4A (Expenses $ 6137349 including grants of $ 1202) (Revenue $ 3198602)
AH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY PROVIDES PATIENTS WITH ACCESS TO PRIMARY CARE THROUGH FAMILY MEDICINE PRACTITIONERS THAT PROVIDE CONTINUING, COMPREHENSIVE HEALTH CARE FOR INDIVIDUAL FAMILY MEMBERS OF BOTH GENDERS AND ALL AGES. BY PLACING SPECIAL ATTENTION ON THE FAMILY AS A GROUP, THE FAMILY MEDICINE PRACTITIONER PROVIDES INTEGRATED CARE TO ALL PATIENTS WITHIN A FAMILY. FAMILY PRACTITIONERS; EMPHASIZE DISEASE PREVENTION AND WELLNESS BY RECOMMENDING PREVENTITIVE TESTS, COACH PATIENTS TO CHANGE HEALTH BEHAVIORS SO THEY DO NOT DEVELOP CHRONIC CONDITIONS, MONITOR CHRONIC CONDITIONS TO PREVENT FURTHER COMPLICATIONS, COLLABORATE WITH THE SPECIALIST, COORDINATING THE PATIENT'S HEALTHCARE AND SERVING AS THE PATIENT'S ADVOCATE IN ALL CARE SETTINGS WHEN A REFERRAL TO A SPECIALIST IS NECESSARY.

4B (Expenses $ 2416016 including grants of $ 4771) (Revenue $ 12694751)
ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IS PROUD TO OFFER DIAGNOSTIC IMAGING SERVICES - CLOSE TO HOME - WITHIN THE COMMUNITY. THE DIAGNOSTIC IMAGING SERVICES PROVIDED INCLUDE THE FOLLOWING: CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND.

4C (Expenses $ 1927676 including grants of $ 717) (Revenue $ 1907901)
AS A COMMUNITY HOSPITAL, ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY HAS STAYED COMMITTED TO KEEPING RESIDENTS OF HARRISON COUNTY IN GOOD HEALTH. THROUGH THE YEARS, ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL HAS STRIVED TO IMPROVE THE HEALTH STATUS OF SOUTHWEST IOWA RESIDENT CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS THROUGH 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS.

4D (Expenses $ 15270364 including grants of $ 4114) (Revenue $ 10948140)
OTHER PROGRAM SERVICES:

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: AH-COM MEM HOSPITAL OF MISSOURI VALLEY

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
IN CONDUCTING ITS MOST RECENT CHNA, CHI MISSOURI VALLEY TOOK 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. CHI HEALTH MISSOURI VALLEY ENGAGED IN THE CHNA PROCESS LED BY HCHPH WHICH INCLUDED THE COLLECTION OF PRIMARY AND SECONDARY DATA. PRIMARY DATA WAS COLLECTED THROUGH A COMMUNITY SURVEY AND A KEY INFORMANT SURVEY. HCHPH SOURCED SECONDARY DATA ON A RANGE OF COMMUNITY HEALTH INDICATORS, INCLUDING, BUT NOT LIMITED TO: POPULATION DEMOGRAPHICS, SOCIOECONOMIC FACTORS, HEALTH STATUS (INCLUDING CHRONIC DISEASE AND POOR MENTAL HEALTH PREVALENCE) AND HEALTH OUTCOMES (MORTALITY). COMMUNITY HEALTH DATA WAS ANALYZED TO DISCERN VARIATION FROM BENCHMARKS (INCLUDING COMPARISON TO PEER COUNTIES, THE STATE AND U.S.), IDENTIFY NOTABLE MULTI- YEAR TRENDS IN THE DATA AND ACCOUNT FOR FREQUENCY OF THE ISSUE BEING CITED AS A SIGNIFICANT HEALTH NEED BY COMMUNITY STAKEHOLDERS. HARRISON COUNTY HOME AND PUBLIC HEALTH DEPARTMENT CONVENED INDIVIDUALS FROM ORGANIZATIONS REPRESENTING CHI HEALTH MISSOURI VALLEY, PUBLIC HEALTH, AGING, DISABILITY, MENTAL HEALTH, LOW INCOME AND EDUCATION, THROUGH AN ESTABLISHED COLLECTIVE IMPACT ORGANIZATION, HEALTHY HARRISON COALITION (HHC). THROUGH A SERIES OF MONTHLY MEETINGS FROM DECEMBER 2021- FEBRUARY 2022, COALITION MEMBERS REVIEWED PRIMARY AND SECONDARY DATA ON A VARIETY OF COMMUNITY HEALTH INDICATORS. ALL PARTIES WHO REVIEWED THE DATA FOUND THE DATA TO ACCURATELY REPRESENT THE NEEDS OF THE COMMUNITY. PARTICIPATING ORGANIZATIONS INCLUDE: - HARRISON COUNTY HOME & PUBLIC HEALTH DEPARTMENT (HCHPH)- ANGELS HOME HEALTH- HEARTLAND FAMILY SERVICE- TRIVIUM LIFE SERVICES- SOUTHWEST IOWA REGION MENTAL HEALTH & DISABILITY SERVICES- WELCOME CENTER FARMERS MARKET- THRIVING FAMILIES ALLIANCE- THE CREW CENTER- IOWA DEPARTMENT ON AGING RETIRED AND SENIOR VOLUNTEER PROGRAM (IDA RSVP)- AMERIGROUP- FIRST FIVE- NATIONAL ALLIANCE ON MENTAL HEALTH SOUTHWEST IOWA- HEAD START

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:
PARTICIPATING ORGANIZATIONS INCLUDE: - HARRISON COUNTY HOME & PUBLIC HEALTH DEPARTMENT (HCHPH)- HEALTHY HARRISON COALITION

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 7D:
THIS CNA WAS COMPLETED IN PARTNERSHIP WITH THE HEALTH DEPARTMENT AND HEALTH SYSTEMS, IN ADDITION PRESENTATIONS WERE MADE TO THE HEALTHY HARRISON COALITION ON MAY 11TH, 2022 AND THE COMMUNITY BOARD ON JULY 21ST, 2022.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:
THE MOST RECENT CHNA AND CORRESPONDING IMPLEMENTATION PLAN WAS COMPLETED IN THE TAX REPORTING YEAR 2022. THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON WWW.CHIHEALTH.COM/CHNA. THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY AND SECONDARY DATA FROM COMMUNITY SURVEY AND COALITION MEETING. TOP HEALTH NEEDS (FROM 2022 CHNA): 1. AGING PROBLEMS2. CANCER3. CARDIOVASCULAR DISEASE4. CHILD ABUSE & NEGLECT5. HEALTH RELATED SOCIAL NEEDS6. MENTAL HEALTH 7. OBESITY & LIFESTYLE FACTORS FOR CHRONIC DISEASE8. SUBSTANCE ABUSE9. UNINTENTIONAL INJURIES FOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: BEHAVIORAL HEALTH (MENTAL HEALTH, SOCIAL ISOLATION, SUBSTANCE ABUSE)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- EXPAND ACCESS TO COMMUNITY- BASED MENTAL HEALTH SERVICES FOR YOUTH. * SUPPORT SCHOOL-BASED MENTAL HEALTH PROGRAMS AND TRAINING, SUCH AS YOUTH MENTAL HEALTH FIRST AID TRAINING AND QUESTION. PERSUADE. RESPOND. (QPR)- EXPAND ACCESS TO CLINIC- BASED BEHAVIORAL HEALTH SERVICES FOR YOUTH AND ADULTS. * IMPLEMENT AND SUSTAIN AN INTEGRATED BEHAVIORAL HEALTH/PRIMARY CARE MODEL- PARTNER WITH THE REGION TO SUPPORT AND IMPLEMENT THE CRISIS CENTER NETWORK. * ENGAGE IN THE SOUTHWEST IOWA MENTAL HEALTH AND DISABILITY SERVICES REGION CRISIS CENTER NETWORK AND BEHAVIORAL HEALTH EVALUATION & TRANSFER SERVICE- SUPPORT SOCIAL CONNECTION AND DEMENTIA PREVENTION EDUCATION. * PARTICIPATE IN AND SUPPORT COMMUNITY-BASED SOCIAL GROUPS FOR THE AGING POPULATION TO RECEIVE KINSHIP AND DEMENTIA EDUCATION.- ACCESS TO SUBSTANCE ABUSE PREVENTION. * SUPPORT AND PROMOTE SCHOOL- AND COMMUNITY- BASED PROGRAMMING TO PREVENT YOUTH SUBSTANCE ABUSEPRIORITY HEALTH NEED #2: HEALTH- RELATED SOCIAL NEEDS (FOOD, TRANSPORTATION, HOUSING) TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- SUPPORT AND PROMOTE THE WELCOME CENTER FARMERS' MARKET. * PROVIDE FINANCIAL SUPPORT TO THE WELCOME CENTER FARMER'S MARKET THROUGH ANNUAL SPONSORSHIP- EXPAND ACCESS TO HEALTHY FOODS FOR HARRISON COUNTY RESIDENTS WHO ARE FOOD INSECURE. * PROVIDE FINANCIAL AND IN-KIND SUPPORT FOR COUNTY EFFORTS TO EXPAND HEALTHY FOOD ACCESS TO LOW-INCOME RESIDENTS, SUCH AS THE FRESH FRUIT AND VEGETABLE VOUCHER PROGRAM OR EXPLORATION OF DOUBLE UP FOOD BUCKS PROGRAM- EXPAND ACCESSIBLE TRANSPORTATION AND/ OR HOME BASED CARE AND FOOD DELIVERY. * EXPLORE OPPORTUNITIES TO EXPAND HOME- BASED HEALTH CARE SERVICES AND/OR INCREASE TRANSPORTATION OPPORTUNITIES FOR MEDICAL CARE AND FOOD- ENGAGE IN COMMUNITY EFFORTS TO INCREASE AFFORDABLE HOUSING. * PARTICIPATE IN COMMUNITY COALITIONS EXPLORING OPPORTUNITIES TO INCREASE SAFE, AFFORDABLE WORKFORCE HOUSING IN HARRISON COUNTYTHE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS: 1. AGING - AGING WAS NOT SELECTED AS A STANDALONE PRIORITY, HOWEVER THE COMMUNITY BENEFIT ACTION TEAM (CBAT) HAS EMPLOYED A LIFECOURSE APPROACH TO THE PRIORITY HEALTH NEEDS OF BEHAVIORAL HEALTH AND HEALTH RELATED SOCIAL NEEDS, SO CONSIDERATION OF THE AGING POPULATION WILL BE ADDRESSED WITHIN THE ACCORDANT ACTIVITIES AND STRATEGIES. IN PARTICULAR, THE FOLLOWING ACTIVITIES WILL ADDRESS THE NEEDS OF AN AGING POPULATION: 1) PARTICIPATE IN AND SUPPORT COMMUNITY-BASED SOCIAL GROUPS FOR THE AGING POPULATION TO RECEIVE KINSHIP AND DEMENTIA EDUCATION AND 2) EXPLORE OPPORTUNITIES TO EXPAND HOME- BASED HEALTH CARE SERVICES AND/OR INCREASE TRANSPORTATION OPPORTUNITIES FOR MEDICAL CARE AND FOOD. CHI HEALTH MISSOURI VALLEY RECOGNIZES THE GROWING AGING POPULATION IN HARRISON COUNTY PRESENTS CHALLENGES FOR HEALTH SERVICES INFRASTRUCTURE, HOWEVER HARRISON COUNTY HAS SEVERAL RESOURCES THAT EXIST TO OFFER RELEVANT SUPPORT TO ELDERLY POPULATIONS AND BETTER ADDRESS THE CHALLENGES THAT AGING PRESENTS.2. CANCER - CANCER WAS NOT SELECTED FOR WORK IN AN EFFORT TO MAXIMIZE EXISTING RESOURCES AND STAFF TIME TO ADDRESS NEEDS OR ROOT CAUSES WHICH HAVE THE POTENTIAL TO IMPACT OTHER IDENTIFIED HEALTH NEEDS. HOWEVER, CHI HEALTH WILL CONTINUE TO HOST A CANCER SUPPORT GROUP AND SMOKING CESSATION SERVICES. THROUGH THE HEALTH RELATED SOCIAL NEEDS PRIORITY, (EXPLORE OPPORTUNITIES TO EXPAND HOME- BASED HEALTH CARE SERVICES AND/OR INCREASE TRANSPORTATION OPPORTUNITIES FOR MEDICAL CARE AND FOOD) MAY INDIRECTLY ADDRESS CANCER BY INCREASING ACCESS TO PREVENTIVE CARE AND SCREENINGS. 3. CARDIOVASCULAR DISEASE - THIS HEALTH NEED WAS NOT SELECTED FOR WORK IN AN EFFORT TO MAXIMIZE EXISTING RESOURCES AND STAFF TIME TO ADDRESS NEEDS OR ROOT CAUSES WHICH HAVE THE POTENTIAL TO IMPACT OTHER IDENTIFIED HEALTH NEEDS. HEALTH RELATED SOCIAL NEEDS WAS AN IDENTIFIED HEALTH NEED WHICH WAS PRIORITIZED IN AN EFFORT TO INDIRECTLY ADDRESS CARDIOVASCULAR DISEASE BY INCREASING ACCESS TO HEALTHY FOODS AND IMPROVING FOOD SECURITY. 4. CHILD ABUSE & NEGLECT - WHILE THIS HEALTH NEED WAS NOT PRIORITIZED, ACKNOWLEDGMENT WAS MADE BY THE CBAT THAT THIS NEED IS BEING ADDRESSED BY THE CHILD ABUSE PREVENTION COUNCIL, OF WHICH HARRISON COUNTY HOME AND PUBLIC HEALTH DEPARTMENT (HCHPH) IS THE CONVENER. HCHPH WILL CONTINUE TO LEAD THESE EFFORTS AND SEEK ADDITIONAL FUNDING. 5. OBESITY & LIFESTYLE FACTORS FOR CHRONIC DISEASE - THIS HEALTH NEED WAS NOT SELECTED FOR WORK IN AN EFFORT TO MAXIMIZE EXISTING RESOURCES AND STAFF TIME TO ADDRESS NEEDS OR ROOT CAUSES WHICH HAVE THE POTENTIAL TO IMPACT OTHER IDENTIFIED HEALTH NEEDS. HEALTH RELATED SOCIAL NEEDS WAS AN IDENTIFIED HEALTH NEED WHICH WAS PRIORITIZED IN AN EFFORT TO INDIRECTLY ADDRESS OBESITY & LIFESTYLE FACTORS FOR CHRONIC DISEASE THROUGH THE SPONSORSHIP OF THE WELCOME CENTER'S FARMERS MARKET AND FUNDING OF FRESH FRUIT AND VEGETABLE VOUCHER PROGRAM. 6. SUBSTANCE ABUSE - THIS HEALTH NEED IS BEING ADDRESSED THROUGH THE BEHAVIORAL HEALTH NEED PRIORITY, WITH DEDICATED MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION/ TREATMENT STRATEGIES.THE FOLLOWING TOP HEALTH NEEDS WERE IDENTIFIED AND PRIORITIZED AS PART OF THE CHNA AND IMPLEMENTATION STRATEGY PLAN APPROVED IN 2019. ALTHOUGH A MORE RECENT CHNA WAS COMPLETED IN TAX REPORTING YEAR 2021 (FISCAL YEAR 2022), THE RELATED IMPLEMENTATION PLAN WAS NOT APPROVED UNTIL JULY, 2022 (FISCAL YEAR 2023). THEREFORE THE WORK DESCRIBED BELOW IS TIED TO THE 2019 ASSESSMENT AND PLANS AND REPRESENTS WORK CARRIED OUT BY THE HOSPITAL DURING FISCAL YEAR 2022.THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY AND SECONDARY DATA INCLUDING COMMUNITY STAKEHOLDERS CONVENED THROUGH THE HEALTHY HARRISON COALITION. PARTICIPATING STAKEHOLDERS REPRESENTED: HEALTHCARE, PUBLIC HEALTH, EDUCATION, THE AGING POPULATION, LOW- INCOME POPULATION, PERSONS WITH DISABILITIES AND INDIVIDUALS IMPACTED BY VIOLENCE AND SUBSTANCE ABUSE.TOP HEALTH NEEDS (FROM 2019 CHNA):1. AGING 2. CANCER3. CARDIOVASCULAR DISEASE4. CHILD ABUSE & NEGLECT5. CHRONIC LOWER RESPIRATORY DISEASE6. MENTAL HEALTH7. OBESITY & LIFESTYLE FACTORS FOR CHRONIC DISEASE8. SEXUALLY TRANSMITTED INFECTIONS9. SUBSTANCE ABUSE10. UNINTENTIONAL INJURIESFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: NUTRITION, PHYSICAL ACTIVITY & WEIGHT TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:- SUPPORT HARRISON COUNTY FARMER'S MARKET FRESH FRUIT & VEGETABLE VOUCHER PROGRAM (INCLUDING TRANSPORTATION, EDUCATION AND VOUCHERS).- EXPLORE THE FEASIBILITY OF A COMMUNITY GARDEN IN MISSOURI VALLEY AND SUPPORT COMMUNITY EFFORTS TO IMPLEMENT.- ALIGN WITH AND PROMOTE 5-2-1-0 MESSAGING WHICH ENCOURAGES HEALTHY EATING HABITS AND APPROPRIATE LEVELS OF PHYSICAL ACTIVITY.PRIORITY HEALTH NEED #2: BEHAVIORAL HEALTHTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:- SUPPORT AND PROMOTE SCHOOL- BASED MENTAL HEALTH PROGRAMMING FOCUSED ON PREVENTION OF SUICIDE, SUBSTANCE ABUSE AND BUILDING POSITIVE PARENTING SKILLS, SUCH AS: * COPING THROUGH THE TEEN YEARS (SUICIDE PREVENTION) * ME360 (SUBSTANCE ABUSE PREVENTION) * COMMON SENSE PARENTING (IMPROVING PARENT-CHILD INTERACTIONS THROUGH SKILL DEVELOPMENT) - PARTNER WITH CHI HEALTH CLINICS TO IMPROVE CONTINUUM OF CARE FOR PATIENTS WITH POSITIVE DEPRESSION SCREENING. - PARTNER WITH THE REGION AND CHI HEALTH PSYCHIATRIC ASSOCIATES TO DELIVER MENTAL HEALTH FIRST AID TRAINING (MHFA).

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13H:
THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. PATIENT COOPERATION STANDARDS - A PATIENT MUST COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS.

PART V, SECTION B, LINE 3E:
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

PART I, LINE 3C:
UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE:- THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. - PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS.- THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS.- THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA).FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:- RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS;- HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS OR FREE CARE CLINIC;- PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);- FOOD STAMP ELIGIBILITY;- ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID);- LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR- PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE.

PART I, LINE 6A:
THE CHI HEALTH SYSTEM PRODUCES AN ANNUAL PUBLIC COMMUNITY BENEFIT REPORT THAT IS MAILED TO A CORE CONSTITUENCY, PLACED IN KEY PLACES THROUGHOUT THE ORGANIZATION AND DISTRIBUTED IN COMMUNITY MEETINGS. IT IS ALSO AVAILABLE ON THE COMPANY'S INTRANET SITE, AND ON ITS PUBLIC WEBSITE AT HTTP://WWW.CHIHEALTH.COM/COMMUNITY-BENEFIT.

PART I, LINE 7:
"COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (""CBISA"") SOFTWARE ARE USED TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS."

PART I, LINE 7G:
INCLUDED IN SUBSIDIZED HEALTH SERVICES ARE THE FOLLOWING PHYSICIAN CLINICS:-CHI HEALTH MISSOURI VALLEY RURAL HEALTH CLINIC-CHI HEALTH DUNLAP RURAL HEALTH CLINIC-CHI HEALTH LOGAN RURAL HEALTH CLINIC-CHI HEALTH WOODBINE RURAL HEALTH CLINICTHE TOTAL EXPENSES ASSOCIATED WITH OPERATING THESE CLINICS WERE $2,787,078. REVENUE OFFSETS WERE $568,178. ACCORDINGLY, THE TOTAL SUBSIDIZED COST OF THESE NECESSARY SERVICES WAS $2,218,900. THE CLINICS MEET A COMMUNITY NEED FOR PRIMARY CARE SERVICES OUTSIDE OF THE EMERGENCY ROOM SETTING.

PART II, COMMUNITY BUILDING ACTIVITIES:
CHI HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT INVESTMENTS, AS WELL AS HOSPITAL SPECIFIC INVESTMENTS THAT ADDRESS COMMUNITY HEALTH NEEDS WHICH INCLUDE SUPPORT OF LOCAL HEALTH COALITIONS, INVESTMENTS IN PARTNERSHIPS AND PROGRAMS THAT ADDRESS TOP COMMUNITY HEALTH NEEDS, PARTICIPATION IN LOCAL COMMITTEES AND BOARDS TIED TO TOP HEALTH NEEDS, AND INVESTMENTS IN MANY OTHER WAYS AS DESCRIBED IN OTHER AREAS OF THE SCHEDULE H NARRATIVE.

PART III, LINE 2:
THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE.

PART III, LINE 3:
ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE.

PART III, LINE 4:
"ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 12-13.""PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES."""

PART III, LINE 8:
COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS.COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA'S SURPLUS, AS REPORTED ON PART III, SECTION B, LINE 7, OF $19,675 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS.

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COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.

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INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.

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CHI HEALTH MISSOURI VALLEY IS LOCATED IN MISSOURI VALLEY, IOWA. MISSOURI VALLEY IS IN THE SOUTHWEST CORNER OF HARRISON COUNTY, A NON-METROPOLITAN COUNTY LOCATED IN WEST CENTRAL IOWA. HARRISON COUNTY IS COMPOSED OF NINE SCHOOL DISTRICTS AND TEN INCORPORATED TOWNS: DUNLAP, LITTLE SIOUX, LOGAN, MAGNOLIA, MISSOURI VALLEY, MODALE, MONDAMIN, PERSIA, PISGAH AND WOODBINE. LOGAN IS THE COUNTY SEAT AND THERE ARE ALSO SIX UNINCORPORATED TOWNS, AND 20 TOWNSHIPS. ACCORDING TO THE MOST RECENT CENSUS ESTIMATES, HARRISON COUNTY IS 81% RURAL, ENCOMPASSES 697 SQUARE MILES AND HAS 14,582 RESIDENTS. THE POPULATION DENSITY OF HARRISON COUNTY IS ESTIMATED AT 21.4 PERSONS PER SQUARE MILE, MAKING IT LESS THAN HALF AS DENSELY POPULATED AS THE STATE OF IOWA (54.5 PERSONS PER SQUARE MILE). THE POPULATION OF HARRISON COUNTY IS PRIMARILY NON-HISPANIC WHITE, AND A SLIGHTLY HIGHER PERCENTAGE OF RESIDENTS OVER 65 YEARS OF AGE RESIDE IN HARRISON COUNTY (19.9%), COMPARED TO THE STATE OF IOWA (17.5%). THE MEDIAN INCOME IN HARRISON COUNTY ($63,854) IS SLIGHTLY HIGHER THAN THE STATE AVERAGE ($60,523). HARRISON COUNTY HAS A SIMILAR PERCENTAGE OF HIGH SCHOOL GRADUATES RATES, COMPARED WITH THE STATE OF IOWA (HARRISON COUNTY: 94.1, IOWA: 91.4), BUT EDUCATIONAL ATTAINMENT IS LOWER IN HARRISON COUNTY WITH REGARD TO COMPLETION OF A BACHELOR'S DEGREE (HARRISON COUNTY: 19.46%, IOWA: 28.57%). HARRISON COUNTY HAS 13 DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA) INCLUDING PRIMARY CARE, DENTAL HEALTH, MENTAL HEALTH DISCIPLINES. THE HPSA SCORES RANGE FROM 7 TO 17 (12.77 MEDIAN SCORE) WHERE THE SCORE RANGE IS 0 TO 26 (THE HIGHER THE SCORE INDICATES A GREATER PRIORITY). HARRISON COUNTY HAS TWO DESIGNATED MEDICALLY UNDERSERVED WITH SCORES OF 61.8 AND 60.9 WHERE THE LOWEST SCORE (HIGHEST NEED) IS 0; THE HIGHEST SCORE (LOWEST NEED) IS 100. HARRISON COUNTY IS PRIMARILY RURAL IN NATURE WITH MANUFACTURING AND AGRICULTURE BEING THE MAJOR INDUSTRIES. LOCAL BUSINESSES SUCH AS TOMMY GATE, CARRY-ON TRAILER, AND E4 PRECISION AG PROVIDE STEADY JOB OPPORTUNITIES AND BRING RESOURCES TO THE COMMUNITIES. A STABLE COUNTY GOVERNMENT AS WELL AS STRONG SUPPORT FROM IOWA STATE UNIVERSITY EXTENSION SERVICES ALSO MAXIMIZES RESOURCES IN THE COUNTY. MISSOURI VALLEY IS SITUATED LESS THAN A MILE EAST OF INTERSTATE 29 AND LESS THAN FIVE MILES NORTH OF INTERSTATE 80.

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FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE.USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE.OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS.ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. HOSPITAL COMMUNITY BOARDS (OR THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AND PROGRESS TOWARD IDENTIFIED GOALS.

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THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. AS OF JUNE 30, 2022, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2022, COMMONSPIRIT HEALTH PROVIDED MORE THAN $3.16 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.89 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.9 BILLION IN FISCAL YEAR 2022, HAS TOTAL ASSETS OF APPROXIMATELY $50.31 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY.