4A (Expenses $ 337321131 including grants of $ 0) (Revenue $ 604892017)
See Schedule O

4B (Expenses $ 321405306 including grants of $ 0) (Revenue $ 245514063)
See Schedule O

4C (Expenses $ 265670343 including grants of $ 0) (Revenue $ 184892858)
See Schedule O

4D (Expenses $ 4855101 including grants of $ 5500) (Revenue $ 0)
COMMUNITY SERVICES FOR THE BROADER COMMUNITY THE GREATEST SHARE OF THESE EXPENSES IS USED FOR EDUCATING HEALTH PROFESSIONALS. HELPING TO PREPARE FUTURE HEALTH CARE PROFESSIONALS IS A DISTINGUISHING CHARACTERISTIC OF NOT-FOR-PROFIT HEALTH CARE, AND CONSTITUTES A SIGNIFICANT COMMUNITY BENEFIT. CHRISTUS SANTA ROSA HEALTH CARE CORPORATION ALSO USED CASH DONATIONS AS A VEHICLE TO HELP OUR COMMUNITIES. WE MADE CASH DONATIONS, IN ADDITION TO GRANTS AWARDED THROUGH THE CHRISTUS FUND, TO INCREASE ACCESS TO HEALTH CARE, SUPPORT CAUSES LIKE THE FIGHT AGAINST CANCER, HEART DISEASE, DIABETES, AND FOR MANY OTHER EQUALLY WORTHY PURPOSES. DURING FY 2022, CHRISTUS SANTA ROSA ADVOCATED FOR IMPROVING PUBLIC POLICIES, WORKING TO ESTABLISH, AND IN SOME INSTANCES AUGMENT, GRASSROOTS ADVOCACY AND GREATER ACCESS TO HEALTHCARE SERVICES FOR THE CONSTITUENTS WE SERVE.

Schedule H, Part V, Section B, Line 3E
CHRISTUS Santa Rosa Health System and The Children's Hospital of San Antonio, CHRISTUS Santa Rosa Hospital - New Braunfels and CHRISTUS Santa Rosa Hospital - San Marcos The CHNAs identified many priorities to be addressed. However, given the large population of uninsured patients with chronic illness who seek care at CHRISTUS Santa Rosa Health System, CSRHS chooses to implement programs specifically at this population. To that end, the major community benefit activities enacted by CSRHS are focused on Advancing Health & Wellbeing (Specialty Care & Chronic Illness, Behavioral Health) and Build Resilient Communities & Improving Social Determinants. CSRHS anticipates meeting all of the needs identified.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - CHRISTUS Santa Rosa Health System and The Children's Hospital of San Antonio. Input from persons who represent the community health needs assessment process included synthesizing existing quantitative data on Social, Economic, and Health indicators for the County. Quantitative data was compiled and analyzed from a number of sources, including the U.S. Census, Centers for Disease Control and Prevention, County Health Rankings, Texas Department of State Health Services, San Antonio Metropolitan Health District, and Nowdata. Types of data included public health disease surveillance data, hospitalization records, vital statistics based on birth and death data, and self-reports for health behaviors from large, population-based surveys, such as the behavioral risk factor surveillance survey and youth risk behavior survey. When possible, data was provided down to the subsector level to provide relevant information for more granular geographic areas within Bexar County. To compliment these quantitative data, qualitative information was collect and analysis was based on five focus groups and five key informant interviews from community members, including community health works, people over 65, young adults 15 to 18, and Mayor Ron Nirenberg. The focus groups and interviews were moderated by staff at The Health Collaborative and analyzed by Community Information Now (CI:Now). Using a grounded theory framework and the software Dedoose CI:Now performed open coding as an initial way of identifying general themes, axial coding as a way of connecting the themes into categories and subcategories, and selective coding to identify themes.

Schedule H, Part V, Section B, Line 5 Facility A, 2
Facility A, 2 - CHRISTUS Santa Rosa Hospital - New Braunfels and CHRISTUS Santa Rosa Hospital - San Marcos. Community Focus Groups and Key Informant Interviews were a critical part of robust, primary data collection for the CHNA involved speaking directly to community members, partners and leaders that live in and/or work in the CHRISTUS Santa Rosa Hospital - New Braunfels PSA and CHRISTUS Santa Rosa Hospital - San Marcos PSA. All focus groups were coordinated by hospital site and the CHRISTUS Health system office and facilitated by Metopio. Focus groups included a broad range of individuals from underrepresented, and priority populations in the respective hospital sites. Focus groups were conducted virtually, lasted 90 minutes and had up to 10 community members participate in each group.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - CHRISTUS Santa Rosa Health System and The Children's Hospital of San Antonio. In Bexar County, CHRISTUS Santa Rosa Health System, Methodist Healthcare Ministries, Baptist Health System, WellMed Medical Management, and University Health System worked together. In addition, community focus groups and key informant interviews were conducted.

Schedule H, Part V, Section B, Line 6a Facility A, 2
Facility A, 2 - CHRISTUS Santa Rosa Hospital - New Braunfels and CHRISTUS Santa Rosa Hospital - San Marcos. The hospitals' CHNAs were not a collaboration with any other hospital facility in the area. Spoke directly to community members, partners and leaders that live in and/or work in the PSA. This was done through focus groups and key informant interviews representing the public and not-for-profit community-based organizations. In CSRHS - New Braunfels, participants included Hill County Community Mental Health Center, Recovery Werks, McKenna Foundation, New Braunfels Christian Ministry, NB Food Bank, NB Housing Partners, Volunteers in Medicine, and 10 Community members representing underrepresented and priority populations. In CSRHS - San Marcos, participants included the SM Housing Authority, Hays-Caldwell Women's Center, Hays County Food Bank, Southside Community Center, Community Action Inc. of Hays, Caldwell & Blanco, Central Texas Children's Home and 10 community members representing underrepresented and priority populations.

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - CHRISTUS Santa Rosa Health System and The Children's Hospital of San Antonio. In Bexar County, CHRISTUS Santa Rosa Health System, Methodist Healthcare Ministries, Baptist Health System, WellMed Medical Management, and University Health System worked together. In addition, community focus groups and key informant interviews were conducted.

Schedule H, Part V, Section B, Line 6b Facility A, 2
Facility A, 2 - CHRISTUS Santa Rosa Hospital - New Braunfels and CHRISTUS Santa Rosa Hospital - San Marcos. The hospitals' CHNAs were not a collaboration with any other hospital facility in the area. Spoke directly to community members, partners and leaders that live in and/or work in the PSA. This was done through focus groups and key informant interviews representing the public and not-for-profit community-based organizations. In CSRHS - New Braunfels, participants included Hill County Community Mental Health Center, Recovery Werks, McKenna Foundation, New Braunfels Christian Ministry, NB Food Bank, NB Housing Partners, Volunteers in Medicine, and 10 Community members representing underrepresented and priority populations. In CSRHS - San Marcos, participants included the SM Housing Authority, Hays-Caldwell Women's Center, Hays County Food Bank, Southside Community Center, Community Action Inc. of Hays, Caldwell & Blanco, Central Texas Children's Home and 10 community members representing underrepresented and priority populations.

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - CHRISTUS SRHC and THE CHILDREN'S HOSPITAL OF SAN ANTONIO, CHRISTUS SRH- New Braunfels and and CHRISTUS SRH - San Marcos. The CHNAs identified many priorities to be addressed. However, given the large population of uninsured patients with chronic illness who seek care at CHRISTUS Santa Rosa Health System, CHSRHS chooses to implement programs targeted specifically at this population. To that end, the major community benefit activities enacted by CSRHS are focused on Advancing Health & Wellbeing (Specialty Care & Chronic Illness, Behavioral Health), as well as building resilient communities and improving social determinants by addressing healthy food access and smoking/vaping. CSRHS anticipates meeting all of the needs identified.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - See Schedule, H, Part V, Section A. UNDER THE HOSPITAL'S POLICY, PATIENTS WHO WERE UNINSURED AND MET CERTAIN FINANCIAL CRITERIA WERE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE POLICY ALSO PROVIDED FOR ASSISTANCE FOR MEDICALLY INDIGENT PATIENTS. IN GENERAL, PATIENTS WHO WERE BELOW 300% OF FEDERAL POVERTY GUIDELINES RECEIVED FREE CARE. PATIENTS WHO WERE UNINSURED AND ABOVE 300% OF THE FEDERAL POVERTY GUIDELINE WERE BILLED RATES CONSISTENT WITH AMOUNTS GENERALLY BILLED TO COMMERCIAL PAYERS. PATIENTS WHO WERE UNINSURED AND BETWEEN 300% TO 400% OF FEDERAL POVERTY GUIDELINES COULD APPLY FOR ADDITIONAL ASSISTANCE TO PAY AMOUNTS LESS THAN AGB.

Schedule H, Part V, Section B, Line 15 Facility A, 1
Facility A, 1 - See Schedule, H, Part V, Section A. IN ADDITION TO REGULAR APPLICATIONS, THE HOSPITAL ALSO ASSESSED PATIENTS FOR PRESUMPTIVE ELIGIBILITY TO FACILITATE GIVING ASSISTANCE TO NEEDY PATIENTS. THE HOSPITAL IMPLEMENTED ELECTRONIC ELIGIBILITY TOOLS THAT USED PATIENT DEMOGRAPHIC DATA, CREDIT REPORTS, AND OTHER PUBLICLY AVAILABLE INFORMATION TO ESTIMATE A PATIENT'S INCOME, ASSETS, AND LIQUIDITY. PATIENTS WERE SCREENED AS PART OF THE COLLECTION ATTEMPT PROCESS. WHEN ELECTRONIC SCREENING WAS USED AS THE BASIS FOR PRESUMPTIVE ELIGIBILITY, THE HIGHEST DISCOUNT OF FULL FREE CARE WAS GRANTED FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. IF A PATIENT DID NOT QUALIFY UNDER THE ELECTRONIC ENROLLMENT PROCESS, THE PATIENT COULD STILL BE CONSIDERED UNDER THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS.

Schedule H, Part V, Section B, Line 16 Facility A, 1
Facility A, 1 - See Schedule, H, Part V, Section A. HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICY THE HOSPITAL POSTED SIGNS TO INFORM PATIENTS ABOUT THE AVAILABILITY OF CHARITY CARE IN THE EMERGENCY DEPARTMENT, LOBBY, AND ADMISSIONS AREAS. IN ADDITION, A SUMMARY OF THE POLICY AND DOCUMENTS NEEDED TO APPLY FOR ASSISTANCE WAS WIDELY AVAILABLE AT WWW.CHRISTUSHEALTH.ORG/CHARITYCARE. (THIS WEBSITE WAS THE FIRST RESULT IN GOOGLE WHEN PATIENTS SEARCHED FOR THE HOSPITAL NAME AND CHARITY CARE OR FINANCIAL ASSISTANCE.) EFFECTIVE JULY 1, 2016, THE INDIVIDUAL HOSPITAL'S HOMEPAGE HAD A CONSPICUOUS FINANCIAL ASSISTANCE LINK DIRECTING PATIENTS TO THE CHARITY CARE HOMEPAGE. COUNSELORS ALSO PUBLICIZED THE AVAILABILITY OF FINANCIAL ASSISTANCE DURING ONE-ON-ONE VISITS WITH PATIENTS. THE HOSPITAL ATTEMPTED TO PROVIDE ALL UNINSURED PATIENTS WITH FINANCIAL COUNSELING. SPENDING TIME FACE-TO-FACE WITH PATIENTS ALLOWED COUNSELORS TO FACILITATE THE APPLICATION PROCESS FOR PATIENTS WHO OTHERWISE MIGHT NOT HAVE SOUGHT ASSISTANCE. COUNSELORS HELPED COMPLETE FINANCIAL ASSISTANCE APPLICATIONS AND EVALUATE PAYMENT PLANS FOR OUTSTANDING BALANCES. UNINSURED PATIENTS WERE SCREENED FOR MEDICAID ELIGIBILITY, AND COUNSELORS ALSO ASSISTED ELIGIBLE PATIENTS IN COMPLETING THOSE APPLICATIONS.

Schedule H, Part V, Section B, Line 20 Facility A, 1
Facility A, 1 - See Schedule, H, Part V, Section A. WHEN COLLECTION CALLS RESULTED IN PATIENT CONTACT, BUSINESS AGENTS PERFORMED A VERBAL SCREENING TO SEE IF THE PATIENT MIGHT BE ELIGIBLE FOR CHARITY CARE. IN ADDITION, BILLING STATEMENTS CONTAINED THE FOLLOWING NOTICE: (YOU MAY QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON YOUR INCOME LEVEL. IF YOU DO NOT QUALIFY AND CANNOT MAKE PAYMENT IN FULL, WE WILL WORK WITH YOU TO SET UP AN ACCEPTABLE PAYMENT PLAN.)

Schedule H, Part I, Line 5a BUDGETED CHARITY CARE
THE ORGANIZATION BUDGETS CHARITY CARE FOR INTERNAL FINANCIAL REVIEW PURPOSES ONLY. THE PROVISION OF CHARITY CARE IS NOT LIMITED TO AMOUNTS ESTABLISHED FOR BUDGETARY PURPOSES.

Schedule H, Part I, Line 6a ANNUAL COMMUNITY BENEFIT REPORT
A REPORT OF COMMUNITY BENEFIT IS INCLUDED IN A WRITTEN ANNUAL REPORT FOR CHRISTUS HEALTH, THE ORGANIZATION'S PARENT COMPANY. CHRISTUS HEALTH IS AN INTERNATIONAL, CATHOLIC, FAITH BASED, NONPROFIT HEALTH SYSTEM FORMED IN 1999 WITH A MISSION TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST. THE ANNUAL COMMUNITY BENEFIT REPORT SUMMARIZES ACTIVITIES AND PROGRAMS CONDUCTED DURING THE PAST YEAR TO IMPROVE HEALTH INCLUDING PROACTIVE COMMUNITY HEALTH SERVICES. HOWEVER, THE ANNUAL REPORT IS ONLY A SNAPSHOT OF HOW THE ORGANIZATION DISTINGUISHES ITSELF IN ITS VISION TO BE A LEADER, A PARTNER, AND AN ADVOCATE IN CREATING INNOVATIVE HEALTH AND WELLNESS SOLUTIONS THAT IMPROVE THE LIVES OF INDIVIDUALS AND COMMUNITIES.

Schedule H, Part III, Line 1 BAD DEBT REPORTING IN ACCORDANCE WITH HFMA STATEMENT 15
CHRISTUS HEALTH FOLLOWS IN PRINCIPLE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. THE SYSTEM HAS ADOPTED AN UNCOMPENSATED CARE POLICY WHERE REVENUE FROM SERVICES PROVIDED TO THE UNINSURED IS RECOGNIZED AT THE TIME OF PAYMENT, RATHER THAN AT THE TIME OF SERVICE. THIS POLICY IS THE RESULT OF A LACK OF REASONABLE ASSURANCE OF COLLECTION FOR SERVICES PROVIDED TO THE UNINSURED DUE TO THE SYSTEM'S HISTORICALLY LOW COLLECTION RATE. MANAGEMENT HAS ESTIMATED THAT THE DIFFERENCE BETWEEN RECORDING REVENUE FROM THE UNINSURED ON A CASH BASIS, RATHER THAN THE ACCRUAL BASIS, IS IMMATERIAL. ACCORDINGLY, ALL ACCOUNTS RECEIVABLE FROM THE UNINSURED HAVE BEEN FULLY RESERVED IN THE ALLOWANCE FOR UNCOMPENSATED CARE.

Schedule H, Part VI, Line 7 COMMUNITY BENEFIT REPORT
A COMMUNITY BENEFIT REPORT IS FILED FOR THE STATE OF TEXAS IN THE FORM OF THE ANNUAL STATEMENT OF COMMUNITY BENEFITS STANDARD (ASCBS) FORM AS REQUIRED BY THE HEALTH AND SAFETY CODE, SECTIONS 311.045 AND 311.046. THE CODE REQUIRES NONPROFIT HOSPITALS TO FILE THE ASCBS FORM AND ANNUAL REPORT OF THE COMMUNITY BENEFITS PLAN WITH THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES (DSHS). THE 2012 ASCBS FORM IS EXPANDED TO COLLECT THE INFORMATION ON CHARITY CARE POLICIES AND COMMUNITY BENEFITS IN A STANDARDIZED FORMAT. ALL CHRISTUS HEALTH ENTITIES INCLUDING FACILITIES LOCATED IN STATES THAT DO NOT REQUIRE ANNUAL COMMUNITY BENEFIT REPORTING (I.E., LOUISIANA, AND NEW MEXICO), FOLLOW THE SAME REPORTING RULES AS OUTLINED IN THE CATHOLIC HEALTH ASSOCIATION GUIDE TO PLANNING AND REPORTING COMMUNITY BENEFIT, COPYRIGHT 2008. TOTAL COMMUNITY BENEFIT FOR CHRISTUS HEALTH IS ALSO REPORTED IN THE ANNUAL REPORT PREPARED AND DISTRIBUTED BY THE SYSTEM OFFICE.

Schedule H, Part I, Line 7b UNREIMBURSED MEDICAID
CHRISTUS SANTA ROSA HEALTH CARE CORPORATION REINVESTS ALL SURPLUS FUNDS BACK INTO THE COMMUNITIES WE SERVE THROUGH EXPANDED HEALTH SERVICES, NEW TECHNOLOGIES, AND BETTER FACILITIES.

Schedule H, Part I, Line 7f PERCENT OF TOTAL EXPENSE
TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN(A) IS $1,079,589,693. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS $60,625,133. THIS LEAVES A TOTAL EXPENSE OF $1,018,964,560 FOR PURPOSES OF CALCULATING LINES 7, COLUMN(F).

Schedule H, Part I, Line 7f FIN ASSISTANCE/OTHER BENEFITS AS PERCENTAGE OF COST
THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS REPORTED ON PART I, LINE 7K, COLUMN(C) AS A PERCENTAGE OF TOTAL EXPENSE IS 34.06%, WHICH EXCEEDS THE AMOUNT REPORTED ON PART I, LINE 7K COLUMN(F) WHICH IS COMPUTED USING NET COMMUNITY BENEFIT EXPENSE.

Schedule H, Part I, Line 7i CASH AND IN-KIND CONTRIBUTIONS
CHRISTUS SANTA ROSA HEALTH CARE CORPORATION MADE OVER $23,163,458 IN CASH AND IN-KIND CONTRIBUTIONS DURING FISCAL YEAR 2022. THE AFOREMENTIONED AMOUNT IS DETERMINED IN ACCORDANCE WITH REPORTING RULES FOR SCHEDULE H, WORKSHEET 8. AS SUCH THIS AMOUNT DIFFERS FROM GRANTS REPORTED AT FORM 990, SCHEDULE I, GRANTS AND OTHER ASSISTANCE TO ORGANIZATIONS, GOVERNMENTS, AND INDIVIDUALS AND PART IX, LINES 1 THROUGH 3 GRANTS AND OTHER ASSISTANCE. CHRISTUS HEALTH ESTABLISHED THE CHRISTUS FUND, A GRANT FUND TO PROVIDE RESOURCES TO NONPROFIT AGENCIES AND GROUPS WHOSE VISION, MISSION, AND GOALS ARE CONSISTENT WITH CHRISTUS HEALTH'S MISSION, VALUES AND PHILOSOPHY OF A HEALTHY COMMUNITY. CHRISTUS FUND GRANTS TOTALING $343,000 WERE DONATED BY CHRISTUS HEALTH TO NONPROFIT ORGANIZATIONS LOCATED IN THE COMMUNITY SERVED BY CHRISTUS SANTA ROSA HEALTH CARE CORPORATION. THE GRANT DOLLARS WERE USED TO SUPPORT PROGRAMS THAT PROMOTE THE HEALTH OF THE COMMUNITIES THAT CHRISTUS SANTA ROSA HEALTH CARE CORPORATION SERVES. ALL GRANTS MADE TO OUTSIDE ORGANIZATIONS THROUGH THE CHRISTUS FUND ARE MADE TO NONPROFIT ORGANIZATIONS THAT SUPPORT THE COMMUNITY. INDIGENT FUNDING EXPENSE OF $80,879,634 IS INCLUDED IN SCHEDULE H, PART I, LINE 7(I).

Schedule H, Part V, Section B, Line 13 ITEM A
DETERMINATION OF ELIGIBILITY FOR DISCOUNTED CARE UNDER THE HOSPITAL'S POLICY, PATIENTS WHO WERE UNINSURED AND MET CERTAIN FINANCIAL CRITERIA WERE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE POLICY ALSO PROVIDED FOR ASSISTANCE FOR MEDICALLY INDIGENT PATIENTS. IN GENERAL, PATIENTS WHO WERE BELOW 300% OF FEDERAL POVERTY GUIDELINES RECEIVED FREE CARE. PATIENTS WHO WERE UNINSURED AND ABOVE 300% OF THE FEDERAL POVERTY GUIDELINES WERE BILLED RATES CONSISTENT WITH AMOUNTS GENERALLY BILLED TO COMMERCIAL PAYERS. PATIENTS WHO WERE UNINSURED AND BETWEEN 300% AND 400% OF FEDERAL POVERTY GUIDELINES COULD APPLY FOR ADDITIONAL ASSISTANCE TO PAY AMOUNTS LESS THAN AGB.

Schedule H, Part V, Section B, Line 17
THE HOSPITAL DID NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS DURING THE TAX YEAR. THE POLICY STRICTLY PROHIBITED TAKING LEGAL ACTION AGAINST PATIENTS AND ALSO FORBADE PLACING A LIEN ON THE PATIENT'S HOME. IN THE EVENT OF NONPAYMENT, THE HOSPITAL AND ITS COLLECTIONS GROUPS WOULD SEND STATEMENTS AND MAKE PHONE CALLS.

Schedule H, Part V, Section B, Line 18 ITEM F
THE HOSPITAL DID NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS DURING THE TAX YEAR. THE POLICY STRICTLY PROHIBITED TAKING LEGAL ACTION AGAINST PATIENTS AND ALSO FORBADE PLACING A LIEN ON THE PATIENT'S HOME. IN THE EVENT OF NONPAYMENT, THE HOSPITAL AND ITS COLLECTIONS GROUPS WOULD SEND STATEMENTS AND MAKE PHONE CALLS.

Schedule H, Part V, Section B, Line 16b FAP APPLICATION FORM WEBSITE
https://www.christushealth.org/-/media/christus-health/plan-care/files/bill-pay/financial-assistance/financial-language-documents/v2financial-assistance-application.ashx

Schedule H, Part V, Section B, Line 16c PLAIN LANGUAGE FAP SUMMARY WEBSITE
https://www.christushealth.org/-/media/christus-health/plan-care/files/bill-pay/financial-assistance/financial-language-documents/2021plainlanguagesummaryhospitalenglish.ashx

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
LINE 7A: RATIO OF PATIENT CARE COST TO CHARGES BASED ON SCHEDULE H, WORKSHEET 2 LINE 7B: RATIO OF PATIENT CARE COST TO CHARGES BASED ON SCHEDULE H, WORKSHEET 2 LINE 7E: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE LINE 7F: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE LINE 7I: ACTUAL EXPENSE OF THE CONTRIBUTIONS

Schedule H, Part II COMMUNITY BUILDING ACTIVITIES
THE CHRISTUS HEALTH BOARD OF DIRECTORS APPROVED FUNDING OF A COMMUNITY DIRECT INVESTMENT (CDI) LOAN PROGRAM TO ENSURE THAT THE WORK OF SOCIAL ACCOUNTABILITY AND MORAL AND ETHICAL STEWARDSHIP CONTINUE IN SPITE OF CHALLENGING FISCAL CONDITIONS FACED BY LOCAL OPERATING ENTITIES. THE PURPOSE OF THE CDI PROGRAM IS TO SUPPORT COMMUNITY DRIVEN INITIATIVES, PRIMARILY FOR AFFORDABLE HOUSING AND ECONOMIC DEVELOPMENT BY PROVIDING FINANCING AT BELOW MARKET INTEREST RATES TO NONPROFIT ORGANIZATIONS AT TERMS NOT EXCEEDING MORE THAN FIVE YEARS. THE INCOME EARNED AT THE MARKET RATE LESS OUR LOAN RATE (FOREGONE INCOME) IS CONSIDERED A COMMUNITY BENEFIT FOR REPORTING PURPOSES. THE FOREGONE INTEREST FOR THE CHRISTUS SANTA ROSA REGION IN FISCAL YEAR ENDING JUNE 30, 2021 WAS $0. IN AN EFFORT TO MEET AND ADDRESS THE IDENTIFIED HEALTH CARE NEEDS IN THE COMMUNITIES IT SERVES, CHRISTUS SANTA ROSA HEALTH CARE CORPORATION PROVIDES ACCESS TO HEALTH CARE SERVICES THROUGH PROGRAMS AND LOCAL COMMUNITY PARTNERS AND SERVICE ORGANIZATIONS. THE CHRISTUS HEALTH ADVOCACY DEPARTMENT IS WORKING IN PARTNERSHIP WITH LOCAL, STATE AND FEDERAL POLICY MAKERS TO ENSURE ACTIVITIES AND PROGRAMSARE IN PLACE THAT WILL ENHANCE PUBLIC HEALTH AND ADVANCE GENERAL KNOWLEDGE THROUGH IMPROVED ACCESS TO HEALTH SERVICES AND ADVANCE GENERAL KNOWLEDGE. DURING FY 2021, CHRISTUS HEALTH ADVOCATED FOR IMPROVING PUBLIC POLICIES BY WORKING TO ESTABLISH, AND IN SOME INSTANCES AUGMENT, GRASSROOTS ADVOCACY AND GREATER ACCESS TO HEALTHCARE SERVICES FOR THE CONSTITUENTS WE SERVE. THESE ARE SOME OF THE MAIN COMMUNITY BUILDING ACTIVITIES THAT ARE IMPROVING ACCESS TO HEALTH SERVICES, ENHANCING PUBLIC HEALTH, AND ADVANCING KNOWLEDGE.

Schedule H, Part V, Section B, Line 22 ITEM B
THE HOSPITAL USED THE AVERAGE COMMERCIAL INSURANCE REIMBURSEMENT RATE FROM FISCAL YEAR ENDING 6/30/22 TO DETERMINE AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS AVERAGE RATE WAS THE AVERAGE REIMBURSEMENT RECEIVED FOR CATEGORIES OF SERVICES FROM ALL PRIVATE INSURERS THAT REIMBURSE HOSPITALS ACROSS THE CHRISTUS HEALTH SYSTEM, EXCEPT FOR ST. VINCENT AND LONG-TERM HOSPITALS, AND EXCLUDING IMPLANT AND DRUG CONTRIBUTION DOLLARS. ALL UNINSURED PATIENTS WERE CHARGED NO MORE THAN 45% OF CHARGES FOR THE RELEVANT SERVICE LINE. PATIENTS ELIGIBLE FOR ADDITIONAL FINANCIAL ASSISTANCE WERE CHARGED NO MORE THAN THE AVERAGE RATE (FOR INCOME LEVELS FROM 301% TO 400% OF THE FPL) OR RECEIVED FREE CARE (FOR INCOMES AT OR BELOW 300% OF THE FPL). FOR LAB SERVICES, ELIGIBLE PATIENTS WERE CHARGED A PERCENTAGE OF THE MEDICARE RATE.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE (TOTAL OF ALL HOSPITAL FACILITIES) IS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL STATEMENTS, WHICH IS COMPUTED AS BAD DEBT NET OF CONTRACTUAL ALLOWANCE, PAYMENTS RECEIVED AND RECOVERIES OF BAD DEBT PREVIOUSLY WRITTEN OFF.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
"THE FOOTNOTE TO THE CHRISTUS HEALTH CONSOLIDATED FINANCIAL STATEMENTS SAYS, ""THE PREPARATION OF THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS IN CONFORMITY WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES (U.S. GAAP) REQUIRES MANAGEMENT OF THE SYSTEM TO MAKE ASSUMPTIONS, ESTIMATES, AND JUDGMENTS THAT AFFECT THE AMOUNTS REPORTED IN THE FINANCIAL STATEMENTS, INCLUDING THE NOTES THERETO, AND RELATED DISCLOSURES OF COMMITMENTS AND CONTINGENCIES, IF ANY AT THE DATE OF THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT RELIES ON HISTORICAL EXPERIENCE AND ON OTHER ASSUMPTIONS BELIEVED TO BE REASONABLE UNDER THE CIRCUMSTANCES IN MAKING ITS JUDGMENT AND ESTIMATES. ACTUAL RESULTS COULD DIFFER MATERIALLY FROM THESE ESTIMATES."""

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE SHORTFALL ON PART III, LINE 7 IS NOT COUNTED AS A COMMUNITY BENEFIT. THE AMOUNT ON SCHEDULE H, PART III, LINE 6 IS DETERMINED BY CALCULATING MEDICARE ALLOWABLE COSTS USING WORKSHEET A OF THE MEDICARE COST REPORT. WORKSHEET A OF THE MEDICARE COST REPORT REQUIRES THE ORGANIZATION TO REMOVE NON-ALLOWABLE EXPENSES FROM TOTAL EXPENSES VIA THE ADJUSTMENTS TO EXPENSES WORKSHEETS WITHIN THE MEDICARE COST REPORT. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE FILING ORGANIZATION ASSOCIATED WITH THE FILING ORGANIZATION'S PROVISIONS OF SERVICES TO MEDICARE PATIENTS. SCHEDULE H, PART III, LINE 7 WOULD EQUAL A SHORTFALL OF (15,544,591) IF TOTAL EXPENSES ALLOCABLE TO MEDICARE SERVICES WERE SUBSTITUTED ON SCHEDULE H, PART III, LINE 6.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
IT IS THE POLICY OF THE ORGANIZATION TO PURSUE COLLECTIONS OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR THESE SERVICES. CHRISTUS HEALTH APPLIES ITS COLLECTION EFFORTS CONSISTENTLY AND FAIRLY TO ALL PATIENTS REGARDLESS OF INSURANCE. IF A PATIENT DOES NOT HAVE THE FINANCIAL RESOURCES TO PAY THEIR OUTSTANDING BALANCES, THE GOAL OF THE ORGANIZATION IS TO QUALIFY THESE PATIENTS THROUGH THE ORGANIZATION'S CHARITY POLICY OR SCREEN THE PATIENTS THROUGH ORGANIZATION'S PRESUMPTIVE CHARITY TESTS. IF THE PATIENT QUALIFIES UNDER EITHER POLICY THE ACCOUNT WILL BE WRITTEN OFF BASED UPON LEVEL OF QUALIFICATION. THESE POLICIES SUPPORT THE MISSION AND VISION OF THE ORGANIZATION AND ARE APPROVED BY SENIOR LEADERSHIP.

Schedule H, Part V, Section B, Line 16a FAP website
A - CHRISTUS SANTA ROSA NEW BRAUNFELS: Line 16a URL: https://www.christushealth.org/plan-care/bill-pay/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - CHRISTUS SANTA ROSA NEW BRAUNFELS: Line 16b URL: SEE SUPPLEMENTAL INFO;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - CHRISTUS SANTA ROSA NEW BRAUNFELS: Line 16c URL: SEE SUPPLEMENTAL INFO;

Schedule H, Part VI, Line 4 Community information
CHRISTUS Santa Rosa Health Care Corporation is headquartered in San Antonio, Texas in the South-Central Area of the State. It has six hospital campuses (Medical Center, Westover Hills, Alamo Heights, New Braunfels, San Marcos and The Children's Hospital of San Antonio). It serves the southwestern boarder of Texas and into the Central Texas Hill Country. The area comprises a population of more than 2.3 million individuals. The population consists of 63.20% Hispanic and 36.80% non-Hispanic.

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

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
THE FILING ORGANIZATION RECOGNIZES THAT SOME PATIENTS ARE UNABLE OR UNWILLING TO SEEK FINANCIAL ASSISTANCE DUE TO BARRIERS SUCH AS EDUCATIONAL LEVEL, LITERACY, DOCUMENTATION REQUIREMENTS, OR BEING INTIMIDATED BY THE APPLICATION PROCESS. IN ORDER TO ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAVE NOT SUBMITTED AN APPLICATION, THE ORGANIZATION ENGAGED PARO DECISION SUPPORT, LLC. PARO CHARITY SCORE IS DESIGNED TO IDENTIFY PATIENTS THAT LIKELY QUALIFY FOR FINANCIAL ASSISTANCE BASED ON A PREDICTIVE MODEL AND OTHER FINANCIAL AND ASSET ESTIMATES FOR THE PATIENT DERIVED FROM PUBLIC RECORD SOURCES. IN ORDER TO ASSESS THE BAD DEBT ACCOUNTS THAT WOULD LIKELY QUALIFY FOR CHARITY CARE, THE FOLLOWING CRITERIA WERE ESTABLISHED BASED ON AN ANALYSIS OF HISTORICAL DATA OF CHRISTUS HEALTH AND ITS RELATED ORGANIZATIONS: 1. PARO SCORE OF LESS THAN OR EQUAL TO 586, WHICH IS A PREDICTOR DEFINING THE LIKELY SOCIOECONOMIC CONDITIONS FOR THE PATIENT; 2. ESTIMATED FEDERAL POVERTY LEVEL OF LESS THAN OR EQUAL TO 226%, WHICH IS BASED ON ESTIMATED HOUSEHOLD SIZE AND HOUSEHOLD ESTIMATED INCOME; AND 3. THIRD PARTY DATA AVAILABLE ON PATIENT ACCOUNTS WHICH INDICATE THAT THE PATIENT IS NOT A HOMEOWNER OR A PROBABLE HOMEOWNER. FOR THE FISCAL YEAR ENDING JUNE 30, 2011, THE ORGANIZATION REPORTED THAT 30% OF BAD DEBT EXPENSES WERE ATTRIBUTABLE TO PATIENTS WHO MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE BUT WERE NOT RESPONSIVE TO THE APPLICATION PROCESS EXISTING AT THAT TIME. THIS FIGURE WAS BASED ON THE PARO ANALYSIS AND ESTIMATES OF PATIENTS' FINANCIAL NEEDS THAT EXAMINED WHETHER PATIENTS WERE CHARACTERISTIC OF OTHERS WHO HISTORICALLY QUALIFIED FOR ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. THE PRESUMPTIVE CHARITY CARE ANALYSIS PERFORMED FOR THE PRIOR FISCAL YEAR DETERMINED A BENCHMARK OF BAD DEBT ACCOUNTS IN THE CHRISTUS HEALTH SYSTEM THAT LACKED THE INFORMATION TO QUALIFY FOR CHARITY CARE UNDER THE FILING ORGANIZATION'S CUSTOMARY PROCESS BUT WOULD HAVE LIKELY QUALIFIED FOR ASSISTANCE. DURING THE FISCAL YEAR ENDING JUNE 30, 2022, THE ORGANIZATION UTILIZED THE PARO SCORE TO IDENTIFY THE ACCOUNTS OF INDIVIDUAL PATIENTS THAT WERE LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE DESPITE HAVING NOT COMPLETED AN APPLICATION, AND SUCH ANALYSIS DETERMINED THAT 3.73% OF SUCH ACCOUNTS WERE LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. THE ORGANIZATION GRANTED PRESUMPTIVE ELIGIBILITY FOR THESE ACCOUNTS AND THEY WERE RECLASSIFIED UNDER OUR FINANCIAL ASSISTANCE POLICY. THESE AMOUNTS WERE NOT REPORTED AS BAD DEBT. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 3 IS THE DIFFERENCE BETWEEN THE PRESUMPTIVE CHARITY CARE BENCHMARK ESTABLISHED IN THE FISCAL YEAR ENDING JUNE 30, 2011 AND THE AGGREGATE OF INDIVIDUAL ACCOUNTS FOR WHICH THE ORGANIZATION GRANTED PRESUMPTIVE ELIGIBILITY IN THE FISCAL YEAR ENDING JUNE 30, 2022. THUS, THE ORGANIZATION ESTIMATES THAT ONLY 0.76% OF THE BAD DEBT EXPENSES IN FISCAL YEAR ENDING JUNE 30, 2022 ARE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. IT IS IMPORTANT TO NOTE THAT THE FIGURE CALCULATED FOR FISCAL YEAR ENDING JUNE 30, 2011 WAS ESTIMATED AND NOT EXACT, AND THEREFORE THE DIFFERENCE BETWEEN THE AMOUNTS QUALIFIED AS PRESUMPTIVE CHARITY CARE IN ANY FISCAL YEAR MAY VARY FROM THE BENCHMARK ESTABLISHED IN FISCAL YEAR ENDING JUNE 30, 2011.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
CHRISTUS SANTA ROSA HEALTH CARE CORPORATION MAKES EVERY EFFORT TO EDUCATE PATIENTS ON ITS CHARITY AND DISCOUNT POLICY AND ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS DURING REGISTRATION, PRE REGISTRATION (FOR SCHEDULED TESTS AND SURGERIES), POST REGISTRATION (DURING THEIR HOSPITALIZATION) AND FOLLOWING DISCHARGE (TELEPHONE OR WRITTEN INQUIRY) IN LANGUAGES APPROPRIATE FOR THE POPULATION BEING SERVED. PATIENTS ARE GIVEN INFORMATION AND FORMS BY A FINANCIAL COUNSELOR WHO HELPS THEM COMPLETE THE FORMS DURING THEIR INPATIENT AND OUTPATIENT VISITS. PATIENTS ARE ASKED TO BRING OR MAIL SUPPORTING DOCUMENTATION TO DETERMINE INCOME, ASSETS AND HOUSEHOLD EXPENSES. THE BUSINESS OFFICE REVIEWS THE APPLICATION BASED ON THE INFORMATION PROVIDED BY THE PATIENT. IF THE PATIENT QUALIFIES FOR CHARITY CARE OR A DISCOUNT, A NEW BILL IS GENERATED. PATIENTS WHO DO NOT PROVIDE THE REQUIRED DOCUMENTATION ARE CONSIDERED INELIGIBLE AND ARE BILLED ACCORDINGLY. IF THE DOCUMENTATION IS PROVIDED AT A LATER TIME, THE PATIENT MAY THEN BE DETERMINED TO BE ELIGIBLE FOR CHARITY CARE OR A DISCOUNT. DOCUMENTATION IS RETAINED BY THE BILLING OFFICE FOR SEVEN YEARS. A PUBLIC NOTICE REGARDING THE CHARITY CARE POLICY IS POSTED IN PROMINENT PLACES THROUGHOUT THE HOSPITALS, INCLUDING BUT NOT LIMITED TO THE EMERGENCY ROOM WAITING AREAS AND THE ADMISSIONS OFFICE WAITING AREAS, AS REQUIRED BY BOTH THE STATE OF TEXAS COMMUNITY BENEFIT STANDARD (WHICH ADDRESSES THE DUTIES AND RESPONSIBILITIES OF NONPROFIT HOSPITALS) AND CHRISTUS HEALTH COMMUNITY BENEFIT GUIDELINES #050. IN ADDITION, A PUBLIC NOTICE REGARDING THE CHARITY CARE POLICY AND INFORMATION ON FINANCIAL ASSISTANCE ARE ALSO POSTED ON THE CHRISTUS HEALTH WEBSITE. THE INFORMATION ON FINANCIAL ASSISTANCE INCLUDES EXPLANATIONS ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY FOR FINANCIAL ASSISTANCE.

Schedule H, Part VI, Line 2 Needs assessment
THE CHRISTUS SANTA ROSA HEALTH CARE CORPORATION'S FY 2022 COMMUNITY BENEFIT PLAN IS BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONDUCTED BY THE BEXAR COUNTY COMMUNITY HEALTH COLLABORATIVE IN 2019. IN ADDITION TO THE CHNA CONDUCTED BY THE HEALTH COLLABORATIVE, CHRISTUS SANTA ROSA HEALTH CARE CORPORATION SUPPORTED THE COMAL COUNTY ASSESSMENT OF SOCIAL AND ENVIRONMENTAL DETERMINENTS OF WELL-BEING. RESULTS OF THE NEEDS ASSESSMENT WERE SHARED PUBLICLY WITH CITY AND COUNTY OFFICIALS, AS WELL AS LEADERS FROM THE WIDER MEDICAL COMMUNITY, SOCIAL SERVICE PROVIDERS, EDUCATIONAL AND RESEARCH INSTITUTIONS, BUSINESS LEADERS AND OTHER COMMUNITY STAKEHOLDERS. THE COMMUNITY HEALTH PRIORITIES SET FORTH BY CHRISTUS SANTA ROSA HEALTH CARE CORPORATION ARE BASED ON A CAREFUL REVIEW AND ANALYSIS OF THESE REPORTS AND ANALYSIS OF HEALTH ISSUES IDENTIFIED AT EACH SANTA ROSA HOSPITAL. THE COMMUNITY IS DEFINED AS RESIDENTS OF BEXAR AND COMAL COUNTY. WITHIN BEXAR COUNTY, 10 ZIP CODES WERE IDENTIFIED THAT ARE CONSIDERED AREAS OF HIGH RISK AND UNRESOLVED ONGOING PUBLIC HEALTH PROBLEMS. COMMUNITY DELIVERY WILL CONTINUE TO FOCUS ON THE UNINSURED POPULATION WITH ADDED EMPHASIS ON CHRONIC ILLNESS. SERVICES ARE BASED ON BEST PRACTICES DEVELOPMENT AND IMPLEMENTATION BASED ON COMMUNITY HEALTH SERVICES. THE HEALTH COLLABORATIVE IS A CONSORTIUM OF ORGANIZATIONS JOINED TOGETHER TO PRIORITIZE AND ADDRESS SIGNIFICANT COMMUNITY HEALTH ISSUES. MEMBERS OF THE HEALTH COLLABORATIVE INCLUDE CHRISTUS SANTA ROSA HEALTH CARE CORPORATION, BAPTIST HEALTH SYSTEM, METHODIST HEALTHCARE SYSTEM, UNIVERSITY HEALTH SYSTEM, COMMUNITY FIRST HEALTH PLANS, METHODIST HEALTHCARE MINISTRIES, THE YMCA OF GREATER SAN ANTONIO, AND VARIOUS LOCAL UNIVERSITIES. THE HEALTH COLLABORATIVE HAS COMMISSIONED THE COMMUNITY HEALTH NEEDS ASSESSMENT APPROXIMATELY EVERY THREE YEARS DATING BACK TO 1998. THE 2019 HEALTH COLLABORATIVE CHNA WAS CONDUCTED AND THEN RELEASED IN A 3-PHASE FORMAT. PHASE 1 OF THE ASSESSMENT RELIES ON TRADITIONAL PUBLIC HEALTH SOURCES TO CONSTRUCT OUTCOME INDICATORS OF COMMUNITY HEALTH. THESE FINDINGS ARE LABELED AS HEALTH OUTCOMES. PHASE 2 RELIES ON THE BEXAR COUNTY COMPONENT OF THE BEHAVIOR RISK FACTOR SURVEILLANCE (BRFSS) ADMINISTERED BY THE CENTERS FOR DISEASE CONTROL (CDC) AND OTHER SOURCES OF INFORMATION THAT PERTAIN TO THE COUNTY. INDICATORS OF BEHAVIORS THAT PROMOTE GOOD HEALTH OUTCOMES AND THAT ELEVATE THE RISK OF POOR HEALTH OUTCOMES ARE INCLUDED IN PHASE 2 AND ARE LABELED AS HEALTH BEHAVIORS. IN ADDITION TO THE DATA COLLECTION, CHRISTUS SANTA ROSA HEALTH CORPORATION PARTICIPATED IN COMMUNITY FOCUS GROUP MEETINGS AND NEIGHBORHOOD MEETINGS TO ALLOW RESIDENTS TO PROVIDE INSIGHT INTO THEIR COMMUNITIES. FINALLY, PHASE 3 IS THE ROBUST REVIEW AND ANALYSIS OF THE DATA COLLECTED - BOTH QUANTITATIVE AND QUALITATIVE - AND THE COMPILATION AND RELEASE OF THE REPORT. THE HEALTH COLLABORATIVE HAS BEEN RECOGNIZED AS A NATIONAL BEST PRACTICE. ON APRIL 1, 2020, ADVENTIST HEALTH SYSTEM/SUNBELT, INC., D/B/A CENTRAL TEXAS MEDICAL CENTER (CTMC) IN SAN MARCOS, TEXAS JOINED CHRISTUS SANTA ROSA HEALTH SYSTEM AS CSRHS - NEW BRAUNFELS. CTMC CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2019, WHICH WAS ADOPTED BY CSRHS. THE ASSESSMENT IDENTIFIED THE HEALTH-RELATED NEEDS OF THE COMMUNITY INCLUDING LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. THE MAJOR COMMUNITY BENEFIT ACTIVITIES ENACTED BY CTMC ARE FOCUSED ON ACCESS TO AFFORDABLE HEALTH CARE, HEALTHIER MANAGEMENT OF LIFESTYLE, AND CHRONICDISEASE MANAGEMENT. THE GOALS OF THE ASSESSMENT WERE TO ENGAGE PUBLIC HEALTH AND COMMUNITY STAKEHOLDERS INCLUDING LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS; ASSESS AND UNDERSTAND THE COMMUNITY'S HEALTH ISSUES AND NEEDS; UNDERSTAND THE HEALTH BEHAVIORS, RISK FACTORS AND SOCIAL DETERMINANTS THAT IMPACT HEALTH; IDENTIFY COMMUNITY RESOURCES AND COLLABORATE WITH COMMUNITY PARTNERS; PUBLISH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND USE ASSESSMENT FINDINGS TO DEVELOP AND IMPLEMENT A 2020-2022 COMMUNITY HEALTH IMPROVEMENT PLAN BASED ON THE HOSPITAL PRIORITIZED ISSUES. THE CHNAC INCLUDED REPRESENTATION FROM THE HOSPITAL, PUBLIC HEALTH EXPERTS, AND THE BROAD COMMUNITY. THIS INCLUDED INTENTIONAL REPRESENTATION FROM LOW-INCOME, MINORITY AND OTHER UNDERSERVED POPULATIONS. CENTRAL TEXAS MEDICAL CENTER COLLECTED BOTH PRIMARY AND SECONDARY DATA. THE PRIMARY DATA INCLUDED STAKEHOLDER INTERVIEWS, COMMUNITY MEMBER FOCUS GROUPS AND AN ONLINE SURVEY. SECONDARY DATA SOURCES INCLUDED INTERNAL HOSPITAL UTILIZATION DATA (INPATIENT AND EMERGENCY DEPARTMENT). THIS UTILIZATION DATA SHOWED THE TOP REASONS FOR VISITS TO CENTRAL TEXAS MEDICAL CENTER OVER THE PAST YEAR. IN ADDITION, PUBLICLY AVAILABLE DATA FROM STATE AND NATIONALLY RECOGNIZED DATA SOURCES WERE UTILIZED. PRIMARY AND SECONDARY DATA WAS THEN COMPILED AND ANALYZED IN ORDER TO IDENTIFY THE TOP 6 AGGREGATE ISSUES FROM THE VARIOUS SOURCES OF DATA. THE NEXT STEP WAS A COMMUNITY ASSET INVENTORY. THIS INVENTORY WAS DESIGNED TO HELP CENTRAL TEXAS MEDICAL CENTER AND THECHNAC TO UNDERSTAND EXISTING COMMUNITY EFFORTS TO ADDRESS THE SIX IDENTIFIED ISSUES FROM AGGREGATE PRIMARY AND SECONDARY DATA AND TO PREVENT DUPLICATION OF EFFORTS AS APPROPRIATE. USING THE DATA FINDINGS AND THE COMMUNITY ASSET INVENTORY, THE CHNAC NARROWED THE LIST OF SIX ISSUES TO THREE PRIORITY ISSUES. THE CHNAC USED A PRIORITY SELECTION TOOL THAT USES CLEARLY DEFINED CRITERIA TO SELECT THE TOP ISSUES TO ADDRESS. THE PRIORITY SELECTION CRITERIA INCLUDED, RELEVANCE: HOW IMPORTANT IS THIS ISSUE?; IMPACT: WHAT WILL WE ACHIEVE BY ADDRESSING THIS ISSUE?; AND FEASIBILITY: CAN WE ADEQUATELY ADDRESS THIS ISSUE? THIS REPORT WAS PREPARED BY CENTRAL TEXAS MEDICAL CENTER (CTMC) WITH CONTRIBUTIONS FROM MEMBERS OF THE CTMC COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE REPRESENTING HEALTH LEADERS IN THE COMMUNITY AND CENTRAL TEXAS MEDICAL CENTER LEADERS; IN ADDITION TO THE SHARED STRATEGY GROUP, LLC WHO COLLECTED AND ANALYSIZED THE DATA AND INFORMATION FROM HOUSEHOLD PARTICIPANT SURVEYS AND KEY INFORMANT INTERVIEWS. THEIR CONTRIBUTIONS MADE THIS REPORT POSSIBLE AND LAYED OUT THE GROUNDWORK FOR TO CONTINUE FULFILLING THE MISSION OF EXTENDING THE HEALING MINISTRY OF CHRIST. IN NOVEMBER 2019, THE CENTRAL TEXAS MEDICAL CENTER BOARD APPROVED THE COMMUNITY HEALTH NEEDS ASSESSMENT FINDINGS, PRIORITY ISSUES AND FINAL REPORT. A LINK TO THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS POSTED ON THE HOSPITAL'S WEBSITE PRIOR TO DECEMBER 31, 2019.

Schedule H, Part VI, Line 5 Promotion of community health
"CHRISTUS Santa Rosa Health Care Corporation provides a full range of inpatient and outpatient services to the communities it serves. It conducts its activities and its health care purpose without regard to race, color, creed, religion, gender, orientation, disability, age, or national origin. One of the top health care organizations in South Texas, CHRISTUS Health Care Corporation has six hospital campuses: 1. CHRISTUS Santa Rosa Hospital - Medical Center, located in the South Texas Medical Center of San Antonio 2. The Children's Hospital of San Antonio, located in downtown San Antonio 3. CHRISTUS Santa Rosa Hospital - Westover Hills, located in the Westover Hills area of San Antonio 4. CHRISTUS Santa Rosa Hospital - Alamo Heights, located in the Alamo Heights area of San Antonio 5. CHRISTUS Santa Rosa Hospital - New Braunfels, located in New Braunfels, Texas 6. CHRISTUS Santa Rosa Hospital - San Marcos, located in San Marcos, Texas Each of the facilities of CHRISTUS Santa Rosa share one objective - To lead the way to a healthier community. Each of the six hospitals within CHRISTUS Santa Rosa Health Care Corporation provides a 24-hour emergency room that is open to serve all those in need of emergency care, regardless of ability to pay. CHRISTUS Santa Rosa Health Care Corporation works to facilitate and strengthen access to quality comprehensive health care services for all, particularly the vulnerable and underserved populations. CHRISTUS Santa Rosa Health Care Corporation also supports many local community health services, offering convenient locations for adult and pediatric primary care through family health clinics and mobile health clinics. CHRISTUS Santa Rosa Health Care Corporation offers services such as: Comprehensive Pediatric Care, Intensive and Intermediate care to critically ill infants requiring medical and/or surgical interventions such as the neonatal ECMO Program that provides Veno-Venous or Veno-Arterial Extracorporeal Life support for up to three infants in the NICU; a centralized Level IV NICU and a Wound Care and Hyperbaric Center. In addition, our adult hospitals offer the following; Cardiac Care that is nationally certified by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) and accredited as a Chest Pain Center with Percutaneous Coronary Intervention (PCI) designation from the Society of Chest Pain Centers (SCPC); a comprehensive cancer program; complete obstetrical and newborn services; surgical units; a diabetes care program; and state-of-the-art medical care for children with an array of specialty services and orthopedic services. We also offer rehabilitation treatment for those who have experienced a stroke, a spinal cord injury, closed head injury and more. CHRISTUS Santa Rosa Health Care Corporation collaborates with communities, churches, and other health care organizations to provide comprehensive and accessible health care services and proactive healthcare programs. The Health Collaborative's (as defined in schedule H, Part VI, Question 2) existing priorities of Risk Behaviors, Health Care and Disease and Injury, as they relate to diabetes, obesity, and heart disease, will continue to be addressed through the chronic care management for children and adults as well as preventative care and health education through the collaborative relationships with school districts. The CHRISTUS Santa Rosa Health Care Corporation Community Benefit Plan (""The Plan"") supports the CHNAs priority areas. The Plan's focus is on the community initiatives that can impact family members of all ages with diabetes, obesity, and heart disease. These initiatives are provided through a pediatric mobile clinic, school-based health centers, community health worker program and chronic illness education programs. The Plan includes the work performed at The Center for Miracles which is dedicated to providing free services for abused/neglected children and their affected family members. Other efforts are to provide application assistance to Medicaid/CHIP patients to ensure health care opportunities are offered to women and children. Women, Infant and Children (WIC) services provide nutrition/breastfeeding education and food vouchers to help decrease the incidence of low-birth-weight infants and improve infant mortality rates in Bexar County. CHRISTUS Health reinvests all surplus funds back into the communities it serves through expanded health services, new technologies, and better facilities. As a not-for-profit health system and as part of CHRISTUS Health, a regional governing board comprised largely of independent community members representing the makeup of the area we serve guides CHRISTUS Santa Rosa Health Care Corporation. We are privileged to have an open medical staff comprised of qualified physicians who work with us to provide care to our communities. All qualified physicians who are granted privileges to serve with us in our hospitals must undergo a thorough and comprehensive credentialing and orientation process. ICAL experience and other education for all persons employed and affiliated with CHRISTUS Santa Rosa Health Care Corporation are required to complete annual conflict of interest statements. Individuals employed and affiliated with CHRISTUS Santa Rosa Health Care Corporation are required to complete annual conflict of interest survey."

Schedule H, Part VI, Line 6 Affiliated health care system
CHRISTUS SANTA ROSA HEALTH CARE CORPORATION IS PART OF CHRISTUS HEALTH, AN INTERNATIONAL, CATHOLIC, FAITH BASED, NONPROFIT HEALTH SYSTEM COMPRISED OF ALMOST 350 SERVICES AND FACILITIES INCLUDING MORE THAN 60 HOSPITALS AND LONG TERM CARE FACILITIES, 175 CLINICS AND OUTPATIENT CENTERS, AND OTHER COMMUNITY HEALTH MINISTRIES AND COMMUNITY DEVELOPMENT VENTURES. CHRISTUS SERVICES CAN BE FOUND IN: ARKANSAS, GEORGIA, IOWA, LOUISIANA, NEW MEXICO, TEXAS, AND INTERNATIONALLY IN THE COUNTRIES OF MEXICO, CHILE AND COLOMBIA. A COMMON MISSION, CORE VALUES, AND VISION UNITE THE HEALTH SYSTEM. EACH REGION, INCLUDING CHRISTUS SANTA ROSA HEALTH CARE CORPORATION, DEVELOPS FIVE-YEAR AND TEN-YEAR STRATEGIC PLANS THAT HELP SET THE YEARLY OPERATIONAL PLANS AND BUDGETS. REGIONAL STRATEGIC GOALS ARE SET IN COLLABORATION WITH CHRISTUS HEALTH AND INCLUDE METRICS THAT WILL BE USED TO MEASURE COMMUNITY BENEFIT, CLINICAL OUTCOMES, PATIENT SATISFACTION, AND ASSOCIATE ENGAGEMENT. CHRISTUS HEALTH PROVIDES UPDATED MARKET, DEMOGRAPHICS, AND HEALTH INDICATOR DATA ON AN ANNUAL BASIS. THE DATA SUPPLIED FROM CHRISTUS HEALTH ALONG WITH THE SYSTEM WIDE STRATEGIC INITIATIVES ARE CONSISTENT WITH THE COMMUNITY NEEDS ASSESSMENT OF THE REGION. CHRISTUS SANTA ROSA HEALTH CARE CORPORATION, IN TURN, PARTNERS WITH OTHER NONPROFIT GROUPS (CHURCHES, HEALTH CARE PROVIDERS, AND GOVERNMENT AGENCIES) TO CREATE COLLABORATIONS WHERE HEALTH NEEDS CAN BE ADDRESSED AND THE GENERAL HEALTH OF INDIVIDUALS AND THE COMMUNITY IS IMPROVED.