4A (Expenses $ 17037765 including grants of $ 0) (Revenue $ 20287840)
FREEMAN NEOSHO OFFERS OUTPATIENT SERVICES INCLUDING EMERGENCY MEDICINE, WOMEN'S SERVICES, HEART CARE, ORTHOPAEDICS, OTOLARYNGOLOGY, A PHARMACY, OCCUPATIONAL MEDICINE, REHABILITATION THERAPIES, RADIOLOGY, LABORATORY SERVICES AND MORE. FOR THOSE REQUIRING EMERGENCY MEDICAL CARE, FREEMAN NEOSHO OFFERS AN EMERGENCY ROOM STAFFED BY EXPERIENCED PHYSICIANS 24 HOURS A DAY, 7 DAYS A WEEK. LEADING-EDGE COMPUTED TOMOGRAPHY (CT) AND MAGNETIC RESONANCE IMAGING (MRI) SERVICES ARE AVAILABLE FOR PATIENTS IN THE LARRY D. NEFF CT-MRI SUITE. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.

4B (Expenses $ 4514943 including grants of $ 0) (Revenue $ 5376200)
FREEMAN NEOSHO HOSPITAL PROVIDES INTENSIVE CARE, GENERAL CARE, AND SWING-BED INPATIENT SERVICES. FREEMAN NEOSHO INPATIENT SERVICES TOTALED 668 CASES, OF WHICH, 81, OR 12%, WERE MEDICAID CASES. ADDITIONALLY, 46 INPATIENT CASES, OR 7% OF THE TOTAL, FELL INTO THE SELF-PAY (NO INSURANCE) CATEGORY. INPATIENT - GENERAL SURGERY: FREEMAN NEOSHO CONTINUES TO PROVIDE GENERAL SURGERY SERVICES SO PATIENTS DO NOT HAVE TO TRAVEL OUT OF TOWN FOR SURGERIES-INCLUDING MINIMALLY INVASIVE SURGERIES-THAT COVER A WIDE RANGE OF CONCERNS OR PROBLEMS. SEE SCHEDULE O.

4C (Expenses $ 2958110 including grants of $ 0) (Revenue $ 6808206)
THE FREEMAN NEOSHO EMERGENCY DEPARTMENT TREATED 11,557 CASES, OF WHICH 3,790 WERE MEDICAID CASES, REPRESENTING 33% OF THE TOTAL EMERGENCY ROOM VOLUME. IN ADDITION, THE EMERGENCY ROOM TREATED 1,767 CASES, OR 15%, THAT WERE SELF-PAY (NO INSURANCE). WITH AN EMERGENCY ROOM STAFFED 24 HOURS A DAY BY EXPERIENCED EMERGENCY ROOM PHYSICIANS, FREEMAN NEOSHO EMERGENCY SERVICES PROVIDES A LIFELINE WHEN MEDICAL EMERGENCIES ARISE TO PEOPLE IN RURAL SOUTHWESTERN MISSOURI. MEDFLIGHT AMBULANCE PROVIDES EMERGENCY TRANSPORT SERVICES TO AND FROM FREEMAN NEOSHO HOSPITAL. SEE SCHEDULE O.

SCHEDULE H, PART V, SECTION B, LINE 5
"COMMUNITY INPUT: THE OZARKS HEALTH COMMISSION STEERING COMMITTEE ELECTED TO UTILIZE CONSULTATIVE SERVICES TO ACQUIRE RELIABLE AND REPRESENTATIVE INPUT FROM THE 30-COUNTY OHC REGION. TO THAT END, A CONSULTING FIRM WAS HIRED TO GATHER BOTH QUANTITATIVE AND QUALITATIVE DATA THROUGH 3 AVENUES: COMMUNITY SURVEYS, FOCUS GROUPS AND INTERVIEWS. THE COMMUNITY SURVEY, WHICH COLLECTED QUANTITATIVE DATA, SAW BROAD PARTICIPATION ACROSS ALL 7 COMMUNITIES. THE COMMUNITY FOCUS GROUPS AND INTERVIEWS WHICH COLLECTED QUALITATIVE DATA, CONSISTED OF KEY COMMUNITY STAKEHOLDERS, POLICYMAKERS AND RESIDENTS. ACROSS THE OHC REGION, SIGNIFICANT ENGAGEMENT WAS SEEN FROM HEALTH SYSTEMS, NON-PROFITS, GOVERNMENT, SCHOOLS, LIBRARIES, TRIBAL COMMUNITIES, VULNERABLE POPULATIONS AND DIVERSE COMMUNITIES, HEALTH FOCUSED ORGANIZATIONS AND FAITH-BASED ORGANIZATIONS. THE PURPOSE OF THE SURVEY WAS THE GATHER INSIGHTS FROM EACH COMMUNITY REGARDING HEALTH-RELATED NEEDS, THE IMPACT OF COVID-19 AND COMMUNICATION AND SERVICE USE ISSUES. THE SURVEY WAS DISSEMINATED BY THE OHC COMMISSIONS AND PROJECT LEADERS THROUGHOUT THE 30-COUNTY REGION. IN TOTAL, 2,638 INDIVIDUALS COMPLETED THE SURVEY. EVEN THOUGH SOME DATA LIMITATIONS OCCASIONALLY IMPACT THE CLARITY OF A SPECIFIC ""RANK ORDEROTHER RATING OF NEEDS, MOST RESEARCH (INCLUDING THE RESEARCH INCLUDED IN THIS PROJECT), CLEARLY ILLUMINATE THE SET OF CORE NEEDS. IN MORE RURAL COUNTIES (E.G., LOWER POPULATION OR REDUCED RESEARCH PARTICIPATION), DATA CHALLENGES EXIST, YET THE ROBUST RESEARCH PLAN OF THIS ASSESSMENT AND THE SURVEY SAMPLE SIZE HELPED TO ADDRESS SEVERAL DATA LIMITATIONS. THE SURVEY WAS AVAILABLE ELECTRONICALLY THROUGH AN ON-LINE PLATFORM, AS WELL AS PAPER-BASED IN BOTH ENGLISH AND SPANISH. RESULTS OF THE SURVEY WERE COMPILED AND ANALYZED BY CRESCENDO CONSULTING USING SPSS. THE COMMUNITY SURVEY SUMMARY CONTAINED WITHIN THIS REPORT INCLUDES HIGHLIGHTS AND INSIGHTS OF SURVEY RESULTS; THE FULL COMMUNITY INPUT REPORT CAN BE FOUND IN APPENDIX D. THE QUANTIFIABLE INSIGHTS GAINED FROM THE SURVEY ADDED CONTEXT TO THE DEEPER INSIGHTS COLLECTED IN THE FOCUS GROUPS. FOR THE COMMUNITY FOCUS GROUPS, THE COMMISSION HOPED TO GARNER INFORMATION ON HEALTH PRIORITIES THAT WAS MORE GROUNDED IN BOTH PERSONAL AND PROFESSIONAL EXPERIENCES. FOCUS GROUP MEMBERS WERE RECRUITED FROM THE REGIONAL COMMUNITIES THROUGH MASS AND PERSONAL EMAILS, ONE-ON-ONE CONVERSATIONS, SOCIAL MEDIA, AND THROUGH WORD OF MOUTH. FOCUS GROUPS WERE FACILITATED USING A DISCUSSION GUIDE (LOCATED IN APPENDIX D-2 OF CRESCENDO REPORT). AFTER INTRODUCTIONS, PARTICIPANTS WERE ASKED TO THINK BROADLY ABOUT THE TOPIC AREAS. DISCUSSIONS THEN NARROWED INTO WHAT THEY SAW AS THE BIGGEST CONCERNS FACING THEIR COMMUNITY AND WHAT POSSIBLE SOLUTIONS THEY ENVISIONED. THERE WERE 10 VIRTUAL FOCUS GROUP DISCUSSIONS IN MANY AREAS ACROSS THE SEVEN COMMUNITIES. THIS ALLOWED REGIONAL VOICES TO HIGHLIGHT AREAS THEY SEE AS THE BIGGEST HEALTH-RELATED NEEDS FACING THE COMMUNITY. THE FOCUS GROUPS ADDED INSIGHT AND DEPTH TO COMMUNITY NEEDS PERCEPTIONS. TO BUILD UPON THE FOCUS GROUPS AND HAVE MORE INDEPTH AND PRIVATE CONVERSATIONS ABOUT COMMUNITYWIDE STRENGTHS, BARRIERS TO GETTING CARE, IMPACTS OF THE COVID-19 PANDEMIC, AND IDEAS TO IMPROVE THEIR COMMUNITIES, THIRTY-MINUTE ONE-ON-ONE INTERVIEWS WERE CONDUCTED. CRESCENDO REPRESENTATIVES COMPLETED INTERVIEWS WITH 75 RESIDENTS FROM THE 7 COMMUNITIES."

SCHEDULE H, PART V, SECTION B, LINE 6A
CHNA CONDUCTED WITH OTHER HOSPITAL FACILITIES: IN ADDITION TO FREEMAN HEALTH SYSTEM, A RELATED ORGANIZATION, THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED ALONG WITH COXHEALTH AND MERCY HEALTH.

SCHEDULE H, PART V, SECTION B, LINE 6B
CHNA CONDUCTED WITH OTHER ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED ALONG WITH THE FOLLOWING ORGANIZATIONS: - BARRY COUNTY HEALTH DEPARTMENT - BARTON COUNTY HEALTH DEPARTMENT - BURRELL BEHAVIORAL HEALTH - CHRISTIAN COUNTY HEALTH DEPARTMENT - CITY OF JOPLIN HEALTH DEPARTMENT - DADE COUNTY HEALTH DEPARTMENT - DALLAS COUNTY HEALTH DEPARTMENT - DOUGLAS COUNTY HEALTH DEPARTMENT - HICKORY COUNTY HEALTH DEPARTMENT - HOWELL COUNTY HEALTH DEPARTMENT - JASPER COUNTY HEALTH DEPARTMENT - LAWRENCE COUNTY HEALTH DEPARTMENT - MCDONALD COUNTY HEALTH DEPARTMENT - OZARK COUNTY HEALTH DEPARTMENT - POLK COUNTY HEALTH DEPARTMENT - SHANNON COUNTY HEALTH DEPARTMENT - SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT - STONE COUNTY HEALTH DEPARTMENT - TANEY COUNTY HEALTH DEPARTMENT - TEXAS COUNTY HEALTH DEPARTMENT - VERNON COUNTY HEALTH DEPARTMENT

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

SCHEDULE H, PART V, SECTION B, LINE 10
IMPLEMENTATION STRATEGY URL: HTTPS://WWW.FREEMANHEALTH.COM/ABOUT-US

SCHEDULE H, PART V, SECTION B, LINE 11
ADDRESSING IDENTIFIED NEEDS: FREEMAN HEALTH SYSTEM HAS ADOPTED A JOINT IMPLEMENTATION STRATEGY THAT INCLUDES FREEMAN HOSPITAL WEST, FREEMAN HOSPITAL EAST, FREEMAN NEOSHO HOSPITAL, AND OZARK CENTER. AT THE ORGANIZATIONAL LEVEL, FREEMAN HEALTH SYSTEM HAS ADOPTED FIVE PRIORITIZED HEALTH NEEDS FOR ITS COMMUNITY HEALTH IMPLEMENTATION PLAN FOR THE PERIOD 1/1/2022 THROUGH 12/31/2024. ACCESS TO CARE - INCREASE ACCESS TO HEALTH SERVICES BY ENHANCING HEALTH PROFESSIONAL EDUCATION, RECRUITMENT AND RETENTION EFFORTS MENTAL HEALTH - SUPPORT COMMUNITY HEALTH INITIATIVES THAT ADDRESS MENTAL HEATLH OFFER NEW THERAPIES FOR TREATMENT-RESISTANT DEPRESSION EDUCATE AND TRAIN PSYCHIATRIC RESIDENTS DIABETES - PROVIDE EVIDENCE-BASED TREATMENT OF OBESITY FOR CHILDREN AGES 5 TO 12 BUILD PARTNERSHIPS WITH EMPLOYERS AND SCHOOLS THAT INCREASE AWARENESS, KNOWLEDGE, AND THREATMENT OF HEALTH FACTORS IMPACTING DIABETES. OFFER TRAINING TO PATIENTS WITH DIABETES ON BEST PRACTICES FOR USING DETECTION TECHNOLOGIES. HEART DISEASE - SUPPORT COMMUNITY HEALTH INITIATIVES THAT ADDRESS PREVENTION & SCREENINGS SERVE RURAL PATIENTS THROUGH FREEMAN HEART AND VASCULAR INSTITUTE OUTREACH CLINICS REDUCE RISK OF STRKE BY OFFERING INNOVATIVE IMPLANT PROCEDURES AS AN ALTERNATIVE TO BLOOD THINNER MEDICATION LUNG DISEASE - SUPPORT HEALTH INITIATIVES THAT ADDRESS LUNG DISEASE PREVENTION INVEST IN NEW TECHNOLOGIES TO PREVENT AND TREAT LUNG DISEASE MORE RAPIDLY

SCHEDULE H, PART V, SECTION B, LINE 13H
BASIS FOR CALCULATING AMOUNT CHARGED TO PATIENTS: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY ALSO USES FAMILY SIZE AND EMPLOYMENT STATUS IN THE DETERMINATION OF ELIGIBILITY FOR FREE OR DISCOUNTED CARE.

SCHEDULE H, PART V, SECTION B, LINES 16A-C
FAP, APPLICATION, AND PLS URL: HTTPS://WWW.FREEMANHEALTH.COM/BILLING-AND-INSURANCE

SCHEDULE H, PART I, LINE 3C
OTHER FACTORS IN DETERMINING ELIGIBILITY: IN ADDITION TO FPG LIMITS, THE FAP USES EMPLOYMENT STATUS, MEDICAL INDIGENCY, AND FAMILY SIZE TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE.

SCHEDULE H, PART I, LINE 7F
PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990.

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 AND 3.

SCHEDULE H, PART III, SECTION A, LINE 2
BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED MARCH 31, 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: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING INTERNAL PATIENT DEMOGRAPHICS, AS WELL AS CORE BASED STATISTICAL AREA AND POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. ACCORDING TO THE U.S. CENSUS BUREAU QUICK FACTS, THE ESTIMATED AVERAGE UNINSURED POPULATION FOR FREEMAN JOPLIN'S PRIMARY SERVICE AREA IS 13.65% AND THE AVERAGE UNINSURED POPULATION FOR FREEMAN NEOSHO'S PRIMARY SERVICE AREA IS 17.85%. FREEMAN HOSPITAL-JOPLIN IDENTIFIED 6.7% OF ITS GROSS HOSPITAL REVENUE OR BILLINGS COMING FROM UNINSURED PATIENTS. FREEMAN NEOSHO IDENTIFIED 13.7% OF ITS GROSS REVENUE COMING FROM UNINSURED PATIENTS. IT'S POSSIBLE THAT SOME PATIENTS PRESENTED OUTDATED INSURANCE COVERAGE AT TIME OF ADMISSION, OR FREEMAN ADMISSIONS MAY HAVE INCORRECTLY IDENTIFIED SOME UNINSURED PATIENTS AS INSURED OR MEDICAID ELIGIBLE DURING THE ADMITTING PROCESS. THEREFORE, FREEMAN BELIEVES THAT SOME PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WERE INCORRECTLY REPORTED AS BAD DEBT IN ITS FINANCIAL STATEMENTS.

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 PATIENT 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: 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 III, SECTION C, LINE 9B
COLLECTION POLICY: THE COLLECTION POLICY STATES THAT ANY AMOUNT NOT ADJUSTED FOR FINANCIAL ASSISTANCE DUE TO A PARTIAL 50% ADJUSTMENT OR 75% ADJUSTMENT WILL FOLLOW ITS NORMAL COLLECTION PROCESS. FREEMAN HEALTH WILL CONTINUE TO BILL THE PATIENT FOR 120 DAYS FROM FIRST STATEMENT, IF NO ARRANGEMENTS ARE MADE TO SATISFY THE REMAINING BALANCE WITH A PAYMENT IN FULL OR PAYMENT PLAN, THE ACCOUNT WILL AUTOMATICALLY ROLL TO ITS EXTERNAL AGENCY.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: FREEMAN COMMUNICATES INFORMATION ABOUT FINANCIAL ASSISTANCE, OR CHARITY CARE, OPTIONS AVAILABLE TO PATIENTS IN MANY WAYS. FREEMAN PUBLISHES COMMUNICATION PIECES ON FINANCIAL SERVICES, INCLUDING POSTERS AND FLYERS AT ADMITTING DESKS. FREEMAN ALSO INCLUDES MESSAGING ABOUT ITS FINANCIAL ASSISTANCE PROGRAM ON BILLS, STATEMENTS, AND ENVELOPES SENT TO PATIENTS' HOMES AND ON SIGNS POSTED AROUND FREEMAN PATIENT ACCOUNTS AND ADMISSIONS PUBLIC AREAS. FREEMAN HAS ALSO PLACED FINANCIAL ASSISTANCE INFORMATION, INCLUDING A FINANCIAL ASSISTANCE APPLICATION IN ENGLISH AND SPANISH, ON THE FREEMAN WEBSITE. ADDITIONALLY, FREEMAN HAS IMPLEMENTED SEVERAL EDUCATIONAL OPPORTUNITIES TO ENSURE THE COMMUNITY IS AWARE OF FREEMAN'S FINANCIAL ASSISTANCE PROGRAM. THESE INCLUDE: - FREEMAN ADMISSIONS STAFF MEMBERS PERSONALLY INTERVIEW PATIENTS, BASED ON THE SETTING OF CARE (PRIOR TO SERVICES, AT TIME OF SERVICE, AND AFTER CARE PROVIDED), TO PROVIDE EDUCATION ON AVAILABLE BENEFITS. FREEMAN HELPS UNINSURED AND UNDERINSURED PATIENTS WITH STATE AND FEDERAL ASSISTANCE RESOURCES, AS WELL AS THE FREEMAN FINANCIAL ASSISTANCE PROGRAM. - FREEMAN CONTINUALLY PROVIDES EDUCATION TO EMPLOYEES, FROM CLINICAL STAFF TO VOLUNTEERS, REGARDING ITS FINANCIAL ASSISTANCE POLICY SO THEY CAN HELP CUSTOMERS LEARN ABOUT AVAILABLE RESOURCES. - FREEMAN'S ELIGIBILITY PARTNERS PROGRAM HELPS PATIENTS EXPLORE RESOURCES FOR FINANCIAL ASSISTANCE AND AFFORDABLE MEDICAL COVERAGE. PAYING FOR MEDICAL CARE CAN BE STRESSFUL, AND FREEMAN'S TEAM OF ELIGIBILITY SPECIALISTS HELPS PATIENTS FIND AFFORDABLE COVERAGE AND FIND RELIEF FROM THE BURDEN OF NOT KNOWING WHERE TO TURN FOR HELP. ADDITIONALLY, ELIGIBILITY SPECIALISTS ADVOCATE ON BEHALF OF PATIENTS TO SEEK OUT OPPORTUNITIES FOR MEDICAL FINANCIAL COVERAGE, AND THEY SUPPORT THE COMMUNITY THROUGH EDUCATION, RESOURCES, AND ELIGIBILITY ASSISTANCE. - FREEMAN WORKS WITH MANY OF THE COMMUNITY'S EMPLOYERS, SENDING WRITTEN NOTICES TO THEIR BENEFITS DEPARTMENTS EXPLAINING THE FREEMAN FINANCIAL ASSISTANCE ELIGIBILITY PROCESS. FREEMAN ALSO MEETS WITH EMPLOYERS TO ENSURE THEIR EMPLOYEES UNDERSTAND THE AVAILABILITY OF ASSISTANCE OFFERED THROUGH FREEMAN. FREEMAN HEALTH SYSTEM STRONGLY BELIEVES THAT ITS FINANCIAL ASSISTANCE, OR CHARITY CARE, AND THE RELATED COMMUNITY BENEFIT PROVIDED BY SUCH CARE, IS UNDERSTATED ON ITS FINANCIAL STATEMENTS BECAUSE SOME PATIENTS THAT POTENTIALLY QUALIFY FOR FINANCIAL ASSISTANCE DO NOT WISH TO APPLY FOR IT. IN ADDITION, SOME PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE DO NOT RECEIVE FINANCIAL ASSISTANCE BECAUSE THEY REFUSE TO PROVIDE REQUIRED DOCUMENTATION TO PROCESS THE APPLICATION. THUS, FREEMAN'S BAD DEBT INCLUDES A PORTION THAT COULD BE CLASSIFIED AS FINANCIAL ASSISTANCE IF THE APPLICATION FOR FINANCIAL ASSISTANCE HAD BEEN PROPERLY COMPLETED BY THE PATIENT.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM: FREEMAN HEALTH SYSTEM CONSISTS OF FREEMAN HOSPITAL WEST AND FREEMAN HOSPITAL EAST IN JOPLIN, FREEMAN NEOSHO HOSPITAL, NUMEROUS CLINICS, AND OZARK CENTER, WHICH PROVIDES COMPREHENSIVE BEHAVIORAL HEALTH SERVICES. FREEMAN IS NOT AFFILIATED WITH ANOTHER HEALTHCARE SYSTEM.

SCHEDULE H, PART VI, LINE 7
STATE FILING ON COMMUNITY BENEFIT REPORT: FREEMAN HEALTH SYSTEM IS INCORPORATED IN THE STATE OF MISSOURI AND FILES A COMMUNITY BENEFIT REPORT IN MISSOURI.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT DESCRIBED IN PART V, SECTION B, FREEMAN REVIEWS STUDIES AND ASSESSMENTS FROM JOPLIN HEALTH DEPARTMENT AND OTHER LOCAL GOVERNMENTAL AGENCIES TO ASSESS COMMUNITY NEEDS, INCORPORATING THIS INFORMATION INTO THE FREEMAN STRATEGIC PLAN AND MONITORING THE EDUCATIONAL AND OUTREACH PROGRAMS PROVIDED IN THE COMMUNITY. TO OBTAIN A FRESH LOOK AT THE HEALTH NEEDS OF THE COMMUNITY, FREEMAN HEALTH SYSTEM CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS. THE SURVEY SEEKS COMMUNITY INPUT ON HEALTH NEEDS, ACCESS TO HEALTHCARE, AND WHAT PEOPLE THINK IS IMPORTANT ABOUT HEALTHCARE. THE FEEDBACK PROVIDES A BETTER UNDERSTANDING OF THE HEALTH STATUS, BEHAVIORS, AND NEEDS OF THE POPULATIONS SERVED BY FREEMAN HEALTH SYSTEM. FOR THE SURVEY, FREEMAN COLLABORATES WITH HEALTH DEPARTMENTS AND OTHER HOSPITALS IN 30 COUNTIES UNDER THE AUTHORITY OF THE OZARKS HEALTH COMMISSION. [FREEMAN HEALTH SYSTEM IS A FOUNDING STAKEHOLDER IN THE OZARKS HEALTH COMMISSION (OHC), FORMED IN 2015.] OHC PARTNERS HAVE A VISION OF USING A SYSTEMATIC, DATA-DRIVEN PROCESS TO INFORM DECISIONS AND GUIDE EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELLNESS ON A REGIONAL LEVEL. FOLLOWING THE SURVEY, FREEMAN DEVELOPS A PLAN TO ADDRESS THE NEEDS FOUND IN THE SURVEY. OCH CONDUCTED A NEW SURVEY IN 2022, AND FREEMAN RELEASED A PLAN ON MARCH 31, 2022, TO ADDRESS NEEDS FOUND IN THE SURVEY. AS A RESULT, FREEMAN HEALTH SYSTEM HAS ADOPTED A JOINT IMPLEMENTATION STRATEGY THAT INCLUDES FREEMAN HOSPITAL WEST, FREEMAN HOSPITAL EAST, FREEMAN NEOSHO HOSPITAL, AND OZARK CENTER. AT THE ORGANIZATIONAL LEVEL, FREEMAN HEALTH SYSTEM PRIORITIZED THESE HEALTH NEEDS: ACCESS TO CARE, DIABETES, MENTAL HEALTH, HEART DISEASE, AND LUNG DISEASE, WITH OBJECTIVES OF INCREASING ACCESS TO HEALTH SERVICES AND REDUCING THE LONG-TERM INCIDENCE OF THE CONDITIONS/DISEASES USING ONGOING PREVENTION, DETECTION, AND TREATMENT STRATEGIES. FOR ACCESS TO CARE, STRATEGIES ARE INCREASING ACCESS TO MEDICAL AND BEHAVIORAL HEALTHCARE FOR RURAL RESIDENTS THROUGH TELEHEALTH, LAUNCHING A NEW FAMILY MEDICINE RESIDENCY PROGRAM, AND ADDRESSING HEALTH-RELATED SOCIAL NEEDS OF PATIENTS IN COLLABORATION WITH COMMUNITY-BASED ORGANIZATIONS. FOR MENTAL HEALTH, STRATEGIES ARE SUPPORTING COMMUNITY HEALTH INITIATIVES THAT ADDRESS MENTAL HEALTH, OFFERING NEW THERAPIES FOR TREATMENT-RESISTANT DEPRESSION, AND EDUCATING AND TRAINING PSYCHIATRIC RESIDENTS. FOR DIABETES, STRATEGIES ARE PROVIDING EVIDENCE-BASED TREATMENT OF OBESITY FOR CHILDREN AGED 5-12, BUILDING PARTNERSHIPS WITH EMPLOYERS AND SCHOOLS THAT INCREASE AWARENESS, KNOWLEDGE, AND TREATMENT OF HEALTH FACTORS IMPACTING DIABETES, AND OFFERING TRAINING TO PATIENTS ON BEST PRACTICES FOR USING DIABETES-DETECTION TECHNOLOGIES. FOR HEART DISEASE, STRATEGIES ARE SUPPORTING COMMUNITY HEALTH INITIATIVES THAT ADDRESS PREVENTION AND SCREENING, SERVING RURAL PATIENTS THROUGH FREEMAN HEART & VASCULAR OUTREACH CLINICS, AND REDUCING RISK OF STROKE BY OFFERING INNOVATIVE IMPLANT PROCEDURES AS AN ALTERNATIVE TO BLOOD THINNER MEDICATION. FOR LUNG DISEASE, STRATEGIES ARE SUPPORTING COMMUNITY HEALTH INITIATIVES THAT ADDRESS LUNG DISEASE PREVENTION, AND INVESTING IN NEW TECHNOLOGIES TO PREVENT AND MORE RAPIDLY TREAT LUNG DISEASE. EACH OF THE PRIORITIZED HEALTH NEEDS REPRESENTS A COMPLEX HEALTH CONDITION THAT REQUIRES MULTI-STAKEHOLDER COLLABORATION. FREEMAN HEALTH SYSTEM IS COMMITTED TO COLLABORATING WITH STAKEHOLDERS AT THE LOCAL, REGIONAL, AND STATE LEVELS. INTENTIONAL COLLABORATION INCLUDES PARTICIPATION AND LEADERSHIP IN COALITIONS, INCLUDING JASPER-NEWTON COUNTY HEALTH COLLABORATIVE, REPRESENTING HEALTH CARE PROVIDERS AND COMMUNITY-BASED ORGANIZATIONS PROVIDING HEALTH AND SOCIAL SERVICES; MCDONALD COUNTY HEALTH COALITION, A COUNTY-WIDE COALITION OF COMMUNITY-BASED ORGANIZATIONS PROVIDING HEALTH AND SOCIAL SERVICES; ONE JOPLIN, A COALITION OF NONPROFIT AGENCIES AND BUSINESSES PROMOTING COMMUNITY HEALTH AND WELL-BEING; MISSOURI COUNCIL FOR ACTIVITY AND NUTRITION (MOCAN), A STATE-WIDE STAKEHOLDER NETWORK FOR HEALTHY EATING AND ACTIVE LIVING; UNIVERSITIES WITH NURSING, MEDICAL, AND HEALTH PROFESSIONAL PROGRAMS, INCLUDING MISSOURI SOUTHERN STATE UNIVERSITY (MO), PITTSBURG STATE UNIVERSITY (KS), NORTHEASTERN OKLAHOMA A&M COLLEGE (OK), CROWDER COLLEGE (MO), AND KANSAS CITY UNIVERSITY MEDICAL SCHOOL (MO); AND SOUTHWEST MISSOURI SCHOOL-BASED HEALTH NETWORK, A REGIONAL COALITION OF SCHOOL DISTRICTS WORKING TO IMPROVE ACCESS TO CARE AND QUALITY HEALTH OUTCOMES. TO DETERMINE WHAT PATIENTS THINK OF THE SERVICES THEY RECEIVE, FREEMAN WORKS WITH PRESS GANEY, AN INDEPENDENT COMPANY THAT SURVEYS PATIENTS AT HOME AFTER THEIR DISCHARGE FROM THE HOSPITAL AND ASKS THEM TO RATE FREEMAN IN A VARIETY OF AREAS. RESULTS FROM THESE SURVEYS ARE REFLECTED IN HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) SCORES THAT THE FEDERAL GOVERNMENT USES TO EVALUATE FREEMAN SERVICES. FREEMAN USES INFORMATION OBTAINED IN THE HCAHPS SURVEYS TO EVALUATE TRENDS IN PATIENT CARE AND ADDRESS ANY ISSUES DISCOVERED. ADDITIONALLY, FREEMAN SUBSCRIBES TO AND MANAGES A NUMBER OF DATABASE SERVICES TO ANALYZE CONSUMER USE OF FREEMAN PRODUCTS AND SERVICES AND FORMULATE PLANS TO STAY AHEAD OF PATIENT NEEDS, AND FREEMAN PARTNERS WITH THE MISSOURI HOSPITAL ASSOCIATION FOR DATA ASSESSMENT DEMOGRAPHIC INFORMATION, TREND ANALYSIS, AND EDUCATION. FREEMAN SENIOR LEADERS HAVE DEEP ROOTS IN THE COMMUNITIES THEY SERVE AND BELONG TO SERVICE ORGANIZATIONS SUCH AS ROTARY INTERNATIONAL AND KIWANIS INTERNATIONAL. THEY BELIEVE IN GIVING BACK, AND WHILE PROVIDING LEADERSHIP AND SUPPORT TO A VARIETY OF BOARDS, COUNCILS, AND COMMITTEES, FREEMAN LEADERS ROUTINELY CHECK THE PULSE OF THE COMMUNITY THROUGH THESE ASSOCIATIONS.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: FREEMAN'S PRIMARY SERVICE AREA INCLUDES TWO MISSOURI COUNTIES AND TWO KANSAS COUNTIES WITH A COMBINED POPULATION OF 240,781*. FREEMAN'S SECONDARY SERVICE AREA INCLUDES SIX ADDITIONAL, LARGELY RURAL COUNTIES IN SOUTHWEST MISSOURI, SOUTHEAST KANSAS, AND NORTHEAST OKLAHOMA, WITH A COMBINED POPULATION OF 145,888*. INCOMES AND EDUCATION LEVELS LAG BEHIND NATIONAL AVERAGES, WHILE THE PERCENTAGE OF PEOPLE LIVING IN POVERTY IS HIGHER THAN THE NATIONAL AVERAGE. FREEMAN IS THE ANCHORING INSTITUTION IN A MEDIUM-SIZED COMMUNITY THAT SERVES A WIDE-RANGING RURAL AREA IN FOUR STATES. FREEMAN'S CORPORATE OFFICE AND TWO OF ITS HOSPITALS ARE LOCATED IN JOPLIN, MISSOURI, THE LARGEST CITY IN THE AREA. WITH A POPULATION OF MORE THAN 50,000, THE NUMBER OF PEOPLE IN TOWN BALLOONS TO 270,000** AS PEOPLE VISIT TO SHOP, WORK, AND OBTAIN HEALTHCARE SERVICES ON WEEKDAYS. ACCORDING TO A JOPLIN CHAMBER OF COMMERCE ECONOMIC DEVELOPMENT REPORT, FREEMAN IS THE LARGEST EMPLOYER IN THE AREA. OTHER MAJOR EMPLOYERS INCLUDE TRUCKING COMPANIES, HEALTHCARE ORGANIZATIONS, SCHOOLS, CASINOS, MANUFACTURERS, POULTRY PROCESSING PLANTS, AND TELEMARKETING COMPANIES. MANY PEOPLE WORK IN THE RETAIL AND FOOD SERVICE INDUSTRIES. WHILE METHAMPHETAMINE ADDICTION, HOMELESSNESS, COMPULSIVE GAMBLING, AND CHILDREN LIVING IN POVERTY ARE DISPROPORTIONATELY LARGE PROBLEMS IN THE AREA, THE POPULATION IS LARGELY MIDDLE CLASS. IN ADDITION TO SERVING THE JOPLIN METROPOLITAN AREA, FREEMAN SERVES RURAL COMMUNITIES IN MISSOURI, KANSAS, AND OKLAHOMA. FREEMAN NEOSHO HOSPITAL IS A CRITICAL NEEDS FACILITY THAT SERVES SOUTHWEST MISSOURI, AND FREEMAN OPERATES PRIMARY AND SPECIALTY CLINICS IN MANY SMALLER COMMUNITIES THAT SERVE A LARGELY RURAL POPULATION. CANCER, HEART DISEASE, LUNG DISEASE, DIABETES, INFANT HEALTH PROBLEMS, SUICIDE, ALCOHOL AND SUBSTANCE ABUSE, AND STROKE AS THE MAJOR HEALTH CONCERNS FOR THE AREA, WITH OBESITY, SMOKING AND SECONDHAND SMOKE, AND CHILD ABUSE/NEGLECT AMONG THE PRIME RISK FACTORS. * U.S. CENSUS BUREAU ESTIMATES JULY 2021 **JOPLIN POLICE DEPARTMENT ESTIMATE FOR ANY GIVEN WEEKDAY

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PROMOTION OF COMMUNITY HEALTH: FREEMAN IS NOT-FOR-PROFIT, LOCALLY OWNED, AND GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS COMPOSED OF INDIVIDUALS WHO LIVE IN THE COMMUNITIES SERVED BY FREEMAN. ALL DECISIONS ABOUT WHAT HAPPENS AT FREEMAN ARE MADE LOCALLY-THIS GIVES FREEMAN THE ABILITY FOR NIMBLE RESPONSE TO THE HEALTHCARE NEEDS OF THE COMMUNITY. FREEMAN HAS AN OPEN MEDICAL STAFF AND IS ALWAYS RECRUITING PRIMARY CARE PROVIDERS AND SPECIALISTS. ANY PROFITS GENERATED BY FREEMAN HEALTH SYSTEM, GO BACK INTO THE HEALTH SYSTEM OR THEY ARE INVESTED IN IMPROVING THE HEALTH OF THE COMMUNITIES SERVED BY FREEMAN. FOR INSTANCE, FREEMAN COLLABORATES WITH VARIOUS ORGANIZATIONS TO PROVIDE HEALTHCARE FOR INDIGENT AND UNDERINSURED INDIVIDUALS THROUGHOUT THE REGION. THESE INCLUDE COMMUNITY CLINIC, ACCESS FAMILY CARE, COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS. FREEMAN STAFF MEMBERS, SUCH AS DOCTORS, RESIDENT DOCTORS, AND NURSES, LEND A HAND TO COMMUNITY CLINIC OF JOPLIN AND ACCESS FAMILY CARE, TO HELP PROVIDE FREE OR LOW-COST HEALTHCARE SERVICES TO INDIGENT PORTIONS OF THE COMMUNITY. DEPENDING ON THE SITUATION, FREEMAN STAFF MEMBERS VOLUNTEER THEIR SERVICES OR FREEMAN PAYS THEM TO WORK FOR THE COMMUNITY THROUGH THESE ORGANIZATIONS. FREEMAN ALSO SUPPORTS POST-SECONDARY SCHOOLS THAT PROVIDE HEALTH CAREERS EDUCATION. THESE INCLUDE MISSOURI SOUTHERN STATE UNIVERSITY, PITTSBURG STATE UNIVERSITY, AND CROWDER COLLEGE. THROUGH FREEMAN AUXILIARY, FREEMAN DONATES $2,000 TO SEVEN AREA NURSING SCHOOLS EACH YEAR. ADDITIONALLY, AT THE BRADLEY SCHOOLS OF NURSING AT PSU, FREEMAN FUNDED A 3D VIRTUAL DISSECTION TABLE THAT ENABLES STUDENTS TO ACCURATELY VISUALIZE HUMAN ANATOMY THROUGH A LIFE-SIZED, TOUCH-SCREEN EXPERIENCE. FREEMAN HEALTH SYSTEM WORKS TO IMPROVE THE HEALTH OF THE COMMUNITY THROUGH A VARIETY OF COMMUNITY SERVICE PROGRAMS BOTH INSIDE AND OUTSIDE THE ORGANIZATION. AS A SYSTEM, FREEMAN PARTICIPATES IN THE JOPLIN AREA CHAMBER OF COMMERCE AS A PLATINUM-LEVEL SPONSOR, WITH STAFF MEMBERS SERVING IN LEADERSHIP ROLES AND ON A VARIETY OF COMMITTEES. FREEMAN PROVIDES FINANCIAL SUPPORT FOR A MANY COMMUNITY SERVICE GROUPS, INCLUDING THE ALZHEIMER'S ASSOCIATION, AMERICAN CANCER SOCIETY, AMERICAN DIABETES ASSOCIATION, AMERICAN HEART ASSOCIATION, CHILDREN'S CENTER OF SOUTHWEST MISSOURI, COMMUNITY BLOOD CENTER OF THE OZARKS, COMMUNITY CLINIC OF JOPLIN, FREEMAN SOUTHWEST FAMILY YMCA IN NEOSHO, JOPLIN FAMILY YMCA, GEORGE A. SPIVA CENTER FOR THE ARTS, MARCH OF DIMES, NATIONAL MULTIPLE SCLEROSIS SOCIETY, RONALD MCDONALD HOUSE CHARITIES OF THE FOUR STATES, AND MANY OTHER LOCAL, REGIONAL, AND NATIONAL ORGANIZATIONS. FREEMAN SERVES MORE THAN A MILLION MEALS EACH YEAR AND RECOGNIZES THE IMPORTANCE OF PROVIDING WHOLESOME FOODS TO THE COMMUNITY. ESTABLISHING ITS COMMITMENT TO SERVING LOCAL, NUTRITIOUS, AND SUSTAINABLE FOOD, FREEMAN BECAME THE FIRST HOSPITAL IN MISSOURI TO SIGN THE HEALTHY FOOD IN HEALTHCARE PLEDGE. THE PLEDGE WAS FREEMAN'S FIRST STEP TOWARD IMPROVING COMMUNITY HEALTH THROUGH FOOD POLICY CHANGE. ADDITIONALLY, FREEMAN IS A FOUNDING MEMBER OF THE JOPLIN AREA FOOD ACTION NETWORK (JFAN) WHOSE GOAL IS TO ENSURE LOCAL RESIDENTS HAVE ACCESS TO HEALTHY, NUTRITIOUS FOOD, AN EFFORT KNOWN AS FOOD EQUITY. MEMBERS INCLUDE BUSINESSES, NONPROFIT ORGANIZATIONS, LOCAL GOVERNMENT AGENCIES, FAITH-BASED ORGANIZATIONS, AND INDIVIDUALS. JFAN WORKS TO INCREASE AWARENESS OF FOOD ACCESS, ENGAGE STAKEHOLDERS IN FOOD POLICIES, COLLECT DATA TO BETTER UNDERSTAND FOOD INSECURITY, AND KICK-START COMMUNITY INITIATIVES. FREEMAN HELPS WITH COMMUNITY-BUILDING BY OFFERING SOLUTIONS TO HELP MEET THE NEEDS OF SPECIFIC POPULATIONS, SUCH AS CHILDREN WITH AUTISM, CHILDREN WITH MEDICAL EXPENSES, CHILDREN WHO HAVE EXPERIENCED EMOTIONAL TRAUMA, VETERANS, AND SENIOR CITIZENS. BILL & VIRGINIA LEFFEN CENTER FOR AUTISM, FOR INSTANCE, PROVIDES HOPE FOR CHILDREN WITH AUTISM THROUGH A PRESCHOOL PROGRAM, A SPECIAL EDUCATION CENTER, AND AN AUTISM DIAGNOSTIC TEAM. AS A CHILDREN'S MIRACLE NETWORK HOSPITAL, FREEMAN RAISES MONEY TO HELP SICK AND INJURED CHILDREN WITH MEDICAL EXPENSES. TO ADDRESS CHILD MENTAL AND EMOTIONAL TRAUMA, FREEMAN AND OZARK CENTER OPERATE WILL'S PLACE TO PROVIDE THE COMMUNITY WITH A MUCH-NEEDED CHILD TRAUMA TREATMENT CENTER. TO FURTHER PROMOTE THE HEALTH AND WELL-BEING OF THE AREA'S SENIOR POPULATION, FREEMAN ADVANTAGE OFFERS OPPORTUNITIES FOR LEARNING, TRAVEL, SOCIALIZING, AND HEALTHY LIVING TO ANYONE OVER THE AGE OF 50. THE PROGRAM ALSO INCLUDES MONTHLY MEETINGS WHERE MEMBERS AND THE GENERAL PUBLIC CAN HEAR A VARIETY OF EXPERTS SPEAK ABOUT A WIDE RANGE OF HEALTH TOPICS. ADDITIONALLY, MEN AND WOMEN OF ALL AGES AND FROM ALL WALKS OF LIFE PARTICIPATE IN FREEMAN AUXILIARY, AN ORGANIZATION THAT RAISES MONEY FOR HOSPITAL EQUIPMENT, SERVICES, SCHOLARSHIPS, AND OTHER COMMUNITY NEEDS. FREEMAN DEVELOPMENT OFFICE WORKS WITH THE COMMUNITY TO FIND FUNDING FOR INNOVATIVE, LIFESAVING TECHNOLOGIES AND MEDICAL SERVICES. THE MIRACLE SERVICE DOG PROGRAM IS PROVIDED IN CONJUNCTION WITH CHILDREN'S MIRACLE NETWORK HOSPITALS AT FREEMAN HEALTH SYSTEM. THIS PROGRAM PLACES SERVICE DOGS WITH CHILDREN WITH SPECIAL MEDICAL NEEDS. SERVICE DOGS ARE INDIVIDUALLY TRAINED TO MEET THE SPECIFIC NEEDS OF THE CHILD AND THEIR CONDITION. SERVICE DOGS CAN BE TRAINED TO RESPOND AND ALERT TO SEIZURES, REDIRECT REPETITIVE BEHAVIORS, TETHER AND LOCATE A WANDERING CHILD, INTERRUPT SELF-HARM, AND PERFORM COUNTLESS OTHER TASKS. ONE OF FREEMAN'S GOALS IS TO BECOME THE COMMUNITY'S BEST CORPORATE PARTNER. FREEMAN DONATES TIME, RESOURCES, AND FUNDING AS AN ORGANIZATION, WHILE THOSE WORKING AT FREEMAN GIVE BACK TO THE COMMUNITY AS WELL. IN FY22, MEMBERS OF FREEMAN'S HEARTS & HANDS TEAM (AN EMPLOYEE VOLUNTEER GROUP) COORDINATED 37 COMMUNITY EVENTS AND FUNDRAISERS WITH A TOTAL OF MORE THAN 518 SERVICE HOURS DONATED. BOUNCING BACK FROM THE PANDEMIC, FREEMAN VOLUNTEERS WERE ABLE TO HELP AREA NONPROFITS WITH TASKS SUCH AS PREPARING AND SERVING MEALS FOR THE HOMELESS, RUNNING HYDRATION STATIONS AT ORGANIZED CHARITY RACES, CLEANING UP DOWNTOWN JOPLIN, AND HELPING AT LOCAL FOOD PANTRIES. FREEMAN ALSO PARTNERS WITH SCHOOL DISTRICTS IN JOPLIN, NEOSHO, CARL JUNCTION, SENECA, AND WEBB CITY, SUPPORTING THE SCHOOLS BY RUNNING SCHOOL CARNIVALS, PREPARING CHRISTMAS BASKETS, AND ORGANIZING FUNDRAISING AUCTIONS AND OTHER ACTIVITIES. DURING THE YEAR, FREEMAN EMPLOYEES DONATED THOUSANDS OF FOOD ITEMS AND PIECES OF CLOTHING FOR PROJECTS BENEFITING STUDENTS FROM EARLY CHILDHOOD THROUGH COLLEGE ACROSS THE REGION.