4A (Expenses $ 217421272 including grants of $ 113904) (Revenue $ 244994620)
OUTPATIENT SERVICES: THE HOSPITAL SERVES THE COMMUNITY BY PROVIDING CERTAIN OUTPATIENT SERVICES, INCLUDING AN EMERGENCY DEPARTMENT, BY OR UNDER THE SUPERVISION OF PHYSICIANS, DIAGNOSTIC AND THERAPEUTIC SERVICES FOR MEDICAL DIAGNOSIS, TREATMENT, CARE, OR REHABILITATION OF INJURED, DISABLED, OR SICK PERSONS. THE HOSPITAL HAS BEEN PROVIDING HIGH-QUALITY HEALTHCARE SERVICES TO THE AREA SINCE 1926. SEE SCHEDULE O FOR MORE DETAIL OF SERVICES THE HOSPITAL PROVIDES.

4B (Expenses $ 198177885 including grants of $ 0) (Revenue $ 250930746)
INPATIENT SERVICES: THE HOSPITAL IS A 337-BED ACUTE CARE HOSPITAL ENGAGED IN PROVIDING SERVICES TO INPATIENTS, BY OR UNDER THE SUPERVISION OF PHYSICIANS, DIAGNOSTIC, AND THERAPEUTIC SERVICES FOR MEDICAL DIAGNOSIS, TREATMENT, CARE, OR REHABILITATION OF INJURED, DISABLED, OR SICK PERSONS.

PART V, SECTION B, LINE 5
COMMUNITY INPUT ---------------- IN SEPTEMBER 2011, THE MEDICAL CENTER (TMC) JOINED WITH THE BARREN RIVER DISTRICT HEALTH DEPARTMENT AND NUMEROUS OTHER HEALTHCARE PROVIDERS, COMMUNITY ORGANIZATIONS AND LEADERS TO FORM THE BARREN RIVER COMMUNITY HEALTH PLANNING COUNCIL. THE GOAL OF THE COUNCIL WAS TO RECOGNIZE AND SERVE THOSE MOST IN NEED IN ORDER TO BENEFIT THE WHOLE COMMUNITY. THE COUNCIL IMPLEMENTED A COMMUNITY HEALTH NEEDS SURVEY AND ASSESSMENT PROCESS. KEY HEALTHCARE NEEDS FOR THE COMMUNITY WERE IDENTIFIED FOLLOWED BY THE DEVELOPMENT OF STRATEGIC PLANS TO MEET THOSE NEEDS. THE PROCESS USED WAS PRIMARILY BASED ON THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP), WHICH WAS DEVELOPED BY THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION. COMMUNITY #1 AND #2 SURVEYS WERE CONDUCTED IN 2011 AND 2015. THE MEDICAL CENTER USED THE DATA COLLECTED THROUGH THE SURVEYS TO DEVELOP STRATEGIC PLANS THAT ADDRESSED STRENGTHENING PARTNERSHIPS WITH COMMUNITY HEALTH PROVIDERS AND ORGANIZATIONS, PREVENTATIVE CARE AND DISEASE MANAGEMENT AND ACCESS TO CARE. DURING THE FALL AND WINTER OF 2014-15, THE COUNCIL WAS RENAMED THE BARREN RIVER INITIATIVE TO GET HEALTHY TOGETHER (BRIGHT) COALITION. CYCLE 3 OF THE COMMUNITY ASSESSMENT WAS INITIATED IN THE SPRING OF 2018 BY THE BRIGHT COALITION. BRIGHT MEMBERS WERE RESTRUCTURED INTO FOUR SUBCOMMITTEES BASED ON THE SOCIAL DETERMINANTS OF HEALTH FRAMEWORK. THESE AREAS INCLUDED HEALTH BEHAVIORS, CLINICAL CARE, SOCIAL AND ECONOMIC FACTORS; AND PHYSICAL ENVIRONMENT. BRIGHT MEMBERS JOINED THE GROUP THEY MOST CLOSELY IDENTIFIED WITH PROFESSIONALLY. GAPS AND ASSETS FOR THE NEWLY FORMED GROUP'S AREA OF FOCUS WERE IDENTIFIED FOR EACH OF THE 10 COUNTIES. FROM THERE, EACH OF THE GROUPS DEVELOPED CHNA SURVEY QUESTIONS AND PROVIDED FEEDBACK THAT THEY FELT WOULD IDENTIFY THE COMMUNITY NEEDS IN THEIR SPECIFIC FOCUS AREA. THE SURVEY WAS DISSEMINATED, USING BOTH PAPER AND ELECTRONIC VERSIONS, SEPTEMBER 1 - NOVEMBER 31, 2018 TO ALL 10 COUNTIES IN THE BRADD AREA. THE SURVEY WAS PLACED IN FREESTANDING HEALTH CLINICS, LIBRARIES, HOSPITALS, UK EXTENSION OFFICE LOCATIONS, DISTRIBUTED AT HEALTH FAIRS, DISTRIBUTED TO 50,000 HOMES VIA THE MED CENTER HEALTH WELLNESS PUBLICATION WITH PAID POSTAGE RETURN, PLACED IN THE BOWLING GREEN DAILY NEWS NEWSPAPER AND PROVIDED TO LOCAL HOUSING AUTHORITIES. THE GOAL WAS TO HAVE AS MANY DIFFERENT POPULATIONS REPRESENTED IN THE BRADD AREA RESPOND TO THE SURVEY AS POSSIBLE. THE UNDERSERVED POPULATIONS WERE ESPECIALLY A FOCUS AS FAR AS A DESIRED GROUP OF SURVEY RESPONDENTS. THE SURVEYS WERE ANALYZED BY THE BARREN RIVER AREA HEALTH DEPARTMENT. AFTER REVIEWING THE DATA COLLECTED, IT WAS DETERMINED BY THE BRIGHT COALITION THAT THERE WAS NOT ENOUGH REPRESENTATION OF THE UNDERSERVED POPULATION. EACH OF THE FOUR BRIGHT WORKGROUPS DETERMINED WHERE THE UNDERSERVED POPULATION COULD POTENTIALLY BE REACHED AND WHICH SPECIFIC TOPIC(S) OF THE SURVEY THEY WANTED TO NARROW IN ON TO COLLECT MORE INFORMATION. ADDITIONAL QUESTIONS WERE DEVELOPED TO SURVEY THE SPECIFIC POPULATIONS EITHER INDIVIDUALLY OR IN A FOCUS GROUP SETTING. IT WAS ALSO DETERMINED THAT IT WOULD BE BENEFICIAL TO ASK PROFESSIONALS THAT WORK WITH THESE POPULATIONS OF PEOPLE TO DETERMINE BARRIERS THEY ENCOUNTER WHEN TRYING TO MEET THE NEEDS OF THE COMMUNITIES THEY SERVE. BGWCCHC CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR THE APRIL 2022 THROUGH MARCH 2025 TIME PERIOD THAT CAN BE FOUND ON ITS WEBSITE MEDCENTERHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT. THE INFORMATION PRESENTED IN THIS FORM 990 IS FOR THE ASSESSMENT THAT WAS MADE FOR THE TIME PERIOD THAT ENDED MARCH 31, 2021.

PART V, SECTION B, LINE 6A
OTHER HOSPITAL FACILITIES --------------------------- OTHER FACILITIES THE HOSPITAL'S CHNA WAS CONDUCTED WITH INCLUDE THE MEDICAL CENTER AT FRANKLIN, MONROE COUNTY MEDICAL CENTER, AND TJ SAMSON COMMUNITY HOSPITAL. A FULL LIST OF THESE ORGANIZATIONS CAN BE FOUND ON PAGE 3 OF THE BRIGHT COALITION COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN 2019-2021 LOCATED AT HTTPS://MEDCENTERHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/. WITHIN BRIGHT, THESE STAKEHOLDERS JOINED FORCES TO DETERMINE HOW LEADERS OF SOUTH-CENTRAL KENTUCKY'S RURAL COMMUNITIES CAN WORK TOGETHER TO IMPROVE OVERALL HEALTH STATUSES, STRENGTHEN THE LOCAL ECONOMY, CONTRIBUTE TO EDUCATION SUCCESSES, AND IMPROVE THE QUALITY OF LIFE FOR ALL.

PART V, SECTION B, LINES 7A & 10A
AVAILABILITY TO THE PUBLIC ---------------------------- A COPY OF THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT AND STRATEGIC IMPLEMENTATION PLAN CAN BE FOUND AT: HTTPS://MEDCENTERHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

PART V, SECTION B, LINE 11
ADDRESSING NEEDS ----------------- THE MEDICAL CENTER FOCUSED ON AND ADDRESSED THE FOLLOWING PRIORITY HEALTH ISSUES IN 2019-2021: SUBSTANCE ABUSE - THE HOSPITAL WILL CONTINUE TO MAKE EFFORTS TO EXPAND THE COMMUNITY PARTNERSHIPS AND BUILD ALLIANCES IN THIS AREA. THERE IS GROWING DATA WITHIN THE HOSPITAL SYSTEM OVER THE PAST FIVE YEARS AS WELL AS CONCERN FROM OUTSIDE SOURCES REGARDING OVERDOSES. THERE HAS ALSO BEEN VIOLENCE TOWARDS MEDICAL STAFF AND CHALLENGES TO CONTROLLING PAIN FOR THIS POPULATION OF PATIENTS. CHRONIC DISEASE - INCLUDING ACCESS TO CARE AND PREVENTION FOR OBESITY, DIABETES, LUNG DISEASE AND HEART DISEASE; THESE HAVE BEEN ONGOING FOCUSES FOR THE PREVIOUS ASSESSMENT PERIODS. IF LEFT UNCONTROLLED, OBESITY AND DIABETES ESPECIALLY CAN HAVE A SIGNIFICANT NEGATIVE IMPACT ON OVERALL HEALTH AND QUALITY OF LIFE AND ARE OFTEN THE CATALYST OF OTHER CHRONIC HEALTH ISSUES. NEEDS NOT ADDRESSED ------------------------------------------- SEVERAL ISSUES IDENTIFIED BY THE BRIGHT COALITION SUBCOMMITTEES ARE AREAS THAT MED CENTER HEALTH ALREADY HAS ONGOING ACTIONS IN PLACE, AS DISCUSSED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, BUT ARE NOT THE PRIORITY FOCUS AREAS FOR THE CURRENT CYCLE. OTHER ISSUES MAY BE OUTSIDE OF THE RESOURCES MED CENTER HEALTH IS ABLE TO PROVIDE BUT THE HOSPITAL MAINTAINS RELATIONSHIPS WITH THE ENTITIES ADDRESSING THESE ISSUES AND SUPPORT THEIR EFFORTS THROUGH PARTICIPATING IN EVENTS, PROVIDING EDUCATION, ETC. AS APPROPRIATE. ADDITIONAL DETAIL CAN BE FOUND IN THE IMPLEMENTATION STRATEGY POSTED ON THE LINK INCLUDED IN THE NARRATIVE FOR LINES 7A & 10A.

PART V, SECTION B, LINE 13B & 13H
"ELIGIBILITY CRITERIA - INCOME LEVEL OTHER THAN FPG ---------------------------------------------------- LINE 13B INCOME OTHER THAN FPG -------------------------------- BECAUSE THERE MAY BE CIRCUMSTANCES WHERE A PATIENT/GUARANTOR MAY END UP OWING AN AMOUNT THAT IS LARGE IN RELATION TO HIS INCOME, BUT STILL NOT MEET OUR STANDARD FINANCIAL ASSISTANCE (CHARITY CARE) GUIDELINES, AND BECAUSE WE DO NOT WANT TO CREATE WHAT IS COMMONLY KNOWN AS ""MEDICAL INDIGENCY,"" WE ALSO APPLY THE FOLLOWING GUIDELINES TO CHARITY APPLICATIONS: 1) ONLY PERSONS OR FAMILIES WHO MAKE LESS THAN 20 TIMES (2000%) OF THE SINGLE PERSON FPL ARE ELIGIBLE FOR CATASTROPHIC FINANCIAL ASSISTANCE. THE PURPOSE OF THIS REQUIREMENT IS TO LIMIT THE INCENTIVE TO NOT PURCHASE HEALTH INSURANCE IF A PERSON CAN AFFORD IT. 2) A SELF-PAY PORTION OF A BILL GREATER THAN 20% OF ANNUAL INCOME QUALIFIES A PERSON FOR CATASTROPHIC FINANCIAL ASSISTANCE. 3) THE AMOUNT DUE FROM CATASTROPHIC FINANCIAL ASSISTANCE APPLICANTS IS CAPPED AT 50% OF THEIR DOCUMENTED AND VERIFIED ANNUAL INCOME PLUS THE AMOUNT THE PATIENT'S LIQUID ASSETS EXCEED THEIR IMMEDIATE NEEDS AS PER THE ASSET TEST ABOVE. 4) WE ALLOW PAYMENT OF THIS CAPPED AMOUNT OVER A PERIOD OF UP TO 10 YEARS, WITH UP TO 15 YEARS AVAILABLE WITH THE APPROVAL OF THE DIRECTOR OF COMMONWEALTH FINANCIAL RESOURCES (CFR). 5) THE PAYMENTS ARE TREATED AS LONG-TERM PAY, I.E., THEY REQUIRE A WRITTEN AGREEMENT, AND THE PAYMENTS ARE INTEREST FREE FOR THE REMAINING PORTION OF THE BALANCE DUE. LINE 13H OTHER CRITERIA -------------------------------- PERSONS OR FAMILIES THAT QUALIFY FOR MEDICAID, FOOD STAMPS, AND OTHER INDIGENT CARE PROGRAMS THAT CAN BE AND ARE INDEPENDENTLY VERIFIED ARE DEEMED TO MEET THE FINANCIAL ASSISTANCE GUIDELINES, AS WILL ACCOUNTS IDENTIFIED THROUGH TOOLS OR PROGRAMS WHICH PROVIDE REASONABLE ASSURANCE THAT THE OBLIGATION MEETS OUR FINANCIAL ASSISTANCE GUIDELINES. PATIENT ACCOUNTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THE PATIENT WAS ELIGIBLE FOR MEDICAID WITHIN 60 DAYS BEFORE OR AFTER THE DISCHARGE DATE/DATE OF SERVICE."

PART V, SECTION B, LINE 16A, 16B, & 16C
FAP WEBSITE ------------ A COPY OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY (FAP), FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY OF THE FAP CAN BE FOUND AT: HTTPS://MEDCENTERHEALTH.ORG/CFR/BILLING-POLICIES/FINANCIAL-ASSISTANCE/

PART I, LINE 3C
DETERMINING ELIGIBILITY ------------------------- THE INCOME LIMIT FOR FINANCIAL ASSISTANCE IS 200% OF THE FEDERAL POVERTY LEVEL. DISCOUNTS ARE PROVIDED TO ALL PATIENTS WHO ARE UNINSURED WHOSE INCOME EXCEEDS THE LIMITS TO QUALIFY FOR FINANCIAL ASSISTANCE. SELF-PAY DISCOUNTS ARE NOT LIMITED BASED ON INCOME. THE HOSPITAL ALSO PROVIDES PAYMENT PLANS FOR SELF-PAY PATIENTS. THE ORGANIZATION USES ASSET LEVELS, UNINSURED, UNDERINSURED, MEDICAID ELIGIBILITY, FOOD STAMP ELIGIBILITY, AND PROVIDES FOR CATASTROPHIC DISCOUNTS. SEE THE NARRATIVES FOR LINES 13B AND 13H FOR MORE DETAIL.

PART I, LINE 6
COMMUNITY BENEFIT REPORT -------------------------- THE ANNUAL REPORT TO THE COMMUNITY IS MADE AVAILABLE TO THE PUBLIC VIA NEWSPAPER INSERTS, DIRECT MAILINGS, AND IS POSTED ON COMMONWEALTH HEALTH CORPORATION'S WEBSITE AT: HTTPS://MEDCENTERHEALTH.ORG/ABOUT-US/

PART I, LINE 7
COSTING METHODOLOGY -------------------- A COST ACCOUNTING SYSTEM WAS USED FOR CALCULATIONS ON IRS WORKSHEETS 1 AND 3. THE COSTS RELATED TO MEDICAID PATIENTS WERE DETERMINED USING A COST ACCOUNTING SYSTEM. COSTS FOR OTHER PROGRAMS REFLECT THE DIRECT AND INDIRECT COSTS OF PROVIDING THOSE PROGRAMS.

PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE ------------------------- TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990.

PART II
COMMUNITY BUILDING ACTIVITIES ------------------------------ WE ARE DEDICATED TO SERVING OUR COMMUNITY, BY KEEPING IT HEALTHY AND EARNING TRUST. AS PART OF OUR COMMITMENT, WE GIVE BACK FINANCIALLY INCLUDING FINANCIAL ASSISTANCE. WE EXPAND ACCESS TO CARE WITH MORE PROVIDERS, SPECIALTIES AND TELEMEDICINE OPPORTUNITIES. WE ADDRESSED THE CRITICAL NEED FOR PHYSICIANS THROUGH OUR GRADUATE MEDICAL EDUCATION PROGRAM AND THE UK COLLEGE OF MEDICINE. WE LED THE COVID-19 VACCINE EFFORTS IN SOUTHCENTRAL KENTUCKY.

PART III, LINE 2
BAD DEBT EXPENSE ----------------- THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED MARCH 31, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.

PART III, LINE 3
BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE ------------------------------------------------------------ THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN FINANCIAL ASSISTANCE, CANDIDATES MUST COOPERATE FULLY. IN ADDITION, THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THESE REASONS, THE HOSPITAL BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY, AND THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS NEGLIGIBLE.

PART III, LINE 4
BAD DEBT EXPENSE ------------------ THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE HOSPITAL ELECTED TO EARLY ADOPT ASU 2011-07 ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AN OPERATING EXPENSE FOR FINANCIAL REPORTING PURPOSES.

PART III, LINE 8
MEDICARE SURPLUS / (SHORTFALL) ------------------------------- COSTS REPORTED ON LINE 6 ARE OBTAINED FROM THE COST ACCOUNTING SYSTEM, WHICH ARE BASED UPON COST ACCOUNTING STANDARD PRINCIPALS OF ALLOCATING DIRECT AND INDIRECT EXPENSES TO SERVICES PERFORMED.

PART III, LINE 9
DEBT COLLECTION PRACTICES -------------------------- THE MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THEIR ESTABLISHED RATES. BECAUSE TMC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FINANCIAL ASSISTANCE, REVENUE IS NOT RECORDED FOR SUCH SERVICES. TMC MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF FINANCIAL ASSISTANCE THEY PROVIDE. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THEIR FINANCIAL ASSISTANCE POLICY. OTHER UNCOMPENSATED CARE RELATES PRINCIPALLY TO CONTRACTUAL ALLOWANCES FOR GOVERNMENT PAYERS, DISCOUNTS TAKEN BY COMMERCIAL PAYERS AND BAD DEBTS. BENEFITS FOR THE POOR INCLUDE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES OR WHO ARE UNINSURED. THIS INCLUDES TRADITIONAL FINANCIAL ASSISTANCE AT STANDARD BILLING RATES AND THE COSTS OF TREATING MEDICAID BENEFICIARIES IN EXCESS OF GOVERNMENT PAYMENTS. TMC DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO BE TRADITIONAL FINANCIAL ASSISTANCE. THEREFORE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUE.

PART VI, LINE 2
NEEDS ASSESSMENT ----------------- THE MEDICAL CENTER IS BUILT UPON THE FOUNDATION OF SERVING OUR COMMUNITY, DAY IN AND DAY OUT, WITH QUALITY DEPENDABLE HEALTHCARE. THE MEDICAL CENTER'S CHNA AND STRATEGIC IMPLEMENTATION PLAN ARE POSTED AT: HTTPS://MEDCENTERHEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ------------------------------------------------- UPON REGISTRATION, PATIENTS ARE PROVIDED A PLAIN LANGUAGE SUMMARY OF OUR FINANCIAL ASSISTANCE POLICY WITH INSTRUCTIONS ON HOW TO APPLY FOR FINANCIAL ASSISTANCE AND CONTACT INFORMATION FOR ADDITIONAL ASSISTANCE. SIGNAGE AND BROCHURES DESCRIBING FINANCIAL ASSISTANCE POLICIES ARE AVAILABLE. ADDITIONALLY, THE POLICY AND APPLICATION ARE PUBLICLY AVAILABLE ON THE HOSPITAL'S WEBSITE. UNINSURED PATIENTS DISCUSS PAYMENT OPTIONS INCLUDING FINANCIAL ASSISTANCE WITH FINANCIAL COUNSELORS WHO INFORM THESE PATIENTS ABOUT OUR POLICY AND ASSIST THEM IN APPLYING IF NECESSARY. SUBSEQUENT PATIENT STATEMENTS RECEIVED BY THE PATIENT CONTAIN INFORMATION ABOUT HOW TO APPLY FOR FINANCIAL ASSISTANCE.

PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH ------------------------------ AS PART OF COMMONWEALTH HEALTH CORPORATION, TMC IS PATIENT-FOCUSED, QUALITY-DRIVEN, AND MISSION-LED. OUR MISSION IS TO CARE FOR PEOPLE AND IMPROVE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. WE COMBINE STATE-OF-THE-ART TECHNOLOGY, UNSURPASSED PERSONAL CARE, AND THE FINEST HEALTHCARE PROFESSIONALS TO ENSURE EACH VISIT IS THE VERY BEST IT CAN BE.

PART VI, LINE 4
COMMUNITY INFORMATION ----------------------- BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION (THE MEDICAL CENTER) IS DESIGNATED AS A REGIONAL REFERRAL CENTER BY THE BARREN RIVER REGIONAL HEALTH PLANNING COUNCIL, AN AGENCY OF THE COMMONWEALTH OF KENTUCKY. THE MEDICAL CENTER SERVES PATIENTS THROUGHOUT AN AREA COMPRISING TEN COUNTIES, CALLED THE BARREN RIVER AREA DEVELOPMENT DISTRICT (THE DISTRICT) IN SOUTH-CENTRAL KENTUCKY. THE POPULATION OF THE MEDICAL CENTER'S PRIMARY SERVICE AREA IS APPROXIMATELY 312,000 PEOPLE. THE COMMUNITY IS GROWING, AND WE SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. THE NUMBER OF RESIDENTS IN THE DISTRICT IN HOUSEHOLDS BELOW THE FEDERAL POVERTY GUIDELINES VARY BY COUNTY AND RANGE FROM 19% TO 32%. ACCORDING TO THE SURVEY CONDUCTED BY THE BARREN RIVER DISTRICT HEALTH DEPARTMENT, THE MOST SERIOUS HEALTH PROBLEMS IN THE COMMUNITY ARE OBESITY, ALCOHOL AND DRUG ABUSE, NOT ENOUGH PHYSICAL ACTIVITY, TOBACCO USE, AND POOR DIET.

PART VI, LINE 6
"AFFILIATED HEALTH CARE SYSTEM ------------------------------- THE MEDICAL CENTER IS OWNED AND CONTROLLED BY COMMONWEALTH HEALTH CORPORATION, A RELATED 501(C)(3) ORGANIZATION. COMMONWEALTH HEALTH CORPORATION (CHC) IS A HOLDING COMPANY FOR A TOTAL OF TWELVE FOR-PROFIT AND NONPROFIT CORPORATIONS AND PARTNERSHIPS (COLLECTIVELY, THE ""AFFILIATES"") ENGAGED IN VARIOUS ASPECTS OF THE HEALTH CARE INDUSTRY. CHC OWNS AND OPERATES MULTIPLE PHYSICIAN PRACTICES, WHICH ARE ACQUIRED TO ATTRACT AND RETAIN HIGHLY SKILLED PHYSICIANS IN SPECIALTIES THAT SUPPORT THE MISSION OF CHC AND ITS AFFILIATES. IN ADDITION, CHC OPERATES AND PROVIDES VARIOUS CORPORATE SUPPORT SERVICES INCLUDING PATIENT BILLING, COLLECTIONS, ACCOUNTING, MATERIALS MANAGEMENT, ENGINEERING, SECURITY, HUMAN RESOURCES, INFORMATION SYSTEMS, AND ADMINISTRATIVE SUPPORT TO ITS AFFILIATES. CHC HAS ESTABLISHED VARIOUS DIVISIONS FOR ITS OPERATIONS, INCLUDING THE NONPROFIT ORGANIZATIONS DESCRIBED BELOW (IN ADDITION TO TMC) AND OTHER NONPROFIT AND FOR-PROFIT CORPORATIONS AND PARTNERSHIPS. BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION (""THE MEDICAL CENTER""): ----------------- BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION (""THE MEDICAL CENTER"") IS A NONPROFIT KENTUCKY CORPORATION THAT OPERATES A 337-BED HOSPITAL FACILITY IN BOWLING GREEN, KENTUCKY UNDER THE NAME ""THE MEDICAL CENTER AT BOWLING GREENSINCE OCTOBER 1996, A 25-BED CRITICAL ACCESS HOSPITAL AND 110-BED NURSING HOME FACILITY IN SCOTTSVILLE, KENTUCKY, UNDER THE NAME ""THE MEDICAL CENTER AT SCOTTSVILLE."" IN ADDITION, SINCE JANUARY 2016, THE CORPORATION HAS OPERATED A 25-BED CRITICAL ACCESS ACUTE CARE HOSPITAL IN HORSE CAVE, KENTUCKY UNDER THE NAME ""THE MEDICAL CENTER AT CAVERNA."" THE THREE FACILITIES ARE PART OF ONE CORPORATION BUT ARE SEPARATELY LICENSED BY THE STATE OF KENTUCKY. THE MEDICAL CENTER AT BOWLING GREEN IS THE SOLE MEMBER OF MEDICAL CENTER EMS, LLC (EMS), MEDICAL CENTER PHARMACY OF BOWLING GREEN, LLC (RIVERSIDE PHARMACY) AND ENSPIRE QUALITY PARTNERS, LLC (MED CENTER HEALTH PARTNERS). EMS PROVIDES AMBULANCE SERVICES IN WARREN COUNTY, KENTUCKY. RIVERSIDE OFFERS RETAIL PHARMACY SERVICES IN BOWLING GREEN, KY. MED CENTER HEALTH PARTNERS IS A CLINICALLY INTEGRATED NETWORK OF HEALTHCARE PROVIDERS, WORKING TOGETHER UNDER A PHYSICIAN-LED STRUCTURE TO IMPROVE POPULATION HEALTH, IMPROVE PATIENT EXPERIENCE AND REDUCE THE COST OF HEALTHCARE. THE CORPORATION IS BOTH THE LIMITED PARTNER AND A GENERAL PARTNER IN THE MEDICAL PLAZA PARTNERS, LLP WHICH PROVIDES ON-CAMPUS SPACE FOR HOSPITAL DEPARTMENTS AND OTHER NON-AFFILIATE MEDICAL-RELATED SERVICES. TOGETHER WITH ANOTHER AREA NON-PROFIT ACUTE CARE HOSPITAL CORPORATION, TMC IS AN EQUAL OWNER OF THE BARREN RIVER REGIONAL CANCER CENTER, INC., AN OUTPATIENT RADIATION THERAPY CARE SERVICE LOCATED IN GLASGOW, KENTUCKY. THE MEDICAL CENTER AT SCOTTSVILLE OPERATES TWO RURAL HEALTH CLINICS, ONE IN SCOTTSVILLE, KY AND ONE IN FOUNTAIN RUN, KY. THE MEDICAL CENTER AT CAVERNA OPERATES TWO RURAL HEALTH CLINICS, ONE IN MUNFORDVILLE, KY AND ONE IN HORSE CAVE, KY. COMMONWEALTH HEALTH FREE CLINIC, INC.: -------------------- COMMONWEALTH HEALTH FREE CLINIC, INC. (CHFC) WAS ORGANIZED TO OPERATE A CLINIC, WHICH PROVIDES BASIC MEDICAL AND DENTAL DIAGNOSTIC AND TREATMENT SERVICES FOR CHARITABLE PURPOSES FOR THE UNINSURED AND UNDERINSURED OF SOUTH-CENTRAL KENTUCKY AND ALSO SERVES INDIVIDUALS WHO MAY BE COVERED BY SOME FORM OF INSURANCE, BUT WHO ARE UNABLE TO ACCESS A PROVIDER FOR ACUTE OR CHRONIC HEALTHCARE ISSUES. THE CLINIC OFFERS SERVICES INCLUDING NON-EMERGENCY CLINICAL SERVICES, DENTISTRY, COMMUNITY HEALTH EDUCATION AND COUNSELING, DISEASE/CONDITION SPECIFIC EDUCATION AND COUNSELING, AND ACCESS TO PHARMACEUTICALS. COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC.: --------------------- COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC IS A LONG-TERM ACUTE CARE HOSPITAL THAT OPERATES AS A HOSPITAL WITHIN A HOSPITAL BY LEASING BEDS FROM THE MEDICAL CENTER ON ITS BOWLING GREEN CAMPUS. IT IS AN ACUTE CARE HOSPITAL FOR THOSE PATIENTS REQUIRING AN EXTENDED HOSPITAL STAY (ANTICIPATED LENGTH OF STAY BETWEEN 18-35 DAYS) AND GENERALLY HAVING COMPLEX OR CHRONIC MEDICAL CONDITIONS. THE MEDICAL CENTER AT ALBANY, INC: ------------------------ ON APRIL 1, 2016, COMMONWEALTH HEALTH CORPORATION (CHC) ACQUIRED THE NET ASSETS OF CLINTON COUNTY HOSPITAL, INC., AN ACUTE-CARE HOSPITAL. CHC ASSIGNED THE NET ASSETS OF THE HOSPITAL TO ITS WHOLLY OWNED SUBSIDIARY, THE MEDICAL CENTER AT CLINTON COUNTY, INC., D/B/A THE MEDICAL CENTER AT ALBANY (MCA). MCA EARNS REVENUE BY PROVIDING INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN CLINTON COUNTY AND SURROUNDING COUNTIES IN KENTUCKY. THE MEDICAL CENTER AT FRANKLIN, INC.: --------------------- THE MEDICAL CENTER AT FRANKLIN, INC. (MCF) OPERATES A HOSPITAL IN THE COMMUNITY OF FRANKLIN, SIMPSON COUNTY, KENTUCKY. THIS LOCATION IS JUST 20 MILES FROM THE MEDICAL CENTER'S BOWLING GREEN CAMPUS. MCF IS A MEDICARE DESIGNATED CRITICAL ACCESS HOSPITAL OFFERING ACUTE CARE INPATIENT AND OUTPATIENT PROGRAMS IN ITS 25 BED ACUTE CARE FACILITY. THE MEDICAL CENTER AT FRANKLIN, INC. OPERATES A RURAL HEALTH CLINIC IN FRANKLIN, KENTUCKY. COMMONWEALTH HEALTH FOUNDATION: ------------------------ CHC ENDORSED THE ESTABLISHMENT OF COMMONWEALTH HEALTH FOUNDATION (""THE FOUNDATION"") FOR THE PURPOSE OF FOSTERING, SUPPORTING, AND INITIATING ACTIVITIES FOR AFFILIATED NON-PROFIT 501(C)(3) ORGANIZATIONS. THE FOUNDATION BUILDS RELATIONSHIPS THAT INSPIRE CHARITABLE GIVING IN SUPPORT OF CHC'S MISSION TO CARE FOR PEOPLE AND IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. BLUEGRASS OUTPATIENT CENTER: --------------------------- SINCE 2008, CHC HAS BEEN THE SOLE OWNER OF BLUEGRASS OUTPATIENT CENTER OF BOWLING GREEN, LLC (""BLUEGRASS""). BLUEGRASS PROVIDES COMPREHENSIVE OUTPATIENT REHABILITATION THERAPY SERVICES."