4A (Expenses $ 0 including grants of $ 0) (Revenue $ 18352253)
BAPTIST HEALTH CARE AFFILIATES, INC. HOLDS OWERSHIP INTERESTS IN ENTITIES, SAINT THOMAS HOSPITAL FOR SPECIALTY SURGERY AND BAPTIST AMBULATORY SURGERY CENTER, THAT OPERATE ANCILLARY SERVICES. SAINT THOMAS HOSPITAL FOR SPECIALTY SURGERY IS THE ONLY HOSPITAL IN TENNESSEE DEDICATED TO SPINAL AND JOINT REPLACEMENT SURGERY. SAINT THOMAS HOSPITAL FOR SPECIALTY SURGERY IS NATIONALLY RECOGNIZED IN SPINAL SURGERY AND IS PART OF THE PRESTIGIOUS SAINT THOMAS JOINT REPLACEMENT INSTITUTE. BAPTIST AMBULATORY SURGERY CENTER'S FOCUS IS ON SURGICAL PROCEDURES. As part of the Ascension Catholic health ministry, the filing organization served in support of Ascension's commitment to both care for patients and communities and support caregivers and other associates through the challenges of the COVID-19 global pandemic in FY22.

Schedule H, Part V, Section B, Line 3E
TO BETTER TARGET COMMUNITY RESOURCES ON THE SERVICE AREA'S MOST PRESSING HEALTH NEEDS, THE HOSPITAL PARTICIPATED IN A GROUP DISCUSSION WITH ORGANIZATIONAL DECISION MAKERS AND COMMUNITY LEADERS TO PRIORITIZE THE SIGNIFICANT COMMUNITY HEALTH NEEDS WHILE CONSIDERING SEVERAL CRITERIA: ALIGNMENT WITH ASCENSION HEALTH STRATEGIES OF HEALTHCARE THAT LEAVES NO ONE BEHIND; CARE FOR THE POOR AND VULNERABLE; OPPORTUNITIES FOR PARTNERSHIP; AVAILABILITY OF EXISTING PROGRAMS AND RESOURCES; ADDRESSING DISPARITIES OF SUBGROUPS; AVAILABILITY OF EVIDENCE-BASED PRACTICES; AND COMMUNITY INPUT. THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SEE SCHEDULE H, PART V, LINE 7 FOR THE LINK TO THE CHNA AND SCHEDULE H, PART V, LINE 11 FOR HOW THOSE NEEDS ARE BEING ADDRESSED.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Saint Thomas Hospital for Specialty Surgery. Saint Thomas Hospital for Specialty Surgery COMPLETED ITS 2021 CHNA IN COLLABORATION WITH THE FOLLOWING ORGANIZATIONS AND INDIVIDUALS: -HEALTHY NASHVILLE LEADERSHIP COUNCIL (HNLC) -METRO NASHVILLE PUBLIC HEALTH DEPARTMENT (MPHD) -VANDERBILT UNIVERSITY MEDICAL CENTER - OFFICE OF HEALTH EQUITY -MEASUREMENT MATTERS, LLC -TENNESSEE IMMIGRANT & REFUGEE RIGHTS COALITION -ELMAHABA CENTER THE HEALTHY NASHVILLE LEADERSHIP COUNCIL COLLABORATED WITH Saint Thomas Hospital for Specialty Surgery BY PROVIDING ADVISORY SUPPORT ON MANY CHNA DECISIONS, DEVELOPING THE CHNA SUBCOMMITTEE FOR PRIORITIZATION, AND UTILIZING A HEALTH EQUITY LENS DURING ALL PHASES. THE METRO NASHVILLE PUBLIC HEALTH DEPARTMENT PROVIDED SIGNIFICANT SUPPORT TO Saint Thomas Hospital for Specialty Surgery DURING THE CHNA PROCESS, INCLUDING COORDINATING INTERVIEWEES, SURVEY LINK DISTRIBUTION, HEALTH COUNCIL MEETING FACILITATIONS, AND SIGNIFICANT ANALYSIS FROM THE EPIDEMIOLOGY DEPARTMENT WHILE PRIORITIZING COMMUNITY HEALTH NEEDS. VANDERBILT UNIVERSITY MEDICAL CENTER'S OFFICE OF HEALTH EQUITY HAS PARTNERED WITH Saint Thomas Hospital for Specialty Surgery ON THE PREVIOUS THREE CHNAS IN DAVIDSON COUNTY AND ENJOY A CLOSE RELATIONSHIP ON MANY OF THE ACTIVITIES THAT TOOK PLACE TO CONNECT ON COMMUNITY ENGAGEMENT, GATHER COMMUNITY INPUT, ANALYZE DATA, PRIORITIZE NEEDS, AND RESPOND TO COMMUNITY HEALTH COUNCILS. A PHD FROM MEASUREMENT MATTERS, LLC CONTRACTED WITH Saint Thomas Hospital for Specialty Surgery AND VANDERBILT UNIVERSITY MEDICAL CENTER'S OFFICE OF HEALTH EQUITY TO PROVIDE ANALYSIS FOR THE ONLINE COMMUNITY SURVEY FROM NOVEMBER 2021 TO JANUARY 2022. THIS INDIVIDUAL HELPED TO CATEGORIZE RESPONSES IN ALIGNMENT WITH THE TEAM'S SOCIAL-ECOLOGICAL MODEL, QUANTIFY AND CODE THE RESPONSES, IDENTIFY THEMES THAT THE COMMUNITY WAS RAISING, AND ASSESS ANALYSIS OF RESPONSES BY COUNTY, AGE, RACE, AND ZIP CODE. Saint Thomas Hospital for Specialty Surgery AND THE VANDERBILT UNIVERSITY OFFICE OF HEALTH EQUITY CONTRACTED WITH BOTH THE TENNESSEE IMMIGRANT AND REFUGEE RIGHTS COALITION (TIRRC) AND THE ELMAHABA CENTER TO IDENTIFY AND CONDUCT INTERVIEWS WITH COMMUNITY MEMBERS IN BOTH SPANISH AND ARABIC. Saint Thomas Hospital for Specialty Surgery IS GRATEFUL FOR THESE PARTNERSHIPS AND EXPERTISE. WE LOOK FORWARD TO MORE WAYS TO WORK TOGETHER TO IMPROVE THE HEALTH OF THE COMMUNITY. IN JANUARY 2021, Saint Thomas Hospital for Specialty Surgery BEGAN A COMMUNITY HEALTH NEEDS ASSESSMENT FOR DAVIDSON COUNTY AND WILLIAMSON COUNTY AND SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY USING SEVERAL METHODS: PLANNING MEETINGS WITH COMMUNITY PARTNERS TOOK PLACE BETWEEN JANUARY 2021-JUNE 2021. -26 LOCAL REPORTS FROM COMMUNITY PARTNERS WERE READ, ANALYZED AND CATALOGED AS A PART OF AN ENVIRONMENTAL SCAN FOR DAVIDSON COUNTY BETWEEN MARCH - SEPTEMBER 2021. -11 LOCAL REPORTS FROM COMMUNITY PARTNERS WERE READ, ANALYZED AND CATALOGED AS A PART OF AN ENVIRONMENTAL SCAN FOR WILLIAMSON COUNTY BETWEEN MARCH - SEPTEMBER 2021. INFORMATION GATHERING, USING SECONDARY PUBLIC HEALTH SOURCES, OCCURRED BETWEEN NOVEMBER 2021 - FEBRUARY 2022. -37 COMMUNITY MEMBERS REPRESENTING MANY SECTORS OF THE COMMUNITY, INCLUDING ARABIC AND SPANISH-SPEAKING CITIZENS, PARTICIPATED IN STAKEHOLDER INTERVIEWS IN DAVIDSON COUNTY. -22 COMMUNITY MEMBERS REPRESENTING MANY SECTORS OF THE COMMUNITY, INCLUDING ARABIC AND SPANISH-SPEAKING CITIZENS, PARTICIPATED IN STAKEHOLDER INTERVIEWS IN WILLIAMSON COUNTY. -A COMMUNITY SURVEY WAS DISTRIBUTED AND 366 RESPONSES WERE COLLECTED FROM NOVEMBER 1, 2021 THROUGH DECEMBER 3, 2021 IN DAVIDSON COUNTY. -A COMMUNITY SURVEY WAS DISTRIBUTED AND 177 RESPONSES WERE COLLECTED FROM NOVEMBER 1, 2021 THROUGH DECEMBER 3, 2021 IN WILLIAMSON COUNTY. HEALTHY NASHVILLE LEADERSHIP COUNCIL CHNA SUBCOMMITTEE: -FEBRUARY 8, 2022 - REVIEW ALL CHNA DATA, CONSIDER HEALTH EQUITY QUESTIONS AND VIEWS FROM OTHERS IN SUBCOMMITTEE, VOTE ON TOP NEEDS -FEBRUARY 10, 2022 - REVIEW VOTING RESULTS, PRIORITIZE THE MOST SIGNIFICANT HEALTH NEEDS IN THE COUNTY, DISCUSS SOLUTIONS UTILIZING HEALTH EQUITY FRAMEWORK WILLIAMSON COUNTY HEALTH COUNCIL CHNA SUBCOMMITTEE: MARCH 1, 2022 - REVIEW ALL CHNA DATA, CONSIDER HEALTH EQUITY QUESTIONS AND VIEWS FROM OTHERS IN SUBCOMMITTEE, VOTE ON TOP NEEDS MARCH 3, 2022 - REVIEW VOTING RESULTS, PRIORITIZE THE MOST SIGNIFICANT HEALTH NEEDS IN THE COUNTY, DISCUSS SOLUTIONS UTILIZING HEALTH EQUITY FRAMEWORK THE CHNA PROCESS IN DAVIDSON COUNTY IS COORDINATED BY THE HEALTHY NASHVILLE LEADERSHIP COUNCIL, WHICH HAS STAFFING SUPPORT FROM THE METRO NASHVILLE PUBLIC HEALTH DEPARTMENT, Saint Thomas Hospital for Specialty Surgery AND VANDERBILT UNIVERSITY'S OFFICE OF HEALTH EQUITY. VUMC AND ASCENSION SAINT THOMAS REGULARLY MET WITH AND GAINED ADVICE FROM THE MPHD, AND ALSO INTERVIEWED THE DIRECTOR OF HEALTH FOR MPHD AS A PART OF THE 1-1 INTERVIEW METHODOLOGY. ADDITIONALLY, THE HEALTHY NASHVILLE LEADERSHIP COUNCIL CONTAINS MEMBERS WHO SERVE IN COMMUNITY-FACING CLINICS, INCLUDING FEDERALLY QUALIFIED HEALTH CENTERS AND CLINICS THAT SERVE LOW-INCOME COMMUNITIES. THESE INDIVIDUALS WERE INSTRUMENTAL IN PROVIDING GUIDANCE, ASSISTANCE AND KNOWLEDGE TO THE COMMUNITY HEALTH IMPROVEMENT PROCESS.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Saint Thomas Hospital for Specialty Surgery. SAINT THOMAS HOSPITAL FOR SPECIALTY SURGERY CONDUCTED THE ASSESSMENT IN PARTNERSHIP WITH VANDERBILT UNIVERSITY MEDICAL CENTER.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - Saint Thomas Hospital for Specialty Surgery. THE OTHER ORGANIZATIONS WHO SERVED AS A PARTNER IN THE CONDUCTING OF THE TAX YEAR 2021 CHNA WERE: -METRO NASHVILLE PUBLIC HEALTH DEPARTMENT -HEALTHY NASHVILLE LEADERSHIP COUNCIL -A PhD (CONTRACTOR) from Meaurement Matters, LLC -TENNESSEE IMMIGRANT AND REFUGEE RIGHTS COALITION (TIRRC) (A COMMUNITY GROUP WHO ASSISTED IN CONDUCTING INTERVIEWS WITH COMMUNITY MEMBERS IN SPANISH) -ELMAHABA CENTER (A COMMUNITY CENTER WHO ASSISTED IN CONDUCTING INTERVIEWS WITH COMMUNITY MEMBERS IN ARABIC)

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - Saint Thomas Hospital for Specialty Surgery PART 1. SAINT THOMAS HOSPITAL FOR SPECIALTY SURGERY'S tax year 2018 CHNA IMPLEMENTATION STRATEGY ADDRESSED THE FOLLOWING PRIORITY HEALTH NEEDS: ACCESS TO CARE, MENTAL HEALTH, HEALTHY WEIGHT, AND SUBSTANCE MISUSE. THE COVID-19 PANDEMIC HAD A PROFOUND IMPACT ON ASCENSION SAINT THOMAS HOSPITAL FOR SPECIALTY SURGERY'S ABILITY TO CARRY OUT MANY STRATEGIES. LIKE MANY HEALTH SYSTEMS, STAFF CAPACITY SHIFTED IN 2020; WHILE SOME OF OUR STRATEGIES WERE ABLE TO ADAPT, MANY WERE NOT ABLE TO BE IMPLEMENTED OR FULLY COMPLETED. AN IMPORTANT PIECE OF THE THREE-YEAR CHNA CYCLE IS REVISITING THE PROGRESS MADE ON PRIORITY NEEDS SET FORTH IN THE PRECEDING CHNA. BY REVIEWING THE ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT NEEDS AND EVALUATING THE IMPACT THOSE ACTIONS HAVE MADE IN THE COMMUNITY, IT IS POSSIBLE TO BETTER TARGET RESOURCES AND EFFORTS DURING THE NEXT CHNA CYCLE.THE INFORMATION BELOW DESCRIBES THE ACTIONS TAKEN DURING THE tax year 2018 CHNA TO ADDRESS EACH PRIORITY NEED AND INDICATORS OF IMPROVEMENT. - OPERATE AND EXPAND A COMMUNITY- FACING BREASTFEEDING OUTREACH CLINIC TO SUPPORT AND EDUCATE BREASTFEEDING FAMILIES. *FY20 - 1,578 ENCOUNTERS, $106,066 INVESTMENT *FY21 - 1,410 ENCOUNTERS, $99,430 INVESTMENT *FY22 - 1,096 ENCOUNTERS, $140,892 INVESTMENT - GROW THE DISPENSARY OF HOPE TO PROVIDE MEDICATION ASSISTANCE FOR UNINSURED AND UNDERINSURED COMMUNITY MEMBERS. *FY20 - 10,871 PERSONS SERVED 20,806 ENCOUNTERS FOR A TOTAL INVESTMENT OF $753,481 *FY21- 10,169 PERSONS SERVED, 17,585 ENCOUNTERS FOR A TOTAL INVESTMENT OF $776,355 *FY22 - 4,573 PERSONS SERVED, 22,384 PRESCRIPTIONS FILLED FOR A TOTAL INVESTMENT OF $637,057 DISTRIBUTE DONATED MEDICATION TO CHARITABLE PHARMACIES AND CLINICS *FY20 - NO ACTION STEPS TAKEN *FY21 - NO ACTION STEPS TAKEN *FY22 - NO ACTION STEPS TAKEN - IMPROVE MATERNAL AND INFANT HEALTH THROUGH OFFERING PRENATAL EDUCATION VIA GROUP VISITS *FY20 - NO ACTION STEPS TAKEN *FY21 - NO ACTION STEPS TAKEN *FY22 - NO ACTION STEPS TAKEN - OPERATE SAINT THOMAS HEALTH SCHOLARS TO PROVIDE OPPORTUNITIES FOR STUDENTS IN METRO NASHVILLE PUBLIC SCHOOLS TO ADVANCE THEIR EXPERIENTIAL LEARNING AND OBTAIN INDUSTRY CERTIFICATION IN THE HEALTHCARE FIELD *FY20 - 62 STUDENTS PARTICIPATED *FY21 - 62 STUDENTS PARTICIPATED *FY22 - 45 STUDENTS HAVE PARTICIPATED - INCREASE SCREENING COMPLIANCE THROUGH OUR MOBILE HEALTH UNITS, INCLUDING MISSION IN MOTION MOBILE MAMMOGRAPHY *FY20 - 873 UNINSURED WOMEN SCREENED *FY21 - 575 UNINSURED WOMEN SCREENED *FY22 - 434 UNINSURED WOMEN SCREENED - IMPROVE ACCESS TO CARE VIA TELEMEDICINE CONSULTATIONS, INCLUDING WHEN ACUTE STROKE SYMPTOMS ARE PRESENT *FY20 - APPROXIMATELY 140 COMMUNITY MEMBERS WERE ABLE TO USE THIS SERVICE IN THE FIRST TWO QUARTERS OF FY20, RESULTING IN A NET LOSS TO AST OF $1,909. DURING THE PANDEMIC, MORE EMPHASIS WAS PLACED ON THE NEED TO REIMBURSE FOR TELEHEALTH VISITS, THUS CHANGING THIS TO A SERVICE THAT IS NOW REIMBURSED. *FY21 - NO LONGER COUNTED AS COMMUNITY BENEFIT *FY22 - NO LONGER COUNTED AS COMMUNITY BENEFIT - IMPLEMENT COMMUNITY-WIDE MEDICAL MISSIONS AT HOME THAT INTEGRATE MEDICAL, DENTAL, VISION AND BEHAVIORAL HEALTH, ALONG WITH COMMUNITY RESOURCES. *FY20 - 1 EVENT COMPLETED, $8,553 SPENT BEFORE EVENTS PLACED ON PAUSE DUE TO COVID RESTRICTIONS. *FY21 NO ACTION STEPS TAKEN *FY22 - PLANNING HAS BEGUN FOR A MEDICAL MISSION AT HOME IN NASHVILLE FOR FY23. - PROVIDE COMMUNITY-BASED ORGANIZATIONS WITH FINANCIAL SUPPORT TOWARD THEIR WORK IN ONE OF THE PRIORITIZED NEED AREAS. *FY20-$6,000 BUILDING LIVES FOUNDATION, $12,000 FAMILY & CHILDREN'S SERVICE, $10,000 HOPE CLINIC FOR WOMEN, $16,500 INTERFAITH DENTAL, $15,000 NURSES FOR NEWBORNS, $8,000 PRESTON TAYLOR MINISTRIES, $20,000 SILOAM FAMILY HEALTH CENTER, $4,800 TENNESSEE JUSTICE CENTER *FY21 -$31,200 SILOAM, $15,000 FAMILY & CHILDREN'S SERVICES, $10,000 TENNESSEE JUSTICE CENTER, $20,000 HOPE CLINIC FOR WOMEN, $20,000 YMCA NORTH NASHVILLE, $43,334 INTERFAITH DENTAL *FY22-$3,334 CIVIC TN COVID VACCINE OUTREACH, $38,885 SILOAM HEALTH, $33,334 TENNESSEE JUSTICE CENTER, $16,666 NURSES FOR NEWBORNS PRIORITY NEED: MENTAL HEALTH - PROVIDE MENTAL HEALTH SCREENING, COUNSELING, AND PSYCHIATRIC MEDICATION MANAGEMENT TO COMMUNITY MEMBERS WHO SEEK CARE AT SAINT THOMAS MEDICAL PARTNERS' DAVIDSON FAMILY HEALTH CENTER PCMH SITES *FY20 - NO ACTION STEPS TAKEN *FY21 - PROGRAM IMPLEMENTED AND 30% - 40% OF PATIENTS RECEIVED A DEPRESSION SCREENING *FY22 - 5,681 PATIENTS RECEIVED DEPRESSION SCREENINGS -SUPPORT THE DEVELOPMENT OF A MORE COORDINATED NETWORK TO MEET THE BEHAVIORAL HEALTH NEEDS OF INDIVIDUALS AND COMMUNITIES IN DAVIDSON COUNTY (BEHAVIORAL HEALTH AND WELLNESS COUNCIL - METRO PUBLIC HEALTH DEPT, OTHERS, ETC) *FY20 - NO ACTION STEPS TAKEN *FY21 - WE PARTNERED WITH ACADIA TO OPEN A BEHAVIORAL HEALTH HOSPITAL. THEY ARE BUILDING RELATIONSHIPS WITH COMMUNITY PARTNERS TO SUPPORT AND COORDINATE POST-ACUTE CARE FOR PATIENTS. *FY22 - ASCENSION SAINT THOMAS BEHAVIORAL HEALTH HOSPITAL OPENED. THEY CONTINUE TO BUILD RELATIONSHIPS WITH COMMUNITY PARTNERS TO SUPPORT AND COORDINATE POST-ACUTE CARE FOR PATIENTS. -PROVIDE COMMUNITY-BASED ORGANIZATIONS WITH FINANCIAL SUPPORT TOWARD THEIR WORK IN ONE OF THE PRIORITIZED NEED AREAS. *FY20-$15,000 AGAPE, $6,000 BEGIN ANEW, $10,000 GILDA'S CLUB, $8,000 SEXUAL ASSAULT CENTER *FY21- $25,000 AGAPE, $10,000 BEGIN ANEW, $12,000 SEXUAL ASSAULT CENTER *FY22 -$30,000 AGAPE, $20,000 SEXUAL ASSAULT CENTER, $60,000 END SLAVERY TENNESSEE, $15,000 COMMUNITIES IN SCHOOLS, $10,000 GILDA'S CLUB PRIORITY NEED: HEALTHY WEIGHT - PROVIDE ACCESS TO PHYSICAL ACTIVITY AND NUTRITION EDUCATION AND COUNSELING THROUGH AT LEAST ONE PRIMARY CARE CLINIC. *FY20 NO ACTION STEPS TAKEN *FY21NO ACTION STEPS TAKEN *FY22 NO ACTION STEPS TAKEN - EXPLORE AND LEARN ABOUT OPPORTUNITIES TO REDUCE FOOD WASTE AND INCREASE THE AMOUNT OF FOOD DONATED TO FOOD BANKS WITH COMMUNITY PARTNERS AND HEALTH SYSTEMS. *FY20 - NO ACTION STEPS TAKEN *FY21 - NO ACTION STEPS TAKEN *FY22 - ADMINISTRATIVE RESIDENT HIRED AND HAS HELPED DEVELOP A 3 MONTH PILOT PROGRAM TO TAKE KITCHEN INGREDIENTS THAT WOULD HAVE BEEN SENT TO A LANDFILL TO THE NASHVILLE FOOD PROJECT. THE NASHVILLE FOOD PROJECT COORDINATES GETTING HEALTHY FOOD TO COMMUNITY MEMBERS EXPERIENCING FOOD INSECURITY. IF SUCCESSFUL, THIS PROJECT WILL EXPAND TO OTHER FACILITIES WITHIN OUR MARKET. - EXPLORE OPPORTUNITIES FOR COMMUNITY FACING BARIATRIC MODELS OF CARE THAT WOULD REMOVE BARRIERS FOR THE POOR AND VULNERABLE. *FY20 - NO ACTION STEPS TAKEN *FY21 - NO ACTION STEPS TAKEN *FY22 - NO ACTION STEPS TAKEN - EXPLORE OPPORTUNITIES TO INCREASE ACCESS AND KNOWLEDGE OF HEALTHY EATING THROUGH NEW PARTNERSHIPS. *FY20 - NO ACTION STEPS TAKEN *FY21 - NO ACTION STEPS TAKEN *FY22 - NO ACTION STEPS TAKEN -PROVIDE COMMUNITY-BASED ORGANIZATIONS WITH FINANCIAL SUPPORT TOWARD THEIR WORK IN ONE OF THE PRIORITIZED NEED AREAS. *FY20 -$12,500 INSPIRITUS, $40,000 THE NEW BEGINNINGS CENTER *FY21 $25,000 NASHVILLE FOOD PROJECT, $10,000 PENCIL, $40,000 THE NEW BEGINNINGS CENTER, $30,000 VILLAGE AT GLEN CLIFF, $17,500 INSPIRITUS, $20,000 YMCA, $20,000 CATHOLIC CHARITIES *FY22 $30,400 THE NEW BEGINNINGS CENTER PRIORITY NEED: SUBSTANCE MISUSE -BETTER MEET BASIC NEEDS AND SOCIAL DETERMINANTS FOR INDIVIDUALS IN RECOVERY. *FY20 NO ACTION STEPS TAKEN *FY21 NO ACTION STEPS TAKEN *FY22 NO ACTION STEPS TAKEN -REDUCE RISK-TAKING BEHAVIORS, PROMOTE RESILIENCE, PREVENT PROBLEMS IN INDIVIDUALS AND FAMILIES ACROSS THE LIFE SPAN. *FY20 NO ACTION STEPS TAKEN *FY21 NO ACTION STEPS TAKEN *FY22 NO ACTION STEPS TAKEN - PROVIDE COMMUNITY-BASED ORGANIZATIONS WITH FINANCIAL SUPPORT TOWARD THEIR WORK IN ONE OF THE PRIORITIZED NEED AREAS. *FY20-$6,000 BUILDING LIVES FOUNDATION *FY21 - $15,000 BUILDING LIVES FOUNDATION, $15,000 THE NEXT DOOR, $10,000 RENEWAL HOUSE *FY22 STILL REVIEWING APPLICATIONS FOR THIS FISCAL YEAR

Schedule H, Part V, Section B, Line 11 Facility , 2
"Facility , 2 - Saint Thomas Hospital for Specialty Surgery PART 2. FOLLOWING THE COMPLETION OF THE tax year 2021 CHNA ASSESSMENT, SIGNIFICANT NEEDS WERE FURTHER NARROWED DOWN TO A SET OF PRIORITIZED NEEDS THAT THE HOSPITAL WILL ADDRESS WITHIN THE IMPLEMENTATION STRATEGY. TO ARRIVE AT THE PRIORITIZED NEEDS, SAINT THOMAS HOSPITAL FOR SPECIALTY SURGERY COLLABORATED WITH THE DAVIDSON COUNTY AND WILLIAMSON COUNTY HEALTH DEPARTMENTS AND THE DAVIDSON COUNTY AND WILLIAMSON COUNTY HEALTH COUNCILS TO FACILITATE DISCUSSIONS DURING DAVIDSON AND WILLIAMSON HEALTH COUNCIL MEETINGS IN FEBRUARY AND MARCH 2022 TO PRIORITIZE THE TOP NEEDS IN THEIR RESPECTIVE COMMUNITIES. COMMUNITY MEMBERS IN DAVIDSON COUNTY CHOSE TO PRIORITIZE FIVE NEEDS: WHOLE HEALTH, HOUSING/TRANSPORTATION, FOOD ACCESS/FOOD INSECURITY, ECONOMIC OPPORTUNITY AND JOB SKILL DEVELOPMENT AND AWARENESS AND NAVIGATION OF COMMUNITY RESOURCES. COMMUNITY MEMBERS IN WILLIAMSON COUNTY PRIORITIZED FOUR NEEDS: AFFORDABLE HOUSING, MENTAL HEALTH, HEALTHY LIVING AND PREVENTION AND SUBSTANCE MISUSE. SAINT THOMAS HOSPITAL FOR SPECIALTY SURGERY IDENTIFIED ADDITIONAL CRITERIA TO PRIORITIZE THE SIGNIFICANT NEEDS INCLUDING: -HEALTH EQUITY LENS AND FRAMEWORK - HAVE DISPARITIES FOR LOW-INCOME AND PEOPLE OF COLOR BEEN IDENTIFIED THROUGH THE CHNA PROCESS? -FEASIBILITY - THE ABILITY TO MAKE PROGRESS AND CAPTURE DATA RELATED TO HEALTH IMPACT. -COMMUNITY READINESS AND MOMENTUM - IS THE COMMUNITY READY TO ADDRESS OR MODIFY INTERVENTIONS TO ADDRESS THE ISSUE? -ALIGNMENT WITH OTHERS - IS THIS NEED IN ALIGNMENT WITH OUR ORGANIZATION'S STRENGTHS? HAS THIS NEED ALSO BEEN IDENTIFIED IN THE COMMUNITY? -SOCIAL DETERMINANTS OF HEALTH FOLLOWING THE COMPLETION OF THE tax year 2021 CHNA, Saint Thomas Hospital for Specialty Surgery HAS SELECTED THE PRIORITIZED NEEDS OUTLINED BELOW FOR ITS tax year 2021 IMPLEMENTATION STRATEGY. ASCENSION HAS DEFINED ""PRIORITIZED NEEDS'' AS THE SIGNIFICANT NEEDS WHICH HAVE BEEN PRIORITIZED BY THE HOSPITAL TO ADDRESS THROUGH THE THREE-YEAR CHNA CYCLE: -ACCESS TO CARE - THIS NEED WAS SELECTED BECAUSE ACCESS TO CARE IS IN ALIGNMENT WITH THE ORGANIZATIONAL STRENGTHS AND PRIORITIES, AND WAS IDENTIFIED AS A TOP PRIORITY BY MOST ASCENSION TENNESSEE MINISTRIES. -MENTAL HEALTH - THIS NEED WAS SELECTED BECAUSE MENTAL HEALTH WAS ONE OF THE OVERALL TOP NEEDS IDENTIFIED BY ASCENSION TENNESSEE MINISTRIES DURING THE 2021 CHNA PROCESS. -SUBSTANCE MISUSE - THIS NEED WAS SELECTED BECAUSE SUBSTANCE MISUSE WAS ONE OF THE OVERALL TOP NEEDS IDENTIFIED BY ASCENSION TENNESSEE MINISTRIES DURING THE 2021 CHNA PROCESS. Saint Thomas Hospital for Specialty Surgery UNDERSTANDS THE IMPORTANCE OF ALL THE HEALTH NEEDS OF THE COMMUNITY AND IS COMMITTED TO PLAYING AN ACTIVE ROLE IN IMPROVING THE HEALTH OF THE PEOPLE IN THE COMMUNITY'S IT SERVES. FOR THE PURPOSES OF THIS IMPLEMENTATION STRATEGY, ASCENSION SAINT THOMAS HOSPITAL MIDTOWN HAS CHOSEN TO FOCUS ITS EFFORTS ON THE PRIORITIES LISTED ABOVE. DURING THE CHNA AND IMPLEMENTATION STRATEGY BRAINSTORMING PHASE ACROSS THE ASCENSION TENNESSEE MINISTRY (8 COUNTIES), COMMUNITY BENEFIT AND HOSPITAL LEADERS AGREED TO A COLLECTIVE IMPACT MODEL TOWARD ADDRESSING NEEDS THAT APPEARED IN MULTIPLE COUNTIES.THIS MODEL IS AN EFFORT TO ALLOCATE RESOURCES IN WAYS THAT CAN MORE MEANINGFULLY IMPACT PRIORITY AREAS. THE 3 NEEDS CHOSEN (ACCESS TO CARE, MENTAL HEALTH, AND SUBSTANCE MISUSE) WERE PRIORITIZED IN 5 OR MORE OF THE (8) COUNTIES SURVEYED. HOWEVER, ADDITIONAL NEEDS AND SOCIAL DRIVERS THAT WERE IDENTIFIED IN EACH COMMUNITY WILL BE MONITORED AND ADDRESSED THROUGH FOCUS PRIORITY AREAS. THE tax year 2021 IMPLEMENTATION STRATEGIES ARE BASED ON PRIORITIZED NEEDS FROM THE HOSPITAL'S MOST RECENT CHNA. THESE STRATEGIES AND ACTION PLANS REPRESENT WHERE THE HOSPITAL WILL FOCUS ITS COMMUNITY EFFORTS OVER THE NEXT THREE YEARS. WHILE THESE REMAIN A PRIORITY, THE HOSPITAL WILL CONTINUE TO OFFER ADDITIONAL PROGRAMS AND SERVICES TO MEET THE NEEDS OF THE COMMUNITY, WITH SPECIAL ATTENTION TO THOSE WHO ARE POOR AND VULNERABLE. PRIORITIZED HEALTH NEED: ACCESS TO CARE -SUPPORT BRINGING TOGETHER DIFFERENT SECTORS TO UTILIZE LOCAL DATA TO WORK TOGETHER ON SOLUTIONS FOR SHARED TOP HEALTH NEEDS PRIORITIZED HEALTH NEED: SUBSTANCE MISUSE -INCREASE OPPORTUNITIES TO ENGAGE IN SUBSTANCE USE DISORDER PREVENTION, IDENTIFICATION AND TREATMENT PRIORITIZED HEALTH NEED: MENTAL HEALTH -INTEGRATE MENTAL HEALTH SERVICES, SUPPORT AND/OR EDUCATION INTO PRIMARY CARE CLINICS AND/OR EMERGENCY Saint Thomas Hospital for Specialty Surgery HAS DEVELOPED A MEASUREMENT AND EVALUATION PROCESS FOR THE IMPLEMENTATION STRATEGY. THE MINISTRY AND 501R COMMITTEE FOR Saint Thomas Hospital for Specialty Surgery WILL MONITOR AND EVALUATE THE ACTION PLANS OUTLINED IN THIS PLAN FOR THE PURPOSE OF REPORTING AND DOCUMENTING THE IMPACT THESE ACTION PLANS HAVE ON THE COMMUNITY. Saint Thomas Hospital for Specialty Surgery USES A TRACKING SYSTEM TO CAPTURE COMMUNITY BENEFIT ACTIVITIES AND IMPLEMENTATION. TO ENSURE ACCOUNTABILITY, DATA WILL BE AGGREGATED INTO AN ANNUAL COMMUNITY BENEFIT REPORT THAT WILL BE MADE AVAILABLE TO THE COMMUNITY. Saint Thomas Hospital for Specialty Surgery will adresss all the prioritized needs. However, additional needs and social drivers that were identified in each community will be monitored and addressed through focus priority areas."

Schedule H, Part I, Line 3c FACTORS OTHER THAN FPG
"IN ADDITION TO FPG, THE ORGANIZATION USES MEDICAL INDIGENCY, ASSET TEST, INSURANCE STATUS AND RESIDENCY AS OTHER FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A Patient may not be eligible for the financial assistance if such Patient is deemed to have sufficient assets to pay pursuant to an ""Asset Test."" The Asset Test involves a substantive assessment of a Patient's ability to pay based on the categories of assets measured in the FAP Application. A Patient with such assets that exceed 250% of such Patient's FPL amount may not be eligible for financial assistance. AN ASSET TEST APPLIES IF A PATIENT HAS ELIGIBLE LIQUID ASSETS THAT EXCEED 250% OF THE PATIENT'S FPG LEVEL FOR CONSIDERATION OF FINANCIAL ASSISTANCE ELIGIBILITY. LIQUID ASSETS INCLUDE ASSETS THAT CAN BE CONVERTED TO CASH WITHIN 1 YEAR. THESE INCLUDE ITEMS SUCH AS CHECKING ACCOUNTS, SAVINGS ACCOUNTS, TRUST FUNDS AND LUXURY ITEMS SUCH AS RECREATIONAL VEHICLES, BOATS, A SECOND HOME, ETC."

Schedule H, Part I, Line 5a BUDGET AMOUNTS FOR FREE OR DISCOUNTED CARE
THE ORGANIZATION ADMINISTERS ITS FINANCIAL ASSISTANCE POLICY IN ACCORDANCE WITH THE TERMS OF THE POLICY.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
"THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (""CHA"") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED."

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2022 was $656,102 charges, ($124,659 at cost).

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BASED ON THE ORGANIZATION'S ADMINISTRATION OF ITS FINANCIAL ASSISTANCE PROGRAM, NO ESTIMATE FOR BAD DEBT ATTRIBUTABLE TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS IS DEEMED APPLICABLE TO HOSPITAL OPERATIONS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE ORGANIZATION IS PART OFASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSESBAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 17-20, OF THE AUDITED FINANCIAL STATEMENTS.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE GROSS CHARGES TO CALCULATE MEDICARE COSTS, WHICH ARE THEN COMPARED TO MEDICARE PAYMENTS RECEIVED, TO DETERMINE A MEDICARE GAIN OR LOSS. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT A MEDICARE SHORTFALL (LOSS) IS NOT TREATED AS COMMUNITY BENEFIT, EVEN THOUGH THE HOSPITAL HAS INCURRED LOSSES IN PROVIDING CARE TO MEDICARE PATIENTS. THEREFORE, NONE OF THE AMOUNT ON LINE 7 IS TREATED AS COMMUNITY BENEFIT.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
BAPTIST HEALTH CARE AFFILIATES, INC. FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED IF ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. ANY OPEN PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED FOR THE AMOUNTS FOR WHICH THE PATIENT QUALIFIES.

Schedule H, Part V, Section B, Line 16a FAP website
- Saint Thomas Hospital for Specialty Surgery: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- Saint Thomas Hospital for Specialty Surgery: Line 16b URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- Saint Thomas Hospital for Specialty Surgery: Line 16c URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part VI, Line 2 Needs assessment
Baptist Healthcare Affiliates, Inc. d/b/a Ascension Saint Thomas Hospital for Specialty Surgery uses several internal databases and external reports from third parties, including government sources, to assess the healthcare needs of the communities served. The information provides key indicators about health, socioeconomic status, disparities, and other demographics that identify areas of focus and inform our strategies. These reports include, but are not limited to: -US Census Bureau -Sg2 healthcare intelligence -Healthcare claims datasets -State datasets -CMS -Internal data sets Baptist Healthcare Affiliates, Inc. utilizes information from these sources to develop programs and provide appropriate services needed throughout the region.

Schedule H, Part VI, Line 5 Promotion of community health
Baptist Healthcare Affiliates, Inc. governing body consists of persons representing diverse aspects and interests of the community. Many members of Baptist Healthcare Affiliates, Inc.'s governing body reside and provide healthcare services in the primary service area Baptist Healthcare Affiliates, Inc. extends medical staff privileges to all qualified physicians. Baptist Healthcare Affiliates, Inc. applied surplus funds for improvements in patient care with over $589K invested back into patient care projects in FY22. Baptist Healthcare Affiliates, Inc. provided over $487K in care to the poor in FY22 through its affiliated clinics operations and hospital programs.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
BAPTIST HEALTH CARE AFFILIATES, INC. IS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL, IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, BAPTIST HEALTH CARE AFFILIATES, INC. HOSPITAL'S FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES, BAPTIST HEALTH CARE AFFILIATES, INC. HOSPITAL PROVIDES FULL FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 250% OF THE FEDERAL POVERTY LEVEL AND SLIDING SCALE ASSISTANCE UP TO 400% OF THE FEDERAL POVERTY LEVEL. BAPTIST HEALTH CARE AFFILIATES, INC. WIDELY PUBLICIZES ITS: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY VIA THE HOSPITAL FACILITY'S WEBSITE - https://healthcare.ascension.org/locations/tennessee/tnnas/nashville-saint-thomas-hospital-for-specialty-surgery/financial-assistance-and-mdsave http://www.sthspecialtysurgery.com/patients/financial-assistance/policy-documents.aspx BAPTIST HEALTH CARE AFFILIATES, INC. MAKES PAPER COPIES OF THE: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION. THE PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. BAPTIST HEALTH CARE AFFILIATES, INC. INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION MAY BE FOUND. BAPTIST HEALTH CARE AFFILIATES, INC. INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 4 Community information
Baptist Healthcare Affiliates, Inc. serves 16 counties in its primary service area (PSA) with 76.2% of the hospital's annual admissions coming from these counties. The PSA has approximately 2,453,582 residents and is projected to grow by 6.1% over the next five years. Median age in the PSA is 37.2 and projected five-year median age is 38.4. In the PSA, the 18-44 age range is projected to grow by 2.3% and the 65+ age range is projected to grow by 21.1% over the next five years. PSA median household income is $73,843. Within the 16-county primary service area, there are six counties designated as a medically underserved area, five counties designated as a medically underserved population and one county designated as a partially medically underserved area. There are no other hospitals located within the primary service area serving patients exclusively for joint and spine care. There are many hospitals in the PSA with these services within an acute care hospital or ambulatory setting.

Schedule H, Part VI, Line 6 Affiliated health care system
Baptist Healthcare Affiliates, Inc. is a Member of Ascension Health Alliance, d/b/a Ascension (Ascension). Ascension is a Missouri nonprofit corporation formed on September 13, 2011. Ascension is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or health ministries, located in 19 of the United States and the District of Columbia. Ascension Health is the sole corporate member of Saint Thomas Health d/b/a Ascension Saint Thomas. Ascension is sponsored by Ascension Sponsor, a public juridic person. The participating entities of Ascension Sponsor are the Daughters of Charity of St. Vincent de Paul, St. Louise Province; the Congregation of St. Joseph; the Congregation of the Sisters of St. Joseph of Carondelet; the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province. Baptist Healthcare Affiliates, Inc. operates in Middle Tennessee and is part of Saint Thomas Health d/b/a Ascension Saint Thomas which owns and operates health care related entities, including 12 hospital campuses, in addition to a comprehensive network of affiliated joint ventures, medical practices, clinics and rehabilitation facilities across Middle Tennessee.