MCHS Community Benefit

Mount Carmel Health System Community Benefit Report Fiscal Year 2010

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FY2010 COMMUNITY BENEFIT REPORT About Us As a mission-driven organization, Mount Carmel provides millions of dollars in uncompensated benefits to the community each year. We provided more than $80 million in uncompensated Community Benefit in last fiscal year alone.

The community benefits Mount Carmel provides are representative of our Core Values – Respect, Compassion, Excellence, Care of the Poor and Underserved and Social Justice. Through many services – only some of which are reported in detail here -- Mount Carmel brings comfort and hope to tens of thousands of people in the communities we serve each year.

About Community Benefit Community Benefit is a measurement of the total amount of money, time and resources that are dedicated to provide care or promote health and healing in response to identified community needs. Mount Carmel produces this Community Benefit Report to demonstrate how we are fulfilling our charitable mission. Mount Carmel follows the Community Benefit reporting guidelines of the Catholic Health Association of the United States (CHA), which states that Community Benefit programs must: • • • • •

Generate a low or negative margin; Respond to needs of special populations, such as persons living in poverty and other disenfranchised persons; Supply services or programs that would likely be discontinued – or would need to be provided by another notfor-profit or government provider – if the decision was made on a purely financial basis; Respond to public health needs; and Involve education or research that improves overall community health

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Community benefit is generally classified into two categories: (1.) benefits to the poor and (2.) benefits to the broader community.

BENEFITS TO THE POOR include the medical care, education and programs that are provided to poor and underserved populations.

Poor and underserved are those at 200% of or lower than the federally-defined poverty level, beneficiaries of Medicaid, or those who are “medically in jeopardy” (for example, low income HIV/AIDS and cancer patients and efforts to reduce infant mortality in these populations). This is what is traditionally referred to as “charity care.” In accordance with our mission and as a tax exempt organization, Mount Carmel cares for everyone, regardless of ability to pay.

Unpaid Costs of Medicaid are also included in this category. The amount that Medicare and Medicaid reimburses healthcare providers, including hospitals, is generally less than what it actually costs to treat these patients. Benefits to the community provided because of this shortfall are not reported in the totals printed at the end of this report, in accordance with CHA guidelines.

BENEFITS FOR THE BROADER COMMUNITY include medical care, education and programs that are provided for the entire community. This category includes the following costs: •

Public Programs include programs that benefit the community and are never billed to patients. Examples include internships, residency education and job shadowing.

•

Community Services include a broader range of services, including the following: • Community Health Services are programs such as education, screenings, support groups and other service-oriented programs.

• Subsidized Health Services include emergency and trauma services and efforts in preventive medicine, such as community clinics like the Mount Carmel Health Stations program.

• Health Professions Education is the money that finances the residency program.

• Research includes a variety of research programs approved through the Mount Carmel Institutional Review Board.

• Donations are materials, time or money donated to non-profit agencies. Event sponsorships such as the Hilltop Bean Dinner, March for Babies, and the American Heart Walk also are included.

• Community Building Activities include education and other programs that build community such as blood drives, Operation Feed, and representation on many Chambers of Commerce.

• Community Benefit Operations include those employees with responsibility for reporting on Community Benefit activities.

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FY10 Focus: Increasing Access for Those in Need Mount Carmel Crime & Trauma Assistance Program Violent crime can be devastating. The trauma experienced by the victims and their loved ones can be felt physically, emotionally, socially and spiritually. The Mount Carmel Crime and Trauma Assistance Program (CTAP) was developed to respond to this need for recovery assistance.

Mary* experienced repeated trauma at a very young age. After a series of devastating events, Mary was referred to the Mount Carmel Crime & Trauma Assistance program.

“Before the CTAP program, I was frozen emotionally,” said Mary. “I didn’t trust anyone. I had no hope that I could find help.”

Mount Carmel’s Crime & Trauma Assistance Program provides access to the therapy that victims of violent crime need to move forward. It is one of only two assistance programs in the state of Ohio that provides free individual therapy, group counseling and advocacy services to adults, children and teens affected by violence. CTAP offers outreach, advocacy and counseling services to both survivors and co-survivors. In fiscal year 2010, CTAP provided recovery counseling to over 600 patients.

CTAP has built a reputation in the central Ohio region as the “go-to” program to help victims of violent crimes. Through education, empowerment and therapeutic intervention, the counselors at CTAP are helping victims reclaim their lives.

CTAP offered Mary a place to feel safe, and she is very grateful for the staff and resources.

“This program is extraordinary because it exists. I feel fortunate to live in Columbus, Ohio and to have this incredible resource in our community,” said Mary. “I am better now than I ever was before. I can function in everyday life and I don’t have to relive those awful moments of my past. With CTAP, I learned to trust again.”

Many former victims donate to the CTAP program to help others who have experienced overwhelming events. The CTAP program is funded through the Mount Carmel Foundation, private grants and federal funding. * All client names have been changed to protect their anonymity.

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Mount Carmel Evergreen Program Children can have a great deal of difficulty understanding and coping with grief – especially the pain and confusion of losing a parent at a very young age. Heather remembers the day her mother died very well. She and her sisters were 23, 18, 15 and 9 years old, respectively.

Mount Carmel Hospice was called in shortly after the cancer Heather’s mother had been fighting moved to her brain. A few days later, Heather’s mom passed away. It was the kindness of the hospice staff that helped the family get through those tough days.

“The hospice staff was amazing. They were so uplifting and comforting,” said Heather.

The Evergreen Program is provided through Mount Carmel Hospice to help families cope with the death of someone special to them. With its funds completely provided by donations from the Mount Carmel Foundation, Evergreen provides bereavement counseling and support free of charge to those in need, allowing access for all.

The program is geared toward children ages six through high school. Named after the Evergreen tree, which is known for its endurance and ability to maintain its color throughout all seasons, the Mount Carmel Evergreen Program hopes that it can help grieving children to stand tall and weather the seasons of their lives.

Evergreen volunteers lead small groups, and use art, music, games, puppet shows and discussion to provide support and understanding. The group meets each month and has a summer program to help families heal together. Evergreen also visits schools and businesses in the community. In fiscal year 2010, Evergreen facilitated 210 support groups with more than 2,000 participants.

A year after her mother died, one of Heather’s friends began volunteering at the Mount Carmel Evergreen program and told her about it. Heather knew she wanted to be involved. She has been volunteering with Evergreen for 10 years. She loves to be a part of the healing process for children.

“I wanted to help others who were experiencing the same loss we had. We were perpetually stuck emotionally after my mom died. This was a great way to bring healing.” said Heather. “Just when you think you are not making progress, parents will give you insight that what you have done is working. It’s a great feeling.”

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Mount Carmel Welcome Home Program Lachelle was a very excited first-time mom. She was especially thrilled to have a wonderful early Christmas present with her beautiful baby boy being born just two weeks before the holiday. Little did she know, her free in-home nurse visit from Mount Carmel’s Welcome Home Program would make a timely discovery that would save her baby’s life.

“The nurse checked my child and noticed he was having a little trouble breathing. She advised me to get him in to the pediatrician that day,” said Lachelle. “When I got there, they noticed he was pale and decided to check his blood. His hemoglobin level was a 7.9. Newborns should be around 14.”

The pediatrician quickly called Nationwide Children’s Hospital and admitted Lachelle’s baby. It was discovered that he had a form of anemia and needed a full blood transfusion.

“I couldn’t believe my son had a life-threatening situation occurring right before my eyes. Had that home visit not been scheduled, I hate to think what would have happened to my child. It could have been too late to save him and I would have had no clue. I am so grateful for my nurse and appreciate her insistence on getting my child to the doctor’s office that day.”

The Mount Carmel Welcome Home program allows moms and babies to access free in-home nurse visits within the first few weeks of leaving the hospital. Mount Carmel began the program in 1988 and has offered in-home nurse visits to over 17,000 moms and babies. In 2010, the program made over 1,200 home visits.

During the hour-long visit, the specially-trained Mount Carmel Registered Nurse provides support and education through newborn assessments including weight gain, jaundice, nutrition, respiratory and cardiovascular status; maternal health assessments including breast-feeding and psychological support; education on infant and child mortality risks; and referrals to community resources such as lactation consultants, Women, Infant, and Children (WIC) nutrition programs, and pediatricians.

The Welcome Home program serves first-time moms, single moms, teen moms, moms with social worker-identified concerns and moms requesting a visit. Approximately 14% of visits are to new moms and 45% are to single parents.

Welcome Home visits provide a link from the hospital to the home to monitor physical, psychological and social issues that can interfere with the health and welfare of the mother or child. Mount Carmel Welcome Home is the only hospital-based nurse home visit program offered in Franklin County.

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Mount Carmel PrescriptionEase Program Joyce never imagined she would be a widow in her mid-50’s. Her husband had been a small business owner. His passing left Joyce alone and in charge of the struggling company. Despite her most valiant efforts, Joyce lost the business. She found herself without a source of income or health benefits. Shortly thereafter, Joyce had a heart attack. She couldn’t afford insurance or healthcare.

“I was at a loss. I didn’t know what to do. I knew I didn’t have the money to pay for medications, let alone the hospital bill. It was a scary time.”

While in the hospital, Joyce’s nurse told her about the Mount Carmel PrescriptionEase program. The program was created as an advocacy effort to clear any roadblocks that may prevent Mount Carmel patients and physicians from accessing pharmaceutical companies’ patient assistance programs. Most drug companies allow eligible patients to participate in these assistance programs free-of-charge. However, navigating the paperwork and processes to be approved and enrolled can be quite complex. That is where PrescriptionEase comes in.

Through PrescriptionEase, Joyce was able to get all six of her doctor-prescribed medicines, including Plavix™, free-of-charge.

“Without the PrescriptionEase program, I would never be able to afford these medicines. The staff is fabulous. They even handle all of the refills each month. I wouldn’t know what to do without them.”

For the fourth consecutive year, PrescriptionEase is one of only three advocacy programs in the United States allowed to expedite Plavix™ applications without the required income paperwork, and is able to order a free 90-day supply of Plavix™ to be shipped the next day.

The staff at PrescriptionEase also collaborates with other organizations. The PrescriptionEase program donated over $8,000 in medications to the new Central Ohio Charitable Pharmacy. These unopened, unexpired medications were not used by patients due to changes in medication or eligibility status to the pharmacy. The Central Ohio Charitable Pharmacy’s mission complements PrescriptionEase. It is a “bridge” pharmacy – to increase access to prescription medications for low-income, uninsured, and underinsured individuals who experience gaps in their insurance coverage and/or challenges in accessing medications through other programs.

In fiscal year 2010, the PrescriptionEase Program had over 330 active participants and saved its patients more than $1.3 million in retail medication costs. Over the six year tenure of the program, PrescriptionEase has assisted over 1500 underserved patients and saved more than $4 million.

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Mount Carmel Diabetes Management Program Countless men, women and children in central Ohio go without much-needed healthcare because they lack insurance, are faced with a language barrier or are homeless and cannot access necessary resources. Having this access gives patients the education they need to understand their health conditions and what they need to do to take care of themselves.

The Mount Carmel Diabetes Management Program was launched through Mount Carmel Health Stations two years ago to address the diabetes public health crisis, which is particularly severe among underserved populations.

Operated in a primary care physician office setting, patients of all income levels are provided with ongoing physician oversight, education and other resources. Studies have shown that when patients are given this level of support, they can better control their diabetes. The program offers printed information in English, Spanish or Somalian. Diabetic education classes are offered through Mount Carmel’s own diabetes education program and through “Journey to Control” diabetes education classes provided by Merck.

After one year, a review of patient charts showed that patients were better at managing their disease and preventing complications. There was an 11% increase in patients receiving the hemoglobin A1C test (a key test to measure average blood sugar), a 7% increase in patients getting a retinal eye exam, and almost a 3% improvement in patient blood pressure control. In addition, four patients reduced their visits to area emergency departments and one patient reduced the incidence of multiple hospitalizations.

Linda had been living with diabetes for over six years and did not truly understand her disease until she visited Dr. Dennis Ruppel at one of Mount Carmel’s Health Stations.

Mount Carmel Health Stations are primary care practices located in two local churches, First Church of God and Church for All People. Studies have shown that patients who use a primary care physician as their medical home have on average 33 % lower health care costs and 10 % lower mortality. The practices offer medical services for adults and children over 12 years of age in underserved populations, including adult immunizations. Patients are offered a sliding fee schedule, and Health Stations staff works with them on billing and financial arrangements.

“I went to see Dr. Ruppel and he told me my sugars were really high. He said that I needed to get to Mount Carmel East as soon as possible,“ said Linda. “I never want to have that feeling again.”

Dr. Ruppel and his staff taught Linda how to create menus and eat properly to control her disease. “I had been to other doctors over the years but he is the only one who really cared,” said Linda. “I feel a close connection to him. He takes the time to listen and explain things to me.”

Linda remains very impressed with the level of care she received. “I would recommend this doctor to anybody. He saved my life and I owe a lot to him.”

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FY11 Focus: Mount Carmel Programs Evolve to Meet Changing Needs Street Medicine Program Homelessness is a growing epidemic in our society. On any given night in America, more than 1.6 million men, women and children are residents at temporary housing shelters within churches or other charitable organizations. Another 600,000 are living on the streets or in tent villages.

The Mount Carmel Mobile Coach and Health Stations locations see thousands of patients each year, but there were still populations that we were unable to reach with these programs. In mid-2010, Outreach piloted a Street Medicine program to reach more remote homeless populations. While homeless shelters exist throughout our city, some members of the homeless population do not feel safe in shelters, where they claim theft is a major problem. These individuals have erected “tent villages” that provide residents with a sense of community. The residents form a partnership to meet the community’s basic needs and to protect one another from theft and other threats.

To reach this population, a Street Medicine team – which includes a physician or nurse practitioner, a medical technician, and a case management specialist who serves as a patient advocate – travels to areas where these villages are known to exist.

Our visits have been well-received by patients, and the program is expected to evolve and grow in the coming year.

Mental Health Partnership Two of the four primary causes of homelessness, based on U.S. statistics are mental illness and substance abuse. Both of these afflictions can be further complicated by the lack of access to necessary resources. The Mount Carmel mission goes beyond caring for the physical needs of our communities. We are dedicated to healing “mind, body and spirit.” Increasingly, Community Benefit ministries such as the Outreach Mobile Coach and Street Medicine are encountering patients who are in need of mental health services. Mount Carmel works to meet immediate needs, prescribe medication, and connect patients with longer term care if it is needed.

In 2010, we took steps to do even more. We began a contract with Southeast, Inc. to provide these patients with ongoing recovery and mental health services, enabling them to meet with an Advanced Practice Nurse or a Nurse Practitioner on a weekly basis. Southeast accepts most insurance, and these services are provided free-of-charge for patients who cannot afford care.

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Mobile Mammography Coach Breast cancer is a frightening diagnosis, but highly effective treatment is available, particularly in cases that are diagnosed in early stages. The mission of our Mobile Mammography Coach is to increase access for all women, and it has scheduled visits nearly every business day of the year to meet our community’s needs.

The coach’s scheduled engagements are increasingly aimed at reaching underserved populations. For example, this year the Mobile Mammography Coach provided screening mammographies at the Asian Festival. In all, we estimate that we served more than 1000 women from vulnerable populations during our many engagements in 2010. To ensure our continuing ability to provide these services, the Mount Carmel Foundation recently ran a capital campaign to fund the purchase of a new coach, which was delivered in mid-2010.

The coach’s 2011 strategic plan will include an increased number of opportunities to reach out to communities where women may otherwise not receive a screening. One area of opportunity is connecting women to sources for additional care when they are diagnosed by the mammogram and need further treatment. In the coming year, we are putting an added emphasis on developing a solid care path for women to ensure they receive the follow up care they need after diagnosis.

The Mobile Mammography Coach is funded through the Mount Carmel Foundation and by grants provided by the Susan G. Komen Foundation.

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Congestive Heart Failure Clinic Very few health issues are more stressful to endure than suffering from heart failure. These traumatic health events can leave a lasting impression on the patients. When it comes to matters of the heart, the effects can be even more concerning as the opportunity for recurrence is even greater. The Mount Carmel Congestive Heart Failure Clinic was established in March 2008 to improve outcomes and lower hospital re-admissions for patients with cardiomyopathy. The ultimate goal of the program is to improve the quality of life for patients with heart failure.

Congestive heart failure (CHF) is the result of the heart’s inability to effectively pump blood to meet the body’s needs. It may be caused by heart muscle weakness, such as after a series of heart attacks, valvular disease like rheumatic aortic stenosis, or an injury such as alcohol poisoning. Congestive heart failure requires continuous therapy and a careful, ongoing dialogue with a physician or nurse clinician.

The Mount Carmel Heart Failure Center is dedicated to working with heart failure patients and their physicians to not only treat heart failure, but also to help patients learn to live with heart failure. While patients remain in the care of their referring physician, our center can help these physicians do even more for their patients through education, medical management, structured patient follow-up and physician follow-up.

Nationwide, nearly 27% of heart failure patients experience further heart problems after their initial admission to the hospital. These continuing problems can result in re-admission or even death. Mount Carmel’s Congestive Heart Failure Clinic has lowered this percentage to 9.6% for participating patients. Underserved populations tend to be more at risk because their access to care may be limited and they often have difficulties affording their medications. Our clinic ensures equity in care by providing services to all populations regardless of patients’ ability to pay.

Lifestyle can have a dramatic impact both on the management of heart-failure symptoms and on the pace at which the condition progresses. The clinic can offer referrals to cardiac rehabilitation facilities, weight loss programs and smoking cessation resources. Staff provides ongoing education about the need to maintain a healthy diet and drink plenty of water.

Patients are carefully monitored to ensure that symptoms improve and hospital admissions are less frequent.

About 65% of the patients remain with the program for ongoing management of their condition, while the remainder are discharged as they learn to manage their condition without extensive medical monitoring. The success of the clinic at Mount Carmel East led to the opening of an additional clinic at Mount Carmel St. Ann’s in November 2010 and one is planned at Mount Carmel West in 2011.

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The Nursing Center for Family Health Lower Lights Ministries is passionate about serving individuals, families and the community of Franklinton in holistic ways.

Using innovative programming, a mission-focused staff and hundreds of dedicated volunteers have worked for nearly 20 years to minister to those in need by equipping them with the tools and skills needed to achieve self-sufficiency.

In September, 2010, the Mount Carmel College of Nursing partnered with Lower Lights Ministry to establish a Lower Lights Christian Health Center at Mount Carmel West. The Nursing Center for Family Health is the first college-based nursemanaged health center in central Ohio and one of several in the United States.

3,000 square feet of leased office space on the Mount Carmel West campus was converted into this nurse-managed health center. The center helps meet the high demand for primary care to the underserved population base in the Franklinton community. Patients have increased access to comprehensive health services, while nursing students have the opportunity to gain hands-on experience.

“The Center will be a great opportunity for many qualified faculty members, graduate students and undergraduates to care for people in an everyday setting and to create health education programs for them,” said Mount Carmel College of Nursing Dean Ann Schiele, PhD. At the Nursing Center, Advanced Practice Nurses – which are Nurse Practitioners with a sub-specialty such as Family Nurse Practitioners (FNP), Nurse Midwives (CNM), and Adult Health Clinical Nurse Specialists (CNS) – serve as a patient’s primary healthcare provider. They provide preventive health services, patient education and disease management. Services include routine physicals, health screenings, and immunizations, management of chronic disease conditions, acute care of nonemergency conditions, and health education in a variety of areas such as obesity and diabetes management.

Mount Carmel College of Nursing, in keeping with its mission and the core value of social justice, supports the Nursing Center as a learning environment for students. The College received a $25,000 Cardinal Health grant, which was used to purchase equipment. Additional grant funding is pending and grants will continue to be sought. In the meantime, the College has completed renovations and is providing supplies and Nurse Practitioners from its faculty to sustain the practice. Lower Lights Christian Health Center provides the support staff and billing services to generate revenue from services provided to help offset these costs.

Community Needs Assessment Partnership A major component of the Mount Carmel mission is serving together. We believe the needs of our communities are too great to handle alone. To ensure we can reach the majority of these underserved populations, we must build relationships with other like-minded organizations.

To better serve the growing need in our community, Mount Carmel has increased collaboration with other health systems, government programs and non-profit agencies through the Central Ohio Hospital Council. In 2011 this group will work together to complete a community needs assessment to identify what services are needed and where to assess service gaps and to strategize about how to fill those gaps. While most member hospitals complete similar assessments every few years according to IRS guidelines, this is the first year that the council has completed the assessment jointly. We are excited about the impact we can make by collaborating and working on these issues together.

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Community Benefit by the Numbers Mount Carmel Health System – Summary of Quantifiable Benefits for Fiscal Year 2010 For period from July 1, 2009 through June 30, 2010 – Classified as to Low Income and Broader Community Net Persons Total Offsetting % of Organization Community Served Expense Revenue Expenses Revenues Benefit Benefits for Low Income Traditional Charity Care

33,453

$36,619,970

$12,282,822

$24,337,148

1.9%

1.8%

Unpaid Costs of Medicaid

105,339

$92,827,297

$54,795,358

$38,031,939

2.9%

2.8%

30,318 15,425 3,164 4,824

$2,197,596 $1,077,469 $407,190 $14,126

$41,656 $262,123 -

$2,155,940 $815,346 $407,190 $14,126

0.2% 0.0% 0.1% 0.0% 0.0%

0.2% 0.0% 0.1% 0.0% 0.0%

Totals for Community Service

53,731

$3,696,381

$303,779

$3,392,602

0.3%

0.3%

Total for Low Income

192,523

$133,143,648

$67,381,959

$65,761,689

5.1%

4.9%

2,622 108 5,808 4,792 5,424 50

$222,272 $12,746,925 $356,583 $546,284 $122,500 $36,340 $236,368

$500 -

$222,272 $12,746,925 $356,583 $546,284 $122,000 $36,340 $236,368

0.0% 1.0% 0.0% 0.0% 0.0% 0.0% 0.0%

0.0% 0.9% 0.0% 0.0% 0.0% 0.0% 0.0%

18,804

$14,267,272

$500

$14,266,772

1.1%

1.1%

211,327

$147,410,920

$67,382,459

$80,028,461

6.2%

5.9%

Community Services: Community Health Services Health Professions Education Subsidized Health Services Donations Community Building Activities

Benefits for Broader Community Community Services: Community Health Services Health Professions Education Subsidized Health Services Research Donations Community Building Activities Community Benefit Operations Totals for Broader Community Grand Totals:

Note: The Catholic Health Association has directed its membership to withhold the Medicare shortfall figure beginning in 2006.

The Medicare figure withheld from the official report above is: Unpaid Costs of Medicare

303,154

$305,940,531

$283,274,515

$22,666,016

1.7%

1.7%

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Community Benefit by the Numbers Mount Carmel Foundation Support In addition to the previously listed quantifiable benefits, the Mount Carmel Foundation supports system projects and programs that also benefit the community. The table below illustrates the amounts of unrestricted and temporarily restricted donations that were awarded by the Foundation’s Allocation Committee in the past six fiscal years to various projects and programs.

Fiscal Year

Unrestricted Donations Allocated

Temporarily Restricted Donations Allocated

Financial Community Benefit

2010

$1,137,735

$1,805,621

$2,943,356

2009

$957,895

$1,281,715

$2,239,610

2008

$665,548

$1,346,673

$2,012,221

2007

$546,113

$1,259,638

$1,805,751

2006

$381,442

$1,911,687

$2,293,129

2005

$859,426

$1,888,410

$2,747,836

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If you are interested in making a donation to any of the initiatives in this report, please contact the Mount Carmel Foundation at givetomc@mchs.com or 614.546.4500.

If you have any questions about this Community Benefit Report, please contact Sr. Barbara Hahl, Senior Vice President of Mission Services, at bhahl@mchs.com or 614.546.4901.

To order more copies of this report, visit http://www.mountcarmelhealth.com/about-us/community-benefit/.

Mission We serve together at Mount Carmel in Trinity Health, in the spirit of the Gospel to heal body, mind and spirit, to improve the health of our communities and to steward the resources entrusted to us.

Core Values Respect Compassion Excellence Care of the Poor and Underserved Social Justice