TY 2021 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/1099-NEC)	(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				2,224,542	71,161
(2) KENNETH SILVERSTEIN MD...................................................................... CHIEF PHYSICIAN EXECUTIVE	45.0 ................. 0.0		X				1,543,930	41,860
(3) RAY A BLACKWELL MD...................................................................... CHIEF CARDIAC SURGERY	45.0 ................. 0.0				X		1,026,665	43,310
(4) RANDALL GABORIAULT...................................................................... CHIEF DIGITAL & INFO OFFICER	45.0 ................. 0.0			X			981,874	44,350
(5) KIRK N GARRATT MD...................................................................... MEDICAL DIRECTOR - HEART/VASC	45.0 ................. 0.0				X		979,910	26,689
(6) KERT ANZILOTTI...................................................................... CHIEF MEDICAL OFFICER	45.0 ................. 0.0				X		929,510	41,860
(7) VINAY K GHEYI...................................................................... DEPARTMENT CHAIR - RADIOLOGY	45.0 ................. 0.0				X		926,957	35,523
(8) SHARON T KURFUERST...................................................................... CHIEF OPERATING OFFICER	43.0 ................. 2.0			X			909,862	36,778
(9) PAUL K DAVIS MD...................................................................... CARDIAC SURGEON	45.0 ................. 0.0				X		890,648	42,900
(10) ROBERT MCMURRAY...................................................................... TREASURER AND ASS'T SECRETARY	38.0 ................. 7.0		X				849,222	43,310
(11) NEIL JASANI MD...................................................................... CHIEF PEOPLE OFFICER	45.0 ................. 0.0			X			738,148	43,310
(12) FREDERIC T HARAD MD...................................................................... MEMBER	45.0 ................. 0.0	X					720,906	41,152
(13) JENNIFER L SCHWARTZ ESQ...................................................................... CORPORATE SECRETARY	37.0 ................. 8.0		X				720,571	39,853
(14) RIC CUMING RN...................................................................... CHIEF NURSING EXECUTIVE	45.0 ................. 0.0			X			698,589	32,129
(15) LISA C MAXWELL MD...................................................................... PRESIDENT, MEDICAL GROUP	45.0 ................. 0.0			X			662,384	59,877
(16) JOSEPH BENNETT MD...................................................................... MEMBER (THROUGH 12/31/21)	45.0 ................. 0.0	X					659,734	40,410
(17) MICHAEL EPPEHIMER MD...................................................................... FORMER PRES. MED GROUP	0.0 ................. 0.0					X	290,433	1,624

(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/1099-NEC)
(18) CHRISTINE SAUERS........................................................................ MEMBER	1.0 .......................0.0	X
(19) DAVID B STRATTON ESQ........................................................................ MEMBER, CHAIR	1.0 .......................1.0	X	X
(20) DWIGHT D THOMEY ESQ........................................................................ MEMBER	1.0 .......................3.0	X
(21) ERIC T JOHNSON MD........................................................................ MEMBER	1.0 .......................0.0	X
(22) GEORGE FOUTRAKIS........................................................................ MEMBER (THROUGH 12/31/21)	1.0 .......................1.0	X
(23) LOLITA A LOPEZ........................................................................ MEMBER, VICE CHAIR	1.0 .......................0.0	X	X
(24) LOSSIE FREEMAN........................................................................ MEMBER	1.0 .......................0.0	X
(25) PAULA K MAXWELL........................................................................ MEMBER (THROUGH 12/31/21)	1.0 .......................1.0	X
(26) PENELOPE T SARIDAKIS........................................................................ MEMBER (THROUGH 12/31/21)	1.0 .......................0.0	X
(27) SALVATORE CHIP ROSSI........................................................................ MEMBER	1.0 .......................0.0	X
(28) THEODORE G PLUSH........................................................................ MEMBER (THROUGH 3/2022)	1.0 .......................0.0	X
(29) TOM MOORE........................................................................ MEMBER	1.0 .......................0.0	X
(30) JULIE TOPKIS NASON........................................................................ MEMBER	1.0 .......................0.0	X
(31) BARRY NIZIOLEK........................................................................ MEMBER	1.0 .......................0.0	X
(32) PAWAN RASTOGI MD........................................................................ MEMBER	1.0 .......................0.0	X

(A) Name and business address	(B) Description of services	(C) Compensation
GENERAL HEALTHCARE RESOURCES, 2250 HICKORY ROAD SUITE 240 PLYMOUTH MEETING,PA19462	STAFFING SERVICES	47,884,042
MICROSOFT SERVICES, PO BOX 844510 DALLAS,TX752844510	IT SERVICES	7,213,310
CERNER CORPORATION, PO BOX 959156 ST LOUIS,MO631959156	IT SERVICES	29,739,608
CONSTRUCTION SERVICES GROUP LLC, 1630 WEST CHESTER PIKE WEST CHESTER,PA19382	CONSTRUCTION SRVCS	14,514,971
DISABATINO CONSTRUCTION CO, 1 SOUTH CLEVELAND AVE WILMINGTON,DE19805	CONSTRUCTION SRVCS	5,845,951
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 270

- TIN:

SCHEDULE A
(Form 990)

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

2021

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	22,698,446	24,577,838	80,735,115	128,076,121	43,095,263	299,182,783
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	22,698,446	24,577,838	80,735,115	128,076,121	43,095,263	299,182,783
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.						299,182,783

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..	22,698,446	24,577,838	80,735,115	128,076,121	43,095,263	299,182,783
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	32,254,956	40,934,424	38,348,773	34,285,085	42,693,278	188,516,516
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.)..	1,686,211	1,481,357	1,515,817	1,583,245	1,524,457	7,791,087
11	Total support. Add lines 7 through 10						495,490,386

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

10,320,134,708

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 2021 (line 6, column (f) divided by line 11, column (f)) .........

60.381 %

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

61.799 %

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

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

11b

A 35% controlled entity of a person described on 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 on 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) 2021

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) 2021

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 2021 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-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2021

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) (2021)

Schedule B (Form 990) (2021) 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) (2021)

Schedule B (Form 990) (2021)

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) (2021)

Schedule B (Form 990) (2021)

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) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) ........................	249,595	249,595
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................	249,595	249,595
d	Other exempt purpose expenditures ...............................................................................	2,419,010,073	2,475,653,591
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................	2,419,259,668	2,475,903,186
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) 2018	(b) 2019	(c) 2020	(d) 2021	(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	218,022	230,460	249,926	249,595	948,003

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) 2021

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) 2021

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

2021

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) 2021

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 ....	68,569,307	62,232,483	67,336,850	69,132,135	102,737,030
b	Contributions ...	669,502	993,569	1,520,182	518,673	1,197,900
c	Net investment earnings, gains, and losses	-6,744,573	9,205,113	2,545,562	1,845,561	7,177,549
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	4,183,549	3,861,858	9,170,111	4,159,519	41,980,344
f	Administrative expenses ....
g	End of year balance ......	58,310,687	68,569,307	62,232,483	67,336,850	69,132,135

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

Board designated or quasi-endowment SchDMd Bullet

40.820 %

Permanent endowment SchDMd Bullet

42.080 %

Term endowment SchDMd Bullet

17.100 %

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 .....	32,350,503		32,350,503
b	Buildings ....	1,691,701,572	903,641,632	788,059,940
c	Leasehold improvements	34,348,921	9,742,149	24,606,772
d	Equipment ....	866,992,551	674,566,865	192,425,686
e	Other .....	38,905,973	28,504,571	10,401,402
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				1,047,844,303

Schedule D (Form 990) 2021

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	419,786,225	F
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	419,786,225

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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				90,373,706
(2)DUE FROM AFFILIATES				83,439,429
(3)OTHER ASSETS				166,603,469
(4)OTHER RECEIVABLES				30,705,904
(5)ASSETS LIMITED TO USE				0
(6)SUBSIDIARY INVESTMENT				95,888,168
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				467,010,676

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.)	357,656,539
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) 2021

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 FIVE DONOR RESTRICTED ENDOWMENT FUNDS USED FOR A VARIETY OF PURPOSES, INCLUDING SALARY AND PROGRAM SUPPORT. THE ORGANIZATION'S PURPOSE AND TIME RESTRICTED NET ASSETS ARE RESTRICTED FOR INDIGENT CARE, BUILDING AND MAINTENANCE, AND PROGRAM SUPPORT. --------------------

Schedule D (Form 990) 2021

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

2021

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	144,280,871
















3a	Sub-total ....		144,280,871
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)		144,280,871

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2021

Schedule F (Form 990) 2021

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) 2021

Schedule F (Form 990) 2021Page 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) 2021

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990)

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

2021

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) 2021

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 FRIENDS HFGCC5K (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	188,983	188,983
2	Less: Contributions . . . .	188,983	188,983
3	Gross income (line 1 minus line 2) . . . . . .

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) . . . . . . . . . .
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .

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) 2021

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 RELATED WITH THE FRIENDS HFGCC 5K AND THE GOLF CLASSIC EVENT WERE RECORDED DIRECTLY BY CHRISTIANA CARE HEALTH SYSTEM, INC. THE SOLE MEMBER OF THE ORGANIZATION.

Schedule G (Form 990) 2021

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

2021

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) . . .			12,352,059	0	12,352,059	0.510 %
b	Medicaid (from Worksheet 3, column a) . . . . .			330,715,188	279,072,889	51,642,299	2.140 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			343,067,247	279,072,889	63,994,358	2.650 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	47	54,089	13,247,640	3,495,300	9,752,340	0.400 %
f	Health professions education (from Worksheet 5) . . .	6	1,184	77,095,486	13,670,295	63,425,191	2.620 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	1		19,249,661	15,552,330	3,697,331	0.150 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	9		1,567,905	0	1,567,905	0.070 %
j	Total. Other Benefits . .	63	55,273	111,160,692	32,717,925	78,442,767	3.240 %
k	Total. Add lines 7d and 7j .	63	55,273	454,227,939	311,790,814	142,437,125	5.890 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

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)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	1	85,000	0	85,000
2	Economic development	2	42,363	0	42,363
3	Community support	1	105,374	0	105,374	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	5,672	0	5,672
7	Community health improvement advocacy
8	Workforce development	1	212,410	0	212,410	0.010 %
9	Other
10	Total	6	450,819	0	450,819	0.020 %

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. ......

19,560,265

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. ......

1,084,122

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).....

518,092,905

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

628,301,557

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

-110,208,652

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) 2021

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) 2021

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 21

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 22

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) 2021

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) 2021

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) 2021

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) 2021

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)	CHRISTIANACARE'S OFFICE OF HEALTH EQUITY SOUGHT THE PARTICIPATION OF A BROAD ARRAY OF INDIVIDUALS TO INFORM THE 2022 CHNA. THIS WAS AN IMPORTANT ASPECT OF THE CHNA PROCESS THAT ALLOWED US TO EXEMPLIFY THE CHRISTIANACARE WAY: WE SERVE OUR NEIGHBORS AS RESPECTFUL, EXPERT, CARING PARTNERS IN THEIR HEALTH. WE DO THIS BY CREATING INNOVATIVE, EFFECTIVE, AFFORDABLE, AND EQUITABLE SYSTEMS OF CARE THAT OUR NEIGHBORS VALUE. EFFECTIVELY SERVING OUR COMMUNITIES REQUIRES US TO LISTEN AND LEARN SO THAT WE CAN PROVIDE OUR COMMUNITIES WITH WHAT IS IMPORTANT TO THEM. THE CHNA IS A WELCOME OPPORTUNITY TO EXAMINE WHETHER WE ARE MEETING THE NEEDS OF THOSE WE SERVE. WHEN COMPLETING THIS AND PRIOR CHNAS, OUR INTENTION WAS TO HEAR DIRECTLY FROM COMMUNITY MEMBERS AND STAKEHOLDERS. WHILE UNDERTAKING THE 2022 CHNA, COVID-19 CASES WERE REACHING A NEW PEAK IN OUR STATE AND CHRISTIANACARE WAS FORCED TO ISSUE CRISIS STANDARDS OF CARE FOR THE FIRST TIME IN ITS HISTORY. BECAUSE OF THIS, WE DECIDED TO HOST VIRTUAL COMMUNITY MEETINGS TO RECEIVE COMMUNITY INPUT TO PREVENT INCREASED COMMUNITY TRANSMISSION OF COVID-19. OUR PREFERRED FORMAT WOULD HAVE BEEN MEETINGS HELD IN THE COMMUNITY AT ACCESSIBLE LOCATIONS TO PROMOTE COMMUNITY PARTICIPATION, BUT SAFETY HAD TO BE PRIORITIZED. IN ADDITION TO THE COMMUNITY MEETINGS, WE ALSO CONDUCTED INTERVIEWS WITH THE CABINET SECRETARY AND DEPUTY SECRETARY FOR DELAWARE HEALTH AND SOCIAL SERVICES AND THE DIRECTOR FOR THE DELAWARE DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH TO GAIN THEIR PERSPECTIVES ON THE HEALTH OF OUR COMMUNITIES. WE ARE GRATEFUL FOR THE PARTICIPATION OF ALL THOSE WHO SHARED THEIR EXPERIENCE AND PROVIDED INPUT. ALL COMMUNITY MEETINGS FOLLOWED THE SAME FORMAT. SECONDARY DATA WERE PRESENTED INCLUDING A SUMMARY OF UNFAVORABLE COMMUNITY HEALTH INDICATORS. PARTICIPANTS WERE ASKED TO PROVIDE FEEDBACK ON THE SECONDARY DATA ANALYSIS AND IDENTIFY COMMUNITY HEALTH ISSUES THAT WERE MISSING FROM THE DATA. TO CONCLUDE, ALL PARTICIPANTS WERE ASKED TO COMPLETE AN ONLINE SURVEY AND TO IDENTIFY THREE TO FIVE COMMUNITY HEALTH ISSUES THEY CONSIDER TO BE MOST SIGNIFICANT. IN TOTAL, 35 INDIVIDUALS WHO REPRESENTED ORGANIZATIONS INCLUDING DELAWARE HEALTH AND SOCIAL SERVICES, NON-PROFIT ORGANIZATIONS, LOCAL BUSINESSES, HEALTHCARE PROVIDERS, LOCAL POLICYMAKERS, AND SCHOOL SYSTEMS PARTICIPATED IN FOUR VIRTUAL COMMUNITY STAKEHOLDER MEETINGS. THE 2022 CHNA ALSO INCLUDED THE INPUT OF YOUNG DELAWAREANS. CHRISTIANACARE CAREGIVERS WHO PROVIDE REPRODUCTIVE HEALTH EDUCATION TO ADOLESCENTS IN SCHOOLS THROUGHOUT THE STATE PROVIDED THE SECONDARY DATA PRESENTATION TO 110 STUDENTS PARTICIPATING IN THEIR CLASSES AT WILLIAM PENN HIGH SCHOOL IN NEW CASTLE. WE SOUGHT INPUT FROM AND WANTED TO HEAR FROM YOUNG PEOPLE BECAUSE THEY MAKE UP A SIGNIFICANT PART OF OUR COMMUNITY. FINALLY, 45 CHRISTIANACARE CAREGIVERS WHO REPRESENTED ADMINISTRATION, NURSING, CASE MANAGEMENT, SOCIAL SERVICES, PROJECT MANAGEMENT, AND HEALTH EQUITY DEPARTMENTS PARTICIPATED IN AN ADDITIONAL TWO VIRTUAL MEETINGS. WE PROVIDED THEM WITH INFORMATION ABOUT THE CHALLENGES OUR COMMUNITY IS FACING AND GAINED THEIR PERSPECTIVE BASED ON THEIR EXPERIENCES SERVING OUR COMMUNITY. AT CHRISTIANACARE, ALL EMPLOYEES ARE REFERRED TO AS CAREGIVERS REGARDLESS OF THEIR POSITION. THROUGHOUT THIS SECTION, WE WILL REFER TO CAREGIVERS AS OPPOSED TO EMPLOYEES OR STAFF. CHRISTIANACARE CONTRACTED WITH VERIT HEALTHCARE CONSULTING, LLC (VERIT) TO COMPLETE ITS 2022 CHNA. IN COOPERATION WITH CHRISTIANACARE'S OFFICE OF HEALTH EQUITY, VERIT CONDUCTED THE RESEARCH, PRIMARY AND SECONDARY DATA COLLECTION, REVIEW, AND ANALYSIS, TO DEVELOP THE CHNA. -------------------- PART V, SECTION B, LINE 6 (JOINT CHNA) CHRISTIANACARE'S TWO HOSPITAL FACILITIES IN DELAWARE, CHRISTIANA HOSPITAL AND WILMINGTON HOSPITAL, JOINTLY CONDUCTED THEIR CHNA. -------------------- PART V, SECTION B, LINE 7 (CHNA PUBLIC AVAILABILITY) CHRISTIANACARE'S CHNA IS AVAILABLE ON ITS WEBSITE AT: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY- HEALTH-NEEDS-ASSESSMENT/ A PAPER COPY OF THE CHNA IS ALSO AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST. -------------------- PART V, SECTION B, LINE 10 (IMP. PLAN PUBLIC AVAILABILITY) CHRISTIANACARE'S CHIP IS AVAILABLE ON ITS WEBSITE AT: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY-HEALT H-IMPLEMENTATION-PLAN/ A PAPER COPY OF THE CHIP IS ALSO AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST. --------------------
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	IN THE MOST RECENT CHNA, FINALIZED IN JUNE 2022, CHRISTIANACARE IDENTIFIED THE FOLLOWING AS THE COMMUNITY'S MOST SIGNIFICANT NEEDS: - ACCESS TO HEALTH SERVICES - CHRONIC HEALTH CONDITIONS - MATERNAL AND CHILD HEALTH - MENTAL HEALTH AND SUBSTANCE USE DISORDERS - SOCIAL DETERMINANTS OF HEALTH - VIOLENT CRIME CHRISTIANACARE WILL ADDRESS ALL THESE SIGNIFICANT AREAS OF NEED. EXCEPT FOR THE NEWLY ADDED CHRONIC HEALTH CONDITIONS, THESE NEEDS WERE ALSO PRIORITIZED IN 2019. WE WILL CONTINUE TO ADDRESS THESE NEEDS THROUGH PROGRAMMING WE HAVE CREATED, ADAPTED, AND EXPANDED SINCE OUR 2019 CHNA. WHILE UNDERTAKING THIS CHNA, WE WERE FORTUNATE TO LEARN FROM MANY HIGH SCHOOL STUDENTS ABOUT WHAT THEY CONSIDERED TO BE SIGNIFICANT AREAS OF NEED. THE SIGNIFICANT AREAS OF NEED THAT THEY SELECTED MIRRORED THE SELECTIONS OF THE ADULTS WHO PARTICIPATED, WITH TWO ADDITIONAL SIGNIFICANT AREAS OF NEED IDENTIFIED BY MANY OF THE STUDENTS: SEXUALLY TRANSMITTED INFECTIONS AND SMOKING, TOBACCO, AND VAPE PRODUCT USE. CHRISTIANACARE ADDRESSES BOTH THESE AREAS IN ITS SCHOOL-BASED HEALTH CENTERS AND SINCE 1995 HAS BEEN THE RECIPIENT OF A STATE GRANT TO OPERATE THE ALLIANCE FOR ADOLESCENT PREGNANCY PREVENTION (AAPP). AAPP PROVIDES EDUCATION TO STUDENTS THROUGHOUT DELAWARE TO REDUCE THE NUMBER OF TEENS WHO ARE SEXUALLY ACTIVE, CONTRACT AND SPREAD SEXUALLY TRANSMITTED INFECTIONS, BECOME PREGNANT AND BECOME TEEN PARENTS. WHILE WE WILL NOT PRIORITIZE THESE ADDITIONAL AREAS OF NEED IDENTIFIED BY THE TEENS, WE WILL CONTINUE TO ADDRESS THEM THROUGH DIRECT INTERACTION WITH STUDENTS IN THE SCHOOL-BASED HEALTH CENTERS AND THROUGH AAPP PROGRAMMING. ACCESS TO HEALTH SERVICES ON JUNE 2, 2022, THE CHRISTIANACARE BOARD APPROVED A NEW 5-YEAR STRATEGIC PLAN FOR IMPLEMENTATION, WHICH IDENTIFIES OUR ASPIRATIONS, GOALS AND IMPERATIVES. ONE OF THE ASPIRATIONS IS TO RADICALLY SIMPLIFY ACCESS. TO ACCOMPLISH THIS, WE WILL LOOK TO DIGITAL SOLUTIONS TO EASE ACCESS AND REDUCE ADMINISTRATIVE BURDEN AND WORK TOWARDS DEVELOPING A PLAN TO REDUCE ACCESS BARRIERS RELATED TO OUT-OF-POCKET EXPENSE BY USING AUTOMATED PROCESSES. WE ARE COMMITTED TO MAKING CARE MORE CONVENIENT AND AFFORDABLE FOR OUR PATIENTS WHICH WE EXPECT TO IMPROVE ACCESS. WE ALSO RECOGNIZE THAT DIGITAL SOLUTIONS ALONE WILL NOT IMPROVE ACCESS FOR ALL. COMMUNITY-BASED SERVICES REMAIN VITAL TO THE HEALTH OF OUR COMMUNITIES ALONG WITH FINDING INNOVATIVE WAYS TO DELIVER THESE SERVICES. THROUGHOUT THIS NARRATIVE, WE WILL SHARE THE INNOVATIVE WAYS WE ARE SERVING OUR COMMUNITY BY PROVIDING RADICALLY CONVENIENT SERVICE. IN JUNE 2022, CHRISTIANACARE INTRODUCED ITS TWO MOBILE HEALTH SERVICES VANS IN A RIBBON CUTTING CEREMONY IN WILMINGTON'S SOUTHBRIDGE NEIGHBORHOOD. SOUTHBRIDGE IS LOCATED IN THE 19801 ZIP CODE, AN AREA OF HIGH NEED, AND A NEIGHBORHOOD THAT WE INTEND TO CONTINUE TO SERVE THROUGH MOBILE HEALTH SERVICES. THE VANS ARE SUPPORTED BY BARCLAYS WITH A $1 MILLION INVESTMENT AS PART OF ITS COVID-19 COMMUNITY AID PACKAGE. MOBILE HEALTH SERVICES WILL ALLOW US TO BRING CARE TO OUR NEIGHBORS WHO MAY HAVE DIFFICULTY ACCESSING CARE OTHERWISE. IMPORTANTLY, RECEIVING CARE ON THE VAN WILL NOT BE A ONE-TIME EVENT, BUT THE START OF A RELATIONSHIP THAT WILL HELP AN INDIVIDUAL IMPROVE THEIR HEALTH AND WELLNESS. IN SERVICE TO THAT EXPECTATION, WE ARE BEING INTENTIONAL ABOUT WHERE WE PROVIDE MOBILE HEALTH SERVICES. WHILE WE EXPECT TO PROVIDE ONE-TIME SERVICES LIKE VACCINATIONS AND SCREENINGS ON THE VANS, WE WILL ALSO SELECT COMMUNITY LOCATIONS WHERE THE VANS WILL BE REGULARLY STATIONED TO PROVIDE ONGOING PRIMARY CARE AND ACCESS TO SPECIALTY CARE FOR OUR NEIGHBORS. THE COMPLEX CARE AND COMMUNITY MEDICINE DEPARTMENT IS WORKING CLOSELY WITH THE COMMUNITY HEALTH DEPARTMENT TO IDENTIFY AREAS IN THE COMMUNITY WHERE THE VANS SHOULD GO AND THE COMMUNITY ORGANIZATIONS THAT CAN BE PARTNERED WITH TO HOST THE VANS. COMMUNITY PARTNERSHIPS ARE NECESSARY TO ENSURE WE ARE BRINGING SERVICES TO THE COMMUNITY THAT ARE WANTED, NEEDED, AND USED. IT IS ALSO OUR FIRMLY HELD BELIEF THAT COMMUNITY PARTNERSHIPS WILL ENABLE US AND OUR PARTNERS TO BETTER ADDRESS THE VARIED NEEDS OF THOSE WE SERVE. FOR MOST OF FY2022, THE VANS WERE BEING OUTFITTED TO SERVE AS PRACTICES ON WHEELS. IN THE EARLY MONTHS OF FY2023, THE FOCUS HAS BEEN ON DETERMINING WHERE THE VANS SHOULD BE IN THE COMMUNITY AND AT WHAT CADENCE. THE VANS HAVE PROVIDED SERVICES AT A HANDFUL OF COMMUNITY LOCATIONS OVER THE LAST SEVERAL MONTHS AND SINCE NOVEMBER 2022, ONE VAN HAS BEEN ROUTINELY STATIONED OUTSIDE OF THE WILMINGTON HOSPITAL, ALSO LOCATED IN THE HIGH-NEED 19801 ZIP CODE. THIS HAS SERVED AS A FIRST OPPORTUNITY TO PROVIDE PRIMARY CARE SERVICES ON THE VAN. TWO PRIMARY CARE PRACTICES LOCATED IN WILMINGTON HOSPITAL HAVE BEEN SENDING OVERFLOW PATIENTS TO THE VAN WHEN NECESSARY TO ENSURE ACUTE PATIENTS ARE SEEN. WE ARE ALSO PLEASED TO REPORT THAT ON A FEW OCCASIONS, INDIVIDUALS WALKING PAST THE VAN, WITH NO INTENTION OF SEEING A PHYSICIAN, HAVE ENDED UP RECEIVING SERVICES IN THE VAN BECAUSE THEY STOPPED TO TALK WITH THE CAREGIVERS, SHARED HEALTH CONCERNS, AND WERE GIVEN THE OPPORTUNITY TO BE SEEN RIGHT THEN AND THERE. THIS IS EXACTLY THE TYPE OF CONVENIENCE AND MOTIVATION TO ADDRESS HEALTH CONCERNS WE WANT TO PROVIDE OUR NEIGHBORS THROUGH OUR MOBILE HEALTH SERVICES.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	IN ANOTHER EXAMPLE OF PROVIDING RADICAL CONVENIENCE, CHRISTIANACARE OPERATES 23 SCHOOL-BASED HEALTH CENTERS (SBHCS) THROUGHOUT NEW CASTLE COUNTY IN ELEMENTARY, MIDDLE, AND HIGH SCHOOLS. SBHCS OFFER CONVENIENT ACCESS TO HEALTH CARE FOR STUDENTS AND PROVIDE THE OPPORTUNITY TO ADDRESS HEALTH ISSUES AT THE EARLIEST AND MOST PREVENTABLE STAGES. BY VIRTUE OF THEIR ACCESSIBILITY, SBHCS ALSO ADVANCE HEALTH EQUITY IN THE COMMUNITY. IN FY2022, OUR SBHCS SERVED 29,890 STUDENTS AND WE EXPECT THIS NUMBER TO INCREASE AS CHRISTIANACARE HAS OPENED TWO NEW SBHCS IN KUUMBA ACADEMY CHARTER SCHOOL IN WILMINGTON AND ODESSA HIGH SCHOOL IN SOUTHERN NEW CASTLE COUNTY. INACCESSIBLE OR NON-EXISTENT MENTAL HEALTH SERVICES IS A NATIONAL CONCERN THAT IS ALSO HELD AMONG DELAWAREANS. BOTH ADULT AND TEENAGE PARTICIPANTS IN THE 2022 CHNA COMMUNITY MEETINGS IDENTIFIED MENTAL HEALTH AS THE MOST SIGNIFICANT AREA OF NEED IN NEW CASTLE COUNTY. IN RESPONSE TO THE NEED WE ARE SEEING IN THE COMMUNITY, PARTICULARLY AMONG OUR YOUTH, CHRISTIANACARE HAS PRIORITIZED EXPANDING BEHAVIORAL HEALTH SERVICES IN SBHCS IN FY2023. PROVIDING YOUTH WITH THE SERVICES AND THE TOOLS TO ADDRESS THEIR MENTAL HEALTH NEEDS EARLY WILL HELP PREVENT MORE SIGNIFICANT MENTAL HEALTH ISSUES AS THEY GROW OLDER. NEARLY A DECADE AGO, CHRISTIANACARE RECEIVED A GRANT TO HIRE MARKETPLACE GUIDES WHO WOULD ASSIST UNINSURED INDIVIDUALS IN ENROLLING IN THE HEALTH INSURANCE MARKETPLACE. IN THE YEARS SINCE, THAT WORK HAS TRANSFORMED INTO OUR HEALTH GUIDE PROGRAM BASED IN THE WILMINGTON HOSPITAL. THE HEALTH GUIDES CONNECT PATIENTS TO HEALTH CARE SERVICES AND COMMUNITY RESOURCES, AS WELL AS ASSIST WITH HEALTH INSURANCE ENROLLMENT AND PRESCRIPTION ASSISTANCE. IN FY2022, CHRISTIANACARE EXPANDED THE HEALTH GUIDE PROGRAM BY HIRING TWO NEW BILINGUAL HEALTH GUIDES TO SERVE ON-SITE AT TWO ADDITIONAL CHRISTIANACARE PRIMARY CARE PRACTICES, CHRISTIANACARE'S SU CENTRO DE SALUD, WITH PRIMARY CARE AT KIRKWOOD LOCATED IN WILMINGTON AND THE MEDICAL ARTS PAVILION (MAP) LOCATED ON THE NEWARK CAMPUS. THESE ADDITIONAL HEALTH GUIDES WILL ENSURE MORE INDIVIDUALS ARE HELPED IN ACCESSING NEEDED RESOURCES TO RECEIVE CARE AND THAT THOSE WHOSE PRIMARY LANGUAGE IS SPANISH WILL HAVE AN EASIER TIME ACCESSING THOSE SERVICES. IN FY2022, 1,433 INDIVIDUALS RECEIVED ASSISTANCE FROM THE HEALTH GUIDES. THE HEALTH GUIDES ALSO CONNECT PATIENTS TO THE MEDICAL LEGAL PARTNERSHIP (MLP), A COLLABORATION WITH THE DELAWARE COMMUNITY LEGAL AID SOCIETY, INC. (CLASI) WHICH ASSISTS PATIENTS WITH THE MITIGATION OF CIVIL LEGAL HARDSHIPS. CHRISTIANACARE HAS CONTRACTED WITH CLASI SINCE 2015 TO HELP PATIENTS ADDRESS THEIR CIVIL LEGAL NEEDS IN AREAS SUCH AS 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. UNDERSTANDABLY, THESE ISSUES PREVENT PATIENTS FROM BEING ABLE TO OBTAIN OR FOCUS ON THEIR HEALTHCARE. WITH THE RESOLUTION OF THESE BARRIERS, PATIENTS CAN PRIORITIZE THEIR HEALTH. THIS PARTNERSHIP HAS BECOME EVEN MORE CRUCIAL SINCE THE PANDEMIC, WHICH HAS EXACERBATED THE INEQUITIES ALREADY FELT BY LOW-INCOME COMMUNITIES IN THE AREAS THE MLP IS ABLE TO REMEDIATE. IN FY2022, 153 PRIMARY CARE PATIENTS WERE REFERRED TO THE MLP WITH 172 DISCRETE LEGAL MATTERS. MOST OF THESE PATIENTS WERE FEMALE WITH CLOSE TO HALF IDENTIFYING AS BLACK OR HISPANIC. THE AVERAGE INCOME OF REFERRED PATIENTS WAS AT 65 PERCENT OF THE FEDERAL POVERTY LEVEL AND ALMOST 50 PERCENT OF THE REFERRED PATIENTS LIVED IN THE CITY OF WILMINGTON. CHRISTIANACARE CONTINUES TO PARTNER WITH CLASI TO PROVIDE THIS SERVICE TO PATIENTS. THE COMMUNITY HEALTH WORKER (CHW) PROGRAM, LIKE THE HEALTH GUIDES AND THE MLP, IS COMMITTED TO HELPING PATIENTS OVERCOME BARRIERS TO GOOD HEALTH. EVEN WHEN PATIENTS ARE CONNECTED TO CARE, OTHER HARDSHIPS IN THEIR LIVES OR CHALLENGES IN COORDINATING COMPLEX MEDICAL CARE CAN DETER ACCESS. THE CHWS SERVE TO PROVIDE THE EMOTIONAL AND INSTRUMENTAL SUPPORT TO HELP PATIENTS OVERCOME THOSE CHALLENGES. CHWS MEET PATIENTS IN THEIR HOMES TO HELP THEM ORGANIZE THEIR MEDICATION OR LEARN A RECIPE; AT THE GYM TO WORK OUT; OR AT THE SOCIAL SECURITY OFFICE TO FILL OUT FORMS. CHWS PROMOTE ACCESS TO HEALTH SERVICES NOT ONLY BY HELPING PATIENTS ADDRESS THEIR HEALTH NEEDS, BUT ALSO BY VIRTUE OF THEIR ACCESSIBILITY. CHRISTIANACARE CHWS SERVE DIFFERENT POPULATIONS WITH AN EVIDENCE-BASED APPROACH. ALL CHWS RECEIVE TRAINING THROUGH PENN MEDICINE'S IMPACT (INDIVIDUALIZED MANAGEMENT FOR PATIENT CENTERED TARGET) MODEL. THE CHWS WORK TO IMPROVE HEALTH OUTCOMES BY ADDRESSING SOCIAL NEEDS, HELPING PATIENTS TO IDENTIFY AND ACHIEVE PATIENT-CENTERED GOALS, AND CONNECTING PATIENTS TO CARE. SUMMARIES OF THE CHW PROGRAMS WILL BE PROVIDED IN THIS SECTION, AND AS WILL BE DEMONSTRATED, OUR CHW INITIATIVE ALSO ADDRESSES OTHER PRIORITIZED AREAS OF NEED. CHRISTIANACARE'S CHWS ARE A BEDROCK OF THE STRATEGY WE EMPLOY TO SUPPORT OUR COMMUNITY. IT EXEMPLIFIES OUR COMMITMENT TO RADICAL ACCESS AND PARTNERING WITH OUR PATIENTS. IN FY2022, OUR CHW INITIATIVE GREW CONSIDERABLY WITH THE ADDITION OF BEHAVIORAL HEALTH, MEDICAID ENGAGEMENT, AND SOCIAL DETERMINANTS OF HEALTH CHWS. BEHAVIORAL HEALTH CHWS CHRISTIANACARE LAUNCHED THE BEHAVIORAL HEALTH CHW PROGRAM IN OCTOBER 2021, WHICH ASSISTS PATIENTS IN INCREASING THEIR INDEPENDENCE AND RESILIENCE. THE 4 BEHAVIORAL HEALTH CHWS ARE EMBEDDED WITHIN CHRISTIANACARE OUTPATIENT BEHAVIORAL HEALTH PRACTICES TO SUPPORT CHILDREN AND ADOLESCENTS AS WELL AS ADULTS WITH MENTAL HEALTH AND/OR SUBSTANCE USE DIAGNOSES FOR UP TO 6 MONTHS. IN FY22, 137 PATIENTS, INCLUDING 40 CHILDREN/ADOLESCENTS, WORKED WITH THESE CHWS.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	EMERGENCY DEPARTMENT CHWS CHRISTIANACARE'S EMERGENCY DEPARTMENT CHW PROGRAM LAUNCHED IN FEBRUARY 2021. EMBEDDED IN THE WILMINGTON HOSPITAL'S EMERGENCY DEPARTMENT, THIS 3-MONTH PROGRAM DELIVERS EPISODIC CARE TO THOSE PATIENTS THAT FREQUENT THE EMERGENCY DEPARTMENT (2 OR MORE VISITS IN THE PRIOR 90 DAYS). THE 2 EMERGENCY DEPARTMENT CHWS MEET PATIENTS AT BEDSIDE AND IN THE COMMUNITY TO CONNECT THE PATIENTS WITH RESOURCES AND PRIMARY CARE AND LONG-TERM SUPPORT. IN FY2022, THIS PROGRAM SERVED 60 INDIVIDUALS. MEDICAID ENGAGEMENT CHWS LAUNCHED IN JUNE 2021, MEDICAID ENGAGEMENT AIMS TO REACH PATIENTS THROUGHOUT THE STATE WHO ARE NEWLY ENROLLED IN DELAWARE MEDICAID TO CONNECT THEM TO PRIMARY CARE SERVICES AND COMMUNITY RESOURCES THAT ADDRESS THEIR SOCIAL DETERMINANTS OF HEALTH. IN FY22, 4 MEDICAID ENGAGEMENT CHWS ATTEMPTED OUTREACH TO 746 PATIENTS. OF THOSE, 98 PATIENTS SCHEDULED A PRIMARY CARE APPOINTMENT, AND 19 PATIENTS UPDATED THEIR PAYER. PRIMARY CARE CHWS CHRISTIANACARE'S PRIMARY CARE CHWS ENGAGE PATIENTS WITH DIABETES, HYPERTENSION, AND/OR HIGH EMERGENCY DEPARTMENT UTILIZATION IN PRIMARY CARE SERVICES. THE 7 PRIMARY CARE CHWS ARE EMBEDDED WITHIN 6 PRIMARY CARE PRACTICES TO DELIVER SERVICES IN A 6-MONTH PROGRAM TO ADULTS WITH MEDICAID INSURANCE. IN FY2022, A PRIMARY CARE CHW BEGAN SERVING A NEW CHRISTIANACARE PRACTICE, SU CENTRO DE SALUD, WITH PRIMARY CARE AT KIRKWOOD AND A SECOND CHW WAS HIRED FOR THE WILMINGTON ADULT MEDICINE PRACTICE TO MEET PATIENT NEED MORE ADEQUATELY. CHWS WERE ALSO TRAINED TO ASSIST PATIENTS WITH SELF-MONITORED BLOOD PRESSURE READINGS. IN TOTAL, 240 PATIENTS WERE SERVED BY THE PRIMARY CARE CHWS IN FY2022. SOCIAL DETERMINANTS OF HEALTH CHWS CHRISTIANACARE'S SOCIAL DETERMINANTS OF HEALTH (SDOH) CHW PROGRAM LAUNCHED IN NOVEMBER 2021. IT WAS DESIGNED TO IMPROVE HEALTH OUTCOMES AND REDUCE LONGSTANDING DISPARITIES IN HEALTH. THIS PROGRAM INCLUDES A?FOCUS ON SCREENING FOR SOCIAL DETERMINANTS OF HEALTH TO IDENTIFY AND ADDRESS THE BARRIERS TO HEALTHCARE. AFTER STEADY EXPANSION DURING FY2022, THERE ARE NOW 4 SDOH CHWS EMBEDDED AT FOUR PRIMARY CARE PRACTICES. THE SDOH CHWS CONDUCT IN-DEPTH PATIENT INTERVIEWS AND SCREENINGS AT PRIMARY PRACTICES FOR PRE-APPOINTMENT PREPARATION AND ANNUAL APPOINTMENTS. THEY IDENTIFY SOCIAL CARE NEEDS AND CONNECT PATIENTS TO COMMUNITY RESOURCES. IN FY2022, 120 PATIENTS WERE SCREENED USING CHRISTIANACARE'S SDOH SCREENING TOOL AND 120 PATIENTS WERE ENROLLED INTO THE SDOH CHW PROGRAM. WOMEN'S HEALTH CHWS CHRISTIANACARE'S WOMEN'S HEALTH CHWS SEEK TO REMOVE BARRIERS TO CARE AND CONNECT PATIENTS TO RESOURCES TO PROMOTE POSITIVE MATERNAL AND INFANT BIRTH OUTCOMES. FIVE WOMEN'S HEALTH CHWS ARE EMBEDDED THROUGHOUT CHRISTIANACARE'S WOMEN'S HEALTH SERVICES INCLUDING INPATIENT, OUTPATIENT, OBSTETRICS (OB) TRIAGE, AND THE NEONATAL INTENSIVE CARE UNIT (NICU). WOMEN'S HEALTH CHWS SERVE PATIENTS OF ALL AGES THROUGHOUT NEW CASTLE AND KENT COUNTY THAT ARE UNINSURED, INSURED WITH MEDICAID, OR ARE MEDICAID-ELIGIBLE WITH ONE OR MORE OF THE FOLLOWING CONDITIONS: CHRONIC DISEASE, MENTAL HEALTH AND/OR SUBSTANCE USE ISSUE(S), LATE OR NO ENTRY TO PRENATAL CARE, HISTORY OF POOR BIRTH OUTCOMES, BMI AT/ABOVE 30, OR ARE AT-RISK FOR BIRTH DEFECTS. SERVICE DELIVERY CONSISTS OF EPISODIC AND LONGITUDINAL CARE DURING THE PERINATAL PERIOD. IN FY2022, THE PROGRAM EXPANDED TO SERVE THE NICU AND OB TRIAGE SERVICES. IN TOTAL, 126 PATIENTS WERE SERVED IN FY2022. SCHOOL-BASED HEALTH CENTER CHWS SEVEN CHWS ARE EMBEDDED WITHIN 21 SCHOOL-BASED HEALTH CENTERS (SBHC) OPERATED BY CHRISTIANACARE. THE CHWS SERVED 1073 STUDENTS IN FY2022 BY CONNECTING THEM AND THEIR FAMILY TO NEEDED RESOURCES SUCH AS CLOTHING, FOOD, TRANSPORTATION, AND UTILITY ASSISTANCE. THEY ALSO ASSISTED STUDENTS IN MEETING THEIR HEALTH NEEDS THROUGH CONNECTION TO PRIMARY CARE PRACTICES, DENTAL SERVICES, AND EYE CARE AS WELL AS HELPING TO ENROLL THEM IN HEALTH INSURANCE. OBTAINING HEALTH INSURANCE WAS THE MOST PROVIDED SERVICE FOLLOWED BY CONNECTION TO A PRIMARY CARE PROVIDER. PEDIATRIC CARE CENTER CHRISTIANACARE ALSO MADE A SIGNIFICANT INVESTMENT TO BETTER SERVE CHILDREN AND THEIR FAMILIES BY OPENING A NEW 14 BED PEDIATRIC CARE CENTER LOCATED IN THE NEWARK CAMPUS. LAUNCHED IN OCTOBER 2021, THE CENTER PROVIDES 24/7 COMBINED SHORT-STAY INPATIENT AND EMERGENCY CARE FOR CHILDREN AND TEENS. THE PEDIATRIC CARE CENTER WILL SIGNIFICANTLY IMPROVE ACCESS TO CARE FOR CHILDREN IN NEW CASTLE COUNTY. DENTAL SERVICES ACCESSING DENTAL SERVICES IS ALSO CHALLENGING FOR MANY COMMUNITY MEMBERS AND CHRISTIANACARE HAS LONG WORKED TO ADDRESS THIS NEED. IN JANUARY 2021, CHRISTIANACARE COMPLETED A TWO-YEAR RENOVATION PROJECT THAT INCREASED THE CLINICAL CAPACITY OF OUR DENTISTRY AND ORAL-MAXILLOFACIAL SURGERY PRACTICES. THE SUCCESS OF THIS EXPANSION WAS SHOWN IN FY2022 WITH A RECORD HIGH NUMBER OF VISITS. CHRISTIANACARE'S DENTAL CLINIC HAS PROVIDED COMPREHENSIVE CARE, INCLUDING ORAL SURGERY, FOR UNINSURED AND UNDERINSURED INDIVIDUALS THROUGHOUT DELAWARE FOR OVER SIXTY YEARS. EVERY FRIDAY, THE DENTAL CLINIC SERVES UNINSURED PEDIATRIC PATIENTS. FEES AT THE CLINIC ARE KEPT AT A REDUCED LEVEL AND ONLY MEDICAID IS ACCEPTED. ANNUALLY, 11,000 PATIENTS ARE SEEN AT THIS CLINIC BY DENTAL RESIDENTS AND VOLUNTEER AND EMPLOYED DOCTORS. THE RESIDENTS SERVING THE DENTAL CLINIC ALSO PROVIDE DENTAL SERVICE IN THE COMMUNITY THROUGH ROTATIONS AT AFFILIATED DENTAL CLINICS AT WESTSIDE FAMILY HEALTHCARE AND DELAWARE TECHNICAL COMMUNITY COLLEGE. CHRISTIANACARE DENTAL RESIDENTS ALSO PROVIDE COMMUNITY OUTREACH. IN APRIL 2022, DENTAL RESIDENTS PROVIDED MOUTH AND THROAT CANCER SCREENINGS ON TWO SEPARATE OCCASIONS AT THE SUNDAY BREAKFAST MISSION. THE SUNDAY BREAKFAST MISSION, LOCATED IN WILMINGTON IN THE 19801 ZIP CODE, PROVIDES EMERGENCY SHELTER TO MEN, WOMEN, AND CHILDREN. CHRISTIANACARE ROUTINELY PARTNERS WITH THIS ORGANIZATION TO PROVIDE SERVICES TO ITS GUESTS. IN APRIL 2022, 53 INDIVIDUALS WERE SCREENED AND FOR THOSE THAT REQUIRED FOLLOW-UP, AN APPOINTMENT WAS SCHEDULED FOR THEM AT THE DENTAL CLINIC.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	CHRONIC HEALTH CONDITIONS IN OUR 5-YEAR STRATEGIC PLAN, CHRISTIANACARE ADOPTED THE ASPIRATION OF ENDING DISPARITIES IN ACCESS, EXPERIENCE, CARE DELIVERY, AND HEALTH OUTCOMES. TO EVEN BEGIN THE WORK OF ENDING DISPARITIES, WE MUST FIRST IDENTIFY DISPARITIES AND THEN DEVELOP EFFECTIVE STRATEGIES TO REDUCE THEM. IN FY2023, WE WILL BUILD SYSTEMS AND PROCESSES TO IDENTIFY AND REDUCE DISPARITIES IN QUALITY MEASURES AND HEALTH OUTCOMES WITH A FOCUS ON CHRONIC DISEASE, CANCER, AND MATERNAL/INFANT HEALTH OUTCOMES. OUR EXPECTATION IS THAT REDUCING DISPARITIES IN THESE AREAS WILL ULTIMATELY IMPROVE HEALTH OUTCOMES. AS DESCRIBED PREVIOUSLY, CHRONIC CONDITIONS ARE AN ELIGIBILITY REQUIREMENT TO PARTICIPATE IN THE PRIMARY CARE AND WOMEN'S HEALTH CHW PROGRAMS. THE CHW WORKS WITH THE PATIENTS TO IMPROVE SELF-MANAGEMENT OF THEIR CHRONIC CONDITIONS. WHILE CHRONIC CONDITIONS ARE NOT A REQUIREMENT TO PARTICIPATE IN EACH CHW PROGRAM, IF A PATIENT HAS A CHRONIC CONDITION, IT WILL BE ADDRESSED BY ANY OF THE CHWS WHO HAVE THE SHARED GOAL OF IMPROVING HEALTH. TO ADDRESS CHRONIC DISEASE OUTCOMES AND FOOD INSECURITY AMONG OUR LOW-INCOME PATIENTS, WE LAUNCHED THE DELAWARE FOOD FARMACY (DFF) IN PARTNERSHIP WITH LUTHERAN COMMUNITY SERVICES IN FEBRUARY 2021. THIS 6-MONTH COMPREHENSIVE FOOD PHARMACY SERVES PRIMARY CARE PATIENTS WITH UNCONTROLLED?HYPERTENSION, DIABETES, AND/OR CONGESTIVE HEART FAILURE. PARTICIPANTS IN THIS PROGRAM RECEIVE WEEKLY MEDICALLY TAILORED GROCERY BOXES DELIVERED TO THEIR HOMES BY LUTHERAN COMMUNITY SERVICES. THE BOXES CONTAIN ENOUGH FOOD FOR THE PATIENT AND THEIR FAMILY MEMBERS TO PREPARE ABOUT 10 MEALS. THE FOOD PROVISIONS ARE GUIDED BY AN EVIDENCE-BASED EATING PLAN. ALONG WITH THE FOOD, PARTICIPANTS MEET EACH WEEK WITH A DFF CHW, WHO ASSISTS THEM WITH GOAL SETTING AND IMPROVING DIETARY KNOWLEDGE AND CULINARY SKILLS. PARTICIPANTS ALSO RECEIVE ADDITIONAL SUPPORT FROM CHRISTIANACARE PHARMACISTS, REGISTERED DIETITIANS, AND BEHAVIORAL HEALTH CONSULTANTS AS WELL AS BLOOD PRESSURE CUFFS, GLUCOSE MONITORS, AND SCALES FOR SELF-MONITORING. THE DFF INCLUDES AN ONGOING ROBUST EVALUATION THAT EXAMINES PRE-TO-POST ENROLLMENT CHANGES IN FOOD INSECURITY AND NUTRITIONAL AND CHRONIC DISEASE OUTCOMES. TWENTY-FOUR HOUR DIETARY RECALLS, PATIENT SURVEYS, AND MEDICAL RECORD DATA ARE BEING USED TO DOCUMENT PROGRAM PROCESS AND OUTCOMES. IN FY2022, 79 PATIENTS PARTICIPATED, AND 198 COMMUNITY MEMBERS WERE FED THROUGH THE DFF. OF THE DFF PARTICIPANTS, 75% WERE FOOD INSECURE, AND THE MAJORITY HAD ONE OR MORE CHRONIC CONDITIONS. A LITTLE MORE THAN HALF OF THE PARTICIPANTS WERE FEMALE AND MOST PARTICIPANTS WERE BLACK/AFRICAN-AMERICAN (70%) WITH ANOTHER 14% IDENTIFYING AS HISPANIC. DEMONSTRATING THE EFFECTIVENESS OF THE PROGRAM, 90% OF THESE PARTICIPANTS LOST WEIGHT. OUTCOMES OF EARLIER DFF PARTICIPANTS, THERE HAVE BEEN A TOTAL OF 95, HAVE ALSO BEEN PROMISING WITH PATIENTS SHOWING INCREASED CALCIUM AND FIBER INTAKE, DECREASES IN HBA1C AND BLOOD PRESSURE, WEIGHT LOSS, AND DECREASES IN ANXIETY AND DEPRESSION. OUR PARTNERSHIP WITH LUTHERAN COMMUNITY SERVICES HAS BEEN A KEY COMPONENT OF THIS PROGRAM'S SUCCESS AND WE LOOK FORWARD TO EXPANDING OUR SUCCESS WITH THEM OVER THE NEXT SEVERAL MONTHS. CHRISTIANACARE IS ACTIVELY ENGAGED IN DEVELOPING A CULTURALLY CENTERED DFF TO OFFER TO OUR SPANISH-SPEAKING PATIENTS. IN THE UPCOMING YEAR, CHRISTIANACARE WILL FURTHER EXPAND THE DFF TO SERVE A TARGETED SUBSET OF PATIENTS IN OUR WOMEN'S HEALTH PRACTICES. THE DFF OPERATES OUT OF CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT, BUT THE PARTICIPATION OF MULTIPLE DEPARTMENTS MAKES THIS PROGRAM AND ITS EXPANSION POSSIBLE. THE DFF DEMONSTRATES CHRISTIANACARE'S COMPREHENSIVE APPROACH TO PROVIDING HOLISTIC AND CONVENIENT CARE THAT RECOGNIZES THE PATIENT AS A WHOLE PERSON. WITH LONG TERM COMMUNITY PARTNER, URBAN ACRES, CHRISTIANACARE ALSO OPERATES A PRODUCE DELIVERY PROGRAM. ADULT PATIENTS LIVING IN NEW CASTLE COUNTY WHO ARE ON MEDICAID OR ARE MEDICAID ELIGIBLE AND HAVE DIABETES, HYPERTENSION, AND/OR NEED FOOD ASSISTANCE ARE ELIGIBLE. THIS 3-TO-6-MONTH WEEKLY DELIVERY PROGRAM IS DESIGNED TO INCREASE PATIENT ACCESS TO THE FRESH PRODUCE NECESSARY TO LIVE A HEALTHIER LIFE. ALONG WITH A BAG OF PRODUCE CONSISTING OF 1 LEAFY GREEN, 2-3 ADDITIONAL VEGETABLES, AND 2-3 FRUITS, PATIENTS ARE ALSO CONNECTED TO SUSTAINABLE FOOD ASSISTANCE PROGRAMS AND RECEIVE EDUCATIONAL MATERIALS ON THE HEALTH BENEFITS OF FRUITS AND VEGETABLES. IN FY2022, 178 PATIENTS WERE SERVED. OF THOSE PATIENTS, 65% WERE FEMALE, 54% WERE BLACK/AFRICAN AMERICAN, AND 19% WERE HISPANIC. THE MEAN AGE OF THESE PATIENTS WAS 57.54.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	MATERNAL AND CHILD HEALTH IN 2015, DELAWARE HAD THE SECOND HIGHEST INFANT MORTALITY RATE AMONG ALL STATES. IN 2020, DELAWARE WAS RANKED 31ST HIGHEST INFANT MORTALITY RATE AMONG THE STATES. THIS IMPROVEMENT WAS THE RESULT OF CONCENTRATED EFFORTS BY STATE AND COMMUNITY AGENCIES AS WELL AS HEALTH SYSTEMS LIKE CHRISTIANACARE WHICH HAS TAKEN A LEADING ROLE IN THIS EFFORT. THE SIGNIFICANT DECREASE IN THE INFANT MORTALITY RATE IS AN ACCOMPLISHMENT TO BE CELEBRATED, BUT THERE IS STILL WORK TO BE DONE TO IMPROVE MATERNAL AND INFANT OUTCOMES, PARTICULARLY DISPARATE OUTCOMES ACROSS RACE AND ETHNICITY. CHRISTIANACARE CONTINUES TO ADDRESS MATERNAL AND CHILD HEALTH WITH EXCEPTIONAL AND INNOVATIVE CLINICAL CARE COMBINED WITH COMMUNITY SUPPORTS LIKE THE HEALTH AMBASSADORS WHICH WILL BE DESCRIBED IN FURTHER DETAIL IN THIS SECTION. WE ALSO ADDRESS SOCIAL DETERMINANTS OF HEALTH BECAUSE WE BELIEVE THAT PROVIDING OUR COMMUNITIES AND NEIGHBORS WITH LIFE RESOURCES WILL HAVE A POSITIVE EFFECT ON HEALTH OUTCOMES INCLUDING THE LONG-TERM IMPACT OF IMPROVING MATERNAL AND INFANT OUTCOMES. AS HAS BEEN DEMONSTRATED THROUGHOUT THIS NARRATIVE, CHRISTIANACARE IS COMMITTED TO REDUCING DISPARITIES, PROVIDING RADICAL CONVENIENCE, AND IMPLEMENTING INNOVATIVE STRATEGIES TO IMPROVE HEALTH OUTCOMES. OVER THE LAST SEVERAL YEARS, CHRISTIANACARE'S WOMEN'S HEALTH DEPARTMENT HAS SUCCESSFULLY IMPLEMENTED THESE OBJECTIVES TO SIGNIFICANTLY IMPROVE MATERNAL AND INFANT HEALTH. POST-PARTUM HYPERTENSION MONITORING--REDUCTION OF DISPARITIES CHRISTIANACARE CLINICAL LEADERS DESIGNED AND IMPLEMENTED A POST-PARTUM HYPERTENSION MONITORING PROGRAM FROM FEBRUARY 2019 THROUGH MAY 2020 TO IMPROVE EARLY DETECTION OF POSTPARTUM HYPERTENSION BY OVERCOMING LOW ATTENDANCE FOR FOLLOW-UP OFFICE VISITS. WOMEN WITH HIGH BLOOD PRESSURE COMPRISED MOST POSTPARTUM READMISSIONS, WITH BLACK WOMEN READMITTED TWICE AS OFTEN AS WHITE WOMEN, BUT ONLY 30% OF PATIENTS ATTENDED POSTPARTUM OFFICE VISITS. THE STUDY TEAM EVALUATED HISTORICAL DATA TO LEARN ABOUT THE BARRIERS ASSOCIATED WITH THE POOR POSTPARTUM OFFICE VISIT RATE. PATIENTS REPORTED CHALLENGES WITH THE TIME AND RESOURCES REQUIRED TO TRAVEL TO APPOINTMENTS, THE EXERTION ASSOCIATED WITH THE EFFORT, AND THE PERCEIVED LOW BENEFIT FROM THE VISIT. TO ADDRESS THESE BARRIERS, CHRISTIANACARE CONNECTED A TARGETED POPULATION OF NEW MOTHERS PRIOR TO HOSPITAL DISCHARGE WITH TWISTLE, A REMOTE PATIENT MONITORING PLATFORM. PATIENTS WHO CONSENTED TO PARTICIPATE IN THE PROGRAM RECEIVED A BRIEF OVERVIEW OF THE PLATFORM AND TUTORIAL ON THE MONITORING EQUIPMENT PRIOR TO HOSPITAL DISCHARGE. THE PROGRAM INCLUDED SENDING EDUCATIONAL MATERIALS AND ASSESSMENT FORMS AUTOMATICALLY TO PATIENTS' CELL PHONES ON A PRESCRIBED SCHEDULE. PATIENTS WITH BLOOD PRESSURE IN THE NORMAL RANGE RECEIVED AUTOMATED REPLIES THAT OFFERED IMMEDIATE REASSURANCE. ABNORMAL READINGS WERE PROMPTLY ROUTED TO THE CARE TEAM FOR FOLLOW-UP. THIS PROCESS PROVIDED AN OPPORTUNITY FOR THE CARE TEAM TO PROACTIVELY TITRATE MEDICATION AND AVOID PATIENTS REQUIRING READMISSION FOR HYPERTENSIVE CRISIS. THIS PROGRAM SUCCESSFULLY REDUCED POSTPARTUM HYPERTENSION READMISSION RATES AND ELIMINATED A LONGSTANDING RACIAL DISPARITY. NOTABLY, 91% OF NEW MOTHERS SUBMITTED AT LEAST ONE BLOOD PRESSURE READING IN THE REMOTE MONITORING PROGRAM, AND 70% OF PATIENTS ENGAGED IN THE FULL 10-DAY PROTOCOL. THE PROGRAM SUCCESSFULLY REDUCED OVERALL POSTPARTUM PATIENT READMISSIONS BY 55%. AMONG BLACK MOTHERS, THE READMISSION RATE DROPPED FROM 61% TO 31%. THIS PROGRAM HAS NOW BECOME STANDARD PRACTICE THROUGHOUT CHRISTIANACARE'S WOMEN'S HEALTH PRACTICES. BASED ON PATIENT FEEDBACK, THE DURATION OF THE MONITORING PROGRAM WAS EXTENDED FROM 10 DAYS TO 42 DAYS. THE ADDITIONAL TIME SUPPORTS EACH PATIENT'S CARE TRANSITION TO THEIR PRIMARY PHYSICIAN OR THE IDENTIFICATION OF A PRIMARY CARE PROVIDER FOR THOSE WITHOUT ONE. PRENATAL AND POSTPARTUM DIABETES MONITORING-REDUCTION OF DISPARITIES WOMEN'S HEALTH CLINICAL LEADERS TACKLED POOR COMPLIANCE WITH POSTPARTUM DIABETES TESTING IN THE SAME MANNER. WOMEN WITH GESTATIONAL DIABETES ARE ASKED TO COMPLETE 2-HOUR GLUCOSE TOLERANCE TEST 6-12 WEEKS POST-DELIVERY. WHILE GESTATIONAL DIABETES RESOLVES AFTER DELIVERY FOR MOST WOMEN, SOME DEVELOP TYPE 2 DIABETES. AS WITH THE PREVIOUSLY DESCRIBED PATIENTS, THE LOGISTICS OF GETTING TO THE DIABETES SCREENING APPOINTMENT PRESENTED MANY CHALLENGES, ESPECIALLY FOR WOMEN FROM LOW-INCOME AND MINORITY COMMUNITIES. TO OVERCOME THOSE BARRIERS, PATIENTS WERE ASKED TO SUBMIT THREE FASTING BLOOD SUGARS AT HOME AND TEXT THE RESULTS. PATIENTS WITH ABNORMAL RESULTS COMPLETED THE 2-HOUR GLUCOSE TOLERANCE TEST AND WERE CONNECTED TO PRIMARY CARE. TEXT-BASED SCREENING FOR POSTPARTUM DIABETES TESTING ACHIEVED IMPROVED COMPLIANCE WITH A 92% INCREASE IN COMPLIANCE RATES COMPARED TO STANDARD SCREENING (25% VERSUS 48%) AND A 213% INCREASE IN THE DETECTION OF TYPE 2 DIABETES (5.4% IN THE STANDARD SCREENING GROUP COMPARED TO 16.9% IN TEXT-BASED SCREENING). ENGAGEMENT WITH TEXT-BASED SCREENING NARROWED THE RACIAL GAP IN CARE WITH A 211% INCREASE IN COMPLIANCE AMONG BLACK WOMEN. IMPROVEMENTS IN COMPLIANCE WITH TEXT-BASED CARE LED TO A 180% HIGHER DIABETES DETECTION AMONG NON-BLACK WOMEN AND A 577% INCREASE AMONG BLACK WOMEN. THESE PROGRAMS DEMONSTRATE HOW DISPARITIES CAN BE EFFECTIVELY ADDRESSED. THESE SUCCESSES WILL INFORM THE WOMEN'S HEALTH DEPARTMENT AS IT PARTNERS WITH THE DELAWARE FOOD FARMACY TO USE FOOD AS MEDICINE TO SERVE HIGH-RISK OBESE PREGNANT PATIENTS. WE LOOK FORWARD TO SHARING INFORMATION ABOUT THIS PROGRAM AS IT PROGRESSES.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	BIRTHING COMPANION CERTIFICATE PARTNERSHIP WITH UNIVERSITY OF DELAWARE CHRISTIANACARE IS ALSO ADDRESSING DISPARITIES IN MATERNAL AND CHILD HEALTH THROUGH ITS COLLABORATION WITH UNIVERSITY OF DELAWARE'S DIVISION OF PROFESSIONAL AND CONTINUING STUDIES AND SCHOOL OF NURSING TO CREATE A BIRTHING COMPANION CERTIFICATE IN THE FALL OF 2021. BIRTH COMPANIONS SUPPORT AND ADVOCATE FOR WOMEN DURING THEIR PREGNANCY, LABOR AND BIRTH, AND AFTER DELIVERY. NURSING STUDENTS PARTICIPATING IN THIS COURSE PROGRAM ARE PROVIDED WITH THE SKILLS THEY NEED TO PURSUE THE REQUIREMENTS OF BECOMING A DOULA. THIS PROGRAM SERVES THE DUAL PURPOSE OF HELPING THE PATIENT AND PROVIDING THE NURSING STUDENT WITH CLINICAL EXPERIENCE AND THE OPPORTUNITY TO WORK CLOSELY WITH PATIENTS WHO MAY BE IN VERY DIFFERENT CIRCUMSTANCES THAN THEIR OWN. THIS WILL GIVE THE PARTICIPATING STUDENTS AN EARLY LESSON IN THE IMPORTANCE OF RECOGNIZING PATIENTS AS A WHOLE PERSON. COMMUNITY HEALTH WORKERS, HEALTHY BEGINNINGS, AND OTHER PROGRAMS TO ADDRESS INFANT MORTALITY AND DISPARITIES CHRISTIANACARE HAS SEVERAL PROGRAMS DESIGNED TO PROMOTE MATERNAL AND CHILDREN'S HEALTH IN A HOLISTIC MANNER. AS DESCRIBED PREVIOUSLY, WOMEN'S HEALTH CHWS ARE EMBEDDED THROUGHOUT CHRISTIANACARE'S WOMEN'S HEALTH SERVICES INCLUDING INPATIENT, OUTPATIENT, OBSTETRICS (OB) TRIAGE, AND THE NEONATAL INTENSIVE CARE UNIT (NICU). THESE CHWS PARTNER WITH PATIENTS TO PROVIDE CONNECTION TO NEEDED SOCIAL AND HEALTH RESOURCES TO ULTIMATELY IMPROVE HEALTH. IN PARTNERSHIP WITH THE DELAWARE DIVISION OF PUBLIC HEALTH, CHRISTIANACARE HAS OFFERED HEALTHY BEGINNINGS FOR OVER A DECADE. CREATED TO ADDRESS DELAWARE'S HIGH INFANT MORTALITY RATE, THIS PROGRAM PROVIDES PRECONCEPTION CARE TO IDENTIFY AND ADDRESS RISKS TO FUTURE PREGNANCY, PREGNANCY PLANNING TO SET THE STAGE FOR A HEALTHY PREGNANCY, AND PRENATAL CARE FROM CONCEPTION TO CHILDBIRTH. HEALTHY BEGINNINGS OFFERS A MULTIDISCIPLINARY TEAM OF DOCTORS, NURSE PRACTITIONERS, NURSE EDUCATORS, SOCIAL WORKERS, RESOURCE MOTHERS, DIETICIANS, AND CASE MANAGERS TO ENSURE THE PATIENT HAS THE CLINICAL AND SOCIAL RESOURCES NEEDED TO ACHIEVE POSITIVE OUTCOMES FOR MOTHER AND BABY AND REDUCE DISPARATE OUTCOMES. IN FY2022, PATIENTS IN THIS PROGRAM RECEIVED THE FOLLOWING SERVICES TO SUPPORT THEIR HEALTH: PERSONAL HEALTH AND WELLNESS, WEIGHT MANAGEMENT, STRESS MANAGEMENT, EMOTIONAL HEALTH TREATMENT, FAMILY PLANNING, CONTRACEPTION, DOMESTIC ABUSE SCREENING, TOBACCO CESSATION, AND HYPERTENSION SCREENING AND TREATMENT. IN FY2022, 1,148 PATIENTS WERE ENROLLED IN HEALTHY BEGINNINGS, OF THOSE, 80.8% WERE BLACK AND 73.9% LIVED-IN HIGH-RISK ZONES (19703, 19720, 19801, 19802, 19804, 19805, 19809). HEALTH AMBASSADORS FOR THE LAST DECADE, THE STATE OF DELAWARE HAS AWARDED CHRISTIANACARE GRANT FUNDING TO SUPPORT ITS HEALTH AMBASSADORS PROGRAM. LIKE THE HEALTHY BEGINNINGS PROGRAM, THE HEALTH AMBASSADORS PROGRAM WAS CREATED IN RESPONSE TO THE HIGH INFANT MORTALITY RATE. HEALTH AMBASSADORS GUIDE FAMILIES ON THE PATH TO GOOD HEALTH. THEY SERVE PREGNANT WOMEN AND FAMILIES WITH CHILDREN AGED 0 TO 5 IN TARGETED HIGH-RISK ZIP CODES TO CONNECT WOMEN AND YOUNG FAMILIES TO HEALTH CARE, SOCIAL SERVICES, HOME VISITING, AND EDUCATIONAL PROGRAMS. THE HEALTH AMBASSADORS ALSO PROMOTE KEY MATERNAL AND CHILD HEALTH MESSAGES INCLUDING THE BENEFITS OF BREASTFEEDING AND THE IMPORTANCE OF SAFE SLEEP. IN FY2022, THE HEALTH AMBASSADORS EXPANDED THEIR REACH BY HIRING A SECOND BILINGUAL HEALTH AMBASSADOR IN JUNE 2022 TO SERVE THE SPANISH SPEAKING COMMUNITY, AS WELL AS PREGNANT AND PARENTING WOMEN WITH SUBSTANCE USE DISORDER RECEIVING TREATMENT AT A SUBSTANCE USE DISORDER TREATMENT CLINIC IN CLAYMONT. FROM JUNE TO NOVEMBER 2022, THE HEALTH AMBASSADORS HAD AN INCREASE IN SERVICES FOR SPANISH SPEAKING FAMILIES BY 40% COMPARED TO THE SAME PERIOD THE PREVIOUS YEAR. THE HEALTH AMBASSADORS WERE ALSO AT THE FOREFRONT OF PROVIDING RELIEF TO FAMILIES IMPACTED BY THE INFANT FORMULA SHORTAGE. THE HEALTH AMBASSADORS PARTNERED WITH THE STATE AND OTHER COMMUNITY ORGANIZATIONS TO COLLECT BABY FOOD AND FORMULA AND HOST A BABY FOOD AND FORMULA DRIVE IN JUNE 2022 FOR FAMILIES IN NEED. WHILE THE CRISIS OF THE INFANT FORMULA SHORTAGE DID ABATE TOWARDS THE END OF 2022, FINDING FORMULA CONTINUES TO BE A CHALLENGE FOR SOME FAMILIES AND THE HEALTH AMBASSADORS PROVIDE THE NEEDED SUPPORT FOR THESE FAMILIES. THE HEALTH AMBASSADORS ALSO PROVIDED FAMILIES WITH 2,882 ESSENTIAL ITEMS SUCH AS FOOD BOXES (227), CAR SEATS (179), PACKAGES OF DIAPERS (640), STROLLERS (27), CLOTHING (160), AND MORE. IN MOST CASES, THE HEALTH AMBASSADORS DELIVERED THESE ITEMS TO THE FAMILY'S HOME. THE HEALTH AMBASSADORS ALSO PROVIDED 625 REFERRALS FOR FAMILIES TO RECEIVE SERVICES SUCH AS HOME VISITING, HOUSING, AND HEALTH INSURANCE. WHILE THERE WAS ALWAYS FREQUENT COMMUNICATION BETWEEN THE WOMEN'S HEALTH CHWS, HEALTH AMBASSADORS, AND HEALTHY BEGINNINGS, IN FY2022, THESE GROUPS BEGAN A WEEKLY HUDDLE TO ENSURE THE HIGH NEEDS PATIENTS THEY SERVE ARE RECEIVING THE MOST EFFECTIVE CARE AND THE NEEDED RESOURCES FOR FAMILIES FROM PRECONCEPTION TO RAISING YOUNG CHILDREN.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	ALLIANCE FOR ADOLESCENTS PREGNANCY PREVENTION (AAPP) SINCE 1995, THE STATE OF DELAWARE HAS ALSO PROVIDED CHRISTIANACARE WITH A GRANT TO OPERATE THE ALLIANCE FOR ADOLESCENTS PREGNANCY PREVENTION (AAPP). AAPP 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. IN FY2022, CHRISTIANACARE'S AAPP TEAM PROVIDED 500 ADOLESCENTS WITH EDUCATION. AAPP OFFERS THREE COURSES: 1. BE PROUD! BE RESPONSIBLE: A SIX-MODULE CURRICULUM THAT PROVIDES ADOLESCENTS, AGES 13 TO 18, WITH THE KNOWLEDGE, MOTIVATION, AND SKILLS NECESSARY TO CHANGE THEIR BEHAVIORS IN WAYS THAT WILL REDUCE THEIR RISK OF CONTRACTING HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS. 2. MAKING PROUD CHOICES: AN EIGHT-MODULE CURRICULUM THAT PROVIDES YOUNG ADOLESCENTS, AGES 11 TO 13, WITH THE KNOWLEDGE, CONFIDENCE, AND SKILLS NECESSARY TO REDUCE THEIR RISK OF SEXUALLY TRANSMITTED INFECTIONS (STIS), HIV, AND PREGNANCY. 3. WISE GUYS: A TEN-MODULE PROGRAM DESIGNED TO PREVENT ADOLESCENT PREGNANCY, EMPOWER YOUNG MEN TO RECOGNIZE CHALLENGES THEY MAY FACE IN LIFE, AND GIVE THEM THE TOOLS TO OVERCOME THESE CHALLENGES. SELF-REPORTED PRE-TEST AND POST-TEST KNOWLEDGE, ATTITUDE, AND BEHAVIOR MEASURES BETWEEN SEPTEMBER 2021 AND APRIL 2022 DEMONSTRATED STUDENTS' INCREASED KNOWLEDGE AFTER PARTICIPATING IN BE PROUD! BE RESPONSIBLE! AND MAKING PROUD CHOICES COURSES. DATA FOR WISE GUYS WAS INCOMPLETE, BUT WE EXPECT TO SEE POSITIVE RESULTS IN FY2023. IMPORTANTLY, EVERY STUDENT WAS PROVIDED A SATISFACTION SURVEY AT THE END OF THEIR COURSE AND 94% RATED THE AAPP SERIES AS "EXCELLENT"GOOD6% RATED IT AS "FAIR". 100% OF RESPONDENTS ANSWERED "YES" TO THE QUESTION OF WHETHER THEIR EDUCATOR EXPLAINED THE PROGRAM IN A WAY THEY COULD UNDERSTAND. DELAWARE HEALTHY MOTHER & INFANT CONSORTIUM (DHMIC) CHRISTIANACARE CAREGIVERS ARE ALSO SERVING THE STATE THROUGH COLLABORATIVE EFFORTS SUCH AS THE DELAWARE HEALTHY MOTHER & INFANT CONSORTIUM (DHMIC). DR. DAVID PAUL, CHRISTIANACARE CHAIR OF PEDIATRICS, AGAIN SERVED AS CO-CHAIR OF DHMIC IN FY2022. THE MISSION OF DHMIC IS TO PROVIDE STATEWIDE LEADERSHIP AND COORDINATION OF EFFORTS TO PREVENT INFANT MORTALITY AND TO IMPROVE THE HEALTH OF WOMEN OF CHILDBEARING AGE AND INFANTS THROUGHOUT DELAWARE. CHRISTIANACARE CAREGIVERS ALSO SERVE ON THE DELAWARE MATERNAL MORTALITY REVIEW PANEL WHICH REVIEWS MATERNAL DEATHS AND RECOMMENDS TERTIARY AND SYSTEMIC CHANGES TO REDUCE MORTALITY RATES. MENTAL HEALTH AND SUBSTANCE USE DISORDERS EVEN BEFORE THE CORONAVIRUS PANDEMIC EXACERBATED THE ISSUES OF ACCESS TO BEHAVIORAL HEALTH SERVICES AND BROUGHT INCREASED ATTENTION TO THE BEHAVIORAL HEALTH NEEDS OF VULNERABLE POPULATIONS, OUR COMMUNITY HAD LONG IDENTIFIED MENTAL HEALTH AND SUBSTANCE USE DISORDERS AS A SIGNIFICANT AREA OF NEED. TO ADDRESS THIS AREA OF NEED, CHRISTIANACARE IS WORKING TO PROVIDE MORE ACCESS BY HIRING ADDITIONAL CAREGIVERS AND DEVELOPING AND EXPANDING PROGRAMS. CHRISTIANACARE'S BEHAVIORAL HEALTH TEAM WORKED TOWARDS A GOAL OF HIRING 71 NEW CAREGIVERS IN BOTH CLINICAL AND NON-CLINICAL ROLES TO ADDRESS BEHAVIORAL HEALTH BY THE END OF FISCAL YEAR 2023. IT HAS BEEN A CHALLENGE IN OUR STATE AND NATIONALLY TO FILL BEHAVIORAL HEALTH POSITIONS. CHRISTIANACARE IS NOT IMMUNE TO THOSE CHALLENGES, BUT WE ARE ENCOURAGED BY THE PROGRESS WE HAVE ALREADY MADE. CHRISTIANACARE LAUNCHED A GENDER WELLNESS CLINIC IN OCTOBER 2021 WHICH SERVES ANYONE AGE 13 OR OLDER EXPLORING THEIR GENDER IDENTITY, EXPERIENCING GENDER DYSPHORIA, OR WHO NEEDS EDUCATION AND SUPPORT AROUND SOCIAL AND MEDICAL TRANSITION. A NEW GERIATRIC MENTAL HEALTH PROGRAM IS IN DEVELOPMENT IN COLLABORATION WITH CHRISTIANACARE'S SWANK MEMORY CENTER. THIS PROGRAM WILL BE COMPRISED OF TWO NEW SENIOR PSYCH SOCIAL WORKERS AND A GERIATRIC PSYCHIATRIST. ALSO SET TO LAUNCH THIS YEAR IS THE FIRST EPISODE CLINIC, AN EARLY INTERVENTION MODEL DESIGNED TO CONNECT PATIENTS WITH RESOURCES TO REDUCE INAPPROPRIATE ED VISITS AND READMISSION TO INPATIENT FLOORS. FINALLY, NOW THAT COVID-19 RESTRICTIONS HAVE EASED, WE ARE VERY PLEASED TO RETURN TO OFFERING GROUP THERAPY PROGRAMS FOR ADULTS AND CHILDREN. WE ARE ALSO WORKING TO EXPAND OUR SUBSTANCE USE AND EMBEDDED BEHAVIORAL HEALTH CARE MODELS. EMBEDDED BEHAVIORAL HEALTH CARE INCREASES ACCESS AND EARLY PREVENTION AS WELL AS ENABLES US TO SERVE THE PATIENT HOLISTICALLY BY ADDRESSING THE CONNECTION BETWEEN PHYSICAL AND MENTAL HEALTH. AN ADVANCED PRACTICE CLINICIAN IS NOW EMBEDDED WITHIN PROJECT RECOVERY, CHRISTIANACARE'S OUTPATIENT SUBSTANCE USE DISORDER TREATMENT PROGRAM. WITH THE ADDITION OF TWO NEW BEHAVIORAL HEALTH CONSULTANTS (BHC), SIX WOMEN'S HEALTH PRACTICES ARE NOW SERVED BY BHCS. WE INTEND TO EXPAND EMBEDDED BEHAVIORAL HEALTH INTO NEW PRACTICES THIS YEAR AND WILL BE ABLE TO SHARE THAT PROGRESS NEXT YEAR. IN FY2022, CHRISTIANACARE ALSO LAUNCHED THE BEHAVIORAL HEALTH CHW PROGRAM, AS DESCRIBED IN THE ACCESS TO CARE SECTION. THROUGH THIS PROGRAM, CHWS ARE EMBEDDED IN CHRISTIANACARE'S OUTPATIENT BEHAVIORAL HEALTH SERVICES TO SUPPORT CHILDREN, ADOLESCENTS, AND ADULTS WITH MENTAL HEALTH AND/OR SUBSTANCE USE DIAGNOSES FOR UP TO 6 MONTHS.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	ANOTHER PROGRAM CHRISTIANACARE HAS OPERATED TO ADDRESS SUBSTANCE USE DISORDER IS PROJECT ENGAGE, AN EARLY INTERVENTION AND REFERRAL TO SUBSTANCE USE DISORDER TREATMENT PROGRAM. PEERS IN SUBSTANCE USE DISORDER RECOVERY ENGAGE WITH INPATIENTS AND PATIENTS IN THE EMERGENCY DEPARTMENT WHO ARE STRUGGLING WITH SUBSTANCE USE DISORDER. THE PEERS USE MOTIVATIONAL INTERVIEWING TO EMPOWER EACH PATIENT IN THE DECISION-MAKING PROCESS, ASSISTING THEM TO TAKE THE CRITICAL FIRST STEP TO SEEK HELP FOR THE SUBSTANCE USE DISORDER. PEERS WILL CONNECT THESE PATIENTS TO TREATMENT PROGRAMS AND OTHER COMMUNITY RESOURCES. IN FY2022, PROJECT ENGAGE PEERS HAD A TOTAL OF 2061 ENGAGEMENTS WITH PATIENTS AND MADE 977 REFERRALS TO TREATMENT. CHRISTIANACARE'S PROVISION OF BEHAVIORAL HEALTH SERVICES IN SCHOOL-BASED HEALTH CENTERS IS NOT THE ONLY COMMUNITY-BASED EFFORT BEING UNDERTAKEN TO PROVIDE RADICALLY CONVENIENT SERVICE TO OUR NEIGHBORS. SINCE 2020, CHRISTIANACARE HAS PARTNERED WITH THE NEW CASTLE COUNTY POLICE DEPARTMENT (NCCPD) TO ADDRESS MENTAL HEALTH AND SUBSTANCE USE DISORDER IN THE COMMUNITY. SUPPORTED BY FEDERAL AND STATE GRANT FUNDING, THE UNDERLYING GOALS OF THIS PARTNERSHIP ARE TO DIVERT INDIVIDUALS AWAY FROM THE CRIMINAL JUSTICE SYSTEM AND EMERGENCY DEPARTMENTS WHEN APPROPRIATE AND WORK TO CONNECT INDIVIDUALS TO CARE IN THE COMMUNITY. THREE CHRISTIANACARE CAREGIVERS, TWO MENTAL HEALTH PROFESSIONALS AND A CASE MANAGER, ARE EMBEDDED IN THE POLICE DEPARTMENT'S BEHAVIORAL HEALTH UNIT (BHU) TO ADDRESS MENTAL HEALTH NEEDS IN THE COMMUNITY. SERVING WITH THE POLICE IN A CO-RESPONDER MODEL, THE MENTAL HEALTH PROFESSIONALS RESPOND TO 911 CALLS AND OFFICER REFERRALS WHEN MENTAL ILLNESS IS BELIEVED TO BE A PRIMARY FACTOR FOR POLICE INVOLVEMENT. THEY PROVIDE SUPPORT TO THE COMMUNITY MEMBER AT A TIME OF CRISIS AS WELL AS EDUCATION TO THE OFFICERS ON HOW TO IDENTIFY MENTAL ILLNESS AND PROVIDE ESSENTIAL DE-ESCALATION TACTICS. ONCE THE INITIAL CRISIS HAS BEEN ABATED, THE CASE MANAGER CONTINUES TO WORK TO CONNECT THESE INDIVIDUALS TO THE APPROPRIATE COMMUNITY TREATMENT AND TO ADDRESS ANY SOCIAL NEEDS. IN FY2022, CHRISTIANACARE RECEIVED ADDITIONAL GRANT FUNDING TO EMPLOY ANOTHER MENTAL HEALTH PROFESSIONAL TO BETTER MEET THE NEEDS THE POLICE ARE EXPERIENCING IN THE COMMUNITY. THREE ADDITIONAL CHRISTIANACARE CAREGIVERS SUPPORT THE NCCPD'S HERO HELP PROGRAM WHICH ADDRESSES SUBSTANCE USE DISORDER BY SUPPORTING THOSE SEEKING TREATMENT. THESE CAREGIVERS RESPOND TO NON-FATAL OVERDOSES, PROVIDE OUTREACH IN THE COMMUNITY, WORK WITH INDIVIDUALS TO DEVISE A TREATMENT PLAN AND OBTAIN TREATMENT, PROVIDE ONGOING CASE MANAGEMENT, AND ADDRESS ANY NEEDS INDIVIDUALS MAY HAVE THAT SERVE AS BARRIERS TO OBTAINING TREATMENT. THE INITIAL GRANT FUNDING WHICH ENABLED US TO BEGIN OUR PARTNERSHIP WITH THE POLICE WILL EXPIRE IN OCTOBER 2023. CHRISTIANACARE WILL SEEK ADDITIONAL SUPPORT TO CONTINUE THIS PARTNERSHIP - AND EXPAND IT WITH MORE CAREGIVERS EMBEDDED IN THE NCCPD. THIS PROGRAM ADDRESSES A SIGNIFICANT NEED IN THE COMMUNITY AND ENABLES US TO SERVE OUR COMMUNITY AND THE POLICE. THE NCCPD RECOGNIZES THAT SUBSTANCE USE DISORDER AND MENTAL HEALTH ISSUES ARE OFTEN THE DRIVING FACTORS LEADING TO INVOLVEMENT WITH POLICE. OUR PARTNERSHIP PROVIDES THEM WITH THE SUPPORT TO RESPOND APPROPRIATELY AND IT ALLOWS CHRISTIANACARE TO PROVIDE MORE SERVICES IN THE COMMUNITY. CHRISTIANACARE'S COMMUNITY SUBSTANCE OVERDOSE SUPPORT (SOS), CREATED IN PARTNERSHIP WITH NEW CASTLE COUNTY, PROVIDES OUTREACH TO INDIVIDUALS WITH SUBSTANCE USE DISORDER (SUD) LIVING IN NEW CASTLE COUNTY. SOS ACCEPTS SELF-REFERRALS, INTERNAL REFERRALS FOR CHRISTIANACARE PATIENTS, AND NEW CASTLE COUNTY EMS REFERRALS OF INDIVIDUALS THEY HAVE REVIVED WITH NALOXONE, THE OPIOID OVERDOSE REVERSING MEDICATION, AND TAKEN TO ONE OF CHRISTIANACARE'S EMERGENCY DEPARTMENTS. SOS GOES TO INDIVIDUALS' HOMES OR OTHER COMMUNITY LOCATIONS AND USES MOTIVATIONAL INTERVIEWING TECHNIQUES TO ENCOURAGE THE INDIVIDUAL TO ENTER SUBSTANCE USE DISORDER TREATMENT. IF NEEDED, SOS WILL HELP THE PATIENT ADDRESS ANY BARRIERS TO TREATMENT AND ASSIST THEM WITH ENROLLING IN TREATMENT. SOS ALSO PROVIDES NALOXONE AND TRAINING ON ITS USE AS WELL AS OTHER HARM REDUCTION EDUCATION IN THE COMMUNITY. IN FY2022, SOS DISTRIBUTED 290 NALOXONE KITS OF WHICH 132 WERE REFILLS. THIS DEMONSTRATES THE LIKELIHOOD OF THE NALOXONE BEING USED AS A LIFESAVING MEASURE. SOS ALSO RECEIVED A TOTAL OF 669 REFERRALS. THEY WERE ABLE TO SUCCESSFULLY CONTACT 38% OF THOSE REFERRALS, AND OF THOSE, 9% AGREED TO TREATMENT. IF AN INDIVIDUAL WAS UNWILLING TO GO TO TREATMENT, THEY WERE OFFERED HARM REDUCTION EDUCATION AND NALOXONE AND ENCOURAGED TO CONTACT SOS ONCE THEY WERE READY TO PURSUE TREATMENT. VIOLENCE IN RECOGNITION OF VIOLENCE AS A PUBLIC HEALTH ISSUE, CHRISTIANACARE LAUNCHED A HOSPITAL BASED VIOLENCE INTERVENTION PROGRAM (HVIP), EMPOWERING VICTIMS OF LIVED VIOLENCE (EVOLV), IN FEBRUARY 2021. EVOLV IS DESIGNED TO CREATE A SINGLE CARE TEAM USING EVIDENCE BASED SYNERGISTIC STRATEGIES. EVOLV AIMS TO ADDRESS VIOLENCE AND SUPPORT PATIENTS IMPACTED BY COMMUNITY VIOLENCE IN EFFORTS TO IMPROVE HEALTH AND WELL-BEING AND REDUCE RECIDIVISM OF NEW AND RECURRING INJURIES. 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 ARE ELIGIBLE TO PARTICIPATE IN EVOLV. THE LENGTH OF THE PROGRAM IS THREE MONTHS AND PROVIDES THE PATIENT WITH ACCESS TO A DEDICATED SOCIAL WORKER AND COMMUNITY HEALTH WORKER (CHW). EVOLV ASSISTS PATIENTS IN MANY SERVICES POST-DISCHARGE INCLUDING FOLLOW-UP CARE, EDUCATION, EMPLOYMENT, SOCIAL SUPPORT, CONNECTION TO COMMUNITY RESOURCES, LEGAL SUPPORTS, AND IDENTIFYING AND ACHIEVING PATIENT CENTERED GOALS AND OUTCOMES. IN FY2022, EVOLV SERVED 82 PATIENTS AND CONTINUED TO WORK CLOSELY WITH THE TRAUMA DEPARTMENT. FURTHER STRENGTHENING THIS RELATIONSHIP WAS THE COMPLETION OF EVOLV'S INTEGRATION INTO CHRISTIANACARE'S ELECTRONIC HEALTH RECORD. THIS WILL IMPROVE COMMUNICATION BETWEEN EVOLV AND CLINICIANS AS WELL AS DATA TRACKING. EVOLV CLINICAL AND PROGRAM LEADS ALSO SUBMITTED A GRANT PROPOSAL FOR FEDERAL AND STATE FUNDING TO EXPAND THE PROGRAM WITH ADDITIONAL CHWS. AS THEY HAVE DONE SINCE EVOLV WAS BEING DESIGNED, THE EVOLV TEAM CONTINUES TO ENGAGE WITH GOVERNMENT AND COMMUNITY ORGANIZATIONS ADDRESSING VIOLENCE TO ENSURE COHESION IN THEIR EFFORTS TO REDUCE VIOLENCE IN OUR COMMUNITIES, ESPECIALLY IN WILMINGTON. THE TRAUMA DEPARTMENT IS ALSO ADDRESSING VIOLENCE THROUGH EDUCATION. THROUGHOUT THE YEAR, TRAUMA DEPARTMENT CAREGIVERS PROVIDED STOP THE BLEED TRAINING TO COMMUNITY GROUPS AND STUDENTS. STOP THE BLEED IS A NATIONAL AWARENESS CAMPAIGN THAT EMPOWERS BYSTANDERS WITH THE KNOWLEDGE AND TOOLS THEY NEED TO RECOGNIZE AND STOP LIFE-THREATENING BLEEDING. THE TRAUMA DEPARTMENT ALSO REVAMPED STUDENT PROGRAMS ADDRESSING VIOLENCE IT HAD PREVIOUSLY OFFERED TO CREATE A NEW OFFERING FOR STUDENTS THAT REFRAMES GUN VIOLENCE AS A PUBLIC HEALTH ISSUE. STUDENTS DISCUSS THE INDIVIDUAL AND COMMUNITY FACTORS THAT PUT PEOPLE AT RISK FOR GUN VIOLENCE AS WELL AS THE PHYSICAL AND EMOTIONAL IMPACTS OF GUN VIOLENCE. STUDENTS ARE ALSO EMPOWERED WITH INFORMATION TO HELP THEM IDENTIFY THE WARNING SIGNS OF GUN VIOLENCE. STUDENTS IN MIDDLE AND HIGH SCHOOLS THROUGHOUT NEW CASTLE COUNTY RECEIVED THIS EDUCATION.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	SOCIAL DETERMINANTS OF HEALTH CHRISTIANACARE IS COMMITTED TO THE STRATEGY OF ADDRESSING SOCIAL DETERMINANTS OF HEALTH (SDOH) TO IMPROVE HEALTH OUTCOMES. THE CHWS, THE HEALTH GUIDES, THE HEALTH AMBASSADORS, AND THE PEERS WHO COMPRISE THE SOS OUTREACH TEAM ADDRESS CHRISTIANACARE'S DIFFERENT IDENTIFIED AREAS OF NEED, BUT THEY SHARE THE SAME OBJECTIVE OF HELPING INDIVIDUALS OVERCOME THEIR SOCIAL BARRIERS TO GOOD HEALTH. THE DELAWARE FOOD FARMACY AND THE PRODUCE DELIVERY PROGRAM WERE DESIGNED TO SERVE FOOD INSECURE PATIENTS, AND TEXT-BASED BLOOD PRESSURE MONITORING AND SCREENING FOR DIABETES WAS IMPLEMENTED IN WOMEN'S HEALTH TO OVERCOME PATIENT BARRIERS SUCH AS TRANSPORTATION. IN ADDITION TO THE INDIVIDUAL PROGRAMS THAT DIRECTLY ADDRESS SOCIAL DETERMINANTS OF HEALTH, CHRISTIANACARE IS ALSO ADDRESSING SDOH ON A SYSTEMWIDE SCALE. CHRISTIANACARE DESIGNED AND IMPLEMENTED ONE SDOH SCREENING INSTRUMENT TO ADMINISTER TO PATIENTS. TO IMPROVE THE FACILITATION OF THE SDOH SCREENING INSTRUMENT, WE RECENTLY INTRODUCED PATIENT SELF-ADMINISTRATION OF THE SDOH SCREENING INSTRUMENT. ALLOWING PATIENTS TO COMPLETE THE SCREENING ON THEIR OWN WILL INCREASE THE NUMBER OF SDOH SCREENS COMPLETED, IMPROVE EFFICIENCY, AND PROVIDE A BETTER PATIENT EXPERIENCE, AS PATIENTS MAY FEEL MORE COMFORTABLE ENTERING ANSWERS TO QUESTIONS THAT CAN FEEL INVASIVE. WE PUT A GREAT DEAL OF TIME AND RESOURCES INTO CREATING AND OPERATIONALIZING THE SDOH SCREENING INSTRUMENT BECAUSE WE MUST UNDERSTAND THE OBSTACLES THAT STAND IN THE WAY OF OUR PATIENTS IMPROVING THEIR HEALTH. THE SDOH SCREENING WILL ALSO PROVIDE US WITH A BROADER PICTURE OF THE CHALLENGES OUR COMMUNITIES FACE SO THAT WE CAN RESPOND APPROPRIATELY WITH INTERNAL PROGRAMMING AND STRATEGIES THAT ADDRESS THOSE NEEDS AS WELL AS THROUGH COMMUNITY PARTNERSHIPS. IN OUR FY2023 ANNUAL OPERATING PLAN, WE SET THE GOAL OF INCREASING BY 25%, THE PERCENTAGE OF PATIENTS WITH COMPLETE SDOH SCREENS FROM HIGH-RISK COMMUNITIES AS DEFINED IN THE CHNA (HIGH-RISK COMMUNITIES ARE THOSE IN THE 19801, 19802, 19804, 19805, AND 19720 ZIP-CODES). WE WOULD NOT PURSUE SCREENING OUR PATIENTS FOR THEIR SOCIAL NEEDS AS AGGRESSIVELY AS WE HAVE IF WE HAD NO TOOLS TO HELP THEM ADDRESS THOSE NEEDS. TO THAT END, WE PARTNERED WITH UNITE US TO LAUNCH AN ELECTRONIC CARE COORDINATION NETWORK, UNITE DELAWARE, IN LATE 2019. THE UNITE DELAWARE NETWORK CONNECTS SOCIAL SERVICES AND CLINICAL CARE PROVIDERS ACROSS THE STATE. WITH THIS NETWORK, ANY HEALTHCARE PROVIDER OR SOCIAL SERVICE AGENCY CAN HELP AN INDIVIDUAL ADDRESS THE DIVERSE ARRAY OF NEEDS THEY MAY HAVE BY SENDING AN ELECTRONIC REFERRAL ON BEHALF OF THE PATIENT TO THE APPROPRIATE ORGANIZATION. THE SENDER OF THAT REFERRAL WILL BE ABLE TO TRACK WHETHER THAT NEED WAS MET OR NOT AND TAKE ADDITIONAL ACTION IF NEEDED TO HELP THE PATIENT MEET THEIR NEED. UNITE DELAWARE NOW INCLUDES TWO OTHER DELAWARE HOSPITALS AND OVER 200 COMMUNITY-BASED ORGANIZATIONS. CHRISTIANACARE FUNDS THE UNITE DELAWARE PLATFORM BECAUSE WE BELIEVE IT CAN HELP DELAWAREANS THROUGHOUT THE STATE ADDRESS THEIR NEEDS AND IT ALSO PROVIDES BENEFITS AT NO COST TO THE PARTICIPATING COMMUNITY-BASED ORGANIZATIONS THAT PARTICIPATE IN THE NETWORK. IN MAY 2022, UNITE DELAWARE WAS INTEGRATED INTO CHRISTIANACARE'S MEDICAL HEALTH RECORD TO ENABLE EASIER OPERABILITY FOR PROVIDERS TO SEND A REFERRAL IN A CLINICAL SETTING AND SO THE PATIENT'S ENTIRE CARE TEAM CAN HAVE INSIGHT INTO THEIR SOCIAL NEEDS. ANOTHER GOAL OF CHRISTIANACARE'S FY2023 ANNUAL OPERATING PLAN IS TO INCREASE BY 25% THE NUMBER OF REFERRALS CAREGIVERS SEND THROUGH THE UNITE DELAWARE NETWORK ON BEHALF OF PATIENTS IN THE HIGH-RISK COMMUNITIES AS DEFINED IN THE CHNA. HALFWAY INTO FY2023, WE ARE ON TRACK TO MEET BOTH ANNUAL OPERATING PLAN GOALS FOR INCREASED SDOH SCREENING AND UNITE DELAWARE REFERRALS. TRANSPORTATION HAS ROUTINELY BEEN IDENTIFIED AS A BARRIER TO CARE. TO ADDRESS THAT NEED, CHRISTIANACARE PARTNERED WITH ROUNDTRIP TO PROVIDE TRANSPORTATION TO MEDICAL SERVICES FOR ELIGIBLE PATIENTS WHO HAVE A TRANSPORTATION BARRIER. IN 2020, CHRISTIANACARE PILOTED THIS PROGRAM IN TWO DEPARTMENTS AND IN FY2022, WE UNDERTOOK A CONSIDERABLE EXPANSION. THERE ARE NOW EIGHTEEN PARTICIPATING PROGRAMS AND DEPARTMENTS USING ROUNDTRIP TO SERVE PATIENTS WITH TRANSPORTATION BARRIERS. OUR EXPECTATION IS THAT PATIENTS' HEALTH WILL IMPROVE WHEN THE TRANSPORTATION BARRIER IS REMOVED, AND WE EXPECT TO DESIGN AND IMPLEMENT AN EVALUATION TO DEMONSTRATE THAT IN THE COMING MONTHS. IN FY2022, JUST OVER 9,000 RIDES WERE PROVIDED TO PATIENTS THROUGH ROUNDTRIP. AS A HEALTH SYSTEM, WE BELIEVE IT IS NECESSARY TO IDENTIFY AND ADDRESS THE SOCIAL NEEDS OF OUR PATIENTS BECAUSE THE BEST CLINICAL CARE WILL NOT, FOR EXAMPLE, OVERCOME THE POOR HEALTH OUTCOMES OF A DIABETIC PATIENT WHO LIVES IN A FOOD DESERT. THROUGHOUT THIS DOCUMENT, WE HAVE SHARED SUCCESSFUL STRATEGIES WE HAVE EMPLOYED TO ADDRESS SOCIAL NEEDS, AND WE KNOW THAT COMMUNITY PARTNERSHIPS ARE A REQUIREMENT FOR BUILDING UPON THAT SUCCESS. TO SUPPORT COMMUNITY-BASED ORGANIZATIONS WE LAUNCHED THE COMMUNITY INVESTMENT FUND IN DECEMBER 2019. THAT YEAR, WE AWARDED NEARLY $2 MILLION IN FUNDING TO 32 COMMUNITY-BASED ORGANIZATIONS TO ADDRESS THE AREAS OF NEED PRIORITIZED IN THE 2019 CHNA. WE WERE UNABLE TO PROVIDE THIS FUNDING IN FY2021 DUE TO THE FINANCIAL UNCERTAINLY CAUSED BY THE PANDEMIC, BUT IN FY2022, WE PROVIDED 13 ORGANIZATIONS WITH OVER $1 MILLION IN FUNDING TO ADDRESS FOOD INSECURITY AND HOUSING. IN ADDITION TO THE COMMUNITY INVESTMENT FUND, CHRISTIANACARE ALSO PROVIDED A COMBINED $310,000 IN FUNDING TO: - THE DELAWARE COALITION AGAINST DOMESTIC VIOLENCE TO SUPPORT A CHW PROGRAM SERVING SURVIVORS OF DOMESTIC VIOLENCE. - THE WEST END NEIGHBORHOOD HOUSE TO SUPPORT ITS DROP-IN CENTER WHICH SERVES UNACCOMPANIED HOMELESS YOUTH, AGED 18-23, INCLUDING THOSE WHO EXPERIENCED THE FOSTER CARE SYSTEM AND/OR IDENTIFY AS LGBTQ+. - THE WILMINGTON NEIGHBORHOOD CONSERVANCY LAND BANK IN SUPPORT OF ITS LOWER HILLTOP AFFORDABLE HOUSING INITIATIVE TO PROVIDE MORE AFFORDABLE HOUSING OPTIONS TO THE COMMUNITY. - THE ARC OF DELAWARE TO SUPPORT THE DEVELOPMENT OF A STATEWIDE WEBSITE THAT CAN SERVE AS A REPOSITORY OF THE EXISTING SOCIAL AND RECREATIONAL PROGRAMS FOR ADULTS WITH DISABILITIES AND BE THE STARTING POINT OF A COORDINATED EFFORT TO DETERMINE WHAT ADDITIONAL PROGRAMMING IS NEEDED STATEWIDE TO MEET UNADDRESSED NEEDS FOR THIS POPULATION. - DELAWARE TECH COMMUNITY COLLEGE TO ENHANCE THE OFFERINGS OF THE FOUR FOOD CLOSETS OPERATED AT EACH OF ITS CAMPUSES THROUGHOUT DELAWARE FOR THEIR FOOD INSECURE STUDENTS.
PART V, SECTION B, LINE 11 (ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA)	THE ABOVE IS NOT AN EXHAUSTIVE LIST OF THE FUNDING CONTRIBUTED TO COMMUNITY ORGANIZATIONS IN FY2022, BUT IT DEMONSTRATES OUR COMMITMENT TO SUPPORTING THE DIVERSE EFFORTS OF OUR COMMUNITY PARTNERS TO MEET THE NEED OF OUR COMMUNITIES. CHRISTIANACARE IS ALSO INVESTING IN WORKFORCE DEVELOPMENT. FOR THE NEXT FOUR YEARS, CHRISTIANACARE WILL AWARD TEN STUDENTS MERIT-BASED SCHOLARSHIPS OF $12,500 PER YEAR, PER STUDENT, TO ATTEND AN HBCU. THE FOCUS OF THE SCHOLARSHIP PROGRAM WILL BE MINORITY STUDENTS WHO ARE PURSUING A FIELD OF STUDY IN HEALTH CARE. THESE STUDENTS WILL ALSO BE INVITED TO PARTICIPATE IN AN INTERNSHIP PROGRAM AT CHRISTIANACARE. WE MADE THIS COMMITMENT BECAUSE WE RECOGNIZE THE IMPORTANCE OF DIVERSITY IN THE HEALTH CARE FIELD TO IMPROVE PATIENT CARE. CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT ALSO OFFERS YOUTH PROGRAMMING THAT EXPOSES THE PARTICIPANTS, OR SCHOLARS AS WE REFER TO THEM, TO POTENTIAL CAREERS IN THE HEALTH FIELD AND PROVIDES THEM WITH THE SKILLS AND EXPERIENCE TO SUPPORT THEIR DEVELOPMENT INTO YOUNG ADULTS EVEN IF THEY CHOOSE TO TAKE A DIFFERENT PATH. IN FY2022, THE FOLLOWING PROGRAMS WERE OFFERED: BACK 2 BASICS 2.0: THIS PROGRAM, OFFERED IN PARTNERSHIP WITH JOBS FOR DELAWARE GRADS, A SCHOOL-TO-WORK TRANSITIONAL PROGRAM DEDICATED TO HELPING YOUTH REACH ACADEMIC AND ECONOMIC SUCCESS, WAS CREATED IN RESPONSE TO THE CORONAVIRUS PANDEMIC. IT PROVIDES HIGH SCHOOL SCHOLARS WITH THE OPPORTUNITY TO PARTICIPATE IN 12 IMMERSIVE SESSIONS THROUGH A CASE STUDY APPROACH. IN FY2022, 21 SCHOLARS ENROLLED IN THIS PROGRAM. NURSING CAREER COLLABORATIVE: THIS PROGRAM WAS DEVELOPED TO SERVE AS A PATHWAY TO NURSING FOR HIGH SCHOOL SCHOLARS FROM WILLIAM PENN HIGH SCHOOL AND FREIRE CHARTER SCHOOL. THROUGH THE NURSING CAREER COLLABORATIVE, SCHOLARS ARE EDUCATED AND EXPOSED TO THE FIELD AND FUNDAMENTALS OF NURSING. ON THEIR LAST DAY OF THE PROGRAM, SCHOLARS ALSO HAD AN OPPORTUNITY TO SHADOW ON A UNIT WITH A NURSE. IN FY2022, 9 SCHOLARS PARTICIPATED. CHRISTIANACARE'S COMMUNITY HEALTH DEPARTMENT ALSO OFFERED THE CAMP FRESH PROGRAM FOR THE 15TH YEAR. CAMP FRESH IS AN 8-WEEK SUMMER PROGRAM THAT EXPLORES HEALTH AND WELLNESS WITH 11-18-YEAR OLD YOUTH. CAMP FRESH PROMOTES IMPROVED NUTRITION, MENTAL WELLNESS, INCREASED PHYSICAL ACTIVITY, AWARENESS OF REPRODUCTIVE HEALTH AND IDENTIFYING OPPORTUNITIES FOR PERSONAL, ACADEMIC, AND PROFESSIONAL GROWTH. CAMP FRESH SERVES DELAWARE YOUTH, MOST LIVING IN FEDERALLY RECOGNIZED HIGH-RISK ZIP CODES. YOUTH ARE ELIGIBLE TO ATTEND IF THEIR FAMILY RECEIVES OR IS ELIGIBLE TO RECEIVE MEDICAID. IN THE SUMMER OF 2021, CAMP FRESH TRANSFORMED THE DISRUPTION CAUSED BY THE CORONAVIRUS PANDEMIC INTO AN OPPORTUNITY TO TRY SOMETHING NEW IN THE FORM OF AN 8-WEEK LEADERSHIP PROGRAM, THE CAMP FRESH INFLUENCERS. THE CAMP FRESH INFLUENCER PROGRAM WAS DESIGNED TO PROVIDE YOUTH WITH LEADERSHIP SKILLS AS WELL AS IMPROVE CAMP FRESH THROUGH THEIR PARTNERSHIP. INFLUENCERS PROVIDED THEIR OPINIONS ABOUT CAMP FRESH PROGRAMMING AND MADE RECOMMENDATIONS FOR IMPROVEMENT AND ADVANCEMENT. A TOTAL OF 8 INFLUENCERS COMPLETED THIS PROGRAM. FROM JUNE TO AUGUST 2022, CHRISTIANACARE HOSTED A CAMP FRESH PROGRAM THAT INCORPORATED LESSONS LEARNED FROM THE INFLUENCERS. THERE WERE 24 PARTICIPANTS AND BASED ON FEEDBACK RECEIVED FROM THE INFLUENCERS, THIS WAS THE FIRST TIME THAT CAMPERS AS YOUNG AS 11 YEARS OLD WERE ABLE TO PARTICIPATE. THIS SUMMER ALSO SAW THE EMPLOYMENT OF THE FIRST JUNIOR COUNSELOR WHO HAD BEEN A PREVIOUS CAMP FRESH CAMPER. OTHER FIRSTS WERE STATE RECOGNITION OF CAMP FRESH AS AN EXEMPT SUMMER CAMP PROVIDER AND THE CERTIFICATION OF ALL CAMP FRESH CAREGIVERS IN "SERVSAFE" TO PARTICIPATE IN FOOD PREPARATION AS CAMP FRESH PROVIDES LUNCH, SNACK, AND DINNER FOR ALL CAMPERS. OUTSIDE OF THE SUMMER MONTHS, CAMPERS ARE OFFERED CAMP FRESH 360. PARTICIPANTS OF CAMP FRESH 360 COME TOGETHER TWICE PER MONTH WITH ADDITIONAL HEALTH EDUCATION SESSIONS THAT ARE OFFERED TO YOUTH, THEIR PARENTS/GUARDIANS, FAMILY MEMBERS AND FRIENDS. CHRISTIANACARE ALSO PARTNERS WITH COMMUNITY ORGANIZATIONS OFFERING YOUTH PROGRAMMING TO PROVIDE EXPOSURE TO THE HEALTH CARE FIELD. IN FY 2022, 9 MEDICAL ASSISTANT TRACT SCHOLARS FROM DELCASTLE AND ST. GEORGES TECHNICAL HIGH SCHOOLS CAME TO CHRISTIANACARE FOR THE CO-OP EXPERIENCE. IN APRIL 2022, ABOUT 30 MIDDLE SCHOOL SCHOLARS WHO PARTICIPATE IN THE BRANDYWINE LIFESAVERS CAME TO CHRISTIANACARE'S NEWARK CAMPUS FOR A CAREER EXPO THAT EXPOSED THEM TO VARIOUS NURSING SPECIALTIES. CAREGIVERS SPOKE WITH STUDENTS ABOUT THEIR WORK AND PROVIDED DEMONSTRATIONS. BRANDYWINE SCHOOL DISTRICT NURSES DEVELOPED THE LIFESAVERS PROGRAM TO CREATE A PIPELINE WITH YOUNGER STUDENTS TO GIVE THEM TIME TO LEARN ABOUT POSSIBLE CAREERS IN HEALTH CARE. THE PROGRAM ALSO FOCUSES ITS ATTENTION ON STUDENTS FROM BACKGROUNDS NOT REPRESENTED IN THE NURSING PROFESSION. NURSING STUDENTS FROM THE UNIVERSITY OF DELAWARE ALSO SHADOWED CAREGIVERS IN THE COMMUNITY HEALTH DEPARTMENT TO GAIN EXPOSURE TO THE SOCIAL DETERMINANTS OF HEALTH AND CHRISTIANACARE'S COMMUNITY WORK. THE EXPECTATION IS THAT THIS WILL PROVIDE THESE FUTURE NURSES WITH THE UNDERSTANDING OF THE CHALLENGES THEIR PATIENTS FACE. --------------------
PART V, SECTION B, LINE 13 (ELIGIBILITY FOR PROVIDING DISCOUNTED CARE)	FEDERAL POVERTY GUIDELINES ARE NOT USED TO DETERMINE DISCOUNTED CARE. A SELF-PAY DISCOUNT OF 15% IS APPLIED TO ALL UNINSURED PATIENT ACCOUNTS REGARDLESS OF INCOME. PATIENTS WITH INCOME IN EXCESS OF 200% OF THE FEDERAL POVERTY LEVEL WILL RECEIVE A 15% DISCOUNT. --------------------
PART V, SECTION B, LINE 16 (FINANCIAL ASSISTANCE POLICY AVAILABILITY)	A COPY OF THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY CAN BE ACCESSED AT: HTTPS://CHRISTIANACARE.ORG/US/EN/VISIT-US/FOR-PATIENTS/FINANCIAL-ASSISTANC E-PROGRAM-SUMMARY/FINANCIAL-ASSISTANCE-PROGRAM --------------------
PART V, SECTION B, LINE 20 (ADDITIONAL EFFORTS MADE BEFORE AN ECA)	CHRISTIANA CARE HEALTH SERVICES COMMUNICATES IN WRITING ABOUT COLLECTION PLACEMENT AND THE FINANCIAL ASSISTANCE POLICY. --------------------
PART V, SECTION B, LINE 22 (CHARGES FOR FAP-ELIGIBLE INDIVIDUALS)	FAP-ELIGIBLE INDIVIDUALS (THOSE WITH INCOME LESS THAN 200% OF FEDERAL POVERTY GUIDELINES) ARE NOT RESPONSIBLE FOR ANY CHARGES. --------------------

Schedule H (Form 990) 2021

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) 2021

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 FY2022 TAX YEAR. BOTH DOCUMENTS ARE AVAILABLE AT THE FOLLOWING LINK ON THE CCHS WEBSITE: HTTPS://CHRISTIANACARE.ORG/ABOUT/WHOWEARE/COMMUNITYBENEFIT/COMMUNITY- HEALTH-IMPLEMENTATION-PLAN/ -------------------- PART I, LINE 7 (BAD DEBT EXPENSE, COSTING METHODOLOGY USED) IMPLICIT PRICE CONCESSIONS ARE TREATED AS A CONTRA-REVENUE ITEM ON THE STATEMENT OF REVENUE. AS A RESULT, THERE ARE NO BAD DEBT EXPENSES INCLUDED ON FORM 990, PART IX THAT NEED TO BE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES LISTED. THE COSTING METHODOLOGY USED IN CALCULATING THE AMOUNTS REPORTED ON THE LINE 7 TABLE ARE BASED ON A COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2. --------------------
PART 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. PATIENTS MAY ALSO ESTABLISH INTEREST-FREE MONTHLY PAYMENT ARRANGEMENTS FOR ANY OUTSTANDING BALANCE THAT IS NOT COVERED BY A THIRD PARTY PAYER. AS PART OF THE SELF PAY DUNNING PROCESS, CHRISTIANA CARE MAKES UNINSURED PATIENTS AWARE OF THE FINANCIAL ASSISTANCE PROGRAM WITH THE RELEASE OF OUR FIRST STATEMENT. FOR ALL SUBSEQUENT STATEMENTS, PATIENTS HAVE AN OPPORTUNITY TO CALL OUR CUSTOMER SERVICES DEPARTMENT IF THEY ARE UNABLE TO MAKE PAYMENT IN FULL. IF A PATIENT QUALIFIES FOR A CHARITABLE ADJUSTMENT, THEY ARE EXTENDED THE COURTESY OF AN AUTOMATIC ADJUSTMENT TO THEIR BILLS FOR THE NEXT YEAR AND FOR ONE YEAR PRIOR TO THE DATE A PATIENT'S APPLICATION IS APPROVED. PATIENTS WOULD NEED TO REAPPLY FOR CHARITABLE CONSIDERATION AFTER THE ONE YEAR HAS LAPSED. ALL COLLECTION ACTIONS WOULD CEASE ONCE A PATIENT IS DEEMED ELIGIBLE FOR CHARITY OR ONCE A PATIENT ESTABLISHES AND MAINTAINS A MONTHLY PAYMENT ARRANGEMENT. --------------------
PART VI, LINE 2 (NEEDS ASSESSMENT)	AT CHRISTIANACARE, WE ABIDE BY THE CHRISTIANACARE WAY. WE SERVE OUR NEIGHBORS AS EXPERT, CARING PARTNERS IN THEIR HEALTH. WE DO THIS BY CREATING INNOVATIVE, EFFECTIVE, AFFORDABLE, AND EQUITABLE SYSTEMS OF CARE THAT OUR NEIGHBORS VALUE. WE PARTNER WITH OUR NEIGHBORS TO PROVIDE THEM WITH SYSTEMS OF CARE THAT THEY VALUE. TO EFFECTIVELY DO THIS, WE MUST LISTEN TO AND LEARN FROM OUR COMMUNITIES CONSISTENTLY. A NEEDS ASSESSMENT CANNOT REPLACE ONGOING TRUSTED PARTNERSHIPS AND A WILLINGNESS TO LISTEN ACTIVELY AND SEEK NEW KNOWLEDGE, TWO OF THE BEHAVIORS THAT GUIDE CHRISTIANACARE CAREGIVERS. MANY OF THE WAYS IN WHICH CHRISTIANACARE ASSESSES THE HEALTH NEEDS OF OUR COMMUNITY HAVE BEEN DESCRIBED IN EARLIER SECTIONS. WE IMPLEMENTED A SYSTEM WIDE SDOH SCREENING INSTRUMENT TO LEARN DIRECTLY FROM OUR PATIENTS ABOUT THEIR CHALLENGES, AND WE PARTNERED WITH UNITE US TO LAUNCH UNITE DELAWARE IN THE STATE WHICH PROVIDES A TOOL TO ADDRESS OUR PATIENTS' NEEDS AS WELL AS INSIGHT INTO THE NEEDS OF DELAWAREANS. FOR EXAMPLE, USE OF THE NETWORK HAS SHOWN THAT HOUSING AND FOOD INSECURITY ARE CONSISTENTLY THE MOST REFERRED NEEDS. THE COMMUNITY INVESTMENT FUND PROVIDES US WITH THE OPPORTUNITY TO LEARN FROM COMMUNITY-BASED ORGANIZATIONS (FOR FY2022, THERE WERE MORE THAN 60 APPLICANTS) ABOUT THE CHALLENGES THEIR COMMUNITIES FACE AND HOW THEY THINK BEST TO ADDRESS THEM. DIRECTLY PARTNERING WITH COMMUNITY ORGANIZATIONS SUCH AS URBAN ACRES, LUTHERAN COMMUNITY SERVICES, AND THE NEW CASTLE COUNTY POLICE DEPARTMENT ALSO PROVIDES INSIGHT INTO OUR COMMUNITY. CHRISTIANACARE ALSO PARTNERED WITH COMMUNITY STAKEHOLDERS AND ORGANIZATIONS TO CREATE SEVERAL GROUPS WHICH PROVIDE US WITH A DIRECT LINE OF CONTACT INTO OUR COMMUNITIES. THE GREATER WILMINGTON COMMUNITY PARTNERSHIP WAS FORMED WITH COMMUNITY PARTNERS IN 2012. INITIALLY CREATED IN PARTNERSHIP WITH HOMELESS SHELTER PROVIDERS TO COLLABORATIVELY ADDRESS THE NEEDS OF HOMELESS INDIVIDUALS, THIS GROUP HAS CONTINUED TO MEET MONTHLY FOR INFORMATION AND RESOURCE SHARING AND THE OPPORTUNITY TO DISCUSS COMMUNITY CHALLENGES. PARTICIPANTS INCLUDE THOSE FROM FAITH-BASED, NON-PROFIT, AND GOVERNMENT ORGANIZATIONS. CHRISTIANACARE CAREGIVERS PLAN AND HOST THE MEETINGS WITH INPUT FROM PARTICIPANTS. THE DELAWARE HEALTH MATERNAL AND INFANT CONSORTIUM CREATED THE WILMINGTON CONSORTIUM TO EDUCATE PROFESSIONALS WORKING WITH FAMILIES WITH CHILDREN FROM BIRTH TO AGE 5. LIKE THE GREATER WILMINGTON COMMUNITY PARTNERSHIP, THE PURPOSE OF THE GROUP IS TO SHARE RESOURCES AND DISCUSS COMMUNITY ISSUES AS THEY RELATE TO FAMILIES WITH YOUNG CHILDREN. CHRISTIANACARE CAREGIVERS CO-CHAIR THE GROUP WHICH MEETS BI-MONTHLY AND PROVIDE THE ADMINISTRATIVE SUPPORT FOR IT TO OPERATE. MEMBERS ARE ALSO ABLE TO SHARE COMMUNITY EVENTS AND RESOURCES WHICH ARE SENT OUT TO ALL MEMBERS IN A WEEKLY EMAIL. THE COMMUNITY ENGAGEMENT ADVISORY COUNCIL, CO-CHAIRED BY CHRISTIANACARE'S CHIEF HEALTH EQUITY OFFICER, WAS FORMED TO PROVIDE CHRISTIANACARE WITH DIRECT CONTACT WITH COMMUNITY LEADERS AND STAKEHOLDERS TO GAIN THEIR PERSPECTIVE ON COMMUNITY NEEDS AND IDENTIFY OPPORTUNITIES IN WHICH BOTH THE COMMUNITY AND CHRISTIANACARE CAN BENEFIT FROM WORKING TOGETHER TOWARDS MUTUAL GOALS. PARTICIPATION BY CHRISTIANACARE LEADERS ON COMMUNITY BOARDS AND COMMITTEES ALSO PROVIDES INSIGHT INTO COMMUNITY NEEDS. THE DELAWARE HEALTHY MOTHER AND INFANT CONSORTIUM, THE VISION COALITION OF DELAWARE, THE DELAWARE BUSINESS ROUNDTABLE, THE DRUG OVERDOSE FATALITY REVIEW COMMISSION, AND AIDS DELAWARE ARE ALL CHAIRED AND CO-CHAIRED BY CHRISTIANACARE CAREGIVERS. CHRISTIANACARE'S PATIENT & FAMILY HEALTH EDUCATION TEAM HAS ALSO BEEN INVOLVED IN A MULTI-YEAR PARTNERSHIP WITH THE UNIVERSITY OF DELAWARE PARTNERSHIP FOR HEALTHY COMMUNITIES AND THE DELAWARE DIVISION OF PUBLIC HEALTH TO CREATE A STRATEGIC PLAN FOR HEALTH LITERACY IN OUR STATE. THIS EFFORT BRINGS TOGETHER EXISTING NETWORKS FROM THROUGHOUT THE STATE IN THE HEALTH, EDUCATION, AND GOVERNMENTAL SECTORS AS WELL AS A CONTRACTED PROJECT WITH PMG CONSULTING TO ASSESS THE BASELINE NEEDS IN THE STATE AND TO GENERATE A STRATEGIC PLAN FOR ONGOING WORK. THIS PARTNERSHIP WILL SERVE TO MAKE CHRISTIANACARE A MORE HEALTH LITERATE ORGANIZATION AS WELL AS BENEFIT ALL DELAWAREANS. OUR PARTICIPATION ALSO ALLOWS US MORE INSIGHT INTO THE CHALLENGES WITHIN OUR COMMUNITY AND THROUGHOUT DELAWARE, AND HOW OUR PARTNERS ARE RESPONDING. --------------------
PART VI, LINE 3 (PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE)	FOR FY22 UNINSURED INDIVIDUALS WITH A HOUSEHOLD INCOME GREATER THAN 200% OF THE FEDERAL POVERTY LEVEL WERE ELIGIBLE FOR A STANDARD DISCOUNT OF 15%. EFFECTIVE FEBRUARY 1, 2023, CHRISTIANACARE WILL UPDATE ITS FINANCIAL ASSISTANCE POLICY TO MAKE IT AVAILABLE FOR MORE PATIENTS. THE FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLD WILL BE INCREASED FROM 200% TO 400% OF THE FEDERAL POVERTY LEVEL. PATIENTS FACING CATASTROPHIC COSTS, WHERE THE MEDICAL EXPENSES FOR AN EPISODE OF CARE EXCEED 20% OF THEIR ANNUAL INCOME, CAN NOW APPLY FOR FINANCIAL ASSISTANCE AS WELL. CHRISTIANACARE'S PRESUMPTIVE ELIGIBILITY PROCESS WAS ALSO UPDATED AND CLARIFIED IN THE FINANCIAL ASSISTANCE POLICY TO REDUCE THE BURDEN ON PATIENTS TO SUPPLY SUPPORTING DOCUMENTATION. THE PROCESS FOR CHRISTIANACARE REPRESENTATIVES TO MAKE IMMEDIATE CASE-BY-CASE DETERMINATIONS OF INDIVIDUAL ELIGIBILITY AND ACCEPT ALTERNATIVE QUALIFYING DOCUMENTATION FOR FINANCIAL ASSISTANCE WAS ALSO UPDATED AND STREAMLINED. CHRISTIANACARE'S FINANCIAL ASSISTANCE POLICY, ALONG WITH THE FOLLOWING MATERIALS ARE ALSO AVAILABLE ON OUR WEBSITE: HTTPS://CHRISTIANACARE.ORG/US/EN/VISIT-US/FOR-PATIENTS/FINANCIAL-ASSISTANC E-PROGRAM-SUMMARY/FINANCIAL-ASSISTANCE-PROGRAM IN ENGLISH, SPANISH, AND MANDARIN: - A PLAIN LANGUAGE SUMMARY, - THE FINANCIAL ASSISTANCE APPLICATION, - A DESCRIPTION OF THE APPLICATION PROCESS, - THE INCOME SCALES, - THE FINANCIAL ASSISTANCE SERVICE AREA, AND - A LIST OF PARTICIPATING AND NON-PARTICIPATING PROVIDERS. THE FINANCIAL ASSISTANCE PROGRAM IS PUBLICIZED THROUGH PAMPHLETS, SIGNAGE, ONLINE NOTICES ON THE CHRISTIANACARE WEBSITE, AND IN-PATIENT SERVICE AREAS. THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PROVIDED TO PATIENTS WHO ARE UNINSURED OR UNDERINSURED AND WHO INDICATE THEIR INABILITY TO PAY FOR MEDICALLY NECESSARY SERVICES AT INTAKE OR DISCHARGE. BECAUSE THEY ARE THE MOST SPOKEN LANGUAGES BESIDES ENGLISH, APPLICATIONS AND SUPPORTING DOCUMENTS SUCH AS THE PLAIN LANGUAGE SUMMARY ARE ALSO AVAILABLE IN SPANISH, MANDARIN, AND CANTONESE. TRANSLATION ASSISTANCE BY PHONE TO COMPLETE NECESSARY FORMS FOR ANYONE NOT PROFICIENT IN READING, WRITING, OR SPEAKING ENGLISH IS ALSO AVAILABLE MONDAY THROUGH FRIDAY FROM 9 A.M. TO 4 P.M. PATIENTS MAY ALSO CALL PATIENT FINANCIAL SERVICES TO REQUEST INFORMATION AND AN APPLICATION AND TO TALK CONFIDENTIALLY ABOUT THEIR SITUATION. IF CHRISTIANACARE DETERMINES THAT THE PATIENT MAY QUALIFY FOR OTHER COVERAGE, FINANCIAL COUNSELING WILL BE PROVIDED TO ASSIST PATIENTS TO APPLY FOR THE AVAILABLE COVERAGE. CHRISTIANACARE'S FINANCIAL ASSISTANCE POLICY WEBPAGE AND PLAIN LANGUAGE SUMMARY ALSO INCLUDES CONTACT INFORMATION OF STATE AND FEDERAL HEALTH INSURANCE RESOURCES FOR THOSE WHO ARE UNINSURED. CHRISTIANACARE'S HEALTH GUIDES ARE ALSO AVAILABLE TO HELP PATIENTS OVERCOME FINANCIAL BARRIERS. THEY ASSIST PATIENTS IN COMPLETING THE CHRISTIANACARE'S APPLICATION FOR FINANCIAL ASSISTANCE AS WELL AS ENROLL IN HEALTH INSURANCE OR APPLY FOR PRESCRIPTION ASSISTANCE OR MEDICAID TO NAME JUST A FEW EXAMPLES. IN FY2022, THE HEALTH GUIDES ASSISTED 50 PATIENTS IN SUBMITTING REQUESTS FOR ADJUSTMENTS TO THEIR MEDICAL BILLS RECEIVED FROM MULTIPLE SOURCES FOR A TOTAL OF $305,141. --------------------
PART VI, LINE 4 (COMMUNITY INFORMATION)	WHILE CHRISTIANACARE PROVIDES SERVICES IN FOUR STATES, THE 2022 CHNA DEFINED CHRISTIANACARE'S COMMUNITY AS NEW CASTLE COUNTY, DELAWARE BECAUSE OF THE HIGH PERCENTAGE OF NEW CASTLE COUNTY RESIDENTS AMONG THOSE DISCHARGED FROM CHRISTIANACARE'S TWO DELAWARE HOSPITALS. IN FY2021, 77% OF CHRISTIANA HOSPITAL'S DISCHARGES AND 91% OF WILMINGTON HOSPITAL'S DISCHARGES WERE NEW CASTLE COUNTY RESIDENTS. THE TOTAL POPULATION OF NEW CASTLE COUNTY IN 2021 WAS APPROXIMATELY 553,500 PERSONS. THIS POPULATION IS EXPECTED TO GROW 2.6% FROM 2020 TO 2030. THE POPULATION 65 YEARS OF AGE AND OLDER IS ANTICIPATED TO GROW BY 30.5% DURING THAT TIME. THERE IS CONSIDERABLE VARIATION AMONG SOCIOECONOMIC CONDITIONS IN NEW CASTLE COUNTY. TO ENSURE THESE VARIATIONS WERE NOT OVERLOOKED, THE 2022 CHNA ASSESSED COMMUNITY HEALTH NEEDS IN TWO GEOGRAPHIC AREAS OF NEW CASTLE COUNTY: "COMMUNITY 1" (ZIP CODES 19801, 19802, 19804, 19805, AND 19720) AND "COMMUNITY 2" (ALL OTHER NEW CASTLE COUNTY ZIP CODES). COMMUNITY 1 ACCOUNTED FOR 28% OF CHRISTIANACARE DISCHARGES IN 2021 AND COMMUNITY 2 ACCOUNTED FOR 52% OF CHRISTIANACARE DISCHARGES. IN COMMUNITY 1, APPROXIMATELY 48% OF THE POPULATION IDENTIFIES AS BLACK; IN COMMUNITY 2, THIS STATISTIC IS 17%. APPROXIMATELY 15% OF THE OVERALL POPULATION IN COMMUNITY 1 IDENTIFIES AS HISPANIC; IN COMMUNITY 2, THIS STATISTIC IS ABOUT 8%. THE OVERALL POVERTY RATE IN NEW CASTLE COUNTY HAS BEEN BELOW DELAWARE AND U.S. AVERAGES; HOWEVER, RATES FOR BLACK AND FOR HISPANIC COUNTY RESIDENTS HAVE BEEN SUBSTANTIALLY HIGHER THAN RATES FOR WHITE RESIDENTS. THE POVERTY RATE IN COMMUNITY 1 HAS BEEN MORE THAN DOUBLE THE RATE FOR COMMUNITY 2 (16.8% COMPARED TO 8.3%). LOW-INCOME CENSUS TRACTS ARE MOST PREVALENT IN NEWARK, WILMINGTON AND THROUGHOUT COMMUNITY 1. IN MANY OF THESE CENSUS TRACTS, MORE THAN ONE-HALF OF HOUSEHOLDS ARE "RENT BURDENED," ARE CATEGORIZED AS "HIGH NEED" BY THE DIGNITY HEALTH COMMUNITY NEED INDEXTM (CNI) AND ARE IN THE TOP QUARTILE NATIONALLY FOR "SOCIAL VULNERABILITY" ACCORDING TO THE CENTERS FOR DISEASE CONTROL'S SOCIAL VULNERABILITY INDEX. BECAUSE OF THESE DISPARITIES AMONG NEW CASTLE COUNTY COMMUNITIES, WE HAVE COMMITTED TO HELPING PATIENTS LIVING IN THE HIGH-NEEDS COMMUNITIES OF COMMUNITY 1 ADDRESS THEIR SOCIAL NEEDS THROUGH INCREASED SDOH SCREENING AND RESOURCE REFERRALS THROUGH UNITE DELAWARE. WHILE THE DATA DEMONSTRATE THAT COMMUNITY 2 RESIDENTS ARE NOT AS LIKELY TO HAVE POOR SOCIAL DETERMINANTS OF HEALTH, WE RECOGNIZE THAT THERE ARE CERTAINLY INDIVIDUALS IN THIS AREA FACING CHALLENGES AS WELL. OUR COMMITMENT TO SDOH SCREENING AMONG ALL PATIENTS WILL ENSURE THOSE PATIENTS ARE NOT OVERLOOKED. --------------------
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, AND EQUITABLE 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 LICENSED 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 265 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)	CHRISTIANACARE IS CENTERED ON IMPROVING HEALTH OUTCOMES, MAKING HIGH-QUALITY CARE MORE ACCESSIBLE, AND LOWERING HEALTH CARE COSTS. GUIDED BY OUR VALUES, LOVE AND EXCELLENCE, CHRISTIANACARE HAS GROWN, AND CONTINUES TO GROW, TO MEET THE NEEDS OF OUR COMMUNITY. CHRISTIANACARE HAS AN EXTENSIVE NETWORK OF PRIMARY CARE AND OUTPATIENT SERVICES, HOME HEALTH CARE, URGENT CARE CENTERS, THREE HOSPITALS (1,435 LICENSED BEDS), A FREESTANDING EMERGENCY DEPARTMENT, A LEVEL I TRAUMA CENTER AND A LEVEL III NEONATAL INTENSIVE CARE UNIT, A COMPREHENSIVE STROKE CENTER, AND REGIONAL CENTERS OF EXCELLENCE IN HEART AND VASCULAR CARE, CANCER CARE, AND WOMEN'S HEALTH. CHRISTIANACARE PROVIDES SERVICES THAT DELAWAREANS CANNOT FIND ELSEWHERE IN THE STATE SUCH AS AN EPILEPSY MONITORING UNIT, A COMPREHENSIVE PAIN CENTER, WHICH OFFERS EFFECTIVE, NON-OPIOID PAIN TREATMENT STRATEGIES FOR INDIVIDUALS WITH ACUTE AND CHRONIC PAIN, ADULT KIDNEY TRANSPLANT, AND A LEVEL 2 PEDIATRIC EMERGENCY CARE FACILITY. CHRISTIANACARE IS ALSO ONE OF THE LARGEST COMMUNITY-BASED TEACHING HOSPITALS CONDUCTING RESEARCH IN THE UNITED STATES. WE ARE COMMITTED TO ADVANCING HEALTH AND HEALTH EQUITY THROUGH RESEARCH AND INNOVATION AS DEMONSTRATED THROUGHOUT THIS NARRATIVE AND AS SHOWN BY OUR INSTITUTE FOR RESEARCH ON EQUITY AND COMMUNITY HEALTH. THIS EMBEDDED RESEARCH INSTITUTE CONDUCTS APPLIED RESEARCH FOCUSED ON ISSUES OF EQUITY AND COMMUNITY HEALTH, POPULATION HEALTH, AND VIRTUAL HEALTH, AS WELL AS TRAINING THE NEXT GENERATION OF CLINICAL SCIENTISTS WITH THE GOAL TO BRIDGE THE GAP BETWEEN CLINICAL AND TRANSLATIONAL RESEARCH, ADVANCEMENTS IN THE QUALITY OF CARE, AND IMPROVED HEALTH OUTCOMES FOR ALL. ALONG WITH SERVING OUR PATIENTS AND COMMUNITY THROUGH EXCEPTIONAL CLINICAL SERVICES, TRAINING THE NEXT GENERATION OF HEALTHCARE WORKERS, CONDUCTING ROBUST RESEARCH TO ADVANCE HEALTH OUTCOMES, AND AN UNWAVERING COMMITMENT TO EQUITY, WE ARE ALSO COMMITTED TO PROVIDING AFFORDABLE AND VALUE-BASED CARE. CHRISTIANACARE IS A FOUNDING PARTNER IN EBRIGHTHEALTH ACO, AN ACCOUNTABLE CARE ORGANIZATION THAT SERVES APPROXIMATELY 30,000 REGIONAL MEDICARE BENEFICIARIES FROM DELAWARE, PENNSYLVANIA, AND MARYLAND. CHRISTIANACARE'S CAREVIO PROVIDES THE CARE COORDINATION FOR THIS INITIATIVE. CAREVIO IS ANOTHER EXAMPLE OF CHRISTIANACARE'S AWARD WINNING INNOVATION TO BETTER SERVE INDIVIDUALS. CAREVIO HARNESSES AN INFORMATION TECHNOLOGY PLATFORM THAT IDENTIFIES THE PATIENTS WHO ARE AT HIGHEST RISK AND WHO HAVE SIGNIFICANT CARE NEEDS, INCLUDING THOSE WHO DO NOT REGULARLY ACCESS PRIMARY CARE AND PREVENTIVE SERVICES. UNDERSTANDING WHO IS AT RISK FOR POOR HEALTH ENABLES CLINICIANS TO PROACTIVELY CONTACT THE INDIVIDUAL TO CONNECT THEM TO THE HEALTH SERVICES THEY NEED. IN PERFORMANCE YEAR 2021, THE EBRIGHTHEALTH ACO REDUCED HEALTH CARE SPENDING BY $7 MILLION AND EARNED A QUALITY SCORE OF 82.1%. THIS MARKS THE SIXTH CONSECUTIVE YEAR THAT EBRIGHTHEALTH ACO HAS REDUCED HEALTH CARE COSTS FOR ITS ATTRIBUTED BENEFICIARIES, BRINGING THE CUMULATIVE AMOUNT SAVED TO MORE THAN $44.5 MILLION. CHRISTIANACARE ALSO LAUNCHED ONE OF THE FIRST MEDICAID ACOS IN THE STATE, DELAWARE MEDICAID QUALITY PARTNERS ACO ON JULY 1, 2021. THIS ACO SERVES MORE THAN 18,000 MEDICAID PATIENTS AND LIKE THE EBRIGHTHEALTH ACO, IT WILL ALSO BE SUPPORTED BY CAREVIO. HEALTH EQUITY, CARE STANDARDIZATION, AND SOCIAL DETERMINANTS OF HEALTH ARE AREAS OF FOCUS FOR THIS ACO TO ENSURE PATIENTS ARE SET UP FOR SUCCESS IN ACHIEVING POSITIVE HEALTH OUTCOMES. CHRISTIANACARE'S LEADERSHIP IN THE AREAS OF CLINICAL CARE, INNOVATION, AND RESEARCH CONTRIBUTE TO NATIONAL RECOGNITION. THE FOLLOWING ARE TWO AWARDS WE RECENTLY RECEIVED AMONG MANY. FOR THE 7TH YEAR IN A ROW, THE COLLEGE OF HEALTHCARE INFORMATION MANAGEMENT EXECUTIVES (CHIME) HAS GIVEN CHRISTIANACARE THE "MOST WIRED" DESIGNATION. AMONG THE MORE THAN 38,000 ORGANIZATIONS SURVEYED BY CHIME, CHRISTIANACARE RANKED ABOVE ITS PEERS IN THE CATEGORIES OF ANALYTICS AND DATA MANAGEMENT, POPULATION HEALTH, INFRASTRUCTURE, AND PATIENT ENGAGEMENT. FOR THE 3RD YEAR IN A ROW, HEALTHGRADES NAMED CHRISTIANACARE AS ONE OF AMERICA'S 50 BEST HOSPITALS. CHRISTIANACARE IS AMONG THE TOP 1% OF MORE THAN 4,500 HOSPITALS ASSESSED NATIONWIDE FOR CONSISTENT, YEAR-OVER-YEAR SUPERIOR CLINICAL PERFORMANCE. AS THE LARGEST PRIVATE EMPLOYER IN THE STATE OF DELAWARE, CHRISTIANACARE ALSO STRIVES TO BE A LEADER AMONG OTHER BUSINESSES AND ORGANIZATIONS. IN EARLY 2019, CHRISTIANACARE INCREASED ITS MINIMUM WAGE TO $15 AN HOUR, AND BEGINNING IN JULY 2020, CHRISTIANACARE BEGAN OFFERING 12 WEEKS OF PAID PARENTAL LEAVE FOR ITS CAREGIVERS. IN HONOR OF MARTIN LUTHER KING DAY IN JANUARY 2019, CHRISTIANACARE ALSO PROVIDED A COMMUNITY SERVICE BENEFIT TO ITS CAREGIVERS WHICH PROVIDES THEM WITH PAID COMMUNITY SERVICE TIME, IN ADDITION TO THEIR PAID TIME OFF, TO VOLUNTEER AT CHARITABLE, NON-PROFIT ORGANIZATIONS. IN FY2022, 425 HOURS WERE SPENT IN COMMUNITY SERVICE AT A COST OF OVER $24,000 TO CHRISTIANACARE. FINALLY, CHRISTIANACARE HAS ALSO COMMITTED TO BEING AN ANTI-RACISM ORGANIZATION. THAT COMMITMENT CAN BE FOUND HERE: ANTI-RACISM COMMITMENT - CHRISTIANACARE. CHRISTIANACARE'S CONTINUED GROWTH, ADAPTATION, AND INNOVATION WILL ALWAYS BE DRIVEN BY OUR FOUNDATION OF SERVICE TO OUR COMMUNITY AND ADDRESSING THE NEEDS THEY IDENTIFY. OUR MOST IMPORTANT PARTNERSHIP WILL ALWAYS BE WITH OUR NEIGHBORS. --------------------
PART VI, LINE 7 (STATES FILING OF COMMUNITY BENEFIT REPORT)	THERE IS NO PRESENT STATE OF DELAWARE REQUIREMENT FOR CHRISTIANACARE TO FILE A COMMUNITY BENEFIT REPORT. CHRISTIANACARE HAS ESTABLISHED A COMMUNITY BENEFIT DEDICATED SECTION ON ITS WEBSITE WHERE THE CHNA AND CHIP CAN BE FOUND, ALONG WITH ARTICLES ABOUT CHRISTIANACARE'S COMMUNITY BENEFIT INITIATIVES AND STORIES. THIS CAN BE ACCESSED AT: https://christianacare.org/us/en/about-us/who-we-are/community-benefit --------------------

Schedule H (Form 990) 2021

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
SchJMediumBullet

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2021

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)	573,656 ------------- 0	108,750 ------------- 0	38,500 ------------- 0	18,804 ------------- 0	22,348 ------------- 0	762,058 ------------- 0	0 ------------- 0
2JANICE E NEVIN MD PRESIDENT & CEO	(i) (ii)	1,395,891 ------------- 0	828,651 ------------- 0	0 ------------- 0	60,660 ------------- 0	10,501 ------------- 0	2,295,703 ------------- 0	0 ------------- 0
3JENNIFER L SCHWARTZ ESQ CORPORATE SECRETARY	(i) (ii)	504,545 ------------- 0	216,026 ------------- 0	0 ------------- 0	16,843 ------------- 0	23,010 ------------- 0	760,424 ------------- 0	0 ------------- 0
4JOSEPH BENNETT MD MEMBER (THROUGH 12/31/21)	(i) (ii)	547,436 ------------- 0	101,298 ------------- 0	11,000 ------------- 0	17,400 ------------- 0	23,010 ------------- 0	700,144 ------------- 0	0 ------------- 0
5KENNETH SILVERSTEIN MD CHIEF PHYSICIAN EXECUTIVE	(i) (ii)	1,227,165 ------------- 0	316,765 ------------- 0	0 ------------- 0	18,850 ------------- 0	23,010 ------------- 0	1,585,790 ------------- 0	0 ------------- 0
6KIRK N GARRATT MD MEDICAL DIRECTOR - HEART/VASC	(i) (ii)	743,932 ------------- 0	235,978 ------------- 0	0 ------------- 0	18,850 ------------- 0	7,839 ------------- 0	1,006,599 ------------- 0	0 ------------- 0
7LISA C MAXWELL MD PRESIDENT, MEDICAL GROUP	(i) (ii)	487,510 ------------- 0	174,874 ------------- 0	0 ------------- 0	36,867 ------------- 0	23,010 ------------- 0	722,261 ------------- 0	0 ------------- 0
8MICHAEL EPPEHIMER MD FORMER PRES. MED GROUP	(i) (ii)	290,433 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	1,624 ------------- 0	292,057 ------------- 0	0 ------------- 0
9NEIL JASANI MD CHIEF PEOPLE OFFICER	(i) (ii)	529,312 ------------- 0	208,836 ------------- 0	0 ------------- 0	20,300 ------------- 0	23,010 ------------- 0	781,458 ------------- 0	0 ------------- 0
10PAUL K DAVIS MD CARDIAC SURGEON	(i) (ii)	749,835 ------------- 0	140,813 ------------- 0	0 ------------- 0	18,850 ------------- 0	24,050 ------------- 0	933,548 ------------- 0	0 ------------- 0
11RANDALL GABORIAULT CHIEF DIGITAL & INFO OFFICER	(i) (ii)	721,909 ------------- 0	259,965 ------------- 0	0 ------------- 0	20,300 ------------- 0	24,050 ------------- 0	1,026,224 ------------- 0	0 ------------- 0
12RAY A BLACKWELL MD CHIEF CARDIAC SURGERY	(i) (ii)	852,819 ------------- 0	173,846 ------------- 0	0 ------------- 0	20,300 ------------- 0	23,010 ------------- 0	1,069,975 ------------- 0	0 ------------- 0
13RIC CUMING RN CHIEF NURSING EXECUTIVE	(i) (ii)	486,094 ------------- 0	212,495 ------------- 0	0 ------------- 0	17,400 ------------- 0	14,729 ------------- 0	730,718 ------------- 0	0 ------------- 0
14ROBERT MCMURRAY TREASURER AND ASS'T SECRETARY	(i) (ii)	600,633 ------------- 0	248,589 ------------- 0	0 ------------- 0	20,300 ------------- 0	23,010 ------------- 0	892,532 ------------- 0	0 ------------- 0
15SHARON T KURFUERST CHIEF OPERATING OFFICER	(i) (ii)	654,345 ------------- 0	255,517 ------------- 0	0 ------------- 0	20,300 ------------- 0	16,478 ------------- 0	946,640 ------------- 0	0 ------------- 0
16KERT ANZILOTTI CHIEF MEDICAL OFFICER	(i) (ii)	739,637 ------------- 0	189,873 ------------- 0	0 ------------- 0	18,850 ------------- 0	23,010 ------------- 0	971,370 ------------- 0	0 ------------- 0
17VINAY K GHEYI DEPARTMENT CHAIR - RADIOLOGY	(i) (ii)	706,300 ------------- 0	220,657 ------------- 0	0 ------------- 0	20,300 ------------- 0	15,233 ------------- 0	962,490 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

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 3 TOP MANAGEMENT COMPENSATION AS PROVIDED IN THE FORM 990, SCHEDULE J INSTRUCTIONS, SINCE THE ORGANIZATION RELIES ON A RELATED ORGANIZATION WHICH USES ONE OR MORE OF THE METHOD DESCRIBED IN LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIALS' COMPENSATION, THIS QUESTION HAS BEEN LEFT UNANSWERED. REFER TO SCHEDULE O FOR A DESCRIPTION OF THE COMPENSATION REVIEW AND APPROVAL PROCESS. --------------------
FORM 990, SCHEDULE J, PART I, LINE 4A	DETAIL OF SEVERANCE PAYMENTS MICHAEL EPPEHIMER, MD (FORMER PRESIDENT MED GROUP) RECEIVED A SEVERANCE PAYMENT OF $283,184 DURING THE YEAR. --------------------
FORM 990, SCHEDULE J, PART I, LINE 4B	SUPPLEMENTAL NONQUALIFIED PLAN PARTICIPATION CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS") MAINTAINS AN IRC SECTION 457(F) DEFERRED COMPENSATION PLAN. THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A PARTICIPATED AND/OR RECEIVED DISTRIBUTIONS FROM THE 457(F) PLAN DURING THE YEAR: KERT ANZILOTTI- $135,455 RIC CUMING, RN- NO DISTRIBUTION RANDALL GABORIAULT- $117,198 KIRK N. GARRATT, MD- $20,140 VINAY K. GHEYI- $19,294 NEIL JASANI, MD- $31,244 SHARON T. KURFUERST- $23,571 LISA C. MAXWELL, MD- NO DISTRIBUTION ROBERT MCMURRAY- NO DISTRIBUTION JANICE E. NEVIN, MD- $165,126 JENNIFER L. SCHWARTZ, ESQ.- NO DISTRIBUTION KENNETH SILVERSTEIN, MD- NO DISTRIBUTION --------------------
FORM 990, SCHEDULE J, PART I, LINE 7	PROVISION OF NON-FIXED PAYMENTS CHRISTIANA CARE HEALTH SYSTEM, INC. ("SYSTEM") IS THE SOLE MEMBER OF THIS ORGANIZATION. ALL OFFICER/TRUSTEE COMPENSATION ARRANGEMENTS, INCLUDING THE PAYMENT OF DISCRETIONARY BONUS AND/OR INCENTIVE COMPENSATION PAYMENTS TO ELIGIBLE EMPLOYEES, ARE DETERMINED BY THE SYSTEM BOARD. PAYMENTS MADE TO ANY DISQUALIFIED PERSON ARE APPROVED BY THE COMPENSATION COMMITTEE OF SYSTEM THROUGH THE PROCESS DESCRIBED IN FORM 990, PART VI, SECTION B, LINE 15. --------------------

Schedule J (Form 990) 2021

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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

2021

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 ..............	0
3 Total proceeds of issue ..................	305,483,000
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 .............	145,360,019
11 Other spent proceeds .............	157,798,005
12 Other unspent proceeds .............	0
13 Year of substantial completion .............	2021
	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 2020, 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 2020, 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) 2021

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 .........	0 %
6 Total of lines 4 and 5 .............	0 %
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. ..	0 %
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) 2021

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. -------------------- FORM 990, SCHEDULE K, PART II, LINE 5 ADDITIONAL INFORMATION REGARDING CAPITALIZED INTEREST FROM PROCEEDS ALTHOUGH CCHS CAPITALIZES INTEREST FOR BOOK PURPOSES, BOND PROCEEDS ARE NOT USED TO PAY INTEREST AND ARE THEREFORE NOT REPORTED ON PART II, LINE 5. --------------------

Schedule K (Form 990) 2021

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Schedule L
(Form 990)

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

2021

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) 2021

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) ERIN KURFUERST	DAUGHTER OF KEY EMPLOYEE	62,749	EMPLOYMENT		No
(2) WL GORE ASSOCIATES INC	TRUSTEE IS AN OFFICER	2,481,977	PURCHASE OF MEDICAL SUPPLIES		No
(3) NEUROSCIENCES II EXTRA SPACE LLC	TRUSTEE IS > 35% OWNER	195,127	PROPERTY LEASE		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990) 2021

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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

2021

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	7	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) (2021)

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) (2021)

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SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

CHRISTIANA CARE HEALTH SERVICES INC

Employer identification number

51-0103684

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINES 6 & 7A,7B	GOVERNING BODY AND MANAGEMENT CHRISTIANA CARE HEALTH SYSTEM, INC. ("SYSTEM"), A TAX-EXEMPT ORGANIZATION, IS THE SOLE MEMBER OF CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS"). THE SYSTEM BOARD ELECTS DIRECTORS OF CCHS AT ITS ANNUAL MEETING. THE ANNUAL OPERATING BUDGET OF CCHS IS APPROVED BY THE CCHS BOARD, THE SYSTEM FINANCE COMMITTEE, AND THE SYSTEM BOARD. --------------------
FORM 990, PART VI, SECTION B, LINE 11	FORM 990 REVIEW PROCESS INFORMATION RELATED TO CHRISTIANA CARE'S FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO PRICEWATERHOUSECOOPERS LLP FOR REVIEW. THE FINAL 2021 FORM 990 FOR THE FISCAL YEAR ENDING JUNE 30, 2022 WAS REVIEWED AND APPROVED BY VARIOUS SENIOR MANAGEMENT OFFICIALS. THE ORGANIZATION'S GOVERNING BOARD WAS ALSO PROVIDED ACCESS TO THE APPROVED 2021 FORM 990 VIA ITS BOARD OF DIRECTOR'S PORTAL. --------------------
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST POLICY OUR CONFLICT OF INTEREST ("COI") POLICY IS LOCATED IN THE CAREGIVER RESOURCE CENTER ON THE EMPLOYEE PORTAL. THERE IS AN ANNUAL MANDATORY EDUCATION FOR MANAGERS WHICH INCLUDES AN ELECTRONIC SIGN OFF ACKNOWLEDGING COMPLETION OF THE EDUCATION, REPORTING OF A REAL OR PERCEIVED CONFLICT OR THAT NO CONFLICTS OF INTEREST EXISTS. THE HR/EMPLOYEE RELATIONS TEAM FOLLOWS UP WITH ANYONE WHO HAS A CONFLICT OR PERCEIVED CONFLICT OR DOES NOT COMPLETE THE EDUCATION IN ORDER TO RESOLVE. SEVERAL REPORTING MECHANISMS ALSO EXIST FOR EMPLOYEES TO REPORT CONCERNS. THE BOARD OF DIRECTORS HAS THEIR OWN COI POLICY. COI IS A STANDING AGENDA ITEM ON EACH BOARD OR BOARD COMMITTEE MEETING. BOARD MEMBERS EXPECTATIONS FOR COI ARE CLEARLY COMMUNICATED. --------------------
FORM 990, PART VI, SECTION B, LINE 15	COMPENSATION REVIEW AND APPROVAL PROCESS THE BOARD OF DIRECTORS OF CHRISTIANA CARE HEALTH SYSTEM, INC. ("SYSTEM"), THE SOLE MEMBER OF CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS") ESTABLISHES CCHS'S COMPETITIVE TOTAL COMPENSATION POLICY AND PRACTICE. THE EXECUTIVE COMPENSATION COMMITTEE ("ECC") OF THE SYSTEM BOARD ENGAGES AN INDEPENDENT THIRD PARTY ANNUALLY WHO ASSESSES DATA FROM SEVERAL MAJOR SURVEYS TO ENSURE TOTAL REMUNERATION IS MARKET COMPETITIVE AND QUALIFIES FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTIONS RULE, SECTION 4958 OF THE INTERNAL REVENUE CODE. AFTER DELIBERATION, THE ECC DOCUMENTS THEIR DECISIONS IN MEETING MINUTES. --------------------
FORM 990, PART VI, SECTION B, LINE 16B	JOINT VENTURE ARRANGEMENTS ALTHOUGH THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY IN PLACE REGARDING PARTICIPATION IN JOINT VENTURE RELATIONSHIPS, WHEN ANY SUCH RELATIONSHIPS ARE CONSIDERED, THEY ARE FIRST REVIEWED AND EVALUATED BY MANAGEMENT OFFICIALS IN CONJUNCTION WITH 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 $ 76,125,946 CHANGE IN NET ASSET OF SYSTEM (2,507,283) OTHER CHANGES (10,407,025) ----------- TOTAL $ 63,211,638

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

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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

2021

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 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 51-0103684	SUPPORT SRVCS	DE	0	0	CCH SERVICES
(2) CHRISTIANA CARE QUALITY PARTNERS LLC 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 51-0103684	SUPPORT SRVCS	DE	-258,911	4,553,320	CCH SERVICES
(3) CHRISTIANA CARE QUALITY PARTNERS ACOLLC 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 51-0103684	SUPPORT SRVCS	DE	1,364,861	0	CCH SERVICES
(4) CHRISTIANA CARE CARE LINK LLC 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 51-0103684	SUPPORT SRVCS	DE	-9,307,615	8,108,607	CCH SERVICES
(5) CHRISTIANA CARE CTR FOR VIRTUAL HLTH LLC 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 86-2155365	SUPPORT SRVCS	DE	-4,901,241	2,360,150	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 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 52-1479538	FUNDRAISING	DE	501(C)(3)	7	NA		No
(2)CHRISTIANA CARE HEALTH INITIATIVES 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 51-0295186	OUTPATIENT SV	DE	501(C)(3)	10	CCH SYSTEM		No
(3)CHRISTIANA CARE HOME HEALTH & COM SRVCS 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 51-0064334	HOME HLTHCARE	DE	501(C)(3)	7	CCH SYSTEM		No
(4)UNION HOSPITAL OF CECIL COUNTY FDN 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 52-1794552	FUNDRAISING	MD	501(C)(3)	7	AFFINITY		No
(5)UNION HOSPITAL OF CECIL COUNTY INC 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 52-0607945	HLTHCARE SVCS	MD	501(C)(3)	3	AFFINITY		No
(6)UNION HOSPITAL OF CECIL COUNTY HLTH SVCS 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 52-1794553	PROPERTY MGMT	MD	501(C)(3)	10	AFFINITY		No
(7)UNION HOSPITAL OF CECIL COUNTY ONCOLOGY 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 81-2662359	HEALTHCARE	MD	501(C)(3)	3	AFFINITY		No
(8)AFFINITY HEALTH ALLIANCE INC 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 52-1794697	MANAGEMENT	DE	501(C)(3)	12B, II	CCH SERVICES	Yes
(9)CHRISTIANA CARE WEST GROVE INC 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 88-3155785	HEALTHCARE	PA	501(C)(3)	12C,III-FI	CCH SERVICES	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	-2,680,257	18,027,420		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	-410,647	333,403		No	0		No	79.800 %
(4) LEEWARD HEALTH LLC 4000 NEXUS DRIVE STE C3-300 WILMINGTON,DE19803 88-3132477	MED ADV RISK	DE	CCH SYSTEM					No			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 NW3-100 WILMINGTON,DE19803 20-5891272	HEALTHCARE	DE	CCH SERVICES	C CORP	196,509	4,847,681	100.000 %	Yes
(2) CHRISTIANA CARE HEALTH PLANS 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 51-0352728	INSURANCE	DE	CCH SYSTEM	C CORP			100.000 %		No
(3) CHRISTIANA CARE DEFERRED COMP PLAN 4755 OGLETOWN STANTON RD NEWARK,DE19718 81-6359549	DEF COMP PLAN	DE	CCH SERVICES	TRUST	0	0	100.000 %	Yes
(4) CHRISTIANA CARE EXEC DEFERRED COMP PLAN 4755 OGLETOWN STANTON RD NEWARK,DE19718 35-7048822	DEF COMP PLAN	DE	CCH SERVICES	TRUST	0	0	100.000 %	Yes
(5) CARE ASSOCIATES DEFERRED COMP PLAN 4755 OGLETWON STANTON RD NEWARK,DE19718 35-7048714	DEF COMP PLAN	DE	CCH SERVICES	TRUST	0	0	100.000 %	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	-3,413,621	71,448,076	100.000 %	Yes
(7) CHRISTIANA CARE STRATEGIC INVESTMENTS 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 85-3348300	STRATEGY	DE	CCH SYSTEM	C CORP					No
(8) UNION HOSPITAL OF CECIL COUNTY VENTURES 4000 NEXUS DR NW3-100 WILMINGTON,DE19803 52-1793691	MEDICAL SERVICES	MD	AFFINITY	C CORP					No

Schedule R (Form 990) 2021

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) ............................

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	ADOQR	35,526,124	FMV
(2) CHRISTIANA CARE GO HEALTH URGENT CARE LLC	ADJPR	25,126,630	FMV
(3) THE DE CTR FOR MAT FETAL MED OF CC INC	K,O	936,747	FMV
(4) CHRISTIANA CARE INSURANCE CO LTD	Q,R	38,582,984	FMV
(5) AFFINITY HEALTH ALLIANCE INC	ADOQR	2,074,946	FMV
(6) CLINERGY LLC	O	629,581	FMV
(7) CHRISTIANA CARE HOME HEALTH & COMM SERVICES	ADOQR	5,157,651	FMV

Schedule R (Form 990) 2021

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) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

TY 2021 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 $ 3,994,382 CHRISTIANA CARE HEALTH SERVICES 249,595 2,419,010,073 CHRISTIANA CARE HOME HEALTH AND COMMUNITY SERVICES NONE 43,668,856 CHRISTIANA CARE HEALTH INITIATIVES NONE 8,980,280 ------------ -------------- TOTAL $ 249,595 $2,475,653,591 THE ORGANIZATION HAS MADE THE LOBBYING ELECTION UNDER I.R.C. SECTION 501(H) FOR THE TAX YEAR ENDED JUNE 30, 2022. THIS ELECTION WAS NOT REVOKED BEFORE THE START OF THE ORGANIZATION'S TAX YEAR THAT BEGAN IN 2021.

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	13
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 2021 (Part V, line 2a) ......	5	13,804
6	Total number of volunteers (estimate if necessary) .............	6	538
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	1,391,208
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	128,076,121	43,095,263
9	Program service revenue (Part VIII, line 2g) .........	2,187,692,532	2,339,408,720
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	199,105,805	205,839,630
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	18,852,326	16,410,989
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	2,533,726,784	2,604,754,602
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)	1,317,604,659	1,432,780,622
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)....	829,007,353	986,479,046
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	2,146,612,012	2,419,259,668
19	Revenue less expenses. Subtract line 18 from line 12.......	387,114,772	185,494,934
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	4,818,599,325	4,236,219,870
21	Total liabilities (Part X, line 26).............	1,336,477,794	1,095,605,855
22	Net assets or fund balances. Subtract line 21 from line 20.....	3,482,121,531	3,140,614,015

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 2,046,596,178 including grants of $ 0 ) (Revenue $ 2,351,033,382 )
	AS PART OF ITS MISSION OF SERVICE, THE HOSPITALS AND MEDICAL STAFF OF CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS") OFFER A FULL RANGE OF HEALTH SERVICES TO ADDRESS THE NEEDS OF ITS LOCAL COMMUNITIES. THIS INCLUDES THE PROVISION OF COMPREHENSIVE HEALTH CARE SERVICES TO RESIDENTS OF THE STATE OF DELAWARE, NORTHERN MARYLAND, SOUTHEASTERN PENNSYLVANIA AND SOUTHERN NEW JERSEY, WITHOUT REGARD TO THE PATIENTS' RACE, GENDER, ETHNICITY, AGE, DISABILITY, RELIGION, OR ABILITY TO PAY. DURING FISCAL 2022, THE HOSPITALS OF CCHS RECORDED 428,698 PATIENT DAYS, 60,094 ADMISSIONS, 220,800 EMERGENCY DEPARTMENT VISITS, AND THE BIRTHS OF 6,829 BABIES. ADDITIONALLY, CCHS'S MEDICAL GROUP ENGAGED WITH PATIENTS DURING A TOTAL OF 286,992 PRIMARY CARE VISITS. DURING THE FISCAL YEAR, CCHS PROVIDED $65,232,695 OF UNCOMPENSATED AND UNREIMBURSED CARE, AND ENGAGED IN A VARIETY OF OTHER ACTIVITIES TO SUPPORT AND ASSIST THE LOCAL COMMUNITIES THAT ARE MORE FULLY DISCUSSED IN SCHEDULE H.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses2,046,596,178

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	15,753,885	0	686,096

1a	Federated campaigns..		1a	16,784
b	Membership dues..		1b
c	Fundraising events..		1c	188,983
d	Related organizations		1d	4,876,002
e	Government grants (contributions)		1e	35,672,389

f	All other contributions, gifts, grants, and similar amounts not included above		1f	2,341,105

g	Noncash contributions included in lines 1a - 1f:$		1g	70,440

h Total. Add lines 1a-1f.......		43,095,263

		Business Code
2a	NET PROGRAM SERVICE REVENUES	622110	2,298,378,209	2,298,378,209	0	0
b	OTHER REVENUES	900099	41,030,511	36,557,233	1,391,208	3,082,070
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		2,339,408,720

3 Investment income (including dividends, interest, and othersimilar amounts) ......			39,431,408			39,431,408
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents	0	3,261,870	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	3,261,870	6c
d	Net rental income or (loss).......			3,261,870			3,261,870
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	5,940,715	658,239,375	7a
b	Less: cost or other basis and sales expenses		497,771,868	7b
c	Gain or (loss)	5,940,715	160,467,507	7c
d	Net gain or (loss).........			166,408,222			166,408,222
8a	Gross income from fundraising events (not including $ 188,983of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
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	1,524,457	0	0	1,524,457
b	AFFILIATE REVENUES		900099	11,624,662	11,624,662	0	0
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			13,149,119
12	Total revenue. See instructions.....			2,604,754,602	2,346,560,104	1,391,208	213,708,027

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 ...........	10,610,922	8,913,175	1,697,747	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........	1,103,156,058	925,445,517	177,710,541	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	74,647,438	62,703,848	11,943,590	0
9	Other employee benefits .......	168,324,411	141,392,505	26,931,906	0
10	Payroll taxes ...........	76,041,793	63,792,069	12,249,724	0
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	3,243,673	2,499,317	744,356	0
c	Accounting ...........	393,660	303,323	90,337	0
d	Lobbying ...........	249,595	192,318	57,277	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	7,134,471	0	7,134,471	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	130,628,957	100,652,308	29,976,649	0
12	Advertising and promotion ....	6,675,303	5,143,459	1,531,844	0
13	Office expenses .......	7,241,870	5,580,010	1,661,860	0
14	Information technology ......	66,340,795	51,116,952	15,223,843	0
15	Royalties ..	0
16	Occupancy ...........	32,715,864	25,208,249	7,507,615	0
17	Travel ............	1,773,596	1,366,592	407,004	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	4,960,010	3,821,790	1,138,220	0
20	Interest ...........	10,353,749	8,555,095	1,798,654	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	116,353,679	82,840,809	33,512,870	0
23	Insurance ...	24,254,484	18,688,581	5,565,903	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	418,245,187	418,245,187	0	0
b	OTHER SUPPLIES AND SERVICES	155,914,153	120,135,074	35,779,079	0
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	2,419,259,668	2,046,596,178	372,663,490	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 ........			440,619,940	1	141,444,726
2	Savings and temporary cash investments .........			191,331,183	2	191,508,175
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			313,356,780	4	370,268,568
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 ............			37,414,184	8	46,112,024
9	Prepaid expenses and deferred charges ......			17,267,840	9	28,837,684
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,664,299,520
b	Less: accumulated depreciation	10b	1,616,455,217	1,106,742,213	10c	1,047,844,303
11	Investments—publicly traded securities .			1,780,366,763	11	1,522,391,684
12	Investments—other securities. See Part IV, line 11 .....			571,984,820	12	419,786,225
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 ...........			358,499,797	15	467,010,676
16	Total assets. Add lines 1 through 15 (must equal line 33)...			4,818,599,325	16	4,236,219,870

17	Accounts payable and accrued expenses .....	394,195,384	17	431,963,789
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	312,855,885	20	305,985,527
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	629,426,525	25	357,656,539
26	Total liabilities. Add lines 17 through 25..	1,336,477,794	26	1,095,605,855

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	3,414,358,021	27	3,083,488,363
28	Net assets with donor restrictions ...........	67,763,510	28	57,125,652
	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 ...........	3,482,121,531	32	3,140,614,015
33	Total liabilities and net assets/fund balances ........	4,818,599,325	33	4,236,219,870

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