4A (Expenses $ 800316784 including grants of $ 388091) (Revenue $ 875190154)
Founded in 1997, Texas Health Resources (THR) provides direction and oversight to its wholly-controlled affiliates. The range of centralized services provided by THR include information services, managed care contracting, human resources, revenue cycle, legal, tax, compliance, supply chain, business development, insurance, treasury, marketing, general accounting, and strategic planning. THR operates professional office buildings leased primarily to physicians who are members of the medical staff of THR affiliated hospitals. THR also operates, manages and coordinates physician services through Texas Health Physicians Group (THPG), a wholly owned affiliate of THR. THPG is a network of primary and specialty care physician practices providing the north Texas area community access to quality health care delivered either through an office setting or through a hospital program.

Part V, Section B
Facility #1 - Texas Health Flower Mound Facility #2 - Texas Health Rockwall Facility #3 - USMD at Arlington Facility #4 - Texas Health Southlake Facility #5 - Physicians Medical Center Part V. Section B, Line 3e - Facilities #1 - #5 The significant health needs of the community are in line with the significant health needs that have been prioritized and identified in the current CHNA. Part V. Section B, Line 5 - Facility #1 Texas Health Flower Mound's (THFM) 2019 CHNA was a collaborative process utilizing qualitative and quantitative methods to assess the health needs of persons within the service areas in the Denton/Wise Counties region. The 2019 CHNA was conducted at the Denton/Wise Counties regional level to generate community-driven solutions for better integration in addressing the clinical and social needs of individuals living in North Texas. Between April 2018 and August 2018, the communities' health needs were assessed through key informant interviews, secondary data analysis, a windshield survey serving to assist asset-mapping through community observation, and focus groups. Key informants and focus group participants included, but were not limited to faith community representatives, public health officials, lay community members, school officials and city administration. The organization engaged fifty community members with interests specific to the health of individuals in the Denton/Wise Counties region in the CHNA development process. Forty of these community members were engaged across six separate focus groups held in zip-codes that were identified as underserved areas. Ten served as key informants, and the windshield survey was conducted by two Texas Health graduate fellows and four community health managers. To gain a comprehensive understanding of the health needs and priorities of individuals in this region, Texas Health used focus group sessions and key informant interviews to engage the medically underserved, low-income or minority populations along with representatives from the following community organizations: Cultivar Capital, Inc.; DATCU Credit Union; Denton County Public Health; First Refuge Ministries; Hankins, Eastup, Deaton, Tonn & Seay; John E. Baines, P.C.; Maximus, Inc.; Saint Andrews Presbyterian Church; Texas Department of State Health Services; Texas Women's University; United Way of Denton County; and University of North Texas. Findings from all data sources (secondary data, interviews and focus groups, and the windshield survey/observational asset mapping) were compared. Recurring themes were pulled and analyzed to stratify the top medical and social determinant of health needs. The outlined needs/barriers impacted the development of the 2020 CHNA implementation plan, which leveraged integrated strategies across THR's internal and external stakeholders to enhance its service and program delivery in the target communities. Part V. Section B, Line 5 - Facility #2 Texas Health Rockwall's (THRW) 2019 CHNA was a collaborative process utilizing qualitative and quantitative methods to assess the health needs of persons within the service areas in the Dallas/Rockwall Counties region. The 2019 CHNA was conducted at the Dallas/Rockwall Counties regional level to generate community-driven solutions for better integration in addressing the clinical and social needs of individuals living in North Texas. Between May 2018 and August 2018, the communities' health needs were assessed through key informant interviews, secondary data analysis, a windshield survey serving to assist asset-mapping through community observation, and focus groups. Key informants and focus group participants included, but were not limited to faith community representatives, public health officials, lay community members, school officials and city administration. The organization engaged 102 community members with interests specific to the health of individuals in the Dallas/Rockwall Counties region in the CHNA development process. Ninety-six of these community members were engaged across seven separate focus groups held in zip-codes that were identified as underserved areas. Six served as key informants, and the windshield survey was conducted by two Texas Health graduate fellows and three community health managers. To gain a comprehensive understanding of the health needs and priorities of individuals in this region, Texas Health used focus group sessions and key informant interviews to engage the medically underserved, low-income or minority populations along with representatives from the following community organizations : Arlington-Mansfield YMCA; CCR & Associates; Cigna; Communities Foundation of Texas; Ernst & Young; Fee, Smith, Sharp & Vitullo, LLP; Fischer & Company; International Leadership of Texas; Literacy Achieves; Preston Hollow Presbyterian Church; Scheef & Stone, LLP; St. Barnabas Presbyterian Church; Texas Woman's University; The Senior Source and Toyota Motor North America. Findings from all data sources (secondary data, interviews and focus groups, and the windshield survey/observational asset mapping) were compared. Recurring themes were pulled and analyzed to stratify the top medical and social determinant of health needs. The outlined needs/barriers impacted the development of the 2020 CHNA implementation plan, which leveraged integrated strategies across THR's internal and external stakeholders to enhance its service and program delivery in the target communities. Part V. Section B, Line 5 - Facilities #3 and #4 The 2019 CHNA for USMD Hospital Arlington (USMD) and Texas Health Southlake (THSL) was a collaborative process utilizing qualitative and quantitative methods to assess the health needs of persons within the service areas in the Tarrant/Parker Counties region. The 2019 CHNA was conducted at the Tarrant/Parker Counties regional level to generate community-driven solutions for better integration in addressing the clinical and social needs of individuals living in North Texas. Between April 2018 and August 2018, the communities' health needs were assessed through key informant interviews, secondary data analysis, a windshield survey serving to assist asset-mapping through community observation, and focus groups. Key informants and focus group participants included, but were not limited to faith community representatives, public health officials, lay community members, school officials and city administration. The organization engaged 159 community members with interests specific to the health of individuals in the Tarrant/Parker Counties region in the CHNA development process. One hundred forty-nine of these community members were engaged across eleven separate focus groups held in zip-codes that were identified as underserved areas. Ten served as key informants, and the windshield survey was conducted by two Texas Health graduate fellows and five community health managers. To gain a comprehensive understanding of the health needs and priorities of individuals in this region, Texas Health used focus group sessions and key informant interviews to engage the medically underserved, low-income or minority populations along with representatives from the following community organizations: Azle ISD; Broadie's Aircraft; City of Bedford; Emergency Medicine Consultant Ltd.; Ft Worth South, Inc.; Higginbotham Insurance Agency; Higher Praise Family Church; KPMG; Private Wealth Solutions Inc.; Parker County Hospital District; Tarrant County College; Tarrant Transit Alliance; The Abbey Church; Thos.S. Byrne, Inc.; United Way of Tarrant County; Urban Theory; and Z's Cafe & Catering. Findings from all data sources (secondary data, interviews and focus groups, and the windshield survey/observational asset mapping) were compared. Recurring themes were pulled and analyzed to stratify the top medical and social determinant of health needs. The outlined needs/barriers impacted the development of the 2020 CHNA implementation plan, which leveraged integrated strategies across THR's internal and external stakeholders to enhance its service and program delivery in the target communities. Part V. Section B, Line 5 - Facility #5 Physicians Medical Center's (PMC) 2019 CHNA was a collaborative process utilizing qualitative and quantitative methods to assess the health needs of persons within the service areas in the Collin County region. The 2019 CHNA was conducted at the Collin County regional level to generate community-driven solutions for better integration in addressing the clinical and social needs of individuals living in North Texas. Between April 2018 and August 2018, the communities' health needs were assessed through key informant interviews, secondary data analysis, a windshield survey serving to assist asset-mapping through community observation, and focus groups. Key informants and focus group participants included, but were not limited to faith community representatives, public health officials, lay community members,

Texas Health Resources
Part I, Line 3c - Patient Eligibility The Schedule H for Texas Health Resources (THR) is filed solely because it has an ownership interest in five taxable joint ventures operating as hospitals. THR is a functionally integrated supporting organization and does not operate its own hospital. THR supports a system of faith-based, non-profit hospitals, an employed physician organization and an organization for medical research and education. THR has adopted a Financial Assistance Policy (FAP) which covers its wholly owned non-profit hospitals and most of its hospital joint ventures. Patients with a family income at or below 200% of applicable Federal Poverty Guidelines (FPG) may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income, as determined on a sliding scale based on FPG, may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income in relation to FPG. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's financial assistance application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a financial assistance application. Part I, Line 7 - Cost-to-Charge Ratio A cost-to-charge ratio is used to compute the amounts reported on Lines 7a-7c. The cost-to-charge ratio is derived from Worksheet 2 - Ratio of Patient Care Cost-to-Charges, as found in the Schedule H Instructions. The amounts reported on Lines 7e-7i were computed using direct costs, as determined by a cash outlay. Part II - Community Building The organization participates in community building activities that aim to address the disparities in the social determinants of health factors that influence the overall health and wellbeing of individuals in the communities Texas Health serves. As identified in the community health needs assessment, there are areas of need that are not aligned with the traditional operations of a hospital system. Our volunteerism, collaborations and partnership opportunities with various community-based organizations and coalitions foster our ability to address the social and environmental needs for the purpose of providing for the whole person beyond the clinical services. Part III, Lines 2, 3 & 4 - Bad Debts Bad debt expense is not included as a community benefit for purposes of reporting community benefits. Each patient qualifying for charity care is treated as a charity patient and no charges related to that patient are included in bad debt expense. Each joint venture hospital estimates bad debt expense utilizing various methods, analytical tools and benchmarks. Typically, bad debt expense is based upon a combination of factors including, but not limited to, aging of receivables, analyzing revenue trends in the healthcare industry and payor class, and assessing historical collection experience considering business and economic conditions. Part III, Line 8 - Medicare Shortfall The state of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care & community benefit. For state purposes, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost-to-charge ratio (with costs determined in accordance with generally accepted accounting principles) to billed charges. THR is the parent company of a healthcare system filing a combined community benefit report in Texas. THR is not a hospital and does not have Medicare data to report to the state of Texas. The data provided for Sch H is THR's share of operations from its taxable joint ventures which operate hospitals in Texas. The Medicare amounts reported on Sch H are from the taxable joint venture hospitals' cost accounting systems. The taxable joint ventures are not required to file community benefit reports with or report Medicare shortfalls to the state of Texas. Part III, Line 9b - Debt Collection During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Financial Assistance Policy. Part VI, Line 2 - Needs Assessment In 2019, Texas Health Resources (Texas Health) completed a community health needs assessment (CHNA) for 25 facilities across 5 regions using the following steps: - Demographic analysis by region - Secondary data analysis of health indicators to identify zip codes of highest-needs within each region and prioritize zip codes for the community impact initiative - Primary data collection via key informant interviews, focus groups, and a windshield survey - Synthesis of secondary and primary data to identify the most pressing health needs by region - Prioritization of health needs that Texas Health would focus on within the current CHNA cycle, resulting in the identification of these health needs: Behavioral health; Chronic disease prevention and management; and access, navigation, and health literacy. In addition to the CHNA, a community readiness assessment was conducted in 2020 to identify zip codes/communities that were ready to address the health and social needs in their communities within the next 3 years. Through this effort, sixteen zip codes emerged as highest readiness, which resulted in the launch of the community impact initiative that awarded grants to community-based organizations in these geographic locations to address the needs in their communities. In 2021, seven additional zip codes were added to this initiative, through additional funds to the community based organizations we have been able to expand resources and services to more community members. Part VI, Line 3 - Patient Education A description of the Financial Assistance Policy (FAP), the Plain Language Summary of the FAP (PLS) and the FAP application are available on the THR website at www.TexasHealth.org in English and other languages. Financial assistance information is included in the patient's admission packets. Signs alerting patients of financial assistance and related contact information are posted in various areas of the hospital including admissions & registration and the emergency room. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms necessary to apply for the assistance. At the same time, patients are provided with a financial assistance application. The patient is informed that the hospital is offering financial assistance to patients deemed medically or financially indigent. The PLS is included on the back of our patient bills. The patient is informed of how to qualify for financial assistance, how to ask for help, necessary documentation, and THR's collection process. The onsite financial counselors may assist the patient in completing the application and obtain available verification information. The counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and financial assistance have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the FAP. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a FAP. Part VI, Line 4 - Community Information THR does not operate its own hospitals, but has ownership in five joint ventures operating as hospitals. The joint ventures operate hospitals in various communities throughout North Texas. The communities served by the hospital