4A (Expenses $ 201047545 including grants of $ 0) (Revenue $ 335678429)
See Schedule O

4B (Expenses $ 346867068 including grants of $ 0) (Revenue $ 306849318)
See Schedule O

4C (Expenses $ 124747086 including grants of $ 0) (Revenue $ 149649297)
See Schedule O

4D (Expenses $ 0 including grants of $ -3703625) (Revenue $ 0)
Additional Grants

Schedule H, Part V, Section B, Line 3E

Schedule H, Part V, Section B, Line 3 Facility A, 1
Facility A, 1 - SEE SCHEDULE H, PART V, SECTION A. CHRISTUS SPOHN HEALTH SYSTEM, AS PART OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPLEMENTATION PLAN, COMMITTED TO ADDRESSING THE FOLLOWING HEALTH NEEDS IDENTIFIED IN ITS COMMUNITY: BEHAVIORAL HEALTH, AFFORDABLE HOUSING, COMMUNITY AND FAMILY VIOLENCE, TRUST IN COMMUNITY RESOURCES AND SYSTEMS BY VULNERABLE POPULATIONS, AND UNNECESSARY USE OF THE EMERGENCY ROOM. TO MAXIMIZE RESOURCES AVAILABLE FOR THE PRIORITY AREAS LISTED ABOVE, LEADERS AND STAFF AT CHRISTUS SPOHN DETERMINED THAT THE FOLLOWING ISSUES WOULD NOT BE EXPLICITLY INCLUDED IN THEIR COMMUNITY HEALTH IMPROVEMENT PLAN: DIABETES, OBESITY, PHYSICIAN RECRUITMENT, RETENTION, AND TRANSPORTATION IN THE COASTAL BEND. WHILE THE NEEDS PRIORITIZATION COMMITTEE STRESSED THAT THESE NEEDS REMAIN PRESSING, THEY WERE NOT RANKED HIGH ENOUGH FOR INCLUSION IN THE FINAL PRIORITY LIST BECAUSE COMMITTEE MEMBERS EITHER (A) DID NOT FEEL CHRISTUS SPOHN WAS OPTIMALLY POSITIONED TO ADDRESS THE NEED IN AN IMPACTFUL WAY OR (B) PERCEIVED A RELATIVE ABUNDANCE OF CAPACITY AND RESOURCES ALREADY BEING DIRECTED AT THE NEED; THROUGH OUR CONTINUED COMMUNITY COLLABORATION WITH A DIVERSE GROUP OF PROVIDERS, ORGANIZATIONS, AND ENGAGED COMMUNITY LEADERS, WE WILL CONTINUE TO IDENTIFY AREAS WHERE WE CAN WORK TOGETHER TO IMPROVE THE HEALTH AND WELLNESS OF THE COASTAL BEND. EFFORTS TO ADDRESS BEHAVIORAL HEALTH, AFFORDABLE HOUSING, COMMUNITY AND FAMILY VIOLENCE, TRUST IN COMMUNITY RESOURCES AND SYSTEMS BY VULNERABLE POPULATIONS, AND UNNECESSARY EMERGENCY ROOM USE SHOULD SIGNIFICANTLY IMPACT THE ADDITIONAL IDENTIFIED NEEDS OF DIABETES AND OBESITY IN OUR COMMUNITY.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - SEE SCHEDULE H, PART V, SECTION A. CHRISTUS SPOHN DID TAKE INPUT FROM PERSONS WHO REPRESENT BROAD INTERESTS IN THE COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED BY TEXAS HEALTH INSTITUTE, WHICH CONSIDERED INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY BY PERFORMING ONE-ON-ONE KEY INFORMANT INTERVIEWS, FOCUS GROUP MEETINGS, AND A FINAL NEEDS PRIORITIZATION MEETING. NURSES, COMMUNITY HEALTH WORKERS, PROFESSORS, GRASSROOTS ORGANIZERS, SOCIAL SERVICE PROVIDERS, FQHCS, HEALTHCARE PROFESSIONALS, AND FAITH-BASED PROFESSIONALS PROVIDED COMMUNITY HEALTH NEEDS ASSESSMENT INPUT. THE INTERVIEWS AND MEETINGS INCLUDED REPRESENTATIVES FROM COASTAL BEND CENTER FOR INDEPENDENT LIVING, CHRISTUS SPOHN, AMISTAD COMMUNITY HEALTH CENTER, TEXAS A&M COASTAL BEND HEALTH EDUCATION CENTER, COASTAL BEND NEIGHBORHOOD EMPOWERMENT, DRISCOLL HEALTH PLAN, METHODIST HEALTHCARE MINISTRIES, METRO MINISTRIES, SOUTH COASTAL AREA HEALTH EDUCATION CENTER, AND TEXAS A&M AGRILIFE EXTENSION.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - SEE SCHEDULE H, PART V, SECTION A. SIGNIFICANT NEEDS ADDRESSED AND NOT ADDRESSED CHRISTUS Spohn Health System, as part of its community health needs assessment and community health implementation plan, is committed to addressing the following health needs identified in its community: chronic illnesses (heart disease, diabetes, and obesity), behavioral health (mental health and substance abuse), access to care, improving employment, and increasing access to housing and wrap-around services. CHRISTUS Spohn addresses chronic illness by providing opportunities for education and resource assistance related to heart disease, diabetes, and obesity. Spohn will utilize its community health workers and nurse navigators to educate, provide resources, and provide case management and continue to partner with local organizations on community education initiatives focused on diabetes education. CHRISTUS Spohn addresses behavioral health-related needs by providing resources to combat mental illness or substance abuse. Spohn has implemented free depression screenings to all Spohn-clinic patients, provides free counseling to all Spohn-clinic patients at the time of their visit, and has expanded in-patient behavioral health services through a partnership with oceans healthcare, and sustaining and enhancing collaborations and referral relationships with local behavioral health service providers. CHRISTUS Spohn addresses access to care by focusing on increasing access to primary care providers. All in-patients without a primary care provider are offered assistance in finding a provider before discharge. Additionally, Spohn utilizes its Hector P Garcia Family Health Center to address this need. The Hector P Garcia clinic offers free assistance in finding a primary care provider, enrolling into Nueces County Hospital District services to obtain a primary care provider, and offers extended hours at the walk-in Quick Care clinic six days a week with no appointment necessary. CHRISTUS Spohn addresses improving employment by cultivating and maintaining partnerships with clinical and non-clinical education programs. These partnerships result in CHRISTUS Spohn being the premier teaching hospital in the Coastal Bend region. CHRISTUS Spohn is addressing increasing access to housing and wrap-around services by supporting local organizations that focus on providing these services and creating a community collaboration. Spohn supports these organizations by inviting them to apply for CHRISTUS Fund grants, offering partnership and collaboration to meet shared goals, and by sharing resources. Additionally, Spohn has created and heads the area Homeless Leaders Collaborative, a group of organizations that are working to facilitate a results-based accountability approach to mitigate and eliminate homelessness in select Coastal Bend communities. To maximize resources available for the priority areas listed above, CHRISTUS Spohn determined that the following issues would not be explicitly included in their community health improvement plan: physician recruitment & retention and transportation. While the needs prioritization committee stressed that these needs remain pressing, they were not ranked high enough for inclusion in the final priority list because committee members either (a) did not feel CHRISTUS Spohn was optimally positioned to address the need in an impactful way, or (b) perceived a relative abundance of capacity and resources already being directed at the need. Through our continued community collaboration with a diverse group of providers, organizations, and engaged community leaders, we will continue to identify areas where we can work together to improve the health and wellness of the coastal bend.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - SEE SCHEDULE H, PART V, SECTION A. DETERMINATION OF ELIGIBILITY FOR DISCOUNTED CARE Under the hospital's policy, uninsured patients who meet certain financial criteria are eligible for financial assistance. The policy also assisted medically indigent patients. Patients below 200% of federal poverty guidelines generally received free care. Patients who were uninsured and above 200% of the federal poverty guideline were billed rates consistent with amounts generally billed to commercial payers. Patients who were uninsured and between 200 and 400 percent 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 - SEE SCHEDULE H, PART V, SECTION A. FAP APPLICATION FORM'S METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE In addition to regular applications, the hospital also assessed patients for presumptive eligibility to facilitate assisting 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 the electronic screening was used as the basis for presumptive eligibility, the highest discount of complete 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 - SEE SCHEDULE H, PART V, SECTION A. HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICY A summary of the policy and documents needed to apply for assistance was widely available at www.christushealth.org/charitycare. This website was the first result in google when patients searched for the hospital name and charity care or financial assistance. Effective July 1, 2016, the individual hospital's homepage had a conspicuous financial assistance link directing patients to the charity care homepage. Financial counselors also publicized the availability of financial assistance during one-on-one visits with patients. The hospital attempted to provide all uninsured patients with financial counseling. Spending time face-to-face with patients allowed counselors to facilitate the application process for patients who otherwise might not have sought assistance. Counselors helped complete financial assistance applications and evaluate payment plans for outstanding balances. Uninsured patients were screened for Medicaid eligibility, and counselors assisted eligible patients in completing those applications.

Schedule H, Part V, Section B, Line 20 Facility A, 1
Facility A, 1 - SEE SCHEDULE H, PART V, SECTION A. The financial assistance policy is introduced when collection calls result in patient contact. The agents performed a verbal screening on the call 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 on 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
DID THE HOSPITAL FACILITY HAVE IN PLACE DURING THE TAX YEAR A SEPARATE BILLING AND COLLECTIONS POLICY, OR A WRITTEN FINANCIAL ASSISTANCE POLICY THAT EXPLAINED ACTION THE HOSPITAL FACILITY MAY TAKE UPON NON-PAYMENT? The hospital did not engage in extraordinary collection actions during the tax year. The policy strictly prohibited taking legal action against patients and 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 18 Item F
The hospital did not engage in any extraordinary collection actions during the tax year. The policy strictly prohibited taking legal action against patients and 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 Item B
DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. 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 45% OF 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 (FOR INCOMES AT OR BELOW 300% OF THE FPL). FOR LAB SERVICES, ELIGIBLE PATIENTS WERE CHARGED A PERCENTAGE OF THE MEDICARE RATE.

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 I, Line 7f PERCENT OF TOTAL EXPENSE
Total expense from form 990, part ix, line 25, column (a) is $817,009,274. The bad debt expense included in this amount is $22,281,082. This leaves a total expense of $794,728,192 for calculating line 7, column (f).

Schedule H, Part I, Line 7f FIN ASSISTANCE/ OTHER BENEFITS AS A PERCENTAGE OF COST
The organization's total community benefit expense, as reported in part I, line 7k, column (c) as a percentage of the total expense, is 31.65%, which exceeds the amount reported in part I, line 7k, column (f), which is computed using net community benefit expense.

Schedule H, Part I, Line 7i CASH AND IN-KIND CONTRIBUTIONS
CHRISTUS Spohn Health System made cash and in-kind contributions during the fiscal year. The amount is calculated following reporting rules for schedule h, worksheet 8. This amount differs from grants reported in form 990, schedule I, grants and other assistance to organizations, governments, and individuals, and part ix, lines 1 through 3 grants and other assistance. CHRISTUS Health established the CHRISTUS fund, a grant fund to provide resources to nonprofit agencies and groups whose vision, mission, and goals are consistent with CHRISTUS Health's mission, values, and philosophy of a healthy community. CHRISTUS fund grants were provided to two nonprofit organizations in the fiscal year. The grant dollars were used to support programs promoting the health needs of the community CHRISTUS Spohn serves. All grants to outside organizations through the CHRISTUS fund are made to nonprofit organizations supporting community health. These grant dollars are not included on schedule h, part i, line 7(i).

Schedule H, Part III, Line 3 BAD DEBT ATTRIBUTABLE TO PTS UNDER CHARITY CARE
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 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 derived from public record sources. For the fiscal year ending June 30, 2011, the organization reported that 30% of bad debt expenses were attributable to patients who may have been eligible for financial assistance but were not responsive to the existing application process. 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 determined a benchmark of bad debt accounts in CHRISTUS Health that lacked the information to be eligible for charity care under the filing organization's customary process but would have likely qualified for assistance. During the fiscal year, 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. The organization granted presumptive eligibility for these accounts, which 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. It is important to note that the figure calculated for the fiscal year ending June 30, 2011, was estimated and not exact. Therefore, the difference between the amounts qualified as presumptive charity care in any fiscal year may vary from the benchmark established in the fiscal year ending June 30, 2011.

Schedule H, Part III, Line 8
The medical center uses the Medicare cost report methodology, which Apportions routine costs (room and board) based on Medicare or Medicaid days to total days and apportions ancillary costs based on program charges to total charges.

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 II COMMUNITY BUILDING ACTIVITIES
The CHRISTUS Health advocacy department is working in partnership with local, state, and federal policymakers to ensure activities and programs are in place that will enhance public health and advance general knowledge. During the fiscal year, 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 our patients. Some leading 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. The indigent care health program is a limited benefit plan administered by CHRISTUS Spohn in which certain medical services are covered for eligible Nueces county recipients. Eligibility entitles qualified residents within Nueces county to receive health care services while residing within the county, including major medical expenses, hospitalization, and surgeries, routine medical expenses, office visits, annual exams, medications, and durable medical equipment, all subject to co-payments. CHRISTUS Spohn remains committed to providing the community with access to affordable, quality health care by collaborating with physicians, Spohn family health centers, hospitals, and various local organizations to seek solutions to improve their health and well-being.

Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (Continuation)
21. As a nonprofit organization and part of CHRISTUS Health, a regional governing board mainly comprised of independent community members Representing the makeup of the area we serve guides CHRISTUS Spohn health system corporation. 22. We are privileged to have an open medical staff comprised of qualified physicians who work with us to provide care to our communities. All qualified physicians who are granted privileges to serve with us in our hospitals must undergo a thorough credentialing and orientation process. 23. All persons employed and affiliated with CHRISTUS Spohn Health System must complete an annual conflict of interest statement. 24. CHRISTUS Health reinvests all surplus funds into the communities it serves through expanded health services, new technologies, and better facilities. 25. During the fiscal year, CHRISTUS Health advocated for improvement in public policies and worked to establish, and in some instances augment, grassroots advocacy for greater access to health care services for all. CHRISTUS Spohn is committed to building healthier communities and will continue to collaborate with organizations throughout the region, whenever possible, to address those needs not explicitly targeted by our system's community health improvement plan.

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 7b UNREIMBURSED MEDICAID
CHRISTUS SPOHN HEALTH SYSTEM CORPORATION REINVESTS ALL SURPLUS FUNDS BACK IN TO THE COMMUNITIES WE SERVE THROUGH EXPANDED HEALTH SERVICES, NEW TECHNOLOGIES, AND BETTER FACILITIES.

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 I, Line 7 Costing Methodology used to calculate financial assistance
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 7g: subsidized health services cost is at FMV

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 SPOHN HOSPITAL SHORELINE: Line 16a URL: HTTPS://WWW.CHRISTUSHEALTH.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - CHRISTUS SPOHN HOSPITAL SHORELINE: Line 16b URL: SEE SUPPLEMENTAL INFO;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - CHRISTUS SPOHN HOSPITAL SHORELINE: Line 16c URL: SEE SUPPLEMENTAL INFO;

Schedule H, Part VI, Line 5 Promotion of community health
CHRISTUS Spohn collaborates with community organizations, churches, businesses, social service organizations, and other healthcare organizations to facilitate and strengthen the accessibility of quality healthcare services for all, especially vulnerable and underserved populations. Activities undertaken by CHRISTUS Spohn to promote the health and wellness of the community include: 1. CHRISTUS Spohn has established healthcare facilities across four cities and four counties in the coastal bend to provide access to healthcare services to as many people as possible. These facilities include three hospital campuses in Corpus Christi: shoreline campus, memorial campus, and south campus. As well as three rural hospitals: Spohn Kleberg in Kingsville, Spohn Alice in Alice, and Spohn Beeville in Beeville. 2. CHRISTUS Spohn's other healthcare facilities include investments in two ambulatory surgery centers (Corpus Christi SurgiCare, ltd. And shoreline surgery center, l.l.p.) 3. CHRISTUS Spohn offers convenient locations for primary care through the CHRISTUS Spohn family health centers and a CareVan mobile Outreach clinic. 4. CHRISTUS Spohn collaborates with the federally qualified health centers (FQHCs) in its region and other nonprofit health clinics in the area that are committed to creating greater access to primary care. 5. CHRISTUS Spohn aids in the recruiting of physicians who ultimately contract with the CHRISTUS provider network, which in turn contracts with CHRISTUS Spohn to provide the physician services in the CHRISTUS Spohn family health centers. Most of the clients who receive primary care and chronic disease management are uninsured or receive coverage from Medicaid/chip/Nueces county hospital district. 6. Implementing the community health worker and care management concept at all CHRISTUS Spohn family health centers establishes an in-house working network to provide continuity of care for the indigent and underserved, from primary care services to in-patient and ambulatory services. This program assists patients in managing their chronic illnesses, providing health education, obtaining community-based resources, preventing unnecessary emergency department use, and avoiding preventable hospitalizations. 7. The CHRISTUS Spohn CareVan is a mobile clinic that delivers OB and women's services four days a week (including prenatal care, pap smears, laboratory and ultra-sound testing, annual exams, and referrals for free mammograms and pre-natal care) to uninsured women. This preventative and wellness care help with early detection that otherwise might result in more serious health issues requiring hospitalization. 8. When not in use for women's services, the CareVan is serving the coastal bend by providing health screenings, immunizations, health education, and counseling to vulnerable and underserved populations throughout the community. 9. The dr. Hector P. Garcia memorial family health center is an entire healthcare complex located on the grounds of CHRISTUS Spohn's memorial hospital. It provides education to coastal bend residents on nights and weekends; offers specialty clinics, laboratory services, and imaging services to insured and uninsured patients; a full pharmacy with walk-in access; and a quick care walk-in clinic operating 9 am to 9 pm Monday through Saturday and 11 am to 5 pm on Sunday. 10. The CHRISTUS Spohn family medicine academic center clinic is within walking distance from CHRISTUS Spohn's memorial hospital. Family medicine residents in a Texas A&M affiliated residency program work alongside the attending physicians of the CHRISTUS provider network to provide care to the underserved and uninsured population of the coastal bend. An average of 100-120 patients are seen daily in the clinic. Most of these patients have Medicaid coverage or lack insurance altogether. 11. In addition to the family medicine academic center clinic and the walk-in quick care clinic, CHRISTUS Spohn has two family health centers located in the greater Corpus Christi area. Each family health center clinic cares for Nueces county hospital district patients and patients with other payor sources. The locations are listed below: a. Christus Spohn family health center - Robstown, 1038 Texas Yes Blvd., Robstown, TX 78380 b. CHRISTUS Spohn family health center - Westside, 4617 Greenwood Drive, Corpus Christi, TX 78416 12. Specialty clinics are located in the Hector P Garcia memorial family health center. These clinics exist for follow-up care and Specialty care. Physicians/providers offer a centralized area for easy access to cardiovascular, neurology, nephrology, orthopedic, Gynecological, and plastic surgery care. Also, contracts with off-campus providers ensure that other specialty medical services are available for those who would typically not be able to access specialty care outside this controlled setting. 13. The revamping of the Nueces county health department's (NCHD) indigent care program included CHRISTUS Spohn as its partner in providing health care services. In reorganizing its services, a central goal of the NCHD indigent care program is to route eligible participants to the appropriate settings. The CHRISTUS Spohn partnership provides the following programs: (a) um/cm plan; (b) pre-approval of services with verification of medical necessity and a tie-in to the care Management program; (c) an empanelment of clients into a medical home concept; (d) target of populations, i.e., diabetic patients with a1c's greater than 10, into the full-service track; (e) weekly multidisciplinary diabetic clinic to meet target population's need; (f) pharmaceutical case management; (g) preferred provider list with cm/um management; and (h) medical director for the indigent care plan. 14. CHRISTUS Spohn Hospital memorial is the designated contract provider for the Nueces center for mental health and Intellectual disabilities (MHID). It provides onsite psychiatric triage as part of its contractual relationships with MHID. This provides an alternative for patients who utilize the Emergency Department as a first resort. 15. CHRISTUS Spohn has rural health clinics in Beeville and Freer, providing services to the uninsured, underinsured, and broader community. CHRISTUS Spohn employs the staff in these clinics. 16. CHRISTUS Spohn health system hospitals in Alice, Beeville, and Kleberg collaborate with the community action corporation of South Texas' FQHC in its respective areas. These clinics provide primary care to uninsured and underinsured patients. This prevents patients from utilizing the hospital emergency departments as their medical home. 17. Ongoing collaboration with Mission of Mercy, a national nonprofit organization that provides free primary care to uninsured patients. CHRISTUS Spohn provides lab work, diabetes education, and flu vaccinations to patients at no charge. In addition, the CHRISTUS Spohn CareVan refers uninsured patients who need primary care to Mission of Mercy. Likewise, Mission of Mercy refers women needing a mammogram or pre-natal care to the CHRISTUS Spohn CareVan. 18. Diabetes education is provided through diabetes self-management training classes. These classes are offered at the Hector P Garcia memorial family health center through the Texas A&M coastal bend health education center (CBHEC). Diabetes support groups, self-management training classes, and additional diabetes resources are offered through Texas A&M CBHEC in various locations throughout the community. CHRISTUS Spohn collaborates with Texas A&M CBHEC to host diabetes health fairs throughout the coastal bend. CHRISTUS Spohn houses a certified diabetes educator at the Hector P Garcia memorial family health center to provide on-site education and referrals to patients in immediate need. 19. CHRISTUS Spohn is proud to be a teaching hospital committed to educating health professionals (graduate medical education, nursing students, allied health professionals, pharmacists, etc.). Helping to prepare future healthcare professionals is a distinguishing characteristic of nonprofit healthcare. 20. CHRISTUS Spohn also utilizes cash donations as a vehicle to help our communities. CHRISTUS Spohn made cash donations, in addition to grants awarded through the CHRISTUS fund, to support the fight against cancer, diabetes, heart disease, and many other important community initiatives.

Schedule H, Part VI, Line 6 Affiliated health care system
CHRISTUS Spohn Health System 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 facilities, 175 clinics and outpatient centers, and other community health ministries and community development ventures. Christus services can be found in Arkansas, Georgia, Iowa, Louisiana, New Mexico, Texas, and internationally in the countries of Mexico, Chile, and Colombia.

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

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% 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 AN ANALYSIS DETERMINED THAT 3.73% 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 0.59% OF THE BAD DEBT EXPENSES IN FISCAL YEAR ENDING JUNE 30, 2021 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 AT THE DATE OF THE CONSOLIDATED FINANCIAL STATEMENTS. 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 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 2 Needs assessment
CHRISTUS SPOHN HEALTH SYSTEM IS A NON-PROFIT, CATHOLIC, INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT INCLUDES FIVE ACUTE CARE HOSPITALS IN FOUR COUNTIES IN THE COASTAL BEND REGION. CHRISTUS SPOHN'S DEDICATED ASSOCIATES PROVIDE CARE TAILORED TO THE INDIVIDUAL NEEDS OF EVERY PATIENT, AIMING TO DELIVER HIGH-QUALITY SERVICES WITH EXCELLENT CLINICAL OUTCOMES. CHRISTUS SPOHN WORKS CLOSELY WITH THE LOCAL COMMUNITY TO IDENTIFY AND INCORPORATE REGIONAL HEALTH NEEDS INTO SYSTEM-WIDE PLANNING AND STRATEGY. TO THIS END, CHRISTUS SPOHN COMMISSIONED METOPIO TO CONDUCT AND PRODUCE ITS 2020-2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AS REQUIRED BY LAW TO BE PERFORMED ONCE EVERY THREE YEARS AS A CONDITION OF 501(C)(3) TAX-EXEMPT STATUS. IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT, METOPIO STAFF, CHRISTUS SPOHN LEADERSHIP, AND COMMUNITY STAKEHOLDERS ANALYZED INDICATORS OF HEALTH NEEDS BASED ON DEMOGRAPHICS AND SOCIOECONOMIC TRENDS; MEASURES OF PHYSICAL, BEHAVIORAL, SOCIAL, AND EMOTIONAL HEALTH; AND RISK FACTORS AND BEHAVIORS THAT PROMOTE HEALTH OR PRODUCE SICKNESS. THE LATTER PROVIDED INSIGHT INTO SOCIAL DETERMINANTS OF HEALTH OPERATING IN THE REPORT AREA, SUCH AS POVERTY RATES, LACK OF AFFORDABLE HOUSING, LACK OF SKILLED LABOR TRAINING, AND FOOD INSECURITY. REPORT FINDINGS COMBINE SECONDARY ANALYSIS FROM PUBLICLY AVAILABLE DATA SOURCES, HOSPITAL UTILIZATION DATA, AND INPUT FROM THOSE WITH INTIMATE KNOWLEDGE OF THE LOCAL PUBLIC HEALTH AND HEALTHCARE SYSTEMS TO PRESENT A COMPREHENSIVE OVERVIEW OF UNMET HEALTH NEEDS IN THE REGION. CHRISTUS SPOHN AND METOPIO GUIDED THE NEEDS ASSESSMENT PROCESS THROUGHOUT THE PROJECT'S LIFE, ENSURING THE DATA AND ANALYSES REMAINED GROUNDED IN THE LOCAL CONTEXT. FOCUS GROUPS AND NEEDS PRIORITIZATION MEETINGS PROVIDED INPUT FROM COMMUNITY MEMBERS AND STAKEHOLDERS REPRESENTING THE COASTAL BEND REGION. A FINAL LIST OF FIVE PRIORITIZED HEALTH NEEDS WAS DEVELOPED THROUGH AN ITERATIVE DEBRIEFING AND REFINEMENT OF FINDINGS. BASED ON COMMUNITY INPUT AND ANALYSIS OF A MYRIAD OF DATA, THE PRIORITIES FOR THE COMMUNITIES SERVED BY CHRISTUS SPOHN HEALTH SYSTEM FOR 2023-2025 FALL INTO TWO DOMAINS UNDERNEATH AN OVERARCHING GOAL OF ACHIEVING HEALTH EQUITY. THE TWO DOMAINS AND CORRESPONDING HEALTH NEEDS ARE: 1) ADVANCE HEALTH AND WELL-BEING BY ADDRESSING: CHRONIC ILLNESS, SPECIFICALLY, HEART DISEASE, DIABETES, AND OBESITY; BEHAVIORAL HEALTH, SPECIFICALLY, MENTAL HEALTH AND SUBSTANCE ABUSE; AND ACCESS TO CARE 2) BUILD RESILIENT COMMUNITIES AND IMPROVE SOCIAL DETERMINANTS OF HEALTH BY IMPROVING EMPLOYMENT BY BUILDING EDUCATION AND TRAINING OPPORTUNITIES; INCREASING ACCESS TO HOUSING AND WRAP-AROUND SERVICES. THIS PRIORITY LIST OF HEALTH NEEDS AND THE DATA COMPILED TO SUPPORT THE SELECTION LAYS THE FOUNDATION FOR CHRISTUS SPOHN HEALTH SYSTEM TO REMAIN AN ACTIVE, INFORMED PARTNER IN POPULATION HEALTH IN THE REGION FOR YEARS TO COME.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
CHRISTUS Spohn 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. A new bill is generated if the patient qualifies for charity care or a discount. Patients who do not provide the required documentation are considered ineligible and are billed accordingly. If the documentation is provided later, the patient may be determined to be eligible for charity care or a discount. The billing office retains documentation 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. 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 Spohn Health System is located along the lower Texas coastal area (often called the coastal bend), which includes a 14-county region with a population of more than 600,000 individuals. While CHRISTUS Spohn's service area is vast, it has hospitals strategically located in four coastal bend counties: Bee, Jim Wells, Kleberg, and Nueces. These four counties have a total population of 465,734 residents; the community information for the four hospital counties reflects the communities of the coastal bend region while representing the bulk of individuals using CHRISTUS Spohn's services. Just over 75% of the four-county population resides in Nueces county. Seventy-eight percent of residents in the four counties live in Nueces county, the only urban county, while the remaining 22% live in the remaining rural counties. This mirrors the urban-rural breakdown of the Texas population statewide. The population within the four-county area had a population change of 4.7% from 2010 to 2017. Individuals aged 18 to 64 (working-aged adults) constitute 61% of the total population. Of the remaining population, 14% are 65 and older, 18% are school-aged children, and 7% are in infancy or early childhood. Overall, the population ages 65 and older are slightly higher than that of the population of Texas (12%). Compared to Texas, the population of the four counties where CHRISTUS Spohn has hospitals has a higher proportion of Hispanic residents. The Hispanic/Latino population in the area is 64%. This is significantly higher than the state of Texas at 39% and 17% of total U.S. citizens. The Asian, Native Hawaiian/pacific islander, and Native American/Alaska Native categories comprise less than 2% of the area's population. The area's population is evenly distributed by gender (50% male, 50% female), mirroring the gender distribution of Texas and the U.S. Consolidated median income data for the four-county area is not available. Still, county-level data shows that Nueces county has a median annual family income of just over $14,000 higher than bee county ($61,273 compared to $47,234). For all four counties, the income level is lower than Texas' median family income ($64,585). Poverty is widespread in the area, with 40% of residents across the four counties earning annual incomes at or below 200% FPL. Bee county and Jim Wells county have even higher poverty at 47% and 48%, respectively. According to 2019 federal guidelines, 200% FPL corresponds to an income of $51,500 per year for a family of four. Spanish-speaking populations have higher poverty rates than English-speaking populations in the area (16% versus 19%). The poverty within the English-speaking population mirrors the Texas and U.S. poverty levels. At the same time, the poverty within the Spanish-speaking population is lower than the Texas and U.S. poverty levels (19%, 24%, 23%). The high school graduation rate for the region is on par with Texas for the four-county area. However, when broken down by county, Bee county, and Jim Wells county have a higher percentage of the population that have not completed high school at 29% and 27%, respectively. College graduation is significantly lower in the region compared to the state of Texas at 26% versus 35%, respectively. The four-county area's unemployment rate is similar to the state of Texas, while food insecurity is slightly lower. Eleven percent of the four-county area residents experience food insecurity (i.e., uncertainty about whether they will be able to get enough nutritious food at some point during the year) compared to about 15% of Texas residents. At 18%, the rate of uninsured in the report area is the same as Texas' rate of uninsured. Less than 1% of elderly adults in the area are uninsured due to the availability of Medicare coverage for the age group. In contrast, 1 in 4 working-age adults in the report area are uninsured, and approximately 1 in 10 children living in the report area are uninsured. Currently, Texas remains among the 14 states that have declined to expand Medicaid.