4A (Expenses $ 242757597 including grants of $ 0) (Revenue $ 247267838)
INTEGRIS AMBULATORY CARE CORPORATION (IACC) IS INCLUDED IN THE INTEGRIS HEALTH SYSTEM. IACC PROVIDED CHARITY CARE AT COST OF $1,886,140 USING A COST TO CHARGE RATIO METHOD OF CALCULATION. IACC ALSO PROVIDED CARE FOR PATIENTS WHO DID NOT PAY AND MUST BE WRITTEN OFF AS BAD DEBT COST OF $6,044,282, BASED ON A COST TO CHARGE RATIO METHOD OF CALCULATION. FOR ADDITIONAL DETAILS REGARDING COMMUNITY BENEFIT, SEE THE COMPLETE COMMUNITY BENEFIT REPORT ON SCHEDULE O.

PART V, SECTION A:
INTEGRIS AMBULATORY CARE CORP, (IACC) IS A MEMBER OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM (INTEGRIS HEALTH SYSTEM OR SYSTEM) CONTROLLED BY INTEGRIS HEALTH, INC. AS SUCH IACC FOLLOWS CERTAIN POLICIES AND PROCEDURES ESTABLISHED AT THE SYSTEM LEVEL, MANY OF WHICH ARE DESCRIBED BELOW.

PART V, SECTION B, LINE 3E
FACILITY REPORTING GROUP A:THE SIGNIFICANT HEALTH NEEDS OF IACC ARE PRESENTED AS A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.FACILITY REPORTING GROUP B:THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT FOR OKLAHOMA CENTER FOR ORTHOPAEDIC AND MULTI-SPECIALTY SURGERY, LLC (OCOM) ARE PRESENTED AS A PRIORITIZED DESCRIPTION OF THOSE NEEDS.FACILITY REPORTING GROUP C:THE SIGNIFICANT HEALTH NEEDS OF COMMUNITY HOSPITAL, LLC AND TPG HOSPITAL, LLC (HPI) ARE PRESENTED AS 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: LAKESIDE WOMEN'S HOSPITAL LLC - FACILITY GROUP

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
EACH COMMUNITY HEALTH NEEDS ASSESSMENT AIMS TO ALIGN LOCAL PLANNING EFFORTS WITH ASSESSMENTS AND INTERVENTIONS CONDUCTED BY COUNTY HEALTH DEPARTMENTS. THIS PLANNING PROCESS REPRESENTS A COMMITMENT TO A MORE DELIBERATE APPROACH TO WORKING TOGETHER. CENTRAL OKLAHOMA HEALTH IMPACT TEAM MEMBER: PHIL MAYTUBBY, DEPUTY CHIEF EXECUTIVE OFFICER, OKLAHOMA CITY COUNTY HEALTH DEPARTMENT IN CONDUCTING THE CHNA, THE HOSPITALS TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY BY STAKEHOLDER MEETINGS, SECONDARY DATA RESEARCH, COMMUNITY SURVEYS, COMMUNITY CHATS AND INFORMATIONAL INTERVIEWS WITH COMMUNITY LEADERS. ETHNICITIES INPUT WAS OBTAINED FROM SURVEYS BY TARGETING POPULATION GATHERING PLACES SUCH AS COMMUNITY CLINICS, CHURCHES, AFTER SCHOOL PROGRAMS, AND PUBLIC TRANSPORTATION SERVICES.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:
FOUR NON-PROFIT HOSPITALS ENGAGED IN A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT: INTEGRIS HEALTH, MERCY HOSPITAL OKLAHOMA CITY, OU HEALTH, AND SSM HEALTH ST. ANTHONY. THIS ASSESSMENT EVALUATED THE HEALTH NEEDS OF OKLAHOMA COUNTY.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:
THE FOUR NON-PROFIT HOSPITALS ENGAGING IN THE JOINT COMMUNITY HEALTH NEEDS ASSESSMENT FOR OKLAHOMA COUNTY ALSO PARTNERED WITH THE OKLAHOMA CITY COUNTY HEALTH DEPARTMENT TO ASSESS THE NEEDS OF THE COMMUNITY.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 7D:
THE CHNA IS WIDELY AVAILABLE TO THE COMMUNITY. THE PLANS WERE ALSO ADDED TO EACH FACILITY'S WEBSITE AND CLEARLY TITLED. THE PLANS WERE ALSO DISTRIBUTED TO ADMINISTRATION, LOCAL BOARDS AT COMMUNITY FORUMS, COALITIONS, OTHER LOCAL AGENCIES, AND ORGANIZATIONS. COPIES OF THE PLAN WERE PLACED IN EACH FACILITY'S ADMINISTRATION OFFICES FOR DISTRIBUTION AS WELL.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:
THE CHNA PROCESS ASSISTED IN DETERMINING AVAILABLE RESOURCES, GAPS IN SERVICES, AND BOTH PERCEIVED AND ACTUAL NEEDS WITHIN THE INTEGRIS HEALTH SERVICE AREAS. THIS PROCESS LED TO THE IDENTIFICATION OF FOUR PRIORITY AREAS. ALTHOUGH THERE IS NO SINGLE FACTOR THAT PREDICTS A HEALTH OUTCOME, THE AREAS IDENTIFIED AS PRIORITY FOR OKLAHOMA COUNTY, BY THE HOSPITAL SYSTEMS AND COMMUNITY STAKEHOLDERS, INCLUDE: ACCESS TO EDUCATION, ACCESS TO MEANINGFUL EMPLOYMENT, ACCESS TO HEALTHY FOOD, AND ACCESS TO HEALTHCARE.THE NEEDS IDENTIFIED BY THE CHNA WERE INITIALLY PRIORITIZED THROUGH COLLABORATION WITH THE LOCAL COMMUNITY COALITIONS. THE LOCAL PRIORITIZED NEEDS WERE THEN REEXAMINED BY INTEGRIS HEALTH THROUGH ADMINISTRATION OF THE DEVELOPED COMMUNITY HEALTH IMPROVEMENT PLAN AND WHICH, IF ANY OF THE REMAINING, WERE CURRENTLY BEING ADDRESSED THROUGH OTHER COMMUNITY RESOURCES AND/OR SERVICES. INTEGRIS HEALTH OPTED TO CONCENTRATE ON TWO OF THE FOUR PRIORITY AREAS IDENTIFIED IN EACH OF THE SERVICE AREAS- ACCESS TO HEALTHY FOOD AND ACCESS TO HEALTHCARE BELIEVING THAT A UNITED EFFORT WOULD ALLOW FOR A SHARING OF RESOURCES, PERSONNEL, PROGRAMS, ETC., AND ENSURE CONSISTENCY IN IMPLEMENTATION AND EVALUATION METHODS, THEREBY INCREASING POTENTIAL TO MORE EFFECTIVELY COMBAT THE ISSUES SYSTEM-WIDE. IN ADDITION TO THE TWO PRIORITY AREAS, TOBACCO USE WAS ALSO ADDED TO THE SYSTEM FOCUS AREAS TO CONTINUE TO ADDRESS THIS ISSUE IN ALL SERVICE AREAS. ACCESS TO HEALTHY FOOD IS BEING ADDRESSED BY THE FOLLOWING PROGRAM IMPLEMENTATION: INTEGRIS HEALTH I-CREW, FOOD BANK PROGRAMS, AND PARTNERSHIPS WITH LOCAL COALITIONS. THE INTEGRIS HEALTH I-CREW WILL ESTABLISH TWO PARTNERSHIP OPPORTUNITIES DIRECTLY TARGETING IMPROVING ACCESS TO HEALTHY FOOD. LAKESIDE WOMEN'S HOSPITAL WILL ALSO COORDINATE AT LEAST ONE FOOD DRIVE. IN ADDITION TO THE PROGRAMS MENTIONED, INTEGRIS HEALTH WILL SUPPORT LOCAL EFFORTS WITH COALITIONS WHO SUPPORT AND INCREASE ACCESS TO HEALTHY FOOD.ACCESS TO HEALTHCARE IS BEING ADDRESSED BY THE FOLLOWING PROGRAM IMPLEMENTATION: INTEGRIS HEALTH MOBILE CARE CLINIC AND PARTNERSHIPS WITH LOCAL COALITIONS. INTEGRIS HEALTH MOBILE CARE CLINIC SERVES 50 COMMUNITY MEMBERS. IN ADDITION, INTEGRIS HEALTH WILL SUPPORT LOCAL EFFORTS WITH COALITIONS WHO SUPPORT, PREVENT, AND EDUCATE ON INCREASING ACCESS TO CARE.TOBACCO USE PREVENTION IS BEING ADDRESSED BY THE FOLLOWING PROGRAM IMPLEMENTATION: OKLAHOMA TOBACCO HELPLINE REFERRALS, SOCIAL MEDIA CAMPAIGNS, AND PARTNERSHIPS WITH LOCAL COALITIONS. OKLAHOMA TOBACCO HELPLINE REFERRALS GOAL IS TO REFER 25 PERSONS FOR TOBACCO CESSATION SERVICES. INTEGRIS HEALTH WILL ESTABLISH TWO PARTNERSHIP OPPORTUNITIES FOR SOCIAL MEDIA CAMPAIGNS THAT SUPPORT AND PROMOTE TOBACCO USE PREVENTION. IN ADDITION TO THE PROGRAMS MENTIONED, INTEGRIS HEALTH WILL SUPPORT LOCAL EFFORTS WITH COALITIONS WHO SUPPORT, PREVENT, AND EDUCATE ON TOBACCO USE PREVENTION.IT WAS DETERMINED THAT THE REMAINING PRIORITY AREAS IDENTIFIED IN THE CHNA WERE ALREADY BEING ADDRESSED THROUGH LOCAL AGENCIES AND/OR COALITIONS AND PARTNERSHIP EFFORTS WITHIN THE COMMUNITY. AS SUCH, INTEGRIS HEALTH COMMITTED TO PROVIDE SUPPORT AND RESOURCES TO THE COMMUNITY PARTNERS TAKING THE LEAD ON THOSE PARTICULAR ISSUES.

PART V, SECTION B
FACILITY REPORTING GROUP B

FACILITY REPORTING GROUP B CONSISTS OF:
- FACILITY 2: OK CTR ORTHPDIC & MLTI-SPCLTY SURG

FACILITY REPORTING GROUP - B PART V, SECTION B, LINE 5:
SEE SCHEDULE H, PART VI, LINE 2

FACILITY REPORTING GROUP - B PART V, SECTION B, LINE 6A:
DESCRIPTION:THE HOSPITAL FACILITIES INCLUDED IN THE JOINT CHNA ARE AS FOLLOWS:- COMMUNITY HOSPITAL NORTH- COMMUNITY HOSPITAL SOUTH- COMMUNITY HOSPITAL NORTHWEST SURGICAL- INTEGRIS COMMUNITY HOSPITAL - MOORE- INTEGRIS COMMUNITY HOSPITAL - DEL CITY- INTEGRIS COMMUNITY HOSPITAL - OKC WEST- INTEGRIS COMMUNITY HOSPITAL - COUNCIL CROSSING- OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY (OCOM)

FACILITY REPORTING GROUP - B PART V, SECTION B, LINE 11:
SEE SCHEDULE H, PART VI, LINE 2

PART V, SECTION B
FACILITY REPORTING GROUP C

FACILITY REPORTING GROUP C CONSISTS OF:
- FACILITY 3: COMMUNITY HOSPITAL, LLC, - FACILITY 4: TPG HOSPITAL, LLC

FACILITY REPORTING GROUP - C PART V, SECTION B, LINE 6A:
DESCRIPTION:THE HOSPITAL FACILITIES INCLUDED IN THE JOINT CHNA ARE AS FOLLOWS:- COMMUNITY HOSPITAL NORTH- COMMUNITY HOSPITAL SOUTH- COMMUNITY HOSPITAL NORTHWEST SURGICAL- INTEGRIS COMMUNITY HOSPITAL - MOORE- INTEGRIS COMMUNITY HOSPITAL - DEL CITY- INTEGRIS COMMUNITY HOSPITAL - OKC WEST- INTEGRIS COMMUNITY HOSPITAL - COUNCIL CROSSING- OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY (OCOM)

PART V, SECTION B, LINE 7A, 7B, AND LINE 10A:
REPORTING GROUP A:HTTPS://INTEGRISOK.COM/ABOUT-INTEGRIS/SERVING-OUR-COMMUNITY/REPORTSHTTPS://WWW.MERCY.NET/ABOUT/OUR-COMMUNITIES/COMMUNITY-BENEFITS/REPORTING GROUP B:HTTPS://OCOMHOSPITAL.COM/HTTPS://INTEGRISOK.COM/ABOUT-INTEGRIS/SERVING-OUR-COMMUNITY/REPORTSHTTPS://OCOMHOSPITAL.COM/REPORTING GROUP C:HTTPS://COMMUNITYHOSPITALOKC.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTHTTPS://NWSURGICALOKC.COM/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTHTTPS://WWW.INTEGRISCOMMUNITYHOSPITAL.COM/

PART V, SECTION B, LINES 16A, 16B, AND 16C
REPORTING GROUP AHTTPS://INTEGRISOK.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCEREPORTING GROUP BHTTPS://OCOMHOSPITAL.COM/FINANCIAL-ASSISTANCE-POLICY-2/REPORTING GROUP C:HTTPS://NWSURGICALOKC.COM/PATIENTS/ACCOUNT-ASSISTANCE

REPORTING GROUP B: PART V, SECTION B, LINE 5
OCOM HAS BEEN IN EXISTENCE SINCE 2002 AND IS COMPRISED OF TWO SURGICAL HOSPITALS, ONE OUTPATIENT PHYSICAL THERAPY LOCATION AND THREE OFF-SITE IMAGING CENTERS. ALL OF THE FACILITIES SERVICE OKLAHOMA CITY, IN OKLAHOMA COUNTY, OKLAHOMA.OCOM PRIDES ITSELF IN PROVIDING FIRST-CLASS SURGICAL SERVICES FOR THE LOCAL COMMUNITY IN A SAFE, COMFORTABLE, AND WELCOMING ENVIRONMENT; ONE IN WHICH HOSPITAL STAFF WOULD BE HAPPY TO TREAT THEIR OWN FAMILIES. OCOM STRIVES TO CREATE THE SURGICAL STANDARD ALL PHYSICIANS WANT FOR THEIR PATIENTS. OCOM EMPLOYS 224 TEAM MEMBERS INCLUDING FULLTIME, PART-TIME AND PRN WITH APPROXIMATELY 60 PHYSICIAN PROVIDERS.OCOM'S SOUTH HOSPITAL LOCATION INCLUDES NINE INPATIENT ROOMS, SIX OPERATING ROOMS, AND ONE ENDOSCOPIC/PAIN MANAGEMENT PROCEDURE ROOM. OCOM'S NORTH LOCATION INCLUDES THREE OPERATING ROOMS AND DOES NOT HAVE INPATIENT ROOMS. HOSPITAL OCOM'S STATE-OF-THE-ART EQUIPMENT ALLOWS SURGEONS TO PERFORM A VARIETY OF SURGICAL PROCEDURES IN THE SPECIALTY AREAS OF DENTISTRY, GENERAL SURGERY, GASTROENTEROLOGY (GI), GYNECOLOGY, IMAGING, OPTHALMALOGY, ORTHOPAEDIC, PAIN MANAGEMENT, PHYSICAL THERAPY, PLASTIC SURGERY, PODIATRY AND UROLOGY.OCOM HOLDS A TJC CERTIFICATE OF DISTINCTION FOR TOTAL HIP AND TOTAL KNEE PROGRAMS, IS A CMS FIVE-STAR RATED FACILITY, AND IS THE RECIPIENT OF THE PRESS GANEY GUARDIAN OF EXCELLENCE AND HEALTHGRADES OUTSTANDING PATIENT EXPERIENCE AWARDS.OKLAHOMA COUNTY IS IN THE CENTRAL PART OF OKLAHOMA AND IS THE LARGEST COUNTY IN OKLAHOMA IN TERMS OF POPULATION. OKLAHOMA CITY IS THE COUNTY SEAT AND IS THE LARGEST CITY IN THE STATE. THERE ARE 20 CITIES AND SMALL TOWNS LOCATED IN THE COUNTY. OKLAHOMA COUNTY EMPLOYS 379,291 PEOPLE. THE ECONOMY SPECIALIZES IN MINING, OIL, GAS, QUARRYING, EXTRACTION, MANAGEMENT OF COMPANIES AND ENTERPRISES, AND PUBLIC ADMINISTRATION. ACCORDING TO THE 2019 POPULATION ESTIMATES, THE POPULATION OF OKLAHOMA COUNTY WAS 797,434.OKLAHOMA COUNTY HAS 14 HOSPITALS, TWO FEDERALLY QUALIFIED HEALTH CENTERS WITH 14 SATELLITE CLINICS, APPROXIMATELY 17 FREE COMMUNITY CLINICS, ONE TRIBAL CLINIC, A CITY-COUNTY HEALTH DEPARTMENT WITH MULTIPLE LOCATIONS THROUGHOUT THE COUNTY, AND A STATE HEALTH DEPARTMENT. PUBLIC TRANSPORTATION, TAXI SERVICES, TWO PUBLIC AND SEVERAL PRIVATE AIRPORTS, AND PARAMEDIC LEVEL AMBULANCE SERVICES ARE ALSO LOCATED WITHIN THE COUNTY.ACCORDING TO THE OKLAHOMA CITY-COUNTY HEALTH DEPARTMENT 2021 DATA, THE MEDIAN AGE IN OKLAHOMA COUNTY WAS 34.5 YEARS, WHICH IS SLIGHTLY YOUNGER THAN THE STATE OF OKLAHOMA AT 36.4 YEARS. THE PERCENT LIVING IN POVERTY IN OKLAHOMA COUNTY IS 16.7% WHICH IS SLIGHTLY LOWER THAN THE STATE AT 16.0%. IN 2018, THE MEDIAN HOUSEHOLD INCOME IN OKLAHOMA COUNTY OF $52,855 WAS SLIGHTLY HIGHER THAN THE STATE OF $51,424. BOTH LAGGED BEHIND THE NATIONAL MEDIUM INCOME OF $60,293. OKLAHOMA COUNTY RESIDENTS RECEIVED SLIGHTLY MORE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) BENEFITS THAN THE STATE RATE IN 2018 (13.3% VS. 13.1%.) THE RACIAL/ETHNIC BREAKOUT OF OKLAHOMA COUNTY WAS 56.0% WHITE, 14.8% BLACK OR AFRICAN AMERICAN, 17.4% HISPANIC OR LATINO, 6.7% AMERICAN INDIAN OR ALASKA NATIVE, AND 4.7% ASIAN AND PACIFIC ISLANDER.AMONG OKLAHOMA RESIDENTS 18 AND OLDER, 30% OF PERSONS HELD A BACHELOR'S DEGREE OR HIGHER AS OF 2019. ON SEPTEMBER 30, 2021, NEW UNEMPLOYMENT NUMBERS WERE RELEASED FROM THE U.S. BUREAU OF LABOR STATISTICS SHOWING OKLAHOMA CITY RANKS FIRST FOR METROPOLITAN COMMUNITIES WITH A 2010 CENSUS POPULATION OF ONE MILLION OR MORE. OKLAHOMA CITY HAD AN UNEMPLOYMENT RATE OF ONLY 2.6% AND IS THE LOWEST RATE SINCE 2019. THE PERCENT OF UNINSURED ADULTS (AGE 18-64), IN OKLAHOMA COUNTY, ACCORDING TO DATA FROM THE 2021 U.S. CENSUS BUREAU, WAS CONSISTENT WITH THE STATE RATE OF 16.8%. ACCORDING TO THE OKLAHOMA HEALTH CARE AUTHORITY FAST FACTS, JANUARY 2021, THERE WERE A TOTAL OF 200,287 PERSONS ENROLLED IN MEDICAID IN OKLAHOMA COUNTY AND 946,412 PERSONS ENROLLED IN MEDICAID IN THE STATE OF OKLAHOMA DURING THE SAME PERIOD. AS OF FEBRUARY 2021, THERE WERE 92,632 PERSONS IN OKLAHOMA COUNTY AND 572,942 PERSONS IN THE STATE OF OKLAHOMA ENROLLED IN MEDICARE ACCORDING TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, MEDICARE ENROLLMENT DASHBOARD. BETWEEN 2015 AND 2019, THE AVERAGE NUMBER OF PERSON PER HOUSEHOLD IN OKLAHOMA COUNTY WAS 2.56 WHICH WAS SLIGHTLY LOWER THAN THE STATE AT 2.58.DURING THE SAME PERIOD, THE PERCENT OF PERSONS, 5 YEARS OR OLDER, IN OKLAHOMA COUNTY WHO SPOKE A LANGUAGE OTHER THAN ENGLISH AT HOME WAS 17.4% COMPARED TO THE STATE RATE OF 10.5%. IN 2020, ACCORDING TO THE 2020 COUNTY HEALTH RANKINGS FOR OKLAHOMA COUNTY, ACCESS TO A PRIMARY CARE PHYSICIAN, PEOPLE PER ONE PROVIDER, WAS 1,170 COMPARED TO THE STATE OF OKLAHOMA WHICH WAS 1,620 PEOPLE PER ONE PROVIDER. ACCESS TO DENTISTS AND MENTAL HEALTH IN OKLAHOMA COUNTY, PEOPLE PER ONE PROVIDER, ACCORDING TO THE SAME SOURCE, WAS 980 AND 150, RESPECTIVELY AND 1640 AND 250, PEOPLE PER ONE PROVIDER FOR THE STATE OF OKLAHOMA. BETWEEN 2015-2017, THE AVERAGE LIFE EXPECTANCY IN OKLAHOMA COUNTY IS 74.9 YEARS WHEREAS THE AVERAGE IN THE U.S. IS 78.8 YEARS.BETWEEN 2016-2018, CARDIOVASCULAR DISEASE WAS THE LEADING CAUSE OF DEATH IN OKLAHOMA COUNTY. AT 337.7 DEATHS PER 100,000, MALES HAD 100 MORE DEATHS PER 100,000 COMPARED TO FEMALES WITH A RATE OF 235.9 DEATHS PER 100,000. CANCER WAS THE SECOND LEADING CAUSE OF DEATH IN OKLAHOMA CITY-COUNTY BETWEEN 2016-2018, THE AGE-ADJUSTED MORTALITY RATE IN OKLAHOMA COUNTY WAS 188.0 PER 100,000 DEATHS, ONLY SLIGHTLY HIGHER THAN THE STATE RATE OF 177.8 PER 100,000 DEATHS BUT 27.6 DEATHS PER 100,000 GREATER THAN THE NATIONAL CANCER DEATH RATE. OKLAHOMA COUNTY HAD HIGHER DIABETES MORTALITY BETWEEN 2016-2018 COMPARED TO THE STATE AND NATIONAL RATES. THE OVERALL AGE-ADJUSTED DIABETES MORTALITY RATE IN THE COUNTY WAS 34.6 DEATHS PER 100,000. OKLAHOMA IS THE NINTH MOST OBESE STATE IN THE NATION, OKLAHOMA'S OBESITY RATE AS OF 2021 WAS AT 36.4%. THE SUICIDE RATES IN OKLAHOMA COUNTY AND THE STATE OF OKLAHOMA WERE HIGHER THAN THE NATIONAL AVERAGE BETWEEN 2016-2018. THE AGE-ADJUSTED SUICIDE RATE IN OKLAHOMA COUNTY WAS 18 DEATHS PER 100,000 PEOPLE.A COMPREHENSIVE AND A COLLABORATIVE JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY FOUR NON-PROFIT HEALTH SYSTEMS AS ALL FOUR HEALTH SYSTEMS DEFINE THEIR COMMUNITY AS OKLAHOMA COUNTY. THIS CHNA INCLUDED INTEGRIS HEALTH SYSTEM AND THEIR JOINT VENTURE HOSPITALS: HEALTHCARE PARTNERS (HIP), INTEGRIS COMMUNITY HOSPITALS AND OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI SPECIALTY SURGERY. THE CHNA UTILIZES RELEVANT HEALTH DATA TO IDENTIFY THE SIGNIFICANT COMMUNITY HEALTH NEEDS OF OKLAHOMA AND CLEVELAND COUNTIES IN THE STATE OF OKLAHOMA. ALL OF THE JOINT VENTURE HOSPITALS LIE WITHIN OKLHOMA COUNTY, EXCEPT FOR ONE SMALL CAMPUS OF THE INTEGRIS COMMUNITY HOSPITALS (MOORE), WHICH LIES ON THE NORTHERN EDGE OF CLEVELAND COUNTY. THE GOAL OF THIS REPORT IS TO PROVIDE RESIDENTS WITH A DEEPER UNDERSTANDING OF THE HEALTH NEEDS IN THEIR COMMUNITY AND TO HELP GUIDE THE HOSPITALS IN THEIR COMMUNITY BENEFIT PLANNING EFFORTS AND THE DEVELOPMENT OF AN IMPLEMENTATION STRATEGY TO ADDRESS IDENTIFIED NEEDS. COMMUNITY INPUT WAS RECEIVED DURING STAKEHOLDER MEETINGS, COMMUNITY SURVEYS COLLECTED DURING APRIL 2021-JULY 2021 AND ONLINE CHATS WHICH WERE CONDUCTED FROM MAY 23, 2021 - JUNE 30, 2021.THE AFFORDABLE CARE ACT (ACA) REQUIRES 501(C)(3), TAX-EXEMPT HOSPITALS TO CONDUCT A CHNA AT LEAST ONCE EVERY THREE TAX YEARS AND TO ADOPT A STRATEGIC IMPLEMENTATION PLAN FOR ADDRESSING IDENTIFIED NEEDS. INTEGRIS HEALTH LAST CONDUCTED A CHNA DURING FISCAL YEAR 2022.THE OCOM BOARD OF DIRECTORS REVIEWED AND ADOPTED THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND THE IMPLEMENTATION PLAN ON JULY 25, 2022.

REPORTING GROUP B: PART V, SECTION B, LINE 5 CONTINUED
INTERVIEW METHODOLOGY:METHODS OF COLLECTING AND ANALYZING DATA AND INFORMATION INCLUDED ONLINE SURVEYS, FOCUS GROUPS, PUBLISHED DATA, AND HOSPITAL SPECIFIC DATA. FOCUS GROUPS AND SURVEYS WERE CONDUCTED TO DIALOGUE DIRECTLY WITH LOCAL COMMUNITY MEMBERS. COMMUNITY INPUT WAS GATHERED FROM OKLAHOMA COUNTY RESIDENTS OF ALL BACKGROUNDS, SOCIOECONOMIC STATUS, AND DEMOGRAPHICS THROUGH SURVEYS. INPUT INCLUDED MEMBERS OF UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THERE WAS ALSO A TARGETED EFFORT TO CONDUCT FOCUS GROUPS WITH AT-RISK POPULATIONS IN LOW SOCIOECONOMIC ZIP CODES.COMMUNITY PARTNERS THAT ASSISTED IN DATA COLLECTION FOR COMMUNITY CHATS INCLUDED STANLEY HUPFELD ACADEMY, CROSSINGS COMMUNITY CENTER, CROSSINGS COMMUNITY CLINIC AND THE MOORE FOOD RESOURCE CENTER. COMMUNITY SURVEYS WERE AVAILABLE ONLINE. EACH PARTNER UTILIZED SOCIAL MEDIA TO PUBLICIZE THE SURVEY TO RESIDENTS IN THEIR SERVICE AREA. PARTNERS ASSISTING IN THE DISSEMINATION OF THE ONLINE SURVEY INCLUDED CROSSINGS COMMUNITY CLINIC, HPI COMMUNITY HOSPITAL AND NORTHWEST SURGICAL HOSPITAL, INTEGRIS COMMUNITY HOSPITALS AND OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY.IN ADDITION TO THE INPUT FROM COMMUNITY CHATS, ONLINE SURVEYS AND DOT VOTING, THE COMPILATION OF PUBLIC HEALTH DATA, STATE AND NATIONAL DATA, GAVE A BROADER VIEW OF THE OVERALL HEALTH STATUS OF THE COUNTY. HEALTH DATA WAS ALSO COLLECTED FROM A VARIETY OF SOURCES, INCLUDING BUT NOT LIMITED TO, THE OKLAHOMA HEALTH CARE AUTHORITY, FAST FACTS, THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. MEDICARE ENROLLMENT DASHBOARD, THE 2020 COUNTY HEALTH RANKINGS, OKLAHOMA COUNTY, THE 2020 COUNTY HEALTH RANKINGS. CLEVELAND COUNTY AND THE U.S. CENSUS BUREAU, CENTERS FOR DISEASE CONTROL AND PREVENTION. ADULT OBESITY PREVALENCE, MENTAL HEALTH AMERICA, THE STATE OF MENTAL HEALTH IN AMERICA AND CITY OF NORMAN. REQUESTS FOR PROPOSALS FOR A HOMELESSNESS STRATEGIC PLAN. POPULATION DEMOGRAPHIC INFORMATION WAS ALSO COLLECTED BY INTEGRIS HEALTH USING A NUMBER OF THE ABOVE SOURCES AND INCLUDED INFORMATION REGARDING POPULATION BY RACE, AGE, MEDIAN HOUSEHOLD INCOME AND EDUCATION AND ECONOMIC STATISTICS IN OKLAHOMA COUNTY.DUE TO THE COVID-19 PANDEMIC, LOCAL HEALTH DEPARTMENTS WERE UNABLE TO PUBLISH UPDATED PUBLIC HEALTH DATA. INTEGRIS HEALTH REVIEWED AND USED THE MOST CURRENT AVAILABLE DATA FOR THE PURPOSE OF PROVIDING A COMPREHENSIVE OVERVIEW OF THE COMMUNITY. WITH RESPECT TO THOSE PROVIDING INPUT, DUE TO THE COVID-19 PANDEMIC AND THE IMMENSE NEEDS AND REQUIRED FOCUS ASSOCIATED WITH IT, NO INPUT FROM OTHERS IN THE COMMUNTIY THAT HAD EXPERTISE IN PUBLIC HEALTH WAS OBTAINED. HOWEVER, SOME INPUT WAS PULLED FROM THE OKLAHOMA COUNTY CHNA COMPLETED TWO YEARS PRIOR WHICH DID INCLUDE INPUT FROM THE OKC COUNTY HEALTH DEPARTMENT, UNITED WAY OF CENTRAL OKLAHOMA AND THE OKLAHOMA STATE DEPARTMENT OF HEALTH. ADDITIONALLY, THE HOSPITALS PROVIDED INTERNAL DATA FOR ANALYSIS AND CONSIDERATION IN THE CHNA PROCESS.IN TOTAL, THE ONLINE SURVEY WAS ADMINISTERED TO 402 INDIVIDUALS, AND FOCUS GROUP SURVEYS WERE CONDUCTED AMONG 90 PARTICIPANTS TO GATHER QUALITATIVE DATA. THE FOCUS GROUPS WERE ADAPTED DUE TO COVID-19 RESTRICTIONS. INTEGRIS HEALTH REPRESENTATIVES PROVIDED OPEN-ENDED SURVEYS TO PARTICIPANTS VIA AN ONLINE PLATFORM, ASKING PARTICIPANTS TO ANSWER THE OPEN-ENDED QUESTIONS WHILE DISCUSSING TOPICS AS A GROUP. AFTER INTEGRIS HEALTH COLLECTED THIS QUALITATIVE AND QUANTITATIVE DATA, THEY RETURNED IT TO THE UNIVERSITY OF CENTRAL OKLAHOMA'S COMMUNITY INTERVENTION CLASS FOR ANALYSIS. WHEN REVIEWING THE QUANTITATIVE SURVEYS FROM THE 402 PARTICIPANTS AT FIVE SITES (I.E. HPI COMMUNITY HOSPITAL, INTEGRIS COMMUNITY HOSPITAL (CLEVELAND COUNTY), INTEGRIS COMMUNITY HOSPITALS (OKLAHOMA COUNTY), OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY OKLAHOMA COUNTY, AND CROSSINGS COMMUNITY CENTER), ALL LOCATIONS WERE ANALYZED TO FIND COMMONALITIES AND IMPORTANT FINDINGS.OVERALL, FEEDBACK FROM COMMUNITY MEMBERS IN THE QUANTITATIVE SURVEYS HIGHLIGHTED A NEED FOR HEALTHCARE ACCESS ESPECIALLY AS IT RELATES TO MENTAL HEALTH AND SICK VISITS, HEALTH EDUCATION AND PROMOTION (PARTICULARLY RELATED TO PHYSICAL HEALTH ISSUES THAT CAN BE ADDRESSED THROUGH EDUCATION AS WELL AS DETERMINANTS OF HEALTH IN THE COMMUNITY); AND AFFORDABLE MEDICATIONS AND FOOD.WHEN ANALYZING QUALITATIVE FEEDBACK FROM 90 PARTICIPANTS COMPLETING THEIR FOCUS GROUP SURVEYS (FROM MOORE FOOD & RESOURCE CENTER, STANLEY HUPFELD ACADEMY, AND CROSSINGS COMMUNITY CENTER), SEVERAL THEMES AROSE ACROSS THE THREE SITES AND SIX-OPEN-ENDED QUESTIONS. THESE INCLUDED: A NEED AND DESIRE FOR GREATER ACCESS TO HEALTHCARE SERVICES (INCLUDING BOTH PREVENTIVE CARE ON A MYRIAD OF ISSUES AS WELL AS PHYSICIAN APPOINTMENTS); MENTAL HEALTH SERVICES (INCLUDING COUNSELING AS WELL AS REHABILITATION PROGRAMS); EDUCATIONAL SERVICES (INCLUDING NUTRITION EDUCATION; HEALTH EDUCATION FOR A VARIETY OF HEALTH ISSUES AS WELL AS DISEASE PREVENTION AND TREATMENT; AND ACCESS TO CREDIBLE COVID-19 INFORMATION); ENVIRONMENTAL DETERMINANTS OF HEALTH (INCLUDING BUT NOT LIMITED TO FOOD SECURITY ISSUES, TRANSPORTATION AND HOUSING NEEDS, EDUCATION, AFFORDABLE CARE, AND ACCESS TO EMPLOYMENT OPPORTUNITIES); AND FINALLY, ENSURING THAT OLDER ADULTS IN COMMUNITIES ARE INCLUDED IN THE PLANNING AND IMPLEMENTATION OF PROGRAMS AND SERVICES PROVIDED.

REPORTING GROUP B: PART V, SECTION B, LINE 11
INTEGRIS HEALTH COLLABORATED WITH LOCAL COMMUNITY PARTNERS ON THE CHNA AND EVALUATED AND SYNTHESIZED PRIMARY AND SECONDARY DATA TO IDENTIFY SIGNIFICANT COMMUNITY HEALTH NEEDS IN OKLAHOMA AND CLEVELAND COUNTY. THROUGHOUT THE NEEDS PROCESS, FOCUS WAS GIVEN TO THE INTERCONNECTEDNESS OF SOCIAL DETERMINANTS AND HEALTH OUTCOMES IN OKLAHOMA COUNTY.UPON REVIEW AND ANALYSIS OF ALL QUANTITATIVE AND QUALITATIVE FEEDBACK AND DATA, THE MOST RECENTLY CONDUCTED CHNA FOCUSED ON THE SOCIAL DETERMINANTS AND HEALTH OUTCOMES IN OKLAHOMA COUNTY. SOCIAL DETERMINATES OF HEALTH (SDOH) ARE THE CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, LIVE, WORK AND AGE THAT SHAPE HEALTH. SDOH ARE PRIMARY DRIVERS OF HEALTH DISPARITIES AND INCLUDE SIGNIFICANT FACTORS LIKE ECONOMIC STABILITY, EDUCATION ACCESS AND QUALITY, HEALTH CARE ACCESS AND QUALITY, NEIGHBORHOOD AND THE BUILT ENVIRONMENT AND SOCIAL AND COMMUNITY CONTEXT. THIS CHNA PROCESS WAS DESIGNED TO USE DATA TO IDENTIFY THOSE WHO MAY NOT BE THRIVING.INTEGRIS HEALTH THEN ANALYZED AND EVALUATED THE PRIMARY DATA AND THE SECONDARY PUBLIC HEALTH DATA COLLECTED DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT. THIS PROCESS LED TO THE IDENTIFICATION OF FOUR PRIORITY AREAS BASED ON CURRENT SYSTEM WIDE EFFORTS AT INTEGRIS HEALTH AND ALIGNED WITH THE CURRENT COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) GOALS AND OBJECTIVES IN THE OKLAHOMA CITY METRO.THE FOLLOWING FOUR PRIORITIZED NEEDS WERE DETERMINED:- ACCESS TO EDUCATION- ACCESS TO MEANINGFUL EMPLOYMENT- ACCESS TO HEALTHY FOOD- ACCESS TO HEALTHCAREINTEGRIS HEALTH CHOSE TO FOCUS ON ALL OF THE IDENTIFIED PRIORITY ISSUES.* WHILE TOBACCO WAS NOT SPECIFICALLY IDENTIFIED BY THE COMMUNITY AS A PRIORITY NEED, INTEGRIS HEALTH AND THEIR PARTNERS AGREE THAT IT IS A HEALTH ISSUE THAT SHOULD CONTINUE TO BE ADDRESSED. OKLAHOMA COUNTY IS STILL ABOVE THE NATIONAL AVERAGE FOR ADULTS WHO SMOKE. AMONG YOUTH, AS OF 2019, 30.8% OF OKLAHOMA HIGH SCHOOLERS REPORTED CURRENT USE OF ANY TOBACCO PRODUCT. THE STATE OF OKLAHOMA, WITH THE EXPANSION OF ELECTRONIC CIGARETTES AND VAPES, NICOTINE DEPENDENCY CONTINUES TO BE A WIDESPREAD PUBLIC HEALTH CONCERN FOR OKLAHOMA COUNTY RESIDENTS. INTEGRIS HEALTH TRACKS REFERRALS MADE TO THE OKLAHOMA TOBACCO HELPLINE AND REPORTS ARE MADE AVAILABLE QUARTERLY. INTEGRIS HEALTH PROVIDED 2,617 REFERRALS IN FY 2020 AND 2,002 REFERRALS IN FY 2021.EACH HOSPITAL THEN DEVELOPED AN INDIVIDUAL IMPLEMENTATION STRATEGY/COMMUNITY HEALTH IMPROVEMENT PLAN IN A SEPARATE DOCUMENT TO ADDRESS THE NEEDS IDENTIFIED BASED ON THEIR INTERNAL PRIORITIES AND RESOURCES.ACCESS TO EDUCATIONEDUCATION AND HEALTH HAVE ALWAYS BEEN CONNECTED, BUT NEVER AS GREATLY AS THEY CURRENTLY ARE. AMERICANS WITH LESS EDUCATION ARE DYING EARLIER THAN THEIR PEERS. WHILE THE RELATIONSHIP BETWEEN HEALTH AND EDUCATION IS A COMPLEX ONE, IT IS CLOSELY TIED TO A PERSON'S INCOME, SKILLS, AND OPPORTUNITIES THEY HAVE TO LEAD HEALTHY LIVES WITHIN THEIR COMMUNITIES. WHILE EDUCATION, BOTH FORMAL AND INFORMAL, CAN CREATE OPPORTUNITIES FOR BETTER HEALTH, POOR HEALTH, ON THE OTHER HAND, CAN PUT EDUCATION AT RISK.THE CHNA COMMUNITY SURVEY REVEALED MONEY WAS A MAJOR STRESS FACTOR FOR NEARLY ONE IN FIVE RESPONDENTS. WHILE 35% OF THE RESPONDENTS FELT FINANCIALLY SECURE IN MEETING THEIR FAMILY'S NEEDS, ALMOST 30% OF RESPONDENTS REPORTED THEY LIVED PAYCHECK TO PAYCHECK. WHEN ASKED ABOUT BARRIERS TO ACCESS EDUCATION, RESPONDENTS NOTED FINANCIAL CHALLENGES, AND THAT THERE WERE FEW OR NO RESOURCES AT HIGH SCHOOLS TO HELP STUDENTS GO TO AND PAY FOR COLLEGE. COMMUNITY CHAT PARTICIPANTS NOTED THAT HIGHER EDUCATION IN MORE RURAL PARTS OF OKLAHOMA WAS SIMPLY NOT SOUGHT AFTER AND WAS LINKED TO BEING A GENERATIONAL DECISION BASED ON WHETHER THEIR PARENTS WENT TO COLLEGE. HOWEVER, RESPONDENTS FELT THAT EVERYONE SHOULD HAVE THE OPPORTUNITY TO GO TO COLLEGE AND HAVE ACCESS TO NECESSARY RESOURCES. THE RESOURCES IDENTIFIED INCLUDED THINGS SUCH AS CHILDCARE, FINANCES, HEALTHCARE RESOURCES, AND MORE EDUCATIONAL SUPPORT.

REPORTING GROUP B: PART V, SECTION B, LINE 11 CONTINUED
"ACCESS TO MEANINGFUL EMPLOYMENTONE COMPONENT OF A THRIVING COMMUNITY IS THE AVAILABILITY OF QUALITY EMPLOYMENT OPPORTUNITIES. WHILE THE MAJORITY OF OKLAHOMA COUNTY RESPONDENTS SURVEYED WERE EMPLOYED FULL-TIME (53%), THE PERCENTAGES VARIED DRAMATICALLY BASED ON EDUCATION LEVEL. SIXTY-FIVE PERCENT OF OKLAHOMA COUNTY RESIDENTS WITH A COLLEGE DEGREE WERE EMPLOYED FULL-TIME COMPARED TO ONLY 28% WITH LESS THAN A HIGH SCHOOL DEGREE. RESPONDENTS ALSO NOTED THAT THE THINGS THAT MADE IT DIFFICULT TO WORK WERE THEIR HEALTH OR THE HEALTH OF A FAMILY MEMBER. THIS IMPORTANT FINDING SHOWED THE DIRECT IMPACT OF POOR HEALTH ON ACCESS TO EMPLOYMENT. COMMUNITY CHAT PARTICIPANTS NOTED THE NEED TO HAVE QUALITY JOBS AND JOBS THAT WERE MEANINGFUL AND FULFILLING. THE QUALITATIVE ANALYSIS TEAM FOUND FREQUENT ALIGNMENT BETWEEN A PERSON'S EMPLOYMENT STATUS AND JOB-SPECIFIC, WORK-RELATED RESOURCES AS WELL AS THE ABILITY TO ACHIEVE A HEALTHY WORK-LIFE BALANCE. MENTORSHIP WAS ALSO FREQUENTLY MENTIONED IN THE CONTEXT OF EMPLOYMENT. HAVING A JOB WHICH INCLUDED THE SUPPORT OF A MENTOR AS WELL AS A CLEAR CAREER LADDER COULD INCREASE EMPLOYEE RETENTION. COMMUNITY CHAT PARTICIPANTS ALSO FEQUENTLY BROUGHT UP INCOME WITH RESPECT TO WORKRELATED RESOURCES, EMPLOYMENT STATUS, AND FINANCIAL BARRIERS AS IT IS NATURALLY A MAJOR DETERMINATE AS TO WHETHER A PERSON SEEKS EMPLOYMENT. WHILE THE MEDIAN HOUSEHOLD INCOME IN OKLAHOMA COUNTY IS SLIGHTLY HIGHER THAN THE STATE ($52,855 VS $51,424) IT VARIES WIDELY BY RACE/ETHNICITY. MANY DISCUSSED HAVING FINANCIAL BARRIERS DUE TO THEIR INCOME, WAS MAKING IT DIFFICULT TO HAVE A GOOD QUALITY WORK-LIFE BALANCE.ACCESS TO HEALTHY FOODA HEALTHY DIET CAN PROTECT AGAINST MANY CHRONIC NONCOMMUNICABLE DISEASES, SUCH AS HEART DISEASE, DIABETES, AND CANCER. THESE CONDITIONS ARE AMONG THE DEADLIEST IN OKLAHOMA COUNTY AND DISPROPORTIONATELY AFFECT RESIDENTS IN CERTAIN ZIP CODES AND BY RACE/ETHNICITY. THE MAJORITY OF COMMUNITY SURVEY RESPONDENTS (54%), SAID THEY COULD ALWAYS GET HEALTHY FOOD FOR THEIR FAMILY, BUT THIS VARIED BY RACE, ETHNICITY, AND EDUCATION LEVEL. THE MOST FREQUENT RESPONSE (64%) COMMUNITY MEMBERS NOTED AS A BARRIER TO ACCESSING HEALTHY FOODS WAS THE COST OF HEALTHY FOOD IN THE COMMUNITY. NEARLY ONE IN FOUR FELT THEY DID NOT HAVE THE TIME TO BUY OR PREPARE HEALTHY MEALS. FOOD ACCESS INFRASTRUCTURE IN THE COMMUNITY, WHICH INCLUDED TRANSPORTATION AND SCHEDULING, WAS ALSO A BARRIER TO CLAIMING ACCESS TO HEALTHY FOOD. WHILE THE DEFINITION OF HEALTHY FOOD INCLUDED GROCERY STORES, COMMUNITY GARDENS, AND PRESENCE OF HEALTHY FOOD, AS THE ANALYSIS OF COMMUNITY CHATS CONTINUED, IT BECAME APPARENT THAT CHOICE OF FOOD WAS JUST AS CRITICAL FOR FOOD ACCESS AS WAS THE PRESENCE OF QUALITY FOODS. ADDITIONALLY, WHILE SOME PEOPLE WERE ABLE TO ACCESS HEALTHY FOODS, THEY LACKED THE NUTRITIONAL EDUCATION TO KNOW WHAT TO EAT OR HOW TO COOK HEALTHY FOODS. IT WAS ALSO NOTED THAT MANY PEOPLE LACKED THE INCOME TO PURCHASE HEALTHY FOODS BECAUSE OFTENTIMES HEALTHY, FRESH FOODS ARE MORE EXPENSIVE. ACCESS TO HEALTHCAREAS HEALTHCARE ORGANIZATIONS, IT IS IMPORTANT THAT EACH HOSPITAL CONTINUE TO BE ACCESSIBLE TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF INSURANCE STATUS, RACE, SOCIOECONOMIC STATUS, AND OTHER FACTORS. ACCESS TO AFFORDABLE AND QUALITY HEALTHCARE WERE COMMON MESSAGES HEARD FROM COMMUNITY MEMBERS. RESPONDENTS REPORTED THE MOST DIFFICULT TYPE OF HEALTH SERVICES TO GET FOR THEIR HOUSEHOLD WERE DENTAL HEALTH SERVICES, PARTICULARLY AMONG HISPANICS. HEALTHCARE ACCESS IS A MAJOR CHALLENGE IN RACIAL MINORITY COMMUNITIES IN OKLAHOMA COUNTY DUE TO BARRIERS WHICH INCLUDE PERCEIVED FINANCIAL BARRIERS, TRANSPORTATION BARRIERS, SCHEDULING CHALLENGES, AND CULTURAL BARRIERS. AS NOTED ABOVE, ALTHOUGH TOBACCO WAS NOT SPECIFICALLY IDENTIFIED BY THE COMMUNITY AS A PRIORITY NEED, INTEGRIS HEALTH AND THEIR PARTNERS AGREE THAT IT IS A HEALTH ISSUE THAT SHOULD CONTINUE TO BE ADDRESSED. OKLAHOMA COUNTY IS STILL ABOVE THE NATIONAL AVERAGE FOR ADULTS WHO SMOKE. THE STATE OF OKLAHOMA CONTINUES TO HAVE A GRADE OF ""F"" IN HEART DISEASE DEATHS AND A GRADE OF ""D"" IN LUNG CANCER INCIDENCE. WITH THE EXPANSION OF ELECTRONIC CIGARETTES AND VAPES, NICOTINE DEPENDENCY CONTINUES TO BE A WIDESPREAD PUBLIC HEALTH CONCERN FOR OKLAHOMA COUNTY RESIDENTS.SIGNIFICANT COMMUNITY HEALTH NEEDS ADDRESSED BY OCOMINTEGRIS HEALTH WORKED WITH OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY, LLC (OCOM) TO DEVELOP AN IMPLEMENTATION STRATEGY TO PRIORITIZE AND ADDRESS NEEDS OF OCOM'S COMMUNITY, ENTITLED ""COMMUNITY HEALTH IMPROVEMENT PLAN FOR FISCAL YEARS 2023, 2024, AND 2025."" THE OCOM CHIP ADDRESSES THE FOLLOWING PRIORITY ISSUES OF OCOM:- ACCESS TO HEALTHY FOOD- OBESITY- TOBACCOPRIORITY NEED #1: ACCESS TO HEALTHY FOODOCOM ADDRESSED THIS NEED DURING THE TAX YEAR BY ORGANIZING MULTIPLE FOOD DRIVES IN ITS COMMUNITY, IN PARTNERSHIP WITH A REGIONAL FOOD BANK AND COMMUNITY DIETICIANS. IN ADDITION, OCOM SUPPORTED FOOD BANKS AND PANTRIES IN ITS COMMUNITY THROUGH DONATIONS, AND BY ENCOURAGING ITS HOSPITAL STAFF TO VOLUNTEER THEIR TIME AT LOCAL FOOD BANKS AND PANTRIES.PRIORITY NEED #2: OBESITYOCOM ADDRESSED THIS NEED DURING THE TAX YEAR BY PROVIDING PEDIATRIC HEALTHY LIVING EDUCATION, ADULT HEALTH LIVING EDUCATION, AND HEALTHY LIVING RESOURCES. FOR INSTANCE, OCOM PROVIDED EACH PEDIATRIC PATIENT WITH RESOURCES ON HEALTHY EATING EDUCATION, INCLUDED TSET EDUCATIONAL MATERIALS TO ALL PATIENTS IN DISCHARGE PACKETS, AND COMMUNICATED WITH STAFF ON HOW TO ADDRESS HEALTHY LIVING CHALLENGES WITH PATIENTS. OCOM ALSO PARTNERED WITH COMMUNITY CENTERS, SCHOOLS, POLICE DEPARTMENTS, FITNESS CENTERS, CAREER TECH CENTERS, QUALITY IMPROVEMENT ORGANIZATIONS, CHURCHES, LIBRARIES, CHRONIC DISEASE PREVENTION ORGANIZATIONS, AND SUPPORT GROUPS TO PROVIDE HEALTHY LIVING RESOURCES AND EDUCATION TO ITS COMMUNITY.PRIORITY NEED #3: TOBACCOOCOM ADDRESSED THIS NEED DURING THE TAX YEAR BY MAINTAINING A TOBACCO-FREE POLICY ON ITS CAMPUS, PROVIDING TSET EDUCATIONAL MATERIALS IN ALL PATIENT WAITING AREAS, AND OFFERING TSET EDUCATION AND OTHER SMOKING CESSATION RESOURCES TO PATIENTS WHO USE TOBACCO. IT DEVELOPED THESE RESOURCES IN PARTNERSHIP WITH YOUTH AND FAMILY SERVICES, UNITED WAY OF CENTRAL OKLAHOMA, THE OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE, THE OKLAHOMA CITY COUNTY HEALTH DEPARTMENT, AND LYNN INSTITUTES' NORTHEAST OKLAHOMA CITY COLLABORATIVE.SIGNIFICANT COMMUNITY HEALTH NEEDS NOT ADDRESSED BY OCOMOCOM CHOSE NOT TO FOCUS ON SOME OF THE SIGNIFICANT COMMUNITY HEALTH NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA, IN PARTICULAR ACCESS TO CARE, MENTAL HEALTH, EMPLOYMENT, HOUSING, HEALTH EDUCATION AND PROMOTION, TRANSPORTATION, AND POVERTY, AND SAFETY, BECAUSE INTEGRIS HEALTH, WHICH SERVES OKLAHOMA COUNTY, WAS ALREADY TAKING ACTIONS TO ADDRESS ALL OF THESE COMMUNITY NEEDS. ADDITIONALLY, OCOM LACKED THE RESOURCES AND SOME OF THE EXPERTISE TO FOCUS ON THESE NEEDS."

REPORTING GROUP C: PART V, SECTION B, LINE 5
HEALTH VENTURES IS A PARTNERSHIP FORMED IN FY2019 BETWEEN IACC, AN OKLAHOMA NOT FOR PROFIT CORPORATION THAT IS TAX-EXEMPT UNDER SECTION 501(C)(3) AND USP OKLAHOMA, INC. (USP), AN UNRELATED OKLAHOMA FOR PROFIT CORPORATION FOR THE PURPOSE OF ACQUIRING OWNERSHIP IN OR DEVELOPLING FREESTANDING AMBULATORY SURGERY HOSPITALS. ON NOVEMBER 1, 2018, HEALTH VENTURES ACQUIRED 51% OF HPI HOLDINGS, LLC (HPI). HPI OWNS A 100% INTEREST IN COMMUNITY HOSPITAL, LLC AND TPG HOSPITAL, LLC. THIS JOINT VENTURE OPERATED THE COMMUNITY HOSPITAL AND TPG HOSPITAL FACILITIES DURING THE TAX YEAR. THE JOINT VENTURE IS A PARTNERSHIP FOR WHICH A FORM 1065 IS FILED. HOWEVER, WHEN HPI WAS ACQUIRED BY HEALTH VENTURES, COMMUNITY HOSPITAL AND TPG HOSPITAL BECAME SUBJECT TO THE 501(R) PROVISIONS.OKLAHOMA COUNTY IS IN THE CENTRAL PART OF OKLAHOMA. OKLAHOMA CITY IS THE COUNTY SEAT AND IS THE LARGEST CITY IN THE STATE. THERE ARE 20 CITIES AND SMALL TOWNS LOCATED IN THE COUNTY. OKLAHOMA COUNTY EMPLOYS 379,291 PEOPLE. THE ECONOMY SPECIALIZES IN MINING, OIL, GAS, QUARRYING, EXTRACTION, MANAGEMENT OF COMPANIES AND ENTERPRISES, AND PUBLIC ADMINISTRATION. ACCORDING TO THE 2019 POPULATION ESTIMATES, THE POPULATION OF OKLAHOMA COUNTY WAS 797,434.OKLAHOMA COUNTY HAS 14 HOSPITALS, TWO FEDERALLY QUALIFIED HEALTH CENTERS WITH 14 SATELLITE CLINICS, APPROXIMATELY 17 FREE COMMUNITY CLINICS, ONE TRIBAL CLINIC, A CITY-COUNTY HEALTH DEPARTMENT WITH MULTIPLE LOCATIONSTHROUGHOUT THE COUNTY, AND A STATE HEALTH DEPARTMENT. PUBLICTRANSPORTATION, TAXI SERVICES, TWO PUBLIC AND SEVERAL PRIVATE AIRPORTS, AND PARAMEDIC LEVEL AMBULANCE SERVICES ARE ALSO LOCATED WITHIN THE COUNTY.ACCORDING TO THE OKLAHOMA CITY-COUNTY HEALTH DEPARTMENT 2021 DATA, THE MEDIAN AGE IN OKLAHOMA COUNTY WAS 34.5 YEARS, WHICH IS SLIGHTLY YOUNGER THAN THE STATE OF OKLAHOMA AT 36.4 YEARS. THE PERCENT LIVING IN POVERTY IN OKLAHOMA COUNTY IS 16.7% WHICH IS SLIGHTLY LOWER THAN THE STATE AT 16.0%. IN 2018, THE MEDIAN HOUSEHOLD INCOME IN OKLAHOMA COUNTY OF $52,855 WAS SLIGHTLY HIGHER THAN THE STATE OF $51,424. BOTH LAGGED BEHIND THE NATIONAL MEDIUM INCOME OF $60,293. OKLAHOMA COUNTY RESIDENTS RECEIVED SLIGHTLY MORE SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) BENEFITS THAN THE STATE RATE IN 2018 (13.3% VS. 13.1%.) THE RACIAL/ETHNIC BREAKOUT OF OKLAHOMA COUNTY WAS 56.0% WHITE, 14.8% BLACK OR AFRICAN AMERICAN, 17.4% HISPANIC OR LATINO, 6.7% AMERICAN INDIAN OR ALASKA NATIVE, AND 4.7% ASIAN AND PACIFIC ISLANDER.AMONG OKLAHOMA RESIDENTS 18 AND OLDER, 30% OF PERSONS HELD A BACHELOR'S DEGREE OR HIGHER AS OF 2019. ON SEPTEMBER 30, 2021, NEW UNEMPLOYMENT NUMBERS WERE RELEASED FROM THE U.S. BUREAU OF LABOR STATISTICS SHOWING OKLAHOMA CITY RANKS FIRST FOR METROPOLITAN COMMUNITIES WITH A 2010 CENSUS POPULATION OF ONE MILLION OR MORE. OKLAHOMA CITY HAD AN UNEMPLOYMENT RATE OF ONLY 2.6% AND IS THE LOWEST RATE SINCE 2019.THE PERCENT OF UNINSURED ADULTS (AGE 18-64), IN OKLAHOMA COUNTY, ACCORDING TO DATA FROM THE 2021 U.S. CENSUS BUREAU, WAS CONSISTENT WITH THE STATE RATE OF 16.8%. ACCORDING TO THE OKLAHOMA HEALTH CARE AUTHORITY FAST FACTS, JANUARY 2021, THERE WERE A TOTAL OF 200,287 PERSONS ENROLLED IN MEDICAID IN OKLAHOMA COUNTY AND 946,412 PERSONS ENROLLED IN MEDICAID IN THE STATE OF OKLAHOMA DURING THE SAME PERIOD. AS OF FEBRUARY 2021, THERE WERE 92,632 PERSONS IN OKLAHOMA COUNTY AND 572,942 PERSONS IN THE STATE OF OKLAHOMA ENROLLED IN MEDICARE ACCORDING TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, MEDICARE ENROLLMENT DASHBOARD. BETWEEN 2015 AND 2019, THE AVERAGE NUMBER OF PERSON PER HOUSEHOLD IN OKLAHOMA COUNTY WAS 2.56 WHICH WAS SLIGHTLY LOWER THAN THE STATE AT 2.58. DURING THE SAME PERIOD, THE PERCENT OF PERSONS, 5 YEARS OR OLDER, IN OKLAHOMA COUNTY WHO SPOKE A LANGUAGE OTHER THAN ENGLISH AT HOME WAS 17.4% COMPARED TO THE STATE RATE OF 10.5%. IN 2020, ACCORDING TO THE 2020 COUNTY HEALTH RANKINGS FOR OKLAHOMA COUNTY, ACCESS TO A PRIMARY CARE PHYSICIAN, PEOPLE PER ONE PROVIDER, WAS 1,170 COMPARED TO THE STATE OF OKLAHOMA WHICH WAS 1,620 PEOPLE PER ONE PROVIDER. ACCESS TO DENTISTS AND MENTAL HEALTH IN OKLAHOMA COUNTY, PEOPLE PER ONE PROVIDER, ACCORDING TO THE SAME SOURCE, WAS 980 AND 150, RESPECTIVELY AND 1640 AND 250, PEOPLE PER ONE PROVIDER FOR THE STATE OF OKLAHOMA. BETWEEN 2015-2017, THE AVERAGE LIFE EXPECTANCY IN OKLAHOMA COUNTY IS 74.9 YEARS WHEREAS THE AVERAGE IN THE U.S. IS 78.8 YEARS.BETWEEN 2016-2018, CARDIOVASCULAR DISEASE WAS THE LEADING CAUSE OF DEATH IN OKLAHOMA COUNTY. AT 337.7 DEATHS PER 100,000, MALES HAD 100 MORE DEATHS PER 100,000 COMPARED TO FEMALES WITH A RATE OF 235.9 DEATHS PER 100,000. CANCER WAS THE SECOND LEADING CAUSE OF DEATH IN OKLAHOMA CITY-COUNTY BETWEEN 2016-2018, THE AGE-ADJUSTED MORTALITY RATE IN OKLAHOMA COUNTY WAS 188.0 PER 100,000 DEATHS, ONLY SLIGHTLY HIGHER THAN THE STATE RATE OF 177.8 PER 100,000 DEATHS,

REPORTING GROUP C: PART V, SECTION B, LINE 5 CONTINUED
ONLY SLIGHTLY HIGHER THAN THE STATE RATE OF 177.8 PER 100,000 DEATHS BUT 27.6 DEATHS PER 100,000 GREATER THAN THE NATIONAL CANCER DEATH RATE. OKLAHOMA COUNTY HAD HIGHER DIABETES MORTALITY BETWEEN 2016-2018 COMPARED TO THE STATE AND NATIONAL RATES. THE OVERALL AGE-ADJUSTED DIABETES MORTALITY RATE IN THE COUNTY WAS 34.6 DEATHS PER 100,000. OKLAHOMA IS THE NINTH MOST OBESE STATE IN THE NATION, OKLAHOMA'S OBESITY RATE AS OF 2021 WAS AT 36.4%. THE SUICIDE RATES IN OKLAHOMA COUNTY AND THE STATE OF OKLAHOMA WERE HIGHER THAN THE NATIONAL AVERAGE BETWEEN 2016-2018. THE AGE-ADJUSTED SUICIDE RATE IN OKLAHOMA COUNTY WAS 18 DEATHS PER 100,000 PEOPLE.A COMPREHENSIVE AND A COLLABORATIVE JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY FOUR NON-PROFIT HEALTH SYSTEMS AS ALL FOUR HEALTH SYSTEMS DEFINE THEIR COMMUNITY AS OKLAHOMA COUNTY. THIS CHNA INCLUDED INTEGRIS HEALTH SYSTEM AND INCLUDES THE JOINT VENTURE HOSPITALS: HEALTHCARE PARTNERS (HIP), INTEGRIS COMMUNITY HOSPITALS AND OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI SPECIALTY SURGERY THE CHNA UTILIZES RELEVANT HEALTH DATA TO IDENTIFY THE SIGNIFICANT COMMUNITY HEALTH NEEDS OF OKLAHOMA AND CLEVELAND COUNTIES IN THE STATE OF OKLAHOMA. ALL OF THE JOINT VENTURE HOSPITALS LIE WITHIN OKLHOMA COUNTY, EXCEPT FOR ONE SMALL CAMPUS OF THE INTEGRIS COMMUNITY HOSPITALS (MOORE), WHICH LIES ON THE NORTHERN EDGE OF CLEVELAND COUNTY. THE GOAL OF THIS REPORT IS TO PROVIDE RESIDENTS WITH A DEEPER UNDERSTANDING OF THE HEALTH NEEDS IN THEIR COMMUNITY AND TO HELP GUIDE THE HOSPITALS IN THEIR COMMUNITY BENEFIT PLANNING EFFORTS AND THE DEVELOPMENT OF AN IMPLEMENTATION STRATEGY TO ADDRESS IDENTIFIED NEEDS. COMMUNITY INPUT WAS RECEIVED DURING STAKEHOLDER MEETINGS, COMMUNITY SURVEYS COLLECTED DURING APRIL 2021-JULY 2021 AND ONLINE CHATS WHICH WERE CONDUCTED FROM MAY 23, 2021 - JUNE 30, 2021.THE AFFORDABLE CARE ACT (ACA) REQUIRES 501(C)(3), TAX-EXEMPT HOSPITALS TO CONDUCT A CHNA AT LEAST ONCE EVERY THREE TAX YEARS AND TO ADOPT A STRATEGIC IMPLEMENTATION PLAN FOR ADDRESSING IDENTIFIED NEEDS. HPI AND ITS COLLABORATORS LAST CONDUCTED A CHNA IN ITS 2021 TAX YEAR.

REPORTING GROUP C: PART V, SECTION B, LINE 11
"THE MOST RECENTLY CONDUCTED CHNA IDENTIFIED A NUMBER OF SIGNIFICANT NEEDS IN THE OKLAHOMA COUNTY COMMUNITY SERVED BY HPIAND THE OTHER COLLABORATORS FACILITIES, WHICH WERE DETERMINED BY EVALUATING AND SYNTHESIZING PRIMARY AND SECONDARY DATA TO IDENTIFY SIGNIFICANT COMMUNITY HEALTH NEEDS IN OKLAHOMA AND CLEVELAND COUNTY.UPON REVIEW AND ANALYSIS OF ALL QUANTITATIVE AND QUALITATIVE FEEDBACK AND SURVEYS THE FOLLOWING SIGNIFICANT NEEDS FOR OKLAHOMA COUNTY WERE IDENTIFIED:- EMPLOYMENT- FOOD INSECURITY- HOUSING- HEALTH EDUCATION AND PROMOTION- ACCESS TO HEALTHCARE- OBESITY- MENTAL HEALTH - TRANSPORTATIONTHE ABOVE NEEDS SPAN THE AREAS DENOTED BELOW AND WERE OFTEN INTERRELATED. ALL ARE SOCIAL DETERMINATES OF HEALTH.SIGNFICANT COMMUNITY HEALTH NEEDS WERE THEN IDENTIFIED AND PRIORITIZED IN ALL OF THE FOLLOWING AREAS:- ECONOMIC STABILITY- NEIGHBORHOOD AND BUILT ENVIRONMENT- HEALTH AND HEALTHCARE- SOCIAL AND COMMUNITY CONTEXT - EDUCATIONINTEGRIS HEALTH THEN ANALYZED AND EVALUATED THE PRIMARY DATA AND THE SECONDARY PUBLIC HEALTH DATA COLLECTED DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ISSUES WERE PRIORITIZED BASED ON CURRENT SYSTEM WIDE EFFORTS AT INTEGRIS HEALTH AND ALIGNED WITH THE CURRENT COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) GOALS AND OBJECTIVES IN THE OKLAHOMA CITY METRO.THE IMPLEMENTATION PLAN FOR HPI, ENTITLED ""FY 2022 COMMUNITY HEALTH IMPROVEMENT PLAN,"" SPECIFICALLY ADDRESSES THE FOLLOWING PRIORITY ISSUES:- ACCESS TO CARE- FOOD INSECURITY - TOBACCOHPI ADDRESSED THIS NEED DURING THE TAX YEAR BY PROVIDE RESOURCES AND HELP ENROLLING IN NEW MEDICAID EXPANSION. ALL CAMPUSES HAVE INFORMATION REGARDING THE FINANCIAL ASSISTANCE PROGRAMS. PROVIDE FREE HEALTH CLINIC SERVICE INFORMATION TO PATIENTS IN NEED.PRIORITY NEED #2: FOOD INSECURITYHPI ADDRESSED THIS NEED DURING THE TAX YEAR BY ORGANIZING FOOD DRIVE AND SUPPORTING FOOD BANK/PANTRIES FINANCIALLY THROUGH DONATIONS. ESTABLISH ONE FOOD DRIVE IN 2ND QUARTER (APRIL, MAY, AND JUNE 2022).PRIORITY NEED #3: TOBACCOHPI ADDRESSED THIS NEED DURING THE TAX YEAR BY HOSPITAL RESOURCES: EDUCATIONAL MATERIAL, REFERRAL SYSTEM, OKLAHOMA CITY COUNTY HEALTH DEPARTMENT PARTNERSHIP AND WELLNESS INITIATIVES, EMPLOYEE ASSISTANCE PROGRAM, FINANCIAL SUPPORT, MOBILE ASSESSMENT TEAM AND SCREENING TOOL IN PARTNERSHIP WITH YOUTH AND FAMILY SERVICES, UNITED WAY OF CENTRAL OKLAHOMA, OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE, AMERICAN FOUNDATION FOR SUICIDE PREVENTION, 211 REFERRAL SYSTEM, YWCA, OKLAHOMA CITY COUNTY HEALTH DEPARTMENT AND LIGHTHOUSE MEDICAL CLINIC. ALSO PROVIDING TSET EDUCATION TO ALL PATIENTS AND ENSURING SIGNAGE IS POSTED."

SCHEDULE H, PART V, SECTION B, LINE 20D
REPORTING GROUP B & C:NEITHER OCOM OR HPI MADE ANY PRESUMPTIVE ELIGIBILITY DETERMINATIONS. DURING THE TAX YEAR, ALL PATIENTS ARE PROVIDED WITH A FINANCIAL ASSISTANCE APPLICATION AND A PLAIN LANGUAGE SUMMARY AT ADMISSION OR UPON REQUEST. ALL PATIENTS ARE ELIGIBLE TO APPLY FOR FINANCIAL ASSISTANCE DURING THE APPLICATION PERIOD, WHICH ENDS ON THE 240TH DAY AFTER OCOM MAILS OR ELECTRONICALLY PROVIDES THE INDIVIDUAL WITH THE FIRST BILLING STATEMENT. ONCE AN APPLICATION IS RECEIVED IT IS GIVEN TO A BUSINESS OFFICE REPRESENTATIVE TO REVIEW FOR PRE-APPROVAL PER FPL GUIDELINES IN THE FINANCIAL ASSISTANCE POLICY. IF PRE-APPROVED, AN ADJUSTMENT REQUEST IS THEN GIVEN TO THE CONTROLLER TO REVIEW FOR FIRST LEVEL APPROVAL. IF APPROVED FIRST LEVEL, THE FINANCIAL ASSISTANCE APPLICATION AND ADJUSTMENT REQUEST ARE SENT TO THE CEO FOR FINAL APPROVAL. THE PATIENT IS THEN NOTIFIED VIA CALL AND/OR LETTER THAT HIS OR HER APPLICATION HAS BEEN APPROVED.

PART I, LINE 6A:
INTEGRIS HEALTH, INC., (EIN: 73-1192764), THE PARENT ORGANIZATION OF INTEGRIS AMBULATORY CARE CORPORATION, PRODUCES A CONSOLIDATED COMMUNITY BENEFIT REPORT THAT IS MADE AVAILABLE TO THE PUBLIC.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY-BUILDING ACTIVITIES IMPROVE THE COMMUNITY'S HEALTH AND SAFETY BY ADDRESSING THE ROOT CAUSE OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ENVIRONMENTAL HAZARDS. THESE ACTIVITIES STRENGTHEN THE COMMUNITY'S CAPACITY TO PROMOTE THE HEALTH AND WELL-BEING OF ITS RESIDENTS BY OFFERING THE EXPERTISE AND RESOURCES OF THE HEALTH CARE ORGANIZATION. COSTS FOR THESE ACTIVITIES INCLUDE CASH AND IN-KIND DONATIONS AND EXPENSES FOR THE DEVELOPMENT OF A VARIETY OF COMMUNITY-BUILDING PROGRAMS AND PARTNERSHIPS.

PART III, LINE 2:
COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 16.14%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE.

PART III, LINE 3:
IACC DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE.

PART III, LINE 4:
IACC DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF INTEGRIS HEALTH, INC. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS:A PORTFOLIO APPROACH BY MAJOR PAYOR CATEGORIES AND TYPES OF SERVICE WAS USED TO ESTIMATE THE HISTORICAL COLLECTIONS EXPERIENCE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO NET PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. PORTFOLIO COLLECTION ESTIMATES ARE UPDATED AT LEAST QUARTERLY BASED ON ACTUAL COLLECTIONS EXPERIENCE.INTEGRIS HEALTH BELIEVES THAT REVENUE RECOGNIZED BY UTILIZING THE PORTFOLIO APPROACH APPROXIMATES THE REVENUE THAT WOULD HAVE BEEN RECOGNIZED IF AN INDIVIDUAL CONTRACT APPROACH WAS USED. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE ASSESSED FIRST FOR ELIGIBILITY FOR CHARITY CARE OR RECORDED AS BAD DEBT EXPENSE.

PART III, LINE 8:
THE COST TO CHARGE METHODOLOGY WAS USED IN ORDER TO CALCULATE THE MEDICARE ALLOWABLE COSTS RELATED TO PAYMENTS RECEIVED FROM MEDICARE. ANY RESULTING SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT.

SCHEDULE H, PART III, LINE 4
REPORTING GROUP B:FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE:OCOM DOES NOT HAVE A STAND-ALONE AUDIT AND IS INCLUDED IN THE CONSOLIDATED FINANCIALS OF INTEGRIS AMBULATORY CARE CORP, WHICH DOES NOT SPECIFICALLY ADDRESS BAD DEBT. OCOM ACCOUNTS FOR BAD DEBT EXPENSE AS FOLLOWS:-75% OF ACCOUNTS RECEIVABLE NET OF THE CONTRACTUAL ALLOWANCE AGED 120 DAYS OR GREATER (EXCLUDING LEGAL LIABILITY), PLUS 25% OF ACCOUNTS RECEIVABLE NET OF THE CONTRACTUAL ALLOWANCE IN THE 90 DAY BUCKET. WE RESERVE 50% OF LEGAL LIABILITY OVER 120 DAYS.

PART VI, LINE 3:
REPORTING GROUP APART VI, LINE 3: PATIENT EDUCATION - ELIGIBILITY FOR ASSISTANCEINTEGRIS HEALTH USES A MULTI-FACETED APPROACH TO EDUCATE OUR PATIENTS ON THE AVAILABILITY OF CHARITY AS WELL AS STATE AND FEDERAL FINANCIAL ASSISTANCE. THIS INCLUDES:*POSTERS CLEARLY DISPLAYED IN EVERY PATIENT REGISTRATION AREA SPEAKING TO OUR FINANCIAL ASSISTANCE PROGRAMS.*A FINANCIAL RIGHTS AND RESPONSIBILITY BROCHURE GIVEN TO EVERY PATIENT AT THE TIME OF THEIR REGISTRATION WHICH PROVIDES FINANCIAL ASSISTANCE PROGRAM DETAILS.*A CLEARLY MARKED PRESENCE ON THE INTEGRIS HEALTH ON-LINE BUSINESS OFFICE WEBSITE WITH A SECTION DEVOTED TO FINANCIAL ASSISTANCE PROGRAM DETAILS AS WELL AS AN ON-LINE CHARITY APPLICATION.*A DESCRIPTION OF THE FINANCIAL ASSISTANCE PROGRAM AS WELL AS THE APPLICATION PROCESS IS INCLUDED ON EVERY PATIENT BILL.FINANCIAL COUNSELORS MEET WITH PATIENTS TO IDENTIFY ELIGIBILITY FOR FEDERAL AND STATE ASSISTANCE PROGRAMS.REPORTING GROUP BPART VI, LINE 3: PATIENT EDUCATION - ELIGIBILITY FOR ASSISTANCEOCOM PATIENTS WERE INFORMED AND EDUCATED OVER THE PHONE OR IN PERSON PRIOR TO MEDICAL SERVICES BEING PROVIDED ABOUT THE AVAILABILITY AND ELIGIBILITY OF FINANCIAL ASSISTANCE. IF A PATIENT DECIDED TO APPLY FOR FINANCIAL ASSISTANCE AFTER THE MEDICAL SERVICES WERE PROVIDED, PATIENTS WERE FURTHER EDUCATED OVER THE PHONE OR IN PERSON ABOUT THE AVAILABILITY AND ELIGIBILITY OF FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY APPLICATION INSRUCTIONS WERE ALSO MADE AVAILABLE ONLINE WITH THE ABILITY TO BE PRINTED DIRECTLY FROM THE OCOM WEBSITE, WITHOUT CHARGE. PATIENTS COULD ALSO REQUEST A COPY OF THE FINANCIAL ASSISTANCE POLICY APPLICATION INSTRUCTIONS FROM OCOM'S WEBSITE OR BY MAIL BY CALLING THE OCOM BUSINESS OFFICE.REPORTING GROUP CPART VI, LINE 3: PATIENT EDUCATION - ELIGIBILITY FOR ASSISTANCE HPI FACILITY PATIENTS WERE INFORMED AND EDUCATED ONLINE, BY TELEPHONE, BY MAIL, ON POSTED SIGNS AND PAPER COPIES OR BROCHURES LOCATED IN ALL REGISTRATION AREAS THROUGHOUT THE FACILITIES, IN PERSON, AND IN BILLING STATEMENTS ABOUT THE AVAILABILITY AND ELIGIBILITY OF FINANCIAL ASSISTANCE. REGISTRATION STAFF REFERS PATIENTS TO WEBSITE AND TO THE BILLING DEPARTMENT AS NEEDED OR REQUESTED. THEY PRINT OFF CHARITY APPLICATIONS AND ASSISTS PATIENTS IN COMPLETING. IF TRANSLATION IS NEEDED TO HELP COMPLETE FORMS A CALL IS MADE INTO THE LANGUAGE LINE FOR ASSISTANCE. IF FINANCIAL NEED IS DETERMINED WHEN PATIENT IS IN PERSON AT FACILITY, EXAMPLE LACK OF INSURANCE OR UNABLE TO PAY, PATIENT IS ASSISTED WITH APPLICATION AND/OR REFERRED TO BILLING TO ASSIST. SCHEDULING, FINANCIAL COUNSELOR, REGISTRATION, AND AUTHORIZATION DEPARTMENT, REFER PATIENTS IN NEED OF ASSISTANCE TO WEBSITE AND TO BILLING AS NEEDED.

PART VI, LINE 7, REPORTS FILED WITH STATES
OK

SCHEDULE H, PART VI
REPORTING GROUP APART I, LINE 7: COSTING METHODOLOGY: THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE CHARITY ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF CHARITY ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON PART 1, LINE 7. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE.REPORTING GROUP BPART I, LINE 7:OCOM'S TOTAL EXPENSE INCLUDED IN PART IX, LINE 25, COLUMN (A) OF FORM 990 WAS $261,891,489, WHICH WAS USED FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F).

SCHEDULE H, PART III, LINE 8
REPORTING GROUP ATHE AMOUNTS REPORTED ON PART III, LINES 5 AND 6 REPRESENT INTEGRIS AMBULATORY CARE CORPORATION'S (IACC) PROPORTIONATE SHARE OF THE ALLOWABLE COSTS AND MEDICARE REIMBURSMENTS THAT ARE REPORTED ON OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY'S (OCOM) MEDICARE COST REPORT & LAKESIDE WOMEN'S HOSPITAL LLC (LWH) MEDICARE COST REPORT.COSTING METHODOLOGY: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO AND THE MEDICARE FILED COST REPORT.REPORTING GROUP BTHE COST TO CHARGE METHODOLOGY WAS USED IN ORDER TO CALCULATE THE MEDICARE ALLOWABLE COSTS RELATED TO PAYMENTS RECEIVED FROM MEDICARE. ANY RESULTING SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT.

PART VI, LINE 2:
"REPORTING GROUP APART VI, LINE 2: NEEDS ASSESSMENT INTEGRIS HEALTH UTILIZES A VARIETY OF TOOLS TO DETERMINE THE HEALTH CARE NEEDS OF OUR COMMUNITIES. THESE INCLUDE PARTNERSHIPS WITH LOCAL COMMUNITY AGENCIES AND ORGANIZATIONS TO DETERMINE SPECIFIC TARGET MARKET NEEDS, PROGRAM SURVEYS AND COMMUNITY FOCUS GROUPS, PROGRAM EVALUATIONS FROM PARTICIPANTS IN OUR COMMUNITY HEALTH SCREENINGS, HEALTH EDUCATION AND SUPPORT GROUPS, THE COUNTY HEALTH RANKINGS REPORT AND THE OKLAHOMA STATE HEALTH DEPARTMENT'S ""STATE OF THE STATE HEALTH REPORT.""AFTER REVIEWING THESE MATERIALS FOR ISSUES CONCERNING ACCESS TO CARE, HEALTH EDUCATION NEEDS AND GAPS IN SERVICES IN OUR COMMUNITIES, INTEGRIS HEALTH DETERMINES HOW TO ADDRESS THESE ISSUES BY DEVELOPING PROGRAMS/SERVICES TO IMPLEMENT, INCLUDING, BUT NOT LIMITED TO, HEALTH SCREENINGS, COMMUNITY HEALTH EDUCATION AND WELLNESS PROGRAMS, SUPPORT GROUPS, AND ACCESS TO HEALTH CARE FACILITIES. INTEGRIS HEALTH UTILIZES OUR HEALTH SYSTEM RESOURCES, FACILITIES AND PERSONNEL FOR MANY OF THESE PROGRAMS, BUT ALSO PARTNERS WITH OUR COMMUNITIES AND DEVELOPS COLLABORATIONS WITH LOCAL NON-PROFIT AGENCIES, CIVIC ORGANIZATIONS, SCHOOLS, AND CHURCHES TO IMPROVE THE ISSUES IDENTIFIED.REPORTING GROUP BPART VI, LINE 2: NEEDS ASSESSMENT A COMPREHENSIVE AND A COLLABORATIVE JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY FOUR NON-PROFIT HEALTH SYSTEMS AS ALL FOUR HEALTH SYSTEMS DEFINE THEIR COMMUNITY AS OKLAHOMA COUNTY. INTEGRIS HEALTH SYSTEM WAS ONE OF THE FOUR NON-PROFIT HEALTH SYSTEMS THAT CONDUCTED THIS CHNA. INTEGRIS HEALTH SYSTEM INCLUDES THEIR JOINT VENTURE HOSPITALS: HEALTHCARE PARTNERS (HIP), INTEGRIS COMMUNITY HOSPITALS, AND OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY BY INTEGRIS HEALTH DURING THE FISCAL YEAR ENDED JUNE 30, 2022.THE COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH INCLUDED OCOM, WAS APPROVED AND ADOPTED BY OCOM'S BOARD OF DIRECTORS ON JULY 25, 2022. ADDITIONALLY, THE RELATED IMPLEMENTATION STRATEGY, OCOM PREPARED, REFERRED TO AS THEIR COMMUNITY HEALTH IMPROVEMENT PLAN OR CHIP, WAS ALSO APPROVED AND ADOPTED BY THEIR BOARD ON JULY 25, 2022.AS DISCUSSED IN SCHEDULE H, SECTION B, PART V ABOVE, A COMPREHENSIVE AND A COLLABORATIVE JOINT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED FOR HEALTHCARE PARTNERS INVESTMENTS (HIP), INTEGRIS COMMUNITY HOSPITALS AND OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY BY INTEGRIS HEALTH DURING THE FISCAL YEAR ENDED JUNE 30, 2022. THE CHNA UTILIZES RELEVANT HEALTH DATA RECEIVED FROM THE HOSPITAL CHNA COLLABORATORS AND FROM OKLAHOMA COUNTY RESIDENTS OF ALL BACKGROUNDS, SOCIOECONOMIC STATUS, AND DEMOGRAPHICS TO IDENTIFY THE SIGNIFICANT COMMUNITY HEALTH NEEDS OF OKLAHOMA AND CLEVELAND COUNTIES IN THE STATE OF OKLAHOMA.INTEGRIS HEALTH THEN ANALYZED AND EVALUATED THE PRIMARY DATA AND THE SECONDARY PUBLIC HEALTH DATA COLLECTED DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ISSUES WERE PRIORITIZED BASED ON CURRENT SYSTEMWIDE EFFORTS AT INTEGRIS HEALTH AND ALIGNED WITH THE CURRENT COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) GOALS AND OBJECTIVES IN THE OKLAHOMA CITY METRO. FOCUS WAS ALSO GIVEN TO THE INTERCONNECTEDNESS OF SOCIAL DETERMINANTS AND HEALTH OUTCOMES IN OKLAHOMA COUNTY.THE FOLLOWING FOUR PRIORITIZED NEEDS WERE DETERMINED:- ACCESS TO EDUCATION- ACCESS TO MEANINGFUL EMPLOYMENT- ACCESS TO HEALTHY FOOD- ACCESS TO HEALTHCARETOBACCO *INTEGRIS HEALTH CHOSE TO FOCUS ON ALL OF THE IDENTIFIED PRIORITY ISSUES.* AS ALSO NOTED IN SCHEDULE H, SECTION B, PART V, WHILE TOBACCO WAS NOT SPECIFICALLY IDENTIFIED BY THE COMMUNITY AS A PRIORITY NEED, INTEGRIS HEALTH AND THEIR PARTNERS AGREE THAT IT IS A HEALTH ISSUE THAT SHOULD CONTINUE TO BE ADDRESSED. OKLAHOMA COUNTY IS STILL ABOVE THE NATIONAL AVERAGE FOR ADULTS WHO SMOKE AND NICOTINE DEPENDENCY CONTINUES TO BEA WIDESPREAD PUBLIC HEALTH CONCERN FOR OKLAHOMA COUNTY RESIDENTS.EACH HOSPITAL THEN DEVELOPED AN INDIVIDUAL CHIP IN A SEPARATE DOCUMENT TO ADDRESS THE NEEDS IDENTIFIED, BASED ON THEIR INTERNAL PRIORITIES AND RESOURCES.THE IMPLEMENTATION PLAN FOR OCOM SPECIFICALLY ADDRESSES THE FOLLOWING PRIORITY ISSUES:- ACCESS TO HEALTHY FOOD- OBESITY- TOBACCOIN ORDER TO ADDRESS EACH PRIORITIZED NEED, HOSPITAL RESOURCES WERE ALLOCATED AND COMMUNITY PARTNERSHIPS WERE IDENTIFIED TO ASSIST. SPECIFIC PROGRAMS WERE IMPLEMENTED WITH SUPPORTING ACTIVITIES AND YEARLY TARGET GOALS.REPORTING GROUP CPART VI, LINE 2: NEEDS ASSESSMENTHPI COLLABORATED WITH INTEGRIS HEALTH IN A JOINT CHNA.HTTPS://COMMUNITYHOSPITALOKC.COM/APPLICATION/FILES/2916/2826/6047/CHNA2021.PDFHTTPS://NWSURGICALOKC.COM/APPLICATION/FILES/6016/2826/5929/CHNA2021.PDFHTTPS://WWW.INTEGRISCOMMUNITYHOSPITAL.COM/INT-ASSETS/UPLOADS/FORMS/INTEGRIS-HEALTH-JOINT-CHNA_2020-2021.PDF"

PART VI, LINE 6:
REPORTING GROUP APART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM ROLES IACC IS A MEMBER OF INTEGRIS HEALTH SYSTEM, OF WHICH INTEGRIS HEALTH, INC. IS THE CONTROLLING MEMBER. INTEGRIS HEALTH SYSTEM IS AN OKLAHOMA HEALTH CARE SYSTEM WHICH SUPPORTS THE COMMUNITY NEEDS ACROSS THE STATE. THE MISSION OF INTEGRIS HEALTH IS TO IMPROVE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES WE SERVE. THE FACILITIES OF OTHER TAXPAYERS ARE LISTED ON THE SCHEDULE H OF THEIR RESPECTIVE FORMS 990.REPORTING GROUP BPART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM ROLESAS DESCRIBED ABOVE, OCOM WAS RESTRUCTURED EFFECTIVE NOVEMBER 1, 2018 WHEN A NEW JOINT VENTURE WAS FORMED BETWEEN INTEGRIS AND USP OK. WHEN THE NEW JOINT VENTURE WAS FORMED WITH INTEGRIS, OCOM BECAME SUBJECT TO THE 501(R) PROVISIONS.REPORTING GROUP CPART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMHPI IS A JOINT VENTURE FORMED BETWEEN INTEGRIS AND USP OK. WHEN THE NEW JOINT VENTURE WAS FORMED WITH INTEGRIS, HPI BECAME SUBJECT TO THE 501(R) PROVISIONS.

SCHEDULE H, PART III, LINE 9B
REPORTING GROUP APATIENTS MAY, AT ANY TIME DURING THE COLLECTION CYCLE, SUBMIT FINANCIAL INFORMATION FOR FINANCIAL ASSISTANCE OR CHARITY CONSIDERATION PURSUANT TO INTEGRIS POLICY SYS-RCM-100 CHARITY SERVICES.ALL AVAILABLE AVENUES OF ASSISTANCE AND AVAILABLE PAYMENTS FROM THIRD PARTY PAYORS MUST BE EXHAUSTED BEFORE SUCH ASSISTANCE FOR CHARITY OR OTHER FINANCIAL ASSISTANCE IS CONSIDERED.IACC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE.

PART VI, LINE 4:
REPORTING GROUP APART VI, LINE 4: COMMUNITY INFORMATION INTEGRIS HEALTH SYSTEM IS THE STATE'S LARGEST OKLAHOMA-OWNED HEALTH CARE SYSTEM AND ONE OF THE STATE'S LARGEST PRIVATE EMPLOYERS, WITH HOSPITALS, REHABILITATION CENTERS, PHYSICIAN'S CLINICS, MENTAL HEALTH FACILITIES, CANCER CENTERS, INDEPENDENT LIVING CENTERS, AND HOME HEALTH AGENCIES THROUGHOUT MOST OF THE STATE. ALL COUNTIES IN WHICH INTEGRIS HEALTH OPERATES INCLUDE ONE OR MORE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS. INTEGRIS AMBULATORY CARE CORPORATION (IACC) IS LOCATED IN OKLAHOMA CITY, WHICH IS IN OKLAHOMA COUNTY IN CENTRAL OKLAHOMA.REPORTING GROUP BPART VI, LINE 4: COMMUNITY INFORMATIONOCOM IS LOCATED IN OKLAHOMA CITY WITH AN HOPD LOCATION (OCOM NORTH) IN NORTHWEST OKLAHOMA CITY AND THREE FREESTANDING IMAGING FACILITIES TO SERVICE OKLAHOMA CITY, IN OKLAHOMA COUNTY, OKLAHOMA. OKLAHOMA CITY IS THE COUNTY SEAT AND THE LARGEST CITY IN THE STATE. THERE ARE 20 CITIES AND SMALL TOWNS LOCATED IN THE COUNTY. THE ECONOMY SPECIALIZES IN OIL, GAS, QUARRYING, EXTRACTION, MANAGEMENT OF COMPANIES AND ENTERPRISES, AND PUBLIC ADMINISTRATION. OKLAHOMA COUNTY'S POPULATION IS GROWING ACROSS ALL RACIAL AND ETHNIC GROUPS. THERE WAS A 5.9% INCREASE IN TOTAL POPULATION FROM 2014-2019. ACCORDING TO THE 2019 POPULATION ESTIMATES, THE POPULATION OF OKLAHOMA COUNTY WAS 797,434. AS OF 2019, THE MEDIAN AGE FOR OKLAHOMA COUNTY WAS 34.6 YEARS WHILE THE MEDIAN AGE FOR THE STATE OF OKLAHOMA WAS 34.1 YEARS. AS OF 2018, APPROXIMATELY 16.7% OF THE PEOPLE IN OKLAHOMA COUNTY LIVED BELOW THE POVERTY LEVEL AND WERE NOT ALWAYS ABLE TO MEET THEIR BASIC NEEDS LIKE AFFORDABLE HOUSING, HEALTH CARE, HEALTHY FOOD, TRANSPORTATION, AND SOCIAL SERVICES (2018). THE MEDIAN HOUSEHOLD INCOME FOR OKLAHOMA COUNTY WAS $52,855 COMPARED TO $51,424 FOR THE STATE OF OKLAHOMA AND $60,293 FOR THE NATIONAL AVERAGE (2021 WELLNESS SCORE FROM 2018). THE MAJORITY OF RESIDENTS IN OKLAHOMA COUNTY IDENTIFY AS WHITE (56%). THE NEXT LARGEST RACES/ETHNICITIES IN OKLAHOMA COUNTY ARE HISPANIC/LATINO (17.4%), BLACK OR AFRICAN AMERICAN (14.8%), AMERICAN INDIAN/ALASKAN NATIVE (6.7%), AND ASIAN/PACIFIC ISLANDER (4.7%) OR SOME OTHER RACE (4.1%).THE OVERALL MORTALITY RATES IN OKLAHOMA CITY COUNTY FROM 2016-2018 WAS 932.6 DEATHS PER 100,000 PEOPLE. THAT WAS GREATER THAN THE NATIONAL RATE OF 728.9 AND THE STATE RATE OF 894.7 DEATHS PER 100,000. MORTALITY RATES WERE HIGHEST AMONG AMERICAN INDIANS. NON-HISPANICS HAD A HIGHER MORTALITY RATE THAN HISPANICS. THE ZIP CODES WITH THE HIGHEST MORTALITY RATES WERE 73007, 73141, AND 73102. AMONG OKLAHOMA COUNTY RESIDENTS, 30% HELD A BACHELOR'S DEGREE OR HIGHER IN 2019. SINCE THE COVID-19 PANDEMIC, THE EMPLOYMENT SITUATION IN OKLAHOMA HAS IMPROVED. ON SEPTEMBER 30, 2019, THE UNEMPLOYMENT RATE FOR OKLAHOMA CITY WAS 2.6%. ACCORDING TO THE U.S. BUREAU OF LABOR STATISTICS, OKLAHOMA RANKED FIRST FOR METROPOLITAN CITIES WITH A CENSUS POPULATION OF GREATER THAN ONE MILLION OR MORE.REPORTING GROUP CPART VI, LINE 4: COMMUNITY INFORMATIONOKLAHOMA COUNTY IS IN THE CENTRAL PART OF OKLAHOMA. OKLAHOMA CITY IS THE COUNTY SEAT AND IS THE LARGEST CITY IN THE STATE. THERE ARE 20 CITIES AND SMALL TOWNS LOCATED IN THE COUNTY. (1) OKLAHOMA COUNTY EMPLOYS 379,291 PEOPLE. THE ECONOMY SPECIALIZES IN MINING, OIL, GAS, QUARRYING, EXTRACTION, MANAGEMENT OF COMPANIES AND ENTERPRISES, AND PUBLIC ADMINISTRATION. ACCORDING TO THE 2019 POPULATION ESTIMATES, THE POPULATION OF OKLAHOMA COUNTY WAS 797,434. (1) THE COUNTY OCCUPIES 708 SQUARE MILES. AS OF 2010 CENSUS, THERE WERE 1,013 PERSONS PER SQUARE MILE. (1) OKLAHOMA COUNTY HAS 14 HOSPITALS, TWO FEDERALLY QUALIFIED HEALTH CENTERS WITH 14 SATELLITE CLINICS, APPROXIMATELY 17 FREE COMMUNITY CLINICS, ONE TRIBAL CLINIC, A CITY-COUNTY HEALTH DEPARTMENT WITH MULTIPLE LOCATIONS THROUGHOUT THE COUNTY, AND A STATE HEALTH DEPARTMENT. PUBLIC TRANSPORTATION, TAXI SERVICES, TWO PUBLIC AND SEVERAL PRIVATE AIRPORTS, AND PARAMEDIC LEVEL AMBULANCE SERVICES ARE ALSO LOCATED WITHIN THE COUNTY.

SCHEDULE H, PART VI
INTEGRIS AMBULATORY CARE CORPORATION (IACC) IS A MEMBER OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM (INTEGRIS HEALTH SYSTEM OR SYSTEM) CONTROLLED BY INTEGRIS HEALTH, INC. AS SUCH IACC FOLLOWS CERTAIN POLICIES AND PROCEDURES ESTABLISHED AT THE SYSTEM LEVEL, MANY OF WHICH ARE DESCRIBED ABOVE.IACC DOES NOT HAVE A DIRECTLY OWNED HOSPITAL FACILITY, BUT OWNS A MINORITY INTEREST IN FOUR HOSPITAL FACILITIES, OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SPECIALTY SURGERY (OCOM), THROUGH ITS INVESTMENT IN SOUTHWEST AMBULATORY SURGERY CENTER, LLC, COMMUNITY HOSPITAL AND TPG HOSPITAL (D/B/A NW SURGICAL HOSPITAL (HPI FACILITIES), THROUGH ITS INVESTMENT IN HPI AND LAKESIDE WOMEN'S HOSPITAL, LLC (LWH). THE ACTIVITY REPORTED ON SCHEDULE H, PARTS I-III INCLUDES THE ACTIVITY OF OCOM, HPI FACILITIES & LWH AS WELL AS THE DIRECT ACTIVITY OF IACC AND IACC'S PROPORTIONATE SHARE OF THE ACTIVITY OF THE NON-HOSPITAL JOINT VENTURES LISTED ON SCHEDULE H, PART V, SECTION D.

PART VI, LINE 5:
REPORTING GROUP APART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHEVIDENCE OF THE ORGANIZATIONS' RESPONSIVENESS TO THE COMMUNITY, INCLUDING OPPORTUNITIES FOR COMMUNITY INVOLVEMENT IN GOVERNANCE AND ADVISORY GROUPS.IACC'S BOARD OF DIRECTORS IS APPOINTED BY INTEGRIS HEALTH, INC. INTEGRIS HEALTH, INC. IS GOVERNED BY A BOARD OF DIRECTORS SPECIFICALLY MADE UP OF MEN AND WOMEN WHO LIVE AND WORK IN THE COMMUNITY INCLUDING: LOCAL BUSINESS OWNERS, CIVIC LEADERS, COMMUNITY VOLUNTEERS, REPRESENTATIVES WORKING IN HIGHER EDUCATION, UTILITY COMPANIES, AND A VARIETY OF NON-PROFIT ORGANIZATIONS. PATIENT AND COMMUNITY ADVISORY GROUPS HAVE ALSO BEEN ESTABLISHED AT SEVERAL INTEGRIS FACILITIES ACROSS THE STATE. THESE GROUPS GIVE HOSPITAL LEADERS INPUT, SUGGESTIONS, AND FEEDBACK ON WAYS TO IMPROVE PROGRAMS, SERVICES, COMMUNITY NEEDS, AND PROCESS IMPROVEMENT IN CLINICAL AREAS.PROGRAMS ESTABLISHED TO MEET COMMUNITY NEEDS INCLUDE A FALLS PREVENTION PROGRAM FOR SENIOR CITIZENS, COMMUNITY HEALTH SCREENINGS AND PHYSICIAN LECTURES REQUESTED BY LOCAL SCHOOLS, CHURCHES, CIVIC GROUPS, AND COMMUNITY LEADERS TO ADDRESS SPECIFIC HEALTH ISSUES WHICH INCLUDE: DIABETES, CANCER DIAGNOSIS AND TREATMENT OPTIONS, OBESITY AND PHYSICAL FITNESS PROGRAMS, MEN'S UROLOGICAL HEALTH PROGRAMS AND PROSTATE SCREENINGS, CANCER SCREENINGS, SPANISH DIABETES EDUCATIONS, AND STROKE LECTURES.ADVOCACY INITIATIVES FOR PROMOTING COMMUNITY-WIDE, STATE OR NATIONAL EFFORTS TO IMPROVE HEALTH OF THE POPULATION AND INCREASE ACCESS.INTEGRIS HEALTH PARTNERS WITH THE OKLAHOMA LIONS CLUB MOBILE HEALTH UNIT, THE OKLAHOMA STATE HEALTH DEPARTMENT, AND THE OKLAHOMA TURNING POINT PROGRAM TO INCREASE HEALTH SCREENING OPPORTUNITIES AND HEALTH ACCESS FOR PEOPLE LIVING IN RURAL, UNDERSERVED AREAS OF OKLAHOMA. THE PARTNERSHIP INCLUDES DONATION OF RESOURCES AND MONEY TO SPONSOR THE OPERATION OF THE LIONS MOBILE HEALTH UNIT WHICH TRAVELS AROUND THE STATE OFFERING FREE HEALTH SCREENINGS AND MEDICAL INFORMATION. THE OKLAHOMA STATE HEALTH DEPARTMENT AND THE OKLAHOMA TURNING POINT PROGRAM ASSIST WITH HEALTH SCREENINGS AND HELP WITH REFERRALS TO MEDICAL HOMES AND CLINICS FOR PEOPLE WITHOUT A PHYSICIAN AND FOR THOSE UNINSURED OR UNDERINSURED.INTEGRIS HEALTH HAS ESTABLISHED THE INTEGRIS HEALTH COMMUNITY GIVING FUND GRANT TARGETING THE THREE PRIORITIZED HEALTH AREAS. INTEGRIS HEALTH'S 2023-2025 COMMUNITY HEALTH PRIORITIES ARE ACCESS TO CARE (INCLUDING MENTAL HEALTH, OBESITY AND CHRONIC DISEASE PREVENTION/MANAGEMENT), ACCESS TO HEALTHY FOOD, AND TOBACCO USE PREVENTION, THROUGH RISK REDUCTION AND BEHAVIOR CHANGE, SCREENING, AND TREATMENT STRATEGIES. EVIDENCE-BASED PROGRAMS THAT PROMOTE HEALTH AND WELLNESS OR CREATE ACCESS TO COMPREHENSIVE MEDICAL CARE CONTINUE TO BE A PRIORITY OF THE COMMUNITY GIVING FUND. IN ORDER TO QUALIFY FOR GRANT FUNDING, THE PROGRAM OR SERVICE MUST ALIGN WITH ONE OR MORE OF FOLLOWING HEALTH PRIORITIES AND PROVIDE EVIDENCE-BASED DATA TO SUPPORT THE PROGRAM STRATEGIES (REPORTED QUARTERLY TO INTEGRIS HEALTH DURING THE GRANT YEAR):ACCESS TO CARE (INCLUDES MENTAL HEALTH, OBESITY AND CHRONIC DISEASE PREVENTION/MANAGEMENT)- IMPROVE ACCESS TO MEDICAL CARE SERVICES, BEHAVIORAL HEALTH, OR SUBSTANCE USE TREATMENT. IMPROVE THE PREVENTION, DETECTION, TREATMENT AND/OR MANAGEMENT OF DEPRESSION, AND REDUCE THE SUICIDE RATES. ACCESS TO HEALTHY FOOD- IMPROVE ACCESS TO HEALTHY AND AFFORDABLE FOOD AND KNOWLEDGE OF HEALTHY FOOD AND LIFESTYLE CHOICES.TOBACCO USE- REDUCE VAPING, ELECTRONIC CIGS, TOBACCO USE AND SECONDHAND SMOKE EXPOSURE.INTEGRIS HEALTH PARTNERS WITH LOCAL CIVIC GROUPS, SUCH AS OUR CHAMBERS OF COMMERCE, TECHNOLOGY SCHOOLS, COMMUNITY COLLEGES, CHURCHES, AND LOCAL SCHOOLS IN A VARIETY OF EVENTS AND PROGRAMS TO EDUCATE THE COMMUNITY ON HEALTH/WELLNESS ISSUES, CREATE OPPORTUNITIES FOR HEALTH ACCESS, PROVIDE COMMUNITY SCREENINGS IN UNDERSERVED AREAS OF OKLAHOMA, AND TO GIVE STUDENTS AND COMMUNITY MEMBERS THE OPPORTUNITY TO VOLUNTEER FOR THESE EVENTS. THIS INCLUDES MEDICAL STUDENTS WHO WORK WITH INTEGRIS HEALTH ACROSS THE STATE AT OUR EVENTS TO LEARN MORE ABOUT PROVIDING HEALTH SERVICES TO THE COMMUNITY AND TO HELP TRAIN THEM FOR FUTURE WORK IN THE HEALTHCARE ARENA.INTEGRIS HEALTH WORKS WITH THE OKLAHOMA HOSPITAL ASSOCIATION, THE OKLAHOMA STATE MEDICAL ASSOCIATION, THE HEALTH ALLIANCE FOR THE UNINSURED, THE OKLAHOMA STATE HEALTH DEPARTMENT, THE OKLAHOMA MENTAL HEALTH ASSOCIATION, AND LOCAL NON-PROFIT ORGANIZATIONS SUCH AS THE OKLAHOMA CHAPTERS OF AMERICAN HEART ASSOCIATION, AMERICAN LUNG ASSOCIATION, AMERICAN DIABETES ASSOCIATION, AMERICAN CANCER SOCIETY, AND OTHER LOCAL HEALTH AND WELLNESS ORGANIZATIONS AND AGENCIES TO DETERMINE HEALTH CARE NEEDS IN THE STATE, ISSUES CONCERNING SPECIFIC CITIES, ACCESS TO HEALTH ISSUES, NEIGHBORHOOD AND ENVIRONMENT ISSUES, AND OTHER SOCIAL DETERMINANTS OF HEALTH THAT AFFECT THE LIVES OF OUR RESIDENTS. A VARIETY OF COALITIONS HAVE BEEN STARTED TO ADDRESS SPECIFIC HEALTH AND WELLNESS ISSUES AND TO DETERMINE INTERVENTIONAL STRATEGIES FOR IMPLEMENTATION.THE IMPACT PROGRAMS ARE HAVING ON COMMUNITY HEALTH, ESPECIALLY PREVENTION ACTIVITIES, EFFORTS TO IMPROVE HEALTH AND INCREASE ACCESS TO HEALTH CARE SERVICES AND REDUCING HEALTH CARE COSTS.INTEGRIS HEALTH COMMUNITY HEALTH PROGRAMS ACROSS THE STATE ARE IMPLEMENTED TO EDUCATE OUR RESIDENTS AND HEALTH AND WELLNESS ISSUES AFFECTING THEM AND THEIR COMMUNITIES. WORKING WITH PARTNER AGENCIES AND ORGANIZATIONS IN THE COMMUNITIES WE SERVE GIVES US THE OPPORTUNITY TO CREATE PROGRAMS THAT SPECIFICALLY ADDRESS NEGATIVE HEALTH INDICATORS AFFECTING THE COMMUNITY. PREVENTION AND HEALTH EDUCATION HAVE BEEN THE PRIORITY FOR INTEGRIS HEALTH FOR MANY YEARS IN AN EFFORT TO BETTER EDUCATE THE PUBLIC ON TAKING CARE OF THEIR HEALTH AND CREATING AWARENESS ABOUT THEIR BEHAVIORS MAY NEGATIVELY AFFECT THEIR HEALTH AND THE HEALTH OF THEIR FAMILIES. WORKING WITH PARTNER AGENCIES, ORGANIZATIONS, PHYSICIANS, AND LOCAL CLINICS, INTEGRIS HEALTH HAS BEEN ABLE TO HELP SLOWLY IMPROVE THE ACCESS TO HEALTHCARE IN THE METROPOLITAN AREAS, INCREASING ACCESS BY DEVELOPING REFERRAL NETWORKS BETWEEN FREE CLINICS ACROSS OKLAHOMA CITY AND IN SOME RURAL AREAS.ALL OF THESE PROGRAMS AND PARTNERSHIPS, COUPLED WITH EDUCATING THE COMMUNITY ABOUT AVAILABLE SERVICES, CAN HELP US CONTINUE TO REDUCE SOME OF THE HEALTHCARE COSTS WE SEE IN OUR HOSPITALS, CLINICS, AND EMERGENCY DEPARTMENTS.REPORTING GROUP BPART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHOCOM IS A MEMBER OF THE OHA, WHICH ADVOCATES FOR AFFORDABLE, HIGH-QUALITY CARE FOR THE STATE OF OKLAHOMA AND SUPPORTING RURAL HEALTH. OCOM CONTRACTS WITH RESEARCH INTERNATIONAL TO PERFORM IMAGING STUDIES FOR PATIENTS INVOLVED IN RESEARCH. OCOM PARTICIPATED IN THE HEALTHY OVER HUNGRY CEREAL DRIVE WHICH SUPPORTS THE REGIONAL FOOD BANK OF OKLAHOMA TO HELP SUPPORT OKLAHOMA'S MOST VULNERABLE AND HUNGRY. OCOM ALSO PARTICIPATED IN THE OKLAHOMA BLOOD INSTITUTE BLOOD DRIVE QUARTERLY DURING 2022.

SCHEDULE H, PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT
"REPORTING GROUP BOCOM WAS NOT REQUIRED TO FILE, AND DID NOT FILE, A COMMUNITY BENEFIT REPORT WITH THE STATE OF OKLAHOMA FOR THE FISCAL YEAR ENDED JUNE 30, 2022.501(R) ERRORS AND CORRECTIONSIN MARCH 2022, OCOM'S CONTROLLER AND BUSINESS MANAGER REVIEWED ITS FINANCIAL ASSISTANCE POLICY (FAP) IN CONSULTATION WITH ITS PROFESSIONAL TAX ADVISORS AND FOUND SEVERAL PARTS OF ITS FAP THAT WERE NOT FULLY COMPLIANT WITH SECTION 501(R)(4) OF THE INTERNAL REVENUE CODE. THESE ERRORS REFLECTED A MISUNDERSTANDING OF FINAL 501(R) REGULATIONS BY THOSE OCOM STAFF MEMBERS WHO DEVELOPED THE FAP. OCOM PROMPTLY WORKED WITH ITS PROFESSIONAL TAX ADVISORS TO REVISE THESE PARTS OF THE FAP TO BRING THEM INTO FULL COMPLIANCE WITH SECTION 501(R). OCOM MADE THESE REVISIONS TO THE FAP IN CONSULTATION WITH ITS PROFESSIONAL TAX ADVISORS IN APRIL 2022, ITS GOVERNING BODY APPROVED THE AMENDED FAP ON AND IT POSTED THE AMENDED FAP ON ITS WEB SITE ON APRIL 6, 2022. THESE FAP REVISIONS WERE COMPRISED OF:1. REVISING THE PARAGRAPH REGARDING AMOUNTS GENERALLY BILLED (AGB) TO PROVIDE GREATER SPECIFICITY REGARDING HOW THAT PERCENTAGE IS DETERMINED AND APPLIED AND INCLUDING A LINK TO THE PUBLICLY ACCESSIBLE WEB SITE URL THAT CONTAINS THE SPECIFIC AGB PERCENTAGE. THE REVISED PARAGRAPH NOW READS AS FOLLOWS:THE AMOUNTS BILLED FOR MEDICALLY NECESSARY AND GENERALLY AVAILABLE MEDICAL SERVICES TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NOT BE MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE COVERING SUCH CARE. IN ADDITION, AMOUNTS CHARGED FOR MEDICALLY NECESSARY AND GENERALLY AVAILABLE MEDICAL SERVICES TO UNINSURED PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NOT BE MORE THAN THE AGB. OCOM DETERMINES AGB BASED ON ALL CLAIMS PAID IN FULL TO OCOM BY MEDICARE AND PRIVATE HEALTH INSURERS (INCLUDING PAYMENTS BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS THEMSELVES), OVER A 12-MONTH PERIOD, DIVIDED BY THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS (LOOK-BACK METHOD). THE CURRENT AGB PERCENTAGE CAN BE FOUND AT HTTPS://OCOMHOSPITAL.COM/FINANCE-OPTIONS/. IN THE EVENT A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE HAS PAID MORE THAN THE AGB FOR A MEDICALLY NECESSARY AND GENERALLY AVAILABLE MEDICAL SERVICE, OCOM WILL REFUND THE PATIENT THE AMOUNT OVER THE AGB CALCULATED AMOUNT.OCOM HAS CHANGED ITS PROCEDURES TO PROVIDE THAT IT WILL POST THE UPDATED AGB PERCENTAGE EVERY 12 MONTHS, AFTER IT IS RE-CALCULATED BASED ON CLAIMS ALLOWED DURING THOSE 12 MONTHS. AS SUCH, THE NEXT UPDATE WILL BE DONE IN MAY OF 2023.2. REVISING APPENDIX A OF THE FAP-""PROVIDER LIST"" TO SPECIFY WHICH OF THE NON-EMPLOYED PROVIDERS OF MEDICALLY NECESSARY AND GENERALLY AVAILABLE CARE ARE COVERED BY THE FAP, AND WHICH ARE NOT COVERED BY THE FAP. OCOM HAS CHANGED ITS PROCEDURES TO PROVIDE THAT IT WILL UPDATE THIS PROVIDER LIST AT LEAST ONCE EVERY THREE MONTHS TO REFLECT ANY CHANGES IN THE NON-EMPLOYED PROVIDERS COVERED AND NOT COVERED BY THE FAP. OCOM RECENTLY DISCOVERED THAT ITS LIST OF NON-EMPLOYED PROVIDERS OF MEDICALLY NECESSARY CARE IN ITS HOSPITAL FACILITY (""PROVIDER LIST""), WHICH IT MAINTAINS ON ITS WEB SITE, HAD NOT BEEN UPDATED SINCE APRIL 2022 DUE TO CHANGES THAT OCCURRED WITHIN THE ORGANIZATION'S LEADERSHIP. THIS ERROR WAS DISCOVERED BY OCOM'S CONTROLLER ON 04/13/2023 AND OCOM THEN UPDATED AND POSTED THIS LIST ON ITS WEB SITE ON 04/21/2023. OCOM HAS ESTABLISHED A PROCESS FOR THE CONTROLLER TO REVIEW AND UPDATE ITS PROVIDER LIST, AS APPLICABLE, AT LEAST QUARTERLY GOING FORWARD.3. REVISING THE PARAGRAPH REGARDING MEDICAL CARE DISCOUNTS AVAILABLE TO PATIENTS BASED ON THEIR INCOME LEVEL TO MORE SPECIFICALLY AND CLEARLY INDICATE THE ELIGIBILITY CRITERIA A PATIENT MUST MEET TO QUALIFY FOR EACH DISCOUNT; IN PARTICULAR, THE ANNUAL INCOME LEVEL (USING FEDERAL POVERTY GUIDELINES (""FPG"") A PATIENT MUST FALL BELOW TO QUALIFY FOR EACH TYPE OF DISCOUNT. OCOM ADDED A CHART TO SHOW HOW EACH SPECIFIC PERCENTAGE DISCOUNT CORRESPONDS TO A FAP ELIGIBLE PATIENT'S ANNUAL FPG INCOME LEVEL. OCOM HAS CHANGED ITS PROCEDURES TO PROVIDE THAT IT WILL UPDATE THIS SECTION OF THE FAP TO REFLECT ANY CHANGES IN EITHER THE DISCOUNTS OR ELIGIBLE CRITERIA FOR THOSE DISCOUNTS THAT OCOM MAY MAKE.OCOM IS NOT AWARE OF ANY INDIVIDUALS WHO HAVE BEEN ADVERSELY AFFECTED BY THESE 501(R)- RELATED ERRORS IN ITS FAP, AND ACCORDINGLY HAS NOT TAKEN ANY ACTIONS TO RESTORE INDIVIDUALS TO THE POSITION THEY WOULD HAVE BEEN IN HAD THESE ERRORS NOT OCCURRED.4. INTEGRIS HEALTH SYSTEM, WHICH INCLUDES OCOM COMPLETED ITS PRIOR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), DURING ITS FISCAL YEAR 2021. OCOM'S BOARD APPROVED THE CHNA ON APRIL 29, 2021, AND POSTED ITS CHNA REPORT ONLINE ON THAT DATE. SUBSEQUENTLY, INTEGRIS HEALTH AND OCOM CONDUCTED ANOTHER CHNA WHICH IT COMPLETED, UPON APPROVAL BY THE INTEGRIS BOARD, ON JULY 25, 2022. OCOM COMPLETED ITS IMPLEMENTATION STRATEGY FOR THIS CHNA-TITLED ""COMMUNITY HEALTH IMPROVEMENT PLAN"" (CHIP) AND POSTED THAT CHIP ONLINE ON JULY 25, 2022. OCOM SUBSEQUENTLY REALIZED THAT IT HAD NOT POSTED ITS 2022 CHNA REPORT ONLINE, THEN PROMPTLY POSTED THIS REPORT ONLINE ON MAY 3, 2023.REPORTING GROUP C:HPI WAS NOT REQUIRED TO FILE, AND DID NOT FILE, A COMMUNITY BENEFIT REPORT WITH THE STATE OF OKLAHOMA FOR THE FISCAL YEAR ENDED JUNE 30, 2022."