4A (Expenses $ 32041198 including grants of $ 163147) (Revenue $ 46260316)
Texas Health Presbyterian Hospital Kaufman (THK) was opened in 1975 and is a 42 staffed bed hospital located in Kaufman, Texas. THK serves the rural community of Kaufman and the surrounding area. It offers a wide range of services including general surgery, orthopedic surgery, ICU, Telemetry, medical surgical care, and a 24 hour emergency department. THK provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The hospital provides care to persons covered by governmental programs including Medicare and Medicaid for reimbursement that does not always cover the cost of providing the care. Recognizing its mission to the community, services are provided to both financially indigent and medically indigent patients. To the extent reimbursement for services is below cost, THK recognizes the difference as charity care. Community benefit is also provided through many free programs to the community. These services are essential to provide complete healthcare to the communities they served. Some of these programs include Supported Senior Citizens in Kaufman County with free flu clinics, Health Fairs especially for Senior Citizens centers in Kemp and Kaufman, and community health fairs at local and surrounding service area schools. Community members were informed about such subjects as general health and high blood pressure. There was also blood pressure screening available free of charge, Matter of Balance Classes to Kaufman County Senior Citizens Monthly, diabetes education, and a Car Seat Fitting Station for the community. The hospital also supports the local community service area through volunteer time and monetary contributions. Programs sponsored include, but are not limited to, the local area school district, United Way, Meals on Wheels (Senior Connect), Salvation Army's food program, Angel Tree, local churches and the Kaufman Center Food Bank. THK also has a close relationship with the community college TVCC and Texas Tech University pharmacy program. THK had 4,529 patient days, 1,260 discharges, 28,667 outpatient encounters, and 22,336 emergency room visits during the 2021 calendar year.

Part V, Section B
Texas Health Kaufman Part V. Section B, Line 3e The significant health needs of the community are in line with the significant health needs that have been prioritized and identified in the current CHNA. Part V. Section B, Line 5 Texas Health Kaufman's (THK) 2019 CHNA was a collaborative process utilizing qualitative and quantitative methods to assess the health needs of persons within the service areas in the Southern Region, consisting of Erath, Johnson, Ellis & Kaufman Counties. The 2019 CHNA was conducted at the regional level to generate community-driven solutions for better integration in addressing the clinical and social needs of individuals living in North Texas. Between April 2018 and August 2018, the communities' health needs were assessed through key informant interviews, secondary data analysis, a windshield survey serving to assist asset-mapping through community observation and focus groups. Key informants and focus group participants included, but were not limited to faith community representatives, public health officials, lay community members, school officials and city administration. The organization engaged 138 community members with interests specific to the health of individuals in the Southern Region Counties in the CHNA development process. One hundred twenty-three of these community members were engaged across six separate focus groups held in zip-codes that were identified as underserved areas. Fifteen served as key informants, and the windshield survey was conducted by two Texas Health graduate fellows and four community health managers. To gain a comprehensive understanding of the health needs and priorities of individuals in this region, Texas Health used focus group sessions and key informant interviews to engage the medically underserved, low-income or minority populations along with representatives from the following community organizations: Cain & Associates; City of Cleburne; Compassion Counseling Center; Cornerstone Assembly of God; Elmo Crime Watch; Elmo Water Department; H-E-B Grocery; Hood County Committee on Aging; Hope Medical Clinic; Kaufman Chamber of Commerce; Lighthouse Center for Learning; Oakdale & Hannibal United Methodist Churches; Ruth's Place; Senior Connect; Southwest Adventist University; Specialized Fleet Services; Tarleton State University; Texas Department of State Health Services; Texas Veterans Commission; and Tri County Ford. Findings from all data sources (secondary data, interviews and focus groups, and the windshield survey/observational asset mapping) were compared. Recurring themes were pulled and analyzed to stratify the top medical and social determinant of health needs. The outlined needs/barriers will inform the development of the 2020 CHNA implementation plan, which will leverage integrated strategies across THR's internal and external stakeholders to enhance its service and program delivery in the target communities. Part V. Section B, Line 6a The 2019 CHNA for the Southern Region was done in collaboration with Texas Health Cleburne (THC), Texas Health Stephenville (THS), Texas Health Kaufman (THK), and Texas Health Huguley Hospital Fort Worth South. Part V. Section B, Lines 7a and 10a The most recently adopted implementation strategy and the CHNA is widely available on the following website at: https://www.texashealth.org/Community-Health/Community-Health-Needs-Assess ment Part V. Section B, Ln 11 The 2020 - 2022 implementation strategy focused on reforming the delivery of our services in the target communities. The hospital is part of the Texas Health Resources (THR) healthcare system, which developed a system-wide community benefit strategy to increase its hospitals' ability to impact the community health needs of the target areas with a higher focus on three health priorities. Through the prioritization process these three health priorities from the 2019 CHNA were determined to be ongoing issues that THR hospitals needed to address: 1. Behavioral Health 2. Chronic Disease Prevention & Management 3. Access to Health Services and Healthcare Navigation & Literacy In 2021, Texas Health Kaufman addressed significant health needs with the following approaches: 1. Behavioral Health 1a. Texas Health Community Impact 1a1. Through an RFP process by Texas Health Resources through its Texas Health Community Impact (THCI) Initiative, agencies in the Southern region were awarded grants to address depression, anxiety, and food insecurity among underserved individuals in specific zip-codes in the hospital's region. The collaborating organizations in this effort include Erath County United Way, Tarleton State University Health Sciences and Human Services, Meals on Wheels of Erath County, HOPE. Inc, Pantry and More, Basic Needs, Grace Place, Dublin Love Basket, AgriLife, Stephenville ISD, Texas Bank, Pecan Valley Centers for Behavioral and Developmental Healthcare, and Tarleton Army Senior Reserve Officer's Training Corps (ROTC). 2. Chronic Disease Prevention & Management 2a. Healthy Education Lifestyle Program (HELP) 2a1. The Healthy Education Lifestyle Program (HELP) is an innovative way of delivering diabetes and hypertension management to uninsured populations. Every HELP visit is comprised of three key components: an individual visit with a mid-level practitioner, including necessary lab testing; an education session by the nurse to increase health literacy; and a support group facilitated by a nurse, which is crucial for establishing and ensuring accountability for improved health outcomes. The goal of HELP is to increase the percentage of diabetic patients whose A1c levels were improved, and the percentage of patients whose blood pressure were controlled based in the management/treatment guidelines. The implementation of the HELP virtual clinic at THK increased their ability to serve eligible patients and report clinical outcomes of improved A1c levels and blood pressure. 2b. Diabetes Education 2b1. Texas Health Kaufman offers a support group to provide education and raise awareness within the community about diabetes and how to live with the condition. Components of the program include education on how to eat well, exercise with purpose and live a healthy lifestyle overall. In addition to this support group, THK also offers Diabetes Basics Classes to community members and local business in the community. 2c. Clinic Connect 2c.1. Historically, Texas Health Resources has funded the work of local community health clinics in its mission to improve the health of the people in the communities served. The goal of Clinic Connect is to create a collaborative relationship with local non-profit community-based clinics by providing financial support, educational opportunities, information sharing, and expanded services to improve healthcare access and quality for underserved and vulnerable populations. The Clinics receiving funds are required to report on specific process and outcome measures, including average wait time for appointments, percentage of diabetic patients whose A1c levels were improved, and percentage of patients whose blood pressure were controlled based on the management/treatment guidelines. In 2021, Texas Health Kaufman awarded a grant to Carevide Kaufman Clinic for the implementation of Clinic Connect. This award contributed to their ability to serve patients and report clinical outcomes of improved A1c, blood pressure. 3. Access, Literacy, and Navigation (ALN) 3a. Health Workshops 3a1. Child Automobile Safety Initiative (CASI) is a program focused on protecting children from injury in motor vehicle collisions by providing free car seat safety checks and community-based education. 3a2. Flu vaccination clinics were offered to local parishes and city residents by the Faith Community Nurses. All the priority health needs identified are being addressed by the hospital in the categories listed above. Part V. Section B, Line 13 h Although a patient may have been notified of the Financial Assistance Policy, there are times when the patient chooses not to complete the Financial Assistance Application. Texas Health routinely screens uninsured patients using an independent third party for financial assistance eligibility. Part V. Section B, Lines 16 a, b & c The FAP, FAP Application and the Plain Language Summary of the FAP were widely available at this website: https://www.texashealth.org/Costs-and-Billing/Financial-Assistance

Texas Health Kaufman
Part I, Line 3c - Patient Eligibility Patients with family income at or below 200% of applicable Federal Poverty Guidelines (FPG) may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. Patients with a family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income, as determined on a sliding scale based on FPG, may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income in relation to FPG. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's financial assistance application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a financial assistance application. Part I, Line 7 - Cost-to-Charge Ratio A cost-to-charge ratio is used to compute the amounts reported on Lines 7a-7c. The cost-to-charge ratio is derived from Worksheet 2 - Ratio of Patient Care Cost-to-Charges, as found in the Schedule H Instructions. The amounts reported on Lines 7e-7i were computed using direct costs, as determined by a cash outlay. Part II - Community Building The organization participates in community building activities that aim to address the disparities in the social determinants of health factors that influence the overall health and wellbeing of individuals in the communities Texas Health serves. As identified in the community health needs assessment, there are areas of need that are not aligned with the traditional operations of a hospital system. Our volunteerism, collaborations and partnership opportunities with various community-based organizations and coalitions foster our ability to address the social and environmental needs for the purpose of providing for the whole person beyond the clinical services. Part III, Lines 2, 3 & 4 - Bad Debts Bad debt expense is not included for purposes of reporting community benefits. Each patient qualifying for charity care is treated as a charity patient and no charges related to that patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THR's annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Net Patient Service Revenue (Dollars in Thousands) that reads as follows: Patient service revenue is reported at the amount that reflects the consideration to which the System expects to be entitled in exchange for providing patient care. Healthcare services promised in the contract with a patient represent a bundle of goods and (or) services that is distinct and accounted for as a single performance obligation. The transaction price for the bundled goods and (or) services provided is estimated by reducing the total standard charges by variable price concessions, including contractual adjustments based on the terms provided by (in the case of Medicare and Medicaid) or negotiated with (in the case of managed care and commercial insurance companies) third-party payors, the System's discount policies, and other implicit price concessions based on historical collections experience for uninsured and under-insured patients who do not qualify for financial assistance. A portfolio approach by major payor categories and types of service is used to estimate the historical collections experience. Subsequent changes to the estimate of the transaction price are generally recorded as adjustments to patient service revenue in the period of the change. Portfolio collection estimates are updated at least quarterly based on actual collections experience. The System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach was used. Under Texas Health's financial assistance policy, the Tax-Exempt Hospitals, THRW, and THPG provide care to patients without charge or at amounts less than their established rates if the patient meets certain established criteria. The consolidated joint venture hospitals and healthcare entities have similar financial assistance policies, or have adopted the Texas Health financial assistance policy. As the System does not pursue collection of amounts determined to qualify as financial assistance, those amounts are not reported as patient service revenue or patient accounts receivable. Revenue related to providing care to patients is recognized as the performance obligation is satisfied over the period of time the patient is receiving treatment, as the patient is simultaneously receiving and consuming the benefits provided by the System. The performance obligation is generally satisfied over an average period of less than five days for inpatient services and one day for outpatient services. Generally, patients and third-party payors are billed within days after the services are performed and (or) the patient is discharged. The transaction price related to unsatisfied or partially unsatisfied performance obligations at the end of the reporting period primarily relate to inpatient acute care services for patients who remain admitted at that time (in-house patients). As of December 31, 2021 and 2020, contract assets of $50,827 and $49,827, respectively, were recorded in patient accounts receivable on the consolidated balance sheets. Patient accounts receivable is reported at the amount that reflects the consideration to which the System expects to be entitled in exchange for providing patient care. The primary collection risks relate to uninsured patient accounts, including patient accounts for which the primary insurance company has paid the amounts covered by the applicable agreement, but patient responsibility amounts remain outstanding. Implicit price concessions relate primarily to amounts due directly from patients based upon management's assessment of historical write-offs and expected net collections considering business and economic conditions, trends in health care coverage, and other collection indicators. Patient accounts are monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. Accounts are written off when all reasonable internal and external collection efforts have been performed. Estimated implicit price concessions of $463,241 and $366,511 were recorded as reductions to patient accounts receivable at December 31, 2021 and 2020, respectively, on the consolidated balance sheets. Part III, Line 8 - Medicare Shortfall The state of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care & community benefit. For state purposes, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost-to-charge ratio (with costs determined in accordance with generally accepted accounting principles) to billed charges. The shortfall amount reported to the state of Texas for 2021 is $4,878,328. Sch H requires a different method to calculate the Medicare shortfall shown on Part III, Lines 5-7. Part III, Line 9b - Debt Collection During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Financial Assistance Policy. Part VI, Line 2 - Needs Assessment In 2019, Texas Health Resources (Texas Health) completed a community health needs assessment (CHNA) for 25 facilities across 5 regions using the following steps: - Demographic analysis by region - Secondary data analysis of health indicators to identify zip codes of highest-needs within each region and prioritize zip codes for the community impact initiative - Primary data collection via key informant interviews, focus groups, and a winds