4A (Expenses $ 925095488 including grants of $ 9297226) (Revenue $ 1372109690)
SEE SCHEDULE O

SCHEDULE H, PART V, SECTION B, LINE 3E
THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

SCHEDULE H, PART V, SECTION B, LINE 5
INPUT FROM COMMUNITY REPRESENTATIVES TARGETED INTERVIEWS AND FOCUS GROUPS WERE USED TO GATHER INFORMATION AND OPINIONS FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY HOAG MEMORIAL HOSPITAL PRESBYTERIAN. HOAG UTILIZED A MIXED-METHODS APPROACH TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING DATA SOURCES INFORMED THIS REPORT: - KEY STAKEHOLDER INTERVIEWS (KSIS). SEMI-STRUCTURED INTERVIEWS WERE CONDUCTED WITH 21 INDIVIDUALS. INTERVIEWEES WERE SELECTED IN COLLABORATION WITH HOAG HOSPITAL COMMUNITY BENEFIT STAFF. INTERVIEWS WERE CONDUCTED TO OBTAIN INFORMATION ABOUT THE HEALTH NEEDS OF ORANGE COUNTY RESIDENTS FROM A SYSTEMS-LEVEL PERSPECTIVE. PARTICIPATING INTERVIEWEES REPRESENTED THE FOLLOWING: HEALTH EDUCATORS/SERVICE PROVIDERS, MEDICAL RESEARCH, EXECUTIVE DIRECTORS/CEO'S OF COMMUNITY ORGANIZATIONS, LOCAL FUNDING AGENCIES, HEALTH SERVICES COORDINATORS, COUNTY HEALTH OFFICER, COUNTY PUBLIC HEALTH NURSE, MENTAL HEALTH SPECIALISTS, AND CITY OFFICIALS. INTERVIEWEES PROVIDED INFORMATION ABOUT: (1) HEALTH PRIORITIES; (2) CAUSES AND CONTRIBUTING FACTORS OF POOR HEALTH; (3) ACCESS TO AND AVAILABILITY OF SERVICE PROVISION; (4) THEIR STRENGTHS AS SERVICE PROVIDERS; AND (5) RECOMMENDATIONS AND STRATEGIES FOR IMPROVING THE PROVISION OF HEALTH SERVICES TO ORANGE COUNTY RESIDENTS. - PROVIDER SURVEY. THE PROVIDER SURVEY WAS DEVELOPED AND ADMINISTERED ONLINE BY EVALCORP DURING MARCH AND APRIL 2020 TO INDIVIDUALS AT OVER 170 ORGANIZATIONS/DEPARTMENTS THAT PROVIDE OR FUND HEALTH SERVICES TO COMMUNITY MEMBERS. THE SURVEY WAS DISTRIBUTED TO A WIDE RANGE OF COUNTY, PRIVATE, AND NON-PROFIT AGENCIES WHO SERVE RESIDENTS OF ORANGE COUNTY. DURING THE TWO-MONTH SURVEY ADMINISTRATION TIMEFRAME, A TOTAL OF 140 RESPONSES WERE COLLECTED AND USED FOR ANALYSIS. THE PURPOSE OF THE SURVEY WAS TO OBTAIN PROVIDERS' PERSPECTIVES AND EXPERIENCES REGARDING PRIORITY HEALTH NEEDS, AND THE AVAILABILITY AND PROVISION OF HEALTH SERVICES THROUGHOUT ORANGE COUNTY. - COMMUNITY MEMBER SURVEY. THE COMMUNITY SURVEY WAS DEVELOPED BY EVALCORP AND DISTRIBUTED ONLINE FROM JULY 1 THROUGH AUGUST 10, 2020 TO COMMUNITY MEMBERS VIA 18 COMMUNITY-BASED AGENCIES. THE SURVEY WAS DISTRIBUTED THROUGH A WIDE RANGE OF COUNTY, PRIVATE, AND NON-PROFIT AGENCIES WHO SERVE RESIDENTS OF ORANGE COUNTY. DURING THE FIVE-WEEK SURVEY ADMINISTRATION TIMEFRAME, A TOTAL OF 548 RESPONSES WERE COLLECTED. - FOCUS GROUPS. FOCUS GROUPS WERE CONDUCTED TO ASSESS CURRENT MENTAL AND BEHAVIORAL HEALTH NEEDS, ACCESS TO CARE, AVAILABILITY OF EXISTING RESOURCES, AND NEEDS CAN BE ADDRESSED WITHIN ORANGE COUNTY. ALL FOCUS GROUPS USED A SEMI-STRUCTURED PROTOCOL AND WERE FACILITATED IN ONE OF THE FOLLOWING LANGUAGES: SPANISH, ENGLISH, VIETNAMESE, OR CAMBODIAN (KHMER). FOCUS GROUPS WERE PURPOSIVELY SAMPLED TO REPRESENT A VARIETY OF AGES FROM YOUTH TO OLDER ADULTS, RACE/ETHNICITIES, AND VULNERABLE OR UNDERSERVED POPULATIONS (E.G., LGBTQ+ AND VETERANS). EIGHT FOCUS GROUPS WERE SUCCESSFULLY CONDUCTED WITH A TOTAL OF 54 PARTICIPANTS IN ATTENDANCE ACROSS THE EIGHT SESSIONS. TABLE 2 OF THE 2019 CHNA PROVIDES FURTHER DETAILS ABOUT EACH OF THE FOCUS GROUPS. THE FOLLOWING COMMUNITY PARTNERS/ORGANIZATIONS ASSISTED US THROUGHOUT THE DATA COLLECTION PROCESS: - ACCESS CALIFORNIA SERVICES - ALZHEIMER'S FAMILY CENTER - AMERICAN LEGION - CALOPTIMA - CAMBODIAN FAMILY - COMMUNITY HEALTH INITIATIVES OF ORANGE COUNTY - COUNCIL ON AGING - FIRST 5 ORANGE COUNTY - GIRLS INC. - HUMAN OPTIONS - ILLUMINATION FOUNDATION - JAMBOREE HOUSING - KIDS HEALTHY - MOMS ORANGE COUNTY - NAMI - NEWPORT MESA UNIFIED SCHOOL DISTRICT - HOPE CLINIC - OMID MULTICULTURAL INSTITUTE FOR DEVELOPMENT (OMID) - ORANGE COUNTY ASIAN PACIFIC ISLANDER COMMUNITY ALLIANCE - ORANGE COUNTY HUMAN RELATIONS - ORANGE COUNTY MECCA - ORANGE COUNTY UNITED WAY - ORANGE COUNTY WOMEN'S HEALTH PROJECT - RADIANT HEALTH CENTERS - SECOND HARVEST FOOD BANK - SHARE OURSELVES - UNIVERSITY OF CALIFORNIA, IRVINE

SCHEDULE H, PART V, SECTION B, LINE 6A
HOAG MEMORIAL HOSPITAL PRESBYTERIAN AND HOAG ORTHOPEDIC INSTITUTE CONDUCTED A COMBINED CHNA.

SCHEDULE H, PART V, SECTION B, LINE 7A
FACILITY 1 HTTPS://WWW.HOAG.ORG/ABOUT-HOAG/COMMUNITY-BENEFIT/REPORTS/ FACILITY 2 HTTPS://WWW.HOAG.ORG/ABOUT-HOAG/COMMUNITY-BENEFIT/REPORTS/

SCHEDULE H, PART V, SECTION B, LINE 10A
FACILITY 1 HTTPS://WWW.HOAG.ORG/ABOUT-HOAG/COMMUNITY-BENEFIT/REPORTS/ FACILITY 2 HTTPS://WWW.HOAG.ORG/ABOUT-HOAG/COMMUNITY-BENEFIT/REPORTS/

SCHEDULE H, PART V, SECTION B, LINE 11
THE 2019 CHNA IDENTIFIED THE FOLLOWING AS HOAG'S SIGNIFICANT NEEDS TO BE ADDRESSED: MENTAL HEALTH, ACCESS TO CARE, ECONOMIC SECURITY, PREVENTION OF CHRONIC DISEASE AND MANAGEMENT, WOMEN'S HEALTH, AND SUBSTANCE USE. FOR EACH HEALTH NEED THE HOSPITALS PLAN TO ADDRESS, THE STRATEGIES BELOW OUTLINE THE ACTIONS THE HOSPITALS INTEND TO TAKE, INCLUDING PROGRAMS AND RESOURCES IT PLANS TO COMMIT AND PLANNED COLLABORATION WITH OTHER ORGANIZATIONS. MENTAL HEALTH STRATEGIES 1) PROVIDE MENTAL HEALTH CARE SERVICES THROUGH HOAG'S MENTAL HEALTH CENTER PRIMARILY FOCUSED ON THE LOW-INCOME POPULATION. 2) PROVIDE FUNDING AND/OR IN-KIND SUPPORT TO COMMUNITY NONPROFIT ORGANIZATIONS THAT FOCUS ON MENTAL HEALTH THAT GOES BEYOND OUR SCOPE OF CARE. 3) PROVIDE WORKFORCE DEVELOPMENT OPPORTUNITIES (INTERNSHIPS, INTERNAL AND EXTERNAL PROFESSIONAL DEVELOPMENT) FOR THE MENTAL HEALTH PROFESSION. 4) USE EXISTING PATHWAYS TO EXPAND OUR CONTINUUM OF CARE FOR MENTAL HEALTH. ACCESS TO CARE STRATEGIES 1) PROVIDE FINANCIAL ASSISTANCE THROUGH FREE AND DISCOUNTED CARE FOR HEALTH CARE SERVICES, CONSISTENT WITH THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. 2) OFFER INFORMATION AND ENROLLMENT ASSISTANCE FOR NO COST AND LOW-COST INSURANCE PROGRAMS. 3) PROVIDE FUNDING AND/OR IN-KIND SUPPORT TO COMMUNITY CLINICS. 4) PROVIDE FUNDING AND/OR IN-KIND SUPPORT TO COMMUNITY NONPROFIT ORGANIZATIONS THAT REDUCE BARRIERS TO ACCESSING CARE. 5) PROVIDE PARTNERS WITH SPACE AND RESOURCES AT THE MELINDA HOAG SMITH CENTER FOR HEALTHY LIVING. 6) PROVIDE TRANSPORTATION SUPPORT FOR SENIORS TO INCREASE ACCESS TO HEALTH CARE SERVICES. ECONOMIC SECURITY STRATEGIES 1) PROVIDE FUNDING AND/OR IN-KIND SUPPORT TO COMMUNITY NONPROFIT ORGANIZATIONS THAT FOCUS ON ECONOMIC SECURITY MEASURES. 2) BUILD COMMUNITY CAPACITY BY PROVIDING COLLABORATIVE PARTNERS WITH SPACE AND RESOURCES AT THE MELINDA HOAG SMITH CENTER FOR HEALTHY LIVING. 3) CONTINUE AND EXPAND PROGRAMS THAT ALLEVIATE FOOD INSECURITY. PREVENTION OF CHRONIC DISEASE AND MANAGEMENT STRATEGIES 1) PROVIDE FUNDING AND/OR IN-KIND SUPPORT TO COMMUNITY CLINICS. 2) PROVIDE FUNDING AND/OR IN-KIND SUPPORT TO COMMUNITY NONPROFIT ORGANIZATIONS THAT FOCUS ON DISEASE PREVENTION, INCLUDING OBESITY PREVENTION AND CHRONIC DISEASE MANAGEMENT. 3) PROVIDE PARTNERS WITH SPACE AND RESOURCES AT THE MELINDA HOAG SMITH CENTER FOR HEALTHY LIVING. 4) OFFER CHRONIC DISEASE PREVENTION, MANAGEMENT, EDUCATION, CARE NAVIGATION, SCREENINGS AND SUPPORT GROUPS. 5) CONTINUE TO PROVIDE WELLNESS AND PREVENTION PROGRAMS TO VULNERABLE COMMUNITIES. WOMEN'S HEALTH STRATEGIES 1) PROVIDE FUNDING AND/OR IN-KIND SUPPORT TO ORGANIZATIONS FOCUSED ON WOMEN'S HEALTH. 2) COLLABORATE WITH HOAG WOMEN'S HEALTH INSTITUTE IN IDENTIFYING GAPS IN CARE FOR THE LOW INCOME AND VULNERABLE PATIENT POPULATION. 3) OFFER HEALTH EDUCATION, CARE NAVIGATION, ADVOCACY AND RESOURCE BROKERING. SUBSTANCE USE STRATEGIES 1) PROVIDE FUNDING AND/OR IN-KIND SUPPORT TO ORGANIZATIONS FOCUSED ON SUBSTANCE USE 2) COLLABORATE WITH HOAG'S ADDICTION TREATMENT CENTERS TO DEVELOP OPPORTUNITIES FOR LOW-INCOME POPULATION. 3) COLLABORATE WITH FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS) THAT ADDRESS SUBSTANCE USE DISORDERS AND PROVIDE MEDICATION-ASSISTED TREATMENT (MAT). TO ACCOMPLISH SOME OF THESE STRATEGIES HOAG WILL ALSO COLLABORATE WITH COMMUNITY PARTNERS. SHARING RESOURCES AND ENHANCING THE CAPACITY OF PARTNER ORGANIZATIONS SUPPORTS THE ACHIEVEMENTS OF OUR GOALS. POTENTIAL COLLABORATIVE PARTNERS INCLUDE, BUT ARE NOT LIMITED TO: - ADVOCACY GROUPS - COMMUNITY HEALTH CENTERS AND COMMUNITY CLINICS - COMMUNITY-BASED ORGANIZATIONS - FAITH BASED ORGANIZATIONS - FAMILY RESOURCE CENTERS - FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS) - LOCAL MUNICIPALITIES - MENTAL HEALTH ASSOCIATIONS - ORANGE COUNTY HEALTH CARE AGENCY - SCHOOL DISTRICTS AND SCHOOLS - LOCAL FOOD BANKS - SENIOR CENTERS AND ADULT DAY CENTERS

SCHEDULE H, PART V, SECTION B, LINE 13H
HOAG PROVIDES FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE FAMILY INCOME LEVELS OF UP TO 400% THE FEDERAL POVERTY LEVEL (FPL) GUIDELINES. HOAG GIVES CONSIDERATION TO ELIGIBLE PATIENTS WITH INSURANCE IF THEY INCUR HIGH MEDICAL COSTS AS DEFINED BY CALIFORNIA LAW, AND ALSO HAVE FAMILY INCOMES UP TO 400% OF THE FPL. HMHP AND HOI'S POLICY ALSO PROVIDES FOR DISCRETIONARY DETERMINATION OF CHARITY CARE TAKING INTO CONSIDERATION INDIVIDUAL FACTS AND CIRCUMSTANCES.

SCHEDULE H, PART V, SECTION B, LINE 15E
PATIENTS CAN APPLY FOR FINANCIAL ASSISTANCE BY COMPLETING A FINANCIAL ASSISTANCE PROGRAM (FAP) APPLICATION. APPLICATIONS CAN BE FOUND ON THE HOAG.ORG WEBSITE, VIA FINANCIAL COUNSELORS, BY MAIL, AND BY CONTACTING HOAG'S PATIENT FINANCIAL SERVICES CALL CENTER AT (949) 764-8400 FOR HOAG AND (949) 764-8404 FOR HOI.

SCHEDULE H, PART V, SECTION B, LINE 16A
FACILITY 1 HTTPS://WWW.HOAG.ORG/PATIENTS-VISITORS/BILLING-INFORMATION/FINANCIAL-ASSIS TANCE-CHARITY-CARE/ FACILITY 2 https://www.hoagorthopedicinstitute.com/for-patients/billing-and-insurance /financial-assistance/

SCHEDULE H, PART V, SECTION B, LINE 16B
FACILITY 1 HTTPS://WWW.HOAG.ORG/PATIENTS-VISITORS/BILLING-INFORMATION/FINANCIAL-ASSIS TANCE-CHARITY-CARE/ FACILITY 2 https://www.hoagorthopedicinstitute.com/for-patients/billing-and-insurance /financial-assistance/

SCHEDULE H, PART V, SECTION B, LINE 16C
PLAIN LANGUAGE SUMMARY FACILITY 1 HTTPS://WWW.HOAG.ORG/PATIENTS-VISITORS/BILLING-INFORMATION/FINANCIAL-ASSIS TANCE-CHARITY-CARE/ FACILITY 2 https://www.hoagorthopedicinstitute.com/for-patients/billing-and-insurance /financial-assistance/

SCHEDULE H, PART I, LINE 3C
IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES, INCLUDING BUT NOT LIMITED TO DISABILITY AND HOMELESSNESS ARE CONSIDERED WHEN DETERMINING ELIGIBILITY.

SCHEDULE H, PART I, LINE 6A
HOAG MEMORIAL HOSPITAL PRESBYTERIAN PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT: HTTPS://WWW.HOAG.ORG/ABOUT-HOAG/COMMUNITY-BENEFIT/REPORTS/

SCHEDULE H, PART I, LINE 7A-I
COST ACCOUNTING SYSTEM WAS USED TO DERIVE THE COST-TO-CHARGE RATIO. OUR TOTAL COSTS (DIRECT AND INDIRECT) AND TOTAL CHARGES WERE $314,836,194 AND $225,515,951, RESPECTIVELY. THIS RESULTED IN A COST-TO-CHARGE RATIO OF APPROXIMATELY 139.6% WHICH WAS USED TO CALCULATE CHARITY CARE AT COST (GROSS PATIENT CHARGES WRITTEN OFF ON THE P&L TIMES COST-TO-CHARGE RATIO). THE COST ACCOUNTING SYSTEM ADDRESSES INPATIENT, OUTPATIENT AND VARIOUS PAYOR TYPES. FOR THE SECTIONS OF LINE 7 AS APPLICABLE, WORKSHEET 2 WAS NOT USED WHILE THE COST TO CHARGE RATIO WAS USED.

SCHEDULE H, PART I, LINE 7, COLUMN F
THE PROPORTIONATE SHARE OF THE ORGANIZATION'S JOINT VENTURE EXPENSES HAVE BEEN INCLUDED IN THE CALCULATION OF THE COMMUNITY BENEFIT EXPENSE PERCENTAGES.

SCHEDULE H, PART I, LINE 7G
NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED.

SCHEDULE H, PART III, LINE 2
HMHP ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ACCOUNTING STANDARDS UPDATE 2014-09 TOPIC 606 (ASU 606) EFFECTIVE JANUARY 1, 2018. ASU 606 AND THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) DIFFERENTIATE BAD DEBT FROM IMPLICIT PRICE CONCESSIONS. ACCORDINGLY, HMHP NO LONGER SEPARATELY PRESENTS A PROVISION FOR BAD DEBTS ON THE STATEMENT OF OPERATIONS OR THE RELATED ALLOWANCE FOR BAD DEBTS ON THE BALANCE SHEET.

SCHEDULE H, PART III, LINE 4
The organization's audited financial statements do not include a footnote discussing bad debt expense, accounts receivable, allowance for doubtful accounts or similar designations. SCHEDULE H, Part III, Line 8 TREATMENT OF MEDICARE SHORTFALL/(SURPLUS) AS COMMUNITY BENEFIT THE ORGANIZATION DOES NOT TREAT THE SURPLUS FROM MEDICARE AS A COMMUNITY BENEFIT. MEDICARE COSTING METHODOLOGY MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO.

SCHEDULE H, PART III, LINE 9B
PATIENT ACCOUNTS MANAGEMENT IS RESPONSIBLE FOR THE COLLECTION OF PATIENT ACCOUNTS AFTER DISCHARGE. PROCEDURES ARE FOLLOWED IN ACCORDANCE WITH THE FAIR DEBT COLLECTION PRACTICES ACT. ACCOUNTS UNPAID AFTER ONE HUNDRED FIFTY (150) DAYS MAY BE RECOMMENDED FOR ASSIGNMENT TO AN OUTSIDE COLLECTION AGENCY. ALL APPROPRIATE EFFORTS TO COLLECT AND/OR RESOLVE THE BALANCES DUE WITH THE PATIENT, GUARANTOR OR THIRD PARTY PAYOR MUST BE EXHAUSTED PRIOR TO RECOMMENDATION TO COLLECTORS.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT HMHP CONDUCTED A NEW 2019 COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOPED A RELATED IMPLEMENTATION STRATEGY WHICH WERE ADOPTED NOVEMBER 5-6, 2020. PRIORITIZED NEEDS FROM THIS CHNA WILL BE USED TO PLAN AND EVALUATE PROGRAMMING FOR 3 YEARS, 2020-2022. A DESCRIPTION OF HOW THEY ARE BEING ADDRESSED WILL BE PROVIDED WITH THE SCHEDULE H EACH TAX YEARS. HMHP'S 2019 CHNA AND 2020-2022 IMPLEMENTATION STRATEGIES MAY BE VIEWED ONLINE AT: HTTPS://WWW.HOAG.ORG/ABOUT-HOAG/COMMUNITY-BENEFIT/REPORTS IN ADDITION TO THE COMMUNITY WIDE NEEDS ASSESSMENT CONDUCTED EVERY THREE YEARS, HOAG CONTINUALLY ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY IN VARIOUS WAYS. MANY OF THE COMMUNITY BENEFIT STAFF SERVE ON BOARD OF DIRECTORS AND COMMITTEES OF NONPROFIT ORGANIZATIONS WHICH ALLOWS THEM TO BE ACTIVELY ENGAGED WITH THE COMMUNITY AS WELL AND PROVIDE SUPPORT AND STRATEGIC DIRECTION. CLIENTS THAT ACCESS SERVICES AT THE MELINDA HOAG SMITH CENTER FOR HEALTHY LIVING ALSO COMPLETE A SCREENING TOOL WHICH ALLOWS US TO ASSESS FUTURE PROGRAMMING NEEDS FOR THE COMMUNITY. THE DIRECTOR OF THE DEPARTMENT SERVES AS THE CHAIR OF THE ORANGE COUNTY MENTAL HEALTH BOARD AND IS ALSO AN ACTIVE MEMBER OF THE BE WELL ORANGE COUNTY PARTNERSHIP WHICH ALLOWS FOR CONTINUOUS ASSESSMENT OF MENTAL HEALTH NEEDS, GAPS AND OPPORTUNITIES FOR THE COUNTY. THE DIRECTOR OF COMMUNITY BENEFIT ALSO COFOUNDED THE COMMUNITY SUICIDE PREVENTION INITIATIVE WITH THE GOAL OF INCREASING AWARENESS AND ACCESSIBILITY TO AVAILABLE RESOURCES, HOSTING COMMUNITY EDUCATIONAL EVENTS, AND REDUCING SUICIDE IN ORANGE COUNTY. COMMUNITY BENEFIT STAFF ALSO HOLD A SEAT WITH THE ORANGE COUNTY HEALTH CARE AGENCY'S HEALTH IMPROVEMENT PARTNERSHIP AND ORANGE COUNTY GRANTMAKERS WHICH BRINGS TOGETHER VARIOUS HEALTH RELATED ORGANIZATIONS AND PHILANTHROPIC FUNDERS TO DISCUSS COMMUNITY NEEDS, PROGRAMMING, AND COLLABORATIVE OPPORTUNITIES. HOAG'S CENTER FOR HEALTHY LIVING ALSO HOSTS A MONTHLY PROFESSIONAL NETWORK RESOURCE EXCHANGE MEETING WHICH BRINGS TOGETHER COMMUNITY LEADERS FROM THE NONPROFIT SECTOR, LOCAL SCHOOL DISTRICTS, AND HEALTH RELATED SERVICES TO DISCUSS RECENT HEALTH TRENDS AND OPPORTUNITIES TO MEET THOSE NEEDS. COMMUNITY BENEFIT STAFF ALSO INTERFACES WITH VARIOUS CITY OFFICIALS IN ORANGE COUNTY WHICH ALLOWS HOAG TO BE ENGAGED AND COLLABORATE ON ISSUES THAT ARISE. OUR ROBUST COMMUNITY BENEFIT GRANTS PROGRAM ALSO PROVIDES US WITH A LENS INTO COMMUNITY NEED AS WE INTERFACE WITH OVER 80 NONPROFIT ORGANIZATIONS WHO APPLY FOR PROGRAM FUNDING. THE APPLICATION PROCESS FOR FUNDING PROVIDES US WITH A LEARNING OPPORTUNITY ABOUT THE ORGANIZATIONS MISSION AS WELL AS GAPS AND NEEDS THEIR COMMUNITY IS FACED WITH.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM IN 2013, HOAG MEMORIAL HOSPITAL PRESBYTERIAN BECAME AFFILIATED WITH ST. JOSEPH HEALTH, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ON JULY 1, 2016, PROVIDENCE HEALTH & SERVICES (PHS) AND ST. JOSEPH HEALTH SYSTEM (SJHS) ENTERED INTO A BUSINESS COMBINATION AGREEMENT. TOGETHER, THE COMBINED CAREGIVERS SERVE IN 51 HOSPITALS, 1,085 CLINICS ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. EFFECTIVE FEBRUARY 1, 2022, HOAG MEMORIAL HOSPITAL PRESBYTERIAN AND PROVIDENCE HEALTH & SERVICES ANNOUNCED THEIR AGREEMENT TO END THEIR AFFILIATION.

SCHEDULE H, PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT CALIFORNIA

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE HOAG PROVIDES FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE FAMILY INCOME LEVELS OF UP TO FOUR TIMES THE FEDERAL POVERTY LEVEL (FPL) GUIDELINES. HOAG GIVES CONSIDERATION TO ELIGIBLE PATIENTS WITH INSURANCE IF THEY INCUR HIGH MEDICAL COSTS AS DEFINED BY CALIFORNIA LAW, AND ALSO HAVE FAMILY INCOMES UP TO 400% OF THE FPL. HOAG INFORMS AND EDUCATES PATIENTS ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE IN THE FOLLOWING WAYS: - FINANCIAL ASSISTANCE NOTICES PRINTED IN ENGLISH AND SPANISH ARE ALSO PLACED IN THE PUBLIC ADMISSION AREAS AT HOAG HOSPITALS. - STATEMENTS MAILED TO THE PATIENT INCLUDE A CLEAR AND CONSPICUOUS NOTICE ADVISING THE PATIENT OF HOAG FINANCIAL ASSISTANCE PROGRAM AND THE APPROPRIATE CONTACT INFORMATION. - PATIENT CAN ALSO VISIT PATIENT FINANCIAL SERVICES TO MEET WITH A FINANCIAL COUNCILOR OR BY CONTACTING HOAG'S PATIENT FINANCIAL SERVICES CALL CENTER TO ANSWER ANY QUESTIONS REGARDING FINANCIAL ASSISTANCE OPTIONS. - HMHP DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE.

SCHEDULE H, PART VI, LINE 4
"COMMUNITY INFORMATION HOAG'S COMMUNITY, AS DEFINED FOR THE PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDES 53 ZIP CODES SPANNING 27 CITIES AND UNINCORPORATED COMMUNITIES IN BOTH ORANGE COUNTY AND LOS ANGELES COUNTY (ONE ZIP CODE IS LOCATED IN LONG BEACH). THIS COMMUNITY DEFINITION WAS DETERMINED BECAUSE A MAJORITY OF HOAG'S PATIENTS ORIGINATE FROM THIS AREA. THE POPULATION OF THE HOSPITAL'S SERVICE AREA IS ESTIMATED AT 1,991,457 PEOPLE. POPULATION ORANGE COUNTY IS THE 47TH LARGEST COUNTY IN CALIFORNIA IN TERMS OF GEOGRAPHIC AREA. IN 2018, THE ORANGE COUNTY POPULATION WAS 3.16 MILLION PEOPLE (3,164,182). BETWEEN 2013 AND 2018, THE TOTAL POPULATION OF ORANGE COUNTY INCREASED BY 112,411, WHICH INDICATES A POPULATION GROWTH RATE OF 3.7% DURING THE FIVE-YEAR PERIOD. IN GENERAL, ORANGE COUNTY'S POPULATION GROWTH RATE IS COMPARABLE TO THE STATE POPULATION GROWTH OF 3.9%. TABLE 4 OF THE 2019 CHNA PROVIDES FURTHER DETAILS. GENDER FROM THE TOTAL ORANGE COUNTY POPULATION, HOAG HOSPITAL SERVES APPROXIMATELY 2M PEOPLE (1,977,308). FEMALES COMPRISED A SLIGHTLY HIGHER PERCENTAGE (51%) OF THE TOTAL POPULATION SERVED BY HOAG HOSPITAL COMPARED TO MALES (50%). THESE NUMBERS ARE SIMILAR ACROSS ORANGE COUNTY AND CALIFORNIA. AGE IN 2018, THE MEDIAN AGE OF ORANGE COUNTY RESIDENTS WAS 38 YEARS. IT IS EXPECTED THAT THE ADULT POPULATION 18 YEARS AND OLDER WILL INCREASE BY 4.4% (107,213) BY 2023 (0.9% GROWTH RATE PER YEAR). THE AGE DISTRIBUTION OF THE HOAG SERVICE AREA IS 22% CHILDREN AND YOUTH, 64% ADULTS, AND 14% SENIORS 65 AND OLDER. TABLE 5 OF THE 2019 CHNA DETAILS THE AGE DISTRIBUTION OF COMMUNITY MEMBERS IN THE HOAG SERVICE AREA COMPARED TO ORANGE COUNTY AND CALIFORNIA. THE SENIOR POPULATION IN THE HOAG SERVICE IS COMPARABLE ACROSS ORANGE COUNTY AND CALIFORNIA IN GENERAL (14% RESPECTIVELY). THE PERCENTAGE OF YOUTH AND YOUNG ADULTS IS SLIGHTLY LOWER COMPARED TO THE COUNTY AND STATE LEVEL. RACE AND ETHNICITY IN 2018, THE THREE MAJOR RACIAL AND ETHNIC GROUPS IN THE HOAG SERVICE AREA WERE: CAUCASIANS (64%), HISPANIC/LATINOS (31%), AND ASIANS (22%). THESE FIGURES ARE LOWER THAN THE PROPORTION OF THE POPULATION IN ORANGE COUNTY PERTAINING TO THESE RACIAL AND ETHNIC GROUPS EXCEPT FOR BLACK OR AFRICAN AMERICANS (2%). TABLE 6 OF THE 2019 CHNA DISPLAYS THE RACE AND ETHNICITY PROPORTIONS OF HOAG, ORANGE COUNTY, AND CALIFORNIA. LANGUAGE THE U.S. CENSUS BUREAU DEFINES THOSE WITH """"LIMITED ENGLISH"""" AS THE POPULATION 5 YEARS AND OLDER WHO SPEAK ENGLISH """"LESS THAN VERY WELL."""" THE PERCENTAGE OF THE POPULATION IN THE HOAG SERVICE AREA WHO FALL WITHIN THIS CATEGORY OF ENGLISH PROFICIENCY IS 18%, WHICH IS SLIGHTLY COMPARABLE TO THAT OF THE COUNTY (18%). FROM THOSE WITH LIMITED ENGLISH SKILLS, THE PREDOMINANT LANGUAGE WITHIN THE HOAG SERVICE AREA IS SPANISH (53%), FOLLOWED BY ASIAN AND PACIFIC ISLANDER LANGUAGES (39%). SEE TABLE 8 OF THE 2019 CHNA. HOUSEHOLD SIZE AND MEDIAN HOUSEHOLD INCOME THERE ARE A TOTAL OF 676,685 OCCUPIED HOUSING UNITS IN THE SERVICE AREA OF WHICH 32% ARE 2 PERSON HOUSEHOLDS, WHICH IS COMPARABLE TO THE COUNTY STATES' OF 31% (TABLE 9). IN GENERAL, THE AVERAGE HOUSEHOLD SIZE IN THE HOAG SERVICE AREA IS 2.84 WHICH IS SLIGHTLY LOWER THAN THE AVERAGE HOUSEHOLD SIZE IN THE COUNTY (3.02) AND THE STATE'S AVERAGE (2.96). ONE OF THE MOST INFLUENTIAL SOCIAL DETERMINANTS OF HEALTH IS INCOME. A HOUSEHOLD'S INCOME WILL DETERMINE A FAMILY'S ABILITY AND RESOURCES TO ACCESS HEALTH CARE OR CONTINUE RECEIVING IT. POVERTY AS OF 2018, 11% OF THE HOAG SERVICE AREA POPULATION WAS LIVING 100% BELOW THE FEDERAL POVERTY LEVEL WHICH WAS COMPARABLE TO THAT OF THE COUNTY IN (11%) AND STATE (12%). IN THE HOAG SERVICE AREA, 29% OF THE POPULATION UNDER 18 YEARS WERE LIVING BELOW 100% THE FEDERAL POVERTY LEVEL. ADDITIONALLY, DATA OUTLINED IN THE 2019 - AN EQUITY PROFILE OF ORANGE COUNTY REPORT FOUND THAT PEOPLE OF COLOR ARE MORE LIKELY TO BE IN POVERTY OR AMONG THE WORKING POOR. POVERTY WAS FOUND TO BE HIGHEST AMONG LATINOS AND NATIVE AMERICANS; WITH LATINOS HAVING THE HIGHEST SHARE OF WORKING POOR. FOR MORE DETAILS ON THIS INFORMATION, PLEASE REFER TO THE 2019 CHNA AT: HTTPS://WWW.HOAG.ORG/ABOUT-HOAG/COMMUNITY-BENEFIT/REPORTS/ OTHER HOSPITALS IN THE AREA INCLUDE, BUT ARE NOT LIMITED TO: - AHMC ANAHEIM REGIONAL MEDICAL CENTER - ANAHEIM - ANAHEIM GENERAL HOSPITAL (ANAHEIM, BUENA PARK) - CHAPMAN MEDICAL CENTER - ORANGE - CHILDREN'S HOSPITAL AT MISSION - MISSION VIEJO - CHILDREN'S HOSPITAL OF ORANGE COUNTY - ORANGE - FOUNTAIN VALLEY RGNL HOSP AND MED CTR - FOUNTAIN VALLEY - GARDEN GROVE HOSPITAL AND MEDICAL CENTER - GARDEN GROVE - HUNTINGTON BEACH HOSPITAL - HUNTINGTON BEACH - KAISER PERMANENTE (IRVINE, ANAHEIM) - KINDRED HOSPITAL (SANTA ANA, WESTMINSTER) - LA PALMA INTERCOMMUNITY HOSPITAL - LA PALMA - MISSION HOSPITAL LAGUNA BEACH - LAGUNA BEACH - MISSION HOSPITAL REGIONAL MEDICAL CENTER - MISSION VIEJO - ORANGE COAST MEMORIAL MEDICAL CENTER - FOUNTAIN VALLEY - SADDLEBACK MEMORIAL MEDICAL CENTER (LAGUNA HILLS/SAN CLEMENTE) - ST. JOSEPH HOSPITAL - ORANGE - ST. JUDE MEDICAL CENTER - FULLERTON - UNIVERSITY OF CALIFORNIA IRVINE MEDICAL CENTER - ORANGE - WESTERN MEDICAL CENTER - SANTA ANA"

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH HOAG MEMORIAL HOSPITAL PRESBYTERIAN PROVIDES VITAL COMMUNITY HEALTH SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE AND DISCOUNTED CARE. HOAG MEMORIAL HOSPITAL PRESBYTERIAN IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE IN ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS: - COMMUNITY BENEFIT STAFF CONTINUOUSLY ASSESS THE HEALTH NEEDS OF THE COMMUNITY BY SERVING ON BOARD OF DIRECTORS AND COMMITTEES OF NONPROFIT ORGANIZATIONS WHICH ALLOWS THEM TO BE ACTIVELY ENGAGED WITH THE COMMUNITY AND PROVIDE SUPPORT AND STRATEGIC DIRECTION. - HOAG HOSPITAL AND SHARE OUR SELVES CORPORATION (SOS) HAVE NURTURED A UNIQUE PARTNERSHIP SINCE 1984. THIS LONG-STANDING RELATIONSHIP BETWEEN SOS AND HOAG HAS ENSURED PRIMARY CARE SERVICES FOR THE MOST VULNERABLE WITH STRATEGIC GOALS THAT WORK TO IMPROVE THE OVERALL WELL-BEING OF OUR SHARED COMMUNITY. THIS COLLABORATIVE PARTNERSHIP HAS ENABLED AN INCREASED ACCESS TO PRIMARY CARE ALLOWING FOR TIMELY, EFFICIENT, AND QUALITY HEALTH CARE FOR THOSE IN NEED AS WELL AS REDUCED UTILIZATION OF EMERGENCY DEPARTMENT DUE TO ACCESS FOR MEDICAL CARE AT SOS. - HOAG HOSPITAL ALSO MAINTAINS A UNIQUE RELATIONSHIP WITH THE ALZHEIMER'S FAMILY CENTER (AFC) WHICH IS COMMITTED TO THE MISSION OF IMPROVING THE QUALITY OF LIFE FOR FAMILIES CHALLENGED BY ALZHEIMER'S DISEASE OR ANOTHER DEMENTIA THROUGH SERVICES TAILORED TO MEET INDIVIDUAL NEEDS. HOAG HOSPITAL OWNS THE AFC FACILITY AND PROVIDES IT AT NO CHARGE, INCLUDING MAINTENANCE SERVICES AS SPECIFIED IN THE LEASE, TO THE AGENCY. ADDITIONALLY, THE HOSPITAL PROVIDES ANNUAL OPERATING AND TRANSPORTATION GRANTS. - HOAG HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY THROUGH A CREDENTIALING PROCESS. MEMBERSHIP AND PRIVILEGES ARE GRANTED TO QUALIFIED MD'S, DO'S, AND OTHER ALLIED HEALTH PROFESSIONALS BY THE MEDICAL STAFF AND HOAG HOSPITAL BOARD OF DIRECTORS. - AS A NOT-FOR-PROFIT INSTITUTION, GOVERNANCE IS PROVIDED BY A VOLUNTEER BOARD OF DIRECTORS COMPRISED OF 18 VOTING MEMBERS. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS. - THE BOARD OF DIRECTORS ALLOCATE A SIGNIFICANT PORTION OF THE NET OPERATING INCOME TO PROMOTING THE HEALTH OF THE COMMUNITY, SPECIFICALLY SERVING THE NEEDS OF THE UNINSURED AND LOW INCOME COMMUNITIES THROUGH CHARITY CARE AND A VARIETY OF FREE OR LOW COST SERVICES AND PROGRAMS PROVIDED BY THE DEPARTMENT OF COMMUNITY HEALTH. - IN AN EFFORT TO INCREASE THE COMMUNITY POOL OF AVAILABLE TRAINED AND EDUCATED HEALTH PROFESSIONALS, HOAG INVESTS ANNUALLY IN HEALTH PROFESSIONAL TRAINING AND DEVELOPMENT. THE HOSPITAL CURRENTLY WORKS WITH A NUMBER OF PROFESSIONAL GROUPS IN THIS ENDEAVOR, INCLUDING NURSES, PHYSICAL THERAPISTS, PHARMACISTS, LABORATORY PROFESSIONALS, SOCIAL WORKERS, AND CLINICAL CARE EXTENDERS. - HOAG PROVIDES UNCOMPENSATED CARE (CHARITY) TO PATIENTS WHO ARE UNABLE TO PAY FOR THE FULL COST OF THEIR CARE. HOAG'S CHARITY CARE AND SELF-PAY DISCOUNT POLICY STATES THAT SELF-PAY AND UNINSURED PATIENTS WHO ARE UNABLE TO PAY FOR THE FULL COST OF THEIR CARE MAY QUALIFY FOR CHARITY OR DISCOUNTS ON A SLIDING SCALE FOR INCOMES UP TO 400% OF THE FEDERAL POVERTY LEVEL. TOTAL QUANTIFIABLE COMMUNITY BENEFIT EXPENDITURES (EXCLUDING MEDICARE COST OF UNREIMBURSED CARE) FOR CY2021 AMOUNTED TO OVER $74 MILLION. THE MELINDA HOAG SMITH CENTER FOR HEALTHY LIVING (MHSCHL) IS A ROBUST ONE-STOP SHOP OF INTERCONNECTED AND SUPPORTIVE SERVICES THAT PROMOTE HEALTH AND WELL-BEING. THE CENTER HOUSES A WIDE VARIETY OF NON-PROFIT PARTNER AGENCIES AND THE PROGRAMS THAT ADDRESS KEY ISSUES AFFECTING THE HEALTH OF OUR COMMUNITY. A KEY COMPONENT WHICH MAKES THE COLLABORATIVE UNIQUE AND IS ESSENTIALLY THE GLUE BETWEEN THE COMMUNITY AND THE CENTER, IS OUR CENTRALIZED REGISTRATION AND CASE MANAGEMENT TEAM. THIS TEAM ASSURES THAT ALL CLIENT'S COMING INTO THE CENTER FILL OUT A SCREENER WHICH SEEKS TO IDENTIFY; SOCIO-ECONOMIC STRESSORS, POTENTIAL HEALTH RISKS, MENTAL AND EMOTIONAL HEALTH ISSUES, LEGAL ISSUES, ACCESS TO HEALTH CARE, AND OTHER LIFE STRESSORS THAT CAN AFFECT ONE'S QUALITY OF LIFE. OUR CASE-MANAGEMENT TEAM PLAYS A CRITICAL ROLE IN LINKING CLIENTS TO THE APPROPRIATE SERVICES, WHILE ALSO MONITORING CLIENT'S PROGRESSION THROUGH THE REFERRAL PROCESS.