4A (Expenses $ 4154617873 including grants of $ 26056466) (Revenue $ 5356272513)
Patient Services - See Schedule O Form 990, Part III, Line 4a

4B (Expenses $ 858972890 including grants of $ 159606732) (Revenue $ 212539460)
Academic and Scientific Research - See Schedule O Form 990, Part III, Line 4b

4D (Expenses $ 228331229 including grants of $ 0) (Revenue $ 276742669)
4d. Other Program Services - Other program services include public health service, academic support, institutional support, and other auxiliary services. Vanderbilt University Medical Center engages in a variety of public service projects, including, but not limited to formulating new approaches to increase health, safety, quality and outcomes, while decreasing total costs; and many other sponsored community health and educational programs. To read more about VUMC's role in the community, visit https://www.vanderbilthealth.com/main/38766

Schedule H, Part V, Section B, Line 3E
The significant health needs identified in the 2019 CHNA of Vanderbilt University Medical Center (VUMC) are a prioritized description of the significant health needs of the community. The 2019 process of prioritizing significant health needs included several phases. VUMC and collaborators collected and analyzed primary data from a broad array of partners and community members. Additionally, VUMC pulled and reviewed hundreds of indicators from publicly available secondary data. In each of the three counties, the CHNA communities served (Davidson, Rutherford, and Williamson Counties), VUMC held a community summit, which included hospital leadership, local health departments, community leaders representing several sectors, community members as well as individuals who participated in interviews and listening sessions as a part of the CHNA process. VUMC also conducted an environmental scan in each county. The results of VUMC's data collection and analysis were presented to the community, and participants were asked to prioritize their communities' most pressing health needs through interactive exercises. The needs prioritized by the community were adopted by VUMC, and each is described at length in VUMC's 2019 CHNA. Through this CHNA process, the community prioritized the significant health needs of Mental Health and Substance Abuse, Access to Resources and Services, Basic Needs and Social Determinants, Prevention, and Education.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Vanderbilt University Medical Center Hospitals. VUMC received input from people representing the broad interests of the community, including those with expertise in public health, through face-to-face interviews and community listening sessions. Interviews took place from February 2018 to May 2018. Listening sessions took place from June 2018 to September 2018. Community summits were held in the fall and winter of 2018 and into 2019. During the 2019 CHNA, VUMC identified leaders from public health, government, education, the faith community, private foundations, community organizations, and academia among others as interviewees. Interviewees were identified in collaboration with Ascension Saint Thomas and local health departments in each county and were selected based on their understanding of the broad interests of the community and marginalized populations. Interviewees also included health department directors from the community served, community physicians, public health researchers, and community-based organizations that have special knowledge and expertise in public health. Sixty-eight community leaders were interviewed with particular attention to marginalized, low-income, and minority populations. Organizations represented in the 2019 Davidson County interviews included Davidson County Metro Council, Nashville Organized for Action and Hope (NOAH), Metro Homeless Impact Division, Metropolitan Government, Nashville Mayor's Office, Meharry Medical College, 58th Legislative District Office, Ascension Saint Thomas, Vanderbilt University Medical Center, Tennessee Office for Refugees, Safety Net Consortium of Middle Tennessee, Salahadeen Center of Nashville, Mental Health Cooperative, Walk Bike Nashville, Sycamore Institute, PFLAG Nashville, Metro Nashville Public Schools, Metro Public Health Department, Interfaith Dental Clinic, Family & Children's Services, Matthew Walker Comprehensive Health Center, Nashville General Hospital, and First Presbyterian. Organizations represented in the 2019 Rutherford County Interviews included Middle Tennessee State University Center for Health & Human Services, Ascension Saint Thomas Rutherford, Rutherford District 13 Office, Nissan Diversity and Inclusion Committee, ATLAS, Murfreesboro Cold Patrol, Rutherford Opioid Taskforce, Middle Tennessee State University, First Baptist Church, Rutherford County EMS, St. Louise Clinic, Rutherford District 21 Office, Smyrna Senior Center, Narcotics Anonymous, Rutherford County Government Office, Veterans' Affairs, Journey Home, Primary Care and Hope Clinic of Rutherford County, Interfaith Dental Clinic, Matthew Walker Comprehensive Health Center - Smyrna, Rutherford County Health Department, and Rutherford County Police Department. Organizations represented in the 2019 Williamson County interviews included Franklin Tomorrow, Williamson County Schools, Fairview Mayor's Office, Williamson Medical Center, Franklin Special School District, Williamson County Public Library, Coordinated School Health, Department of Children's Services, Veterans' Affairs, Williamson County Juvenile Court, Williamson County Health Department, Franklin Mayor's Office, Williamson County Parks & Recreation, Mercy Clinic, Williamson County Anti-Drug Coalition, Franklin Housing Authority, and Graceworks. Populations served by these organizations include racial and ethnic minority groups, individuals seeking social services such as housing or food assistance, individuals seeking affordable healthcare, at-risk youth, those experiencing homelessness, Hispanic/Latinx communities, the medically marginalized, those experiencing mental illness, those with addiction, children, low-income individuals, minorities, marginalized communities, and other vulnerable populations. To better understand community members' opinions of the health needs present in 2019, VUMC held 13 focus groups. These focus groups were conducted across the three counties that represent the community served. The focus groups in Davidson County were held in collaboration with Ascension Saint Thomas as well as the Metro Public Health Department. In Davidson County, sessions were held at Salahadeen Center, Building Lives Foundation, Outreach Base, Elizabeth Park Center, Hartman Park, and Hadley Park. Populations served by these organizations include Muslim youth, people experiencing homelessness, older adults, African American populations, and Latinx populations. In 2019 VUMC held listening sessions that were coordinated with Ascension Saint Thomas and the Rutherford County Health Department. Recruitment was done in coordination with the host sites, which included First Baptist Church of Rutherford, Rutherford County Health Department, and Journey Home. These organizations primarily serve those experiencing homelessness, Latinx, African American, and older adult populations. For the 2019 CHNA in Williamson County, recruitment was done in collaboration with the Williamson County Health Department. Host sites include the Fairview Branch of the Public Library, Mercy Clinic, and the health department. Rural, uninsured/underinsured, and Latinx populations are served by these organizations. Both English and Spanish speakers were included in listening sessions in each county.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Vanderbilt University Medical Center Hospitals. For the 2019 CHNA, Vanderbilt University Medical Center conducted a community health needs assessment in partnership with its affiliated hospital, Vanderbilt Stallworth Rehabilitation Hospital.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - Vanderbilt University Medical Center Hospitals. Vanderbilt University Medical Center (VUMC) identified four significant health needs in the 2019 CHNA. The four significant health needs identified are - alphabetically - 1) Access to Resources and Services; 2) Basic Needs and Social Determinants; 3) Mental Health and Substance Abuse, and 4) Prevention and Education. VUMC addresses all four needs, with a detailed list of programs, investments, and services in the 2019 Implementation Strategy (IS). The 2019 Implementation Strategy includes 83 activities and programs. To date, we have identified 260 activities and programs. The Community Health Improvement Team released a Request for Proposals for community projects that addressed one or more of the CHNA priority areas, specifically requiring applicants to discuss how their proposal would promote health equity and address broader policy, environmental, or systems change. After a competitive review process with a committee of both academic and community reviewers, organizations were selected as recipients of these awards. The grantees received up to $10,000 to carry out their work over 12 months. The Community Health Improvement team is currently planning for the sixth cycle of this mini-grant program. To date, the program has supported 38 community projects. The Community Health Improvement Team continues to support local health departments and health councils in all three counties in the development of their Community Health Improvement Plans (CHIP), which outline their strategies to address the health needs identified through the Community Health Needs Assessment. The team also participates in health and wellness council meetings to develop goals, objectives, and evaluation metrics for the CHIP. VUMC's involvement in this work allows the Community Health Improvement Team to bring VUMC resources to the community and align the CHNA priorities with the Community Health Improvement Plan objectives. In Davidson County, VUMC is involved in collaboratives focused on the four prioritized needs. The Safety Net Consortium of Middle Tennessee (SNC), which focused on access to, and quality of care for the uninsured continues to meet monthly and launched My Health Care Home, a web-based tool that facilitates finding and accessing federally qualified health centers, faith-based and charitable clinics that serve the under/uninsured. Leaders from the Office of Population Health, the Meharry-Vanderbilt Alliance, and the Office of Health Equity both participate in monthly SNC meetings. The Community Health Improvement Team is also active with the Healthy Nashville Leadership Council and the Associate Vice President Chairs this mayoral-appointed committee and continues to co-lead the Health Equity Workgroup. The workgroup's focus is to educate the community on topics related to addressing health inequities as well as strengthening capacity and advancing equity for minority-led non-profit organizations that are on the front lines of promoting health equity and well-being in vulnerable communities. Finally, VUMC's Office of Health Equity has increased its working knowledge of health equity by presenting Seeds of Equity training internally and externally. The team will have presented the Seeds of Equity training (created by the Healthy Nashville Leadership Council) 10 times during FY2022 to audiences of about 10 to 100 persons. While this training is specific to Nashville, VUMC Community Health Improvement Team is working with community partners in other counties of focus and Vanderbilt Wilson County Hospital to expand the reach of the training. VUMC staff has also participated in the opioid task force (currently known as WE CARE Coalition) spear-headed by Saint Thomas Rutherford, the Prevention Coalition for Success, and the Patterson Park Coalition. VUMC's Community Health Improvement team also participates in the Rutherford County Wellness Council. In Williamson County, VUMC's Community Health Improvement Team also participates in local community groups such as the anti-drug coalition, Franklin Justice, Equity Coalition, and the Williamson County Health Council, which promotes improvements in community health and equity. The VUMC Community Health Improvement Team has addressed the Williamson Health Council meeting to share the four priorities and data from the CHNA.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - VANDERBILT UNIVERSITY MEDICAL CENTER HOSPITALS. In addition to notification on the website, or patient request, VUMC patients are notified of available assistance under federal, state or local government programs or under the organization's charity care policy via signage posted in the patient care registration points including hospitals, emergency departments, and hospital based clinics; brochures available at registration points; and language included on all billing statements mailed to patients advising that VUMC has a financial assistance program if help is needed paying medical bills. Pre-admitting, registration, or billing personnel may refer uninsured or low income patients to financial counseling personnel to discuss qualifications for free or discounted care.

Schedule H, Part V, Section B, Line 3E
The significant health needs identified in the 2022 CHNA of Vanderbilt Wilson County Hospital (VWCH) are a prioritized description of the significant health needs of the community, identified by the CHNA. The 2022 process of prioritizing the significant needs included several phases. VWCH collected and analyzed primary data from a broad array of partners and community members as well as conducted an environmental scan. Additionally, VWCH pulled and reviewed indicators from publicly available secondary data. In collaboration with the local Health Department and Health Council, VWCH convened a subcommittee that included hospital leadership, the local health department, community leaders, and community members as a part of the CHNA process. The results of VWCH's data collection and analysis were presented to the Health Council and participants were asked to prioritize their most pressing health needs through interactive exercises and a electronic survey that was part of the prioritization process. The needs prioritized by the communities were adopted by VWCH, and each is described at length in VWCH's 2022 CHNA. Through this CHNA process, the community prioritized the significant health needs of Mental Health and Substance Abuse, Access to Healthcare, Housing and Transportation, and Health Literacy.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Vanderbilt Wilson County Hospital. Input from people representing the broad interests of the community, including those with expertise in public health, was obtained through virtual and face-to-face interviews. Interviews took place from August 2021 to September 2021. In October 2021, the Wilson County Health Council facilitated meetings to prioritize the needs of Wilson County. For the 2022 CHNA, Vanderbilt Wilson County Hospital (VWCH) identified leaders from public health, government, education, the faith community, community organizations, and substance use providers among others as interviewees. Interviewees were identified in collaboration with the local health department and were selected based on their understanding of the broad interests of the community and marginalized populations. Interviewees also included the health department director from the community served, medical providers, and community-based organizations that have special knowledge and expertise in public health. Eleven community leaders were interviewed with particular attention to marginalized, low-income, and minority populations. Organizations represented in Wilson County interviews held in 2021 included Brooks House, Charis Health, DrugFree Wilco, Mt. Juliet Senior Center, Wilson County CASA, Wilson County Chamber of Commerce, Wilson County Health Department, Wilson County Mayor's Office, a member of the Latinx community, Wilson County Schools, and the Wilson County Sheriff's Office. Populations served by these organizations include racial and ethnic minority groups, individuals seeking social services such as housing or food assistance, individuals seeking affordable healthcare, at-risk youth, those experiencing homelessness, Hispanic and Latinx, the medically marginalized, those experiencing mental illness, those with addiction, children, low-income individuals, minorities, marginalized communities, and other vulnerable populations. To better understand community members' opinions of the health needs present in 2022, VWCH conducted forty-six community member interviews. The interviews were held at Compassionate Hands, Mt. Juliet Senior Center, and the Wilson County Health Department. Populations served by these organizations included people experiencing homelessness, older adults, and the Latinx community. Both English and Spanish speakers were included in the interviews.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - Vanderbilt Wilson County Hospital. Vanderbilt Wilson County Hospital (VWCH) identified four significant health needs in the 2022 CHNA. The four significant health needs identified are - alphabetically: 1) Access to Healthcare; 2) Health Literacy; 3), Housing and Transportation and 4) Mental Health and Substance Abuse. VWCH addresses all four needs, with a detailed list of programs and services in the 2022 Implementation Strategy (IS). The 2022 Implementation Strategy includes 57 activities and programs. The Community Health Improvement Team released a Request for Proposals for community projects that addressed one or more of the CHNA priority areas, specifically requiring applicants to discuss how their proposal would promote health equity and address broader policy, environmental, or systems change. After a competitive review process with a committee of both academic and community reviewers, organizations were selected as recipients of these awards. The grantees received up to $10,000 to carry out their work over 12 months. The Community Health Improvement team is currently planning for the sixth cycle of this mini-grant program. To date, the program has supported 38 community projects. The Community Health Improvement Team continues to support the local health department and health council in the development of their Community Health Improvement Plans (CHIP), which outline their strategies to address the health needs identified through the Community Health Needs Assessment. VWCH's involvement in this work allows the Community Health Improvement Team to bring VWCH resources to the community and align the CHNA priorities with the Community Health Improvement Plan objectives. Finally, VUMC's Office of Health Equity has increased its working knowledge of health equity by presenting Seeds of Equity training internally and externally. The team will have presented the Seeds of Equity training (created by the Healthy Nashville Leadership Council) 10 times during FY2022 to audiences of about 10 to 100 persons. While this training is specific to Nashville, VUMC Community Health Improvement Team is working with community partners in other counties of focus and VWCH to expand the reach of the training.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - Vanderbilt Wilson County Hospital. In addition to notification on the website, or patient request, VWCH patients are notified of available assistance under federal, state or local government programs or under the organization's charity care policy via signage posted in the patient care registration points including hospitals, emergency departments, and hospital based clinics; brochures available at registration points; and language included on all billing statements mailed to patients advising that VWCH has a financial assistance program if help is needed paying medical bills. Pre-admitting, registration, or billing personnel may refer uninsured or low income patients to financial counseling personnel to discuss qualifications for free or discounted care.

Schedule H, Part V, Section B, Line 2
On January 1, 2021, Vanderbilt University Medical Center acquired the assets and operations of Vanderbilt Tullahoma-Harton Hospital (formerly Tennova Healthcare-Harton, State License 00000018), a 135-bed facility, from subsidiaries of Community Health Systems, Inc.

Schedule H, Part V, Section B, Line 16 Facility , 1
"Facility , 1 - Vanderbilt Tullahoma-Harton Hospital. In addition to notification on the website, or patient request, Vanderbilt Tullahoma-Harton Hospital (""VTHH"") patients are notified of available assistance under federal, state or local government programs or under the organization's charity care policy via signage posted in the patient care registration points including hospitals, emergency departments, and hospital based clinics; brochures available at registration points; and language included on all billing statements mailed to patients advising that VTHH has a financial assistance program if help is needed paying medical bills. Pre-admitting, registration, or billing personnel may refer uninsured or low income patients to financial counseling personnel to discuss qualifications for free or discounted care."

Schedule H, Part V, Section B, Line 2
On January 1, 2021, Vanderbilt University Medical Center acquired the assets and operations of Vanderbilt Bedford Hospital (formerly Tennova Healthcare-Shelbyville, State License 00000002), a 60-bed facility, from subsidiaries of Community Health Systems, Inc.

Schedule H, Part V, Section B, Line 16 Facility , 1
"Facility , 1 - Vanderbilt Bedford Hospital. In addition to notification on the website, or patient request, Vanderbilt Bedford Hospital (""VBCH"") patients are notified of available assistance under federal, state or local government programs or under the organization's charity care policy via signage posted in the patient care registration points including hospitals, emergency departments, and hospital based clinics; brochures available at registration points; and language included on all billing statements mailed to patients advising that VBCH has a financial assistance program if help is needed paying medical bills. Pre-admitting, registration, or billing personnel may refer uninsured or low income patients to financial counseling personnel to discuss qualifications for free or discounted care."

Schedule H, Part V, Section B, Line 3E
The significant health needs identified in the 2019 CHNA of Vanderbilt Stallworth Rehabilitation Hospital (Stallworth) are a prioritized description of the significant health needs of the community, identified by the CHNA. The 2019 process of prioritizing significant health needs included several phases. Stallworth and collaborators collected and analyzed primary data from a broad array of partners and community members. Additionally, Stallworth pulled and reviewed hundreds of indicators from publicly available secondary data. In each of the three counties, the CHNA communities served (Davidson, Rutherford, and Williamson Counties), Stallworth held a community summit, which included hospital leadership, local health departments, community leaders representing several sectors, community members as well as individuals who participated in interviews and listening sessions as a part of the CHNA process. Stallworth also conducted an environmental scan in each county. The results of Stallworth's data collection and analysis were presented to the community, and participants were asked to prioritize their communities' most pressing health needs through interactive exercises. The needs prioritized by the community were adopted by VUMC and Stallworth, and each is described at length in VUMC's 2019 CHNA. Through this CHNA process, the community prioritized the significant health needs of Mental Health and Substance Abuse, Access to Resources and Services, Basic Needs and Social Determinants, Prevention, and Education.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Vanderbilt Stallworth Rehabilitation Hospital. Input from people representing the broad interests of the community, including those with expertise in public health, was obtained through face-to-face interviews and community listening sessions. Interviews took place from February 2018 to May 2018. Listening sessions took place from June 2018 to September 2018. Community summits were held in the fall and winter of 2018 and into 2019. For the 2019 CHNA, Stallworth identified leaders from public health, government, education, the faith community, private foundations, community organizations, and academia among others as interviewees. Interviewees were identified in collaboration with local health departments in each county and were selected based on their understanding of the broad interests of the community and underserved populations. Interviewees also included health department directors from the community served, community physicians, public health researchers, and community-based organizations that have special knowledge and expertise in public health. Sixty-eight community leaders were interviewed with particular attention to marginalized, low-income, and minority populations. Organizations represented in Davidson County interviews held in 2019 included Davidson County Metro Council, Nashville Organized for Action and Hope (NOAH), Metro Homeless Impact Division, Metropolitan Government, Nashville Mayor's Office, Meharry Medical College, 58th Legislative District Office, Saint Thomas Health, Vanderbilt University Medical Center, Tennessee Office for Refugees, Safety Net Consortium of Middle Tennessee, Salahadeen Center of Nashville, Mental Health Cooperative, Walk Bike Nashville, Sycamore Institute, PFLAG Nashville, Metro Nashville Public Schools, Metro Public Health Department, Interfaith Dental Clinic, Family & Children's Services, Matthew Walker Comprehensive Health Center, Nashville General Hospital, and First Presbyterian. Organizations represented in the 2019 Rutherford County Interviews included MTSU Center for Health & Human Services, Ascension Saint Thomas Rutherford, Rutherford District 13 Office, Nissan Diversity and Inclusion Committee, ATLAS, Murfreesboro Cold Patrol, Rutherford Opioid Taskforce, Middle Tennessee State University, First Baptist Church, Rutherford County EMS, St. Louise Clinic, Rutherford District 21 Office, Smyrna Senior Center, Narcotics Anonymous, Rutherford County Government Office, Veterans' Affairs, Journey Home, Primary Care and Hope Clinic of Rutherford County, Interfaith Dental Clinic, Matthew Walker Comprehensive Health Center - Smyrna, Rutherford County Health Department, and Rutherford County Police Department. Organizations represented in Williamson County interviews held in 2019 included Franklin Tomorrow, Williamson County Schools, Fairview Mayor's Office, Williamson Medical Center, Franklin Special School District, Williamson County Public Library, Coordinated School Health, Department of Children's Services, Veterans' Affairs, Williamson County Juvenile Court, Williamson County Health Department, Franklin Mayor's Office, Williamson County Parks & Recreation, Mercy Clinic, Williamson County Anti-Drug Coalition, Franklin Housing Authority, and Graceworks. Populations served by these organizations include racial and ethnic minority groups, individuals seeking social services such as housing or food assistance, individuals seeking affordable healthcare, at-risk youth, those experiencing homelessness, Hispanic and Latinx community leaders, the medically marginalized, those experiencing mental illness, those with addiction, children, low-income individuals, minorities, marginalized communities, and other vulnerable populations. To better understand community members' opinions of the health needs present in 2019 Stallworth held 13 focus groups. These were conducted across the three counties that represent the community served. The focus groups in Davidson County were held in collaboration with Ascension Saint Thomas as well as the Metro Public Health Department. In Davidson County, sessions were held at Salahadeen Center, Building Lives Foundation, Outreach Base, Elizabeth Park Center, Hartman Park, and Hadley Park. Populations served by these organizations include Muslim youth, people experiencing homelessness, older adults, African American populations, and Latinx populations. In 2019 Stallworth held listening sessions that were coordinated with Ascension Saint Thomas and the Rutherford County Health Department. Recruitment was done in coordination with the host sites, which included First Baptist Church of Rutherford (2), Rutherford County Health Department, and Journey Home. These organizations primarily serve those experiencing homelessness and Latino, African American, and older adult populations. For the 2019 CHNA in Williamson County, recruitment was done in collaboration with the Williamson County Health Department. Host sites include the Fairview Branch of the Public Library, Mercy Clinic, and the health department. Rural, uninsured/underinsured, and Latinx populations are served by these organizations. Both English and Spanish speakers were included in listening sessions in each county.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Vanderbilt Stallworth Rehabilitation Hospital. For the 2019 CHNA, Vanderbilt Stallworth Rehabilitation Hospital conducted a health needs assessment in partnership with its affiliated health system, Vanderbilt University Medical Center.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - Vanderbilt Stallworth Rehabilitation Hospital. Vanderbilt Stallworth Rehabilitation Hospital (Stallworth) identified four significant health needs in the 2019 CHNA. The four significant health needs identified are - alphabetically: 1) Access to Resources and Services; 2) Basic Needs and Social Determinants; 3) Mental Health and Substance Abuse, and 4) Prevention and Education. Stallworth addresses all four needs, with a detailed list of programs, investments, and services in the 2019 Implementation Strategy (IS). The 2019 Implementation Strategy includes 83 activities and programs. To date, we have identified 260 activities and programs. Stallworth holds monthly grand rounds for members of the medical community to discuss topics that have an impact on rehabilitation and post-acute care. In addition, Stallworth offers several support groups and educational classes for patients and caregivers. The monthly stroke support group and stroke education classes, which meet weekly, are open to both patients and caregivers. Stallworth works to build strong collaborations throughout the community and throughout the country and currently supports the work of the American Heart and Stroke Association, United Spinal Association, Achilles Foundation, the Arthritis Foundation, Brain Injury Association of Tennessee, Williamson County Senior Expo, the Annual Harold ""Jobe"" Bernard Stroke and Neurosciences Symposium, Senior Health Fairs, Fifty Forward assisted living facilities, Maury County Senior Center, and the Hendersonville Senior Center. In December 2020, Stallworth expanded hours for its psychologist's contract to provide a resource for the inpatient population. Stallworth collaborates with the Trauma Survivors Network, which provides a host of free resources to help patients and families cope with the challenges of trauma recovery. In addition, the Spinal Cord Injury Peer Mentor Program, which is held monthly, includes training for peer mentor volunteers who help patients as they make the significant life changes often associated with trauma recovery. Finally, housing evaluations are done during the pre-admission process to assess home readiness after a traumatic injury. Once an individual is admitted as an inpatient at Stallworth, a recurring housing assessment is done, and Stallworth staff often connect patients with community resources to assist in the transition. Through ongoing partnerships and engagement of key stakeholders, Stallworth will continue to collaborate to meet the needs identified in the most recent needs assessment. Stallworth serves a patient demographic that has needs that are unique in the patient landscape of Vanderbilt University Medical Center. As such, the CHNA team conducted a listening session to explore more granular needs of Stallworth's patients related to the identified needs. The listening session was conducted with the patients participating in a support group for traumatic brain injuries hosted at Stallworth."

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - VANDERBILT STALLWORTH REHABILITATION HOSPITAL. Patients are notified of available assistance under federal, state or local government programs or under Stallworth's charity care policy via signage at the front desk, in the main elevator to the patient care units & along the back hallway of the hospital. Pamphlets regarding this information are distributed upon admission and a statement is included on any patient bills. In addition, pre-admitting, registration, case management or billing personnel may refer uninsured or low income patients to financial personnel to discuss qualifications for free or discounted care.

Schedule H, Part V, Section B, Line 2
On January 1, 2021, Vanderbilt University Medical Center acquired a minority interest in Tennova Healthcare - Clarksville (State License 00000090), a 270-bed facility, from subsidiaries of Clarksville Volunteer Health Inc.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - Tennova Healthcare - Clarksville. IN ADDITION TO NOTIFICATION ON THE WEBSITE, OR PATIENT REQUEST, Tennova Healthcare - Clarksville PATIENTS ARE NOTIFIED OF AVAILABLE ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY VIA SIGNAGE POSTED IN THE PATIENT CARE REGISTRATION POINTS INCLUDING HOSPITALS, EMERGENCY DEPARTMENTS, AND HOSPITAL BASED CLINICS.

Schedule H, Part I, Line 7k VANDERBILT UNIVERSITY MEDICAL CENTER HOSPITALS
Column (f) Community Benefit Expense: The total community benefit expense using Part I, Line 7, Column (c) (before direct offsetting revenue) as a percentage of total expenses is 36.47%.

Schedule H, Part V, Section B, Line 20 Extraordinary Collection Actions
The VUMC, VWCH, VTHH, and VBCH Financial Assistance Policy permits the use of ECAs. However, VUMC, VWCH, VTHH, and VBCH did not engage in any ECAs during FY2022. The Stallworth Financial Assistance Policy explicitly forbids the use of ECAs. The Tennova Healthcare - Clarksville Financial Assistance Policy permits the use of ECAs. However, the Financial Assistance Policy forbids the use of any ECAs prior to making reasonable efforts to determine the individual's eligibility under the facility's Financial Assistance Policy.

Schedule H, Part VI, Line 7 State filing of community benefit report
Not applicable.

Schedule H, Part III, Line 7 Medicare Shortfall
The amount reported as Medicare shortfall on Schedule H, Part III, line 7 does not include Medicare Managed programs. If Medicare Managed programs were included in Schedule H, Medicare costs reported on line 6 would be an additional $563M and Medicare revenue reported on line 5 would be an additional $311M, for a net increase in the Medicare shortfall of $252M. If VUMC includes traditional Medicare and Medicare Managed programs, the Medicare shortfall is $536M for the fiscal year ended June 30, 2022.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
THE COSTING METHODOLOGY USED TO CALCULATE CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFIT COSTS REPORTED WAS BASED ON AN OVERALL COST-TO-CHARGE RATIO FOR ALL PATIENT POPULATIONS. THE COST TO CHARGE RATIO WAS CALCULATED USING IRS WORKSHEET 2.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
The costing methodology used to calculate bad debt expense reported in Part III, Lines 2 and 3 was based on an overall cost-to-charge ratio for all patient populations. Discounts and payments on accounts considered as bad debt offset the total bad debt expense recorded. Process to determine amount of bad debt attributable to individuals eligible for financial assistance - The accounts that have not been paid are first reviewed under a presumptive charity policy. For those accounts that do not meet presumptive eligibility criteria, it is estimated that 3% of the balances are attributable to individuals who would qualify for financial assistance. This estimate is based on experience of patient accounting management as well as a methodical review of outstanding patient accounts.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
Due to the adoption of ASC 606, the audited financial statements of VUMC no longer disclose the consolidated amount of bad debt expense.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
Costing Methodology - Medicare Allowable Costs: The methodology for determining Medicare allowable costs consisted of applying an overall hospital cost-to charge ratio to gross Medicare charges from the hospital billing system. The resulting shortfall is entirely deemed as community benefit because the cost of providing related care consistently exceeds reimbursement from Medicare. The hospital accepts all Medicare patients with the knowledge that there may be shortfalls and operates to promote the health of the community. The organization believes the Medicare shortfall should be treated as a community benefit because Medicare does not fully compensate hospitals for the cost of providing hospital care to Medicare beneficiaries. In FY22, such shortfalls amounted to 283,490,080.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Collection Practices: Although Vanderbilt University Medical Center's policies do not contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance, in practice, if a patient qualifies for a 100% charity care write off, the account is closed and no further collection efforts are made. If a patient qualifies for a partial charity care write off, the account is reduced for the applicable charity discount and normal collection efforts are made. Although no extraordinary collection actions were taken in FY22, the extraordinary collection actions that may be taken, after reasonable efforts are made to ensure a patient is not eligible for financial assistance on the remaining balance, include: * Attachment or seizure of a bank account or other personal property * Commencement of a civil action against an individual * Wage garnishment Written approval must be obtained from VUMC before any of the above ECAs can take place.

Schedule H, Part V, Section B, Line 16a FAP website
- Vanderbilt University Medical Center Hospitals: Line 16a URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Wilson County Hospital: Line 16a URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Tullahoma-Harton Hospital: Line 16a URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Bedford Hospital: Line 16a URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Stallworth Rehabilitation Hospital: Line 16a URL: https://encompasshealth.com/locations/vanderbiltstallworth/financial-assistance; - Tennova Healthcare - Clarksville: Line 16a URL: https://www.tennovaclarksville.com/hospital-501-r-information;

Schedule H, Part V, Section B, Line 16b FAP Application website
- Vanderbilt University Medical Center Hospitals: Line 16b URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Wilson County Hospital: Line 16b URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Tullahoma-Harton Hospital: Line 16b URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Bedford Hospital: Line 16b URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Stallworth Rehabilitation Hospital: Line 16b URL: https://encompasshealth.com/locations/vanderbiltstallworth/financial-assistance; - Tennova Healthcare - Clarksville: Line 16b URL: https://www.tennovaclarksville.com/hospital-501-r-information;

Schedule H, Part VI, Line 5 Promotion of community health
"For information on how VUMC promotes the health of the community please see: ""Facts About Vanderbilt University Medical Center"" as found at: https://www.vumc.org/about/vanderbilt-university-medical-center (Please use lowercase to access the website) ""Vanderbilt in Tennessee: County by County"" as found at: https://www.vanderbilt.edu/community-relations/map/ (Please use lowercase to access the website) ""2019 Economic Impact Report"" as found at: https://www.vanderbilt.edu/reports/2019-economic-impact-report/ (Please use lowercase to access the website)"

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Vanderbilt University Medical Center Hospitals: Line 16c URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Wilson County Hospital: Line 16c URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Tullahoma-Harton Hospital: Line 16c URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Bedford Hospital: Line 16c URL: https://www.vanderbilthealth.com/information/financial-assistance; - Vanderbilt Stallworth Rehabilitation Hospital: Line 16c URL: https://encompasshealth.com/locations/vanderbiltstallworth/financial-assistance; - Tennova Healthcare - Clarksville: Line 16c URL: https://www.tennovaclarksville.com/hospital-501-r-information;

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
VUMC, VWCH, VTHH, AND VBCH patients are notified of available assistance under Federal, State or local government programs or under VUMC's charity care policy via signage posted in the patient care registration points including hospitals, emergency departments, and hospital-based clinics; brochures available at registration points; and language included on all statements mailed to patients advising that VUMC has a financial assistance program if help is needed paying medical bills. Pre-Admitting, Registration, or Billing personnel may refer uninsured or low-income patients to financial counseling personnel to discuss qualifications for free or discounted care. Stallworth patients are notified of available assistance under Federal, State or local government programs or under Stallworth's charity care policy via signage posted at various locations within the hospital. Pamphlets regarding this information are distributed upon admission and a statement is included on any patient bills. In addition, pre-Admitting, Registration, Case Management or Billing personnel may refer uninsured or low-income patients to financial personnel to discuss qualifications for free or discounted care. TENNOVA HEALTHCARE - CLARKSVILLE PATIENTS ARE NOTIFIED OF AVAILABLE ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY VIA the facility's website, by patient request, and via SIGNAGE POSTED IN THE PATIENT CARE REGISTRATION POINTS INCLUDING HOSPITALS, EMERGENCY DEPARTMENTS, AND HOSPITAL BASED CLINICS.

Schedule H, Part VI, Line 4 Community information
Vanderbilt University Medical Center, located in Nashville, Tennessee, serves primarily Tennessee, northern Alabama and southern Kentucky. Vanderbilt University Medical Center owns the Vanderbilt University Hospital, the Monroe Carell Jr. Children's Hospital at Vanderbilt, and Vanderbilt Psychiatric Hospital. These facilities operate under one hospital license as Vanderbilt University Medical Center (VUMC). VUMC (excludes Vanderbilt Health Services, LLC and subsidiaries) have approximately 75,000 annual discharges. VUMC also provides approximately 2.8 million annual outpatient visits, including 190,000 to the emergency departments. Vanderbilt University Medical Center Hospitals provide critical and often unique health care resources to the community and provide broad access to care. The majority of VUMC's patients live in four Tennessee counties: Davidson, Williamson, Rutherford and Montgomery. Vanderbilt Wilson County Hospital is a two-campus 245-bed facility located in Mount Juliet, Tennessee and is the sole provider of inpatient and outpatient medical services in Wilson County. Vanderbilt Tullahoma-Harton Hospital is a 135-bed facility located in Tullahoma, Tennessee and serves Coffee County, Tennessee. Vanderbilt Bedford Hospital is a 60-bed facility located in Shelbyville, Tennessee and is the sole provider of inpatient and outpatient medical services in Bedford County, Tennessee. Vanderbilt Stallworth Rehabilitation Hospital, located in Nashville, Tennessee, serves middle Tennessee, southern Kentucky and the northern parts of Mississippi, Alabama and Georgia. This 80-bed hospital is a joint venture between Vanderbilt University Medical Center and Encompass Health and offers comprehensive acute rehabilitation services. Annually, Vanderbilt Stallworth Rehabilitation Hospital has approximately 1,168 discharges. The majority of Stallworth's patients live in four Tennessee counties - Davidson, Williamson, Rutherford and Montgomery. Tennova Healthcare - Clarksville is a 270-bed facility located in Clarksville, Tennessee and is the sole provider of inpatient and outpatient medical services in Montgomery County, Tennessee. Tennova Healthcare - Clarksville is a joint venture between Vanderbilt University Medical Center and Community Health Systems, Inc.

Schedule H, Part VI, Line 6 Affiliated health care system
VANDERBILT UNIVERSITY MEDICAL CENTER OWNS THE VANDERBILT UNIVERSITY HOSPITAL, THE MONROE CARELL JR. CHILDREN'S HOSPITAL AT VANDERBILT, AND VANDERBILT PSYCHIATRIC HOSPITAL. THESE FACILITIES OPERATE UNDER ONE HOSPITAL LICENSE AS VANDERBILT UNIVERSITY MEDICAL CENTER (VUMC). ADDITIONALLY, VUMC OWNS VANDERBILT WILSON COUNTY HOSPITAL, VANDERBILT TULLAHOMA-HARTON HOSPITAL, AND VANDERBILT BEDFORD HOSPITAL WHICH EACH OPERATE UNDER THEIR OWN RESPECTIVE HOSPITAL LICENSES. VUMC ALSO HAS OWNERSHIP INTEREST IN SEVERAL AFFILIATED ENTITIES, WHICH PROVIDE CLINICAL SERVICES. VUMC'S HOSPITALS, CLINICS, AND AFFILIATED ENTITIES PROVIDE THE FOLLOWING HEALTHCARE SERVICES TO THE COMMUNITIES IT SERVES: EMERGENCY CARE, INPATIENT HOSPITAL CARE, OUTPATIENT TREATMENT, DIAGNOSTIC TESTING, ANCILLARY CARE, PRIMARY CARE SERVICES, AND HOME HEALTH CARE. VUMC PROVIDES A NUMBER OF CLINICAL SERVICES UNIQUE TO ITS REGION INCLUDING: A LEVEL 1 TRAUMA CENTER, A LEVEL 1 PEDIATRIC TRAUMA CENTER, A COMPREHENSIVE REGIONAL BURN CENTER, A LEVEL 4 NEONATAL INTENSIVE CARE UNIT, TENNESSEE'S ONLY COMPREHENSIVE SOLID ORGAN TRANSPLANT CENTER, THE VANDERBILT-ESKIND DIABETES CENTER, AND THE VANDERBILT-INGRAM CANCER CENTER, THE ONLY NATIONAL CANCER INSTITUTE-DESIGNATED COMPREHENSIVE CANCER CENTER IN TENNESSEE TO TREAT BOTH ADULT AND PEDIATRIC CANCER PATIENTS. IN ADDITION, VUMC'S HEALTH CARE SYSTEM INCLUDES THE VANDERBILT HEALTH AFFILIATED NETWORK, AN AFFILIATED NETWORK OF DOCTORS, REGIONAL HEALTH SYSTEMS AND OTHER HEALTH CARE PROVIDERS THAT COLLABORATE TO PROVIDE COORDINATED AND COST-EFFECTIVE HEALTH CARE SERVICES TO THE COMMUNITIES SERVED. THESE ARE CONTRACTUAL AFFILIATE RELATIONSHIPS ONLY WITH NO OWNERSHIP INTEREST IN THE FACILITIES OR PHYSICIAN PRACTICES. VUMC ALSO COLLABORATES WITH OTHER HOSPITAL SYSTEMS IN THE REGION, PROVIDING HEALTH CARE AND/OR RESEARCH AND ACADEMIC SUPPORT. FOR A LIST OF ALL ORGANIZATIONS RELATED TO VANDERBILT UNIVERSITY MEDICAL CENTER AND THE PRIMARY ACTIVITY OF EACH, PLEASE REFER TO SCHEDULE R.

Schedule H, Part VI, Line 2 Needs assessment
"Vanderbilt University Medical Center (""VUMC"") and Vanderbilt Stallworth Rehabilitation Hospital (Stallworth) continually assess the healthcare needs of the communities they serve. The Vanderbilt Patient and Family Advisory Council is comprised of community volunteers and partners with VUMC's health care team and leadership to assess needs and evaluate services and programs. VUMC and Stallworth have also formed the Community Health Improvement Working Group, an internal committee of program managers as well as other leadership roles which meet regularly and make recommendations to the CHNA Advisory Committee. The CHNA Advisory Committee comprises VUMC and Stallworth senior leaders who meet continually to assess the needs of the community and drive improvements in care and processes for the communities they serve. To understand in more depth the needs of specific populations, VUMC's Community Health Improvement team has conducted additional listening sessions to determine how their experiences align with the broad categories of needs that were identified in the 2019 CHNA, and what strategies will best address the needs of the community. These listening sessions have included one (1) session with patients served by Stallworth and three (3) with the LGBTQ community. VUMC and Stallworth further assess the health care needs of the communities served by playing an active role in groups such as the Healthy Nashville Leadership Council, Williamson County Health Council, and the Rutherford County Wellness Council. VUMC and Stallworth review the many needs assessments published by these local groups (Alignment Nashville, Saint Thomas Health, Nashville Area Chamber of Commerce, Metro Social Services, Healthy Nashville, and the TN Department of Health, among others) to help gauge the needs and resources within the community. For the 2019 CHNA, VUMC and Stallworth completed a systematic review of 31 recent assessments completed by community partners across the three counties, highlighting populations served, the geographic area covered, and themes highlighted in the report. In addition, VUMC and Stallworth have developed partnerships with the state department of health to stay abreast of important community health needs. The COVID-19 pandemic exposed and exacerbated longstanding drivers of health inequities, disproportionately impacting racial and ethnic minorities and VUMC has been at the forefront of addressing these. VUMC enacted many COVID-19-specific initiatives to ensure that resources and important communications remain available to all community members. For example, the Community Health Improvement Team promptly convened a workgroup with other relevant community organizations to create, share, and distribute resources for populations that speak languages other than English. Along with this effort, VUMC selected a group of leaders to sit on the ""VUMC COVID-19 Expert Vaccine Panel,"" providing expertise and addressing vaccine hesitancy at various town halls or community events. VUMC also embedded strategies to mitigate health inequities in its COVID-19 Command Center early in the pandemic. Led by the Office of Health Equity, an inter-professional COVID Health Equity Team comprised of physicians, nurses, social workers, and operational leaders with expertise in minority health, SDOH, quality improvement, public health, health communication, clinical research, diversity and inclusion, and telehealth was assembled. This team was critical in implementing a systems approach to address the complex drivers of COVID-19 inequities. The creation of interactive dashboards populated with data for all patients tested for SARS-CoV-2 at VUMC facilitated disaggregation of metrics by race, ethnicity, primary language, and ZIP Code. These data points were also linked to community-level socioeconomic data to understand disparities in testing, positivity rates, hospitalizations, treatment, and death. For example, to understand the social and environmental context for patients most impacted by inequities, the Health Equity Workstream mapped the ZIP Codes of patients who tested positive and found the highest number of cases in two adjacent ZIP Codes. In these two zip codes, more than 30% of residents' primary language is not English and the adjusted gross income is $36,384, compared with the county average of $56,507 median. By disaggregating data by REAL, and implementing strategies informed by social context, VUMC may prevent or lessen health inequities and be better positioned to address underlying contributors to health. Vanderbilt Wilson County Hospital (VWCH) continually assesses the healthcare needs of the communities it serves. In October of 2021, VWCH convened its Patient and Family Advisory Council to improve upon the patient experience in Wilson County through regular council meetings and interaction with VWCH patients. VWCH has also formed the Community Health Improvement Working Group, an internal committee of program managers as well as other leadership roles which meet regularly and make recommendations to the CHNA Advisory Committee. The CHNA Advisory Committee comprises senior leaders, including the CEO of VWCH, who meet continually to assess the needs of the community and drive improvements in care and processes for the communities they serve. In February 2021, VWCH and the Office of Government and Community Affairs collaborated with the Wilson County Health Department to offer COVID-19 vaccinations to eligible individuals as determined by the CDC guidelines. During this effort, over 15,000 vaccinations were given to Wilson County residents, which includes many offsite vaccination events. Some of these sites include Del Webb Residents (55+ community), Wilson County Jail, Wilson County Schools Staff, Mt. Juliet Christian Academy Staff, as well as various other events. VWCH donated 4,100 KN95 masks to community organizations in Wilson County. Organizations receiving the donations included shelters and local universities. In collaboration with OHE, the Vanderbilt School of Nursing Mobile Vaccination Program has partnered with VWCH, the local health department, and the health council to increase the percentage of COVID-19-vaccinated individuals living in underserved and/or vulnerable communities within Wilson County. The program has successfully vaccinated 120 people in Wilson County who may not have had access to the vaccine if not for the program. In addition to the initiatives listed above, Vanderbilt's Pediatric Primary Care Clinic located in Wilson County, along with all Vanderbilt pediatric clinics has provided an abundance of online information on the COVID-19 vaccine, as well as supported families as children (5-11 years) became eligible to receive the vaccine. In the first two weeks of this group becoming eligible, these clinics administered 2,000 vaccines to children. VWCH further assesses the health care needs of the communities it serves by playing an active role in groups such as the Wilson County Health Council and Drug-Free Wilco to help gauge the needs and resources within the community. For the 2022 CHNA, VWCH completed a systematic review of 6 recent assessments completed by community partners highlighting populations served, the geographic area covered, and themes highlighted in the report. In addition, VWCH has developed partnerships with the state department of health to stay abreast of important community health needs."