4A (Expenses $ 149836262 including grants of $ 240283) (Revenue $ 165841149)
OPERATION OF ADVENTHEALTH CENTRAL TEXAS HOSPITAL, A 230-BED ACUTE-CARE HOSPITAL AND ADVENTHEALTH ROLLINS BROOK HOSPITAL, A 25-BED ACUTE-CARE HOSPITAL; 7,634 PATIENT ADMISSIONS, 33,718 PATIENT DAYS, AND 128,003 OUTPATIENT VISITS IN THE CURRENT YEAR.

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: ADVENTHEALTH CENTRAL TEXAS, - FACILITY 2: ADVENTHEALTH ROLLINS BROOK

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
IN ORDER TO ENSURE BROAD COMMUNITY INPUT, ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK CREATED A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO HELP GUIDE THE HOSPITALS THROUGH THEIR 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. THE COMMITTEE INCLUDED REPRESENTATION FROM THE HOSPITALS, PUBLIC HEALTH OFFICIALS AND THE BROAD COMMUNITY AS WELL AS REPRESENTATION FROM LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. MEMBERS OF THE CHNAC INCLUDED INDIVIDUALS FROM THE FOLLOWING ORGANIZATIONS: GREATER KILLEEN COMMUNITY CLINIC - PROVIDES HEALTH SERVICES THAT OFFER A COMPRENSIVE APPROACH TOWARD HEALTH, BUILDS INNOVATIVE PARTNERSHIPS AND ADVOCATES FOR THOSE WHO HAVE LIMITED ACCESS TO HEALTH CARE SERVICES.BELL COUNTY INDIGENT HEALTH SERVICES DEPARTMENT - SERVES THE COMMUNITY AND VERY LOW-INCOME RESIDENTS. PROVIDES HEALTH CARE FOR TEXAS RESIDENTS IN NEED WHO DO NOT QUALIFY FOR OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS. UNITED WAY OF GREATER FORT HOOD AREA - PROVIDES SOCIAL SERVICES AND SOCIAL SERVICE FUNDING TO COMMUNITY AGENCIES SERVING LOW-INCOME AND MINORITY POPULATIONS, AS WELL AS LOW-INCOME AND MINORITY FAMILIES FROM FORT HOOD.BELL COUNTY PUBLIC HEALTH DISTRICT - SERVES BELL COUNTY COMMUNITIES, ORGANIZATIONS AND CITIZENS THROUGH EDUCATION AND LEADERSHIP TO PREVENT DISEASE AND PROTECT THE PUBLIC'S HEALTH.TEXAS A&M AGRILIFE EXTENSION - PROVIDES HEALTHY LIVING EDUCATION PROGRAMS AND SUPPORT TO THE COMMUNITY.TEXAS A&M ROLLINS BROOK - IMPROVES HEALTH EDUCATION IN THE AREA THROUGH ITS CURRENT SELECTION OF HEALTH EDUCATION PROGRAMS. CITY OF KILLEEN - SERVES THE CITY OF KILLEEN THROUGH COORDINATION OF HEALTH SERVICES AND MEMBERSHIP ON COMMUNITY HEALTH COALITIONS.CENTRAL TEXAS AREA AGENCY ON AGING - SERVES INDIVIDUALS 60 YEARS OF AGE AND OLDER AND THEIR FAMILIES RESIDING IN BELL AND SURROUNDING COUNTIES.IN CONDUCTING IT 2019 CHNA, ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH IN MULTIPLE WAYS. FIRST, THE CHNAC, WHICH INCLUDED INDIVIDUALS THAT REPRESENTED THE BROAD COMMUNITY AND INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, MET QUARTERLY TO BUILD THE CHNA.TO SOLICIT BROAD COMMUNITY INPUT, ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK CONDUCTED STAKEHOLDER INTERVIEWS AND COMMUNITY SURVEYS. COMMUNITY SURVEYS WERE DISTRIBUTED BOTH IN PERSON AND ONLINE AT VARIOUS LOCATIONS WITHIN BELL, CORYELL AND LAMPASAS COUNTIES. IN PERSON SURVEY LOCATIONS INCLUDED HEALTH SCREENINGS, IMMUNIZATION CLINICS, THE HOSPITALS' WELLNESS CLASSES, THE GREATER KILLEEN COMMUNITY CLINIC AND AMONG VARIOUS CHURCH CONGREGATIONS. ONLINE SURVEYS WERE DISTRIBUTED AMONG ADVENTHEALTH CENTRAL TEXAS AND ROLLINS BROOK TEAM MEMBERS, THE BOYS & GIRLS CLUB OF ROLLINS BROOK AND THROUGH EMAIL. DURING THE CHNA CYCLE, 91 IN-PERSON SURVEYS AND 124 ONLINE SURVEYS WERE COMPLETED BY PEOPLE OF ALL INCOMES AND ETHNICITIES.IN ADDITION TO THE SURVEYS, 25 INDIVIDUAL STAKEHOLDER SURVEYS WERE COLLECTED ONLINE BY EMAILING COMMUNITY LEADERS THAT REPRESENT PUBLIC HEALTH, VARIOUS SPECIAL POPULATIONS, LOW-INCOME AND MINORITY POPULATIONS. SURVEY QUESTIONS FOCUSED ON THE BEST QUALITIES OF BELL AND LAMPASAS COUNTY, ALONG WITH THE MOST NEEDED HEALTH AND HUMAN SERVICES. ADDITIONALLY, THE KEY INFORMANTS AND OTHERS WERE ASKED ABOUT POTENTIAL SOLUTIONS AND RECOMMENDATIONS FOR PROMOTING GOOD HEALTH IN BELL AND LAMPASAS COUNTIES.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 7D:
THE HOSPITALS HAVE ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS MUST BE POSTED ON THE HOSPITALS' WEBSITE AT LEAST UNTIL THE DATE THE HOSPITAL FACILITIES HAVE MADE WIDELY AVAILABLE ON THEIR WEBSITE THEIR TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS. THE HOSPITALS WILL ALSO MAKE A PAPER COPY OF THEIR COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST AND WITHOUT CHARGE, AT LEAST UNTIL THE DATE THE HOSPITAL FACILITIES HAVE MADE AVAILABLE FOR PUBLIC INSPECTION THEIR TWO SUBSEQUENT COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:
"METROPLEX ADVENTIST HOSPITAL, INC. D/B/A ADVENTHEALTH CENTRAL TEXAS AND METROPLEX ADVENTIST HOSPITAL, INC. D/B/A ADVENTHEALTH ROLLINS BROOK WILL BE REFERRED TO IN THIS DOCUMENT AS ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK RESPECTIVELY OR ""THE HOSPITALS"".THE HOSPITALS ARE A SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE 501(C)(3) PARENT ORGANIZATION OF A HOSPITAL AND HEALTHCARE SYSTEM KNOWN AS ADVENTHEALTH. IN JANUARY 2019, EVERY WHOLLY-OWNED ENTITY OF AHSSHC ADOPTED THE ADVENTHEALTH SYSTEM BRAND. OUR IDENTITY HAS BEEN UNIFIED TO REPRESENT THE FULL CONTINUUM OF CARE OUR SYSTEM OFFERS. ANY REFERENCES TO OUR PRIOR COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) OR PRIOR COMMUNITY HEALTH PLANS (CHPS) WILL UTILIZE OUR NEW NAME FOR CONSISTENCY. ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK ARE BOTH PART OF THE MULTI-STATE DIVISION OF ADVENTHEALTH. THE DIVISION INCLUDES 17 HOSPITAL FACILITIES. THIS IS THE SECOND-YEAR UPDATE FOR ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK'S 2020-2022 COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY. THE HOSPITALS DEVELOPED THIS PLAN AND POSTED IT IN MAY 2020 AS PART OF THEIR 2019 COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. FOR THE DEVELOPMENT OF BOTH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THE COMMUNITY HEALTH PLAN/IMPLEMENTATION STRATEGY, THE HOSPITALS WORKED TO DEFINE AND ADDRESS THE NEEDS OF LOW-INCOME, MINORITY AND UNDERSERVED POPULATIONS IN THEIR SERVICE AREA. THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT USED PRIMARY DATA INTERVIEWS AND SURVEYS; SECONDARY DATA FROM LOCAL, REGIONAL, AND NATIONAL HEALTH-RELATED SOURCES; AND HOSPITAL PREVALENCE DATA TO HELP THE HOSPITALS DETERMINE THE HEALTH NEEDS OF THE COMMUNITY THEY SERVE. ONCE THE DATA WAS GATHERED, THE PRIMARY ISSUES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE PRIORITIZED BY COMMUNITY AND HOSPITAL STAKEHOLDERS, WHO THEN SELECTED KEY ISSUES FOR THE HOSPITAL TO ADDRESS IN ITS 2020-2022 COMMUNITY HEALTH PLAN. THE SECOND-YEAR PROGRESS ON THE COMMUNITY HEALTH PLAN IS NOTED BELOW. THE NARRATIVE DESCRIBES THE PRIORITIZED ISSUES IDENTIFIED IN 2019 AND GIVES AN UPDATE ON THE STRATEGIES ADDRESSING THOSE ISSUES. THERE IS ALSO A DESCRIPTION OF THE IDENTIFIED ISSUES THAT THE HOSPITALS DID NOT ADDRESS. ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK CHOSE THREE PRIORITIES FOR THEIR 2020-2022 COMMUNITY HEALTH PLAN: 1. PHYSICAL INACTIVITY2. MENTAL ILLNESS & PTSD3. FOOD INSECURITY PRIORITY 1: PHYSICAL INACTIVITY 2019 DESCRIPTION OF THE ISSUE:PHYSICAL INACTIVITY IS THE PERCENTAGE OF ADULTS AGED 20 AND OLDER REPORTING NO LEISURE-TIME PHYSICAL ACTIVITY (COUNTY HEALTH RANKINGS & ROADMAPS, 2018). PHYSICAL INACTIVITY IS LINKED TO HIGHER PREVALENCE OF CHRONIC DISEASES AND INCREASED HEALTH CARE COSTS. INACTIVITY CAUSED 11% OF PREMATURE MORTALITY IN THE UNITED STATES AND CAUSED MORE THAN 5.3 MILLION OF THE 57 MILLION DEATHS THAT OCCURRED WORLDWIDE IN 2008 (THE LANCET, 2012). IT IS RECOMMENDED THAT ADULTS GET 150 MINUTES OF MODERATE INTENSITY AEROBIC ACTIVITY PER WEEK (AMERICAN HEART ASSOCIATION, 2018). IN THE HOSPITALS' SERVICE AREA, 25% OF COMMUNITY MEMBERS DO NOT PARTICIPATE IN PHYSICAL ACTIVITY (COUNTY HEALTH RANKINGS & ROADMAPS, 2018). THESE RESULTS WERE VALIDATED IN THE PREVALENCE OF CHRONIC DISEASES AND THE COMMUNITY SURVEY REVEALED 42% OF RESPONDENTS PARTICIPATE IN 30 MINUTES OF PHYSICAL ACTIVITY LESS THAN 3 DAYS A WEEK. THE HOSPITALS ADDRESSED PHYSICAL INACTIVITY ON THE PREVIOUS 2016 CHNA. IN RESPONSE TO THE ISSUE, THE HOSPITALS DEVELOPED A WELLNESS PROGRAM TO OFFER 13 FREE FITNESS CLASSES A WEEK. THE HOSPITALS FOUNDATION IS CURRENTLY RAISING FUNDS TO BUILD A DEDICATED WELLNESS BUILDING THAT WOULD ALLOW FOR EXPANSION OF CLASSES.2021 UPDATE: THE ADVENTHEALTH CENTRAL TEXAS COMMUNITY AND ADVENTHEALTH ROLLINS BROOK HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE PHYSICAL INACTIVITY PRIORITY. 1. INCREASE ACCESS TO AFFORDABLE FITNESS CLASSES TO LOW INCOME POPULATIONS2. IMPROVE COMMUNITY KNOWLEDGE OF THE HEALTH BENEFITS ASSOCIATED WITH AN ACTIVE LIFESTYLEGOAL 1: INCREASE ACCESS TO AFFORDABLE FITNESS CLASSES TO LOW INCOME POPULATIONS OBJECTIVE 1: THE FIRST OBJECTIVE IS TO OFFER 13 FREE WEEKLY EXERCISE CLASSES TO INCREASE ACCESS FOR 200 ADULTS TO ACHIEVE THE RECOMMENDED 150 MINUTES OF PHYSICAL ACTIVITY WEEKLY FOR THE RESIDENTS OF KILLEEN, COPPERAS COVE AND LAMPASAS COUNTIES. THIS OBJECTIVE IS FUNDED AND MANAGED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. THE PROGRAM PROVIDES 13 FITNESS CLASSES EVERY WEEK TO LOW-INCOME ADULTS IN THE HOSPITALS' PRIMARY SERVICE AREA. THE HOSPITALS EXCEEDED THEIR SET METRIC OF SERVING 200 ADULTS WITH 211 PARTICIPANTS ATTENDING OVER 2,568 CLASSES. THE SECOND METRIC FOR THE OBJECTIVE WAS MET, TO INCREASE THE NUMBER OF INDIVIDUALS THAT REACH THE RECOMMENDED 150 MINUTES OF PHYSICAL ACTIVITY BY 10% FROM THE BASELINE OF 25%. OF THE ADULTS THAT ATTENDED THE FITNESS CLASSES, 31% REPORTED AN INCREASE IN THEIR WEEKLY MINUTES OF PHYSICAL ACTIVITY ACHIEVED. DUE TO THE COVID-19 PANDEMIC, THE HOSPITALS MOVED THE CLASSES TO A VIRTUAL PLATFORM TO MAINTAIN SOCIAL DISTANCING GUIDELINES.OBJECTIVE 2: THE SECOND OBJECTIVE IS TO PROVIDE 30 PARTICIPANTS THE OPPORTUNITY TO LOWER THEIR BODY MASS INDEX BY AT LEAST 5% BY INCORPORATING GROUP EXERCISE, NUTRITION INSTRUCTION AND BEHAVIORAL INTERVENTIONS BY THE END OF YEAR ONE THROUGH THE COMPREHENSIVE LIFESTYLE INTERVENTION PROGRAM (CLIP). THIS OBJECTIVE IS FUNDED AND CONDUCTED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. CLIP IS AN INTENSIVE TWELVE-WEEK LIFESTYLE INTERVENTION PROGRAM, DESIGNED TO INCORPORATE THE PRINCIPLES OF PHYSICAL ACTIVITY, NUTRITION, AND BEHAVIORAL HEALTH TO HELP PARTICIPANTS IMPROVE THEIR OVERALL HEALTH BY LOWERING THEIR BODY MASS INDEX. DUE TO COVID-19, THE PROGRAM WAS DELAYED. THE FIRST TWO COHORTS OF THE CLIP PROGRAM ARE SET TO BEGIN IN JUNE 2022 AND RUN THROUGH NOVEMBER 2022.GOAL 2: IMPROVE COMMUNITY KNOWLEDGE OF THE HEALTH BENEFITS ASSOCIATED WITH AN ACTIVE LIFESTYLEOBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE 24 WALKS PER YEAR THROUGH THE WALK WITH A DOC PROGRAM, LED BY LOCAL PROVIDERS, TO ENCOURAGE HEALTHY BEHAVIOR CHANGES TO INCLUDE REGULAR EXERCISE WHILE GAINING KNOWLEDGE ON VARIOUS HEALTH TOPICS. THIS OBJECTIVE IS FUNDED AND CONDUCTED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. AS PART OF A PARTNERSHIP WITH BAYLOR SCOTT & WHITE, A LOCAL HOSPITAL WHICH SERVES THE SAME PRIMARY SERVICE AREA AS THE HOSPITALS, THE DECISION WAS MADE TO PARTNER ON THE INITIATIVE TO INCREASE ACCESS AND AWARENESS OF THE EVENT. THE WALK WITH A DOC PROGRAM PROVIDES THE COMMUNITY AN OPPORTUNITY TO LEARN ABOUT A VARIETY OF HEALTH TOPICS, WHILE PARTICIPATING IN A 30-MINUTE WALK, LED BY OUR PHYSICIANS. THE HOSPITALS HELD SIX WALKS THAT WERE ATTENDED BY 34 PARTICIPANTS. THE HOSPITALS DID NOT MEET THEIR SET METRIC OF 24 WALKS BECAUSE THE WALK WITH A DOC PROGRAM WAS SUSPENDED IN JUNE 2021 DUE TO COVID-19 SAFETY PRECAUTIONS. DUE TO THE CHANGING NEEDS OF THE COMMUNITY THROUGH THE COVID-19 PANDEMIC, THE HOSPITALS BEGAN USING ALTERNATIVE METHODS SUCH AS SOCIAL MEDIA AND COMMUNITY TALKS TO CONNECT WITH THE COMMUNITY AND SHARE RESOURCES TO IMPROVE KNOWLEDGE OF ACTIVE LIFESTYLES. OBJECTIVE 2: THE SECOND OBJECTIVE IS TO PROVIDE EDUCATION ON THE HEALTH BENEFITS OF PHYSICAL ACTIVITY DURING 60 FREE COMMUNITY HEALTH SCREENINGS AND PROVIDE ATTENDEES WITH THEIR BODY MASS INDEX (BMI), CHOLESTEROL AND BLOOD PRESSURE, BY THE END OF YEAR THREE. THIS OBJECTIVE IS FUNDED AND CONDUCTED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. THE COMMUNITY HEALTH SCREENINGS PROVIDE INDIVIDUALS IN UNDERSERVED COMMUNITIES WITH THEIR BODY MASS INDEX, CHOLESTEROL, AND BLOOD PRESSURE READINGS. AT THESE SCREENINGS, ATTENDEES RECEIVE EDUCATIONAL MATERIALS ON IMPROVING THEIR HEALTH ALONG WITH FLYERS FOR ATTENDING THE HOSPITALS' FREE FITNESS CLASSES. SCREENINGS ARE HOSTED BOTH AT THE HOSPITALS AND OUT IN THE COMMUNITY AT LOCAL CHURCHES AND BUSINESS IN OUR PRIMARY SERVICE AREA. THE HOSPITALS PROGRESSED ON THEIR SET METRIC OF 60 FREE COMMUNITY HEALTH SCREENINGS WITH 7 SCREENINGS HOSTED THIS YEAR. THE NUMBER OF SCREENINGS WERE LIMITED DUE TO COVID-19 SURGES. AT THE SEVEN SCREENINGS, 118 INDIVIDUALS WERE SCREENED. THESE INDIVIDUALS WERE PROVIDED HEALTH RELATED MATERIALS AND RESOURCES TO ADDRESS ANY OUT-OF-RANGE FINDINGS. **SEE CONTINUATION"

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13H:
EFFECTIVE MARCH 1, 2020, THE FILING ORGANIZATION'S HOSPITAL FACILITY (OR FACILITIES) AUGMENTED THEIR FINANCIAL ASSISTANCE POLICY WITH A COVID-19 FINANCIAL GRACE ADDENDUM. PURSUANT TO THE COVID-19 FINANCIAL GRACE ADDENDUM, UNINSURED PATIENTS TREATED FOR COVID-19 RELATED EVALUATIONS ARE TO RECEIVE FREE OR DISCOUNTED CARE DEPENDING ON THE PATIENT'S COOPERATION IN SUBMITTING NECESSARY FINANCIAL ASSISTANCE INFORMATION. INSURED PATIENTS TESTED FOR COVID-19 ARE NOT EXPECTED TO HAVE OUT-OF-POCKET EXPENSES BASED ON INSURANCE COMMUNITY RESPONSE TO WAIVE PATIENT FINANCIAL RESPONSIBILITY. IF A PAYER UNEXPECTEDLY FAILS TO WAIVE PATIENT RESPONSIBILITY FOR COVID-19 RELATED TESTING, THE FILING ORGANIZATION WILL NOT BALANCE BILL PATIENTS FOR ANY OUT-OF-POCKET EXPENSES RELATED TO COVID-19. IN ADDITION, PATIENTS WITH EXISTING PAYMENT PLANS ARE PROVIDED OPPORTUNITIES FOR REDUCING THEIR MONTHLY PAYMENTS.

SCH H, PART V, SECTION B, LINE 7A
THE CHNA REPORT CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS

SCH H, PART V, SECTION B, LINE 10A
THE HOSPITALS' MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE FOUND AT URL:HTTPS://WWW.ADVENTHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS

SCH H, PART V, SECTION B, LINE 11 CONTINUATION
FACILITY REPORTING GROUP - APRIORITY 2: MENTAL ILLNESS & PTSD 2019 DESCRIPTION OF THE ISSUE:MENTAL WELLNESS IS A GOOD INDICATOR OF OVERALL HEALTH. MENTAL WELLNESS CAN INFLUENCE OTHER FACTORS OF HEALTH INCLUDING MORTALITY RATES, UNEMPLOYMENT, POVERTY, AND THE PERCENTAGE OF ADULTS WHO DID NOT COMPLETE HIGH SCHOOL. THE HOSPITALS' PRIMARY SERVICE AREA (PSA) HOUSES FORT HOOD, ONE OF THE LARGEST MILITARY BASES IN THE WORLD. THERE IS A SIGNIFICANTLY HIGHER POPULATION OF VETERANS LIVING IN THE COMMUNITY, CONTRIBUTING TO A HIGHER NUMBER OF INDIVIDUALS DIAGNOSED WITH POST TRAUMATIC STRESS DISORDER (PTSD). THE HOSPITALS' SERVICE AREA REPORTED AN AVERAGE OF 3.6 MENTALLY UNHEALTHY DAYS IN THE PAST 30 DAYS (COUNTY HEALTH RANKINGS & ROADMAPS, 2018). OF MEDICAID ELIGIBLE ADULTS, 19.1% ARE IMPACTED BY SOME TYPE OF DEPRESSION (COUNTY HEALTH RANKINGS & ROADMAPS, 2018). COMMUNITY STAKEHOLDERS REPORTED HIGH NEEDS FOR MENTAL HEALTH SERVICES IN THE POPULATIONS THEY SERVE. BELL COUNTY DOES HAVE A SIGNIFICANTLY HIGHER NUMBER OF MENTAL HEALTH PROVIDERS, 480 INDIVIDUALS: ONE PROVIDER, AS COMPARED TO THE TEXAS AVERAGE, 960 INDIVIDUALS: ONE PROVIDER (COUNTY HEALTH RANKINGS & ROADMAPS, 2018).2021 UPDATE: THE ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK COMMUNITY HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE MENTAL ILLNESS & PTSD PRIORITY. 1. INCREASE ACCESS TO AFFORDABLE MENTAL HEALTH RESOURCES TO LOW INCOME POPULATIONS 2. PREPARE COMMUNITY PARTNERS TO IDENTIFY AND ADDRESS MENTAL HEALTH NEEDS GOAL 1: INCREASE ACCESS TO AFFORDABLE MENTAL HEALTH RESOURCES TO LOW INCOME POPULATIONS OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PARTNER WITH THE KILLEEN INDEPENDENT SCHOOL DISTRICT (KISD) TO PLACE A SOCIAL WORKER IN EACH OF THE KISD'S 45 CAMPUSES TO ASSIST IN ADDRESSING MENTAL HEALTH NEEDS OF THE STUDENTS AND THEIR FAMILIES AND CONNECTING THEM TO COMMUNITY RESOURCES BY THE END OF YEAR THREE. THIS OBJECTIVE IS MANAGED THROUGH BOTH HOSPITALS AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. THE INITIATIVE PROVIDES CAMPUSES WITH SOCIAL WORKERS TO HELP STUDENTS AND FAMILIES WITH MENTAL HEALTH NEEDS AND TO CONNECT THEM TO COMMUNITY RESOURCES THAT COULD BE HELPFUL IN IMPROVING THEIR QUALITY OF LIFE. THE HOSPITALS DID PROGRESS ON ITS SET METRIC OF PLACING A SOCIAL WORKER IN EACH OF THE DISTRICT'S 45 CAMPUSES, ALTHOUGH NO SOCIAL WORKERS WERE PLACED. HOSPITAL REPRESENTATIVES AND SCHOOL OFFICIALS COLLABORATED TO REALIGN THE STRATEGY FOR A NEW DEPLOYMENT IN AUGUST 2021 AND THE HOSPITALS ARE CURRENTLY RECRUITING SOCIAL WORKERS TO FILL THESE POSITIONS.OBJECTIVE 2: THE SECOND OBJECTIVE IS TO ADD A SPIRITUAL WHOLENESS SCREENING TO THE REGISTRATION PROCESS OF THE HOSPITAL'S FREE COMMUNITY HEALTH SCREENINGS PROGRAM FOR 200 UNINSURED INDIVIDUALS TO BE SCREENED BY THE END OF YEAR ONE. THE SPIRITUAL WHOLENESS SCREENINGS ARE CONDUCTED THROUGH BOTH HOSPITALS AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. THE SPIRITUAL WHOLENESS SCREENING IDENTIFIES INDIVIDUALS IN NEED OF MENTAL WELLNESS SUPPORT AND CONNECTS THEM WITH A SPIRITUAL ADVISOR WHO CAN REFER THE INDIVIDUAL TO THE RESOURCES THEY NEED TO SEEK HELP. THE HOSPITALS FELL SHORT OF THEIR SET METRIC OF 200 UNINSURED INDIVIDUAL SCREENINGS WITH 118 INDIVIDUALS SCREENED. OF THE 118 INDIVIDUALS SCREENED, 16 INDICATED THEY WANTED TO BE CONTACTED BY A SPIRITUAL ADVISOR FROM THE HOSPITALS' PASTORAL CARE DEPARTMENT. EACH OF THE INDIVIDUALS WAS CONTACTED AND REFERRED TO THE APPROPRIATE RESOURCES. THE OBJECTIVE WAS NOT ACHIEVED BECAUSE THE MAJORITY OF THE HEALTH SCREENINGS IN 2021 WERE CANCELLED DUE TO THE COVID-19 PANDEMIC. GOAL 2: PREPARE COMMUNITY PARTNERS TO IDENTIFY AND ADDRESS MENTAL HEALTH NEEDSOBJECTIVE 1: THE FIRST OBJECTIVE IS TO HOST THE ANNUAL CONNECTING THE DOTS BEHAVIORAL HEALTH SUMMIT WHICH WILL PROVIDE 300 PUBLIC HEALTH PROFESSIONALS EDUCATION ON THE SOCIAL DETERMINANTS OF HEALTH AND CONNECT THEM TO RESOURCES TO SHARE WITH THEIR CLIENTS/PATIENTS BY THE END OF YEAR TWO. THIS OBJECTIVE IS FUNDED AND CONDUCTED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. IN 2021, THE SUMMIT WAS MOVED TO A VIRTUAL CONTINUING EDUCATION PLATFORM. 163 MENTAL HEALTH PROFESSIONALS IN THE COMMUNITY COMPLETED THE COURSE. IN 2022, THE HOSPITAL HAS RESUMED THE IN-PERSON SUMMIT. PRIORITY 3: FOOD INSECURITY 2019 DESCRIPTION OF THE ISSUE:FOOD INSECURITY IS A LACK OF CONSISTENT ACCESS TO ENOUGH FOOD FOR AN ACTIVE, HEALTHY LIFE (USDA, 2019). A LACK OF HEALTHY FOOD CAN HEAVE DETRIMENTAL IMPACTS ON ONE'S OVERALL HEALTH. FOOD INSECURITY IS NOT ISOLATED TO THOSE IN POVERTY, AND IT OFTEN PRESENTS WITH OTHER ISSUES SUCH AS LOW INCOMES, LACK OF TRANSPORTATION AND MEDICAL CONCERNS (FEEDING AMERICA, 2019). IN 2018, AN ESTIMATED ONE IN NINE AMERICANS WERE FOOD INSECURE, EQUATING TO MORE THAN 37 MILLION AMERICANS, INCLUDING MORE THAN 11 MILLION CHILDREN (U.S. DEPARTMENT OF AGRICULTURE ECONOMIC RESEARCH SERVICE, 2019). IN THE HOSPITALS' SERVICE AREA, 20.9% OF INDIVIDUALS ARE FOOD INSECURE (COUNTY HEALTH RANKINGS & ROADMAPS, 2018). THIS IS SIGNIFICANTLY HIGHER THAN THE NATIONS AVERAGE OF ONE IN EVERY NINE INDIVIDUALS BEING FOOD INSECURE (FEEDING AMERICA, 2019). THIS CONCERN HAS BECOME EXACERBATED ON THE NORTH SIDE OF KILLEEN, AS BOTH GROCERY STORES HAVE CLOSED IN 2019.2021 UPDATE: THE ADVENTHEALTH CENTRAL TEXAS COMMUNITY AND ADVENTHEALTH ROLLINS BROOK HEALTH PLAN HAS TWO DESIRED GOAL STATEMENTS UNDER THE FOOD INSECURITY PRIORITY. 1. INCREASE ACCESS TO HEALTHY FOOD FOR LOW-INCOME COMMUNITY MEMBERS IN FOOD DESERTS 2. IMPROVE KNOWLEDGE AND SKILLS ON HOW TO PREPARE HEALTHIER FOOD TO IMPROVE OVERALL NUTRITION GOAL 1: INCREASE ACCESS TO HEALTHY FOOD FOR LOW-INCOME COMMUNITY MEMBERS IN FOOD DESERTS OBJECTIVE 1: THE FIRST OBJECTIVE IS TO SERVE FOOD TO 500 FAMILIES A MONTH LIVING IN FOOD DESERTS IN ZIP CODES 76541, 76543 AND 76522 THROUGH THE MOBILE FOOD PANTRY PROGRAM. THIS REFUGE MOBILE FOOD PANTRY IS FUNDED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. THE REFUGE MOBILE FOOD PANTRY PROVIDES A MONTHLY MOBILE FOOD PANTRY TO INDIVIDUALS LIVING IN A FOOD DESERT IN NORTH KILLEEN COUNTY THAT DO NOT HAVE TRANSPORTATION TO OTHER LOCAL FOOD PANTRIES. THE HOSPITALS EXCEEDED THEIR SET METRIC OF SERVING 500 FAMILIES MONTHLY WHICH WAS SUPPORTED BY A FINANCIAL DONATION OF $2,500. IN 2021, 521 FAMILIES WERE SERVED IN THESE ZIP CODES. EACH FAMILY RECEIVED ON AVERAGE 20 POUNDS OF FRESH FOOD AND 40-50 POUNDS OF SHELF STABLE ITEMS. OBJECTIVE 2:THE SECOND OBJECTIVE IS TO PROVIDE NUTRITIOUS MEALS TO 400 LOW INCOME FAMILIES A WEEK, LIVING IN THE 76541 ZIP CODE THROUGH THE FOOD CARE CENTER PROGRAM. THE FOOD CARE CENTER IS ONE OF SEVERAL LOCAL FOOD PANTRIES AND SOUP KITCHENS PROGRAMS FUNDED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. THE LOCAL PANTRIES PROVIDE CONSISTENT ACCESS TO FOOD FOR LOW-INCOME FAMILIES. THE HOSPITALS MET THEIR SET METRIC OF $2,500 DOLLARS DONATED. THE SECOND METRIC FOR THE OBJECTIVE WAS MET, WITH 12 MEALS DONATED TO THE MISSION SOUP KITCHEN. BETWEEN THE FOOD CARE CENTER AND MISSION SOUP KITCHEN OVER 11,000 FAMILIES WERE SERVED IN 2021. ONE BARRIER TO VOLUNTEERISM FROM HOSPITAL STAFF WERE THE RESTRICTIONS DUE TO THE COVID-19 PANDEMIC. INITIALLY, THE HOSPITALS PLANNED TO MEET THIS OBJECTIVE THROUGH FINANCIAL AND VOLUNTEER SUPPORT, ALTHOUGH, BECAUSE OF COVID-19 AND SOCIAL RESTRICTIONS, ONLY THE FINANCIAL CONTRIBUTION WAS MADE IN 2021. THE HOSPITALS INTEND TO PROVIDE THE VOLUNTEER COMPONENTS TO THESE LOCAL ORGANIZATIONS ONCE COVID-19 PRECAUTIONS ALLOW. **SEE CONTINUATION

SCH H, PART V, SECTION B, LINE 11 CONTINUATION
FACILITY REPORTING GROUP - AGOAL 2: IMPROVE KNOWLEDGE AND SKILLS ON HOW TO PREPARE HEALTHIER FOOD TO IMPROVE OVERALL NUTRITION OBJECTIVE 1: THE FIRST OBJECTIVE IS TO PROVIDE HEALTHY COOKING SUGGESTIONS TO 30,000 COMMUNITY MEMBERS THROUGH HOSPITAL NEWSLETTER PUBLICATIONS TO IMPROVE COMMUNITY KNOWLEDGE OF HEALTHY FOOD PREPARATION BY THE END OF YEAR THREE. THE HOSPITALS' QUARTERLY PUBLICATION, INSPIRING BETTER, IS FUNDED AND DEPLOYED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. INSPIRING BETTER IS A QUARTERLY PUBLICATION SENT TO INDIVIDUALS LOCATED IN THE COMMUNITIES SERVED BY THE HOSPITALS. THE MAGAZINE INCLUDES SEVERAL HEALTHY LIFESTYLE ARTICLES, RELEVANT TO THE NEEDS IN OUR COMMUNITY INCLUDING HEALTHY RECIPES AND TIPS FOR MAKING BETTER NUTRITION CHOICES. THE HOSPITALS EXCEEDED THEIR SET METRIC OF 30,000 WITH 120,000 COMMUNITY MEMBERS REACHED. DUE TO THE PANDEMIC THE HOSPITALS CANCELLED MUCH OF THEIR NUTRITION PROGRAMING AND COUNSELING. OBJECTIVE 2: THE SECOND OBJECTIVE IS THROUGH THE DIABETES MANAGEMENT, MATERNAL/CHILD EDUCATION AND THE COMPREHENSIVE LIFESTYLE INTERVENTION PROGRAM (CLIP), THE HOSPITAL WILL PROVIDE ATTENDEES WITH THE EDUCATION AND RESOURCES TO CHOOSE AND PREPARE HEALTHY FOODS. EDUCATION WILL IMPROVE PARTICIPANT'S CONFIDENCE IN HEALTHY FOOD PREPARATION BY 10% FROM A BASELINE OF 60%, MEASURED BY A PRE- AND POST-TEST BY THE END OF YEAR THREE. THE HOSPITALS' DIABETES MANAGEMENT, NEW PARENTING CLASSES, AND THE COMPREHENSIVE LIFESTYLE INTERVENTION PROGRAM ARE FUNDED AND MANAGED THROUGH BOTH HOSPITALS AND FUNDING AND OUTCOMES REPORTED REPRESENT BOTH HOSPITALS. THE HOSPITALS PLANNED TO HOLD FREE CLASSES FOR THE COMMUNITY WHICH FOCUSED ON THE BENEFITS OF LEADING A HEALTHY LIFESTYLE AND PREVENTIVE MEDICINE. DUE TO COVID-19, THE PROGRAM WAS DELAYED AND, AS A RESULT OF THE PANDEMIC, THE NEEDS AND RESOURCES OF THE COMMUNITY HAVE CHANGED. DURING THE PAST YEAR, THE HOSPITALS HAVE PIVOTED WHERE NECESSARY TO ADDRESS THE IMMEDIATE NEEDS OF THE COMMUNITY DURING THE PANDEMIC AND WILL CONTINUE TO DO SO. THE HOSPITALS INTEND TO RESUME THESE CLASSES ONCE COVID-19 AND SOCIAL DISTANCING PRECAUTIONS ALLOW. COMMUNITY NEEDS NOT CHOSEN BY ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK:THE PRIMARY AND SECONDARY DATA IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED MULTIPLE COMMUNITY ISSUES. THE HOSPITAL AND COMMUNITY STAKEHOLDERS USED THE FOLLOWING CRITERIA TO NARROW THE LARGER LIST TO THE PRIORITY AREAS NOTED ABOVE:1. HOW ACUTE IS THE NEED? (BASED ON DATA AND COMMUNITY CONCERN)2. WHAT IS THE TREND? IS THE NEED GETTING WORSE?3. DOES THE HOSPITAL PROVIDE SERVICES THAT RELATE TO THE PRIORITY? 4. IS SOMEONE ELSE - OR MULTIPLE GROUPS - IN THE COMMUNITY ALREADY WORKING ON THIS ISSUE? 5. IF THE HOSPITAL WERE TO ADDRESS THIS ISSUE, ARE THERE OPPORTUNITIES TO WORK WITH COMMUNITY PARTNERS? BASED ON THIS PRIORITIZATION PROCESS, THE HOSPITAL DID NOT CHOOSE THE FOLLOWING COMMUNITY ISSUES:1. POVERTY: THERE ARE STRONG CONNECTIONS BETWEEN POVERTY AND POOR HEALTH, CONTRIBUTING TO UNSTABLE HOUSING, LOW INCOME, UNSAFE NEIGHBORHOODS, OR SUBSTANDARD EDUCATION (CDC, 2019). IN THE HOSPITALS' SERVICE AREAS, 13.7% OF THE POPULATION LIVES BELOW THE FEDERAL POVERTY LEVEL (FPL). 26.7 % OF SURVEY RESPONDENTS HAVE AN ANNUAL HOUSEHOLD INCOME OF LESS THAN $35,000 AND 36.8% OF RESPONDENTS HAVE NOT COMPLETED POST-SECONDARY EDUCATION. MANY COMMUNITY PARTNERS ARE ADDRESSING THE CONTRIBUTING FACTORS OF POVERTY; INCLUDING EDUCATION, HOUSING, TRANSPORTATION, JOB PLACEMENT, CHILDCARE AND NUTRITION. THE CHNAC BELIEVES THAT ADDRESSING THE ISSUE OF FOOD INSECURITY WILL BENEFIT IMPOVERISHED MEMBERS OF THE COMMUNITY. 2. DIABETES: OF THE HOSPITALS' SERVICE POPULATION, 10.2% HAS DIABETES, COMPARED TO THE STATE OF TEXAS, WHICH IS 9.54% (COUNTY HEALTH RANKINGS & ROADMAPS, 2018). DIABETES LOWERS LIFE EXPECTANCY BY UP TO 15 YEARS AND INCREASES THE RISK OF HEART DISEASE BY TWO TO FOUR TIMES (CDC, 2018). SINCE OTHER COMMUNITY PARTNERS ARE DOING WORK TO PROVIDE DIABETES RESOURCES AND EDUCATION, THE CHNAC OPTED NOT TO SELECT THIS AS A TOP PRIORITY.3. TRANSPORTATION: IN THE HOSPITALS' SERVICE AREA, 5.7% OF THE POPULATION DOES NOT HAVE ACCESS TO A VEHICLE (U.S. CENSUS BUREAU, 2017). THESE INDIVIDUALS MUST RELY ON SOME TYPE OF CARPOOL OR PUBLIC TRANSPORTATION, OFTEN MAKING IT DIFFICULT TO MAKE APPOINTMENTS, CONSISTENTLY HAVE ACCESS TO HEALTHY FOODS AND FIND EMPLOYMENT. CURRENTLY, THE HILL COUNTRY TRANSIT DISTRICT (THE HOP) OPERATES FIVE FIXED ROUTES THROUGHOUT KILLEEN AND COPPERAS COVE, INCLUDING THE ADA PARATRANSIT TO ACCOMMODATE INDIVIDUALS WITH DISABILITIES IN RURAL AREAS. THE HOP IS CURRENTLY DEVELOPING OPTIONS TO EXPAND OPERATION TIMES AND INCREASE ROUTES. THIS PRIORITY WAS NOT SELECTED BECAUSE OTHER COMMUNITY PARTNERS ARE CURRENTLY ADDRESSING TRANSPORTATION NEEDS. 4. SMOKING/RESPIRATORY: MORE THAN 16 MILLION AMERICANS ARE LIVING WITH A DISEASE CAUSED BY SMOKING (CDC, 2019). SMOKING CAUSES CANCER, HEART DISEASE, STROKE, LUNG DISEASES, DIABETES, AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), WHICH INCLUDES EMPHYSEMA AND CHRONIC BRONCHITIS (CDC, 2019). ALL MEASURES RELATED TO SMOKING PREVALENCE AND RESPIRATORY DISEASES WERE HIGH IN THE SERVICE AREA WHEN COMPARED TO THE STATE AVERAGE. 18.2% OF ADULTS CURRENTLY SMOKE AND 43.34 DEATHS PER 100,000 ARE RELATED TO LUNG DISEASE. 14.8% OF OUR SERVICE AREA HAS BEEN DIAGNOSED WITH ASTHMA. EFFECTIVE SEPTEMBER 1, 2019, THE STATE OF TEXAS PASSED A BILL TO INCREASE THE LEGAL SALE OF TOBACCO AGE TO 21. THE HOSPITALS DO NOT CURRENTLY HAVE THE CAPACITY TO ADDRESS THE ISSUE AT THIS TIME. 5. OBESITY: IN THE HOSPITALS' SERVICE AREA, 30.1% OF THE POPULATION IS OBESE AND 42.4% ARE OVERWEIGHT. INDIVIDUALS WITH A BODY MASS INDEX (BMI) OVER 30 ARE CONSIDERED OBESE AND A BMI OVER 25 ARE OVERWEIGHT (CDC, 2018). PEOPLE WHO HAVE OBESITY ARE AT INCREASED RISK FOR MANY SERIOUS DISEASES AND HEALTH CONDITIONS INCLUDING THE FOLLOWING: TYPE 2 DIABETES, HIGH CHOLESTEROL, SOME CANCERS, PAIN, STROKE, AND OTHER CHRONIC ILLNESSES (CDC, 2018). THE HOSPITALS WILL ADDRESS TWO OF THE CONTRIBUTING FACTORS TO OBESITY, INCLUDING FOOD INSECURITY AND PHYSICAL INACTIVITY.

PART I, LINE 6A:
"THE FILING ORGANIZATION WAS A PARTIALLY OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) DURING ITS CURRENT TAX YEAR. DURING THE CURRENT YEAR, AHSSHC SERVED AS A PARENT ORGANIZATION TO 30 TAX-EXEMPT 501(C)(3) HOSPITAL ORGANIZATIONS AND A NUMBER OF OTHER HEALTH CARE FACILITIES THAT OPERATED IN 10 STATES WITHIN THE U.S. THE SYSTEM OF ORGANIZATIONS UNDER THE CONTROL AND OWNERSHIP OF AHSSHC IS KNOWN AS ""ADVENTHEALTH"".ALL HOSPITAL ORGANIZATIONS WITHIN ADVENTHEALTH COLLECT, CALCULATE, AND REPORT THE COMMUNITY BENEFITS THEY PROVIDE TO THE COMMUNITIES THEY SERVE. ADVENTHEALTH ORGANIZATIONS EXIST SOLELY TO IMPROVE AND ENHANCE THE LOCAL COMMUNITIES THEY SERVE. ADVENTHEALTH HAS A SYSTEM-WIDE COMMUNITY BENEFITS ACCOUNTING POLICY THAT PROVIDES GUIDELINES FOR ITS HEALTH CARE PROVIDER ORGANIZATIONS TO CAPTURE AND REPORT THE COSTS OF SERVICES PROVIDED TO THE UNDERPRIVILEGED AND TO THE BROADER COMMUNITY. EACH ADVENTHEALTH HOSPITAL FACILITY REPORTS THEIR COMMUNITY BENEFITS TO THEIR BOARD OF DIRECTORS AND STRIVES TO COMMUNICATE THEIR COMMUNITY BENEFITS TO THEIR LOCAL COMMUNITIES. ADDITIONALLY, THE FILING ORGANIZATION'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT AND ASSOCIATED IMPLEMENTATION STRATEGY CAN BE ACCESSED ON THE FILING ORGANIZATION'S WEBSITE."

PART I, LINE 7:
THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS.

PART II, COMMUNITY BUILDING ACTIVITIES:
THE FILING ORGANIZATION IS INVOLVED WITH AND SUPPORTIVE OF VARIOUS ACTIVITIES IN ITS SERVICE AREA THAT WORK COLLABORATIVELY TO HELP THOSE IN NEED AND TO IMPROVE THE HEALTH AND SAFETY OF THE RESIDENTS OF THE COMMUNITY. THE FILING ORGANIZATION'S WELLNESS DEPARTMENT OFFERS VARIOUS HEALTH PROMOTION AND EDUCATIONAL PROGRAMS INCLUDING THE FOLLOWING: ARTHRITIS EXERCISE, LALECHE LEAGUE (ASSISTANCE TO MOTHERS WHO BREASTFEED THROUGH MOTHER-TO-MOTHER SUPPORT, ENCOURAGEMENT, AND EDUCATION), SENIOR EXCERCISE, GRIEF RECOVERY, DIABETES EDUCATION, ASTHMA EDUCATION, SMOKING CESSATION CLASSES, CANCER COSMETOLOGY CLASS AND SUPPORT GROUPS FOR THOSE AFFECTED BY CANCER. IN ADDITION TO THE ACTIVITIES LISTED ABOVE, THE FILING ORGANIZATION ALSO ORGANIZES HEALTH EVENTS & HEALTH FAIRS THAT PROVIDE HEALTH SCREENINGS ALONG WITH HEALTH INFORMATION, IMMUNIZATION CINICS, AND HEART CHECK (BLOOD PRESSURE MONITOR AND HEALTH EDUCATION PAMPHLETS) FREE TO THE PUBLIC.

PART III, LINE 2:
THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE.

PART III, LINE 4:
FINANCIAL STATEMENT FOOTNOTE RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS:THE FINANCIAL INFORMATION OF THE FILING ORGANIZATION IS INCLUDED IN A CONSOLIDATED AUDITED FINANCIAL STATEMENT FOR THE CURRENT YEAR.THE APPLICABLE FOOTNOTE FROM THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ADDRESSES ACCOUNTS RECEIVABLE, THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, AND THE PROVISION FOR BAD DEBTS CAN BE FOUND ON PAGES 8 AND 9. PLEASE NOTE THAT DOLLAR AMOUNTS ON THE ATTACHED CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE IN THOUSANDS.

PART III, LINE 8:
COSTING METHODOLOGY:MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO.RATIONALE FOR INCLUDING A MEDICARE SHORTFALL AS COMMUNITY BENEFIT:AS A 501(C)(3) ORGANIZATION, THE FILING ORGANIZATION PROVIDES EMERGENCY AND NON-ELECTIVE CARE TO ALL REGARDLESS OF ABILITY TO PAY. ALL HOSPITAL SERVICES ARE PROVIDED IN A NON-DISCRIMINATORY MANNER TO PATIENTS WHO ARE COVERED BENEFICIARIES UNDER THE MEDICARE PROGRAM. AS A PUBLIC INSURANCE PROGRAM, MEDICARE PROVIDES A PRE-ESTABLISHED REIMBURSEMENT RATE/AMOUNT TO HEALTH CARE PROVIDERS FOR THE SERVICES THEY PROVIDE TO PATIENTS. IN SOME CASES, THE REIMBURSEMENT AMOUNT PROVIDED TO A HOSPITAL MAY EXCEED ITS COSTS OF PROVIDING A PARTICULAR SERVICE OR SERVICES TO A PATIENT. IN OTHER CASES, THE MEDICARE REIMBURSEMENT AMOUNT MAY RESULT IN THE HOSPITAL EXPERIENCING A SHORTFALL OF REIMBURSEMENT RECEIVED OVER COSTS INCURRED. IN THOSE CASES WHERE AN OVERALL SHORTFALL IS GENERATED FOR PROVIDING SERVICES TO ALL MEDICARE PATIENTS, THE SHORTFALL AMOUNT SHOULD BE CONSIDERED AS A BENEFIT TO THE COMMUNITY. TAX-EXEMPT HOSPITALS ARE REQUIRED TO ACCEPT ALL MEDICARE PATIENTS REGARDLESS OF THE PROFITABILITY, OR LACK THEREOF, WITH RESPECT TO THE SERVICES THEY PROVIDE TO MEDICARE PATIENTS. THE POPULATION OF INDIVIDUALS COVERED UNDER THE MEDICARE PROGRAM IS SUFFICIENTLY LARGE SO THAT THE PROVISION OF SERVICES TO THE POPULATION IS A BENEFIT TO THE COMMUNITY AND RELIEVES THE BURDENS OF GOVERNMENT. IN THOSE SITUATIONS WHERE THE PROVISION OF SERVICES TO THE TOTAL MEDICARE PATIENT POPULATION OF A TAX-EXEMPT HOSPITAL DURING ANY YEAR RESULTS IN A SHORTFALL OF REIMBURSEMENT RECEIVED OVER THE COST OF PROVIDING CARE, THE TAX-EXEMPT HOSPITAL HAS PROVIDED A BENEFIT TO A CLASS OF PERSONS BROAD ENOUGH TO BE CONSIDERED A BENEFIT TO THE COMMUNITY. DESPITE A FINANCIAL SHORTFALL, A TAX-EXEMPT HOSPITAL MUST AND WILL CONTINUE TO ACCEPT AND CARE FOR MEDICARE PATIENTS. TYPICALLY, TAX-EXEMPT HOSPITALS PROVIDE HEALTH CARE SERVICES BASED UPON AN ASSESSMENT OF THE HEALTH CARE NEEDS OF THEIR COMMUNITY AS OPPOSED TO THEIR TAXABLE COUNTERPARTS WHERE PROFITABILITY OFTEN DRIVES DECISIONS ABOUT PATIENT CARE SERVICES THAT ARE OFFERED. PATIENT CARE PROVIDED BY TAX-EXEMPT HOSPITALS THAT RESULTS IN MEDICARE SHORTFALLS SHOULD BE CONSIDERED AS PROVIDING A BENEFIT TO THE COMMUNITY AND RELIEVING THE BURDENS OF GOVERNMENT.

PART VI, LINE 7, REPORTS FILED WITH STATES
TX

PART III, LINE 3:
METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY:SELF-PAY PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM). IF AN INDIVIDUAL DOES NOT SUBMIT A COMPLETE FAA FORM WITHIN 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL, AN INDIVIDUAL MAY BE CONSIDERED FOR PRESUMPTIVE ELIGIBILITY BASED UPON A SCORING TOOL THAT IS DESIGNED TO CLASSIFY PATIENTS INTO GROUPS OF VARYING ECONOMIC MEANS. THE SCORING TOOL USES ALGORITHMS THAT INCORPORATE DATA FROM CREDIT BUREAUS, DEMOGRAPHIC DATABASES, AND HOSPITAL SPECIFIC DATA TO INFER AND CLASSIFY PATIENTS INTO RESPECTIVE ECONOMIC MEANS CATEGORIES. INDIVIDUALS WHO EARN A CERTAIN SCORE ON THE SCORING TOOL ARE CONSIDERED TO QUALIFY AS ELIGIBLE FOR THE MOST GENEROUS FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. AS DETERMINED BY THE FILING ORGANIZATION, A NOMINAL AMOUNT OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORING TOOL IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION CANNOT BE MADE BASED UPON INFORMATION SUPPLIED BY THE INDIVIDUAL. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY.

PART III, LINE 9B:
THE HOSPITAL FILING ORGANIZATION'S COLLECTION PRACTICES ARE IN CONFORMITY WITH THE REQUIREMENTS SET FORTH IN THE 2014 FINAL REGULATIONS REGARDING THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R)(4) (R)(6). NO EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ARE INITIATED BY THE HOSPITAL FILING ORGANIZATION IN THE 120-DAY PERIOD FOLLOWING THE DATE AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL (OR, IF LATER, THE SPECIFIED DEADLINE GIVEN IN A WRITTEN NOTICE OF ACTIONS THAT MAY BE TAKEN, AS DESCRIBED BELOW). INDIVIDUALS ARE PROVIDED WITH AT LEAST ONE WRITTEN NOTICE (NOTICE OF ACTIONS THAT MAY BE TAKEN) AND A COPY OF THE FILING ORGANIZATION'S PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY THAT INFORMS THE INDIVIDUAL THAT THE HOSPITAL FILING ORGANIZATION MAY TAKE ACTIONS TO REPORT ADVERSE INFORMATION TO CREDIT REPORTING AGENCIES/BUREAUS IF THE INDIVIDUAL DOES NOT SUBMIT A FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM) OR PAY THE AMOUNT DUE BY A SPECIFIED DEADLINE. THE SPECIFIED DEADLINE IS NOT EARLIER THAN 120 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS SENT TO THE INDIVIDUAL AND IS AT LEAST 30 DAYS AFTER THE NOTICE IS PROVIDED. A REASONABLE ATTEMPT IS ALSO MADE TO ORALLY NOTIFY AN INDIVIDUAL ABOUT THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FAA FORM DURING THE 240-DAY PERIOD FOLLOWING THE DATE ON WHICH THE FIRST POST-DISCHARGE BILLING STATEMENT WAS SENT TO THE INDIVIDUAL, THE HOSPITAL FILING ORGANIZATION SUSPENDS ANY REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS (OR CEASES ANY OTHER ECA'S) AND PROVIDES A WRITTEN NOTICE TO THE INDIVIDUAL DESCRIBING WHAT ADDITIONAL INFORMATION OR DOCUMENTATION IS NEEDED TO COMPLETE THE FAA FORM. THIS WRITTEN NOTICE CONTAINS CONTACT INFORMATION INCLUDING THE TELEPHONE NUMBER AND PHYSICAL LOCATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY, AS WELL AS CONTACT INFORMATION OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS OR, ALTERNATIVELY, A NONPROFIT ORGANIZATION OR GOVERNMENTAL AGENCY THAT CAN PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS IF THE HOSPITAL FACILITY IS UNABLE TO DO SO. IF AN INDIVIDUAL SUBMITS A COMPLETE FAA FORM WITHIN A REASONABLE TIME-PERIOD AS SET FORTH IN THE NOTICE DESCRIBED ABOVE, THE HOSPITAL FILING ORGANIZATION WILL SUSPEND ANY ADVERSE REPORTING TO CONSUMER CREDIT REPORTING AGENCIES/BUREAUS UNTIL A FINANCIAL ASSISTANCE POLICY ELIGIBILITY DETERMINATION CAN BE MADE.

SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B, LINE 8
RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. UNREIMBURSED COSTS ARE CONSIDERED A COMMUNITY BENEFIT TO THE ELDERLY AND ARE COMBINED INTO AN ANNUAL COMMUNITY BENEFIT STATEMENT PREPARED BY ADVENTHEALTH. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO ALL MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ 3,790,062 - DIFFERENCE IN COSTING METHODOLOGY: (1,220,038)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (2,818,867) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS PER THE FILING ORGANIZATION'S COMMUNITYBENEFIT REPORTING $ (248,843)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S PORTION OF THE COMPANY'S ANNUAL COMMUNITY BENEFIT STATEMENT IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING ANY MEDICARE SURPLUS/(SHORTFALL) FOR PURPOSES OF THE ANNUAL COMMUNITY BENEFIT REPORTING IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. THE COMPANY'S OWN COMMUNITY BENEFIT STATEMENT CAPTURES THE UNREIMBURSED COST OF PROVIDING SERVICES TO ALL MEDICARE BENEFICIARIES THROUGHOUT THE ORGANIZATION.

PART VI, LINE 2:
THE HOSPITAL CONDUCTS COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) EVERY THREE YEARS. ITS 2019 CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY DECEMBER 31, 2019, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S 2019 CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN FINAL REGULATION SECTION 1.501(R)-3. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY.SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY.

PART VI, LINE 3:
THE FINANCIAL ASSISTANCE POLICY (FAP), FINANCIAL ASSISTANCE APPLICATION FORM (FAA FORM), AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY (PLS) OF THE FILING ORGANIZATION'S HOSPITAL FACILITY ARE TRANSPARENT AND AVAILABLE TO ALL INDIVIDUALS SERVED AT ANY POINT IN THE CARE CONTINUUM. THE FAP, FAA FORM, PLS, AND CONTACT INFORMATION FOR THE HOSPITAL FACILITY'S FINANCIAL COUNSELORS ARE PROMINENTLY AND CONSPICUOUSLY POSTED ON THE FILING ORGANIZATION'S HOSPITAL FACILITY'S WEBSITE. THE WEBSITE INDICATES THAT A COPY OF THE FAP, FAA FORM, AND PLS IS AVAILABLE AND HOW TO OBTAIN SUCH COPIES IN THE PRIMARY LANGUAGES OF ANY POPULATIONS WITH LIMITED PROFICIENCY IN ENGLISH THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE MEMBERS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY (REFERRED TO BELOW AS LEP DEFINED POPULATIONS). SIGNAGE IS DISPLAYED IN PUBLIC LOCATIONS OF THE FILING ORGANIZATION'S HOSPITAL FACILITY, INCLUDING AT ALL POINTS OF ADMISSION AND REGISTRATION AND THE EMERGENCY DEPARTMENT. THE SIGNAGE CONTAINS THE HOSPITAL FACILITY'S WEBSITE ADDRESS WHERE THE FAP, FAA FORM, AND PLS CAN BE ACCESSED AND THE TELEPHONE NUMBER AND PHYSICAL LOCATION THAT INDIVIDUALS CAN CALL OR VISIT TO OBTAIN COPIES OF THE FAP, FAA FORM AND PLS OR TO OBTAIN MORE INFORMATION ABOUT THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS. PAPER COPIES OF THE HOSPITAL FACILITY'S FAP, FAA FORM AND PLS ARE AVAILABLE UPON REQUEST AND WITHOUT CHARGE, BOTH IN PUBLIC LOCATIONS IN THE HOSPITAL FACILITY AND BY MAIL. PAPER COPIES ARE MADE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGES OF ANY LEP DEFINED POPULATIONS. THE FILING ORGANIZATION'S HOSPITAL FACILITY'S FINANCIAL COUNSELORS SEEK TO PROVIDE PERSONAL FINANCIAL COUNSELING TO ALL INDIVIDUALS ADMITTED TO THE HOSPITAL FACILITY WHO ARE CLASSIFIED AS SELF-PAY DURING THE COURSE OF THEIR HOSPITAL STAY OR AT TIME OF DISCHARGE TO EXPLAIN THE FAP AND FAA FORM AND TO PROVIDE INFORMATION CONCERNING OTHER SOURCES OF ASSISTANCE THAT MAY BE AVAILABLE, SUCH AS MEDICAID. A PAPER COPY OF THE HOSPITAL FACILITY'S PLS WILL BE OFFERED TO EVERY PATIENT AS A PART OF THE INTAKE OR DISCHARGE PROCESS. A CONSPICUOUS WRITTEN NOTICE IS INCLUDED ON ALL BILLING STATEMENTS SENT TO PATIENTS THAT NOTIFIES AND INFORMS RECIPIENTS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, INCLUDING THE FOLLOWING: 1) THE TELEPHONE NUMBER OF THE HOSPITAL FACILITY'S OFFICE OR DEPARTMENT THAT CAN PROVIDE INFORMATION ABOUT THE FAP AND THE FAA FORM; AND 2) THE WEBSITE ADDRESS WHERE COPIES OF THE FAP, FAA FORM AND PLS MAY BE OBTAINED. REASONABLE ATTEMPTS ARE MADE TO INFORM INDIVIDUALS ABOUT THE HOSPITAL FACILITY'S FAP IN ALL ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE INDIVIDUAL'S CARE. COPIES OF THE PLS ARE DISTRIBUTED TO MEMBERS OF THE COMMUNITY IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE.

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THE FILING ORGANIZATION CURRENTLY OPERATES 2 HOSPITAL FACILITIES, ADVENTHEALTH CENTRAL TEXAS AND ADVENTHEALTH ROLLINS BROOK, IN THE NORTHERN HILL COUNTRY OF CENTRAL TEXAS. COMBINED, THESE FACILITIES ARE A MAJOR HEALTHCARE PROVIDER IN BELL, CORYELL, AND LAMPASAS COUNTIES.ADVENTHEALTH CENTRAL TEXAS (AHCT), LOCATED IN BELL COUNTY, IS LICENSED FOR 170 ACUTE-CARE BEDS AND 60 PSYCHIATRIC CARE BEDS. IN ADDITION, AHCT ALSO OPERATES A 24-HOUR EMERGENCY CENTER, BEHAVIOR HEALTH CARE, DIGESTIVE CARE, HEART AND VASCULAR CARE, IMAGING SERVICES, LAB SERVICES, MEN'S CARE, MOTHER AND BABY CARE, ORTHOPEDIC CARE, SENIOR CARE AND SLEEP CARE. AS THE PRIMARY HEALTH CARE PROVIDER FOR WEST BELL, CORYELL AND LAMPASAS COUNTIES, AHCT SERVES MORE THAN 125,000 PATIENTS PER YEAR, WITH MORE THAN 300 PHYSICIANS OFFERING 43 MEDICAL SPECIALITIES AND A VARIETY OF WELLNESS SERVICES. AHCT IS LOCATED NEXT TO FORT HOOD, THE LARGEST MILITARY BASE IN THE COUNTRY WHICH MAKES THE COMMUNITY HEAVILY DEPENDENT ON THE POST AND THE SOLDIERS (AND THEIR FAMILIES) STATIONED THERE. ADVENTHEALTH ROLLINS BROOK (AHRB), LOCATED IN LAMPASAS COUNTY, TEXAS, IS LICENSED FOR 25 BEDS. BECAUSE OF ITS LOCATION AND POPULATION SERVED, AHRB IS A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL. IN ADDITION, AHRB OFFERS MANY TECHNOLOGICAL SERVICES INCLUDING A 24-HOUR EMERGENCY CENTER, A STATE-OF-THE-ART LABORATORY, MEDICAL/SURGICAL ROOMS, CT SCANNING, MAMMOGRAPHY AND CARDIO-PULMONARY SERVICES WITH EKG AND STRESS TESTING. AHRB ALSO OFFERS ACCESS TO A SLEEP DISORDER CENTER AND BONE DENSITY (DEXA) SCAN CAPABILITIES.AHRB IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. IT IS THE SOLE HOSPITAL FACILITY FOR THE LAMPASAS COMMUNITY. THE COUNTY OF LAMPASAS COVERS APPROXIMATELY 714 SQUARE MILES. SIMILAR TO BELL COUNTY, LAMPASAS COUNTY'S ECONOMY IS ALSO HEAVILY DEPENDENT ON THE SOLDIERS (AND THEIR FAMILIES) STATIONED AT FORT HOOD, LOCATED LESS THAN 25 MILES AWAY. THE DEMOGRAPHIC MAKEUP OF THE HOSPITAL'S COMMUNITY IS AS FOLLOWS: - POPULATION 196,840 - POPULATION OVER 65 7.98% - POVERTY (BELOW 100% FPL) 13.07% - UNEMPLOYMENT RATE 6.10% - VIOLENT CRIME RATE (PER 100,000 POP.) 361.0 - POP. AGE 25+ WITH NO HIGH SCHOOL DIPLOMA 8.70% - UNINSURED ADULTS 17.25% - UNINSURED CHILDREN 7.56% - FOOD INSECURITY RATE 20.90% - POP. WITH LOW FOOD ACCESS 43.54%DURING 2021, THE HOSPITAL'S PATIENT PERCENTAGE POPULATION WAS MADE UP OF THE BELOW PAYORS WITH THE REMAINING PERCENTAGE OF THE PATIENTS BEING COVERED UNDER COMMERCIAL INSURANCE. IN 2021, ABOUT 69.3% OF THE HOSPITAL'S IN-PATIENTS WERE ADMITTED THROUGH THE HOSPITAL'S EMERGENCY DEPARTMENT. - MEDICARE PATIENTS 41.10% - MEDICAID PATIENTS 15.20% - SELF-PAY PATIENTS 9.50%

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"THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO THE FILING ORGANIZATION'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF ""EXTENDING THE HEALING MINISTRY OF CHRIST AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT AND COMMUNITY BUILDING INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES AND REPORTS THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, THE HOSPITAL PROVIDED $343,434 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $2,656,201 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY."

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THE FILING ORGANIZATION IS A PART OF A FAITH-BASED HEALTHCARE SYSTEM OF ORGANIZATIONS WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). THE SYSTEM IS KNOWN AS ADVENTHEALTH. AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 48 HOSPITALS THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 10 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AS THE PARENT ORGANIZATION OF ADVENTHEALTH, AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO ITS SUBSIDIARY ORGANIZATIONS. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS IT, CORPORATE COMPLIANCE, LEGAL, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. CERTAIN SUPPORT SERVICES, SUCH AS HUMAN RESOURCES, PAYROLL, A/P, AND SUPPLY CHAIN MANAGEMENT ARE PROVIDED PURSUANT TO A SHARED SERVICES MODEL BY AHSSHC TO ITS SUBSIDIARY ORGANIZATIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING EACH ADVENTHEALTH SUBSIDIARY HOSPITAL ORGANIZATION WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS INCLUSION IN A LARGER SYSTEM OF HEALTHCARE ORGANIZATIONS. AS A PART OF A SYSTEM OF HOSPITAL AND OTHER HEALTH CARE ORGANIZATIONS, THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO SYSTEM EFFICIENCIES, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. EACH ADVENTHEALTH SUBSIDIARY PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY AN ADVENTHEALTH SUBSIDIARY ORGANIZATION MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. AS THE REPORTING OF THE FORM 990 IS DONE ON AN ENTITY BY ENTITY BASIS, THERE IS NO SINGLE FORM 990 THAT CAPTURES THE PROGRAMS AND OPERATIONS OF ADVENTHEALTH AS A WHOLE. THE READER IS DIRECTED TO VISIT THE WEB-SITE OF ADVENTHEALTH AT WWW.ADVENTHEALTH.COM TO LEARN MORE ABOUT THE MISSION AND OPERATIONS OF ADVENTHEALTH.