4A (Expenses $ 557763 including grants of $ 0) (Revenue $ 9228443)
THE ORGANIZATION CONTROLS HOSPITALS AND OTHER MEDICAL FACILITIES THAT SERVICE THE HEALTH NEEDS OF THE AMARILLO, TEXAS COMMUNITY THROUGH ITS MEMBER INTEREST IN BSA HEALTH SYSTEM OF AMARILLO, LLC. THESE FACILITIES PROVIDE INPATIENT AND OUTPATIENT SERVICES WHICH COVER SERVICES INCLUDING, BUT NOT LIMITED TO, SURGICAL SERVICES, REHAB, PHYSICAL THERAPY, AND HOSPICE. IN ADDITION, AN EMERGENCY ROOM IS OPERATED 24 HOURS A DAY, 7 DAYS A WEEK.

4B (Expenses $ 181402257 including grants of $ 181402257) (Revenue $ 0)
THE ORGANIZATION MADE GRANTS IN 2015 RELATED TO THE DELIVERY OF HEALTH CARE SERVICES TO UNDERSERVED POPULATIONS IN AMARILLO.

Part V, Line 5
"HPBHF, BCS, AND BSA RETAINED ASCENT HEALTH CONSULTING TO ASSIST IN COMPILING A COMMUNITY HEALTH NEEDS ASSESSMENT IN ACCORDANCE WITH SECTION 501(R) OF THE CODE. A RANDOM-DIGIT DIAL TELEPHONIC SURVEY WAS PERFORMED USING NATIONAL AND LOCAL QUESTIONS FOR COMPARISON. A KEY INFORMANT SURVEY WAS PERFORMED WITH COMMUNITY LEADERS FOR INPUT. FINALLY, FOCUS GROUPS WERE UTILIZED FOR INPUT. A 2014 CHNA REPORT WAS DEVELOPED WHICH MADE FOUR RECOMMENDATIONS FOR IMPLEMENTATION. PART V, LINE 6A THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH BSA Hospital, Panhandle Surgical Hospital, and Quail Creek Surgical Hospital. PART V, LINE 6B THE HOSPITAL FACILITY'S CHNA WAS CONDUCTED WITH BAPTIST COMMUNITY SERVICES AND HIGH PLAINS BAPTIST HEALTH FOUNDATION. PART V, LINE 11 CHNA SIGNIFICANT NEEDS IDENTIFIED THE 2014 CHNA IDENTIFIED FOUR SIGNIFICANT NEEDS, ALL OF WHICH ARE BEING ADDRESSED IN THE IMPLEMENTATION PLAN adopted in 2015 CHNA Recommendation #1 - Design and Implement an ""Access to Care"" Navigation Services Project For Amarillo HPBHF, BSA, and Baptist Community Services (""BCS"") will coordinate the services of the current BCS nurse navigator program with the BSA case management department in order to better coordinate the care and outcomes of BCS residents and other BSA patients from hospitalization through post hospitalization transitional services after discharge from BSA. CHNA Recommendation #2 - Create and Finance the Campaign for a Healthy Amarillo focusing on Exercise and Healthy Eating HPBHF will work with its sister organization, ATC Health Promotion Foundation, to develop a plan with other stakeholders in Amarillo for development of a ""Healthy Amarillo"" education and activity program aimed at healthy lifestyles for the citizens of Amarillo. CHNA Recommendation #3 - Expand and Enhance Senior Services Projects to Focus on Exercise, Nutrition, Social Interaction and Memory Care HPBHF will assist BCS in the development and construction of a state-of-the-art assisted living memory care facility in Amarillo to help in meeting current unmet needs in Amarillo. Further, HPBHF will coordinate with and assist the Texas Tech Medical School to expand the current geriatric residency program in Amarillo. CHNA Recommendation #4 - Create a Non-Profit Organization to Solely Address Amarillo Health Needs HPBHF and its sister organization, High Plains Christian Ministries Foundation, will develop a coordinated grant program to identify and financially assist appropriate health care programs and projects to better meet the health care needs of the citizens of Amarillo discussed in the CHNA. PART V, LINE 15E METHOD TO APPLY FOR FINANCIAL ASSISTANCE The financial assistance and charity care policy is available upon request; however, patients are notified of the policy as follows: Patients who have a high deductible or are uninsured are informed of the charity care policy at the time of pre-registration, and patients are then directed to a financial counselor if they wish to pursue financial assistance. If prior arrangements for financial assistance were not made prior to admission, patients are directed to a financial counselor for screening. Patients admitted through the emergency department who indicate an inability to pay or are uninsured are screened by financial counselors to determine eligibility for financial assistance. Patients are notified of the availability of financial assistance at the time of billing. SIGNS ARE PLACED STRATEGICALLY THROUGHOUT THE HOSPITAL FACILITY. PART V LINE 16A AND 16C THE FAP AND PLAIN LANGUAGE SUMMARY MAY BE FOUND AT www.bsahs.org/content/discount-policies PART V, LINE 22D In keeping with the mission and philosophy of the Baptist St. Anthonys Health System, BSA will apply a discount of 25% on all services provided to uninsured patients, who do not qualify for a 100% discount. In addition, BSA will provide charity care services, within the resources available, to financially or medically indigent patients. These services will be discounted up to 100% depending on patients need. For those uninsured or underinsured patients who do not qualify for charity, financial aid may be available. Financially indigent patients whose gross annual income is at or below 200% of the most recently published Federal Poverty Guidelines are eligible for a 100% discount. Patients whose gross annual income is between 200% and 400% of the Federal Poverty Guidelines are eligible for financial assistance with graduated discounts between 20% and 80%. All discounts are applied to gross charges. Medically indigent patients whose total medical bills for all sources exceed 25% of their gross annual income are eligible for financial assistance under the hospital's policy. Once it has been determined that the patient is medically indigent, BSA will adjust our current medical bills down to 25% of the patients income. If the patient still cannot pay, we will ask the patient to bring in proof of all current outstanding medical bills for review. If the total of those bills is still 25% of their yearly earnings, BSAs bills will be adjusted down so that all of the patients medical bills total 25% of their income. Once medical indigence has been determined and existing account balances have been adjusted accordingly future accounts will need to be considered independent of the original determination."

Schedule H Supplemental Information
"PART I, LINE 3C Baptist St. Anthony's Hospital uses income-based criteria for determining eligibility for free or discounted care under its financial assistance policy. Financially indigent patients whose gross annual income is 200% of the Federal Poverty Income Guidelines or less are eligible for free care while those with gross annual income between 200% and 400% of the Federal Poverty Income Guidelines are eligible for discounted care under the organization's financial assistance policy. The Hospital also uses an assets test to determine eligibility for charity care. Assets are evaluated to determine if the guarantor has any liquid assets in excess of those critical to living or not being used to support the family's support system. Part I, Line 6a N/A Part I, Line 7 THE ORGANIZATION IS ONE OF THE TWO OWNERS OF BSA HEALTH SYSTEM OF AMARILLO, LLC, A TEXAS LIMITED LIABILITY COMPANY, THAT OPERATES BSA HOSPITAL IN AMARILLO, TX. BSA HOSPITAL IS CONTRACTUALLY REQUIRED TO BE OPERATED IN ACCORDANCE WITH THE REQUIREMENTS WITH SECS. 501(C)(3) AND 501(R) OF THE CODE AND REV. RUL. 69-545. THE ORGANIZATION HAS CONTRACTUAL AUTHORITY TO REQUIRE COMPLIANCE WITH THESE REQUIREMENTS ON AN ON-GOING BASIS. THE RESPONSES THROUGHOUT SCHEDULE H ARE WITH RESPECT TO THE OPERATIONS OF BSA HOSPITAL. ALL DOLLAR FIGURES HAVE BEEN ADJUSTED TO REFLECT HPBHF'S 20% MEMBER INTEREST IN THE BSA HOSPITAL. The Hospital used a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, to calculate the amounts reported in the table in Part I, line 7. Part II n/a Part III, Line 2 Costing Methodology for Bad Debts The organization has used 2015 audited financial statements and the cost-to-charge ratio methodology provided for in optional Worksheet A- Estimated Bad Debt Expense (at Cost). At the end of 2015, the organization estimated the amount of bad debt expense that could reasonably be attributable to patients who likely would qualify for financial assistance under the hospitals charity care policy. As a result, a reclassifying entry was made from bad debt expense to recognize this amount appropriately as charity. Consequently, a zero amount is being reported in Part III, Section A, Line 3. PART III, LINE 3 SEE RESPONSE FOR PART III LINE 2. Part III, Line 4 THE FOOTNOTE TO THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF BAPTIST COMMUNITY SERVICES AND AFFILIATES IS NOT DIRECTLY APPLICABLE TO SCHEDULE H, AS THE HOSPITAL ACTIVITIES MAINTAINED VIA A 20% LLC INVESTMENT ARE ONLY INCLUDED IN SUMMARY FORM. Part III, LIne 8 The costing methodology is the structure built into the CMS 2552-96, transmittals 23-25. Costs are grouped from the general ledger and classified in the appropriate cost center as allowable or non-reimbursable. Then adjustments are made on w/s A8 for reductions to allowable costs due to income offsetting revenues or costs identified as non reimbursable per CMS regulations. Additionally, costs are reclassified on W/S A6 for proper matching of costs and revenues or nature of the expense incurred. Next, the overhead costs are allocated to the direct and non-reimbursable expenses based on appropriate CMS allocation techniques and statistical bases. The total cost related to the Medicare revenue is taken from the following areas. The accommodation or routine portion of costs is taken from CMS 2552-96 D-1 line 37 for the appropriate Title XVIII provider or sub-provider. Cost for I/P ancillary service are taken from D-4 line 102, column 3. Costs for O/P ancillary services are taken from DV line 102, column 9. Subsidized care services are claimed as a community benefit for the following reason. These services exclude Medicaid and charity services already reported separately. These services are regarded as a community benefits because they are vital to the community in the case of Neonatal, and Obstetrical services furnished at a negative margin by Baptist St Anthonys. Also other health services are provided to older patients with complications and complex health problems. These services are also necessary for public health and could not be fully provided by other resources available in the community if they were not providers by Baptist St Anthonys. Part III, Line 9b The following is an excerpt from the Bad Debt Policy. It refers collectors to the Charity Policy once it is identified that a patient may qualify. The charity policy/procedure is followed from there. When reviewing accounts as potential bad debt, the collection and reviewing personnel should always look for signs that the account might qualify for charity. Such signs may include prior charity, a large dollar amount owed to BSA, employment status, marital status, and any combination of these or other factors that may become evident while working the account. In cases where a patient cannot or will not provide sufficient information to fully document eligibility for Charity Care, a presumption of eligibility may be made based on statistical data and other reliable assumptions so long as those assumptions are properly documented. Presumptive Charity and/or Financial Aid will be applied after all normal collection activities have been exhausted and before accounts are sent to an external collection agency. This may include one or more of the following situations: - Collections and Payment Prediction and Charity Eligibility based on MedeAnalytics - Insurance coverage is no longer in effect. - Patient cannot be located through collection attempts, is unemployed and uninsured. - Patient is unresponsive to collection attempts, is unemployed, uninsured, no credit information available. - Patient resided in a shelter or indicates they are homeless with no income or assets to validate. - Patient is not able to provide income information. - Patient is deceased and there is no estate. - Patient residence is in an area of high poverty. Once a determination of eligibility for Charity Care under Financial or Medical Indigence is made, no further collection efforts shall be pursued for the amount applied toward Charity Care. All patients approved will either be classified as financially indigent, medically indigent, or qualified for financial discount. PART VI, LINE 2 NEEDS ASSESSMENT Baptist Community Services, High Plains Baptist Health Foundation, BSA Hospital, Panhandle Surgical Hospital and Quail Creek Surgical Hospital commissioned AscentHealth Consulting (AHC) to perform a CHNA using tried and true methods of collecting information, analyzing trends by comparing similar data from prior years and summarizing the data into a cogent, concise recommendation for moving forward with project planning. This CHNA is designed to provide focus for solutions that will impact community health trends over time. These solutions will require commitment and community consensus: hospitals, providers, government, nonprofit agencies and private industry must all collectively address these needs and work together to leverage existing and future resources. Financial and human capital must be invested to ""move the needle"" on health trends. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE BSA employs the services of Medical Advocacy Services for Healthcare, Inc. (MASH) to screen patients for assistance under federal and state programs, including Medicaid, SSI Medicaid and RSDI Medicare Disability, and Victims of Violent Crime Assistance. MASH screens all uninsured inpatients and outpatient and ER accounts over $500. Inpatients are contacted by personal visit while they are in the hospital. The MASH advocate works with the patient and/or family members to gather the required information and begin the application process. For outpatients and ER patients, MASH contacts them via telephone and/or locating letters with number of attempts varying based on the total charges on the account. In addition, BSA offers Charity Care and Financial Assistance. Patients are made aware of the assistance availability in multiple ways: - At the point of pre-registration for scheduled services when the patient indicates an inability to pay - At the point of registration for unscheduled services, - By Business Office staff post discharge - BSA employs 2 FTE who serve as Financial Counselors who work with patients in person, telephonically and by written correspondence. - BSAs patient statements indicate that Financial Assistance is available and provide a phone number to call if the patient is in need. - BSAs Financial Assistance Policy is published on the BSA website - All accounts with a patient balance that is not paid by the time the scheduled statements have been sent receive up to two automated phone calls. The automated message notifies patients at that time that financial assistance is available and gives the patient/guarantor the option of indicating that they would like for someone to contact them to discuss this option. PART VI, LINE 4 COMMUNITY INFORMATION The community served by Baptist Sain"