2 waiting areas environment in which we all live. Along with its historical recycling programs, Penacook Place initiated several » The glass used was low-e: which reflects heat back to its source so it helps stay cooler in the summer and warmer in exciting programs, which will bear fruit in 2018. the winter In the last 12 months, the following upgrades were made planned and designed: • Replaced the main roof of Building 3 • New roofing system to allow reflective light to assist in cooling while melting snow to reduce ice dams and eventual » The objective was to add another layer of roof insulation and upgrade the rubber membrane to eliminate water leaks; reflective roofing chosen for roof-mounted solar panels pooling and penetration • Updated HVAC system bringing significant efficiency pickups within the system • Minor modification to the boiler system to further maximize efficiency, i.e. adjusted the circuit setters to better balance the flow of water to eliminate short cycling of the boilers • Computer controlled environmental monitoring for additional efficiency • Mary Immaculate Residential Buildings 2 and 3 have been awarded the 2017 Energy Star Award • Lighting conversion of the entire building to LED bulbs. Made possible through a National Grid program

Each of these will produce not only significant cost savings over time, but will also provide improved living and working In addition to the efforts of our residential community listed above, we also made the following initiatives in our conditions within the buildings. With the decreased heat of the LED bulbs and the upgraded roof, the HVAC system skilled nursing facility: will need to work that much less. Additionally, the improved insulating properties of the roof will reduce the need for • Installed Led lighting throughout the facility with motion-sensor controls. heat, and the reflective properties will reduce the need for electricity when the solar is installed in the next phase. We » This effort not only enhanced our lighting, but also has been projected to have a 63% reduction in KW with CO2, anticipate the majority of the work to be completed by June of 2018. SO2 and NOx reductions • Led lighting fair for employees • Scored an 86 for Energy Star Rating • Mission Council promoted an energy conservation program to encourage residents, staff and family members to turn off lights and televisions when not in use. » The 'do the earth a favor be a power saver’ program continues with signage reminding all those in the community

2018 | Stewardship Report 68 2018 | Stewardship Report 69 OUR NAME IS OUR

APPENDICES PROMISE Covenant Health Systems Annual Report

Annual Report 2018 | Stewardship Report 70 2017 STRATEGIC PLAN Dear Friends…

Too often in the world today, promises are made and broken easily – testing our trust. At Covenant PYRAMID Health, we believe that the promises we have made must be kept, and our name should be synonymous with integrity, compassion and high quality care.

PATIENTS & RESIDENTS The spirit of this is captured in our tagline, “Our Name is Our Promise.” This is not new – Covenant Health Systems was founded over 30 years ago with a vision of partnering with religious congregations to maintain and expand access to high quality, Catholic, not-for-profit MISSION healthcare. As one of the first lay Public Juridic Persons of Pontifical Right (PJP), we are steadfast in our mission, rooted in our faith and driven by our passion for our patients, residents and the communities we We are a Catholic health ministry, providing healing and serve. Today, we are honored to represent our foundresses, along with 20 other religious congregations care for the whole person, in and dioceses, in providing for the healthcare needs of our communities – especially for those who are service to all in our communities. most vulnerable among us.

As we reflect on and celebrate all that’s been accomplished throughout our history, our commitment to VISION our covenant with our patients, residents, employees and communities is as strong as ever. While this We will be a growing Catholic, integrated, must never change, we understand that other aspects of our organization must continually evolve to community-centered health partner. ensure our future success. We are confident in our ability to do this, together.

In 2017, we focused on further fulfilling our ongoing covenant by treating all in our care with respect and VALUES compassion, by fostering teamwork among our employees, by doing what we say we are going to do COMPASSION COLLABORATION and by doing our very best. We are excited to share stories, updates and facts about our organization INTEGRITY EXCELLENCE that highlight how we are living this out and how we will continue to deliver on these promises in the years ahead. As always, we appreciate your support for Covenant Health and its member facilities, and we sincerely thank you for the trust you’ve placed in us. COVENANT MANAGEMENT METHOD With sincere appreciation,

OUR GOALS PEOPLE QUALITY PERFORMANCE GROWTH & » We attract, develop We are a premier provider » We relentlessly TRANSFORMATION & retain superior of care achieving the pursue operational » We offer innovative, teams quadruple aim: excellence relevant consumer » Patient experience Louise Trottier David R. Lincoln » Best place to work/ » We promote a culture experiences » Provider engagement Board Chair President/CEO high engagement of fiscal responsibility » Population health » We provide seamless Covenant Health Systems Covenant Health Systems integrated care » Affordable healthcare and Covenant Health, Inc. and Covenant Health, Inc.

EXPANDING THE MINISTRY The Catholic identity of Covenant Health will serve as our foundation and compass to guide and grow our mission and ministry of healing and health. Our Name is Our Promise | 73 OUR PROMISE TO OUR LEGACY Honoring and Advancing Catholic Health Care

The unique qualities of Catholic health care go beyond our not-for-profit status. All Catholic health and elder care facilities are committed to meeting the needs of the underserved. Many are in urban areas, where they were founded by religious communities to care for the poor. In fact, some of Covenant Health’s skilled nursing facilities were founded as poorhouses and orphanages before converting to long-term care facilities to better serve the changing needs of the community.

OUR Guided by this legacy, we have remained in our communities at a time when others have moved to more "Health care is an essential affluent suburbs, and we have refocused our services to be safeguard of human life culturally sensitive to the needs of new populations that are and dignity and there is an now turning to us for care. As always, we are committed to obligation for society to ensure PROMISE serving every member of our community regardless of his that every person be able to or her religious faith. We provide pastoral care and mission- realize this right." related services. Our pain management and palliative care TO OUR LEGACY programs are innovative in our industry but originate in our Joseph Louis Cardinal Bernardin Catholic tradition of care with compassion.

TO OUR PATIENTS Our boards, leadership teams and employees take pride in honoring our mission of Catholic health care, and together, we will continue to advance these tenets as we evolve and grow to meet the needs of our communities, families, friends and neighbors both now and for TO OUR PROVIDERS generations to come. Mary Immaculate Hosts TO OUR EMPLOYEES Tea with the Grey Nuns to Celebrate Mission Week TO OUR COMMUNITIES Nearly 100 employees attended a Mission Week tea with the Grey Nuns.

Youville Place Celebrates TH 20 Anniversary Pictured left to right: Joanne Scianna, COO; Sister June Ketterer, SGM; Nicole Breslin, President/ CEO; Sister Jeanne Poor, SGM; and Joanne Parsons, former President/CEO

Our Name is Our Promise | 75 OUR PROMISE TO OUR PATIENTS AND RESIDENTS Covenant is Building a System of Care to Better Coordinate and Improve Healthcare Delivery Michael Kelley, MD Chief Medical Officer, Behavioral Health Let’s face it, health care isn’t always as user-friendly St. Mary's Health System Lewiston, Maine and easy to navigate as it should be – we want to change this. If you or a loved one have ever dealt with a serious health issue, you know how easy it is to become overwhelmed by the sheer number of appointments, medical records and next steps “We believe our you will encounter along the way. We believe our Covenant’s Skilled Nursing Facilities Deploy patients want patients want and deserve better than this. New Technology to Improve Care and Reduce and deserve In 2017, Covenant Health continued its efforts to Disruptions for Residents build a “system of care” that will improve the way care is coordinated and delivered. Our new system In Fall 2017, four of Covenant Health’s skilled nursing facilities introduced TripleCare, an of care will offer a wide array of inpatient and innovative telemedicine technology platform that reduces strain on residents by minimizing outpatient services centered around our patients’ unnecessary trips to the hospital. TripleCare allows nurses to connect seamlessly with than this.” needs and preferences. physicians 24/7 to discern if a resident’s immediate healthcare needs can be addressed at the better facility or if he or she should be transported to the hospital. Many of our new initiatives will be achieved with the implementation of the CareLink (Epic) electronic This technology is used in non-life-threatening situations, like when a resident suffers a minor health record. This new technology will help us fall or is beginning to show symptoms of an illness. TripleCare is also helpful when caring achieve better health outcomes for patients by for residents who are frail or suffering from dementia because it minimizes transitions and engaging our clinicians in the active practice of hospitalizations that increase confusion and potential exposure to illnesses and infections. collaboration and development of best practices. It will also encourage patients to become true TripleCare’s virtual bedside visits equip facility employees to provide better, more responsive partners in managing their health. care to residents on evenings, weekends and holidays when physicians aren’t typically on site—and when hospital transfers most often occur. Since launching TripleCare, facilities have We believe this focus on building a comprehensive reported a significant decrease in transfers to the hospital—a win for caregivers, residents and system of care will make health care better by their family members. Pamela Beahm, MD ensuring the people we serve have access to the Pediatrician, St. Joseph Hospital Covenant Health was the first to implement this telemedicine option in Maine. The post- Pediatrics Sky Meadows Office very best care when they need it, where they want it Nashua, NH and how they would like it to be delivered. acute facilities utilizing this technology include St. Mary’s d’Youville Pavilion-Lewiston; Mary Immaculate-Lawrence; St. Joseph Manor-Brockton; and Maristhill-Waltham.

2018 | Stewardship Report 76 Our Name is Our Promise | 77 OUR PROMISE TO OUR PROVIDERS Providers Lead the Way to Better Patient Care through the Integrated Medical Group

In 2017, Covenant Health’s Integrated Medical Group (IMG) elevated the role of physicians in leadership and launched an exciting effort to improve patient care and experience. IMG is working diligently to deploy new technology that will strengthen care coordination from the office setting through our acute care hospitals. With Left to right: Marie(Leone) Lotin; Dorothy St. Vil; Francoise Aubourg; and Marise Jean Youville Place, Lexington, MA CareLink technology, IMG will have the tools needed to improve communication between providers and patients, provide secure access to medical records, as well as improve convenience when patients are scheduling or OUR PROMISE TO OUR EMPLOYEES changing appointments. Our Employees are the Another strength of the new technology is its ability to manage the flow of patients at IMG offices. This should Heart of Covenant Health Michael Newman, MD reduce delays for patients and improve the efficiency of 6,500 Medical Director, We are proud of the exceptional care our Covenant St. Mary’s Center for Orthopaedics providers and staff – resulting in more time to tend to our Employees Lewiston, ME patients’ personal needs as well as their clinical needs. family delivers to our patients and residents every day, and we are committed to ensuring all our employees, nurses and physicians have the support and resources they need to deliver on our promise to patients and the communities we serve. Not only do members of the Covenant family provide exceptional care to our patients, they are proud of our legacy and are “CareLink provides committed to helping us achieve our mission and vision for the future. to their own electronic healthpatients record to helpaccess them take 3 As the heart of our organization, the care we provide Hospitals of themselves and allows the healthcare and the work done in the community would not be possible without these dedicated professionals. We better care are honored that these hard-working men and women team access to information across their care continuum.” choose to pursue their calling at Covenant Health, and we sincerely appreciate the excellent care and million - William Wood, MD, Vice President of Medical Affairs little (often unnoticed) things the members of the St. Joseph Healthcare (Bangor, ME) Covenant Health family do each day. 10 Post-Acute Facilities

2018 | Stewardship Report 78 Our Name is Our Promise | 79 OUR PROMISE TO OUR COMMUNITIES Food Insecurity Covenant Health Invests in Communities Many of the communities we serve suffer from poverty and hunger. Covenant Health works with community partners to address these challenges. Covenant Health's service area includes communities from Maine to Pennsylvania, each with thier own unique socioeconomic and health needs. Our mission and Catholic legacy calls us to partner with other community organizations, schools, businesses and public officials to meet the needs of the communities we serve. Together, we are making an even greater impact than we could alone.

unique stops, up from 9 the In 2017, Covenant Health invested $38,706,000 in outreach, education, programs, 13 previous season sponsorships, charity care, loss on Medicaid and grants to address issues ranging from literacy, food insecurity, homelessness and more. transactions St. Mary’s Nutrition Center made several 2,700 exciting changes for the Good Food Bus of transactions were from (mobile farmer’s market) that translated into 42% communities at risk for food positive growth and success on the ground insecurity in 2017. Most notably were improvements to worth of local food purchased Education the mobile market set-up, staff structure and $22,000 from farmers schedule. Exchanging the 30-foot school bus for a truck and trailer, hiring a Coordinator 40% increase of sales from 2016 and Assistant Coordinator, and including more stops allowed us to bring more good as many Anchor Meals (healthy food to more people and more easily. 2X dinner meal bags) sold

St. Mary’s Villa spearheaded a Little Pantry Project in 2016 and it continues today. Each week the Pantry Congratulations to St. Mary’s Health System In partnership with Lazarus House Ministries, is stocked full of nonperishable food items and is Fall 2017 Medical Assistant candidates! a not-for-profit organization working to available to our immediate community. It provides As part of the medical assistant training break the cycle of poverty through a hand a nourishing meal or two to get any family by until program, 20 candidates completed 140 up rather than a hand out, Mary Immaculate payday. It is heavily utilized and has been a well- hours of classroom time and 160 hours of staff trained interns from their culinary received outreach to our community. clinical time. In Spring 2018, many students arts program. Through hands on learning, took their national certification exams, and all students spent their intern hours in working St. Joseph Healthcare in Bangor partnered with the Eastern Area Agency on Aging and the candidates are guaranteed an interview with side by side with staff in the MI kitchen Good Shepherd Food Pantry to provide food to patients identified with food insecurity. The St. Mary’s for a medical assisting role. Thank preparing meals for the residents. The interns employees of St. Joseph Healthcare provided hours of service to start and maintain the St. you to the managers and the community developed culinary job skills and a better Joseph Closet, St. Joseph Food Pantry and St. Joseph Cupboard which benefit patients, partners in Lewiston-Auburn who make the understanding of business etiquette and employees and the community. program a great success! expectations as an employee. Youville Place residents and staff prepared 200 bag lunches for a local homeless shelter. Each bag contained a sandwich, drink, fruit and cookies.

2018 | Stewardship Report 80 Our Name is Our Promise | 81 OUR PROMISE TO THE FUTURE Strengthening Communities St. Mary’s Regional Health System provided nearly Covenant Health Strengthens the Patient/ 130 gardeners with space, seedlings and technical Provider Relationship through MyChart assistance for their gardening plot. This season the Nutrition Center worked alongside organizations, Covenant Health is implementing CareLink, a highly-secure electronic health record system, businesses and residents from both Lewiston at all three of its community hospitals. CareLink will expand opportunities for engagement and Auburn to support the creation of three more between patients and their providers by providing a way for patients and their families to neighborhood-centered gardens. more closely partner with their provider and play a more active role in managing their care. In addition, CareLink, which is based on Epic – the gold standard in electronic health record systems – will help ensure care is delivered in a consistent and seamless way, no matter where a patient enters the health system. The result will be safer, more reliable and more patient- Giving Back centered care.

Our patients will benefit from MyChart, CareLink’s patient-facing online portal. MyChart equips providers and clinical staff to track a patient’s history in a single record - from his or her first visit through every phase of care. MyChart also provides patients with easy access to their own health records and a collection of tools to help them better manage their health.

In Nashua, one of St. Joseph Hospital’s Residents and staff at St. Mary’s Health With MyChart, patients will be able to: most touching community giving programs Care Center in Worcester have a deep love is the Community Christmas Basket project. and appreciation of God’s precious animals, View privacy-protected medical information including test results, medications, This annual giving project began 58 years especially dogs. They sponsor a periodic immunization records, allergies, after-visit summaries and care instructions ago with the St. Joseph School of Nursing. collection of food and monetary donations, In 2017, St. Joseph staff employees and blankets and other supplies for the Animal Communicate with care teams via secure email volunteers donated hundreds of gifts, Rescue League and share a weekly post of including bicycles, clothes, toys and food animals in need via social media. items to 61 area families, which included 100 Request prescription refills adults and 161 children during Christmas. Approximately 50 volunteers delivered View, manage and schedule appointments baskets to families in their homes.

We are excited by the many benefits the launch of CareLink and MyChart will provide our patients and caregivers, and we believe it is a major step forward in our effort to build a system For additional stories and information about the ways Covenant Health is giving of care designed to meet the needs of future generations. back to the communities it serves, please see our annual stewardship report. The report will be available on our website, covenanthealth.net, in Late Spring 2018. By Spring 2018, all three hospitals in the Covenant Health system will go live with CareLink and MyChart.

2018 | Stewardship Report 82 Our Name is Our Promise | 83 COVENANT HEALTH LEADERSHIP

Historic $10 Million Donation from Albert Lepage Foundation Paves the Way to a Better

Experience for Patients and Their Families David R. Lincoln, John M. Ahle Katherine L. Bechtold, Karen Bowling, FACHE SVP & Chief RN, MHA, NE-BC MBA President/CEO Financial Officer SVP & Chief Nursing SVP & Chief In October 2017, we announced that the Albert Officer Information Officer Lepage Foundation had generously committed a $10 million gift to establish the Albert Lepage Center for Patient Experience at St. Mary’s in Lewiston, Maine. This donation was the largest in St. Mary’s history. The Center for Patient Experience will provide enhancements that result in a more welcoming, accessible and comfortable experience every time a patient visits the hospital. “The Androscoggin County J. Bradford Coffey John M. Emerson Gerard J. Foley, Peter Holden John Newman, Esq.

We believe the experience we provide our patients community has greatly SVP & President, SVP, Integrated Esq., FACHE SVP & Interim SVP, General is just as important as the quality of care we Covenant Health Medical Group SVP, President Counsel Foundation Post-Acute Care St. Mary’s Health provide. Based on this belief, we are continually benefited from St. Mary’s System

looking for ways to improve, such as the upcoming “ expertise and compassion. launch of MyChart, a secure online patient portal that will allow our patients to interact with their I’m confident the new center provider and schedule appointments more easily. “ will position St. Mary’s to The Center for Patient Experience is sure to advance our efforts even further. lead the industry in ensuring

Mr. Lepage has been a longtime supporter of a patient’s experience Mary Prybylo, Reynold G. Spadoni, Jason VanDiver Douglas Waite, MD St. Mary’s. We sincerely appreciate the generosity is exceptional.” RN, MSN Deacon SVP, Strategy & SVP & Chief of his foundation, The Albert Lepage Foundation, SVP & President SVP, Mission Marketing Medical Officer St. Joseph Integration & and are confident this investment will help us - Albert Lepage Healthcare/St. Interim President, positively transform the patient experience in new Joseph Hospital St. Joseph Hospital, Nashua and exciting ways.

2018 | Stewardship Report 84 Our Name is Our Promise | 85 SYSTEM FINANCIALS | Fiscal Year-End 12.31.17

Utilization 2017 2016

Nursing Home Days 413,278 370,872

Hospital Adjusted Discharges 55,674 53,887

Hospital Patient Days 73,181 72,013

BOARD OF Financial Activities (in thousands) DIRECTORS Total Operating Revenue $670,060 $645,389 Expenses

Salaries & Benefits $386,423 $375,658

Lesley Adkison, PhD, RN James F. Loftus, IV Supplies & Other $234,869 $221,837 Nursing Practice Innovation Leader President/CEO Newton Wellesley Hospital 101.1 More FM/WBEB – Philadelphia Provider Taxes $21,353 $18,652

Kenneth E. Arnold William Lucy Depreciation & Interest $33,198 $34,335 Retired Senior Vice President, Senior Vice President Commercial Services Total Operating Expenses $675,843 $650,482 General Counsel and Secretary Katahdin Trust Company LifeSpan Corporation Operating Margin ($5,783) ($5,093) Dan Mingle, MD, MS Bruce Bonnell, MD, MPH President/CEO Non-operating Gains (Losses) $44,372 $23,881 Geriatric Internist Mingle Analytics Chief of Geriatric Medicine Excess of Revenues Over Expenses $38,589 $18,788 Spaulding Hospital for Continuing Thomas Mortimer Medical Care President/CEO Haverhill Bank Aisha Bonny, MSW Financial Ratios Sr. Director of Operations John Oliverio, Vice Chair Child Family and Community Services President/CEO Operating Margins -0.9% -0.8% BAMSI Wheaton Franciscan Healthcare Excess Margin 5.8% 3.0% John Isaacson (Past Chair) John M. Pallone Days Cash on Hand 243 229 Chief Executive Officer Founder and Principal Lee Management Company Shaheen, Pallone & Associates, P.C. Debt Service Coverage 2.4 2.1

Thomas Kelly Louise Trottier, Board Chair Debt Capitalization 34.9% 30.7% Retired CEO Retired Senior Vice President of Retail Banking HealthSmart TD Bank Charity Care 1.5% 1.2%

David R. Lincoln, FACHE Support for the Broader Community 1.0% 1.0% President/CEO Unpaid Cost of Medicaid 3.2% 3.3% Covenant Health

2018 | Stewardship Report 86 Our Name is Our Promise | 87 COVENANT HEALTH

CONGREGATIONS WHO HAVE TRUSTED ORGANIZATIONS THEIR MISSION TO COVENANT HEALTH Daughters of Mary of the Sisters of Charity of Immaculate Conception Montreal “Grey Nuns” New Britain, CT Lexington, MA SPONSORED/MEMBER MANAGED/MANAGEMENT Missionary Sisters Sisters of Charity SERVICES Fanny Allen Corporation of the Society of Mary of St. Hyacinthe Burlington, VT Bangor Nursing & Rehabilitation Center Waltham, MA St. Hyacinthe, Quebec, Canada Maristhill Nursing and Rehabilitation Center Bangor, ME Waltham, MA Campion Health Center Poor Sisters of Jesus Crucified and Sisters of Holy Cross Weston, MA Mary Immaculate Health/Care Services the Sorrowful Mother Manchester, NH Lawrence, MA St. Joseph Rehabilitation and Residence Brockton, MA Portland, ME Sisters of Mercy-Northeast Mount St. Rita Health Centre Religious Hospitallers Community Cumberland, RI of St. Joseph Cumberland, RI Penacook Place AFFILIATED Colchester, VT Haverhill, MA Bethany Health Care Center Sisters of Notre Dame de Namur St. André Health Care Facility Framingham, MA Servants of the Immaculate Ipswich, MA Biddeford, ME Heart of Mary - Good Shepherd Elizabeth Seton Residence Sisters of Quebec Sisters of St. Felix of Cantalice, St. Joseph Healthcare Wellesley, MA Bangor, ME Saco, ME Felician Sisters of North America Fall River Jewish Home Beaver Falls, PA St. Joseph Hospital Fall River, MA Sisters of Charity-Halifax Nashua, NH Holy Cross Health Center Halifax, Nova Scotia, Canada Sisters of St. Joseph of Boston St. Joseph Manor Health Care Manchester, NH Brighton, MA Brockton, MA Marillac Residence St. Mary Health Care Center Wellesley, MA Worcester, MA Mason Wright Senior Living Center DIOCESE WHERE COVENANT HEALTH SPONSORED St. Mary’s Health System Springfield, MA Lewiston, ME ORGANIZATIONS PROVIDE SERVICES Matulaitis Rehabilitation & Skilled Care St. Mary’s Villa Putnam, CT Elmhurst Township, PA Roman Catholic Roman Catholic Diocese Notre Dame du Lac Archdiocese of Boston of Providence Youville Assisted Living Residences Worcester, MA Cambridge and Lexington, MA Boston, MA Providence, RI Notre Dame Long Term Care Worcester, MA Roman Catholic Diocese Roman Catholic Diocese of Burlington of Scranton Regina Cleri Residence Boston, MA Burlington, VT Scranton, PA Salemhaven, Inc. Roman Catholic Diocese of Roman Catholic Diocese Salem, NH Manchester of Worcester Sancta Maria Nursing Facility Manchester, NH Worcester, MA Cambridge, MA Roman Catholic Diocese of Portland Portland, ME 88 OUR NAME IS OUR PROMISE

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