4A (Expenses $ 227546166 including grants of $ 948202) (Revenue $ 304689284)
Ascension Providence is a 280-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2022, Ascension Providence treated 14,665 adults and children for a total of 70,138 patient days of service. The hospital also provided services for 231,116 outpatient visits, which included 5,039 outpatient surgeries and 56,168 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 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 - Ascension Providence. The 2021 CHNA was conducted from July 2021 to January 2022, and utilized the multi-stage process including data gathering, validation, sensemaking and prioritization, which incorporated data from both primary and secondary sources. Primary data sources, sometimes called qualitative data, included information provided by groups/individuals, e.g., community residents, health care consumers, health care professionals, community stakeholders, and multi-sector representatives. Special attention was given to the needs of individuals and communities who are more vulnerable, and to unmet health needs or gaps in services. Together with the efforts of our contractors, an estimated total of 39 individuals participated in focus groups and interviews, held between July 2021 and November 2021. Populations represented by participants included medically underserved, low-income, minority groups, and rural, urban and suburban groups. Multiple methods were used to gather community input, including key stakeholder interviews, community focus groups and a community survey. Together with the efforts of our collaborators, an estimated total of 39 individuals participated in the focus groups and interviews, held between July 2021 and November 2021. Populations represented by participants included medically underserved, low-income, minority groups, and rural, urban and suburban groups. Recognizing its vital importance in understanding the health needs and assets of the community, Ascension Providence solicited input from a range of public health and social service providers that represent the broad interests of the Ascension Providence service area. A concerted effort was made to ensure that the individuals and organizations represented the needs and perspectives of: 1) public health practice and research; 2) individuals who are medically underserved, are low-income, or considered among the minority populations served by the hospital; and 3) the broader community at large and those who represent the broad interests and needs of the community served. A series of four focus groups with approximately 15 participants were conducted by Alpinista Consulting to gather input from community members in the following counties: Bosque, Coryell, Falls, Freestone, Hill, Hamilton, Limestone, and McLennan. Populations represented by participants included medically underserved, low-income, minority groups, and rural, urban and suburban groups. A survey was conducted by Ascension Providence to gather the perceptions, thoughts, opinions, and concerns of the community regarding health outcomes, health care access, and social determinants of health for Ascension Providence. Nineteen individuals participated in the survey, held between August 2021 and October 2021. Five one-on-one interviews were conducted by the Ascension Texas Community Benefit team to gather feedback from key stakeholders on the health needs and assets of Ascension Texas. These interviews represented two different organizations and agencies. The following organizations were represented during stakeholder interviews conducted in 2021: -American Gateways -Baylor University -McLennan Community College -McLennan Public Health -Rural critical access hospital in Groesbeck, TX The following organizations were represented during stakeholder focus groups conducted in 2021: -Baylor Scott & White Health -Baylor University -Carter Bloodcare -Heart of Texas MMHR -Prosper Waco -Waco Habitat for Humanity -Waco ISD -Women, Infants and Children (WIC) -United Way of Waco

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - Ascension Providence. During the 2021 Community Health Needs Assessment (CHNA) process, which included both quantitative and qualitative analysis, Ascension Providence identified and prioritized four main needs for the 8 county service area including McLennan, Coryell, Hill, Limestone, Freestone, Bosque, Falls and Hamilton Counties which include: (1) Mental and Behavioral Health, (2) Access to Care, (3) Social Determinants of Health, (4) Health Equity. To address the needs identified in the 2021 CHNA, an Implementation Strategy (IS) for Ascension Providence was adopted in August of 2022. Due to the recent timing of adopting the new IS, this report shows the impact of the previous 2019 IS. Impact on the most recent 2021 CHNA will be reported starting next year. Ascension Providence will address all of the health needs identified through the CHNA. During the 2019 Community Health Needs Assessment (CHNA) process, which included both quantitative and qualitative analysis, Ascension Providence identified and prioritized three main needs for McLennan County: (1) Access to Healthcare, (2) Lifestyle and Healthy Behaviors and (3) Women's Health. To address these key needs, Ascension Providence has developed a Community Health Improvement Plan. Although mental health was not identified in the McLennan County CHNA, Ascension Providence will also address this need. Ascension Providence has a large volume of patients with mental and behavioral health needs that come to the emergency department with limited resources. Additionally, Robert Wood Johnson's County Health Rankings show that McLennan County residents have 3.8 poor mental health days on average compared to the Texas state average of 3.4. The various actions included in the Implementation Strategy are not intended to be exhaustive or inclusive of every single Ascension Texas strategy, initiative or program. Instead, the plan highlights the most significant actions that the hospital has undertaken to address the health needs prioritized in the Community Health Needs Assessment, including those strategies that are expected to make the most significant impact on the delivery of health care in the region for the poor and vulnerable. The Implementation Strategy for Ascension Providence addresses all three needs identified in the 2019 McLennan County CHNA as well as Mental Health. As required by IRS guidelines, for each need, Ascension Seton has identified key actions to address the need: -The anticipated impact of these actions -Available resources to address the need -Potential collaborations Hospital-based strategies in the Ascension Providence Implementation Strategy to address each of the identified community health needs include those listed below. It is of note that most Ascension Texas hospitals in Travis County and the surrounding service areas are participating in a common strategy around mental health to improve coordination throughout the community. Access to Healthcare -Provide medical, dental and vision care through recurring Medical Missions at Home events. -Provide a navigator in the emergency department to connect patients to primary care providers and specialists. -Needs addressed in FY22: In FY22 Ascension Providence hosted a Medical Mission at Home in downtown Waco, Texas which offered medical, dental and vision care. Ascension Providence also continued to provide a navigator in the emergency department who helps connect people with appointments and community resources. Lifestyle and Healthy Behaviors -Provide education and management to community members with diabetes. -Needs addressed in FY22: Due to the pandemic, programs addressing chronic disease changed to not include community-based nutrition learning sessions. Women's Health -Connect un- and/or under-insured women to prenatal resources in partnership with CareNet. -Expand access to breast health care for the uninsured or underinsured through the Pink Partner Fund. -Needs addressed in FY22: CareNet prenatal program provides care and education to approximately 1800 patients annually. In June 2021, the Midwife group added a day per week to provide services at Carenet. The Pink Partner Fund continues to provide mammograms to uninsured or underinsured individuals. Mental Health -Provide behavioral health navigator for the Ascension Providence emergency department. -Create a behavioral health consortium, comprised of hospital leaders and mental and behavioral health clinicians, to provide a forum to identify site-specific needs around access to mental and behavioral health services, and consider and implement best practices that improve delivery of care to a wider variety of patients both in and outside hospitals. -Needs addressed in FY22: Behavioral health navigator continues to assist patients in the Emergency Department (ED) with many that the navigator serves being high utilizers or difficult to place patients. In May 2020 DePaul became involved in the Continuity of Care Community Project (COC) coordinated by Prosper Waco. Seven entities are involved and it is part of a 2 year research grant to discern gaps in the BH care /needs within the community.

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 II Community Building Activities
There were no community building activities to report this year. All reported activities qualify as community benefit.

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 $23,499,985 AT CHARGES ($5,676,571 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
Ascension Providence 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. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS 365 Days 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
- ASCENSION PROVIDENCE: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- ASCENSION PROVIDENCE: Line 16b URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- ASCENSION PROVIDENCE: Line 16c URL: https://healthcare.ascension.org/Financial-Assistance;

Schedule H, Part VI, Line 4 Community information
The total population of the 8 county primary service area is estimated to be 463,623 residents in calendar year 2022 and is expected to increase by approximately 3.6% to 480,216 residents in five years. The average income of the primary service area is $78,383 based on Claritas-Environics 2022. Approximately 16% of the service area residents live below the poverty line, with 27% uninsured or Medicaid patients. Within the primary service area, there are 32 federally-designated medically underserved areas. There are 10 other acute care hospitals located within the primary service area.

Schedule H, Part VI, Line 7 State filing of community benefit report
TX

Schedule H, Part VI, Line 2 Needs assessment
Ascension Providence uses internal and external data and reports from third parties, including government sources, to assess the healthcare needs of the communities we serve. These reports provide key information about health, socioeconomic, demographic factors that identify areas of need and inform our strategies that help to meet those needs of our community. These reports include, but are not limited to: 1. Local and State Department of Health Reports 2. Local Government Planning Departments 3. US Census Bureau 4. Economic Impact Studies 5. Sg2 healthcare intelligence 6. Healthcare claims datasets 7.State datasets 8. CMS 9. CDC 10. Internal data sets Ascension Providence utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, Ascension Providence considers the health care needs of the overall community when evaluating internal financial and operational decisions.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Ascension Providence 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, Ascension Providence'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. Ascension Providence PROVIDES FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 250% OF THE FEDERAL POVERTY LEVEL. And, patients with incomes above 250% of the FPL but not exceeding 400% of the FPL, will receive a sliding scale discount on that portion of the charges for services provided for which the Patient is responsible following payment by an insurer. Ascension Providence WIDELY PUBLICIZES ITS: - FINANCIAL ASSISTANCE POLICY - Amount Generally Billed Calculation - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE Plain Language Summary - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - Billing and Collections Policy VIA THE HOSPITAL FACILITY'S WEBSITE - www.healthcare.ascension.org/Financial-Assistance/Texas Ascension Providence MAKES PAPER COPIES OF THE: - FINANCIAL ASSISTANCE POLICY - Amount Generally Billed Calculation - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE Plain Language Summary - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - Billing and Collections Policy 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. Ascension Providence 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. Ascension Providence INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 5 Promotion of community health
Ascension Porvidence's governing body is comprised of persons representing diverse aspects and interests of the community. Many members of the hospital governing bodies reside in the organization's primary service area; who are neither employees nor independent contractors of the organization, nor family members thereof. Applications for medical staff privileges at Ascension Providence hospital facilities are open to all qualified physicians in the community, subject to completing an Ascension Providence application and hospital privileging process to ensure that the applicant physician meets the requirements for the privileges requested by the applicant physician. Ascension Providence is continuously improving its patient care services to address the needs of the community we serve. Surplus funds generated from Ascension Texas' operations are reinvested in the organization's activities, including patient care.

Schedule H, Part VI, Line 6 Affiliated health care system
Ascension Providence IS A MEMBER OF ASCENSION. ASCENSION HEALTH ALLIANCE, D/B/A 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 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. Ascension Providence OPERATES A HOSPITAL FACILITY in McLennan County and is part of Ascension Texas WHICH OWNS AND OPERATES, DIRECTLY AND INDIRECTLY THROUGH JOINT VENTURES, HEALTH CARE RELATED ENTITIES, INCLUDING Ascension Seton Medical Center Austin, Dell Children's Medical Center of Central Texas, Dell Seton Medical Center at the University of Texas, Ascension Seton Hays, Ascension Seton Williamson, Ascension Seton Northwest, Ascension Seton Highland Lakes, Ascension Seton Southwest, Ascension Seton Edgar B. Davis, Ascension Seton Shoal Creek, Ascension Seton Smithville, Ascension Seton Bastrop, Pam Rehabilitation Hospital of Round Rock, Northwst Hills Surgical Hospital, Cedar Park Regional Medical Center, Seton Medical Center Harker Heights, Warm Springs Rehabilitation Hospial of Kyle, Central Texas Rehabilitaton Hospital and Ascension Providence. THE HEALTH SYSTEM PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF Central Texas and beyond.