4A (Expenses $ 21411250 including grants of $ 0) (Revenue $ 28024837)
SEE SCHEDULE O.

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED IN THE CHNA OF ST. MARK'S MEDICAL CENTER (SMMC) ARE PRESENTED AS A PRIORITIZED DESCRIPTION.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - ST. MARKS MEDICAL CENTER. ST. MARK'S MEDICAL CENTER (SMMC) IS A 65-BED, 100,000-SQUARE FOOT 501(C)(3) NOT-FOR-PROFIT HOSPITAL PROVIDING ADVANCED HEALTH CARE CLOSE TO HOME FOR PATIENTS IN THE CENTRAL TEXAS COMMUNITIES OF FAYETTE AND LEE COUNTIES, AS WELL AS THE SURROUNDING AREAS. THE COMPREHENSIVE HEALTH SERVICES, ADVANCED TECHNOLOGIES AND MEDICAL SPECIALISTS AT SMMC RIVAL THOSE OF MAJOR METROPOLITAN INSTITUTIONS. THE HOSPITAL HAS A CLINICAL AFFILIATION WITH ST. DAVID'S HEALTH CARE IN AUSTIN AND CONTINUES TO BUILD BEST CLINICAL PRACTICES AS IT GROWS TO SERVE PATIENTS BETTER. SMMC IS THE PROUD RECIPIENT OF THE TMF HEALTH QUALITY INSTITUTE SILVER AWARD, EXEMPLIFYING THE HOSPITAL'S DEDICATION TO CONTINUOUS QUALITY IMPROVEMENT. THE HOSPITAL IS A PART OF THE COMMUNITY HOSPITAL CORPORATION (CHC) FAMILY OF HOSPITALS. CHC IS A NOT-FOR-PROFIT COMPANY WHOSE SOLE MISSION IS TO HELP NOT-FOR-PROFIT HOSPITALS, SUCH AS SMMC, REMAIN COMMUNITY-OPERATED AND GOVERNED. BASED ON HOSPITAL INPATIENT DISCHARGE DATA, THE DEFINED SERVICE AREA OF SMMC IS FAYETTE AND LEE COUNTIES IN TEXAS. BOTH COUNTIES COMBINED COMPRISE 82.1% OF FISCAL YEAR 2021 INPATIENT DISCHARGES. THE POPULATION OF FAYETTE COUNTY IS EXPECTED TO INCREASE 3.1% FROM 2021 (25,460) TO 2026 (26,258) AND THE POPULATION OF LEE COUNTY IS EXPECTED TO INCREASE 3.3% FROM 2021 (18,092) TO 2026 (18,684), WITH THE EXPECTED GROWTH RATE OF BOTH COUNTIES FALLING BELOW THE 7.9% EXPECTED GROWTH RATE FOR THE STATE OF TEXAS FROM 2021 (29,969,514) TO 2026 (32,346,738). AS OF 2021, THE RACIAL/ETHNIC BREAKOUT OF FAYETTE COUNTY WAS 81.9% WHITE, 6.0% BLACK, 0.4%, ASIAN, 0.8% AMERICAN INDIAN AND 10.9% ALL OTHERS. THE RACIAL/ETHNIC BREAKOUT OF LEE COUNTY IN 2021 WAS 77.6% WHITE, 10.5% BLACK, 0.5% ASIAN, 0.7% AMERICAN INDIAN AND 10.7% ALL OTHERS. HISPANIC IS CLASSIFIED AS AN ETHNICITY AND IS CATEGORIZED SEPARATELY FROM WHITE, BLACK, ASIAN, AMERICAN INDIAN AND ALL OTHERS. BY 2026, THE WHITE NON-HISPANIC POPULATION IN FAYETTE COUNTY IS EXPECTED TO INCREASE BY 2.2% AND TO INCREASE BY 2.9% IN LEE COUNTY. BY 2026, THE BLACK POPULATION IS EXPECTED TO DECREASE BY 1.5% IN FAYETTE COUNTY AND TO INCREASE BY 0.5% IN LEE COUNTY. THE ASIAN POPULATION IS EXPECTED TO INCREASE BY 20.0% IN FAYETTE COUNTY AND BY 25.5% IN LEE COUNTY BY 2026. THE AMERICAN INDIAN POPULATION IS EXPECTED TO INCREASE BY 5.5% IN FAYETTE COUNTY AND BY 13.3% IN LEE COUNTY. ALL OTHER RACIAL/ETHNIC GROUPS ARE EXPECTED TO INCREASE BY 11.5% IN FAYETTE COUNTY AND BY 6.7% IN LEE COUNTY BY 2026. THE HISPANIC POPULATION IS EXPECTED TO INCREASE BY 13.2% IN FAYETTE COUNTY AND BY 9.5% IN LEE COUNTY BY 2026. BETWEEN 2011 AND 2019, THE PERCENT OF FOREIGN-BORN RESIDENTS INCREASED IN BOTH FAYETTE AND LEE COUNTIES, THE STATE AND THE NATION. IN 2015-2019, FAYETTE COUNTY (7.6%) HAD A LOWER PERCENT OF FOREIGN-BORN RESIDENTS THAN LEE COUNTY (8.4%), THE STATE (17.0%) AND THE NATION (13.6%). AS OF 2021, FAYETTE COUNTY (48.7 YEARS) HAD AN OLDER MEDIAN AGE THAN BOTH LEE COUNTY (41.1 YEARS) AND THE STATE OF TEXAS (35.3 YEARS). THE MEDIAN AGE IN BOTH COUNTIES AND THE STATE IS EXPECTED TO INCREASE SLIGHTLY OVER THE NEXT FIVE YEARS (2021-2026). AS OF 2021, THE MEDIAN HOUSEHOLD INCOMES IN BOTH FAYETTE ($60,548) AND LEE ($56,620) COUNTIES ARE LOWER THAN THAT OF THE STATE ($63,524). BETWEEN 2021 AND 2026, THE MEDIUM HOUSEHOLD INCOMES IN FAYETTE COUNTY, LEE COUNTY, AND THE STATE ARE EXPECTED TO INCREASE. FAYETTE COUNTY (20.6%) AND LEE COUNTY (15.4%) HAVE A LOWER PERCENTAGE OF RESIDENTS WITH A BACHELOR OR ADVANCED DEGREE THAN THE STATE (31.3%) (2021). IN 2014-2018, 16.0% OF THE NATION LIVED IN A DISTRESSED COMMUNITY, AS COMPARED TO 26.0% OF THE NATION THAT LIVED IN A PROSPEROUS COMMUNITY. IN 2014-2018, 24.5% OF THE POPULATION IN TEXAS LIVED IN A DISTRESSED COMMUNITY, AS COMPARED TO 26.2% OF THE POPULATION THAT LIVED IN A PROSPEROUS COMMUNITY. IN 2014-2018, THE DISTRESS SCORE IN FAYETTE COUNTY WAS 48.1 WHICH FALLS WITHIN THE MID-TIER ECONOMIC CATEGORY, WHILE THE DISTRESS SCORE IN LEE COUNTY WAS 35.4 WHICH FALLS WITHIN THE COMFORTABLE ECONOMIC CATEGORY AND IS MORE PROSPEROUS AS COMPARED TO OTHER COUNTIES IN THE STATE. WITH RESPECT TO UNEMPLOYMENT, RATES IN BOTH FAYETTE AND LEE COUNTIES AND THE STATE INCREASED BETWEEN 2018 AND 2020. IN 2020, BOTH FAYETTE (4.7) AND LEE (4.9) COUNTIES HAD A LOWER UNEMPLOYMENT RATE THAN THE STATE (7.6). OVER THE MOST RECENT 12-MONTH TIME PERIOD, MONTHLY UNEMPLOYMENT RATES IN FAYETTE AND LEE COUNTIES DECREASED. FOR FAYETTE COUNTY, AUGUST 2020 HAD THE LOWEST UNEMPLOYMENT RATE (4.1) AS COMPARED TO JUNE 2020 WITH THE HIGHEST RATE (5.8). FOR LEE COUNTY, AUGUST 2020 AND MAY 2021 HAD THE LOWEST UNEMPLOYMENT RATE (4.3) AS COMPARED TO JUNE AND JULY 2020 WITH THE HIGHEST RATE (6.1). AS OF 2019, THE MAJORITY OF EMPLOYED PERSONS IN BOTH FAYETTE AND LEE COUNTIES ARE WITHIN OFFICE AND ADMINISTRATION SUPPORT OCCUPATIONS. THE MOST COMMON EMPLOYED GROUPINGS IN FAYETTE COUNTY ARE OFFICE AND ADMINISTRATION SUPPORT OCCUPATIONS (14.7%); SALES AND RELATED OCCUPATIONS (10.6%); CONSTRUCTION AND EXTRACTION OCCUPATIONS (9.4%); PRODUCTION OCCUPATIONS (8.5%); AND MANAGEMENT OCCUPATIONS (8.4%). IN LEE COUNTY, THE MOST COMMON EMPLOYED GROUPINGS ARE OFFICE AND ADMINISTRATION SUPPORT OCCUPATIONS (12.6%); SALES AND RELATED OCCUPATIONS (10.5%); CONSTRUCTION AND EXTRACTION OCCUPATIONS (9.5%); MANAGEMENT OCCUPATIONS (8.6%); AND PRODUCTION OCCUPATIONS (6.9%). IN 2015-2019, DRIVING ALONE WAS THE MOST FREQUENT MEANS OF TRANSPORTATION TO WORK FOR BOTH FAYETTE AND LEE COUNTIES AND THE STATE. IN 2015-2019, FAYETTE COUNTY (8.0%) HAD THE LOWEST PERCENT OF PEOPLE WHO CARPOOLED TO WORK AS COMPARED TO LEE COUNTY (11.0%) AND THE STATE (10.0%). FAYETTE COUNTY (23.6 MINUTES) HAD A SHORTER MEAN TRAVEL TIME TO WORK THAN LEE COUNTY (29.1 MINUTES) AND THE STATE (27.2 MINUTES) (2015-2019). IN 2021, LEE COUNTY (21.6%) HAD THE HIGHEST PERCENTAGE OF FAMILIES LIVING BELOW THE POVERTY LEVEL AS COMPARED TO FAYETTE COUNTY (19.1%) AND THE STATE (18.0%). BETWEEN 2015 AND 2019, THE PERCENTAGE OF CHILDREN (<18 YEARS) LIVING BELOW POVERTY IN BOTH FAYETTE AND LEE COUNTIES AND THE STATE DECREASED. IN 2019, FAYETTE COUNTY (15.3%) HAD A LOWER PERCENTAGE OF CHILDREN (<18 YEARS) LIVING BELOW POVERTY THAN LEE COUNTY (16.1%) AND THE STATE (19.2%). ACCORDING TO FEEDING AMERICA, AN ESTIMATED 13.3% OF FAYETTE COUNTY RESIDENTS ARE FOOD INSECURE AS COMPARED TO 12.7% IN LEE COUNTY AND 14.1% IN TEXAS (2019). ADDITIONALLY, 18.5% OF THE YOUTH POPULATION (UNDER 18 YEARS OF AGE) IN FAYETTE COUNTY ARE FOOD INSECURE, AS COMPARED TO 18.0% IN LEE COUNTY AND 19.6% IN TEXAS (2019). THE AVERAGE MEAL COST FOR A FAYETTE COUNTY RESIDENT IS $3.05, AS COMPARED TO $3.22 IN LEE COUNTY AND $2.68 IN TEXAS (2019). BETWEEN 2014 AND 2018, FAYETTE COUNTY MAINTAINED A LOWER PERCENTAGE OF RECIPIENTS WHO QUALIFIED FOR SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) BENEFITS THAN LEE COUNTY AND THE STATE. ADDITIONALLY, THE PERCENTAGE OF SNAP BENEFIT RECIPIENTS IN BOTH COUNTIES OVERALL INCREASED BETWEEN 2014 AND 2018. IN 2018, FAYETTE COUNTY (7.3%) HAD A LOWER PERCENTAGE OF RECIPIENTS WHO QUALIFIED FOR SNAP BENEFITS THAN BOTH LEE COUNTY (10.8%) AND THE STATE (12.2%). IN 2018-2019, FAYETTE COUNTY (53.5%) AND LEE COUNTY (60.0%) HAD A LOWER PERCENTAGE OF PUBLIC SCHOOL STUDENTS ELIGIBLE FOR FREE OR REDUCED PRICE LUNCH THAN THE STATE (60.5%) AND A HIGHER PERCENTAGE THAN THE NATION (49.5%). FAYETTE COUNTY (95.5%) AND LEE COUNTY (96.3%) HAD A HIGHER HIGH SCHOOL GRADUATION RATE THAN THE STATE (91.4%) AND THE NATION (87.7%) (2018-2019).

Schedule H, Part V, Section B, Line 5 Facility , 2
"Facility , 2 - ST. MARKS MEDICAL CENTER, CONTINUED. HEART DISEASE IS THE LEADING CAUSE OF DEATH IN FAYETTE COUNTY AND THE STATE AND THE SECOND LEADING CAUSE OF DEATH IN LEE COUNTY (2015-2019). BETWEEN 2015 AND 2019, HEART DISEASE MORTALITY RATES OVERALL DECREASED IN BOTH FAYETTE COUNTY AND THE STATE AND INCREASED IN LEE COUNTY. IN 2019, THE HEART DISEASE MORTALITY RATE IN FAYETTE COUNTY (183.0 PER 100,000) WAS HIGHER THAN LEE COUNTY (180.3 PER 100,000) AND THE STATE (167.5 PER 100,000). CANCER IS THE SECOND LEADING CAUSE OF DEATH IN BOTH FAYETTE COUNTY AND THE STATE, AND THE LEADING CAUSE OF DEATH IN LEE COUNTY (2017-2019). BETWEEN 2015 AND 2019, CANCER MORTALITY RATES OVERALL DECREASED IN BOTH COUNTIES AND THE STATE. IN 2017-2019, THE CANCER MORTALITY RATE IN LEE COUNTY (186.4 PER 100,000) WAS HIGHER THAN FAYETTE COUNTY (117.7 PER 100,000) AND THE STATE (143.5 PER 100,000). FATAL ACCIDENTS IS THE THIRD LEADING CAUSE OF DEATH IN BOTH FAYETTE AND LEE COUNTIES, AND THE FIFTH LEADING CAUSE OF DEATH IN THE STATE (2015-2019). BETWEEN 2015 AND 2019, ACCIDENT MORTALITY RATES DECREASED IN FAYETTE COUNTY, INCREASED IN LEE COUNTY, AND SLIGHTLY INCREASED IN THE STATE. IN 2017-2019, THE ACCIDENT MORTALITY RATE IN LEE COUNTY (71.6 PER 100,000) WAS HIGHER THAN THE RATE IN FAYETTE COUNTY (48.3 PER 100,000) AND THE STATE (38.7 PER 100,000). THE LEADING CAUSE OF FATAL ACCIDENTS IN FAYETTE AND LEE COUNTY IS DUE TO MOTOR VEHICLE ACCIDENTS (2017-2019). CEREBROVASCULAR DISEASE IS THE FOURTH LEADING CAUSE OF DEATH IN BOTH FAYETTE AND LEE COUNTIES, AND THE THIRD LEADING CAUSE OF DEATH IN THE STATE (2015-2019). BETWEEN 2015-2019, CEREBROVASCULAR DISEASE MORTALITY RATES DECREASED IN BOTH COUNTIES AND THE STATE. IN 2017-2019, THE CEREBROVASCULAR DISEASE MORTALITY RATE IN BOTH FAYETTE (31.3 PER 100,000) AND LEE (36.3 PER 100,000) COUNTIES WAS LOWER THAN THE STATE (40.2 PER 100,000). ESSENTIAL HYPERTENSION AND HYPERTENSIVE RENAL DISEASE IS THE FIFTH LEADING CAUSE OF DEATH IN FAYETTE COUNTY, THE SIXTH LEADING CAUSE OF DEATH IN LEE COUNTY, AND IS NOT A LEADING CAUSE OF DEATH IN THE STATE (2015-2019). BETWEEN 2015 AND 2019, ESSENTIAL HYPERTENSION AND HYPERTENSIVE RENAL DISEASE MORTALITY RATES INCREASED IN FAYETTE COUNTY AND SLIGHTLY INCREASED IN THE STATE. IN 2017-2019, THE ESSENTIAL HYPERTENSION AND HYPERTENSIVE RENAL DISEASE MORTALITY RATE IN BOTH LEE (29.3 PER 100,000) AND FAYETTE (29.2 PER 100,000) COUNTY IS HIGHER THAN THE STATE (8.7 PER 100,000). CHRONIC LOWER RESPIRATORY DISEASE, (CLRD), ALZHEIMER'S DISEASE, DIABETES MELLITUS, SEPTICEMIA, AND INFLUENZA AND PNEUMONIA ARE ALSO, LEADING CAUSES OF DEATH IN EITHER FAYETTE AND LEE COUNTY OR IN BOTH COUNTIES. AS OF NOVEMBER 8, 2021, THE PERCENT OF THE POPULATION (AGE 5+) THAT WAS FULLY VACCINATED FOR COVID-19 IN FAYETTE COUNTY (51.1%) WAS HIGHER THAN LEE COUNTY (46.8%) BUT LOWER THAN THE STATE (60.5%). BETWEEN 2016 AND 2020, DIABETES PREVALENCE RATES IN ADULTS (AGE 18+) IN THE STATE SLIGHTLY INCREASED. IN 2017-2019, FAYETTE & LEE COUNTIES (8.6%) HAD A LOWER PERCENT OF ADULTS (AGE 18+) WHO HAD EVER BEEN DIAGNOSED WITH DIABETES THAN THE STATE (12.2%). IN 2018, THE PERCENT OF MEDICARE BENEFICIARIES WITH DIABETES IN FAYETTE COUNTY (23.2%) WAS THE LOWEST AS COMPARED TO LEE COUNTY (27.4%), THE STATE (28.8%) AND THE NATION (27.0%). BETWEEN 2016 AND 2020, OBESITY PREVALENCE RATES IN ADULTS (AGE 18+) IN FAYETTE AND LEE COUNTIES OVERALL DECREASED, WHILE RATES IN THE STATE SLIGHTLY INCREASED. IN 2018-2020, FAYETTE AND LEE COUNTIES (36.9%) HAD A HIGHER PERCENT OF OBESE ADULTS (AGE 18+) THAN THE STATE (34.9%). LEE COUNTY (60.9%) HAS THE HIGHEST RATE OF MEDICARE FEE-FOR-SERVICE RESIDENTS WITH HYPERTENSION AS COMPARED TO FAYETTE COUNTY (59.8%), THE STATE (59.9%) AND THE NATION (57.2%) (2018). BETWEEN 2016 AND 2020, ASTHMA PREVALENCE RATES IN ADULTS (AGE 18+) IN THE STATE SLIGHTLY INCREASED. IN 2017-2019, FAYETTE & LEE COUNTIES (15.7%) HAD A HIGHER PERCENTAGE OF ADULTS (AGE 18+) EVER DIAGNOSED WITH ASTHMA THAN THE STATE (13.0%). BETWEEN 2016 AND 2020, ARTHRITIS PREVALENCE RATES IN ADULTS (AGE 18+) IN THE STATE SLIGHTLY DECREASED. IN 2018-2020, FAYETTE & LEE COUNTIES (29.0%) HAD A HIGHER PERCENTAGE OF ADULTS (AGE 18+) EVER DIAGNOSED WITH ARTHRITIS THAN THE STATE (21.0%). BETWEEN 2016 AND 2020, THE RATE OF ADULTS (AGE 18+) IN THE STATE THAT HAVE BEEN DIAGNOSED WITH A DEPRESSIVE DISORDER INCREASED. IN 2017-2019, FAYETTE & LEE COUNTIES (14.5%) HAD A HIGHER PERCENTAGE OF ADULTS (AGE 18+) EVER DIAGNOSED WITH A DEPRESSIVE DISORDER THAN THE STATE (16.8%). BETWEEN 2016 AND 2020, THE PERCENT OF ADULTS (AGE 18+) WHO SELF-REPORTED THAT THEY HAD A DISABILITY IN THE STATE INCREASED. THE PERCENT OF ADULTS (AGE 18+) WHO SELF-REPORTED THAT THEY HAD A DISABILITY IN FAYETTE & LEE COUNTIES (15.8%) WAS LOWER THAN THE STATE (26.8%) (2017-2019). AS OF 2019, FAYETTE COUNTY (23.4%) HAS A LOWER RATE OF UNINSURED ADULTS (AGE 18-64) AS COMPARED TO LEE COUNTY (24.5%) AND THE STATE (24.3%). BOTH FAYETTE AND LEE COUNTIES AND THE STATE EXPERIENCED SLIGHT INCREASES IN THE PERCENTAGE OF UNINSURED ADULTS (AGE 18-64) BETWEEN 2015 AND 2019. A COMPREHENSIVE, SIX-STEP COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA"") WAS CONDUCTED FOR ST. MARK'S MEDICAL CENTER (SMMC) BY COMMUNITY HOSPITAL CORPORATION (CHC). THIS CHNA UTILIZES RELEVANT HEALTH DATA AND STAKEHOLDER INPUT TO IDENTIFY THE SIGNIFICANT COMMUNITY HEALTH NEEDS IN FAYETTE AND LEE COUNTIES IN TEXAS. COMMUNITY INPUT WAS RECEIVED DURING INTERVIEWS CONDUCTED BY CHC FROM JULY 12, 2021 - AUGUST 5, 2021. THE CHNA IS DESIGNED IN ACCORDANCE WITH CHNA REQUIREMENTS IDENTIFIED IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND FURTHER ADDRESSED IN THE INTERNAL REVENUE SERVICE FINAL REGULATIONS RELEASED ON DECEMBER 29, 2014. THE SMMC BOARD REVIEWED AND ADOPTED THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN ON APRIL 28, 2022. INTERVIEW METHODOLOGY: SMMC WORKED WITH CHC IN THE DEVELOPMENT OF ITS CHNA. SMMC PROVIDED ESSENTIAL DATA AND RESOURCES NECESSARY TO INITIATE AND COMPLETE THE PROCESS, INCLUDING THE DEFINITION OF THE HOSPITAL'S STUDY AREA AND THE IDENTIFICATION OF KEY COMMUNITY STAKEHOLDERS TO BE INTERVIEWED. BACKGROUND INFORMATION ABOUT SMMC, INCLUDING THE MISSION, VISION, AND SERVICES WAS PROVIDED BY THE HOSPITAL OR TAKEN FROM ITS WEBSITE. POPULATION DEMOGRAPHICS INFORMATION WAS COLLECTED BY CHC USING SOURCES WHICH INCLUDED STRATASAN, THE U.S. CENSUS BUREAU AND THE UNITED STATES BUREAU OF LABOR STATISTICS AND INCLUDED INFORMATION REGARDING POPULATION CHANGE BY RACE, ETHNICITY, AGE, MEDIAN INCOME ANALYSIS, UNEMPLOYMENT AND ECONOMIC STATISTICS IN THE STUDY AREA. HEALTH DATA WAS ALSO COLLECTED FROM A VARIETY OF SOURCES, INCLUDING BUT NOT LIMITED TO, THE ROBERT WOOD JOHNSON FOUNDATION, TEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES, SPARKMAP, UNITED STATES CENSUS BUREAU AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION. SMMC PROVIDED CHC WITH A LIST OF PERSONS WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH IN FAYETTE AND LEE COUNTIES, INCLUDING PUBLIC HEALTH REPRESENTATIVES AND OTHER INDIVIDUALS WHO FOCUS SPECIFICALLY ON UNDERREPRESENTED GROUPS. FROM THAT LIST, SEVENTEEN IN DEPTH INTERVIEWS WERE CONDUCTED USING A STRUCTURED INTERVIEW GUIDE, WITH THE TWO GROUPS OUTLINED IN THE INTERNAL REVENUE SERVICE FINAL REGULATIONS ISSUED DECEMBER 29, 2014. DISCUSSED WERE THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. WITH RESPECT TO INDIVIDUALS PROVIDING INPUT, IT WAS NOTED IN THE CHNA THAT 64.7% OF THOSE PROVIDING INPUT ARE MEMBERS OF A MEDICALLY UNDERSERVED, LOW-INCOME OR MINORITY POPULATION IN THE COMMUNITY, OR INDIVIDUALS OR ORGANIZATIONS SERVING OR REPRESENTING THE INTERESTS OF SUCH POPULATIONS. 5.9% OF THOSE PROVIDING INPUT WORK FOR A STATE, LOCAL, TRIBAL OR REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENT (OR EQUIVALENT DEPARTMENT OR AGENCY) WITH KNOWLEDGE, INFORMATION OR EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY AND 29.4% OF THOSE PROVIDING INPUT ARE COMMUNTIY LEADERS."

Schedule H, Part V, Section B, Line 5 Facility , 3
Facility , 3 - ST. MARKS MEDICAL CENTER, CONTINUED. INTERVIEWEES INCLUDED: * THOMAS BORGSTEDTE, MD: PHYSICIAN-FAMILY PRACTICE, LA GRANGE FAMILY HEALTH CLINIC; BOARD MEMBER, ST. MARK'S MEDICAL CENTER * LADONNA BOYD: DIRECTOR, BLUEBONNET TRAILS COMMUNITY SERVICES * LOIS CHAPMAN: NURSE, BASTROP CLINIC - TX DHHS REGION 7 FIELD OFFICE LOCATION * MIKAELA DEBARBA: RETAIL PHARMACIST, HEB - LA GRANGE * ROGER DEES: SUPERINTENDENT, GIDDINGS INDEPENDENT SCHOOL DISTRICT * NANCY DOYLE: PAYROLL AND BENEFITS CLERK, GIDDINGS INDEPENDENT SCHOOL DISTRICT * KELLY FRANKE: EXECUTIVE DIRECTOR, COMBINED COMMUNITY ACTION - FAYETTE, LEE, BASTROP CO. * SALLY GARRETT: COUNTY EXTENSION AGENT, TEXAS A&M AGRILIFE EXTENSION - FAYETTE COUNTY * BRENDAN GILBREATH: HOMELAND SECURITY ASSISTANT, FAYETTE COUNTY * MARY KAHANEK: PRESIDENT, ST. MARK'S VOLUNTEERS * SHERI KEHLER: CHIEF EXECUTIVE OFFICER, TEJAS HEALTH CARE * CHRIS LITTLE: LEAD PASTOR, CROSSPOINT CHURCH * CRAIG MOREAU: CHIEF OF EMERGENCY MANAGEMENT AND HOMELAND SECURITY FOR FAYETTE COUNTY, FAYETTE COUNTY * DUDLEY PILAND: BOARD CHAIR, ST. MARK'S MEDICAL CENTER * JOSHUA VANDEVER: DIRECTOR, FAYETTE COUNTY EMERGENCY MEDICAL SERVICES * WILLIAM WAGNER: SUPERINTENDENT, LA GRANGE INDEPENDENT SCHOOL DISTRICT * JOE WEBER: JUDGE, FAYETTE COUNTY POPULATIONS THAT WERE IDENTIFIED AS THE MOST AT RISK FOR INADEQUATE CARE IN THE COMMUNITY BY INTERVIEWEES WERE: ELDERLY, OBSTETRIC POPULATION, LOW INCOME/WORKING POOR, RACIAL/ETHNIC GROUPS, YOUTH POPULATIONS, TEENAGERS/ADOLESCENTS, UN/UNDERINSURED, AND VETERANS. THESE UNDERSERVED GROUPS WERE IDENTIFIED AS MOST AT RISK FOR INADEQUATE CARE DUE TO THE FOLLOWING: ELDERLY * TRANSPORTATION BARRIERS * LACK OF LOCAL SPECIALTY SERVICES * SOCIAL ISOLATION * PRESCRIPTION COSTS * ADDITIONAL SPACE/FACILITY TO CATER TO ALZHEIMER'S AND DEMENTIA PATIENTS OB POPULATION * LACK OF LOCAL OB-RELATED SERVICES AND PROVIDERS LOW INCOME/WORKING POOR * LACK OF LOCAL, AFFORDABLE PREVENTIVE CARE, DENTAL CARE * ESTABLISHING PROVIDER RELATIONSHIP * COST OF INSURANCE, PARTICULAR DEDUCTIBLES AND AFFORDING PRESCRIPTIONS * TRANSPORTATION BARRIERS RACIAL/ETHNIC * LANGUAGE BARRIERS * HEALTHY LIFESTYLE EDUCATION YOUTH POPULATION * IMMUNIZATIONS * LIMITED ACCESS TO PEDIATRIC CARE, LONG WAIT TIMES TEENAGERS/ADOLESCENTS * NEED FOR MENTAL HEALTH SERVICES, PRIMARY PREVENTION * HEALTHY LIFESTYLE EDUCATION * DRUG PREVENTION AND EDUCATION * SEX EDUCATION UN/UNDERINSURED * LACK OF LOCAL, AFFORDABLE PREVENTIVE CARE, DENTAL CARE * ESTABLISHING PROVIDER RELATIONSHIP * COST OF INSURANCE, PARTICULAR DEDUCTIBLES AND AFFORDING PRESCRIPTIONS * OVERUSE OF EMERGENCY ROOM AS CLINIC VETERANS * LACK OF ACCESS TO LOCAL RESOURCES AND SERVICES * LACK OF MENTAL HEALTH RESOURCES * TRANSPORTATION BARRIERS

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - ST. MARKS MEDICAL CENTER. THE MOST RECENTLY CONDUCTED CHNA IDENTIFIED FIVE SIGNIFICANT NEEDS IN THE COMMUNITY SERVED BY ST. MARK'S MEDICAL CENTER, (SMMC). THE NEEDS WERE IDENTIFIED BY ASSESSING THE PREVALENCE OF THE ISSUES FOUND WITHIN THE HEALTH DATA FINDINGS, COMBINED WITH THE FREQUENCY AND SEVERITY OF MENTIONS IN COMMUNITY INPUT. HOSPITAL LEADERSHIP MET WITH COMMUNITY HOSPITAL CORPORATION, (CHC), TO REVIEW THE RESEARCH FINDINGS AND PRIORITIZE THE COMMUNITY HEALTH NEEDS. THE FINAL LIST OF PRIORITIZED NEEDS IS AS FOLLOWS: 1. CONTINUED RECRUITMENT OF PRIMARY AND SPECIALTY CARE SERVICES AND PROVIDERS 2. ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS 3. ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS 4. CONTINUED FOCUS ON COVID-19 PREVENTION & RESPONSE 5. PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES THE CHNA TEAM PARTICIPATED IN A PRIORITIZATION PROCESS USING A STRUCTURED MATRIX TO RANK THE COMMUNITY HEALTH NEEDS BASED ON THREE CHARACTERISTICS: SIZE AND PREVALENCE OF THE ISSUE, EFFECTIVENESS OF INTERVENTIONS AND THE HOSPITAL'S CAPACITY TO ADDRESS THE NEED. ONCE THIS PRIORITIZATION PROCESS WAS COMPLETE, HOSPITAL LEADERSHIP DISCUSSED THE RESULTS AND DECIDED TO ADDRESS ALL FIVE OF THE PRIORITIZED NEEDS IN VARIOUS CAPACITIES THROUGH A HOSPITAL SPECIFIC IMPLEMENTATION PLAN. PRIORITY #1: CONTINUED RECRUITMENT OF PRIMARY AND SPECIALTY CARE SERVIES AND PROVIDERS OBJECTIVE: IMPLEMENT AND OFFER PROGRAMS THAT AIM TO ADDRESS ACCESS TO PRIMARY AND SPECIALTY CARE SERVICES IN THE COMMUNITY THROUGH RECRUITMENT AND RETENTION EFFORTS 1.A. SMMC WILL CONTINUE TO PROVIDE OPPORTUNITIES FOR BETTER COMMUNITY ACCESS TO PRIMARY AND SPECIALTY CARE PROVIDER SERVICES DEDICATED FULL TIME TO THE LOCAL COMMUNITY THROUGH INDEPENDENT AND/OR JOIN RECRUITMENT, AS WELL AS CONTINUAL EVALUATION OF IDENTIFIED NEEDS AND ADDITIONAL EQUIPMENT FOR PROVIDER SERVICES. 1.B. SMMC WILL CONTINUE TO PROVIDE REFERENCE LAB SERVICES TO EXTERNAL PROVIDERS AS REQUESTED. 1.C. SMMC WILL CONTINUE TO INCREASE ACCESS TO CARE THROUGH THE PROVISION OF TELEHEALTH SERVICES TO APPLICABLE PATIENTS. 1.D. SMMC PHYSICIANS AND NURSING STAFF WILL CONTINUE TO IMPLEMENT TRANSFER PROCESSES TO EFFECTIVELY WORK IN CONJUNCTION WITH EQUIPMENT, SUPPLIES, AND PROCESSES OF ST. DAVID'S MEDICAL CENTER TO ENSURE SEAMLESS TRANSITION FOR PATIENTS REQUIRING TRANSPORT TO A HIGHER LEVEL OF CARE. 1.E. SMMC WILL CONTINUE TO SERVE AS A CLINICAL SITE FOR STUDENTS FROM LOCAL PROGRAMS IN THE AREAS OF HEALTH INFORMATION MANAGEMENT, IMAGING, LABORATORY, RESPIRATORY THERAPY, RN, LVN AND SURGICAL TECHNOLOGISTS. 1.F. SMMC WILL CONTINUE TO PARTICIPATE IN ST. DAVID'S HEALTHCARE CLINICAL OUTREACH PROGRAMS TO INCLUDE ADVANCED CARDIAC LIFE SUPPORT (ACLS), PEDIATRIC ADVANCED LIFE SUPPORT (PALS), TRAUMA NURSING CORE CURRICULUM, PREPAREDNESS FOR PRECIPITOUS DELIVERIES IN THE EMERGENCY DEPARTMENT, AND OTHER CRITICAL CARE TOPICS. CONTINUING MEDICAL EDUCATION FOR PHYSICIANS IS OFFERED AS WELL. 1.G. SMMC WILL CONTINUE TO MARKET NEWLY RECRUITED SPECIALIST AND PRIMARY CARE PROVIDERS THROUGH COMMUNITY INTRODUCTIONS, RADIO ADS, AND PRESS RELEASES. 1.H. SMMC WILL CONTINUE TO OFFER A SWINGBED PROGRAM FOR ITS PATIENT POPULATION. PRIORITY #2: ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS OBJECTIVE: PROVIDE ACCESS TO HEALTH CARE AND SERVICES TO VULNERABLE POPULATIONS, SUCH AS THE INDIGENT, MINORITY, AND ELDERLY POPULATIONS 2.A. SMMC CONTINUES TO ESTABLISH PARTNERSHIPS WITH LOCAL COMMUNITY ORGANIZATIONS TO PROVIDE HEALTHCARE-RELATED SUPPORT AS OPPORTUNITIES ARISE. 2.B. SMMC PROVIDES THE MD SAVE PROGRAM FOR SELF-PAY AND THOSE WITH HIGH DEDUCTIBLES IN ORDER TO OFFER CERTAIN SERVICES AT A DISCOUNTED RATE TO ASSIST THE COMMUNITY WITH THEIR HIGH DEDUCTIBLE PLANS OR INDIVIDUALS WHO ARE UNINSURED. 2.C. SMMC WILL CONTINUE TO MAKE OSTEOPOROSIS SCREENINGS AVAILABLE TO THE ELDERLY POPULATION. 2.D. SMMC WILL CONTINUE TO PROVIDE INPATIENT AND ER CARE THROUGH ITS CONTRACT WITH BASTROP FEDERAL CORRECTION INSTITUTION. 2.E. SMMC WILL CONTINUE TO OFFER EDUCATION ON MEDICARE RULES AND REGULATIONS TO SENIOR CITIZENS, AS WELL AS EDUCATION TO ALL POPULATIONS ON ADVANCED DIRECTIVES AND END OF LIFE PLANNING UPON REQUEST. 2.F. SMMC WILL CONTINUE TO PROVIDE INCREASED ACCESS TO MEDICAL SERVICES AND RECORDS THROUGH THE ONLINE PHYSICIAN DIRECTORY ON THE HOSPITAL WEBSITE. 2.G. SMMC WILL CONTINUE TO OFFER REDUCED COST MAMMOGRAPHY SERVICES IN CONJUNCTION WITH BREAST CANCER AWARENESS EVENTS. 2.H. SMMC PROVIDES A LEASED, ON-SITE VA CLINIC FOR VETERANS TO SEEK CARE AND ACCESS LOCAL SPECIALTY CARE THROUGH THE HOSPITAL. 2.I. IN COMPLIANCE WITH THE INPATIENT AND LONG-TERM CARE HOSPITAL PROSPECTIVE PAYMENT SYSTEM FINAL RULE, SMMC PUBLICLY SHARES ITS PRICING INFORMATION ONLINE IN AN EFFORT TO INCREASE PRICE TRANSPARENCY AND EMPOWER CONSUMERS TO MAKE INFORMED CHOICES ABOUT THEIR CARE. INFORMATION IS UPDATED ANNUALLY. 2.J. SMMC WILL CONTINUE TO PROVIDE EDUCATIONAL OPPORTUNITIES FOR SENIOR CITIZENS, SUCH AS THE FAYETTE COUNTY SENIOR DAY, LEE COUNTY SENIOR DAY, THE FAYETTE & LEE COUNTY SENIOR EXPO, AND LOCAL HEALTH FAIRS AS REQUESTED. BLOOD PRESSURE, CHOLESTROL, AND BLOOD GLUCOSE SCREENINGS WITH COUNSELING FOR OUT OF RANGE RESULTS ARE ALSO PROVIDED. PRIORITY #3: ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE SERVICES AND PROVIDERS OBJECTIVE: INCREASE ACCESS TO MENTAL HEALTH RESOURCES FOR ALL RESIDENTS 3.A. SMMC WILL CONTINUE TO COLLABORATE FREQUENTLY THROUGHOUT THE YEAR WITH THE LOCAL MHMR AUTHORITY, AS WELL AS THE LOCAL EMS SERVICES TO ASSURE THAT WE ARE WORKING TOGETHER ON TREATMENT AND PLACEMENT FOR APPLICABLE PATIENTS. 3.B. SMMC WILL CONTINUE TO COLLABORATE WITH LOCAL SCHOOL DISTRICTS TO PROVIDE EDUCATION ON MENTAL AND BEHAVIORAL HEALTH RELATED TOPICS UPON REQUEST. PRIORITY #4: CONTINUED FOCUS ON COVID-19 PREVENTION AND RESPONSE OBJECTIVE: IMPLEMENT AND OFFER PROGRAMS THAT AIM TO REDUCE THE IMPACT OF THE COVID-19 PANDEMIC 4.A. SMMC WILL CONTINUE TO PROVIDE EDUCATION ON COVID-19 AS NEEDED. 4.B. SMMC CONTINUES FOLLOWING CDC GUIDELINES AND COMMUNITY STANDARDS TO CONTROL THE SPREAD AND REDUCE RISK OF COVID-19 INFECTION WHEN DISCHARGING PATIENTS TO A LOWER LEVEL OF CARE AND THEIR HOME ENVIRONMENT. 4.C. SMMC CONTINUES TO REPORT COVID-19 TEST AND PATIENT ADMISSIONS DATA TO THE STATE AND CENTERS FOR DISEASE CONTROL (CDC) IN AN ONGOING EFFORT TO SHARE TIMELY INFORMATION AND RESEARCH REGARDING THE PANDEMIC. VACCINATION RATES AT THE HOSPITAL ARE ALSO PROVIDED. ADDITIONALLY, SMMC SERVES AS A COVID-TESTING SITE FOR PATIENTS WHO WERE REFERRED BY THEIR PROVIDER. PRIORITY #5: PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES OBJECTIVE: PROVIDE OPPORTUNITIES FOR PREVENTION, EDUCATION AND SERVICES THAT AIM TO REDUCE MORTALITY RATES AND THE PREVALENCE OF CHRONIC CONDITIONS AND UNHEALTHY LIFESTYLES IN THE COMMUNITY 5.A. SMMC WILL CONTINUE TO HOST LUNCH & LEARN EVENTS TO EDUCATE REGIONAL EXTERNAL CLINICS ON MEDHOST AND LEADING REACH REFERRAL SOFTWARE WITH THE GOAL OF IMPROVING COORDINATION ACROSS THE CONTINUUM OF CARE. 5.B. SMMC WILL CONTINUE TO PROVIDE FLU VACCINES ON AN ANNUAL BASIS TO EMPLOYEES AND THEIR FAMILIES, AS WELL AS THE SMMC AUXILIARY. 5.C. SMMC WILL CONTINUE TO SPONSOR THE MULTIPLE SCLEROSIS MS-150 BIKE RIDE, INCLUDING HOSTING CAMP ST. MARK'S FOR RIDERS AND PROVIDING ER CARE AS NEEDED. 5.D. SMMC WILL CONTINUE TO PROVIDE INTERVIEWEES (PHYSICIANS AND TENURED CLINICAL STAFF) FOR THE LOCAL RADIO SHOW ""THE DOCTOR'S CORNER,"" WHICH FEATURES DIFFERENT MEDICAL TOPICS PERIODICALLY. 5.E. SMMC PERSONNEL ARE AVAILABLE AS SPEAKERS FOR CIVIC GROUPS, INDUSTRIAL PARTNERS, FOR MEDIA APPEARANCES AND HEALTH FAIRS TO ADDRESS HEALTH CARE TOPICS OF CONCERN TO THE PUBLIC. 5.F. SMMC WILL CONTINUE TO PARTICIPATE IN COLLEGE/CAREER NIGHT WITH LOCAL SCHOOL DISTRICTS. SMMC SUPPORT GROUP PROGRAMS AND EDUCATIONAL SERVICES ARE AVAILABLE UPON REQUEST. ADDITIONALLY, SMMC WILL CONTINUE TO PROVIDE MEETING SPACE FOR COMMUNITY RESOURCE AND EDUCATIONAL GROUPS (I.E., LION'S CLUB, CPR CLASSES, ETC.) AVAILABLE UPON REQUEST. 5.G. SMMC WILL CONTINUE TO PARTCIPATE IN COLLEGE/CAREER NIGHT WITH LOCAL SCHOOL DISTRICTS. 5.H. SMMC WILL CONTINUE ITS MEMBERSHIP ON THE CAPITAL AREA REGIONAL TRAUMA ADVISORY COUNCIL. ADDITIONALLY, SMMC WILL CONTINUE TO PROVIDE PRESENTATIONS TO GIDDINGS ISD AND LA GRANCE ISD STUDENTS REGARDING ANY HEALTH TOPICS OF INTEREST UPON REQUEST. 5.I. SMMC PERSONNEL SERVE IN LEADERSHIP ROLES AND AS VOLUNTEERS WITH MANY AGENCIES AND COMMITEES IN THE COMMUNITY."

Schedule H, Part V, Section B, Line 11 Facility , 2
Facility , 2 - ST. MARK'S MEDICAL CENTER, CONTINUED. 5.J. SMMC WILL CONTINUE TO OFFER HEART DISEASE MANAGEMENT EDUCATION AS PART OF THE CARDIAC REHAB PROGRAM. AS A PREREQUISITE FOR THE PROGRAM, PATIENTS MUST COMPLETE NUTRITIONAL COUNSELING THROUGH THE SMMC DIETITIAN. PATIENTS WHO DO NOT WISH TO PARTICIPATE FULLY IN THE CARDIAC REHAB PROGRAM ARE INVITED TO SIT IN ON HEART DISEASE MANAGEMENT PATIENT EDUCATION SESSIONS. 5.K. SMMC WILL PARTNER WITH AUSTIN HEART TO PERIODICALLY HOST MEETINGS FOR THE COMMUNITY REGARDING HOW TO IMPROVE HEART HEALTH UPON REQUEST. 5.L. SMMC WILL CONTINUE TO PARTNER WITH THE LA GRANGE BLUEBONNET LION'S CLUB AND THE LA GRANGE POLICE DEPARTMENT TO PARTICIPATE IN THE DRUG TAKE BACK PROGRAM FOR THE COMMUNITY. 5.M. SMMC WILL CONTINUE TO ALLOW LOCAL STUDENTS INTERESTED IN PURSUING A CAREER IN HEALTH CARE TO SHADOW PROVIDERS AND ROTATE THROUGH THE FACILITY IN ORDER TO EXPERIENCE THE DIFFERENT DEPARTMENTS WITHIN THE HOSPITAL UPON REQUEST. 5.N. SMMC WILL CONTINUE ENGAGING THE COMMUNITY THROUGH PARTICIPATION IN LOCAL EVENTS AS OPPORTUNITIES ARISE.

Schedule H, Part V, Section B, Line 13 Facility , 1
Facility , 1 - ST. MARK'S MEDICAL CENTER. ALL PATIENTS AND INSURANCES ARE BILLED AT 100% OF CHARGES. ST. MARK'S MEDICAL CENTER (SMMC) CONTRACTUALLY NEGOTIATES WITH PAYORS TO ACCEPT SOMETHING LESS THAN 100% OF CHARGES. MEDICARE PAYS BASED ON FEE SCHEDULES AND DIAGNOSIS RELATED GROUPS, ETC. SELF PAY AND THOSE QUALIFYING FOR FINANCIAL ASSISTANCE ARE ALL BILLED AT 100% OF CHARGES UNTIL SUCH TIME IT IS DETERMINED THAT THEY QUALIFY FOR FINANCIAL ASSISTANCE. BASED UPON THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY A PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE ON A SLIDING SCALE, UP TO A MAXIMUM OF 100%. PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE HAVE THEIR ACCOUNTS REDUCED BASED ON THE LEVEL OF FINANCIAL ASSISTANCE. THE BALANCE OF THE ACCOUNT AFTER APPLICATION OF THE DISCOUNT IS HANDLED CONSISTENT WITH THE HOSPITAL'S COLLECTION POLICY.

Schedule H, Part V, Section B, Line 16 Facility , 1
Facility , 1 - ST. MARK'S MEDICAL CENTER. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE WHEN REGISTERING, THROUGH DISCHARGE PLANNING ETC. STATEMENTS FOR SELF PAY HAVE A TAG LINE STATING IF THEY THINK THEY QUALIFY FOR FINANCIAL ASSISTANCE TO PLEASE CALL THIS NUMBER. WHENEVER A BILL IS DISCUSSED AND A PATIENT INDICATES THEY CAN'T PAY UPFRONT, FINANCIAL ASSISTANCE IS EXPLAINED TO THEM SO THAT IN THE EVENT IT APPLIES THEY KNOW ABOUT IT. IT IS ALSO POSTED ON BULLETIN BOARDS THROUGHOUT THE HOSPITAL THAT FINANCIAL ASSISTANCE IS AVAILABLE.

Schedule H, Part VI Errors and Omissions Related to the Financial Assistance Policy
Pursuant to Rev. Proc. 2015-21, St. Mark's Medical Center acknowledges the following error in noncompliance with Section 501(r)(4) and its correction of that error. In particular, St. Mark's needed to temporarily remove its financial assistance policy (FAP) from its web site in order to update its web site as required to obtain a Rural Emergency Hospital (REH) designation from the Centers for Medicare and Medicaid Services (CMS). This REH designation is designed by CMS to maintain access to critical outpatient hospital services in rural communities. St. Mark's removed the FAP from its web site late February 2023. Once St. Mark's had sufficiently updated its website to qualify for the REH designation, THE Chief Financial Officer placed its FAP back on its web site https://www.smmctx.org/patients-visitors on March 8, 2023, making its FAP widely available to the public free of charge.

Schedule H, Part I, Line 7b Costing methodology
"THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION (""HHSC"") REPLACED THE HISTORICAL MEDICAID UPL PROGRAM WITH THE TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM WAIVER (""WAIVER""). THE WAIVER INCLUDES AN UNCOMPENSATED CARE (""UC"") POOL WHICH HHSC USES TO MAKE SUPPLEMENTAL MEDICAID PAYMENTS TO HOSPITALS TO HELP DEFRAY UNCOMPENSATED CARE COSTS RELATED TO PROVIDING CARE TO MEDICAID ELIGIBLES OR TO INDIVIDUALS WHO HAVE NO SOURCE OF THIRD-PARTY COVERAGE. TO QUALIFY FOR UC PAYMENTS, HOSPITALS MUST SUBMIT A UC APPLICATION TO HHSC WHICH REPORTS THE HOSPITAL'S COST OF PROVIDING UNCOMPENSATED CARE BASED ON THE UC METHODOLOGY PROSCRIBED BY HHSC. FOR THE PERIOD OF JULY 1, 2021 THROUGH JUNE 30, 2022, ST. MARK'S MEDICAL CENTER RECEIVED $495,879 IN UC PAYMENTS AS A SUPPLEMENTAL COST OF REIMBURSEMENT FOR THE TREATING OF MEDICAID ELIGIBLE INDIVIDUALS AND INDIVIDUALS WITHOUT A SOURCE OF THIRD-PARTY COVERAGE."

Schedule H, Part I, Line 3c CHARITY STATUS DETERMINATION
ST. MARK'S MEDICAL CENTER (SMMC) USES BOTH FINANCIAL STATUS AS WELL AS AMOUNT OF MEDICAL DEBT TO DETERMINE CHARITY STATUS.

Schedule H, Part I, Line 6a COMMUNITY BENEFIT REPORT
THE COMMUNITY BENEFIT REPORT WAS PREPARED BY THE PARENT ORGANIZATION, COMMUNITY HOSPITAL CORPORATION.

Schedule H, Part VI, Line 6 AFFILIATED HEALTH CARE SYSTEM
ST. MARK'S MEDICAL CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
PATIENTS ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS AT NET REALIZABLE VALUE BASED ON CERTAIN ASSUMPTIONS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE NET REALIZABLE VALUE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE NET REALIZABLE VALUE IS BASED ON THE ESTIMATED CONTRACTUAL REIMBURSEMENT PERCENTAGES, WHICH IS BASED ON CURRENT CONTRACT PRICES OR HISTORICAL CLAIMS PAID DATA BY PAYOR. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THRID-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE NET REALIZABLE VALUE IS DETERMINED USING ESTIMATES OF HISTORICAL COLLECTION EXPERIENCE. THESE ESTIMATES ARE ADJUSTED FOR RECOVERIES AND ANY ANTICIPATED CHANGES IN TRENDS, INCLUDING SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE COST INFORMATION PROVIDED WAS OBTAINED FROM OUR MEDICARE COST REPORT. ANY SHORTFALL IS A COMMUNITY BENEFIT AS IT IS THE COST OF PROVIDING CARE TO THE COMMUNITY THAT IS NOT REIMBURSED BY THE MEDICARE PROGRAM. BY PROVIDING CARE TO THESE INDIVIDUALS, THE HOSPITAL IS IMPROVING THE HEALTH OF THE COMMUNITY.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
IF A PATIENT QUALIFIES FOR 100% CHARITY, THE ENTIRE ACCOUNT IS WRITTEN-OFF. IF THEY QUALIFY FOR PARTIAL CHARITY, THE CHARITY PORTION IS WRITTEN-OFF AND THE PATIENT RECEIVES MONTHLY STATEMENTS WITH REGARD TO THE SELF-PAYMENT BALANCE. FULL PAYMENT IS EXPECTED FROM THE PATIENT. AFTER 180 DAYS FROM DATE OF SERVICE, IF THE SELF PAYMENT BALANCE REMAINS UNPAID, THIS AMOUNT IS TURNED OVER TO A COLLECTION AGENCY AND THE ACCOUNT IS MOVED TO BAD DEBT ACCOUNTS RECEIVABLE.

Schedule H, Part V, Section B, Line 16a FAP website
- ST. MARK'S MEDICAL CENTER: Line 16a URL: https://www.smmctx.org/patients-visitors - SEE PART VI FOR ERRORS AND OMISSIONS RELATED TO THE FAP;

Schedule H, Part V, Section B, Line 16b FAP Application website
- ST. MARK'S MEDICAL CENTER: Line 16b URL: https://www.smmctx.org/patients-visitors - SEE PART VI FOR ERRORS AND OMISSIONS RELATED TO THE FAP;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- ST. MARK'S MEDICAL CENTER: Line 16c URL: https://www.smmctx.org/patients-visitors - SEE PART VI FOR ERRORS AND OMISSIONS RELATED TO THE FAP;

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

Schedule H, Part VI, Line 2 Needs assessment
AS REPORTED IN SCHEDULE H, PART V, SECTION B, LINES 1-7, ST. MARK'S MEDICAL CENTER, (SMMC), CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING FISCAL YEAR 6/30/2022. SMMC'S LEADERSHIP DEVELOPED AN IMPLEMENTATION PLAN TO IDENTIFY SPECIFIC ACTIVITIES AND SERVICES WHICH DIRECTLY ADDRESS THE TOP PRIORITIES. THE OBJECTIVES WERE IDENTIFIED BY STUDYING THE PRIORITIZED HEALTH NEEDS, WITHIN THE CONTEXT OF THE HOSPITAL'S OVERALL STRATEGIC PLAN AND THE AVAILABILITY OF FINITE RESOURCES. THE PLAN INCLUDES A RATIONALE FOR EACH PRIORITY, FOLLOWED BY OBJECTIVES, SPECIFIC IMPLEMENTATION ACTIVITIES, RESPONSIBLE LEADERS, ANNUAL UPDATES AND PROGRESS, AND KEY RESULTS (AS APPROPRIATE). THE CHNA AND IMPLEMENTATION STRATEGY FOR TAX YEAR 2021, WAS REVIEWED AND ADOPTED BY THE HOSPITAL'S GOVERNING BOARD ON APRIL 28, 2022. THE HOSPITAL'S CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN THE FINAL REGULATIONS RELEASED DECEMBER 29, 2014. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY. THE HEALTH CARE NEEDS FOR THE COMMUNITY SERVED ARE DETERMINED BY ASSESSING THE PREVALENCE OF THE ISSUES IDENTIFIED IN THE HEALTH DATA FINDINGS, COMBINED WITH THE FREQUENCY AND SEVERITY OF MENTIONS IN THE INTERVIEWS CONDUCTED WITH PERSONS HAVING SPECIAL KNOWLEDGE OF PUBLIC HEALTH IN FAYETTE AND LEE COUNTIES, INCLUDING PUBLIC HEALTH REPRESENTATIVES, NOT-FOR-PROFIT ORGANIZATION PROFESSIONALS, CHARITIES AND OTHER INDIVIDUALS WHO FOCUS SPECIFICALLY ON UNDERREPRESENTED GROUPS.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE WHEN REGISTERING, THROUGH DISCHARGE PLANNING ETC. OUR STATEMENTS FOR SELF PAY HAVE A TAG LINE STATING IF THEY THINK THEY QUALIFY FOR FINANCIAL ASSISTANCE TO PLEASE CALL THIS NUMBER. WHENEVER A BILL IS DISCUSSED, AND A PATIENT INDICATES THEY CAN'T PAY UPFRONT, FINANCIAL ASSISTANCE IS EXPLAINED TO THEM SO THAT IN THE EVENT IT APPLIES THEY KNOW ABOUT IT. IT IS ALSO POSTED ON BULLETIN BOARDS THROUGHOUT THE HOSPITAL THAT FINANCIAL ASSISTANCE IS AVAILABLE. ALL SELF-PAY WITHOUT ABILITY TO PAY AT TIME OF SERVICE ARE REFERRED TO OUR ELIGIBILITY VENDOR. THIS ALLOWS THEM TO BE ASSESSED FOR ANY PROGRAMS THAT MAY COVER THEIR MEDICAL EXPENSES SUCH AS MEDICAID, COUNTY PROGRAMS OR ANY OTHER STATE PROGRAMS THAT MAY BE AVAILABLE.

Schedule H, Part VI, Line 5 Promotion of community health
"DURING THIS FISCAL YEAR, ST. MARK'S MEDICAL CENTER (SMMC), PRIORITIZED THE HEALTH OF THEIR COMMUNITY BY ONGOING PARTICIPATION IN NUMEROUS COMMUNITY AND WELLNESS ACTIVITIES, INCLUDING: HEALTHY HEART CHOICES, CAREER EDUCATION DAYS, DRUG TAKE-BACK PROGRAM, REDUCED COST MAMMOGRAPHY SCREENINGS IN CONJUNCTION WITH BREAST CANCER AWARENESS EVENTS, OSTEOPOROSIS SCREENINGS AND CALCIUM SCORING. SMMC LEADERS AND SUBJECT MATTER EXPERTS ALSO GUESTED MULTIPLE TIMES ON THE LOCAL WEEKLY RADIO PROGRAM, ""DOCTORS CORNER,"" WHICH FEATURES VARIOUS MEDICAL TOPICS OF VALUE TO THE COMMUNITY. SMMC HOSTED A FREE, PUBLIC HEALTH FAIR THAT FEATURED WELLNESS EXPERTS, INFORMATION AND MATERIAL TO ATTENDEES. ADDITIONALLY, SMMC'S PUBLIC FACEBOOK PAGE ROUTINELY PROMOTED WELLNESS INFORMATION AND RESOURCES FOR HEALTHY LIFESTYLE CHOICES AND SCREENING RECOMMENDATIONS. SMMC CONTINUES TO PROVIDE NURSING STAFF AT NO CHARGE TO THE LA GRANGE INTERMEDIATE SCHOOL DISTRICT (ISD) SYSTEM TO ASSIST WITH ATHLETIC PHYSICALS. SMMC ALSO COLLABORATES WITH LOCAL SCHOOL DISTRICTS TO PROVIDE EDUCATION ON MENTAL AND BEHAVIORAL HEALTH RELATED TOPICS UPON REQUEST. ADDITIONALLY, SMMC PROVIDES PRESENTATIONS TO GIDDINGS ISD AND LA GRANGE ISD STUDENTS REGARDING SPECIFIC HEALTH TOPICS OF INTEREST. SMMC ALSO ALLOWS STUDENTS INTERESTED IN PURSUING A CAREER IN HEALTH CARE TO SHADOW PROVIDERS AND ROTATE THROUGH THE FACILITY IN ORDER TO EXPERIENCE DAY-TO-DAY ACTIVITIES IN THE DIFFERENT DEPARTMENTS WITHIN THE HOSPITAL. SMMC EMPLOYEES PARTICIPATE IN FUNDRAISING AND OTHER COMMUNITY EVENTS SUCH AS: DEPUTY SANTA GIFTS AT CHRISTMAS, A BLOOD DRIVE SUPPORTED BY EMPLOYEES AND THE PUBLIC WITH WE ARE BLOOD ORGANIZATION, FOOD DRIVES DURING THANKSGIVING, ANGEL TREE FOR LOCAL FAMILIES IN NEED, SPONSORSHIP OF THE MULTIPLE SCLEROSIS MS-150 BIKE RIDE - INCLUDING HOSTING CAMP ST. MARK'S FOR RIDERS AND PROVIDING EMERGENCY CARE AS NEEDED, AS WELL AS VARIOUS CIVIC GROUP GUEST SPEAKERS. SMMC HAS ALWAYS HAD AN OPEN APPLICATION PROCESS FOR ALL ACTIVE AND CONSULTING MEDICAL STAFF. THE SMMC BOARD OF DIRECTORS IS COMPRISED OF REPRESENTATIVES FROM THE COMMUNITIES WE SERVE, INCLUDING FAYETTE AND LEE COUNTY RESIDENTS, AND ARE ELECTED AND APPROVED BY THE BOARD. SURPLUS FUNDS ARE USED TO PURCHASE NEEDED HOSPITAL EQUIPMENT AND ASSIST WITH RECRUITING OF PHYSICIANS TO OUR COMMUNITIES."

Schedule H, Part VI, Line 4 Community information
ST. MARK'S MEDICAL CENTER, (SMMC), SERVES THE CENTRAL TEXAS COMMUNITIES OF FAYETTE AND LEE COUNTIES, AS WELL AS SURROUNDING AREAS. THE POPULATION OF FAYETTE COUNTY IS EXPECTED TO INCREASE 3.1% FROM 2021 (25,460) TO 2026 (26,258) AND THE POPULATION OF LEE COUNTY IS EXPECTED TO INCREASE 3.3% FROM 2021 (18,092) TO 2026 (18,684), WITH THE EXPECTED GROWTH RATE OF BOTH COUNTIES FALLING BELOW THE 7.9% EXPECTED GROWTH RATE FOR THE STATE OF TEXAS FROM 2021 (29,969,514) TO 2026 (32,346,738). THE MAJORITY OF RESIDENTS IN BOTH FAYETTE AND LEE COUNTIES IDENTIFY AS WHITE-NON HISPANIC AT 81.9% AND 77.6%, RESPECTIVELY, (2021). BECAUSE THE HISPANIC MEMBERS OF THE POPULATION ARE CONSIDERED AN ETHNICITY, THE NUMBERS ARE CALCULATED SEPARATELY FROM OTHER RACES. THE HISPANIC POPULATION IS EXPECTED TO INCREASE BY 13.2% IN FAYETTE COUNTY AND BY 9.5% IN LEE COUNTY BY 2026. THE ASIAN PFOPULATION IS THE FASTEST GROWING POPULATION IN BOTH COUNTIES. BY 2026, THE ASIAN POPULATION IN FAYETTE COUNTY IS EXPECTED TO INCREASE BY 20.0% AND BY 25.5% IN LEE COUNTY. AS OF 2021, FAYETTE COUNTY (48.7 YEARS) HAD AN OLDER MEDIAN AGE THAN BOTH LEE COUNTY (41.1 YEARS) AND THE STATE OF TEXAS (35.3 YEARS). THE MEDIAN AGE IN BOTH COUNTIES AND THE STATE IS EXPECTED TO INCREASE SLIGHTLY OVER THE NEXT FIVE YEARS (2021-2026). WITH RESPECT TO UNEMPLOYMENT, RATES IN BOTH FAYETTE AND LEE COUNTIES AND THE STATE INCREASED BETWEEN 2018 AND 2020. IN 2020, BOTH FAYETTE (4.7) AND LEE (4.9) COUNTIES HAD A LOWER UNEMPLOYMENT RATE THAN THE STATE (7.6). OVER THE MOST RECENT 12-MONTH TIME PERIOD, MONTHLY UNEMPLOYMENT RATES IN FAYETTE AND LEE COUNTIES DECREASED. FOR FAYETTE COUNTY, AUGUST 2020 HAD THE LOWEST UNEMPLOYMENT RATE (4.1) AS COMPARED TO JUNE 2020 WITH THE HIGHEST RATE (5.8). FOR LEE COUNTY, AUGUST 2020 AND MAY 2021 HAD THE LOWEST UNEMPLOYMENT RATE (4.3) AS COMPARED TO JUNE AND JULY 2020 WITH THE HIGHEST RATE (6.1). AS OF 2021, THE MEDIAN HOUSEHOLD INCOMES IN BOTH FAYETTE ($60,548) AND LEE ($56,620) COUNTIES ARE LOWER THAN THAT OF THE STATE ($63,524). FAYETTE COUNTY AND LEE COUNTY HAVE LOWER EDUCATIONAL ATTAINMENT RATES THAN THE STATE (2021). IN 2021, LEE COUNTY (21.6%) HAD THE HIGHEST PERCENTAGE OF FAMILIES LIVING BELOW THE POVERTY LEVEL AS COMPARED TO FAYETTE COUNTY (19.1%) AND THE STATE (18.0%). AS OF 2019, AN ESTIMATED 13.3% OF FAYETTE COUNTY RESIDENTS ARE FOOD INSECURE AS COMPARED TO 12.7% IN LEE COUNTY AND 14.1% IN TEXAS. THE AVERAGE MEAL COST FOR A FAYETTE COUNTY RESIDENT IS $3.05, AS COMPARED TO $3.22 IN LEE COUNTY AND $2.68 IN TEXAS (2019). AS OF 2019, FAYETTE COUNTY (23.4%) HAS A LOWER RATE OF UNINSURED ADULTS (AGE 18-64) AS COMPARED TO LEE COUNTY (24.5%) AND THE STATE (24.3%). CANCER AND HEART DISEASE ARE THE TWO LEADING CAUSES OF DEATH IN FAYETTE AND LEE COUNTIES. IN 2019, THE HEART DISEASE MORTALITY RATE IN FAYETTE COUNTY WAS HIGHER THAN LEE COUNTY AND THE STATE. IN 2017-2019, THE CANCER MORTALITY RATE IN LEE COUNTY (WAS HIGHER THAN FAYETTE COUNTY AND THE STATE. IN 2018-2020, FAYETTE AND LEE COUNTIES HAD A HIGHER PERCENT OF OBESE ADULTS (AGE 18+) THAN THE STATE. LEE COUNTY HAD THE HIGHEST RATE OF MEDICARE FEE-FOR-SERVICE RESIDENTS WITH HYPERTENSION AS COMPARED TO FAYETTE COUNTY, THE STATE AND THE NATION (2018). SEDENTARY LIFESTYLE AND CULTURAL FACTORS ARE ALL CONTRIBUTORS TO THESE CHRONIC HEALTH CONDITIONS. AS OF NOVEMBER 8, 2021, THE PERCENT OF THE POPULATION (AGE 5+) THAT IS FULLY VACCINATED FOR COVID-19 IN FAYETTE COUNTY (51.1%) IS HIGHER THAN LEE COUNTY (46.8%) BUT LOWER THAN THE STATE (60.5%). THERE ARE HIGHER PERCENTAGES OF RESIDENTS PARTICIPATING IN UNHEALTHY LIFESTYLE BEHAVIORS SUCH AS SMOKING TOBACCO IN FAYETTE AND LEE COUNTIES THAN THE STATE. WITH REGARD TO MATERNAL AND CHILD HEALTH, FAYETTE AND LEE COUNTIES HAVE LOWER RATES OF MOTHERS RECEIVING INADEQUATE PRENATAL CARE THAN THE STATE. FAYETTE COUNTY HAS HIGHER TEEN (AGE 0-19 YEARS) BIRTH RATES THAN LEE COUNTY AND THE STATE.