4A (Expenses $ 64111127 including grants of $ 37646) (Revenue $ 90675374)
SEE SCHEDULE H.

FLAGET MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: CHI SAINT JOSEPH HEALTH CONTRACTED WITH THE COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KENTUCKY (CEDIK) TO CONDUCT A CHNA. CEDIK FACILITATED THE PROCESS OF PRIMARY DATA COLLECTION THROUGH COMMUNITY SURVEYS, FOCUS GROUPS AND KEY INFORMANT INTERVIEWS TO CREATE AN IMPLEMENTATION PLAN TO ADDRESS IDENTIFIED HEALTH NEEDS. IN ADDITION, COUNTY SPECIFIC SECONDARY DATA WAS GATHERED TO HELP EXAMINE THE SOCIAL DETERMINANTS OF HEALTH. THROUGHOUT THE PROCESS, CEDIK AND THE COMMUNITY STEERING COMMITTEE MADE IT A PRIORITY TO GET INPUT FROM POPULATIONS THAT ARE OFTEN NOT ENGAGED IN CONVERSATIONS ABOUT THEIR HEALTH NEEDS OR GAPS IN SERVICE. ORGANIZATIONS CONSULTED: NELSON COUNTY HEALTH DEPARTMENT, BARDSTOWN AT HOME, GUTHRIE OPPORTUNITY CENTER, NELSON COUNTY COMMUNITY CLINIC, BLACKMON & WALTON DENTISTRY, NELSON COUNTY EMS, NELSON COUNTY SCHOOL DISTRICT, BARDSTOWN CITY SCHOOL, NELSON COUNTY CHAMBER OF COMMERCE, AND LOCAL NAMI CHAPTER.

FLAGET MEMORIAL HOSPITAL
"PART V, SECTION B, LINE 11: STRATEGIES TO ADDRESS SIGNIFICANT HEALTH NEEDS IDENTIFIED: BEHAVIORAL HEALTH INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE GOAL: ADDRESS BEHAVIORAL HEALTH, INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE, FROM A CHI SAINT JOSEPH HEALTH SYSTEM APPROACH, INCLUDING WORKING UPSTREAM TO ADDRESS ISSUES THAT UNDERLIE MENTAL HEALTH AND SUBSTANCE ABUSE. OUTCOME OBJECTIVE: BY JUNE 2022, INCREASE MENTAL HEALTH RESOURCES, INCLUDING TELEHEALTH, PARTICIPATION AND COLLABORATION WITH COMMUNITY PARTNERS TO ADDRESS BEHAVIORAL HEALTH; DECREASE SUBSTANCE ABUSE AS MEASURED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION. STRATEGIES WILL BE ACCOMPLISHED THROUGH PARTICIPATION AND COLLABORATION WITH COMMUNITY PARTNERS. INFORMATION ABOUT AVAILABLE RESOURCES WILL BE PROVIDED WITH EACH OPPORTUNITY. STRATEGIES MENTAL HEALTH: SUPPORT LEGISLATION CONSIDERING A HOLISTIC APPROACH TO ADDRESS MENTAL HEALTH, INCLUDING TELEHEALTH. PURSUE VARIOUS PRIVATE, STATE AND FEDERAL GRANTS TO ADDRESS MENTAL HEALTH NEEDS. EPIC PROJECT CONSIDER PARTICIPATING WITH PARTNERS IN PEDIATRIC THERAPY AND THE NELSON COUNTY HEALTH DEPARTMENT TO IDENTIFY INDIVIDUALS WHO HAVE EXPERIENCED CHALLENGING AND ADVERSE SITUATIONS THROUGHOUT THEIR LIFETIME THAT COULD IMPACT THEIR MENTAL AND PHYSICAL HEALTH. PARTICIPATE AND SUPPORT LOCAL GROUPS AND EVENTS THAT HAVE A MISSION TO PROMOTE MENTAL WELL-BEING. INCREASE ACCESS TO MENTAL HEALTH SERVICES BY IMPROVING COLLABORATION BETWEEN FLAGET MEMORIAL HOSPITAL, COMMUNITY AND LOCAL MENTAL HEALTH FACILITIES. LEVERAGE EXPERTISE IN MENTAL HEALTH TO INCREASE ACCESS TO MENTAL HEALTH SERVICES, INCLUDING TELEHEALTH. COLLABORATE WITH OUR LADY OF PEACE TO PROVIDE PEACE FOR PARENTS SEMINARS ON TOPICS SUCH AS ANXIETY, DEPRESSION, SUICIDE, BULLYING AND SUBSTANCE ABUSE. UTILIZE TELEHEALTH FOR CONSULTATIONS THROUGH THE EMERGENCY DEPARTMENT. CONTINUE GREEN DOT PROGRAM TO ADDRESS VIOLENCE IN THE AREA SCHOOLS AND IDENTIFY HIGH RISK KIDS AND CONTINUED LEADERSHIP OF THE VIOLENCE PREVENTION COMMUNITY COALITION. STRATEGIES SUBSTANCE ABUSE: PARTICIPATE AND SUPPORT KENTUCKY HOSPITAL ASSOCIATION (KHA) AND THE CABINET FOR HEALTH AND FAMILY SERVICES AS PART OF THE KENTUCKY OPIOID RESPONSE EFFORT (KORE) TO LAUNCH THE KENTUCKY STATEWIDE OPIOID STEWARDSHIP (KY SOS) PROGRAM. ADVANCE CHI SAINT JOSEPH HEALTH'S RECENT NEW POSITION OF OPIOID STEWARDSHIP PHARMACIST AND FORTHCOMING DRUG TASK FORCE. PARTICIPATE AND SUPPORT THE KENTUCKY CHAMBER OF COMMERCE'S OPIOID TASK FORCE. PARTICIPATE AND/OR SPONSOR EVIDENCE-BASED SUBSTANCE ABUSE INITIATIVES ADDRESSING THE OPIOID CRISIS. PROMOTE COLLABORATION BETWEEN THE PUBLIC AND PRIVATE SECTORS. PROMOTE AND SUPPORT COMMUNITY SUPPORT PROGRAMS SUCH AS ALCOHOLICS ANONYMOUS (AA) AND NARCOTICS ANONYMOUS (NA). IDENTIFY OPPORTUNITIES TO ADDRESS ALCOHOL AND SUBSTANCE USE. SUPPORT LOCAL GROUPS AND EVENTS THAT HAVE A MISSION TO PREVENT ALCOHOL AND SUBSTANCE USE AND CARE FOR THOSE WHO ARE EXPERIENCING MENTAL HEALTH ISSUES AND/OR SUBSTANCE ABUSE. EXPLORE THE FEASIBILITY OF EXPANDING TELEHEALTH OPPORTUNITIES FOR ALCOHOL AND DRUG COUNSELING. OBESITY AND DIABETES INCLUDING WELLNESS & EXERCISE GOAL: ADDRESS OBESITY AND DIABETES, INCLUDING WELLNESS AND EXERCISE, THROUGH EDUCATION AND PREVENTION. OUTCOME OBJECTIVE: TO DECREASE OBESITY AND DIABETES AS MEASURED BY KENTUCKY BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY AND TO INCREASE WELLNESS AND EXERCISE AS MEASURED BY COUNTY HEALTH RANKINGS AND ROADMAPS. (KY RANKS 7TH FOR DIABETES; AND, 8TH FOR OBESITY.) STRATEGIES WILL BE ACCOMPLISHED THROUGH PARTICIPATION AND COLLABORATION WITH COMMUNITY PARTNERS. INFORMATION ABOUT AVAILABLE RESOURCES WILL BE PROVIDED WITH EACH OPPORTUNITY. STRATEGIES: ADVOCATE FOR INITIATIVES THAT ADDRESS THE RISK FACTORS THAT LEAD TO OBESITY AND CHRONIC DISEASE IN CHILDREN. SUPPORT LEGISLATION TO PROVIDE TAX BREAKS AND OTHER INCENTIVES FOR THE CREATION OF WELLNESS PROGRAMS ENABLING BUSINESSES TO EDUCATE AND ENCOURAGE EMPLOYEES TO ENGAGE IN HEALTHY LIFESTYLES AND OBTAIN PREVENTIVE CARE. PROMOTE HEALTHY OPTIONS FOR DIET AND EXERCISE. PROVIDE COMMUNITY SUPPORTED AGRICULTURE PROGRAMS AND/OR FARMERS MARKETS. PROMOTE HEALTHY FOOD INITIATIVE AND ""MINDFUL"" PROGRAM. OFFER ITEMS AND EDUCATIONAL MATERIALS FROM THE ""HARVEST OF THE MONTH"" PROGRAM. PROVIDE NUTRITION LABELING IN THE CAFETERIA. ESTABLISH DIABETES EDUCATION CLASSES WITH INDIVIDUAL COUNSELING, ALONG WITH MEDICAL NUTRITION THERAPY. PURSUE OPPORTUNITIES TO DEVELOP AND/OR EXPAND PARTNERSHIPS TO INCREASE ACCESS TO RESOURCES RELATED TO DIET AND EXERCISE. PARTICIPATE AND SUPPORT LOCAL GROUPS AND EVENTS THAT HAVE A MISSION TO PROMOTE HEALTHY DIET AND EXERCISE TO PREVENT NEGATIVE HEALTH OUTCOMES. PROMOTE AND SUPPORT THE AMERICAN DIABETES ASSOCIATION. EDUCATION ABOUT RESOURCES GOAL: ADDRESS LACK OF KNOWLEDGE ABOUT AVAILABLE RESOURCES FOR DISEASES AND SERVICES AT FLAGET MEMORIAL HOSPITAL. OUTCOME OBJECTIVE: BY JUNE 2022, INCREASE KNOWLEDGE ABOUT DISEASES AND SERVICES AT FLAGET MEMORIAL HOSPITAL BY ACCEPTING 85% OF INVITATIONS AND PARTICIPATING IN COMMUNITY AND SCHOOL EVENTS TO PROVIDE EDUCATION MATERIALS AND INFORMATION; HOST A MINIMUM OF TWO EDUCATIONAL SESSIONS AT FACILITY COVERING SERVICES AND/OR DISEASES. STRATEGIES WILL BE ACCOMPLISHED THROUGH PARTICIPATION AND COLLABORATION WITH COMMUNITY PARTNERS. INFORMATION ABOUT AVAILABLE RESOURCES WILL BE PROVIDED WITH EACH OPPORTUNITY. STRATEGIES: PARTICIPATE IN COMMUNITY EVENTS AND SCHOOL EVENTS TO PROVIDE EDUCATION ABOUT DISEASES AND SERVICES AT FLAGET MEMORIAL HOSPITAL. HOST EDUCATIONAL SESSIONS AT FLAGET MEMORIAL HOSPITAL TO SHARE KNOWLEDGE ABOUT DISEASES AND SERVICES. CONTINUE ADVISORY COUNCIL TO PROVIDE EDUCATION ABOUT RESOURCES AND ENCOURAGE MEMBERS TO SHARE WITH THE COMMUNITY. IDENTIFY SPECIALTY PROVIDERS WHO ARE WILLING TO EXPAND THEIR SERVICES TO THE FLAGET MEMORIAL HOSPITAL SERVICE AREA."

FLAGET MEMORIAL HOSPITAL
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.

SCHEDULE H, 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.

SCHEDULE H, PART V, SECTION B, LINE 7A:
HTTPS://WWW.CHISAINTJOSEPHHEALTH.ORG/LIBRARY/DEFAULT-TAB-BAR-BACK/ABOUT-US/HEALTHY-COMMUNITIES/2023-2025-COMMUNITY-HEALTH-NEEDS-ASSESSMENT

SCHEDULE H, PART V, SECTION B, LINE 10A:
HTTPS://WWW.CHISAINTJOSEPHHEALTH.ORG/LIBRARY/DEFAULT-TAB-BAR-BACK/ABOUT-US/HEALTHY-COMMUNITIES/2023-2025-COMMUNITY-HEALTH-NEEDS-ASSESSMENT

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:
FLAGET HEALTHCARE INC. COMMUNITY BENEFIT REPORT IS CONTAINED IN THE REPORT OF A RELATED ORGANIZATION - CHI SAINT JOSEPH HEALTH.

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 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:
FLAGET HEALTHCARE, INC. MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. FLAGET HEALTHCARE, INC.'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. FLAGET HEALTHCARE, INC. 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, FLAGET HEALTHCARE, INC. 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 VI, LINE 4:
GEOGRAPHIC AREA FOR THE PURPOSES OF THE CHNA, FLAGET MEMORIAL HOSPITAL HAS DEFINED NELSON COUNTY AS THE PRIMARY SERVICE AREA. NELSON COUNTY WILL SERVE AS THE UNIT OF ANALYSIS FOR THE CHNA AND HEALTH NEEDS DISCUSSED WILL PERTAIN TO RESIDENTS OF THIS COUNTY. POPULATION NELSON COUNTY CONTINUES TO GROW IN POPULATION, BUT IS NOT AS DIVERSE AS THE LARGER CONTIGUOUS COUNTY OF JEFFERSON. FEDERALLY DESIGNATED MUAS ARE PRESENT IN BOTH COUNTIES. DEMOGRAPHICS:TOTAL POPULATION 45,640ASIAN/PACIFIC ISLANDER 0.36%BLACK/AFRICAN AMERICAN - NON-HISPANIC 5.18%HISPANIC OR LATINO 1.93%WHITE NON-HISPANIC 89.93%ALL OTHERS 2.60%FAMILIES BELOW POVERTY 12,218POPULATION 25+ WITH LESS THAN HIGH SCHOOL GRADUATION: 3,219PERCENT CIVILIAN LABOR FORCE UNEMPLOYED 3.8%

PART III, LINE 4:
"FLAGET HEALTHCARE, INC. 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. FLAGET HEALTHCARE, INC.'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $3,435,196 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS.

PART III, LINE 9B:
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.

PART VI, LINE 3:
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.

PART VI, LINE 5:
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.