4A (Expenses $ 504835801 including grants of $ 407950) (Revenue $ 598562205)
Founded in 1997, Texas Health Resources (THR) provides direction and oversight to its wholly-controlled affiliates. The range of centralized services provided by THR include information services, managed care contracting, human resources, revenue cycle, legal, tax, compliance, supply chain, business development, insurance, treasury, marketing, general accounting, and strategic planning. THR operates professional office buildings leased primarily to physicians who are members of the medical staff of THR affiliated hospitals. THR also operates, manages and coordinates physician services through Texas Health Physicians Group (THPG), a wholly owned affiliate of THR. THPG is a network of primary and specialty care physician practices providing the north Texas area community access to quality health care delivered either through an office setting or through a hospital program.

Facility #1 -Rockwall Regional Hospital
"Part V Section B, Ln 5 -Facility #1 Rockwall Regional Hospital utilized vast amounts of qualitative and quantitative data to assess the health needs of the persons in the communities served. As a means to further understand the needs from those engaged in the community, Rockwall Regional Hospital conducted a series of community feedback sessions. Participants of the community feedback interviews included, but were not limited to: political leaders, faith community representatives, public health officials, lay community members, physicians, school officials and city administration. The information gathered from the community feedback sessions helped Rockwall Regional Hospital to understand the health needs from a community perspective and align this to the data analysis. Part V. Section B-7d - Facility #1 Rockwall Regional Hospital produced executive summaries of the completed CHNAs along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the State of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Ln 11 - Facility #1 CHNA 2013 revealed a vast number of community health issues that require collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, Rockwall Regional Hospital categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the said issues, two areas were chosen and are being addressed through the 2014-2016 implementation plan. 2014 was the first year of implementation and the focus was to create the systems, structure and interventions that could be consistently deployed at the hospital and at other system hospitals for a consistent impact across the region. The two areas of priority are first, Awareness, Literacy and Navigation (""ALN"") and second, Chronic Disease. In addition, our efforts were to clearly align and coordinate services and interventions with community partners for a collective impact to meet these two priority areas defined. 1. Awareness, Literacy and Navigation (ALN) 1a. Community Health Improvement Strategies include collaboration to develop an area resource guide of key services available to the local community, individuals and non-profit partners that address the social determinants of health. Collation of this information began through the community health councils and community partners during 2014. This ""easy to understand and use"" guide will provide key details including how to access the resource and/or service in the local community to meet the individual's needs. This guide information collected in 2014 will be made available in an online and/or print format during 2015. 1b. Support/sponsorship of Community Health and Wellness activities: The hospital provides community benefit grants, sponsorships and other in-kind resources to improve the health status of the communities served. Grants are provided to address health disparities, disease management, wellness, disease prevention and health promotion programs, and various community health events. 1c. Texas Health Rockwall provided a range of health information on promoting healthy living, diabetes, nutrition, breast cancer, colon cancer, preventive services, preventive health, bike safety, CPR and many other topics addressing the health needs of different populations in the communities served. This was provided through various outreach efforts such as Health Fairs in the community and in settings such as local businesses, health clinics and chamber of commerce events. Through these efforts and with active involvement of about 230 hospital employees over 2,853 people were reached in the Rockwall Community. 2. Chronic Disease - Community Health Improvement strategies include maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic foci to address chronic diseases remains a top priority. 2a. The hospital provided and facilitated Bariatric Surgery Support group to strengthen individual skills related to managing weight and reducing obesity through sessions that address actions such as journaling, using local park resources as a ""gym"" and learning to manage eating during the holiday season. 2b. The hospital provided a Diabetes class focused on healthy nutrition and management of the disease. Rockwall Regional Hospital will not adopt new strategies for the following identified needs in the community for the reasons listed. 1) Access: Provider Supply - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 2) Injury and Violence - lack of expertise, low priority assigned, need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 3) Maternal, Infant & Child Health - This need is currently being addressed by multiple outside organizations in the community. The facility will continue to address the need at its current level of support. 4) Mental Health - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 5) Oral Health - lack of expertise. 6) Other Clinical/Preventive - the facility will continue to address the need at its current level of support. 7) Social Determinants - resource constraints, low priority assigned and lack of effective intervention. 8) Substance Abuse - resource constraints and the facility will continue to address the need at its current level of support. 9) Transportation - lack of expertise. Part V Section B-16A&B - Facility #1 The website where FAP and FAP application was widely available: www.texashealthrockwall.com/patient-visitors/insurance-billing.html Pt V, Sec B-20e - Facility #1 - Billing and Collections A Plain Language Summary (PLS) of the charity policy is provided on the back of all billing statements. Pt V, Sec B-22d - - Facility #1 Charges to Individuals Eligible for Assistance under the FAP The hospital used the Look-Back Method to compute its Amounts Generally Billed (AGB) percentage. The 4 largest managed care plans were combined and averaged to calculate the AGB. The AGB percentage is used to determine the discount taken from the patient's gross charges. Initially, an uninsured patient is sent a bill with charges less the AGB percentage. If a patient becomes FAP-eligible, then charity care is given for the patient balance due. At no time will the patient pay more than the AGB percentage of their hospital bill. If a patient becomes FAP-eligible, then charity care is given for the patient balance due. At no time will the patient pay more than the AGB percentage of their hospital bill."

Facility #2 - Physicians Medical Center, LLC
"Part V Section B, Ln 5 -Facility #2 Physicians Medical Center, LLC utilized vast amounts of qualitative and quantitative data to assess the health needs of the persons in the communities served. As a means to further understand the needs from those engaged in the community, Physicians Medical Center, LLC conducted a series of community feedback sessions. Participants of the community feedback interviews included, but were not limited to: faith community representatives, public health officials, lay community members, and school officials. The information gathered from the community feedback sessions helped Physicians Medical Center, LLC to understand the health needs from a community perspective and align this to the data analysis. Part V. Section B-7d - Facility #2 Physicians Medical Center, LLC produced executive summaries of the completed CHNAs along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the State of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Ln 11 - Facility #2 CHNA 2013 revealed a vast number of community health issues that require collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, Physicians Medical Center, LLC categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the said issues, two areas were chosen and are being addressed through the 2014-2016 implementation plan. 2014 was the first year of implementation and the focus was to create the systems, structure and interventions that could be consistently deployed at the hospital and at other system hospitals for a consistent impact across the region. The two areas of priority are first, Awareness, Literacy and Navigation (""ALN"") and second, Chronic Disease. In addition, our efforts were to clearly align and coordinate services and interventions with community partners for a collective impact to meet these two priority areas defined. 1. Awareness, Literacy and Navigation (ALN) 1a. Community Health Improvement Strategies include collaboration to develop an area resource guide of key services available to the local community, individuals and non-profit partners that address the social determinants of health. Collation of this information began through the community health councils and community partners during 2014. This ""easy to understand and use"" guide will provide key details including how to access the resource and/or service in the local community to meet the individual's needs. This guide information collected in 2014 will be made available in an online and/or print format during 2015. 1b. Support/Sponsorship of Community Health and Wellness activities: The Hospital provides community benefit grants, sponsorships and other in-kind resources to improve the health status of the communities served. Grants are provided to address health disparities, disease management, wellness, disease prevention and health promotion programs, and various community health events. 1c. PMC Plano provided sponsorship and/or donations for various community efforts such as Heart Walk and Food Drives. The hospital also addressed the health needs of women in the community by providing outreach through efforts such as Ladies Night Out events to provide health information on promoting healthy living, heart health and preventive health. Through these efforts and with active involvement of 12 employees, over 346 people were reached in the community. 2. Chronic Disease - Community Health Improvement strategies include maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic foci to address chronic diseases remains a top priority. Physicians Medical Center, LLC will not adopt new strategies for the following identified needs in the community for the reasons listed. 1) Access: Provider Supply - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 2) Mental Health - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 3) Nutrition, Physical activity and Obesity - need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 4) Oral Health - lack of expertise. 5) Other Clinical/Preventive - the facility will continue to address the need at its current level of support. 6) Social Determinants - resource constraints, low priority assigned and lack of effective intervention. 7) Transportation - lack of expertise. Part V Section B-16A&B - Facility #2 The website where FAP and FAP application was widely available: www.thcds.com/patient-visitors/billing-information/ Pt V, Sec B-20e - Facility #2 - Billing and Collections A Plain Language Summary (PLS) of the charity policy is provided on the back of all billing statements. Pt V, Sec B-22d - - Facility #2 Charges to Individuals Eligible for Assistance under the FAP The hospital used the Look-Back Method to compute its Amounts Generally Billed (AGB) percentage. The 4 largest managed care plans were combined and averaged to calculate the AGB. The AGB percentage is used to determine the discount taken from the patient's gross charges. Initially, an uninsured patient is sent a bill with charges less the AGB percentage. If a patient becomes FAP-eligible, then charity care is given for the patient balance due. At no time will the patient pay more than the AGB percentage of their hospital bill."

Facility #3 -Southlake Specialty Hospital LLC
"Part V Section B, Ln 5 -Facility #3 Southlake Specialty Hospital, LLC utilized vast amounts of qualitative and quantitative data to assess the health needs of the persons in the communities served. As a means to further understand the needs from those engaged in the community, Southlake Specialty Hospital, LLC conducted a series of community feedback sessions. Participants of the community feedback interviews included, but were not limited to: faith community representatives, public health officials, lay community members, and school officials. The information gathered from the community feedback sessions helped Southlake Specialty Hospital, LLC to understand the health needs from a community perspective and align this to the data analysis. Part V. Section B-7a - Facility #3 The CHNA is available at the hospital's website at www.texashealthsouthlake.com/thrinthecommunity.php. Part V. Section B-7d - Facility #3 Southlake Specialty Hospital, LLC produced executive summaries of the completed CHNAs along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the State of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Ln 11 - Facility #3 CHNA 2013 revealed a vast number of community health issues that require collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, Southlake Specialty Hospital, LLC categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the said issues, two areas were chosen and are being addressed through the 2014-2016 implementation plan. 2014 was the first year of implementation and the focus was to create the systems, structure and interventions that could be consistently deployed at the hospital and at other system hospitals for a consistent impact across the region. The two areas of priority are first, Awareness, Literacy and Navigation (""ALN"") and second, Chronic Disease. In addition, our efforts were to clearly align and coordinate services and interventions with community partners for a collective impact to meet these two priority areas defined. 1. Awareness, Literacy and Navigation (ALN) 1a. Community Health Improvement Strategies include collaboration to develop an area resource guide of key services available to the local community, individuals and non-profit partners that address the social determinants of health. Collation of this information began through the community health councils and community partners during 2014. This ""easy to understand and use"" guide will provide key details including how to access the resource and/or service in the local community to meet the individual's needs. This guide information collected in 2014 will be made available in an online and/or print format during 2015. 1b. Support/Sponsorship of Community Health and Wellness activities: The Hospital provides community benefit grants, sponsorships and other in-kind resources to improve the health status of the communities served. Grants are provided to address health disparities, disease management, wellness, disease prevention and health promotion programs, and various community health events. 1c. Texas Health Southlake provided a range of health information on promoting healthy living, diabetes, nutrition, heart health, cancer, preventive health and other topics addressing the health needs of different populations in the communities served. This was provided through various outreach efforts such as Health Fairs in the community and in settings such as local businesses, city and chamber of commerce events. Through these efforts and with active involvement of about 478 hospital employees over 105,520 people were reached in the community. 2. Chronic Disease - Community Health Improvement strategies include maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic foci to address chronic diseases remains a top priority. Southlake Specialty Hospital, LLC will not adopt new strategies for the following identified needs in the community for the reasons listed. 1) Access: Provider Supply - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 2) Injury and Violence - lack of expertise, low priority assigned, need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 3) Maternal, Infant & Child Health - the facility will continue to address the need at its current level of support. 4) Mental Health - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 5) Preventive/Wellness - need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 6) Social Determinants - resource constraints, low priority assigned and lack of effective intervention. 7) Substance Abuse - resource constraints and the facility will continue to address the need at its current level of support. 8) Transportation - lack of expertise. Part V Section B-16A&B - Facility #3 The website where FAP and FAP application was widely available: www.texashealthsouthlake.com/charitycare.php Pt V, Sec B-20e - Facility #3 - Billing and Collections A Plain Language Summary (PLS) of the charity policy is provided on the back of all billing statements. Pt V, Sec B-22d - - Facility #3 Charges to Individuals Eligible for Assistance under the FAP The hospital used the Look-Back Method to compute its Amounts Generally Billed (AGB) percentage. The 4 largest managed care plans were combined and averaged to calculate the AGB. The AGB percentage is used to determine the discount taken from the patient's gross charges. Initially, an uninsured patient is sent a bill with charges less the AGB percentage. If a patient becomes FAP-eligible, then charity care is given for the patient balance due. At no time will the patient pay more than the AGB percentage of their hospital bill."

Facility #4 - Flower Mound Hospital Partners
"Part V Section B, Ln 5 -Facility #4 Flower Mound Hospital Partners utilized vast amounts of qualitative and quantitative data to assess the health needs of the persons in the communities served. As a means to further understand the needs from those engaged in the community, Flower Mound Hospital Partners conducted a series of community feedback sessions. Participants of the community feedback interviews included, but were not limited to: faith community representatives, public health officials, lay community members, physicians and school officials. The information gathered from the community feedback sessions helped Flower Mound Hospital Partners understand the health needs from a community perspective and align this to the data analysis. Part V. Section B-7d - Facility #4 Flower Mound Hospital Partners produced executive summaries of the completed CHNAs along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the State of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Ln 11 - Facility #4 CHNA 2013 revealed a vast number of community health issues that require collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, Flower Mound Hospital Partners categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the said issues, two areas were chosen and are being addressed through the 2014-2016 implementation plan. 2014 was the first year of implementation and the focus was to create the systems, structure and interventions that could be consistently deployed at the hospital and at other system hospitals for a consistent impact across the region. The two areas of priority are first, Awareness, Literacy and Navigation (""ALN"") and second, Chronic Disease. In addition, our efforts were to clearly align and coordinate services and interventions with community partners for a collective impact to meet these two priority areas defined. 1. Awareness, Literacy and Navigation (ALN) 1a. Community Health Improvement Strategies include collaboration to develop an area resource guide of key services available to the local community, individuals and non-profit partners that address the social determinants of health. Collation of this information began through the community health councils and community partners during 2014. This ""easy to understand and use"" guide will provide key details including how to access the resource and/or service in the local community to meet the individual's needs. This guide information collected in 2014 will be made available in an online and/or print format during 2015. 1b. Support/Sponsorship of Community Health and Wellness activities: The Hospital provides community benefit grants, sponsorships and other in-kind resources to improve the health status of the communities served. Grants are provided to address health disparities, disease management, wellness, disease prevention and health promotion programs, and various community health events. 1c. Texas Health Flower Mound provided health fairs targeted to different populations in the communities served such as the Woman's Health Fair, the YMCA Health Fair and Seniors in Motion. In addition, several sponsorships were provided to the address the health needs of the community which included communities in schools of north Texas, Denton County Food Bank to supporting a community Baby shower. Through these efforts and with active involvement of about 94 hospital employees over 37,000 people were reached in the Flower Mound Community. 2. Chronic Disease - Community Health Improvement strategies include maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic foci to address chronic diseases remains a top priority. Flower Mound Hospital Partners will not adopt new strategies for the following identified needs in the community for the reasons listed. 1) Access: Provider Supply - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 2) Mental Health - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 3) Nutrition, Physical Activity and Obesity - need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 4) Reproductive and Sexual Health - need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 5) Social Determinants - resource constraints, low priority assigned and lack of effective intervention. Part V Section B-16A&B - Facility #4 The website where FAP and FAP application was widely available: www.texashealthflowermound.com/patient-visitor-info/charity-care/ Pt V, Sec B-20e - Facility #4 - Billing and Collections A Plain Language Summary (PLS) of the charity policy is provided on the back of all billing statements. Pt V, Sec B-22d - - Facility #4 Charges to Individuals Eligible for Assistance under the FAP The hospital used the Look-Back Method to compute its Amounts Generally Billed (AGB) percentage. The 4 largest managed care plans were combined and averaged to calculate the AGB. The AGB percentage is used to determine the discount taken from the patient's gross charges. Initially, an uninsured patient is sent a bill with charges less the AGB percentage. If a patient becomes FAP-eligible, then charity care is given for the patient balance due. At no time will the patient pay more than the AGB percentage of their hospital bill."

Facility #5 - USMD Hospital at Arlington
"Part V Section B, Ln 5 -Facility #5 USMD at Arlington utilized vast amounts of qualitative and quantitative data to assess the health needs of the persons in the communities served. As a means to further understand the needs from those engaged in the community, USMD at Arlington conducted a series of community feedback sessions. Participants of the community feedback interviews included, but were not limited to: public health officials, lay community members, school officials and city administration. The information gathered from the community feedback sessions helped USMD at Arlington understand the health needs from a community perspective and align this to the data analysis. Part V. Section B-7a - Facility #5 The CHNA can be found on the hospital's website at www.usmdarlington.com/patients-visitors/locations-directions. Part V. Section B-7d - Facility #5 USMD at Arlington produced executive summaries of the completed CHNAs along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the State of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Ln 11 - Facility #5 CHNA 2013 revealed a vast number of community health issues that require collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, USMD at Arlington categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the said issues, two areas were chosen and are being addressed through the 2014-2016 implementation plan. 2014 was the first year of implementation and the focus was to create the systems, structure and interventions that could be consistently deployed at the hospital and at other system hospitals for a consistent impact across the region. The two areas of priority are first, Awareness, Literacy and Navigation (""ALN"") and second, Chronic Disease. In addition, our efforts were to clearly align and coordinate services and interventions with community partners for a collective impact to meet these two priority areas defined. 1. Awareness, Literacy and Navigation (ALN) 1a. Community Health Improvement Strategies include collaboration to develop an area resource guide of key services available to the local community, individuals and non-profit partners that address the social determinants of health. Collation of this information began through the community health councils and community partners during 2014. This ""easy to understand and use"" guide will provide key details including how to access the resource and/or service in the local community to meet the individual's needs. This guide information collected in 2014 will be made available in an online and/or print format during 2015. 1b. Support/Sponsorship of Community Health and Wellness activities: The Hospital provides community benefit grants, sponsorships and other in-kind resources to improve the health status of the communities served. Grants are provided to address health disparities, disease management, wellness, disease prevention and health promotion programs, and various community health events. 2. Chronic Disease - Community Health Improvement strategies include maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic foci to address chronic diseases remains a top priority. USMD at Arlington will not adopt new strategies for the following identified needs in the community for the reasons listed. 1) Access: Provider Supply - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 2) Maternal, Infant & Child Health - the facility will continue to address the need at its current level of support. 3) Mental Health - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 4) Oral Health - lack of expertise. 5) Other Clinical/Preventive - the facility will continue to address the need at its current level of support. 6) Preventive/Wellness - need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 7) Social Determinants - resource constraints, low priority assigned and lack of effective intervention. 8) Substance Abuse - resource constraints and the facility will continue to address the need at its current level of support. 9) Transportation - lack of expertise. Pt V, Sec B-22d - - Facility #5 Charges to Individuals Eligible for Assistance under the FAP The hospital used the Look-Back Method to compute its Amounts Generally Billed (AGB) percentage. The 4 largest managed care plans were combined and averaged to calculate the AGB. The AGB percentage is used to determine the discount taken from the patient's gross charges. Initially, an uninsured patient is sent a bill with charges less the AGB percentage. If a patient becomes FAP-eligible, then charity care is given for the patient balance due. At no time will the patient pay more than the AGB percentage of their hospital bill."

Facility #6- USMD Hospital at Fort Worth
"Part V Section B, Ln 5 - Facility #6 USMD Hospital at Fort Worth utilized vast amounts of qualitative and quantitative data to assess the health needs of the persons in the communities served. As a means to further understand the needs from those engaged in the community, USMD Hospital at Fort Worth conducted a series of community feedback sessions. Participants of the community feedback interviews included, but were not limited to: public health officials, lay community members, and school officials. The information gathered from the community feedback sessions helped USMD Hospital at Fort Worth understand the health needs from a community perspective and align this to the data analysis. Part V. Section B-7a - Facility #6 The CHNA can be found on the hospital's website at www.usmdfortworth.com/patients-visitors/locations-directions. Part V. Section B-7d - Facility #6 USMD Hospital at Fort Worth produced executive summaries of the completed CHNAs along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the State of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Ln 11 - Facility #6 CHNA 2013 revealed a vast number of community health issues that require collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, USMD Hospital at Fort Worth categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the said issues, two areas were chosen and are being addressed through the 2014-2016 implementation plan. 2014 was the first year of implementation and the focus was to create the systems, structure and interventions that could be consistently deployed at the hospital and at other system hospitals for a consistent impact across the region. The two areas of priority are first, Awareness, Literacy and Navigation (""ALN"") and second, Chronic Disease. In addition, our efforts were to clearly align and coordinate services and interventions with community partners for a collective impact to meet these two priority areas defined. 1. Awareness, Literacy and Navigation (ALN) 1a. Community Health Improvement Strategies include collaboration to develop an area resource guide of key services available to the local community, individuals and non-profit partners that address the social determinants of health. Collation of this information began through the community health councils and community partners during 2014. This ""easy to understand and use"" guide will provide key details including how to access the resource and/or service in the local community to meet the individual's needs. This guide information collected in 2014 will be made available in an online and/or print format during 2015. 1b. Support/Sponsorship of Community Health and Wellness activities: The Hospital provides community benefit grants, sponsorships and other in-kind resources to improve the health status of the communities served. Grants are provided to address health disparities, disease management, wellness, disease prevention and health promotion programs, and various community health events. 2. Chronic Disease - Community Health Improvement strategies include maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic foci to address chronic diseases remains a top priority. USMD Hospital at Fort Worth will not adopt new strategies for the following identified needs in the community for the reasons listed. 1) Access: Provider Supply - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 2) Cancer - need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 3) Injury and Violence - lack of expertise, low priority assigned, need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 4) Maternal, Infant & Child Health - the facility will continue to address the need at its current level of support. 5) Mental Health - resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 6) Nutrition, Physical Activity and Obesity - need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 7) Oral Health - lack of expertise. 8) Other Clinical/Preventive - the facility will continue to address the need at its current level of support. 9) Social Determinants - resource constraints, low priority assigned and lack of effective intervention. 10) Tobacco - low priority assigned. 11) Transportation - lack of expertise. Pt V, Sec B-22d - - Facility #6 Charges to Individuals Eligible for Assistance under the FAP The hospital used the Look-Back Method to compute its Amounts Generally Billed (AGB) percentage. The 4 largest managed care plans were combined and averaged to calculate the AGB. The AGB percentage is used to determine the discount taken from the patient's gross charges. Initially, an uninsured patient is sent a bill with charges less the AGB percentage. If a patient becomes FAP-eligible, then charity care is given for the patient balance due. At no time will the patient pay more than the AGB percentage of their hospital bill."

Facility #7 - Sherman Grayson Health System
"Part V Section B, Ln 5 -Facility #7 Sherman Grayson Health System (Sherman Grayson) utilized vast amounts of qualitative and quantitative data to assess the health needs of the persons in the communities served. As a means to further understand the needs from those engaged in the community, Sherman Grayson conducted a series of community feedback sessions. Participants of the community feedback interviews included, but were not limited to: political leaders, lay community members, physicians, school officials and city administration. The information gathered from the community feedback sessions helped Sherman Grayson to understand the health needs from a community perspective and align this to the data analysis. Part V. Section B, Line 7d - Facility #7 Sherman Grayson produced executive summaries of the completed CHNAs along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the State of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Ln 11 - Facility #7 CHNA 2013 revealed a vast number of community health issues that require collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, Sherman Grayson categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the said issues, two areas were chosen and are being addressed through the 2014-2016 implementation plan. 2014 was the first year of implementation and the focus was to create the systems, structure and interventions that could be consistently deployed at the hospital and at other system hospitals for a consistent impact across the region. The two areas of priority are first, Awareness, Literacy and Navigation (""ALN"") and second, Chronic Disease. In addition, our efforts were to clearly align and coordinate services and interventions with community partners for a collective impact to meet these two priority areas defined. 1. Awareness, Literacy and Navigation (ALN) 1a. Community Health Improvement Strategies include collaboration to develop an area resource guide of key services available to the local community, individuals and non-profit partners that address the social determinants of health. Collation of this information began through the community health councils and community partners during 2014. This ""easy to understand and use"" guide will provide key details including how to access the resource and/or service in the local community to meet the individual's needs. This guide information collected in 2014 will be made available in an online and/or print format during 2015. 1b. Support/Sponsorship of Community Health and Wellness activities: The Hospital provides community benefit grants, sponsorships and other in-kind resources to improve the health status of the communities served. Grants are provided to address health disparities, disease management, wellness, disease prevention and health promotion programs, and various community health events. 2. Chronic Disease - Community Health Improvement strategies include maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic foci to address chronic diseases remains a top priority. 2a. The hospital provided a range of health information on heart disease, weight management, and diabetes addressing the health needs of different populations in the communities served. This was provided through various outreach efforts such as health and community events at which both screenings and/or health information was provided. Through these efforts and with active involvement of about 36 hospital employees over 2,500 people were reached in the community. Sherman Grayson will not adopt new strategies for the following identified needs in the community for the reasons listed. 1) Access: Provider Supply - resource constraints, lack of effective intervention and the facility will continue to address the need at its current level of support. 2) Cancer - The need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 3) Injury and Violence - lack of expertise, low priority assigned, need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 4) Maternal, Infant & Child Health - need is currently being addressed by multiple organizations in the community and the facility will continue to address the need at its current level of support. 5) Mental Health - resource constraints, lack of effective intervention and the facility will continue to address the need at its current level of support. 6) Oral Health - lack of expertise. 7) Other Clinical/Preventive - the facility will continue to address the need at its current level of support. 8) Social Determinants - resource constraints, low priority assigned and lack of effective intervention. 9) Substance Abuse - resource constraints and the facility will continue to address the need at its current level of support. 10) Tobacco - low priority assigned. 11) Transportation - lack of expertise."

Patient Eligibility
"Part I, Line 3c The Schedule H for Texas Health Resources (""THR"")is filed solely because it has an ownership interest in 7 taxable joint ventures operating as hospitals. THR is a functionally integrated supporting organization and does not operate its own hospital. THR supports a system of faith-based, non-profit hospitals, an employed physician organization and an organization for medical research and education. THR has adopted a charity care policy which covers all 14 non-profit hospitals it supports. Patients with 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 charity care 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 charity care application."

Cost to Charge Ratio
Part I, Ln 7 A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate.

Bad Debt Expense
Part III, Lines 2, 3 & 4 Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad debt expense. Each of the Joint Venture hospitals estimates bad debt expense utilizing various methods, analytical tools and benchmarks. Typically, bad debt expense is based upon a combination of factors including, but not limited to, aging of receivables, analyzing revenue trends in the healthcare industry and payor class, and assessing historical collection experience considering business and economic conditions.

Medicare Shortfall
Part III, Ln 8 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. THR is the parent company of a healthcare system filing a combined community benefit report in Texas. THR is not a hospital and does not have Medicare data to report to Texas. The data provided for Sch H is THR's share of operations from its taxable joint ventures which operate hospitals in Texas. The taxable joint ventures are not required to file community benefit reports with or report Medicare Shortfalls to the State of Texas.

Debt Collection
Part III, Line 9b 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 Charity Care Program.

Needs Assessment
Part VI, Line 2 The organization is the parent of the Texas Health Resources (THR) healthcare system. In addition to the THR hospitals' community Health Needs Assessment (CHNA), THR developed and implemented, as a healthcare system, a Community Benefit Framework (CBF), based on the Public Health Institute's best practices ASACB program. The CBF systematically integrates internal practices into the community to improve the efficiency and effectiveness of THR's community health improvement (CHI) strategy, to address disproportionate unmet health needs (DUHN), to address primary prevention and to improve community capacity. CBF provides a quantitative approach to parallel the CHNA in identifying key communities within THR's service area, and the means to align them with a THR entity. The CBF contains five phases: assessment/profile, infrastructure, Community Health Council, programmatic review and strategy development. THR works with each entity's community health representative to examine its structure and programs for gaps, needs, strengths, and alignment with the CBF, CHNA and ASACB standards.

Community Information
Part VI, Line 4 Texas Health Resources does not operate its own hospital, but has ownership in 7 joint ventures operating as hospitals. The joint ventures operate hospitals in various communities throughout North Texas. The communities served by the hospitals vary in age and race. The population of the communities range from 129,000 to 1.3 million and the percentage of the population in these communities who are uninsured varies from 13% to 22.5%. The median income of the communities served by the hospitals ranges from $42,000 to $84,000.

Promotion of Community Health
Part VI, Line 5 Each of the Joint Venture hospitals further THR's exempt purpose by promoting the health of the community by following THR's charity care policy, by conducting a CHNA along with adopting the implementation strategy set forth and by providing discounted healthcare to FAP-eligible individuals in the community.

Affiliated Health Care System
Part VI, Line 6 The organization is the parent of the THR healthcare system. THR is one of the largest faith-based, nonprofit healthcare delivery systems in the US and the largest in North TX in terms of patients served. The system of 14 hospitals includes an organization for medical research and education. The system also includes a foundation that fosters philanthropic relationships which support the programs and services of the hospitals it supports. The mission of the hospitals in the THR system is to improve the health of the people in the communities we serve. THR takes its responsibility to its communities seriously and invests charitable resources to promote good health and prevent disease. Not only does THR provide health care to those who do not have the means to pay, its hospitals also conduct a variety of programs designed to improve health and prevent illness in the community. The community health strategies of THR and its affiliated healthcare organizations are driven by community health needs, are community-based, include confronting health problems at the source and emphasize health promotion, disease prevention, and early treatment of illness.

State Community Benefit Report
Part VI, Line 7 The organization files a Texas Annual Statement of Community Benefit Standard. Texas has established a minimum level of charity care and community benefit that must be provided by nonprofit hospitals in order to retain their Texas tax-exempt status. The standard set by the state is met when charity care and community benefits are provided in a combined amount equal to at least five percent of the hospital's or hospital system's net patient revenue, of which charity care and government-sponsored indigent health care are provided in an amount equal to at least four percent of net patient revenue. THR is the parent company of a healthcare system filing the combined community benefit report in Texas. THR reported other community benefits in this report. The data provided for Schedule H is THR's share of operations from its taxable joint ventures which operate hospitals in Texas. The taxable joint ventures are not required to file community benefit reports with the state of Texas.

Patient Education
"Part VI, Line 3 A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. A Plain Language Summary titled ""Getting Help Paying Your Bill"" is included on the back of our patient statements. The plain language summary informs the patients of how to qualify for charity, how to apply for help, necessary documentation, and informs of THR's collection activities. The onsite financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program."

Community Building
Part II The organization participates in community building activities that aim to address the socio-economic factors that influence the overall health of individuals in the communities served. As identified in the community health needs assessment, there are areas of need that are not in alignment with the operations of a hospital system. Our volunteerism, collaborations and partnerships with various aid organizations and various area coalitions aid in addressing the socio-economic factors that are the backbone for many underlying health concerns. The organization also partners with local universities to increase promotion and training of diverse candidates into the healthcare workforce which in turn increases access to healthcare for many in the community.