4A (Expenses $ 8404051 including grants of $ 0) (Revenue $ 7436083)
OPERATED A 36 BED HOSPITAL PROVIDING INPATIENT AND OBSERVATION HOSPITAL STAYS. 339 INPATIENT DAYS AND 168 OBS PATIENTS FOR 278 OBS DAYS. WE HAVE RADIOLOGY, LAB, RESPIRATORY, PHYSICIAN, AND IV THERAPIES. TOTAL INPATIENT AND OUTPATIENT PROCEDURES INCLUDED: 1,042 EKG/EEG, 1,084 RESP. THERAPY, 5,098 RADIOLOGY, 1,217 IV, 3,578 PHYSICAL THERAPY, AND 55,291 LAB.

4B (Expenses $ 3719654 including grants of $ 0) (Revenue $ 4679802)
WE OPERATE 3 RURAL HEALTH CLINICS AND AN ADDITIONAL OUTPATIENT CLINIC THAT PROVIDE PRIMARY CARE AND SPECIALTY SERVICES INCLUDING WOMEN'S HEALTH, WELL CHILD CARE, PREVENTATIVE CARE, CARDIOLOGY, PODIATRY, PSYCHOLOGY, AND CHIROPRACTIC CARE.

4C (Expenses $ 1807501 including grants of $ 977) (Revenue $ 1395947)
WE OPERATE A 5 BED EMERGENCY ROOM. WE STABILIZE PATIENTS FOR TRANSFER WHEN HIGHER LEVEL CARE IS REQUIRED. WE HAVE THE CAPACITY TO PROVIDE PRECIPITOUS DELIVERY. WE PROVIDE TEL-PSYCH SERVICES WHEN REQUIRED. WE ALSO PROVIDE STROKE EVALUATION AND INTERVENTION.

SCHEDULE H, PART V, SECTION B, LINE 5
INPUT FROM REPRESENTATIVES FROM THE COMMUNITY: IN 2021 THE HOSPITAL CONDUCTED FOCUS GROUP MEETINGS TO DISCUSS THE HEALTH NEEDS OF THE COMMUNITY WITH REPRESENTATIVES FROM THE FOLLOWING CONSTITUENCIES: Marlin City Mayor, County public safety officers and fire department, District Attorney, Marlin Housing Authority, Falls County Extension Agent, Golden Years Nursing Home Administrator and staff, AMD Emergency Medical Services (EMS), Heart of Texas MHMR, Marlin Independent School District, Community non-profit organization leaders, Diverse private citizens, Business leaders, FCHC administrator and department leaders, FCHC Board of Directors, and Advanced Practice Professionals, and other healthcare workers. ADDITIONALLY, some residents within the City and service area were randomly asked about their perceptions of the local hospital and access to healthcare.

SCHEDULE H, PART V, SECTION B, LINE 11
"NEEDS ADDRESSED AND NOT ADDRESSED: THE CHNA IDENTIFIED THE FOLLOWING NEEDS TO ADDRESS IN THE IMPLEMENTATION STRATEGY: Emergency Medical Services (EMS / Ambulance) - Timely response is critical in emergency situations. The single biggest need echoed throughout the county is faster EMS response to emergencies. FCHC is looking into options through collaboration with other Falls County offices, grants, and/or other means to improve the EMS service in Falls County. Community Communication, Awareness, & Collaboration - The City of Marlin and Falls County offers dedicated people, local businesses, and groups who are actively engaged in providing good services. Like most communities, however, these groups often work independently with little interaction, collaboration, or joint planning among each other. Enthusiastic discussion broke out during the community focus group sessions as participants began learning from each other about resources that each offered. A desire was created to continue these discussions and collaborate on ways that they may collectively engage in efforts to improve the life, health, and wellbeing of those living in Falls County. Informal networks for collaboration can be very effective. Community Health Education, Outreach, and Collaboration - Community health education and expanded outreach is offered as a primary recommendation. FCHC has received several grants to promote health and vaccine awareness and is utilizing the funds to provide education and build vaccine confidence. In addition, FCHC is collaborating with Falls County Ag Extension office, Communities in Schools, and other agencies to participate in joint events promoting health and wellness. Mental Health - Based upon community response and public data, mental health ranks as a priority health need in Falls County. Issues of mental health are complex and typically linked to environmental factors beyond the scope of the hospital, medical providers, or any single organization. The root causes or results of mental health issues are often linked to social issues like unemployment, poverty, nutrition, drug abuse, family disfunction, education, housing, and other factors. Mental health, regardless of causes, impacts the physical health and wellbeing of individuals. A need exists for both improved awareness of and local access to mental health counseling services in Marlin. Falls Community Hospital has partnered with Texas A&M to provide free behavioral health services through telemedicine at our clinic in Rosebud. Telehealth is also being used effectively in counties across Texas to expand access to psychiatry and other mental health services. Consultative services can be accessed locally by patients while linked to remote providers. Expansion of telehealth should be considered as an option for expanding local access to mental health. Chronic Disease Self-Management - the programs seek to teach patients to take charge of their own health through education, active monitoring, and behavioral adjustments. Many who suffer from chronic disease such as diabetes, hypertension, COPD, CHF, and other illnesses have low income and lack insurance to afford a personal primary care practitioner or purchase medication. Each new patient receives a baseline evaluation with an Advanced Practice Provider (Nurse Practitioner or Physician Assistant) and a ""medical home"" place to return for monitoring and check-up. The program provides the patient with nutritional consults and personalized education on how to manage their specific disease. The goal is to engage the patient in improving their overall health and wellbeing and provide a meaningful continuum of care with an established provider. An added benefit is to reduce unfunded utilization of the ED for chronic care visits that can be more appropriately managed in a lower cost setting. Marlin RHC's physicians are implementing new programs to educate patients during their visit and training providers and staff on the importance of patient education. Drug Abuse - Drug abuse is widely recognized as a major problem in Falls County, as well as the State of Texas. Illegal drug usage adversely impacts the entire county, both the public sector and private sector. There is no single source solution to reducing illegal drug usage. The problem must be addressed as a community problem and receive input from multiple sectors of the county. Falls Community Hospital has created new policies regarding administration of narcotics and pain management. Water - Supply and distribution of safe household water should be continued for improvement by the City of Marlin. Access to safe water is a basic essential to community health. The City of Marlin is constantly working to make upgrades to the water system in Marlin. FCHC representatives are attending city water meetings to stay up to date on improvements and current conditions. Economic Development and Social Infrastructure - Community health is heavily impacted by social and economic factors such as jobs, income, housing, education. It is recommended that leaders from the public and private sectors assess needs, resources available, and opportunities together in an effort to expand jobs, local employment, and tax base. Creating jobs and improving economic development will help to improve the social infrastructure, reduce generational poverty, and increase local tax revenue that will enable the City and County to afford to provide more services. DUE TO LIMITED RESOURCES THE HOSPITAL HAS NOT ADDRESSED COMMUNITY COMMUNICATION, AWARENESS, & COLLABORATION AND ECONOMIC DEVELOPMENT AND SOCIAL INFRASTRUCTURE."

SCHEDULE H, PART V, SECTION B
COMPLIANCE WITH 501R: FALLS COMMUNITY HOSPITAL & CLINIC, INC. IDENTIFIED A FEW AREAS WHERE THEY WERE NOT YET FULLY COMPLIANT WITH THE FINAL 501R REGULATIONS. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP) DOES NOT INCLUDE ALL THE INFORMATION NEEDED TO MEET THE REQUIREMENTS UNDER SECTION 501(R)(4). SOME OF THE LANGUAGE MISSING FROM THE FAP INCLUDES THE FOLLOWING: -DESCRIPTION OF THE METHOD USED TO CALCULATE THE AMOUNTS GENERALLY BILLED TO PATIENTS -A LIST OF PROVIDERS OR DESCRIPTION OF THE DEPARTMENTS, CLINICS, PRACTICES, ETC. DELIVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE COVERED OR NOT COVERED BY THE FAP THE HOSPITAL ALSO IDENTIFIED THAT THE FAP DOES NOT INCLUDE ANY LANGUAGE IDENTIFYING ANY EXTRAORDINARY COLLECTION ACTIONS. THE HOSPITAL'S PERSONNEL AND MANAGEMENT ARE WORKING DILIGENTLY TOWARD CORRECTING THE POLICIES TO MEET THE REGULATIONS. ANY ADDITIONAL FAILURES TO COMPLY WILL BE CORRECTED AS THEY ARE IDENTIFIED. TOP MANAGEMENT WILL MONITOR THE COMPLIANCE ANNUALLY TO CONFIRM THE HOSPITAL CONTINUES TO STAY COMPLIANT WITH THE REQUIREMENTS UNDER 501R.

SCHEDULE H, PART III, SECTION A, LINE 2
BAD DEBT EXPENSE: AT THE END OF EACH INTERIM PERIOD AND AT YEAR END, WE CALCULATE AN ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS USING AGGREGATED INFORMATION ABOUT PATIENT ACCOUNTS RECEIVABLE AND RECENT HISTORICAL STATISTICS ABOUT THE AMOUNTS THAT WE HAVE COLLECTED ON SIMILAR ACCOUNTS AS DEFINED BY PAYER CLASSIFICATION AND THE AGE OF THE RECEIVABLE. BAD DEBT EXPENSE/RECOVERY IS THE AMOUNT OF THE ADJUSTMENT NECESSARY AT THE END OF EACH PERIOD BASED ON OUR ANALYSIS PLUS THE SUM OF THE AMOUNTS ACTUALLY WRITTEN OFF TO BAD DEBT DURING THE PERIOD. WRITE OFFS FOR PATIENTS THAT QUALIFY FOR CHARITY AND INDIGENT CARE WILL NOT BE INCLUDED IN BAD DEBT.

SCHEDULE H, PART III, SECTION A, LINE 3
COMMUNITY BENEFIT METHODOLOGY: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS LEFT IT BLANK.

SCHEDULE H, PART III, SECTION A, LINE 4
BAD DEBT EXPENSE FOOTNOTE: NOT APPLICABLE DUE TO THE ADOPTION OF ASU TOPIC 606 REVENUE FROM CONTRACTS WITH CUSTOMERS.

SCHEDULE H, PART III, SECTION B, LINE 8
COSTING METHODOLOGY AND SHORTFALL: THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ANCILLARY COSTS BASED ON MEDICARE OR MEDICAID COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. IN ADDITION, THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT.

SCHEDULE H, PART III, SECTION C, LINE 9B
DEBT COLLECTION PROCESS: THE COLLECTION POLICY STATES THAT AN ITEMIZED STATEMENT IS SENT TO THE COLLECTIONS COUNSELOR FOR VERIFICATION OF CHARITY COVERAGE AND ADJUSTMENT FOR THOSE WHO HAVE QUALIFIED FOR CHARITY ASSISTANCE. ONCE A PATIENT HAS BEEN DETERMINED TO QUALIFY FOR THE HOSPITAL'S CHARITY ASSISTANCE POLICY, NO ADDITIONAL COLLECTION EFFORTS WILL BE MADE ON THAT ACCOUNT IN EXCESS OF THE CO-PAY REQUIRED OF THAT PATIENT.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT: FALLS COMMUNITY HOSPITAL PERFORMS A REGULAR ASSESSMENT OF THE COMMUNITY POPULATION AND FACILITIES TO DETERMINE NEEDS IN THEIR AREA. FALLS COMMUNITY HOSPITAL THEN IDENTIFIES STRATEGIES TO MEET THOSE NEEDS THROUGH IMPROVED PHYSICIAN RECRUITING, ADDITIONAL SERVICES, OR INCREASING PUBLIC AWARENESS OF SERVICES AND PROGRAMS OFFERED BY THE HOSPITAL.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE FOR PATIENTS UNABLE TO PAY FOR HEALTH CARE IS AVAILABLE AND PUBLICIZED. IT IS POSTED IN THE LOCAL NEWSPAPER AT LEAST ANNUALLY AND IS POSTED NEAR THE ADMISSION DESKS OF THE HOSPITAL AND CLINICS.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: FALLS COUNTY IS A RURAL COUNTY WITH A POPULATION OF APPROXIMATELY 17,493 PEOPLE. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IS $33,744 AND 21% OF THE POPULATION LIVE IN POVERTY. THE MEDIAN RESIDENT AGE IS 39.9 YEARS.

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH: THE HOSPITAL ANNUALLY HOSTS A COUNTY HEALTH FAIR THAT PROVIDES FREE CHOLESTEROL, PSA AND GLUCOSE SCREENINGS AS WELL AS NUTRITION EDUCATION. THESE SCREENINGS HELP IMPROVE THE DIETS OF THE COMMUNITY IN AN EFFORT TO DECREASE OBESITY AND ENCOURAGE PREVENTIVE TESTING. ADDITIONALLY, THE ORGANIZATION OFFERS A PEDIATRIC IMMUNIZATION CLINIC AND PROVIDES TEXAS HEALTH STEP EXAMS TO MEDICAID RECIPIENTS.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM: N/A

SCHEDULE H, PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT: NOT APPLICABLE FOR 2022 FISCAL YEAR.

SCHEDULE H, PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE: BAD DEBT EXPENSE IN THE AMOUNT OF $3,312,022 WAS INCLUDED ON FORM 990, PART IX, LINE 25 IN TOTAL EXPENSES. HOWEVER, THIS AMOUNT WAS EXCLUDED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF PATIENT CARE COST TO CHARGES.

SCHEDULE H, PART I, LINE 7
FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. THE COST COMPUTED ON WORKSHEET 8 WAS FROM THE HOSPITAL'S INCOME STATEMENT. THE COST COMPUTED ON WORKSHEET 6 WAS PULLED FROM THE TEXAS STATE SUPPLEMENTAL REPORT.

SCHEDULE H, PART I, LINE 3
FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE CARE: - MEDICAL INDIGENCY - INSURANCE STATUS - RESIDENCY