4A (Expenses $ 25004249 including grants of $ 11193) (Revenue $ 33429202)
ST. FRANCIS IS EQUIPPED WITH STATE-OF-THE-ART OPERATING ROOMS, AND THE SURGEONS ON STAFF CONTINUE TO EXPAND THE PROCEDURES AVAILABLE ACROSS MANY SPECIALTIES INCLUDING ORTHOPEDICS, NEUROSURGERY, UROLOGY, AND BARIATRIC AND RECONSTRUCTIVE SURGERY. OTHER SURGICAL SPECIALTIES INCLUDE LAPAROSCOPIC, BREAST CANCER, COLORECTAL, COSMETIC, GASTROENTEROLOGY, GYNECOLOGICAL, SPINE, AND VASCULAR SURGERY.

4B (Expenses $ 10618762 including grants of $ 11483) (Revenue $ 34293651)
THE DIAGNOSTIC AND PATHOLOGY DEPARTMENTS AT ST. FRANCIS OFFERS AN ARRAY OF ON-SITE TESTING SERVICES. WE UTILIZE STATE-OF-THE-ART INSTRUMENTATION AND HAVE A HIGHLY SKILLED STAFF AVAILABLE 24/7. IN ADDITION TO OUR STAFF OF REGISTERED MEDICAL TECHNOLOGISTS AND PHLEBOTOMISTS, WE HAVE THREE PATHOLOGISTS ON SITE, A QUALIFIED HISTOLOGY TEAM, AND SECRETARIES WHO ARE BEYOND COMPARISON IN EFFICIENCY AND CUSTOMER SERVICE. TESTING CAPABILITIES VARY FROM ROUTINE SCREENING TESTS TO MORE SPECIALIZED TESTING SUCH AS PROTEIN ELECTROPHORESIS. WE ALSO HAVE A COMPREHENSIVE MICROBIOLOGY DEPARTMENT OPERATING SEVEN DAYS A WEEK.

4C (Expenses $ 4198660 including grants of $ 3539) (Revenue $ 10567908)
THE ST. FRANCIS CANCER TREATMENT CENTER HAS SERVED CENTRAL NEBRASKA SINCE 1994 AND IS ACCREDITED BY THE COMMISSION ON CANCER FROM THE AMERICAN COLLEGE OF SURGEONS WITH COMMENDATION FOR EXCELLING IN EVERY ASPECT OF CANCER CARE. HERE, PATIENTS HAVE ACCESS TO MEDICAL AND RADIATION ONCOLOGY TREATMENT, A DEDICATED PHARMACY, CLINICAL TRIALS, AND A CANCER REHABILITATION TEAM ALL IN ONE LOCATION - CONVENIENCE NOT TYPICALLY FOUND IN OTHER CANCER CENTERS. IN ADDITION, THE HIGHLY SKILLED TEAM PROVIDES CERTIFIED GENETICS COUNSELING, TOBACCO CESSATION COUNSELING, NURSE NAVIGATION, SURVIVORSHIP SERVICES, AN EDUCATIONAL LIBRARY, SUPPORT GROUPS, AND EDUCATIONAL SEMINARS.

4D (Expenses $ 81020933 including grants of $ 17349) (Revenue $ 51812527)
OTHER SERVICES

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: SAINT FRANCIS MEDICAL CENTER, - FACILITY 2: CHI HEALTH ST. FRANCIS, - FACILITY 3: CHI HEALTH ST. FRANCIS

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
IN CONDUCTING ITS MOST RECENT CHNA, CHI HEALTH ST. FRANCIS AND THE SKILLED NURSING UNIT 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. INPUT FROM THE COMMUNITY WAS PRIMARILY SOUGHT THROUGH TWO COMMUNITY-BASED MEETINGS. STAKEHOLDERS PARTICIPATING IN THESE INPUT SESSIONS REPRESENT LOW-INCOME, MINORITY POPULATIONS, MEDICALLY UNDERSERVED POPULATIONS, AND THE AGING POPULATION, AS WELL AS THOSE AFFECTED BY VIOLENCE. ON JUNE 15, 2021, 35 PARTICIPANTS GATHERED TO IDENTIFY FORCES IMPACTING THE HEALTH OF THE COMMUNITY AND REVIEW SECONDARY DATA RELATED TO HEALTH BEHAVIORS, ACCESS, AND OUTCOMES. THE GROUP ALSO REVIEWED AND APPROVED THE 5-QUESTION SURVEY THAT WAS THEN DISTRIBUTED TO THE COMMUNITY. ON SEPTEMBER 2, 2021, CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD) CONVENED A BROAD GROUP OF COMMUNITY STAKEHOLDERS TO REVIEW DATA, AND FACILITATED DISCUSSION TO IDENTIFY THE TOP HEALTH NEEDS IN THE COMMUNITY. THE GROUP REVIEWED THE SECONDARY DATA FOR CDHD'S THREE-COUNTY REGION (HALL, HAMILTON, AND MERRICK COUNTIES), AND TOOK INTO CONSIDERATION PREVALENCE, MORTALITY, AND TREND WHERE POSSIBLE TO DETERMINE TOP NEEDS. FOLLOWING THE DATA PRESENTATION, THERE WAS A LARGE GROUP DIALOGUE AROUND THE DATA TO ADD CONTEXT AND UNCOVER MISSING ELEMENTS. FINALLY, PARTICIPANTS SPLIT INTO SMALLER GROUPS OF 3-4 TO PRIORITIZE THE TOP HEALTH NEEDS, AND AFTER A BRIEF SMALL GROUP DISCUSSION PERIOD EACH GROUP REPORTED OUT TO THE LARGER GROUP IN AN EFFORT TO IDENTIFY COMMON PRIORITIES ACROSS PARTICIPANTS. ORGANIZATIONS PROVIDING INPUT AT THE COMMUNITY ENGAGEMENT SESSIONS: AURORA COMMUNITY HEALTH, BRYAN HEALTH, BRYAN HEALTH MERRICK MEDICAL CENTER, CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD), CDHD WIC DEPARTMENT, CDHD BOARD OF HEALTH, CENTRAL NEBRASKA DHHS, COUNCIL OF ALCOHOLISM AND ADDICTION, HALL COUNTY COMMISSIONER, HALL COUNTY COMMUNITY COLLABORATIVE (H3C), H3C BOARD OF DIRECTORS, HALL COUNTY HOUSING AUTHORITY, HALL COUNTY JUVENILE SERVICES, HEARTLAND HEALTH CENTER, HEARTLAND UNITED WAY, HEAD START, CFBD INC, CHI HEALTH, CHI HEALTH ST. FRANCIS, CITY OF AURORA, CITY OF GRAND ISLAND, CITY OF GRAND ISLAND CITY COUNCIL, GRAND ISLAND CHAMBER OF COMMERCE, GRAND ISLAND PARKS AND RECREATION, GRAND ISLAND PUBLIC SCHOOLS, GRAND ISLAND REGIONAL MEDICAL CENTER, GRAND ISLAND SALVATION ARMY, HOPE HARBOR, ICHOOSEPURPLE CONSULTING, MEMORIAL COMMUNITY HEALTH, MULTICULTURAL COALITION, NEBRASKA ASSOCIATION OF LOCAL HEALTH DIRECTORS, NEBRASKA EXTENSION, NORTHWEST PUBLIC SCHOOLS, PREVENTION PROJECT

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:
CHI HEALTH ST. FRANCIS AND THE SKILLED NURSING UNIT (SNU) CONDUCTED THIS CHNA JOINTLY. THE CHNA REPORT OUTLINES THE COMMUNITY DESCRIPTION, PROCESS, FINDINGS, AND PRIORITIZED HEALTH NEEDS FOR BOTH CHI HEALTH ST. FRANCIS AND SNU. OTHER HEALTH SYSTEMS INVOLVED IN THE ASSESSMENT ARE GRAND ISLAND REGIONAL MEDICAL CENTER, MERRICK MEDICAL CENTER - BRYAN HEALTH, AND MEMORIAL COMMUNITY HEALTH.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:
CENTRAL DISTRICT HEALTH DEPARTMENTNEBRASKA ASSOCIATION OF LOCAL HEALTH DEPARTMENTS

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 7D:
AN OVERVIEW OF THE MOST RECENT CHNA WAS SHARED WITH THE CHI HEALTH ST. FRANCIS AND SNU COMMUNITY BOARD ON APRIL 28TH, 2022.

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 2022. 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 PRIMARY DATA COLLECTION, A SECONDARY DATA REVIEW, AND TWO COMMUNITY INPUT SESSIONS.TOP HEALTH NEEDS (FROM 2022 CHNA): 1. ACCESS TO CARE2. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH & SUBSTANCE USE)3. CANCER4. CHRONIC DISEASE5. MATERNAL, INFANT, AND CHILD HEALTH6. SOCIAL DETERMINANTS OF HEALTH7. 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- 2025:1.1 IDENTIFY AND ADDRESS KNOWN BARRIERS TO ACCESSING TIMELY AND EFFECTIVE HEALTH CARE IN HALL COUNTY, TO ENSURE SERVICES ARE COORDINATED, OPTIMIZED, AND PROMOTED.1.1.1 COLLABORATE WITH EXISTING SAFETY-NET AND HEALTH CARE PROVIDERS THROUGH A HEALTH DEPARTMENT LED WORK GROUP TO IDENTIFY AND ADDRESS GAPS IN THE CONTINUUM OF HEALTH AND RELATED SERVICES FOR ALL. WORK MAY FOCUS ON: HEALTH CARE WORKFORCE (I.E. PROFESSIONAL DEVELOPMENT, INCREASING THE COMMUNITY HEALTH WORKER (CHW) WORKFORCE, ETC.) - CAPACITY BUILDING OF COMMUNITY PARTNERS - IDENTIFYING COMMON BARRIERS TO ACCESSING CARE AND COLLECTIVELY WORK TO ADDRESS BARRIERS1.1.2 IMPROVING COLLABORATION BETWEEN EMERGENCY DEPARTMENT AND SAFETY NET PROVIDERS TO ENSURE REFERRAL OF RELEVANT PATIENTS TO A MEDICAL HOME, COMMUNICATING WITH THE PATIENTS' PRIMARY CARE PHYSICIAN REGARDING ED VISIT, INCREASING OUTREACH TO REDUCE BARRIERS TO CARE (E.G. EXPLORING FURTHER PARTNERSHIP WITH JBS SWIFT). 1.1.3 PROVIDE PREVENTION/WELLNESS AND SAFETY OUTREACH FOR CHRONIC DISEASE AND CONNECTION TO HEALTH CARE SERVICES.1.1.4 ASSESS AND ADDRESS GAPS IN ACCESSING HEALTHCARE SERVICES FOR THE AGING POPULATION SPECIFICALLY (SNU)1.1.5 EXPLORE WORK RELATED TO SCHOOL-BASED PRIMARY HEALTH CARE AND DETERMINE NEED AND CAPACITY TO INCREASE/IMPROVE SERVICES ALREADY OFFERED BY CHI HEALTH ST. FRANCIS AND AFFILIATES IN SCHOOL SETTINGS. 1.1.6 IMPLEMENT SOCIAL NEEDS SCREENING AND REFERRAL PROTOCOL USING UNITE US TO ENSURE EFFICIENT CONNECTION TO COMMUNITY BASED RESOURCES TO REMEDIATE UNMET HEALTH-RELATED SOCIAL NEEDS.PRIORITY HEALTH NEED #2: BEHAVIORAL HEALTHTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023- 2025:2.1 ENGAGE WITH CENTRAL DISTRICT HEALTH DEPARTMENT, HALL COUNTY COMMUNITY COLLABORATIVE (H3C), AND OTHER COMMUNITY PARTNERS TO IMPROVE CLINICAL AND COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES, AND ADDRESS GAPS IN CARE TO ENSURE BEHAVIORAL HEALTH SERVICES ARE OPTIMIZED WITHIN HALL COUNTY.2.1.1 PARTICIPATE IN AND SUPPORT A HEALTH DEPARTMENT LED WORK GROUP TO: - INCREASE KNOWLEDGE OF BEHAVIORAL HEALTH ACCESS POINTS - ALIGN EFFORTS, FORM PARTNERSHIPS TO LEVERAGE COMMUNITY RESOURCES AND IMPROVE ACCESS TO SERVICES - IDENTIFY AND SUPPORT PREVENTATIVE METHODS TO ADDRESS BEHAVIORAL HEALTH NEEDS PRIOR TO CRISIS2.1.2 PROMOTE AND SUPPORT COMMUNITY-BASED TRAININGS AND PROGRAMS RELATED TO CRISIS RESPONSE FOR COMMUNITY-BASED PUBLIC HEALTH AND SOCIAL SERVICE PROVIDERS. ACTIVITIES MAY INCLUDE: - SUPPORTING REGION 3 STRATEGY TO CREATE A YOUTH SYSTEM OF CARE - COLLABORATING WITH LAW ENFORCEMENT ON INVOLUNTARY COMMITMENTS TO IMPROVE THE RELEVANT PLACEMENT FOR BEHAVIORAL HEALTH PATIENTS (CIVIL PROTECTIVE CUSTODY) AND EXPLORE OPPORTUNITIES TO ADVOCATE FOR LEGISLATIVE CHANGE ALLEVIATING CHALLENGES WITH PLACEMENT - CONTINUING SUPPORT TO FAMILY PROGRAMS SUPPORTING PARENTS AND BUILDING STRONGER FAMILY CONNECTIONS (I.E. ROOTED IN RELATIONSHIPS AND CIRCLE OF SECURITY) AND SOCIAL EMOTIONAL LEARNING FOR CHILDREN (I.E. DISCOVERY KIDS) - STRATEGIC PLANNING AROUND SUBSTANCE USE AND OVERDOSES, WITH A FOCUS ON YOUTH UNDER 252.1.3 EXPAND ACCESS TO RESOURCES AND PROVIDE SUPPORT FOR INDIVIDUALS WITH ALZHEIMER'S AND RELATED DEMENTIAS AND THEIR CAREGIVERS2.2 PROVIDE RESOURCES TO AND SUPPORT TO VICTIMS OF VIOLENCE2.2.1 SUPPORT VICTIMS OF VIOLENCE BY INCREASING THE CAPACITY OF STAFF TO RECOGNIZE AND RESPOND TO VIOLENCE, SUPPORT COMMUNITY PARTNERS LEADING VIOLENCE PREVENTION EFFORTS AND CARE FOR VICTIMS OF VIOLENCE, AND INCREASE THE FORENSIC NURSE EXAMINER WORKFORCE.THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS: CANCER AND CHRONIC DISEASE: IN ORDER TO MEANINGFULLY ADDRESS THE SELECT PRIORITY HEALTH NEEDS ABOVE AND MAXIMIZE IMPACT, ST. FRANCIS & SNU DID NOT PRIORITIZE WORK IN THIS AREA. HOWEVER, THERE IS SIGNIFICANT OUTREACH AND PREVENTION WORK THAT WILL CONTINUE AT THE HOSPITAL, SUCH AS PARTICIPATION IN HEALTH FAIRS, PARTNERING WITH ORGANIZATIONS SERVING THE AGING POPULATION, AND A NUMBER OF EDUCATIONAL SUPPORT GROUPS THAT IMPACT THESE HEALTH AREAS. ADDITIONALLY, THERE ARE EXISTING BODIES OF WORK BEING LED BY COMMUNITY PARTNERS, AND ST. FRANCIS IS ENGAGED WITH THIS GROUP TO DETERMINE ITS ROLE IN ADDRESSING BARRIERS TO, AND PROMOTING HEALTHY EATING AND ACTIVE LIVING ACROSS THE COMMUNITY. MATERNAL, INFANT, AND CHILD HEALTH: THE PRIMARY FACTORS DRIVING THIS HEALTH NEED ARE RELATED TO A SHORTAGE OF OBSTETRICS AND GYNECOLOGICAL PROVIDERS. AS THE HOSPITAL WILL BE WORKING WITH THE HEALTH DEPARTMENT LED WORK GROUP TO IDENTIFY AND ADDRESS GAPS IN THE CONTINUUM OF HEALTHCARE AND HEALTH RELATED SERVICES FOR ALL, AND IN ORDER TO ENSURE RESOURCES CAN BE LEVERAGED TO MAKE IMPACT IN THE PRIORITIZED HEALTH NEED AREA ACCESS TO CARE, ST. FRANCIS & SNU WILL NOT BE WRITING A STRATEGY TO ADDRESS THIS SPECIFIC HEALTH NEED. HOWEVER, CHI HEALTH ST. FRANCIS IS WORKING WITH HEARTLAND HEALTH TO PROVIDE INCREASED OBSTETRICS AND GYNECOLOGICAL SERVICES AT THE FEDERALLY QUALIFIED HEALTH CENTER AND WILL CONTINUE TO EXPLORE OPPORTUNITIES TO IMPROVE HEALTH OUTCOMES BOTH INTERNALLY AND WITH PARTNERS. SOCIAL DETERMINANTS OF HEALTH: LEADERS REPRESENTING BOTH HOSPITALS ARE ACTIVELY ENGAGING ON A REGULAR BASIS WITH COMMUNITY PARTNERS WHO ARE CURRENTLY DOING WORK IN THIS AREA, SUCH AS GROW GRAND ISLAND, HALL COUNTY COMMUNITY COLLABORATIVE, AND CENTRAL DISTRICT HEALTH DEPARTMENT. MUCH OF THE WORK TO ADDRESS THIS HEALTH NEED AREA FOCUSES ON IMPROVING SOCIAL FACTORS SUCH AS POVERTY AND HOUSING. WHILE IT WILL BE IMPORTANT FOR THE HOSPITALS TO SUPPORT THIS WORK, THE COMMUNITY IS WORKING ON COLLECTIVE STRATEGIES AND THE HOSPITAL IS DETERMINING ITS ROLE IN SUPPORTING THE WORK AS CONVERSATIONS PROGRESS. AS SUCH, ST. FRANCIS & SNU WILL NOT WRITE A STRATEGY TO ACTIVELY ADDRESS THIS BROAD HEALTH NEED UNTIL THE HOSPITALS' ROLES BECOME CLEARER.VIOLENCE/ INJURY: IN ORDER TO MEANINGFULLY ADDRESS THE SELECTED PRIORITIES, THE HOSPITAL WILL NOT CREATE A SPECIFIC STRATEGY AROUND THIS HEALTH AREA. HOWEVER, VIOLENCE IN THE COMMUNITY 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. ADDITIONALLY, ST. FRANCIS FOUNDATION WILL CONTINUE TO FOCUS ON ADDRESSING HUMAN TRAFFICKING AND INTERPERSONAL VIOLENCE BY STRENGTHENING THE CAPACITY OF HEALTH CARE WORKERS TO RECOGNIZE AND ADDRESS VIOLENCE, AND ALSO SUPPORTING COMMUNITY PARTNERS WHO LEAD THIS WORK IN GRAND ISLAND 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 2022, THE RELATED IMPLEMENTATION PLAN WAS NOT APPROVED UNTIL JULY, 2022. 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 PRIMARY DATA OBTAINED THROUGH A SECONDARY DATA REVIEW AND THREE COMMUNITY INPUT SESSIONS.TOP HEALTH NEEDS (FROM 2019 CHNA):1. ACCESS TO CARE2. AGING ISSUES3. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH & SUBSTANCE ABUSE)4. CULTURE OF HEALTH (ALSO IDENTIFIED AS SOCIAL DETERMINANTS OF HEALTH)5. MATERNAL, INFANT & CHILD HEALTH6. OBESITY7. VIOLENCE

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.

PART V, SECTION B, LINE 11 (CONTINUED):
PRIORITY HEALTH NEED #1: ACCESS TO HEALTHCARE SERVICESTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:1.1: SUPPORT A HEALTH-DEPARTMENT LED WORK GROUP IN IDENTIFYING AND ADDRESSING KNOWN BARRIERS TO ACCESSING TIMELY AND EFFECTIVE HEALTH CARE IN HALL COUNTY, TO ENSURE SERVICES ARE COORDINATED, OPTIMIZED, AND PROMOTED1.1.1: COLLABORATE WITH EXISTING SAFETY-NET PROVIDERS (CENTRAL DISTRICT HEALTH DEPARTMENT, HEARTLAND HEALTH, THIRD CITY COMMUNITY CLINIC, COMMUNITY SCHOOL & HEARTLAND UNITED WAY, OTHERS) THROUGH A HEALTH DEPARTMENT LED WORK GROUP TO IDENTIFY AND ADDRESS GAPS IN THE CONTINUUM OF HEALTHCARE AND HEALTH RELATED SERVICES FOR ALL. (CHI HEALTH ST. FRANCIS & SKILLED NURSING FACILITY) WORK MAY FOCUS ON:- IMPROVING COLLABORATION BETWEEN EMERGENCY DEPARTMENT AND THE SAFETY NET PROVIDERS (HEARTLAND HEALTH FEDERALLY QUALIFIED HEALTH CENTER, AND THIRD CITY COMMUNITY CLINIC) TO ENSURE REFERRAL OF RELEVANT PATIENTS TO THE FQHC MEDICAL HOME, AND/OR COMMUNICATING WITH THE PATIENTS PRIMARY CARE PHYSICIAN REGARDING ED VISIT- ENSURE SERVICES ARE OPTIMIZED ACROSS PROVIDERS AND REDUCE DUPLICATION WHERE POSSIBLE- ENSURE THE CONNECTION AND COMMUNICATION TO SOCIAL SERVICE PROVIDERS IN SUPPORT OF MEETING PATIENTS SOCIAL NEEDS WHICH MAY BE AFFECTING THEIR HEALTH- IDENTIFYING COMMON BARRIERS TO ACCESSING TIMELY AND EFFECTIVE CARE WHEN NEEDED (I.E. TRANSPORTATION, LACK OF CHILD CARE, OR HOURS OF OPERATION) AND WORK COLLECTIVELY TO IDENTIFY STRATEGIES TO REDUCE BARRIERS- ASSESS AND ADDRESS GAPS IN ACCESSING HEALTHCARE SERVICES FOR THE AGING POPULATION SPECIFICALLY (SKILLED NURSING FACILITY)1.2: EXPLORE WORK RELATED TO SCHOOL-BASED PRIMARY HEALTH CARE AND DETERMINE NEED AND CAPACITY TO INCREASE/IMPROVE SERVICES ALREADY OFFERED BY CHI HEALTH ST. FRANCIS IN SCHOOL SETTINGS. (CHI HEALTH ST. FRANCIS)PRIORITY HEALTH NEED #2: BEHAVIORAL HEALTH (TO INCLUDE MENTAL HEALTH, SUBSTANCE ABUSE, AND VIOLENCE)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:2.1: ENGAGE WITH CENTRAL DISTRICT HEALTH DEPARTMENT AND HALL COUNTY COMMUNITY COLLABORATIVE (H3C) TO IMPROVE CLINICAL AND COMMUNITY-BASED BEHAVIORAL HEALTH SERVICES, AND ADDRESS GAPS IN CARE TO ENSURE BEHAVIORAL HEALTH SERVICES ARE OPTIMIZED WITHIN THE HALL COUNTY COMMUNITY.2.1.1: ENGAGE WITH CENTRAL DISTRICT HEALTH DEPARTMENT (CDHD) LEADERSHIP AND HALL COUNTY COMMUNITY COLLABORATIVE (H3C) TO CONTINUE TO BUILD CAPACITY AND SUSTAINABILITY OF THE COLLECTIVE IMPACT BEHAVIORAL HEALTH COALITION WHICH MAY INCLUDE FUNDING AND/OR TECHNICAL ASSISTANCE (CHI HEALTH ST. FRANCIS)2.2: SUPPORT THE COALITION TO PRIORITIZE COLLECTIVE STRATEGIES TO ADDRESS MENTAL HEALTH, SUBSTANCE ABUSE, AND VIOLENCE ISSUES WHICH MAY INCLUDE (CHI HEALTH ST. FRANCIS):2.2.1: PROMOTE AND SUPPORT COMMUNITY-BASED TRAININGS RELATED TO CRISIS RESPONSE FOR COMMUNITY-BASED PUBLIC HEALTH AND SOCIAL SERVICE PROVIDERS.2.2.2: SUPPORTING REGION 3 STRATEGY TO CREATE A YOUTH SYSTEM OF CARE2.2.3: COLLABORATE WITH LAW ENFORCEMENT ON INVOLUNTARY COMMITMENTS TO IMPROVE THE RELEVANT PLACEMENT FOR BEHAVIORAL HEALTH PATIENTS (CIVIL PROTECTIVE CUSTODY) AND EXPLORE OPPORTUNITIES TO ADVOCATE FOR LEGISLATIVE CHANGE ALLEVIATING CHALLENGES WITH PLACEMENT.2.2.4: CONTINUED SUPPORT TO FAMILY PROGRAMS SUPPORTING PARENTS AND BUILDING STRONGER FAMILY CONNECTIONS (I.E. ROOTED IN RELATIONSHIPS AND CIRCLE OF SECURITY) AND SOCIAL EMOTIONAL LEARNING FOR CHILDREN (I.E. DISCOVERY KIDS)2.2.5 EXPLORE GAPS AND BUILD CAPACITY TO ADDRESS OPIOID ADDICTION IN THE AREA2.2.6 EXPLORE EXISTING VIOLENCE PREVENTION EFFORTS AND IDENTIFY AND BUILD CAPACITY TO ADDRESS GAPS IN COMMUNITY RESPONSE TO VIOLENCE

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 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 ESTATE.

PART I, LINE 6A:
THE 2021 COMMUNITY BENEFIT REPORT FOR ST. FRANCIS MEDICAL CENTER 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 I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 21,192.

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.

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:
SAINT FRANCIS MEDICAL CENTER MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. SAINT FRANCIS MEDICAL CENTER'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. SAINT FRANCIS MEDICAL CENTER 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, SAINT FRANCIS MEDICAL CENTER 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:
"SAINT FRANCIS MEDICAL CENTER 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. SAINT FRANCIS MEDICAL CENTER'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $12,458,333 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:
THE 2020 POPULATION FOR HALL COUNTY WAS 62,895, AND INCREASED BY 7.3% SINCE 2010. AS OF 2019, 13.9% OF RESIDENTS IN THE COUNTY WERE BORN OUTSIDE THE UNITED STATES AND 90.9% WERE CITIZENS, A SLIGHT INCREASE FROM 2018. IN 2019, 27.7% OF THE RESIDENTS IN HALL COUNTY WERE HISPANIC. HALL COUNTY IS UNIQUELY A MULTICULTURAL COMMUNITY. COMPARED TO NEIGHBORING COUNTIES OF HAMILTON AND MERRICK, WITH BETWEEN ONE AND TWO PERCENT OF THEIR POPULATIONS BEING FOREIGN BORN, THIS IS A SIGNIFICANT PORTION OF THE HALL COUNTY POPULATION, AND PRESENTS UNIQUE CHALLENGES FOR HEALTHCARE AND OTHER PUBLIC SECTOR SERVICES. A REVIEW OF THE SOCIOECONOMIC FACTORS SHOW HALL COUNTY IS SLIGHTLY BELOW THE STATE FOR MEDIAN HOUSEHOLD INCOME, AND SLIGHTLY HIGHER IN OVERALL POVERTY RATES. POVERTY RATES HAVE INCREASED SLIGHTLY FROM 12.0% IN 2018 TO 12.8% IN 2019 FOR HALL COUNTY, WHILE THERE WAS A DECREASE FROM 10.8% TO 9.2% FOR NEBRASKA OVERALL. THE PERCENTAGE OF CHILDREN IN POVERTY (17.2% FOR HALL COUNTY) HAS REMAINED THE SAME SINCE 2018, AND IS LOWER THAN THE STATE AT 18.5%. WHEN LOOKING AT THE PERCENTAGE OF CHILDREN IN POVERTY IN HALL COUNTY BY RACE AND ETHNICITY, WE SEE A LARGE DISPARITY WITH 21.9% OF HISPANIC OR LATINO AND 46.2% OF BLACK OR AFRICAN AMERICAN CHILDREN IN POVERTY. HALL COUNTY ALSO HAS A HIGHER PERCENT OF CHILDREN LIVING IN SINGLE PARENT HOUSEHOLDS AT 29% COMPARED TO 21% ACROSS THE STATE. THESE DISPARITIES ARE SEEN AT BOTH THE STATE AND NATIONAL LEVELS. SINCE THE 2019 CHNA, HALL COUNTY AND NEBRASKA OVERALL HAVE SEEN IMPROVEMENT IN UNEMPLOYMENT RATES. THE PERCENT OF THE POPULATION UNDER 65 YEARS OF AGE WITHOUT HEALTH INSURANCE HAS DROPPED FROM 13.4% DOWN TO 11.9% IN HALL COUNTY, AND FROM 9.6% TO 8.2% IN NEBRASKA OVERALL. HALL COUNTY IS DESIGNATED A HEALTH PROFESSIONAL SHORTAGE AREA IN MENTAL HEALTH WITH A HPSA SCORE OF 11. THE SCORE RANGES FROM 0-26 WHERE THE HIGHER THE SCORE, THE GREATER THE PRIORITY. HALL COUNTY IS CONSIDERED A MEDICALLY UNDERSERVED AREA IN PRIMARY CARE WITH AN INDEX OF MEDICAL UNSERVED SCORE OF 59.2 (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).GRAND ISLAND HAS A WIDE RANGE OF HEALTHCARE PROVIDERS, INCLUDING MEDICAL, DENTAL, AND MENTAL HEALTH SERVICES THAT NOT ONLY ADDRESS THE NEEDS OF THE LOCAL POPULATION, BUT ALSO RESIDENTS FROM THROUGHOUT CENTRAL NEBRASKA AND FROM ACROSS THE STATE. POPULATION HEALTH SERVICES ARE PROVIDED THROUGH COMMUNITY HEALTH WORKERS AND DIABETES EDUCATORS EMBEDDED WITHIN THE HEALTH DEPARTMENT AND MULTICULTURAL COALITION OF GRAND ISLAND. SOME OF THE PROMINENT HEALTH PROVIDERS AVAILABLE THROUGHOUT THE COUNTY, INCLUDE: -CHI HEALTH CLINICS IN GRAND ISLAND -GRAND ISLAND REGIONAL MEDICAL CENTER -HEARTLAND HEALTH CENTER -THIRD CITY COMMUNITY CLINIC -CHOICE FAMILY HEALTH CARE -URGENT CARE CLINICS (TWIN RIVERS, CHI HEALTH QUICK CARE) -CENTRAL DISTRICT HEALTH DEPARTMENT -CHI HEALTH ST. FRANCIS CANCER TREATMENT CENTER -CHI HEART HEALTH -GRAND ISLAND VA MEDICAL CENTER -GRAND ISLAND CLINIC -LITZENBERG MEMORIAL COUNTY HOSPITAL -MEMORIAL COMMUNITY HEALTH -MID-PLAINS CENTER FOR BEHAVIORAL HEALTH

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.