4A (Expenses $ 28471059 including grants of $ 6446) (Revenue $ 32136307)
Clara Barton Hospital Association provided a wide range of health care services to residents of its service area including 3,303 patient days of inpatient care, 24,535 outpatient hospital visits and 35,995 visits to our primary care and surgical clinics.

Clara Barton Hospital Association, Inc.
Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Barton County Health Department. The Hospital reached out to members of the community with broad interests in the community served and special knowledge of or expertise in public health from groups such as local hospitals, public health community, free clinics, community based clinics, service providers, school leaders, and local government. A Town Hall meeting of 39 attendees was conducted. The Town Hall meeting reflected on the size and seriousness of any health concerns cited and discussed current community health strengths, as well as identifying and ranking top community health concerns. In addition to the Town Hall meeting, CHNA surveys were completed by Barton County residents. The survey was created to measure Barton County residents' views regarding health care perceptions of delivery, access, and health practices.

Clara Barton Hospital Association, Inc.
Part V, Section B, Line 6b: Barton County Health Department (located in Great Bend, KS - Barton County)

Clara Barton Hospital Association, Inc.
"Part V, Section B, Line 11: The annual update below pertains to the CHNA and implementation strategy completed for the 2018 tax year, which is the third-annual update for the three-year cycle. Next year's annual update will pertain to the CHNA and implementation strategy completed for the 2021 tax year.1.Diabetic Education (Diet/Exercise) and Decreasing ObesityCBH continues to offer a full range of inpatient and outpatient nutrition services designed to help our patients achieve optimal health and feel their best. Our goal is to provide evidence-based nutrition care for treatment of acute and chronic illnesses and to promote nutritional health for adults and children who are either referred by their physician or taking steps on their own to improve their health. Whether someone simply wants to learn to eat healthier, or if they have special dietary needs, our registered dietitian will conduct an individualized nutrition assessment and create an individualized plan just for that person. Reasons why individuals may seek the assistance of a Registered Dietitian: Chronic Disease, Gut Health, Disordered Eating, Women's Health, Athletes, Patients interested in Bariatric Surgery, Practical Lifestyle Advice.CBH has representation on several boards that focus on diet and exercise such as the Health for Life Coalitions, Be Well Barton County and Kansas Healthy Hospitals.CBH remains dedicated to providing our community nutrition expertise. During 2021 we very actively looked to hire an additional Registered Dietitian. One was found and is slated to start in January 2022.Through out the year CBH posts healthy recipes on our Facebook to share with the community.Quarterly Lab fairs are offered to the public at a discounted rate.Clara Barton offers a full range of both inpatient and outpatient nutrition services designed to help patients achieve optimal health.April 28, 2021, CBH hosted a community wide event for National Walk at Lunch Day.May 2021, bike sharrows were painted on streets in Great Bend to encourage biking and to make it safer for the community. May 2021 the Cottonwood Extension office share information on ""Kids and Vegetables"". Topics included how to keep snacks healthy. How to follow the MyPlate food guide system for healthy eating. How to involve kids in selecting and preparing their healthy snacks. June 2021 the Cottonwood Extension office shared information on ""Fluids important to manage heat, humidity safely"". Topics included staying hydrated as the temperature climbs. Why water is important and how much you should drink. The effects of excessive water loss or dehydration as well as the signs of heat exhaustion.During the Barton County Fair, July 2021, nutritious smoothie recipes were shared with attendees. A blender bike was brought in. A bike with an apparatus above the wheel holding the blender. Participants could hop on the bike and blend up a smoothie. The blender bike was brought in to support and encourage children and families to eat well and be active.Tuesday October 5, 2021, the Hoisington Library hosted an educational program about fermenting vegetables. The program shared the different methods of fermenting vegetables and the health benefits of including a small amount of fermented food in a healthy daily meal plan. 2. Provide SpecialistsCBH continues to partner with Wichita Urology to bring Dr. Andrew Jensen twice a month. With Salina Regional Neurosurgery to bring Dr. Scott Boswell once a month and Rheumatologist Dr. Kenneth Baxa six times a month. Central Kansas Orthopedic Group to bring the orthopedic services of Dr. Randall Hildebrand to the community twice a month, once for clinic and once for surgical procedures. With the Hutchinson Clinic to bring Dr. Costy Mattar a cardiology specialist twice a month, OB/GYN services of Dr. Christine Sanders monthly, Pulmonologist Dr. Humayun Ashraf once a month, Podiatrist Andrea Drieling monthly and Dr. Curt Thompson a diagnostic radiology specialist weekly. With the Wichita Surgical Specialists to bring Dr. Brett Grizzell specializing in cardiothoracic surgery monthly. With Abay Neuroscience of Wichita to bring Dr. Matthew Henry monthly. With Maternal - Fetal Associates of Kansas to bring Dr. Evans, MD - Perinatology monthly. With Cardiovascular Consultants of Wichita to bring Cardiologist Dr. Bassem Chehab, MD twice a month.June of 2021 CBH expanded its pediatric care services with the addition of Pediatrician Dr. Kayla Johnson.Dr. Roxanne Stiles joined our surgical practice August 2021. 3. Improve Assessment/Placement for Mental HealthFebruary 2021 CBH received their annual recertification as a Patient-Centered Medical Home by the national Committee for Quality Assurance (NCQA). This certification establishes a model of care that is patient-focused, improving the quality of care, enhancing patient experience, building relationships between patients and providers, and providing additional clinic services to better serve patient needs. This includes a quality measure tracking the number of PHQ-9 assessments that are completed.CBH continued our partnership with the KU Alzheimer's Disease Center to improve assessment of Alzheimer patients and to provide care giver counceling once a month. CBH offers Behavioral & Mental Health Therapy for children and adults. July 2021 The Golden Belt Community Foundation awarded a $25,000 grant to the Zero Reasons Why project in our community. The goal is to reduce youth suicide rates. Superintendents from all Golden Belt schools meet to get a better understanding of the program and how they might incorporate it in their schools. Joining as partners in this program are the Behavioral Health Advisory Committee; Juvenile Justice Authority; and Suicide Prevention Task Force of the Central Kansas Partnership.Fall of 2021 Hoisington High School Students started the Zero Reasons Why Program. This is a teen-led campaign to reduce teen suicide and emphasize that mental health is as important as physical health. Other schools getting involved include: Central Plains, Stafford, St John-Hudson, Ellinwood, Sterling, Chase-Raymond, Lyons, Great Bend, Fort Larned and Pawnee Heights.Luna, a Bernese Mountain Therapy Dog and her handler Glen stops by CBH on a weekly basis to visit patients providing love and comfort.Saturday, September 18, 2021 the community held the Golden Belt Glow Run for Life 5k/1 mile run at Veterans memorial Park in Great Bend. This event is an awareness and remembrance event that raises awareness for suicide prevention. The Cottonwood extension District Facebook page has started including segments for ""Wellness Wednesday"" These posts are short videos created by the staff at High Plains mental Health, that address mental health topics.4. Develop Substance Abuse Education (Alcohol & Tobacco)A Tobacco Free City Park ordinance was passed in the City of Hoisington February 2021. This includes all forms of tobacco as well as e-cigarettes. April 2021 New Tobacco Free Park Signage was placed in both Great Bend and Hoisington Parks.Rise Up Central Ks has been very active in the community providing resources to prevent, overcome, and abstain from substance misuse. September 2021 Barton County Commission approved a Recovery Proclamation. September 2021 held a Narcan March at Jack Kilby Bandshell. The event included recovery out loud, speakers and luminaries.Antibiotic Stewardship is a coordinated program designed to promote the appropriate use of antimicrobials. Goals of this program include improving patient outcomes, decreasing the spread of infection, and reducing bacterial resistance. Drug resistant bacteria develop from the misuse of antibiotics and can result in life-threatening infections. Taking steps to encourage proper antibiotic use helps to slow bacterial resistance, decrease adverse health effects, and ensure that life-saving medications remain available. At CBH our focus on antibiotic stewardship directly correlates with the principals of community health and wellness. CBH continue efforts in developing complete antibiotic stewardship program that promote the proper use of antibiotic medications. Our stewardship efforts demonstrate a commitment to our patients by improving safety, outcomes, and a dedication to quality of care.During 2021 the All-Stars program continued in our local school systems. The programs are designed to help students talk about the benefits of avoiding drugs and alcohol. One of its goals is to reduce use and abuse, especially of gateway drugs: alcohol, cigarettes, marijuana and inhalants. Free Naloxone Training offered February 2021 - Participants learned how to recognize and respond to signs of an overdose and how to administer Naloxone."

Clara Barton Hospital Association, Inc.
Part V, Section B, Line 11: CBH again partnered with the Great Bend Health department to host a community baby shower for pregnant mothers in need. Education was provided on Smoking Cessation, Safe Sleep and Breast Feeding.CBH continues to participate in the Kan-Quit cessation program. 5. Provide Sex Education in Schools (Decrease Teenage Pregnancy, Decrease Unmarried Mothers)During 2021 the All-Stars program continued in our local school systems. The programs are designed to help students talk about the benefits of avoiding drugs and alcohol, but it also seeks to help students avoid other risky behaviors, such as early sexual experience, fighting and bulling.Prevention education and services are provided by the Barton County Health Department. They include services such as sex education, birth control counseling, physical exams, pap tests, disease screening, sexual and reproductive health, family planning etc.6. Improve Immunization RatesFebruary 2021 CBH received their annual recertification as a Patient-Centered Medical Home by the national Committee for Quality Assurance (NCQA). This certification establishes a model of care that is patient-focused, improving the quality of care, enhancing patient experience, building relationships between patients and providers, and providing additional clinic services to better serve patient needs. This includes a quality measure for Immunizations.Flu vaccines and covid vaccines are offered anytime in all of CBH clinics. In addition the following opportunities were made available to the community:CBH hosted a Drive-Thru for Covid Vaccines from 8:00 - 10:00 3/10/2021.CBH hosted a Walk-in COVID Vaccine Clinic during our Lab Fair from 7:00 - 9:00 4/17/2021.CBH hosted a Drive-Thru for Covid Vaccines from 8:00 - 10:00 4/21/2021.CBH hosted a Drive-Thru for Flu Vaccines from 8:00 - 10:00 10/9/2021.CBH hosted a Vaccine Clinic 11/3/2021 from 7:00 - 11:00. Vaccines available included: Flu, Covid and Covid booster. Free breakfast was given to everyone attending this event.CBH Staff went directly to the schools in Hoisington to give faculty and students vaccinations as well as several community worksites.7. Provide Senior Physical Activity at a Reasonable PriceThe Hoisington activity center charges a small one-time life-time fee of $20 for anyone who lives in the Hoisington school district USD 431. The City of Hoisington offers several free parks where residents can walk, run, and play. Bicentennial Park offers a 1-mile outdoor walking trail along with tennis courts, horseshoe pits, pickleball courts and a dog park.CBH offers a walking loop around the hospital campus. 2.5 laps is a mile. The loop also offers 5 pieces of exercise equipment geared towards Physical Therapy rehab and the Seniors.Great Bend Recreation Center offers reduced (daily, monthly, six month and yearly) rates for seniors. Walking is free to the public. Senior Activities are available most of the time for free. Veterans' Memorial Park in Great Bend offers a 1-mile fitness trail, tennis courts, a fitness station with workout equipment, a dog park and fishing. Club 1 Fitness is the largest health club in Great Bend. It offers a comprehensive weight room, cardio equipment, an Olympic size swimming pool and offers over 40 group fitness classes, including many for the Senior age group. Memberships are discounted for Seniors. Hoisington is in the process of establishing a bike share program. During 2021 bikes were purchased, bike station sites were selected and erected. Public access will be given in 2022. Bikes will be stationed near the city office, Rodeway Inn & Suites Hotel and the Hoisington Activity Center. Free to the public.

Clara Barton Hospital Association, Inc.
Part V, Section B, Line 20e: CBH notified all uninsured patients about the Hospital's FAP by letter, orally, and on patient statements.

Part I, Line 7:
Financial assistance at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of financial assistance provided for services not reported as subsidized health services.Unreimbursed Medicaid costs were also determined using a blend of cost-to-charge ratios for certain services and an overall cost-to-charge ratio derived from Worksheet 2 for all other services.The cost of providing subsidized health services was determined using a cost-to-charge ratio for each service.Actual costs and revenues were utilized for all other items reported on line 7.

Part I, Line 7g:
Subsidized health services are comprised of services that the Hospital provides despite a financial loss to the organization. These services include the operation of a 24-hour emergency room, physician clinics, diabetic and dietician services, and various therapy services. The amount of costs attributed to physician clinics amount to $4,627,050.

Part III, Line 4:
The Hospital recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, the Hospital recognizes revenue on the basis of its standard rates for services provided. On the basis of historical experience, a significant portion of the Hospital's uninsured patients will be unable or unwilling to pay for the services provided. Thus, the Hospital records a significant provision for bad debts related to uninsured patients in the period the services are provided.Part III, Line 2:Bad debt expense at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was applied to the charges deemed uncollectible during the year for all other services.Part III, Line 3:Bad debt expense attributable to patients eligible under the organization's financial assistance policy was determined using an estimated 2% of total bad debts. The Hospital takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible.All non-reimbursed costs for treatment of patients in our community provides a community benefit since patients unwilling or unable to pay have received a valuable service at no cost or at a reduced cost to them. This improves the health of our community as a whole.

Part III, Line 8:
Medicare allowable costs were determined by using amounts from the Hospital's Medicare cost report as filed with the Medicare Administrative Contractor. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services. Caring for Medicare patients fulfills a community need and relieves a government burden as these patients typically have low or fixed income. Therefore, any shortfall should be included as a community benefit.

Part III, Line 9b:
The collection policy states that the patient must cooperate with the Hospital to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for health care services, such as Medicaid. Then the information is gathered and assessed in order to determine eligibility for charity care. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and/or the patient's legal representative. Those patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program, prior to the consideration for charity care.

Part VI, Line 2:
"The Hospital works closely with the Barton County Health Department and Kansas Department of Health and Environment to identify trends in the community. Education and information is provided to the public, including information on West Nile, chicken pox, and whooping cough, for example. The Hospital also trends data in the hospital and clinics to identify emerging issues. The Hospital has provided, a fall prevention program, ""Stepping On"", for interested elderly members of Hoisington and surrounding areas. The Hospital also trends trauma data in the emergency room and as a result provided literature to the public on fall prevention."

Part VI, Line 3:
There is signage posted at admissions desk. Patients are referred to a financial counselor at admission if they do not have insurance. The financial counselor also works with a Medicaid helper to try and get qualified patients registered for the Medicaid program. Effort is made during billing of deductible and co-payment to see if patient can qualify for charity care.

Part VI, Line 4:
The community being served is located in central Kansas and consists of approximately 2,700 residents. The average household income is $47,566. 12.6% of the community residents live below federal poverty level. Neighboring hospitals include facilities in Ellinwood and Great Bend. They are approximately 18 and 11 miles away respectively.

Part VI, Line 5:
The Hospital's Board of Directors is elected from the community at large. This allows independent individuals who reside in the primary service area to serve as a director. The Hospital also extends medical staff privileges to all qualified physicians in the community. Any surplus in funds is retained by the Hospital and aids in improving overall patient care and facility maintenance.