4A (Expenses $ 484176530 including grants of $ 229303) (Revenue $ 542044830)
See Schedule O

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - CHRISTUS GOOD SHEPHERD MEDICAL CENTER. CHRISTUS GOOD SHEPHERD MEDICAL CENTER (CGSMC) ENGAGED TEXAS HEALTH INSTITUTE (THI), A NON-PROFIT, NON-PARTISAN PUBLIC HEALTH INSTITUTE, TO CONDUCT A CHNA. FIRST, THI CONDUCTED KEY INFORMANT INTERVIEWS OF RESIDENTS LIVING IN THE REPORT AREA AND WHO POSSESS KNOWLEDGE ABOUT THE REGION'S HEALTH-RELATED CHALLENGES. FOR EXAMPLE, KEY STAKEHOLDERS INCLUDED NONPROFIT LEADERS, HEALTH DEPARTMENT AUTHORITIES, UNIVERSITY AND COLLEGE LEADERS, HEALTHCARE PROVIDERS OR LEADERS, HUMAN SERVICES PROVIDERS, LOCAL AND STATE AGENCIES, PEOPLE REPRESENTING DISTINCT GEOGRAPHIC AREAS AND PEOPLE REPRESENTING DIVERSE RACIAL/ETHNIC GROUPS. ALL INTERVIEWS WERE CONDUCTED USING A STANDARD QUESTIONNAIRE DEVELOPED BY THI. FOLLOWING THE KEY INFORMANT INTERVIEWS, A FOCUS GROUP WAS DEVELOPED TO OBTAIN CLARITY AROUND NEEDS AND CONCEPTS PROPOSED FOR INCLUSION IN THE CHNA. THE FOCUS GROUP REPRESENTED DIVERSE POPULATION GROUPS, OCCUPATIONS, AND HEALTHCARE OR RELATED SERVICE PROVIDERS (E.G., CLINICS, COMMUNITY ORGANIZATIONS AND SOCIAL SERVICE AGENCIES). THE GROUP FOLLOWED A SEMI-STRUCTURED PROTOCOL INTENDED TO ELICIT RESPONSES ALIGNED WITH THE FOLLOWING OBJECTIVES: 1. IDENTIFY SIGNIFICANT HEALTH NEEDS 2. IDENTIFY COMMUNITY RESOURCES TO MEET ITS HEALTH NEEDS 3. IDENTIFY BARRIERS AND REASONS FOR UNMET NEEDS 4. IDENTIFY SUPPORTS, PROGRAMS, AND SERVICES THAT WOULD HELP IMPROVE THE NEEDS OR ISSUES

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - CHRISTUS GOOD SHEPHERD MEDICAL CENTER. GOOD SHEPHERD HEALTH SYSTEM OPERATES HOSPITALS IN LONGVIEW AND MARSHALL. THE CHNA WAS CONDUCTED TO INCLUDE BOTH OF THE FOLLOWING SYSTEM HOSPITAL FACILITIES: THE GOOD SHEPHERD HOSPITAL, INC. (D/B/A GOOD SHEPHERD MEDICAL CENTER) HARRISON COUNTY HOSPITAL ASSOCIATION (D/B/A GOOD SHEPHERD MEDICAL CENTER - MARSHALL)

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - CHRISTUS GOOD SHEPHERD MEDICAL CENTER. THE FOLLOWING PRIORITIZED COMMUNITY NEEDS WERE IDENTIFIED THROUGH THE CHNA: 1. MENTAL HEALTH 2. PRIMARY CARE ACCESS 3. HEALTH SYSTEMS PERFORMANCE 4. HOMELESSNESS 5. EMPLOYMENT SPECIFIC HOSPITAL SERVICES AND PROGRAMS IN PLACE DURING 2022 TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS ARE AS FOLLOWS: 1) MENTAL HEALTH MENTAL HEALTH IS CONSIDERED THE NUMBER ONE COMMUNITY NEED IN NORTHEAST TEXAS, MUCH LIKE THE REST OF THE STATE OF TEXAS. SERVICES FOR PATIENTS AND THEIR FAMILIES HAVE LONG WAIT TIMES FOR APPOINTMENTS, SCARCE INPATIENT CARE OPTIONS AND AVAILABILITY, AND INSUFFICIENT MENTAL HEALTH PROFESSIONALS IN THE REGION. THE CHNA REPORT AREA ALSO HAS A GROWING NUMBER OF YOUNG PEOPLE AND AGING ADULTS WHO REQUIRE SERVICES WITH VERY LITTLE ACCESS OR AVAILABILITY. WITHIN THE RURAL COMMUNITIES THERE IS A RECURRING THEME OF DRUG ABUSE, PARTICULARLY WITH METHAMPHETAMINES AND OPIOIDS. HOSPITAL EMERGENCY PSYCHIATRIC EVALUATION AND STABILIZATION SERVICES EMPLOY A FULL-TIME PSYCHIATRIST AND ADMINISTRATIVE DIRECTOR OF BEHAVIORAL HEALTH TO LEAD PSYCHIATRIC TRAINED REGISTERED NURSES AND BEHAVIORAL HEALTH TECHNICIANS STAFFED IN THE EMERGENCY DEPARTMENT. TOGETHER THIS TEAM PROVIDES CARE FOR PATIENTS PRESENTING TO THE HOSPITAL FOR EMERGENT PSYCHIATRIC CARE. THE HOSPITAL PSYCHIATRIST AND CONTRACTED TELEHEALTH PSYCHIATRISTS CONDUCT PSYCHIATRIC EVALUATIONS. THE REGISTERED NURSES IN CONCERT WITH COMMUNITY HEALTH CORE ASSIGNED SOCIAL WORKERS AND/OR THERAPISTS ARRANGE PLACEMENT FOR NEXT LEVELS OF CARE. MENTAL HEALTH EMERGENCY PATIENTS - CONTINUED UTILIZATION OF PREFERRED PSYCHIATRIC ROOMS IN THE EMERGENCY ROOM. THERE ARE DESIGNATED INPATIENT PREFERRED ROOMS FOR PSYCHIATRIC PATIENTS ON W300 MEDICAL UNIT (W338, W339, W340 AND W341). - CONTRACTED WITH TELEPSYCHIATRY SERVICES THROUGH FOREFRONT FOR AFTER-HOURS BEHAVIORAL HEALTH SCREENINGS AND EVALUATIONS. PSYCHIATRIC TRANSPORT SERVICES FY 2022 PROVIDED $327,127 IN SUPPORT OF TRANSPORTATION TO SHORT-TERM REGIONAL PSYCHIATRIC STAYS AT REGIONAL CRISIS STABILIZATION UNIT (RCSU), AND OTHER SHORT-TERM INPATIENT PSYCHIATRIC FACILITIES. IN FY 2022 THERE WERE 495 PATIENTS TRANSPORTED. OUTPATIENT PSYCHIATRIC SERVICES INTERNALLY REFERRED PATIENTS RECEIVED TREATMENT FROM A PSYCHIATRIST WITHIN OUR INTERNAL MEDICINE CLINIC. A TOTAL OF 835 PATIENTS WERE SEEN IN THE CLINIC IN FY 2022, UP FROM 627 IN 2021. THERE WERE 1331 ACTUAL PATIENT VISITS IN FY 2022 COMPARED TO 1347 IN FY 2021. 20 PERCENT BEING MEDICAID OR UNINSURED PATIENTS IN FY 2022, 3.4 percent points lower than THE PERCENTAGE OF FY 2021. ALL PATIENTS WERE SEEN WITHIN 30 DAYS; IN OUR REGION A TYPICAL WAIT FOR A MENTAL HEALTH PROVIDER IS 6-12 MONTHS. OTHER MENTAL HEALTH INITIATIVES - COST OF STAFF TIME ON AN IN-PERSON AND VIRTUAL PROGRAM FOR REMEMBERING BABIES LOST IN PREGNANCY AND INFANCY TOTALED $866. TOTAL ATTENDEES: 109. - COST OF STAFF TIME ON Sexual Assault Nurse Examiner presentation to the Women's Center of East Texas TOTALED $157. TOTAL ATTENDEES: 15. - COST OF STAFF TIME ON Homeless Resource Day TOTALED $3,066. TOTAL ATTENDEES: 250. - COST OF STAFF TIME ON Mental Health Education to Marshall Extension Office TOTALED $1,410. TOTAL ATTENDEES: 25. 2) PRIMARY CARE ACCESS THIS PRIORITY IS BASED ON THE OBSERVATION THAT EVEN INSURED INDIVIDUALS IN THE REPORT AREA LACK A MEDICAL HOME, A CONTINUUM OF CARE, ROUTINE PREVENTATIVE CARE, AND CARE COORDINATION. DURING 2022 CGSMC REFERRED UNINSURED OR UNDERINSURED PATIENTS LACKING A MEDICAL HOME TO FQHCS THAT OFFER PRIMARY AND PREVENTATIVE SERVICES AT SLIDING SCALE RATES. SPORTS MEDICINE ATHLETIC TRAINERS FOR FY22, SPORTS MEDICINE ATHLETIC TRAINERS WERE PROVIDED TO AREAS SCHOOLS SERVING 87,768 STUDENT ATHLETES AT A COST OF $420,397. WE ALSO OFFER A FREE SATURDAY MORNING SPORTS MEDICINE CLINIC FROM AUGUST TO NOVEMBER FOR SPORTS-RELATED INJURIES. FOR FY22 THE SALARY COST WAS $9,097 SERVING 130 STUDENTS. OUR ATHLETIC TRAINERS ALSO OFFERED FREE SPORTS PHYSICAL EXAMS TO 1,096 STUDENTS IN AREA SCHOOLS AT A COST OF $18,932. INSTITUTE FOR HEALTHY LIVING (IHL) SCHOLARSHIPS TO IMPROVE HEALTH ACCESS, THE IHL OFFERS SCHOLARSHIPS TO COVER MEMBERSHIP DUES OF FINANCIALLY-ELIGIBLE PERSONS WITH POOR HEALTH WHO WOULD BENEFIT FROM THE USE OF WELLNESS FACILITIES. IN 2022, THE IHL PROVIDED SCHOLARSHIPS TO 9 INDIVIDUALS TOTALING $2,609. PRIMARY CARE CLINICS CHRISTUS GOOD SHEPHERD'S INTERNAL MEDICINE RESIDENCY PROGRAM OPERATES A PRIMARY CARE CLINIC SO THE RESIDENTS ARE ABLE TO FOLLOW THEIR OWN INPATIENT POPULATION IN AN OUTPATIENT CONTINUITY CLINIC. THIS IS A TRAINING ENVIRONMENT FOR THE RESIDENTS TO DEVELOP SKILLS AND COMPETENCIES FOR IMPLEMENTING COORDINATED MULTIDISCIPLINARY CARE INTO THEIR FUTURE PRACTICE. IT IS WELL RECOGNIZED THAT PATIENT POPULATIONS WITH THIS LEVEL OF CHRONIC DISEASE MORBIDITY MAY EXPERIENCE FRAGMENTED AND UNCOORDINATED CARE IN THE CURRENT HEALTHCARE ENVIRONMENT. THIS PROJECT HELPS EXPAND PRIMARY CARE ACCESS TO THE LEVEL OF COORDINATED CARE WHICH THE PCMH OFFERS. THIS INITIATIVE AIMS TO ELIMINATE FRAGMENTED AND UNCOORDINATED CARE, WHICH CAN LEAD TO EMERGENCY DEPARTMENT AND HOSPITAL OVER-UTILIZATION. DURING FISCAL YEAR 2022, 5,080 PATIENTS WERE SEEN IN THE INTERNAL MEDICINE RESIDENT CLINIC WITH 19 PERCENT OF THOSE PATIENTS BEING EITHER MEDICAID OR UNINSURED. IN ADDITION TO THE RESIDENT CLINIC, GSMC AND TRINITY CLINICS AFFILIATED WITH CHRISTUS HEALTH ALSO PROVIDE FAMILY MEDICINE, INTERNAL MEDICINE, URGENT CARE, OB/GYN AND PEDIATRIC PRIMARY CARE SERVICES AT FOUR HOSPITAL BASED AND SEVEN FREE-STANDING CLINICS IN LONGVIEW, MARSHALL AND SURROUNDING CITIES. TELEMEDICINE VISITS/COVID-19 RESPONSE IN RESPONSE TO THE COVID-19 PANDEMIC, CGSMC AND TRINITY CLINICS DRASTICALLY EXPANDED TELEHEALTH SERVICES AND ONLINE SCREENING TOOLS WITH THE LAUNCH OF SECURE VIDEO AND TELEPHONE VISITS. THESE SERVICES PROVIDED BOTH CONTINUED ACCESS AND PATIENT SAFETY DURING THE PANDEMIC. TO FURTHER ENHANCE PATIENT ACCESS AND SAFETY, DRIVE-THROUGH EMERGENCY SERVICES, INCLUDING REDUCED COST COVID-19 SCREENING, WERE AVAILABLE AT OUR EMERGENCY CENTERS IN NORTH LONGVIEW AND KILGORE. TRANSPORTATION ASSISTANCE CGSMC PROVIDED TAXI TRANSPORTATION TO HOME UPON DISCHARGE FOR 388 FINANCIALLY-ELIGIBLE PATIENTS AT A COST OF $11,063.

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - CHRISTUS GOOD SHEPHERD MEDICAL CENTER. 3) HEALTH SYSTEM PERFORMANCE STAKEHOLDERS STATED THE NEED FOR INCREASED COORDINATION AMONG LOCAL ORGANIZATIONS TO PROVIDE INTEGRATED CARE AND INCREASED ACCESS TO SERVICES. INCREASING THE COORDINATION WITHIN HEALTH SYSTEMS WILL IMPROVE ACCESS TO CARE AND REDUCE OVERUTILIZATION OF THE EMERGENCY DEPARTMENT. SPECIFIC ACTIONS TAKEN BY CGSMC INCLUDED: HEALTH PROFESSIONALS EDUCATION & TRAINING PRIMARY AND SPECIALTY CARE ACCESS CANNOT BE MAINTAINED WITHOUT AVAILABLE TRAINED PROFESSIONALS TO PROVIDE PATIENT CARE. CGSMC IS A LEADER IN THE NORTHEAST TEXAS REGION IN PROVIDING HEALTH PROFESSIONALS TRAINING AND EDUCATION. DURING FISCAL YEAR 2022, GSMC PROVIDED THE FOLLOWING TRAINING AT THE LONGVIEW AND MARSHALL CAMPUSES: - TRAINED 36 INTERNAL MEDICINE RESIDENTS AND ONE EMERGENCY MEDICINE RESIDENT AT A NET COST OF $794,862. (SINCE INCEPTION OF THE RESIDENCY TRAINING PROGRAM IN 2012 OVER 100 RESIDENTS HAVE COMPLETED TRAINING WITH SEVEN PROGRAM GRADUATES CHOOSING CAREERS AT CGSMC AND MANY OTHERS CHOOSING TO TAKE POSITIONS WITHIN THE EAST TEXAS REGION.) - PROVIDED OVER 5,112 NURSING STUDENT TRAINING ENCOUNTERS (USUALLY 8 TO 10 HOURS EACH) AT A COST OF $347,987. - PROVIDED 2,120 TRAINING ENCOUNTERS FOR THERAPISTS AND OTHER ALLIED HEALTH PROFESSIONAL STUDENTS AT A COST OF $140,393. - IN A PARTNERSHIP WITH THE UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER - FT. WORTH, TRAINED SIX THIRD YEAR AND FOUR FOURTH YEAR MEDICAL STUDENTS WHO ARE INTERESTED IN BECOMING RURAL PHYSICIANS. SEXUAL ASSAULT NURSE EXAMINER (SANE) PROGRAM SEXUAL ASSAULT SURVIVORS HAVE ACCESS TO SEXUAL ASSAULT EXAMINATIONS AND EVIDENCE COLLECTION THROUGH CHRISTUS GOOD SHEPHERD MEDICAL CENTER'S SANE PROGRAM. THE PROGRAM HAS OPERATED SINCE 2020. WE HAVE A SANE COORDINATOR, AND OTHER AS NEEDED SANE STAFF WHO ROTATE CALL AND CONDUCT EXAMINATIONS AND EVIDENCE COLLECTION. THE COMMUNITY BENEFIT IS IMPROVED ACCESS TO INDIVIDUALS IN THIS COMMUNITY, AND A DECREASED NEED FOR INDIVIDUALS TO SEEK CARE IN DISTANT CITIES. SOME TURNOVER OF STAFF OCCURRED IN THE PAST YEAR, AND AN ADDITIONAL NURSE IS CURRENTLY IN TRAINING. ADDITIONAL VOLUNTEERS ARE NEEDED TO RECEIVE TRAINING AND ENGAGE IN THE SANE PROGRAM, AND RECRUITMENT IS UNDERWAY. BESIDES PROVIDING SANE FORENSIC EXAMS, A CGSMC INTERNAL MEDICINE CLINIC ALSO PROVIDES SURVIVORS ACCESS TO MENTAL HEALTH SERVICES FOR POST-TRAUMATIC STRESS CAUSED BY THE ASSAULT. CGSMC OFFERS THE ONLY SANE PROGRAM IN GREGG AND HARRISON COUNTIES. COMMUNITY EDUCATION & OUTREACH - COST OF STAFF TIME ON Stop the Bleed training - Marshall Independent School District TOTALED $1,301. TOTAL ATTENDEES: 415. - COST OF STAFF TIME ON Stroke Education to Marshall Rotary Club TOTALED $1,082. TOTAL ATTENDEES: 25. - COST OF STAFF TIME ON Heart Disease Education to Marshall Rotary Club, Red Dress Luncheon and Retired Teachers District TOTALED $6,395. TOTAL ATTENDEES: 242. SUPPORT FOR COMMUNITY AGENCIES & NOT-FOR-PROFIT GROUPS - CGSMC EMPLOYEES PROVIDE THEIR TIME AND EXPERTISE SERVING ON VARIOUS COMMITTEES AND ATTENDING MEETINGS OF COMMUNITY AGENCIES AND NOT-FOR-PROFIT GROUPS. THE VALUE OF TIME SPENT SERVING THE COMMUNITY THROUGH THESE ACTIVITIES IN 2022 WAS $7,660. - HOSPITAL SPACE WITH A RENTAL VALUE OF $2,856 WAS PROVIDED TO COMMUNITY GROUPS AT NO CHARGE. GRANTS TO COMMUNITY ORGANIZATIONS CGSMC PROVIDES GRANTS TO LOCAL ORGANIZATIONS WHO ADDRESS COMMUNITY HEALTH NEEDS, PARTICULARLY THE PRIORITIES OF THE CHNA, OR WHO ADDRESS SOCIAL DETERMINANTS OF HEALTH. IN FY22, CGSMC PROVIDED GRANTS TO: - Hope Mommies - grant for $1,000 to assemble Hope Boxes that are given to moms/parents when they are unable to take their babies home. Monies will also be used for scholarship money to send moms to the annual retreat. - The Pines Catholic Camp - grant for $2,666 for the purchase of two automated external defibrillators for use at the campus in Big Sandy, Texas. This rural facility has approximately 8,000 visitors annually and is located approximately 27 miles (41 minutes) from the closest medical facility. Food Insecurity The Covid pandemic exacerbated food insecurity in our region. To address this need, CGS donated $12,452 in food to local shelters and food pantries. COMMUNITY NEEDS THAT CANNOT BE ADDRESSED NEED PRIORITIES 4) AND 5) WERE HOMELESSNESS AND EMPLOYMENT WE RECOGNIZE BOTH HOMELESSNESS AND EMPLOYMENT ARE SIGNIFICANT ISSUES WITHIN THE COMMUNITIES WE SERVE. ULTIMATELY, CGSMC ELECTED NOT TO INCLUDE THESE CHNA PRIORITIES WITHIN OUR COMMUNITY HEALTH IMPLEMENTATION PLAN. CGSMC IS NOT OPTIMALLY POSITIONED TO SUPPORT THESE MAJOR COMMUNITY NEEDS. HOWEVER, CGSMC REMAINS COMMITTED TO SUPPORTING AGENCIES AND PROGRAMS THAT DIRECTLY ADDRESS THESE NEEDS BY PARTICIPATING IN the city of longview. ANNUAL HOMELESSNESS RESOURCE DAY, AND COMMUNITY JOB FAIRS. ADDITIONALLY, CGSMC SERVES AS THE LARGEST EMPLOYER IN GREGG COUNTY.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - CHRISTUS GOOD SHEPHERD MEDICAL CENTER. UNDER THE HOSPITAL'S POLICY, PATIENTS WHO WERE UNINSURED AND MET CERTAIN FINANCIAL CRITERIA WERE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE POLICY ALSO PROVIDED FOR ASSISTANCE FOR MEDICALLY INDIGENT PATIENTS. IN GENERAL, PATIENTS WHO WERE BELOW 300 OF FEDERAL POVERTY GUIDELINES RECEIVED FREE CARE. PATIENTS WHO WERE UNINSURED AND ABOVE 300 OF THE FEDERAL POVERTY GUIDELINE WERE BILLED RATES CONSISTENT WITH AMOUNTS GENERALLY BILLED TO COMMERCIAL PAYERS. PATIENTS WHO WERE UNINSURED AND BETWEEN 300 AND 400 OF FEDERAL POVERTY GUIDELINES COULD APPLY FOR ADDITIONAL ASSISTANCE TO PAY AMOUNTS LESS THAN AGB.

Schedule H, Part V, Section B, Line 15 Facility A, 1
Facility A, 1 - CHRISTUS GOOD SHEPHERD MEDICAL CENTER. IN ADDITION TO REGULAR APPLICATIONS, THE HOSPITAL ALSO ASSESSED PATIENTS FOR PRESUMPTIVE ELIGIBILITY TO FACILITATE GIVING ASSISTANCE TO NEEDY PATIENTS. THE HOSPITAL IMPLEMENTED ELECTRONIC ELIGIBILITY TOOLS THAT USED PATIENT DEMOGRAPHIC DATA, CREDIT REPORTS, AND OTHER PUBLICLY AVAILABLE INFORMATION TO ESTIMATE A PATIENT'S INCOME, ASSETS, AND LIQUIDITY. PATIENTS WERE SCREENED AS PART OF THE COLLECTION ATTEMPT PROCESS. WHEN ELECTRONIC SCREENING WAS USED AS THE BASIS FOR PRESUMPTIVE ELIGIBILITY, THE HIGHEST DISCOUNT OF FULL FREE CARE WAS GRANTED FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. IF A PATIENT DID NOT QUALIFY UNDER THE ELECTRONIC ENROLLMENT PROCESS, THE PATIENT COULD STILL BE CONSIDERED UNDER THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS.

Schedule H, Part V, Section B, Line 16 Facility A, 1
Facility A, 1 - CHRISTUS GOOD SHEPHERD MEDICAL CENTER. IN AN EFFORT TO MORE WIDELY PUBLICIZE OUR FINANCIAL ASSISTANCE WITHIN OUR COMMUNITY, INCLUDING PERSONS MORE LIKELY TO REQUIRE FINANCIAL ASSISTANCE, WE SUBMITTED A COPY OF OUR PLAIN LANGUAGE FINANCIAL ASSISTANCE POLICY TO A NUMBER OF ORGANIZATIONS THAT INTERACT WITH POOR POPULATION GROUPS. THESE ORGANIZATIONS INCLUDE COUNTY HEALTH DEPARTMENTS, FQHCS, VARIOUS NON-PROFITS AND MINISTRIES SUPPORTED BY THE UNITED WAY AND OTHER AGENCIES SERVING THE POOR, AND AREA CHURCHES.

Schedule H, Part V, Section B, Line 20 Facility A, 1
Facility A, 1 - CHRISTUS GOOD SHEPHERD MEDICAL CENTER. WHEN COLLECTION CALLS RESULTED IN PATIENT CONTACT, BUSINESS AGENTS PERFORMED A VERBAL SCREENING TO SEE IF THE PATIENT MIGHT BE ELIGIBLE FOR CHARITY CARE. IN ADDITION, BILLING STATEMENTS CONTAINED THE FOLLOWING NOTICE: YOU MAY QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON YOUR INCOME LEVEL. IF YOU DO NOT QUALIFY AND CANNOT MAKE PAYMENT IN FULL, WE WILL WORK WITH YOU TO SET UP AN ACCEPTABLE PAYMENT PLAN.

Schedule H, Part V, Section B, Line 17
THE HOSPITAL DID NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS DURING THE TAX YEAR. THE POLICY STRICTLY PROHIBITED TAKING LEGAL ACTION AGAINST PATIENTS AND ALSO FORBADE PLACING A LIEN ON THE PATIENT'S HOME. IN THE EVENT OF NONPAYMENT, THE HOSPITAL AND ITS COLLECTIONS GROUPS WOULD SEND STATEMENTS AND MAKE PHONE CALLS.

Schedule H, Part V, Section B, Line 22 DETERMINE THE MAX AMOUNTS THAT CAN BE CHARGED TO FAP
THE HOSPITAL USED THE AVERAGE COMMERCIAL INSURANCE REIMBURSEMENT RATE FROM FISCAL YEAR ENDING 6/30/22 TO DETERMINE AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS AVERAGE RATE WAS THE AVERAGE REIMBURSEMENT RECEIVED FOR CATEGORIES OF SERVICES FROM ALL PRIVATE INSURERS THAT REIMBURSE HOSPITALS ACROSS THE CHRISTUS HEALTH SYSTEM, EXCEPT FOR ST. VINCENT AND LONG-TERM HOSPITALS, AND EXCLUDING IMPLANT AND DRUG CONTRIBUTION DOLLARS. ALL UNINSURED PATIENTS WERE CHARGED NO MORE THAN 40% OF THE CHARGES FOR THE RELEVANT SERVICE LINE. PATIENTS ELIGIBLE FOR ADDITIONAL FINANCIAL ASSISTANCE WERE CHARGED NO MORE THAN THE AVERAGE RATE (FOR INCOME LEVELS FROM 301% TO 400% OF FPL), OR RECEIVED FREE CARE (INCOMES BELOW 300% FPL). FOR LAB SERVICES, ELIGIBLE PATIENTS WERE CHARGED A PERCENTAGE OF THE MEDICARE RATE.

Schedule H, Part I, Line 3c CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE
THE HOSPITAL FOLLOWS FINANCIAL ASSISTANCE POLICIES OF CHRISTUS HEALTH. THE QUALIFICATION THRESHOLD FOR FINANCIAL ASSISTANCE IS 400 PERCENT OF FPG. ELIGIBILITY FOR FREE CARE (100 PERCENT DISCOUNTS) IS AT OR BELOW 300 PERCENT FPG.

Schedule H, Part I, Line 5a BUDGETED CHARITY CARE
THE ORGANIZATION BUDGETS CHARITY CARE FOR INTERNAL FINANCIAL REVIEW PURPOSES ONLY. THE PROVISION OF CHARITY CARE IS NOT LIMITED TO AMOUNTS ESTABLISHED FOR BUDGETARY PURPOSES.

Schedule H, Part I, Line 6a ANNUAL COMMUNITY BENEFIT REPORT
A REPORT OF COMMUNITY BENEFIT IS INCLUDED IN A WRITTEN ANNUAL REPORT FOR CHRISTUS HEALTH, THE ORGANIZATION'S PARENT COMPANY. CHRISTUS HEALTH IS AN INTERNATIONAL, CATHOLIC, FAITH BASED, NONPROFIT HEALTH SYSTEM FORMED IN 1999 WITH A MISSION TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST. THE ANNUAL COMMUNITY BENEFIT REPORT SUMMARIZES ACTIVITIES AND PROGRAMS CONDUCTED DURING THE PAST YEAR TO IMPROVE HEALTH INCLUDING PROACTIVE COMMUNITY HEALTH SERVICES. HOWEVER, THE ANNUAL REPORT IS ONLY A SNAPSHOT OF HOW THE ORGANIZATION DISTINGUISHES ITSELF IN ITS VISION TO BE A LEADER, A PARTNER, AND AN ADVOCATE IN CREATING INNOVATIVE HEALTH AND WELLNESS SOLUTIONS THAT IMPROVE THE LIVES OF INDIVIDUALS AND COMMUNITIES.

Schedule H, Part I, Line 7 ALLOCATION OF MEDICAID SUPPLEMENTAL PAYMENTS
DURING THE CURRENT REPORTING PERIOD, THE STATE OF TEXAS PARTICIPATED IN A SPECIAL 1115 MEDICAID WAIVER WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). VARIOUS SUPPLEMENTAL PAYMENTS UNDER THE WAIVER ARE INTENDED TO HELP HOSPITALS OFFSET MEDICAID AND UNINSURED LOSSES AND/OR CREATE NEW PROGRAMS DESIGNED TO IMPROVE THE PATIENT CARE EXPERIENCE, ENHANCE HEALTH OUTCOMES AND REDUCE COSTS FOR THESE SAME PATIENT POPULATIONS. SUPPLEMENTAL PAYMENTS ARE CAPPED BY MEDICAID AND UNINSURED LOSSES DETERMINED FROM A SPECIAL UNCOMPENSATED CARE (UC) TOOL DESIGNED BY THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION (HHSC). CHRISTUS GOOD SHEPHERD MEDICAL CENTER RECOGNIZED $37,860,605 OF MEDICAID SUPPLEMENTAL PAYMENT INCOME IN 2022. THERE WERE $22,271,638 OF EXPENDITURES RECOGNIZED IN 2022 RELATED TO PROVIDER TAXES USED TO GENERATE THE NON-FEDERAL SHARE OF MEDICAID SUPPLEMENTAL PAYMENTS, RESULTING IN A NET P&L BENEFIT OF $15,588,967 RELATED TO MEDICAID SUPPLEMENTAL PAYMENTS UNDER THE TEXAS MEDICAID WAIVER. FOR PURPOSES OF IRS FORM 990 SCHEDULE H REPORTING, CONSISTENT WITH CHRISTUS HEALTH POLICY, 100 OF NET MEDICAID SUPPLEMENTAL PAYMENTS ARE REPORTED AS MEDICAID DIRECT OFFSETING REVENUE.

Schedule H, Part I, Line 7f BAD DEBT EXPENSE
BAD DEBT IN THE AMOUNT OF $51,276,805, WAS NOT INCLUDED IN TOTAL EXPENSE USED TO COMPUTE THE PERCENTAGE REPORTED IN PART I, LINE 7 COL (F).

Schedule H, Part II COMMUNITY BUILDING ACTIVITIES
THE CHRISTUS HEALTH ADVOCACY DEPARTMENT IS WORKING IN PARTNERSHIP WITH LOCAL, STATE AND FEDERAL POLICY MAKERS TO ENSURE ACTIVITIES AND PROGRAMS ARE IN PLACE THAT WILL ENHANCE PUBLIC HEALTH AND ADVANCE GENERAL KNOWLEDGE. DURING FY 2022, CHRISTUS HEALTH ADVOCATED FOR IMPROVING PUBLIC POLICIES, WORKING TO ESTABLISH, AND IN SOME INSTANCES AUGMENT, GRASSROOTS ADVOCACY AND GREATER ACCESS TO HEALTH CARE SERVICES FOR THE PATIENTS WE SERVE. SOME OF THE MAIN COMMUNITY BUILDING ACTIVITIES ARE IMPROVING ACCESS TO HEALTH SERVICES AND BUILDING COLLABORATIVE RELATIONSHIPS WITH OTHER ORGANIZATIONS SEEKING TO ADDRESS CHRONIC CONDITIONS THAT DISPROPORTIONATELY IMPACT THE POOR AND UNDERSERVED.

Schedule H, Part V, Section B, Line 18 Line 18f
THE HOSPITAL DID NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS DURING THE TAX YEAR. THE POLICY STRICTLY PROHIBITED TAKING LEGAL ACTION AGAINST PATIENTS AND ALSO FORBADE PLACING A LIEN ON THE PATIENT'S HOME. IN THE EVENT OF NONPAYMENT, THE HOSPITAL AND ITS COLLECTIONS GROUPS WOULD SEND STATEMENTS AND MAKE PHONE CALLS.

Schedule H, Part I, Line 7
LINE 7A: RATIO OF PATIENT CARE COST TO CHARGES BASED ON SCHEDULE H, WORKSHEET 2 LINE 7B: RATIO OF PATIENT CARE COST TO CHARGES BASED ON SCHEDULE H, WORKSHEET 2 LINE 7E: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE LINE 7F: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE LINE 7I: ACTUAL EXPENSE OF THE CONTRIBUTIONS

Schedule H, Part VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT
A COMMUNITY BENEFIT REPORT IS PREPARED FOR THE HOSPITAL SYSTEM EACH YEAR AND IS SUBMITTED ALONG WITH AN AHA SURVEY TO THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES WITH A COPY PROVIDED TO HARRISON COUNTY AND GREGG COUNTY.

Schedule H, Part V, Section B, Line 16b FAP APPLICATION FORM WEBSITE
HTTPS://WWW.CHRISTUSHEALTH.ORG/-/MEDIA/CHRISTUS-HEALTH/PLAN-CARE/FILES/BILL-PAY/FINANCIAL-ASSISTANCE/FINANCIAL-LANGUAGE-DOCUMENTS/V2FINANCIAL-ASSISTANCE-APPLICATION.ASHX

Schedule H, Part V, Section B, Line 16c PLAIN LANGUAGE FAP SUMMARY WEBSITE
https://www.christushealth.org/-/media/christus-health/plan-care/files/bill-pay/financial-assistance/financial-language- documents/2021plainlanguagesummaryhospitalenglish.ashx

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE (TOTAL OF ALL HOSPITAL FACILITIES) IS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL STATEMENTS, WHICH IS COMPUTED AS BAD DEBT NET OF CONTRACTUAL ALLOWANCE, PAYMENTS RECEIVED AND RECOVERIES OF BAD DEBT PREVIOUSLY WRITTEN OFF.

Schedule H, Part V, Section B, Line 16a FAP website
A - CHRISTUS GOOD SHEPHERD MED CTR-LNGVW: Line 16a URL: https://www.christushealth.org/plan-care/bill-pay/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - CHRISTUS GOOD SHEPHERD MED CTR-LNGVW: Line 16b URL: SEE SUPPLEMENTAL INFO;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - CHRISTUS GOOD SHEPHERD MED CTR-LNGVW: Line 16c URL: SEE SUPPLEMENTAL INFO;

Schedule H, Part VI, Line 2 Needs assessment
NO NEED ASSESSMENT OTHER THAN CHNA CONDUCTED IN FY20.

Schedule H, Part III, Line 1 BAD DEBT REPORTING IN ACCORDANCE WITH HFMA STATEMENT 15
CHRISTUS HEALTH FOLLOWS IN PRINCIPLE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. THE SYSTEM HAS ADOPTED AN UNCOMPENSATED CARE POLICY WHERE REVENUE FROM SERVICES PROVIDED TO THE UNINSURED IS RECOGNIZED AT THE TIME OF PAYMENT, RATHER THAN AT THE TIME OF SERVICE. THIS POLICY IS THE RESULT OF A LACK OF REASONABLE ASSURANCE OF COLLECTION FOR SERVICES PROVIDED TO THE UNINSURED DUE TO THE SYSTEM'S HISTORICALLY LOW COLLECTION RATE. MANAGEMENT HAS ESTIMATED THAT THE DIFFERENCE BETWEEN RECORDING REVENUE FROM THE UNINSURED ON A CASH BASIS, RATHER THAN THE ACCRUAL BASIS, IS IMMATERIAL. ACCORDINGLY, ALL ACCOUNTS RECEIVABLE FROM THE UNINSURED HAVE BEEN FULLY RESERVED IN THE ALLOWANCE FOR UNCOMPENSATED CARE.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
THE FILING ORGANIZATION RECOGNIZES THAT SOME PATIENTS ARE UNABLE OR UNWILLING TO SEEK FINANCIAL ASSISTANCE DUE TO BARRIERS SUCH AS EDUCATIONAL LEVEL, LITERACY, DOCUMENTATION REQUIREMENTS, OR BEING INTIMIDATED BY THE APPLICATION PROCESS. IN ORDER TO ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAVE NOT SUBMITTED AN APPLICATION, THE ORGANIZATION ENGAGED PARO DECISION SUPPORT, LLC. PARO CHARITY SCORE IS DESIGNED TO IDENTIFY PATIENTS THAT LIKELY QUALIFY FOR FINANCIAL ASSISTANCE BASED ON A PREDICTIVE MODEL AND OTHER FINANCIAL AND ASSET ESTIMATES FOR THE PATIENT DERIVED FROM PUBLIC RECORD SOURCES. FOR THE FISCAL YEAR ENDING JUNE 30, 2011, THE ORGANIZATION REPORTED THAT 30 PERCENT OF BAD DEBT EXPENSES WERE ATTRIBUTABLE TO PATIENTS WHO MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE BUT WERE NOT RESPONSIVE TO THE APPLICATION PROCESS EXISTING AT THAT TIME. THIS FIGURE WAS BASED ON THE PARO ANALYSIS AND ESTIMATES OF PATIENTS' FINANCIAL NEEDS THAT EXAMINED WHETHER PATIENTS WERE CHARACTERISTIC OF OTHERS WHO HISTORICALLY QUALIFIED FOR ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. THE PRESUMPTIVE CHARITY CARE ANALYSIS PERFORMED FOR THE PRIOR FISCAL YEAR DETERMINED A BENCHMARK OF BAD DEBT ACCOUNTS IN THE CHRISTUS HEALTH SYSTEM THAT LACKED THE INFORMATION TO QUALIFY FOR CHARITY CARE UNDER THE FILING ORGANIZATION'S CUSTOMARY PROCESS BUT WOULD HAVE LIKELY QUALIFIED FOR ASSISTANCE. DURING THE FISCAL YEAR ENDING JUNE 30, 2022, THE ORGANIZATION UTILIZED THE PARO SCORE TO IDENTIFY THE ACCOUNTS OF INDIVIDUAL PATIENTS THAT WERE LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE DESPITE HAVING NOT COMPLETED AN APPLICATION, AND SUCH ANALYSIS DETERMINED THAT 3.73 PERCENT OF SUCH ACCOUNTS WERE LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. THE ORGANIZATION GRANTED PRESUMPTIVE ELIGIBILITY FOR THESE ACCOUNTS AND THEY WERE RECLASSIFIED UNDER OUR FINANCIAL ASSISTANCE POLICY. THE AMOUNTS WERE NOT REPORTED AS BAD DEBT. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 3 IS THE DIFFERENCE BETWEEN THE PRESUMPTIVE CHARITY CARE BENCHMARK ESTABLISHED IN THE FISCAL YEAR ENDING JUNE 30, 2011 AND THE AGGREGATE OF INDIVIDUAL ACCOUNTS FOR WHICH THE ORGANIZATION GRANTED PRESUMPTIVE ELIGIBILITY IN THE FISCAL YEAR ENDING JUNE 30, 2022. THUS, THE ORGANIZATION ESTIMATES THAT ONLY 0.538 PERCENT OF THE BAD DEBT EXPENSES IN FISCAL YEAR ENDING JUNE 30, 2022 ARE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. IT IS IMPORTANT TO NOTE THAT THE FIGURE CALCULATED FOR FISCAL YEAR ENDING JUNE 30, 2011 WAS ESTIMATED AND NOT EXACT, AND THEREFORE THE DIFFERENCE BETWEEN THE AMOUNTS QUALIFIED AS PRESUMPTIVE CHARITY CARE IN ANY FISCAL YEAR MAY VARY FROM THE BENCHMARK ESTABLISHED IN FISCAL YEAR ENDING JUNE 30, 2011.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE FOOTNOTE TO THE CHRISTUS HEALTH CONSOLIDATED FINANCIAL STATEMENTS SAYS, THE PREPARATION OF THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS IN CONFORMITY WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES (U.S. GAAP) REQUIRES MANAGEMENT OF THE SYSTEM TO MAKE ASSUMPTIONS, ESTIMATES, AND JUDGMENTS THAT AFFECT THE AMOUNTS REPORTED IN THE FINANCIAL STATEMENTS, INCLUDING THE NOTES THERETO, AND RELATED DISCLOSURES OF COMMITMENTS AND CONTINGENCIES, IF ANY. THE SYSTEM CONSIDERS CRITICAL ACCOUNTING POLICIES TO BE THOSE THAT REQUIRE MORE SIGNIFICANT JUDGMENTS AND ESTIMATES IN THE PREPARATION OF ITS FINANCIAL STATEMENTS, INCLUDING THE FOLLOWING: RECOGNITION OF NET PATIENT SERVICE REVENUES, WHICH INCLUDE CONTRACTUAL ALLOWANCES; AND THE PROVISIONS FOR BAD DEBT; ESTIMATES FOR REIMBURSEMENT UNDER THE UPPER PAY LIMIT, DISPROPORTIONATE SHARE MEDICAID 1115 WAIVER PROGRAMS; RESERVES FOR LOSSES AND EXPENSES RELATED TO HEALTH CARE PROFESSIONAL AND GENERAL LIABILITIES; ACCRUALS FOR CLAIMS INCURRED BUT NOT YET REPORTED RELATED TO THE SYSTEM'S HEALTH PLANS; DETERMINATION OF FAIR VALUES OF CERTAIN FINANCIAL INSTRUMENTS; DETERMINATION OF FAIR VALUE OF CERTAIN GOODWILL AND LONG-LIVED ASSETS, INCLUDING ASSETS ACQUIRED; AND RISKS AND ASSUMPTIONS FOR MEASUREMENT OF PENSION AND RETIREE MEDICAL LIABILITIES. MANAGEMENT RELIES ON HISTORICAL EXPERIENCE AND ON OTHER ASSUMPTIONS BELIEVED TO BE REASONABLE UNDER THE CIRCUMSTANCES IN MAKING ITS JUDGMENT AND ESTIMATES. ACTUAL RESULTS COULD DIFFER MATERIALLY FROM THESE ESTIMATES.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE SOURCE OF INFORMATION ON LINES 5 AND 6 IS THE FYE JUNE 30, 2022 MEDICARE COST REPORT. THE REVENUES WERE DERIVED FROM COST REPORT WORKSHEETS E PART A, E PART B AND E-3, PART III. COST INFORMATION WAS OBTAINED BY SUMMING OF MEDICARE PART A ALLOWABLE COSTS REPORTED ON WORKSHEET D-1, PART II (FOR BOTH INPATIENT ACUTE PPS AND INPATIENT REHAB FACILITY) AND WORKSHEET DV, COLUMNS 5.00 THROUGH 7.00 FOR MEDICARE OUTPATIENT PPS SERVICES. SINCE ALLOWABLE COSTS ARE NOT DETERMINED FOR SERVICES RENDERED TO MEDICARE PATIENTS ENROLLED IN MEDICARE ADVANTAGE (MEDICARE PART C) OR FOR PHYSICIAN SERVICES BILLED UNDER MEDICARE PART B, NEITHER THE REVENUES OR COSTS RELATED TO THESE SERVICES HAVE BEEN INCLUDED ON LINES 5 OR 6. THE COST REPORT USES FINANCIAL AND STATISTICAL DATA TO DEVELOP PER DIEMS AND COST TO CHARGE RATIOS THAT ULTIMATELY DETERMINE ALLOWABLE MEDICARE INPATIENT AND OUTPATIENT COSTS. (NOTE: EFFECTIVE AUGUST 1, 2017, THE LICENSE AND MEDICARE PROVIDER NUMBER OF GOOD SHEPHERD MEDICAL CENTER - LONGVIEW AND GOOD SHEPHERD MEDICAL CENTER - MARSHALL WERE COMBINED. THIS MERGER RESULTED IN ONE COST REPORT FOR THE COMBINED HOSPITALS.)

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
IT IS THE POLICY OF THE ORGANIZATION TO PURSUE COLLECTIONS OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR THESE SERVICES. CHRISTUS HEALTH APPLIES ITS COLLECTION EFFORTS CONSISTENTLY AND FAIRLY TO ALL PATIENTS REGARDLESS OF INSURANCE. IF A PATIENT DOES NOT HAVE THE FINANCIAL RESOURCES TO PAY THEIR OUTSTANDING BALANCES, THE GOAL OF THE ORGANIZATION IS TO QUALIFY THESE PATIENTS THROUGH THE ORGANIZATION'S CHARITY POLICY OR SCREEN THE PATIENTS THROUGH ORGANIZATION'S PRESUMPTIVE CHARITY TESTS. IF THE PATIENT QUALIFIES UNDER EITHER POLICY THE ACCOUNT WILL BE WRITTEN OFF BASED UPON LEVEL OF QUALIFICATION. THESE POLICIES SUPPORT THE MISSION AND VISION OF THE ORGANIZATION AND ARE APPROVED BY SENIOR LEADERSHIP.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
CHRISTUS GOOD SHEPHERD MEDICAL CENTER MAKES EVERY EFFORT TO EDUCATE PATIENTS ON ITS CHARITY AND DISCOUNT POLICY AND ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS DURING REGISTRATION, PRE REGISTRATION (FOR SCHEDULED TESTS AND SURGERIES), POST REGISTRATION (DURING THEIR HOSPITALIZATION) AND FOLLOWING DISCHARGE (TELEPHONE OR WRITTEN INQUIRY) IN LANGUAGES APPROPRIATE FOR THE POPULATION BEING SERVED. PATIENTS ARE GIVEN INFORMATION AND FORMS BY A FINANCIAL COUNSELOR WHO HELPS THEM COMPLETE THE FORMS DURING THEIR INPATIENT AND OUTPATIENT VISITS. PATIENTS ARE ASKED TO BRING OR MAIL SUPPORTING DOCUMENTATION TO DETERMINE INCOME, ASSETS AND HOUSEHOLD EXPENSES. THE BUSINESS OFFICE REVIEWS THE APPLICATION BASED ON THE INFORMATION PROVIDED BY THE PATIENT. IF THE PATIENT QUALIFIES FOR CHARITY CARE OR A DISCOUNT, A NEW BILL IS GENERATED. PATIENTS WHO DO NOT PROVIDE THE REQUIRED DOCUMENTATION ARE CONSIDERED INELIGIBLE AND ARE BILLED ACCORDINGLY. IF THE DOCUMENTATION IS PROVIDED AT A LATER TIME, THE PATIENT MAY THEN BE DETERMINED TO BE ELIGIBLE FOR CHARITY CARE OR A DISCOUNT. DOCUMENTATION IS RETAINED BY THE BILLING OFFICE FOR SEVEN YEARS. A PUBLIC NOTICE REGARDING THE CHARITY CARE POLICY IS POSTED IN PROMINENT PLACES THROUGHOUT THE HOSPITALS, INCLUDING BUT NOT LIMITED TO THE EMERGENCY ROOM WAITING AREAS AND THE ADMISSIONS OFFICE WAITING AREAS, AS REQUIRED BY BOTH THE STATE OF TEXAS COMMUNITY BENEFIT STANDARD (WHICH ADDRESSES THE DUTIES AND RESPONSIBILITIES OF NONPROFIT HOSPITALS) AND CHRISTUS HEALTH COMMUNITY BENEFIT GUIDELINES #050. IN ADDITION, A PUBLIC NOTICE REGARDING THE CHARITY CARE POLICY AND INFORMATION ON FINANCIAL ASSISTANCE ARE ALSO POSTED ON THE CHRISTUS HEALTH WEBSITE. THE INFORMATION ON FINANCIAL ASSISTANCE INCLUDES EXPLANATIONS ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY FOR FINANCIAL ASSISTANCE.

Schedule H, Part VI, Line 4 Community information
CHRISTUS GOOD SHEPHERD MEDICAL CENTER - MARSHALL IS LOCATED IN THE PINEY WOOD OF EAST TEXAS AND SERVICES A RURAL COMMUNITY WHICH INCLUDES HARRISON, NORTHERN PANALO AND SOUTHERN MARION COUNTIES. THE POPULATION IN EACH OF THESE COUNTIES IS DIVERSE IN INCOME AND ETHNICITY. HARRISON COUNTY, ESTABLISHED IN 1839, IS LOCATED IN NORTHEASTERN TEXAS ALONG THE LOUISIANA BORDER AND COMPRISES 900 SQUARE MILES. MARSHALL, THE COUNTY SEAT, IS LOCATED 152 MILES EAST OF DALLAS AND 39 MILES WEST OF SHREVEPORT. ACCORDING TO THE 2019 CENSUS ESTIMATES, 14.7 PERCENT OF HARRISON COUNTY POPULATION LIVES IN POVERTY. 17.4 PERCENT OF HARRISON COUNTY RESIDENTS ARE AGE 65 OR OLDER. THE CENSUS BUREAU REPORTS THAT ONLY 19.1 PERCENT OF ADULTS HOLD A COLLEGE DEGREE OR HIGHER LEVEL OF EDUCATION. EDUCATION LEVEL IMPACTS THE TYPES OF AVAILABLE JOBS AND BENEFIT LEVELS, INCLUDING HEALTHCARE COVERAGE. IN OTHER SERVICE LOCATIONS, MARION COUNTY HAS A MEDIAN ANNUAL INCOME OF $37,283 AND 21.9 PERCENT OF ITS RESIDENTS LIVE IN POVERTY. PANOLA COUNTY HAS A MEDIAN ANNUAL HOUSEHOLD INCOME OF $51,569 AND 15.7 PERCENT OF ITS RESIDENTS LIVE IN POVERTY. UNEMPLOYMENT RATES DURING THE 2020 COVID-19 PANDEMIC HAVE INCREASED AND LIKELY WORSENED POVERTY LEVELS. (SOURCE: U.S. CENSUS BUREAU) GOOD SHEPHERD MEDICAL CENTER - LONGVIEW IS ALSO LOCATED IN NORTHEAST TEXAS AND SERVES AN 11-COUNTY REGION INCLUDING THE FOLLOWING COUNTIES: GREGG, HARRISON, MARION, MORRIS, PANOLA, RUSK, UPSHUR, CAMP, CASS, WOOD AND TITUS. THE PROJECTED 2019 PRIMARY 6 COUNTIES POPULATIONS SERVED BY BOTH HOSPITALS ARE GREGG 123,945, HARRISON 66,553, MARION 9,854, UPSHUR 41,753, RUSK 54,406 AND PANOLA 23,194 AND TOTAL 319,705. GREGG, THE LARGEST COUNTY IN THE SERVICE AREA, HAS A POVERTY RATE OF 15.1 PERCENT AND 15.7 PERCENT OF THE POPULATION IS OVER 65 (SOURCE: U.S. CENSUS BUREAU). WITHIN THE AREA SERVED THERE ARE MANY OBSTACLES TO OVERCOME REGARDING HEALTH CARE COVERAGE. MANY FIND IT DIFFICULT TO AFFORD THE COST OF HEALTHCARE BOTH IN BASIC PREVENTION AND IN TREATMENT OF EXISTING CONDITIONS. CHRISTUS GOOD SHEPHERD MEDICAL CENTERS IN LONGVIEW AND MARSHALL OFFER A TRUE SYSTEM OF HEALTHCARE THAT ENCOMPASSES THE REACH OF OUR REGION.

Schedule H, Part VI, Line 5 Promotion of community health
THE COMMUNITY BUILDING ACTIVITIES INCLUDE OUR WELLNESS CENTER AND THE PROGRAMS WE OFFER TO KEEP OUR COMMUNITY HEALTHY. ALTHOUGH, THE COVID PANDEMIC HAS REQUIRED REDUCED OFFERINGS, THE WELLNESS CENTER is THE HUB OF OUR PROGRAM OFFERING FITNESS AND WELLNESS PROGRAMS FOR INDIVIDUALS, FAMILIES AND BUSINESSES IN OUR COMMUNITy, INCLUDING HOSPITAL EMPLOYEES AND THEIR FAMILIES. WE ALSO OFFER A VARIETY OF WATER AEROBICS, ADULT AEROBIC CLASSES, SENIOR EXERCISE CLASSES, SPECIALTY CLASSES SUCH AS ZUMBA, CARDIAC REHAB, ETC. WE ALSO OFFER ACUTE, CHRONIC AND PREVENTATIVE EDUCATIONAL PROGRAMS TO OUR COMMUNITY. WE PROVIDE COMMUNITY EDUCATIONAL SERVICES AND PROGRAMS, SUCH AS CPR, CERTIFIED DIABETIC EDUCATION PROGRAMS, WOUND CARE EDUCATION AND PREVENTION, SEATBELT AWARENESS, tobacco cessation, and nutrition education. WE OFFER HEALTH FAIRS THAT PROVIDE BASIC SCREENING EXAMS AT NO COST TO OUR COMMUNITY. OUR CASE MANAGEMENT AND SOCIAL SERVICES PROGRAM OFFERS THE AVAILABILITY OF EXTERNAL SOURCES AND PROGRAMS TO ASSIST PATIENTS AND THEIR FAMILIES, SUCH AS WIC AND OTHER GOVERNMENT AND PRIVATE PROGRAMS.

Schedule H, Part VI, Line 6 Affiliated health care system
CGSMC IS PART OF CHRISTUS HEALTH, AN INTERNATIONAL, CATHOLIC, FAITH-BASED, NONPROFIT HEALTH SYSTEM COMPRISED OF ALMOST 350 SERVICES AND FACILITIES INCLUDING MORE THAN 60 HOSPITALS AND LONG-TERM CARE AFFILIATED HEALTH CARE SYSTEM FACILITIES, 175 CLINICS AND OUTPATIENT CENTERS, AND OTHER COMMUNITY HEALTH MINISTRIES AND COMMUNITY DEVELOPMENT VENTURES. CHRISTUS SERVICES CAN BE FOUND IN: ARKANSAS, LOUISIANA, NEW MEXICO, TEXAS, AND IN SIX PROVINCES OF MEXICO, COLOMBIA AND CHILE. A COMMON MISSION, CORE VALUES, AND VISION UNITE THE HEALTH SYSTEM. EACH REGION, INCLUDING CGSMC, DEVELOPS FIVE-YEAR AND TEN-YEAR STRATEGIC PLANS THAT HELP SET THE YEARLY OPERATIONAL PLANS AND BUDGETS. REGIONAL STRATEGIC GOALS ARE SET IN COLLABORATION WITH CHRISTUS HEALTH AND INCLUDE METRICS THAT WILL BE USED TO MEASURE COMMUNITY BENEFIT, CLINICAL OUTCOMES, PATIENT SATISFACTION, AND ASSOCIATE ENGAGEMENT. CHRISTUS HEALTH PROVIDES UPDATED MARKET, DEMOGRAPHICS, AND HEALTH INDICATOR DATA ON AN ANNUAL BASIS. THE DATA SUPPLIED FROM CHRISTUS HEALTH ALONG WITH THE SYSTEM-WIDE STRATEGIC INITIATIVES ARE CONSISTENT WITH THE COMMUNITY NEEDS ASSESSMENT OF THE REGION. CGSMC, IN TURN, PARTNERS WITH OTHER NONPROFIT GROUPS (CHURCHES, HEALTH CARE PROVIDERS, AND GOVERNMENT AGENCIES) TO CREATE COLLABORATIONS WHERE HEALTH NEEDS CAN BE ADDRESSED AND THE GENERAL HEALTH OF INDIVIDUALS AND THE COMMUNITY IS IMPROVED.