Community Benefit Insight - Tax-exempt hospital

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Lake Regional Health System

Lake Regional Health System

54 Hospital Drive
Osage Beach, MO 65065

Bed count	99	Medicare provider number	260186	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 237339737

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

8.21%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 7,899,192 3.56 %
Medicaid as % of operating expenses	$ 9,785,452 4.41 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 297,243 0.13 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 6,816 0.00 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 232,076 0.10 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 23,823,805 10.73 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 4,367,618 18.33 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 112856251 including grants of $ 0) (Revenue $ 139600891)
LAKE REGIONAL HEALTH SYSTEM PROVIDES OUTPATIENT SERVICES SUCH AS DIAGNOSTIC IMAGING, LABORATORY AND PHYSICAL THERAPY SERVICES TO THE COMMUNITY AND SURROUNDING RURAL AREAS. THE HOSPITAL PROVIDED A TOTAL OF 355,210 OUTPATIENT SERVICE VISITS. THE HOSPITAL PROVIDED COVID-19 TESTING AND IP TREATMENT SERVICES DURING ITS 2022 FISCAL YEAR.

4B (Expenses $ 53568098 including grants of $ 0) (Revenue $ 62044840)
LAKE REGIONAL HEALTH SYSTEM PROVIDES INPATIENT SERVICES TO THE COMMUNITY AND SURROUNDING RURAL AREAS. THE HOSPITAL PROVIDED 20,226 INPATIENT DAYS, 2,711 SKILLED NURSING FACILITY INPATIENT DAYS AND 997 NURSERY PATIENT DAYS FOR A TOTAL OF 23,934 INPATIENT DAYS.

4C (Expenses $ 7759141 including grants of $ 0) (Revenue $ 19942984)
LAKE REGIONAL HEALTH SYSTEM'S EMERGENCY DEPARTMENT IS A LEVEL III TRAUMA CENTER (GRANTED THROUGH A SPECIAL STATE CREDENTIALING PROCESS REQUIRING EXTENSIVE EDUCATION AND SERVICE REVIEW) PROVIDING 24-HOUR EMERGENCY MEDICAL SERVICE TO A FIVE COUNTY AREA. THE UNIVERSITY OF MISSOURI STAFF FOR LIFE HELICOPTER IS BASED HERE. THE EMERGENCY DEPARTMENT PROVIDED 36,022 VISITS.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

SCHEDULE H, PART V, SECTION B, LINE 5
COMMUNITY REPRESENTATION: FROM MAY TO JULY 2021, A TOTAL OF 724 COMMUNITY SURVEYS WERE COLLECTED ONLINE AND VIA PAPER COPY. THE SURVEY WAS INTENDED TO YIELD INFORMATION ABOUT THE OVERALL HEALTH OF THE COMMUNITY. SURVEY TOPICS INCLUDE DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS, BEHAVIORAL RISK FACTORS, HEALTH CONDITIONS, RESPONSE TO COVID-19, AND ACCESS TO HEALTH CARE. NOTICE OF THE SURVEY WAS SHARED WITH THE COMMUNITY THROUGH LOCAL MEDIA AND SOCIAL MEDIA. TO REACH LOW-INCOME, MEDICALLY UNDERSERVED AND CHRONICALLY ILL POPULATIONS, A PAPER VERSION OF THE SURVEY WAS DISTRIBUTED AT SUPPORT GROUPS, COMMUNITY EVENTS, COUNTY HEALTH DEPARTMENT SITES, A FREE CLINIC SITE, A FEDERALLY-QUALIFIED HEALTH CENTER AND LAKE REGIONAL PRIMARY CARE CLINICS. THE ONLINE SURVEY WAS SHARED WITH LAKE-AREA COMMUNITY PARTNERS, INCLUDING SCHOOL DISTRICTS; POPULATION HEALTH PARTNERS, INCLUDING COUNTY HEALTH DEPARTMENTS; AND BUSINESS PARTNERS, INCLUDING CHAMBERS OF COMMERCE. LAKE REGIONAL EMPLOYEES ALSO PARTICIPATED IN THE SURVEY. ADDITIONALLY, DIRECT INTERVIEWS WITH LOCAL FIRST RESPONDERS, BUSINESS OWNERS, SCHOOL HEALTH COORDINATORS, AND OTHER HEALTH ORGANIZATION REPRESENTATIVES ALSO WERE RECORDED

SCHEDULE H, PART V, SECTION B, LINE 7A
CHNA WEBSITE: HTTPS://WWW.LAKEREGIONAL.COM/ABOUT-US/REPORTS/

SCHEDULE H, PART V, LINE 10A
IMPLEMENTATION STRATEGY WEBSITE: HTTPS://WWW.LAKEREGIONAL.COM/ABOUT-US/REPORTS/

SCHEDULE H, PART V, SECTION B, LINE 11
ADDRESSING IDENTIFIED NEEDS: LAKE AREA COMMUNITY HEALTH PARTNERS MET IN AUGUST 2021 TO REVIEW THE DATA COLLECTED FROM SECONDARY RESEARCH AND THE COMMUNITY NEEDS ASSESSMENT SURVEY. THE COMMITTEE INCLUDED LAKE REGIONAL EMPLOYEES; LOCAL HEALTH DEPARTMENT ADMINISTRATORS; AND A REPRESENTATIVE FROM A FEDERALLY-QUALIFIED HEALTH CENTER. COMMON THEMES WERE IDENTIFIED, SCORED AND WEIGHTED TO PRIORITIZE THE HEALTH NEEDS OF THE COMMUNITY. THE TOP COMMUNITY HEALTH PRIORITIES IDENTIFIED WERE: - MENTAL HEALTH - ACCESS TO HEALTH CARE - ABILITY TO PAY AND/OR LACK OF INSURANCE MENTAL HEALTH WAS CITED AS THE HIGHEST PRIORITY NEED TO BE ADDRESSED. THE AREA FACES LIMITED RESOURCES FOR TREATMENT OF MENTAL HEALTH, INCLUDING LACK OF ACCESS TO BEHAVIOR HEALTH SPECIALISTS. GOALS RELATED TO MENTAL HEALTH INCLUDED: INCREASE STAFF AND COMMUNITY KNOWLEDGE ABOUT RISK FACTORS AND WARNING SIGNS OF MENTAL ILLNESS, AS WELL AS HOW TO INTERACT WITH A PERSON IN CRISIS. OFFER MONTHLY SUPPORT GROUP MEETINGS TO ASSIST INDIVIDUALS IN ENHANCING COPING SKILLS FOLLOWING PHYSICAL, MENTAL AND/OR EMOTIONAL TRAUMA, THROUGH EDUCATION, MUTUAL SUPPORT AND INFORMATION SHARING IN A CONFIDENTIAL SETTING. CONNECT BEHAVIORAL HEALTH PATIENTS TO COUNSELING AND COMMUNITY RESOURCES. ACCESS TO HEALTH CARE WAS CITED AS ONE OF THE MOST PRESSING HEALTH CONCERNS AS IT RELATES TO LACK OF HEALTH PROVIDERS OR RECEIVING MEDICAL ATTENTION IN A TIMELY MANNER. GOALS RELATED TO ACCESS TO HEALTH CARE INCLUDED: EXPANSION IN LACLEDE COUNTY, INCLUDING BUILDING A NEW CLINIC INCLUDING SPECIALTY, REHAB, AND OTHER SERVICES. OUTREACH SERVICES IN LACLEDE COUNTY, INCLUDING CARDIAC AND ORTHOPEDIC SERVICES CURRENTLY AND PLANS TO ADD GASTROENTEROLOGY, NEPHROLOGY, AND SLEEP MEDICINE. TELEHEALTH EXPANSION AND PROMOTION AT ALL SPECIALTY AND PRIMARY CARE CLINICS. ABILITY TO PAY FOR HEALTH CARE AND LACK OF INSURANCE WAS CITED AS ANOTHER ONE OF THE MOST PRESSING HEALTH CONCERNS AND RELATES TO ECONOMIC FACTORS INCLUDING LOW-PAYING JOBS, SEASONAL EMPLOYMENT, HIGH HEALTH-CARE COSTS, LIMITED LOW-COST HOUSING AND AFFORDABILITY OF BASIC NECESSITIES. GOALS RELATED TO ABILITY TO PAY INCLUDED: EDUCATE LAKE REGIONAL STAFF AND COMMUNITIES REGARDING ASSISTANCE PROGRAMS, AS WELL AS FREE, LOW-COST, AND SLIDING SCALE CLINICS AND SERVICES. OFFERING FINANCIAL ASSISTANCE THROUGH COMMERCE BANK HEALTH SERVICES FINANCING PROGRAM. MISSOURI HEALTHNET EXPANSION AND ENROLLMENT

SCHEDULE H, PART V, SECTION B, LINE 13H
FACTORS USED IN DETERMINING BASIS FOR AMOUNTS CHARGED TO PATIENTS: FINANCIAL ASSISTANCE WILL BE CONSIDERED ON CATASTROPHICALLY NEEDY PATIENTS ON A CASE-BY-CASE BASIS. THE HOSPITAL WILL USE PRESUMPTIVE ELIGIBILITY WHEN A PATIENT IS PROVEN TO HAVE THE FOLLOWING CIRCUMSTANCES: -HOMELESS OR RECEIVING CARE FORM A HOMELESS CLINIC -PARTICIPATION IN WOMEN'S INFANTS AND CHILDREN'S PROGRAMS (WIC) -FOOD STAMP ELIGIBILITY -ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (E.G. MEDICAID SPEND-DOWN) -LOW INCOME/SUBSIDIZED HOUSING (SECTION 8) IS PROVIDED AS A VALID ADDRESS -PATIENT IS DECEASED WITH NO KNOWN ESTATE -INCARCERATED PRISONERS NOT EXPECTED TO BE RELEASED SOON -MENTALLY INCAPACITATED

SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C
URL: HTTP://LAKEREGIONAL.COM/PATIENTS/PATIENT-RESOURCES/FINANCIAL-SERVICES/ UNINSURED-PATIENTS/DEFAULT.ASPX

SCHEDULE H, PART V, SECTION B, LINE 16I
LEP TRANSLATIONS: THERE ARE NO GROUPS WITH LIMITED ENGLISH PROFICIENCY THAT RISE TO THE THRESHOLD REQUIRED UNDER IRC SECTION 501(R). HOWEVER, A SPANISH TRANSLATION IS AVAILABLE.

SCHEDULE H, PART V, SECTION B, LINE 16J
OTHER METHODS OF PUBLICIZING CHARITY CARE POLICY: ALL PATIENTS THAT ARE IN A ROOM HAVE ACCESS TO A BINDER THAT EXPLAINS THE FINANCIAL ASSISTANCE POLICY.

Supplemental Information

Schedule H (Form 990) Part VI

SCHEDULE H, PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE: THE PERCENT OF TOTAL EXPENSE ON SCHEDULE H, PART I, LINE 7, COLUMN (F), WAS CALCULATED USING TOTAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A).

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEET 1, 3, AND 6.

SCHEDULE H, PART III, SECTION A, LINE 2
BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HEALTH SYSTEMS DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HEALTH SYSTEM'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED APRIL 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.

SCHEDULE H, PART III, SECTION A, LINE 3
BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: LINE 3 WAS DETERMINED BY TAKING THE BAD DEBT EXPENSE (LINE 2) TIMES THE PERCENT OF PERSONS BELOW THE POVERTY LEVEL BASED ON US CENSUS BUREAU DATA.

SCHEDULE H, PART III, SECTION A, LINE 4
BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENTS ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.

SCHEDULE H, PART III, SECTION B, LINE 8
COMMUNITY BENEFIT: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT, AS LRHS IS CLASSIFIED AS A RURAL REFERRAL CENTER AND SOLE COMMUNITY HOSPITAL, AND ALTERNATIVELY COULD QUALIFY AS A MEDICARE-DEPENDENT HOSPITAL. THIS DEMONSTRATES THAT LRHS IS THE ONLY REASONABLE SOURCE OF HOSPITAL CARE AVAILABLE TO MEDICARE BENEFICIARIES IN OUR SERVICE AREA, AND LIKEWISE TREATS ALL BENEFICIARIES IN OUR SERVICE AREA THAT PRESENT THEMSELVES FOR CARE, DESPITE KNOWING WE WILL GENERALLY LOSE MONEY FOR CARING FOR MEDICARE PATIENTS. ADDITIONALLY, SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.

SCHEDULE H, PART VI, SECTION C, LINE 9B
COLLECTION POLICY: COLLECTION ACTIVITY WILL BE SUSPENDED DURING THE CONSIDERATION OF COMPLETED FINANCIAL ASSISTANCE APPLICATION OR AN APPLICATION FOR ANY OTHER HEALTHCARE BRACKET (I.E. MEDICARE, MEDICAID, ETC.) A NOTE WILL BE ENTERED INTO THE PATIENT'S ACCOUNT TO SUSPEND COLLECTION ACTIVITY UNTIL THE FINANCIAL ASSISTANCE PROCESS IS COMPLETE. IF THE ACCOUNT HAS BEEN PLACED WITH A COLLECTION AGENCY, THE AGENCY WILL BE NOTIFIED TO SUSPEND COLLECTION EFFORTS UNTIL A DETERMINATION IS MADE. THIS NOTIFICATION WILL BE DOCUMENTED IN THE ACCOUNT NOTES. THE PATIENT WILL BE NOTIFIED VERBALLY THAT THE COLLECTION ACTIVITY WILL BE SUSPENDED DURING CONSIDERATION. IF A FINANCIAL ASSISTANCE DETERMINATION ALLOWS FOR A PERCENT REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE, PAYMENT TERMS WILL BE ESTABLISHED ON THE BASIS OF DISPOSABLE INCOME.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT DESCRIBED IN SCHEDULE H, PART V, SECTION B, A SECONDARY DATA REPORT WAS COMPILED FROM WWW.EXPLOREMOHEALTH.ORG, WHICH SUPPLIES COUNTY HEALTH DATA WITH ZIP CODE LEVEL DATA AND ANALYSIS FROM THE WASHINGTON SCHOOL OF MEDICINE AND HOSPITAL INDUSTRY DATA INSTITUTE. THIS REPORT REFERENCES SEVERAL SOURCES INCLUDING BUT NOT LIMITED TO THE U.S. CENSUS BUREAU, MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES, AND CENTERS FOR DISEASE CONTROL AND PREVENTION. PRIMARY DATA COLLECTION INVOLVED CONDUCTING A NEEDS ASSESSMENT SURVEY.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: SIGNAGE WILL BE POSTED IN ALL PATIENT INTAKE AREAS, INCLUDING, BUT NOT LIMITED TO, THE EMERGENCY ROOM AND THEY ADMISSION/PATIENT REGISTRATION AREAS. ALL PUBLIC INFORMATION AND/OR FORMS REGARDING THE PROVISIONS OF FINANCIAL ASSISTANCE WILL USE LANGUAGES THAT ARE APPROPRIATE FOR LRHS SERVICE AREA IN ACCORDANCE WITH THE STATE'S LANGUAGE ASSISTANCE SERVICES ACT. THIS POLICY WILL BE MADE AVAILABLE IN SPANISH. THE FINANCIAL ASSISTANCE APPLICATION IS POSTED ON THE LRHS WEBSITE. LRHS HAS FINANCIAL COUNSELORS IN THE PATIENT FINANCIAL SERVICE DEPARTMENT. THESE COUNSELORS MEET WITH SELF PAY PATIENTS WHEN THEY ARE IN THE FACILITY TO DISCUSS THE POLICY, AS WELL AS EDUCATE PATIENTS ON ASSISTANCE THEY MAY BE ELIGIBLE FOR UNDER FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM: THE AFFILIATED HEALTH CARE SYSTEM OF THE ORGANIZATION INCLUDES LAKE REGIONAL MEDICAL MANAGEMENT AND LAKE REGIONAL IMAGING PARTNERS. A WHOLLY OWNED SUBSIDIARY, LAKE REGIONAL MEDICAL MANAGEMENT, INC., D/B/A LAKE REGIONAL MEDICAL GROUP (MEDICAL MANAGEMENT), OPERATES MEDICAL CLINICS AND RETAIL PHARMACIES IN CAMDEN, MILLER AND MORGAN COUNTIES. THE ORGANIZATION HAS A 51% OWNERSHIP OF LAKE REGIONAL IMAGING PARTNERS, LLC (IMAGING PARTNERS). IMAGING PARTNERS IS A LIMITED LIABILITY COMPANY THAT OPERATES AN IMAGING CENTER IN OSAGE BEACH, MISSOURI, WHICH OFFERS CLOSED HYBRID MRI SERVICES, PET AND CT SCANS, ULTRASOUND SERVICES AND RADIOGRAPHY IMAGING SERVICES. THE 49% MINORITY INTEREST IN IMAGING PARTNERS IS OWNED BY A GROUP OF LOCAL RADIOLOGIST.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: LRHS IS LOCATED IN OSAGE BEACH, MISSOURI, AND SERVES THE AREA SURROUNDING THE LAKE OF THE OZARKS, A 54,000 ACRE MAN-MADE LAKE LOCATED IN CENTRAL MISSOURI. LRHS' SERVICE AREA ENCOMPASSES A FOUR COUNTY AREA: CAMDEN, LACLEDE, MILLER, AND MORGAN COUNTIES. THE OVERALL SERVICE AREA 2019 POPULATION IS ESTIMATED AT 96,469. IN ADDITION TO THE RESIDENT POPULATION OF NEARLY 100,000, IN THE OVERALL SERVICE AREA, THE EVER-INCREASING VISITOR POPULATION IS A SIGNIFICANT FACTOR FOR THIS POPULAR TOURIST DESTINATION. THE LAKE OF THE OZARKS CONVENTION AND VISITORS BUREAU ESTIMATES THAT 5.0 MILLION VISITORS WILL TRAVEL TO THE REGION ANNUALLY. THE PROJECTED POPULATION GROWTH OF LRHS' SERVICE AREA AND ESPECIALLY THE CONTINUING MIGRATION INTO THE LAKE AREA OF RETIREES AND THE EVER-INCREASING VISITOR POPULATION, IS A SIGNIFICANT FACTOR IN THE RISING NEED FOR ACCESSIBLE AND EXPANDED MEDICAL SERVICES FOR THE LAKE AREA. THE MEDIAN HOUSEHOLD INCOME FOR EACH COUNTY IS AS FOLLOWS: CAMDEN = $53,478, LACLEDE = $47,257, MILLER = $47,171 AND MORGAN = $39,003. THE CAMDEN COUNTY 2022 ANNUAL UNEMPLOYMENT RATE AT 2.8%, BELOW THE STATE (3.4%) AND NATIONAL (3.6%) AVERAGES. CAMDEN COUNTY HAS APPROXIMATELY 14.8% OF PERSONS BELOW POVERTY LEVEL. THE IMMEDIATE 4-COUNTY AREA OF CAMDEN, LACLEDE, MILLER, AND MORGAN ESTIMATES UNINSURED INDIVIDUALS AT 34.25%. THERE ARE NO OTHER HOSPITALS WITHIN A 25-MILE RADIUS. USING HOSPITAL INDUSTRY DATA INSTITUTE DATA, THE LRHS MARKET IS PRIMARILY SHARED WITH 4 HOSPITALS IN THE AREA.

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH: LRHS SHOWS ITS SUPPORT OF THE COMMUNITY BY PROVIDING A TRIM KIDS PROGRAM. TRIM KIDS IS A 12-WEEK PLAN TO BUILD HEALTH KIDS, HEALTH FAMILIES AND HEALTH COMMUNITIES. THE TRIM KIDS PROGRAM IS A PROVEN, PRACTICAL GUIDE FOR PARENTS TO TAKE SPECIFIC SEQUENTIAL STEPS TO ENCOURAGE HEALTHY HABITS IN THEIR CHILDREN SUCH AS MAKING HEALTHY FOOD CHOICES AND ONGOING PHYSICAL ACTIVITY. THE PROGRAM IS FACILITATED BY A DIETITIAN, EXERCISE PHYSIOLOGIST, REGISTERED NURSE AND BEHAVIOR MODIFICATION PROFESSIONAL ASSOCIATED WITH LRHS. LRHS' WORKFORCE DEVELOPMENT PROGRAM INCLUDES A TWO-DAY CAREER CAMP FOR STUDENTS 10-14. THE STUDENTS LEARN ABOUT CAREERS IN NURSING, REHAB THERAPIES, LABORATORY, SURGERY AND RESPIRATORY THERAPY. CAMP INSTRUCTORS ALSO COVER TOPICS SUCH AS PATIENT CONFIDENTIALITY, INFECTION CONTROL, DISASTER MANAGEMENT, DATA MANAGEMENT, PROFESSIONAL SCHOOLS IN MISSOURI AND SCHOLARSHIP OPPORTUNITIES. ANOTHER WORKFORCE DEVELOPMENT PROGRAM AVAILABLE TO HIGH SCHOOL STUDENTS AND ADULTS INTERESTED IN PURSING NURSING CAREERS IN A FIVE-DAY NURSING CAMP. PARTICIPANTS GAIN AN UNDERSTANDING OF NURSING FUNDAMENTALS AS THEY VISIT NURSING UNITS, JOB SHADOW EXPERIENCED NURSES, LEARN ABOUT STATE-OF-THE-ART EQUIPMENT, RECEIVE CPR TRAINING, PARTICIPATE IN DISASTER MANAGEMENT TRAINING AND INTERACT WITH STAFF.

Operating expenses	$ 221,928,738
Total amount spent on community benefits as % of operating expenses	$ 18,220,779 8.21 %