4A (Expenses $ 5556936721 including grants of $ 18524963) (Revenue $ 6694634314)
Memorial Hermann Health System is a nonprofit, values-driven, community-owned health system dedicated to improving health. Our vision is to create healthier communities, now and for generations to come. Our values are community, compassion, credibility, and courage. Charting a better future. A future that's built upon the HEALTH of our community. This is the driving force for Memorial Hermann, redefining health care for the individuals and many diverse populations we serve. Our 6,700 affiliated physicians and 30,000 employees practice the highest standards of safe, evidence-based, quality care to provide a personalized and outcome-oriented experience across our more than 260 care delivery sites. As one of the largest not-for-profit health systems in Southeast Texas, Memorial Hermann has an award-winning and nationally acclaimed Accountable Care Organization, 17 hospitals and numerous specialty programs and services conveniently located throughout the Greater Houston area (Memorial Hermann Health System owns and operates 14 hospitals and has joint ventures with three other hospital facilities, including Memorial Hermann Surgical Hospital First Colony, Memorial Hermann Surgical Hospital Kingwood and Memorial Hermann Rehabilitation Hospital-Katy). Beginning in 1990, U.S. News & World Report has ranked our nation's leading hospitals annually. And in every one of those years, TIRR Memorial Hermann has been named among the very best rehabilitation hospitals in the United States. TIRR Memorial Hermann ranks best in Texas and No. 3 in the nation for rehabilitation. Memorial Hermann-Texas Medical Center is one of the nation's busiest Level I trauma centers and serves as the primary teaching hospital for McGovern Medical School at UTHealth. Memorial Hermann-Texas Medical Center was ranked #4 best hospital in Texas, and also listed in the U.S. News rankings in the specialty areas of Cardiology and Heart Surgery, Ear, Nose and Throat, and Gastroenterology and GI Surgery. Also making the Top 10 statewide rankings were Memorial Hermann Greater Heights Hospital and Memorial Hermann Memorial City Medical Center were tied at #6. Children's Memorial Hermann Hospital was nationally ranked in Pediatric Cardiology and Heart Surgery, as well as Pediatric Neurology and Neurosurgery. The Heart Center at Children's Memorial Hermann Hospital has earned the Society of Thoracic Surgeons' (STS) highest rating for quality related to patient care and congenital heart surgery outcomes. Only 12 pediatric heart programs in the United States and Canada earned the distinguished STS three-star rating for congenital heart surgery, following analysis of data collected from 119 participating programs from January 2014 to December 2017. The STS star rating system is one of the most highly regarded overall measures of quality in health care, comparing the nationally benchmarked outcomes of cardiothoracic surgery programs in the U.S. and Canada. For the seventh time, Memorial Hermann Memorial City Medical Center was named one of the nation's top 100 hospitals by IBM Watson Health. Formerly known as the Truven Health Analytics 100 Top Hospitals, the study spotlights the best-performing hospitals based on a scorecard of publicly available clinical, operational and patient satisfaction metrics and data. Memorial Hermann Southeast Hospital, Memorial Hermann Greater Heights Hospital, Memorial Hermann Southwest Hospital and Memorial Hermann The Woodlands Medical Center all have received Chest Pain Center accreditation from The Joint Commission (TJC). An independent, not-for-profit organization, TJC accredits and certifies nearly 21,000 healthcare organizations and programs in the United States. Healthcare organizations that have received this accreditation have demonstrated a high level of expertise in dealing with patients with heart attack symptoms. Memorial Hermann-Texas Medical Center (TMC) and Memorial Hermann Memorial City Medical Center earned national recognition as top performers for superior quality and safety by the Vizient Quality and Accountability Study. Memorial Hermann-TMC received the 2018 Bernard A. Birnbaum, MD, Quality Leadership Award for Academic Medical Centers, and ranked ninth of 99 participating academic medical centers. Memorial Hermann Memorial City received the 2018 Bernard A. Birnbaum, MD, Quality Leadership Award for Complex Teaching Medical Centers, ranking seventh among 100 participating teaching medical centers. Memorial Hermann Sugar Land Hospital was named a recipient of the 2016 Malcolm Baldrige National Quality Award, the nation's highest Presidential honor for performance excellence. U.S. Commerce Secretary Penny Pritzker made the announcement recognizing Memorial Hermann Sugar Land for its outstanding commitment to sustainable excellence through innovation, improvement and visionary leadership. Since the healthcare category was introduced in 1999, only 21 healthcare organizations nationwide have been awarded the Malcolm Baldrige National Quality Award. Memorial Hermann Sugar Land was the first Houston area hospital and the third in Texas to win the prestigious award. For more than 114 years, our focus has been the best interest of our community. During the fiscal year, Memorial Hermann Health System provided community benefits of more than $474 million (as reported on the Internal Revenue Service Form 990, Schedule H) annually through financial assistance, school-based health centers, and other community benefit programs. During the fiscal year, Memorial Hermann admitted 172,080 patients resulting in 1,000,654 days of care, delivered 26,167 babies, had 689,795 emergency visits, 3,200 life flight missions, and over 890,000 diagnostic and therapy visits. Now and for generations to come, the health of our community will be at the center of what we do - charting a better future for all.

PART V, SECTION B, LINE 5
Memorial Hermann Health System took into account input from persons representing the community through key informant interviews and a community survey. A total of 47 key informant interviews were conducted with leaders and staff from organizations that provide services directly to the community and officials that represent governmental and non-governmental entities. Interviewees invited to participate were recognized as having expertise in public health, special knowledge of community health needs, representing the broad interests of the community served by the hospital, and/or being able to speak to the needs of medically underserved or vulnerable populations. The interviews took place between October 25, 2021, and February 11, 2022. Interview questions focused on the interviewee's background and organization, the biggest perceived health needs and barriers of concern in the community, and the impact of health issues on the populations they serve. Input from community residents was collected through an online survey. The survey consisted of 12 questions related to top health needs in the community, individuals' perception of their overall health, individuals' access to health care services, as well as demographic, social, and economic determinants of health. The community survey was distributed online through SurveyMonkey from November 17, 2021 to January 28, 2022. Online survey distribution included email outreach and social media posts. Paper surveys were also made available and answers to the paper survey were entered into the SurveyMonkey tool. Both online and paper formats of the survey were made available in English and Spanish. A total of 1,056 responses were collected. Survey respondents were asked to select top issues most affecting the community's quality of life. The majority of respondents identified Obesity/ Overweight, Mental Health and Mental Disorders, Diabetes, Substance Abuse (alcohol, tobacco, drugs, etc.), and Cancers as top issues in the community. The following list of organizations contributed key informant interviews: AccessHealth (FQHC); Alvin City; Alvin ISD Board of Trustees; Avenue CDC; Baker Ripley; Catholic Charities - Archdiocese of Galveston; Child Advocates of Fort Bend; Children at Risk; Colorado County - Indigent Health Care; Department of State Health Services; East Fort Bend Human Needs Ministry; El Centro de Corazon; Episcopal Health Foundation; Fort Bend County Health and Human Services; Fort Bend County Sheriff's Office; Healthcare for the Homeless - Houston; Houston Galveston Institute (HGI); Houston Health Department; Houston Housing Authority; Interfaith Community Clinic; Kinder Institute for Urban Research; Legacy Community Health; Liberty County Sheriff's Office; LoneStar Family Health Center; Montgomery County Food Bank; Patient Care Intervention Center (PCIC); Pearland ISD School Board; Prairie View A&M - College of Nursing; Santa Maria Hostel, Inc.; Texas House of Representatives - District 29. CHNAs were designed in accordance with CHNA requirements identified in the Patient Protection and Affordable Care Act and further addressed in the Internal Revenue Service final regulations released on December 29, 2014.

Part V, Section B, Line 7
https://www.memorialhermann.org/giving-back/community-benefit/reports-comm unity

Part V, Section B, Line 10
https://www.memorialhermann.org/giving-back/community-benefit/reports-comm unity

Part V, Section B, Line 11
Memorial Hermann continually identifies and meets the region's healthcare needs, committed to making greater Houston a healthier and more vital place to live. To support and engage our community, the foundation for our work rests on four intersecting pillars - Access to Health Care, Emotional Well-being; Food as Health, and Exercise is Medicine - designed: to provide care for uninsured and underinsured; to reach those Houstonians needing low-cost care; to support the existing infrastructure of non-profit clinics and federally qualified health centers; to address mental and behavioral care services through innovative access points; to work against food insecurity and physical inactivity; and to educate individuals and their families on how to access the services needed by and available to them. These four tenets became the system's expanded focus to address the 60% of health that is determined by lifestyle and environment to impact the 20% of health that is impacted by traditional health care. Signature, cornerstone initiatives supporting the four pillars include: health centers for schools; mobile dental vans; ER navigators; community resource centers; nurse health line; StepHEALTHY (physical activity programming); park activations; culture of food health (nutrition literacy and food access); neighborhood health centers; and mental health crisis clinics. The 2022 CHNA findings resulted from the analysis of an extensive set of secondary data (over 200 indicators from national and state public secondary data sources) and primary data collected from community leaders, non-health professionals, and organizations serving the community at large, vulnerable populations, and/or populations with unmet health needs. Through an examination of the primary and secondary data, the following top health needs were identified: access to healthcare; cancers; children's health; diabetes; heart disease/stroke; injuries, violence, and safety; mental health and mental disorders; obesity/overweight; older adults/elderly care; oral health; physical activity; respiratory/lung disease (asthma, COPD, etc.); substance abuse (alcohol, tobacco, drugs, etc.); wellness and lifestyle; women's health. Eighty stakeholders from the 13 licensed facilities in the Memorial Hermann Health System completed a survey to prioritize the significant health issues, based on criteria including: Ability to Impact: the perceived likelihood of positive impact on each health issue; and, Scope & Severity: gauge on the magnitude of each health issue. With Memorial Hermann's four pillars designed to deliver effective upstream interventions, addressing the above identified community needs continue to fall within our four pillars: access to healthcare; emotional well-being; food as health; exercise is medicine. The CHNA process enables each hospital within Memorial Hermann to develop programs and services that advance the health of its community, building the foundation for systemic change across the greater Houston area. Memorial Hermann supports initiatives that increase patients' access to care to ensure they receive care at the right location, at the right cost, at the right time. Ongoing efforts include system-wide programs like Nurse Health Line - a 24/7 free resource where community members (uninsured and insured) within the greater Houston community can call to discuss their health concerns, receive recommendations on the appropriate setting for care, and get connected to appropriate resources; ER Navigation - navigating uninsured and Medicaid patients that access the ER for primary care, treatable and avoidable issues, to a medical home; and OneBridge Health Network - connecting uninsured patients, meeting eligibility criteria, including a referral from a PCP, with the specialty care connections they need to get well. Additional efforts include: transportation vouchers to provide a safe way home upon discharge; Neighborhood Health Center vouchers through the ER Case management team to promote awareness of and improve access for the appropriate level of care; offering access to teen pregnancy information and resources to expecting students at schools including at-risk, low income, underserved children; participating in Project Mammogram - a community program offering free mammograms and breast ultrasounds to qualifying area women and men; partnering with schools to provide a concussion trained PCP or ED physician on site at High School sports events; offering short-term medications/prescriptions upon discharge for uninsured; providing skilled nursing services and post hospitalization follow-up visit upon discharge for the uninsured/underinsured; participating in a Physician Match Program for those lacking health insurance where physicians at the hospital may provide services to patients without insurance and the hospital matches the physician contribution; offering Resource Assistance Connections; and, offering Community Resource Centers on the campuses of select hospitals to engage a variety of service providers to provide a continuum of community care to underinsured, discharged patients and community clients. System-wide initiatives focusing on emotional well-being and that connect and care for community members experiencing a mental health concern include access to appropriate psychiatric specialists at the time of their crisis with the Memorial Hermann Crisis Clinics; ER support and community connections through the Memorial Hermann Psychiatric Response team; connections between medical and mental health providers with the Memorial Hermann Integrated Care Program; and, knowledge to navigate the system, regardless of their ability to pay through support from Memorial Hermann Psychiatric Response Case Management. Implemented initiatives concentrating on food as health and increase awareness of food insecurity, provision of food programs, and education that promotes the reduction/postponement of chronic disease include: screening for food insecurity via ER staff and care managers and connecting patients to Houston Food Bank for SNAP eligibility and food pantry connections. Memorial Hermann also conducts various education and support groups for members within the hospital and the surrounding community, including Amputation Support Group; Mended Hearts Support Group; Heart and Stroke Support Groups (including STEMI) to encourage a change in knowledge and health status; Diabetes Support Group, including nutrition classes with healthy nutritional recipes to individuals with a diabetes diagnosis. Memorial Hermann also provides blood pressure screenings at community and hospital events; offers low-cost heart screenings to youth athletes; provides low cost/free school athletic physicals; participates in seasonal community food and supply drives to support those struggling with food insecurity; participates in the American Heart Association's Annual Heart Walk to raise funds for the organization and create awareness in the community around heart health activities; provides access to information/services to support management of chronic or life-threatening diseases through free Oncology Nutrition Therapy consults to cancer patients and their caregivers; and, offers free breastfeeding support groups, general education about breastfeeding and donation, and acts as Milk Bank Donor Depot donation centers via a partnership with the Austin milk bank. Implemented initiatives that encourage physical activities and that promote improved health, social cohesion, and emotional well-being through exercise is medicine include: improving health and social cohesion through food distribution and 'a walk in the park' at Moody and Castillo Parks in the Near Northside; improving health and social cohesion through Walking Clubs (including Walk with a Doc), Dancing with a Doc, Senior Fitness, and Soccer for Success; participating in a Pediatric Weight Loss Management Program in which a population 12-17 years are taught nutrition including healthy meal recipes, how to pack a healthy lunch, how to eat out healthy, how to read food labels, and exercising for better health; providing support of local adaptive sports leagues; offering physical activity classes such as yoga, tai chi, Zumba, and Pilates; and, working with Healthy Outdoor Communities - a community collaborative to create thriving parks and communities and contribute to integrated programming and resources that promote more active and healthy outdoor lifestyles leading to better mental health, well-being, and resiliency in children and youth of color and their families as well as the community at large. The following additional significant health needs emerged: Older Adults and Elderly Care, Cancer, Children's Health and Women's Health. These topics have not been specifically prioritized, but due to the interrelationship of social determinants and health, many of these areas fall, tangentially, within the prioritized health needs and may be addre

Part V, Section B, Line 13b
Patients who have an outstanding account balance owed on their hospital bills may be eligible for a discount if all of the following criteria are met: 1) balance exceeds ten percent of the person's annual gross family income; 2) they are unable to pay all or a portion of the remaining bill balance; and 3) the bill balance is at least $5,000. Under these circumstances, the patient or guarantor is expected to cooperate with the financial assistance process and supply personal or financial information and documentation relevant to making a determination of eligibility. If approved, the patient will be responsible for paying no more than ten percent of their annual gross family income towards the remaining outstanding account balances or AGB discount will be applied, whichever is less and most beneficial for the patient's financial situation.

Part V, Section B, Line 16
https://www.memorialhermann.org/patients-visitors/patient-services/financi al-care/financial-assistance-program

Part I, Line 3c
Patients who have an outstanding account balance owed on their hospital bills may be eligible for a discount if all of the following criteria are met: 1) balance exceeds ten percent of the person's annual gross family income; 2) they are unable to pay all or a portion of the remaining bill balance; and 3) the bill balance is at least $5,000. Under these circumstances, the patient or guarantor is expected to cooperate with the financial assistance process and supply personal or financial information and documentation relevant to making a determination of eligibility. If approved, the patient will be responsible for paying no more than ten percent of their annual gross family income towards the remaining outstanding account balances or AGB discount will be applied, whichever is less and most beneficial for the patient's financial situation.

Part I, Line 6a
Memorial Hermann Health System prepares and files an annual report of community benefit plan with the Texas Department of State Health Services. This report is made available through the organization's webpage at https://communitybenefit.memorialhermann.org/about-us/report-to-the-commun ity/

Part I, Line 7
A cost-to-charge ratio is used to calculate the amounts on line 7a. The remaining lines are calculated from the books and records of specific segments of the organization.

Part I, Line 7, Column (F)
The bad debt expense is included on Form 990, Part IX, Line 25, column (a), but removed for purposes of calculating the percentage in column (f) totaled $0.

Part III, Line 2
Bad debt expense is determined based on GAAP and is explained under significant accounting policies within section net patient service revenue and patient accounts receivable in the consolidated audited financial statements.

Part III, Line 4
Footnotes related to Accounts Receivable and Allowance for Doubtful Accounts can be located on pages 8 through 11 on Memorial Hermann Health System's fiscal year ending 2022 consolidated audited financial statements. Memorial Hermann entered zero on Schedule H, Part III, Line 3. From prior experience, the organization believes a portion of bad debt expense may be attributable to patients who would otherwise qualify for financial assistance. The organization estimates this could range from 0-5 percent. Memorial Hermann makes efforts to educate patients about its financial assistance program. Regardless, patients may choose not to apply for financial assistance or provide complete applications. See Part VI supplemental information line 3c narrative for more information regarding Memorial Hermann's efforts to inform and educate patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's financial assistance policy.

Part III, Line 8
Reasons why the Medicare shortfall reported on Line 7, if any, should be treated as a community benefit include: absent the Medicare program, many of the individuals would likely qualify for financial assistance or other needs-based government programs; as payments to treat Medicare individuals are below cost of care, the burdens of government are relieved relative to these patients, Memorial Hermann Health System provides care to Medicare patients regardless of any Medicare shortfall; the real possibility that continued reductions in reimbursement may create further difficulties in access to care for Medicare patients; financial resources utilized to cover any Medicare shortfall is no longer available to cover financial assistance and any other community benefit needs; IRS Revenue Ruling 69-545 provides, in part, that hospitals serving patients with governmental health benefits, including as an example Medicare, is an indication that the hospital operates for the promotion of health in the community; Texas nonprofit hospitals must provide a minimum level of community benefit in order to obtain exemption from state and local taxes. According to the current Texas health and safety code, the unreimbursed cost of Medicare is considered to be a community benefit in determining these state statutory requirements as it helps relieve a governmental burden of providing this care that would otherwise be provided through the county hospital system in Texas. The amount reported in Part III, Section b, on Line 7 was calculated in accordance with the Schedule H instructions utilizing the organization's allowable cost reported in the Medicare cost reported based on a cost to charge ratio.

Part III, Line 9b
Memorial Hermann Health System's billing and collection policy prohibits any collection efforts for the portion of a patient's account balance that qualifies for assistance under the organization's financial assistance policy. With respect to any remaining balance due, if any, the billing and collection policy contains actions which may be taken in the event of nonpayment and are applied equally to all patient types.

Part VI, Line 5
Memorial Hermann Health Center for Schools Memorial Hermann Health Centers for Schools is comprised of ten school-based clinics and three mobile dental vans and designed to be a holistic medical, mental health, and dental home for uninsured and underinsured children and a secondary access point for insured children. Health Centers for Schools exist in 10 locations serving children in 80+ schools throughout the Houston, Pasadena, Alief, Aldine and Lamar Consolidated School Districts. Services offered include sick and well-visits, sports physicals, immunizations, chronic care for asthma, obesity, cholesterol, etc., mental health therapy, navigation services, and nutritional guidance. Three Mobile Dental Clinics rotate among the centers, providing restorative as well as preventive dental care. These school-based health centers (SBHCs) are located in schools and school districts with students with documented barriers to healthcare. Through transportation from feeder schools, the SBHCs offer accessible healthcare to children who would otherwise not obtain it and keep children in school where they can learn. With appropriate consent, students can be seen without their parent. No payment is collected beyond billing Medicaid. All ten Health Centers for Schools operate Monday through Friday, 40 hours/week, 12 months/year. Providing services to patients from a variety of cultural and socio-economic backgrounds, Health Centers for Schools serve individuals who have barriers to health care beyond the status of insurance. Neighborhood Health Centers - Northeast, Northwest, and Southwest Bridging the gap for primary care, for individuals and families without private health insurance and who do not qualify for sliding-scale federal poverty coverage at area FQHCs, are our three Neighborhood Health Centers (NHCs). Each center provides preventative, acute, and chronic care at little more than cost. An essential step in establishing the NHC as a patient's primary care home is education on how to navigate the healthcare delivery system and the importance of maintaining wellness visits and good health. NHCs are open every day, with extended hours for walk-ins as well as scheduled appointments. ER Navigators (Community Health Workers) Placed in all Memorial Hermann ERs, Community Health Workers (CHWs) meet with patients to help eliminate barriers to healthcare access issues and connect to medical homes. With 27,000 annual initial ER interventions, each with follow-up calls, ER Navigation realizes a 72% decrease in ER visits in the 6-month pre/post navigation intervention time frame and 62% in the 12-month time frame. The Community Resource Centers at Memorial Hermann Hospitals Southwest, Greater Heights, and Northeast The Memorial Hermann Community Resource Center at Southwest is a pilot program located inside Memorial Hermann Southwest Hospital (MHSW) professional building. The Center is designed to offer MH Southwest Hospital Emergency department, onsite physicians and care managers, as well as community members with accessing community resources, some of which will provide scheduled services on site; completing eligibility applications; and, receiving information and education on public health and social services. To date, specific services include: assistance enrolling in public health insurance; applications for public social services (SNAP, WIC, etc.); and referrals to the onsite partners that have begun to provide weekly schedules at the Center (Houston Food Bank, area Federally Qualified Health Centers, Memorial Hermann Behavioral Health and Chronic Disease prescription assistance). As we work with our clients and community, we are continually assessing the need and opportunities for new partners. The goal is for collaboration with patients, the community, and service providers to result in upstream factors and efforts. OneBridge Health Network (Previously Provider Health Network) In an effort to close the loop for needed specialty care, OneBridge Health Network was created. Our Federally Qualified Health Center partners can be connected to volunteer specialists to address debilitating conditions that, if treated, can return the patient to feeling well and improved quality of life. OneBridge verifies that patients qualify for the specialty care, ensures pre-specialty visit testing is completed, provides navigation support for other quality-of-life needs, and ensures seamless transition from referring primary care provider to specialist and back to primary care provider. Pathways for Health, Pathways for Costs Pathways for Health, Pathways for Costs is a program that engages under-insured and uninsured patients being discharged from the hospital. The program is appropriate when clinicians think the patient will require further hospital services as a result of not having the support structures in place to follow through with their health issue post-discharge. Pathways are designed to identify patients, assist them in scheduling and understanding their upcoming outpatient procedures, and assess other needs or barriers to care. The initial effort is a paracentesis pathway (i.e., needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid for diagnostic or therapeutic purposes) in which patients admitted for abdominal distortion, liver disease or ascites (i.e., accumulation of fluid in the peritoneal cavity, causing abdominal swelling) are placed on regular outpatient schedules. This process results in patients not postponing their care, avoid costly ER visits and emergency procedures, and remain more in control of their health with improved quality of life. Food as Health Recognizing that the lack of access to and understanding of healthy foods is a connection to health, the Food as Health program was initiated in 2015. Efforts reside in a variety of environments, all with the goal of reducing food insecurities and freeing up purchasing dollars for other needs. Patients identified as food insecure receive a referral to the Houston Food Bank and guidance on questions to ask for an appropriate food pantry referral. Discharged patients at hospitals with Community Resource Centers are provided with a basic food care package. Food distribution occurs bi-monthly in the Near Northside. School-based clinic families, educated by our dietitians on utilizing affordable whole foods have access to at least 30 pounds of free fruits and vegetables plus additional whole foods twice a month. All of the programs provide access to Community Health Workers to assist in enrolling for the very essential SNAP benefits. Creating a healthy eating environment that is fruitful, educational, and sustainable, the Culture of Food Health initiative focuses on enhancing green spaces by creating nutrition hubs in which community residents can attend nutrition education classes, agricultural and gardening workshops, and offer an access point to obtain healthier food items through a community garden. Exercise is Medicine (EIM) EIM focuses on helping residents to self-manage their health and wellness with exercise and physical activity programming, Memorial Hermann collaborates with partners across the region to activate park features and promote safe, engaging, culturally appropriate opportunities for people to get fit within their own neighborhoods and communities. Physical activity is promoted through a variety of programs, all with the goal of providing education on the benefits of regular exercise from emotional wellbeing to support in combating chronic diseases and health complications. Memorial Hermann Mental Health Crisis Clinics Memorial Hermann is a safety net system for Greater Houston's most vulnerable, especially patients with mental health issues. In 2013, we conducted considerable community engagement with partners and local stakeholders, reviewed over a decade of referral data, identified gaps in our region and studied public transportation routes; all of this led to the creation of our Mental Health Crisis Clinics (MHCC), an innovative access point. Three clinic locations were selected in retail centers with careful signage to minimize the stigma associated with accessing behavioral health. While COVID-19 has exacerbated mental health needs in our community, our MHCCs eliminate the 90-plus day wait time to be connected to outpatient behavioral health. MHCCs offer psychiatric urgent care, so any patient in need can walk-in, without an appointment, and be immediately assessed and cared for by a licensed mental health team. Extended and weekend hours enable patients to access care during non-traditional hours. Our care team includes board certified adult and child psychiatrists, psychiatric-focused nurse practitioners and physician assistants, behavioral health clinicians and support staff. Every patient is systematically screened for suicide risk, assessed by our team and participates in psycho-social education. As appropriate, clinicians create

Part VI, Line 7
Texas

Part VI, Line 2
Improving the health of a community is essential to enhancing the quality of life for residents in the region and supporting future social and economic well-being. In 2013, in 2016, 2019 and most recently in 2022, Memorial Hermann Health System engaged in a community health planning process that was two-fold: (1) a Community Health Needs Assessment (CHNA) to identify the health-related needs and strengths of the community and (2) a Strategic Implementation Plan (SIP) to identify major health priorities, develop goals, and select strategies and identify partners to address these priority issues across the community. The CHNA was guided by a participatory, collaborative approach, which examined health in its broadest sense. This process included integrating existing secondary data on social, economic, and health issues in the region with qualitative information from a community survey with community residents and service providers and interviews with community stakeholders. The CHNAs were conducted in accordance with state and federal guidelines including IRC Section 501(r) and the Texas Health and Safety Code Section 311.

Part VI, Line 3
Memorial Hermann Health System is committed to making healthier communities, now and for generations to come. Patients who qualify for financial assistance through Memorial Hermann's Financial Assistance Program may be notified in the following ways: patient consent-the health care consent that is signed upon registration for healthcare services includes a statement that if charity services are required, eligibility determination should be requested upon admission to the hospital or upon receipt of itemized bill or statement; financial counseling: Memorial Hermann patients are encouraged to seek information from their hospital's financial counselor if they anticipate difficulty paying their portion of the hospital bill. Our financial counselors will make every effort to assist patients who are uninsured, underinsured, or face other financial challenges associated with paying for the health care services we provide. Financial counselors may screen patients for eligibility for a variety of government funded programs, assist with a worker's compensation or liability claim, set up an extended time payment plan, or help patients apply for financial assistance, plain language summary and application. A paper copy of the plain language summary of Memorial Hermann's FAP and a paper copy of the financial assistance application will be made available to all patients at the earliest practical time of service. Memorial Hermann will have free paper copies of these documents available upon request in the emergency department and registration areas. Free paper copies are also available by mail or by calling 713-338-5502 or 1-800-526-2121, option 5; translated copies available: Memorial Hermann translates its FAP, plain language summary, financial assistance application, and billing and collections policy for limited English proficient individuals representing the lesser of five percent or 1,000 individuals of the community served by its hospital facilities. Memorial Hermann makes free copies of these documents available on the Memorial Hermann website and upon request in the emergency department and hospital registration areas. Free paper copies are also available by mail by calling 713-338-5502 or 1-800-526-2121, option 5; signage- all financial assistance signage will be clearly and conspicuously posted in locations that are visible to the public, including, but not limited to, Memorial Hermann emergency department and patient registration areas. Signage will indicate that financial assistance is available and the phone number to reach a financial counselor for more information; website - Memorial Hermann's post notice in a prominent place on its website that financial assistance is available, with an explanation of the financial assistance application process. Memorial Hermann posts its FAP with a list of providers who are covered and not covered under the FAP, plain language summary, financial assistance application, and the billing and collections policy on Memorial Hermann's website; patient bills and statements - patient statements will include a request that the patient is responsible to inform Memorial Hermann of any available health insurance coverage, and will include a notice of the Memorial Hermann FAP, a telephone number to request financial assistance, and the website address where financial assistance documents can be obtained; mail or fax: patients may mail or fax a written request for free copies of these documents to the address below and including the individual's full name and return mailing address to which they want Memorial Hermann to send the copies. Memorial Hermann Health System, ATTN: Financial Assistance, 909 Frostwood, Suite 3:100 Houston, Texas 77024, fax: 713-338-6500 Assistance, 909 Frostwood, Suite 3:100 Houston, Texas 77024, fax: 713-338-6500 713-338-6500 713-338-6500 713-338-6500 713-338-6500 713-338-6500.

Part VI, Line 4
Demographics: Memorial Hermann serves the region of Greater Houston, including areas along the Gulf Coast in Southeast Texas, where several counties are without hospital district services. The Metropolitan Service Area is home to roughly 7 million people-the fifth largest in the U.S.-and it continues to be one of the fastest growing. We are proud of our diversity, with no racial or ethnic majority present; the population is 36% White, 38% Hispanic, 17% Black, and 8% Asian, and nearly 1 in 4 residents are foreign born, contributing to a wide variety of cultures and ethnicities throughout the region. Immigration is a valued part of our identity, and roughly 40% of residents speak languages other than English at home. Twenty-seven percent of the total population are minors, and 10% are over 65 years of age, resulting in a potential workforce of approximately 4.3 million. Notably, only 33% of those 25 years of age and older have a college degree or higher. Prior to the COVID-19 pandemic, 16% of all residents fell at or below the Federal Poverty Threshold. Major Employers: Houston's unemployment rate spiked during 2020 due to the COVID-19 pandemic, but ended 2021 at just 4.8%. The energy industry dominates the Houston economy, but grocery stores and health care (including Memorial Hermann Health System, MD Anderson Cancer Center, and Houston Methodist) are the largest employers, along with United Airlines. Memorial Hermann collaborates with these health systems on community improvement efforts. Reducing poverty and increasing existing graduation rates (a goal of our Health Centers for Schools initiative) is paramount to supporting our economy's continued strength and prosperity across all sectors. Key Community Health Needs Assessment Findings (Significant Health and Social Service Challenges): Pre-pandemic, the percentage of Harris County's population without health insurance totaled 20.8%, higher than the state average of 17.7% and more than double the national average of 8.9%. Current estimates escalate this rate to 24.2%. Without insurance, people skip services that detect underlying health issues, leading to delayed treatment, poor outcomes, and higher costs. The rising rate of obesity is the single biggest threat to the Greater Houston area; 34% of adults are overweight, increasing the risk of dying from cancer, heart disease, stroke, diabetes, liver disease and kidney disease. With 20% of adults self-reporting five or more poor mental health days a year, the need for increased access to behavioral health care is significant and projected only to escalate in the aftermath of the pandemic. In addition, health disparities exist across different races and ethnicities: half of Hispanics are without a usual source of care; African American women are three times more likely to die from a pregnancy related death than other racial groups; and African Americans have experienced significantly higher infection and death rates from COVID-19 than white Americans. COVID-19: More than 1,540,000 individuals in the region have been infected with COVID-19, and more than 15,000 did not survive. Throughout the pandemic, Memorial Hermann worked collaboratively with other health care organizations to expand access to COVID-19 vaccines. Food insecurity spiked during the pandemic, with nearly 30% of households reporting not having enough to eat. Those rates have reduced but remain at an average of 15%. Houston has ranked among the top three cities in the nation for evictions filed during the pandemic.

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Memorial Hermann Health System is a non-profit, values-driven, community-owned health system dedicated to improving the health of the communities we serve. We are one of the largest not-for-profit health systems in southeast Texas and the second largest employer in the area. With a market share of 27% in the 12 counties that comprise Greater Houston, our vision is to create healthier communities, now and for generations to come. Governed by a Board of 22 community members, our integrated system of 6,700 affiliated physicians and 29,000 employees practices the highest standards of safe, evidence-based quality care as we strive to provide a personalized and outcome-oriented experience across our 270 care delivery sites, including 17 (13 licensed) hospitals and numerous specialty programs and services conveniently located throughout the greater Houston area. With 115 years of history serving our region, our system is a trusted source for health care ranging from burn treatment and wound care, oncology, pediatrics, maternal health, diabetes and endocrinology, digestive health, general surgery, cardiovascular care, neurology and neurosurgery, nutrition, ophthalmology, orthopedics, rehabilitation, robotic surgery, transplants, weight loss and more. Our flagship hospital, Memorial Hermann-Texas Medical Center, houses one of the nation's busiest Level 1 trauma centers and serves as the primary teaching hospital for McGovern Medical School at UTHealth Houston. Memorial Hermann Life Flight, spearheaded by the late legend Dr. Red Duke, is the only hospital-based air ambulance service in Houston. Our system also runs the only comprehensive burn center in Houston and our Mischer Neuroscience Institute is the largest and most comprehensive neuroscience program in Texas. We are also a national leader in rehabilitation treatment and care, with TIRR Memorial Hermann ranking No. 2 this past year by U.S. News & World Report. All aspects of the health system - care delivery, physicians and health solutions are brought together to create a truly integrated health system. This breadth of service uniquely positions Memorial Hermann to collaborate with other providers to assess and create health care solutions for individuals in greater Houston's diverse communities; to provide superior quality, cost-efficient, innovative and compassionate care; to support teaching and research to advance the health professionals and health care of tomorrow; and to provide holistic health care which addresses the physical, social, psychological and spiritual needs of individuals. Memorial Hermann has an award-winning and nationally acclaimed Accountable Care Organization, and our Memorial Hermann physician network, MHMD, comprises physicians from Memorial Hermann Medical Group, UTHealth and private physicians and specialists. We offer leading-edge clinical expertise, patient-centered care, and leading-edge technology and innovation. Through Memorial Hermann's subsidiary, Memorial Hermann Community Benefit Corporation (MHCBC), Memorial Hermann implements programs to work with other healthcare providers, government agencies, business leaders and community stakeholders to ensure that all residents of the greater Houston area have access to the care they need to improve their quality of life and the overall health of the community. The mission of Memorial Hermann Community Benefit Corporation is to test and measure innovative solutions that promote good health for the individual, the health system and the community. MHCBC collaborates with others as well as creates signature, evidence-based ways to improve the communities where people live, work, learn, and play. MHCBC areas of expertise span access and navigation, nutrition and physical activity, support of the whole person, and rigorous outcome measurement. Primary program focus include education on, access to, and provision of primary medical, dental, mental health, and social service support to underserved populations; food as health; and, exercise as medicine. New programs are piloted, and proved programs are replicated in the community. Community benefit corporation funding tenets include: provision of primary and/or specialty care for the uninsured and underinsured; contribution to the existing infrastructure of non-profit clinics and FQHC's; programs, practices, and policies that affect the health of individuals, families, and communities; commitment to measurement; existence of collaborative partners; programmatic inclusion of health education and literacy; strive towards sustainability. As required by the Community Health Needs Assessment-Section 501(r)(3)-requirement of the acaACA, Memorial Hermann Community Benefit Corporation supports the Memorial Hermann Health System licensed acute care, rehab, and surgical and ER hospitals in conducting community needs assessments. The corresponding implementations strategies balance the individuality of the different hospitals with the system strategy of collectively supporting community objectives to achieve the necessary alignment and leverage to impact true community change.