4A (Expenses $ 158307381 including grants of $ 892406) (Revenue $ 97311930)
PATIENT CARE TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN IS ONE OF THE NATION'S LEADING PEDIATRIC CENTERS FOR THE TREATMENT OF ORTHOPEDIC CONDITIONS, CERTAIN RELATED ARTHRITIC AND NEUROLOGICAL DISORDERS AND LEARNING DISORDERS, SUCH AS DYSLEXIA. PATIENTS RECEIVE TREATMENT REGARDLESS OF THE FAMILY'S ABILITY TO PAY. THE ORTHOPEDICS PROGRAM INCLUDES OUTPATIENT CLINIC VISITS AND INPATIENT STAYS FOR THE DIAGNOSIS AND TREATMENT OF SUCH CONDITIONS AS SCOLIOSIS, CLUBFOOT, DISLOCATED HIP, LEGG-PERTHES, LIMB-LENGTH DIFFERENCES AND LIMB DEFICIENCIES, HAND DIFFERENCES AND SPORTS INJURIES. (CONTINUED ON SCHEDULE O)

4B (Expenses $ 14935368 including grants of $ 0) (Revenue $ 0)
RESEARCH THE HOSPITAL'S DEDICATED RESEARCH CENTER, THE SARAH M. AND CHARLES E. SEAY CENTER FOR MUSCULOSKELETAL RESEARCH, IS MADE UP OF SIX CENTERS OF EXCELLENCE - SCOLIOSIS AND SPINE DISORDERS, CLUBFOOT AND FOOT DISORDERS, HIP DISORDERS, LIMB LENGTH AND RECONSTRUCTION, HAND DIFFERENCES AND SPORTS MEDICINE - SUPPORTED BY RESEARCH DIVISIONS AND CORE FACILITIES. (CONTINUED ON SCHEDULE O)

4C (Expenses $ 7476037 including grants of $ 0) (Revenue $ 0)
EDUCATION TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN FUNCTIONS AS A PREMIER TEACHING INSTITUTION, PROVIDING COMPREHENSIVE EDUCATION AND TRAINING TO ORTHOPEDIC RESIDENTS AND POST-GRADUATE ORTHOPEDIC FELLOWS. IN ADDITION , THE HOSPITAL CONTRIBUTES TO THE EDUCATION OF ALLIED HEALTH PROFESSIONALS BY PROVIDING CLINICAL EXPERIENCE AND DIDACTIC EDUCATION FOR STUDENTS AS WELL AS CONTINUING EDUCATION FOR HEALTH CARE PROFESSIONALS. THE HOSPITAL IS CURRENTLY AFFILIATED WITH 57 INSTITUTIONS, INCLUDING COLLEGES, UNIVERSITIES AND TECHNICAL PROGRAMS. (CONTINUED ON SCHEDULE O)

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - TEXAS SCOTTISH RITE HOSPITAL. SCOTTISH RITE FOR CHILDREN (SCOTTISH RITE) AND ASCENDIENT HEALTHCARE ADVISORS (ASCENDIENT) COLLABORATED TO CONDUCT AND ASSESS THE NEEDS OF THE COMMUNITY IN PRODUCING THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT. PRIMARY DATA INCLUDED INFORMATION GATHERED FROM INTERNET-BASED AND PAPER SURVEYS, FOCUS GROUPS AND INTERVIEWS WITH VARIOUS PATIENT FAMILIES, LOCAL ORGANIZATIONS AND HEALTH SERVICE PROVIDERS AND LEADERS WITHIN SCOTTISH RITE. SECONDARY DATA INCLUDED INFORMATION REGARDING THE DEMOGRAPHICS, HEALTH AND HEALTH CARE RESOURCES, BEHAVIORAL HEALTH, DISEASE TRENDS AND COUNTY RANKINGS OF THE COMMUNITY SERVED BY SCOTTISH RITE. THE DATA COLLECTION AND ANALYSIS PROCESS BEGAN IN MAY 2022 AND CONTINUED THROUGH TO THE DEVELOPMENT OF THE DOCUMENT IN AUGUST 2022. IN CONJUNCTION WITH SCOTTISH RITE LEADERSHIP, ASCENDIENT DRAFTED THE SURVEY AND SCOTTISH RITE CONDUCTED A HEALTH SURVEY IN PERSON IN DALLAS AND FRISCO AND ALSO IN ELECTRONIC FORMAT TO CURRENT AND FORMER SCOTTISH RITE PATIENTS. COMMUNITY ENGAGEMENT AND FEEDBACK WAS OBTAINED THROUGH SEVERAL WAYS: A) PATIENT INTERNET-BASED AND PAPER SURVEYS DISTRIBUTED IN THE SCOTTISH RITE CLINICS WITH PERSONAL ASSISTANCE FOR FAMILIES THAT NEEDED HELP UNDERSTANDING/FILLING OUT THE INFORMATION B) FOUR PATIENT FAMILY FOCUS GROUPS WITH REPRESENTATION FROM 12 PATIENT FAMILIES, C) INTERNET-BASED SURVEYS AND INTERVIEWS WITH LEADERS FROM COMMUNITY PARTNERS, D) AS WELL AS SIGNIFICANT INPUT AND DIRECTION FROM SCOTTISH RITE LEADERSHIP AND THE STEERING COMMITTEE. ALL STAKEHOLDERS WERE ASKED TO PROVIDE THEIR FEEDBACK ABOUT THE HEALTH OF CHILDREN IN THE SCOTTISH RITE COMMUNITY AND FACTORS INFLUENCING THE HEALTH STATUS OF CHILDREN IN THE BROADER COMMUNITY. THE DATA WERE AGGREGATED BY SOURCE (I.E., PATIENTS, COMMUNITY LEADERS AND PARTNERS AND SCOTTISH RITE LEADERSHIP) AND THEN ANALYZED TO UNDERSTAND THE CURRENT PERCEIVED HEALTH NEEDS IN THE COMMUNITY THROUGH THE LENS OF THOSE WE SERVE, THOSE WE COLLABORATE WITH AND THOSE WHO LEAD US INTERNALLY. THANKS TO THE HARD WORK OF OUR DEDICATED STAFF, PARTNERS AND VOLUNTEERS, SCOTTISH RITE WAS ABLE TO GATHER AN ABUNDANCE OF PRIMARY DATA TO GAIN A BETTER UNDERSTANDING OF THE HEALTH NEEDS IN THE COMMUNITY AND THE ROLE SCOTTISH RITE PLAYS IN HELPING KIDS LEAD HEALTHY, HAPPY LIVES. LEVERAGING THESE SOURCES, THE STEERING COMMITTEE WAS ABLE TO INCORPORATE INPUT FROM 1,680 SCOTTISH RITE PATIENTS, 22 COMMUNITY LEADERS/PARTNERS AND 31 SCOTTISH RITE LEADERS. OF NOTE, TO ENSURE THAT HISTORICALLY UNDERSERVED POPULATIONS INCLUDING MINORITIES, PERSONS WITH LOW-INCOME, UNINSURED OR UNDERINSURED AND THOSE WITH LIMITED ENGLISH PROFICIENCY WERE REPRESENTED IN THIS ASSESSMENT, SCOTTISH RITE DISTRIBUTED INTERNET-BASED AND PAPER PATIENT SURVEYS IN ENGLISH AND SPANISH FOR PATIENTS THAT MAY NOT HAVE INTERNET ACCESS AT HOME AND/OR PREFER TO RESPOND IN SPANISH. ROUGHLY 26 PERCENT OF PATIENT RESPONDENTS IDENTIFIED THEMSELVES AS HISPANIC/LATINX AND 13 PERCENT INDICATED THAT SPANISH WAS THE PRIMARY LANGUAGE SPOKEN IN THEIR HOMES. ADDITIONALLY, 27 PERCENT OF PATIENT RESPONDENTS HAVE MEDICAID OR HAVE NO INSURANCE AT ALL AND MORE THAN HALF OF THE PATIENT FOCUS GROUP PARTICIPANTS REPORTED HAVING MEDICAID AND/OR USING CRAYON CARE, WHICH IS SCOTTISH RITE'S FINANCIAL ASSISTANCE PROGRAM. NEARLY ALL SURVEY RESPONDENTS INDICATED THEY LIVED IN THE CHNA COMMUNITY. IN ADDITION, SCOTTISH RITE CONDUCTED FOUR PATIENT FOCUS GROUPS TO SOLICIT INPUT FROM PATIENTS' FAMILIES REGARDING THE HEALTH NEEDS OF THEIR CHILDREN. THE PATIENT FOCUS GROUPS WERE CONDUCTED AUGUST AND SEPTEMBER 2022, AT SCOTTISH RITE'S DALLAS AND FRISCO CAMPUSES. NINE QUESTIONS WERE ASKED AND DISCUSSED, THEN USED TO HELP GATHER DATA FROM THE PARTICIPANTS. INPUT WAS COLLECTED FROM 22 KEY STAKEHOLDERS THROUGH IN-PERSON INTERVIEWS AND ELECTRONIC SURVEYS IN 2022. THESE KEY STAKEHOLDERS WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, THEIR INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS OR THEIR AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRY. THESE INTERVIEWS ARE INTENDED TO ASCERTAIN OPINIONS AMONG INDIVIDUALS WHO ARE LIKELY TO BE KNOWLEDGEABLE ABOUT THE COMMUNITY AND INFLUENTIAL OVER THE OPINIONS OF OTHERS ABOUT HEALTH CONCERNS IN THE COMMUNITY. SECONDARY DATA ASSESSED FACTORS, SUCH AS DEMOGRAPHICS, SOCIOECONOMIC INDICATORS (HOUSEHOLD INCOME AND POVERTY, INSURANCE COVERAGE AND CHILDREN LIVING IN SINGLE-PARENT HOUSEHOLDS) AND COMMUNITY HEALTH STATUS INDICATORS RELEVANT TO THE SERVICES PROVIDED BY SCOTTISH RITE (RATES FOR CONDITIONS TREATED BY SCOTTISH RITE, NUMBER OF CHILDREN IN TEXAS WITH DISABILITIES AND RATE FOR HEALTH ISSUES IDENTIFIED BY STAKEHOLDERS AND PATIENTS, SUCH AS ASTHMA AND OBESITY). KEY SOURCES FOR SECONDARY DATA ON THE COMMUNITY SERVED BY SCOTTISH RITE INCLUDED DATA MADE AVAILABLE BY PARTICIPATING ORGANIZATIONS AND NUMEROUS PUBLIC DATA SOURCES RELATED TO DEMOGRAPHICS, SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH, HEALTH EQUITY, HEALTH STATUS AND DISEASE TRENDS, MENTAL/BEHAVIORAL HEALTH TRENDS AND MODIFIABLE HEALTH RISKS. SOME OF THE SECONDARY DATA SOURCES INCLUDED BUT WERE NOT LIMITED TO TEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES, CDC, UNITED WAY, AMERICAN COMMUNITY SURVEY OF THE U.S. CENSUS BUREAU, USDA, OMH - OFFICE OF MINORITY HEALTH, COUNTY HEALTH RANKINGS AND ROADMAPS AND THE OPPORTUNITY ATLAS. THE PROCESS OF DETERMINING THE PRIORITY HEALTH NEEDS FOR THE 2022 CHNA BEGAN WITH THE COLLECTION AND ANALYSIS OF HUNDREDS OF DATA POINTS. ALL INDIVIDUAL DATA MEASURES FROM BOTH PRIMARY AND SECONDARY SOURCES WERE GATHERED, ANALYZED AND INTERPRETED. TO COMBINE DATA POINTS INTO MORE EASILY DISCUSSABLE CATEGORIES, ALL INDIVIDUAL DATA MEASURES WERE GROUPED INTO SIX CATEGORIES AND 20 CORRESPONDING FOCUS AREAS BASED ON COMMON THEMES. GIVEN THE LARGE NUMBER OF INDIVIDUAL DATA MEASURES THAT WERE COLLECTED, ANALYZED AND INTERPRETED THROUGHOUT THIS PROCESS TO DEVELOP THE 20 CATEGORIES, IT WAS NOT FEASIBLE TO MAKE EACH OF THEM A PRIORITY. THE STEERING COMMITTEE TOOK INTO CONSIDERATION NEED VARIATION BY GEOGRAPHY, PRIORITIES FROM SECONDARY DATA, PRIORITIES FROM PRIMARY DATA, SCOTTISH RITE LEADERSHIP RANKINGS AND SCOTTISH RITE'S ABILITY TO IMPACT THE NEED TO HELP DETERMINE WHICH HEALTH NEEDS SHOULD BE PRIORITIES. THE FOLLOWING FACTORS WERE USED TO PRIORITIZE THE IDENTIFIED HEALTH NEEDS: SIZE OF THE PROBLEM; SERIOUSNESS OF THE PROBLEM; SCOPE OF THE ISSUES ON IMPACTED POPULATIONS; IMPORTANCE OF THE ISSUE TO THE COMMUNITY; AND THE PREVALENCE OF COMMON THEMES. MEMBERS OF SCOTTISH RITE'S LEADERSHIP PROVIDED INPUT REGARDING RATINGS FOR THE FACTORS DESCRIBED ABOVE. THE IDENTIFIED HEALTH NEEDS WERE PRIORITIZED, TAKING INTO ACCOUNT THE IMPORTANCE OF THE NEED AS WELL AS THE PERCEIVED DEGREE OF INFLUENCE SCOTTISH RITE HAS TO IMPACT OR RESPOND TO THAT NEED. ALTHOUGH SOME KEY HEALTH ISSUES WERE IDENTIFIED AS PRIORITY AREAS BY THE COMMUNITY AT LARGE, THESE NEEDS WERE NOT FOUND TO BE IN ALIGNMENT WITH SCOTTISH RITE'S PRIMARY MISSION AND STRATEGIC PLAN AS A PREMIER PEDIATRIC ORTHOPEDIC PROVIDER.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - TEXAS SCOTTISH RITE HOSPITAL. SCOTTISH RITE ENGAGED THE SERVICES OF ASCENDIENT TO ASSESS THE NEEDS OF THE COMMUNITY AND COLLABORATED WITH ASCENDIENT IN PRODUCING THE ORGANIZATION'S CHNA REPORT.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - TEXAS SCOTTISH RITE HOSPITAL. AS PART OF THE CHNA, SCOTTISH RITE AND ASCENDIENT CONDUCTED THE ASSESSMENT FROM JUNE 2022 TO SEPTEMBER 2022. THE PRIMARY AND SECONDARY DATA GATHERED WERE THEN ANALYZED TO IDENTIFY SIGNIFICANT HEALTH NEEDS FOR THE COMMUNITY SERVED BY SCOTTISH RITE. AS A RESULT OF THE ANALYSIS, EIGHT HEALTH NEEDS WERE IDENTIFIED AS BEING SIGNIFICANT TO THE COMMUNITY. THE FOLLOWING HEALTH NEEDS WERE IDENTIFIED AND SUBSEQUENTLY GROUPED AND PRIORITIZED BY MANAGEMENT INTO THREE PRIORITY AREAS BASED ON THEIR OVERALL ASSESSMENT OF THE QUALITATIVE AND QUANTITATIVE DATA. SCOTTISH RITE FOCUSED ON THE IDENTIFIED AREAS WHERE THE ORGANIZATION CAN MOST EFFECTIVELY USE ITS EXPERTISE AND RESOURCES TO HAVE A SIGNIFICANT IMPACT. THESE THREE AREAS ARE: 1. IMPROVE ACCESS TO HEALTH CARE SERVICES 2. OBSESITY/DIABETES/FITNESS/NUTRITION 3. IMPROVE SOCIAL DETERMINANTS OF HEALTH 1. SCOTTISH RITE STRATEGIES FOR IMPROVING ACCESS TO HEALTH CARE SERVICES: A: ACCESS TO CARE REPRESENTS THE PRESENCE OF SEVERAL COMPONENTS, INCLUDING COVERAGE (I.E., INSURANCE), A PHYSICAL LOCATION WHERE CARE IS PROVIDED, THE ABILITY TO RECEIVE TIMELY HEALTH CARE WHEN NEEDED AND AN ADEQUATE WORKFORCE OF PROVIDERS. TAKEN TOGETHER, THESE COMPONENTS ENABLE INDIVIDUALS TO OBTAIN TIMELY HEALTH CARE SERVICES THAT ACHIEVE THE BEST POSSIBLE HEALTH OUTCOMES. IT IS WIDELY ACKNOWLEDGED THAT UNDERREPRESENTED POPULATIONS, SUCH AS LOW INCOME, MINORITY AND LESS EDUCATED POPULATIONS, EXPERIENCE GREATER DISPARITIES IN OBTAINING HEALTH CARE SERVICES. THE INABILITY TO ACCESS HEALTH CARE SERVICES CONTRIBUTES TO POOR HEALTH STATUS. THUS, HEALTH DISPARITIES ARE WELL-KNOWN TO BE ASSOCIATED WITH ACCESS TO CARE. AS DESCRIBED IN FURTHER DETAIL BELOW, ACCESS TO CARE WAS IDENTIFIED AS A SIGNIFICANT HEALTH NEED FOR THE COMMUNITY IN PRIMARY AND SECONDARY DATA ANALYSIS. THESE DATA FINDINGS EMPHASIZED THE BURDEN, SCOPE AND SEVERITY OF ACCESS TO CARE AMONG OUR COMMUNITY, AS WELL AS THE IMPORTANCE THAT OUR COMMUNITY PLACES ON ADDRESSING THE NEED. SCOTTISH RITE RECOGNIZES ACCESS TO CARE AS A HEALTH NEED FOR WHICH THE ORGANIZATION CAN FEASIBLY MAKE EFFECTIVE INTERVENTIONS. WHILE SCOTTISH RITE HAS REMAINED COMMITTED TO OUR MISSION TO PROVIDE THE HIGHEST QUALITY CARE AVAILABLE FOR CHILDREN, WITHIN OUR SCOPE OF SERVICES, REGARDLESS OF THE FAMILY'S ABILITY TO PAY, WE ALSO RECOGNIZE THERE ARE CHILDREN IN NEED OF CARE WHOSE FAMILIES MAY BE UNAWARE OF FINANCIAL ASSISTANCE PROGRAMS OR THE HEALTH CARE RESOURCES AVAILABLE TO HELP THEIR CHILD, PARTICULARLY IN CIRCUMSTANCES INVOLVING RARE ORTHOPEDIC AND RELATED NEURODEVELOPMENTAL CONDITIONS THAT REQUIRE HIGHLY SPECIALIZED CARE. IN ADDITION, SCOTTISH RITE SERVES THOUSANDS OF PATIENTS ANNUALLY WITH FINITE RESOURCES AND TIME. IN OUR ROLE AS A HEALTH CARE PROVIDER, WE BELIEVE WE CAN MAKE CONTINUED STRIDES IN IMPROVING ACCESS TO CARE. RESOURCES TO ADDRESS ACCESS TO CARE AFFORDABILITY OF HEALTH SERVICES SCOTTISH RITE IS COMMITTED TO ITS MISSION TO PROVIDE THE HIGHEST QUALITY CARE AVAILABLE FOR CHILDREN, WITHIN OUR SCOPE OF SERVICES, REGARDLESS OF THE FAMILY'S ABILITY TO PAY. SCOTTISH RITE'S FINANCIAL ASSISTANCE PROGRAM, KNOWN AS CRAYON CARE, OFFERS CARE AT NO COST OR SIGNIFICANTLY DISCOUNTED COST TO ELIGIBLE FAMILIES. OUR FINANCIAL COUNSELORS STRIVE TO ENSURE THAT ALL FAMILIES ARE INFORMED AND FAMILIAR WITH THIS PROGRAM. ELIGIBILITY FOR CRAYON CARE IS BASED ON HOUSEHOLD INCOME AND MEDICAL EXPENSES, AND NO APPLICATIONS SUBMITTED BY ELIGIBLE FAMILIES ARE DENIED. INFORMATION ABOUT CRAYON CARE IS PROVIDED IN SEVERAL WAYS, INCLUDING A PLAIN LANGUAGE SUMMARY THAT IS POSTED AT THE REGISTRATION DESKS AND PROVIDED TO NEW PATIENTS IN REGISTRATION PACKETS THAT ARE GIVEN TO ALL PATIENT FAMILIES AT LEAST ANNUALLY. SCOTTISH RITE CONTINUES TO INFORM AND EDUCATE LOCAL ORGANIZATIONS AND SCHOOL DISTRICTS OUT IN THE COMMUNITY ABOUT CRAYON CARE. MORE DETAILED INFORMATION REGARDING OUR CRAYON CARE POLICY, APPLICATION, FINANCIAL ASSISTANCE SUMMARY AND OTHER FREQUENTLY ASKED QUESTIONS ARE ALSO AVAILABLE AT THE ORGANIZATION'S WEBSITE . ALL FAMILIES ARE ENCOURAGED TO APPLY. OF NOTE, FROM OCTOBER 2021 THROUGH JULY 2022, SCOTTISH RITE HAS RECEIVED AND APPROVED THE CRAYON CARE APPLICATIONS FOR 4,200 ELIGIBLE PATIENT FAMILIES OUT OF THE 5,155 APPLICANT PATIENT FAMILIES THAT WERE GIVEN CRAYON CARE APPLICATIONS DIRECTLY BY SCOTTISH RITE STAFF. FURTHERMORE, THROUGH OUR DEDICATED TEAM IN FAMILY SERVICES, WE ALSO PROVIDE INSURANCE ENROLLMENT ASSISTANCE TO UNDERINSURED/UNINSURED PATIENTS. IN ADDITION, SCOTTISH RITE PARTICIPATES IN A COMMUNITY RESOURCE COORDINATION GROUP (CRCG) MADE UP OF LOCAL PARTNERS AND COMMUNITY MEMBERS THAT WORK WITH PARENTS, CAREGIVERS, YOUTH AND ADULTS TO IDENTIFY AND COORDINATE SERVICES AND SUPPORT, INCLUDING FINANCIAL ASSISTANCE, INSURANCE COVERAGE, PRIMARY CARE AND SPECIALTY SERVICES, MENTAL AND BEHAVIORAL HEALTH CARE AND MORE. ACCESS TO CARE WHEN A PATIENT'S NEEDS FALL OUTSIDE OF SCOTTISH RITE'S SCOPE OF SERVICES, OUR TEAM IDENTIFIES EXTERNAL RESOURCES THAT ARE AVAILABLE FOR CARE, FUNDING AND/OR EDUCATION. AS DETAILED IN CHAPTER 1, SCOTTISH RITE'S FAMILY RESOURCE CENTER EXISTS TO HELP CONNECT CURRENT AND FORMER PATIENTS, AS WELL AS OTHER COMMUNITY MEMBERS, WITH PROVIDERS AND ORGANIZATIONS THAT ARE WELL-EQUIPPED TO SERVE THEM. SCOTTISH RITE'S FAMILY RESOURCE CENTER ALSO CONNECTS FAMILIES WITH GRANTS FOR CARE OUTSIDE OF SCOTTISH RITE AND WORKS WITH EXTERNAL PROVIDERS TO FUND OFFSITE CARE FOR LOW-INCOME SCOTTISH RITE PATIENTS. EXAMPLES OF EXISTING HEALTH CARE PROGRAMS WITHIN THE COMMUNITY AVAILABLE TO ACCESS CARE INCLUDE BUT ARE NOT LIMITED TO: * CHILDREN'S HEALTH * UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER * COOK CHILDREN'S MEDICAL CENTER * COOK CHILDREN'S PEDIATRIC SPECIALTIES PROSPER * MEDICAL CITY CHILDREN'S HOSPITAL * BAYLOR INSTITUTE FOR IMMUNOLOGY RESEARCH * TEXAS CHILD NEUROLOGY * ATHENA DIAGNOSTICS * COMMUNITY RESOURCE COORDINATION GROUP IN ADDITION, SCOTTISH RITE COORDINATES WITH OUTSIDE VENDORS TO DELIVER DURABLE MEDICAL EQUIPMENT TO PATIENTS SUCH AS WHEELCHAIRS, WALKERS, CANES, CRUTCHES, BATHROOM EQUIPMENT, HOSPITAL BEDS AND PRESSURE RELIEF CUSHIONS. MEDICAL SUPPLIES USED FOR FEEDING, WOUND CARE, RESPIRATORY CARE AND/OR INCONTINENCE ARE ALSO ORDERED FOR FAMILIES USING OUTSIDE VENDORS. EXAMPLES OF THESE ORGANIZATIONS INCLUDE BUT ARE NOT LIMITED TO: * ANGELS OF CARE * TRAVIS MEDICAL SUPPLY * J&R MEDICAL * UNIVERSAL MED SUPPLY * ALLUMED * C&R MEDICAL * APRIA * HEALTHLINE MEDICAL, MEDCO * MEDICAL PLUS SUPPLY * PATIENT SUPPORT SERVICES SCOTTISH RITE PROVIDES LIMITED PSYCHOLOGY SERVICES AND REGULARLY SCREENS PATIENTS FOR MENTAL AND BEHAVIORAL HEALTH CONCERNS. HOWEVER, WE RECOGNIZE THAT THERE ARE ORGANIZATIONS WITHIN THE COMMUNITY THAT ARE HIGHLY SPECIALIZED AND DEDICATED TO WORKING WITH THE MENTAL AND BEHAVIORAL HEALTH OF CHILDREN AND FAMILIES. WHEN NEEDED, SCOTTISH RITE'S SOCIAL WORKERS AND/OR PSYCHOLOGISTS HELP COORDINATE WITH THESE SPECIALIZED FACILITIES TO ASSIST PATIENTS WITH THE SCHEDULING PROCESS. EXAMPLES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING ORGANIZATIONS: * CHILD AND FAMILY GUIDANCE CENTER * JEWISH FAMILY AND CHILDREN'S SERVICES * RICHLAND OAKS COUNSELING CENTER * THE FAMILY STUDY CENTER AT THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER

Schedule H, Part V, Section B, Line 11 Facility , 2
Facility , 2 - TEXAS SCOTTISH RITE HOSPITAL - CONTINUED. 2. SCOTTISH RITE STRATEGIES FOR OBESITY/DIABETES/FITNESS/NUTRITION: A HEALTHY DIET, ACCESS TO NUTRITIOUS FOODS AND REGULAR PHYSICAL ACTIVITY HELP PROMOTE HEALTH BY REDUCING THE RISK OF HEART DISEASE, STROKE AND CERTAIN FORMS OF CANCER, STRENGTHENING MUSCLES, BONES AND JOINTS, IMPROVING MOOD AND ENERGY LEVELS AND MAINTAINING A HEALTHY WEIGHT. IN CONTRAST, DIABETES AND OBESITY - POTENTIAL CONSEQUENCES OF UNHEALTHY DIET AND INADEQUATE PHYSICAL ACTIVITY - ARE RISK FACTORS FOR MANY SERIOUS HEALTH CONDITIONS AND CHRONIC DISEASES. ACCORDING TO THE CDC, OBESITY PREVALENCE INCREASED FROM 14 PERCENT TO 20 PERCENT FOR CHILDREN AND ADOLESCENTS BETWEEN 1999 AND MARCH 2020. SIMILARLY, BETWEEN 2001 AND 2017, THE INCIDENCE OF YOUTH AGES 10-19 WITH TYPE 2 DIABETES INCREASED FROM 34 PER 100,000 CHILDREN TO 67 PER 100,000 CHILDREN. OBESITY OCCURS MORE FREQUENTLY AMONG UNDER-REPRESENTED POPULATIONS. AMONG CHILDREN AND ADOLESCENTS IN THE UNITED STATES BETWEEN 2017 AND 2020, OBESITY PREVALENCE WAS 26.2 PERCENT AMONG HISPANIC CHILDREN, 24.8 PERCENT AMONG NON-HISPANIC BLACK CHILDREN, 16.6 PERCENT AMONG NON-HISPANIC WHITE CHILDREN AND 9.0 PERCENT AMONG NON-HISPANIC ASIAN CHILDREN. OBESITY PREVALENCE IN CHILDREN AND ADOLESCENTS INCREASES AS THE HEAD OF HOUSEHOLD'S LEVEL OF EDUCATION DECREASES. IN A STUDY OF OBESITY IN CHILDREN BY HOUSEHOLD INCOME, OBESITY PREVALENCE WAS 18.9 PERCENT IN THE LOWEST INCOME GROUP, 19.9 PERCENT IN THE MIDDLE-INCOME GROUP AND 10.9 PERCENT IN THE HIGHEST INCOME GROUP. TYPE 2 DIABETES, WHICH IS PREVENTABLE, IS MORE COMMON IN YOUTH IN RACIAL OR ETHNIC MINORITY GROUPS THAN AMONG WHITE YOUTH. BETWEEN 2001 AND 2017, TYPE 2 DIABETES PREVALENCE INCREASED MOST RAPIDLY AMONG NON-HISPANIC BLACK AND HISPANIC CHILDREN. IN THIS ASSESSMENT, PRIMARY AND SECONDARY DATA AFFIRMED THAT DIET, EXERCISE, ACCESS TO HEALTHY FOOD, DIABETES AND OBESITY REPRESENT A NOTABLE HEALTH NEED AMONG CHILDREN IN THE COMMUNITY. THESE FINDINGS, DESCRIBED IN GREATER DETAIL BELOW, INDICATE THAT NUTRITION, FITNESS, DIABETES AND OBESITY ARE A SIGNIFICANT AND FAR-REACHING BURDEN THAT THE COMMUNITY CONSIDERS IMPORTANT TO ADDRESS. IN ADDITION TO THE DISPARITIES ASSOCIATED WITH THIS NEED, THE BURDEN OF THE NEED AND THE PERCEIVED IMPORTANCE THAT THE COMMUNITY PLACES ON ADDRESSING THE NEED, SCOTTISH RITE IDENTIFIED THIS AS A PRIORITY NEED AREA BASED ON THE RELEVANCE OF THIS CONCERN TO THE WORK OF SCOTTISH RITE AND THE FEASIBILITY OF INTERVENTIONS THAT SCOTTISH RITE CAN IMPLEMENT. AS A PEDIATRIC ORTHOPEDIC SURGERY PROVIDER, SCOTTISH RITE RECOGNIZES THAT OBESE AND DIABETIC CHILDREN ARE AT INCREASED RISK OF FRACTURES AND ARE MORE LIKELY TO EXPERIENCE ADVERSE PERIOPERATIVE EVENTS AND OUTCOMES. , , ADDITIONALLY, IMPROVED PHYSICAL ACTIVITY IS AN IMPORTANT GOAL OF MANY SCOTTISH RITE SERVICES. SUBSEQUENTLY, OBESITY, DIABETES, NUTRITION AND FITNESS WERE RECOGNIZED AS PARTICULARLY RELEVANT HEALTH NEEDS IN OUR COMMUNITY FOR WHICH SCOTTISH RITE CAN FEASIBLY AND EFFECTIVELY OFFER INTERVENTIONS. RESOURCES TO ADDRESS OBESITY/DIABETES/FITNESS/NUTRITION GIVEN THE UNIQUE CONDITIONS TREATED BY SCOTTISH RITE, THE SCOTTISH RITE THERAPEUTIC RECREATION DEPARTMENT HELPS CHILDREN WITH CHRONIC MEDICAL CONDITIONS OR DISABILITIES DEVELOP THE SKILLS AND KNOWLEDGE NEEDED TO ENABLE THEM TO PARTICIPATE IN RECREATION AND LEISURE ACTIVITIES. AS DESCRIBED IN CHAPTER 1, PHYSICIANS CAN REFER PATIENTS TO THERAPEUTIC RECREATION FOR INPATIENT AND OUTPATIENT SERVICES, SUCH AS: * ADAPTIVE SPORTS, INCLUDING TENNIS, DANCE AND GOLF * ADAPTED CYCLE EVALUATIONS * SUPPORT FOR CAMPS IN ADDITION, THE THERAPEUTIC RECREATION DEPARTMENT WORKS WITH COMMUNITY ORGANIZATIONS TO SUPPORT PATIENTS AND FAMILIES, INCLUDING: * RISE (RECOVERY, INSPIRATION, SUCCESS, EMPOWERMENT): A NONPROFIT CHARITABLE ORGANIZATION BASED IN THE DALLAS-FORT WORTH METROPLEX THAT OFFERS INCLUSIVE ADAPTIVE RECREATIONAL SPORTS PROGRAMS FREE OF CHARGE TO PARTICIPANTS. * AMBUCS: A NATIONAL NON-PROFIT ORGANIZATION THAT ENCOURAGES MOBILITY AND INDEPENDENCE THROUGH PROVISION OF ADAPTIVE TRYKES, SCHOLARSHIPS FOR THERAPISTS AND A RANGE OF COMMUNITY SERVICE EFFORTS. SCOTTISH RITE HAS NUMEROUS OTHER PROGRAMS AND PARTNERSHIPS THAT PROMOTE FITNESS, AS DESCRIBED IN CHAPTER 1. THESE INCLUDE PARTNERSHIPS WITH THE DALLAS MAVERICKS BASKETBALL ACADEMY, FC FAST SOCCER ACADEMY, WORLD OLYMPIC GYMNASTICS ACADEMY (WOGA) AND THE FRISCO YMCA. SCOTTISH RITE HAS DEVELOPED A BRIDGE PROGRAM, TO HELP YOUNG ATHLETES WHO HAVE COMPLETED THEIR PHYSICAL THERAPY PERFORM FOCUSED TRAINING TO SAFELY RETURN TO THEIR SPORT. FURTHER, SOCIAL WORKERS AND MEDICAL CONSULT COORDINATORS AT SCOTTISH RITE HELP FAMILIES ARRANGE TO RECEIVE FOLLOW-UP CARE AS ORDERED BY THE MEDICAL STAFF ASSOCIATED WITH OBESITY, FITNESS, NUTRITION AND DIABETES. A RANGE OF RESOURCES THROUGHOUT THE COMMUNITY SUPPORT THESE AREAS, INCLUDING (BUT NOT LIMITED TO) THOSE LISTED BELOW: WEIGHT MANAGEMENT, FITNESS, NUTRITION AND OBESITY SCOTTISH RITE PARTICIPATES IN COALITION-LED COMMUNITY AWARENESS CAMPAIGNS AND PROGRAMS THAT WE MAKE PATIENT REFERRALS TO, INCLUDING: * THE COACH CLINIC AT CHILDREN'S HEALTH- SCOTTISH RITE SUPPORTS THIS PROGRAM, WHICH WAS ESTABLISHED FOR CHILDREN WITH OBESITY AND WEIGHT-RELATED COMPLICATIONS. GET UP & GO (FORMERLY LEAN PROGRAM) WORKS IN CONJUNCTION WITH THE COACH CLINIC AND NUTRITION CLINICS AT CHILDREN'S HEALTH TO OFFER A FREE 10-WEEK WEIGHT MANAGEMENT PROGRAM. AS SCOTTISH RITE CONTINUES TO IDENTIFY CHILDREN WHO WOULD BENEFIT FROM THESE PROGRAMS, THE APPROPRIATE REFERRALS ARE MADE TO CHILDREN'S HEALTH. * MEDICAID AND CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN) PROGRAMS - THESE PROGRAMS ALSO PROVIDE SUPPORT TO THE SCOTTISH RITE PATIENTS AND FAMILIES AND WILL PAY FOR SEVERAL VISITS RELATED TO CERTAIN WEIGHT MANAGEMENT ISSUES WITH A CLINICAL DIETICIAN. AS CHILDREN WHO WOULD BENEFIT FROM THESE SERVICES ARE IDENTIFIED, REFERRALS ARE MADE. OTHER COMMUNITY RESOURCES FOR PEDIATRIC FITNESS, OBESITY AND WEIGHT MANAGEMENT INCLUDE: * THE YMCA OF METROPOLITAN DALLAS OFFERS A NUMBER OF PROGRAMS DESIGNED TO IMPROVE THE HEALTH OF FAMILIES, INCLUDING FIT FOR HEALTH (FREE HEALTHY LIFESTYLE PROGRAMS FOR PARENTS AND THEIR CHILDREN), GET UP AND GO (A WEIGHT MANAGEMENT PROGRAM FOR FAMILIES OFFERED IN PARTNERSHIP WITH CHILDREN'S HEALTH) AND KAMP K'AANA (A HEALTH AND WELLNESS SUMMER CAMP PROGRAM FOR CHILDREN ABOVE THEIR HEALTHY WEIGHT). ADDITIONALLY, THE YMCA OFFERS AFTERSCHOOL PROGRAMS THAT PROVIDE HEALTHY LUNCHES TO KIDS AND INCLUDES AT LEAST 30 MINUTES OF OUTDOOR OR INDOOR PHYSICAL ACTIVITY AND MOVEMENT A DAY. DIABETES * THE NORTHERN TEXAS AND OKLAHOMA CHAPTER OF THE JUVENILE DIABETES RESEARCH FOUNDATION (JDRF) OFFERS RESOURCES FOR CHILDREN LIVING WITH TYPE 1 DIABETES, INCLUDING COMMUNITY FORUMS, INFORMATIONAL GUIDES AND SUPPORT GROUPS. * PEDIATRIC DIABETES PROGRAMS AT COOK CHILDREN'S AND CHILDREN'S HEALTH PROVIDE HEALTH AND EDUCATION SERVICES FOR PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES. 3. SCOTTISH RITE STRATEGIES FOR IMPROVING SOCIAL DETERMINANTS OF HEALTH: A: ACCORDING TO HEALTH.GOV , SOCIAL DETERMINANTS OF HEALTH (SDOH) ARE THE CONDITIONS IN THE ENVIRONMENTS WHERE PEOPLE ARE BORN, LIVE, LEARN, WORK, PLAY, WORSHIP, AND AGE THAT AFFECT A WIDE RANGE OF HEALTH, FUNCTIONING, AND QUALITY-OF-LIFE OUTCOMES AND RISKS. MANY CONDITIONS IN THE ENVIRONMENT, REFERRED TO AS SOCIAL DETERMINANTS OF HEALTH (SDOH), AFFECT HEALTH, FUNCTIONING AND QUALITY-OF-LIFE OUTCOMES AND RISKS. THE AMERICAN HOSPITAL ASSOCIATION (AHA) CATEGORIZES THESE FACTORS INTO THE FOLLOWING DOMAINS: - FOOD - HOUSING - TRANSPORTATION - HEALTH BEHAVIORS - VIOLENCE - EDUCATION - SOCIAL SUPPORT - EMPLOYMENT WHILE MANY OF THE FACTORS THAT CONTRIBUTE TO HEALTH ARE EITHER NOT CONTROLLABLE OR ARE SOCIETAL IN NATURE, HEALTH CARE PROVIDERS NEED TO HOLISTICALLY EVALUATE THE UNDERLYING FACTORS THAT MAY IMPACT AN INDIVIDUAL'S HEALTH IN ADDITION TO THEIR CURRENT HEALTH CONDITIONS. SDOH CONTRIBUTE TO WIDE HEALTH DISPARITIES AND INEQUITIES. FOR EXAMPLE, LOWER EDUCATIONAL ATTAINMENT IS ASSOCIATED WITH LOW LITERACY SKILLS AND LIMITED LITERACY IS A KNOWN BARRIER TO ACCESSING HEALTH INFORMATION, PROPER MEDICATION USE AND UTILIZATION OF PREVENTATIVE SERVICES. AS DESCRIBED IN FURTHER DETAIL BELOW, SDOH WERE IDENTIFIED AS SIGNIFICANT HEALTH NEEDS FOR THE COMMUNITY IN PRIMARY AND SECONDARY DATA ANALYSIS. SURVEY RESULTS AND CONVERSATIONS WITH STAKEHOLDERS HIGHLIGHTED THE BURDEN, SCOPE AND SEVERITY OF SOCIAL DETERMINANTS AMONG OUR COMMUNITY, AS WELL AS THE IMPORTANCE OUR COMMUNITY PLACES ON ADDRESSING THE NEED.

Schedule H, Part V, Section B, Line 11 Facility , 3
Facility , 3 - TEXAS SCOTTISH RITE HOSPITAL - CONTINUED. WHILE SCOTTISH RITE RECOGNIZES THAT BROAD RANGE OF SOCIAL DETERMINANTS CANNOT BE ENTIRELY WITHIN THE PURVIEW OF THE ORGANIZATION, THE ORGANIZATION CAN FEASIBLY IMPLEMENT INTERVENTIONS TO EFFECTIVELY ADDRESS SOME KEY COMPONENTS OF SDOH. NOTABLY, GIVEN THE PEDIATRIC POPULATION SERVED BY SCOTTISH RITE, THE ORGANIZATION CONSIDERS PARTNERSHIP WITH EDUCATORS AN IMPORTANT OPPORTUNITY TO REDUCE DISPARITIES. OTHER BENEFITS: IN ADDITION TO ITS CORE ORTHOPEDIC SERVICES AND ADDRESSING THE NEEDS ARTICULATED, SCOTTISH RITE PROVIDES A NUMBER OF OTHER SERVICES TO THE COMMUNITY AS DESCRIBED IN THE TEXT BELOW: FRACTURE CLINIC: THE FRACTURE CLINIC SPECIALIZES IN THE DIAGNOSIS, MANAGEMENT AND TREATMENT OF NEW FRACTURES. THE CLINIC PROVIDES INCREASED ACCESS THROUGH WALK-IN HOURS AND SAME-DAY OR NEXT-DAY APPOINTMENTS. IN FY 2022, THERE WERE MORE THAN 6,100 PATIENTS EVALUATED AND MORE THAN 11,700 OUTPATIENT CLINIC VISITS. NEUROLOGY AND REHABILITATION MEDICINE: THE NEUROLOGY AND REHABILITATION MEDICINE DEPARTMENT AT SCOTTISH RITE PROVIDES CARE FOR ORTHOPEDIC PATIENTS WHO ALSO HAVE RELATED NEUROLOGICAL DISORDERS AND NEUROMUSCULAR DISEASES, SUCH AS DEVELOPMENTAL DELAY, CEREBRAL PALSY, BRAIN MALFORMATIONS, EPILEPSY AND OTHER CONDITIONS DUE TO BRAIN, SPINAL CORD AND PERIPHERAL NERVE ABNORMALITIES. THE INSTITUTION HAS SPECIALIZED CLINICS TAILORED TO THE SPECIFIC NEEDS OF CHILDREN WITH THESE NEUROLOGIC CONDITIONS. IN FY 2022, THERE WERE MORE THAN 3,100 OUTPATIENT CLINIC VISITS. PEDIATRIC DEVELOPMENTAL DISABILITIES: THE PEDIATRIC DEVELOPMENTAL DISABILITIES DEPARTMENT AT SCOTTISH RITE PROVIDES CARE FOR PATIENTS WHOSE ORTHOPEDIC PROBLEMS ARE ACCOMPANIED BY OTHER PEDIATRIC MEDICAL CONDITIONS. DEVELOPMENTAL DISABILITIES IS A BROAD TERM USED TO DESCRIBE A VARIETY OF CONDITIONS THAT CHILDREN ARE BORN WITH OR ACQUIRE. CHILDREN WITH DEVELOPMENTAL DISABILITIES OFTEN HAVE PHYSICAL, SOCIAL, LEARNING OR BEHAVIORAL CHALLENGES. SOME OF THE PEDIATRIC DEVELOPMENTAL DISABILITIES ASSOCIATED WITH ORTHOPEDIC CONDITIONS INCLUDE SPINA BIFIDA, CEREBRAL PALSY (LIMITED TO RELATED ORTHOPEDIC CONDITIONS) AND CERTAIN GENETIC CONDITIONS WITH ORTHOPEDIC COMPLICATIONS. THE DEPARTMENT TAKES AN INTERDISCIPLINARY APPROACH TO PROVIDING THE BEST POSSIBLE PATIENT-CENTERED CARE FOR THESE CHILDREN. THE STAFF INCLUDES PHYSICIANS WHOSE SUB-SPECIALTY IS NEURO-DEVELOPMENTAL DISABILITIES, DIETICIANS, PHYSICAL, OCCUPATIONAL, THERAPEUTIC AND RESPIRATORY THERAPISTS AND NURSE PRACTITIONERS. IN ADDITION TO WORKING WITH THE CHILD, THE DEPARTMENT FOCUSES ON TEACHING FAMILY MEMBERS ABOUT THE CONDITION AND HOW THEY CAN HELP THE CHILD ATTAIN OPTIMAL PHYSICAL, MENTAL AND SOCIAL HEALTH. IN FY 2022, THERE WERE MORE THAN 2,600 OUTPATIENT CLINIC VISITS. ORTHOTICS AND PROSTHETICS: THE ORTHOTICS AND PROSTHETICS (O&P) DEPARTMENT AT SCOTTISH RITE FOR CHILDREN PROVIDES STATE-OF-THE-ART, CUSTOM-MADE ORTHOSES AND PROSTHESES FOR PATIENTS WITH SPECIAL ORTHOPEDIC NEEDS. THE ORTHOTISTS AND PROSTHETISTS PROVIDE COMPREHENSIVE CARE THROUGH CONSULTATIONS, MEASURING, CASTING AND MOLDING, FITTING, ALIGNMENT, FABRICATION AND FOLLOW-UP VISITS AT THE DALLAS AND FRISCO CAMPUSES. SINCE THE O&P TEAM IS ONSITE, THEY HAVE THE ABILITY TO COLLABORATE WITH DOCTORS, THERAPISTS AND OTHER MEDICAL STAFF DURING THE CHILD'S VISITS. IN OPERATION FOR MORE THAN 40 YEARS, DURING FY 2022, THE SCOTTISH RITE O&P DEPARTMENT FITTED MORE THAN 8,000 PROSTHETIC AND ORTHOTIC DEVICES. PSYCHOLOGY: THE PSYCHOLOGY DEPARTMENT IS COMPRISED OF PEDIATRIC PSYCHOLOGISTS AND FELLOWS WHO HAVE EXPERTISE IN WORKING WITH CHILDREN WITH COMPLEX MEDICAL CONDITIONS, INJURIES AND REHABILITATION. PSYCHOLOGY PROVIDES QUALITY PSYCHOLOGICAL INTERVENTION AND CONSULTATION, IN COLLABORATION WITH THE MEDICAL TEAM, TO IMPROVE PATIENT CARE FOR CHILDREN AND ADOLESCENTS WITH HEALTH-RELATED CONDITIONS AND SPORT INJURIES. PSYCHOLOGISTS WORK SIDE-BY-SIDE WITH WORLD-RENOWNED PEDIATRIC ORTHOPEDIC SURGEONS, SPORTS MEDICINE PHYSICIANS AND OTHER CLINICAL TEAM MEMBERS TO PROVIDE CARE FOR THE WHOLE CHILD. PSYCHOLOGISTS COORDINATE AND PARTICIPATE IN INTERDISCIPLINARY HEALTH CARE, RELATED TEAMS, COMMITTEES AND RESEARCH. DIRECT SERVICES ARE PROVIDED TO SCOTTISH RITE PATIENTS, THEIR FAMILIES AND CAREGIVERS ON AN INPATIENT AND OUTPATIENT BASIS, AND IN FY 2022, THERE WERE MORE THAN 4,000 PATIENT VISITS. SEE FURTHER DETAIL ABOVE. DENTAL CLINIC ORAL HEALTH IS IMPORTANT PART OF OVERALL HEALTH CARE WHICH CAN AFFECT PATIENT OUTCOMES. MANY CHILDREN AT TSRHC ARE MEDICALLY COMPLEX AND ARE NOT ABLE TO RECEIVE DENTAL CARE IN A PRIVATE PRACTICE SETTING. TSRHC DENTAL CLINIC HAS A HIGHLY SPECIALIZED STAFF THAT ARE TRAINED IN THE CARE OF SPECIAL NEEDS CHILDREN. THE DENTAL CLINIC AT SRC PROVIDES THIS BENEFIT TO INSURE THE BEST CLINICAL OUTCOMES FOR OUR PATIENTS. IN FY 2022, THE DENTAL CLINIC HAD APPROXIMATELY 1,600 VISITS. RHEUMATOLOGY: RHEUMATOLOGY IS DEVOTED TO THE DIAGNOSIS AND THERAPY OF RHEUMATIC DISEASES. RHEUMATOLOGISTS DEAL MAINLY WITH CLINICAL PROBLEMS INVOLVING JOINTS, SOFT TISSUES, AUTOIMMUNE DISEASES, VASCULITIS AND HERITABLE CONNECTIVE TISSUE DISORDERS. MANY OF THESE DISEASES ARE NOW KNOWN TO BE DISORDERS OF THE IMMUNE SYSTEM, AND RHEUMATOLOGY IS INCREASINGLY THE STUDY OF IMMUNOLOGY. ARTHRITIS, WHICH MEANS INFLAMMATION OF A JOINT (WHERE TWO OR MORE BONES MEET), ACTUALLY REFERS TO MORE THAN 100 DIFFERENT CONDITIONS THAT ALL FALL INTO THE CATEGORY OF RHEUMATOLOGY. ARTHRITIS AND OTHER RHEUMATIC CONDITIONS ARE DIAGNOSED BY STIFFNESS, SWELLING, PAIN AND LIMITED MOVEMENT IN JOINTS AND OTHER SUPPORTING BODY STRUCTURES, SUCH AS MUSCLES, TENDONS, LIGAMENTS, CONNECTIVE TISSUES AND BONES. SCOTTISH RITE'S RHEUMATOLOGY CLINIC TREATS CHILDREN WITH CONDITIONS THAT CAN CAUSE INFLAMMATION IN MANY DIFFERENT PARTS OF THE BODY. IN FY 2022, THERE WERE MORE THAN 4,400 PATIENT VISITS. DYSLEXIA AND LEARNING DISORDERS: SCOTTISH RITE PROVIDES A VARIETY OF SERVICES TO CHILDREN BETWEEN THE AGES OF 5 AND 14 IN ITS LUKE WAITES CENTER FOR DYSLEXIA AND LEARNING DISORDERS (CENTER FOR DYSLEXIA). SERVICES INCLUDE EVALUATION AND DIAGNOSIS FOR CHILDREN WITH ACADEMIC LEARNING DISORDERS, DYSLEXIA INTERVENTION FOR STUDENTS, DYSLEXIA THERAPIST TRAINING, EDUCATIONAL OUTREACH AND RELATED RESEARCH. THE CENTER FOR DYSLEXIA OFFERS THE DYSLEXIA THERAPIST TRAINING PROGRAM TO CERTIFIED TEXAS PUBLIC SCHOOL TEACHERS. THE TWO-YEAR COMPREHENSIVE TRAINING, ACCREDITED BY THE INTERNATIONAL MULTISENSORY STRUCTURED LANGUAGE EDUCATIONAL COUNCIL, IS DESIGNED FOR TEACHERS OF STUDENTS WITH DYSLEXIA AND USES PROVEN INTERVENTION TECHNIQUES PUBLISHED AS TAKE FLIGHT: A COMPREHENSIVE INTERVENTION FOR STUDENTS WITH DYSLEXIA. THE CENTER FOR DYSLEXIA HAS CONTINUED TO DEVELOP INTERVENTION CURRICULA TO MEET THE NEEDS OF STUDENTS OF ALL AGES, INCLUDING BRIDGES: A DYSLEXIA INTERVENTION CONNECTING TEACHER, AVATAR & STUDENT (THE AVATAR WAS DESIGNED IN COLLABORATION WITH THE UNIVERSITY OF TEXAS AT DALLAS) BUILD: A K-1 EARLY READING INTERVENTION FOR CHILDREN IN KINDERGARTEN AND FIRST GRADE WHO ARE AT RISK FOR DYSLEXIA AND TAKE FLIGHT: A COMPREHENSIVE INTERVENTION FOR SECONDARY STUDENTS WITH DYSLEXIA. THE CENTER FOR DYSLEXIA'S OUTREACH SERVICES ALLOW THE ORGANIZATION TO EXPAND ITS MISSION AND HELP THOUSANDS OF STUDENTS THROUGH SUPPORT SERVICES FOR PARENTS AND EDUCATORS. IT OFFERS CONSULTATION AND TRAINING TO SCHOOLS IN THE IDENTIFICATION OF DYSLEXIA AND THE USE OF READING INTERVENTIONS DEVELOPED AT THE INSTITUTION. RESEARCH AT THE CENTER FOR DYSLEXIA FOCUSES ON THE CAUSES AND TREATMENT OF DYSLEXIA AND LEARNING DISORDERS. RESEARCH PROJECTS HAVE INCLUDED STUDIES ON THE EFFECTIVENESS OF THE TAKE FLIGHT AND BRIDGES, THE EFFECTS OF THE CURRICULA TAUGHT IN PUBLIC SCHOOLS AND LONG-TERM OUTCOMES OF THE CENTER'S DYSLEXIA INTERVENTION. DURING THE COVID-19 PANDEMIC, STUDENTS AND TEACHERS OF THE DYSLEXIA LAB SCHOOL TRANSITIONED HOME AND WERE USING ONLINE LEARNING, AND THERAPIST TRAINING ACTIVITIES TRANSITIONED TO ONLINE ONLY, ALL WITH A GOAL OF MINIMIZING DISRUPTION OF SERVICES. IN PERSON SERVICES AND TRAINING RESUMED AS SOON AS POSSIBLE IN ACCORDANCE WITH ALL GUIDELINES. IN FY 2022, THERE WERE MORE THAN 720 PATIENTS EVALUATION AND MORE THAN 1,400 CLINIC VISITS. . PHYSICAL AND OCCUPATIONAL THERAPY: THE PHYSICAL THERAPY DEPARTMENT AT SCOTTISH RITE WORKS WITH PATIENTS TO HELP THEM DEVELOP OR MAINTAIN MAXIMUM MOVEMENT AND ABILITY. PHYSICAL THERAPISTS PERFORM VARIOUS TESTS TO DETERMINE THE PATIENT'S RANGE OF MOTION AND MUSCLE STRENGTH AND MAKE RECOMMENDATIONS FOR WALKERS, CRUTCHES AND OTHER DURABLE MEDICAL EQUIPMENT BEST SUITED TO THE CHILD'S NEEDS.

Schedule H, Part V, Section B, Line 11 Facility , 4
Facility , 4 - TEXAS SCOTTISH RITE HOSPITAL - CONTINUED. SCOTTISH RITE'S OCCUPATIONAL THERAPY DEPARTMENT TEACHES PATIENTS TO USE SPECIALIZED EQUIPMENT AND USE THEIR BODIES IN NEW WAYS THAT WILL HELP THEM WITH ACTIVITIES OF DAILY LIVING, SUCH AS EATING AND DRESSING ON THEIR OWN. PATIENTS LEARN SKILLS THAT WILL HELP THEM GAIN INDEPENDENCE AND PREPARE FOR LIVING INDEPENDENTLY AS AN ADULT. OCCUPATIONAL THERAPISTS ALSO ASSESS PATIENT DEVELOPMENT AND EVALUATE MOTOR SKILLS, PERSONAL AND SOCIAL INTERACTION AND LANGUAGE ABILITIES AND MAKE RECOMMENDATIONS FOR WHEELCHAIRS. IN FY 2022, THERE WERE MORE THAN 28,600 PHYSICAL AND OCCUPATIONAL THERAPY CLINIC VISITS. LODGING: MANY FAMILIES TRAVEL FROM OUTSIDE THE LOCAL AREA FOR TREATMENT AT SCOTTISH RITE. SOCIAL WORKERS REFER FAMILIES TO THE RONALD MCDONALD HOUSE (RMH), WHICH PROVIDES LODGING, MEALS AND TRANSPORTATION AT VERY LITTLE TO NO COST TO PATIENT FAMILIES. WHEN RMH DOES NOT HAVE A VACANCY, SOCIAL WORKERS PROVIDE A LIST OF OTHER HOTELS IN THE VICINITY WHERE FAMILIES MAY CHOOSE TO STAY. FAMILIES WITH MEDICAID MAY BE REIMBURSED BY MEDICAID FOR LODGING IN MANY SITUATIONS. THE WEBSITE HAS AN EXTENSIVE LIST OF HOTELS IN THE AREA. SOCIAL WORKERS ALSO HELP NAVIGATE OTHER LODGING ASSISTANCE OPTIONS AS AVAILABLE. RESOURCES TO ADDRESS CHILD HEALTH STATUS: SOCIAL WORKERS AND MEDICAL CONSULT COORDINATORS HELP FAMILIES ARRANGE TO RECEIVE FOLLOW-UP CARE WITH THE SERVICES LISTED BELOW AS ORDERED BY THE MEDICAL STAFF. PATIENT FAMILIES CHOOSE THEIR PROVIDER(S) FROM A LIST OF OPTIONS PROVIDED BY SOCIAL WORKERS BASED ON LOCATION AND THE PATIENT'S FUNDING SOURCE: - DURABLE MEDICAL EQUIPMENT - HOME HEALTH SERVICES - MEDICAL SUPPLIES - MENTAL HEALTH SERVICES - OUTPATIENT PHYSICAL REHABILITATION - TESTING AND SPECIALISTS - WEIGHT MANAGEMENT SCOTTISH RITE TRANSITIONS PATIENTS TO ADULT PROVIDERS AS THEY APPROACH THE AGE OF 18. A GROUP OF SCOTTISH RITE SOCIAL WORKERS, NURSES, ADMINISTRATORS AND MEDICAL STAFF WORK TO TRANSITION SCOTTISH RITE PATIENTS TO ENSURE THAT ALL PATIENTS NEEDING ADDITIONAL COORDINATION AS THEY MOVE FROM PEDIATRIC TO ADULT CARE RECEIVE THE NECESSARY ASSISTANCE. NEEDS NOT ADDRESSED IN THE CHNA: SOME ISSUES IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT HAVE NOT BEEN ADDRESSED IN THIS PLAN. SCOTTISH RITE CONSIDERED THE LEVELS TO WHICH SOME NEEDS WERE ALREADY BEING ADDRESSED IN THE SERVICE AREA. ADDITIONALLY, SOME COMMUNITY NEEDS FALL OUTSIDE THE SCOPE OF EXPERTISE AND RESOURCES OF THE ORGANIZATION AS A PEDIATRIC ORTHOPEDIC HOSPITAL AND AMBULATORY SURGICAL CENTER.

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - TEXAS SCOTTISH RITE HOSPITAL. NEITHER THE ORGANIZATION NOR ANY AUTHORIZED THIRD PARTY PERFORMED ANY OF THE ACTIONS SET FORTH IN LINE 19 (A-E).

Schedule H, Part I, Line 3b PART I, LINE 3B
FPG AS A FACTOR IN DETERMINING ELIGIBLITY FOR DISCOUNTED CARE FAMILY INCOME LIMIT FOR ELIGIBLITY FOR DISCOUNTED CARE: 1000%

Schedule H, Part I, Line 3c ELIGIBILITY FOR FINANCIAL ASSISTANCE
SINCE ITS FOUNDING IN 1921, TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN (SCOTTISH RITE) HAS PROVIDED CARE TO PATIENTS WITH NEEDS WITHIN THE HOSPITAL'S SCOPE OF SERVICES AT NO CHARGE. AS THE HOSPITAL BEGAN ACCEPTING REIMBURSEMENT IN OCTOBER 2012, IT IMPLEMENTED A NEW CHARITY CARE/FINANCIAL ASSISTANCE POLICY. FINANCIALLY INDIGENT PATIENTS, OR THOSE WHOSE INCOME IS LESS THAN OR EQUAL TO 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES (FPG), ARE ELIGIBLE FOR A 100 PERCENT DISCOUNT. ADDITIONALLY, MEDICALLY INDIGENT PATIENTS ARE ALSO ELIGIBLE FOR DISCOUNTED CARE, WITH ELIGIBILITY BASED ON FPG, MEDICAL EXPENSES AND ABILITY TO PAY.

Schedule H, Part I, Line 6a COMMUNITY BENEFIT REPORT
A COMMUNITY BENEFIT REPORT WAS CREATED FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2022, A COMMUNITY BENEFIT REPORT WILL BE FILED WITH THE STATE OF TEXAS. THE COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST.

Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH, continued
SCOTTISH RITE'S PATIENT EDUCATION IS CREATED AND MAINTAINED BY AN INTERDISCIPLINARY TEAM OF PHYSICIANS, NURSES AND ANCILLARY SERVICES THROUGHOUT THE ORGANIZATION. THE GUIDING PRINCIPLE IS BASED ON HEALTH LITERACY UNIVERSAL PRECAUTIONS, WHICH MEANS TREATING ALL PATIENTS IF THEY ARE AT RISK OF NOT UNDERSTANDING HEALTH INFORMATION. THIS APPROACH ACKNOWLEDGES THAT HEALTH CARE PROVIDERS CANNOT ACCURATELY IDENTIFY WHO UNDERSTANDS AND WHO DOES NOT; THAT HEALTH LITERACY IS SITUATIONAL AND CAN BE IMPACTED WHEN INDIVIDUALS OR THEIR CHILDREN ARE SICK, FRIGHTENED OR IN PAIN; AND THAT EVERY INDIVIDUAL BENEFITS FROM CLEAR, ACTIONABLE INFORMATION. THIS ROBUST LIBRARY OF MATERIALS INCLUDES EDUCATION PIECES ABOUT SPECIFIC SURGERIES, CONDITIONS AND MEDICAL PROCESSES, ALONG WITH MORE GENERAL AND BASIC HEALTH EDUCATION. AVAILABLE IN BOTH ENGLISH AND SPANISH, MORE THAN 450 PIECES OF EDUCATION ARE AVAILABLE FOR STAFF USE TO PROVIDE TO PATIENTS AND FAMILIES. THE MATERIAL IS WRITTEN BY SCOTTISH RITE STAFF AND MANAGED BY THE PATIENT EDUCATION COMMITTEE, WITH OVERSIGHT BY THE PATIENT EDUCATION ADVISORY BOARD. REFERRAL TO OTHER PROVIDERS: WHEN SCOTTISH RITE IS UNABLE TO PROVIDE SERVICES, SCOTTISH RITE IDENTIFIES EXTERNAL RESOURCES THAT ARE AVAILABLE TO THE FAMILY. EXAMPLES OF EXISTING HEALTH CARE PROGRAMS WITHIN THE COMMUNITY AVAILABLE TO ADDRESS THE IDENTIFIED NEEDS INCLUDE BUT ARE NOT LIMITED TO: CHILDREN'S HEALTH; UT SOUTHWESTERN MEDICAL CENTER; COOK CHILDREN'S MEDICAL CENTER; MEDICAL CITY CHILDREN'S HOSPITAL; BAYLOR INSTITUTE FOR IMMUNOLOGY RESEARCH; TEXAS CHILD NEUROLOGY; AND ATHENA DIAGNOSTICS. RESOURCES TO ADDRESS COORDINATION OF CARE: RESOURCE DETAILS ARE MAINTAINED BY THE SCOTTISH RITE SOCIAL WORK TEAM AND ARE FOUND IN THE RESOURCE DIRECTORY AND ON THE STAFF INTRANET PAGE. RESOURCES FOUND WITHIN THIS DIRECTORY INCLUDE VENDOR INFORMATION FOR SERVICES, SUCH AS - DURABLE MEDICAL EQUIPMENT, MEDICAL SUPPLIES, CUSTOM EQUIPMENT - HOME NURSING SERVICES AND SPECIALTY THERAPIES (EXAMPLES: AQUATIC, EQUESTRIAN THERAPY) - NUTRITION SUPPLIES - OUTPATIENT AND INPATIENT BEHAVIORAL HEALTH RESOURCES, SOCIAL SKILLS TRAINING AND PSYCHIATRY. THIS INFORMATION IS SEARCHABLE BY THE SERVICE NEEDED, COUNTIES SERVED AND INSURANCE ACCEPTED. OTHER COORDINATION EFFORTS INCLUDE SOCIAL WORK RESPONSE TO TRANSITION PLANNING, SCHOOL ACCOMMODATIONS, ACCESS TO HEALTH CARE, PSYCHOSOCIAL SUPPORT AND PARENT ADVOCACY. SCOTTISH RITE TRANSITIONS PATIENTS TO ADULT PROVIDERS AS THEY APPROACH THE AGE OF 18. A GROUP OF SCOTTISH RITE SOCIAL WORKERS, NURSES, ADMINISTRATORS AND MEDICAL STAFF WORK TO TRANSITION SCOTTISH RITE PATIENTS TO ENSURE THAT ALL PATIENTS NEEDING ADDITIONAL COORDINATION AS THEY REACH ADULTHOOD RECEIVE THE NECESSARY ASSISTANCE. CATEGORIES OF CARE THAT STAFF HELPS TRANSITION PATIENTS TO ADULT CARE INCLUDE LEGAL AND GUARDIANSHIP, PRIMARY AND SPECIALTY CARE, FUNDING, EDUCATION AND/OR VOCATIONAL PROGRAMS. MEDICAID TRANSPORTATION: SOCIAL WORKERS IN THE SCOTTISH RITE FAMILY SERVICES DEPARTMENT ARE AVAILABLE TO HELP FAMILIES UNDERSTAND AND NAVIGATE THE PROCESSES FOR MEDICAID TRANSPORTATION ASSISTANCE, LODGING AND MEALS WHEN ELIGIBLE FOR THESE SERVICES. SOUTHWEST AIRLINES TICKET VOUCHERS: SCOTTISH RITE SOCIAL WORKERS ARE ABLE TO FACILITATE AIRLINE TICKETS FROM SOUTHWEST AIRLINES FOR FAMILIES LIVING OUTSIDE THE DALLAS/FORT WORTH METROPLEX THAT DO NOT HAVE OTHER RESOURCES TO HELP WITH TRAVEL TO THE CAMPUSES FOR APPOINTMENTS. SOUTHWEST AIRLINES DONATES TICKET VOUCHERS TO BE USED BY FAMILIES WITH NO OTHER MEANS OF TRANSPORTATION. IF SUCH FAMILIES CAN GET TO A SOUTHWEST AIRLINES HUB, SOCIAL WORKERS WILL COORDINATE THE TRIP WITH THE FAMILY USING THE VOUCHERS.

Schedule H, Part I, Line 7 COSTING METHODOLOGY
LINES 7(A) AND (B) COMMUNITY BENEFIT EXPENSE IN COLUMN (C) WERE CALCULATED USING WORKSHEET 2: RATIO OF PATIENT CARE COST TO CHARGES. LINES 7(E), (F), AND (H) COMMUNITY BENEFIT EXPENSES WERE CALCULATED USING A STEP-DOWN ALLOCATION METHOD.

Schedule H, Part III, Line 9b COLLECTION PRACTICES
A PATIENT'S ACCOUNT WILL BE REVIEWED FOR FINANCIAL ASSISTANCE ELIGIBILITY AND THE APPROPRIATE APPLICATION OF ANY APPLICABLE THIRD-PARTY PAYMENT, AND/OR DISCOUNTS BEFORE INITIATING A STATEMENT TO THE PATIENT. ONCE A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE PATIENT SHALL BE NOTIFIED OF THE AMOUNT QUALIFYING UNDER THE POLICY, AND NO FURTHER BILLING ACTIONS SHALL BE TAKEN FOR AMOUNTS QUALIFYING UNDER THE POLICY. AFTER A PATIENT'S ACCOUNT BALANCE IS REDUCED BY ANY DISCOUNTS AVAILABLE UNDER THIS POLICY, THE PATIENT WILL BE RESPONSIBLE FOR THE REMAINDER OF HIS OR HER OUTSTANDING ACCOUNT BALANCE. THE HOSPITAL WILL SEND THREE POST-DISCHARGE BILLING STATEMENTS OVER A 120-DAY PERIOD.

Schedule H, Part VI, Line 6 AFFILIATED HEALTHCARE SYSTEM
NOT APPLICABLE

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
BAD DEBT EXPENSE IS COMPRISED OF ACTUAL UNCOLLECTIBLE AMOUNTS PLUS AN ALLOWANCE BASED ON HISTORICAL DATA. DISCOUNTS ARE NOT INCLUDED IN BAD DEBT.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BAD DEBT EXPENSE DOES NOT INCLUDE ANY COSTS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE HOSPITAL HAD AN ESTIMATED AMOUNT THAT AROSE FROM PROVIDING CHARITY CARE SERVICES OF APPROXIMATELY $17,000,000 AND 16,000,000 FOR YEARS ENDED SEPTEMBER 30, 2022, AND 2021, RESPECTIVELY. THE HOSPITAL UTILIZED THE COSTS TO CHARGE RATIOS AS CALCULATED BASED ON ITS MOST RECENT COST REPORTS FILED WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
A PATIENT'S ACCOUNT WILL BE REVIEWED FOR FINANCIAL ASSISTANCE ELIGIBILITY AND THE APPROPRIATE APPLICATION OF ANY APPLICABLE THIRD-PARTY PAYMENT, AND/OR DISCOUNTS BEFORE INITIATING A STATEMENT TO THE PATIENT. ONCE A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE PATIENT SHALL BE NOTIFIED OF THE AMOUNT QUALIFYING UNDER THE POLICY, AND NO FURTHER BILLING ACTIONS SHALL BE TAKEN FOR AMOUNTS QUALIFYING UNDER THE POLICY. AFTER A PATIENT'S ACCOUNT BALANCE IS REDUCED BY ANY DISCOUNTS AVAILABLE UNDER THIS POLICY, THE PATIENT WILL BE RESPONSIBLE FOR THE REMAINDER OF HIS OR HER OUTSTANDING ACCOUNT BALANCE. THE HOSPITAL WILL SEND THREE POST-DISCHARGE BILLING STATEMENTS OVER A 120-DAY PERIOD.

Schedule H, Part II, Line 9 COMMUNITY BUILDING ACTIVITIES
ALTHOUGH MANY OF THESE ACTIVITIES WERE PUT ON HOLD DURING THE COVID-19 PANDEMIC, AS RESTRICTIONS WERE LIFTED, SCOTTISH RITE REENGAGED IN COMMUNITY BUILDING ACTIVITIES SUCH AS THERAPEUTIC RECREATION COMMUNITY OUTREACH PROGRAMS, WHICH HELP CONNECT PATIENTS TO RESOURCES IN THE COMMUNITY AND PROMOTE HEALTH. EXAMPLES OF PROGRAMS THE ORGANIZATION PROVIDES TO PATIENTS: SPORTS AND RECREATION PROGRAMS - LEARN TO GOLF, A PROGRAM THAT PROVIDES THE TOOLS AND INSTRUCTION NEEDED FOR YOUNG PATIENTS TO EXPERIENCE THE REHABILITATIVE BENEFITS OF THE GAME OF GOLF AND CONNECT WITH LOCAL JUNIOR GOLF PROGRAMS AND INSTRUCTORS - SUMMER ALL-STARS, WHICH EMPHASIZES FUN, FITNESS, HEALTHY COMPETITION AND TEAM SPIRIT FOR BOTH PATIENTS AND THEIR SIBLINGS. THE PROGRAM ALSO CONNECT PATIENTS WITH LOCAL JUNIOR TENNIS PROGRAMS AND INSTRUCTORS. - SPECIALTY CAMPS ARE AVAILABLE FOR CHILDREN UP TO AGE 17 - FAMILY HAND CAMP FOR YOUNGER PATIENTS WITH HAND DIFFERENCES AND THEIR FAMILIES - HAND CAMP FOR PATIENTS WITH HAND DIFFERENCES AGES 10 - 17 - CAMP TLC FOR PATIENTS WITH SPINA BIFIDA - CAMP BREAKING BOUNDARIES FOR PATIENTS WITH CEREBRAL PALSY - CAMP JOINT ADVENTURE FOR PATIENTS WITH ARTHRITIS, ARTHROGRYPOSIS AND MULTIPLE MISSING LIMBS - AMPUTEE SKI TRIP FOR TEENAGE PATIENTS WITH MISSING LIMBS THESE PROGRAMS ARE DESIGNED TO EMPOWER PARTICIPANTS IN THEIR DAILY LIVES AND HAVE A POSITIVE, ENDURING EFFECT ON SELF-ESTEEM. THE ORGANIZATION ALSO HOSTS VARIOUS PEER AND PARENT SUPPORT GROUPS FOR THE COMMUNITY, SUCH AS PALS (PROSTHETICS AND LIMB SUPPORT), HANDS DOWN SUPPORT GROUP, ETC. THE ORGANIZATION ANNUALLY HOSTS AN EVENT FOCUSED ON COMMUNITY DEVELOPMENT. BIKE RODEO AND CHILD SAFETY DAY, WHICH IS HELD AT NO CHARGE TO PARTICIPANTS, IS FOCUSED ON EDUCATION AND PREVENTION. SCOTTISH RITE REGULARLY ENGAGES WITH THE COMMUNITY, EDUCATING YOUNG ATHLETES, PARENTS, COACHES AND SCHOOL DISTRICTS ABOUT SPORTS SAFETY, INJURY PREVENTION AND CONCUSSION MANAGEMENT AT HEALTH FAIRS AND COACHING CLINICS. SCOTTISH RITE IS ALSO ENGAGED WITH COMMUNITY PARTNERS FOR REVERCHON PARK ROUND UP. THIS ANNUAL EVENT BRINGS TOGETHER COMMUNITY AND CITY DEPARTMENTS AS WELL AS VOLUNTEERS FROM THE COMMUNITY TO HELP BEAUTIFY AND MAINTAIN HISTORIC REVERCHON PARK, LOCATED IN SCOTTISH RITE'S BACKYARD. SCOTTISH RITE ALSO CONNECTS WITH THE COMMUNITY THROUGH ITS T. BOONE PICKENS TRAINING AND CONFERENCE CENTER BY ANNUALLY HOSTING MANY EVENTS TO EDUCATE AND INFORM COMMUNITY MEMBERS ON VARIOUS MEDICAL AND NON-MEDICAL TOPICS. THESE EVENTS TRADITIONALLY INCLUDE MEETINGS REGARDING CHILD HEALTH CARE ORGANIZED BY THE DALLAS-FORT WORTH HOSPITAL COUNCIL, ADVANCED MEDICAL TRAINING FOR NURSES AND PHYSICIANS IN CONJUNCTION WITH UT SOUTHWESTERN MEDICAL CENTER AND GATHERINGS OF PATIENT/FAMILY SUPPORT GROUPS FOR THOSE UNDERGOING TREATMENT FOR A CONDITION TREATED AT SCOTTISH RITE.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE ORGANIZATION MAINTAINS ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS FOR ESTIMATED LOSSES RESULTING FROM A PAYOR'S INABILITY TO MAKE PAYMENTS ON ACCOUNTS. THE ORGANIZATION ASSESSES THE REASONABLENESS OF THE ALLOWANCE ACCOUNT BASED ON HISTORICAL WRITE-OFFS, CASH COLLECTIONS, THE AGING OF THE ACCOUNTS AND OTHER ECONOMIC FACTORS. ACCOUNTS ARE WRITTEN OFF WHEN COLLECTION EFFORTS ARE UNSUCCESSFUL. MANAGEMENT CONTINUALLY MONITORS AND ADJUSTS ITS ALLOWANCES ASSOCIATED WITH ITS RECEIVABLES. AS A RESULT OF THE NEW FASB ACCOUNTING STANDARDS CODIFICATION (ASC) REVENUE FROM CONTRACTS WITH CUSTOMERS, TOPIC 606 PRONOUCEMENT, FOOTNOTE FOR ALLOWANCE FOR DOUBTFUL ACCOUNT IS NOT REQUIRED FOR FINANCIAL STATEMENTS. THEREFORE, NO FOOTNOTE WAS INCLUDED FOR FISCAL YEAR END 2022 AUDITED FINANCIAL STATEMENTS.

Schedule H, Part V, Section B, Line 16a FAP website
- TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN: Line 16a URL: WWW.SCOTTISHRITEHOSPITAL.ORG;

Schedule H, Part V, Section B, Line 16b FAP Application website
- TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN: Line 16b URL: WWW.SCOTTISHRITEHOSPITAL.ORG;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN: Line 16c URL: WWW.SCOTTISHRITEHOSPITAL.ORG;

Schedule H, Part VI, Line 2 Needs assessment
IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, THE HOSPITAL IS AN ACTIVE PARTICIPANT IN VARIOUS DALLAS-FORT WORTH HOSPITAL COUNCIL ACTION GROUPS. A MEMBER OF THE HOSPITAL LEADERSHIP TEAM CHAIRS THE HEALTHCARE COLLABORATIVE WITH THE COUNCIL. THROUGH THE COLLABORATIVE, THE OTHER MAJOR HOSPITAL REPRESENTATIVES WITHIN THE COMMUNITY COME TOGETHER TO GATHER AND ANALYZE DATA, RESOURCES, DISPARITIES AND ACCESS NEEDS, WHILE STRATEGIZING SOLUTIONS FOR CLOSING IDENTIFIED GAPS. IN RECENT YEARS, UNDERTAKINGS OF THIS COLLABORATIVE HAVE INCLUDED A HEALTH NEEDS ASSESSMENT RELATED TO MENTAL HEALTH ACCESS AND SUBSTANCE ABUSE, AS WELL AS THE CREATION, OPTIMIZATION AND MAINTENANCE OF A SEARCHABLE MENTAL HEALTH RESOURCE GUIDE AVAILABLE THROUGH A PUBLIC WEBSITE. THROUGH ADDITIONAL SUBGROUPS, OTHER HEALTH NEEDS ASSESSMENTS AND ACTION PLANS HAVE BEEN CREATED TO ADDRESS MENTAL HEALTH FIRST AID TRAINING, OBESITY AND HEALTH LITERACY. THE HOSPITAL MAINTAINS REPRESENTATION AND CONTRIBUTIONS ON THE MENTAL HEALTH AND HEALTH LITERACY SUBGROUPS.

Schedule H, Part VI, Line 5 Promotion of community health
MEDICAL CARE IS PROVIDED TO CHILDREN WITH ORTHOPEDIC AND RELATED CONDITIONS NOT TREATED AT OTHER MEDICAL FACILITIES. MANY PROVIDERS AT SCOTTISH RITE RECEIVE REFERRALS FROM PHYSICIANS AND CHILDREN'S HOSPITALS IN THE PRIMARY SERVICE AREA BECAUSE THE PATIENT'S CONDITION IS EITHER TOO ACUTE OR, IN SOME CASES, SO RARE, THE REFERRING FACILITY DOES NOT HAVE ADEQUATELY TRAINED OR EXPERIENCED STAFF TO PROVIDE THE NECESSARY CARE. THE ORGANIZATION HAS A PROCESS TO DETERMINE IF IT IS THE APPROPRIATE FACILITY TO MEET A CHILD'S CLINICAL NEEDS. THE PROCESS BEGINS WITH A TELEPHONE CALL, REQUEST THROUGH THE WEBSITE, REFERRAL FROM A PHYSICIAN OR AN APPLICATION FOR SERVICES. AN INTERNAL MECHANISM IS UTILIZED TO DETERMINE IF SCOTTISH RITE CAN APPROPRIATELY MEET THE NEEDS OF THE CHILD. WHEN SCOTTISH RITE IS UNABLE TO PROVIDE SERVICES, SCOTTISH RITE, AS PART OF ITS CARE COORDINATION SERVICES, IDENTIFIES REFERRAL RESOURCES THAT ARE PROVIDED TO THE FAMILY. IN ADDITION TO GENERAL PEDIATRIC ORTHOPEDIC SERVICES, THE PEDIATRIC ORTHOPEDIC SERVICES FOR WHICH PATIENTS ARE PRIMARILY REFERRED TO THE INSTITUTION INCLUDE SCOLIOSIS AND SPINE DISORDERS, CLUBFOOT AND OTHER FOOT DISORDERS, REDUCTION DEFICITS (LIMB LENGTHENING), HAND AND UPPER LIMB DIFFERENCES, HIP DISORDERS, SPORTS MEDICINE, FRACTURES, PROGRAMS RELATED TO CONGENITAL LIMB DEFICIENCIES AND AMPUTATIONS, NEUROLOGY, RHEUMATOLOGY AND PEDIATRIC DEVELOPMENTAL DISABILITIES TREATED IN ADDITION OR RELATED TO OTHER ORTHOPEDIC CONDITIONS. RESEARCH: SINCE OPENING ITS DOORS IN 1921, SCOTTISH RITE HAS COMMITTED TO DISCOVERING NEW AND BETTER WAYS TO CARE FOR CHILDREN AFFECTED BY PEDIATRIC ORTHOPEDIC CONDITIONS AND CERTAIN RELATED NEUROLOGICAL AND ARTHRITIC DISORDERS. THE INSTITUTION'S DEDICATED RESEARCH CENTER, THE SARAH M. AND CHARLES E. SEAY CENTER FOR MUSCULOSKELETAL RESEARCH, IS MADE UP OF SIX CENTERS FOR EXCELLENCE SUPPORTED BY RESEARCH DIVISIONS AND CORE FACILITIES: SCOLIOSIS AND SPINE; CLUBFOOT AND FOOT DISORDERS; HIP DISORDERS; LIMB LENGTH DISCREPANCIES AND RECONSTRUCTION; HAND DIFFERENCES; AND SPORTS MEDICINE. THROUGH THE YEARS, SCOTTISH RITE RESEARCHERS AND PHYSICIANS HAVE GENERATED MORE THAN 50 PATENTS AND MADE IMPORTANT DISCOVERIES THAT HAVE HELPED CHILDREN WORLDWIDE. THESE FINDINGS AND INNOVATIONS ALLOW THE MEDICAL COMMUNITY TO FORM NEW HYPOTHESES TO EXPLAIN WHAT CAUSES CERTAIN CONDITIONS WHILE PROVIDING TOOLS FOR FUTURE RESEARCH. THE MAJOR DISCOVERIES AND RESEARCH APPLICATIONS AT SCOTTISH RITE INCLUDE: THE FIRST GENE ASSOCIATED WITH IDIOPATHIC SCOLIOSIS; TWO MORE GENETIC MARKERS OF THE CONDITION; THE TSRH SILOTM 5.5 SPINAL SYSTEM; THE TRUE/LOKTM EXTERNAL FIXATION SYSTEM ; AND THE TRUE/LOK HEXAPOD SYSTEMTM. THE INSTITUTION IS COMMITTED TO TRANSLATING ITS SCIENTIFIC DISCOVERIES INTO IMPROVED CARE AND TREATMENT OUTCOMES FOR CHILDREN WITH MUSCULOSKELETAL CONDITIONS. TO THAT END, THE ORGANIZATION HAS LAUNCHED A MULTIDISCIPLINARY CENTER FOR PEDIATRIC BONE BIOLOGY AND TRANSLATIONAL RESEARCH. THE CENTER INCLUDES 3,200 SQUARE FEET OF LABORATORIES AND OFFICES DEDICATED TO BONE-RELATED RESEARCH. IN COLLABORATION WITH UT SOUTHWESTERN MEDICAL CENTER, RESEARCHERS WILL EXPLORE THE ROOT CAUSES OF BONE DISORDERS WITH A BENCH TO BEDSIDE TRANSLATIONAL RESEARCH AND TREATMENT APPROACH. IN ADDITION, IT WILL FURTHER EXPAND THE FACILITY'S ROLE AS A TRAINING SITE FOR FELLOWS, VISITING SCIENTISTS AND STUDENTS. IT WILL ALSO HOST INTERNATIONAL GATHERINGS DEDICATED TO COLLABORATIVE RESEARCH THAT WILL BENEFIT CHILDREN THROUGHOUT THE COMMUNITY AND AROUND THE WORLD. MEDICAL EDUCATION: FOR MORE THAN 40 YEARS, IN ASSOCIATION WITH THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL, SCOTTISH RITE FOR CHILDREN HAS PROVIDED AN EXTRAORDINARY EXPERIENCE IN THE FIELD OF PEDIATRIC ORTHOPEDICS TO PROMISING ORTHOPEDIC SURGEONS. NEARLY 200 PHYSICIANS HAVE BENEFITED FROM THE FELLOWSHIP IN PEDIATRIC ORTHOPEDICS AND SCOLIOSIS, GOING ON TO PROVIDE NEEDED PEDIATRIC SPECIALTY SERVICES ACROSS THE COUNTRY AND AROUND THE WORLD. THE FELLOWSHIP HAS RECENTLY BEEN EXPANDED TO INCLUDE ADDITIONAL FELLOWS IN THE FIELD OF PEDIATRIC ORTHOPEDIC SPORTS SURGERY. IN ADDITION TO THE FELLOWSHIP PROGRAM, THE INSTITUTION PARTICIPATES WITH 88 EDUCATIONAL INSTITUTIONS FOR 22 RESIDENT AND FELLOW LEVEL FIELDS OF STUDY, AS WELL AS 28 DISCIPLINES INVOLVING GRADUATE, UNDERGRADUATE AND HIGH SCHOOL STUDENTS. THE RESIDENCY TRAINING PROGRAM AFFLIATIONS ARE WITH MANY DIFFERENT INSTITUTIONS INCLUDING UTSW, BAYLOR UNIVERSITY MEDICAL CENTER, DALLAS COUNTY HOSPITAL DISTRICT (DCHC), UC SAN DIEGO, TEXAS A&M, CHILDREN'S MEDICAL CENTER OF DALLAS, AND TRIPLER ARMY MEDICAL CENTER. THE ORGANIZATION PARTICIPATES IN RESIDENCY TRAINING PROGRAMS IN AREAS AS DIVERSE AS NEUROLOGY, PEDIATRIC RHEUMATOLOGY, ORTHOPEDICS, RADIOLOGY, PEDIATRIC DEVELOPMENTAL DISABILITIES, PLASTIC SURGERY FOR HAND, PEDIATRIC REHABILITATION MEDICINE, ANESTHESIA, ORTHOPEDIC SPORTS MEDICINE, UROLOGY, DENTISTRY, PEDIATRIC NEUROLOGY, PEDIATRIC NEUROSURGERY, NEUROPHYSIOLOGY, PEDIATRIC HEADACHE MEDICINE AND PEDIATRIC EMERGENCY MEDICINE. SCOTTISH RITE FOR CHILDREN ALSO HAS EXTENSIVE AFFILIATION PROGRAMS FOR EDUCATION OF STUDENTS IN CLINICAL AREAS SUCH AS PHYSICAL THERAPY, OCCUPATIONAL THERAPY, ORTHOTIC AND PROSTHETICS, TRAINING OF PA STUDENTS, STEM EDUCATION FOR HIGH SCHOOL AND COLLEGE FEMALES, DIETETICS, SCRUB STUDENTS, THERAPEUTIC RECREATION AND SPEECH PATHOLOGY. FAMILY RESOURCE CENTER: THE CHRISTI CARTER URSCHEL FAMILY RESOURCE CENTER'S MISSION IS TO PROVIDE HEALTH INFORMATION AND SUPPORT RESOURCES TO PATIENTS AND FAMILIES IN ORDER TO HELP THEM MAKE INFORMED HEALTH CARE DECISIONS AND IMPROVE THEIR QUALITY OF LIFE. SCOTTISH RITE UNDERSTANDS THAT FAMILIES WHOSE CHILDREN ARE DIAGNOSED WITH MEDICAL CONDITIONS HAVE MANY QUESTIONS, AND THE FAMILY RESOURCE CENTER CAN HELP THE SCOTTISH RITE PATIENTS AND FAMILIES FIND ANSWERS. A MEDICAL LIBRARIAN AND A LICENSED SOCIAL WORKER ARE AVAILABLE TO HELP PATIENTS AND FAMILIES LOCATE INFORMATION AND RESOURCES. STAFF MEMBERS CAN ALSO ANSWER QUESTIONS ABOUT COMMUNITY SUPPORT GROUPS AND EXTERNAL AGENCIES. THE CENTER SERVES AN AVERAGE OF 1,700 FAMILIES ANNUALLY. FAMILY ROOM AND CHAPEL ON DALLAS CAMPUS: THE FAMILY ROOM IS PRIMARILY UTILIZED BY PATIENT FAMILIES AS A COMFORTABLE SURGERY WAITING AREA, WHILE THE CHAPEL LOCATED NEXT DOOR PROVIDES A PLACE OF WORSHIP WITH NONDENOMINATIONAL SERVICES EACH SUNDAY. FAMILY ROOM IN FRISCO: THE RONALD MCDONALD FAMILY ROOM ACCOMMODATES 25 PEOPLE AND OFFERS A PLACE OF RESPITE, RELAXATION AND COMFORT TO FAMILIES WITH CHILDREN RECEIVING OUTPATIENT CARE AT THE FRISCO CAMPUS. RESEARCH SHOWS THAT STAYING CLOSE BY ALLOWS PARENTS TO BETTER COMMUNICATE WITH THEIR CHILD'S MEDICAL TEAM AND IMPROVES ADHERENCE TO COMPLICATED TREATMENT PLANS. FAMILIES WITH ACCESS TO A RONALD MCDONALD FAMILY ROOM REPORT A BETTER OVERALL CLINICAL EXPERIENCE. CHILD LIFE SERVICES: CHILD LIFE SPECIALISTS FOCUS ON EACH PATIENT AND THEIR FAMILY'S SPECIFIC NEEDS BY PROMOTING OPTIMAL PSYCHOSOCIAL DEVELOPMENT AND EDUCATIONAL NEEDS OF CHILDREN AND TEENAGERS TO HELP REDUCE FEAR AND PROMOTE COPING DURING THEIR VISIT. THEY PROVIDE SERVICES, SUCH AS PREPARATION AND SUPPORT FOR MEDICAL PROCEDURES, EDUCATION ABOUT DIAGNOSIS, COPING TECHNIQUES TO USE DURING MEDICAL EXPERIENCES, ENGAGEMENT IN MEDICAL PLAY, OUTLETS FOR SELF-EXPRESSION AND SUPPORT FOR SIBLINGS. THE CHILD LIFE DEPARTMENT WELCOMED THE ADDITION OF A FACILITY DOG IN 2021, AND THE FRISCO CAMPUS IS EXPECTED TO HAVE A FACILITY DOG JOIN IN 2023. FACILITY DOG INTERVENTION WITH PATIENTS PROMOTES POSITIVE COPING AND DECREASES THE CHANCE OF MEDICAL-RELATED TRAUMA. IN FY 2022, MORE THAN 10,900 PATIENTS WERE SERVED. FAMILY SERVICES DEPARTMENT: THE FAMILY SERVICES DEPARTMENT SERVES AS A SUPPORT CENTER FOR PATIENTS AND THEIR FAMILIES WHILE THEY ARE RECEIVING TREATMENT AT SCOTTISH RITE. FAMILY SERVICES INCLUDES THESE AREAS: MEDICAL SOCIAL WORK FOR RESOURCES AND REFERRALS; FINANCIAL ASSISTANCE PROGRAMS AND FAMILY SERVICES COUNSELING; LANGUAGE INTERPRETATION AND TRANSLATION SERVICES; AND COORDINATION OF OFF-SITE MEDICAL SERVICES. IN FY 2022, THERE WERE MORE THAN 32,200 CALLS AND VISITS PROVIDED. RESOURCES TO ADDRESS CHILD HEALTH STATUS: SOCIAL WORKERS AND MEDICAL CONSULT COORDINATORS HELP FAMILIES ARRANGE TO RECEIVE FOLLOW-UP CARE FOR THE SERVICES ORDERED BY THE MEDICAL STAFF. PATIENT FAMILIES CHOOSE THEIR PROVIDER(S) FROM A LIST OPTIONS PROVIDED BY SOCIAL WORKERS BASED ON LOCATION AND THE PATIENT'S FUNDING SOURCE. THESE SERVICES INCLUDE WEIGHT MANAGEMENT, OUTPATIENT PHYSICAL REHAB, HOME HEALTH SERVICES, DURABLE MEDICAL EQUIPMENT, MEDICAL SUPPLIES, TESTING AND SPECIALISTS AND MENTAL HEALTH.

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
FAMILIES ARE CONTACTED BY FAMILY SERVICES COUNSELORS PRIOR TO EACH PATIENT'S SCHEDULED SURGICAL PROCEDURES, INPATIENT VISITS, MRI, CT AND ORTHOTICS AND PROSTHETICS TO INFORM THEM ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND TO ASSESS THEIR POTENTIAL QUALIFICATION FOR FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS. FAMILIES ARE NOTIFIED UPON CHECK-IN FOR OUTPATIENT APPOINTMENTS THAT FAMILY SERVICES COUNSELORS ARE AVAILABLE TO OFFER THE SAME APPLICATION. THE FACILITY HAS ALSO POSTED SPECIFICS ABOUT AVAILABLE FINANCIAL ASSISTANCE AT REGISTRATION, IN PATIENT WAITING AREAS, ON THE WEBSITE AND IN A SUMMARY PRINTED IN ENGLISH AND SPANISH THAT IS INSERTED INTO EACH PATIENT'S REGISTRATION PACKET. IN ADDITION, EACH POST-DISCHARGE BILLING STATEMENT WILL NOTIFY THE PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE INDIVIDUALS, INCLUDING A PHONE NUMBER FOR INQUIRIES ABOUT FINANCIAL ASSISTANCE AND A WEBSITE WHERE ADDITIONAL INFORMATION CAN BE OBTAINED. INFORMATION REGARDING THIS POLICY AND HOW TO APPLY FOR FINANCIAL ASSISTANCE WILL ALSO BE PROVIDED DURING PHONE CONVERSATIONS WITH PATIENTS REGARDING FINANCIAL CHARGES AND/OR ACCOUNT BALANCES.

Schedule H, Part VI, Line 4 Community information
THE COMMUNITY SERVED BY SCOTTISH RITE CAN BEST BE DEFINED BY UNDERSTANDING ITS PATIENT POPULATION AND CLINICAL FOCUS. THE ORGANIZATION IS A 501(C)(3) PEDIATRIC ORTHOPEDIC HOSPITAL IN DALLAS, TEXAS, AND AN OUTPATIENT DEPARTMENT, INCLUDING AN AMBULATORY SURGERY CENTER IN FRISCO, TEXAS. SCOTTISH RITE TREATS PEDIATRIC ORTHOPEDIC CONDITIONS, SPORTS INJURIES, FRACTURES, AS WELL AS CERTAIN RELATED ARTHRITIC AND NEUROLOGICAL DISORDERS AND DYSLEXIA/LEARNING DISORDERS. SCOTTISH RITE PROVIDES PREMIER PEDIATRIC ORTHOPEDIC AND DYSLEXIA SERVICES TO PEDIATRIC PATIENTS FOR WHOM THE SERVICES PROVIDED BY THE ORGANIZATION OFFER HOPE OF IMPROVEMENT. THOUGH THE ORGANIZATION IS DEDICATED TO PROVIDING CARE TO CHILDREN FROM AROUND THE STATE OF TEXAS AND THROUGHOUT THE U.S., THE COMMUNITY SERVED BY SCOTTISH RITE IS COMPRISED OF EIGHT COUNTIES IN NORTH TEXAS THAT, IN TOTAL, SPAN 6,537 SQUARE MILES, WHICH COMPRISE APPROXIMATELY 80 PERCENT OF ALL SCOTTISH RITE'S INPATIENT DISCHARGES. SIMILARLY, ALTHOUGH SCOTTISH RITE HAS A BROAD REACH RELATIVE TO OUTPATIENT SERVICES, IN FY 2021, APPROXIMATELY 90 PERCENT OF ALL OUTPATIENT VISITS AT SCOTTISH RITE LOCATIONS ORIGINATED FROM THE EIGHT-COUNTY SERVICE AREA. DEFINING ITS PRIMARY COMMUNITY WILL ALLOW THE ORGANIZATION TO MORE EFFECTIVELY FOCUS ITS RESOURCES TO ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS TARGETING AREAS OF GREATEST NEED AND HEALTH DISPARITIES. POPULATION FIGURES WERE OBTAINED FROM ESRI, A LEADING GIS PROVIDER THAT UTILIZES U.S. CENSUS DATA PROJECTED FORWARD USING PROPRIETARY METHODOLOGIES. ACCORDING TO ESRI, THE 2021 ESTIMATED POPULATION FOR THE PRIMARY SERVICE AREA WAS 7,467,106 PEOPLE. BASED ON ESRI DATA, THE MEDIAN HOUSEHOLD INCOME FOR THE PRIMARY SERVICE AREA WAS $77,035, WHILE TEXAS' AVERAGE MEDIAN HOUSEHOLD INCOME WAS $66,048. IN 2021, APPROXIMATELY 25.4 PERCENT OF THE PRIMARY SERVICE AREA POPULATION WAS YOUNGER THAN 18 YEARS OF AGE.