4A (Expenses $ 85351285 including grants of $ 44982) (Revenue $ 135738720)
ALEGENT HEALTH-BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS OFFER PATIENTS THE MOST COMFORTABLE AND COMPREHENSIVE OPERATING ROOM SERVICES.

4B (Expenses $ 69494045 including grants of $ 55436) (Revenue $ 167286797)
BERGAN MERCY MEDICAL CENTER IS EQUIPPED WITH THE LATEST TECHNOLOGIES IN THE DIAGNOSTIC CENTER. THE CENTER IS COMPLETELY DIGITAL SO PATIENTS ARE NEVER WAITING ON FILMS. FEMALE PATIENTS CAN COUNT ON EXPERT IMAGING TESTS INCLUDING ULTRASOUND, BONE DENSITY TESTING, STEREOTACTIC BREAST BIOPSY AND DIGITAL MAMMOGRAPHY. THERE ARE A WIDE RANGE OF AVAILABLE TESTS AT THE DIAGNOSTIC CENTER THAT INCLUDE THE FOLLOWING: DIGITAL MAMMOGRAPHY, MRI AND OPEN MRI, CT, PET CT AND CARDIAC CT, 64-SLICE CT, FLUOROSCOPY, PULMONARY FUNCTION TESTING, ULTRASOUND, CARDIOVASCULAR IMAGING, PHLEMBOTOMY, NUCLEAR MEDICINE, DIGITAL IMAGING, EEG, EKG AND EMG, STRESS TESTING AND ARTERIOGRAM.

4C (Expenses $ 40740957 including grants of $ 23365) (Revenue $ 70507299)
BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS OFFER A WIDE RANGE OF CARDIOVASCULAR SERVICES IN THE REGION, USING A TEAM APPROACH TO ADDRESS THE TOTAL NEEDS OF THE CARDIOVASCULAR PATIENT. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM PROVIDES A COMPREHENSIVE RANGE OF CARDIAC SERVICES, INCLUDING BUT NOT LIMITED TO: VASCULAR AND CARDIAC SURGERY, HEART SCANS AND HEART CHECKS, CARDIAC REHABILITATION, VASCULAR ULTRASOUND, NUCLEAR STRESS TESTS, DUAL SOURCE CT SCANNER AND ANGIOPLASTY. IN 2006, MERCY HOSPITAL OPENED A NEW STATE-OF-THE-ART CARDIAC CATHETERIZATION LAB, ALLOWING PHYSICIANS TO PERFORM PROCEDURES SUCH AS HEART CATHETERIZATIONS, CORONARY INTERVENTIONS INCLUDING BALLOON ANGIOPLASTY AND STENTING, AS WELL AS IMPLANTATION OF PACEMAKERS AND DEFIBRILLATORS.

4D (Expenses $ 394675249 including grants of $ 82308) (Revenue $ 248378594)
BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS PROVIDE A LARGE RANGE OF HOSPITAL SERVICES INCLUDING BUT NOT LIMITED TO: EMERGENCY DEPARTMENT, INPATIENT HOSPITAL FACILITIES, PROCEDURE CENTER, ORTHOPEDIC SERVICES, DIGESTIVE HEALTH CENTER, FAMILY LIFE CENTER, RADIOLOGY, UROLOGY AND PHYSICAL THERAPY. PATIENTS ARE AT THE CENTER OF EVERYTHING DONE AT BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS.

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: CHI HEALTH CUMC - BERGAN MERCY, - FACILITY 2: CHI HEALTH MERCY COUNCIL BLUFFS, - FACILITY 3: LASTING HOPE RECOVERY CENTER

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
IN CONDUCTING ITS MOST RECENT CHNA, THE CHI HEALTH CREIGHTON UNIVERSITY MEDICAL CENTER - BERGAN MERCY 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. IN THIS CYCLE OF THE CHNA PROCESS, PROFESSIONAL RESEARCH CONSULTANTS (PRC), A THIRD-PARTY NATIONAL HEALTHCARE RESEARCH FIRM, CONTRACTED BY LOCAL HEALTH SYSTEMS (INCLUDING CHI HEALTH) AND HEALTH DEPARTMENTS. THE ASSESSMENT CONDUCTED ENCOMPASSED A FOUR-COUNTY AREA, INCLUDING POTTAWATTAMIE COUNTY, IOWA AND DOUGLAS, SARPY, AND CASS COUNTIES, NEBRASKA. THE ASSESSMENT WAS COMPOSED OF A SECONDARY DATA ANALYSIS, COMMUNITY HEALTH SURVEY, ONLINE KEY INFORMANT, AND COMMUNITY PRESENTATION. BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), ALONG WITH OTHER PUBLIC HEALTH SURVEYS, AND CUSTOMIZED TO ADDRESS GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION, DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES, THE PRC COMMUNITY HEALTH SURVEY WAS DEVELOPED BY THE SPONSORING ORGANIZATIONS AND PRC. THE SURVEY WAS KEPT SIMILAR TO A PREVIOUS SURVEY USED IN THE REGION IN 2011, 2015, AND 2018 TO ALLOW FOR TREND ANALYSIS. THE PRC COMMUNITY HEALTH SURVEY WAS COMPLETED BY 2,527 RESIDENTS VIA MIXED MODE METHODOLOGY, INCLUDING A TELEPHONE SURVEY WHICH INCORPORATED BOTH LANDLINE AND CELL PHONE INTERVIEWS, AS WELL AS THROUGH ONLINE QUESTIONNAIRES, AND UTILIZED A STRATIFIED RANDOM SAMPLE OF INDIVIDUALS AGE 18 AND OVER ACROSS THE METRO AREA. THE HIGHER DOUGLAS COUNTY SAMPLE REFLECTS A TARGET OF 50 SURVEYS PER ZIP CODE WITHIN THE COUNTY (ALTHOUGH SOME LESSER-POPULATED ZIP CODES DID NOT REACH THIS THRESHOLD). ONCE THE INTERVIEWS WERE COMPLETED, THESE WERE WEIGHTED IN PROPORTION TO THE ACTUAL POPULATION DISTRIBUTION SO AS TO APPROPRIATELY REPRESENT THE METRO AREA AS A WHOLE. PARTICIPANTS IN THE KEY INFORMANT SURVEY WERE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY AND WERE IDENTIFIED THROUGH THE SPONSORING ORGANIZATIONS. THE LIST INCLUDED PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS WHO THE SPONSORS FELT WERE ABLE TO IDENTIFY PRIMARY CONCERNS WITHIN THE POPULATIONS THEY SERVE, AS WELL AS THE COMMUNITY AS A WHOLE. KEY INFORMANTS WERE CONTACTED VIA EMAIL TO INTRODUCE THE PURPOSE OF THE SURVEY AND WERE PROVIDED A LINK TO COMPLETE THE SURVEY ONLINE. A TOTAL OF 150 KEY INFORMANTS COMPLETED THE SURVEY. DATA PRESENTATION AND DISCUSSION WAS IMPLEMENTED AT THE WELLBEING PARTNERS XCHANGE SUMMIT. COMMUNITY INPUT WAS COLLECTED AT THE XCHANGE SUMMIT ON OCT 6, 2021, CO-SPONSORED BY THE LOCAL AREA HOSPITAL SYSTEMS- CHI HEALTH, METHODIST HEALTH SYSTEM, CHILDREN'S HOSPITAL & MEDICAL CENTER AND NEBRASKA MEDICINE- ALONG WITH SEVERAL OTHER NON-GOVERNMENTAL HEALTH AND SOCIAL SERVICE ORGANIZATIONS. OVER 94 INDIVIDUALS REPRESENTING HEALTHCARE, PUBLIC HEALTH, SOCIAL SERVICES AND OTHERS ENGAGED IN A COMMUNITY CONVERSATION TO DIVE DEEPER INTO RESOURCES AND GAPS IN OUR REGIONAL APPROACH TO MENTAL HEALTH.IN CONDUCTING ITS MOST RECENT CHNA, THE CHI MERCY COUNCIL BLUFFS 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 THE TWO COUNTIES SERVED BY CHI HEALTH MERCY COUNCIL BLUFFS WAS ACCOMPLISHED BY USING DATA AND COMMUNITY INPUT FROM TWO SEPARATE PROCESSES: THE OMAHA METRO AREA PROCESS, LED BY PROFESSIONAL RESEARCH CONSULTANTS AND THE MILLS COUNTY PROCESS LED BY CHI MERCY COUNCIL BLUFFS, IN PARTNERSHIP WITH MILLS COUNTY PUBLIC HEALTH DEPARTMENT (MCPH).IN ORDER TO PRIORITIZE HEALTH NEEDS FOR MILLS COUNTY, CHI HEALTH MERCY COUNCIL BLUFFS PRESENTED TO THE HEALTHY MILLS COALITION IN PARTNERSHIP WITH MCPH ON DECEMBER 10, 2021 AND FACILITATED A DISCUSSION TO PRIORITIZE NEEDS. AFTER SMALL GROUP DISCUSSIONS WERE COMPLETED, A LARGE GROUP DISCUSSION WAS FACILITATED BY CHI MERCY COUNCIL BLUFFS TO IDENTIFY THEMES, RANK TOP NEEDS, BUILD CONSENSUS AND VOTE. THE HEALTHY MILLS COALITION MEETING REPRESENTED THOSE WHO SERVE MINORITY, AT-RISK, UNINSURED, AND AGING POPULATIONS, AS WELL AS THOSE AFFECTED BY VIOLENCE. PARTICIPATING AGENCIES INCLUDED: MILLS COUNTY PUBLIC HEALTH, GLENWOOD FIRE DEPARTMENT, GLENWOOD POLICE DEPARTMENT, CAMPUS LIFE, MILLS COUNTY EXTENSION, GOLDEN HILLS RESOURCE CONSERVATION AND DEVELOPMENT (BOOST4FAMILIES), HEARTLAND FAMILY SERVICE, WEST CENTRAL COMMUNITY ACTION - HEAD START, WEST CENTRAL COMMUNITY ACTION, FAMILY, INC., AND FINANCIAL ADVOCATE.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:
- CHI HEALTH CREIGHTON UNIVERSITY MEDICAL CENTER BERGAN MERCY- CHI HEALTH IMMANUEL- CHI HEALTH LAKESIDE- CHI HEALTH MERCY COUNCIL BLUFFS- CHI HEALTH MIDLANDS- LASTING HOPE RECOVERY CENTER- NEBRASKA SPINE HOSPITAL (A JOINT VENTURE)- NEBRASKA MEDICINE (BELLEVUE MEDICAL CENTER AND NEBRASKA MEDICAL CENTER)- METHODIST HEALTH SYSTEM (METHODIST HOSPITAL, METHODIST JENNIE EDMUNDSON HOSPITAL, AND METHODIST WOMEN'S HOSPITAL)

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:
- PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC)- DOUGLAS COUNTY HEALTH DEPARTMENT- POTTAWATTAMIE COUNTY PUBLIC HEALTH- SARPY/CASS HEALTH DEPARTMENT- MILLS COUNTY PUBLIC HEALTH- HEALTHY MILLS COALITION- OMAHA COMMUNITY FOUNDATION- CHARLES DREW HEALTH CENTER, INC.- ONE WORLD COMMUNITY HEALTH CENTERS, INC.- THE WELLBEING PARTNERS

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 7D:
THIS CHNA WAS COMPLETED IN PARTNERSHIP WITH THE HEALTH DEPARTMENT AND HEALTH SYSTEMS, IN ADDITION PRESENTATIONS WERE MADE TO REGIONAL HEALTH COUNCIL ON APRIL 12TH, 2022, CHI MERCY COUNCIL BLUFFS ON MAY 10TH, 2022, CHI CUMC-BM COMMUNITY BOARD ON MAY 12TH, 2022, CHI IMMANUEL COMMUNITY BOARD ON MAY 19TH , 2022, CHI LAKESIDE COMMUNITY BOARD ON JUNE 2ND, 2022, AND CHI MIDLANDS COMMUNITY BOARD ON JUNE 7TH, 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 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 PRIMARY AND SECONDARY DATA REVIEW INCLUDING A COMMUNITY SURVEY, AND KEY INFORMANT INTERVIEWS.TOP HEALTH NEEDS (FROM 2022 CHNA): 1. MENTAL HEALTH2. ACCESS TO INTEGRATED CARE/ SYSTEMS OF CARE3. NUTRITION, PHYSICAL ACTIVITY & WEIGHT4. SUBSTANCE ABUSE5. DIABETES6. SEXUAL HEALTH7. INJURY & VIOLENCE8. HEART DISEASE & STROKE9. TOBACCO USE10. INFANT HEALTH & FAMILY PLANNING11. POTENTIALLY DISABLING CONDITIONS12. ORAL HEALTH13. ACCESS TO HEALTH CARE SERVICES14. RESPIRATORY DISEASE15. CANCERFOR THIS PLAN THE HOSPITALS PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: BEHAVIORAL HEALTH (MENTAL HEALTH/SUBSTANCE MISUSE)TO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023-2025:- EXPAND ACCESS TO MENTAL HEALTH SERVICES FOR YOUTH * OPERATE AN INTEGRATED SCHOOL-BASED MENTAL HEALTH PROGRAM * PURSUE THE ESTABLISHMENT OF THE LASTING HOPE CENTER FOR CHILDREN AND FAMILIES- EXPAND ACCESS TO RESOURCES FOR INDIVIDUALS LIVING WITH ALZHEIMER'S AND DEMENTIA- RELATED DISEASES (ADRD) * PROVIDE SUPPORT FOR INDIVIDUALS WITH ALZHEIMER'S/ DEMENTIA AND THEIR CAREGIVERS (SYSTEM)- EXPAND ACCESS TO BEHAVIORAL HEALTH SERVICES FOR ADULTS IN CRISIS * CONTINUE TO PROVIDE ACCESS TO OUTPATIENT BEHAVIORAL HEALTH SERVICES AND REDUCE BEHAVIORAL HEALTH READMISSIONS THROUGH LASTING HOPE RECOVERY CENTER OUTPATIENT CLINIC- ADVOCATE FOR POLICY CHANGE * LEAD POLICY AND ADVOCACY EFFORTS THAT EXPAND ACCESS TO BEHAVIORAL HEALTH SERVICES * SUPPORT SARPY/CASS TOBACCO COALITION - DECREASE BEHAVIORAL HEALTH WORKFORCE SHORTAGE THROUGH EDUCATIONAL PARTNERSHIPS * DEVELOP, IMPLEMENT AND EVALUATE BEHAVIORAL HEALTH WORKFORCE RECRUITMENT AND RETENTION STRATEGIES- REDUCE MENTAL HEALTH STIGMA * SUPPORT INTERNAL/ COMMUNITY MENTAL HEALTH STIGMA REDUCTION CAMPAIGNS- EARLY DETECTION OF DEPRESSION AND CONNECTION TO MENTAL HEALTH SERVICES AMONG PREGNANT PEOPLE * CONDUCT PERINATAL DEPRESSION SCREENING DURING PRENATAL VISIT, WHILE INPATIENT FOR DELIVERY AND AT POSTPARTUM VISIT- PREVENT SUICIDE * EXPLORE LOCAL SCHOOL NEEDS REGARDING SUICIDE PREVENTION SUICIDE AND PROVIDE TRAINING AND FINANCIAL RESOURCES (E.G. QUESTION. PERSUADE. RESPOND (QPR), MENTAL HEALTH FIRST AID, ETC.)- PARTNER WITH THE REGION TO PROMOTE ADULT/YOUTH MENTAL HEALTH FIRST AID TRAINING- PARTNER WITH MILLS COUNTY PUBLIC HEALTH TO ADMINISTER COMMUNITY-BASED PROGRAMMING FOR JUSTICE INVOLVED FAMILIES AFFECTED BY SUBSTANCE ABUSE. PRIORITY HEALTH NEED #2: HEALTH-RELATED SOCIAL NEEDSTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023-2025:- HEALTHY FOOD ACCESS * IMPLEMENT AND EVALUATE A FOOD PRESCRIPTION PROGRAM PILOT * PROVIDE FINANCIAL SUPPORT AND PROMOTION OF DOUBLE UP FOOD BUCKS, A SNAP INCENTIVE PROGRAM * PROVIDE FINANCIAL SUPPORT TO ORGANIZATIONS ADDRESSING FOOD SECURITY, SUCH AS SAVING GRACE * SUPPORT A SENIOR AND WIC FARMERS MARKET VOUCHER REDEMPTION PROGRAM AND POP UP FARMSTANDS- FINANCIAL LITERACY * PROVIDE FINANCIAL SUPPORT AND PROMOTION OF THE BRIDGES OUT OF POVERTY FINANCIAL LITERACY PROGRAM- SUPPORT EFFORTS TO ADDRESS HOUSING STABILITY * IMPLEMENT AND SUSTAIN A MEDICAL RESPITE PROGRAM * SUPPORT A HEALTH AND HOUSING COALITION * EVALUATE AND SUSTAIN AN INPATIENT HOUSING CASE MANAGEMENT PROGRAM - ADDRESS TRANSPORTATION BARRIERS TO ACCESSING HEALTHCARE SERVICES * CONVENE AN INTERNAL WORKING GROUP TO EXPLORE OPPORTUNITIES TO MEET PATIENT TRANSPORTATION NEEDS- SOCIAL NEEDS INTEGRATION * DEVELOP AND TEST REFERRAL PROCESSES FOR SOCIAL NEEDS THROUGH UNITE US * LEVERAGE COMMUNITY HEALTH WORKERS TO IMPROVE PATIENT OUTCOMES AND REDUCE HEALTH DISPARITIES * SUPPORT THE IMPLEMENTATION OF PATHWAYS COMMUNITY HUB TO SUSTAIN A COMMUNITY HEALTH WORKER (CHW) WORKFORCE IN THE OMAHA METRO AND REDUCE DISPARATE MATERNAL AND INFANT HEALTH OUTCOMES - INCREASE THE NUMBER AND DIVERSITY OF YOUTH INTERESTED IN HEALTH CARE CAREERS * CREATE A HEALTH CARE CAREER PIPELINE FOR STUDENTS * SUPPORT SIEMBRA SALUD, HEALTH CAREER LADDER PROGRAM (SYSTEM) - LEVERAGE PUBLIC HEALTH NURSES TO CONDUCT HOME-BASED RISK ASSESSMENTS OF FREQUENT EMS UTILIZERS AND COORDINATE REFERRALS TO COMMUNITY-BASED SERVICES- CONNECTION TO COMMUNITY-BASED SERVICES FOR UNMET HEALTH NEEDSPRIORITY HEALTH NEED #3: VIOLENCE PREVENTION & INTERVENTIONTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN FISCAL YEARS 2023-2025:- PROVIDE RESOURCES AND SUPPORT TO VICTIMS OF VIOLENCE * SUPPORT AND EXPAND THE FORENSIC NURSE EXAMINER PROGRAM * SUPPORT TRAUMA RESPONSE, INCLUDING INPATIENT CASE MANAGEMENT AND COMMUNITY-BASED VIOLENCE INTERVENTION EFFORTS - PREVENT VIOLENCE AND INTERVENE WHEN IT IS SUSPECTED * INCREASE HEALTH SYSTEM AND COMMUNITY CAPACITY TO IDENTIFY VICTIMS OF HUMAN TRAFFICKING AND RESPOND APPROPRIATELY- PROVIDE TRAUMA-INFORMED CARE FOR PATIENTS * EXPLORE ONGOING OPPORTUNITIES TO PROMOTE TRAUMA INFORMED CARE PRACTICES WITHIN THE BEHAVIORAL HEALTH SERVICE LINE- SUPPORT SCHOOL-BASED PROGRAMMING TO INCREASE PROTECTIVE FACTORS AND REDUCE RISK FACTORS FOR VIOLENCE * PROVIDE FUNDING TO COMMUNITY-BASED ORGANIZATIONS DELIVERING EDUCATION AND TRAINING TO LOCAL SCHOOLSSEE PART V, SECTION B, LINE 11 DISCLOSURE 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. ACCESS TO HEALTHCARE SERVICES - ACCESS TO CARE IS A FUNDAMENTAL COMPONENT OF CHI HEALTH'S MISSION AND STRATEGY. THIS ISSUE WAS NOT ELEVATED TO A PRIORITY FOR THIS PARTICULAR PLAN BECAUSE THE INTENT WAS TO IDENTIFY ADDITIONAL STRATEGIES AND INITIATIVES THAT REACH ABOVE AND BEYOND CHI HEALTH'S TYPICAL BUSINESS. FOR EXAMPLE, CHI HEALTH CONTINUES TO OFFER A WIDE ARRAY OF PRIMARY CARE ACCESS POINTS INCLUDING: EXTENDED CLINIC HOURS, PRIORITY CARE SERVICES (WALK-IN CARE), QUICK CARE AND VIRTUAL CARE. ADDITIONAL PROGRAMS LIKE MD SAVE, WHICH ALLOWS PATIENTS TO PRE-PURCHASE CERTAIN SERVICES AT A DISCOUNTED PRICE, AND THE MEDICATION ACCESS PROGRAM (A PRESCRIPTION MEDICATION FINANCIAL ASSISTANCE PROGRAM), ARE WORKING TO LOWER THE COST OF CARE TO THE CONSUMER. IN ADDITION TO PROVIDING THE MAJORITY OF CARE TO THE UNINSURED AND UNDERINSURED IN THE OMAHA METRO AREA, CHI HEALTH WILL CONTINUE TO ADDRESS ACCESS TO HEALTHCARE SERVICES THROUGH FINANCIAL SUPPORT PROVIDED TO THE MAGIS CLINIC, HOPE MEDICAL, FEDERALLY QUALIFIED HEALTH CENTERS-CHARLES DREW AND ONE WORLD COMMUNITY HEALTH CENTER-AND THROUGH FREE HEALTH SCREENINGS AND IMMUNIZATION CLINICS IN THE COMMUNITY. CHI HEALTH PARTNERS WITH NELSON MANDELA ELEMENTARY TO PROVIDE SCHOOL-BASED HEALTH SERVICES THROUGH A CONTRACTED NURSING MODEL. IN ADDITION, CHI HEALTH MERCY COUNCIL BLUFFS WILL BE WORKING TO ALIGN WITH ALLCARE HEALTH CENTER AND POTTAWATTAMIE COUNTY PUBLIC HEALTH DEPARTMENT AS WORK DEVELOPS TO ADDRESS SPECIFIC ACCESS-RELATED STRATEGIES. 2. CANCER - CHI HEALTH DID NOT PRIORITIZE CANCER AS A TOP HEALTH NEED BASED ON THE CONSIDERATIONS ABOVE AND IN ORDER TO FOCUS AND MEANINGFULLY IMPACT OTHER AREAS OF NEED. CHI HEALTH WILL CONTINUE TO PERFORM EXISTING CANCER OUTREACH THROUGHOUT THE COMMUNITY AND FINANCIALLY SUPPORT COMMUNITY PARTNERS SUCH AS THE AMERICAN CANCER SOCIETY, THE NEBRASKA CANCER COALITION AND PROJECT PINK'D. CHI HEALTH PARTICIPATES IN THE EVERY WOMAN MATTERS AND NEBRASKA COLON CANCER SCREENING PROGRAMS TO PROVIDE TESTING AND DIAGNOSTIC SERVICES FOR THE MEDICALLY UNDERSERVED IN NEBRASKA. ADDITIONALLY, CHI HEALTH CLINICS ARE WORKING TO INCREASE UTILIZATION OF HPV VACCINATION TO PREVENT CERVICAL CANCER.3. DIABETES - CHI HEALTH DID NOT PRIORITIZE DIABETES BASED ON THE CONSIDERATIONS ABOVE AND IN ORDER TO FOCUS AND MEANINGFULLY IMPACT OTHER AREAS OF NEED. CHI HEALTH WILL CONTINUE PERFORMING DIABETES OUTREACH AND EDUCATION ACROSS THE OMAHA METRO AREA, INCLUDING THROUGH THE INTEGRATION OF CERTIFIED DIABETES EDUCATORS INTO PRIMARY CARE CLINICS. SEE ALSO HEALTH RELATED SOCIAL NEEDS FOR RELATED ACTIVITIES, SUCH AS THE CURA PROJECT/ PRODUCE PRESCRIPTION PROGRAM FOR LOW- INCOME, DIABETIC PATIENTS.4. HEART DISEASE AND STROKE - WHILE THIS NEED WAS NOT PRIORITIZED SPECIFICALLY, THE FOCUS ON SUBSTANCE ABUSE THROUGH THE BEHAVIORAL HEALTH PRIORITY WILL HAVE AN IMPACT ON BEHAVIORAL RISK FACTORS FOR HEART DISEASE AND STROKE, SUCH AS ALCOHOL AND SUBSTANCE ABUSE. ADDITIONALLY, CHI HEALTH OFFERS PROGRAMMING DESIGNED TO MITIGATE RISK FACTORS FOR HEART DISEASE AND STROKE THROUGH CHI HEALTH HEART CARE CLASSES INCLUDING HEALTHY COOKING CLASSES. CHI HEALTH IS A FINANCIAL SUPPORTER OF THE AMERICAN HEART ASSOCIATION.5. INFANT HEALTH & FAMILY PLANNING - WHILE THIS NEED WAS NOT PRIORITIZED SPECIFICALLY, IT IS ANTICIPATED THAT THE PRIORITY FOCUS AREAS WILL HAVE AN IMPACT ON INFANT HEALTH & FAMILY PLANNING, PARTICULARLY THROUGH THE PATHWAYS COMMUNITY HUB PROGRAM, PERINATAL DEPRESSION SCREENING, BLACK, INDIGENOUS, PEOPLE OF COLOR (BIPOC) DOULA PROGRAM AND CENTERING PREGNANCY. REPRESENTATIVES FROM CHI HEALTH PARTICIPATE IN THE DOUGLAS COUNTY HEALTH DEPARTMENT- LED BABY BLOSSOMS COLLABORATIVE. IN ADDITION, CHI SUPPORTS ORGANIZATIONS FOCUSED ON IMPROVING CHILD AND MATERNAL HEALTH OUTCOMES AND REDUCING RACIAL/ ETHNIC DISPARITIES, SUCH AS I BE BLACK GIRL AND MARCH OF DIMES. IN ADDITION, CHI MERCY COUNCIL BLUFFS PARTICIPATES IN AND PROVIDES IN-KIND SUPPORT TO THE SOUTHWEST IOWA BREASTFEEDING COALITION.6. INJURY - IN ORDER TO MEANINGFULLY ADDRESS THE SELECT PRIORITY HEALTH NEEDS ABOVE AND MAXIMIZE IMPACT, MERCY CB DID NOT PRIORITIZE THIS HEALTH NEED AREA FOR WORK ON THIS ISP. HOWEVER, MERCY CB TRAUMA TEAM OFFERS THE EVIDENCE-BASED STOP THE BLEED TRAINING TO SCHOOLS AND COMMUNITY AGENCIES TO PREVENT LOSS OF LIFE DURING CATASTROPHIC EVENTS. MERCY CB WILL CONTINUE TO INVEST IN THIS WORK AS COMMUNITY NEED AND HOSPITAL CAPACITY CONTINUE. 7. NUTRITION, PHYSICAL ACTIVITY AND WEIGHT - THIS NEED WILL BE ADDRESSED IN PART THROUGH THE FOOD ACCESS STRATEGIES UNDER THE HEALTH RELATED SOCIAL NEEDS PRIORITY, INCLUDING PROVIDING FINANCIAL SUPPORT FOR DOUBLE UP FOOD BUCKS AND THE WOMEN, INFANT & CHILDREN (WIC)/ SENIOR FARMER'S MARKET VOUCHER PROGRAM. THERE IS SIGNIFICANT EXISTING WORK WITHIN CHI HEALTH AND THE COMMUNITY TO ADDRESS NUTRITION, PHYSICAL ACTIVITY AND WEIGHT STATUS, SUCH AS THE HEALTHY FAMILIES PROGRAM, AND 5-4-3-2-1 GO! CAMPAIGN. ADDITIONALLY, CHI HEALTH PROVIDES FINANCIAL SUPPORT AND IN-KIND CONTRIBUTIONS TO ORGANIZATIONS COMMITTED TO THIS WORK, SUCH AS: CITY SPROUTS, BIG GARDEN/ ""GATHER"" MOBILE KITCHEN CLASSROOM, SAVING GRACE AND WHISPERING ROOTS.8. RESPIRATORY DISEASES - CHI HEALTH DID NOT PRIORITIZE RESPIRATORY DISEASES BASED ON THE CONSIDERATIONS ABOVE AND IN ORDER TO FOCUS AND MEANINGFULLY IMPACT OTHER AREAS OF NEED. CHI HEALTH WILL CONTINUE TO PROVIDE FISCAL SPONSORSHIP, PROVIDE IN- KIND SUPPORT OF TOBACCO EDUCATION AND ADVOCACY OF THE MIDLANDS (TEAM). 9. ORAL HEALTH - CHI HEALTH DID NOT PRIORITIZE RESPIRATORY DISEASES BASED ON THE CONSIDERATIONS ABOVE AND IN ORDER TO FOCUS AND MEANINGFULLY IMPACT OTHER AREAS OF NEED. OTHER COMMUNITY PARTNERS ARE ADDRESSING THIS NEED SUCH AS CHARLES DREW HEALTH CENTER DENTAL CLINIC, ONE WORLD COMMUNITY HEALTH CENTER AND FAMILY INC.10. POTENTIALLY DISABLING CONDITIONS - THIS NEED WILL BE MET IN PART THROUGH THE BEHAVIORAL HEALTH PRIORITY, WHICH IDENTIFIES, ""PROVIDING SUPPORT FOR INDIVIDUALS WITH ALZHEIMER'S/ DEMENTIA AND THEIR CAREGIVERS"" AS A KEY ACTIVITY. IN ADDITION, CHI HEALTH IMMANUEL OPERATES AN INPATIENT AND OUTPATIENT GERIATRIC PSYCHIATRY PROGRAM AND RECENTLY OPENED A NEUROLOGICAL INSTITUTE. CHI HEALTH PROVIDES FINANCIAL SUPPORT TO THE NEBRASKA ALZHEIMER'S ASSOCIATION FOR FREE CARE CONSULTATION FOR FAMILIES WITH A LOVED ONE WHO HAS RECENTLY RECEIVED A DEMENTIA/ ALZHEIMER'S DIAGNOSIS.11. SEXUAL HEALTH - THERE IS EXTENSIVE EXISTING WORK CURRENTLY TAKING PLACE AROUND SEXUALLY TRANSMITTED DISEASES ACROSS THE OMAHA METRO AREA LED BY COMMUNITY PARTNERS, SUCH AS THE DOUGLAS COUNTY HEALTH DEPARTMENT, WOMEN'S FUND AND THE FEDERALLY QUALIFIED HEALTH CENTERS. THEREFORE, THIS IS NOT AN AREA THAT CHI HEALTH PRIORITIZED. HOWEVER, AS MENTIONED IN THE CANCER SECTION ABOVE, CHI HEALTH CLINICS ARE FOCUSING ON HPV VACCINATION FOR THE PREVENTION OF CERVICAL CANCER.12. SUBSTANCE ABUSE - THIS NEED WILL BE ADDRESSED IN PART THROUGH THE SUBSTANCE ABUSE STRATEGY UNDER THE BEHAVIORAL HEALTH PRIORITY.13. TOBACCO USE - THIS NEED WILL BE ADDRESSED IN PART THROUGH THE TOBACCO PREVENTION STRATEGY UNDER THE BEHAVIORAL HEALTH PRIORITY.14. VIOLENCE - IN ORDER TO MEANINGFULLY ADDRESS THE SELECT PRIORITY HEALTH NEEDS ABOVE AND MAXIMIZE IMPACT, MERCY CB DID NOT PRIORITIZE THIS HEALTH NEED AREA FOR WORK ON THIS ISP. IMPORTANTLY, CHI HEALTH IS WORKING AT THE SYSTEM LEVEL TO ENSURE FORENSIC NURSE EXAMINERS (FNES) ARE AVAILABLE 24/7 AT THE HOSPITAL, AND TO IMPROVE TRAUMA-INFORMED CARE AMONG EMERGENCY CARE, WOMEN'S HEALTH, CASE MANAGERS, AND CLINIC PROVIDERS, WHILE ALSO SEEKING SYSTEM-LEVEL STRATEGIES TO ADDRESS HUMAN TRAFFICKING. 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 REPORTING YEAR 2021, THE RELATED IMPLEMENTATION PLAN WAS NOT APPROVED UNTIL JULY 2022 (TAX REPORTING YEAR 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 THE COMMUNITY HEALTH SURVEY AND KEY INFORMANT SURVEY, AS WELL AS A REVIEW OF SECONDARY DATA ON A VARIETY OF HEALTH INDICATORS.TOP HEALTH NEEDS (FROM 2019 CHNA): SOURCE FROM SIGNIFICANT HEALTH NEEDS OR FINDINGS SECTION OF THE CHNA1. ACCESS TO HEALTHCARE SERVICES2. CANCER3. DEMENTIA & ALZHEIMER'S DISEASE4. DIABETES5. HEART DISEASE & STROKE6. INJURY & VIOLENCE 7. NUTRITION, PHYSICAL ACTIVITY, & WEIGHT8. RESPIRATORY DISEASES9. SEXUALLY TRANSMITTED DISEASES 10. SUBSTANCE ABUSE11. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH AND SUBSTANCE ABUSE)SEE PART V, SECTION B, LINE 11 DISCLOSURE CONTINUED."

FACILITY REPORTING GROUP A, PART V, SECTION B, LINE 11 (CONTINUED):
FOR THIS JOINT IMPLEMENTATION STRATEGY PLAN, THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS. THEY REPRESENT STRATEGIES THE HOSPITAL WILL EITHER LEAD OR PARTICIPATE IN JOINTLY WITH OTHER CHI HEALTH HOSPITALS, (DESIGNATED AS A 'SYSTEM' STRATEGY BELOW). ONLY STRATEGIES THAT ARE LED OR CO-LED BY CHI HEALTH CREIGHTON UNIVERSITY MEDICAL CENTER - BERGAN MERCY ARE REPORTED BELOW. PRIORITY HEALTH NEEDS AND STRATEGIES ARE NUMBERED TO ALIGN WITH THE PUBLISHED JOINT IMPLEMENTATION PLAN AT WWW.CHIHEALTH.COM/CHNA. PRIORITY HEALTH NEED #1: BEHAVIORAL HEALTHTO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2019-2021:- PROVIDE SUPPORT FOR INDIVIDUALS WITH ALZHEIMER'S/ DEMENTIA AND THEIR CAREGIVERS (LAKESIDE/ SYSTEM)- LEAD POLICY/ ADVOCACY EFFORTS THAT EXPAND ACCESS TO BEHAVIORAL HEALTH SERVICES (SYSTEM)- ADDRESS BEHAVIORAL HEALTH WORKFORCE SHORTAGE THROUGH EDUCATIONAL PARTNERSHIPS (LASTING HOPE RECOVERY CENTER)- OPERATE AN OUTPATIENT BEHAVIORAL HEALTH CLINIC ON SITE TO FACILITATE IMPROVED CONTINUUM OF CARE AND REDUCED READMISSIONS (LASTING HOPE RECOVERY CENTER)- PROVIDE LEADERSHIP AND SUPPORT FOR THE BUILD HEALTH CHALLENGE LED BY HEARTLAND FAMILY SERVICE (SYSTEM)- SUPPORT THE MENTAL HEALTH STIGMA REDUCTION CAMPAIGN COORDINATED BY THE WELLBEING PARTNERS.- CONVENE INTERNAL STAKEHOLDERS TO: * ENSURE INTERNAL GAPS IN CARE AND COORDINATION ARE ASSESSED * IDENTIFY RELEVANT REPRESENTATION FROM THE CHI HEALTH MERCY AND BEHAVIORAL HEALTH SERVICES TEAM TO ENGAGE IN COMMUNITY/REGION LED CONVERSATIONS TO ADDRESS KNOWN GAPS IN THE BEHAVIORAL HEALTH-CARE CONTINUUM. PARTICIPATE IN COMMUNITY CONVERSATIONS AND DEVELOP RELEVANT ACTION PLANS.- MONITOR AND INFORM THE FOLLOWING ACTIVITIES THROUGH AN INTERNAL COMMUNITY BENEFIT ACTION TEAM (CBAT) - CONTINUE TO PARTICIPATE IN REGION ACTIVITIES IN A STEERING OR INFORMING CAPACITY AND ENSURE ALIGNMENT WITH COMMUNITY-INFORMED AND REGION-LED STRATEGIES TO: * MAXIMIZE CRISIS STABILIZATION * ACCESS TO APPROPRIATE LEVELS OF CARE * DECREASE WAIT TIMES FOR PATIENTS NEEDING BEHAVIORAL HEALTH SERVICES AND MEDICATION MANAGEMENT * CARE COORDINATION * DETOX SERVICES * REDUCE NO-SHOW FOR FIRST-TIME APPOINTMENTS TO BEHAVIORAL HEALTH SERVICES- SUPPORT THE OFFERING OF TRAININGS TO PROMOTE APPROPRIATE CRISIS RESPONSE AND CARE ACCESS LEVELS SUCH AS CRISIS DE-ESCALATION TRAINING, MENTAL HEALTH FIRST AID, ETC.- CONTINUED EXPLORATION AND CAPACITY BUILDING FOR INTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH SERVICESPRIORITY HEALTH NEED #2: SOCIAL DETERMINANTS OF HEALTHTO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2019-2021:- FINANCIAL SUPPORT AND PROMOTION OF DOUBLE UP FOOD BUCKS, A SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) INCENTIVE PROGRAM (SYSTEM)- PROVIDE FINANCIAL SUPPORT AND IN-KIND CONTRIBUTIONS FOR THE MAINTENANCE AND EXPANSION OF COMMUNITY GARDENS (CUMC BERGAN/ UNIVERSITY CAMPUS)- SIEMBRA SALUD- 'GROW WELLNESS' A BACKYARD GARDEN, HOME VISITING AND EDUCATION PROGRAM DESIGNED TO INCREASE FOOD ACCESS FOR LOW-INCOME LATINO RESIDENTS IN EAST OMAHA (SYSTEM)- SUPPORT FARMER'S MARKETS NUTRITION EDUCATION PROGRAMS (SYSTEM)- PROVIDE FUNDING AND IN-KIND SUPPORT FOR THE IMPLEMENTATION OF THE SHARE OUR TABLE FOOD SECURITY PLAN IN THE OMAHA METRO (SYSTEM)- REFERRAL/ CASE MANAGEMENT FOR PATIENTS EXPERIENCING HOMELESSNESS (IMMANUEL/ CUMC BERGAN)- PROVIDE FINANCIAL SUPPORT AND PROMOTION OF THE BRIDGES OUT OF POVERTY TRAINING PROGRAM (IMMANUEL/ CUMC BERGAN)- DEVELOP AND TEST SCREENING AND REFERRAL PROCESSES FOR SOCIAL NEEDS THROUGH UNITE US (SYSTEM)- PARTICIPATE IN INTERNAL AND EXTERNAL WORKFORCE DEVELOPMENT EFFORTS (E.G. STEP UP SUMMER INTERNSHIP PROGRAM, CAREER ACADEMY AND EMPOWERMENT NETWORK FINANCIAL SUPPORT) (SYSTEM)- SUPPORT COMMUNITY LINK PROGRAM AND RELATED EFFORTS TO ADDRESS OUR PATIENTS IDENTIFIED SOCIAL NEEDS THROUGH COMMUNITY ADVOCATES (SYSTEM)- CONTINUE PARTICIPATING IN STEERING OF BRIDGES OUT OF POVERTY TRAINING EFFORTS IN COUNCIL BLUFFS/POTTAWATTAMIE COUNTY * ENSURE FUNDING FOR LOCAL COURSES TO BE OFFERED TO INDIVIDUALS MOST AT RISK FOR POOR HEALTH OUTCOMES BASED ON SOCIAL AND BASIC NEEDS NOT BEING MET- PROVIDE LEADERSHIP (BOARD LEVEL) AND RESOURCE SUPPORT TO THE 712 INITIATIVE FOR WORK RELATED TO IMPROVING HEALTHY FOOD ACCESS * COMMUNITY GARDENS * FARMER'S MARKET * ECONOMIC DEVELOPMENT EFFORTS- EXPLORE OPPORTUNITIES TO ALIGN WITH MILLS COUNTY PUBLIC HEALTH IN GLENWOOD TO ADDRESS RELEVANT SOCIAL FACTORS IMPACTING HEALTH DISPARATELY AMONG CERTAIN POPULATIONS (TRANSPORTATION, ACCESS TO HEALTHCARE AND HEALTHY FOODS)- EXPLORE OPPORTUNITIES TO ENGAGE WITH LOCAL SCHOOL DISTRICTS TO SUPPORT THE TEACHING OF HEALTHY EATING AND ACTIVE LIVING HABITS TO CHILDREN.PRIORITY HEALTH NEED #3: VIOLENCE PREVENTION & INTERVENTION TO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2019-2021:- EXPAND THE FORENSIC NURSE EXAMINER PROGRAM (FORMERLY SANE) (SYSTEM) - SUPPORT YOUTURN'S HOSPITAL RESPONSE PROGRAM FOR TRAUMA VICTIMS AND THEIR FAMILIES (CUMC BERGAN/ IMMANUEL)- ALIGN WITH STATE- LEVEL EFFORTS TO IDENTIFY VICTIMS OF HUMAN TRAFFICKING IN HEALTHCARE SETTINGS AND PROVIDE SUPPORT RESOURCES (SYSTEM)- EXPLORE ONGOING OPPORTUNITIES TO PROMOTE TRAUMA INFORMED CARE PRACTICES AND ALIGN WITH TRAUMA INFORMED CITY INITIATIVE (SYSTEM)

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 CHI HEALTH SYSTEM PRODUCES AN ANNUAL PUBLIC COMMUNITY BENEFIT REPORT THAT IS MAILED TO A CORE CONSTITUENCY, PLACED IN KEY PLACES THROUGHOUT THE ORGANIZATION AND DISTRIBUTED IN COMMUNITY MEETINGS. IT IS ALSO AVAILABLE ON THE COMPANY'S INTRANET SITE, AND ON ITS PUBLIC WEBSITE AT HTTP://WWW.CHIHEALTH.COM/COMMUNITY-BENEFIT.

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: - PROVIDING STOP THE BLEED COURSES FOR EXTERNAL COMMUNITY ORGANIZATIONS / GROUPS (BLEEDING CONTROL BASIC COURSE - BCON)

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:
ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM'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. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 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, ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 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:
"ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 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. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $10,766,867 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:
"CHI HEALTH CREIGHTON UNIVERSITY MEDICAL CENTER - BERGAN MERCY AND LASTING HOPE RECOVERY CENTER ARE LOCATED IN OMAHA, NE AND LARGELY SERVE THE OMAHA METRO AREA THAT CONSISTS OF DOUGLAS, SARPY, AND CASS COUNTIES IN NEBRASKA AND POTTAWATTAMIE COUNTY IN IOWA. THESE FOUR COUNTIES WERE IDENTIFIED AS THE COMMUNITY FOR THIS CHNA, AS THEY ENCOMPASS THE PRIMARY SERVICE FOR CHI HEALTH HOSPITALS LOCATED IN THE OMAHA METRO AREA, THUS COVERING BETWEEN 75% AND 90% OF PATIENTS SERVED. THESE COUNTIES ARE CONSIDERED TO BE AND REFERRED TO AS THE ""OMAHA METRO AREA."" FOR THE PURPOSES OF THE CHNA DOUGLAS, SARPY, AND CASS COUNTIES IN NEBRASKA AND POTTAWATTAMIE COUNTY IN IOWA WERE IDENTIFIED AS THE COMMUNITY FOR THIS CHNA. WITH A TOTAL POPULATION OF OVER 800,000 IN THE FOUR COUNTY AREA, THE DATA SHOW A LARGELY NON-HISPANIC WHITE POPULATION ACROSS THE FOUR COUNTIES WITH GREATER DIVERSITY OBSERVED IN DOUGLAS COUNTY AND TO A LESSER EXTENT, SARPY COUNTY, BOTH OF WHICH ARE THE MOST URBAN COUNTIES IN THE OMAHA METRO AREA. WHILE DOUGLAS COUNTY IS THE MOST DIVERSE OF THE FOUR COUNTIES, WITH 11.5% OF THE POPULATION IDENTIFYING AS BLACK OR AFRICAN AMERICAN AND 12.9% IDENTIFYING AS HISPANIC, IT IS LESS DIVERSE THAN THE UNITED STATES OVERALL (13.4% BLACK OR AFRICAN AMERICAN, 18.5% HISPANIC). CASS COUNTY HAS THE LARGEST PERCENTAGE OF THE POPULATION OVER THE AGE OF 65 YEARS (16%), INDICATING UNIQUE HEALTH NEEDS SPECIFIC TO THE AGING POPULATION. DOUGLAS COUNTY HAS THE HIGHEST PERCENTAGE OF UNINSURED RESIDENTS OVERALL AND UNINSURED CHILDREN (UNDER THE AGE OF 19). THE AVERAGE INCOME FOR THE FOUR COUNTY AREA IS AS FOLLOWS: DOUGLAS (66,600), SARPY (83,051), CASS (73,683) AND POTTAWATTAMIE (60,065). SARPY COUNTY HAS THE HIGHEST MEDIAN INCOME IN THE FOUR COUNTY AREA (DOUGLAS: $66,600, SARPY $83,051, CASS: $73,683, POTTAWATTAMIE: $60,065). DOUGLAS COUNTY HAS THE HIGHEST PERCENTAGE OF PEOPLE LIVING IN POVERTY IN THE FOUR COUNTY AREA (DOUGLAS: 9.8%, SARPY:4.9%, CASS 5.9%, POTTAWATTAMIE: 9.2%). THE PERCENTAGE OF PERSONS WITHOUT HEALTH INSURANCE UNDER 65 IS 10.3% IN DOUGLAS COUNTY, 5.7% IN SARPY COUNTY, 6.6% IN CASS COUNTY, AND 6% IN POTTAWATTAMIE COUNTY. THE FOUR COUNTY SERVICE AREA HAS 26 DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA) INCLUDING PRIMARY CARE, DENTAL HEALTH, MENTAL HEALTH DISCIPLINES. THE 26 DESIGNATED HPSA HAVE SCORES THAT RANGE FROM NINE TO 25 WHERE THE SCORE RANGE IS ZERO TO 26 (HIGHER SCORES INDICATE AN INCREASINGLY GREATER HEALTH PROFESSIONAL SHORTAGE). THE FOUR COUNTY SERVICE AREA HAS EIGHT DESIGNATED MEDICALLY UNDERSERVED AREAS (MUA) INCLUDING PRIMARY CARE. THE EIGHT DESIGNATED MUA'S HAVE SCORES THAT RANGE FROM 44.9 - 64.3 IN WHICH THE LOWEST SCORE (HIGHEST NEED) IS ZERO; THE HIGHEST SCORE (LOWEST NEED) IS 100. CHI HEALTH MERCY COUNCIL BLUFFS IS LOCATED IN COUNCIL BLUFFS, IOWA, ON THE WESTERN EDGE OF POTTAWATTAMIE COUNTY, IA BORDERING THE MAJOR METROPOLITAN AREA OF OMAHA, NE TO THE WEST. POTTAWATTAMIE COUNTY COVERS APPROXIMATELY 950 SQUARE MILES INCLUDING 16 COMMUNITIES WITH 93,667 RESIDENTS. COUNCIL BLUFFS IS PRIMARILY A METROPOLITAN AREA AND MAKES UP 67% OF THE POTTAWATTAMIE COUNTY POPULATION WHILE THE REMAINING COMMUNITIES ARE MORE RURAL IN NATURE. THERE ARE 14 TOWNS IN POTTAWATTAMIE COUNTY, OUTSIDE OF COUNCIL BLUFFS: AVOCA, CARSON, CARTER LAKE, CRESCENT, HANCOCK, MACEDONIA, MCCLELLAND, MINDEN, NEOLA, OAKLAND, SHELBY, TREYNOR, UNDERWOOD AND WALNUT. MILLS COUNTY COVERS APPROXIMATELY 440 SQUARE MILES INCLUDING EIGHT RURAL COMMUNITIES WITH A TOTAL POPULATION OF 15,068 RESIDENTS. THERE ARE SEVEN INCORPORATED TOWNS IN MILLS COUNTY: EMERSON, GLENWOOD, HASTINGS, HENDERSON, MALVERN, PACIFIC JUNCTION, SILVER CITY AND A PORTION OF TABOR LIES WITHIN THE COUNTY BORDER. THE DATA SHOW A PRIMARILY NON-HISPANIC WHITE POPULATION, HOWEVER POTTAWATTAMIE COUNTY ALSO HAS A SLIGHTLY HIGHER HISPANIC POPULATION THAN MILLS COUNTY AND THE STATE OF IOWA. THE ESTIMATED HISPANIC POPULATION IN POTTAWATTAMIE COUNTY HAS REMAINED SINCE 2018 AT 7.9%. POTTAWATTAMIE COUNTY HAS A LOWER GRADUATION RATE (HIGH SCHOOL AND BACHELOR'S DEGREE OR HIGHER) THAN BOTH MILLS COUNTY AND THE STATE OF IOWA. WHILE POVERTY RATES IN BOTH COUNTIES ARE LOWER THAN THE STATE OF IOWA, CHILD POVERTY RATES IN POTTAWATTAMIE COUNTY ARE COMPARABLE TO THE STATE.THE MEDIAN INCOME IS $60,065 IN POTTAWATTAMIE AND $72,079 MILLS LOWER THAN THE MEDIAN INCOME FOR THE STATE OF IOWA ($60,523). POTTAWATTAMIE COUNTY HAS A HIGHER PERCENTAGE OF PEOPLE LIVING IN POVERTY (9.2%) WHEN COMPARED TO MILLS COUNTY (8.3%) BUT LOWER WHEN COMPARED TO THE STATE AS A WHOLE (10.2%). THE PERCENTAGE OF PEOPLE WITHOUT HEALTH INSURANCE (UNDER 65) IS 4.8% IN MILLS COUNTY AND 6% IN POTTAWATTAMIE COUNTY AND THE STATE AS A WHOLE. POTTAWATTAMIE COUNTY HAS FOUR DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA) INCLUDING PRIMARY CARE, DENTAL HEALTH, MENTAL HEALTH DISCIPLINES. THE FOUR DESIGNATED HPSA'S IN POTTAWATTAMIE COUNTY HAVE SCORES THAT RANGE FROM NINE TO 23 (17 MEDIAN SCORE), WHERE THE SCORE RANGE IS 0-26 (THE HIGHER THE SCORE, THE GREATER THE PRIORITY). MILLS COUNTY HAS NO HPSA DESIGNATIONS. POTTAWATTAMIE COUNTY HAS ONE DESIGNATED MEDICALLY UNDERSERVED AREA WITH A SCORE OF 50.9 WHERE THE LOWEST SCORE (HIGHEST NEED) IS ZERO; THE HIGHEST SCORE (LOWEST NEED) IS 100.THE FOLLOWING ORGANIZATIONS REPRESENT HOSPITALS AND OTHER HEALTHCARE SYSTEMS DELIVERING HEALTHCARE SERVICES IN THE OMAHA COUNCIL BLUFFS METROPOLITAN AREA:FEDERALLY QUALIFIED HEALTH CENTERS * ALL CARE HEALTH CENTER * CHARLES DREW HEALTH CENTER * ONE WORLD COMMUNITY HEALTH CENTERS, INC. * COUNCIL BLUFFS COMMUNITY HEALTH CENTER * FRED LEROY HEALTH & WELLNESS CENTERHEALTH DEPARTMENTS * DOUGLAS COUNTY HEALTH DEPARTMENT * POTTAWATTAMIE COUNTY PUBLIC HEALTH DEPARTMENT * SARPY CASS DEPARTMENT OF HEALTH & WELLNESSHEALTH SYSTEMS (HOSPITALS/ CLINICS): * CHI HEALTH CLINICS * CHILDREN'S HOSPITAL & MEDICAL CENTER * METHODIST HEALTH SYSTEM * NEBRASKA MEDICINE * VA NEBRASKA-WESTERN IOWA HEALTH CARE SYSTEM"

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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.

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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.