4A (Expenses $ 2891468520 including grants of $ 9592561) (Revenue $ 2960765197)
PATIENT CARE: TEXAS CHILDREN'S HOSPITAL IS AN INTERNATIONALLY RECOGNIZED FULL-SERVICE PEDIATRIC HOSPITAL OPERATING THREE CAMPUSES IN THE HOUSTON AREA, THE LARGEST OF WHICH IS LOCATED IN THE TEXAS MEDICAL CENTER. ONE OF THE LARGEST PEDIATRIC HOSPITALS IN THE UNITED STATES, THE HOSPITAL IS CONSISTENTLY RANKED AS THE BEST CHILDREN'S HOSPITAL IN TEXAS, AND AMONG THE TOP IN THE NATION. TEXAS CHILDREN'S HAS GARNERED WIDESPREAD RECOGNITION FOR ITS EXPERTISE AND BREAKTHROUGHS IN PEDIATRIC AND WOMEN'S HEALTH. THE HOSPITAL INCLUDES TEXAS CHILDREN'S HOSPITAL; THE JAN AND DAN DUNCAN NEUROLOGICAL RESEARCH INSTITUTE; THE FEIGIN CENTER FOR PEDIATRIC RESEARCH; TEXAS CHILDREN'S PAVILION FOR WOMEN, A COMPREHENSIVE OBSTETRICS/GYNECOLOGY HOSPITAL FOCUSING ON HIGH-RISK BIRTHS; TEXAS CHILDREN'S HOSPITAL WEST CAMPUS, A COMMUNITY HOSPITAL IN SUBURBAN WEST HOUSTON; AND TEXAS CHILDREN'S HOSPITAL THE WOODLANDS, THE FIRST HOSPITAL DEVOTED TO CHILDREN'S CARE FOR COMMUNITIES NORTH OF HOUSTON, A SECOND COMMUNITY HOSPITAL THAT OPENED APRIL 2017. TEXAS CHILDREN'S HOSPITAL WILL BE OPENING A BRAND NEW SEPARATELY LICENSED CHILDREN'S HOSPITAL IN AUSTIN, TX PLANNED FOR FEBRUARY 2024. TEXAS CHILDREN'S PAVILION FOR WOMEN OFFERS A FULL SPECTRUM OF GYNECOLOGICAL AND MATERNAL AND FETAL MEDICINE SERVICES, INCLUDING AN ARRAY OF FETAL DIAGNOSTIC PROCEDURES AND HIGHLY SPECIALIZED FETAL SURGERIES, THREE PRIVATE OB/GYN PRACTICES, THE FAMILY FERTILITY CENTER, THE MENOPAUSE CENTER AND THE WOMEN'S PLACE - CENTER FOR REPRODUCTIVE PSYCHIATRY. DURING THE YEAR THE HOSPITAL OVERALL OPERATED 863 INPATIENT BEDS AND MORE THAN 130 AMBULATORY SPECIALTY CLINICS, SUPPORTED BY AN AWARD-WINNING MEDICAL STAFF CONSISTING OF MORE THAN 870 BOARD-CERTIFIED PEDIATRIC PHYSICIANS, OBSTETRICIANS AND GYNECOLOGISTS, ADULT SUBSPECIALISTS AND DENTISTS AND A DEDICATED AND HIGLY SKILLED NURSING AND SUPPORT STAFF OF MORE THAN 11,300. IN 2022, THE PAVLION PERFORMED APPROXIMATELY 6,745 DELIVERIES AND THE HOSPITAL SYSTEM EXCEEDED 1,785,700 OUTPATIENT CLINIC VISITS. THE ORGANIZATION ALSO CREATED TEXAS CHILDREN'S HEALTH PLAN, THE NATION'S FIRST HMO FOR CHILDREN; TEXAS CHILDREN'S PEDIATRICS, THE LARGEST PEDIATRIC PRIMARY CARE NETWORK IN THE COUNTRY; TEXAS CHILDREN'S URGENT CARE CLINICS THAT SPECIALIZE IN AFTER-HOURS CARE TAILORED SPECIFICALLY FOR CHILDREN; AND A GLOBAL HEALTH PROGRAM THAT'S PROVIDING CARE TO CHILDREN AND WOMEN ALL OVER THE WORLD. TEXAS CHILDREN'S HOSPITAL IS AFFILIATED WITH BAYLOR COLLEGE OF MEDICINE.

4B (Expenses $ 119294534 including grants of $ 395764) (Revenue $ 33722464)
RESEARCH: TEXAS CHILDREN'S/BAYLOR RESEARCHERS AT THE FEIGIN CENTER, THE JAN AND DAN DUNCAN NEUROLOGICAL RESEARCH INSTITUTE AND THE CHILDREN'S NUTRITION RESEARCH CENTER ARE CONDUCTING SOME OF THE MOST INNOVATIVE ONGOING RESEARCH IN A VARIETY OF AREAS FROM PEDIATRIC CARDIOLOGY TO INFECTIOUS DISEASES, NUTRITION, VACCINES AND PEDIATRIC NEUROLOGY AND NEUROGENETICS. DURING 2022, TEXAS CHILDREN'S INVESTED IN MORE THAN $119 MILLION IN OVER 1,957 CLINICAL, BASIC AND TRANSLATIONAL RESEARCH PROJECTS, EXPLORING A WIDE RANGE OF CHILDREN'S AND WOMEN'S HEALTH ISSUES. IN ADDITION, THE HOSPITAL CONTINUED ITS STRATEGIC FOCUS ON THE GROWTH AND SUCCESS OF ALL TEXAS CHILDREN'S RESEARCH ENDEAVORS THROUGH ENHANCED INFRASTRUCTURE, SUCH AS THE EXPANSION OF THE JAN AND DAN DUNCAN NEUROLOGICAL RESEARCH INSTITUTE WHERE INVESTIGATORS CAN ACCESS CUTTING EDGE IMAGING MODALITIES, SUCH AS TWO-PHOTON MICROSCOPY, AND STATE-OF-THE-ART NEUROPHYSIOLOGY AND BEHAVIORAL SCIENCE CORE RESOURCES.

4C (Expenses $ 65822521 including grants of $ 218369) (Revenue $ 13722268)
EDUCATION: THE HOSPITAL SERVES AS THE PRIMARY PEDIATRIC TEACHING FACILITY FOR BAYLOR COLLEGE OF MEDICINE (THEIR LONG-TERM ACADEMIC PARTNER). IN ADDITION, THE TEXAS CHILDREN'S PAVILION FOR WOMEN IS ONE OF THE PREMIER PRIVATE TRAINING HOSPITALS FOR BAYLOR COLLEGE OF MEDICINE'S DEPARTMENT OF OBSTECTRICS AND GYNECOLOGY. THE CLOSE AFFILIATION BETWEEN THE INSTITUTIONS EXTENDS THROUGH TEXAS CHILDREN'S OPERATIONS, BAYLOR FACULTY INCLUDING SERVICE CHIEFS, MEDICAL DIRECTORS AND STAFF PHYSICIANS ACROSS THE HOSPITAL'S 51 SUB-SPECIALTY CARE OFFERINGS. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2022, THE HOSPITAL INVESTED MORE THAN $55 MILLION IN THE TRAINING OF OVER 1,300 TRAINEES IN 100 TRAINING PROGRAMS ROTATING AT TEXAS CHILDREN'S. BAYLOR AND TEXAS CHILDREN'S HAVE A PROVEN TRACK RECORD RECRUITING TRANSFORMATIVE PHYSICIAN-SCIENTISTS AND ONE OF THE STRONGEST PEDIATRIC RESIDENCY PROGRAMS IN THE COUNTRY. BAYLOR'S PEDIATRIC RESIDENCY PROGRAM IS THE LARGEST TRAINING GROUND FOR PEDIATRICS AND ONE OF THE MOST COMPETITIVE IN THE COUNTRY. MORE THAN 1,700 STUDENTS APPLY EACH YEAR FROM THE TOP MEDICAL SCHOOLS AROUND THE COUNTRY.

Schedule H, Part V, Section B, Line 3E
Prioritized Community Health Needs Texas Children's identified four key health needs through an extensive process including but not limited to key informant interviews, focus groups and community meeting surveillance. A team of graduate students from the UTHealth School of Public Health then utilized extant data sources and academic literature to investigate each of these health needs. The findings were brought before the hospital's Community Benefits Workgroup (CBW) on July 15, 2022, for guidance on prioritizing them from the hospital's Network of Care perspective. The CBW consists of physicians and administrative leaders across the Texas Children's Network of Care, who provide critical guidance to the Community Benefits Department regarding community health issues. Their guidance is shaped by the institution's mission to create a healthier future for children and women throughout our global community by leading in patient care, education and research. It is also shaped by the four core values of Texas Children's: to embrace freedom, lead tirelessly, live compassionately and amplify unity.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - Texas Children's Hospital. To assess the health needs of the community that Texas Children's serves, a Community Health Needs Assessment (CHNA) team was established, which included members from the Texas Children's Community Benefits department, a consultant from The University of Texas School of Public Health and UT Public Health students from Fundamentals and Applications of Geographic Information Systems (GIS) and Community Assessment Methods classes from the Fall 2021 through Fall 2022 semesters. The CHNA team embarked on a year and a half-long effort to solicit and consider input from persons who represent the broad interests of Greater Houston, including those with special knowledge of or expertise in public health. This involved a host of qualitative data-gathering efforts, which included key informant interviews, focus groups and community meeting surveillance. Key Informant Interviews The CHNA team engaged with more than 20 organizations in Greater Houston that represent the broad interests of the community Texas Children's serves. These organizations represented a variety of sectors that interface with vulnerable populations. After establishing rapport with representatives from each organization and describing the CHNA project, the team invited each partner to participate in a recorded virtual interview. Trained interviewers from the team used the Key Informant Interview Guide (Appendix A), developed from previous CHNAs, updated with time relevant questions, to ensure consistency and validity and utilized probing questions to further detail as needed when conducting the interviews. These key informant interviews were conducted for approximately 30-60 minutes. Questions included background of the interviewees' organizations, community health status and concerns, healthy living, access to health care and social services, COVID-19's impact on access to health care and social services and community health issues, ways to improve community health and advice for Texas Children's team members as they develop their community health implementation strategy for 2023-2025 to address top health concerns. Qualitative data was coded using descriptive and in vivo codes to generate prominent themes that arose in the data (see Analysis). Each interview recording was run through Cisco WebEx's text to speech software, which produced a written transcript for each interview as well as word clouds of the most used words/phrases for key questions. Focus Groups The CHNA team also conducted focus groups with community members who represent the broad interests of the Texas Children's service area. These focus groups were aimed at collecting qualitative data. The team planned, scheduled, coordinated and facilitated these focus groups according to the project timeline, utilizing virtual meeting platforms to ensure participants' safety while including as many community voices as possible. Community Meeting Surveillance The CHNA team reviewed and documented the findings of several community-based meetings to understand community health needs and issues within the Texas Children's service area. The Community Meeting Surveillance Guide (Appendix C) was utilized as a guide to collect information at meetings such as relevant issues and topics specifically referring to underserved women and children. These meetings included several community meetings for the Mayor's Complete Communities Initiative. Ongoing Participation in Local Community Health Initiatives Texas Children's Department of Community Benefits participates in several community health initiatives, workgroups, and councils throughout Greater Houston providing ongoing insight into the health needs of the communities we serve.

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - Texas Children's Hospital. To assess the health needs of the community that Texas Children's serves, a Community Health Needs Assessment (CHNA) team was established, which included members from the Texas Children's Community Benefits department, a consultant from The University of Texas School of Public Health and UT Public Health students from Fundamentals and Applications of GIS and Community Assessment Methods classes from the Fall 2021 through Fall 2022 semesters. No other hospital facilities were involved in these efforts.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - Texas Children's Hospital. The CHNA was conducted with The University of Texas School of Public Health.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - Texas Children's Hospital. HOW TEXAS CHILDREN'S IS ADDRESSING NEEDS IDENTIFIED IN ITS 2022 CHNA Texas Children's 2022 Community Health Needs Assessment identified four key community health issues needing specific Hospital expertise and resources, prioritized in the following order: 1. Mental and Behavioral Health 2. Social Determinants of Health a. Economic stability b. Food insecurity c. Access to care d. Health literacy 3. Maternal Health 4. Chronic Disease and Unhealthy Lifestyle Texas Children's is addressing these needs by employing the strategies outlined in the Texas Children's 2023-2025 Community Health Implementation Strategy. This strategy, developed by the CBW and reviewed and endorsed by the Board of Trustees, presents current actions Texas Children's is taking to address these needs in addition to proposed actions and strategies. Mental and Behavioral Health Current and planned actions to address this issue: Action 1 - Support the community with resources, evidence-based tools, and trainings in prevention and early intervention in mental and behavioral health. * Through clinical services, training and education, research and community programs, the Division of Public Health Pediatrics is leading a larger effort to reframe how children and families receive care and services that mitigate adversities and that foster resilience within our community. Texas Children's Hospital offers trainings related to behavioral health in the community through partnerships with Public Health Pediatrics and the Behavioral Health department. * The Gatekeeper Training program was specially designed to teach Texas Children's and Baylor College of Medicine employees how to identify warning signs of suicide and to provide tools for navigating these difficult situations. More than 13,000 team members have completed this training and report feeling more comfortable about engaging in challenging conversations related to suicide. All new onboarding employees receive this as required training as well. * Texas Children's Health Plan is establishing partnerships with Aldine ISD and additional Houston area school systems to provide education on mental health for adolescents. Action 2 - Explore the logistics of continuing and expanding services provided in current Texas Children's mental and behavioral health programs. * Texas Children's Hospital and The Menninger Clinic have partnered to address the mental health epidemic adolescents are facing in the wake of the COVID-19 pandemic and crisis warnings sounded by the U.S. Surgeon General. This new affiliation will expand access to inpatient care for Houston patients ages 12 to 17 experiencing a behavioral health crisis. * Texas Children's is expanding behavioral health services in the Greater Houston area. Recent philanthropic support has allowed Texas Children's to hire behavioral health specialists in Texas Children's Pediatrics (TCP) practices in Fort Bend County. The ultimate goal is to add more behavioral health specialists in TCP practices throughout the Greater Houston area. * Texas Children's Behavioral Support team supports partnerships with the community and care management to establish community connections for discharge planning, including school partnerships, community providers for therapeutic and psychiatric needs and long-term care facilities when indicated. Action 3 - Support initiatives, programs and screenings to increase identification of mental and behavioral health issues. Expanded suicide risk screening has proven to optimize identification of adults and children at risk of suicide (Bryan et al., 2023). * Texas Children's screens patients for suicide ideation in inpatient areas, Emergency Centers and Behavioral Health care clinics and locations. * Texas Children's Government Relations continues to identify opportunities for Texas Children's physician experts and leaders to advocate at the state legislature by participating in various committee hearings with a focus on pediatric mental health in Texas. * At the federal level, Texas Children's is actively engaged in advocacy on the following legislative proposals: S. 4472, Health Care Capacity for Pediatric Mental Health Act H.R. 4943, Children's Mental Health Infrastructure Act H.R. 4944, Helping Kids Cope Act H.R. 7236, Strengthening Kids Mental Health Now Act Social Determinants of Health Current and planned actions to address this issue: Action 1 - Support programs and partnerships that improve quality of life and health outcomes across communities living in poverty. Research shows socioeconomic factors alone may account for 47% of health outcomes, while health behaviors, clinical care and the physical environment account for 34%, 16% and 3% of health outcomes, respectively (Whitman et al., 2022). * In response to community needs and community feedback, in 2022 the Division of Public Health Pediatrics launched upSTART, a suite of community-based programs offered to families with young children that addresses early brain development, social determinants of health, mental health and maternal health. Licensed nurses, social workers, community health workers, speech-language pathologists and parent educators work together to provide education and training and connect families to community resources. * Texas Children's plans to establish a strategic partnership with a non-profit or community agency which addresses food insecurity in the Greater Houston Area. Action 2 - Support efforts to screen families for social determinants of health and connect families to resources. * Findhelp.org is a free-for-use search engine to connect social services providers with the people they serve. Using zip code information, it connects users with a list of social service categories including food, housing, care, and transit. This tool facilitates referrals, establishes connections and supports quick follow-up and close referral loops. * The Center for Child Health Policy and Advocacy received grant funding through Episcopal Health Foundation which allowed implementation of a bundle of interventions to improve neurocognitive and developmental outcomes in young children at risk for health inequities. This bundle will use an intergenerational care model, focused on the needs of young children and their parents, to maximize benefits to the child. Two major upstream factors significantly associated with poor neurocognitive and developmental outcomes in children will be addressed - maternal mental health and household food insecurity. The program includes integrated screening for food insecurity, social needs, and mental health needs with direct connections to behavioral health clinicians and/or Houston Food Bank Navigators (respectively). Action 3- Participate in community-based collaborative efforts to support access to basic needs and social determinants of health. * Drs. Claire Bocchini and Michelle Lopez are members of the Board of Directors of CHILDREN AT RISK, a non-partisan research and advocacy nonprofit dedicated to understanding and addressing the root causes of child poverty and inequality. Established in 1989 by Houston child advocates and researchers, it has grown into a statewide organization tackling Texas children's and families' most pressing needs. Texas Children's Hospital has been a continuing sponsor for CHILDREN AT RISK, contributing to ongoing initiatives such as this. * Dr. Nancy Correa sits on the Steering Committee of the Health Equity Collective, a multi-sector effort focused on creating a more equitable health ecosystem in Greater Houston. The Collective has over 400 members representing over 140 organizations and more than 50 coalitions aligned with a shared mission to establish an impactful, sustainable, data-driven system to promote health equity and address the social drivers of health outcomes. Through this data sharing ecosystem, we aim to implement a comprehensive population-level approach to understand and effectively and efficiently address SDOH across the Greater Houston area. Action 4- Leverage partnerships and services to support community-based organizations focused on improving health insurance coverage and education in vulnerable communities. * Texas Children's Health Plan (TCHP) identifies geographic-specific partnerships with over 30 organizations, including nonprofit groups, community organizations, social services, school districts and police departments. Through these partnerships, community outreach events are facilitated to assist families with applications for the Children's Health Insurance Programs (CHIP) and Medicaid Programs. (See continuation of Part V, Line 11)

Schedule H, Part V, Section B, Line 11 Facility , 2
"Facility , 2 - Texas Children's Hospital. Maternal Health Current actions and plans to address this issue: Action 1 - Support and expand partnerships and programs which offer support services for pregnant women and new mothers. * Texas Children's Center for Childhood Injury Prevention - The Safe at Home Program focuses on infant safe sleep, home safety and water safety education and teaches parents how to childproof their homes and identify potential drowning hazards that may cause injury to their children. * upWORDS2 is offered to parents who have participated in the upWORDS program and are seeking additional sessions on early brain development and positive parenting. * upLIFT: Many mothers experience symptoms of depression and anxiety during pregnancy and in the year after giving birth. Through upLIFT, a licensed social worker meets with the mother in her home. * Family Connects supports families of newborns and is delivered in their homes by a registered nurse. The nurses support parents in caring for their newborns, conduct health assessments of the baby and the mother from the comfort of the home, answer questions about caring for the newborn(s), identify parent needs and help connect families with community services and resources virtually. Up to eight sessions are provided to support the new mother in learning new tools and strategies to help ease symptoms of depression and anxiety. * TCHP has established a workgroup to increase information about the importance of mental health and resources. Action 2- Support initiatives which focus on reducing racial inequalities in accessing maternal health resources. * Continued support for The Harris County Child Fatality Review Team (CFRT): The CFRT is led by Public Health Pediatrics. It brings together local partners to review child mortality from a public health perspective in order to identify trends and strategies to decrease preventable child deaths. * Maintaining an active Patient & Family Advisory Council. Texas Children's believes patients and families are important partners in care and our allies for quality, safety and an optimal patient experience. We are committed to providing patient- and family-centered care that is tailored to meet the unique needs of our population. The Department of Patient and Family Engagement aims to enhance communication and strengthen collaboration with patients and families at both the micro (bedside) and macro (organizational) levels. Our Specialists work to engage patients and families to serve as Advisors on a wide variety of hospital projects, committees, and strategic initiatives, helping ensure the consumer voice is a guiding force in all that we do. * Texas Children's Government Relations Department. In its mission to ensure that Texas children have access to effective, high quality, comprehensive and appropriately funded health care, Texas Children's Government Relations Department actively advocates for increased access to public programs designed to serve children and their families. Hospital leadership regularly shares its voice at the local, state and national levels to increase awareness of issues that shape public policy related to children's health. * TCHP held a cultural competency focus group in December 2022 and heard from members about an increasing focus on mental health (across Black and Hispanic groups) but a lack of awareness of benefits. Action 3- Advocate for the support, access, and expansion of Medicaid coverage for mothers' post-partum. * Texas Children's Government Relations continues to identify opportunities for Texas Children's physician experts and leaders to advocate at the state legislature by participating in various legislative committee hearings with a focus on maternal health in Texas. Chronic Disease and Unhealthy Lifestyle Current and planned actions to address this issue: Action 1 - Support and connect families with low-cost/no-cost community resources to support healthy eating and physical activity in neighborhoods. According to the 2018 Physical Activity Guidelines Advisory Committee Scientific Report, strong evidence demonstrates that, in children and adolescents, higher amounts of physical activity are associated with more favorable status for multiple health indicators (Physical Activity Guidelines, 2018). Additionally, it was concluded in the Youth Risk Behavior Survey that more opportunities are needed for children to learn about a healthy diet and physical activity. It was also suggested that communities work together to create positive environmental changes (Youth Risk Behavior Survey, 2019). * Current collaborations include the Texas Children's Health Plan, Texas Children's Pediatrics, Houston Food Bank, Kids Meals and various food pantries across Houston. * Texas Children's works with Episcopal Health Foundation, City of Houston Parks Department and the Memorial Hermann Community Benefit Corporation to improve park space in the Alief area of Houston, an economically disadvantaged community that is part of the Mayor's Complete Communities initiative. Community Benefit resources and foundations are utilized to support and enhance programming and equipment at a park in Alief and track utilization and health outcomes over time. Action 2 - Support opportunities aimed to better inform, educate, and engage the public regarding chronic disease prevention and management. According to the CDC, approximately two in five children ages 6-17 have a chronic health condition such as asthma, diabetes or epilepsy. The CDC recommends a coordinated effort between children, their families, community groups, social service agencies, schools and medical providers to manage chronic diseases in this population (CDC, 2023). * The Children's Nutrition Research Center (CNRC) is a unique cooperative venture between Texas Children's, Baylor College of Medicine and the U.S. Department of Agriculture/Agricultural Research Service. The CNRC has over 40 faculty members conducting nutrition-related research. Research goals center on establishing evidence-based guidelines promoting health, growth and development through optimal nutrition. These guidelines are for use by physicians, parents and others responsible for the care and feeding of children. * Texas Children's operates mobile clinics to provide trusted, high-quality medical services to children who may not have the access or opportunity to receive health care. This fleet of mobile clinics travels to low-income, largely Hispanic neighborhoods to provide comprehensive health care to underserved children. They provide free care to children from newborn to 18 years of age and are open to the public; children do not have to attend the school where the clinic is parked to receive care. * TCHP has a partnership with Harris County Public Health Department to remediate known environmental asthma triggers for high-risk asthma members. Action 3- Provide culturally appropriate support for healthy lifestyles in underserved communities. According to studies, ""there has been a growing awareness that providing culturally sensitive pediatric primary care, especially during well-child visits, is a potentially modifiable way to address health care disparities and promote health equity (Okoniewski, MD 2022). * Texas Children's plans to establish a strategic partnership with a nonprofit or community agency which addresses the community regarding chronic disease prevention and management in the Greater Houston Area."

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - Texas Children's Hospital. A notice of the financial assistance policy is posted in the Hospital's emergency rooms, waiting rooms and admissions offices.

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - Texas Children's Hospital. Line 20A is not checked because the Hospital does not perform any Extraordinary Collection Actions.

Schedule H, Part VI, Line 7 State filing of community benefit report
Additional information: The Hospital files the Annual Statement of Community Benefits Standard (ASCBS), the State of Texas' community benefit reporting for not-for-profit hospitals. For the fiscal year ended September 30, 2022, the Hospital reported $545,567,905 as the total annual charity and community benefit in its ASCBS. Differences between Schedule H and the ASCBS are stated below. The resulting difference of $211,626 (in $1000's) between the ASCBS and the amounts recorded in Part I line 7 are due primarily to varying reporting requirements as outlined below (in $1000's): ASCBS does not include LPPF taxes. Additionally, the ASCBS RCC is calculated using 2021 financial information. $234,058. ASCBS includes financial assistance provided to community by related organizations $(4,403) ASCBS includes the unreimbursed cost of community building activities $(1,042) ASCBS includes the unreimbursed cost of Medicare and Champus $(16,987) Total variance between Part I line 7 and ASCBS $211,626.

Schedule H, Part V, Section B, Line 16 Hospital Facilities - FAP WEBSITE
The website for Schedule H, Part V, Lines 16a-c is: https://www.texaschildrens.org/patients-and-visitors/insurance-and-billing-assistance/financial-arrangements

Schedule H, Part V, Section A HOSPITAL FACILITIES
The Hospital is licensed by the Texas Department of State Health Services under license number 000117. The Hospital is comprised of multiple buildings on three campuses. All are included under one license number; therefore, the Hospital is one hospital facility.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
0

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
For Part 1, Line 7, Texas Children's Hospital (Hospital) applied the ratio of patient care costs (RCC) to charges derived from Worksheet 2 to the charges the Hospital forgave pursuant to the financial assistance policy (FAP) (line 7a), Medicaid charges (line 7b), other means-tested charges (line 7c) and research patient care charges (line 7h). Worksheets 1, 2, 3, 4, 5, 6, 7 & 8 and the corresponding instructions have been used as the primary basis for completing Part 1, Line 7. For each subsidized health service, the Hospital used the RCC for Medicaid cost report line 90.00 Outpatient Clinics where the subsidized health service cost centers reside and applied it to the respective gross patient charges to calculate community benefit expense. The exception to the above is Renal Outpatient Services. Costs incurred for Renal Outpatient Services reside in multiple cost centers and multiple Medicaid cost report lines. The RCC for the related Medicaid cost report line where the actual gross patient charges were recorded was used to calculate community benefit expense for Renal Outpatient Services. For each subsidized stand-alone clinic, the Hospital calculated a specific ratio of patient care costs to charges using the same method prescribed in worksheet 2 and applied it to the respective clinics' gross patient charges to calculate community benefit expenses. For Part 1, Line 7, the Hospital applied indirect cost ratios from the 2022 Medicaid cost report to direct program expense to determine total community benefit expense related to community health improvement services and community benefit operations (line 7e), health professional education programs other than Graduate Medical Education (GME) (line 7f) and in-kind contributions (line 7i). The indirect cost ratios computed from the 2022 Medicaid cost report are both comprehensive and a good proxy of the associated overhead costs. For Part 1, Line 7f, the Hospital included the direct and indirect expense from the 2022 Medicaid cost report for state accredited and nationally accredited GME programs. For Part 1, Line 7h, the Hospital included the direct and indirect expense from the 2022 Medicaid cost report for research. No industry-sponsored research activities are included in line 7h.

Schedule H, Part II Community Building Activities
The Hospital's community building activities promote the health of the communities served and support organizations focused on the root causes of health problems (e.g., poverty and homelessness) and vulnerable populations (e.g., children with special healthcare needs). Vulnerable Population Economic Improvement (Line 2) Net Community Building Expense Cristo Rey Work Study Program $ 72,900 TOTAL $ 72,900 Community Support Activities (Line 3) Net Community Building Expense Ronald McDonald House Houston $ 75,000 Project Joy & Hope $ 20,000 Sam Houston Area Council - Boy Scouts of America $ 20,000 Candlelighters Childhood Cancer Family Alliance $ 15,000 Lifeline Chaplaincy $ 15,000 The Sanctuary Foster Care Services $ 10,298 Covenant House $ 10,000 Houston Angels $ 5,245 Down Syndrome Association $ 5,150 Bo's Place $ 5,100 SEARCH - Houston without Homeless $ 5,000 YES to YOUTH - Montgomery County Youth Services $ 5,000 Avondale House $ 2,510 AJF - Ashley Jadine Foundation $ 1,070 BakerRipley $ 780 Houston Jewish Family Foundation $ 250 TOTAL $ 195,403 Leadership Development and Training for Community Member Activities (Line 5) Net Community Building Expense Junior League of Houston $ 120,000 American Leadership Forum $ 20,000 Jack and Jill of America $ 10,000 TOTAL $ 150,000 Coalition Building Activities (Line 6) Net Community Building Expense The Woodforest Charitable Foundation $ 750 TOTAL $ 750 Community Health Improvement Advocacy Activities (Line 7) Net Community Building Expense Texas Liver Foundation $ 15,000 Hand to Hold $ 10,000 Children At Risk $ 10,000 Change Happens! $ 5,000 Texas Medical Association $ 3,500 Interfaith of The Woodlands $ 2,500 Colon Cancer Coalition $ 797 TOTAL $ 46,797 Other (Line 9) Net Community Benefit Expenses SIRE - Therapeutic Horsemanship $ 25,000 Houston Children's Charity $ 25,000 Center for Pursuit $ 17,500 Texas Hearing Institute $ 15,000 The Brookwood Community $ 10,000 TOTAL $ 92,500

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
In accordance with HFMA Statement 15 and ASU 2014-09, Topic 606, Bad debt expense represents the difference between the standard rates (or explicit contracted rates) and the amounts expected to be collected from a third-party payor after all reasonable collection efforts have been exhausted. Also in accordance with HFMA Statement 15 and ASU 2014-09, Topic 606, Bad debt expense is calculated as the charges written off (at full established rate), less any indirect funds received to offset charges written off.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
Bad debt attributable to patients eligible under financial assistance policy: The Hospital does not contend that any of its bad debt expense is attributable to the organization's financial assistance policy (FAP) or should be considered a community benefit. Robust screening processes are used in determining FAP-eligibility and financial assistance amounts are not expected to result in cash flows. All uncollected charges attributable to patients eligible under the organization's FAP are included in line 7a (at cost).

Schedule H, Part VI, Line 5 Promotion of Community Health
"Continued from prior response on schedule H, Part VI, Line 5 b. In 2019, our $350 million expansion, the Lester and Sue Smith Legacy Tower, completed its first full year operation. The Hospital's new home for surgery, critical care and Texas Children's Heart Center was designed to help meet the increasing demand for the highly-specialized, critical and medically-complex pediatric care that few centers in the country can provide. It enhances patient care by giving caregivers and families in critical and progressive care areas much-needed additional space. The tower houses a 130-bed intensive care unit, new operating rooms with the latest technology and a cardiovascular intensive care unit. Additionally, in December 2020, Texas Children's opened a first-of-its-kind dedicated facility designed by and for adults with congenital heart disease. The 27,000-square-foot space, situated on the 24th floor of Lester and Sue Smith Legacy Tower, is entirely managed by the dedicated Adult Congenital Heart team. Our multidisciplinary team of specialists are trained in both pediatric and adult congenital heart disease. We work closely with patients on the wide spectrum of challenges that congenital heart disease patients face throughout their lives. This innovative approach to care is unprecedented, and another step forward for the no. 1 ranked hospital for cardiology and heart surgery by U.S. News & World Report. The facility includes 16 universal care beds equipped for all levels of treatment, integrated inpatient/outpatient space, a cardiac rehabilitation gym, and a diagnostics lab. Demand for the level of care Texas Children's provides continues to grow - here in our local community and far beyond Houston. Further expanding the Heart Center allows Texas Children's to advance quality, service and safety, improve the patient and family experience, and expand access to expert cardiac care. c. Texas Children's Hospital West Campus serves one of the fastest growing pediatric populations in the country. As the population grows, so has this community hospital. To meet the needs of these diverse neighborhoods, the Hospital continues to look at its patients and engage community-based organizations and leaders to determine what programs, services and initiatives may make the most impact in west Houston. In 2022, Texas Children's Hospital provided pediatric care with over 435,000 visits at the West Campus. The campus provides subspecialty outpatient care including physician visits, therapy services, and a full complement of diagnostic services. The Hospital has 86 inpatient beds, which includes a 22 bed pediatric intensive care unit and remains the only 24/7 dedicated pediatric emergency center in the west Houston area. The hospital continues to operate a state of the art Special Isolation Unit to care for those patients with highly contagious diseases such as Ebola. In addition, a 28,500 square foot, state-of-the-art sports medicine clinic continues to serve the Greater Houston area with physicians specialized in Orthopedics and Sports Medicine, and with dedicated physical therapists focusing on the unique needs of a pediatric athlete. In an effort to focus on our most vulnerable patients, West Campus continues to utilize its Complex Care Clinic to support patients with complex medical needs including care coordination needs, medical fragility, technology dependence, and increased health care utilization. To meet the need for providing increased access to diagnostic services, West Campus operates an Interventional Radiology Suite providing a wide range of image-guided minimally invasive procedures such as Needle Biopsies, and the placement of central lines, feeding and drainage tubes for abscess or other abnormal collections of pus/fluid in the body. The patients most commonly served by this department include those with Hypersalivation, Varicocele, deep Vein thrombosis, Cystic Fibrosis, foreign body removal and Venous system related diseases. West Campus continues to offer the largest pediatric sleep center, with 15 beds dedicated to pediatric sleep medicine with an accompanying sleep clinic. In response to the pandemic in 2020, West Campus was the first facility to accept and treat a COVID-19 patient within the Texas Children's system; in addition the facility offers COVID-19 drive through testing to support ongoing clinical operations with approximately 100 patients tested per day in the height of the pandemic. d. Texas Children's Health Plan operates two Centers for Children and Women, family-centered medical homes for TCHP members located within two of Houston's most underserved areas, Greenspoint and Sharpstown. The facilities offer primary pediatric and obstetric care, pediatric optometry and dentistry and onsite imaging, speech therapy, lab and pharmacy. TCHP provides STAR Kids, a Medicaid-managed care plan for children and young adults up to 21 years old with disabilities. The STAR Kids program offers the same benefits as Medicaid plus many extra services, including long-term support, service coordination through the STAR Kids health plan, and help in the home to optimize the environment for the child with disabilities, among other benefits. e. The Jan and Dan Duncan Neurological Research Institute (NRI) at Texas Children's Hospital is the world's first comprehensive pediatric neurological research center devoted to collaborative efforts to understand neurological conditions like autism, cerebral palsy and epilepsy - a class of disorders that together are expected to exceed more than a half-trillion dollars annually in healthcare costs. The NRI includes more than 400,000 square feet of advanced research and office space, including a new laboratory floor, a customized nuclear MRI suite and additional vivarium space. f. At Texas Children's, we believe in providing women, mothers and babies quality health care at every important stage of their lives. We call this model ""family-centered care."" Texas Children's Pavilion for Women brings together obstetricians, gynecologists, oncologists, surgeons, geneticists and nurses from the Hospital and Baylor College of Medicine, to accomplish this purpose. With high-risk births on the rise nationally, our renowned experts and specialists focus on furthering obstetrical research. We also provide advanced treatment, including level IV neonatal intensive care units to give premature and sick babies more extensive support and care. g. The Feigin Tower is the Hospital's central hub for pediatric research. The Hospital is an internationally recognized leader in pediatric research and continues to be a leading recipient of pediatric grant funding through the National Institutes of Health (NIH). With total external and internal funding of more than $189 million annually, researchers conduct more than 1,750 clinical, basic science and translational research projects to identify groundbreaking treatments and cures for childhood diseases."

Schedule H, Part V, Section B, Line 16a FAP website
- TEXAS CHILDREN'S HOSPITAL: Line 16a URL: See Part VI;

Schedule H, Part V, Section B, Line 16b FAP Application website
- TEXAS CHILDREN'S HOSPITAL: Line 16b URL: See Part VI;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- TEXAS CHILDREN'S HOSPITAL: Line 16c URL: See Part VI;

Schedule H, Part I, Line 7g Subsidized Health Services
The Hospital has included four hospital-based outpatient clinical services (The Developmental Pediatrics and Autism Center, Renal Outpatient Services, Special Needs Primary Care Clinic, and Mental Health Services - includes pediatric and maternal services) and four stand-alone clinics (the Mobile Clinic Outreach Program, Pediatric Dentistry, the Primary Care practice at Palm Center, and the Vannie E. Cook Jr. Children's Cancer and Hematology Clinic) as subsidized health services in Part I, Line 7g. Gross expenses of $16,847,514, offsetting revenue of $6,779,174 and net expenses of $10,068,340 are included in that line. The stand-alone clinics include gross expenses of $8,060,543, offsetting revenue of $2,110,823 and net expenses of $5,949,720 in line 7g. These clinics qualify as subsidized health services because they provide care and services to vulnerable, low income populations whose communities lack primary care services and programs. The Texas Children's Autism Center and Meyer Center for Developmental Pediatrics provide diagnostic services for children suspected of having an Autism Spectrum Disorder, Developmental Delay, Intellectual Disabilities, Learning problems, etc. These multidisciplinary centers are comprised of developmental pediatricians, neurologists, psychologists and psychiatrists who work collaboratively to provide a comprehensive diagnostic evaluation. They also have a social work team to help families obtain resources in the community and school not provided at the Hospital. The Autism Center and The Meyer Center for Developmental Pediatrics are housed in the same location and have over 3,000 patient visits annually. Renal Outpatient Services - Services started in 1980 in response to community needs for chronic hemodialysis for children. Approximately 80 chronic patients are seen annually by pediatric nephrologists and undergo dialysis treatment at the hospital or at home in order to improve their health outcomes while maintaining a child's normalcy of school and activities with friends. In addition to chronic end stage renal dialysis patients, approximately 4,350 patients are treated in pheresis and renal clinics. The Special Needs Primary Care Clinic provides a medical home, case management and social services for children with very complex underlying medical conditions. These patients have difficulty finding a general pediatrician to oversee their care and tend to utilize emergency rooms and subspecialists for routine care. The Psychiatry Service serves patients with a wide variety of psychiatric conditions often which are comorbid. Services include diagnostic assessments and treatment of complex anxiety and mood disorders, Tourette's syndrome, Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, medication management for children with Autism Spectrum Disorders, among other conditions. The Service also has a consult liaison service to the inpatient units of the Hospital. The Service has approximately 5,100 patient visits annually. The Psychology Service serves patients with varying degrees of assessment and treatment needs. Services include neuropsychological testing, cognitive assessments, treatment in the areas of pre-school and school age disruptive behavior, anxiety and mood disorders, and complex ADHD. The Psychology Service works closely with other services within Texas Children's Hospital, both inpatient and outpatient, in helping patients adjust to and manage complicated or serious medical diagnoses. The Service has approximately 700 patient visits annually. Mobile Clinic Outreach Program -The Hospital's mobile clinics partner with underserved schools in the city and travel to low-income neighborhoods to provide free health care to children and adolescents from birth to age 18 who do not have insurance. As part of its goal to build a community of healthy children, the Hospital operates mobile clinics to provide trusted, high-quality medical services to children who normally might not have the opportunity to receive health care. In 2021, the COVID-19 pandemic limited the program to providing car-side immunization only services. In 2022, the mobile clinics conveniently and safely provided vaccines at 400 events covering over 140 different locations in Greater Houston. The mobile clinics provided approximately 6,500 free immunizations to all Texas Vaccines for Children-eligible patients. Additionally, we were able to help families apply for public health insurance, such as Medicaid, CHIP and the Harris Health Eligibility Card. We also provide referrals for social services and affordable permanent medical homes. Pediatric Dentistry Services - Community based dentists are generally not equipped to treat dental patients with special needs that often require treatment in the operating room or heavy sedation. The Pediatric Dental Clinic at Texas Children's Hospital (Dental Clinic) was developed to care for these children. The Dental Clinic is primarily focused on patients with cardiac issues, cancer, neurologic disorders and other medical issues. Approximately 71% of the patients seen in the Dental Clinic are insured through Medicaid. In 2022, the Dental Clinic had over 4,900 patient visits which included approximately 500 operating room cases. Additionally, the Pediatric Orthodontic Clinic at Texas Children's Hospital (Orthodontic Clinic) treats children who have congenital anomalies and/or cleft palates in conjunction with the Plastic Surgery department. In 2022, the Orthodontic Clinic had over 3,100 patient visits with approximately 62% insured through Medicaid. The Vannie E. Cook Jr. Children's Cancer and Hematology Clinic (Vannie Cook Clinic) is located in McAllen, Texas and is a joint effort between the Vannie E. Cook Jr. Cancer Foundation, Baylor College of Medicine and Texas Children's Cancer and Hematology Centers. The Vannie Cook Clinic offers treatment to children along the Mexico border in South Texas who suffer from cancer and blood disorders. It is the only comprehensive pediatric cancer treatment facility in South Texas. Many of these patients previously would have traveled to San Antonio or Houston for their treatment, a hardship physically, emotionally and financially for them and their families. It is a comprehensive care facility offering diagnostic and cancer treatment services, cancer genetic counseling and a long-term survivorship program which follows childhood cancer survivors through adulthood. Most of the patients (75%) are from low-income, uninsured or underinsured families. Every year, the clinic staff sees approximately 1,200 patients and of these patients, approximately 600 are newly diagnosed. Texas Children's Hospital Primary Care Practice at Palm Center provides comprehensive routine and preventive health care, including well child check-ups, sick visits, sports physicals, immunizations and management of chronic pediatric medical conditions. Texas Children's Hospital Primary Care Practice at Palm Center serves as the largest Texas Children's Hospital and Baylor College of Medicine practice that provides primary care experience for pediatric medical students and residents. This clinic's location in the Palm Center neighborhood in Houston's Third Ward offers a great opportunity to serve the community while modeling best practices to the next generation of pediatricians. Third Ward is a historically African American community with a rich history and cultural legacy along with a renewed sense of purpose and commitment. The clinic's location offers free parking and is conveniently located at the Palm Center Station on the MetroRail's Purple Line.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
Footnote describing accounts receivables (page 14) of audited financial statements: Patient accounts receivable include reductions for explicit contractual agreements, discounts provided to uninsured and underinsured patients, implicit price concessions, and charity adjustments and are recorded on an accrual basis at net realizable value in the consolidated balance sheets. The estimate of patient accounts receivable is based primarily on Texas Children's historical collection and write-off experience and the aging of patient accounts receivables. Changes in business and economic conditions, trends in federal, state and private employer health care coverage, and other collection indicators are also taken into consideration when estimating price concessions each quarter. Footnote describing Net Patient Service Revenue, and implicit price concessions based on historical collection rates (page 38) of audited financial statements: Net patient service revenues are recorded as goods and services are provided at the transaction price estimated by Texas Children's to reflect the total consideration due from patients and third-party payors. The transaction price, which involves significant estimates, is determined based on Texas Children's standard charges for the goods and services provided with a reduction recorded for price concessions, which include discounts based on third party contractual arrangements and patient discounts, as well as implicit price concessions based on historical collection rates. As performance obligations are met (i.e.: room, board, ancillary services, level of care, etc.), net patient service revenue is recognized based upon an allocated transaction price as goods and services are provided to the patient. In instances where performance obligations are across multiple periods, the transaction price is allocated by applying an estimated implicit and explicit rate to gross charges based on the separate performance obligations or the patient's length of stay. Substantially all performance obligations have a duration of less than one year. Texas Children's has elected to apply the optional exemption provided in Accounting Standards Codification 606-10-50-14(a) and is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially satisfied at the end of the reporting period, which are primarily related to inpatient acute care services.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
The sources used to determine the amount reported as Medicare Allowable Costs on Part III, line 6 was the Hospital's 2022 Medicare cost report and supporting work papers. Substantial shortfalls typically arise from payments that are less than the cost to provide the care or services and do not include any amounts relating to inefficient or poor management. The Hospital accepts Medicare patients seeking pediatric or women's health services, as reflected on the year-end Medicare cost report, with the knowledge that there may be shortfalls. IRS Revenue Ruling 69-545, which established the community benefit standards for nonprofit hospitals, implies that treating Medicare patients is a community benefit and states that if a hospital serves patients with governmental health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
Patients who have qualified for financial assistance, if the discount is less than 100%, will be responsible for payment of any applicable hospital charges at a reduced rate. If the patient does not pay the amount and fails to renegotiate a payment plan (if applicable), the uncollected balance will be considered an implicit price concession. Provisions for estimated retroactive adjustments under such programs are provided in the period the related services are rendered, adjusted in future periods as final settlements are determined, and are included in other current assets. The Hospital may use reasonable efforts to collect outstanding patient receivables which include but are not limited to: telephone calls, email and couriered written correspondence. The Hospital does not engage in extraordinary actions to force collections on patient accounts.

Schedule H, Part VI, Line 2 Needs assessment
In addition to the CHNA, Texas Children's Hospital's Community Benefits department structure and purpose includes engaging with internal and external partners in the development of community partnerships. Community Benefits maintains strong relationships with community-facing internal stakeholders including Injury Prevention, Public Health Pediatrics, and Texas Children's Health Plan. Additionally, Community Benefits actively participates in external Greater Houston area coalitions focused on community health needs such as Health Equity Collective, Understanding Houston, Children at Risk, and Maternal Mortality and Morbidity Review Committees (MMRCs). This team also identifies new programs, funding opportunities and reporting community benefit programs' progress, outcomes and evaluation. To accomplish this, Community Benefits employs the ICARE framework: * Identify community health needs as they arise. * Collect data. * Align the Texas Children's community-related efforts with identified needs. * Recognize components of Texas Children's that provide quality community-related services * Enhance community-related health efforts across the entire system. A Community Benefits Workgroup, comprised of physician and administrative leaders from across Texas Children's, works in collaboration with the Community Benefits department. The CBW is charged with determining how best to address identified community needs. Members/Leaders in the Hospital's supported programs created to address existing community health needs provide critical guidance to the Community Benefits department on how best to measure program success and continued support, or expansion of these efforts to other areas of the community.

Schedule H, Part VI, Line 7 State filing of community benefit report
TX

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
All patients who receive services at the Hospital or their families are notified of their rights and responsibilities and the availability of government or hospital sponsored programs if financial assistance is needed. * Information is provided during inpatient and outpatient registration where materials are always available in both English and Spanish. * Notices of the Hospital's financial assistance program are posted in public waiting and registration areas, including Admissions, Emergency Center, outpatient clinics and other prominent areas. A variety of language services are available upon request. * The Hospital's Financial Assistance Policy, Financial Assistance Application and a plain language summary of the Financial Assistance Policy are posted on Texas Children's Hospital's public website in both English and Spanish. The site directs patient families to contact admissions counselors and financial counselors in the Admissions department for more information about available financial options and resources. * Financial counselors are available to determine eligibility for government and/or hospital-sponsored financial assistance. Financial counselors receive training on eligibility requirements for financial assistance and government programs. * State Out-stationed Eligibility Workers (OEW) are on-site to support the government-sponsored assistance program application process. * Referrals for charity consideration may originate with the scheduling, pre-service, customer service departments, hospital social workers and clinicians, external providers and through self-referral. These referrals are directed to the appropriate department's financial counselors who discuss options, including charity assistance. * Financial counselors also contact patients arriving via the Emergency Center after appropriate medical screenings to discuss eligibility for government programs like Medicaid, CHIP, CSHCN and charity assistance.

Schedule H, Part VI, Line 4 Community information
"Given the services provided to patients from around the world, the Hospital defines its community as local, national and international. In regards to the CHNA, the Hospital focuses on addressing local needs. For community benefit reporting purposes, Texas Children's Hospital defines the community it serves as the Houston-The Woodlands-Sugar Land Metropolitan Statistical Area (MSA), also known as ""Greater Houston."" An MSA - defined by the U.S. Office of Management and Budget (OMB) and used by the Census Bureau and other federal government agencies for statistical purposes - is a geographical region with a high population density and close economic ties throughout the area. While the Texas Children's Hospital Network of Care treats patients from around the globe, most of our patients (90.9% in Fiscal Year 2019) come from Greater Houston. In terms of land area, Greater Houston is approximately 9,440 square miles, making it larger than the states of New Hampshire (9,350 sqm), New Jersey (8,721 sqm), Connecticut (5,543 sqm), Delaware (2,489 sqm) and Rhode Island (1,545 sqm). For more in depth information on each county in the Hospital's community benefits service area, including demographic profiles, please refer to the Hospital's CHNA online: https://www.texaschildrens.org/about-us/community-benefit-efforts/reports-community-health-needs In general, Texas Children's focuses community benefit efforts in neighborhoods with high concentrations of poverty because poverty is linked to many other social determinants of health. Several research institutions have developed indexes to better understand neighborhood-level factors beyond poverty that can affect health outcomes. These indexes include the CDC's Social Vulnerability Index (SVI), Ohio State University's Childhood Opportunity Index (COI), and HRSA/The University of Wisconsin's Area Deprivation Index (ADI). These indexes often score neighborhoods based on a variety of factors related to socioeconomic status to paint a more comprehensive picture of the disadvantages faced by neighborhood residents. Texas Children's uses the Area Deprivation Index to identify the most vulnerable neighborhoods in our service area because it is based on the most current data of all of the indexes. Additionally, it provides data at a higher spatial resolution, the census block group, compared to other indexes that oftentimes use census tracts or zip codes. The ADI was developed by HRSA over twenty years ago for county-level use, but has since been adapted and validated to the census block group level by researchers at the University of Wisconsin-Madison. The ADI ranks each census block group in each state from 1 to 10 based socioeconomic factors, such as income, education, employment, and housing quality. Census block groups that receive a score of 1 are the lowest on the ADI, and are the least disadvantaged neighborhoods, while census block groups that receive a score of 10 are the highest on the ADI and are the most disadvantaged neighborhoods."

Schedule H, Part VI, Line 5 Promotion of community health
As a leader in pediatrics and women's health, the Hospital continues its mission to serve the community through preeminent research, education and patient care. This ongoing commitment ensures the health and well-being of the youngest and most vulnerable members of the community, whether they reside in nearby neighborhoods or on the other side of the world. In addition to the information supplied in other sections of this document, the following are examples of the Hospital's ongoing commitment to the community it serves: 1) Texas Children's Board of Trustees is composed of representatives who reside in the greater Houston community and are not employees of the hospital. Many Trustees are business and civic leaders who are active in other local charitable organizations. 2) The Hospital extends medical staff privileges to all qualified non-hospital-based physicians from the community. Privileges are granted in accordance with medical staff bylaws. 3) Emphasizing its world-class expertise in highly specialized fields, the Hospital operates Centers of Excellence in oncology, cardiology and neonatology. Ranked second among all children's hospitals nationally by U.S. News & World Report, Texas Children's Hospital is the only children's hospital in Texas to receive the prestigious Honor Roll designation. In the 2022 U.S. News survey - which uses data from 2021 - the Hospital ranked in the top ten in eight subspecialties, #1 in the nation in Pulmonology, and #1 in the nation in cardiology/heart surgery for the sixth year in a row. As a national leader among pediatric institutions, the Hospital has multidisciplinary expertise in some of the most complex medical challenges facing children today. 4) As part of its responsiveness to the community, the Hospital operates and supports several advisory committees, comprised of community members and patient families. These groups consult with Hospital representatives on a wide range of topics designed to increase the quality of care and services provided. 5) The Hospital invests its operating margin in capital projects and programmatic initiatives focused on improving patient care, medical education and research. 6) The Hospital served as a training center for nursing students, supporting approximately 1,700 candidates in 2022. Although these trainees are not obligated to remain at the Hospital upon certification, they gain valuable knowledge for their careers in pediatrics. 7) Texas Children's Medical Legal Partnership (MLP) promotes the health of vulnerable, low-income populations by addressing legal needs that affect patient health. In fiscal year 2022, there were a total of over 200 consultations. The MLP brings together lawyers, doctors and social workers when a legal situation is required. A staff attorney and volunteers provide free legal advice to patients and families on a variety of legal matters including improving housing conditions, obtaining guardianships for adult children or unrelated caregivers and securing public school accommodations for children with disabilities. MLP also connects patient families with volunteer attorneys to represent them. 8) The Hospital's 24/7 transport service, the Kangaroo Crew, comprises a fixed-wing aircraft and ground ambulance medical service providing coordinated patient assessment, necessary intervention and safe, rapid transport of critically ill or injured patients. All transport service personnel are specially trained in pediatric/neonatal transport medicine and safety in accordance with Federal Aviation Administration (FAA) and Texas Department of State Health Services guidelines. 9) The transport service team is a member of the Pediatric Disaster Coalition (Coalition), a planning group that consists of subject matter experts from freestanding children's hospitals, facilities with dedicated pediatric/neonatal units, pediatric specialty transport organizations, local and state public health and federal partners. The Coalition shares recommendations and technical guidance with other healthcare facilities throughout the state, as well as federal agencies and other national organizations including Child Health Care Association (CHCA), Children's Hospital Association (CHA), Association of Air Medical Services (AAMS) and American Academy of Pediatrics (AAP) Section on Transport Medicine. 10) At Texas Children's Hospital, we are committed not only to providing the best possible care, but also to expanding that care-reaching out to more children and families and providing more specialized services where they are most needed. The Hospital is committed to creating a healthier future for children and women throughout our global community by leading in patient care, education and research: a. This region has embraced Texas Children's Hospital The Woodlands since we opened the doors in 2017. We have brought world class pediatric care closer to home for the North Region's patient and families. This pediatric hospital campus increases access to pediatric subspecialty care within the following services: adolescent medicine and physical rehabilitation, allergy and immunology, cardiology, cancer and hematology, dermatology, developmental pediatrics, diabetes and endocrinology, gastroenterology, hepatology and nutrition, genetics, infectious disease, neonatology, neurology, neurosurgery, ophthalmology, orthopedics, otolaryngology, palliative care, pediatric and adolescent gynecology, pediatric surgery, plastic surgery, psychiatry, psychology, pulmonology, rheumatology, sports medicine and urology. Hospital facilities include 25 emergency center rooms, 74 outpatient rooms, five radiology rooms, Six operating rooms and 46 acute care beds, 14 pediatric intensive care and 14 neonatal intensive care beds with plans allowing for expansion up to 200 beds. Pediatric Emergency Services are available 24 hours a day, open every day, and are provided regardless of ability to pay. Additional hospital services include: radiology, pathology, sleep center, infusion center, helipad access, audiology, cardiac stress tests, echosonography, pulmonary diagnostics, developmental physical, occupational and speech therapy and sports physical therapy as well as motion gait analysis and fetal medicine testing. Along with serving families throughout The Woodlands area, the Hospital serves families throughout Greater North Houston and north of Houston including Montgomery, Angelina, Walker, Brazos, Grimes, Madison, Liberty, Harris, Polk, San Jacinto, Trinity and Hardin counties. (SEE CONTINUATION OF PART VI, LINE 5)

Schedule H, Part VI, Line 6 Affiliated health care system
The Hospital is affiliated with Texas Children's Pediatrics (TCP, EIN 76-0460242) in promoting health care in the community served. TCP is one of the nation's largest pediatric primary care networks. With 50 practices in the Greater Houston area, 13 in Austin, and 1 in College station, TCP pediatricians serve approximately 25 percent of Houston's children, helping treat and prevent infectious illnesses. Eight TCP practices, identified as the Community Cares Program, are located in medically underserved neighborhoods and provide consistent care for little or no cost to more than 43,000 children who otherwise would seek services from emergency rooms or go without care. In addition to providing high quality, affordable primary care, each Community Cares practice is uniquely designed to meet the needs of the diverse communities they serve. Using the medical home model of care, we provide: wrap-around services that eliminate logistical, cultural and social barriers to access care; counseling and educational services with emphasis on risk behaviors; on-site social workers and specialists who provide assistance signing up for Medicaid/CHIP or other Affordable Care Act providers; partnerships with local dentists, pharmacies and other services to ensure comprehensive affordable health care is provided; extra support and guidance for parents to promote total health and well-being of children. In addition to providing care to children in our community during normal business hours, TCP through its subsidiary, Texas Children's Urgent Care (TCUC, EIN 47-2029489), provides urgent care when kids get sick at night or on the weekends. As of the end of 2022, there were ten TCUC sites around the greater Houston area and one location in South Austin as well as our telemedicine virtual care option. These sites provide families with convenient access to care when it is needed most, and saves them time and money from seeking out inappropriate use of emergency center care. Our three busiest locations are located adjacent to our Medical Center EC, West Camps EC, and Woodlands Campus EC. These locations have helped redirect patients to seeking care in a more appropriate setting, as well as reducing the cost of care from the patient side. The impact has been tremendous on reducing the low acuity visits being treated in our Emergency Center. Texas Children's Health Plan (TCHP, EIN 76-048264) is the largest and most frequently selected provider of Children's Medicaid/CHIP coverage in the region. TCHP was founded in 1996 by Texas Children's Hospital making it the nation's first health maintenance organization (HMO) created just for children. Through a contractor role with the Texas Health and Human Services Commission (HHSC), Texas Children's Health Plan provides STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens and children in Houston and surrounding areas. Starting in November 2016, Texas Children's Health Plan also provides STAR Kids to children and young adults under the age of 21 with disabilities. As of September 2022, the Health Plan has over 590,000 members. The staff and network of over 4,300 primary care physicians, 6,800 specialists and 118 hospitals that provide acute care and inpatient and outpatient behavioral health and substance abuse treatment are committed to providing excellent service and patient care to TCHP members. The Hospital is Baylor College of Medicine's primary pediatric training hospital, with one of the largest pediatric residency programs in the country. The hospital's medical staff consists of approximately 1,750 board-certified, primary care physicians, OBGYN physicians, pediatric subspecialists and pediatric-surgical subspecialists. Together, the Hospital and Baylor College of Medicine represent one of the most active and best funded pediatric research programs in the country. Baylor College of Medicine investigators at the Hospital are conducting innovative research in nearly every pediatric subspecialty with the goal of quickly translating discoveries into breakthrough treatments for children everywhere.