4A (Expenses $ 220504694 including grants of $ 0) (Revenue $ 237198312)
ASCENSION TEXAS SERVES AS AN INTEGRAL PART OF THE ROMAN CATHOLIC CHURCH TO CARRY OUT ITS MISSION IN SUPPORT OF OR IN FURTHERANCE OF ITS CHARITABLE PURPOSES. IT ALSO SERVES AS THE PARENT CORPORATION FOR AN INTEGRATED HEALTHCARE DELIVERY AND FINANCING NETWORK. OUR MISSION INCLUDES THE FOLLOWING: - FURTHER THE PHILOSOPHY AND MISSION OF ASCENSION HEALTH OF HEALING AND SERVICE TO THE SICK AND POOR, AND PROMOTE, SUPPORT AND ENGAGE IN ANY OF THE RELIGIOUS, CHARITABLE, EDUCATIONAL AND SCIENTIFIC MINISTRIES ESTABLISHED BY ASCENSION HEALTH. - PROVIDE MEDICALLY NECESSARY SERVICES TO PATIENTS WHO ARE FINANCIALLY OR MEDICALLY INDIGENT REGARDLESS OF THE PERSON'S RACE, CREED, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE OR ABILITY TO PAY. BASED ON AN ESTABLISHED ELIGIBILITY SYSTEM, MEDICAL SERVICES WILL BE PROVIDED TO THE EXTENT THE CORPORATION'S FINANCIAL RESOURCES PERMIT. - RAISE FUNDS FROM THE PUBLIC AND FROM ALL OTHER SOURCES AVAILABLE, RECEIVE AND MAINTAIN SUCH FUNDS AND EXPEND PRINCIPAL AND INCOME THERE FROM IN SUPPORT OF OR IN FURTHERANCE OF THE CHARITABLE PURPOSES. - ACQUIRE, OWN, USE, LEASE AS LESSOR OR LESSEE, CONVEY AND OTHERWISE DEAL IN AND WITH REAL AND PERSONAL PROPERTY AND ANY INTEREST THEREIN, ALL IN SUPPORT OF OR IN FURTHERANCE OF THE CHARITABLE PURPOSES. - CONTRACT WITH OTHER FOR PROFIT AND NONPROFIT ORGANIZATIONS, INDIVIDUALS AND GOVERNMENTAL AGENCIES IN SUPPORT OF OR IN FURTHERANCE OF THE CHARITABLE PURPOSES. - ENGAGE IN ANY LAWFUL ACTIVITIES WITHIN THE PURPOSES FOR WHICH A NONPROFIT CORPORATION MAY BE ORGANIZED UNDER THE TEXAS BUSINESS ORGANIZATIONS CODES WHICH ARE IN FURTHERANCE OF OR IN SUPPORT OF THE CHARITABLE PURPOSES. - PROMOTE COOPERATION AND EXCHANGE OF KNOWLEDGE AND EXPERIENCE AMONG THE VARIOUS APOSTOLATE WITHIN THE HEALTH CARE MISSION. As part of the Ascension Catholic health ministry, the filing organization served in support of Ascension's commitment to both care for patients and communities and support caregivers and other associates through the challenges of the COVID-19 global pandemic in FY22.

Schedule H, Part V, Section B, Line 3E
TO BETTER TARGET COMMUNITY RESOURCES ON THE SERVICE AREA'S MOST PRESSING HEALTH NEEDS, THE HOSPITAL PARTICIPATED IN A GROUP DISCUSSION WITH ORGANIZATIONAL DECISION MAKERS AND COMMUNITY LEADERS TO PRIORITIZE THE SIGNIFICANT COMMUNITY HEALTH NEEDS WHILE CONSIDERING SEVERAL CRITERIA: ALIGNMENT WITH ASCENSION HEALTH STRATEGIES OF HEALTHCARE THAT LEAVES NO ONE BEHIND; CARE FOR THE POOR AND VULNERABLE; OPPORTUNITIES FOR PARTNERSHIP; AVAILABILITY OF EXISTING PROGRAMS AND RESOURCES; ADDRESSING DISPARITIES OF SUBGROUPS; AVAILABILITY OF EVIDENCE-BASED PRACTICES; AND COMMUNITY INPUT. THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SEE SCHEDULE H, PART V, LINE 7 FOR THE LINK TO THE CHNA AND SCHEDULE H, PART V, LINE 11 FOR HOW THOSE NEEDS ARE BEING ADDRESSED.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - Facility Group A. Joint Venture Hospitals in Ascension Texas 11-county service region including: A,1 - Cedar Park Regional Medical Center (JV) A,2 - Warm Springs Rehabilitation Hospital of Kyle (JV) A,3 - Central Texas Rehabilitation Hospital (JV) The 2021 CHNA was conducted from July 2021 to January 2022, and utilized processes which incorporated data from both primary and secondary sources. Primary data sources, sometimes called qualitative data, included information provided by groups/individuals, e.g., community residents, health care consumers, health care professionals, community stakeholders, and multi-sector representatives. Special attention was given to the needs of individuals and communities who are more vulnerable, and to unmet health needs or gaps in services. Together with the efforts of our hospital partners and consultants, an estimated total of 230 individuals participated in focus groups or interviews, held between July 2021 and December 2021. Populations represented by participants included medically underserved, low-income, minority groups, and rural, urban and suburban groups. Multiple methods were used to gather community input, including key stakeholder interviews, community focus groups and a community survey. Recognizing its vital importance in understanding the health needs and assets of the community, Ascension Texas, in collaboration with hospital partners at St. David's Foundation, Baylor Scott and White, and public health leaders for Travis and Williamson counties solicited input from a range of public health and social service providers that represent the broad interest of Ascension Texas service area. A concerted effort was made to ensure that the individuals and organizations represented the needs and perspectives of: 1) public health practice and research; 2) individuals who are medically underserved, are low-income, or considered among the minority populations served by the hospital; and 3) the broader community at large and those who represent the broad interests and needs of the community served. Ascension Texas drew from a number of sources to complete the qualitative analysis for this CHNA. A series of 19 focus groups with approximately 100 participants were conducted by Alpinista Consulting to gather input from community members in the following counties: Burnet, Llano, Blanco, Fayette, Lee and Gonzales, along with Travis and Williamson for focus groups that focused on children's needs. Ascension Texas also received feedback from community members in Bastrop, Caldwell, Hays and Williamson counties from the Texas Health Institute (THI) through a partnership agreement with hospital partner St. David's Foundation. THI conducted a total of 11 focus groups in these four counties, with three each (two in English and one in Spanish) in Bastrop, Caldwell and Hays counties, and two (both in English) in Williamson county. A total of 58 community residents participated in those across the counties. Finally, as part of collaborations led by public health departments in Travis and Williamson counties, Ascension Texas received reports from the community focus groups conducted in each of those counties. As part of the CHA Task Force, hospital partner Baylor Scott and White contracted with IBM Watson to conduct a focus group which included representatives from county government, church organizations, providers, local non-profits, and other community-based organizations. Most of the participants work with at-risk populations; the group at-large serve low-income populations, minorities, the medically under-served and homeless populations. A series of 14 one-on-one interviews were conducted by the Ascension Texas Community Benefit team to gather feedback from key stakeholders on the health needs and assets of Ascension Texas. These interviews represented 14 different organizations and agencies. Some agencies also participated in the focus groups, held between September 2021 and October 2021. Sectors represented by participants included community non-profits, foundations, social service providers and health organizations. A survey was conducted by Ascension Texas to gather the perceptions, thoughts, opinions, and concerns of the community regarding health outcomes, health care access, and social determinants of health for Ascension Texas. Fifty- one individuals participated in the survey, held between August 2021 and October 2021. Ascension Seton associates were also invited to participate in multiple focus groups and discussions related to the creation of the CHA. The following organizations were represented during stakeholder interviews conducted in 2021: - 4:12 Kids - Advocacy Outreach - Affordable Central Texas - AGE of Central Texas - Amigos de Jesus - Austin Clubhouse - Austin Asian Community Health Initiative - Bastrop County Cares - Baylor Scott White Health - Blanco Chamber of Commerce - Blanco County EMS - Bluebonnet Trails - Boys Girls Club of the Austin Area - Buda Food Pantry - Catholic Charities of Central Texas - Central Health - Central Texas Food Bank - Central Texas Interfaith - Children's Optimal Health - City of Manor - City of Pflugerville - City of Smithville - City of Taylor - Combined Community Action, Inc. - Community Care - Community Health Centers of South Central Texas - Dickey Museum Multipurpose Center - Faith Action in georgetown - First Methodist Church San Marcos - Georgetown Chamber of Commerce - Georgetown Health Foundation - Georgetown Independent School District - Gonzales County - Harris-Ross Head Start - Hays County Food Bank - Hays County Indigent Health Care Program - Integral Care - Interagency Support Council of eastern Williamson County, Inc. - Lampasas ISD - Lone Star Circle of Care - Luling City Council - Mobile Outreach Team Williamson County Emergency Services - Partners in Hope - Partnerships for Children - Pavilion Clubhouse of Williamson County - People's Community Clinic - Regarding Cancer - School District in Hays County - Texas Department of State Health Services - The Caring Place - United Way of Williamson County - Where We Thrive - Williamson County and City and Health District - Williamson County Child Advocacy Center - Williamson County Indigent Care Program - Workforce Solutions Rural Capital Area - Texas AM College of Nursing The following organizations were represented during stakeholder focus groups conducted in 2021: - Bluebonnet Trails - Catholic Charities of Central Texas - Central Texas Food Bank - Child Protective Services - Dell Medical School at The University of Texas - Lone Star Circle of Care - Michael and Susan Dell Foundation - NAMI Central Texas - Texas Department of State Health Services - The Hogg Foundation - United Way of Greater Austin - YMCA Travis County - YMCA Williamson County

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - Facility Group A. A,1 - Cedar Park Regional Medical Center (JV) A,2 - Warm Springs Rehabilitation Hospital of Kyle (JV) A,3 - Central Texas Rehabilitation Hospital (JV) The other Ascension hospital facilities with which the reporting hospitals conducted the CHNA include: - Dell Children's Medical Center of Central Texas - Ascension Seton Medical Center Austin - Dell Seton Medical Center at the University of Texas - Ascension Seton Williamson - Ascension Seton Hays - Ascension Seton Northwest - Ascension Seton Highland Lakes - Ascension Seton Southwest - Ascension Seton Edgar B. Davis - Ascension Seton Bastrop - Ascension Seton Smithville - Ascension Seton Shoal Creek - PAM Rehabilitation Hospital of Round Rock (JV) - Northwest Hills Surgical Hospital (JV) The other hospital facilities with which the reporting hospitals conducted the CHNA include: -St. David's Foundation, which represents various hospital facilities that serve Travis, Williamson, Hays, Bastrop and Caldwell counties within the Ascension Seton service area -Baylor Scott White Health, which represent various hospital facilities serving Travis, Williamson, Hays, Llano, Burnet, and Blanco counties within the Ascension Seton service area

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - Facility Group A. A,1 - Cedar Park Regional Medical Center (JV) A,2 - Warm Springs Rehabilitation Hospital of Kyle (JV) A,3 - Central Texas Rehabilitation Hospital (JV) The hospitals in this reporting group were included in the Ascension Seton CHNA because they are within Travis, Williamson and Hays Counties, respectively, which are covered by the Ascension Seton service area. The Ascension Seton CHNA was completed in partnership with the following non-hospital facilities: 1. Austin Public Health and collaborative partners including: - Capital Metro - Central Health - City of Austin Transportation Department - Travis County - Integral Care - The University of Texas at Austin Dell Medical School - The University of Texas Health Science Center at Houston, School of Public Health 2. Williamson County Cities Health District and collaborative partners including - Williamson County - Bluebonnet Trails Community Services - Georgetown Health Foundation - Healthy Williamson County Coalition - Lone Star Circle of Care - Opportunities for Williamson Burnet Counties - United Way of Williamson County

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - A,1 - Cedar Park Regional Medical Center. During the 2019 Community Health Needs Assessment (CHNA) process, which included both quantitative and qualitative analysis, the identified and prioritized three main needs for Williamson County were: (1) Behavioral health, stress and wellbeing (2) Chronic disease risk factors, (3) Access and affordability of healthcare, (4) Building a resilient Williamson County, (5) Social determinants of health. To address these key needs, Ascension Texas has developed a Community Health Improvement Plan for each of its hospitals and joint ventures in Williamson County. Each plan identifies the action the hospital, with the support of the Ascension Texas network, plans to take to address the prioritized needs. The various actions included in the Implementation Strategy are not intended to be exhaustive or inclusive of every single Ascension Texas strategy, initiative or program. Instead, the plan highlights the most significant actions that each hospital has undertaken to address the health needs prioritized in the CHNA, including those strategies that are expected to make the most significant impact on the delivery of health care in the region for the poor and vulnerable. Cedar Park Regional Medical Center will address needs identified in the 2019 North Region CHNA including behavioral health, stress and well-being, and chronic disease risk factors. Cedar Park Regional Medical Center will not address access and affordability of care, building a resilient Williamson County or social determinants of health in this Implementation Strategy. The strategies outlined for mental health, stress and wellbeing, and chronic disease risk factors also address access to care through education and connection to community resources for reduced and no-cost health care services and community collaborations to improve coordination within Williamson County. Ascension Seton Williamson is an Ascension hospital that is also located in Williamson County. Ascension Seton Williamson is addressing building a resilient Williamson County during this three-year implementation cycle. While neither implementation strategies directly address social determinants of health, Cedar Park Regional Medical Center and Ascension Seton Williamson will partner with community organizations to better understand and help address social determinants of health in Williamson County. As required by IRS guidelines, for each need, Ascension has identified key actions to address the need: - The anticipated impact of these actions - Available resources to address the need - Potential collaborations Hospital-based strategies in the Cedar Park Regional Medical Center Implementation Strategy to address each of the identified community health needs include those listed below. It is of note that most Ascension Texas hospitals in Central Texas are participating in a common strategy around mental health to improve coordination throughout the community. Behavioral Health, Stress and Wellbeing - Promote behavioral health, stress management, and wellbeing through education and partnerships in the community to improve the mental health care continuum. - Needs addressed in FY22: Collaborated with community partners to optimize the continuum of care for ED patients presenting with mental health disorders. Collaboration with community partners to provide referral cards for ED caregivers whenever child abuse/ neglect is suspected. Collaboration with community partners to provide information on free support groups and classes. Provide free virtual breastfeeding support groups for patients which address wellbeing and stress management after childbirth. Provide resources promoting wellbeing to Healthy Women affinity group members and Senior Circle members. Have participated in the grant requests from the Leander Educational Excellence Foundation to add programs to decrease students' stress and enhance wellbeing. Chronic Disease Risk Factors - Identify, educate and support people with chronic disease or at risk for chronic disease. - Needs addressed in FY22: host Bariatric Seminars and Support Groups and virtual seminars for Senior Circle. Provided information on the prevention and treatment of chronic disease in Senior Circle e-newsletters and Healthy Woman e-newsletters. During the 2021 Community Health Needs Assessment (CHNA) process (final report published in June 2022), which included both quantitative and qualitative analysis, Ascension Seton identified and prioritized four main needs for the 11 county service area including Bastrop, Blanco, Burnet, Caldwell, Fayette, Gonzales, Hays, Lee, Llano, Travis and Williamson Counties which include: (1) Mental and Behavioral Health, (2) Access to Care, (3) Social Determinants of Health, (4) Health Equity. To address the needs identified in the 2021 CHNA, an Implementation Strategy (IS) for each Ascension Seton facility was adopted in August of 2022. Cedar Park Regional Medical Center will not address social determinants of health nor health equity. Ascension Texas partners will be addressing each of these needs in their IS. Due to the timing of the recently adopted IS, the impact report provided in this report shows the impact of the previous 2019 IS. Impact on the most recent 2021 CHNA will be reported starting next year.

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - A,2 - Warm Springs Rehabilitation Hospital of Kyle. During the 2019 Community Health Needs Assessment (CHNA) process, which included both quantitative and qualitative analysis, the identified and prioritized two main needs for Hays County including access to care and mental health. To address these key needs, Ascension Texas has developed a Community Health Improvement Plan for each of its hospitals and joint ventures in Hays County. Each plan identifies the action the hospital, with the support of the Ascension Texas network, plans to take to address the prioritized needs. The various actions included in the Implementation Strategy are not intended to be exhaustive or inclusive of every single Ascension Texas strategy, initiative or program. Instead, the plan highlights the most significant actions that each hospital has undertaken to address the health needs prioritized in the CHNA, including those strategies that are expected to make the most significant impact on the delivery of health care in the region for the poor and vulnerable. Warm Springs Rehabilitation Hospital of Kyle will address the need of access to care identified in the 2019 South 1 Region CHNA. The Implementation Strategy for Warm Springs Rehabilitation Hospital of Kyle will not address mental health at this time. Ascension Seton Hays, a hospital serving the same region, will be addressing this need in this implementation cycle. As required by IRS guidelines, for each need, Warm Springs Rehabilitation Hospital of Kyle has identified key actions to address the need: - The anticipated impact of these actions - Available resources to address the need - Potential collaborations Hospital-based strategies in the Warm Springs Rehabilitation Hospital of Kyle Implementation Strategy to address each of the identified community health needs include those listed below. It is of note that most Ascension Texas hospitals in Central Texas are participating in a common strategy around mental health to improve coordination throughout the community. Access to care - Provide monthly stroke support group for stroke survivors. - Provide facility space for nursing and therapy students and for professional organizations to support workforce development for rehabilitation services. - Needs addressed in FY22: Stroke support groups continued monthly. Hosted clinical rotations for PT, PTA, OT and COTA students. Additionally, hosted clinical rotations for LVN, RN and Accelerated BSN programs. During the 2021 Community Health Needs Assessment (CHNA) process (final report published in June 2022), which included both quantitative and qualitative analysis, Ascension Seton identified and prioritized four main needs for the 11 county service area including Bastrop, Blanco, Burnet, Caldwell, Fayette, Gonzales, Hays, Lee, Llano, Travis and Williamson Counties which include: (1) Mental and Behavioral Health, (2) Access to Care, (3) Social Determinants of Health, (4) Health Equity. To address the needs identified in the 2021 CHNA, an Implementation Strategy (IS) for each Ascension Seton facility was adopted in August of 2022. Warm Springs Rehabilitation Hospital of Kyle will not address mental and behavioral health, social determinants of health nor health equity. Ascension Texas partners will be addressing each of these needs in their IS. Due to the timing of the recently adopted IS, the impact report provided in this report shows the impact of the previous 2019 IS. Impact on the most recent 2021 CHNA will be reported starting next year.

Schedule H, Part V, Section B, Line 11 Facility A, 3
Facility A, 3 - A,3 - Central Texas Rehabilitation Hospital. During the 2019 Community Health Needs Assessment (CHNA) process, which included both quantitative and qualitative analysis, the identified and prioritized three main needs for Travis County: (1) Access to Healthcare, (2) Mental Health, (3) Diabetes and other Chronic Disease. To address these three key needs, Ascension Texas has developed a Community Health Improvement Plan for each of its hospitals and joint ventures in Travis County. Each plan identifies the action the hospital, with the support of the Ascension Texas network, plans to take to address the prioritized needs. Since Ascension Seton has multiple sites throughout Travis County, both inpatient and outpatient, some actions described in the Implementation Strategies are not strictly operated by Central Texas Rehabilitation Hospital or any other one facility. The various actions included in the Implementation Strategy are not intended to be exhaustive or inclusive of every single Ascension Texas strategy, initiative or program. Instead, the plan highlights the most significant actions that each hospital has undertaken to address the health needs prioritized in the Community Health Needs Assessment, including those strategies that are expected to make the most significant impact on the delivery of health care in the region for the poor and vulnerable. The Implementation Strategy for Central Texas Rehabilitation Hospital addresses needs identified in the 2019 Ascension Seton Central Region: Travis County Community Health Needs Assessment including affordability of healthcare and chronic disease. Central Texas Rehabilitation Hospital will not address mental health. Ascension Texas partners will be addressing mental health in their Implementation Strategies by creating a behavioral health consortium to identify specific needs of each hospital and implementing best practices. At this time Central Texas Rehabilitation Hospital will not participate in the consortium, however they may be able to adopt some best practices from this strategy in the future. As required by IRS guidelines, for each need, Central Texas Rehabilitation Hospital has identified key actions to address the need: - The anticipated impact of these actions - Available resources to address the need - Potential collaborations Hospital-based strategies in the Central Texas Rehabilitation Hospital Implementation Strategy to address each of the identified community health needs include those listed below. It is of note that most Ascension Texas hospitals in Travis County and the surrounding service areas are participating in a common strategy around mental health to improve coordination throughout the community. Access to and affordability of healthcare - Provide facility space for professional organization meetings to support workforce development for rehabilitation services. Chronic Disease - Provide stroke prevention and education programs. - Needs addressed in FY22: Provided monthly stroke support groups to improve quality of life after individuals have a stroke. During the 2021 Community Health Needs Assessment (CHNA) process (final report published in June 2022), which included both quantitative and qualitative analysis, Ascension Seton identified and prioritized four main needs for the 11 county service area including Bastrop, Blanco, Burnet, Caldwell, Fayette, Gonzales, Hays, Lee, Llano, Travis and Williamson Counties which include: (1) Mental and Behavioral Health, (2) Access to Care, (3) Social Determinants of Health, (4) Health Equity. To address the needs identified in the 2021 CHNA, an Implementation Strategy (IS) for each Ascension Seton facility was adopted in August of 2022. Central Texas Rehabilitation Hospital will not address mental health, social determinants of health nor health equity. Ascension Texas partners will be addressing each of these needs in their IS. Due to the timing of the recently adopted IS, the impact report provided in this report shows the impact of the previous 2019 IS. Impact on the most recent 2021 CHNA will be reported starting next year.

Schedule H, Part V, Section B, Line 3E
TO BETTER TARGET COMMUNITY RESOURCES ON THE SERVICE AREA'S MOST PRESSING HEALTH NEEDS, THE HOSPITAL PARTICIPATED IN A GROUP DISCUSSION WITH ORGANIZATIONAL DECISION MAKERS AND COMMUNITY LEADERS TO PRIORITIZE THE SIGNIFICANT COMMUNITY HEALTH NEEDS WHILE CONSIDERING SEVERAL CRITERIA: ALIGNMENT WITH ASCENSION HEALTH STRATEGIES OF HEALTHCARE THAT LEAVES NO ONE BEHIND; CARE FOR THE POOR AND VULNERABLE; OPPORTUNITIES FOR PARTNERSHIP; AVAILABILITY OF EXISTING PROGRAMS AND RESOURCES; ADDRESSING DISPARITIES OF SUBGROUPS; AVAILABILITY OF EVIDENCE-BASED PRACTICES; AND COMMUNITY INPUT. THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SEE SCHEDULE H, PART V, LINE 7 FOR THE LINK TO THE CHNA AND SCHEDULE H, PART V, LINE 11 FOR HOW THOSE NEEDS ARE BEING ADDRESSED.

Schedule H, Part V, Section B, Line 5 Facility B, 1
Facility B, 1 - FACILITY GROUP B. Joint Venture Hospital in Bell County: B,4 - Seton Medical Center Harker Heights (JV) The 2022 CHNA was conducted from July 2021 to January 2022, and utilized processes which incorporated data from both primary and secondary sources. Primary data sources, sometimes called qualitative data, included information provided by groups/individuals, e.g., community residents, health care consumers, health care professionals, community stakeholders, and multi-sector representatives. Special attention was given to the needs of individuals and communities who are more vulnerable, and to unmet health needs or gaps in services. Together with the efforts of our collaborators, a total of 15 individuals participated in focus groups, held between July 2021 and November 2021 and 31 people responded to the survey in Bell County. Multiple methods were used to gather community input, including key stakeholder interviews, community focus groups and a community survey. Recognizing its vital importance in understanding the health needs and assets of the community, Seton Medical Center Harker Heights (SMCHH), via its partnership with Ascension Seton, solicited input from a range of public health and social service providers that represent the broad interests of Bell County. A concerted effort was made to ensure that the individuals and organizations represented the needs and perspectives of: 1) public health practice and research; 2) individuals who are medically underserved, are low-income, or considered among the minority populations served by the hospital; and 3) the broader community at large and those who represent the broad interests and needs of the community served. SMCHH, via its partnership with Ascension Seton, conducted two focus groups with ten people to complete the qualitative analysis for this CHNA. Populations represented by participants included medically underserved, low-income, minority groups, and rural, urban and suburban groups. A survey was conducted in Bell County to gather the perceptions, thoughts, opinions, and concerns of the community regarding health outcomes, health care access, and social determinants of health for Bell County and the Seton Medical Center Harker Heights service area. Thirty-one individuals participated in the survey from Bell County, held between August 2021 and October 2021. The following organizations were represented during stakeholder focus groups conducted in 2021: - Body of Christ Community CLinic - Catholic Charities - Christ Church - Fort Hood - Greater Killeen Community Clinic - Lone Star Circle of Care - Refugee Services of Texas - Rogers ISD - Temple Chamber of Commerce - Women, Infants and Children (WIC)

Schedule H, Part V, Section B, Line 11 Facility B, 1
Facility B, 1 - B,2 - SETON MEDICAL CENTER HARKER HEIGHTS. During the 2019 Community Health Needs Assessment (CHNA) process, which included both quantitative and qualitative analysis, the identified and prioritized four main needs for Bell County including inequitable health care access, mental health, chronic disease, and coordination of care. To address these key needs, Ascension Texas has developed a Community Health Improvement Plan for each of its hospitals and joint ventures in Hays County. Each plan identifies the action the hospital, with the support of the Ascension Seton network, plans to take to address the prioritized needs. The various actions included in the Implementation Strategy are not intended to be exhaustive or inclusive of every single Ascension Texas strategy, initiative or program. Instead, the plan highlights the most significant actions that each hospital has undertaken to address the health needs prioritized in the CHNA, including those strategies that are expected to make the most significant impact on the delivery of health care in the region for the poor and vulnerable. Seton Medical Center Harker Heights will address needs identified in the Bell County CHNA including chronic disease and coordination of care. This Implementation Strategy will not directly address mental health or inequitable access to care. Ascension Texas partners will be addressing mental health in their Implementation Strategies by creating a behavioral health consortium to identify specific needs of each hospital and implementing best practices. At this time Seton Medical Center Harker Heights will not participate in the consortium, however they may be able to adopt some best practices from this strategy in the future. The strategies outlined for chronic disease and coordination of care also address inequitable access to care through the elimination of cost barriers and the work of community collaborations to improve coordination within the healthcare system in Bell County. As required by IRS guidelines, for each need, Seton Medical Center Harker Heights has identified key actions to address the need: - The anticipated impact of these actions - Available resources to address the need - Potential collaborations Hospital-based strategies in the Seton Medical Center Harker Heights Implementation Strategy to address each of the identified community health needs include those listed below. It is of note that most Ascension Texas hospitals in Central Texas are participating in a common strategy around mental health to improve coordination throughout the community. Chronic disease - Provide free and reduced cost chronic disease care through the Greater Killeen Community Clinic. - Needs Addressed in FY22: Seton Harker Heights continued to provide care to low income, uninsured individuals through the Greater Killeen Free Clinic and enroll individuals through the Greater Killeen Free Clinic in the Chronic Disease program for disease management. Coordination of care - Participate in a local health planning effort to improve the coordination of care across the health system. - Needs addressed in FY22: Seton Harker Heights leadership attended monthly meetings with regional hospital leaders to address local health concerns including addressing the ongoing COVID-19 pandemic. During the 2021 Community Health Needs Assessment (CHNA) process (final report published in June 2022), which included both quantitative and qualitative analysis, Ascension Seton identified and prioritized four main needs for the 11 county service area including Bastrop, Blanco, Burnet, Caldwell, Fayette, Gonzales, Hays, Lee, Llano, Travis and Williamson Counties which include: (1) Mental and Behavioral Health, (2) Access to Care, (3) Social Determinants of Health, (4) Health Equity. To address the needs identified in the 2021 CHNA, an Implementation Strategy (IS) for each Ascension Seton facility was adopted in August of 2022. Seton Medical Center Harker Heights will not address mental and behavioral health, social determinants of health nor health equity. Ascension Texas partners will be addressing each of these needs in their IS. Due to the timing of the recently adopted IS, the impact report provided in this report shows the impact of the previous 2019 IS. Impact on the most recent 2021 CHNA will be reported starting next year.

Schedule H, Part V, Section B, Line 16 WEB SITES FOR FINANCIAL ASSISTANCE
THE FAP, FAP APPLICATION FORM AND PLAIN LANGUAGE SUMMARY CAN BE LOCATED AT: CEDAR PARK REGIONAL MEDICAL CENTER: HTTPS://WWW.CEDARPARKREGIONAL.COM/FINANCIAL-ASSISTANCE-PROGRAM SETON MEDICAL CENTER HARKER HEIGHTS HTTPS://SETONHARKERHEIGHTS.NET/FINANCIAL-ASSISTANCE WARM SPRINGS REHABILITATION HOSPITAL OF KYLE: https://pamhealth.com/facilities/find-facility/rehabilitation-hospitals/pam-rehabilitation-hospital-kyle CENTRAL TEXAS REHABILITATION HOSPITAL: https://www.centraltexasrehabhospital.com/patient-experience/financial-assistance-policy

Schedule H, Part I, Line 3c FACTORS OTHER THAN FPG
"IN ADDITION TO FPG, THE ORGANIZATION USES MEDICAL INDIGENCY, ASSET TEST, INSURANCE STATUS AND RESIDENCY AS OTHER FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A Patient may not be eligible for the financial assistance if such Patient is deemed to have sufficient assets to pay pursuant to an ""Asset Test."" The Asset Test involves a substantive assessment of a Patient's ability to pay based on the categories of assets measured in the FAP Application. A Patient with such assets that exceed 250% of such Patient's FPL amount may not be eligible for financial assistance. AN ASSET TEST APPLIES IF A PATIENT HAS ELIGIBLE LIQUID ASSETS THAT EXCEED 250% OF THE PATIENT'S FPG LEVEL FOR CONSIDERATION OF FINANCIAL ASSISTANCE ELIGIBILITY. LIQUID ASSETS INCLUDE ASSETS THAT CAN BE CONVERTED TO CASH WITHIN 1 YEAR. THESE INCLUDE ITEMS SUCH AS CHECKING ACCOUNTS, SAVINGS ACCOUNTS, TRUST FUNDS AND LUXURY ITEMS SUCH AS RECREATIONAL VEHICLES, BOATS, A SECOND HOME, ETC."

Schedule H, Part I, Line 5a BUDGET AMOUNTS FOR FREE OR DISCOUNTED CARE
THE ORGANIZATION ADMINISTERS ITS FINANCIAL ASSISTANCE POLICY IN ACCORDANCE WITH THE TERMS OF THE POLICY.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
"THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION (""CHA"") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED."

Schedule H, Part II Community Building Activities
In FY22, Ascension Texas contributed no funds for community building. In FY22, through its investment in Warm Springs Rehabilitation of Kyle, Ascension Texas contributed $300 toward programs to support the community. In FY22 Ascension Texas Joint Venture Hospitals including Cedar Park Regional Medical Center, Central Texas Rehabilitation Hospital and Seton Medical Center Harker Heights contributed no funds for community building.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BASED ON THE ORGANIZATION'S ADMINISTRATION OF ITS FINANCIAL ASSISTANCE PROGRAM, NO ESTIMATE FOR BAD DEBT ATTRIBUTABLE TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS IS DEEMED APPLICABLE TO HOSPITAL OPERATIONS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE ORGANIZATION IS PART OFASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSESBAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 17-20, OF THE AUDITED FINANCIAL STATEMENTS.

Schedule H, Part III, Line 8 Community benefit methodology for determining medicare costs
A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE GROSS CHARGES TO CALCULATE MEDICARE COSTS, WHICH ARE THEN COMPARED TO MEDICARE PAYMENTS RECEIVED, TO DETERMINE A MEDICARE GAIN OR LOSS. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT A MEDICARE SHORTFALL (LOSS) IS NOT TREATED AS COMMUNITY BENEFIT, EVEN THOUGH THE HOSPITAL HAS INCURRED LOSSES IN PROVIDING CARE TO MEDICARE PATIENTS. THEREFORE, NONE OF THE AMOUNT ON LINE 7 IS TREATED AS COMMUNITY BENEFIT.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
THE ORGANIZATION FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED IF ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED FOR THE AMOUNTS FOR WHICH THE PATIENT QUALIFIES.

Schedule H, Part V, Section B, Line 16a FAP website
A - Cedar Park Regional Medical Center: Line 16a URL: SEE PT VI; B - Seton Medical Center Harker Heights: Line 16a URL: SEE PT VI;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - Cedar Park Regional Medical Center: Line 16b URL: SEE PT VI; B - Seton Medical Center Harker Heights: Line 16b URL: SEE PT VI;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - Cedar Park Regional Medical Center: Line 16c URL: SEE PT VI; B - Seton Medical Center Harker Heights: Line 16c URL: SEE PT VI;

Schedule H, Part VI, Line 4 Community information
The total population of the 21 county primary service area is estimated to be 3,372,628 residents in calendar year 2022 and is expected to increase by approximately 6.2% to 3,582,609 residents in five years. The average income of the primary service area is $112,142 based on Claritas-Environics 2022 Approximately 11% of the service area residents live below the poverty line, with 22% uninsured or Medicaid patients. Within the primary service area, there are 52 federally-designated medically underserved areas. There are 54 other acute care hospitals located within the primary service area.

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

Schedule H, Part VI, Line 2 Needs assessment
Ascension Texas uses internal and external data and reports from third parties, including government sources, to assess the healthcare needs of the communities we serve. These reports provide key information about health, socioeconomic, demographic factors that identify areas of need and inform our strategies that help to meet those needs of our community. These reports include, but are not limited to: 1. Local and State Department of Health Reports 2. Local Government Planning Departments 3. US Census Bureau 4. Economic Impact Studies 5. Sg2 healthcare intelligence 6. Healthcare claims datasets 7. State datasets 8. CMS 9. CDC 10. Internal data sets Ascension Texas utilizes information from these secondary sources to develop programs and provide appropriate services needed throughout the region. In addition, Ascension Texas considers the health care needs of the overall community when evaluating internal financial and operational decisions.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
ASCENSION TEXAS IS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL, IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, ASCENSION TEXAS'S FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES; ASCENSION TEXAS PROVIDES FINANCIAL ASSISTANCE FOR THOSE WHO EARN UP TO 400% OF THE FEDERAL POVERTY LEVEL. ASCENSION TEXAS WIDELY PUBLICIZES ITS: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY VIA THE HOSPITAL FACILITY'S WEBSITE - www.healthcare.ascension.org/Financial-Assistance/Texas ASCENSION TEXAS MAKES PAPER COPIES OF THE: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION. THE PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. ASCENSION TEXAS INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION MAY BE FOUND. ASCENSION TEXAS INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSIONS AREAS.

Schedule H, Part VI, Line 5 Promotion of community health
Ascension Texas' governing body is comprised of persons representing diverse aspects and interests of the community. Many members of the hospital governing bodies reside in the organization's primary service area; who are neither employees nor independent contractors of the organization, nor family members thereof. Applications for medical staff privileges at Ascension Texas hospital facilities are open to all qualified physicians in the community, subject to completing an Ascension Seton application and hospital privileging process to ensure that the applicant physician meets the requirements for the privileges requested by the applicant physician. Ascension Texas is continuously improving its patient care services to address the needs of the community we serve. Surplus funds generated from Ascension Texas' operations are reinvested in the organization's activities, including patient care.

Schedule H, Part VI, Line 6 Affiliated health care system
"Ascension Texas is a member of Ascension Health, a Missouri nonprofit corporation and a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local health care facilities (each a ""Health Ministry and together, the ""Health Ministries""), located in the United States and the District of Columbia. In December 2011, Ascension Health Alliance, doing business as Ascension (""Ascension""), became the sole corporate member and parent organization of Ascension Health. In addition to serving as the sole corporate member of Ascension Health, Ascension serves as the member or shareholder of various other subsidiaries. Ascension, its subsidiaries, and the Health Ministries are referred to collectively from time to time hereafter as the system (""The System""). Ascension is sponsored by Ascension Sponsor, a Public Juridical Person. The Participating Entities of Ascension Sponsor are the Daughters of Charity of St. Vincent de Paul, St. Louise Province, the Congregation of St. Joseph, the Congregation of the Sisters of St. Joseph of Carondelet, the Congregation of Alexian Brothers of the Immaculate Conception Province - American Province and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province. Ascension Texas, located in Austin, Texas, is a holding corporation controlling two nonprofit systems that organize, develop, coordinate and deliver a complex, full continuum of health care services for residents of Austin (""Ascension Seton"") and Waco (""Ascension Providence"") and more generally in the Central Texas area. Admitting physicians are primarily practitioners in each such local area. Ascension Texas is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of Ascension Health are related to providing health care services."