4A (Expenses $ 2132398247 including grants of $ 0) (Revenue $ 2482961806)
Norton Hospitals, Inc. (NHI) was formed to: I) provide on a nonprofit basis, hospital or health care facilities and services for the care and treatment of ill and injured persons and those who otherwise require medical care and related services of the kind customarily furnished most effectively by hospitals or health care facilities; II) conduct educational activities related to rendering care to the sick and injured; III) promote and conduct scientific research related to the care of the sick and injured. NHI has a total of 1,907 licensed beds, Norton Hospital - 605 beds; Norton Children's Hospital - 300 beds; Norton Audubon Hospital - 432 beds; Norton Women's and Children's Hospital - 373 beds; and Norton Brownsboro Hospital - 197 beds. These hospitals operate twenty-four (24) hours a day, seven (7) days a week. In 2021, NHI's hospitals and diagnostic centers served 68,502 inpatients, 646,869 outpatients, 235,728 emergency department visits, and 30,260 observation cases. In addition, NHI's operating rooms cared for 16,312 inpatient surgical patients and 39,433 outpatient surgical patients. Additionally, 8,300 deliveries were performed at NHI birthing centers. Under its charity care program, NHI provided free care to 7,291 patients, at a cost of $14.2 million. Also, NHI grants a discount from billed charges to any patients that have no access to private health insurance or do not qualify for government assistance or charity care. Under this program, 7,498 patients were provided care at discounted rates. Another contribution to the community was educational support of $77.4 million, primarily to the University of Louisville School of Medicine. Community health improvement services totaled $20.1 million and contributions to community groups were $1.9 million.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - ALL HOSPITALS. NORTON HOSPITALS, INC. OWNS AND OPERATES FIVE HOSPITALS LOCATED IN LOUISVILLE, JEFFERSON COUNTY, KENTUCKY. THE HOSPITALS ARE: - NORTON HOSPITAL - NORTON CHILDREN'S HOSPITAL - NORTON WOMEN'S AND CHILDREN'S HOSPITAL - NORTON AUDUBON HOSPITAL - NORTON BROWNSBORO HOSPITAL

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - OTHER ORGANIZATIONS. Norton collaborated with the Louisville Metro Department of Public Health and Wellness (LMDPHW) and a variety of partners ranging from other local health systems to the Jefferson County Public School system and other community organizations. All of these organizations worked together to ensure a coordinated approach to gathering initial primary data. Through this collaboration, a community health survey was conducted using both online and paper survey methodologies. After the conclusion of the survey, a few specific under-represented populations in the survey results were found. To ensure that the opinions and perspectives of these groups were adequately represented, eight targeted focus groups were held. Community input also was obtained through key stakeholder interviews of 43 community leaders and health care providers. To ensure the medically underserved were represented in this CHNA, interviews were conducted with representatives from LMDPHW, Jefferson County Public Schools and health care organizations serving neighborhoods where median household incomes are very low, as well as agencies providing services related to mental health, domestic violence and recent immigration to the United States.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - All Hospitals. DRUG USE IN 2019 THE KENTUCKY POISON CONTROL CENTER OF NORTON CHILDREN'S HOSPITAL LAUNCHED A 24/7 SUPPORT HOTLINE FOR HEALTH CARE PROVIDERS, PATIENTS AND FIRST RESPONDERS ON OPIOID-RELATED ISSUES. THE KENTUCKY OPIOID ASSISTANCE & RESOURCE HOTLINE - (800) 854-6813 - IS STAFFED BY TOXICOLOGY-CERTIFIED NURSES AND PHARMACISTS. FOR THE COMMUNITY, THE HOTLINE OFFERS ADVICE ON SAFE MEDICATION DISPOSAL, WHERE TO GET NALOXONE AND HOW TO USE IT. STAFF ALSO CAN DIRECTLY CONNECT USERS AND THEIR FAMILIES TO OPERATION UNITE FOR SUBSTANCE USE DISORDER TREATMENT AND ASSIST DISPLACED PATIENTS OF PAIN CLINICS THAT SUDDENLY CLOSE. THE NORTON MATERNAL OPIATE AND SUBSTANCE TREATMENT (MOST) PROGRAM WAS CREATED TO HELP PREGNANT WOMEN BREAK THE CYCLE OF ADDICTION. THE MOST PROGRAM OFFERS KNOWLEDGEABLE, SUPPORTIVE STAFF MEMBERS WHO ARE SKILLED IN CARING FOR PREGNANT WOMEN WITH SUBSTANCE USE DISORDERS AND FOR THEIR BABIES. IN 2021, 101 WOMEN ENROLLED IN THE PROGRAM AND 78% DELIVERED THEIR BABIES FULL TERM. Norton Hospitals, Inc. (NHI) IS WORKING TO EXPAND THIS ADDICTION RECOVERY PROGRAM THROUGH USE OF NURSE PRACTITIONERS/NAVIGATORS. IN 2018 NHI CREATED AN OPIOID STEWARDSHIP PROGRAM TO DEVELOP PROTOCOLS FOR OPIOID USE AND DISPOSAL IN BOTH THE HOSPITAL AND AMBULATORY SETTING, AND TO PROMOTE ALTERNATIVE PAIN MANAGEMENT METHODS TO REDUCE THE NUMBER OF OPIOIDS IN THE COMMUNITY. THE PROGRAM FOCUSES ON CHANGING PRESCRIPTION PRACTICES BASED ON RECOMMENDATIONS MADE BY THE JOINT COMMISSION, A HEALTH CARE ACCREDITATION ORGANIZATION. OBESITY NHI OFFERS FREE HEALTHY LIVING WELLNESS GROUP VIRTUAL CLASSES LED BY CERTIFIED HEALTH COACHES, FOR PARENTS OF CHILDREN AGES 8 TO 17. THIS CLASS SERIES IS AIMED AT SUPPORTING FAMILIES ON THEIR WELLNESS JOURNEYS THROUGH HELPING THEM REACH THEIR WELLNESS GOALS IN AN ENGAGING AND SUPPORTIVE VIRTUAL GROUP SETTING. NORTON CHILDREN'S PREVENTION & WELLNESS TEAM ALSO OFFERS GROWING COOKS, A TWO-WEEK VIRTUAL COOKING CLASS FOR TEENS AGE 13-18 THEY CAN TAKE FROM HOME. EACH FAMILY RECEIVES A GIFT CARD TO OFFSET GROCERY COSTS. THE NORTON HEALTH & WELLNESS CENTER OFFERS FREE WEIGHT MANAGEMENT SEMINARS TO THE COMMUNITY IN EITHER AN IN-PERSON OR ONLINE SETTING. SERVICES INCLUDE EDUCATIONAL SEMINARS, SUPPORT GROUPS, AND A DEMONSTRATION KITCHEN. NHI CONTINUES TO OFFER FREE HEALTH SCREENINGS AND EDUCATION TO THE COMMUNITY THROUGH USE OF OUR MOBILE PREVENTION UNIT, AS WELL AS THROUGH VARIOUS COMMUNITY EVENTS AND HEALTH FAIRS. IN 2021, THERE WERE OVER 500 FREE SCREENINGS PERFORMED IN THE COMMUNITY.. THROUGH A PARTNERSHIP WITH MORE THAN 200 COMMUNITY ORGANIZATIONS, THE NORTON HEALTHCARE MOBILE PREVENTION CENTER CONNECTS PEOPLE TO WELLNESS AT MULTIPLE STOPS EVERY WEEK. MANY OF THE SCREENINGS ARE PROVIDED AT LOW COST OR NO COST, AND OTHERS TYPICALLY ARE COVERED BY INSURANCE. SMOKING/TOBACCO USE NORTON HEALTHCARE PREVENTION & WELLNESS OFFERS A COMPREHENSIVE TOBACCO CESSATION PROGRAM TO HELP THOSE IN THE COMMUNITY STRUGGLING WITH TOBACCO ADDICTION. CLASSES MEET FOR EIGHT 60- TO 90-MINUTE SESSIONS OVER SEVEN WEEKS. CLASSES FOLLOW THE AMERICAN LUNG ASSOCIATION FREEDOM FROM SMOKING PROGRAM, PROVEN TO BE EFFECTIVE FOR MILLIONS OF SMOKERS. THE COMPREHENSIVE LUNG CENTER AT NORTON CANCER INSTITUTE IS A SCREENING CENTER OF EXCELLENCE, AS DESIGNATED BY THE LUNG CANCER ALLIANCE. LED BY A TEAM OF LUNG SPECIALISTS, THE CENTER COMBINES FOUR COMPREHENSIVE COMPONENTS - PREVENTION, SCREENING, DIAGNOSIS AND TREATMENT - TO ENSURE EACH PATIENT HAS ACCESS TO STATE-OF-THE-ART LUNG CANCER SCREENING, SAME-DAY FOLLOW-UP APPOINTMENTS AND FAST-TRACK TREATMENT AND SUPPORT SERVICES. THE COMPREHENSIVE LUNG CENTER ALLOWS PATIENTS TO SEE AN ONCOLOGIST, SURGEON, RADIATION ONCOLOGIST, COUNSELOR, NUTRITIONIST AND OTHER MEMBERS OF THE CARE TEAM ALL IN ONE VISIT. NHI HAS ESTABLISHED A NO SMOKING POLICY ON ALL CAMPUSES TO ELIMINATE EXPOSURE TO TOBACCO SMOKE FOR OUR PATIENTS AND FAMILIES. NHI HAS MULTIPLE PULMONOLOGISTS ON STAFF AND OFFERS A BROAD RANGE OF ACUTE CARE SERVICES AS WELL AS RESPIRATORY THERAPY AT ALL NHI AND AMBULATORY FACILITIES. MENTAL HEALTH NHI IMPLEMENTED THE COLUMBIA-SUICIDE SEVERITY RATING SCALE IN APRIL 2019. THIS IS A QUESTIONNAIRE WHICH IS USED TO ASSESS SUICIDE RISKS FOR PATIENTS AT ALL ACCESS POINTS, INCLUDING THE EMERGENCY ROOM AND AMBULATORY SETTING. THE TOOL IS USED TO ASSESS PATIENT RISK AND ENSURE REFERRAL TO APPROPRIATE RESOURCES FOR TREATMENT. FROM 2019 TO 2021 THE NUMBER OF SUICIDE SCREENINGS COMPLETED AT NORTON HEALTHCARE INCREASED BY 54%. HEALTH EDUCATORS FROM NORTON CHILDREN'S PREVENTION & WELLNESS TEAM PARTNER WITH LOCAL MIDDLE/HIGH SCHOOLS TO OFFER PEER-TO-PEER EDUCATION AND AWARENESS ABOUT MENTAL HEALTH CONCERNS. WORKSHOPS ARE OFFERED IN SCHOOL HEALTH AND PHYSICAL EDUCATION CLASSROOMS, AT AFTER-SCHOOL EVENTS AND SUMMER PROGRAMS. WORKSHOPS PROVIDE PEER EDUCATION TO SUPPORT YOUNG PEOPLE IN DEVELOPING POSITIVE GROUP NORMS AND MAKING HEALTHY DECISIONS. THIS SERIES TEACHES STUDENTS HOW TO REDUCE STRESS AND EMPOWERS STUDENTS TO BECOME VOICES IN THEIR SCHOOLS AND TO ENCOURAGE HEALTHY BEHAVIORS AND DECISION-MAKING. NORTON CHILDREN'S HOSPITAL OFFERS INPATIENT PSYCHIATRIC CARE FOR CHILDREN AGES 2 TO 17 THROUGH THE ACKERLY CHILD PSYCHIATRIC UNIT. THEIR MISSION IS TO HELP CHILDREN AND FAMILIES REACH THEIR FULLEST POTENTIAL IN A NURTURING AND SAFE ENVIRONMENT. THEY ARE EQUIPPED TO SERVE PATIENTS WITH DEVELOPMENTAL DISABILITIES AND AUTISM, AND EXTEND CARE REGARDLESS OF A FAMILY'S BACKGROUND OR ABILITY TO PAY. IN THE AMBULATORY SETTING, NORTON CHILDREN'S MEDICAL GROUP PSYCHIATRY & PSYCHOLOGY OFFERS CHILD AND ADOLESCENT PSYCHIATRY SERVICES. IN 2019, NHI ESTABLISHED THE NORTON BEHAVIORAL HEALTH PRACTICE, WITH THE GOAL OF PROVIDING CLINICALLY INTEGRATED FAMILY AND PATIENT-CENTERED MENTAL HEALTH CARE. THE PRACTICE OFFERS TELEMEDICINE VISITS IN PRIMARY CARE LOCATIONS TO IMPROVE ACCESS AND HELP OVERCOME THE STIGMA OFTEN ASSOCIATED WITH MENTAL HEALTH FACILITIES. THE PRACTICE CARED FOR ALMOST 3,000 UNIQUE PATIENTS IN 2021. NORTON WOMEN'S MENTAL HEALTH SERVICES PROVIDES OUTPATIENT WOMEN'S MENTAL HEALTH SERVICES ON THE NORTON - ST. MATTHEWS CAMPUS. THEY ARE COMMITTED TO PROVIDING QUALITY MENTAL HEALTH CARE TO WOMEN ACROSS THEIR LIFESPAN. THE NORTON CANCER INSTITUTE BEHAVIORAL ONCOLOGY PROGRAM IS STAFFED BY A TEAM TRAINED AND EQUIPED TO CARE FOR THE EMOTIONAL AND MENTAL HEALTH NEEDS OF PATIENTS AND THEIR FAMILIES. NORTON CANCER INSTITUTE IS ONE OF FEW ONCOLOGY PROGRAMS NATIONWIDE OFFERING A ROBUST PROGRAM FOR MENTIAL AND EMOTIONAL HEALTH NEEDS. NORTON CHILDREN'S BEHAVIORAL & MENTAL HEALTH, AFFILIATED WITH THE U OF L SCHOOL OF MEDICINE, PROVIDES OUTPATIENT AND INPATIENT MENTAL HEALTH CARE FOR CHILDREN AGES 2 TO 21. PATIENTS AND THEIR FAMILIES HAVE ACCESS TO CHILD PSYCHIATRIC AND PSYCHOLOGICAL EVALUATION AND TREATMENTS. SERVICES INCLUDE MEDICATION THERAPY AND A BROAD RANGE OF INDIVIDUAL, GROUP, AND FAMILY THERAPIES. A SOCIAL WORKER IS ON CALL TO ASSIST WITH ADDRESSING BARRIERS TO CARE. CARE COORDINATION NHI, IN PARTNERSHIP WITH THE UNITED WAY, IS PARTICIPATING IN THE UNITED COMMUNITY INITIATIVE. UNITED COMMUNITY SEEKS TO LINK HEALTH CARE SERVICES AND SOCIAL SERVICES VIA A DATABASE PLATFORM CALLED UNITE US. NHI CAN REFER PATIENTS WITH SOCIOECONOMIC NEEDS TO APPROPRIATE RESOURCES USING THIS DATABASE PLATFORM. THE DATABASE IS INTEGRATED INTO THE PATIENT'S ELECTRONIC MEDICAL RECORD SO THAT PROVIDERS CAN SEE PATIENT REFERRALS TO SOCIAL SERVICES AS WELL AS THE OUTCOME OF THOSE REFERRALS. NHI HAS ESTABLISHED A SOCIAL SERVICES ASSESSMENT TOOL TO STREAMLINE THE SCREENING AND DOCUMENTATION OF SOCIAL NEEDS FOR PATIENTS. THE ASSESSMENT IS INTEGRATED IN THE ELECTRONIC MEDICAL RECORD AND UTILIZED BY SOCIAL WORKERS TO IDENTIFY AND DOCUMENT SOCIAL NEEDS AND TO REFER PATIENTS TO APPROPRIATE SOCIAL SERVICES RESOURCES USING THE UNITE US DATABASE PLATFORM. IN 2019, NHI LAUNCHED THE NORTON BABY APP TO STREAMLINE CARE FOR OBSTETRICS PATIENTS FROM PREGNANCY PLANNING, TO EXPECTING A NEW BABY, TO THE NEW PARENT STAGE. THE APP IS A ONE-STOP-SHOP FOR EXPECTANT MOTHERS AND PROVIDES HEALTH METRICS MONITORING, APPOINTMENT TRACKING, CHECKLISTS, HEALTH TIPS, AND MORE. IN 2021, 5,700 PATIENTS UTILIZED THE NORTON BABY APP. NORTON WOMEN'S CARE LAUNCHED A NEW DOULA PROGRAM IN 2021 THAT AIMS TO IMPROVE THE LONG-TERM HEALTH OF NEW MOTHERS IN UNDERSERVED AREAS OF THE COMMUNITY. THIS NEW PROGRAM WILL INCLUDE SEVERAL HOME VISITS THROUGHOUT THE PATIENT'S PREGNANCY AND THE PERIOD AFTER DELIVERY. PATIENTS MUST LIVE IN SPECIFIC UNDERSERVED NEIGHBORHOODS TO BE ELIGIBLE, AND WILL RECEIVE ADDITIONAL PRENATAL CARE THROUGH NORTON OB/GYN PRACTICES.

Schedule H, Part V, Section B, Line 11 Facility A, 2
"Facility A, 2 - All Hospitals. ACCESS TO CARE IN 2020 NORTON HEALTHCARE CREATED THE INSTITUTE FOR HEALTH EQUITY AS ONE OF FIVE INITIATIVES TO ADDRESS INEQUALITIES WITHIN THE COMMUNITY. THE PRIMARY FOCUS OF THE INSTITUTE IS TO IDENTIFY AND REMOVE OBSTACLES THAT PREVENT PEOPLE IN UNDERSERVED AREAS FROM RECEIVING THE HEALTH CARE THEY DESERVE, AS WELL AS TO ELIMINATE DISPARITIES IN CARE. IN 2021 THE INSTITUTE MOVED INTO THE VILLAGE @ WEST JEFFERSON, AN OFFICE BUILDING AT THE SOUTHEAST CORNER OF 12TH AND JEFFERSON STREETS, IN THE RUSSELL NEIGHBORHOOD OF LOUISVILLE. NHI IS POSITIONING THE INSTITUTE FOR HEALTH EQUITY TO SERVE AS A CENTRAL HUB FOR COMMUNITY-BASED ORGANIZATIONS AND RESOURCES TO COME TOGETHER TO ADDRESS FACTORS THAT CONTRIBUTE TO HEALTH DISPARITIES, INCLUDING HOUSING, HEALTHY FOOD OPTIONS, TRANSPORTATION AND CHILD CARE. THE 3,751-SQUARE-FOOT SPACE WAS BUILT TO ACCOMMODATE STAFF MEMBERS, COMMUNITY MEETING SPACE, CONSULTATION ROOMS FOR SOCIAL WORK AND MENTAL HEALTH CONSULTATIONS, AND A TELEHEALTH ROOM WHERE PATIENTS CAN HAVE ONE-ON-ONE APPOINTMENTS WITH MEDICAL PROVIDERS THROUGH VIDEOCONFERENCING TECHNOLOGY. THE SPACE ALSO HAS EDUCATIONAL RESOURCES FOR HEALTH AND WELL-BEING. GOODWILL INDUSTRIES OF KENTUCKY AND NORTON HEALTHCARE BROKE GROUND IN 2022 ON THE NORTON HEALTHCARE GOODWILL OPPORTUNITY CAMPUS AT 28TH STREET AND BROADWAY THAT WILL INCLUDE A 120,000 SQUARE-FOOT OPPORTUNITY CENTER AND THE FIRST HOSPITAL IN THE MOST UNDERSERVED PART OF THE COMMUNITY. TOGETHER, BOTH ORGANIZATIONS ARE INVESTING MORE THAN $100 MILLION TO TRANSFORM A 20-ACRE BROWNFIELD SITE IN THE PARKLAND NEIGHBORHOOD INTO AN ""OPPORTUNITY CAMPUS"" THAT WILL HOUSE GOODWILL'S HEADQUARTERS OPERATION, A FULL-SERVICE HOSPITAL AND A COLLECTION OF LOCAL SOCIAL-SERVICE AGENCIES THAT WILL WORK TOGETHER TO SERVE AN ESTIMATED 50,000 PEOPLE EVERY YEAR. WEST LOUISVILLE IS A NINE-NEIGHBORHOOD COMMUNITY WHERE THE MEDIAN HOUSEHOLD INCOME IS $21,000. THE AREA HAS ENDURED YEARS OF DISINVESTMENT THAT HAS LEFT MANY OF ITS 65,000 RESIDENTS WITH LIMITED EMPLOYMENT AND SELF-SUFFICIENCY RESOURCES. NORTON COMMUNITY MEDICAL ASSOCIATES - LA CLINICA PRESTON, NORTON HEALTHCARE'S FIRST 100% BILINGUAL PRACTICE, OPENED IN 2021 IN OKOLONA WITH STAFF AND PROVIDERS WHO UNDERSTAND THE UNIQUE CONCERNS OF LOUISVILLE'S LATINX COMMUNITY AND FAMILIES. THOUGH TRANSLATION SERVICES HAVE ALWAYS BEEN AVAILABLE AT NORTON HEALTHCARE FACILITIES, AN OFFICE EQUIPPED WITH TRUSTED EMPLOYEES WHO BRIDGE LANGUAGE AND CULTURE GAPS IS A WAY TO IMPROVE CARE FOR THE GROWING LATINX COMMUNITY. IN 2019 THE LOUISVILLE URBAN LEAGUE AND NORTON HEALTHCARE ANNOUNCED NORTON'S SUPPORT OF THE WEST END MULTI-USE SPORTS AND LEARNING COMPLEX. NORTON HEALTHCARE CONTRIBUTED $5 MILLION TO THE PROJECT THROUGH A $3 MILLION GRANT AND AN ADDITIONAL CHALLENGE GRANT OF $2 MILLION IN MATCHING FUNDS. THE FACILITY IS NAMED THE NORTON SPORTS HEALTH ATHLETICS & LEARNING COMPLEX AND OFFICIALLY OPENED IN FEBRUARY 2021. THE KEY TO ENSURING HEALTH EQUITY IS INCREASING ACCESS TO CARE IN LOUISVILLE'S UNDERSERVED AREAS. NORTON EXPANDED ACCESS IN UNDERSERVED AREAS THROUGH THE OPENING OF A NEW PRIMARY CARE PRACTICE IN THE WEST END, INCLUDING A COVID-19 TESTING AND VACCINATION CENTER AT THAT LOCATION. NORTON ALSO PURCHASED A SECOND MOBILE UNIT, MAKING IT EASIER FOR THE COMMUNITY TO ACCESS PREVENTIVE SERVICES SUCH AS MAMMOGRAMS, WELL-WOMAN EXAMS AND COLON CANCER SCREENINGS. ADDITIONAL SITE OPENINGS ARE PLANNED IN WEST AND SOUTH LOUISVILLE TO FURTHER EXPAND ACCESS TO CARE."

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - All Hospitals. Other eligibility criteria in addition to the criteria answered above would include as described in the Financial Assistance Policy: * The patient does not qualify for subsidized coverage of government assistance such as Disproportionate Share Hospital, Children's Health Insurance Program, Medicaid, Medicaid Managed Care Organization, or Hoosier Healthcare. * To be eligible for assistance for non-emergent Medically Necessary Care, a patient (or that patient's guarantor) must be a resident of Kentucky, Indiana, Tennessee, Ohio, or Illinois. This residency requirement does not apply to emergency care.

Schedule H, Part V, Section B, Line 16 Facility A, 1
Facility A, 1 - ALL HOSPITALS. See response to Part VI, Line 3; Patient education of eligibility for assistance.

Schedule H, Line 7, Input 7 STATE FILING OF COMMUNITY BENEFIT REPORT
Not required at this time by Commonwealth of Kentucky.

Schedule H, Part I, Line 6b Community Benefit Report
The annual community benefit initiative report is for all five hospitals in Norton Hospitals, Inc.'s (NHI) and is contained in the report prepared by NHI's parent corporation, Norton Healthcare, Inc.

Schedule H, Part I, Line 7f Bad debt
In accordance with accounting guidance, bad debt is not presented as an expense, but is included as a reduction in net patient service revenue.

Schedule H, Part III, Line 3 Bad Debt Expense under the organization's financial assistance policy
FOR FINANCIAL STATEMENT PURPOSES, NORTON Healthcare HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). Implicit price concessions includes BAD DEBTS. Therefore, Bad debts ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 and bad debt expense is not separately reported as an expense. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT attributable to patients eligible under Norton Hospital's financial assistance policy ON A GROSS BASIS.

Schedule H, Part VI, Line 5 Promotion of community health
"Norton Healthcare Inc. is a not-for-profit corporation based in Louisville, Kentucky, In 2021, Norton Healthcare, through its affiliate, Norton Hospitals Inc. (NHI), had a total of 1,907 licensed beds: Norton Audubon Hospital, 432 beds; Norton Brownsboro Hospital, 197 beds; Norton Children's Hospital, 300 beds; Norton Hospital, 605 beds; and Norton Women's & Children's Hospital, 373 beds. These five hospitals operate 24 hours a day, seven days a week. In 2021, Norton Healthcare, through its affiliate, Community Medical Associates Inc., had approximately 3.1 million patient encounters. Norton Healthcare's hospitals, diagnostic centers and Norton Cancer Institute served 68,502 inpatients and 646,869 outpatients, and saw 235,728 emergency room visits. In addition, Norton Healthcare hospitals' operating rooms cared for 16,312 inpatient surgical patients and 39,433 outpatient surgical patients. Additionally, 8,300 babies were delivered at Norton Healthcare birthing facilities at Norton Hospital and Norton Women's & Children's Hospital. NHI EXTENDS MEDICAL PRIVILEGES TO ALL PHYSICIANS IN THE COMMUNITY WHO MEET THE CREDENTIALING QUALIFICATIONS NECESSARY FOR APPOINTMENT TO ITS MEDICAL STAFF BY SPECIALTY. As part of our commitment to improving the health of our community, Norton Healthcare provides funding for a wide array of lifesaving and life-enhancing services that benefit the communities we serve. In 2021, under its charity care program, Norton Healthcare provided free care to 7,291 patients, at a cost of $14.2 million. Also, Norton Healthcare grants a discount from billed charges to any patients who have no access to private health insurance or do not qualify for government assistance or charity care. Under this program, 7,498 patients were provided care at discounted rates. Other contributions to the community was educational support of $77.4 million, primarily to the University of Louisville (UofL) School of Medicine. Community health improvement services totaled $20.1 million and contributions to community groups were $1.9 million. Norton Healthcare employees donated more than 209,000 hours of community service, a benefit valued at more than $1.1 million in salaries. In addition, many employees self-reported personal volunteer activities. Norton Healthcare provides programmatic support to the UofL School of Medicine through funding and facilities. During the 2021 calendar year, 209 residents completed clinical rotations in 50 specialties at Norton Healthcare facilities. Residency programs are part of the $77.4 million in educational support and clinical funding provided to the medical school. Norton Healthcare's Board of Trustees includes representatives from the community and largest employers in the region that live and work in the NHI's primary service area. Members are neither employees of nor independent contractors with the organization, nor family members thereof. Contributions to the community * Norton Healthcare employees and physicians gave nearly $815,643 to our 2021-2022 Combined Giving Campaign to help support non-profit organizations that also are committed to improving the health and well-being of community residents. Supported organizations include WHAS Crusade for Children, Metro United Way, Fund for the Arts, and our own Norton Children's Hospital Foundation and Norton Healthcare Foundation. * In 2021, 68 employees helped ""raise the roof"" on Norton Healthcare's 16th Habitat for Humanity home. The number of participating employees remained limited compared to prior years due to COVID-19 restrictions. * In 2021, an estimated 1,400 Norton Healthcare employees donated time and funds to plan, purchase and deliver gifts, food and clothing for the Caring Tree program. The program assisted 521 employees and their 1,147 children and dependents by providing for their families at Christmas. * More than 44,000 pounds of usable surplus medical supplies valued at more than $716,000, and over $552,805 in equipment, were donated for use locally and around the world. Norton Healthcare donated syringe pumps to Malawi as they tried to recover from rain storms and cyclones in addition to the ongoing struggles against Covid-19. These supplies were delivered in February of 2022 and went to three hospitals and 6 smaller clinics serving orphans, women and infants. * NORTON HEALTHCARE ESTABLISHED THE INSTITUTE FOR HEALTH EQUITY TO ADDRESS HEALTH AND RACIAL INEQUALITIES IN THE COMMUNITY. THE PURPOSE OF THE INSTITUTE FOR HEALTH EQUITY IS TO IDENTIFY AND REMOVE OBSTACLES THAT PREVENT PEOPLE FROM RECEIVING THE HEALTH CARE THEY DESERVE, AS WELL AS TO ELIMINATE DISPARITIES IN CARE. THIS INCLUDES INCREASING ACCESS TO CARE AND PARTNERING WITH LOCAL ORGANIZATIONS, POSITIONING THE INSTITUTE FOR HEALTH EQUITY TO SERVE AS A CENTRAL HUB FOR COMMUNITY-BASED ORGANIZATIONS AND RESOURCES TO COME TOGETHER TO ADDRESS FACTORS THAT CONTRIBUTE TO HEALTH DISPARITIES, INCLUDING HOUSING, HEALTHY FOOD OPTIONS, TRANSPORTATION AND CHILD CARE."

Schedule H, Part VI, Line 5 Promotion of community health
"Norton Children's Prevention & Wellness * Child passenger safety technicians check car and booster seats and also provide car and booster seats at free checkup clinics statewide. In 2021 731 virtual and in-person car seat checks were completed. Additionally, 50 new child passenger safety technicians were certified on how to properly install car seats. * More than 6,300 second graders across Kentucky learned about bicycle safety through the Norton Children's Hospital Bike Safety Rodeo in 2021. Safety City also welcomed over 2,500 second-grade students to learn about bike and pedestrian safety. * In a virtual program, more than 5,200 kindergarten students participated in the 38th annual Children and Hospitals Week event. The program was held throughout the last three months of the school year, and supported by a Kohl's Cares grant. Children and Hospitals Week is designed to teach safe decisions and behaviors to help lessen the fear and anxiety children may have about coming to a hospital. * Norton Children's food pantries served over 16,000 individuals with food insecurity needs. * Norton Children's Prevention & Wellness provided 15,000 toothbrushes, toothpaste and oral hygiene information to the community. * Norton Children's Prevention & Wellness launched the ""Parenting With You"" podcast for parents to help children lead healthier lifestyles. Its 10 episodes in 2021 had more than 800 downloads. * After switching from in-person programming in March of 2020 due to the COVID-19 pandemic, Norton Children's Prevention & Wellness continued with virtual events in 2021, serving over 5,000 individuals with prevention and wellness programming. Events included cooking workshops, teen wellness workshops, child safety classes and safe grandparenting classes. * The ""Just for Kids"" Transport Team transports babies and children from across the region to Norton Children's Hospital. Transportation is provided by airplane, helicopter and specially equipped ambulances (mobile intensive care units). In 2021, 2,459 transportation trips were completed. Kentucky Poison Control Center of Norton Children's Hospital Norton Children's Hospital is home to the Kentucky Poison Control Center. In 2021, the center received more than 40,000 calls and provided continued assistance through more than 42,000 follow-up calls to concerned families in all 120 counties in Kentucky, as well as to physicians and other health care providers from every health care facility in the state. The center provided treatment consultation and education about how to correctly handle exposures to poisons. In addition, the center distributed more than 10,000 prevention education resources to physicians' offices, health departments and schools, and almost 1,000 packets of materials to individuals who called the poison hotline at (800) 222-1222, which is available 24 hours a day, 7 days a week. The staff of the poison control center also answer the Kentucky HIV and Kentucky Opioid Assistance and Resource hotlines, and managed the state's COVID-19 hotline during 2020 and 2021. Norton Neuroscience Institute Founded in 2009, Norton Neuroscience Institute is continuing its quest to be the regional and national leader in treatment, research and academic training for adult and pediatric neuroscience disciplines. Norton Neuroscience Institute ensures patients will be treated for neurological disorders without having to leave the region for care. Subspecialty neurosurgeons, neurologists and other neurology-related specialists have joined the growing institute. These physicians and advanced practice providers offer expertise in stroke care, epilepsy, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), brain tumors, headaches, concussions, spine care, endovascular and cerebrovascular neurosurgery, and many other neurological conditions. * Kentucky is considered to be part of the ""stroke belt,"" a region of the United States that sees a high number of incidents of stroke cases. As a result, Norton Neuroscience Institute has committed to being a leader in stroke care. Norton Brownsboro Hospital is a designated Comprehensive Stroke Center. Norton Audubon Hospital and Norton Hospital are certified Primary Stroke Centers, and Norton Women's & Children's Hospital is an Acute Stroke Ready certified center. * Neurosurgeons with Norton Neuroscience Institute were the first in Kentucky to use minimally invasive surgery techniques, including robotic surgery, laser ablation and stereoelectroencephalography (SEEG) in the treatment of brain tumors and epilepsy for children and adults. * Norton Neuroscience Institute offers treatment for all neurological disorders. Providers work together for the patient, providing multidisciplinary programs in areas of brain tumor, ALS, movement disorders, epilepsy, trigeminal neuralgia (face pain) and stroke. * In 2019, Norton Neuroscience Institute's pediatric neurosurgeons came together with the UofL School of Medicine Department of Neurology Division of Child Neurology to create Norton Children's Neuroscience Institute, affiliated with the UofL School of Medicine. While both groups having been working together for decades, the creation of the new institute allows for leading experts to work more seamlessly together to treat the full spectrum of spine and brain conditions in children. * In 2021, the Norton Neuroscience Institute Resource Center provided free opportunities for education and support to more than 8,442 total attendees. * In June 2021, a new Norton Neuroscience Institute facility opened on the Norton Brownsboro Hospital campus, providing comprehensive, multidisciplinary neuroscience services with leading-edge technologies and enhanced research and outreach efforts. Norton Neuroscience Institute - Brownsboro comprises more than 48,000 square feet and supports patients with many types of neurological conditions, including brain, spinal and nervous system tumors; stroke; epilepsy; migraine and headache; dementia; and memory disorders. It also is home to Norton Neuroscience Institute Cressman Parkinson's & Movement Disorders Center and Norton Neuroscience Institute Cressman Neurological Rehabilitation. Norton Prevention & Wellness * Norton Prevention & Wellness played a key role in supporting the community throughout the COVID-19 pandemic. In 2021, this department conducted and supported COVID-19 vaccinations at fixed locations, as well as through mobile vaccine clinics at multiple sites, including places of worship, businesses and schools, providing over 12,000 first, second and third doses of vaccine to members of the community. * In 2021, Norton Prevention & Wellness staff provided preventive screenings aboard the Norton Prevention & Wellness Mobile Prevention Center in collaboration with various community partners. Over 1,400 women received mammograms and/or wellness exams, including cervical cancer screenings, aboard the mobile unit. Of those, approximately 11% had not been screened in the past five years and 12% had never had a mammogram. Of the 164 Mobile Prevention Center events, over half took place in underserved communities and over 60% of patients came from medically underserved areas. * Education on cardiovascular health, effects of smoking, prostate health, breast health and women's health, colon health and more was provided to almost 1,200 community members at various events, such as health fairs and presentations. If eligible and interested, participants were offered referrals for a colonoscopy or given an at-home testing kit that they could mail to the lab and later receive their results. Colonoscopy referrals were made for 65 people and 39 people received at-home testing kits. To help eliminate barriers to care, Norton Prevention & Wellness implemented a dedicated phone number, (502) 446-WELL, that links eligible patients to colonoscopy scheduling or requesting in-home tests. * In collaboration with many community partners, staff provided over 900 health screenings (blood pressure, body mass index, glucose and cholesterol levels) for almost 350 participants in multiple locations throughout Jefferson County and surrounding counties, including in Southern Indiana. Unfortunately, due to COVID-19, health events were significantly reduced. Each participant received education on healthy lifestyle choices, such as diet and exercise. Group education on various health and wellness topics was provided throughout the year. * Norton Prevention & Wellness conducted 15 American Lung Association Freedom From Smoking classes in 2021, with over 242 people attending. One-third reported they were tobacco-free. One class was taught in Spanish. * The Get Healthy Walking Club has over 6,000 members. 2021 brought over 1,000 new members to the free club aimed at improving overall health. Get Healthy Walking Club members have free access to walk at the Louisville Zoo each day from March through October, 8 to 9:30 a.m."

Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care
"Norton Hospitals, Inc. has a policy where we discount charges for all self-pay patients with no insurance coverage regardless of income qualifications. Because of this policy, we responded ""No"" to line 3b in that we do not utilize federal poverty guidelines for providing discounted care."

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
Norton Healthcare, Inc.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
The costing methodology used to calculate the community benefit expenses was to calculate the cost by hospital location (five separate locations under one Medicare provider number). The cost was determined based on a specific location cost to charge ratio. The cost used in the calculator was reduced by provider taxes, Graduate Medical Education expenses, and other costs. The adjusted cost to charge ratio was then multiplied times the gross charges for qualified financial assistance charges, Medicaid, and the state Disproportionate Program (other means tested government program) to obtain the specific community benefit expense.

Schedule H, Part VI, Line 5 Promotion of community health
Community education and workforce development As one of Kentucky's largest health care systems, Norton Healthcare has established a culture of continual, lifelong learning. Opportunities are available through our Human Resources Department's Workforce Development team and our Norton Healthcare Institute for Education & Development. Workforce Development encourages continuing education, offers programs to improve job performance and provides financial assistance for educational programs aimed toward key areas of workforce need within the organization. Norton Healthcare encourages and supports the career goals of employees and their dependents by providing financial assistance and scholarships as well as other advancement opportunities. Established in the early 2000s, Workforce Development has assisted more than 6,000 students with tuition assistance. In 2021, Workforce Development financially supported more than 750 students with over $4.5 million in educational assistance programs. * In 2021, Workforce Development provided nearly 1,400 career coaching sessions to employees and students. Each program participant worked directly with a career management coach. Coaches offer services in resume writing, career and education exploration, financial assistance opportunities and interviewing skills. * The accelerated Norton Healthcare Scholars Program, a student loan program for employees and nonemployees, provides educational funding to students interested in pursuing health care-related degrees in areas of workforce need. It is an affiliation between Norton Healthcare and over 100 colleges and universities nationally. Since 2014, this program has assisted more than 1,000 graduates continue their careers with Norton Healthcare. * In 2018, Norton Healthcare was one of the founding partners in Jefferson County Public Schools' Academies of Louisville, a strategic pipeline development program in conjunction with the local public school system. Jefferson County Public Schools created an academy model in which students have the opportunity to select career-focused education and earn industry-recognized credentials while in high school. Norton Healthcare transformed its summer program and previous high school scholarship offerings into a comprehensive internship program for students on the health care academy track. The program targets high school seniors in health care academy pathways via career exploration in identified health care areas. Beginning in junior year, health care academy students explore career pathways in one of four key areas: patient care, medical office, allied health and pharmacy technician. Each phase offers a rigorous curriculum, training in business acumen and professional development, and hands-on learning opportunities in the students' chosen career fields. The goal is to transition graduating students into staff positions with our organization after completion of the program. Tuition assistance is offered for these new employees to continue their academic and career pursuits while working at Norton Healthcare in the field of their choice. * In 2019, Norton Healthcare announced a strategic partnership program with UPS and its Metropolitan College program. Norton Healthcare-UPS Health Care Career Tracks provides a two-plus-two method, splitting a four-year bachelor's degree into two parts. Typically, the first two years are spent working with UPS in a general or preclinical designation, and then the student begins their clinical program in the last two years. This transition allows students to explore employment with Norton Healthcare as well as become a Norton Healthcare Scholar. This program helps to support career readiness in a health care-related field. The combined tuition assistance offers students a debt-free way to get a college education while working with two of the leading companies in the region. * The Student Nurse Apprenticeship Program (SNAP) is a 12- to 18-month apprenticeship through Norton Healthcare Center for Nursing Practice in which nursing students work and engage in hands-on learning with an experienced mentor while becoming integrated with Norton Healthcare. * In 2019, Norton Healthcare launched new apprenticeship programs. The Surgical Technologist Apprenticeship Program and the Respiratory Therapy Apprenticeship Program allow students to work and learn with tuition assistance as they grow their careers with Norton Healthcare. Development of the Medical Assistant Training Program launched in 2020 with a goal of offering internal training programs to produce quality, prepared medical assistants to introduce into the Norton Healthcare workforce. Several apprenticeship cohorts run throughout each year. Norton Healthcare Institute for Education & Development provides learning opportunities to enhance the professional, educational and personal development of all employees. It consists of seven centers: the Center for Academic Affairs, Center for Allied Health, Center for Continuing Medical, Nursing & Provider Education, Center for eLearning & Clinical Documentation Support, Center for Nursing Practice, Center for Professional Growth, and Center for System Nursing & Ancillary Education. The Center for Professional Growth provides learning and growth opportunities that meet the needs of Norton Healthcare employees. Three types of leadership development courses are offered to address the needs of new, aspiring and current leaders: * N the Know: This is our new leader orientation program. Newly hired and promoted leaders are automatically enrolled. The program has four required courses and six elective courses. * Learning the Norton Way: This six-week program is focused on preparing employees for leadership. Leadership approval is required for all employees who wish to attend. * Leading the Norton Way: This program is for current Norton Healthcare leaders. It is a six-week program focused on best practices for effective leadership. * Additional leadership development is provided through quarterly Norton Healthcare leadership conferences. * Staff development programs include general enrichment courses and personal and professional development opportunities that honor Norton Healthcare's commitment to lifelong learning. A variety of online and instructor-led courses focus on learning topics such as communication, diversity, interpersonal relationship-building, accountability and proficiency in Microsoft Office tools. * Norton Healthcare uses a comprehensive learning management system to provide a variety of online programs that enable staff in any specialty as well as other employees to expand their knowledge and skills. These programs were designed to meet the needs of Norton Healthcare, as well as our community, and to ensure the highest quality of patient care. Norton Faith & Health Ministries Norton Faith & Health Ministries partners with faith communities to weave together health and wellness promotion with the intentional care of the spirit. The department provides mentoring, educational resources and networking opportunities to assist health ministry coordinators and faith community nurses in ministering to their members. In 2021, the department engaged in 62 events with faith partners, including: * Facilitating administering more than 6,000 COVID-19 vaccines at faith community site-based clinics. * Sponsoring health ministry networking programs on COVID-19 updates, legal documents for seniors and self-care practices for professional caregivers. * Partnering with a network of nearly 200 faith communities to supply speakers on whole-person health and wellness, and provide health educational tools, health screenings and one-on-one health ministry mentoring. The department continued to serve as a trusted communication source for timely health and wellness information through a monthly email to a network of health ministry coordinators, a bimonthly e-newsletter to 1,400 subscribers and three issues of the Health Ministries Connection newsletter distributed to faith communities, Norton Healthcare employees and more.

Schedule H, Part VI, Line 5 Promotion of community health
Pastoral Care Department The Pastoral Care Department of Norton Healthcare continued in 2021 to follow through with what they learned during the first year of the pandemic - to bring care, comfort and compassion to weary staff, patients and families 24 hours a day, 7 days a week, every day throughout the year, across the five system hospitals and many outpatient areas. At the start of 2021, there was great hope that the restrictions and heartache from the COVID-19 pandemic would soon be gone, but the year turned out different than expected. Continuing with what was done in 2020, supporting staff remained a high priority for the chaplains. Leadership consistently called on chaplains to be a resource for employees experiencing many stresses throughout the year, and referrals to them were regularly highlighted in communications from leadership describing resources for staff support. While the vaccine was a great sign of hope, the polarization that came with it created uncomfortable situations. Patients continued to be very sick and die unvaccinated. Many departments struggled with staffing shortages. Employees were tired and often burned out. Chaplains responded with relational initiatives, virtual classes on resilience, and even a formal research study on moral distress in the intensive care unit. Chaplains provided care in more than 33,000 documented patient encounters, plus many thousands of family member encounters as well. Some of the many reasons chaplains become involved in the care of patients and families included: * Grief support and facilitation of decision-making at more than 2,000 deaths * Family support for pediatric trauma patients * Conversations about end of-life decisions and goals of care * Education about and enacting advance directives * Offering religious rituals and literature * Discussing ethical dilemmas * Providing comfort and conversation with patients who were lonely, afraid, conflicted, struggling or celebrating good news Chaplains care for people, regardless of their religious or spiritual backgrounds and beliefs, to help them use and strengthen their spiritual, emotional and relational resources to better cope and to thrive. Through formal and informal staff support efforts, teaching, committee involvement, ethics consultations and many other ways, chaplains are fully integrated into the life of the Norton Healthcare system. Norton Heart & Vascular Institute Norton Heart & Vascular Institute is Louisville's leading cardiovascular disease prevention and treatment program. Each year, it provides diagnostic, medical, interventional and surgical care for thousands of patients from Kentucky and Southern Indiana. Norton Heart & Vascular Institute specialists treat patients at Norton Healthcare's four adult-service hospitals and more than 28 outpatient clinics, diagnostic centers and specialty locations throughout Greater Louisville. * Kentucky has one of the highest occurrences of heart disease in the country. As a result, Norton Heart & Vascular Institute has committed to being a leader in acute chest pain care. All four of Norton Healthcare's adult-service hospitals in Louisville are recognized by the American College of Cardiology as Acute Chest Pain Centers. Optimal care for heart attack patients takes coordination at the hospital, emergency medical services and system levels. In 2021, all three Norton Healthcare adult STEMI receiving hospitals received the American Heart Association's Mission: Lifeline Gold Plus STEMI/Chest Pain Receiving Center designation, recognizing excellence in providing the highest level of care for heart attacks. * Many people in our region have more than one chronic health condition, and/or advancing heart disease, which is leading to increased occurrences of heart failure. The Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program provides comprehensive care to manage heart failure, and in some cases, help patients recover from heart failure. In 2020, the program expanded its advanced treatment offerings as Norton Audubon Hospital received ventricular assist device (VAD) accreditation from DNV Healthcare and the U.S. Centers for Medicare & Medicaid Services. This advanced level of care, partnered with navigation, patient education and support of those with heart failure, is key to impacting heart failure care in Kentucky. * Norton Healthcare achieved systemwide noninvasive cardiology accreditation from the Intersocietal Accreditation Commission in 2020. Departments that perform noninvasive cardiology procedures are many times the first touchpoint for Norton Healthcare patients for heart and vascular care. This recognition signifies the highest level of diagnostic capabilities at all Norton Healthcare locations through the use of noninvasive echocardiography, noninvasive vascular ultrasound, nuclear cardiology and positron emission tomography (PET) cardiology. In 2021, Norton Heart & Vascular Institute remains the only health system in Louisville that offers fractional flow reserve derived from computed tomography (FFRCT). * Cardiovascular disease is impacting our community across a wide variety of ages and demographics. In 2021, the Norton Heart & Vascular Institute Young Adult Cardiology Clinic was established to treat patients under age 35 with no prior cardiac care conditions who have been seen for chest pain in the emergency department or a primary care office. Norton Orthopedic Institute Norton Orthopedic Institute provides advanced orthopedic care for all bones and joints, and for people of all ages. Norton Orthopedic Institute is made up of board-certified physicians - many of whom are fellowship trained - who work together with therapists, physical rehabilitation specialists, primary care physicians, neurologists, certified athletic trainers and other care providers to offer a full range of multidisciplinary orthopedic services. These specialists practice a team approach in the diagnosis, treatment and rehabilitation of bone and joint conditions and injuries. Norton Orthopedic Institute's hip and knee replacement program has been certified as an Orthopaedic Center of Excellence by DNV Healthcare, as meeting guidelines of the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons. With locations throughout Greater Louisville, including Southern Indiana, Norton Orthopedic Institute offers several specialty centers focused on providing expertise in general orthopedics, joint replacement, injuries, trauma, pediatrics, oncology, spinal conditions and sports health. Norton Women's Care * Norton Women's Care, with childbirth services at Norton Hospital and Norton Women's & Children's Hospital, was recognized as High Performing in Adult Maternity Care (Uncomplicated Pregnancy) by U.S. News & World Report. This was U.S. News & World Report's first time publishing a list of Best Hospitals for Maternity Care. * In 2021, Norton Women's Care birthing facilities at Norton Hospital and Norton Women's & Children's Hospital provided care and medical services for 8,300 deliveries. * Norton Hospital and Norton Women's & Children's Hospital offered free childbirth education classes, hosting a total of 436 in 2021.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
In accordance with accounting guidance, bad debt is not presented as an expense, but is included as a reduction in net patient service revenue.

Schedule H, Part VI, Line 5 Promotion of Community Health
Norton Healthcare Research Office Norton Healthcare guides one of the largest portfolios of clinical research of any community health care system in the United States. At any point in time, more than 750 clinical studies are active or pending at Norton Healthcare. These studies engage more than 400 Norton Healthcare staff and significantly impact our patients and their families. * Areas of clinical research focus include pediatrics, oncology, cardiology, orthopedics and spine, infectious diseases, neurology, neurosurgery, maternal-fetal medicine and pulmonology. * Norton Healthcare invests significantly in clinical research to benefit our community and patients, and to support clinical science by participating in the development of new clinical interventions (drugs, devices, procedures) that will become generalized and shared with a wide number of patient populations and medical professionals. These new, innovative treatments expand the medical community's knowledge and potentially improve the quality of medical care now and in the future. * In 2021, Norton Healthcare continued to respond to the COVID-19 pandemic by opening and guiding more than 20 COVID-19 treatment studies. As a clinical study site, Norton Healthcare enrolled the first patient in the world for three of those clinical trials. * Norton Healthcare guided a phase 3 study of the one-dose Johnson & Johnson COVID-19 vaccine that gained FDA emergency use authorization early in 2021. Norton Healthcare, in partnership with UK HealthCare and Baptist Health Lexington, gained visibility as the largest enrolling site in the world for this important study. In addition, in June 2021, Norton Children's Research Institute, affiliated with the UofL School of Medicine, announced it would participate in a phase 2/3 clinical trial of the Pfizer COVID-19 investigational vaccine for healthy children ages 6 months to 11 years. It was one of 100 participating sites around the world and the only site in Louisville offering the trial. The study evaluated safety, tolerability and immune response in this age group.

Schedule H, Part II Community Building Activities
NORTON HOSPITALS, INC. (NHI) SUPPORTED OVER 300 COMMUNITY ORGANIZATIONS WITH LEADERSHIP SUPPORT WHICH INCLUDED OVER 209,000 HOURS AND OVER $1.1 MILLION IN SALARIES. NHI REPRESENTATIVES SERVED ON A VARIETY OF NONPROFITS AND GOVERNMENT AGENCIES THAT HELPED IMPROVE ACCESS TO HEALTH SERVICES, ENHANCED THE HEALTH OF THE COMMUNITY, ADVANCED MEDICAL AND HEALTH CARE KNOWLEDGE, AND RELIEVED OR REDUCED THE BURDEN OF GOVERNMENT OR COMMUNITY EFFORT. NHI'S PURPOSE IS TO PROVIDE QUALITY HEALTH CARE TO ALL THOSE WE SERVE, IN A MANNER THAT RESPONDS TO THE NEEDS OF OUR COMMUNITIES AND HONORS OUR FAITH HERITAGE. OUR COMMUNITY BENEFIT INITIATIVE ALIGNS WITH OUR MISSION TO PROMOTE THE HEALTH OF THE COMMUNITY THROUGH SERVICE ON LOCAL BOARDS, ADVISORY COUNCILS AND VOLUNTEERING. NHI EMPLOYEES REPRESENT NHI ON MANY COMMUNITY BOARD POSITIONS THAT HELP TO ENHANCE THE COMMUNITY INCLUDING THE AMERICAN RED CROSS, GREATER LOUISVILLE INC. BOARD, KENTUCKY NURSES ASSOCIATION, HABITAT FOR HUMANITY, METRO UNITED WAY, THE AMERICAN HEART ASSOCIATION, THE RONALD MCDONALD HOUSE, AND MANY MORE. NHI HAS A RICH CULTURAL HISTORY OF PROVIDING COMMUNITY SUPPORT AND NHI EMPLOYEES ARE PASSIONATE ABOUT SERVING OTHERS AND PROMOTING THE HEALTH OF OUR COMMUNITY.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
The method used to determine the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under our financial assistance policy is based on our outside vendor's experience with qualifying accounts as financial assistance. Medassist Firstsource, our outside vendor, screens all self-pay accounts and based on an initial screening, will classify the account as probable financial assistance. If the accounts appear to meet Norton Hospitals, Inc.'s (NHI) financial assistance program guidelines, these accounts are then required to submit the necessary documentation to ultimately be classified as a financial assistance account. Based on all accounts that are classified as probable financial assistance by Medassist Firstsource and their experience with getting accounts qualified as financial assistance, it is estimated that 55% of those accounts classified as probable financial assistance and which do not submit the required documentation would qualify as a NHI financial assistance account. The estimated cost of accounts that are estimated to qualify for our financial assistance programs is calculated based on gross charges for accounts for the year that are probable but do not submit the necessary documentation multiplied times our cost to charge ratio times the 55% estimated conversion factor.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
"In accordance with accounting guidance, bad debt is no longer an expense, but is included as a reduction in net patient service revenue. The following paragraph per the audited financial statements (page 19, first paragraph) discusses the handling of patient deductible and coinsurance not paid by patients; ""Generally, patients who are covered by third-party payors are responsible for patient responsibility balances, including deductibles and coinsurance, which vary in amount. The Corporation estimates the transaction price for patients with deductibles and coinsurance based on historical experience and current market conditions. The initial estimate of the transaction price is determined by reducing the standard charge by any explicit price concessions, discounts, and /or implicit price concessions. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to net patient service revenue in the period of change. Adjustments arising from a change in the transaction price were not significant in 2021 and 2020."""

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
The costing methodology used to determine the Medicare allowable cost was based on the Medicare principles used in completing the Medicare cost report. All cost reported came from the Medicare cost report. Norton Hospitals, Inc. (NHI) accepts all Medicare patients with the knowledge that there may be shortfalls and operates to promote the Health of the community. NHI believes that any Medicare shortfall should be treated as a Community Benefit because Medicare does not typically fully compensate NHI for the cost of providing hospital care to Medicare beneficiaries.

Schedule H, Part V, Section B, Line 16a FAP website
A - Norton Hospital: Line 16a URL: WWW.NORTONHEALTHCARE.COM/FAP;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - Norton Hospital: Line 16b URL: WWW.NORTONHEALTHCARE.COM/FAP;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - Norton Hospital: Line 16c URL: WWW.NORTONHEALTHCARE.COM/FAP;

Schedule H, Part VI, Line 6 Affiliated health care system
Norton Healthcare, Inc. (the controlling company) and its affiliates, including Norton Hospitals, Inc., Norton Properties, Inc., Community Medical Associates, Inc., The Children's Hospital Foundation, Inc., Norton Healthcare Foundation, Inc., and Norton Enterprises, Inc. operate in the Louisville, Kentucky metropolitan area and the operations of the affiliated healthcare system include 1,907 licensed beds, over 300 physician practice locations, and 17 Norton Immediate Care Center locations, and other ancillary health care services.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
After the patient's initial screening for financial assistance, if it is believed that the patient qualifies for financial assistance; Norton Hospitals Inc. will not start collection efforts pending the patient submitting the necessary information to document meeting the financial assistance qualifications. If the patient submits the necessary documentation within a reasonable time period, then there will not be any collection efforts made to collect any amount from the patient. The patient will receive a statement/bill reflecting the amount due through the financial assistance application process pending the patient's financial assistance application, but there will be no collection efforts. Only after an attempt is made to contact the patient to obtain the necessary documentation for completing the financial assistance application and the patient not responding will collection efforts begin. There is ongoing effort throughout the collection process to screen for Medicaid eligibility, Disproportionate Share Hospital, and the need for providing financial assistance applications to patients. When a patient is approved for financial assistance, their account balance is written off.

Schedule H, Part VI, Line 2 Needs assessment
NEEDS ASSESSMENT NORTON HOSPITALS, INC (NHI) REGULARLY AND CONSISTENTLY EVALUATES WORKFORCE AND COMMUNITY HEALTH CARE NEEDS THROUGH PARTNERSHIPS WITH LOCAL HEALTH DEPARTMENTS, EMERGENCY MEDICAL SERVICES, LOCAL AND STATE UNIVERSITIES, AND KENTUCKIANA WORKS, THE WORKFORCE INVESTMENT BOARD FOR THE SEVEN COUNTY REGION SURROUNDING LOUISVILLE. PARTNERSHIPS WITH THESE ORGANIZATIONS, ALONG WITH NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS SUCH AS THE AMERICAN CANCER SOCIETY, AMERICAN HEART ASSOCIATION AND OTHERS, ALSO PROVIDE NHI IMPORTANT STATISTICS AND DATA TO USE IN EVALUATING COMMUNITY ACCESS TO HEALTH CARE SERVICES AND HEALTH CARE DISPARITIES. ADDITIONALLY, NHI ACCESSES DATA FROM ORGANIZATIONS SUCH AS THE CENTER FOR DISEASE CONTROL AND THE UNITED STATES CENSUS BUREAU TO ASSESS AREAS OF GREATEST ANTICIPATED POPULATION GROWTH AND LOW-INCOME AREAS, BOTH OF WHICH MAY BE IN GREATEST NEED FOR PREVENTION EDUCATION, FREE SCREENINGS AND ACCESS TO HEALTH CARE. NORTON HEALTHCARE, INC. (NHC), THE PARENT COMPANY of NHI, CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR ALL FIVE HOSPITALS. THE CHNA DEFINED THE PATIENT SERVICE AREA BY PATIENT ORIGIN FOR INPATIENT STAYS, DEMOGRAPHIC, SOCIOECONOMIC, POPULATION, AND OTHER HEALTH RELATED INDICATORS UTILIZED TO PROVIDE INFORMATION ON THE HEALTH STATUS OF THE COMMUNITY. COMMUNITY INPUT WAS PROVIDED THROUGH PROVIDER AND COMMUNITY INTERVIEWS, TARGETED FOCUS GROUPS AND A COMMUNITY HEALTH SURVEY IN PARTNERSHIP WITH THE LOUSIVILLE METRO DEPARTMENT OF PUBLIC HEALTH AND WELLNESS. HEALTH NEEDS WERE PRIORITIZED AND ADDRESSED BASED ON HEALTH STATUS FINDINGS AND THE COMMUNITY INPUT. THE CHNA IS A COMPONENT OF THE ORGANIZATIONS STRATEGIC PLANNING PROCESS AS RESOURCES ARE NECESSARY TO IMPLEMENT STRATEGIES OUTLINED FOR PRIORITIES IDENTIFIED. THE NHC BOARD OF TRUSTEES AS WELL AS THE LEADERSHIP OF NHC AND HOSPITAL CHIEF ADMINSTRATIVE OFFICERS HAVE APPROVED THE ASSESSMENT AND IMPLEMENTATION PLAN.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
"Signage is posted in all Norton Healthcare, Inc. (NHC) hospital facilities, including the admission area and emergency room, providing information on the ability to apply for financial assistance and to seek help in paying your bill. The signage is translated in five languages and all languages are contained on the same poster. The languages are: English, Spanish, Vietnamese, Croatian, and Arabic. At the time of registration, the Patient Access/Registration department discusses with the patient the financial assistance/charity options, guidelines, and provides assistance as needed in filling out a financial assistance application and answering questions. The patient may also be referred to the NHC eligibility vendor for assistance at no cost to the patient/guarantor. Additional questions from the patient/guarantor can be facilitated through the NHC Single Billing Office (SBO) area, Customer Service, and NHC vendors. NHC has created a number of different options for the patient/guarantor to supply the information/application for financial assistance to NHC. Those various methods of delivery include: in person, by mail, by fax, on-line application submission via the website, and by specific email address. These various options are publicized and made known to the patient. In 2021 statements mailed to the guarantors by Norton Hospitals, Inc. (NHI) contained information to start the financial assistance application process. NHI employs an outside eligibility vendor, Medassist Firstsource. All self-pay accounts for the facilities are placed for eligibility screening with Medassist Firstsource. They screen for NHC financial assistance, Medicaid, Medicaid Managed Care organizations, presumptive eligibility, and Disproportionate Share Hospital/Kentucky Children's Health Insurance Program (DSH/KCHIP). In addition, they may provide education and referral assistance to the appropriate county/state departments for food stamps, rent assistance, heating assistance, etc. The process of completing the application is often performed by Medassist Firstsource. They protect filing deadlines by submitting the appropriate forms to the state/county. They follow up to secure proof of income documents for Norton financial assistance and follow up with a state caseworker as needed. Medassist Firstsource also makes outside field calls or home visits to the patients to secure the needed information for eligibility assistance if the patient is homebound. Additionally, Medassist Firstsource may provide assistance with patient transportation needs so that the patient can make their scheduled appointments with their caseworker. All of the services provided by Medassist Firstsource eligibility are at no cost to the patient. Cost to the hospitals for these eligibility and enrollment services was in excess of $6,900,000 in 2021. NHI has a staff of over 11 full-time employees including a supervisor that are dedicated to performing the following functions: processing, reviewing, and approving the hundreds of financial assistance applications received each week. Additionally, some of those employees make out-bound calls to solicit financial assistance information needed to process the patient's application. Financial assistance for Norton financial assistance is not limited to the self-pay population. Even patients with insurance coverage are encouraged to apply for assistance so their deductible, co-payments, and co-insurance amounts are covered under the various assistance programs. Financial counselors/social workers at the facilities are educated and trained to assist with counseling patients to determine and explain our financial assistance programs. They continue to receive on-going education throughout the entire year regarding eligibility changes and additions for Norton financial assistance, DSH/KCHIP, Medicaid, Medicaid Managed Care organization, presumptive eligibility, etc. As the foundation office receives inquiries directed to their offices, they refer these individuals to Patient Financial Services (PFS) to screen for possible Norton financial assistance or The Norton Children's Hospital Foundation, Inc. (NCHF) funding. If a child's account does not qualify for Norton Financial Assistance, that account is referred to management of PFS for consideration for special funding through NCHF as well as other programs. The charity application was provided on the back of the SBO statement. NHI ensures that all patients were made aware of financial assistance regardless of where the patient's account may have been in the collection cycle. Even if the patient/guarantor had not previously availed themselves of the opportunity to apply for financial assistance and decided they will now cooperate, then allowed the patient/guarantor to apply and approved if they met the qualifications. Financial assistance notifications and applications were made available to the patient/guarantor via telephone, face to face meetings, website, mail, electronically, etc. Primary collection agencies chosen by NHI include with their initial placement letter an insert of a copy of a financial assistance application for the guarantor to complete. Calls resulting from notification correspondence sent by the collection agencies may be routed to Spanish-speaking Customer Service representatives or patient/guarantors may also request an interpreter service to assist in facilitating information regarding financial assistance. NHI has translated the full financial assistance policy, financial assistance applications, and the plain language summary into five languages: English, Spanish, Vietnamese, Croatian, and Arabic. NHI's Customer Service department routinely instructs and screens patients in the protocol regarding financial assistance through the Norton financial assistance program. Since 2007, NHI has offered at the time of final billing all true hospital self-pay patients a significant discount off of the total charges that were reflected on their monthly statements and the amount due. Contracted collection agencies are required to solicit financial assistance applications when the patient/guarantor indicates ""cannot pay"". The statement provided by NHI in 2021 included the link to the NHC website to allow the patient/guarantor to learn more about financial assistance. The statement contained the financial assistance application on the back of the statement so the guarantor could apply using the actual NHI statement and could then mail, fax, bring the application directly to the facilities, or email the form to PFS. The statement included a phone number to call to learn more about the application process and discuss financial assistance options."

Schedule H, Part VI, Line 4 Community information
PRIMARY SERVICE AREA NORTON HOSPITALS INC.'S (NHI) PRIMARY SERVICE AREA POPULATION IS OVER 1.5 MILLION AND EXPECTED TO INCREASE 3% BETWEEN 2022 AND 2027. IN 2016, THE PRIMARY SERVICE AREA INCREASED FROM A 7 COUNTY AREA TO AN AREA INCLUSIVE OF 16 COUNTIES, 5 OF WHICH ARE LOCATED ALONG THE OHIO RIVER BORDER IN KENTUCKY, 4 BORDER THE RIVER IN INDIANA, AND INCLUDES 5 ADDITIONAL KENTUCKY COUNTIES AND 2 ADDITIONAL INDIANA COUNTIES THAT DO NOT BORDER THE OHIO RIVER. 94% OF NHI'S PATIENTS ARE DERIVED FROM THIS SERVICE AREA. APPROXIMATELY 30% OF THE POPULATION IS OVER 55 YEARS OLD; COMPARED TO 30% IN THE USA. THIS PORTION OF THE POPULATION TENDS TO USE ADDITIONAL HEALTHCARE SERVICES. THE PEDIATRIC POPULATION IN 2022 WAS ESTIMATED AT 340,858 AND IS EXPECTED TO INCREASE TO 342,717 WITHIN 5 YEARS AND REPRESENTS 22% OF THE POPULATION. THE NUMBER OF HOUSEHOLDS IN THE PRIMARY SERVICE AREA WAS ESTIMATED AT 618,461 IN 2022 AND IS EXPECTED TO INCREASE 2.8% BY 2027. CURRENTLY 9% OF THE ADULT POPULATION DOES NOT HAVE A HIGH SCHOOL DEGREE AND 14.9% OF THE HOUSEHOLD INCOME IS LESS THAN $25,000 A YEAR; THE MEDIAN HOUSEHOLD INCOME IS $69,108 COMPARED TO $67,521 FOR THE UNITED STATES. NHI TREATS 43% OF THE ADULT INPATIENT CASES IN THE COMMUNITY AND ITS PAYOR MIX IS 50% MEDICARE, 27% MEDICAID/PASSPORT AND 2% SELF PAY. THE LARGEST COUNTY IN THE SERVICE AREA IS JEFFERSON COUNTY AND ITS MAY 2022 PRELIMINARY NON-SEASONALLY ADJUSTED UNEMPLOYMENT RATE WAS 4.1% COMPARED TO 3.8% FOR KENTUCKY AND 3.4% FOR THE UNITED STATES. NHI'S PRIMARY SERVICE AREA HAS ADEQUATE ACCESS TO HOSPITAL CARE, WITH OVER 3,400 INPATIENT SHORT-TERM ACUTE CARE BEDS IN JEFFERSON COUNTY ALONE, 1,716 (52%) OF WHICH ARE PART OF THE NORTON HEALTHCARE SYSTEM. REVIEW OF OCCUPANCY RATES FOR EACH HOSPITAL INDICATES THAT THE INPATIENT NEED IS CURRENTLY BEING MET. THROUGH A CERTIFICATE OF NEED (CON) PROCESS, KENTUCKY HAS A STATE HEALTH PLAN THAT REGULATES HEALTH SERVICES PROVIDED. THE CON PROCESS ESTABLISHES CRITERIA BASED ON COMMUNITY NEED IN AN ATTEMPT TO ENSURE THAT UNNECESSARY DUPLICATION OF SERVICES DOES NOT OCCUR. IN JEFFERSON COUNTY 13.7% OF THE COMMUNITY IS BELOW THE FEDERAL POVERTY GUIDELINES AS COMPARED TO 16.6% OF THE POPULATION BELOW THE FEDERAL POVERTY IN KENTUCKY. POVERTY IS A KEY DRIVER OF HEALTH STATUS AND CREATES BARRIERS TO ACCESS, INCLUDING HEALTH SERVICES, HEALTHY FOOD CHOICES AND OTHER FACTORS THAT CONTRIBUTE TO POOR HEALTH. CERTAIN SEGMENTS OF THE COMMUNITIES SERVED BY NORTON HAVE EXTREME POVERTY. THE CENTRAL AND WEST SEGMENTS OF JEFFERSON COUNTY HAVE POVERTY RATES TWICE THAT OF THE KENTUCKY AND NATIONAL RATES. FOUR AREAS WITHIN JEFFERSON COUNTY HAVE BEEN DESIGNATED AS MEDICALLY UNDERSERVED AREAS BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA). THE HRSA IS THE PRIMARY FEDERAL AGENCY FOR IMPROVING HEALTH CARE FOR PEOPLE WHO ARE ECONOMICALLY AND MEDICALLY VULNERABLE. IT WORKS WITH STATE PARTNERS TO DETERMINE AREAS WITH TOO FEW PRIMARY CARE, DENTAL AND MENTAL HEALTH PROVIDERS AND SERVICES. THERE ARE LIMITED FEDERAL RESOURCES, SO THE DESIGNATION HELPS TO PRIORITIZE AND FOCUS RESOURCES TO AREAS WITH THIS DESIGNATION. SECONDARY SERVICE AREA NHI's SECONDARY SERVICE AREA DECREASED FROM 26 COUNTIES TO 17 COUNTIES IN 2016 AS MANY COUNTIES ARE NOW INCLUDED IN THE PRIMARY SERVICE AREA. NHI's SECONDARY SERVICE AREA POPULATION WAS 434,173 IN 2022 AND IS EXPECTED TO INCREASE 4% BETWEEN 2022 AND 2027. THE SECONDARY SERVICE AREA SPREADS ACROSS 15 KENTUCKY COUNTIES AND 2 INDIANA COUNTIES. THE 55+ AGE COHORT REPRESENTS 30% OF THE SECONDARY SERVICE AREA POPULATION AND IS EQUAL TO 55+ PERCENTAGE IN THE UNITED STATES. THE PEDIATRIC POPULATION IN 2022 WAS ESTIMATED AT 98,116 AND EXPECTED TO INCREASE TO 100,809 BY 2027. ALTHOUGH THE PEDIATRIC POPULATION IS EXPECTED TO REMAIN RELATIVELY FLAT (3% GROWTH), THERE IS A NEED FOR CHILDREN TO HAVE APPROPRIATE ACCESS TO CARE IN THE RURAL AREAS OF KENTUCKY. THE NUMBER OF HOUSEHOLDS IN THE SECONDARY SERVICE AREA WAS ESTIMATED AT 172,614 IN 2022 AND IS EXPECTED TO INCREASE 3.3% BY 2027. ALMOST 45,000 ADULTS IN THIS SERVICE AREA DO NOT HAVE A HIGH SCHOOL EDUCATION AND THE AVERAGE HOUSEHOLD INCOME IS UNDER $25,000 FOR 21.5% OF THE POPULATION. THE MEDIAN HOUSEHOLD INCOME IS $51,664, 5% LESS THAN KENTUCKY AND 25% LESS THAN THE PRIMARY SERVICE AREA AVERAGE HOUSEHOLD INCOME.