4A (Expenses $ 34221860 including grants of $ 34221860) (Revenue $ 0)
SINCE 1996, MHM HAS PROVIDED COMMUNITY GRANTS TO PARTNERS THAT SHARE IN ITS MISSION OF SERVING THE LEAST SERVED: LOW-INCOME FAMILIES AND THE UNINSURED, AND THAT ARE SUCCESSFULLY DELIVERING HEALTHCARE AND SOCIAL SERVICES TO THIS POPULATION IN THEIR RESPECTIVE COMMUNITIES THROUGHOUT SOUTH TEXAS OR ADDRESSING SOCIAL DETERMINANTS OF HEALTH NEEDS IN THEIR RESPECTIVE COMMUNITIES. SHORT-TERM GRANTS INCLUDE DIRECT SERVICES TO PATIENTS AS WELL AS CAPITAL FUNDING FOR CONSTRUCTION OF NEW AND/OR RENOVATIONS TO EXISTING FACILITIES USED FOR THE DELIVERY OF SERVICES.

4B (Expenses $ 20883880 including grants of $ 0) (Revenue $ 32846)
MHM OWNS AND OPERATES TWO PRIMARY CARE CLINICS AT TWO LOCATIONS - WESLEY HEALTH & WELLNESS CENTER AND THE BISHOP ERNEST T. DIXON, JR. CLINIC - IN SAN ANTONIO WHERE MEDICAL, DENTAL, AND BEHAVIORAL HEALTH SERVICES ARE OFFERED TO UNINSURED INDIVIDUALS AND FAMILIES WHO DO NOT QUALIFY FOR ANY TYPE OF BENEFITS SUCH AS MEDICAID OR MEDICARE. SERVICES ARE BASED ON A SLIDING-SCALE FEE, HOUSEHOLD INCOME AND FAMILY SIZE. HOWEVER, NO ONE IS DENIED BASED ON THEIR ABILITY TO PAY. MHM ALSO OPERATES SCHOOL BASED HEALTH CENTERS WHICH PROVIDE PRIMARY MEDICAL CARE, DENTAL CARE, AND COUNSELING TO SCHOOL-AGE CHILDREN AND THEIR SIBLINGS UP TO THE AGE OF 21 IN TWO SCHOOL DISTRICTS.

4C (Expenses $ 11176798 including grants of $ 0) (Revenue $ 0)
THE WESLEY NURSE PROGRAM SPANS 80 SITES THROUGHOUT SOUTH TEXAS AND IS MHM'S LARGEST GEOGRAPHIC OUTREACH PROGRAM. A KEY COMPONENT WESLEY NURSES UNDERTAKE IN THEIR COMMUNITIES IS PROVIDING HEALTH EDUCATION, HEALTH PROMOTION, AND FACILITATION OF RESOURCES. WHILE THE WESLEY NURSE PROGRAM IS A COMPONENT OF MHM'S ECUMENICAL OUTREACH, AND LOCATED WITHIN CHURCHES, IT DOES NOT TEACH A PARTICULAR SET OF DENOMINATIONAL BELIEFS. ALL WESLEY NURSE PROGRAMS ARE FREE AND ALL MEMBERS OF THE COMMUNITY ARE WELCOME. PROGRAMS ARE OFFERED TO GROUPS OR ON AN INDIVIDUAL BASIS.

Schedule H, Part V, Sec B, Line 3e:
THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED IN EACH HOSPITAL FACILITY'S CHNA ARE PRESENTED AS A PRIORITIZED DESCRIPTION.

Schedule H, Part V, Sec B, Line 3J:
"IN 2019, EACH METHODIST HOSPITAL, AS WELL AS THE SYSTEM (MHS), ADOPTED THE HEALTH PRIORITY AREAS BASED UPON THE BEXAR COUNTY COMMUNITY HEALTH ASSESSMENT (UNDERTAKEN BY THE HEALTH COLLABORATIVE), THE BEXAR COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) AND THE SA 2020 GOALS. ADDITIONAL INFORMATION ABOUT THE HEALTH COLLABORATIVE'S ASSESSMENT PROCESS IS NOTED BELOW. IT IS IMPORTANT TO NOTE THAT THE FIVE PRIORITY AREAS IDENTIFIED IN THE PRIOR CHNA HAVE NOT CHANGED IN THE 2019 PLAN. IN 2013, MHS'S IMPLEMENTATION STRATEGY, INCLUDING AN EXECUTION PLAN AND PRIORITIZATION OF HEALTH NEEDS, SERVICES AND METRICS FOR EACH HOSPITAL WERE PRESENTED TO AND APPROVED BY THE MHS COMMUNITY BENEFITS COMMITTEE, THE MHS COMMUNITY BOARD, THE MHS BOARD OF GOVERNORS, AND THE METHODIST HEALTHCARE MINISTRIES BOARD OF GOVERNORS. IN 2016, THE MHS COMMUNITY BENEFITS COMMITTEE, THE MHS COMMUNITY BOARD AND THE MHS BOARD OF GOVERNORS APPROVED THE IMPLEMENTATION STRATEGY FOR 2017 - 2019. IN 2019, THE MHS COMMUNITY BENEFITS COMMITTEE, THE MHS COMMUNITY BOARD AND THE MHS BOARD OF GOVERNORS APPROVED THE IMPLEMENTATION STRATEGY FOR 2020-2022. IN ORDER TO ASSESS THE RURAL AREAS METHODIST HEALTHCARE SERVES, MHS UTILIZED ASSESSMENT INFORMATION FROM THE REGIONAL HEALTHCARE PARTNERSHIP 6 PLAN SUBMITTED TO THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION AS PART OF THE MEDICAID 1115 WAIVER PROGRAM. UNIVERSITY HEALTHCARE SYSTEM (RHP6 ANCHOR) LEAD THIS PROCESS WHICH INCLUDED MULTIPLE MEETINGS, CONFERENCE CALLS AND PUBLIC FORUMS. PARTICIPANTS IN THIS PROCESS INCLUDED HOSPITAL CEOS, COUNTY JUDGES, COUNTY COMMISSIONERS, PHYSICIANS FROM THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO, UNIVERSITY HEALTH SYSTEM AND CHRISTUS SANTA ROSA. INPUT WAS ALSO OBTAINED FROM FEDERALLY QUALIFIED HEALTH CENTERS, HOME HEALTH AGENCIES, CITY GOVERNMENT OFFICIALS, INDIGENT CARE COORDINATORS, ADVOCACY GROUPS AND HEALTHCARE ACCESS SAN ANTONIO. Methodist Healthcare Ministries (MHM) AND MHS ARE MEMBERS OF THE HEALTH COLLABORATIVE (THC) WHICH CONSISTS OF THE FOLLOWING MEMBERS: APPDICTION STUDIOS, BAPTIST HEALTH SYSTEM, CHRISTUS SANTA ROSA HEALTH SYSTEM, BEXAR COUNTY DEPARTMENT OF COMMUNITY RESOURCES, COMMUNITY FIRST HEALTH PLANS, SAN ANTONIO METROPOLITAN HEALTH DISTRICT (METRO HEALTH), OUR LADY OF THE LAKE UNIVERSITY, SAN ANTONIO CLUBHOUSE, UNIVERSITY HEALTH SYSTEM, THE UNIVERSITY OF THE INCARNATE WORD, THE UT HEALTH SCIENCE CENTER AT SAN ANTONIO DEPT. OF FAMILY AND COMMUNITY MEDICINE, THE YMCA AND COMMUNITY MEMBERS AT LARGE. FUNDERS OF THC COMMUNITY HEALTH ASSESSMENT ARE BAPTIST HEALTH FOUNDATION, BEXAR COUNTY, THE KRONKOSKY CHARITABLE FOUNDATION, THE UNITED WAY OF SAN ANTONIO, SAN ANTONIO METROPOLITAN HEALTH DEPARTMENT AND MHM. AS NOTED ABOVE, METHODIST HEALTHCARE SYSTEM IS A PARTNER OF THC. THE COLLABORATIVE UNDERTAKES A COUNTY-WIDE COMMUNITY ASSESSMENT STUDY EVERY THREE YEARS TO GUIDE THE COMMUNITY HEALTH STRATEGIC PLANNING PROCESS. FOR THE 2019 ASSESSMENT PROCESS, THE COLLABORATIVE SHIFTED TO A REGIONAL FOCUS, EXPANDING THE ASSESSMENT TO INCLUDE BEXAR COUNTY, AND ATASCOSA COUNTY. ATASCOSA COUNTY IS LOCATED JUST SOUTH OF BEXAR COUNTY, HOWEVER THE ASSESSMENT NOTED MARKED DIFFERENCES IN MANY SOCIAL DETERMINANTS AS WELL AS DIFFERENCES IN HEALTH BEHAVIORS AND RISK. THC ALSO INDICATED IN THE PREFACE TO THE 2019 PLAN, THAT IT WILL CONTINUE TO EXPAND THE REGIONAL FOCUS IN FUTURE PLANS, ADDING ONE OR TWO ADJOINING COUNTIES IN FUTURE ASSESSMENTS UNTIL ALL COUNTIES SURROUNDING BEXAR COUNTY ARE INCLUDED. THC CONTRACTED WITH COMMUNITY INFORMATION NOW (CI:NOW), A NONPROFIT LOCAL DATA INTERMEDIARY SERVING SOUTH CENTRAL TEXAS, FOR QUANTITATIVE DATA COLLECTION AND ANALYSIS AND FOR DEVELOPMENT OF THE ASSESSMENT NARRATIVE. UNDER THE SUPERVISION OF DR. MELISSA VALERIO-SHEWMAKER, GRADUATE STUDENTS AT THE UTHEALTH HOUSTON SCHOOL OF PUBLIC HEALTH IN SAN ANTONIO ASSISTED IN DEVELOPING THE FOCUS GROUP QUESTIONS AND CONDUCTING THE GROUPS THEMSELVES. SCHOOL OF PUBLIC HEALTH STAFF MS. KATE MARTIN AND MS. SONIA RAMOS CONDUCTED THE KEY INFORMATION INTERVIEWS. THC STAFF HANDLED ALL FOCUS GROUP AND KEY INFORMANT INTERVIEW RECRUITMENT AND SCHEDULING. ALL QUALITATIVE ANALYSIS WAS CONDUCTED BY DR. CAROLINE BERGERON, MS. JORDAN MCILVEEN, AND MS. JENNIFER QUACKENBUSH AT THC. THE 2019 ASSESSMENT CONTAINS QUANTITATIVE DATA ON APPROXIMATELY 150 INDICATORS, EACH BROKEN OUT BY RACE/ETHNICITY GROUP AND SUB-COUNTY GEOGRAPHY (ZIP CODE TABULATION AREA [ZCTA], SECTOR, CENSUS TRACT OR BLOCK GROUP) WHEREVER POSSIBLE. INDICATORS WERE ALSO DISAGGREGATED BY AGE GROUP AND SEX WHERE THOSE VARIABLES WERE THOUGHT TO ADD CRITICAL INFORMATION. THE LIST OF INDICATORS WAS DEVELOPED OVER SEVERAL MONTHS IN THE SUMMER AND FALL OF 2018. AN EXTENSIVE LIST OF CANDIDATE INDICATORS AND ISSUES WAS GENERATED USING PAST ASSESSMENTS, THE COMMUNITY HEALTH IMPROVEMENT PLAN, HEALTH PEOPLE 2020, THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY COUNTY HEALTH RANKINGS, SA2020, LOCAL SUBJECT MATTER EXPERTS, AND A NUMBER OF REFERENCES ON THE ""UPSTREAM"" SOCIAL, ECONOMIC, AND ENVIRONMENTAL CONDITIONS THAT AFFECT HEALTH. TO NARROW THE LIST, THE COMMUNITY NEEDS ASSESSMENT STEERING COMMITTEE USED AN ANONYMOUS DIGITAL SURVEY TO RATE EACH INDICATOR AS HIGH, MEDIUM, OR LOW PRIORITY, SUGGESTING MODIFICATIONS TO THE INDICATOR IF DESIRED. INDICATORS RATED AS LOW PRIORITY WITH A HIGH LEVEL OF AGREEMENT (ABOUT 65% OR MORE OF RESPONDING MEMBERS) WERE DROPPED WITHOUT DISCUSSION, AND HIGH-AGREEMENT, HIGH-PRIORITY MEASURES WERE INCLUDED WITHOUT DISCUSSION. THOSE WITHOUT CLEAR CONSENSUS WERE DISCUSSED UNTIL GENERAL AGREEMENT WAS REACHED. BUDGET CONSTRAINTS PREVENTED THE INCLUSION OF SOME INDICATORS ON WHICH THERE WAS AGREEMENT BUT FOR WHICH THE DATA WAS ESPECIALLY TIME CONSUMING TO FIND, ACQUIRE AND/OR CALCULATE. THE FOLLOWING SOURCES WERE USED HEAVILY FOR THE 2019 ASSESSMENT: - POPULATION AND HOUSING DATA FROM THE U.S. CENSUS BUREAU 2010 SUMMARY FILE 1 - POPULATION ESTIMATES AND PROJECTIONS FROM THE TEXAS STATE DEMOGRAPHIC CENTER AT THE UNIVERSITY OF TEXAS AT SAN ANTONIO - PHYSICAL, SOCIAL, AND ECONOMIC CONDITIONS DATA FROM THE U.S. CENSUS BUREAU AMERICAN COMMUNITY SURVEY ONE-YEAR ESTIMATES, FIVE-YEAR ESTIMATES, AND SUPPLEMENTAL ESTIMATES - CRIME DATA FROM THE U.S. DEPARTMENT OF JUSTICE UNIFORM CRIME REPORT - BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), VITAL STATISTICS, INJURY, BLOOD LEAD, HOSPITAL DISCHARGES, HOSPITAL BED, AND HEALTH PROFESSIONS DATA FROM THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES HEALTH DATA QUERY SYSTEM AND BY SPECIAL REQUEST - MEDICAID AND PUBLIC HEALTH BENEFITS DATA FROM THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION - MORTALITY DATA FROM THE CDC WONDER QUERY SYSTEM - MOTOR VEHICLE CRASH DATA FROM THE TEXAS DEPARTMENT OF TRANSPORTATION - COMMUNICABLE DISEASE AND VITAL STATISTICS DATA FROM THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES - THE WITTE MUSEUM FINALLY, DATA IS COLLECTED AT THE NEIGHBORHOOD LEVEL WITH THE INTENT OF DESCRIBING THE SOCIAL CONTEXTS THAT POSSIBLY GIVE RISE TO HEALTH-RELATED BEHAVIORS DESCRIBED IN THE HEALTH PROFILES AND BRFSS SURVEY DATA. DISCUSSION GROUPS AND INTERVIEWS WERE CONDUCTED CITY-WIDE WITH OVER 160 PARTICIPANTS, RANGING FROM COMMUNITY RESIDENTS, SERVICE PROVIDERS, GOVERNMENT STAFF AND OFFICIALS, AND ADVOCATES FOR THE HEALTH OF BEXAR COUNTY'S LOW-INCOME, MEDICALLY-UNDERSERVED AND MINORITY POPULATIONS. THESE INTERVIEWS AND MEETINGS TOOK PLACE DURING MARCH AND MAY OF 2019. THC CONTRACTED WITH COMMUNITY INFORMATION NOW (CI:NOW), A LOCAL DATA INTERMEDIARY SERVING SOUTH CENTRAL TEXAS, FOR QUANTITATIVE DATA COLLECTION AND ANALYSIS FOR DEVELOPMENT OF THE ASSESSMENT NARRATIVE. USING INFORMATION FROM THE 2016 COLLABORATIVE'S COMMUNITY HEALTH NEEDS ASSESSMENT, AS WELL AS OTHER DATA, METHODIST HEALTHCARE SYSTEM DEVELOPED INDIVIDUAL PLANS FOR EACH CAMPUS, WHICH INCLUDED A 3-YEAR PLAN FOR 2017-2019. THE IMPLEMENTATION STRATEGY INCLUDES THE FOLLOWING: COMMUNICATION PLAN, PRIORITY INITIATIVE WORK PLAN, ROLE AND RESPONSIBILITY ASSIGNMENTS, AND MEASURES/INDICATORS FOR SUCCESS ALONG WITH BASELINE DATA. ADDITIONAL MONITORING OF THE PLAN WILL OCCUR THROUGH THE QUARTERLY COMMUNITY BENEFITS REPORTS TO THE MHS COMMUNITY BENEFITS COMMITTEE AND THE ANNUAL CHARITY CARE REPORT. THE 2017-2019 PLAN HAS BEEN APPROVED BY THE MHS COMMUNITY BENEFITS COMMITTEE, THE MHS COMMUNITY BOARD, AND THE MHS BOARD OF GOVERNORS. METHODIST HEALTHCARE SYSTEM USED INFORMATION FROM THE COLLABORATIVE'S 2019 COMMUNITY HEALTH NEEDS ASSESSMENT TO DEVELOP A 3-YEAR PLAN FOR 2020-2022. LIKE THE IMPLEMENTATION STRATEGY DEVELOPED FOR THE 2017-2019 PLAN, THE PLAN FOR 2020-2022 INCLUDES A COMMUNICATION PLAN, A PRIORITY INITIATIVE WORK PLAN, ROLE AND RESPONSIBILITY ASSIGNMENTS, AND MEASURES/INDICATORS FOR SUCCESS. MONITORING WILL CONTINUE THROUGH THE QUARTERLY REPORTS TO THE MHS COMMUNITY BENEFITS COMMITTEE, AND THE MHS ANNUAL CHARITY CARE REPORT. THE 2020-2022 PLAN HAS BEEN APPROVED BY THE MHS COMMUNITY BENEFITS COMMITTEE, THE MHS COMMUNITY BOARD, AND THE MHS BOARD OF GOVERNORS."

Schedule H, Part V, Sec B, Line 5:
AS NOTED ABOVE, DISCUSSIONS AND INTERVIEWS WERE HELD WITH MULTIPLE STAKEHOLDERS IN THE COMMUNITY. KEY REGIONAL GROUPS AND CITY OFFICIALS INCLUDED THE FOLLOWING: HAVEN FOR HOPE, UNIVERSITY HEALTH SYSTEM, NATIONAL ALLIANCE ON MENTAL HEALTH ILLNESS, SAN ANTONIO FOOD BANK, BEXAR COUNTY ECONOMIC DEVELOPMENT, SAN ANTONIO HOUSING AUTHORITY, COMMUNICARE, SAN ANTONIO METROPOLITAN HEALTH DISTRICT, HEALTHY FUTURES OF TEXAS, THE RIVARD REPORT, ROY MAAS YOUTH ALTERNATIVES, NELSON WOFF, J.D. - BEXAR COUNTY JUDGE, AND NORTHSIDE INDEPENDENT SCHOOL DISTRICT. OTHER DISCUSSION GROUPS INCLUDED INDIVIDUALS REPRESENTING FAITH ORGANIZATIONS, SOCIAL SERVICE PROVIDERS, HOSPITALS, PUBLIC HEALTH LEADERS, ACADEMIC RESEARCHERS, COMMUNITY PLANNING AGENCIES, COMMUNITY FOCUSED ORGANIZATIONS, INDIVIDUAL COMMUNITY MEMBERS, AND BUSINESS LEADERS.

Schedule H, Part V, Sec B, Line 6A:
THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES: METHODIST HEALTHCARE SYSTEM (METHODIST HOSPITAL, METHODIST CHILDREN'S HOSPITAL, A CAMPUS OF METHODIST HOSPITAL, METHODIST SPECIALTY AND TRANSPLANT HOSPITAL, A CAMPUS OF METHODIST HOSPITAL, METROPOLITAN METHODIST HOSPITAL, A CAMPUS OF METHODIST HOSPITAL, NORTHEAST METHODIST HOSPITAL, A CAMPUS OF METHODIST HOSPITAL, METHODIST TEXSAN HOSPITAL, A CAMPUS OF METHODIST HOSPITAL, METHODIST STONE OAK HOSPITAL, METHODIST AMBULATORY SURGERY HOSPITAL - NORTHWEST, METHODIST HOSPITAL SOUTH ); BAPTIST HEALTH SYSTEM (BAPTIST MEDICAL CENTER, NORTH CENTRAL BAPTIST HOSPITAL, MISSION TRAILS BAPTIST HOSPITAL, ST. LUKE'S BAPTIST HOSPITAL, NORTHEAST BAPTIST HOSPITAL); CHRISTUS SANTA ROSA HEALTH SYSTEM (CHRISTUS SANTA ROSA MEDICAL CENTER, CHRISTUS SANTA ROSA WESTOVER HILLS, CHILDREN'S HOSPITAL OF SAN ANTONIO) AND UNIVERSITY HOSPITAL.

Schedule H, Part V, Sec B, Line 6B:
IN ADDITION TO THE HOSPITAL FACILITIES LISTED ABOVE, THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN CONJUNCTION WITH THE FOLLOWING NON-HOSPITAL ORGANIZATIONS: APPDICTION STUDIO, BEXAR COUNTY DEPARTMENT OF COMMUNITY RESOURCES, COMMUNITY FIRST HEALTH PLANS, INTERLEX COMMUNICATIONS, METHODIST HEALTHCARE MINISTRIES OF SOUTH TEXAS, INC., THE CITY OF SAN ANTONIO METROPOLITAN HEALTH DISTRICT, OUR LADY OF THE LAKE UNIVERSITY, SAN ANTONIO CLUBHOUSE, THE UNIVERSITY OF THE INCARNATE WORD, THE UT HEALTH SCIENCE CENTER AT SAN ANTONIO DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE, THE YMCA OF GREATER SAN ANTONIO, AND COMMUNITY MEMBERS AT LARGE.

Schedule H, Part V, Sec B, Line 7a:
HTTPS://SAHEALTH.COM/ABOUT/COMMUNITY/INDEX.DOT Schedule H, Part V, Sec B, Line 7B: http://HEALTHCOLLABORATIVE.NET/REPORTS/

Schedule H, Part V, Sec B, Line 10A:
HTTPS://SAHEALTH.COM/ABOUT/COMMUNITY/INDEX.DOT

Schedule H, Part V, Sec B, Line 11:
"AS NOTED ABOVE, METHODIST HEALTHCARE SYSTEM HAS DEVELOPED A COMMUNITY HEALTH IMPROVEMENT PLAN BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT. PRIORITIES AND SPECIFIC TACTICS INCLUDE THE FOLLOWING, WITH THE INITIAL IMPLEMENTATION IN 2014, AND YEARLY UPDATES THROUGH 2022: METHODIST HEALTHCARE SYSTEM'S COMMUNITY HEALTH IMPROVEMENT PLAN INCLUDED THE FOLLOWING: COMMUNITY HEALTH PRIORITY NO. 1: HEALTHY EATING AND ACTIVE LIVING - COMMUNITY GOAL - TO FOSTER SOCIAL CHANGE AND STRENGTHEN POSITIVE BEHAVIORS AROUND HEALTHY EATING AND ACTIVE LIVING TO ENSURE ACCESS TO NUTRITIOUS FOODS AND BUILD ENVIRONMENTS THAT ENABLE ALL RESIDENTS TO MAKE HEALTHY CHOICES AND LEAD HEALTHY LIVES. TACTICS - COMMUNITY HEALTH PRIORITY NO. 1: - PROMOTE AND REFER PATIENTS LIVING WITH, OR AT RISK FOR, DIABETES TO THE LIVING WITH DIABETES PROGRAM. IN 2020, THIS PROGRAM WAS PLACED ON HOLD DUE TO COVID-19. - HOST AN ANNUAL FOOD DRIVE THAT BENEFITS THE SAN ANTONIO FOOD BANK. DUE TO COVID-19, METHODIST HOSTED A VIRTUAL CEREAL DRIVE. SERVING DONATIONS WERE MADE AS MONETARY DONATIONS. TOTAL COLLECTED WAS $702,253. - CONTINUE METHODIST HEALTHCARE'S EMPLOYER SOLUTION PROGRAM, HEALTHPOWER, IN PARTNERING WITH LOCAL BUSINESSES WHO PARTICIPATE IN METHODIST HEALTHCARE-sponsored WELLNESS ACTIVITIES TO INCLUDE CHALLENGE WEIGH-INS, GLUCOSE, AND BLOOD PRESSURE CHECKS. METHODIST HELD 3 EVENTS WITH 50 ATTENDEES, 5 HEALTH FAIRS WITH 2,250 ATTENDEES AND 4 SCREENING EVENTS WITH 91 ATTENDEES IN THE FIRST QUARTER OF 2020. ALL PLANNED EVENTS AFTER THE FIRST QUARTER WERE CANCELLED DUE TO COVID-19. - CONTINUE INVOLVEMENT WITH THE HEALTHY ME PROGRAM IN PARTNERSHIP WITH THE HEALTH COLLABORATIVE. PRIOR TO COVID-19 CANCELLATIONS, METHODIST PARTICIPATED IN 126 EVENTS WITH 6,722 IN ATTENDANCE. - CONTINUE OUTREACH PROGRAMS GEARED TOWARD IMPROVING THE HEALTH AND WELLNESS OF THE COMMUNITY THROUGH FREE HEALTH EDUCATION SEMINARS ON HEALTHY EATING AND ACTIVE LIVING, HEALTH SERVICES, AND EXERCISE ACTIVITIES. METHODIST HELD 30 OUTREACH EVENTS WITH 450 IN ATTENDANCE EARLY IN 2020. OTHER 2020 PROGRAMS WERE CANCELLED DUE TO COVID-19. - PARTNER WITH THE AMERICAN CANCER SOCIETY TO OFFER TOBACCO CESSATION PROGRAMS TO THE PATIENTS OF METHODIST HEALTHCARE AND COMMUNITY MEMBERS. NO EVENTS HELD IN 2020 DUE TO COVID-19. COMMUNITY HEALTH PRIORITY NO 2: HEALTHY CHILD AND FAMILY DEVELOPMENT - COMMUNITY GOAL - TO MAKE PREGNANCY AND EARLY CHILDHOOD THE FOCUS OF SYSTEM LEVEL CHANGES THAT SUPPORT HEALTH CHILD AND FAMILY DEVELOPMENT. TACTICS: COMMUNITY HEALTH PRIORITY NO. 2: - CONTINUE TO OFFER COMPLIMENTARY PREGNANCY TESTING THROUGH METHODIST FAMILY HEALTH CENTERS AND METHODIST WOMEN AND TEEN CENTERS. IN 2020, THERE WERE 4,257 VISITS AND 2,163 PREGNANCY TESTS PROVIDED. - CONTINUE TO OFFER CALL-A-NURSE FOR CHILDREN HEALTH LINE TELEPHONE SERVICES, WHICH OFFERS FREE MEDICAL ADVICE TO PARENTS OF SICK OR INJURED CHILDREN. IN 2020, THE CALL A NURSE LINE LOGGED 18,219 CALLS, AND PROVIDED 4,305 PHYSICIAN REFERRALS. - CONTINUE TO OFFER THE COMMUNITY PARENTING CLASSES, CAR SEAT INSTALLATIONS, CAR SEAT DISTRIBUTIONS AND LACTATION CONSULTATIONS. NO CAR SEAT DISTRIBUTIONS IN 2020 DUE TO COVID-19. FIVE VIRTUAL INSTALLATION SESSIONS PROVIDED CAR SEAT INSTALLATION INSTRUCTION TO 112 INDIVIDUALS. METHODIST PROVIDED 38,569 LACTATION CONSULTS IN 2020. METHODIST ALSO HELD VIRTUAL CHILDBIRTH EDUCATION COURSES FOR 1,115 ATTENDEES. - PARTNER WITH AREA SCHOOL DISTRICTS TO ESTABLISH A STUDENT/WORK PROGRAM IN METHODIST HEALTHCARE HOSPITALS. THE FIRST GROUP OF STUDENTS GRADUATED IN JUNE OF 2020. METHODIST HOPES TO EXPAND the PROGRAM IN 2021. - PARTNER WITH THE ARCHDIOCESE OF SAN ANTONIO AND ESTABLISH THE CATHOLIC BABY UNIVERSITY TO PROVIDE PARENTING CLASSES AND SUPPORT GROUPS FOR YOUNG PARENTS AS WELL AS CONNECT THEM WITH THE CATHOLIC RELIGION. DUE TO COVID-19, METHODIST WAS UNABLE TO IMPLEMENT THIS PROGRAM. - CONTINUE PARTNERSHIP WITH THE SOUTH TEXAS RADIOLOGY IMAGING CENTERS (STRIC) IN PROVIDING MAMMOGRAMS TO WOMEN IN THE COMMUNITY. METHODIST COULD NOT IMPLEMENT THIS PROGRAM IN 2020 DUE TO COVID-19. - CONTINUE TO PROVIDE ATHLETIC TRAINING IN THE METHODIST HEALTHCARE SERVICE AREA SCHOOL DISTRICTS, AS WELL AS THE VERY IMPORTANT ATHLETE (VIA) PROGRAM AND VERY IMPORTANT KID (VIK) PROGRAM. THESE PROGRAMS WERE LIMITED IN 2020 DUE TO COVID-19. COMMUNITY HEALTH PRIORITY NO. 3: SAFE COMMUNITIES - COMMUNITY GOAL - TO DEVELOP SAFE NEIGHBORHOODS BY IDENTIFYING WHAT WORKS LOCALLY, PLANNING HOW TO REPLICATE SUCCESS IN OUR NEIGHBORHOODS, AND ENHANCING SYSTEMS THAT RESPOND EFFECTIVELY TO COMMUNITY IDENTIFIED SAFETY NEEDS. - PARTNER WITH METHODIST HEALTHCARE SERVICE AREA POLICE DEPARTMENTS AND HOST AN ANNUAL SUBSTANCE TAKE-BACK DAY TO REDUCE THE PREVALENCE OF OVERPRESCRIBED PRESCRIPTIONS IN HOUSEHOLDS. METHODIST COLLECTED 65.8 POUNDS IN PRESCRIPTION DRUGS IN 2020. - PARTNER WITH THE AMERICAN HEART ASSOCIATION TO OFFER HANDS-ONLY CPR CLASSES TO THE COMMUNITY AND CONDUCT POST EVALUTION TO MEASURE KNOWLEDGE GAINED. METHODIST AND THE AMERICAN HEART ASSOCIATION HELD 40 SESSIONS WITH 7,129 IN ATTENDANCE. - PARTNER WITH THE SOUTH TEXAS RADIOLOGY ADVISORY COUNCIL (STRAC) TO OFFER ""STOP THE BLEED"" PROGRAMS TO THE COMMUNITY. METHODIST AND STRAC HOSTED THREE SESSIONS WITH 150 IN ATTENDANCE. - PARTNER WITH MOTHERS AGAINST DRUNK DRIVING (MADD) IN PROVIDING BREATHALYZERS TO THE COMMUNITY. PROGRAM DELAYED DUE TO COVID-19; HOWEVER, THIS ACTIVITY IS PLANNED FOR 2021. COMMUNITY HEALTH PRIORITY NO. 4: BEHAVIORAL HEALTH AND MENTAL WELL-BEING - COMMUNITY GOAL - TO IMPROVE COMPREHENSIVE BEHAVIORAL HEALTH SERVICES AND ACCESS FOR ALL. - CONTINUE METHODIST HEALTHARE TELE-PSYCHIATRY PROGRAM TO IMPROVE ACCESS TO PSYCHIATRISTS AS WELL AS PLACEMENT TO THE APPROPRIATE SETTING. METHODIST PROVIDED 8,678 TELE-PSYCHIATRY CONSULTATIONS IN 2020. - PARTNER WITH THE ALZHEIMER'S ASSOCIATION TO PROVIDE CONTINUING MEDICAL EDUCATION (CME) CLASSES TO MEDICAL PROFESSIONALS ON PROPERLY IDENTIFYING, DIAGNOSING AND COMMUNICATING ON ALZHEIMER'S DISEASE. PROGRAM WAS DELAYED DUE TO COVID-19; HOWEVER, METHODIST'S CME STAFF PLANS TO ROLL OUT OFFERING IN 2021. - CONTINUE TO PROVIDE ONGOING 24/7/365 PASTORAL CARE PRESENCE WITH PATIENTS, FAMILIES AND HEALTHCARE PROFESSIONALS WITH CHAPLAIN CLINICIANS. METHODIST'S CHAPLAIN CLINICIANS PROVIDED BEREAVEMENT SUPPORT TO 8,313 INDIVIDUALS IN 2020. COMMUNITY HEALTH PRIORITY NO. 5: SEXUAL HEALTH - COMMUNITY GOAL - ENSURE THAT MALES AND FEMALES HAVE ACCESS TO EDUCATION AND RESOURCES TO PROMOTE SEXUAL HEALTH. - PROVIDE FREE HUMAN IMMUNODEFICIENCY VIRUS (HIV) SCREENING TESTS TO THE COMMUNITY IN METHODIST HEALTHCARE SERVICE AREAS. METHODIST'S CAMPUSES PROVIDED 8,424 HIV SCREENINGS IN 2020. - PARTNER WITH METHODIST HEALTHCARE MINISTRIES TO PROVIDE FREE EDUCATION REGARDING THE HUMAN PAPILLOMA VIRUS (HPV) VACCINATION TO THE COMMUNITY. THIS PROGRAM WAS NOT OFFERED IN 2020 DUE TO COVID-19. THE INFORMATION ABOVE REFLECTS THE PLAN FOR MHS SYSTEM. RESULTS FROM METHODIST HOSPITAL ARE AS FOLLOWS: COMMUNITY HEALTH PRIORITY NO. 1: HEALTHY EATING AND ACTIVE LIVING - PROVIDE DIABETES EDUCATION TO PATIENTS LIVING WITH, OR AT RISK FOR, DIABETES PRIOR TO DISCHARGE AND OFFER CLASSES TO THE COMMUNITY. 1,970 DIABETES EDUCATION VISITS WERE PROVIDED IN 2020. - PARTNER WITH THE HEALTH COLLABORATIVE TO PROMOTE THE ""IS YOUR DRINK SUGAR PACKED"" CAMPAIGN TO PATIENTS AND THEIR FAMILIES WHO ARE IN THE SURGICAL WAITING ROOMS OF METHODIST HOSPITAL. THIS PROGRAM WAS PLACED ON HOLD IN 2020 DUE TO COVID-19. - PROVIDE A HEALTHY RECIPE BOOKLET THAT TARGETS SPECIFIC ACUTE AND CHRONIC DISEASES. THIS PROGRAM WAS ALSO PLACED ON HOLD IN 2020 DUE TO COVID-19. - CONDUCT AN ANNUAL HEALTH FOOD DRIVE FOR THE SAN ANTONIO FOOD BANK AND PROVIDE VOLUNTEER SUPPORT BY METHODIST HOSPITAL STAFF. METHODIST HEALTHCARE SYSTEM HELD A VIRTUAL CEREAL DRIVE IN 2020 AND COLLECTED 491,575 VIRUTAL SERVINGS THROUGH MONETARY DONATIONS. - PARTNER WITH THE AMERICAN HEART ASSOCIATION TO HOST AN ANNUAL CARDIAC EDUCATION EVENT WITH FOCUS ON HYPERTENSION, DIABETES AND HYPERLIPIDIMIA. THESE EVENTS WERE CANCELLED IN 2020 DUE TO COVID-19. - METHODIST HOSPITAL ALSO HOSTED A VIRTUAL HEALTH LITERACY CONFERENCE IN THE FOURTH QUARTER OF 2020. 714 INDIVIDUALS REGISTERED FOR THIS CONFERENCE. - METHODIST HOSPITAL PARTNERED WITH SOUTH TEXAS RADIOLOGY IMAGING CENTERS TO SPONSOR A BREAST CANCER SCREENING EVENT WHICH ENCOURAGED WOMEN TO HAVE THEIR ANNUAL MAMMOGRAMS. 8,408 SCREENINGS WERE PROVIDED. COMMUNITY HEALTH PRIORITY NO 2: HEALTHY CHILD AND FAMILY DEVELOPMENT - OFFER THE COMMUNITY PARENTING CLASSES INCLUDING ""BUCKLE UP BABY, GETTING READY FOR CHILDBIRTH, PEEK-A-BOO TOURS AND INFANT AND CHILD CPR"". METHODIST HOSTED 156 EVENTS, MANY OF THEM VIRTUAL, DURING 2020. 1,115 ATTENDED THESE EVENTS. - PARTNER WITH GLEN OAKS ELEMENTARY IN THE NORTHSIDE INDEPENDENT SCHOOL DISTRICT TO ADOPT THE SCHOOL AND PROVIDE AT LEAST TWO SCHOOL SUPPLY DRIVES EACH YEAR. DUE TO COVID-19, ONLY ONE DRIVE WAS HELD IN 2020. 724 ITEMS WERE COLLECTED FOR STUDENTS ATTENDING GLEN OAKS. - PROVIDE"

Schedule H, Part V, Sec B, Lines 13B, 13H and 15E:
METHODIST HEALTHCARE SYSTEM USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. THE FOLLOWING IS A SUMMARY OF THE CHARITY CARE POLICY ADOPTED BY METHODIST HEALTHCARE SYSTEM AND METHODIST HEALTHCARE MINISTRIES: FINANCIAL ASSISTANCE ELIGIBILITY SYSTEM - METHODIST REQUIRES THE COMPLETION OF AN APPLICATION, WHICH ALLOWS FOR THE COLLECTION OF APPROPRIATE INFORMATION. - VERIFICATION OF FAMILY MEMBERS IN THE HOUSEHOLD - ADULTS: PATIENT, PATIENT'S SPOUSE AND ANY DEPENDENTS. MINORS: PATIENT, PATIENT'S MOTHER AND FATHER, AND DEPENDENTS OF BOTH. - INCOME CALCULATION - ADULTS: SUM OF THE TOTAL YEARLY GROSS INCOME OF THE PATIENT AND THE PATIENT'S SPOUSE. MINORS: TOTAL YEARLY GROSS INCOME OF THE PATIENT, AND THE PATIENT'S MOTHER AND FATHER. - DOCUMENTATION - VARIOUS OFFICIAL INCOME REPORTING DOCUMENTATION IS REQUIRED (E.G. W-2, WAGE AND TAX STATEMENT, PAYCHECK REMITTANCE AND OTHERS). DOCUMENTATION ASSOCIATED WITH THE PARTICIPATION IN A PUBLIC BENEFIT PROGRAM CAN BE PROVIDED IN LIEU OF INCOME DOCUMENTATION (PROOF OF PARTICIPATION INDICATES THE PATIENT HAS BEEN DEEMED FINANCIALLY INDIGENT AND THEREFORE IS NOT REQUIRED TO PROVIDE INCOME INFORMATION). THERE IS ALSO A VERIFICATION PROCESS IN PLACE FOR PATIENTS THAT DO NOT HAVE APPROPRIATE DOCUMENTATION. - ZIP CODE WRITE-OFF ELIGIBILITY - METHODIST WILL ACCEPT UNINSURED RESIDENTIAL INDIGENT PATIENTS AS ELIGIBLE FOR CHARITY WRITE-OFF UPON EXHAUSTION OF INSURANCE ELIGIBILITY DETERMINATION (I.E. MEDICAID) AND EFFORTS TO OBTAIN A COMPLETED CHARITY APPLICATION WITH SUPPORTING PROOF OF INCOME. THE WRITE-OFF WILL APPLY TO ALL PATIENT TYPES. A RESIDENTIAL INDIGENT PATIENT IS AN UNINSURED PERSON WHO IS ACCEPTED FOR CARE WITH NO OBLIGATION OR WITH A DISCOUNTED OBLIGATION TO PAY FOR THE SERVICES RENDERED, AND LIVES IN SPECIFICALLY DEFINED ZIP CODES--THOSE WITH HIGH POVERTY POPULATIONS. FOR THE YEAR ENDED DECEMBER 31, 2020, THE CHARITY CARE WRITE OFF RELATED TO THIS ELIGIBILITY PROCESS WAS $265.3 MILLION ($330.6 MILLION IN 2019). CHARITY ELIGIBILITY CLASSIFICATIONS - FINANCIALLY INDIGENT - YEARLY INCOME IS LESS THAN OR EQUAL TO 200% OF THE FEDERAL POVERTY GUIDELINES. - MEDICALLY INDIGENT - THE AMOUNT OWED BY THE PATIENT AFTER PAYMENT BY ALL THIRD-PARTY PAYORS MUST EXCEED TEN PERCENT OF THE PATIENT'S YEARLY INCOME AND THE PATIENT MUST BE UNABLE TO PAY THE REMAINING BILL. ACCEPTANCE BY MHS IS BASED ON MEETING EITHER OF TWO CRITERIA: YEARLY INCOME MUST BE GREATER THAN 200%, BUT LESS THAN OR EQUAL TO 500% OF THE FEDERAL POVERTY GUIDELINES. ALTERNATIVELY, PATIENTS WITH ABNORMALLY LARGE ACCOUNTS MAY QUALIFY AS CATASTROPHICALLY ELIGIBLE WHEN THEIR REMAINING BALANCE EXCEEDS A SPECIFIC PERCENTAGE OF THEIR INCOME. IT IS IMPORTANT TO NOTE THAT THE GUIDELINES APPLIED FOR CATASTROPHIC ELIGIBILITY RANGE FROM 201% OF THE FEDERAL POVERTY GUIDELINES TO OVER 1000% OF THE FEDERAL POVERTY GUIDELINES.

Schedule H, Part V, Sec B, Lines 16A:
Https://Sahealth.Com/About/Mission-Values/Financial-Assistance-Policy.Dot Schedule H, Part V, Sec B, Lines 16b - c: https://sahealth.com/about/mission-values/financial-assistance-policy-and- application.dot

Schedule H, Part V, Sec B, Lines 16J and 20E:
"MHS HAS TAKEN STEPS OVER THE PAST SEVERAL YEARS TO HEIGHTEN COMMUNITY AWARENESS REGARDING MHS'S CHARITABLE MISSION. SIGNS THAT PROMINENTLY PRESENT INFORMATION ABOUT THE CHARITY MISSION AND GUIDELINES ARE PRESENT AT ALL POINTS OF ADMISSION. MHS ALSO PUBLISHES A NOTICE OF ITS CHARITY POLICY ANNUALLY IN THE SAN ANTONIO EXPRESS-NEWS. A PATIENT BROCHURE, ENTITLED ""A GUIDE TO YOUR HOSPITAL BILL"", EXPLAINS THE HOSPITAL BILLING PROCESS AND INFORMS PATIENTS OF THE CHARITY POLICY IN THE EVENT THEY NEED FINANCIAL ASSISTANCE. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE IN ENGLISH AND SPANISH ON MHS'S WEBSITE WWW.SAHEALTH.COM. ALL SHARED SERVICE CENTER PERSONNEL RECEIVE TRAINING AND AN ANNUAL REFRESHER COURSE ON THE POLICY AND UNDERSTAND THE CRUCIAL ROLE THEY PLAY IN INFORMING PATIENTS ABOUT THE POLICY. FINANCIAL COUNSELORS AND HOSPITAL CASE MANAGEMENT STAFF EDUCATE PATIENTS AND ARE AVAILABLE TO ASSIST THEM WITH THE CHARITY CARE APPLICATION PROCESS. IN ADDITION TO PROVIDING INFORMATION DURING THE ADMITTING PROCESS, MHS CONTINUES TO PROVIDE INFORMATION ABOUT THE AVAILABILITY OF CHARITY CARE ASSISTANCE DURING THE COLLECTION PROCESS FOR THOSE PATIENTS WHO HAVE BEEN BILLED BUT HAVE NOT PAID."

SCHEDULE H, PART I, LINE 6A:
METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., LLP ('MHS') FILES ANNUAL STATEMENTS OF COMMUNITY BENEFITS AS REQUIRED BY THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES, PER PROVISIONS OF THE TEXAS HEALTH AND SAFETY CODE, CHAPTER 311, SUBCHAPTERS C AND D. METHODIST HEALTHCARE MINISTRIES OF SOUTH TEXAS, INC. ('MHM') OWNS A 50% INTEREST OF MHS SO ONLY 50% OF MHS' FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS ARE REPORTED ON MHM'S FORM 990 SCHEDULE H. SCHEDULE H, PART I, LINE 7: COSTING METHODOLOGY - COST TO CHARGE RATIOS FROM WORKSHEET 2 USED. PART I, LINE 7A EXPLANATION - IN THE STATE OF TEXAS 86TH LEGISLATIVE REGULAR SESSION, A BILL WAS PASSED WHICH AMENDED THE HEALTH AND SAFETY CODE, AUTHORIZING THE BEXAR COUNTY HOSPITAL DISTRICT TO CREATE A NONPUBLIC HOSPITAL PROVIDER PARTICIPATION PROGRAM. THE PARTICIPATION PROGRAM ALLOWS THE COLLECTION OF MANDATORY PAYMENTS FROM NONPUBLIC HOSPITALS. THESE PAYMENTS WILL BE DEPOSITED IN A LOCAL PROVIDER PARTICIPATION FUND (LPPF) TO FUND INTERGOVERNMENTAL TRANSFERS (IGTS) TO BE USED BY HHSC AS THE NONFEDERAL SHARE TO DRAW DOWN MEDICAID SUPPLEMENTAL PAYMENTS UNDER THE 1115 WAIVER PROGRAM AND UNIFORM HOSPITAL RATE INCREASE PROGRAM (UHRIP). THE BILL WAS EFFECTIVE JUNE 10, 2019, HOWEVER THE LPPF PROGRAM COMMENCED ON JANUARY 1, 2020. THE PARTNERSHIP MADE PAYMENTS UNDER THIS LPPF OF $56.5 MILLION FOR THE YEAR ENDED DECEMBER 31, 2020. THE LPPF EXPENSE IS RECORDED WITHIN THE OTHER OPERATING EXPENSES IN THE PARTNERSHIP'S CONSOLIDATED INCOME STATEMENT.

SCHEDULE H, PART VI, LINE 2:
"IN ADDITION TO THE ITEMS SPECIFICALLY NOTED TO ADDRESS THE COMMUNITY HEALTH PRIORITIES, OTHER HIGHLIGHTS FROM 2020 INCLUDE THE FOLLOWING: IN LATE 2011, THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION FILED AN APPLICATION FOR A WAIVER OF CERTAIN FEDERAL MEDICAID REQUIREMENTS UNDER SECTION 1115 OF THE SOCIAL SECURITY ACT. AS A RESULT OF THE GRANTING OF THIS APPLICATION THE TEXAS HEALTH CARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM WAS DEVELOPED TO PROVIDE PAYMENTS (DELIVERY REFORM INCENTIVE PAYMENTS, OR DSRIP) TO HOSPITAL AND OTHER PROVIDERS UPON THEIR ACHIEVING CERTAIN GOALS THAT ARE INTENDED TO IMPROVE THE QUALITY AND LOWER THE COST OF CARE. THIS INITIATIVE DIVIDES THE STATE INTO TWENTY DIFFERENT REGIONS, EACH REGION DEVELOPED A COMMUNITY HEALTH NEEDS ASSESSMENT, AND PROVIDERS IN THE REGION WILL SUBMIT PROJECTS FOR FUNDING CONSIDERATION TO ADDRESS THOSE NEEDS. METHODIST HEALTHCARE SYSTEM RECEIVED APPROVAL FOR THE FOLLOWING PROJECTS: INTRODUCE, EXPAND OR ENHANCE TELEMEDICINE/TELEHEALTH - METHODIST WILL IMPLEMENT A TELEHEALTH PROGRAM THAT WILL PROVIDE TELEHEALTH CONSULTATIONS WITH TRAINED SPECIALISTS IN SELECTED SERVICES. BY THE END OF 2017, THE TELE-STROKE PROGRAM EXPANDED TO INCLUDE TWELVE LOCATIONS. THROUGH THIS PROGRAM, PHYSICIANS CAN DRAMATICALLY INCREASE RESPONSE TIME, TRANSFERS CAN BE MINIMIZED, AND PATIENTS CAN OFTEN RECEIVE LIFESAVING CARE MORE RAPIDLY, OFTEN TIMES AT THEIR HOME HOSPITAL. THE BEHAVIORAL HEALTH TELEMEDICINE PROGRAM'S OPERATIONS STARTED IN JANUARY 2014. THE GOAL OF THIS PROGRAM IS TO PROVIDE TIMELY CONSULTATIONS, DIAGNOSIS AND TREATMENT RECOMMENDATIONS FOR BEHAVIORAL HEALTH/SUBSTANCE ABUSE PATIENTS IN EVERY METHODIST EMERGENCY DEPARTMENT OR IN MEDICAL ACUTE UNITS THROUGHOUT METHODIST. 4,200 BEHAVIORAL HEALTH AND 575 TELE-STROKE CONSULTATIONS WERE PROVIDED FOR THE DSRIP REPORTING PERIOD ENDED SEPTEMBER 30, 2020. OVER 50% OF THE CONSULTATIONS PROVIDED WERE TO MEDICAID OR LOW-INCOME UNINSURED PATIENTS. Enhance behavioral health services - PATIENTS REQUIRING PSYCHIATRIC SERVICES ARE OFTEN ONE OF THE MOST UNDERSERVED POPULATIONS IN THE COMMUNITY, AND METHODIST STRIVES TO ENSURE THAT THESE PATIENTS HAVE ACCESS TO APPROPRIATE CARE. METHODIST HOSPITAL : SPECIALTY AND TRANSPLANT IS ONE OF THE THREE SAN ANTONIO HOSPITALS THAT PROVIDE PSYCHIATRIC EMERGENCY SERVICES (PES) THROUGH THE SOUTHWEST TEXAS CRISIS COLLABORATIVE OF THE SOUTHWEST TEXAS REGIONAL ADVISORY COUNCIL. METHODIST HOSPITAL : SPECIALTY AND TRANSPLANT PROVIDES SIX PES BEDS PROVIDING IMMEDIATE PSYCHIATRIC EVALUATIONS, CLINICAL ASSESSMENTS, AND LINKAGE TO THE NEXT APPROPRIATE LEVEL OF CARE TO ADULT MENTAL HEALTH PATIENTS. ESTABLISH MORE PRIMARY CARE CLINICS - METHODIST OPENED THE METHODIST COMMUNITY HEALTH CENTER IN 2014. THE CENTER IS AN URGENT CARE CENTER LOCATED IN EAST SAN ANTONIO. THE METHODIST COMMUNITY HEALTH CENTER PROVIDES SERVICES TO ALL PATIENTS AT NO COST. THE CENTER PROVIDED 1,608 ENCOUNTERS FOR THE DSRIP REPORTING PERIOD ENDING SEPTEMBER 30, 2020. OF THESE ENCOUNTERS, 80% WERE PROVIDED TO MEDICAID OR LOW-INCOME UNINSURED PATIENTS. THIS LOCATION NOTED AN OVERALL DECREASE IN VOLUME IN 2020 AS A RESULT OF COVID-19. REDESIGN TO IMPROVE THE PATIENT EXPERIENCE - THE FOCUS FOR THIS PROJECT IS TO IMPROVE HOW PATIENTS EXPERIENCE CLINICAL AREA AS WELL AS THE PATIENT'S SATISFACTION WITH THEIR CARE. IN 2016, METHODIST IMPLEMENTED STANDARDIZED GOAL ALIGNMENT BOARDS AT ALL LOCATIONS. THESE DISPLAYS, LOCATED IN PUBLIC AREAS, PROVIDE AN OVERVIEW OF PILLAR GOALS, AS WELL AS PROGRESS TOWARDS MEETING THESE GOALS. METHODIST CONTINUES TO USE THESE BOARDS TO TRACK PROGRESS, AND ALSO STANDARDIZED REPORTING, ADDING PATIENT SAFETY AS A KEY FOCUS. METHODIST ROLLED OUT A NEW ONLINE REPORTING RESOURCE IN THE FOURTH QUARTER OF 2019 THAT PROVIDES MULTIPLE SCORECARDS AND REPORTS THAT ALLOW UNITS TO PRIORITIZE OPPORTUNITIES FOR IMPROVEMENT. APPLY PROCESS IMPROVEMENT METHODOLOGY TO IMPROVE QUALITY/EFFICIENCIES SPECIFIC TO SEPSIS - IMPROVEMENT OF SEPSIS MANAGEMENT IS A KEY INITIATIVE IN METHODIST'S CLINICAL EXCELLENCE PLAN. METHODIST HAS DEVELOPED AND CONTINUES TO REFINE THE SEPSIS EARLY RECOGNITION SCREENING TOOL, WHICH WILL ALLOW CLINICAL STAFF TO BETTER IDENTIFY PATIENTS IN EARLY SEPSIS AND TO PROVIDE RAPID INTERVENTION AND REDUCTION OF PATIENTS DEVELOPING SEVERE SEPSIS AND/OR SEPTIC SHOCK. SEPSIS BUNDLE ELEMENTS ARE NOT INCLUDED IN THE ELECTRONIC TRIAGE SCREENING FOR ED, ICU, IN-HOSPITAL NURSING, AND RAPID RESPONSE TEAMS. EVIDENCE BASED ORDER SETS FOR CPOE CONTINUE TO BE REFINED BASED UPON INPUT FROM THE MEDICAL AND NURSING STAFF. A NEW TOOL, THE SEPSIS PREVENTION & OPTIMIZATION OF THERAPY (SPOT) IS BEING USED AT ALL CAMPUSES. SPOT IS AN APPLICATION THAT MONITORS ALL PATIENT LABS AND VITALS IN REAL TIME AND USES THE INFORMATION TO IDENTIFY PATIENTS WHO ARE AT RISK FOR SEPSIS. TWO METHODIST CAMPUSES HAVE ALSO RECEIVED EITHER SEPSIS CERTIFICATION OR RE-CERTIFICATION FROM THE JOINT COMMISSION. WHEN FACED WITH A THREAT TO PUBLIC HEALTH AND SAFETY, LIKE THAT OF A PANDEMIC, METHODIST HEALTHCARE IS COMMITTED TO DOING WHAT IS RIGHT FOR OUR PEOPLE, OUR PATIENTS, AND OUT COMMUNITIES. SINCE CONFIRMING THE FIRST PATIENT CASE IN FEBRUARY 2020 (THE FIRST CASE IN TEXAS), METHODIST TREATED 8,968 COVID-19 PATIENTS THROUGH DECEMBER 31, 2020. A RESPONSE OF THIS MAGNITUDE WAS POSSIBLE DUE TO THE UNWAVERING COMMITMENT AND TREMENDOUS SACRIFICE OF METHODIST'S EMPLOYEES, WHO HAVE BEEN GUIDED THROUGHOUT THE SYSTEM'S RESPONSE TO COVID-19 BY THESE FOUR CORE PRINCIPLES: 1. BE THERE FOR OUR PATIENTS. 2. PROTECT OUR EMPLOYEES AND CAREGIVERS, BOTH PHYSICALLY AND FINANCIALLY. 3. PARTNER WITH OTHERS TO IMPROVE CARE BEYOND OUR OWN ORGANIZATION. 4. BE A RESOURCE FOR OUR COMMUNITIES AND GOVERNMENTS. BE THERE FOR OUR PATIENTS EARLY ON, METHODIST IMPLEMENTED PROTOCOLS TO ENSURE IT'S FACILITIES WERE SAFE PLACES TO CARE FOR OUR PATIENTS. METHODIST ENHANCED CLEANING PROCEDURES, ENHANCED SCREENING PROTOCOLS, LIMITED VISITORS AND SEPARATED COVID-19 PATIENTS FROM OTHER PATIENTS. METHODIST HEALTHCARE SYSTEM WAS ONE OF THE FIRST HEALTH SYSTEMS IN SOUTH TEXAS TO IMPLEMENT A UNIVERSAL MASKING POLICY FOR ALL STAFF AND PROVIDERS TO HELP REDUCE THE SPREAD OF THE VIRUS - EVEN BEFORE THE U.S. CENTERS FOR DISEASE CONTROL RECOMMENDED SUCH A POLICY. DURING 2020, METHODIST HOSPITALS PERFORMED 127,181 COVID-19 TESTS FOR THE SAN ANTONIO AND CENTRAL AND WEST TEXAS DIVISIONS OF HCA. METHODIST ALSO SHIPPED COVID-19 TESTING INSTRUMENTS AND TEST KITS TO THE HCA GULF COAST AND CONTINENTAL DIVISIONS TO AID WITH THEIR COVID-19 TESTING. METHODIST HOSPITAL WAS THE 2ND HOSPITAL IN TEXAS AND THE FIRST IN HCA TO RECEIVE AND PERFORM THE ABBOTT COVID-19 RAPID TEST. 99.5% OF ALL COVID-19 TESTS PERFORMED IN THE SAN ANTONIO DIVISION WERE COMPLETED IN LESS THAN 24 HOURS FROM COLLECTION TIME. COVID-19 POSTITIVE PATIENTS DID NOT HAVE TO PAY FOR THEIR TREATMENT IN MHS'S HOSPITALS. METHODIST, THROUGH ITS PARTNERSHIP WITH HCA, OFFERED A FREE DEDICATED HOTLINE FOR PATIENTS WHO LOST JOBS AND/OR HEALTH INSURANCE TO GUIDE THEM THROUGH THEIR COVERAGE OPTIONS. AS OF DECEMBER 2020, 7,200 PATIENTS WERE ASSISTED THROUGH THE HOTLINE, WHICH ADDRESSED MORE THAN 20,300 CALLS. PROTECT OUR EMPLOYEES AND CAREGIVERS, BOTH PHYSICALLY AND FINANCIALLY IN 2020, OUR SUPPLY CHAIN DISTRIBUTED 374,092 N95 MASKS, 62,869,606 EXAM GLOVES, 2,697,154 LEVEL I MASKS, 43,692 FACE SHIELDS AND 2,433,138 ISOLATION GOWNS. AS THE PANDEMIC CONTINUES, WE CONTINUE TO WORK TIRELESSLY TO ENSURE WE HAVE ENOUGH PERSONAL PROTECTIVE EQUIPMENT TO PROTECT OUR CAREGIVERS. METHODIST COLLABORATED WITH MAJOR HOTEL CHAINS TO PROVIDE HOUSING FOR PROVIDERS WHO WORK DIRECTLY WITH COVID-19 PATIENTS AND OFFERED SCRUB LAUNDERING FOR THOSE CARING FOR COVID-19 PATIENTS. AT A TIME WHEN HUNDREDS OF HOSPITALS AND HEALTHCARE SYSTEMS WERE LAYING OFF OR FURLOUGHING EMPLOYEES, METHODIST INTRODUCED A PANDEMIC PAY PROGRAM THAT HELPED PROVIDE PAYCHECKS TO EMPLOYEES UNABLE TO WORK AS GOVERNMENT MANDATES HALTED MANY ELECTIVE PROCEDURES. METHODIST ALSO OFFERED QUARANTINE PAY FOR PATIENT CARE STAFF WHO MET CRITERIA FOR EXPOSURE TO COVID-19. METHODIST PROVIDED MULTIPLE RESOURCES TO STAFF WHO WORKED ENDLESS HOURS AND SHIFTS SUCH AS: VIRUTAL MENTAL WELLNESS SEMINARS, COUNSELING, 24/7 ADVICE LINES AND COPING TOOLS, FINANCIAL ASSISTANCE IN THE FORM OF TOOL KITS, WEBINARS AND ADVICE LINES; EMERGENCY CHILDCARE OPTIONS; ON-SITE MINI MARTS AND FREE ""DOCTOR ON DEMAND"" TELEHEALTH VISITS. TOP MHS EXECUTIVES TOOK A 30% PAY CUT AND HOSPITAL CEO'S DONATED 30% OF THEIR PAY FOR THE MONTHS OF APRIL AND MAY TO THE HCA HOPE FUND TO HELP STAFF IN NEED DURING THE PANDEMIC. MHS OFFERED STAFF EASY ACCESS TO COVID-19 TESTING AT THE CARENOW URGENT CARE AND A DRIVE-THROUGH SITE AT METHODIST HOSPITAL AMUBLATORY SURGERY. PARTNER WITH OTHERS TO IMPROVE CARE BEYOND OUR OWN ORGANIZATION THROUGH HCA, METHODIST JOINED A COALITION OF THE NATION'S LEADING MENTAL HEALTH ORGANIZATIONS TO SUPPORT PSYCH HUB'S COVID-19 MENTAL RESOURCE HUB, WHICH PROVIDES EMPLOYEES"

SCHEDULE H, PART VI, LINE 3:
"MHS HAS TAKEN STEPS OVER THE PAST SEVERAL YEARS TO HEIGHTEN COMMUNITY AWARENESS REGARDING MHS'S CHARITABLE MISSION. SIGNS THAT PROMINENTLY PRESENT INFORMATION ABOUT THE CHARITY MISSION AND GUIDELINES ARE PRESENT AT ALL POINTS OF ADMISSION. MHS ALSO PUBLISHES A NOTICE OF ITS FINANCIAL ASSISTANCE POLICY ANNUALLY IN THE SAN ANTONIO EXPRESS-NEWS. A PATIENT BROCHURE, ENTITLED ""A GUIDE TO YOUR HOSPITAL BILL"", EXPLAINS THE HOSPITAL BILLING PROCESS AND INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY IN THE EVENT THEY NEED FINANCIAL ASSISTANCE. INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE IN ENGLISH AND SPANISH ON MHS'S WEBSITE WWW.SAHEALTH.COM. ALL SHARED SERVICE CENTER PERSONNEL RECEIVE TRAINING AND AN ANNUAL REFRESHER COURSE ON THE POLICY AND UNDERSTAND THE CRUCIAL ROLE THEY PLAY IN INFORMING PATIENTS ABOUT THE POLICY. FINANCIAL COUNSELORS AND HOSPITAL CASE MANAGEMENT STAFF EDUCATE PATIENTS AND ARE AVAILABLE TO ASSIST THEM WITH THE FINANCIAL POLICY APPLICATION PROCESS. IN ADDITION TO PROVIDING INFORMATION DURING THE ADMITTING PROCESS, MHS CONTINUES TO PROVIDE INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE DURING THE COLLECTION PROCESS FOR THOSE PATIENTS WHO HAVE BEEN BILLED BUT HAVE NOT PAID. AS NOTED ABOVE, MHS USES MULTIPLE METHODS TO COMMUNICATE AND PUBLICIZE FINANCIAL ASSISTANCE POLICIES. INFORMATION SYSTEMS PROGRAMMING CHANGES have been implemented. THESE CHANGES WILL ALLOW A MESSAGE ABOUT THE POLICIES TO PRINT ON PATIENT BILLING STATEMENTS. SCHEDULE H, PART VI, LINE 4: THE SAN ANTONIO METROPOLITAN STATISTICAL AREA (MSA) OF 2.5 MILLION PEOPLE INCLUDES THE SEVENTH LARGEST PERCENTAGE OF HISPANICS IN THE UNITED STATES. 60% OF THE LOCAL POPULATION IS HISPANIC, 28% IS WHITE NON-HISPANIC, 7% IS BLACK, 3% IS ASIAN AND 2% IS OTHER. TEXAS AND SAN ANTONIO CONTINUE TO LEAD THE NATION IN THE NUMBER OF UNINSURED ADULTS AND CHILDREN (TEXAS IS RANKED NO. 1 WITH 17.7% UNINSURED AND THE U.S. IS 8.9%). OVER ELEVEN PERCENT OF CHILDREN IN TEXAS ARE WITHOUT HEALTH INSURANCE COMPARED TO THE U.S. AT 5.5%. IN SAN ANTONIO, ONE OUT OF FOUR ADULTS AND CLOSE TO ONE OUT OF THREE CHILDREN DO NOT HAVE HEALTH INSURANCE. THE MEDIAN HOUSEHOLD INCOME IN SAN ANTONIO IS $57,379, COMPARED TO $60,629 FOR TEXAS AND $61,937 FOR THE NATION. SAN ANTONIO HAS A LARGE POPULATION LIVING IN POVERTY WHEN COMPARED TO OTHER PARTS OF TEXAS. 18.6% OF SAN ANTONIO RESIDENTS LIVE AT OR BELOW THE POVERTY LEVEL, AND BEXAR COUNTY IS AT 16.4%, COMPARED TO 15.5% FOR TEXAS, AND 14.1% FOR THE U.S. SAN ANTONIO'S PERCENT OF HOUSEHOLDS RECEIVING FOOD STAMPS IS 15.6%, WITH TEXAS AT 13.1%, AND THE U.S. at 13.3%. METHODIST HEALTHCARE SERVES AN ESTIMATED POPULATION OF NEARLY 2.9 MILLION IN BEXAR AND 26 SOUTH AND CENTRAL TEXAS COUNTIES: ATASCOSA, BANDERA, CALDWELL, COMAL, DEWITT, DIMMIT, EDWARDS, FRIO, GILLESPIE, GONZALES, GUADALUPE, KARNES, KENDALL, KERR, KINNEY, LA SALLE, LAVACA, MAVERICK, MCMULLEN, MEDINA, REAL, UVALDE, VAL VERDE, WEBB, WILSON AND ZAVALA. SINCE THIS GEOGRAPHIC AREA IS MAJORITY HISPANIC, MHS SEES THIS REFLECTED IN OUR PATIENT POPULATION. SCHEDULE H, PART VI, LINE 5: SEE RESPONSES FOR SCHEDULE H, PART VI, LINE 2."

Schedule H, Part III, Lines 2 & 3:
"COSTING METHODOLOGY - COST TO CHARGE RATIOS FROM WORKSHEET 2 USED. MHM AND MHS JOINTLY ANALYZED ZIP CODES WHERE, BASED ON FINANCIAL DEMOGRAPHICS, IT APPEARED THAT THE PATIENTS IN THOSE ZIP CODES WOULD LIKELY QUALIFY FOR CHARITY CARE. AN ANALYSIS OF PAST COLLECTIONS IN THE ZIP CODE AREAS AND SEVERAL FEDERAL POVERTY GUIDELINE SURVEYS USING THE ZIP CODES RESULTED IN MHM'S CONCLUSION THAT ALL PATIENTS IN THE IDENTIFIED ZIP CODES ARE PATIENTS THAT, UNDER MHS FINANCIAL ASSISTANCE POLICIES, WOULD LIKELY QUALIFY FOR CHARITY CARE. THE ESTIMATED AMOUNT OF MHS' BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WAS CALCULATED USING ZIP CODE DATA. SCHEDULE H, PART III, LINE 4: Bad debt footnote from Methodist Healthcare System of San Antonio, LTD,. LLP's consolidated financial statements: IN MAY 2014, THE FINANCIAL ACCOUNTING STANDARDS BOARD (""FASB"") ISSUED A NEW STANDARD RELATED TO REVENUE RECOGNITION. THE PARTNERSHIP ADOPTED THE NEW STANDARD EFFECTIVE JANUARY 1, 2018, USING THE FULL RETROSPECTIVE METHOD. THE ADOPTION OF THE NEW STANDARD DID NOT HAVE AN IMPACT ON THE RECOGNITION OF NET PATIENT REVENUES FOR ANY PERIODS PRIOR TO ADOPTION. THE MOST SIGNIFICANT IMPACT OF ADOPTING THE NEW STANDARD IS THAT THE CONSOLIDATED STATEMENTS OF INCOME NO LONGER PRESENTS THE ""PROVISION FOR DOUBTFUL ACCOUNTS"" AS A SEPARATE LINE ITEM, INSTEAD NET PATIENT REVENUE IS PRESENTED NET OF ESTIMATED IMPLICIT PRICE CONCESSION REVENUE DEDUCTIONS. IN ADDITION, THE ""ALLOWANCE FOR DOUBTFUL ACCOUNTS"" IS NO LONGER PRESENTED ON THE CONSOLIDATED BALANCE SHEETS AS A RESULT OF THE ADOPTION OF THE NEW STANDARD. Net patient revenue generally relates to contracts with patients in which the Partnership's performance obligations are to provide health care services to the patients. Revenue is recorded during the period that the obligations to provide health care services are satisfied. Performance obligations for inpatient services are generally satisfied over periods that average approximately five days and performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third party payer (Medicare, Medicaid, managed care health plans, and commercial insurance companies) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third party payers for the services provided to the related patients typically specify payments at amounts less than the Partnership's standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge or identified service. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the estimated transaction price to be received from the third-party payer to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. Net patient revenue is based upon the estimated amounts expected to be received from patients and third-party payers. The estimated transaction price to be received under managed care and commercial insurance plans is based upon the payment terms specified in the related contractual agreements. Revenue related to uninsured patients and uninsured co-payment and deductible amounts for patients who have health care coverage may have an implicit price concession applied. An estimated implicit price concession (based primarily on payer historical collection experience) is recorded within net patient revenue to record self-pay revenue at the estimated amounts to be collected. AS OF DECEMBER 31, 2020, THE BAD DEBT INCLUDED IN REVENUE DEDUCTIONS WAS $112,592,217. THIS AMOUNT IS NOT REFLECTED ON MHM'S 990 PART IX EXPENSES DUE TO THE BAD DEBT AMOUNT BEING REPORTED IN THE METHODIST HEALTHCARE SYSTEM'S FINANCIALS. SCHEDULE H, PART III, LINE 8: THE AMOUNTS REPORTED ON PART III, LINES 5-7 HAVE BEEN DETERMINED BY AGGREGATING THE INFORMATION FROM THE INDIVIDUAL FACILITY COST REPORT(S) FOR EACH OF THE HOSPITALS OPERATED BY MHS. THE HOSPITALS OPERATED BY MHS MAY HAVE COST REPORT YEAR ENDS OTHER THAN DECEMBER 31, 2020. ACCORDINGLY, FOR A FACILITY WITH A NON-CALENDAR COST REPORT YEAR END, THE COST REPORT THAT WAS FILED FOR THE COST REPORT YEAR END THAT ENDED DURING 2020 WAS UTILIZED. IT IS IMPORTANT TO NOTE THAT AMOUNTS INCLUDED IN LINES 5-7 DO NOT INCLUDE MEDICARE REVENUE AND RELATED COST FOR FREESTANDING AMBULATORY SURGERY SERVICES AND FOR PHYSICIAN SERVICES. SCHEDULE H, PART III, LINE 9B: MHS HAS A POLICY TO PROVIDE DISCOUNTS TO THOSE INDIVIDUALS WHO DO NOT HAVE INSURANCE OR ARE NOT COVERED BY A GOVERNMENTAL REIMBURSEMENT PROGRAM. IF A PATIENT QUALIFIES FOR MEDICAID, THEN HE OR SHE IS ONLY RESPONSIBLE FOR ANY NON-COVERED CHARGES. IF THE PATIENT DOES NOT QUALIFY FOR MEDICAID, HE OR SHE MAY COMPLETE THE MHS FINANCIAL ASSISTANCE APPLICATION TO HAVE THE ENCOUNTER REVIEWED FOR A POTENTIAL CHARITY DISCOUNT. IF THE PATIENT'S YEARLY INCOME IS LESS THAN OR EQUAL TO 200% OF THE POVERTY GUIDELINES UPDATED ANNUALLY IN THE FEDERAL REGISTER BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (""FEDERAL POVERTY GUIDELINES""), THE PATIENT WILL BE GRANTED CLASSIFICATION AS FINANCIALLY INDIGENT, AND THE ACCOUNT WILL BE WRITTEN OFF TO CHARITY. LETTERS ARE THEN SENT TO THE PATIENT NOTIFYING THAT THE ACCOUNT HAS QUALIFIED FOR THE CHARITY DISCOUNT AND IS CONSIDERED CLOSED. IN ADDITION, A SLIDING SCALE DISCOUNT IS APPLIED TO ACCOUNTS FOR PATIENTS WHOSE INCOME IS BETWEEN 200% AND 500% OF THE FEDERAL POVERTY GUIDELINES, AND WHOSE REMAINING ACCOUNT BALANCE, AFTER ANY THIRD-PARTY PAYMENTS, EXCEEDS A PERCENTAGE OF THEIR INCOME (""MEDICALLY INDIGENT""). IN ADDITION, PATIENTS WITH ABNORMALLY LARGE ACCOUNTS MAY QUALIFY AS CATASTROPHICALLY ELIGIBLE WHEN THEIR REMAINING BALANCE EXCEEDS A SPECIFIC PERCENTAGE OF THEIR INCOME. IF A PATIENT DOES NOT QUALIFY FOR A CHARITY DISCOUNT, AN UNINSURED DISCOUNT IS APPLIED TO TOTAL CHARGES. IF A PATIENT IS UNABLE TO PAY THE REMAINING BALANCE IN FULL, AFTER APPLYING ANY CHARITY OR UNINSURED DISCOUNTS, MHS WILL WORK WITH THE PATIENT TO SET UP A MONTHLY PAYMENT ARRANGEMENT. THROUGHOUT THE DEBT COLLECTION PROCESS, MHS CONTINUES TO INFORM PATIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE."

SCHEDULE H, PART VI, LINE 6:
"ALL SHARED SERVICE CENTER PERSONNEL RECEIVE TRAINING AND AN ANNUAL REFRESHER COURSE ON THE POLICY AND UNDERSTAND THE CRUCIAL ROLE THEY PLAY IN INFORMING PATIENTS ABOUT THE POLICY. FINANCIAL COUNSELORS AND HOSPITAL CASE MANAGEMENT STAFF EDUCATE PATIENTS AND ARE AVAILABLE TO ASSIST THEM WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IN ADDITION TO PROVIDING INFORMATION DURING THE ADMITTING PROCESS, MHS CONTINUES TO PROVIDE INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE DURING THE COLLECTION PROCESS FOR THOSE PATIENTS WHO HAVE BEEN BILLED BUT HAVE NOT PAID. AS NOTED ABOVE, MHS USES MULTIPLE METHODS TO COMMUNICATE AND PUBLICIZE FINANCIAL ASSISTANCE POLICIES. INFORMATION SYSTEMS PROGRAMMING CHANGES HAVE BEEN IMPLEMENTED. THESE CHANGES WILL ALLOW A MESSAGE ABOUT THE POLICIES TO PRINT ON PATIENT BILLING STATEMENTS. LATE IN 2009 METHODIST CONSOLIDATED ALL BED PLACEMENT SERVICES, INCLUDING RURAL ED TRANSFER ASSISTANCE, INTO A SYSTEM-WIDE PATIENT PLACEMENT CENTER. RURAL TRANSFERS THROUGH THE CENTER DECREASED IN 2020 BY 20%. THE ACCEPTANCE RATE IN 2020 WAS 82% COMPARED TO 98.7% IN 2019. SELF-PAY PATIENTS ACCOUNTED FOR 15.7% OF ALL TRANSFERS IN 2020 AS COMPARED TO 14.9% IN 2019. PEDIATRIC AND HIGH-RISK MATERNAL TRANSFERS ARE ALSO NOW HANDLED THROUGH THESE CONSOLIDATED PLACEMENT SERVICES. THE ACCEPTANCE RATE FOR THESE TRANSFERS WAS 99.4% IN 2020 (99.6% IN 2019). MHS SELF-PAY AND CHARITY PATIENTS ACCOUNTED FOR 8.3% OF ALL PEDIATRIC (AGES 0-17) AND MATERNAL TRANSFERS AS COMPARED TO 6.6% IN 2019. METHODIST AIRCARE, IN PARTNERSHIP WITH REACH AIR MEDICAL SERVICES, HAS THREE RURAL HELICOPTERS IN THE REGION. SPECIALIZED SERVICES AVAILABLE AT MHS FACILITIES INCLUDE THE FOLLOWING: NEONATOLOGY SERVICES, PEDIATRIC SUBSPECIALTY SERVICES, BONE MARROW TRANSPLANT, KIDNEY TRANSPLANTS, HEART TRANSPLANTS, LIVER TRANSPLANTS, PANCREAS TRANSPLANTS, HYPERBARIC OXYGEN TREATMENT, STROKE CARE, MEDICAL AIR TRANSPORT, GAMMA KNIFE RADIOSURGERY, AND BARIATRIC SURGERY. SEE RESPONSES FOR LINE 2 ABOVE REGARDING EXPANSION OF SERVICES IN 2020. THE MAJORITY OF CHARITY CARE PROVIDED BY THE HOSPITALS IS FROM PATIENTS RECEIVING EMERGENCY SERVICES. EMERGENCY DEPARTMENT (ED) VISITS TO METHODIST FACILITIES TOTALED 277,951 IN 2020 (346,435 IN 2019), DOWN ALMOST 20% FROM 2019 DUE TO COVID-19. 20.21% OF TOTAL ED VISITS RESULTED IN INPATIENT ADMISSIONS WITH A 3.21% INCREASE IN ED ADMISSIONS OVER 2019. IN ADDITION, 24.24% OF ALL VISITS TO METHODIST EMERGENCY DEPARTMENTS IN 2020 WERE MADE BY CHARITY OR SELF-PAY PATIENTS. METHODIST CONTINUES TO FOCUS ON IMPROVING ACCESS TO CARE FOR THE COMMUNITY BY IMPROVING EMERGENCY DEPARTMENT ACCESS. WHEN COMPARING 2020 TO 2019, METHODIST SAW AN 8% DECREASE IN THE PATIENT-ARRIVAL-TO-BED (ATB) METRIC AND A 15% IMPROVEMENT IN ARRIVAL-TO-GREET (ATG) METRIC. THE AVERAGE LENGTH OF STAY FOR ALL PATIENTS INCREASED FROM 235.5 MINUTES IN 2019 TO 270.7 MINUTES IN 2020. TEXAS TRANSPLANT INSTITUTE (TTI), AT METHODIST HOSPITAL : SPECIALTY AND TRANSPLANT, A CAMPUS OF METHODIST HOSPITAL, CONTINUES TO PROVIDE INCREASED ACCESS FOR PATIENTS REQUIRING KIDNEY TRANSPLANTS. TTI IS THE HOME OF THE BUSIEST PAIRED EXCHANGE KIDNEY TRANSPLANT PROGRAM IN THE NATION, AND THE NATION'S NO. 1 LIVING DONOR KIDNEY TRANSPLANT PROGRAM. MHS ALSO OPERATES THREE HEALTH BUSES ON THE EAST, SOUTH AND WEST SIDE OF SAN ANTONIO OFFERING COMPLIMENTARY TRANSPORTATION TO VARIOUS HEALTH CARE FACILITIES. THERE WERE 6,660 TRANSPORTS IN 2020, WITH THE DECREASE IN TRANSPORTS DUE TO COVID-19. METHODIST HOSPITAL : METROPOLITAN IN CONJUNCTION WITH METHODIST HOSPITAL WOMEN'S SERVICES AND COMMUNICARE, OPERATES FOUR FAMILY HEALTH CENTERS THAT PROVIDE COMPLIMENTARY PREGNANCY TESTING (2,163 TESTS IN 2020), PHYSICIAN REFERRALS, COUNSELING, HEALTH EDUCATION AND SCREENING PROGRAMS. MHS ALSO OPERATES CALL-A-NURSE FOR CHILDREN, A TELEPHONE SERVICE OFFERING FREE MEDICAL ADVICE BY TRAINED EMERGENCY CARE PEDIATRIC NURSES TO PARENTS OF SICK/ INJURED CHILDREN. THE SERVICE OPERATES FROM 5:00 P.M. TO 8:00 A.M. MONDAY THROUGH FRIDAY AND AROUND THE CLOCK ON WEEKENDS AND HOLIDAYS (WHEN PHYSICIANS' OFFICES ARE CLOSED). CALL VOLUMES IN 2020 WERE 38,569. IN 2015, THE METHODIST CONTACT CENTER WAS SOLD TO HCA WITH THE AGREEMENT TO CONTINUE OPERATING A COMMUNITY PHONE-IN HEALTH RESOURCE CALLED HEALTHLINE DURING NORMAL BUSINESS HOURS. HEALTHLINE CALLERS SCHEDULE ATTENDANCE TO HEALTH AND WELLNESS EVENTS, PARENTING CLASSES, AND RECEIVE PHYSICIAN REFERRALS THROUGH THE METHODIST DOCTORSOURCE PROGRAM. IN 2020, METHODIST REFERRED PHYSICIANS TO 4,305 DOCTORSOURCE CALLERS (UP TO THREE PHYSICIANS MAY BE REFERRED TO EACH CALLER). IN ONE OTHER COMMUNITY BENEFITS CATEGORY, METHODIST PROVIDED OVER $202,895 IN CHARITABLE CONTRIBUTIONS TO NON-PROFIT HEALTH AND HUMAN SERVICE AGENCIES SERVING THE COMMUNITY. METHODIST HEALTHCARE ONCE AGAIN CONTRIBUTED ANNUAL FUNDING TO STRAC'S CRISIS COLLABORATIVE (STCC) IN THE AMOUNT OF $1,620,450. STCC IS AN EFFORT FOCUSED ON ENDING INEFFECTIVE UTILIZATION OF SERVICES FOR THE SAFETY NET POPULATION AT THE INTERSECTION OF MENTAL ILLNESS, HOMELESSNESS, AND HIGH EMERGENCY DEPARTMENT UTILIZATION IN SOUTHWEST TEXAS. STCC IS COMMITTED TO IMPROVEMENT BY DEVELOPING A COMPREHENSIVE, INTGEGRATED CRISIS SYSTEM ACROSS ALL MAJOR PUBLIC PAYORS, HOSPITAL PROVIDERS, PHILANTHROPY, PUBLIC SAFETY AND BEHAVIORAL HEALTH PROVIDERS. MHS COMMITMENT GOES BEYOND ITS FINANCIAL CONTRIBUTION. FOR EXAMPLE, WHEN THE NIX HEALTHCARE SYSTEM SHUT DOWN IT PSYCHIATRIC EMERGENCY SERVICE (PES), MHS ESTABLISHED A SIX-BED PED AS METHODIST HOSPITAL : SPECIALTY AND TRANSPLANT TO HELP FILL THE VOID. MOREOVER, THE LOCAL MENTAL HEALTH AUTHORITY, CHCS, HAS EMBEDDED STAFF IN THE PES UNITS TO ASSURE CARE COORDINATION FOR THE OUTPATIENT SERVICES THAT CHCS WILL PROVIDE FOR PATIENTS THAT ARE TREATED AND RELEASED. MHS FUNDING HAS ALSO SUPPORTED FIVE OTHER STCC INITIATIVES: LAW ENFORCEMENT NAVIGATION OF PATIENTS TAKEN INTO CUSTODY WHO REQUIRE PSYCHIATRIC EVALUATION AND ARE REQUIRED TO DO SO VIA AN EMERGENCY DETENTION ORDER. IT IS SAFE TO SAY THAT, ABSENT THIS CAPABILITY, THE CLOSURE OF ALL PSYCHIATRIC BEDS AT THE NIX WOULD HAVE PRODUCED SEVERE ""BOARDING"" PROBLEMS IN THE EMERGENCY ROOMS OF HOSPITALS WITH NO PSYCHIATRIC UNITS. ACUTE CARE STATION AT HAVEN FOR HOPE, WHICH PROVIDES AN ONSITE PARAMEDIC TO SCREEN 911 CALLS, AND HAS RESULTED IN AN ALMOST 50% REDUCTIONS IN TRANSPORTS BY EMS TO THE EMERGENCY ROOMS OF AREA HOSPITALS. PROGRAM FOR INTENSIVE CARE COORDINATION (PICC), WHICH INTERVENES AND FOLLOWS HIGH UTILIZER (USUALLY HOMELESS) PATIENTS THAT HAVE EXPERIENCED MORE THAN SIX EMERGENCY DETENTIONS WITHIN A YEAR. CROSSPOINT, A 35-BED BEHAVIORAL HEALTH DIVERSION PROGRAM. SIGNIFY, A CLOUD-BASED CARE COORDINATION PLATFORM, STILL IN DEVELOPMENT. METHODIST PLAYS A LEADING ROLE IN THE SUPPORT OF THE HEALTH COLLABORATIVE, INCLUDING THE UTILIZATION OF THEIR COMMUNITY HEALTH NEEDS ASSESSMENT TO ASSIST IN THE DETERMINATION OF WHERE MHS SHOULD CONCENTRATE COMMUNITY ACTIVITIES (SEE ADDITIONAL INFORMATION IN LINE 2, SECTION V). MHS HAS AN OPEN ADMISSIONS POLICY WHICH ALLOWS MEDICAL STAFF TO ADMIT PATIENTS DIRECTLY TO ANY MHS FACILITY REGARDLESS OF THE PATIENT'S ABILITY TO PAY. MHS FUNDS AND PROVIDES TRAINING AND CONTINUING EDUCATION TO PHYSICIANS, NURSES, EMS PROFESSIONALS AND OTHER ALLIED HEALTH PROFESSIONALS. MHS PARTICIPATES IN ALL QUALITY MEASURES (CMS, JCAHO, ETC.). MHS USES THE CMS CORE MEASURES AS THE PRIMARY QUALITY INDICATORS FOR CLINICAL CARE. SCHEDULE H, PART VI, LINE 7: MHS FILES AN ANNUAL STATEMENT OF COMMUNITY BENEFITS WITH THE STATE OF TX."