TY 2020 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) JANICE E NEVIN MD...................................................................... PRESIDENT & CEO	44.0 ................. 1.0	X	X			1,788,006	191,920
(2) KENNETH SILVERSTEIN MD...................................................................... CHIEF PHYSICIAN EXECUTIVE	42.0 ................. 3.0		X			903,548	108,459
(3) PAUL K DAVIS MD...................................................................... CARDIAC SURGEON	45.0 ................. 0.0				X	860,383	38,394
(4) KIRK N GARRATT MD...................................................................... MEDICAL DIRECTOR, HEART/VASC	45.0 ................. 0.0				X	855,018	25,377
(5) RAY A BLACKWELL MD...................................................................... CHIEF CARDIAC SURGERY	45.0 ................. 0.0				X	830,502	39,819
(6) ROBERT MCMURRAY...................................................................... CFO, TREASURER & ASS'T SEC'Y	43.0 ................. 2.0		X			772,585	94,804
(7) FREDERIC T HARAD MD...................................................................... MEMBER	44.0 ................. 1.0	X				803,674	38,394
(8) RANDALL GABORIAULT...................................................................... CHIEF INFORMATION OFFICER	45.0 ................. 0.0			X		735,647	97,545
(9) RAAFAT ABDEL-MISIH MD...................................................................... ONCOLOGY SURGEON	45.0 ................. 0.0				X	793,608	31,797
(10) NICHOLAS J PETRELLI MD...................................................................... MEDICAL DIRECTOR, CANCER	45.0 ................. 0.0				X	790,800	31,797
(11) NEIL JASANI MD...................................................................... CHIEF PEOPLE OFFICER	45.0 ................. 0.0			X		663,354	84,587
(12) SHARON KURFUERST...................................................................... SYSTEM CHIEF OPERATING OFFICER	45.0 ................. 0.0			X		621,153	78,108
(13) RICHARD CUMING...................................................................... CHIEF NURSING EXECUTIVE	44.0 ................. 1.0			X		617,460	75,849
(14) JENNIFER L SCHWARTZ ESQ...................................................................... CORPORATE SECRETARY	40.0 ................. 5.0		X			590,868	82,750
(15) JOSEPH BENNETT MD...................................................................... MEMBER	44.0 ................. 1.0	X				625,037	36,969
(16) MICHAEL EPPEHIMER MD...................................................................... PRES. MED GROUP (THRU 10/2020)	45.0 ................. 0.0			X		624,336	35,301
(17) LISA MAXWELL MD...................................................................... PRESIDENT, MEDICAL GROUP	45.0 ................. 0.0			X		449,912	39,919

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) ANDREW M LUBIN........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................1.0	X
(19) BETTY J CAFFO PHD........................................................................ MBR,VICE CHAIR (THRU 12/31/20)	1.0 .......................3.0	X	X
(20) CHRISTINE SAUERS........................................................................ MEMBER (AS OS 1/1/21)	1.0 .......................0.0	X
(21) DAVID B STRATTON ESQ........................................................................ MEMBER, CHAIR (AS OF 1/1/21)	1.0 .......................2.0	X	X
(22) DONEENE DAMON ESQ........................................................................ MEMBER, CHAIR (THRU 12/31/20)	1.0 .......................1.0	X	X
(23) DWIGHT D THOMEY ESQ........................................................................ MEMBER (AS OF 1/1/21)	1.0 .......................3.0	X
(24) ERIC T JOHNSON MD........................................................................ MEMBER	1.0 .......................0.0	X
(25) GEORGE FOUTRAKIS........................................................................ MEMBER	1.0 .......................1.0	X
(26) KATHLEEN F MCDONOUGH ESQ........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................1.0	X
(27) LOLITA A LOPEZ........................................................................ MEMBER, VICE CHAIR(AS OF 1/21)	1.0 .......................1.0	X	X
(28) LOSSIE FREEMAN........................................................................ MEMBER (AS OF 1/1/21)	1.0 .......................0.0	X
(29) MARK TURNER........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................1.0	X
(30) MEGAN GREENBERG ESQ........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................1.0	X
(31) NICHOLAS M MARSINI JR........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................1.0	X
(32) PAUL KANIEFSKI........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................1.0	X
(33) PAULA K MAXWELL........................................................................ MEMBER (AS OF 1/1/21)	1.0 .......................0.0	X
(34) PENELOPE T SARIDAKIS........................................................................ MEMBER	1.0 .......................1.0	X
(35) RAYMOND W HAMM JR........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................4.0	X
(36) SALVATORE CHIP ROSSIE........................................................................ MEMBER (AS OF 1/1/21)	1.0 .......................0.0	X
(37) FRANK SKIP PENNELLA........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................1.0	X
(38) TARA D ELLIOTT ESQ........................................................................ MEMBER (THRU 12/31/20)	1.0 .......................1.0	X
(39) THEODORE G PLUSH........................................................................ MEMBER (AS OF 1/1/21)	1.0 .......................0.0	X

(A) Name and business address	(B) Description of services	(C) Compensation
SKANSKA USA BUILDING, 518 EAST TOWNSHIP LINE RD BLUE BELL,PA19422	CONSTRUCTION SRVCS	28,125,728
WHITING TURNER CONTRACTING, PO BOX 17596 BALTIMORE,MD21297	CONSTRUCTION SRVCS	26,627,257
CERNER CORPORATION, PO BOX 959156 ST LOUIS,MO631959156	IT SERVICES	24,424,870
CONSTRUCTION SERVICES GROUP LLC, 1630 WEST CHESTER PIKE WEST CHESTER,PA19382	CONSTRUCTION SRVCS	14,232,686
DISABATINO CONSTRUCTION CO, 1 SOUTH CLEVELAND AVE WILMINGTON,DE19805	CONSTRUCTION SRVCS	10,431,738
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 314

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2020

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	35,304,559	22,698,446	24,577,838	80,735,115	128,076,121	291,392,079
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....						0
3	The value of services or facilities furnished by a governmental unit to the organization without charge..						0
4	Total. Add lines 1 through 3	35,304,559	22,698,446	24,577,838	80,735,115	128,076,121	291,392,079
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..						0
6	Public support. Subtract line 5 from line 4.						291,392,079

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
7	Amounts from line 4..	35,304,559	22,698,446	24,577,838	80,735,115	128,076,121	291,392,079
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	26,315,630	32,254,956	40,934,424	38,348,773	34,285,085	172,138,868
9	Net income from unrelated business activities, whether or not the business is regularly carried on..						0
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..	1,705,750	1,686,211	1,481,357	1,515,817	1,599,244	7,988,379
11	Total support. Add lines 7 through 10						471,519,326

Gross receipts from related activities, etc. (see instructions) ..................

9,796,287,565

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 6, column (f) divided by line 11, column (f)) .........

61.799 %

Public support percentage for 2019 Schedule A, Part II, line 14 ...............

53.848 %

16a

33 1/3% support test—2020. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2019. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) 2020	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2020 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2019 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2020 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2019 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2020. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2019. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2020

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2020

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described in 11a above?

11b

A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2020

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2020

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2020 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2020	(iii) Distributable Amount for 2020
1 Distributable amount for 2020 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2020:
a From 2015.......
b From 2016.......
c From 2017.......
d From 2018.......
e From 2019.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2020 distributable amount
i Carryover from 2015 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2020 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2020 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2021. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2016.....
b Excess from 2017.....
c Excess from 2018.....
d Excess from 2019.....
e Excess from 2020.....

Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2

Name of organization CHRISTIANA CARE HEALTH SERVICES INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 3

Name of organization CHRISTIANA CARE HEALTH SERVICES INC		Employer identification number 51-0103684

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Page 4


Name of organization CHRISTIANA CARE HEALTH SERVICES INC			Employer identification number 51-0103684
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2020)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2020

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures). Click to see attachment

B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(a) Filing organization's totals	(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................	0	0
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................	249,926	249,926
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................	249,926	249,926
d	Other exempt purpose expenditures ...............................................................................	2,146,254,538	2,204,890,087
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................	2,146,504,464	2,205,140,013
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.	1,000,000	1,000,000
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................	250,000	250,000
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................		Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) Total

2a	Lobbying nontaxable amount	1,000,000	1,000,000	1,000,000	1,000,000	4,000,000

b	Lobbying ceiling amount (150% of line 2a, column(e))					6,000,000

c	Total lobbying expenditures	198,652	218,022	230,460	249,926	897,060

d	Grassroots nontaxable amount	250,000	250,000	250,000	250,000	1,000,000

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,500,000

f	Grassroots lobbying expenditures	0	0	0	0	0

Schedule C (Form 990 or 990-EZ) 2020

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation

Schedule C (Form 990 or 990EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2020

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	62,232,483	67,336,850	69,132,135	102,737,030	84,884,618
b	Contributions ...	993,569	1,520,182	518,673	1,197,900	11,443,636
c	Net investment earnings, gains, and losses	9,205,113	2,545,562	1,845,561	7,177,549	6,597,077
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	3,861,858	9,170,111	4,159,519	41,980,344	188,301
f	Administrative expenses ....
g	End of year balance ......	68,569,307	62,232,483	67,336,850	69,132,135	102,737,030

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

39.330 %

Permanent endowment SchDMd Bullet

34.800 %

Term endowment SchDMd Bullet

25.870 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .......................

3a(i)

Yes

(ii) Related organizations .......................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	39,426,624		39,426,624
b	Buildings ....	1,672,805,592	841,995,664	830,809,928
c	Leasehold improvements	26,126,507	7,435,183	18,691,324
d	Equipment ....	836,783,999	629,321,007	207,462,992
e	Other .....	37,268,177	26,916,832	10,351,345
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				1,106,742,213

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) OTHER SECURITIES	571,983,820	F
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	571,983,820

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)CONSTRUCTION IN PROGRESS				59,126,124
(2)DUE FROM AFFILIATES				35,258,259
(3)OTHER ASSETS				141,383,130
(4)OTHER RECEIVABLES				26,309,188
(5)ASSETS LIMITED TO USE				534,927
(6)SUBSIDIARY INVESTMENT				95,888,168
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				358,499,796

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	629,426,525
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2020

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

FORM 990, SCHEDULE D, PART V, LINE 3A & 4

DETAIL OF ENDOWMENT FUNDS THE ORGANIZATION'S BOARD DESIGNATED ENDOWMENTS ARE INTENDED TO COVER ANNUAL INCREMENTAL OPERATING EXPENSES OF THE HEALTH SERVICES' TRANSITIONAL CANCER RESEARCH, VALUE INSTITUTE, AND INFANT MORTALITY. THE ORGANIZATION'S PERMANENT ENDOWMENT CONSISTS OF APPROXIMATELY TWENTY FOUR DONOR RESTRICTED ENDOWMENT FUNDS USED FOR A VARIETY OF PURPOSES, INCLUDING SALARY AND PROGRAM SUPPORT. THE ORGANIZATION'S PURPOSE AND TIME RESTRICTED NET ASSETS ARE RESTRICTED FOR INDIGENT CARE, BUILDING AND MAINTANCE, AND PROGRAM SUPPORT. --------------------

Schedule D (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization
CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in the region
	Central America and the Caribbean	Investments	140,942,557
















3a	Sub-total ....		140,942,557
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)		140,942,557

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2020

Schedule F (Form 990) 2020

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2020

Schedule F (Form 990) 2020Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2020

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2020

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
FORM 990, SCHEDULE F, PART I, LINE 2	DETAIL OF SUB-CONTRACTS IN FURTHERANCE OF ITS RESEARCH ACTIVITIES, THE ORGANIZATION MAY MAKE SUB-CONTRACTS TO FOREIGN INSTITUTIONS THAT PERFORM RESEARCH IN CONNECTION WITH RESEARCH GRANTS AWARDED TO THE ORGANIZATION. THE ORGANIZATION DOES NOT CATEGORIZE ANY SUCH SUB-CONTRACTS AS GRANTS FOR FORM 990, SCHEDULE F, PARTS II AND III PURPOSES.

Schedule F (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization
CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2020

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GOLF CLASSIC (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	99,940	99,940
2	Less: Contributions . . . .	83,940	83,940
3	Gross income (line 1 minus line 2) . . . . . .	16,000	16,000

4	Cash prizes . . . . .	0	0	0
5	Noncash prizes . . . .	0	0	0
6	Rent/facility costs . . . .	0	0	0
7	Food and beverages . . .	0	0	0
8	Entertainment . . . .	0	0	0
9	Other direct expenses . . .	0	0	0
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .			0
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .			16,000

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2020

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation
FORM 990, SCHEDULE G, PART II	DETAIL OF FUNDRAISING EVENTS EXPENSES ASSOCIATED WITH THE GOLF CLASSIC EVENT WERE RECORDED DIRECTLY BY A RELATED PARTY.

Schedule G (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			16,212,173	0	16,212,173	0.760 %
b	Medicaid (from Worksheet 3, column a) . . . . .			283,941,307	268,312,691	15,628,616	0.730 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			300,153,480	268,312,691	31,840,789	1.490 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	47	60,025	11,465,346	2,811,168	8,654,178	0.400 %
f	Health professions education (from Worksheet 5) . . .	5	15	86,474,344	12,391,813	74,082,531	3.450 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	1		20,447,813	18,059,517	2,388,296	0.110 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	4		152,806	0	152,806	0.010 %
j	Total. Other Benefits . .	57	60,040	118,540,309	33,262,498	85,277,811	3.970 %
k	Total. Add lines 7d and 7j .	57	60,040	418,693,789	301,575,189	117,118,600	5.460 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020

Schedule H (Form 990) 2020

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	1		50,000	50,000
2	Economic development	2		278,957	278,957	0.010 %
3	Community support	1		101,255	101,255
4	Environmental improvements	1		15,540	15,540
5	Leadership development and training for community members
6	Coalition building	3		35,740	35,740
7	Community health improvement advocacy	1	400	420	420
8	Workforce development	1		83,742	83,742
9	Other
10	Total	10	400	565,654	565,654	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

56,558,325

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

2,371,974

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

500,543,745

Enter Medicare allowable costs of care relating to payments on line 5.....

611,972,581

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-111,428,836

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2020

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)							Facility reporting group
1	CHRISTIANA HOSPITAL 4755 OGLETOWN-STANTON ROAD NEWARK,DE19718 www.christianacare.org LICENSE #HSPTL-002	X	X	X	X	X	A
2	WILMINGTON HOSPITAL 501 WEST 14TH STREET WILMINGTON,DE19801 www.christianacare.org LICENSE #HSPTL-001	X	X	X	X	X	A

Schedule H (Form 990) 2020

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	A-CHRISTIANA AND WILMINGTON HOSPITALS
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2020

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A-CHRISTIANA AND WILMINGTON HOSPITALS
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 0.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 6

Part VFacility Information (continued)

Billing and Collections

	A-CHRISTIANA AND WILMINGTON HOSPITALS
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2020

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	A-CHRISTIANA AND WILMINGTON HOSPITALS
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2020

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION B LINE 5 (INPUT FROM COMMUNITY)	AT CHRISTIANACARE, ONE OF OUR CORE VALUES IS LISTENING ACTIVELY AND SEEKING TO UNDERSTAND, AND WE HONOR THAT COMMITMENT IN HOW WE CONDUCT OUR CHNA. WE DO NOT CONSIDER THE ASSESSMENT JUST A REQUIREMENT TO BE COMPLETED, BUT RATHER A KEY OPPORTUNITY TO LISTEN TO THE VOICE OF THE COMMUNITY, SEEK TO UNDERSTAND THE COMMUNITY'S NEEDS, BUILD TRUST, AND ENSURE THAT WE ARE MEETING THOSE NEEDS. IN JANUARY 2019, CHRISTIANACARE HELD A SERIES OF COMMUNITY MEETINGS TO INFORM THE LAST NEEDS ASSESSMENTS: FOUR MEETINGS OF 98 COMMUNITY STAKEHOLDERS; SIX MEETINGS OF 53 LOCAL TEENAGERS; AND TWO INTERNAL MEETINGS OF 13 CHRISTIANACARE STAFF MEMBERS. THE COMMUNITY STAKEHOLDERS REPRESENTED LOCAL HEALTH DEPARTMENTS, NON-PROFIT ORGANIZATIONS, LOCAL BUSINESSES, HEALTH CARE PROVIDERS, LOCAL POLICYMAKERS, PARKS AND RECREATION DEPARTMENTS, AND SCHOOL SYSTEMS. THE CHRISTIANACARE STAFF MEMBERS WERE THOSE WHO WORKED DIRECTLY WITH PATIENTS. THE TEENAGERS REPRESENTED SEVERAL AREAS ACROSS NEW CASTLE COUNTY, INCLUDING NEWARK, NEW CASTLE, WILMINGTON AND CLAYMONT. CHRISTIANACARE WAS PURPOSEFUL IN THE INCLUSION OF A BROAD ARRAY OF COMMUNITY VOICES AT THESE MEETINGS TO ENSURE A DIVERSITY OF VIEWPOINTS. THE COMMUNITY MEETINGS WERE ALSO HELD IN DIFFERENT AREAS OF NEW CASTLE COUNTY TO ENSURE THAT WE WERE MEETING COMMUNITY MEMBERS IN THEIR OWN COMMUNITIES. THE MEETINGS BEGAN WITH A PRESENTATION OF PRELIMINARY SECONDARY COMMUNITY HEALTH DATA. PARTICIPANTS THEN WERE ASKED (A) TO IDENTIFY COMMUNITY HEALTH ISSUES THAT MAY NOT HAVE BEEN WELL MEASURED BY SECONDARY DATA AND (B) THROUGH A VOTING PROCESS, TO IDENTIFY WHICH NEEDS THEY BELIEVED WERE MOST SIGNIFICANT IN NEW CASTLE COUNTY. IN ADDITION TO THE ABOVE MEETINGS, AN INTERVIEW WAS CONDUCTED WITH AN ASSOCIATE DEPUTY DIRECTOR WITHIN THE DELAWARE DEPARTMENT OF HEALTH AND SOCIAL SERVICES. DURING THAT INTERVIEW, SECONDARY DATA FINDINGS AND SIGNIFICANT NEEDS ALSO WERE DISCUSSED TO GET THE ASSOCIATE DEPUTY DIRECTOR'S PERSPECTIVE. CHRISTIANACARE CONTRACTED WITH VERIT HEALTHCARE CONSULTING, LLC (VERIT) TO COMPLETE ITS 2019 CHNA. IN COOPERATION WITH CHRISTIANACARE'S OFFICE OF HEALTH EQUITY, VERIT CONDUCTED THE RESEARCH, PRIMARY AND SECONDARY DATA COLLECTION, REVIEW, AND ANALYSIS, TO DEVELOP THE CHNA. -------------------- PART V, SECTION B, LINE 6 (JOINT CHNA) CHRISTIANACARE'S TWO HOSPITAL FACILITIES, CHRISTIANA AND WILMINGTON HOSPITALS, JOINTLY CONDUCTED THEIR CHNA. -------------------- PART V, SECTION B, LINE 7 & 10 (CHNA & IMP. STRATEGY PUBLIC AVAILABILITY) CHRISTIANACARE'S CHNA IS AVAILABLE ON ITS WEBSITE AT: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY- HEALTH-NEEDS-ASSESSMENT/ CHRISTIANACARE'S CHNA IS ALSO AVAILABLE IN PAPER COPY TO THE PUBLIC UPON REQUEST. CHRISTIANACARE'S COMMUNITY HEALTH IMPLEMENTATION PLAN (CHIP) IS AVAILABLE ON ITS WEBSITE AT: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY- HEALTH-IMPLEMENTATION-PLAN/ A PAPER COPY OF THE CHIP IS ALSO AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST. --------------------
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	IN THE MOST RECENT CHNA, FINALIZED 0N JUNE 2019, CHRISTIANACARE IDENTIFIED THE COMMUNITY'S MOST SIGNIFICANT NEEDS AS: 1. SOCIAL DETERMINANTS OF HEALTH INCLUDING POVERTY, FOOD INSECURITY, HOUSING, AFFORDABILITY OF CARE, EDUCATION, AND EMPLOYMENT/JOB SECURITY 2. MENTAL HEALTH AND SUBSTANCE USE DISORDER 3. VIOLENCE AND PUBLIC SAFETY 4. MATERNAL AND CHILD HEALTH ESPECIALLY INFANT MORTALITY 5. ACCESS TO DENTAL AND PRIMARY CARE ALL EXCEPT ACCESS TO DENTAL AND PRIMARY CARE WERE ALSO IDENTIFIED AS SIGNIFICANT HEALTH NEEDS IN THE 2016 CHNA. THIS IS UNSURPRISING GIVEN THE COMPLEXITY OF ADDRESSING ISSUES SUCH AS POVERTY AND INFANT MORTALITY. IN THE 2016 CHNA, CHRISTIANACARE ALSO IDENTIFIED TRANSPORTATION, HOUSING, AND EMPLOYMENT AS SIGNIFICANT NEEDS, BUT DETERMINED THAT IT WAS NOT ABLE TO ADDRESS THESE NEEDS AT THAT TIME GIVEN A LACK OF EXPERTISE AND INFRASTRUCTURE. ADDRESSING SOCIAL DETERMINANTS OF HEALTH IS ESSENTIAL TO IMPROVING THE HEALTH OF OUR COMMUNITY, SO WE HAVE ADVANCED OUR ORGANIZATIONAL CAPACITY TO SUPPORT A SOCIAL CARE FRAMEWORK THAT INTEGRATES INTERNAL AND EXTERNAL RESOURCES AS WE WORK TO ADDRESS THESE ISSUES. IN FY21, THE PANDEMIC CONTINUED TO DOMINATE OUR ACTIVITIES INSIDE AND OUTSIDE OF CLINICAL SPACES. IN FY20, WE COLLABORATED WITH THE LATIN AMERICAN COMMUNITY CENTER (LACC) AND KINGSWOOD COMMUNITY CENTER (KCC) TO OFFER COVID-19 TESTING CENTRALLY LOCATED IN WILMINGTON TO PROVIDE ACCESS TO HISTORICALLY UNDERSERVED MINORITY COMMUNITIES. FOR THOSE TESTING POSITIVE, CONTINUED MONITORING WAS OFFERED IN THEIR PREFERRED LANGUAGE. TESTING BEGAN IN APRIL 2020 AT BOTH LACC AND KCC AND IT CONTINUED AT LACC UNTIL APRIL 2021, AT WHICH TIME THE LACC RESUMED ITS OWN PROGRAMMING IN THAT SPACE. DURING THE PERIOD FROM JULY 2020 TO APRIL 2021, CHRISTIANACARE SAW 497 PATIENTS AT THE LACC TESTING SITE AND TESTED 477 PATIENTS. COVID-19 TESTING CONTINUES TO BE OFFERED AT THE KINGSWOOD COMMUNITY CENTER, NOW WITHIN A NEWLY DEVELOPED PRIMARY CARE PRACTICE THAT BEGAN OPERATING IN APRIL 2021. AT THE KINGSWOOD COMMUNITY CENTER, PATIENTS CAN CONNECT TO CHRISTIANACARE VIRTUAL HEALTH FOR A VIRTUAL APPOINTMENT WITH A PRIMARY CARE PROVIDER OR A MEMBER OF THEIR CARE TEAM, AND RECEIVE ACCESS TO MEDICAL SERVICES SUCH AS VACCINES, BLOOD PRESSURE CHECKS, AND IN-PERSON EXAMS. IN PERSON HELP WITH THE VIRTUAL CARE TECHNOLOGY IS ALSO AVAILABLE IF NEEDED. ONE OF THE MOST REWARDING THINGS CHRISTIANACARE WAS ABLE TO DO FOR ITS NEIGHBORS DURING FY21 WAS TO OFFER COVID-19 VACCINATIONS. BETWEEN JANUARY 16, 2021 AND JUNE 11, 2021, CHRISTIANACARE HELD 28 VACCINATION EVENTS AT ITS NEWARK CAMPUS AND ADMINISTRATIVE LOCATION IN WILMINGTON, AVENUE NORTH. A TOTAL OF 22,362 FIRST AND SECOND DOSES WERE PROVIDED TO COMMUNITY MEMBERS. CHRISTIANACARE'S OFFICE OF HEALTH EQUITY ALSO ORGANIZED EIGHT FIRST AND SECOND DOSE VACCINATION EVENTS IN COMMUNITY LOCATIONS THROUGHOUT NEW CASTLE COUNTY BETWEEN FEBRUARY AND JUNE 2021. AT THESE EVENTS, 2,810 1ST DOSES AND 2,616 2ND DOSES WERE PROVIDED. INDIVIDUALS WHO RECEIVED A 1ST DOSE WERE INVITED TO RETURN TO THE SAME LOCATION TO RECEIVE THEIR SECOND DOSE AND SENT REMINDERS AS WELL. THE GOAL OF HOLDING VACCINATION CLINICS IN COMMUNITIES WAS TO BRING THE VACCINE TO THOSE COMMUNITIES THAT MAY NOT HAVE OTHERWISE HAD EASY ACCESS. THE OFFICE OF HEALTH EQUITY WORKED VERY CLOSELY WITH TRUSTED COMMUNITY PARTNERS TO ORGANIZE THESE EVENTS AND PROMOTE THEM TO COMMUNITY MEMBERS. WE WERE PARTICULARLY FOCUSED ON USING THESE VACCINATIONS EVENTS TO ADDRESS DISPARATE VACCINATION RATES WE WERE SEEING IN OUR COMMUNITIES AND NATIONALLY. THE STATISTICS REFLECTING THOSE WE VACCINATED DEMONSTRATE OUR SUCCESS. AT THE FIRST VACCINATION EVENT IN THE COMMUNITY EDUCATION BUILDING IN WILMINGTON, 71% OF THOSE VACCINATED WERE BLACK OR AFRICAN AMERICAN. AT ONE OF THE FINAL VACCINATION EVENTS IN NEWPORT, 82% OF THOSE VACCINATED IDENTIFIED AS HISPANIC OR LATINO. THE VACCINATION CLINICS TOOK A GREAT AMOUNT OF TIME AND EFFORT TO ORGANIZE. EACH EVENT AT THE HOSPITAL REQUIRED 40 - 50 CAREGIVERS TO VOLUNTEER DURING THEIR PERSONAL TIME OR TO STEP AWAY FROM THEIR OTHER DUTIES TO PERFORM EVERYTHING FROM ADMINISTERING THE VACCINE TO GREETING COMMUNITY MEMBERS. THE PHARMACY TEAM SUPPORTED EVERY EVENT AND WERE IN CONSTANT COMMUNICATION WITH THE SITE SUPERVISORS TO ENSURE VACCINE SUPPLY AND DELIVERY WAS SEAMLESS. ALL OUR EVENTS HAD THE SUPPORT AND PRESENCE OF THE EXECUTIVE LEADERSHIP TEAM WHO GREETED AND GUIDED COMMUNITY MEMBERS, PROVIDED VACCINATIONS, AND SCRIBED ALONG WITH OTHER VOLUNTEERS. THE CORE VACCINATION TEAM WAS CONTINUOUSLY IMPROVING EACH EVENT TO ENSURE WE COULD SEE AS MANY COMMUNITY MEMBERS AS VACCINE SUPPLY ALLOWED. WE ALSO CONSISTENTLY ADAPTED TO CDC AND STATE GUIDANCE ON VACCINATION GUIDELINES AND VACCINE SUPPLY CHALLENGES. WE ARE PARTICULARLY PROUD OF THE WORK OUR CAREGIVERS IN INFORMATION TECHNOLOGY (IT) PUT INTO THIS EFFORT. THE IT TEAM CREATED A HOMEGROWN INTERNAL VACCINATION SOFTWARE SOLUTION TO CAPTURE COMMUNITY MEMBER INTAKE AND VACCINE INFORMATION. THEY CREATED REPORTS TO SHARE INTERNALLY AND WITH THE STATE. THE SOFTWARE SYSTEM ALSO ALLOWED THE IT TEAM TO SHARE VACCINE DATA WITH THE STATE FOR THE STATE'S VACCINE REGISTRY. IN FY21, CHRISTIANACARE WAS ALSO ABLE TO BEGIN PROVIDING MONOCLONAL ANTIBODY TREATMENTS TO INDIVIDUALS TO ENSURE THEY DID NOT FACE SEVERE ILLNESS OR HOSPITALIZATION DUE TO COVID-19. TO DATE, 2,395 INDIVIDUALS HAVE RECEIVED THIS TREATMENT SINCE IT WAS FIRST OFFERED IN DECEMBER 2020. TO ENSURE THAT TRANSPORTATION BARRIERS WOULD NOT PREVENT SOMEONE FROM RECEIVING THIS LIFE-SAVING TREATMENT, CHRISTIANACARE'S CENTER FOR VIRTUAL HEALTH AND COMMUNITY HEALTH DEPARTMENT WORKED TOGETHER TO CREATE A PIPELINE TO PROVIDE TRANSPORTATION THROUGH ROUNDTRIP FOR THOSE RECEIVING THESE TREATMENTS. IN FY21, 27 INDIVIDUALS RECEIVED FREE TRANSPORTATION FROM THEIR HOMES TO THE NEWARK CAMPUS TO RECEIVE MONOCLONAL ANTIBODY TREATMENTS. ALONG WITH TESTING, VACCINATION, AND TREATMENT, OUR COMMUNITY TEAMS CONTINUE TO PROVIDE EDUCATION IN THE COMMUNITY REGARDING COVID-19. WE EXPECT TO CONTINUE TO ADAPT AS NEEDED TO BEST SERVE OUR PATIENTS AND COMMUNITIES AS WE CONTINUE TO RESPOND TO THE HEALTH NEEDS OF THE COMMUNITY WHILE THE COVID-19 PANDEMIC CONTINUES. MORE HIGHLIGHTS FROM THIS FISCAL YEAR THAT CHRISTIANACARE HAS UNDERTAKEN TO ADDRESS THE AREAS OF NEED IDENTIFIED IN THE CHNA ARE DESCRIBED BELOW. PLEASE SEE THE CHRISTIANACARE CHIP AT: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY-HEALT H-IMPLEMENTATION-PLAN/ FOR A COMPLETE DESCRIPTION OF HOW CHRISTIANACARE IS ADDRESSING THE IDENTIFIED AREAS OF NEED. 1. SOCIAL DETERMINANTS OF HEALTH IN FY19, CHRISTIANACARE'S OFFICE OF HEALTH EQUITY DESIGNED THE COMMUNITY INVESTMENT FUND IN PARTNERSHIP WITH CHRISTIANACARE'S FINANCE DEPARTMENT. IN THE 2020 FISCAL YEAR, CHRISTIANACARE GAVE NEARLY $2,000,000 IN COMMUNITY INVESTMENT FUNDING TO 32 COMMUNITY ORGANIZATIONS ACROSS THE STATE. DUE TO THE DISRUPTION AND FINANCIAL UNCERTAINTY CAUSED BY THE PANDEMIC, THE OFFICE OF HEALTH EQUITY WAS UNABLE TO PROVIDE COMMUNITY INVESTMENT FUNDING IN FY21, BUT AS OF THIS WRITING, CHRISTIANACARE HAS SELECTED THE SECOND ROUND OF COMMUNITY ORGANIZATIONS TO RECEIVE FY22 COMMUNITY INVESTMENT FUNDING, WHICH WE LOOK FORWARD TO REPORTING ON IN OUR NEXT FILING. CHRISTIANACARE HAS CONTINUED ITS INVOLVEMENT IN THE PURPOSE BUILT COMMUNITIES' REACH RIVERSIDE COMMUNITY DEVELOPMENT INITIATIVE. IN MARCH 2019, CHRISTIANACARE MADE A GIFT OF $1,000,000 TO THE INITIATIVE IN SUPPORT OF COMMUNITY HEALTH AND YOUTH DEVELOPMENT PROGRAMS IN RIVERSIDE, ONE OF WILMINGTON'S OLDEST AND MOST UNDERSERVED COMMUNITIES. IN FY20, CHRISTIANACARE'S CHIEF HEALTH EQUITY OFFICER, BETTINA TWEARDY RIVEROS, SERVED AS A MEMBER ON THE REACH RIVERSIDE BOARD AND AS A CO-CHAIR OF THE HEALTH, WELLNESS, AND SAFETY COMMITTEE. IN FY21, THE CHIEF HEALTH EQUITY OFFICER CONTINUED SERVING AND AS DESCRIBED ABOVE, CHRISTIANACARE NOW HAS A VIRTUAL HEALTH PRIMARY CARE PRACTICE LOCATED AT KINGSWOOD COMMUNITY CENTER. BRINGING EASILY ACCESSIBLE HEALTHCARE INTO THE COMMUNITY WAS ONE OF THE GOALS OF THE INITIATIVE THAT WE WERE EAGER TO HELP THE COMMUNITY MEET.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	THE OFFICE OF HEALTH EQUITY LAUNCHED UNITE DELAWARE IN NOVEMBER 2019. UNITE DELAWARE IS A COORDINATED CARE NETWORK OF HEALTH AND SOCIAL SERVICE PROVIDERS CONNECTED THROUGH A SHARED TECHNOLOGY PLATFORM, UNITE US, WHICH ENABLES ALL ORGANIZATIONS ON THE PLATFORM TO SEND AND RECEIVE REFERRALS TO ADDRESS INDIVIDUALS' SOCIAL AND HEALTH NEEDS. THERE ARE CURRENTLY 156 PARTICIPATING ORGANIZATIONS FROM THROUGHOUT THE STATE OF DELAWARE ON THE PLATFORM THAT CAN ADDRESS A VARIETY OF SOCIAL AND HEALTH NEEDS. IN FY21, CHRISTIANACARE PARTNERED WITH DELAWARE 211 TO BRING THEM ONBOARD THE UNITE US PLATFORM TO ADDRESS ANY NEED THAT MAY NOT BE MET BY THE CURRENT PARTICIPATING PARTNER. THE DELAWARE 211 PARTNERSHIP ENSURES THAT NO DELAWAREAN WHO SEEKS HELP THROUGH UNITE DELAWARE WILL LEAVE EMPTY HANDED. IN FY21, CHRISTIANACARE ALSO BEGAN WORKING WITH UNITE US TO INTEGRATE THE PLATFORM INTO THE ELECTRONIC HEALTH RECORD TO ENSURE EASIER ACCESS TO ADDRESS PATIENTS' NEEDS IN CLINICAL SETTINGS. ANOTHER COMPREHENSIVE WAY IN WHICH CHRISTIANACARE ADDRESSES SOCIAL DETERMINANTS OF HEALTH IS THE DELAWARE MEDICAL LEGAL PARTNERSHIP (MLP) CREATED IN PARTNERSHIP WITH DELAWARE'S COMMUNITY LEGAL AID SOCIETY, INC. ("CLASI"). THE MLP PROVIDES FREE, CIVIL LEGAL SERVICES TO LOW-INCOME PATIENTS, ADULTS, AND CHILDREN WHO ARE FACING LEGAL MATTERS OR NEEDS THAT MAY NEGATIVELY IMPACT THEIR HEALTH OR LEGAL MATTERS OR NEEDS WHICH MAY HAVE BEEN CREATED OR AGGRAVATED BY A PERSON'S HEALTH ISSUES. SOME OF THE MATTERS ADDRESSED THROUGH THIS PROGRAM ARE SAFE HOUSING, PREVENTION OF SUBSIDIZED AND PUBLIC HOUSING EVICTIONS, ASSISTANCE OBTAINING OR PRESERVING INCOME MAINTENANCE AND GOVERNMENT BENEFITS, ACCESS TO SOCIAL SERVICES, APPROPRIATE EDUCATIONAL SERVICES, HEALTH INSURANCE, AND ACCESS TO HEALTH CARE. IN ANTICIPATION THAT THE PANDEMIC WOULD EXACERBATE EXISTING LEGAL NEEDS IN THE AREAS OF HOUSING, UNEMPLOYMENT, DOMESTIC VIOLENCE, AND OTHER AREAS FOR ALREADY VULNERABLE POPULATIONS, CHRISTIANACARE EXPANDED ITS CONTRACT WITH CLASI. WE SERVED 274 INDIVIDUALS IN THE MLP PROGRAM IN FY21, MORE THAN DOUBLE THE NUMBER THAT WERE SERVED IN THE PRIOR FISCAL YEAR. CHRISTIANACARE CONTINUES TO ADDRESS SOCIAL DETERMINANTS OF HEALTH THROUGH ITS COMMITMENT TO A COMMUNITY HEALTH WORKERS (CHW) PROGRAM. AS DELAWARE TRANSITIONS FROM VOLUME TO VALUE, WE ARE TAKING ADVANTAGE OF THE OPPORTUNITY TO DEVELOP A STANDARDIZED, SCALABLE, SUSTAINABLE CHW PROGRAM. CHRISTIANACARE CONTINUES TO PARTNER WITH UNIVERSITY OF PENNSYLVANIA'S CENTER FOR COMMUNITY HEALTH WORKERS' IMPACT TEAM TO ENSURE ADHERENCE TO THE MODEL AND CONTINUED SUCCESS. EMERGENCY DEPARTMENT CHW PROGRAM CHRISTIANACARE'S EMERGENCY DEPARTMENT'S CHW PROGRAM LAUNCHED ON FEBRUARY 1, 2021 AND PROVIDES THREE MONTHS OF LONGITUDINAL SUPPORT TO HIGH ED UTILIZERS AT THE WILMINGTON HOSPITAL IN ORDER TO ASSESS AND ADDRESS THEIR SOCIAL AND ENVIRONMENTAL BARRIERS TO HEALTH. THE TEAM CONSISTS OF TWO COMMUNITY HEALTH WORKERS WHO AIM TO MEET ED PATIENTS AT BEDSIDE, WHEN POSSIBLE, AND CONNECT THEM WITH PRIMARY CARE AND LONG-TERM SUPPORT. THE GOAL OF THE TEAM IS TO INCREASE PATIENTS' ACCESS TO CARE WHILE IDENTIFYING AND ACHIEVING THEIR PERSONAL GOALS AND SOCIAL NEEDS. ELIGIBILITY CRITERIA: - 2 OR MORE ED VISITS WITHIN THE LAST 90 DAYS AT THE WILMINGTON HOSPITAL DURING THIS FISCAL YEAR THE OBJECTIVES OF THE EMERGENCY DEPARTMENT'S CHW PROGRAM WERE TO REACH OUR MOST VULNERABLE PATIENTS FREQUENTING THE ED, ASSESS AND ADDRESS THEIR SOCIAL DETERMINANTS OF HEALTH, IDENTIFY AND ACHIEVE PATIENTS' PERSONAL GOALS, INCREASE THEIR ACCESS TO PRIMARY CARE AND POST HOSPITAL FOLLOW-UP VISITS, IMPROVE PATIENTS' CHRONIC CONDITION LIKE DIABETES AND HYPERTENSION, AND REDUCE 30-DAY READMISSION RATES AND ED UTILIZATION. THE EMERGENCY DEPARTMENT'S CHW PROGRAM IS IN ITS EARLY STAGES AND CURRENTLY HAS SUCCESSFULLY ENROLLED APPROXIMATELY 30 PATIENTS. ENROLLMENT OF THIS PATIENT POPULATION IS UNDERSTANDABLY DIFFICULT DUE TO SEVERE MENTAL HEALTH DIAGNOSES AND THE FACT THAT MANY ELIGIBLE PATIENTS ARE HOMELESS. OVER THE NEXT FISCAL YEAR, THE EMERGENCY DEPARTMENT'S CHW PROGRAM IS GOING TO FOCUS ON ITS OPERATIONAL PROCESSES, SPECIFICALLY TRANSITIONING PROGRAM DOCUMENTATION INTO THE HEALTHECARE PLATFORM. ADDITIONALLY, A ROBUST EVALUATION PLAN WILL BE DEVELOPED TO ASSESS THE PROGRAM'S IMPACT ON PATIENT EXPERIENCE, PATIENT CENTERED GOALS, SOCIAL DETERMINANTS OF HEALTH, ACCESS TO CARE, CHRONIC DISEASE MANAGEMENT, AND HOSPITAL UTILIZATION. PRIMARY CARE CHW PROGRAM CHWS ADDRESS THE SOCIAL DETERMINANTS THAT AFFECT A PATIENT'S OVERALL HEALTH AND TREATMENT OUTCOMES BY CONNECTING THEM TO RESOURCES AND WRAPAROUND SUPPORT WITHIN THEIR COMMUNITY. THE PRIMARY CARE CHWS WORK WITH ELIGIBLE PATIENTS FOR SIX MONTHS AT CHRISTIANACARE'S MAP 2, SMYRNA, FAMILY COMMUNITY MEDICINE AND WILMINGTON ADULT MEDICINE PRACTICES. ELIGIBILITY CRITERIA: - MEDICAID OR MEDICAID ELIGIBLE - HYPERTENSION OR DIABETES - OR HIGH ED UTILIZATION (2 OR MORE ED VISITS IN THE PAST 90 DAYS) DURING THIS FISCAL YEAR THE PROGRAM OBJECTIVES WERE TO REACH OUR MEDICAID PATIENT POPULATION DIAGNOSED WITH HYPERTENSION AND DIABETES, ASSESS AND ADDRESS THEIR SOCIAL DETERMINANTS OF HEALTH, IDENTIFY AND ACHIEVE PATIENTS' PERSONAL GOALS, DECREASE NO SHOW PRIMARY CARE APPOINTMENT RATES, IMPROVE PATIENTS' SELF-MANAGEMENT OF CHRONIC CONDITION, AND REDUCE 30-DAY READMISSION RATES AND ED UTILIZATION. FROM JULY 2020 THROUGH JUNE 2021 THE PRIMARY CARE CHW PROGRAM ENROLLED 231 NEW PATIENTS, 69 OF WHOM HAVE SUCCESSFULLY GRADUATED FROM THE PROGRAM. THESE PATIENTS ARE 55 YEARS OLD ON AVERAGE; 70% BLACK/AFRICAN AMERICAN, 27% WHITE AND 3% OTHER. SIXTY-SEVEN PERCENT ARE FEMALES, AND 92% ARE NON-HISPANIC/NON-LATINO. SCHOOL-BASED HEALTH CENTERS CHW PROGRAM THE SCHOOL-BASED HEALTH CENTERS (SBHC) ARE A PARTNERSHIP BETWEEN CHRISTIANACARE, THE RESPECTIVE SCHOOL DISTRICTS, AND THE DELAWARE DIVISION OF PUBLIC HEALTH. HEALTHCARE IN THE SBHC IS PROVIDED BY A MULTI-DISCIPLINARY TEAM. A NURSE PRACTITIONER, A LICENSED CLINICAL SOCIAL WORKER/ LICENSED PROFESSIONAL COUNSELOR OF MENTAL HEALTH, AND A REGISTERED DIETITIAN PROVIDE CARE TO STUDENTS DURING SCHOOL HOURS. THERE ARE 21 CHRISTIANACARE OPERATED SBHCS. IN FY21, 9 SCHOOLS RECEIVED CHW SERVICES 1-2 DAYS A WEEK, INCLUDING MCKEAN, HOWARD, WILLIAM PENN, CHRISTIANA, HODGSON, NEWARK, GLASGOW, SHORTLIDGE, AND WARNER. THESE SCHOOLS WERE SELECTED TO HAVE A CHW BASED ON HIGH NEEDS, DISPARITIES, AND LOW INSURANCE ENROLLMENT. SBHCS ARE AN ESSENTIAL ACCESS POINT FOR MEDICAL AND BEHAVIORAL HEALTH CARE FOR STUDENTS WHO MAY NOT OTHERWISE BE ABLE TO RECEIVE TREATMENT, DUE TO A VARIETY OF FACTORS INCLUDING PARENT WORK SCHEDULES, TRANSPORTATION, AND COVERAGE. FOR THOSE WITH AN EXISTING PROVIDER, SBHCS DO NOT TAKE THE PLACE OF THE STUDENT'S PEDIATRICIAN OR FAMILY DOCTOR, AND SBHC DOCTORS AND NURSES WILL WORK WITH THE STUDENT'S PRIMARY CARE PROVIDER TO CARE FOR THE STUDENT. WHEN APPLICABLE AND APPROPRIATE, AND WITH PARENT/GUARDIAN PERMISSION, THE SBHC WILL WORK TO SHARE MEDICAL INFORMATION WITH STUDENTS' PRIMARY CARE PROVIDERS TO PREVENT ANY DUPLICATION OF HEALTH CARE SERVICE. ELIGIBILITY CRITERIA: - STUDENT AT ONE OF THE SCHOOLS WITH A SBHC - STUDENTS' PARENT(S)/GUARDIAN(S) COMPLETES REGISTRATION, CONSENT, AND HEALTH HISTORY FORMS - UP-TO-DATE INSURANCE INFORMATION IS NEEDED IF THE STUDENT IS INSURED, HOWEVER, INSURANCE IS NOT REQUIRED. NO CO-PAY, CO-INSURANCE OR DEDUCTIBLE WILL BE CHARGED, AND NO ONE WILL BE TURNED AWAY BASED ON ABILITY TO PAY. DURING THIS FISCAL YEAR THE PRIMARY OBJECTIVES OF THE SBHC CHWS WAS SLIGHTLY DIFFERENT THAN PREVIOUS YEARS DUE TO COVID19. IN ADDITION TO HELPING STUDENTS AND THEIR FAMILIES IDENTIFY FINANCIAL BARRIERS TO HEALTHCARE, CONNECTING THEM TO HEALTHCARE SERVICES, SUBMITTING SOCIAL NEED REFERRALS, PROVIDING RESOURCES, AND HELPING WITH SCHOOL TRANSITIONS, SBHC CHWS PROVIDED SUPPORT FOR COMMUNITY HEALTH PROGRAMS, COVID19 TESTING SITES, AND VACCINATION EVENTS. IN OCTOBER 2020, SBHC CHWS RETURNED TO THEIR ASSIGNED SCHOOL SITES. DURING THIS TIME CHRISTIANACARE STAFF MADE IMPROVEMENTS TO PREVIOUS WORKFLOWS AND IMPLEMENTED NEW POLICIES AND PROCEDURES TO ENSURE COVID19 SAFETY. OUTREACH EFFORTS CONTINUED TO INCREASE AS WELL AS OPPORTUNITIES FOR COLLABORATION. REFERRALS FILTERED IN AT A STEADY PACE AND THE TEAM WAS EQUIPPED WITH THE NECESSARY TOOLS TO SUPPORT THE NEEDS OF STUDENTS AND FAMILIES. THROUGHOUT THE SCHOOL YEAR THE SBHC CHWS SERVED 1,193 UNIQUE STUDENTS AND THEIR FAMILIES. CHWS HELPED THEM COMBAT FINANCIAL BARRIERS TO HEALTHCARE BY CONNECTING 21% TO HEALTH INSURANCE. CHWS IDENTIFIED STUDENTS THAT DID NOT HAVE A PRIMARY CARE PROVIDER (17%) AND CONNECTED THEM WITH A PCP. THEY ALSO PROVIDED 27% OF THE STUDENTS WITH FOOD ASSISTANCE, 10% WITH SCHOOL TRANSITION SUPPORT, 5% WITH CAREER SUPPORT, AND 4% WITH TRANSPORTATION TO HEALTHCARE APPOINTMENTS.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	THIS UPCOMING SCHOOL YEAR, THE SBHC CHW PROGRAM WILL BE IMPLEMENTING THE ADAPTED IMPACT PENN MEDICINE MODEL. CHWS WILL PROACTIVELY SEEK STUDENTS TO ENROLL IN THE PROGRAM FOR EITHER 3 OR 6 MONTHS MAINTAINING A CASE LOAD OF AT LEAST 6 STUDENTS PER SCHOOL (3 SCHOOLS PER CHW). CHWS WILL CONTINUE TO ACCEPT REFERRALS FOR STUDENTS WITH ONE-TIME NEEDS THAT DO NOT MEET THE CRITERIA FOR ENROLLMENT. THE SBHC CHW PROGRAM WILL ALSO BE GAINING 2 NEW FTES TO EXPAND THIS WORK TO 6 MORE SCHOOLS (A.I. DUPONT, BRANDYWINE, CONCORD, DELCASTLE, MCKEAN, AND MOUNT PLEASANT) LEAVING ONLY 5 SITES WITHOUT AN ASSIGNED CHW. CONTINUED ADJUSTMENTS AND IMPROVEMENTS TO THE PROGRAM WILL BE MADE AS NEEDED. WOMEN'S HEALTH CHW PROGRAM MATERNAL HEALTH CAN BECOME A HEALTH ISSUE NOT ONLY FOR BABY, BUT FOR THE EXPECTING MOTHER AS WELL. CHRISTIANACARE IS POISED TO TRANSFORM HEALTHCARE FOR MOTHERS AND BABIES IN DELAWARE WITH A COMMITTED INVESTMENT TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH THROUGH WRAP AROUND SERVICES. WOMEN'S HEALTH CHWS WORK WITH OUTPATIENT MOTHERS AT SUITE 1900 WOMEN'S HEALTH AND WILMINGTON WOMEN'S HEALTH, AND WITH CHRISTIANACARE INPATIENT MOTHERS TO SUPPORT THEM DURING AND AFTER PREGNANCY. ELIGIBILITY CRITERIA: - MEDICAID OR MEDICAID ELIGIBLE - LIVES IN ONE OF THE FOLLOWING ZIP CODES: 19701, 19702, 19711, 19713, 19720, 19801, 19802, 19804, 19805, 19977 - AND MEETS AT LEAST ONE OF THE FOLLOWING CRITERIA: - A HISTORY OF POOR BIRTH OUTCOMES (E.G., LOW BIRTH WEIGHT DELIVERY, PREMATURE BIRTH, INFANT DEATH, FETAL DEATH/STILLBIRTH) - A CHRONIC DISEASE (E.G., DIABETES, HIGH BLOOD PRESSURE). - LATE ENTRY INTO PRENATAL CARE - NO PRENATAL CARE - RISK FOR BIRTH DEFECTS - EXPOSURE OR FAMILY HISTORY - MENTAL ILLNESS - BMI AT OR ABOVE 30. DURING THIS FISCAL YEAR THE OBJECTIVES OF THE WOMEN'S HEALTH CHW PROGRAM WERE TO REACH OUR HIGH-RISK PREGNANT PATIENT POPULATION, ASSESS AND ADDRESS THEIR SOCIAL DETERMINANTS OF HEALTH, IDENTIFY AND ACHIEVE PATIENTS' PERSONAL GOALS, INCREASE POST-PARTUM FOLLOW-UP VISITS, IMPROVE THE USAGE OF LONG-TERM CONTRACEPTION, AND REDUCE 42-DAY READMISSIONS POST-DELIVERY DISCHARGE. FROM JULY 2020 THROUGH JUNE 2021 THE WOMEN'S HEALTH CHW PROGRAM ENROLLED 128 PATIENTS, 86 OF WHICH HAVE SUCCESSFULLY GRADUATED FROM THE PROGRAM. THESE PATIENTS ARE 29 YEARS OLD ON AVERAGE, 48% BLACK/AFRICAN AMERICAN, 25% WHITE, 27% OTHER AND 57% NON-HISPANIC/NON-LATINO. FOOD INSECURITY AS THE LARGEST PRIVATE EMPLOYER IN DELAWARE, WE RECOGNIZE THAT OUR CAREGIVERS REPRESENT OUR COMMUNITIES. BASED ON STATE STATISTICS, NEARLY 1,900 OF OUR MORE THAN 13,000 CHRISTIANACARE CAREGIVERS COULD BE FACING FOOD INSECURITY. ON MAY 17, 2021, CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT IN THE OFFICE OF HEALTH EQUITY RELAUNCHED THE EMPLOYEE FOOD PANTRIES AT BOTH OUR CHRISTIANACARE NEWARK AND WILMINGTON CAMPUSES. THESE ANONYMOUS FOOD PANTRIES, AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK, ARE AVAILABLE TO ALL EMPLOYEES IN NEED OF FOOD ASSISTANCE. TO BEST SERVE AND MEET THE NEEDS AND PREFERENCES OF OUR CAREGIVERS, WE REQUESTED FEEDBACK ON THE TYPES OF NON-PERISHABLE FOODS INCLUDED IN THE FOOD BOXES. THE FOOD BOXES WERE VETTED BY OUR CHRISTIANACARE REGISTERED DIETICIANS TO ENSURE THEY WERE NUTRITIONALLY BALANCED. FOOD ITEMS IN A SINGLE BOX INCLUDE: - PACKAGED TUNA, CANNED CHICKEN, QUICK OATS, WHOLE WHEAT SPAGHETTI, SPAGHETTI SAUCE, MACARONI AND CHEESE, EVAPORATED MILK, YELLOW RICE, BLACK BEANS, JALAPENOS, CARROTS, CORN, GREEN BEANS, PEACHES, PINEAPPLES, UNSWEETENED APPLESAUCE, PEANUT BUTTER, JELLY, DRIED CRANBERRIES IN ADDITION TO THE FOOD, THE BOXES INCLUDE A PACKET WITH COMMUNITY RESOURCE INFORMATION, ALONG WITH HEALTHY RECIPES THAT USE INGREDIENTS PROVIDED IN THE BOX. RECIPES INCLUDE CANNED CHICKEN ENCHILADAS, TUNA FISH CASSEROLE, VEGETABLE RICE, AND OATMEAL MUFFINS WITH DRIED CRANBERRIES. FROM MAY 2021 THROUGH JULY 2021, CHRISTIANACARE PROVIDED 125 FOOD BOXES, WITH AN AVERAGE COST OF $21 PER BOX, TO OUR CAREGIVERS. CHRISTIANACARE IS ALSO CONTINUING ITS LONG-STANDING PARTNERSHIP WITH URBAN ACRES TO SUPPORT PRODUCE DELIVERY. THROUGH THIS PARTNERSHIP, FROM JULY 2020 THROUGH JUNE 2021 WE PROVIDED 190 AT-RISK, FOOD INSECURE, PATIENTS WITH FRESH, LOCAL PRODUCE ON A WEEKLY BASIS FOR A MINIMUM OF 6 MONTHS. - PATIENTS RECEIVE A $10 BAG OF PRODUCE APPROXIMATELY 50/50 FRUITS AND VEGETABLES - THE VARIETY OF FRUITS AND VEGETABLES VARIED SEASONALLY. HOUSEHOLDS OF 5 OR MORE RECEIVE 2 BAGS. THE MAJORITY OF PROGRAM PARTICIPANTS WERE FEMALES (81%) AND NON-HISPANIC (68%). HALF OUR PATIENTS WERE BLACK OR AFRICAN AMERICAN (51%), 24% WERE WHITE AND THE REMAINING QUARTER IDENTIFIED AS OTHER. - NINETY PERCENT OF PROGRAM PARTICIPANTS WERE VERY SATISFIED OR SATISFIED WITH THE PROGRAM AND THE MAJORITY RATED THE QUALITY OF PRODUCE AS EXCELLENT OR VERY GOOD (78%). - NEARLY ALL THE PATIENTS FELT THEY ATE HEALTHIER FOODS BECAUSE OF THE PROGRAM (95%) AND 65% OF PATIENTS WOULD NOT HAVE HAD ENOUGH FOOD TO EAT EACH WEEK WITHOUT THE DELIVERED PRODUCE. - 81% OF PARTICIPANTS CONSUMED ALL THE PRODUCE THAT WAS PROVIDED. THOSE WHO DID NOT EAT ALL THE PRODUCE SAID IT WAS BECAUSE THEY: 1) DID NOT KNOW HOW TO PREPARE IT, 2) DID NOT HAVE THE APPROPRIATE EQUIPMENT, 3) DID NOT LIKE THE TASTE, 4) IT WAS TOO MUCH FOOD. - 50% OF PATIENTS WERE NOT ENROLLED IN SNAP AND 81% OF THOSE UNENROLLED REQUESTED AND RECEIVED ENROLLMENT ASSISTANCE FROM OUR CHWS.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	CHRISTIANACARE'S OFFICE OF HEALTH EQUITY, COMMUNITY HEALTH DEPARTMENT, LAUNCHED THE DELAWARE FOOD FARMACY (DFF) IN COLLABORATION WITH PRIMARY CARE, NUTRITION SERVICES, BEHAVIORAL HEALTH, AND IREACH (CHRISTIANACARE INSTITUTE FOR RESEARCH ON EQUITY AND COMMUNITY HEALTH). CHRISTIANACARE PARTNERED WITH LUTHERAN COMMUNITY SERVICES TO DEVELOP AND LAUNCH THE DFF, A PROGRAM THAT ADDRESSES HEALTHCARE INEQUITIES BY PROVIDING HOLISTIC CARE WITH RADICAL CONVENIENCE. DFF IS DESIGNED TO HELP MEDICAID AT-RISK PATIENTS WITH UNCONTROLLED DIABETES, HYPERTENSION AND/OR HEART FAILURE SELF-MANAGE THEIR CHRONIC CONDITION THROUGH A NUTRITION-BASED COMPREHENSIVE CARE MODEL - TREATING THE "WHOLE PERSON." - THE SIX-MONTH PROGRAM PROVIDES PATIENT WITH PERSONALIZED DISEASE MANAGEMENT, NUTRITIONAL EDUCATION, HEALTH PSYCHOLOGY, SOCIAL CARE ASSISTANCE, AND MEDICALLY TAILORED FOOD BOXES. - FOOD BOXES ARE DELIVERED WEEKLY TO PATIENTS' HOME. THE FOOD PROVIDED IN THESE BOXES CONSISTS OF THE FOLLOWING DASH EATING PLAN FOOD GROUPS: FRESH VEGETABLES, FRESH FRUITS, WHOLE GRAINS, LOW-FAT DAIRY, LEAN MEATS/POULTRY/FISH, AND NUTS/SEEDS/LEGUMES. - EACH WEEK, PATIENTS RECEIVED ENOUGH FOOD TO FEED THEM AND THEIR FAMILIES FOR 10 MEALS. FOR EXAMPLE, A FAMILY OF 4 WOULD RECEIVE ENOUGH FOOD EACH WEEK TO MAKE 40 SEPARATE MEALS. FROM MARCH 2021 THROUGH JUNE 2021 DFF HAS SERVED 13 PATIENTS AND A TOTAL OF 38 COMMUNITY MEMBERS, PROVIDING ENOUGH FOOD FOR OVER 1,800 MEALS. ADDITIONALLY, EACH ENROLLED PARTICIPANT RECEIVED A $200 DFF WELCOME KIT. KIT ITEMS INCLUDE: MEDIUM NON-STICK POT AND PAN, CHEF'S KNIFE, CUTTING BOARD SET, MIXING BOWL SET, MEASURING SPOONS, MEASURING CUPS, STRAINER, OVEN MITTS, VEGETABLE PEELER, CAN OPENER, TONGS, SPATULA, TUPPERWARE, STARTER SPICE KIT, AND A BASIC COOKING 101 COOKBOOK. OVER HALF OF PROGRAM PARTICIPANTS WERE FEMALES (61%), NEARLY ALL WERE NON-HISPANIC (92%), 62% OF PATIENTS WERE BLACK OR AFRICAN AMERICAN, APPROXIMATELY A QUARTER WERE WHITE (23%), AND THE REMAINING 15% IDENTIFIED AS OTHER. SEVENTY-SEVEN PERCENT OF PATIENTS HAD POORLY CONTROLLED DIABETES, 70% WERE DIAGNOSED WITH POORLY CONTROLLED HYPERTENSION AND 7% HAD CONGESTIVE HEART FAILURE, WITH OVER HALF EXPERIENCING COMORBIDITIES (56%). MOST PATIENTS ENROLLED (88%) WERE IDENTIFIED AS BEING FOOD INSECURE HOUSING THIS YEAR, CHRISTIANACARE PROVIDED $50,000 IN FUNDING TO HOUSING ALLIANCE DELAWARE, A STATEWIDE NON-PROFIT ORGANIZATION THAT ADDRESSES AFFORDABLE HOUSING NEEDS AND HOMELESSNESS, TO CONTINUE ITS PROGRAM THAT WILL SERVE CHRONICALLY HOMELESS INDIVIDUALS AT RISK OF POOR HEALTH OUTCOMES BY OFFERING FINANCIAL ASSISTANCE TO REDUCE ECONOMIC BARRIERS TO EXITING HOMELESSNESS AND ENGINEERING A MORE EFFICIENT AND COMPREHENSIVE PROCESS TO ENSURE HOSPITALIZED HOMELESS INDIVIDUALS ARE CONNECTED TO THE HEALTH AND HOUSING SERVICES THEY NEED. A QUALITATIVE ASSESSMENT TO ALLOW THOSE EXPERIENCING CHRONIC HOMELESSNESS TO SHARE THEIR BARRIERS TO RECEIVING BEHAVIORAL, MEDICAL, AND SOCIAL NEEDS IS ALSO CONDUCTED THROUGH THIS PROGRAM. THIS IS THE SECOND YEAR OF FUNDING THIS PROGRAM.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	IN DECEMBER 2020, NEW CASTLE COUNTY GOVERNMENT PURCHASED A HOTEL ALONG I-95 AND RAPIDLY TRANSFORMED IT INTO AN EMERGENCY HOMELESS SHELTER. CHRISTIANACARE SERVED AS A PARTNER TO THE COUNTY DURING THIS PROCESS AND IS NOW ON-SITE PROVIDING MEDICAL CARE TO THE RESIDENTS. WHILE THE IMPACT OF THE PANDEMIC DID NOT ALLOW CHRISTIANACARE TO FUND HOUSING AT THE SAME LEVEL IT DID IN FY20, HOUSING INITIATIVES IN FY22 ARE ALREADY BEING FUNDED. AFFORDABILITY OF CARE CHRISTIANACARE'S FINANCIAL ASSISTANCE PROGRAM ALLOWS ELIGIBLE INDIVIDUALS TO RECEIVE MEDICALLY NECESSARY SERVICES AT NO COST OR AT A 15% STANDARD DISCOUNT. CHRISTIANACARE ALSO OFFERS THE HEALTH GUIDES PROGRAM. HEALTH GUIDES FUNCTION AS COLLABORATIVE, INTERDEPENDENT MEMBERS OF THE PRIMARY CARE PRACTICES AND ADVOCATES OF THEIR COMMUNITY BY SEEKING TO SUPPORT PRIMARILY UNINSURED, UNDERINSURED, AND UNDERREPRESENTED DELAWAREANS IN ALL ASPECTS OF HEALTH CARE. SERVING AS THE "BRIDGE" BETWEEN THE COMMUNITY AND HEALTH CARE PROVIDERS, HEALTH GUIDES PROVIDE ASSISTANCE WITH ACCESSING APPROPRIATE HEALTH CARE SERVICES, CONNECTING TO HEALTH INSURANCE AND FINANCIAL ASSISTANCE OPPORTUNITIES AS WELL AS TO COMMUNITY RESOURCES OUTSIDE THE HEALTH SYSTEM, AND PROVIDING HEALTH AND WELLNESS INFORMATION WITH A FOCUS ON PREVENTION. DURING THIS FISCAL YEAR THERE HAVE BEEN THREE PRIMARY OBJECTIVES FOR THE HEALTH GUIDE PROGRAM. FIRST, IDENTIFY FINANCIAL BARRIERS TO HEALTHCARE. THIS MAY INCLUDE CONNECTION TO MEDICAID, THE MARKETPLACE OR FINANCIAL ASSISTANCE PROGRAMS. SECOND, CONNECT TO HEALTHCARE SERVICES. THIS INCLUDES ANYTHING FROM FINDING A DOCTOR OR SPECIALTY SERVICE, TO HELPING SCHEDULE APPOINTMENTS. THREE, REFER PATIENTS TO COMMUNITY-BASED RESOURCES SUCH AS SOCIAL SUPPORT SERVICES, COMMUNITY-BASED PROGRAMMING, AND EDUCATION TO IMPROVE HEALTH AND WELLNESS. CHRISTIANACARE ALSO COLLECTED DEMOGRAPHIC DATA OF PATIENTS THAT HEALTH GUIDES SERVE TO BETTER UNDERSTAND THE POPULATION AND IDENTIFY NEEDS WITHIN SPECIFIC COMMUNITIES. THROUGHOUT THE PAST FISCAL YEAR, THE HEALTH GUIDES SERVED 1,964 UNIQUE PATIENTS. PATIENTS WERE 53 YEARS OLD ON AVERAGE; 41% WHITE, 31% BLACK/AFRICAN AMERICAN, 4% ASIAN/ASIAN AMERICAN, 13% IDENTIFIED AS OTHER RACE AND 11% EITHER DIDN'T KNOW THEIR RACE OR PREFERRED NOT TO DISCLOSE. THE MAJORITY WERE NON-HISPANIC (81%) AND FEMALE (57%). THE HEALTH GUIDES IDENTIFIED PATIENTS WITH FINANCIAL BARRIERS AND CONNECTED 35% OF PATIENTS TO HEALTH INSURANCE AND 20% TO FINANCIAL ASSISTANCE PROGRAMS. FOURTEEN PERCENT OF PATIENTS WERE CONNECTED TO HEALTHCARE SERVICES LIKE A PRIMARY CARE PROVIDER OR SPECIALTY CARE. FOR PATIENTS UNABLE TO PAY FOR THEIR MEDICATION (34%), HEALTH GUIDES ENROLLED THEM INTO PRESCRIPTION SAVINGS PROGRAMS. THE HEALTH GUIDES ALSO ASSISTED WITH CONNECTING PATIENTS TO HEALTH AND FINANCIAL EDUCATION 7%, FOOD PROGRAMING, 6% AND TRANSPORTATION, 1%. EDUCATION IN FY 21, CHIEF HEALTH EQUITY OFFICER BETTINA TWEARDY RIVEROS CONTINUED TO SERVE AS A BOARD MEMBER ON THE DELAWARE BUSINESS ROUNDTABLE EDUCATION COMMITTEE (DBREC) AND DBREC'S EXECUTIVE COMMITTEE, WHICH SEEKS TO IMPROVE PUBLIC EDUCATION IN DELAWARE BY AGGREGATING AND ALIGNING THE RESOURCES OF ROUNDTABLE MEMBERS AND OTHER BUSINESS LEADERS. SHE ALSO ASSUMED THE ROLE AS CHAIR OF THE VISION COALITION TEAM LEADERSHIP TEAM. THE VISION COALITION IS A PUBLIC-PRIVATE PARTNERSHIP COMPOSED OF A BROAD RANGE OF DELAWAREANS WORKING TOGETHER TO IMPROVE DELAWARE'S PUBLIC EDUCATION. CHRISTIANACARE FIRMLY BELIEVES THAT TO BE READY TO LEARN AND EXCEL IN SCHOOL, CHILDREN NEED TO BE HEALTHY, AND THAT REQUIRES ACCESS TO HEALTH CARE, PREVENTION, TREATMENT, AND EDUCATION. CHRISTIANACARE OPERATES 21 SCHOOL-BASED HEALTH CENTERS THROUGHOUT THE STATE. IN 2018, CHRISTIANACARE OPENED ITS FIRST SCHOOL-BASED HEALTH CENTER AT AN ELEMENTARY SCHOOL, WARNER ELEMENTARY IN THE CITY OF WILMINGTON. IN FY20, CHRISTIANACARE OPENED A SECOND SCHOOL-BASED HEALTH CENTER AT WARNER'S SISTER SCHOOL, SHORTLIDGE ELEMENTARY (K-2ND). BOTH SCHOOLS SERVE HIGH-NEED STUDENTS IN THE HEART OF WILMINGTON. THE STATE DOES NOT REIMBURSE FOR THE COSTS OF OPERATING THESE ELEMENTARY SCHOOL-BASED HEALTH CENTERS, AS IT DOES FOR HIGH SCHOOL SBHCS, BUT CHRISTIANACARE DETERMINED THAT THE COMMUNITY NEED WAS SIGNIFICANT AND IS OPERATING BOTH WARNER AND SHORTLIDGE SBHCS BASED ON OUR COMMITMENT TO MEET THAT COMMUNITY NEED. DURING THIS REPORTING YEAR, CHRISTIANACARE'S SCHOOL-BASED HEALTH CENTERS SERVED 13,636 STUDENTS.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	CHRISTIANACARE'S WORKFORCE PROGRAM AIMS TO EXPOSE HIGH SCHOOL SCHOLARS TO CAREERS IN HEALTH CARE. TYPICALLY, SCHOLARS ARE MISTAKEN IN THINKING THAT THE HEALTH SYSTEM IS PRIMARILY MADE UP OF PROFESSIONALS WEARING WHITE COATS AND/OR SCRUBS. THE PROGRAMMING PROVIDED BY WORK FORCE DEVELOPMENT SETS OUT TO CONFIRM THAT THOSE WEARING WHITE COATS AND SCRUBS ARE NOT THE ONLY PROFESSIONALS IN HEALTHCARE. THE WORK FORCE DEVELOPMENT PROGRAMMING EXPLORES CAREERS IN HEALTH CARE, AIMINGS TO BUILD SUCCESSFUL PARTNERSHIPS AND REDUCE ACHIEVEMENT GAPS. WE EXTEND OUR REACH TO HIGH SCHOOL STUDENTS, SPECIFICALLY THE SYSTEMICALLY OVERLOOKED MEMBERS OF OUR COMMUNITY, TO DEVELOP A PIPELINE FOR A WORKFORCE OF CAREGIVERS THAT REFLECT THE COMMUNITIES WE SERVE. THE WORKFORCE DEVELOPMENT PROGRAM HAS ESTABLISHED MEANINGFUL, LASTING PARTNERSHIPS IN THE COMMUNITY, INCLUDING BUT NOT LIMITED TO WILLIAM PENN HIGH SCHOOL, JOBS FOR DELAWARE GRADS, DELAWARE BIO, THE DEPARTMENT OF EDUCATION, COMMUNITIES IN SCHOOLS, THE DEPARTMENT OF LABOR/TEEN WAREHOUSE, AND THE NATIONAL HEALTH CAREER COLLABORATIVE. DURING FY21, THE WORKFORCE DEVELOPMENT PROGRAM HAS HAD CONSIDERABLE SUCCESSES DESPITE OPERATING DURING THE PANDEMIC. SOME HIGHLIGHTS WERE: - HOSTED THE BACK 2 BASICS VIRTUAL SESSION. THE PANDEMIC PUT A PAUSE ON CHRISTIANACARE'S IN-PERSON JOB SHADOWING OPPORTUNITIES, BUT BECAUSE CAREER PIPELINES AND PATHWAYS REMAIN THE FOUNDATION OF WORKFORCE DEVELOPMENT, WE CREATED VIRTUAL BACK 2 BASICS PROGRAMMING. VIRTUAL SESSIONS WERE HELD TWICE PER MONTH AND SCHOLARS WERE ABLE TO ATTEND A VIRTUAL CAREER FAIR WITH OPPORTUNITY TO ENGAGE AND HAVE ONE-ON-ONE GROUP DIALOGUE WITH HEALTH CARE PROFESSIONALS. - THE WINTER SESSION OF THE HEALTH CAREER COLLABORATIVE WENT VIRTUAL AND WAS COMPLETED IN MARCH 2021. A TOTAL OF 26 WILLIAM PENN HIGH SCHOOL ALLIED HEALTH STUDENTS ENROLLED INTO THE PROGRAM WITH 24 COMPLETING THE WINTER SERIES. - THE WORKFORCE DEVELOPMENT PROGRAM CREATED A MONTHLY NEWSLETTER. THE NEWSLETTER WAS DESIGNED TO KEEP SCHOLARS IN THE KNOW ABOUT COMMUNITY HAPPENINGS, INTRODUCE THEM TO A FEATURED HEALTH CARE PROFESSIONAL, SHARE POETRY, ART AND DESIGN AND PROVIDE A SPACE FOR THEM TO SHARE THEIR TALENTS AS WELL. WE HAD THE PRIVILEGE OF HAVING A PREVIOUS HEALTH CAREER COLLABORATIVE SCHOLAR (WHO WAS IN HIS FIRST YEAR OF COLLEGE AT THE UNIVERSITY OF PENNSYLVANIA) WRITE AN ARTICLE FOR THE NEWSLETTER. - IN OCTOBER 2020, WORKFORCE DEVELOPMENT COLLABORATED WITH THE TEEN WAREHOUSE FOR THE LEARNING FOR CAREERS GRANT FUNDED BY THE DEPARTMENT OF LABOR. CHRISTIANACARE IS PART OF THE EMPLOYEE GROUP FOR THE GRANT. THE GRANT WILL GIVE SCHOLARS AN OPPORTUNITY TO LEARN ABOUT CODING, HTML AND JAVA SCRIPT AND THEN VIRTUALLY SHADOW CHRISTIANACARE'S INNOVATION CENTER. THE SCHOLARS WILL WORK WITH CAREGIVERS AT THE INNOVATION CENTER TO SOLVE A TECHNICAL PROBLEM WITHIN THE HEALTH SYSTEM. OVER THE COURSE OF FY21, 93 STUDENTS WERE ENGAGED BY THE WORKFORCE DEVELOPMENT PROGRAM. WE ARE ALSO PROUD THAT 80 SCHOLARS IN THE FIRST ROUND OF THE WORK FORCE DEVELOPMENT PROGRAMMING HAVE STARTED THEIR FIRST YEAR OF COLLEGE AT SCHOOLS INCLUDING UNIVERSITY OF PENNSYLVANIA, NEUMANN UNIVERSITY AND DEL TECH. TRANSPORTATION IN THE 2016 CHNA, CHRISTIANACARE DECIDED NOT TO ADDRESS TRANSPORTATION AS A COMMUNITY NEED AS WE DID NOT HAVE THE ABILITY TO DO SO. IN 2020, WE BEGAN TO ADDRESS TRANSPORTATION NEEDS BY PARTNERING WITH ROUNDTRIP HEALTH TO PROVIDE CONVENIENT AND FREE TRANSPORTATION TO AND FROM MEDICAL SERVICES FOR THOSE PATIENTS WITH TRANSPORTATION BARRIERS. DURING FY21, THE USE OF ROUNDTRIP WAS SO SUCCESSFUL FOR THE PATIENTS AND CAREGIVERS THAT WE DECIDED TO EXPAND IT TO OTHER AREAS IN FY22. BETWEEN JULY 1, 2020 AND JUNE 30, 2021, 1,493 RIDES WERE GIVEN TO 206 UNIQUE PATIENTS. 2. MENTAL HEALTH AND SUBSTANCE USE DISORDER CHRISTIANACARE STRIVES TO PROVIDE PERSONALIZED AND EFFECTIVE TREATMENT FOR MENTAL HEALTH ILLNESSES AND SUBSTANCE USE DISORDERS. BELOW ARE BRIEF DESCRIPTIONS OF THE BEHAVIORAL HEALTH SERVICES OFFERED AT CHRISTIANACARE. PROJECT ENGAGE: AN EARLY INTERVENTION AND REFERRAL TO SUBSTANCE USE DISORDER TREATMENT PROGRAM DESIGNED TO HELP HOSPITAL PATIENTS WHO MAY BE STRUGGLING WITH ALCOHOL OR DRUG USE. PROJECT ENGAGE COLLABORATES WITH HOSPITAL STAFF TO IDENTIFY AND CONNECT PATIENTS WITH COMMUNITY-BASED TREATMENT PROGRAMS AND OTHER RESOURCES. PROJECT ENGAGE INTEGRATES PEERS IN RECOVERY INTO THE CLINICAL SETTING IN THE HOSPITAL TO MEET WITH PATIENTS AT THEIR BEDSIDE. ALONG WITH THE PATIENT AND HOSPITAL CLINICAL TEAM, PROJECT ENGAGE ALSO WORKS WITH TREATMENT PROVIDERS AND ENSURES TO HELP DEVELOP A DISCHARGE PLAN FOR EACH PATIENT. IN FY 21, PROJECT ENGAGE CONDUCTED 1,614 PATIENT ENGAGEMENTS. PROJECT RECOVERY: PROJECT RECOVERY OFFERS PROFESSIONAL TREATMENT FOR SUBSTANCE USE AND CO-OCCURRING DISORDERS. THE TEAM INCLUDES A PSYCHIATRIST, COUNSELORS, AND A SOCIAL WORKER WHO PERFORM A COMPLETE ASSESSMENT OF HEALTH AND SUBSTANCE USE. TOGETHER WITH THE PATIENT, A COMPREHENSIVE TREATMENT PLAN IS DEVELOPED THAT PUTS THEM ON THE PATH TO A SUBSTANCE-FREE LIFE. PROJECT RECOVERY OFFERS: INDIVIDUAL, GROUP, AND FAMILY THERAPY; MEDICATION-ASSISTED TREATMENT IN AN OFFICE-BASED SETTING; CASE MANAGEMENT; ONGOING CONSULTATION AND COORDINATION WITH DOCTORS OR OTHER PROVIDERS; AND SMOKING CESSATION. ADULT BRIDGE PROGRAM: OUR ADULT BRIDGE PROGRAM GIVES ADULTS RAPID ACCESS TO INDIVIDUALIZED EVALUATION, CARE PLANNING, AND THERAPY. WHEN APPROPRIATE, PATIENTS TRANSFER TO COMMUNITY BASED OR PRIMARY CARE PROVIDERS. EMBEDDED BEHAVIORAL HEALTH CONSULTANTS: CHRISTIANACARE'S INTEGRATED MODEL OF CARE EMBEDS MENTAL HEALTH PROFESSIONALS IN PRIMARY CARE PRACTICES. THIS PRACTICE ENABLES GREATER FOCUS ON WELLNESS, PREVENTION AND WHOLE PERSON CARE. CENTER FOR HOPE AND HEALING: THE CENTER FOR HOPE AND HEALING OFFERS SUPPORT TO PEOPLE IN OUR COMMUNITIES WHO ARE STRUGGLING WITH MENTAL, MEDICAL, AND SOCIAL HEALTH PROBLEMS. THE GOAL OF THE CENTER IS TO GIVE PATIENTS ACCESS TO PROVIDERS WHO CAN HELP STABILIZE THEIR HEALTH AND THEIR LIVES. SPECIALISTS WORK TOGETHER TO QUICKLY STABILIZE PATIENTS' HEALTH AND THEN PUT LONG-TERM SUPPORT IN PLACE WITH OTHER PROVIDERS AND PROGRAMS. THE CENTER OFFERS FLEXIBLE, RESPONSIVE CARE IN A RESPECTFUL, CARING, AND SUPPORTIVE SETTING. THIS FISCAL YEAR, THE CENTER FOR HOPE AND HEALING OPENED A SECOND LOCATION IN WILMINGTON. THIS NEW LOCATION INCORPORATES A PRIMARY CARE PRACTICE FOR THIS PATIENT POPULATION. BEHAVIORAL HEALTH UNIT: IN LATE 2018, CHRISTIANACARE REPLACED ITS INPATIENT BEHAVIORAL HEALTH UNIT AT WILMINGTON HOSPITAL WITH A NEW, EXPANDED FACILITY THAT PROVIDES STATE-OF-THE-ART MEDICAL AND BEHAVIORAL HEALTH CARE. THE NEW BEHAVIORAL HEALTH UNIT IS MORE THAN DOUBLE THE SIZE OF THE OLD SPACE AND INCLUDES FOUR PODS TO ADDRESS SPECIFIC NEEDS: GERIATRIC BEHAVIORAL HEALTH ISSUES, ACUTE BEHAVIORAL HEALTH ISSUES, A DUAL DIAGNOSIS OF BEHAVIORAL HEALTH AND SUBSTANCE USE DISORDER, AND BEHAVIORAL HEALTH/MEDICAL ISSUES. EACH POD HAS SELF-CONTAINED PROGRAMMING AND A DEDICATED NURSING STATION. COMPREHENSIVE PAIN CENTER: THE PAIN MANAGEMENT CENTER IS FOCUSED ON TREATING PAIN WITHOUT PRESCRIBING OPIOIDS. PROVIDERS ARE COMMITTED TO OFFERING THERAPIES FOCUSED ON ALLEVIATING PAIN WHILE SUPPORTING CHRISTIANACARE'S MISSION TO REDUCE DEPENDENCIES ON OPIOID MEDICATIONS. A MULTIMODAL, MULTIDISCIPLINARY PAIN TREATMENT STRATEGY FOCUSED ON IMPROVING FUNCTION IS UTILIZED. OPIOID WITHDRAWAL CLINICAL PATHWAY: CHRISTIANACARE'S OPIOID WITHDRAWAL CLINICAL PATHWAY WAS LAUNCHED IN NOVEMBER 2017 AND PROVIDES A MEDICAL ROADMAP TO HELP THE HOSPITAL CARE TEAM TO BETTER IDENTIFY PATIENTS AT RISK FOR OPIOID ADDICTION AND GUIDE THEM INTO EFFECTIVE TREATMENT. ALL PATIENTS ADMITTED TO THE HOSPITAL ARE SCREENED FOR POSSIBLE OPIOID WITHDRAWAL AND EVALUATED FOR APPROPRIATE DISCHARGE PLANNING TO A COMMUNITY PROVIDER.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	ADDICTION CONSULT SERVICE: INDIVIDUALS ADMITTED TO A CHRISTIANACARE HOSPITAL WITH COMPLEX COMORBIDITIES ARE PROVIDED WITH EXPERT CLINICAL INTERVENTION BY A TEAM OF MEDICAL PROFESSIONALS WITH SPECIALTIES IN ADDICTION MEDICINE. INDIVIDUALS ALSO RECEIVE TRAUMA FOCUSED PSYCHOLOGY SERVICES AT BEDSIDE. PSYCHIATRIC CRISIS TEAM: A GROUP OF SPECIALTY-TRAINED REGISTERED NURSES, PSYCHIATRIC SOCIAL WORKERS AND BEHAVIORAL HEALTH SPECIALISTS ARE AVAILABLE 24 HOURS A DAY FOR EMERGENCY RESPONSE TO THE MEDICAL UNITS. THE TEAM OFFERS IMMEDIATE INTERVENTION FOR THOSE IN CRISIS BECAUSE OF PSYCHIATRIC ILLNESS. CHRISTIANA CARE PSYCHIATRIC EMERGENCY SERVICES: CHRISTIANA CARE PSYCHIATRIC EMERGENCY SERVICES PROVIDES INTEGRATED MEDICAL AND PSYCHIATRIC EMERGENCY CARE THAT INCLUDES AN ASSESSMENT BY A MULTIDISCIPLINARY TEAM, CRISIS INTERVENTION AND OTHER URGENT MENTAL HEALTH SERVICES ON A 24-HOUR BASIS, SEVEN DAYS A WEEK. THE 10-BED PSYCHIATRIC EMERGENCY SERVICES AREA IS LOCATED ADJACENT TO THE EMERGENCY DEPARTMENT AT WILMINGTON HOSPITAL. AT CHRISTIANA HOSPITAL, PATIENTS RECEIVE THE SAME LEVEL OF EXCEPTIONAL CARE IN A 3-BED AREA, LOCATED WITHIN THE EMERGENCY DEPARTMENT AS WELL AS A 5-BED CO-MANAGED MEDICAL PSYCHIATRIC POD. CHRISTIANACARE ALSO CONTINUES TO ADDRESS BEHAVIORAL HEALTH NEEDS IN THE COMMUNITY. CHRISTIANACARE'S COMMUNITY SUBSTANCE OVERDOSE SUPPORT (SOS), EMPLOYS PEER ENGAGEMENT SPECIALISTS WHO ARE IN RECOVERY TO ENGAGE WITH INDIVIDUALS IN THEIR HOMES OR COMMUNITIES AFTER THEY HAVE BEEN BROUGHT TO THE HOSPITAL FOLLOWING A SUSPECTED OVERDOSE. THEY BEGIN A RELATIONSHIP WITH THESE INDIVIDUALS WITH THE GOAL OF GETTING THEM TO TREATMENT. COMMUNITY SOS ALSO OFFERS HARM REDUCTION EDUCATION TO THOSE WHO ARE NOT YET READY TO ENTER TREATMENT AND PROVIDES NALOXONE AND TRAINING ON ITS USE TO THOSE WITH SUBSTANCE USE DISORDER AND THEIR FRIENDS AND FAMILY. IN FY21, COMMUNITY SOS GAVE OUT 325 NALOXONE KITS TO INDIVIDUALS. COMMUNITY SOS PROVIDED INDIVIDUALS WITH NALOXONE KITS AFTER TRAINING THEM ON ITS USE WHILE STATIONED AT THE LATIN AMERICAN COMMUNITY CENTER AND KINGSWOOD COMMUNITY CENTER DURING THE COVID-19 TESTING WINDOWS. IN NOVEMBER 2021, CHRISTIANACARE LAUNCHED A PARTNERSHIP WITH NEW CASTLE COUNTY, WITH SIX CAREGIVERS WORKING AS EMBEDDED RESOURCES WITHIN THE NEW CASTLE COUNTY POLICE DEPARTMENT'S BEHAVIORAL HEALTH UNIT. FOUR OF THESE CAREGIVERS ENGAGE IN THE COMMUNITY WITH INDIVIDUALS WHO SUFFERED A NON-FATAL OVERDOSE AND PROVIDE THEM WITH A TREATMENT PLAN AND ONGOING CASE MANAGEMENT. THE OTHER TWO CAREGIVERS ACCOMPANY COUNTY POLICE WHEN RESPONDING TO 911 CALLS WHEN MENTAL HEALTH IS THOUGHT TO BE AN ISSUE. THE CAREGIVERS WILL ENSURE THE INDIVIDUAL'S MENTAL HEALTH NEEDS ARE ADDRESSED AS WELL AS PROVIDE THEM WITH CONNECTION TO CARE. 3. VIOLENCE AND PUBLIC SAFETY CHRISTIANACARE RECOGNIZES THAT VIOLENCE IS A PUBLIC HEALTH ISSUE AND DETERMINED THAT AS A HEALTH SYSTEM, IT WAS NECESSARY TO ADDRESS VIOLENCE HEAD ON BY IMPLEMENTING A HOSPITAL BASED VIOLENCE INTERVENTION PROGRAM (HVIP). THE HVIP WAS RENAMED "EMPOWERING VICTIMS OF LIVED VIOLENCE" (EVOLV) PRIOR TO ITS LAUNCH ON FEBRUARY 15, 2021. EVOLV WORKS WITH PATIENTS WHO HAVE SUFFERED A GUNSHOT WOUND, STAB WOUND, OR VIOLENT BLUNT ASSAULT, ARE RESIDENTS OF NEW CASTLE COUNTY, AND AGED 13 YEARS OR OLDER. EVOLV'S INITIAL FOCUS INCLUDED PATIENTS ADMITTED IN THE TRAUMA DEPARTMENT FOR A COMPLEX INJURY. THE EVOLV SOCIAL WORKER APPROACHED PATIENTS AT THE HOSPITAL TO INTRODUCE THE PROGRAM GOALS AND EXPLANATION OF SUPPORT. THE SOCIAL WORKER ENROLLS HOSPITALIZED PATIENTS AND PROVIDES A WARM HAND-OFF TO THE EVOLV COMMUNITY HEALTH WORKER (CHW) TO START THE RAPPORT BUILDING PROCESS AND PREPARE FOR THE COMMUNITY ENGAGEMENT PRIOR TO DISCHARGE. THE CHW ACTIVELY FOLLOWS PATIENTS AND SUPPORTS THEM BY PROVIDING THEM WITH ACCESS TO CARE, ADDRESSING ANY SOCIAL DETERMINANTS, AND IDENTIFYING AND ACHIEVING PATIENT CENTERED GOALS AND OUTCOMES. THE LENGTH OF ENGAGEMENT IS THREE MONTHS. CHRISTIANACARE COLLABORATED WITH THE STATE OF DELAWARE DURING FY21 AROUND THE ISSUE OF VIOLENCE. AS PART OF THIS COLLABORATIVE, EVOLV BEGAN ENGAGING WITH COMMUNITY ORGANIZATIONS THAT FOCUS ON VIOLENCE SUCH AS SOCIAL CONTRACT, COMMUNITY INTERVENTION TEAM (CIT), AND GROUP VIOLENCE INTERVENTION (GVI) WHICH EACH HAVE THEIR OWN UNIQUE APPROACH TO ADDRESSING THE GUN VIOLENCE ISSUE IN DELAWARE. CIT AND GVI ARE BOTH WILMINGTON BASED ORGANIZATIONS WITH A MIX OF COMMUNITY AND GOVERNMENTAL SUPPORT. IN FY21, CHRISTIANACARE CONTINUED TO PROVIDE EDUCATION TO YOUTH THROUGHOUT DELAWARE ABOUT VIOLENCE PREVENTION WITH THE CHOICE ROAD PROGRAM, WHICH URGES STUDENTS TO CONSIDER THE CHOICES THEY MAKE, AND A NEW PROGRAM THAT INTRODUCES STUDENTS TO THE CONCEPT OF GUN VIOLENCE AS A PUBLIC HEALTH ISSUE. IN ADDITION TO VIOLENCE PREVENTION, CHRISTIANACARE ALSO EDUCATES ADOLESCENTS AND ADULTS ABOUT SAFE CHOICES TO PREVENT INJURIES. THE TRAUMA TEAM ADAPTED TO HOLD MANY OF THESE SESSIONS VIRTUALLY AND CONTINUED TO BE A PRESENCE IN SCHOOLS AND SENIOR CENTERS DESPITE THE PANDEMIC. 4. MATERNAL AND CHILD HEALTH ESPECIALLY INFANT MORTALITY CHRISTIANACARE IS NOT ONLY WORKING TO IMPROVE THE INFANT MORTALITY RATE THROUGH PROGRAMS AIMED AT PREGNANT WOMEN SUCH AS HEALTHY BEGINNINGS, THE EMBEDDED CHWS IN WOMEN'S HEALTH DESCRIBED PREVIOUSLY, AND HEALTH AMBASSADORS, BUT ALSO BY ADDRESSING SOCIAL DETERMINANTS OF HEALTH. IN 2005, THE DELAWARE HEALTHY MOTHER AND INFANT CONSORTIUM (DHMIC) WAS FOUNDED BY THEN-GOVERNOR RUTH ANN MINNER TO IMPLEMENT RECOMMENDATIONS TO REDUCE INFANT MORTALITY AND RACIAL DISPARITIES THROUGHOUT THE STATE. CHRISTIANACARE HAS REMAINED A LEADER IN DHMIC AND IN THE COMMUNITY TO ADDRESS MATERNAL AND CHILD HEALTH. DR. DAVID PAUL, CHAIR OF PEDIATRICS, SERVES AS DHMIC'S CHAIR. CHRISTIANACARE REPRESENTATIVES ALSO SERVE ON THE FETAL INFANT MORTALITY REVIEW WHICH MEETS EACH YEAR TO CONDUCT A RESPECTIVE REVIEW OF THE HISTORY AND CIRCUMSTANCES SURROUNDING EACH CHILD'S DEATH OR NEAR DEATH IN DELAWARE. THE STATE OF DELAWARE CONTINUES TO DEMONSTRATE ITS CONFIDENCE IN CHRISTIANACARE BY AWARDING IT A GRANT TO SUPPORT THE HEALTH AMBASSADORS PROGRAM SINCE 2012. THE PROGRAM IS DESIGNED TO IMPROVE MATERNAL AND CHILD MORBIDITY AND MORTALITY THROUGH THE PROMOTION OF HEALTH BEFORE, DURING, AND AFTER PREGNANCY. IN FY 21, THE HEALTH AMBASSADORS ASSISTED AND WERE ABLE TO SUCCESSFULLY MEET THE NEEDS OF 3,212 INDIVIDUALS. THE STATE OF DELAWARE HAS ALSO PROVIDED CHRISTIANACARE WITH A GRANT TO OPERATE THE ALLIANCE FOR ADOLESCENTS PREGNANCY PREVENTION (AAPP) SINCE 1995. AAPP, WHICH OPERATES OUT OF CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT, WORKS TO REDUCE THE NUMBER OF TEENS WHO ARE SEXUALLY ACTIVE, BECOME PREGNANT, AND BECOME TEEN PARENTS THROUGH EDUCATIONAL PROGRAMMING OFFERED TO TEENS AND THEIR PARENTS. AAPP PROGRAMMING IS OFFERED THROUGHOUT THE STATE. AAPP OFFERED SIGNIFICANT CHALLENGES THIS YEAR DUE TO SCHOOL CLOSURES AND REMOTE LEARNING. NEVERTHELESS, IN FY21, AAPP PROVIDED EDUCATION TO 163 STUDENTS.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	SINCE 2018, CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT IN THE OFFICE OF HEALTH EQUITY HAS ALSO PROVIDED BOOT CAMP FOR NEW DADS (BCND) AND BOOT CAMP FOR NEW MOMS (BCNM). BCND PROVIDES COMMUNITY-BASED WORKSHOPS TO HELP NEW AND SOON TO BE DADS BECOME CONFIDENT IN THEIR ABILITY TO CARE FOR THEIR INFANTS, SUPPORT THEIR PARTNER, AND SUCCESSFULLY BECOME CAPABLE DADS. THESE WORKSHOPS ARE FOR DADS OF ALL AGES, CULTURES, AND ECONOMIC LEVELS. THE WORKSHOPS ARE CO-FACILITATED BY LOCAL DADS WHO WERE RECRUITED AND TRAINED BY CHRISTIANACARE. BCNM SEEKS TO PROVIDE INFORMATION ABOUT WHAT HAPPENS AFTER PREGNANCY, LABOR, AND DELIVERY. BCNM IS FOCUSED ON HELPING NEW MOMS HANDLE THE CHANGES IN HER LIFE AND THE RELATIONSHIP WITH HER PARTNER ONCE HER BABY HAS BEEN BORN. IN THIS REPORTING YEAR, 6 VIRTUAL SESSIONS WERE HELD FOR MOMS AND DADS. IN PARTNERSHIP WITH THE DELAWARE DIVISION OF PUBLIC HEALTH, CHRISTIANACARE'S HEALTHY BEGINNINGS PROGRAM BRINGS TOGETHER PRECONCEPTION CARE (WHICH IDENTIFIES AND ADDRESSES POTENTIAL RISKS TO FUTURE PREGNANCIES), PREGNANCY PLANNING (WHICH GUIDES THE WOMAN THROUGH THE FIRST STEPS THAT LAY THE GROUNDWORK FOR A HEALTHY PREGNANCY), AND PRENATAL CARE (WHICH ENSURES THE GOOD HEALTH OF MOTHER AND BABY FROM CONCEPTION TO BIRTH). THIS HOLISTIC APPROACH IS UNDERTAKEN BY A TEAM THAT INCLUDES DOCTORS, NURSE PRACTITIONERS, SOCIAL WORKERS, CASE WORKERS, RESOURCE MOTHERS, AND DIETICIANS, WORKING WITH THE MOTHER TO ASSIST HER IN HAVING A HEALTHY PREGNANCY AND INFANT. THE CHRISTIANACARE HEALTHY BEGINNINGS PROGRAM IS ALSO UTILIZING ROUNDTRIP TRANSPORTATION SERVICES TO ENSURE PATIENTS CAN ATTEND THEIR MEDICAL APPOINTMENTS. 5. ACCESS TO DENTAL AND PRIMARY CARE CHRISTIANACARE SUCCESSFULLY EXPANDED DENTAL SERVICES AT WILMINGTON HOSPITAL WITH THE COMPLETION OF A TWO-YEAR RENOVATION PROJECT IN FY20 THAT INCREASED THE CLINICAL CAPACITY OF OUR DENTISTRY AND ORAL-MAXILLOFACIAL SURGERY PRACTICES. THIS INCREASE ENABLES MORE THAN 5,000 ADDITIONAL VISITS PER YEAR AT ONE OF THE FEW ACCESS POINTS IN THE COMMUNITY FOR DENTAL CARE. CHRISTIANACARE IS EXPANDING PRIMARY CARE SERVICES TO SUPPORT IMPROVED ACCESS TO THE PREVENTIVE CARE AND CHRONIC DISEASE MANAGEMENT THAT HELPS PATIENTS TO BE HEALTHY AND AVOID COSTLY UNNECESSARY EMERGENCY ROOM VISITS AND HOSPITAL ADMISSIONS. CHRISTIANACARE WILL CONTINUE TO SEEK OPPORTUNITIES TO PLACE PROVIDERS AND STAFF IN COMMUNITY SETTINGS TO MEET PATIENT NEEDS AT CONVENIENT ACCESS POINTS. THIS IS NECESSARY BECAUSE THERE ARE BARRIERS TO ACCESSING CARE CAUSED BY TRANSPORTATION AND WORK SCHEDULES. WE AIM TO MEET THE NEEDS OF OUR NEIGHBORS IN THE COMMUNITY WHERE THEY LIVE, WORK, AND PLAY AS DEMONSTRATED BY OUR PREVIOUSLY DESCRIBED NEWLY ESTABLISHED PRACTICE AT KINGSWOOD COMMUNITY CENTER AND THE NEW CENTER FOR HOPE AND HEALING PRACTICE. IN FY 21, CHRISTIANACARE ALSO LAUNCHED A PRIMARY CARE PRACTICE EMBEDDED IN THE HELEN F. GRAHAM CANCER CENTER AND RESEARCH INSTITUTE. CHRISTIANACARE IS ONE OF THE FIRST CANCER PROGRAMS IN THE NATION TO OFFER PATIENTS UNDERGOING CANCER TREATMENTS THE OPPORTUNITY TO SEE A PRIMARY CARE PROVIDER ON-SITE. IN FY 21, CHRISTIANACARE ALSO ACQUIRED A PRACTICE, SU CENTRO DE SALUD WITH PRIMARY CARE AT KIRKWOOD , WHICH SERVES PATIENTS WITH SPANISH SPEAKING AND CULTURALLY COMPETENT PROVIDERS AND STAFF TO ENSURE THE HEALTH NEEDS OF HISPANIC COMMUNITY CAN BE MET. --------------------
PART V, SECTION B, LINE 13 (ELIGIBILITY FOR PROVIDING DISCOUNTED CARE)	FEDERAL POVERTY GUIDELINES ARE NOT USED TO DETERMINE DISCOUNTED CARE. A SELF-PAY DISCOUNT OF 15% IS APPLIED TO ALL UNINSURED PATIENT ACCOUNTS REGARDLESS OF INCOME. PATIENTS WITH INCOME IN EXCESS OF 200% WILL ONLY RECEIVE A 15% DISCOUNT. --------------------
PART V, SECTION B, LINE 16 (FINANCIAL ASSISTANCE POLICY AVAILABILITY)	A COPY OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY CAN BE ACCESSED AT: HTTPS://CHRISTIANACARE.ORG/PATIENTS/FINANCIAL-ASSISTANCE-PROGRAM/FINANCIAL -ASSISTANCE/ --------------------
PART V, SECTION B, LINE 20 (ADDITIONAL EFFORTS MADE BEFORE AN ECA)	CHRISTIANA CARE HEALTH SERVICES COMMUNICATES IN WRITING ABOUT COLLECTION PLACEMENT AND THE FINANCIAL ASSISTANCE POLICY. --------------------
PART V, SECTION B, LINE 22 (CHARGES FOR FAP-ELIGIBLE INDIVIDUALS)	FAP-ELIGIBLE INDIVIDUALS (THOSE WITH INCOME LESS THAN 200% OF FEDERAL POVERTY GUIDELINES) ARE NOT RESPONSIBLE FOR ANY CHARGES. --------------------

Schedule H (Form 990) 2020

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2020

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C (DES. OF ELIGIBILITY CRITERIA FOR FREE OR DISCOUNTED CARE)	CHRISTIANA CARE HEALTH SERVICES, INC.("CHRISTIANACARE") HAS A SELF PAY DISCOUNT PERCENTAGE OF 15% THAT IS APPLIED TO ALL UNINSURED PATIENTS' ACCOUNTS, REGARDLESS OF THE PERSON'S ABILITY TO PAY. THIS DISCOUNT PERCENTAGE IS COMPARABLE TO THAT WHICH IS EXTENDED TO OUR MANAGED CARE COMPANIES. -------------------- PART I, LINE 6A (COMMUNITY BENEFIT ANNUAL REPORT INFORMATION) CHRISTIANACARE HEALTH PREPARED A COMMUNITY HEALTH NEEDS ASSESSMENT AND A COMMUNITY HEALTH IMPLEMENTATION PLAN DURING THE FY2019 TAX YEAR. BOTH DOCUMENTS ARE AVAILABLE AT THE FOLLOWING LINK ON THE CCHS WEBSITE: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY- HEALTH-IMPLEMENTATION-PLAN/ -------------------- PART I, LINE 7 (BAD DEBT EXPENSE, COSTING METHODOLOGY USED) IMPLICIT PRICE CONCESSIONS ARE TREATED AS A CONTRA-REVENUE ITEM ON THE STATEMENT OF REVENUE. AS A RESULT, THERE ARE NO BAD DEBT EXPENSES INCLUDED ON FORM 990, PART IX THAT NEED TO BE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES LISTED. THE COSTING METHODOLOGY USED IN CALCULATING THE AMOUNTS REPORTED ON THE LINE 7 TABLE ARE BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. --------------------
PART III, SECTION A, LINE 2 (IMPLICIT PRICE CONCESSIONS/BAD DEBT EXPENSE)	THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 ARE BASED ON ACTUAL CHARGES WRITTEN OFF (AMOUNTS THAT ARE DEEMED TO BE UNCOLLECTIBLE AND RECORDED AS IMPLICIT PRICE CONCESSIONS UNDER ACCOUNTING PRONOUNCEMENT ASC 606). -------------------- PART III, SECTION A, LINE 3 (IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY) THE AMOUNT OF BAD DEBTS (IMPLICIT PRICE CONCESSIONS) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ITS FINANCIAL ASSISTANCE POLICY WAS CALCULATED BASED UPON THE NUMBER OF PRESUMED CHARITY-CARE ELIGIBLE PATIENTS WHO DID NOT COMPLETE THE FAP PAPERWORK DURING THE YEAR. -------------------- PART III, SECTION A, LINE 4 (IMPLICIT PRICE CONCESSION FOOTNOTE) THE TEXT OF THE IMPLICIT PRICE CONCESSION (BAD DEBT EXPENSE) FOOTNOTE CAN BE FOUND ON PAGE 15 OF THE ELECTRONICALLY ATTACHED AUDITED FINANCIAL STATEMENTS. --------------------
PART III, SECTION B, LINE 8 (COSTING METHODOLOGY, MEDICARE SHORTFALL)	THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 6 IS BASED ON A COST TO CHARGE RATIO. CONSISTENT WITH THE CHARITABLE HEALTHCARE MISSION OF CHRISTIANACARE AND THE COMMUNITY BENEFIT STANDARD SET FORTH IN IRS REVENUE RULING 69-545, CHRISTIANACARE PROVIDES CARE FOR ALL PATIENTS COVERED BY MEDICARE SEEKING MEDICAL CARE. SUCH CARE IS PROVIDED REGARDLESS OF WHETHER THE REIMBURSEMENT PROVIDED FOR SUCH SERVICES MEETS OR EXCEEDS THE COSTS INCURRED BY CHRISTIANACARE TO PROVIDE SUCH SERVICES. AS A RESULT, CHRISTIANA CARE VIEWS ANY SHORTFALL REPORTED IN LINE 7 AS AN ADDITIONAL ITEM OF COMMUNITY BENEFIT PROVIDED BY THE ORGANIZATION. -------------------- PART III, SECTION B, LINE 9B (COLLECTION PRACTICES) CHRISTIANACARE HAS A FINANCIAL ASSISTANCE POLICY THAT IDENTIFIES THE CIRCUMSTANCES FOR WHICH A RESPONSIBLE PARTY WOULD BE EXTENDED A 100% ADJUSTMENT ON ALL MEDICAL BILLS. THE GROSS INCOME THRESHOLD FOR THIS CHARITABLE ADJUSTMENT IS 200% OF THE FEDERAL POVERTY LEVEL AND IT IS BASED ON THE NUMBER OF DEPENDENTS IN THE HOUSEHOLD. THE FINANCIAL ASSISTANCE POLICY FURTHER EXPLAINS THAT ANY UNINSURED PATIENT WHO FAILS TO QUALIFY FOR FINANCIAL ASSISTANCE WOULD BE GRANTED A 15% SELF PAY DISCOUNT. IT ALSO REVEALS A PATIENT'S ABILITY TO ESTABLISH INTEREST-FREE MONTHLY PAYMENT ARRANGEMENTS FOR ANY OUTSTANDING BALANCE THAT IS NOT COVERED BY A THIRD PARTY PAYER. AS PART OF THE SELF PAY DUNNING PROCESS, CHRISTIANA CARE MAKES UNINSURED PATIENTS AWARE OF THE FINANCIAL ASSISTANCE PROGRAM WITH THE RELEASE OF OUR FIRST STATEMENT. FOR ALL SUBSEQUENT STATEMENTS, PATIENTS HAVE AN OPPORTUNITY TO CALL OUR CUSTOMER SERVICES DEPARTMENT IF THEY ARE UNABLE TO MAKE PAYMENT IN FULL. IF A PATIENT QUALIFIES FOR A CHARITABLE ADJUSTMENT, THEY ARE EXTENDED THE COURTESY OF AN AUTOMATIC ADJUSTMENT TO THEIR BILLS FOR THE NEXT YEAR AND FOR ONE YEAR PRIOR TO THE DATE A PATIENT'S APPLICATION IS APPROVED. PATIENTS WOULD NEED TO REAPPLY FOR CHARITABLE CONSIDERATION AFTER THE ONE YEAR HAS LAPSED. ALL COLLECTION ACTIONS WOULD CEASE ONCE A PATIENT IS DEEMED ELIGIBLE FOR CHARITY OR ONCE A PATIENT ESTABLISHES AND MAINTAINS A MONTHLY PAYMENT ARRANGEMENT. --------------------
PART VI, LINE 2 (NEEDS ASSESSMENT)	AT CHRISTIANACARE, WE ABIDE BY THE CHRISTIANACARE WAY: WE SERVE OUR NEIGHBORS AS RESPECTFUL, EXPERT, CARING PARTNERS IN THEIR HEALTH. WE DO THIS BY CREATING INNOVATIVE, EFFECTIVE, AFFORDABLE SYSTEMS OF CARE THAT OUR NEIGHBORS VALUE. CHRISTIANACARE IS GUIDED BY ITS COMMITMENT TO PARTNERING WITH OUR NEIGHBORS TO BETTER UNDERSTAND THEIR NEEDS AND GOALS FOR HEALTH. UNDERTAKING THE 2019 CHNA WAS NOT SIMPLY AN IRS REQUIREMENT FOR US, BUT RATHER AN OPPORTUNITY TO LISTEN TO OUR NEIGHBORS. OUR NEIGHBORS ARE IN THE BEST POSITION TO TELL US WHAT THEIR HEALTH NEEDS ARE AND HOW WE CAN ASSIST THEM IN MEETING THOSE NEEDS. OUR ASSESSMENT AND OUR IMPLEMENTATION PLAN WERE BUILT UPON THIS FOUNDATION. OUR ACTIONS MUST BE DIRECTED BY THE NEEDS OF THE COMMUNITY AND WHAT THEY WANT AS OPPOSED TO WHAT WE THINK THEY NEED OR WANT. LISTENING TO OUR NEIGHBORS AND PARTNERING WITH THEM TO ADDRESS THEIR CHALLENGES ARE STRATEGIES THAT CHRISTIANACARE WILL ALWAYS EMPLOY. THESE UNDERPIN ALL SUCCESSFUL INTERVENTIONS TO IMPROVE HEALTH, AND WE HOPE THAT OUR WORK AND PARTNERSHIPS IN FY21 DEMONSTRATED THIS COMMITMENT TO OUR NEIGHBORS. CHRISTIANACARE'S GREATER WILMINGTON COMMUNITY PARTNERSHIP, THE WILMINGTON CONSORTIUM, AND THE COMMUNITY ENGAGEMENT ADVISORY COUNCIL WERE FORMED TO HAVE DIRECT CONTACT WITH COMMUNITY LEADERS AND STAKEHOLDERS TO GAIN PERSPECTIVE AND GUIDANCE FROM THEM REGARDING OUR COMMUNITIES' NEEDS. CHRISTIANACARE ALSO COLLABORATES WITH PARTNERS TO BETTER UNDERSTAND AND ADDRESS PRESSING HEALTH CONCERNS IN OUR STATE. AS DESCRIBED IN THE PREVIOUS SECTION, CHRISTIANACARE PARTICIPATES IN THE FETAL INFANT MORTALITY REVIEW AND THE DELAWARE HEALTHY MOTHER AND INFANT CONSORTIUM TO DECREASE THE INFANT MORTALITY RATE. CHRISTIANACARE'S CHIEF HEALTH EQUITY OFFICER CO-CHAIRS THE REACH RIVERSIDE HEALTH, WELLNESS, AND SAFETY COMMITTEE. CHRISTIANACARE'S VICE PRESIDENT OF BEHAVIORAL HEALTH AND SOCIAL CARE INTEGRATION ALSO CO-CHAIRS THE DRUG OVERDOSE FATALITY REVIEW COMMISSION. AS DESCRIBED PREVIOUSLY, CHRISTIANACARE HAS ALSO TAKEN THE INNOVATIVE APPROACH TO PARTNER DIRECTLY WITH OUR COUNTY POLICE DEPARTMENT TO DIVERT INDIVIDUALS IN OUR COMMUNITIES SUFFERING FROM BEHAVIORAL HEALTH ISSUES FROM THE CRIMINAL JUSTICE SYSTEM AND INTO THE APPROPRIATE TREATMENT. MEMBERS OF THE TRAUMA TEAM ALSO PARTICIPATE IN THE DELAWARE COALITION FOR INJURY PREVENTION, SAFE KIDS DELAWARE, AND SAFE KIDS NEW CASTLE COUNTY, WHILE MEMBERS OF PARENT EDUCATION ALSO PARTICIPATE IN THE BLACK MATERNAL HEALTH AND BREASTFEEDING COALITIONS. WE ALSO RECOGNIZE THAT TO IMPROVE PATIENT HEALTH THERE IS A NEED TO IDENTIFY AND ADDRESS INDIVIDUAL PATIENTS' SDOH. ADDRESSING PATIENTS' SOCIAL NEEDS IN ADDITION TO PROVIDING CLINICAL CARE HAS BECOME A MAJOR PUBLIC HEALTH INITIATIVE AND IS A KEY COMPONENT OF OUR WORK AT CHRISTIANACARE TO CREATE AN INTEGRATED CLINICAL AND SOCIAL CARE FRAMEWORK. CHRISTIANACARE DEVELOPED ITS SYSTEMWIDE STANDARDIZED SDOH SCREENING TOOL THAT IS BEING UNIVERSALLY IMPLEMENTED THROUGHOUT CHRISTIANACARE. AS USE OF THE SCREENING TOOL IS EXPANDING, CHRISTIANACARE INTERNAL ACCESS TO UNITE DELAWARE IS ALSO INCREASING THROUGH INTEGRATION IN THE ELECTRONIC HEALTH RECORD. THESE ARE TWO VITALLY CONNECTED INITIATIVES BECAUSE WE FEEL STRONGLY THAT IF A PATIENT DISCLOSES A NEED, WE MUST BE PREPARED TO HELP THEM ADDRESS IT. UNITE DELAWARE ALLOWS US TO DO EXACTLY THAT THROUGH SOCIAL SERVICE REFERRALS TO A PLATFORM OF COMMUNITY-BASED ORGANIZATIONS. THESE ARE JUST SOME OF THE PARTNERSHIPS AND INITIATIVES CHRISTIANACARE HAS UNDERTAKEN TO LEARN FROM ITS COMMUNITY ABOUT ITS NEEDS. LISTENING TO OUR NEIGHBORS WILL BE AN ONGOING PRIVILEGE AND A COMMITMENT. --------------------
PART VI, LINE 3 (PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE)	CHRISTIANACARE FULFILLS ITS MISSION OF SERVING ITS NEIGHBORS AS RESPECTFUL, EXPERT, CARING PARTNERS IN THEIR HEALTH REGARDLESS OF A PATIENT'S ABILITY TO PAY. CHRISTIANACARE'S FINANCIAL ASSISTANCE POLICY IS DESIGNED TO PROVIDE RELIEF TO INDIVIDUALS IMPACTED BY THE HIGH COST OF HEALTHCARE. THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON CHRISTIANACARE'S WEBSITE AT: HTTPS://CHRISTIANACARE.ORG/PATIENTS/FINANCIAL-ASSISTANCE-PROGRAM/FINANCIAL -ASSISTANCE/, AND IN PAMPHLETS THROUGHOUT CHRISTIANACARE FACILITIES, INCLUDING CHRISTIANACARE'S OUTPATIENT PRACTICES. FINANCIAL ASSISTANCE APPLICATIONS ARE ALSO AVAILABLE IN SPANISH, CANTONESE, AND MANDARIN WHICH ARE THE LANGUAGES MOST SPOKEN IN CHRISTIANACARE'S SERVICE AREA BESIDES ENGLISH. TRANSLATION ASSISTANCE TO COMPLETE THE NECESSARY FORMS IS AVAILABLE FOR ANYONE NOT PROFICIENT IN READING, WRITING, OR SPEAKING ENGLISH. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE PROGRAM IS ALSO AVAILABLE ON OUR WEBSITE AT: HTTPS://CHRISTIANACARE.ORG/PATIENTS/FINANCIAL-ASSISTANCE-PROGRAM/. CHRISTIANACARE'S FINANCIAL ASSISTANCE POLICY APPLIES TO ALL MEDICALLY NECESSARY SERVICES, INCLUDING THE HOSPITAL INPATIENT, OUTPATIENT, AND EMERGENCY DEPARTMENT SERVICES THAT ARE BILLED BY CHRISTIANACARE, AS WELL AS ALL SERVICES RENDERED BY CHRISTIANACARE PHYSICIANS - INCLUDING DENTAL SERVICES THAT REQUIRE HOSPITALIZATION. MEDICALLY NECESSARY SERVICES ARE PROVIDED AT NO CHARGE TO INDIVIDUALS WHOSE HOUSEHOLD INCOME IS LESS THAN 200% OF THE FEDERAL POVERTY LEVEL AND WHO MEET OTHER FINANCIAL ASSISTANCE PROGRAM ELIGIBILITY REQUIREMENTS. UNINSURED INDIVIDUALS WITH A HOUSEHOLD INCOME GREATER THAN 200% OF THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR A STANDARD DISCOUNT OF 15%. IF AN INDIVIDUAL NEEDS ASSISTANCE IN OBTAINING FINANCIAL ASSISTANCE, BESIDES PATIENT FINANCIAL SERVICES REPRESENTATIVES, THE HEALTH GUIDES ARE ALSO AVAILABLE TO PROVIDE INFORMATION AND ASSIST. --------------------
PART VI, LINE 4 (COMMUNITY INFORMATION)	WHILE CHRISTIANACARE PROVIDES SERVICES IN FOUR STATES, NEARLY 80% OF WILMINGTON AND CHRISTIANA HOSPITAL DISCHARGES ARE TO NEW CASTLE COUNTY, DELAWARE, AND SO WE CONSIDER THE CHRISTIANACARE COMMUNITY TO BE PRIMARILY NEW CASTLE COUNTY. THE POPULATION OF NEW CASTLE COUNTY REPRESENTS CONSIDERABLE VARIATION IN SOCIOECONOMIC STATUS. FOR EXAMPLE, THE POVERTY RATE IN ZIP CODE 19801 (WHERE WILMINGTON HOSPITAL IS LOCATED) IS APPROXIMATELY 37% WHILE THE POVERTY RATE IN ZIP CODE 19701 IS UNDER 5%. BECAUSE OF THAT VARIATION, THE 2019 CHNA ASSESSED COMMUNITY HEALTH NEEDS IN TWO GEOGRAPHIC AREAS: "COMMUNITY 1" (ZIP CODES 19801, 19802, 19804, 19805, AND 19720) AND "COMMUNITY 2" (ALL OTHER ZIP CODES). THE DISTINCTION WAS MADE BETWEEN THESE TWO COMMUNITIES TO ENSURE THAT THE BARRIERS TO HEALTH FACED BY COMMUNITY 1 WOULD NOT BE OVERLOOKED WHEN CONSIDERING NEW CASTLE COUNTY AS A WHOLE. THE TOTAL POPULATION OF NEW CASTLE COUNTY IN 2018 WAS APPROXIMATELY 556,000 PERSONS, WITH COMMUNITY 1 COMPRISED OF APPROXIMATELY 162,000 PERSONS, AND COMMUNITY 2 COMPRISED OF 394,000 PERSONS. THE COUNTY'S POPULATION IS EXPECTED TO GROW 3.4 PERCENT FROM 2018 TO 2023; EVERY ZIP CODE IN NEW CASTLE COUNTY IS PROJECTED TO INCREASE IN POPULATION. THE POPULATION 65 YEARS OF AGE AND OLDER IS ANTICIPATED TO GROW AT A MUCH HIGHER RATE OF 19.2 PERCENT. NOTABLE DIFFERENCES BETWEEN COMMUNITY 1 AND COMMUNITY 2 INCLUDE THE FOLLOWING: - COMMUNITY 1 HAS A MUCH HIGHER "PERCENT RACIAL/ETHNIC MINORITY" THAN COMMUNITY 2. - THE PERCENT OF RESIDENTS IN POVERTY AND CONSIDERED LOW INCOME IN COMMUNITY 1 IS ABOUT DOUBLE THE PERCENT FOR COMMUNITY 2. - RESIDENTS OF COMMUNITY 1 ARE MORE LIKELY TO BE UNINSURED AND TO HAVE LIMITED ENGLISH PROFICIENCY. - HIGH SCHOOL GRADUATION RATES ALSO HAVE BEEN MUCH LOWER IN COMMUNITY 1 THAN IN COMMUNITY 2. MORE DETAILED INFORMATION ON THE DEMOGRAPHICS OF CHRISTIANA CARE'S SERVICE AREA POPULATION CAN BE FOUND WITHIN ITS CHNA AT: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY-HEALT H-NEEDS-ASSESSMENT/ -------------------- --------------------
PART VI, LINE 5 (INFORMATION REGARDING PROMOTION OF COMMUNITY HEALTH)	CHRISTIANACARE'S MISSION IS TO SERVE OUR NEIGHBORS AS EXPERT, CARING, PARTNERS IN THEIR HEALTH. WE DO THIS BY CREATING INNOVATIVE, EFFECTIVE AFFORDABLE, SYSTEMS OF CARE THAT OUR NEIGHBORS VALUE. WE ARE COMMITTED TO FULFILLING OUR MISSION OF SERVICE TO OUR NEIGHBORS. AS THE LARGEST HEALTH CARE PROVIDER IN A STATE THAT HAS NO SAFETY NET OR PUBLIC HOSPITAL, WE SERVE A SIGNIFICANT PORTION OF THE COMMUNITY'S UNINSURED AND UNDERINSURED POPULATION ALONG WITH A SUBSTANTIAL PORTION OF THE STATE'S MEDICAID POPULATION. IN DEMONSTRATION OF OUR COMMITMENT TO SERVING OUR NEIGHBORS, IN JULY 2019, CHRISTIANACARE ENTERED INTO AGREEMENTS WITH DELAWARE'S TWO LARGEST MEDICAID PAYORS TO WORK WITH BENEFICIARIES IN POPULATION HEALTH CONTRACTS. IN APRIL 2021, CHRISTIANACARE AND HIGHMARK HEALTH ANNOUNCED A JOINT VENTURE THAT WILL CREATE A NEW MODEL OF VALUE-BASED CARE THAT IS CONTINUOUS, AND DATA AND TECHNOLOGY LED. THIS IS PROBLEM-SOLVING DESIGNED TO TAKE COST AND INEFFICIENCIES OUT OF THE SYSTEM. CHRISTIANACARE INCLUDES AN EXTENSIVE NETWORK OF OUTPATIENT SERVICES, HOME HEALTH CARE, URGENT CARE CENTERS, THREE HOSPITALS (1,435 BEDS), FREE-STANDING EMERGENCY DEPARTMENT, A LEVEL I TRAUMA CENTER AND A LEVEL III NEONATAL INTENSIVE CARE UNIT, A COMPREHENSIVE STROKE CENTER AND REGIONAL CENTERS OF EXCELLENCE IN HEART AND VASCULAR CARE, CANCER CARE AND WOMEN'S HEALTH. IT ALSO INCLUDES THE PIONEERING GENE EDITING INSTITUTE. CHRISTIANACARE IS A NONPROFIT TEACHING HEALTH SYSTEM WITH MORE THAN 260 RESIDENTS AND FELLOWS. WE ARE CONTINUALLY RANKED BY US NEWS & WORLD REPORT AS A BEST HOSPITAL AND THIS FISCAL YEAR, RANKED BY FORBES AS THE 5TH BEST HEALTH SYSTEM TO WORK FOR IN THE UNITED STATES. WITH OUR UNIQUE, DATA-POWERED CARE COORDINATION SERVICE CAREVIOTM AND A FOCUS ON POPULATION HEALTH AND VALUE-BASED CARE, AS DEMONSTRATED THROUGH OUR JOINT VENTURE WITH HIGHMARK, CHRISTIANACARE IS SHAPING THE FUTURE OF HEALTH CARE. CHRISTIANACARE ALSO PROVIDES SERVICES THAT DELAWAREANS CANNOT FIND ELSEWHERE IN THE STATE SUCH AS AN EPILEPSY MONITORING UNIT, A COMPREHENSIVE PAIN CENTER (WHICH OFFERS EFFECTIVE, NON-OPIOID PAIN TREATMENT STRATEGIES FOR INDIVIDUALS WITH ACUTE AND CHRONIC PAIN), KIDNEY TRANSPLANTS, A LEVEL 2 PEDIATRIC EMERGENCY CARE FACILITY, CAR-T CELL THERAPY, A NEW BREAKTHROUGH TREATMENT FOR HIGHLY RESISTANT B-CELL BLOOD CANCERS, AND PROSTATE EMBOLIZATION (A MINIMALLY INVASIVE OUTPATIENT PROCEDURE PERFORMED BY VASCULAR INTERVENTIONAL RADIOLOGISTS). CHRISTIANACARE ALSO LAUNCHED THE FIRST YOUNG ADULT SURVIVORSHIP TRANSITION PROGRAM IN DELAWARE TO HELP ADOLESCENT AND YOUNG ADULT CANCER SURVIVORS AGED 18 TO 39 TO STAY HEALTHY AFTER CHILDHOOD CANCER. MANY CANCER SURVIVORS HAVE UNMET HEALTH NEEDS BECAUSE OF THEIR TREATMENTS. SIGNIFICANT AND DIVERSE RESEARCH IS ALSO HAPPENING AT CHRISTIANACARE. DURING THE COVID-19 PANDEMIC IN 2020, THERE WAS A 34% INCREASE IN ALCOHOL WITHDRAWAL RATES AMONG HOSPITALIZED PATIENTS AT CHRISTIANACARE, ACCORDING TO A RESEARCH LETTER PUBLISHED IN THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. THIS STUDY IS BELIEVED TO BE THE FIRST TO QUANTIFY THE IMPACT OF THE COVID-19 PANDEMIC ON ALCOHOL WITHDRAWAL AMONG HOSPITALIZED PATIENTS. IN BREAKTHROUGH COLON CANCER RESEARCH, SCIENTISTS AT CHRISTIANACARE'S HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE HAVE DISCOVERED A LINK BETWEEN TWO KEY SIGNALING PATHWAYS CRUCIAL TO THE DEVELOPMENT AND GROWTH OF COLON CANCER. THE STUDY IS PUBLISHED IN THE JOURNAL PLOS ONE. CHRISTIANACARE IS ALSO PROUD OF ITS INSTITUTE FOR RESEARCH ON EQUITY AND COMMUNITY HEALTH (IREACH), AN EMBEDDED HEALTH RESEARCH INSTITUTE THAT CONDUCTS APPLIED RESEARCH FOCUSED ON ISSUES OF EQUITY AND COMMUNITY HEALTH, POPULATION HEALTH, AND VIRTUAL HEALTH, AND ALSO TRAINS THE NEXT GENERATION OF CLINICAL SCIENTISTS. THE GOAL IS TO BRIDGE THE GAP BETWEEN CLINICAL AND TRANSLATIONAL RESEARCH, ADVANCEMENTS IN THE QUALITY OF CARE, AND IMPROVED POPULATION HEALTH OUTCOMES FOR ALL. CHRISTIANACARE INNOVATIVELY SERVES ITS COMMUNITY THROUGH CAREVIO, AN AWARD-WINNING CARE MANAGEMENT ORGANIZATION SERVING INDIVIDUALS WITH ACUTE, CHRONIC AND COMPLEX HEALTH CARE NEEDS. CAREVIO EARNED ACCREDITATION IN TWO AREAS - CASE MANAGEMENT AND POPULATION HEALTH PROGRAM - THIS FISCAL YEAR FROM THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA), A PRIVATE, NONPROFIT ORGANIZATION DEDICATED TO IMPROVING HEALTH CARE QUALITY. CAREVIO IS THE FIRST NON-HEALTH-PLAN POPULATION HEALTH MANAGEMENT ORGANIZATION IN DELAWARE TO RECEIVE NCQA ACCREDITATION FOR CASE MANAGEMENT AND POPULATION HEALTH. CAREVIO IS A ROBUST INFORMATION TECHNOLOGY PLATFORM THAT HARNESSES REAL-TIME HEALTH DATA FROM ALL AVAILABLE SOURCES. IT USES A PREDICTION ANALYTICS ENGINE TO COORDINATE CARE, IDENTIFY POPULATIONS MOST AT-RISK AND HELP PREVENT THE NEED FOR HOSPITALIZATIONS AND EMERGENCY DEPARTMENT VISITS THROUGH PREVENTIVE CARE AND HOME CARE. CAREVIO HAS NURSE CARE COORDINATORS, SOCIAL WORKERS, CLINICAL PHARMACISTS, RESPIRATORY THERAPISTS, AND MEDICAL DIRECTORS WHO CONNECT WITH PATIENTS BY PHONE, VIDEO, IN-PERSON VISITS, SECURE TEXTS AND E-MAIL TO HELP THEM MANAGE THEIR HEALTH CARE. CHRISTIANACARE IS A FOUNDING PARTNER IN EBRIGHTHEALTH ACO, AN ACCOUNTABLE CARE ORGANIZATION THAT SERVES APPROXIMATELY 50,000 REGIONAL MEDICARE BENEFICIARIES FROM DELAWARE, PENNSYLVANIA, AND MARYLAND. CAREVIO ALSO PROVIDES THE CARE COORDINATION FOR THIS INITIATIVE. CHRISTIANACARE SUPPORTS THE FIRST STATE SCHOOL LOCATED AT WILMINGTON HOSPITAL IN PARTNERSHIP WITH THE RED CLAY CONSOLIDATED SCHOOL DISTRICT AND THE DELAWARE DEPARTMENT OF EDUCATION. CHILDREN AND ADOLESCENTS FROM KINDERGARTEN THROUGH HIGH SCHOOL, WHO WOULD TYPICALLY BE HOMEBOUND WITH SERIOUS ILLNESSES SUCH AS DIABETES, SICKLE-CELL ANEMIA, SEVERE ASTHMA, CANCER, AND ILLNESSES ATTEND SCHOOL WITH THEIR PEERS WHILE RECEIVING NEEDED MEDICAL TREATMENT. THIS PROGRAM IS ONLY ONE OF THREE IN OPERATION NATIONWIDE, AND IT HAS BEEN A STAPLE OF CHRISTIANACARE'S COMMUNITY PROGRAMS SINCE IT BEGAN SERVING ADOLESCENTS IN 1985 AND EXPANDED TO SERVE ELEMENTARY STUDENTS IN 1991. CHRISTIANACARE IS ALSO A MAJOR TEACHING HOSPITAL. CHRISTIANACARE PARTNERS WITH LEADING COLLEGES AND UNIVERSITIES IN THE REGION TO OFFER A ROBUST NURSING EDUCATION PROGRAM AND WITH LOCAL TECHNICAL COLLEGES TO PROVIDE CLINICAL TRAINING FOR TECHNICAL HEALTHCARE CAREERS. CHRISTIANACARE IS COMMITTED TO INSTILLING IN THE STUDENTS IT TEACHES AND MENTORS THE IMPORTANCE OF OUR COMMUNITY'S HEALTH AND WELL-BEING, AND THE NEED TO CONSIDER THE SOCIAL DETERMINANTS OF HEALTH IN ALL WE DO. FINALLY, CHRISTIANACARE IS CONSISTENTLY RECOGNIZED FOR ITS GOOD WORKS THROUGH THE RECEIPT OF NUMEROUS NATIONAL AWARDS. DURING THIS REPORTING PERIOD: - CHRISTIANACARE WAS RECOGNIZED FOR THE 3RD YEAR IN A ROW AMONG THE WORLD'S BEST HOSPITALS BY NEWSWEEK. THE AMERICAN HOSPITAL ASSOCIATION'S INSTITUTE FOR DIVERSITY AND HEALTH EQUITY ALSO NAMED CHRISTIANACARE A 2021 CAROLYN BOONE LEWIS EQUITY OF CARE AWARD HONOREE. THE CAROLYN BOONE LEWIS EQUITY OF CARE AWARD IS AN ANNUAL RECOGNITION OF OUTSTANDING EFFORTS AMONG HOSPITALS AND HEALTH CARE SYSTEMS TO ADVANCE EQUITY OF CARE TO ALL PATIENTS AND TO SPREAD LESSONS LEARNED AND PROGRESS TOWARD DIVERSITY, INCLUSION, AND HEALTH EQUITY. - FORBES MAGAZINE ALSO RANKED CHRISTIANACARE AS ONE OF THE BEST EMPLOYERS FOR DIVERSITY AND INCLUSION IN THE UNITED STATES IN ITS LIST OF BEST EMPLOYERS FOR DIVERSITY 2021. - FOR ITS OUTSTANDING PATIENT PARTICIPATION RATE IN CANCER CLINICAL TRIALS, CHRISTIANACARE'S HELEN F. GRAHAM CANCER CENTER AND RESEARCH INSTITUTE HAS EARNED TOP NATIONAL RANKINGS FROM SEVERAL ORGANIZATIONS OF THE NATIONAL CANCER INSTITUTE. CHRISTIANACARE'S PATIENT PARTICIPATION RATE INTO CANCER CLINICAL TRIALS EACH YEAR IS NEARLY 30% - MORE THAN SEVEN TIMES THE NATIONAL AVERAGE OF 4%. - CHRISTIANACARE EARNED HEALTHGRADES 2021 AMERICA'S 50 BEST HOSPITALS AWARDT AND IS AMONG THE TOP 1 PERCENT OF MORE THAN 4,500 HOSPITALS ASSESSED NATIONWIDE FOR ITS CONSISTENT, YEAR-OVER-YEAR SUPERIOR CLINICAL PERFORMANCE. - CHRISTIANACARE HAS BEEN HONORED AS ONE OF ONLY 89 INSTITUTIONS OUT OF 722 BY THE AMERICAN COLLEGE OF SURGEONS (ACS) CLINICAL CONGRESS FOR ACHIEVING "MERITORIOUS" OUTCOMES IN SURGICAL PATIENT CARE. CHRISTIANACARE'S GOVERNING BODY, ITS BOARD OF DIRECTORS, IS COMPRISED PRIMARILY OF PERSONS WHO RESIDE IN ITS PRIMARY SERVICE AREA, AND MOST OF THE BOARD MEMBERS ARE NOT EMPLOYEES, FAMILY MEMBERS OF EMPLOYEES, OR INDEPENDENT CONTRACTORS OF CHRISTIANACARE. AS DESCRIBED IN THE CHNA AND CHIP, CHRISTIANACARE FINANCIALLY SUPPORTS IMPROVEMENTS IN ACCESSING CARE, COMMUNITY OUTREACH, IMPROVING THE CARE AND OVERALL HEALTH OF OUR NEIGHBORS, AND CONTINUING TO SUPPORT MEDICAL EDUCATION AND RESEARCH. --------------------
PART VI, LINE 6 (AFFILIATED HEALTHCARE SYSTEM INFORMATION)	CHRISTIANA CARE IS A MAJOR TEACHING HEALTH SYSTEM WITH MORE THAN 1,600 MEDICAL-STAFF MEMBERS AND 260 MEDICAL-DENTAL RESIDENTS AND FELLOWS. MAJOR FACILITIES INCLUDE: - CHRISTIANA HOSPITAL-STANTON CAMPUS: LOCATED IN NEWARK, DELAWARE, THIS CAMPUS IS HOME TO THE 1039 LICENSED BED CHRISTIANA HOSPITAL, THE CHRISTIANA CARE CENTER FOR HEART & VASCULAR HEALTH, THE HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE, THE CHRISTIANA CARE BREAST CENTER, THE CHRISTIANA SURGICENTER, AND THE JOHN H. AMMON MEDICAL EDUCATION CENTER. CHRISTIANA HOSPITAL IS ALSO THE STATE'S ONLY HIGH RISK DELIVERY HOSPITAL FEATURING A LEVEL III NEONATAL INTENSIVE CARE UNIT. CHRISTIANA HOSPITAL IS ALSO A LEVEL I TRAUMA CENTER. - WILMINGTON HOSPITAL CAMPUS: LOCATED IN THE HEART OF THE CITY OF WILMINGTON, THIS CAMPUS INCLUDES THE 321 LICENSED BED WILMINGTON HOSPITAL, THE ROCCO A. ABESSINIO FAMILY WILMINGTON HOSPITAL HEALTH CENTER, THE CENTER FOR REHABILITATION, THE CENTER FOR ADVANCED JOINT REPLACEMENT, THE WILMINGTON ANNEX, THE SWANK MEMORY CENTER, THE FIRST STATE SCHOOL, AND THE ROXANA CANNON ARSHT SURGICENTER. WILMINGTON HOSPITAL IS A LEVEL III TRAUMA CENTER. - MIDDLETOWN EMERGENCY DEPARTMENT: CHRISTIANA CARE FACILITIES ALSO INCLUDE AN EMERGENCY DEPARTMENT FACILITY IN MIDDLETOWN, DELAWARE, THAT SERVES THE MIDDLETOWN, ODESSA AND TOWNSEND, DELAWARE POPULATIONS ON A 24-7 BASIS. THE FACILITY CONTAINS 18 TREATMENT ROOMS, AND IS AVAILABLE TO SERVE MANY OF THE FREQUENT EMERGENCY CARE NEEDS OF THE LOCAL COMMUNITY. - AFFINITY HEALTH ALLIANCE, INC. IS AN AFFILIATED HEALTH CARE SYSTEM WHICH INCLUDES A NUMBER OF HEALTHCARE RELATED ENTITIES, INCLUDING: UNION HOSPITAL OF CECIL COUNTY, INC., UNION HOSPITAL OF CECIL COUNTY FOUNDATION, INC., UNION HOSPITAL OF CECIL COUNTY HEALTH SERVICES, INC., AND UNION HOSPITAL OF CECIL COUNTY ONCOLOGY, INC. --------------------
PART VI, LINE 7 (STATES FILING OF COMMUNITY BENEFIT REPORT)	DELAWARE DOES NOT REQUIRE THE FILING OF A COMMUNITY BENEFIT REPORT. IN THE INTEREST OF SHARING INFORMATION ABOUT ITS COMMUNITY BENEFIT WITH ITS NEIGHBORS, CHRISTIANACARE HAS ESTABLISHED A COMMUNITY BENEFIT DEDICATED SECTION ON ITS WEBSITE WHERE THE CHNA AND CHIP CAN BE FOUND, ALONG WITH ARTICLES ABOUT CHRISTIANACARE'S COMMUNITY BENEFIT INITIATIVES AND STORIES. THIS GROWING COLLECTION OF STORIES CAN BE ACCESSED AT: https://news.christianacare.org/category/in-the-community/community-benefi t. --------------------

Schedule H (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow

Attach to Form 990.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2020

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1FREDERIC T HARAD MD MEMBER	(i) (ii)	696,424 ------------- 0	65,250 ------------- 0	42,000 ------------- 0	18,525 ------------- 0	19,869 ------------- 0	842,068 ------------- 0	0 ------------- 0
2JANICE E NEVIN MD PRESIDENT & CEO	(i) (ii)	1,219,968 ------------- 0	411,174 ------------- 0	156,864 ------------- 0	178,646 ------------- 0	13,274 ------------- 0	1,979,926 ------------- 0	152,113 ------------- 0
3JENNIFER L SCHWARTZ ESQ CORPORATE SECRETARY	(i) (ii)	476,416 ------------- 0	114,452 ------------- 0	0 ------------- 0	62,881 ------------- 0	19,869 ------------- 0	673,618 ------------- 0	0 ------------- 0
4JOSEPH BENNETT MD MEMBER	(i) (ii)	553,258 ------------- 0	60,779 ------------- 0	11,000 ------------- 0	17,100 ------------- 0	19,869 ------------- 0	662,006 ------------- 0	0 ------------- 0
5KENNETH SILVERSTEIN MD CHIEF PHYSICIAN EXECUTIVE	(i) (ii)	727,596 ------------- 0	175,162 ------------- 0	790 ------------- 0	88,590 ------------- 0	19,869 ------------- 0	1,012,007 ------------- 0	0 ------------- 0
6KIRK N GARRATT MD MEDICAL DIRECTOR, HEART/VASC	(i) (ii)	677,549 ------------- 0	130,491 ------------- 0	46,978 ------------- 0	18,525 ------------- 0	6,852 ------------- 0	880,395 ------------- 0	0 ------------- 0
7LISA MAXWELL MD PRESIDENT, MEDICAL GROUP	(i) (ii)	373,713 ------------- 0	76,199 ------------- 0	0 ------------- 0	20,050 ------------- 0	19,869 ------------- 0	489,831 ------------- 0	0 ------------- 0
8MICHAEL EPPEHIMER MD PRES. MED GROUP (THRU 10/2020)	(i) (ii)	440,725 ------------- 0	77,097 ------------- 0	106,514 ------------- 0	19,950 ------------- 0	15,351 ------------- 0	659,637 ------------- 0	91,107 ------------- 0
9NEIL JASANI MD CHIEF PEOPLE OFFICER	(i) (ii)	524,109 ------------- 0	115,482 ------------- 0	23,763 ------------- 0	64,718 ------------- 0	19,869 ------------- 0	747,941 ------------- 0	27,686 ------------- 0
10NICHOLAS J PETRELLI MD MEDICAL DIRECTOR, CANCER	(i) (ii)	633,053 ------------- 0	121,921 ------------- 0	35,826 ------------- 0	20,050 ------------- 0	11,747 ------------- 0	822,597 ------------- 0	0 ------------- 0
11PAUL K DAVIS MD CARDIAC SURGEON	(i) (ii)	775,895 ------------- 0	84,488 ------------- 0	0 ------------- 0	18,525 ------------- 0	19,869 ------------- 0	898,777 ------------- 0	0 ------------- 0
12RAAFAT ABDEL-MISIH MD ONCOLOGY SURGEON	(i) (ii)	715,176 ------------- 0	77,478 ------------- 0	954 ------------- 0	20,050 ------------- 0	11,747 ------------- 0	825,405 ------------- 0	0 ------------- 0
13RANDALL GABORIAULT CHIEF INFORMATION OFFICER	(i) (ii)	591,893 ------------- 0	143,754 ------------- 0	0 ------------- 0	77,452 ------------- 0	20,093 ------------- 0	833,192 ------------- 0	0 ------------- 0
14RAY A BLACKWELL MD CHIEF CARDIAC SURGERY	(i) (ii)	743,981 ------------- 0	86,521 ------------- 0	0 ------------- 0	19,950 ------------- 0	19,869 ------------- 0	870,321 ------------- 0	0 ------------- 0
15RICHARD CUMING CHIEF NURSING EXECUTIVE	(i) (ii)	499,955 ------------- 0	117,505 ------------- 0	0 ------------- 0	64,102 ------------- 0	11,747 ------------- 0	693,309 ------------- 0	0 ------------- 0
16ROBERT MCMURRAY CFO, TREASURER & ASS'T SEC'Y	(i) (ii)	635,123 ------------- 0	137,462 ------------- 0	0 ------------- 0	74,935 ------------- 0	19,869 ------------- 0	867,389 ------------- 0	0 ------------- 0
17SHARON KURFUERST SYSTEM CHIEF OPERATING OFFICER	(i) (ii)	514,901 ------------- 0	106,252 ------------- 0	0 ------------- 0	58,239 ------------- 0	19,869 ------------- 0	699,261 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2020

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
FORM 990, SCHEDULE J, PART I, LINE 1A	DETAIL REGARDING BENEFITS PROVIDED SOCIAL CLUB DUES CCHS PROVIDES A SOCIAL CLUB MEMBERSHIP TO BE USED BY THE PRESIDENT IN CONNECTION WITH THEIR DUTIES. THE PRESIDENT IS RESPONSIBLE FOR AND TAXED ON ANY PERSONAL USE OF SUCH CLUB MEMBERSHIP. --------------------
FORM 990, SCHEDULE J, PART I, LINE 4A	DETAIL OF SEVERANCE PAYMENTS MICHAEL EPPEHIMER, MD WAS PAID $88,958 IN SEVERANCE DURING CALENDAR YEAR 2020. -------------------- FORM 990, SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED PLAN PARTICIPATION CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS") MAINTAINS AN IRC SECTION 457(F) DEFERRED COMPENSATION PLAN. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED AND/OR RECEIVED DISTRIBUTIONS FROM THE 457(F) PLAN DURING THE YEAR: NICHOLAS J. PETRELLI, MD - $ 36,576 KIRK N. GARRATT, MD - $ 39,147 MICHAEL EPPEHIMER, MD - $ 114,236 KENNETH SILVERSTEIN, MD - $ 70,065 NEIL JASANI, MD - $ 73,878 JANICE NEVIN, MD - $ 310,709 RICHARD CUMING - $ 47,002 ROBERT MCMURRAY - $ 54,985 SHARON KURFUERST - $ 38,289 RANDALL GABORIAULT - $ 57,502 JENNIFER L. SCHWARTZ, ESQ. - $ 45,781 LISA MAXWELL, MD - $ 19,777 --------------------
FORM 990, SCHEDULE J, PART I, LINE 7	PROVISION OF NON-FIXED PAYMENTS CCHS PROVIDES DISCRETIONARY BONUS AND/OR INCENTIVE COMPENSATION PAYMENTS TO ELIGIBLE EMPLOYEES. PAYMENTS MADE TO ANY DISQUALIFIED PERSON IS APPROVED BY THE CCHS COMPENSATION COMMITTEE THROUGH THE PROCESS DESCRIBED IN FORM 990, PART VI, SECTION B, LINE 15.

Schedule J (Form 990) 2020

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization
CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number
51-0103684

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	DELAWARE HLTH FACILITIES AUTHORITY SERIES 2020A	51-0272458	246388Tq5	02-11-2020	247,255,000	REFUND SERIES 2008 & 2010		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0
2 Amount of bonds legally defeased ..............	157,570,000
3 Total proceeds of issue ..................	305,482,979
4 Gross proceeds in reserve funds .............	0
5 Capitalized interest from proceeds .............	0
6 Proceeds in refunding escrows ...............	0
7 Issuance costs from proceeds ...............	2,324,976
8 Credit enhancement from proceeds .............	0
9 Working capital expenditures from proceeds .............	0
10 Capital expenditures from proceeds .............	144,825,092
11 Other spent proceeds .............	227,984
12 Other unspent proceeds .............	534,927
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2019, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2019, an advance refunding issue)? ........		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2020

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X

Schedule K (Form 990) 2020

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........	0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........	0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference

Explanation

FORM 990, SCHEDULE K, PART I

ADDITIONAL INFORMATION REGARDING TAX-EXEMPT BONDS THE DELAWARE HEALTH FACILITIES AUTHORITY SERIES 2020A BOND WAS ISSUED TO CHRISTIANA CARE HEALTH SYSTEM, INC. (EIN:52-1479538), A RELATED IRC SECTION 501(C)(3) ORGANIZATION. SINCE ALL BOND PROCEEDS WERE ALLOCATED TO CHRISTIANA CARE HEALTH SERVICES, INC., THIS BOND HAS BEEN REPORTED ON THIS ORGANIZATION'S FORM 990, SCHEDULE K. HOWEVER, CHRISTIANA CARE HEALTH SYSTEM, INC. REMAINS AS THE PRIMARY OBLIGOR OF THE BOND. -------------------- FORM 990, SCHEDULE K, PART II, LINE 3 ADDITIONAL INFORMATION REGARDING PROCEEDS OF ISSUE FOR DELAWARE HLTH FACILITIES AUTHORITY SERIES 2020A, THE TOTAL PROCEEDS OF THE ISSUE REPORTED INCLUDES INVESTMENT EARNINGS. --------------------

Schedule K (Form 990) 2020

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2020

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) NEUROSCIENCES II EXTRA SPACE LLC	TRUSTEE IS > 35% OWNER	194,097	PROPERTY LEASE		No
(2) WL GORE ASSOCIATES INC	TRUSTEE IS AN OFFICER	2,310,410	PURCHASE OF MEDICAL SUPPLIES		No
(3) ERIN KURFUERST	DAUGHTER OF KEY EMPLOYEE	19,564	EMPLOYMENT		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2020

Additional Data

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	13	175,080	FMV
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( )
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2020)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PART I, COLUMN (B)	ADDITIONAL INFORMATION REGARDING SECURITIES REPORTED CHRISTIANA CARE HEALTH SERVICES, INC. REPORTS THE NUMBER OF CONTRIBUTIONS IN PART I, COLUMN (B).

Schedule M (Form 990) (2020)

Additional Data

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Return Reference	Explanation
FORM 990, PART III, LINE 4(D)	DETAIL OF OTHER PROGRAM SERVICES CHRISTIANACARE HEALTH SERVICES ("CCHS"), HEADQUARTERED IN WILMINGTON, DELAWARE, IS ONE OF THE COUNTRY'S LARGEST HEALTH CARE PROVIDERS AND IS A MAJOR TEACHING HOSPITAL WITH TWO CAMPUSES AND MORE THAN 259 MEDICAL-DENTAL RESIDENTS AND FELLOWS. CHRISTIANACARE IS RECOGNIZED AS A REGIONAL CENTER FOR EXCELLENCE IN CARDIOLOGY, CANCER AND WOMEN'S HEALTH SERVICES. THE SYSTEM FEATURES A LEVEL 3 NEONATAL INTENSIVE CARE UNIT, THE ONLY DELIVERING HOSPITAL IN THE STATE TO OFFER THIS LEVEL OF CARE FOR NEWBORNS. CHRISTIANA CARE HEALTH SERVICES IS ALSO HOME TO DELAWARE'S ONLY LEVEL 1 TRAUMA CENTER, THE ONLY OF ITS KIND BETWEEN PHILADELPHIA AND BALTIMORE. A NOT-FOR-PROFIT, NON-SECTARIAN HEALTH SYSTEM, CHRISTIANACARE INCLUDES TWO HOSPITALS WITH MORE THAN 1,200 PATIENT BEDS, PREVENTIVE MEDICINE, REHABILITATION SERVICES, A NETWORK OF PRIMARY CARE PHYSICIANS AND AN EXTENSIVE RANGE OF OUTPATIENT SERVICES. WITH MORE THAN 13,000 EMPLOYEES, CHRISTIANACARE IS THE LARGEST PRIVATE EMPLOYER IN DELAWARE AND ONE OF THE LARGEST EMPLOYERS IN THE PHILADELPHIA REGION. --------------------
FORM 990, PART VI, SECTION A, LINE 2	FAMILY AND BUSINESS RELATIONSHIPS GEORGE FOUTRAKIS, TRUSTEE, AND PAUL KANIEFSKI, TRUSTEE, HAVE A BUSINESS RELATIONSHIP. -------------------- FORM 990, PART VI, SECTION A, LINE 4 CHANGES TO GOVERNING DOCUMENTS EFFECTIVE JANUARY 1, 2021, THE BOARD OF DIRECTORS OF CHRISTIANA CARE HEALTH SYSTEM, INC. ("HEALTH SYSTEM") BECAME THE CORPORATE MEMBERS OF THE HEALTH SYSTEM IN REPLACE OF THE TRUSTEES WHO WERE PREVIOUSLY THE CORPORATE MEMBERS. THIS WAS A MEMBERSHIP SUBSTITUTION. ADDITIONALLY, IT WAS APPROVED TO SEPARATE WHAT WAS PREVIOUSLY A "MIRROR BOARD" FOR THE HEALTH SYSTEM AND CHRISTIANA CARE HEALTH SERVICES, INC. ("HEALTH SERVICES") IN OTHER WORDS, THE SAME DIRECTORS SERVED AS DIRECTORS FOR BOTH HEALTH SYSTEM AND HEALTH SERVICES. THESE BOARDS WERE SEPARATED EFFECTIVE JANUARY 1, 2021 SUCH THAT THERE IS NOW A SEPARATE BOARD FOR HEALTH SYSTEM AND A SEPARATE BOARD FOR HEALTH SERVICES. THIS ALSO RESULTED IN A REORGANIZATION OF THE COMMITTEES TIED TO EACH BOARD. --------------------
FORM 990, PART VI, SECTION A, LINE 7A,B	GOVERNING BODY AND MANAGEMENT THE BOARD OF DIRECTORS OF CHRISTIANACARE HEALTH SYSTEM, INC. ("SYSTEM"), SOLE MEMBER OF CHRISTIANACARE HEALTH SERVICES, INC. ("CCHS"), AT IT'S ANNUAL MEETING IN NOVEMBER, ELECTS DIRECTORS OF CHRISTIANACARE. THE ANNUAL OPERATING BUDGET OF CHRISTIANACARE IS APPROVED BY THE CHRISTIANACARE BOARD, THE SYSTEM FINANCE COMMITTEE AND THE SYSTEM BOARD. --------------------
FORM 990, PART VI, SECTION B, LINE 11	FORM 990 REVIEW PROCESS INFORMATION RELATED TO CHRISTIANA CARE'S FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO PRICEWATERHOUSECOOPERS LLP FOR REVIEW. THE FINAL 2020 FORM 990 FOR THE FISCAL YEAR ENDING JUNE 30, 2021 WAS REVIEWED AND APPROVED BY VARIOUS SENIOR MANAGEMENT OFFICIALS. THE ORGANIZATION'S GOVERNING BOARD WAS ALSO PROVIDED ACCESS TO THE APPROVED 2020 FORM 990 VIA ITS BOARD OF DIRECTOR'S PORTAL. ------------------
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST POLICY OUR CONFLICT OF INTEREST ("COI") POLICY IS LOCATED IN THE CAREGIVER RESOURCE CENTER ON THE EMPLOYEE PORTAL. THERE IS AN ANNUAL MANDATORY EDUCATION FOR MANAGERS WHICH INCLUDES AN ELECTRONIC SIGN OFF ACKNOWLEDGING COMPLETION OF THE EDUCATION, REPORTING OF A REAL OR PERCEIVED CONFLICT OR THAT NO CONFLICTS OF INTEREST EXISTS. THE HR/EMPLOYEE RELATIONS TEAM FOLLOWS UP WITH ANYONE WHO HAS A CONFLICT OR PERCEIVED CONFLICT OR DOES NOT COMPLETE THE EDUCATION IN ORDER TO RESOLVE. SEVERAL REPORTING MECHANISMS ALSO EXIST FOR EMPLOYEES TO REPORT CONCERNS. THE BOARD OF DIRECTORS HAS THEIR OWN COI POLICY. COI IS A STANDING AGENDA ITEM ON EACH BOARD OR BOARD COMMITTEE MEETING. BOARD MEMBERS EXPECTATIONS FOR COI ARE CLEARLY COMMUNICATED. --------------------
FORM 990, PART VI, SECTION B, LINE 15	COMPENSATION REVIEW AND APPROVAL PROCESS THE BOARD OF DIRECTORS ESTABLISHES CHRISTIANACARE'S COMPETITIVE TOTAL COMPENSATION POLICY AND PRACTICE. THE EXECUTIVE COMPENSATION COMMITTEE ("ECC") OF THE BOARD ENGAGES AN INDEPENDENT THIRD PARTY ANNUALLY WHO ASSESSES DATA FROM SEVERAL MAJOR SURVEYS TO ENSURE TOTAL REMUNERATION IS MARKET COMPETITIVE AND QUALIFIES FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTIONS RULE, SECTION 4958 OF THE INTERNAL REVENUE CODE. AFTER DELIBERATION, THE ECC DOCUMENTS THEIR DECISIONS IN MEETING MINUTES. -------------------- FORM 990, PART VI, SECTION B, LINE 16B JOINT VENTURE ARRANGEMENTS ALTHOUGH THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY IN PLACE REGARDING PARTICIPATION IN JOINT VENTURE RELATIONSHIPS, WHEN ANY SUCH RELATIONSHIPS ARE CONSIDERED, THEY ARE FIRST REVIEWED AND EVALUATED BY MANAGEMENT OFFICIALS IN CONJUNCTION WITH PRICEWATERHOUSECOOPERS LLP. --------------------
FORM 990, PART VI, SECTION C, LINE 19	GOVERNANCE, MANAGEMENT, & DISCLOSURE THE FORM 990, GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY OF CCHS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE WEB THROUGH DIGITAL ASSURANCE CERTIFICATION ("DAC"). --------------------
FORM 990, PART XI, LINE 9	DETAIL OF OTHER CHANGES IN NET ASSETS CHANGE IN PENSION AND POST RETIREMENT LIABILITIES $(96,618,358) CHANGE IN NET ASSET OF SYSTEM (2,470,907) ----------- TOTAL $ (99,089,265) ===========

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) CHRISTIANA CARE CAMPUS REALTY LLC 501 WEST 14TH STREET WILMINGTON,DE19801 51-0103684	SUPPORT SRVCS	DE	0	0	CCH SERVICES
(2) CHRISTIANA CARE QUALITY PARTNERS LLC 501 WEST 14TH STREET WILMINGTON,DE19801 51-0103684	SUPPORT SRVCS	DE	-702,790	0	CCH SERVICES
(3) CHRISTIANA CARE QUALITY PARTNERS ACOLLC 501 WEST 14TH STREET WILMINGTON,DE19801 51-0103684	SUPPORT SRVCS	DE	-1,456,772	0	CCH SERVICES
(4) CHRISTIANA CARE CARE LINK LLC 501 WEST 14TH STREET WILMINGTON,DE19801 51-0103684	SUPPORT SRVCS	DE	-4,023,434	0	CCH SERVICES

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)CHRISTIANA CARE HEALTH SYSTEM 501 WEST 14TH STREET WILMINGTON,DE19801 52-1479538	FUNDRAISING	DE	501(C)(3)	7	NA		No
(2)CHRISTIANA CARE HEALTH INITIATIVES 200 HYGEIA DRIVE SUITE 2300 NEWARK,DE19713 51-0295186	OUTPATIENT SV	DE	501(C)(3)	10	CCH SYSTEM		No
(3)CHRISTIANA CARE HOME HEALTH & COM SRVCS 1 READS WAY NEW CASTLE,DE19720 51-0064334	HOME HLTHCARE	DE	501(C)(3)	7	CCH SYSTEM		No
(4)UNION HOSPITAL OF CECIL COUNTY FOUNDATIO 106 BOW STREET ELKTON,MD21921 52-1794552	FUNDRAISING	MD	501(C)(3)	7	AFFINITY		No
(5)UNION HOSPITAL OF CECIL COUNTY INC 106 BOW STREET ELKTON,MD21921 52-0607945	HLTHCARE SVCS	MD	501(C)(3)	3	AFFINITY		No
(6)UNION HOSPITAL OF CECIL COUNTY HLTH SVCS 106 BOW STREET ELKTON,MD21921 52-1794553	PROPERTY MGMT	MD	501(C)(3)	10	AFFINITY		No
(7)UNION HOSPITAL OF CECIL COUNTY ONCOLOGY 106 BOW STREET ELKTON,MD21921 81-2662359	HEALTHCARE	MD	501(C)(3)	3	AFFINITY		No
(8)AFFINITY HEALTH ALLIANCE INC 106 BOW STREET ELKTON,MD21921 52-1794697	MANAGEMENT	MD	501(C)(3)	12B, II	CCH SERVICES	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2020

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) CHRISTIANA CARE GO HEALTH URGENT CARE L 5555 GLENRIDGE CONNECTOR SUITE 700 ATLANTA,GA30342 84-4061485	URGENT CARE SRVCS	DE	CCH SERVICES	RELATED	-2,657,422	1,204,086		No	0		No	50.100 %
(2) CHRISTIANACARE VALUE HEALTH JV LLC 11221 ROE AVENUE LEAWOOD,KS66211 85-1100149	AMBULATORY SRVCS	DE	CCH SERVICES	RELATED	0	25,500		No	0	Yes		51.000 %
(3) CLINERGY LLC 4755 OGLETOWN STANTON RD NEWARK,DE19718 85-2698063	GROUP PURCHASING	DE	CCH SERVICES	RELATED	0	0		No	0		No	79.800 %
(4) LEEWARD HEALTH LLC 4000 NEXUS DRIVE STE C3-300 WILMINGTON,DE19803	MED ADV RISK SHAR	DE	CCH SYSTEM								No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) THE DE CTR FOR MAT FETAL MED OF CC INC 4000 NEXUS DR STE NW3-100 WILMINGTON,DE19803 20-5891272	HEALTHCARE	DE	CCH SERVICES	C CORP	-38,074	5,719,667	100.000 %	Yes
(2) CHRISTIANA CARE HEALTH PLANS 4000 NEXUS DR STE NW3-100 WILMINGTON,DE19803 51-0352728	INSURANCE	DE	CCH SYSTEM	C CORP					No
(3) CHRISTIANA CARE DEFERRED COMP PLAN 4755 OGLETOWN STANTON RD NEWARK,DE19718 81-6359549	DEF COMP PLAN	DE	CCH SERVICES	TRUST				Yes
(4) CHRISTIANA CARE EXEC DEFERRED COMP PLAN 4755 OGLETOWN STANTON RD NEWARK,DE19718 35-7048822	DEF COMP PLAN	DE	CCH SERVICES	TRUST				Yes
(5) CARE ASSOCIATES DEFERRED COMP PLAN 4755 OGLETWON STANTON RD NEWARK,DE19718 35-7048714	DEF COMP PLAN	DE	CCH SERVICES	TRUST				Yes
(6) CHRISTIANA CARE INSURANCE CO LTD PO BOX 1159 878 W BAY RD GRAND CAYMANKY1-1102 CJ 98-1489490	SELF-INSURANCE	CJ	CCH SERVICES	C CORP	2,554,951	74,589,881	100.000 %	Yes
(7) CHRISTIANA CARE STRATEGIC INVESTMENTS 4000 NEXUS DR STE NW3-100 WILMINGTON,DE19803 85-3348300	STRATEGY	DE	CCH SYSTEM	C CORP					No
(8) UNION HOSPITAL OF CECIL COUNTY VENTURES 106 BOW STREET ELKTON,MD21921 52-1793691	MEDICAL SERVICES	MD	AFFINITY	C CORP					No
(9) CENTER FOR VIRTUAL HEALTH LLC 4000 NEXUS DR STE C3-300 WILMINGTON,DE19803 86-2155365	MNGMT & SUPPORT	DE	CCH SERVICES	C CORP	0	0	100.000 %		No
(10) CENTER FOR VIRTUAL HEALTH PRACTICE PA 4000 NEXUS DR STE C3-300 WILMINGTON,DE19803 86-2158927	VIRTUAL PRIM CARE	DE	CNTR VIRTUAL	C CORP					No

Schedule R (Form 990) 2020

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) UNION HOSPITAL OF CECIL COUNTY INC	O	7,770,021	FMV
(2) CHRISTIANA CARE GO HEALTH URGENT CARE LLC	J,P,R	9,463,182	FMV
(3) THE DE CTR FOR MAT FETAL MED OF CC INC	K,O	641,018	FMV
(4) CHRISTIANA CARE INSURANCE CO LTD	Q,R	29,809,654	FMV
(5) CHRISTIANA CARE GO HEALTH URGENT CARE LLC	A,D	39,390,783	FMV
(6) CLINERGY LLC	O	12,493	FMV

Schedule R (Form 990) 2020

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2020

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2020

Additional Data

Software ID:
Software Version:

- TIN:

TY 2020 AffiliatedGroupAttachment

Name:

CHRISTIANA CARE HEALTH SERVICES INC

EIN:

51-0103684

Explanation:

DIRECT OTHER LOBBYING EXEMPT PURPOSE NAME OF ELECTING ORGANIZATION EXPENDITURES EXPENDITURES __________________________________ ____________ _______________ CHRISTIANA CARE HEALTH SYSTEM $ NONE $ 4,670,129 CHRISTIANA CARE HEALTH SERVICES 249,926 2,146,254,538 CHRISTIANA CARE HOME HEALTH AND COMMUNITY SERVICES NONE 45,878,225 CHRISTIANA CARE HEALTH INITIATIVES NONE 8,087,165 ------------ -------------- TOTAL $ 249,926 $2,204,890,087 THE ORGANIZATION HAS MADE THE LOBBYING ELECTION UNDER I.R.C. SECTION 501(H) FOR THE TAX YEAR ENDED JUNE 30, 2021. THIS ELECTION HAS NOT BEEN REVOKED BEFORE THE START OF THE ORGANIZATION'S TAX YEAR THAT BEGAN IN 2020.

1	Briefly describe the organization’s mission or most significant activities: OUR MISSION AS AN ORGANIZATION IS TO SERVE OUR NEIGHBORS AS EXPERT, CARING PARTNERS IN THEIR HEALTH.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	13,069
6	Total number of volunteers (estimate if necessary) .............	6	404
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	5,074,808
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	80,735,115	128,076,121
9	Program service revenue (Part VIII, line 2g) .........	1,885,207,044	2,187,692,532
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	102,844,109	199,105,805
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	13,395,684	18,852,326
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	2,082,181,952	2,533,726,784
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	1,255,954,196	1,317,604,659
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	747,739,423	829,007,353
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	2,003,693,619	2,146,612,012
19	Revenue less expenses. Subtract line 18 from line 12.......	78,488,333	387,114,772
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	4,179,624,084	4,818,599,325
21	Total liabilities (Part X, line 26).............	1,298,158,505	1,336,477,794
22	Net assets or fund balances. Subtract line 21 from line 20.....	2,881,465,579	3,482,121,531

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 426,338,075 including grants of $ 0 ) (Revenue $ 644,993,608 )
	PROVISION OF PROFESSIONAL PATIENT CARE FOR THE HOSPITALS OF CHRISTIANA CARE - DURING THE FISCAL YEAR, RECORDED 343,601 PATIENT DAYS WITH AN APPROXIMATE FTE COUNT OF 3080. THE HOSPITALS OFFER A FULL SCOPE OF SERVICES WITH THE NEED OF THE POPULATION SERVED WITHOUT REGARD TO AGE, RACE OR ECONOMIC CIRCUMSTANCES.

4b	(Code: ) (Expenses $ 172,970,145 including grants of $ 0 ) (Revenue $ 387,857,553 )
	PHARMACY - PROVIDED PHARMACY SERVICES FOR BOTH INPATIENTS AND OUTPATIENTS. DURING FISCAL 2021, 6,825,386 DOSES WERE ADMINISTERED WITH AN APPROXIMATE FTE COUNT OF 241.

4c	(Code: ) (Expenses $ 188,398,566 including grants of $ 0 ) (Revenue $ 334,563,447 )
	OPERATING ROOM - PROVIDED BOTH INPATIENT AND OUTPATIENT SURGICAL PROCEDURES. IN FISCAL 2021, 34,200 CASES WERE PERFORMED, REQUIRING AN APPORXIMATE FTE COUNT OF 610.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 976,782,126 including grants of $ 0 ) (Revenue $ 834,286,065 )
4e	Total program service expenses1,764,488,912

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	13,325,891	0	1,131,789

1a	Federated campaigns..		1a	11,562
b	Membership dues..		1b
c	Fundraising events..		1c	83,940
d	Related organizations		1d	4,343,780
e	Government grants (contributions)		1e	121,643,943

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,992,896

g	Noncash contributions included in lines 1a - 1f:$		1g	175,080

h Total. Add lines 1a-1f.......		128,076,121

		Business Code
2a	NET PROGRAM SERVICE REVENUES	622110	2,157,053,115	2,157,053,115
b	OTHER REVENUES	900099	30,639,417	21,550,898	5,074,808	4,013,711
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		2,187,692,532

3 Investment income (including dividends, interest, and othersimilar amounts) ......			31,040,145			31,040,145
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents	56,017	3,188,923	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	56,017	3,188,923	6c
d	Net rental income or (loss).......			3,244,940			3,244,940
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	5,911,879	655,467,517	7a
b	Less: cost or other basis and sales expenses		493,313,736	7b
c	Gain or (loss)	5,911,879	162,153,781	7c
d	Net gain or (loss).........			168,065,660			168,065,660
8a	Gross income from fundraising events (not including $ 83,940of contributions reported on line 1c). See Part IV, line 18 ....
			8a	16,000
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			16,000			16,000
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	MAINTENANCE FEES		531390	1,406,525			1,406,525
b	AFFILIATE REVENUES		900099	14,008,141	14,008,141
c	MISC REVENUES		900099	176,720			176,720
d	All other revenue ....
e	Total. Add lines 11a–11d ......			15,591,386
12	Total revenue. See instructions.....			2,533,726,784	2,192,612,154	5,074,808	207,963,701

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	16,105,873	13,119,700	2,986,173	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	994,601,375	810,193,359	184,408,016	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	65,322,957	53,211,495	12,111,462	0
9	Other employee benefits .......	173,679,751	141,477,967	32,201,784	0
10	Payroll taxes ...........	67,894,703	55,306,416	12,588,287	0
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	2,946,939	2,199,066	747,873	0
c	Accounting ...........	479,600	357,887	121,713	0
d	Lobbying ...........	249,926	186,500	63,426	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	7,018,042	0	7,018,042	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	15,961,086	11,910,491	4,050,595
12	Advertising and promotion ....	7,287,874	5,438,361	1,849,513	0
13	Office expenses .......	6,674,018	4,980,289	1,693,729	0
14	Information technology ......	64,135,288	47,859,069	16,276,219	0
15	Royalties ..	0
16	Occupancy ...........	24,831,374	18,529,681	6,301,693	0
17	Travel ............	642,895	479,741	163,154	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	2,957,678	2,207,080	750,598	0
20	Interest ...........	11,261,040	9,008,832	2,252,208	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	116,195,870	65,932,047	50,263,823	0
23	Insurance ...	20,769,859	15,498,895	5,270,964	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	386,023,184	386,023,184	0	0
b	OTHER SUPPLIES AND SERVICES	161,572,680	120,568,852	41,003,828	0
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	2,146,612,012	1,764,488,912	382,123,100	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			456,095,574	1	440,619,940
2	Savings and temporary cash investments .........			191,259,896	2	191,331,183
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			261,604,063	4	313,356,780
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			37,495,194	8	37,414,184
9	Prepaid expenses and deferred charges ......			22,701,944	9	17,267,840
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,612,410,899
b	Less: accumulated depreciation	10b	1,505,668,686	1,093,563,570	10c	1,106,742,213
11	Investments—publicly traded securities .			1,374,617,289	11	1,780,367,764
12	Investments—other securities. See Part IV, line 11 .....			413,623,323	12	571,983,820
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			1,015,805	14	1,015,805
15	Other assets. See Part IV, line 11 ...........			327,647,426	15	358,499,796
16	Total assets. Add lines 1 through 15 (must equal line 33)...			4,179,624,084	16	4,818,599,325

17	Accounts payable and accrued expenses .....	326,959,055	17	394,195,384
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	369,600,977	20	312,855,885
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	601,598,473	25	629,426,525
26	Total liabilities. Add lines 17 through 25..	1,298,158,505	26	1,336,477,794

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	2,820,861,635	27	3,414,358,021
28	Net assets with donor restrictions ...........	60,603,944	28	67,763,510
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	2,881,465,579	32	3,482,121,531
33	Total liabilities and net assets/fund balances ........	4,179,624,084	33	4,818,599,325

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No