4A (Expenses $ 41421999 including grants of $ 133813) (Revenue $ 102945571)
CARDIOVASCULAR SERVICESCHI MEMORIAL'S GUERRY HEART AND VASCULAR CENTER OFFERS A TEAM OF CARDIAC SPECIALISTS WHO HAVE TRAINED AT SOME OF THE MOST RENOWNED MEDICAL PROGRAMS IN THE COUNTRY. CHI MEMORIAL AND THE CHATTANOOGA HEART INSTITUTE INTEGRATED SERVICES IN EARLY 2011. WITH 25 CARDIOLOGISTS AND TWO CARDIOTHORACIC SURGEONS, THE CHATTANOOGA HEART INSTITUTE HAS LED THE REGION'S LARGEST CENTER DEDICATED SOLELY TO CARDIOVASCULAR CARE FOR THE PAST 40 YEARS. CHI MEMORIAL HOSPITAL CHATTANOOGA AND CHI MEMORIAL HOSPITAL HIXSON EACH PROVIDE CARDIAC IMAGING SERVICES THAT INCLUDE ECHOCARDIOGRAPHY, STRESS ECHOCARDIOGRAPHY, TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND NUCLEAR CARDIOLOGY. CHI MEMORIAL HOSPITAL CHATTANOOGA HAS FIVE CARDIAC CATHETERIZATION LABORATORIES AND TWO ELECTROPHYSIOLOGY LABORATORIES FOR SPECIALIZED CARDIAC PROCEDURES.

4B (Expenses $ 20112489 including grants of $ 114266) (Revenue $ 87907466)
"IMAGING/ DIAGNOSTIC SERVICESCHI MEMORIAL OFFERS PATIENTS THE FULL RANGE OF OUTPATIENT IMAGING SERVICES. FOR WOMEN, OUR FACILITIES INCLUDE PRIVATE MAMMOGRAPHY SUITES, ""SOFT"" MAMMOGRAPHY, BREAST CANCER EDUCATION AND SUPPORT SERVICES. IMAGING SERVICES ARE AVAILABLE AT CHI MEMORIAL HOSPITAL CHATTANOOGA, CHI MEMORIAL HOSPITAL HIXSON, CHI MEMORIAL HOSPITAL GEORGIA AND CHI MEMORIAL OOLTEWAH IMAGING CENTER. OUR CAPABILITIES INCLUDE CT, 3-T MRI, DEDICATED BREAST MRI, DIGITAL RADIOGRAPHY, DIGITAL FLUOROSCOPY,NUCLEAR MEDICINE, ULTRASOUND, VASCULAR STUDIES, CARDIAC STRESS TESTING, ECOCARDIOGRAPHY, BONE DENSITY, MAMMOGRAPHY, AND PET/CT."

4C (Expenses $ 9695768 including grants of $ 48434) (Revenue $ 37261164)
CANCERTHE REES SKILLERN CANCER INSTITUTE AT CHI MEMORIAL IS THE LEADING PROVIDER OF CANCER SERVICES IN THE CHATTANOOGA AREA. OUR COMPREHENSIVE PROGRAM INCLUDES SEVEN CENTERS OF EXCELLENCE, EACH DEDICATED TO A SPECIFIC TYPE OF CANCER AND SUPPORTED BY INTERDISCIPLINARY TUMOR BOARDS, CLINICAL TRIALS AND ADVANCED TECHNOLOGIES, SUCH AS THE DA VINCI SURGICAL SYSTEM FOR ROBOTIC-ASSISTED MINIMALLY INVASIVE TREATMENT OF PROSTATE, GYNECOLOGIC, HEAD AND NECK, COLORECTAL, LUNG AND OTHER CANCERS. THE REES SKILLERN CANCER INSTITUTE AT CHI MEMORIAL IS THE LEADING PROVIDER OF CANCER SERVICES IN THE CHATTANOOGA AREA. AT CHI MEMORIAL, WE HAVE THE MOST UP TO DATE CANCER TREATMENT MACHINES IN THE INDUSTRY. WE HAVE THE TRUE BEAM STX, NOVALIS TX AND THE SIEMEN'S PRIMUS LINEAR ACCELERATORS. THESE MACHINES USE RADIATION TO TREAT THE PATIENT'S TUMOR.

4D (Expenses $ 552905282 including grants of $ 430036) (Revenue $ 367118936)
CHI MEMORIAL HEALTH PROVIDES ADDITIONAL SERVICES INCLUDING BUT NOT LIMITED TO: PRIMARY AND PREVENTIVE CARE SERVICES, SOCIAL SERVICES, NUTRITION SERVICES, PHYSICAL AND SPEECH THERAPY, RADIOLOGY, ENDOSCOPY CENTER, SLEEP DIAGNOSTIC CENTER, AND MOBILE MAMMOGRAPHY SERVICES THAT EXTENDS ACCESS TO MAMMOGRAPHY, HEALTH SCREENINGS, AND EDUCATIONAL INFORMATION TO RESIDENTS IN 35 COUNTIES ACROSS TENNESSEE, GEORGIA AND ALABAMA.

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 MEMORIAL HOSPITAL, - FACILITY 2: CHI MEMORIAL HOSPITAL HIXSON

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
CHI MEMORIAL CHATTANOOGA, CHI MEMORIAL HIXSON, AND CHI MEMORIAL GEORGIA, AS THE SPONSORS OF THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT, ENGAGED NATIONAL LEADERS IN COMMUNITY HEALTH NEEDS ASSESSMENTS TO ASSIST IN THE PROJECT. STRATASAN, A HEALTHCARE ANALYTICS AND FACILITATION COMPANY BASED OUT OF NASHVILLE, TENNESSEE, PROVIDED THE ANALYSIS OF COMMUNITY HEALTH DATA, FACILITATED THE FOCUS GROUPS, CONDUCTED THE INTERVIEWS, FACILITATED THE TELEPHONE SURVEYS, AND FACILITATED A COMMUNITY HEALTH SUMMIT TO RECEIVE COMMUNITY INPUT INTO THE PRIORITIES AND BRAINSTORM GOALS AND ACTIONS THE COMMUNITY COULD TAKE TO IMPROVE HEALTH.23 COMMUNITY MEMBERS REPRESENTING 20 ORGANIZATIONS PARTICIPATED IN TWO FOCUS GROUP SESSIONS AND INDIVIDUAL INTERVIEWS FOR THEIR PERSPECTIVES ON COMMUNITY NEEDS AND ISSUES IN JANUARY, 2022. THESE PARTICIPANTS REPRESENTED NOT-FOR-PROFIT ORGANIZATIONS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, AND THE ELDERLY (AREA AGENCY ON AGING AT NORTHWEST GEORGIA REGIONAL, BRAINERD COMMUNITY FOOD PANTRY, CHATTANOOGA AREA FOOD BANK, CHATTANOOGA HOUSING AUTHORITY, CHATTANOOGA REGIONAL HOMELESS COALITION, HABITAT FOR HUMANITY OF GREATER CHATTANOOGA, TRI STATE FOOD PANTRY), HEALTH PROVIDERS (HOSPITALS, HEALTH DEPARTMENTS, MEDICAL SOCIETY, PRIMARY CARE CENTERS), EDUCATION PROVIDERS , PUBLIC SAFETY OFFICERS (POLICE DEPARTMENTS, SHERIFF'S DEPARTMENTS), LOCAL GOVERNMENT OFFICIALS (CITY OF CHATTANOOGA, COLLEGEDALE CITY MAYOR, COUNTY COMMISSIONS), AND OTHERS (YMCA, CITY OF CHATTANOOGA FAMILY JUSTICE CENTER).A COMMUNITY HEALTH SUMMIT WAS CONDUCTED IN FEBRUARY, 2022 WITH 68 COMMUNITY STAKEHOLDERS. THE AUDIENCE CONSISTED OF HEALTHCARE PROVIDERS, BUSINESS LEADERS, GOVERNMENT REPRESENTATIVES, SCHOOLS, NOT-FOR-PROFIT ORGANIZATIONS, EMPLOYERS, AND OTHER COMMUNITY MEMBERS. REPRESENTATIVES OF THE HAMILTON COUNTY AND CATOOSA COUNTY HEALTH DEPARTMENTS PARTICIPATED IN THE INTERVIEWS AS WELL AS THE SUMMIT.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:
THE HOSPITAL INTENDS TO TAKE ACTIONS AND TO DEDICATE RESOURCES TO ADDRESS THESE NEEDS, INCLUDING: ACCESS TO AFFORDABLE CARE AND INSURANCE: INSURANCE ENROLLMENT ASSISTANCE, FINANCIAL SUPPORT, AWARENESS OF COMMUNITY RESOURCES, HEALTH COACH POSITIONS, AND A REPLACEMENT FACILITY FOR CHI MEMORIAL HOSPITAL GEORGIA; MENTAL/BEHAVIORAL HEALTH: COUNSELING SERVICES, AWARENESS OF COMMUNITY RESOURCES, TRAINING AND EDUCATION, PARTICIPATION IN THE FUSE PROJECT, THE ARTS AND HEALTHCARE PROGRAM, AND EXPLORATION OF EXPANDED BEHAVIORAL/MENTAL HEALTH SERVICES PROVIDED BY THE HOSPITAL; AFFORDABLE, HEALTHY HOUSING: MEDICAL RESPITE HOUSING, PARTICIPATION IN THE FUSE PROJECT, AND ACCESS TO AND AWARENESS OF COMMUNITY RESOURCES; SUBSTANCE USE DISORDER: SMOKING CESSATION CLASSES AND DRUG ADDICTION RECOVERY SUPPORT; PREVENTION AND EDUCATION: OUTREACH EVENTS, SUPPORT FOR MEDICAL EDUCATION STUDENTS, AND COMMUNITY EDUCATION/TRAINING SESSIONS; VIOLENCE: SUPPORT LOCAL ORGANIZATIONS, TRAINING AND EDUCATION, EXPLORATION OF GRANT FUNDING, AND AWARENESS OF COMMUNITY RESOURCES; OBESITY: CONTINUATION OF THE OBESITY DASHBOARD AND TRAINING AND EDUCATION; FOOD INSECURITY: FINANCIAL SUPPORT, AWARENESS OF COMMUNITY RESOURCES, AND FOOD DONATIONS; CHRONIC DISEASE: SCREENING AND EDUCATION, TRANSITION OF CARE SUPPORT, EXPANSION OF THE NEUROSCIENCES SERVICE LINE, AND DIABETES MANAGEMENT RESOURCES.

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.

SCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP A
PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.MEMORIAL.ORG/EN/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-DISCOUNT.HTML

SCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP A
PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.MEMORIAL.ORG/EN/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-DISCOUNT.HTML

SCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP A
PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.MEMORIAL.ORG/EN/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE-DISCOUNT.HTML

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 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:
IN ACCORDANCE WITH ITS MISSION AND PHILOSOPHY, MEMORIAL HEALTH CARE SYSTEM IS ABLE TO SUPPORT PROGRAMS THAT BENEFIT MOST VULNERABLE MEMBERS OF OUR SOCIETY AND PROMOTE HEALTHY COMMUNITIES THROUGH FUNDRAISING ACTIVITIES. THE NET COST OF FUNDRAISING THAT BENEFITS THE COMMUNITY IS COUNTED AS A COMMUNITY BUILDING ACTIVITY. EMPLOYEES WHO VOLUNTEER IN COMMUNITY NONPROFIT ORGANIZATIONS WHILE BEING PAID ARE ALSO RECORDED HERE. ORGANIZATIONS BEING HELPED INCLUDE UNITED WAY, CHATTANOOGA AREA FOOD BANK, GREENWOOD TERRACE, AND CHATT FOUNDATION (FORMERLY COMMUNITY KITCHEN). COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE THE COST OF PROVIDING PROGRAMS AND SERVICES TO INDIVIDUALS WHO ARE UNABLE TO AFFORD HEALTH CARE DUE TO INADEQUATE RESOURCES AND/OR THOSE THAT ARE UNINSURED OR UNDERINSURED.

PART III, LINE 2:
BAD DEBT EXPENSE REPORTED ON THE MHCS UNAUDITED FINANCIAL STATEMENTS REPRESENTS AN ESTIMATE OF BAD DEBTS BASED ON HISTORICAL COLLECTION RESULTS. IT DOES NOT REPRESENT ACTUAL WRITE-OFFS INCURRED DURING THE PERIOD. THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, TAKING INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHI FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY. THE PROVISION FOR BAD DEBTS IS PRESENTED ON THE CONSOLIDATED STATEMENTS OF OPERATIONS AS A DEDUCTION FROM PATIENT SERVICES REVENUES (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) SINCE CHI ACCEPTS AND TREATS SUBSTANTIALLY ALL PATIENTS WITHOUT REGARD TOTHE ABILITY TO PAY.WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. ALL PATIENTS THAT DO NOT HAVE INSURANCE RECEIVE A DISCOUNT THAT IS CALCULATED EACH YEAR AS 150% OF THE COST TO CHARGE RATIO IN ACCORDANCE WITH TENNESSEE STATE CODE. THIS DISCOUNT IS APPLIED TO THE PATIENTS ACCOUNT PRIOR TO BILLING AND IS TREATED AS AN ADJUSTMENT TO NET PATIENT REVENUE IN THE SAME MANNER AS A MANAGED CARE DISCOUNT. THE PROVISION OF THIS DISCOUNT TO ALL PATIENTS WITHOUT INSURANCE LOWERS THE AMOUNT THAT IS BILLED TO THE PATIENT AND REDUCES THE AMOUNT OF ANY SUBSEQUENT BAD DEBT EXPENSE. IN FISCAL YEAR 2021, SELF PAY DISCOUNTS WERE $ $27.9 MILLION REPRESENTING $ 5.8 MILLION AT COST.

PART VI, LINE 2:
CHI MEMORIAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES IN ADDITION TO CHNAS. THESE METHODS INCLUDE: ONGOING REVIEWS OF LOCAL PUBLIC HEALTH DATA, PERIODIC PROVIDER DEMAND ASSESSMENTS, AND PROVIDER SURVEYS THAT ASSESS GAPS IN CARE.

PART VI, LINE 7, REPORTS FILED WITH STATES
TN

PART III, LINE 3:
MEMORIAL HEALTH CARE SYSTEM, INC. MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. MEMORIAL HEALTH CARE SYSTEM, INC.'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. MEMORIAL HEALTH CARE SYSTEM, INC. 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, MEMORIAL HEALTH CARE SYSTEM, INC. 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:
"MEMORIAL HEALTH CARE SYSTEM, INC. 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. MEMORIAL HEALTH CARE SYSTEM INC.'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $ 26.3 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 MEMORIAL PRIMARILY SERVES 5 COUNTIES: HAMILTON, BRADLEY, CATOOSA, DADE AND WALKER COUNTIES. THE COMMUNITY INCLUDES MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WHO LIVE IN THE GEOGRAPHIC AREAS FROM WHICH CHI MEMORIAL DRAWS ITS PATIENTS. THE COMMUNITY CONSISTS OF A MIXTURE OF URBAN, RURAL, AND SUBURBAN SETTINGS. THE COMMUNITY CONSISTS OF A HIGHER PROPORTION OF THE 65 AND OLDER AGE GROUP WHEN COMPARED TO THE U.S. THIS POPULATION REQUIRES MORE EXTENSIVE HEALTH CARE SERVICES AND IS GROWING AT A HIGHER RATE THAN OTHER AGE GROUPS IN THE COMMUNITY. THE RACIAL AND ETHNIC MAKE-UP OF THE FIVE COUNTIES WAS 80% WHITE, 13% BLACK, 6% HISPANIC ORIGIN, 2% MIXED RACE, 2% ASIAN/PACIFIC ISLANDER, AND 3% OTHER. (THESE PERCENTAGES TOTAL TO OVER 100% BECAUSE HISPANIC IS AN ETHNICITY, NOT A RACE.) THE MAJORITY OF EMPLOYEES IN THE 5-COUNTY AREA ARE EMPLOYED IN: MANUFACTURING (27.9%), EDUCATION SERVICES (19.2%), RETAIL TRADE (10.0%), HEALTH CARE AND SOCIAL ASSISTANCE (8.4%), AND PUBLIC ADMINISTRATION (6.4%). RETAIL TRADE OFFERS HEALTH INSURANCE AT A LOWER RATE THAN HEALTH CARE, PUBLIC ADMINISTRATION, AND EDUCATION SERVICES.THE HOUSEHOLD INCOME DISTRIBUTION OF THE FIVE COUNTIES WAS 24% HIGHER INCOME (OVER $100,000), 56% MIDDLE INCOME, AND 20% LOWER INCOME (UNDER $25,000). THE COMMUNITY HAS SEVERAL CENSUS TRACTS WITH A HIGH NUMBER OF HOUSEHOLDS MAKING BELOW $15,000 PER YEAR. THESE AREAS ARE AT HIGHER RISK FOR HEALTH INEQUITIES. THE 5-COUNTIES MEDIAN HOUSEHOLD INCOME AT $55,253 WAS LOWER THAN TN ($55,276) AND GA ($60,605), AND THE U.S. ($64,730). THE RATE OF POVERTY IN EACH COUNTY WAS HIGHER THAN THE U.S. EXCEPT CATOOSA.THE HEALTH CARE INDEX MEASURES HOW MUCH THE POPULATIONS SPENT OUT-OF-POCKET ON HEALTH CARE SERVICES INCLUDING INSURANCE PREMIUMS. THE U.S. INDEX WAS 100. THE FIVE COUNTIES WAS 88, INDICATING 12% LESS SPENT OUT OF POCKET THAN THE AVERAGE U.S. HOUSEHOLD ON MEDICAL CARE (DOCTOR'S OFFICE VISITS, PRESCRIPTIONS, HOSPITAL VISITS) AND INSURANCE PREMIUMS.THERE ARE TWO OTHER MAJOR HEALTHCARE SYSTEMS SERVING THE COMMUNITY. THERE ARE FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS PRESENT WITHIN THE 5 COUNTIES (HRSA): 1 IN CATOOSA COUNTY, 1 IN DADE COUNTY, 1 IN WALKER COUNTY, AND 1 IN HAMILTON COUNTY.

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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.