4A (Expenses $ 746896625 including grants of $ 429854) (Revenue $ 874857015)
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.

Texas Health Resources
Facility #1 Texas Health Flower Mound Part V. Section B, Line 3e Facility #1 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 Mounds (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 Womens 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 will inform the development of the 2020 CHNA implementation plan, which will leverage integrated strategies across THRs internal and external stakeholders to enhance its service and program delivery in the target communities. Part V. Section B, Line 6a Facility #1 The 2019 CHNA for the Denton/Wise Counties Region was done in collaboration with Texas Health Denton (THDN) and Texas Health Flower Mound (THFM). Part V. Section B, Line 7a Facility #1 The CHNA is widely available on the hospitals website at: -https://www.texashealthflowermound.com/about-us/community-health-needs-as sessment/ Part V. Section B, Lines 7b and 10a Facility #1 The most recently adopted implementation strategy and the CHNA is widely available on the following website at: https://www.texashealth.org/Community-Health/Community-Health-Needs-Assess ment Part V. Section B, Line 8 Facility #1 While a CHNA was conducted in 2019, the implementation strategy tied to the assessment was not adopted until 2020. In 2019, the hospital completed the three year cycle of the hospitals previous CHNAs implementation strategy (2017-2019). Part V. Section B, Ln 11 Facility #1 The 2017 - 2019 implementation strategy was utilized throughout 2019 to develop the programs and activities outlined below. The hospital is a part of the Texas Health Resources healthcare system, which developed a system-wide community benefit strategy to leverage internal and external resources to increase its ability to impact the community health needs of the target areas with a higher focus on these three health priorities which were carried over from the 2016 CHNA: 1. Behavioral Health 2. Chronic Disease Prevention & Management 3. Access to Health Services and Healthcare Navigation & Literacy (ALN) In 2019, Texas Health Flower Mound addressed the significant health identified by supporting the implementation strategy of Texas Health Denton with the following approaches: 1. Behavioral Health 1a. In 2019, The Texas Health initiative known as Texas Health Community Impact (THCI) awarded grants to deliver behavioral health services to underserved communities. The initiative pinpoints specific ZIP codes to address social determinants of health as it relates to behavioral health, with the aim of preventing comorbid problems that may surface in the form of chronic diseases or premature death. THCI calls on agencies from different sectors - education, health care, government, grassroots organizations and others - to unite against identified issues. The THCI grant provides a collaboration with Sanger Independent School District, THRIVE (Together Harnessing our Resources to give Individuals Voice and Empowerment) bringing assistance directly to students at school in Sanger. THRIVE will address the identified needs of resiliency in youth 12-18, food insecurity and lack of transportation. Child Advocacy Center of Denton County will address resiliency in youth 11 to 18 and food insecurity in Bridgeport and Lewisville. 2. Chronic Disease Prevention & Management 2a. Historically, Texas Health has funded the work of local community health clinics in our mission to improve the health of the people in the communities we serve. In 2016, Texas Health launched Clinic Connect, a streamlined process for receiving and evaluating funding requests from clinics that reach vulnerable populations and serve as outpatient resources for our acute care hospitals. The goal of Clinic Connect is to create a collaborative relationship with local non-profit community-based clinics by providing financial support, educational opportunities, information sharing, and expanded services to improve healthcare access and quality for underserved, vulnerable populations. 2b. Offers a variety of educational programs and support groups that are open to the public, such as comprehensive prenatal seminars for expectant couples and breastfeeding classes and support groups that provide ongoing lactation support, education and assistance for breastfeeding mothers within the community. 2c. Offers a Diabetes Support Group on a monthly basis to provide education and support for diabetes to address one of the top healthcare needs in our community health needs assessment. 2d. Educational classes offered to the community through collaborative agreements such as the American Cancer Societys Look Good Feel Better support group for cancer survivors and a stroke support group in association with a local rehabilitation center. 2e. Provides free screenings and information at various community health fairs regarding healthy lifestyle behaviors, heart attack and stroke signs and symptoms that require immediate action to call 911, importance of prenatal care and other key information. 3. Access, Literacy, and Navigation (ALN) 3a. Provides free screenings for diseases that do not have early symptoms but that should be treated or managed early, such as hypertension, diabetes and cancer. 3b. Provides free flu shots to uninsured and high-risk populations. 3c. A Matter of Balance (AMOB), an evidence-based fall prevention program for older adults. 3d. Chronic Disease Self-Management Program (CDSMP), a nationally recognized program designed to enable individuals to build the self-confidence and motivation they need to manage the challenges of living with a chronic disease. 3e. Diabetes Self-Management Program (DSMP), a workshop offering information and skill building exercises specific to diabetes self-management. 3f. Child Automobile Safety Initiative (CASI), a program focused on protecting children from injury in motor vehicle collisions by providing free car seat safety checks and community based education. All significant health needs identified are being addressed by the hospital in one of the categories listed above. Part V. Section B, Lines 16 a, b & c Facility #1 The FAP, FAP Application and the Plain Language Summary of the FAP were widely available at this website: https://www.texashealth.org/About-Texas-Health/Insurance-and-Costs/Financi al-Assistance Facility #2 Texas Health Rockwall Part V. Section B, Line 3e Facility #2 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 #2 Texas Health Rockwalls (THRW) 2019 CHNA was a collaborative process utilizing qualitative and quantitative methods to assess the health needs of persons within the service ar

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 six 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 socio-economic factors that influence the overall health of individuals in the communities served. As identified in the community health needs assessment, there are areas of need that are not in alignment with the operations of a hospital system. Our volunteerism, collaborations and partnerships with various aid organizations and various area coalitions aid in addressing the socio-economic factors that are the backbone for many underlying health concerns. 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 THRs 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 through the following steps: - Demographic analysis by region - Secondary data analysis of health indicators to identify zip codes of highest-needs within each region - Community input data collection and assessment via key informant interviews, focus groups, and a windshield survey - Synthesis of secondary data and community input data to identify most pressing health needs by region - Prioritization of zip codes with immediate health needs using the Social Needs Index value - Prioritization of health needs using standard criteria elected by Texas Health To objectively prioritize the health needs identified by the data analysis and synthesis, each Texas Health facility used the following criteria: alignment with national, state, or local initiatives; magnitude; economic burden on the community; severity; and opportunity to intervene at a prevention level. The top priority health needs across the Texas Health system were Mental Health & Substance Abuse; Exercise, Nutrition, & Weight; and Access to Health Services and Healthcare Navigation & Literacy. 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 patients 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 six joint ventures operating as hospitals. The joint ventures operate hospitals in various communities throughout North Texas. The communities served by the hospitals include those designated as medically underserved areas (MUA) and vary in age and race and ethnicity. The population of the communities range from 845,000 to 2.6 million and the percentage of the households in these communities who are uninsured varies from 11.7% to 23.2%. The percentage of residents in these communities who speak a language other than English at home ranges from 16% to 28.4%. The percentage of r