4A (Expenses $ 30516098 including grants of $ 66255) (Revenue $ 39240897)
CHI HEALTH GOOD SAMARITAN IS VERIFIED BY THE AMERICAN COLLEGE OF SURGEONS (ACS) AS A LEVEL II TRAUMA CENTER. VERIFICATION BY THE ACS DEMONSTRATES THAT GOOD SAMARITAN HAS MET STRINGENT CRITERIA REFLECTING COMMITMENT, EXCELLENCE AND ASSURANCE OF HIGH QUALITY CARE FOR ALL TRAUMA PATIENTS.GOOD SAMARITAN IS ONE OF ONLY A HANDFUL OF HOSPITALS IN THE NATION THAT OPERATES BOTH A GROUND AND AIR AMBULANCE SERVICE AS PART OF OUR TRAUMA PROGRAM AND IN SUPPORT OF THE OTHER MEDICAL SPECIALTIES OFFERED BY OUR FACILITY. OUR GROUND AMBULANCE SERVICE PROVIDES EMERGENCY ADVANCED LIFE SUPPORT RESPONSE TO BUFFALO COUNTY AND SURROUNDING COMMUNITIES AS WELL AS LONG DISTANCE BASIC, ADVANCED AND CRITICAL CARE TRANSPORTATION OF PATIENTS FROM ONE FACILITY TO ANOTHER THROUGHOUT NEBRASKA. GOOD SAMARITAN AIRCARE, OUR ORGANIZATION'S AIR AMBULANCE SERVICE, PROVIDES BOTH INTER-FACILITY AND SCENE RESPONSE FOR CRITICALLY ILL AND INJURED PATIENTS THROUGHOUT CENTRAL NEBRASKA AND NORTHERN KANSAS. GOOD SAMARITAN IS PROUD OF ITS LONG-STANDING RELATIONSHIP WITH RODGERS HELICOPTER SERVICES, LLC IN PROVIDING OUR AIR AMBULANCE OPERATION TO THIS REGION FOR MORE THAN THREE DECADES.IN ADDITION, TRAUMA PREVENTION EFFORTS IN KEARNEY AND SURROUNDING COMMUNITIES HELP BOOST PUBLIC AWARENESS THROUGH MANY FORUMS INCLUDING BIKE RODEOS, CLASSES PROMOTING RESPONSIBLE DECISION-MAKING -- SEAT BELT USE AND DRINKING AND DRIVING, CAR SEAT SAFETY AND NUMEROUS OTHER PROGRAMS.

4B (Expenses $ 15914698 including grants of $ 55535) (Revenue $ 32891684)
THE MISSION OF KEARNEY'S GOOD SAMARITAN HEART CENTER IS TO PROVIDE ADVANCED, COMPREHENSIVE CARE CLOSE TO HOME. OPENED IN 1990 WITH THE FIRST CARDIAC CATHETERIZATION LAB IN OUTSTATE NEBRASKA, THE GOOD SAMARITAN HEART CENTER HAS EVOLVED INTO A FULL SERVICE CARDIAC AND VASCULAR CARE CENTER PROVIDING ALL ADULT CARDIAC AND VASCULAR PROCEDURES ONCE FOUND ONLY IN METROPOLITAN AREAS. IN 2005, GOOD SAMARITAN WAS GIVEN OFFICIAL CHEST PAIN CENTER DESIGNATION BY THE SOCIETY OF CHEST PAIN CENTERS AND RECOGNIZED FOR OFFERING STATE-OF-THE-ART HEART CARE TO ITS PATIENTS, BECOMING THE FIRST MEDICAL FACILITY IN THE STATE OF NEBRASKA TO RECEIVE THIS ACCREDITATION. BEING AN ACCREDITED CENTER MEANS THAT WE FOLLOW STRICTER PROTOCOL-DRIVEN AND SYSTEMATIC GUIDELINES THAT ALLOW A REDUCTION IN TIME TO TREATMENT DURING THE EARLY STAGES OF HEART ATTACK, WHEN TREATMENTS ARE MOST EFFECTIVE. IT ALSO ENABLES US TO BETTER MONITOR PATIENTS WHEN IT IS NOT CLEAR WHETHER THEY ARE HAVING A CORONARY EVENT, MAKING SURE OUR PATIENTS ARE NEITHER SENT HOME TOO EARLY NOR NEEDLESSLY ADMITTED.

4C (Expenses $ 11037498 including grants of $ 72440) (Revenue $ 42903877)
GOOD SAMARITAN HOSPITAL HAS STRIVED TO IMPROVE THE HEALTH STATUS OF CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS IN THIS RURAL COMMUNITY. GOOD SAMARITAN HOSPITAL IS PROUD TO OFFER HEALTHCARE SERVICES CLOSE TO HOME WITHIN THE COMMUNITY. GOOD SAMARITAN HOSPITAL PROVIDES A VARIETY OF DIAGNOSTIC SERVICES TO THE COMMUNITY, SUCH AS CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND.

4D (Expenses $ 103453537 including grants of $ 118390) (Revenue $ 70119091)

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

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: GOOD SAMARITAN HOSPITAL, - FACILITY 2: RICHARD YOUNG BEHAVIORAL HEALTH CENTER

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
IN CONDUCTING ITS MOST RECENT CHNA, CHI HEALTH GOOD SAMARITAN AND RICHARD YOUNG BEHAVIORAL HEALTH CENTER TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE PROCESS OF IDENTIFYING THE COMMUNITY HEALTH NEEDS IN BUFFALO COUNTY WAS ACCOMPLISHED BY REVIEWING SECONDARY DATA, PARTICIPATING IN TWO COMMUNITY-BASED PROCESSES, REVIEWING/VALIDATING THE DATA, PRIORITIZING SIGNIFICANT HEALTH NEEDS THROUGH AN INTERNAL PROCESS, AND FINALLY COLLECTING INPUT AND OBTAINING VALIDATION OF THE NEEDS FROM TWO RIVERS PUBLIC HEALTH DEPARTMENT (TRPHD), THE LOCAL PUBLIC HEALTH AGENCY. BOTH COMMUNITY ASSESSMENTS FOR BUFFALO COUNTY COMMUNITY PARTNERS (BCCP) AND TRPHD INVOLVED INPUT FROM KEY COMMUNITY STAKEHOLDERS. INPUT TO CONFIRM THE TOP HEALTH NEEDS IN THE COMMUNITY FOR THE CHI HEALTH GOOD SAMARITAN AND RYBHC CHNA WAS SOUGHT FROM KEY LEADERS AT TRPHD AND BCCP WHO PROVIDED INPUT BASED ON THEIR PROCESSES, AND REPRESENT A BROAD ARRAY OF STAKEHOLDERS SERVING LOW-INCOME AND AT-RISK INDIVIDUALS, AS WELL AS MINORITIES, THE AGING, AND THOSE AFFECTED BY VIOLENCE. INPUT TO THE BCCP REGULAR ASSESSMENTS IS SECURED THROUGH PARTNERSHIPS WITH OVER 700 BUSINESSES AND 2,500 COMMUNITY MEMBERS. THE ASSESSMENT FOR TRPHD ENGAGED MANY COMMUNITY STAKEHOLDERS THAT ALSO REPRESENT POPULATIONS SIMILAR TO THOSE GIVING INPUT TO THE BCCP PROCESS.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:
THE 2022 CHNA WAS A JOINT ASSESSMENT WITH RICHARD YOUNG BEHAVIORAL HEALTH CENTER.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:
GOOD SAMARITAN HOSPITAL/RICHARD YOUNG BEHAVIORAL HEALTH CENTER (RYBHC) CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN PARTNERSHIP WITH BUFFALO COUNTY COMMUNITY PARTNERS AND TWO RIVERS PUBLIC HEALTH DEPARTMENT.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:
THE MOST RECENT CHNA AND CORRESPONDING IMPLEMENTATION PLAN WAS COMPLETED IN THE TAX REPORTING YEAR 2021. THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON WWW.CHIHEALTH.COM/CHNA. THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH TWO COMMUNITY PROCESSES AND A SECONDARY DATA REVIEW LED BY HOSPITAL STAFF AND INCLUDING INPUT AND VALIDATION FROM HOSPITAL AND COMMUNITY LEADERSHIP. TOP HEALTH NEEDS (FROM 2022 CHNA): 1. ACCESS TO CARE2. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH AND SUBSTANCE ABUSE)3. CHRONIC & INFECTIOUS DISEASE4. SOCIAL DETERMINANTS OF HEALTH5. VIOLENCE/INJURYFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: ACCESS TO CARETO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- ENGAGE WITH LOCAL HEALTH AND HUMAN SERVICE AGENCIES TO IMPROVE ACCESS TO CLINIC AND COMMUNITY BASED HEALTH SERVICES THROUGH OPTIMIZATION OF SERVICE OFFERINGS, COORDINATION OF CARE, PROMOTION OF SERVICES, AND INSURANCE ENROLLMENT SERVICE TO SERVE THOSE MOST IN NEED IN BUFFALO COUNTY * EXPLORE AND IDENTIFY OPPORTUNITIES FOR ALIGNMENT WITH EXISTING HEALTH CARE ACCESS IMPROVEMENT EFFORTS THROUGH TWO RIVERS PUBLIC HEALTH * SUPPORT AND PARTNER WITH HELPCARE CLINIC THROUGH VOLUNTEER CLINICS TO IMPROVE ACCESS FOR UNDER/UNINSURED AND IMPROVE DIABETES MANAGEMENT, THROUGH BOARD PARTICIPATION, AND FINANCIAL SUPPORTPRIORITY HEALTH NEED #2: BEHAVIORAL HEALTHTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- COLLABORATE WITH LOCAL COMMUNITY, PUBLIC HEALTH, AND HEALTH CARE PARTNERS TO SUPPORT COMMUNITY-BASED STRATEGIES TO ADDRESS MENTAL ILLNESS, SUBSTANCE USE, AND VIOLENT BEHAVIORS, WHILE CONTINUING TO BUILD AND OPTIMIZE BEHAVIORAL HEALTH SERVICES INTERNALLY * CONTINUE TO EXPLORE AND BUILD CAPACITY FOR INTEGRATION OF BEHAVIORAL HEALTH INTO PRIMARY CARE AND FURTHER IMPROVE BEHAVIORAL HEALTH ACCESS POINTS WITHIN THE BEHAVIORAL HEALTH SYSTEM OF CARE (I.E. PERINATAL ASSESSMENT AND REFERRAL TO CLINICS FOR POSTPARTUM DEPRESSION SCREENING) * ENSURE CONTINUED PARTICIPATION AND SUPPORT OF COMMUNITY PARTNERS THAT HAVE AN INTEREST IN BEHAVIORAL HEALTH TO ENSURE: 1) ON-GOING COMMUNITY-BASED STRATEGIES TO IMPROVE THE STIGMA OF MENTAL ILLNESS 2) INFORM THE IMPROVEMENT OF CLINICAL SERVICE OFFERINGS 3) IMPROVE CONTINUUM OF CARE MODELS TO ENSURE ACCESS AND UTILIZATION OF APPROPRIATE MENTAL AND PHYSICAL HEALTH SERVICES * PARTNERSHIP MAY INCLUDE ALIGNMENT WITH TRPHD, SOUTH CENTRAL BEHAVIORAL HEALTH SERVICES, AND REGION 3 * SUPPORT AND PARTICIPATE IN BCCP'S MULTI-SECTOR BEHAVIORAL HEALTH COALITION, WHICH WILL FOCUS ON: 1) PROMOTING MENTAL HEALTH AWARENESS THROUGH EVIDENCE BASED TRAINING AND EDUCATION 2) CONTINUING CROSS SECTOR COLLABORATION THROUGH FACILITATION AND ALIGNMENT OF COMMUNITY RESOURCES 3) IDENTIFYING BARRIERS TO ACCESSING BEHAVIORAL HEALTH RESOURCES 4) PROMOTING EASILY UNDERSTOOD AND ACCESSIBLE BEHAVIORAL HEALTH RESOURCES FOR ALL RESIDENTS 5) PROVIDING SPACE AND OPPORTUNITIES FOR LIVED EXPERIENCE VOICES IN BEHAVIORAL HEALTH CONVERSATIONS AND INITIATIVES TO INFORM THE COMMUNITY WORK- PREVENT VIOLENCE, INTERVENE WHEN SUSPECTED, AND PROVIDE RESOURCES AND SUPPORT TO VICTIMS OF VIOLENCE * SUPPORT COMMUNITY AND SCHOOL-BASED PROGRAMMING TO INCREASE PROTECTIVE FACTORS AND REDUCE RISK FACTORS FOR VIOLENCE * INCREASE HEALTH SYSTEM AND COMMUNITY CAPACITY TO IDENTIFY VICTIMS OF HUMAN TRAFFICKING AND RESPOND APPROPRIATELY PRIORITY HEALTH NEED #3: SOCIAL DETERMINANTS OF HEALTHTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:- ENSURE BUFFALO COUNTY RESIDENTS HAVE ACCESS TO BASIC NEEDS THROUGH RESOURCE NAVIGATION, POLICY, SYSTEMS AND ENVIRONMENTAL CHANGES * PARTNER AND SUPPORT BCCP WHICH WILL CREATE A DIVERSE WELLBEING COLLABORATION ACROSS MULTIPLE SECTORS BY: 1) IMPROVING ACCESS TO RESOURCES AND SERVICES (FOOD INSECURITY) THROUGH UNITE US AND MYLNK APP, INCLUDING SUPPORTING THE RELEASE, PROMOTION, UTILIZATION OF THE PLATFORM FOR SOCIAL AND HEALTH CARE SECTORS 2) INTENTIONALLY SUPPORTING EFFORTS IN DIVERSITY AND INCLUSION AS PART OF A BUFFALO COUNTY WIDE FOCUS TO BUILD AND SUSTAIN A POSITIVE AND WELCOMING LEARNING, WORKING, AND LIVING ENVIRONMENT IN OUR COMMUNITIES 3) ENSURING VULNERABLE PEOPLE RESIDING IN BUFFALO COUNTY HAVE ACCESS TO BASIC NEEDS (HEALTHY CHOICES) BY IMPLEMENTING MULTIPLE STRATEGIES THAT INCLUDE PROVIDING INFORMATION, BUILDING SKILLS, PROVIDING SUPPORT, REDUCING BARRIERS/ENHANCING ACCESS, CHANGING CONSEQUENCES/INCENTIVES, ALTERING THE PHYSICAL DESIGN OF THE ENVIRONMENT, AND CHANGE POLICY AND RULES 4) FACILITATE PARTNER CONVERSATIONS AND DRIVE ACTION ON HEALTHY FOOD ACCESS: SUPPORT UNL EXTENSION EFFORTS TO BUILD CAPACITY AT THE KEARNEY AREA FARMERS MARKET (KAFM), EXPAND DOUBLE UP FOOD BUCKS, AND PROMOTE SNAP THROUGH EDUCATION AT THE MARKET AND SCHOOLS. SUPPORT KAFM CAPACITY AND SYSTEMS FOR ELECTRONIC BANKING TRANSACTIONS TO BE AVAILABLE AT FARMER'S MARKETS. PROMOTE DUBF AND SNAP EDUCATION THROUGH DISTRIBUTION OF FLYERS AND MARKETING MATERIALS * SUPPORT HOUSING INSECURITY EFFORTS THROUGH BCCP, RESIDENTIAL ASSISTANCE TO FAMILIES IN TRANSITION, INTERNAL SDOH SCREENING PROCESSES AND EXPLORE OTHER COMMUNITY STRATEGIES AND INITIATIVES * DEVELOP AND TEST REFERRAL PROCESSES FOR SOCIAL NEEDS THROUGH UNITE USSEE PART V, SECTION B, LINE 11 (CONTINUED):

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

FACILITY REPORTING GROUP A, PART V, SECTION B, LINE 11 (CONTINUED):
THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS: 1. CHRONIC AND INFECTIOUS DISEASE- IN ORDER TO MEANINGFULLY ADDRESS THE SELECT PRIORITY HEALTH NEEDS ABOVE AND MAXIMIZE IMPACT, CHI HEALTH GOOD SAMARITAN/RYBHC DID NOT PRIORITIZE CHRONIC AND INFECTIOUS DISEASE FOR WORK ON THIS ISP. HOWEVER, THE HOSPITALS HAVE PRIORITIZED ACCESS TO HEALTHCARE SERVICES AND THESE EFFORTS MAY INDIRECTLY IMPROVE THE ABILITY OF HEALTH CARE SERVICES AND COMMUNITY PARTNERS TO ADDRESS CHRONIC DISEASE ON AN INDIVIDUAL BASIS. SPECIFICALLY, CHI HEALTH GOOD SAMARITAN/RYBHC WILL BE WORKING CLOSELY WITH THE HELPCARE CLINIC IN KEARNEY TO SUPPORT CHRONIC DISEASE MANAGEMENT AND PRIMARY CARE SERVICES, AND WITH TRPHD IN THEIR COMMUNITY-WIDE COVID-19 RELIEF EFFORTS. ADDITIONALLY, THE HOSPITAL CONTRIBUTES SIGNIFICANT IN-KIND AND FINANCIAL RESOURCES TO BUFFALO COUNTY COMMUNITY PARTNERS (BCCP), WHICH ACTIVELY MANAGES A LOCAL COALITION TO ADDRESS CHALLENGES RELATED TO HEALTHY EATING AND AN ACTIVE LIVING NETWORK. CHI HEALTH GOOD SAMARITAN ALSO OFFERS A STATE-OF-THE-ART WELLNESS CENTER THAT PROVIDES A VARIETY OF RESOURCES RELATED TO CHRONIC DISEASE MANAGEMENT, INCLUDING INDIVIDUAL EXERCISE EQUIPMENT AND GROUP EXERCISE CLASSES. 2. VIOLENCE/INJURY- IN ORDER TO MEANINGFULLY ADDRESS THE SELECTED PRIORITY HEALTH NEEDS ABOVE AND MAXIMIZE IMPACT, CHI HEALTH GOOD SAMARITAN/ RYBHC DID NOT PRIORITIZE WORK IN THIS AREA. HOWEVER, VIOLENCE WILL BE ADDRESSED THROUGH THE BEHAVIORAL HEALTH STRATEGY AS MANY OF THE PROGRAMS AND PARTNERS ADDRESSING THE NEED, ALSO SUPPORT WORK AROUND VIOLENCE PREVENTION RECOGNIZING THE RELATIONSHIP BETWEEN THE TWO HEALTH AREAS. CHI HEALTH GOOD SAMARITAN/RYBHC WILL ALSO FOCUS ON ADDRESSING HUMAN TRAFFICKING AND INTERPERSONAL VIOLENCE BY STRENGTHENING THE CAPACITY OF HEALTH CARE WORKERS TO RECOGNIZE AND ADDRESS VIOLENCE, AND ALSO BY SUPPORTING COMMUNITY PARTNERS WHO LEAD THIS WORK IN BUFFALO COUNTY AND SURROUNDING COMMUNITIES. THE FOUNDATION, HEALTHY COMMUNITIES TEAM, AND HOSPITAL STAFF ALSO SUPPORT SAFEKIDS, WHICH PROVIDES OUTREACH AND EDUCATION TO YOUTH TO PROTECT THEM FROM UNINTENTIONAL INJURY. THE FOLLOWING TOP HEALTH NEEDS WERE IDENTIFIED AND PRIORITIZED AS PART OF THE CHNA AND IMPLEMENTATION STRATEGY PLAN APPROVED IN 2019. ALTHOUGH A MORE RECENT CHNA WAS COMPLETED IN TAX YEAR 2021 (FISCAL YEAR 2022), THE RELATED IMPLEMENTATION PLAN WAS NOT APPROVED UNTIL JULY, 2022 (FISCAL YEAR 2023). THEREFORE THE WORK DESCRIBED BELOW IS TIED TO THE 2019 ASSESSMENT AND PLANS AND REPRESENTS WORK CARRIED OUT BY THE HOSPITAL DURING FISCAL YEAR 2022.THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH A REVIEW OF PRIMARY AND SECONDARY DATA, SURVEYS AND KEY STAKEHOLDER INPUT, AND FACILITATED COMMUNITY MEETINGS.TOP HEALTH NEEDS (FROM 2019 CHNA):1. ACCESS TO CARE (INCLUDES BEHAVIORAL AND DENTAL) 2. ALZHEIMER'S DISEASE AND DEMENTIA3. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH AND SUBSTANCE ABUSE) 4. WEIGHT STATUS (NUTRITION, PHYSICAL ACTIVITY, OBESITY) 5. VIOLENCE6. CHRONIC DISEASE7. LIFESTYLE CHOICES AND PERSONAL ACCOUNTABILITYPRIORITY HEALTH NEED #1: ACCESS TO HEALTHCARE SERVICESTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:- ENGAGE WITH LOCAL HEALTH AND HUMAN SERVICE AGENCIES TO IMPROVE ACCESS TO CLINIC AND COMMUNITY BASED HEALTH SERVICES THROUGH OPTIMIZATION OF SERVICE OFFERINGS, COORDINATION OF CARE, PROMOTION OF SERVICES, AND INSURANCE ENROLLMENT SERVICE TO SERVE THOSE MOST IN NEED IN BUFFALO COUNTY * EXPLORE AND IDENTIFY OPPORTUNITIES FOR ALIGNMENT WITH EXISTING HEALTHCARE ACCESS IMPROVEMENT EFFORTS THROUGH TWO RIVERS PUBLIC HEALTH. (GOOD SAMARITAN) * EXPLORE OPPORTUNITY TO SUPPORT HELPCARE CLINIC THROUGH ESTABLISHING VOLUNTEER CLINICS TO IMPROVE ACCESS FOR UN/UNDER-INSURED AND IMPROVE DIABETES MANAGEMENT WORK. (GOOD SAMARITAN) * CONTINUE TO EXPLORE AND BUILD CAPACITY FOR INTEGRATION OF BEHAVIORAL HEALTH INTO PRIMARY CARE. (GOOD SAMARITAN & RYBH) * CONTINUE FUNDING AND SUPPORT OF BUFFALO COUNTY COMMUNITY PARTNERS (BCCP) EFFORTS TO MONITOR AND IMPROVE THE OVERALL HEALTH STATUS OF THE COMMUNITY THROUGH: VIOLENCE PREVENTION PROGRAMMING, INCREASING CAPACITY OF COMMUNITY-BASED SERVICES TO REDUCE STIGMA AND IMPROVE BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE ABUSE), PROMOTE PREVENTIVE HEALTHCARE ACCESS, PROMOTE HEALTHY BEHAVIORS TO REDUCE CHRONIC DISEASE. (GOOD SAMARITAN)* ENGAGE WITH EXISTING WORK RELATED TO EARLY CHILDHOOD SERVICES TO EXPLORE COMMUNITY CAPACITY AND INTEREST IN EXPANDING MATERNAL HOME VISITING TO IMPROVE HEALTH LITERACY, HEALTHCARE ACCESS, AND OVERALL HEALTH OUTCOMES FOR FAMILIES (I.E. PREGNANT AND PARENTING WOMEN WITH CHILDREN AGES 0-3). (GOOD SAMARITAN)PRIORITY HEALTH NEED #2: BEHAVIORAL HEALTH (TO INCLUDE VIOLENCE)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:- COLLABORATE WITH LOCAL COMMUNITY, PUBLIC HEALTH, AND HEALTHCARE PARTNERS TO SUPPORT COMMUNITY BASED STRATEGIES TO ADDRESS MENTAL ILLNESS, SUBSTANCE ABUSE, VIOLENT BEHAVIORS, WHILE CONTINUING TO BUILD AND OPTIMIZE BEHAVIORAL HEALTH SERVICES INTERNALLY * EXPLORE AND BETTER UNDERSTAND OPPORTUNITIES FOR ALIGNMENT WITH REGION 3 BEHAVIORAL HEALTH SERVICES TO: ENSURE AVAILABLE FUNDING AND SUPPORT IS PROVIDED FOR KEY STRATEGIES SUCH AS CRISIS RESPONSE, TRAINING, AND SYSTEM OF CARE WORK. (RYBH) AND IMPROVE CONTINUUM OF CARE MODELS TO ENSURE ACCESS AND UTILIZATION OF APPROPRIATE MENTAL AND PHYSICAL HEALTH SERVICES. (RYBH) * CONTINUE INTENTIONAL COOPERATION AND COORDINATION WITH THE FOLLOWING EXTERNAL PARTNERS: KEARNEY PUBLIC SCHOOLS RELATED TO YOUTH ADMITTED/TREATED/RELEASED FROM RYBH ESPECIALLY WHEN BULLYING IS IDENTIFIED AS AN ISSUE (RYBH) AND SUPPORT TO CENTRAL NEBRASKA/KEARNEY LOSS TEAM (LOCAL OUTREACH TO SUICIDE SURVIVORS) (RYBH) * CONTINUE TO EXPLORE AND BUILD CAPACITY FOR INTEGRATION OF BEHAVIORAL HEALTH IN PRIMARY CARE. (GOOD SAMARITAN & RYBH) * ENSURE CONTINUED PARTICIPATION AND SUPPORT IN THE HEALTHY MINDS COALITION LED BY BCCP, TO ENSURE ON-GOING COMMUNITY-BASED STRATEGIES TO IMPROVE THE STIGMA OF MENTAL ILLNESS AND INFORM THE IMPROVEMENT OF CLINICAL SERVICE OFFERINGS. (GOOD SAMARITAN & RYBH) * EXPLORE ALIGNMENT OPPORTUNITIES WITH TWO RIVERS PUBLIC HEALTH DEPT. (GOOD SAMARITAN & RYBH)

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

PART I, LINE 6A:
THE 2021 COMMUNITY BENEFIT REPORT FOR GOOD SAMARITAN HOSPITAL WAS PREPARED BY ALEGENT CREIGHTON HEALTH, DBA CHI HEALTH, A RELATED ORGANIZATION. THE COMMUNITY BENEFIT REPORT CONTAINS INFORMATION FOR SEVERAL RELATED ORGANIZATIONS IN IOWA AND NEBRASKA.

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

PART II, COMMUNITY BUILDING ACTIVITIES:
CHI HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT INVESTMENTS, AS WELL AS HOSPITAL SPECIFIC INVESTMENTS THAT ADDRESS COMMUNITY HEALTH NEEDS WHICH INCLUDE SUPPORT OF LOCAL HEALTH COALITIONS, INVESTMENTS IN PARTNERSHIPS AND PROGRAMS THAT ADDRESS TOP COMMUNITY HEALTH NEEDS, PARTICIPATION IN LOCAL COMMITTEES AND BOARDS TIED TO TOP HEALTH NEEDS, AND INVESTMENTS IN MANY OTHER WAYS AS DESCRIBED IN OTHER AREAS OF THE SCHEDULE H NARRATIVE. BELOW ARE SPECIFIC EXAMPLES OF WORK THAT FALLS WITHIN THE DEFINITION OF COMMUNITY BUILDING ACTIVITIES. THESE ACTIVITIES ARE CRITICAL IN HELPING BUILD SOCIAL, HEALTH, AND ECONOMIC OPPORTUNITIES IN OUR COMMUNITY THAT ULTIMATELY DRIVE HEALTH STATUS AND QUALITY OF LIFE FOR OUR RESIDENTS:- WORKFORCE DEVELOPMENT-ACTIVITIES TO STRENGTHEN THE COMMUNITY'S CAPACITY TO PROMOTE THE HEALTH AND WELL-BEING OF OUR RESIDENTS BY DRIVING ENTRY INTO HEALTHCARE CAREERS.

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

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

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

PART III, LINE 8:
COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. GOOD SAMARITAN HOSPITAL'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $14,102,089 MILLION REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS.

PART III, LINE 9B:
COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.

PART VI, LINE 3:
INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.

PART VI, LINE 4:
BUFFALO COUNTY'S POPULATION INCREASED BY 8.6% FROM 2010 TO 2020 AND WAS ONE OF THE TWO COUNTIES IN THE TWO RIVERS PUBLIC HEALTH DEPARTMENT DISTRICT TO SEE AN INCREASE IN POPULATION. IN 2019, WHITE ALONE, NOT HISPANIC OR LATINO INDIVIDUALS MADE UP 90% OF THE POPULATION, WHICH WAS LOWER THAN BUFFALO COUNTY (95%). IN THE SAME YEAR, 4.8% OF RESIDENTS IN THE COUNTY WERE BORN OUTSIDE OF THE UNITED STATES, A SLIGHT INCREASE FROM THE YEAR BEFORE (4.6%). 97.2% OF BUFFALO COUNTY RESIDENTS WERE CITIZENS IN 2019. THE MAJORITY OF THE POPULATION RESIDES IN AND AROUND KEARNEY, NEBRASKA. A REVIEW OF THE SOCIOECONOMIC FACTORS SHOWS A MEDIAN HOUSEHOLD INCOME OF $57,064, WHICH IS COMPARABLE TO THE STATE ($59,431), AN ESTIMATED HIGH SCHOOL GRADUATION RATE HIGHER THAN THE STATE (90.7% AND 87.6%, RESPECTIVELY), AND AN UNEMPLOYMENT RATE LOWER THAN THE STATE (0.9% AND 1.3%, RESPECTIVELY). POVERTY (16.7%) AND NUMBER OF PERSONS WITHOUT HEALTH INSURANCE (11.1%) WERE BOTH HIGHER IN BUFFALO COUNTY THAN IN THE STATE (BOTH 9.5%). ADDITIONALLY, THE RATE OF PERSONS WHO SPOKE A LANGUAGE OTHER THAN ENGLISH AT HOME IS 8.0% IN BOTH KEARNEY AND BUFFALO COUNTY.BUFFALO COUNTY IS DESIGNATED A HEALTH PROFESSIONAL SHORTAGE AREA IN THE FOLLOWING AREAS: PRIMARY CARE (HEARTLAND HEALTH, INC. [10]), DENTAL HEALTH (HEARTLAND HEALTH, INC. [10], AND MENTAL HEALTH (MENTAL HEALTH CATCHMENT AREA 3 [12], HEARTLAND HEALTH CENTER, INC. [15]). THE SCORE RANGES FROM 0-26 WHERE THE HIGHER THE SCORE, THE GREATER THE PRIORITY. BUFFALO COUNTY IS CONSIDERED A MEDICALLY UNDERSERVED AREA (MUA) IN PRIMARY CARE WITH AN INDEX OF MEDICAL UNSERVED SCORE OF 47.3 (TO QUALIFY FOR THIS DESIGNATION, THE SCORE MUST BE BELOW OR EQUAL TO 62.0 ON A SCALE OF 0 -100 WITH 100 BEING THE LOWEST NEED).THERE ARE SEVERAL HEALTH RELATED ORGANIZATIONS AND SERVICES, INCLUDING CHI HEALTH THAT ARE SERVING BUFFALO COUNTY: - BUFFALO COUNTY COMMUNITY PARTNERS - CHI HEALTH CLINIC GENERAL SURGERY - CHI HEALTH CLINIC - KEARNEY CLINIC - FAMILY MEDICINE/PRIORITY CARE - CHI HEALTH CLINIC WOMEN'S HEALTH - CHI HEALTH GOOD SAMARITAN HOSPITAL - CHOICE FAMILY - HELPCARE CLINIC - KEARNEY REGIONAL MEDICAL CENTER - REGION 3 BEHAVIORAL HEALTH SERVICES MAIN OFFICE (SERVES 22 COUNTIES) - TWO RIVERS PUBLIC HEALTH DEPARTMENT - YOUTH REHABILITATION AND TREATMENT CENTER AT KEARNEY (NEBRASKA DEPARTMENT OF HEALTH & HUMAN SERVICES)

PART VI, LINE 5:
FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE.USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE.OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS.ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. HOSPITAL COMMUNITY BOARDS (OR THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AND PROGRESS TOWARD IDENTIFIED GOALS.

PART VI, LINE 6:
THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. AS OF JUNE 30, 2022, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2022, COMMONSPIRIT HEALTH PROVIDED MORE THAN $3.16 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.89 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.9 BILLION IN FISCAL YEAR 2022, HAS TOTAL ASSETS OF APPROXIMATELY $50.31 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY.