4A (Expenses $ 737834888 including grants of $ 1689458) (Revenue $ 771500166)
"APPALACHIAN REGIONAL HEALTHCARE INC. (ARH), IS A NOT-FOR-PROFIT HEALTH SYSTEM OPERATING 14 HOSPITALS (NINE OF WHICH ARE INCLUDED IN THIS RETURN) IN BARBOURVILLE, HAZARD, HARLAN, HYDEN, MARTIN, MCDOWELL, MIDDLESBORO, PRESTONSBURG, WEST LIBERTY, WHITESBURG, PAINTSVILLE AND SOUTH WILLIAMSON IN KENTUCKY AS WELL AS BECKLEY AND HINTON IN WEST VIRGINIA. ARH ALSO OPERATES MULTI-SPECIALTY AND FAMILY PRACTICE CLINICS, HOME HEALTH AGENCIES, HOME MEDICAL EQUIPMENT STORES, AND RETAIL AND SPECIALTY PHARMACIES IN THESE AND SURROUNDING AREAS. ARH EMPLOYS MORE THAN 6,000 PEOPLE WITH MOST RECENT ANNUAL PAYROLL AND BENEFITS OF MORE THAN $350 MILLION GENERATED INTO OUR LOCAL ECONOMIES. THE MAJORITY OF THESE EMPLOYEES RESIDE IN THE SAME COMMUNITIES THAT ARH SERVES. ARH ALSO HAS A NETWORK OF 600 ACTIVE AND COURTESY MEDICAL STAFF MEMBERS. ARH IS THE LARGEST PROVIDER OF CARE AND SINGLE LARGEST EMPLOYER IN SOUTHEASTERN KENTUCKY AND THE THIRD LARGEST IN SOUTHERN WEST VIRGINIA. THE COMPANY HAS BEEN RANKED AS ONE OF THE TOP TEN EMPLOYERS IN KENTUCKY BY FORBES MAGAZINE, AND IS CONSISTENTLY RECOGNIZED FOR ITS MEDICAL EXCELLENCE.ARH HAS PUT A MAJOR FOCUS INVESTING IN SIGNIFICANT NEUROSCIENCE GROWTH, INCLUDING CUTTING-EDGE TELEHEALTH EMERGENCY ROOM SERVICE AS WELL AS TELENEUROLOGY CLINICS AND INPATIENT SERVICES ACROSS THE ARH SYSTEM.ARH COMMUNITIES CAN COUNT ON ARH HOSPITALS TO PROVIDE THE BEST IN STROKE CARE WHETHER AT THE BEDSIDE OR VIA ITS NEW TELESTROKE AND TELENEUROLOGY PATIENT CARE AND MONITORING PROGRAM. WITH A SHORTAGE OF NEUROLOGISTS IN THE UNITED STATES, ESPECIALLY IN RURAL AREAS, TELESTROKE AND TELENEUROLOGY PROGRAMS ALLOW EXPERT-LEVEL CARE FROM A NEUROLOGIST IN OUR LOCAL COMMUNITY. SEVERAL ARH LOCATIONS ADDED THE NEW TELESTROKE AND TELENEUROLOGY PATIENT CARE AND MONITORING PROGRAM. THE TELESTROKE PROGRAM ALLOWS ARH TO PROVIDE TIME-CRITICAL DIAGNOSIS TREATMENT SUCH AS THE CLOT DISSOLVING DRUGS (THROMBOLYTICS) USED TO TREAT THE MOST COMMON TYPE OF STROKE. PROVIDING TELESTROKE AND TELENEUROLOGY SERVICES GIVE ALL PATIENTS IN APPALACHIA A BETTER CHANCE OF STROKE SURVIVAL AND RECOVERY.IT IS PART OF ARH'S MISSION TO IMPROVE THE HEALTH AND WELL-BEING OF THE RESIDENTS IT SERVES THROUGH PARTNERSHIPS WITH OUR COMMUNITIES. ONE SUCH EXAMPLE WAS THE BARBOURVILLE ARH HOSPITAL PARTNERSHIP WITH UNION COLLEGE TO OPEN THE ARH CAMPUS HEALTH CENTER-UNION COLLEGE OFFERING ACUTE AND CHRONIC CARE, INCLUDING ANNUAL WELLNESS EXAMS, COLD AND FLU TREATMENT, DIABETES MANAGEMENT, WOMEN'S HEALTH AND SCHOOL, SPORTS AND WORK PHYSICALS FOR MEN, WOMEN AND CHILDREN OF ALL AGES.ARH STRIVES NOT ONLY TO PROVIDE ITS COMMUNITIES EXCEPTIONAL MEDICAL CARE, BUT ALSO TO BUILD PUBLIC AWARENESS OF WARNING SIGNS AND TIPS FOR PREVENTION OF COMMON HEALTH CONDITIONS IN OUR AREA THROUGH FREE EDUCATIONAL SESSIONS. DURING MANY OF THESE EDUCATIONAL EVENTS, FREE HEALTH SCREENINGS ARE OFFERED TO FURTHER IMPROVE THE HEALTH OF THE RESIDENTS ARH SERVES. ARH STRONGLY PROMOTES THE IMPORTANCE OF PREVENTATIVE HEALTH SCREENINGS AND EACH YEAR ARH FACILITIES PROVIDE A NUMBER OF FREE ROUTINE HEALTH SCREENINGS. TO ENCOURAGE WOMEN TO GET ANNUAL SCREENING MAMMOGRAMS, EACH YEAR ARH ALSO OFFERS DISCOUNTED MAMMOGRAM SCREENINGS DURING OCTOBER'S BREAST CANCER AWARENESS MONTH, WHICH COINCIDE WITH AWARENESS EVENTS HELD THROUGHOUT THE MONTH. THE NORTON HEALTHCARE/UK HEALTHCARE STROKE CARE NETWORK RECOGNIZED TUG VALLEY ARH REGIONAL MEDICAL CENTER FOR ITS WORK IN PUBLIC AWARENESS AND COMMUNITY EDUCATION WITH THE ""SERVICE AWARD"" FOR STROKE AWARENESS.ARH ALSO IS A STRONG ADVOCATE OF GOOD NUTRITION IN OUR COMMUNITIES AND HELD FARMER'S MARKETS AT SOME HOSPITAL LOCATIONS BRINGING LOCALLY SOURCED FRESH FRUITS AND VEGETABLES TO VISITORS, PATIENTS AND EMPLOYEES, WHICH IN TURN SUPPORTED LOCAL GROWERS.IN EFFORTS TO PREVENT THE SPREAD OF THE VIRUS THE COVID-19 PANDEMIC AND IN ADHERING TO GUIDANCE FROM PUBLIC HEALTH OFFICIALS THAT CAUTIONED AGAINST LARGE MASS GATHERINGS, THE MAJORITY OF THE IN-PERSON EDUCATION AND OUTREACH ACTIVITIES NORMALLY HELD IN THESE COMMUNITIES HAD TO BE HALTED DURING THIS TIME. HOWEVER, THE SYSTEM WAS STILL ABLE TO PROVIDE MORE THAN $3 MILLION IN COMMUNITY BENEFIT ACTIVITIES TO MORE THAN 47,000 PEOPLE. WHILE THE MAJORITY OF IN PERSON EVENTS CEASED, ARH EMBRACED TECHNOLOGY TO CONTINUE OUR OUTREACH ENDEAVORS BY OFFERING HEALTH EDUCATION AND OUTREACH ACTIVITIES THROUGH ONLINE HEALTH WEBINARS.ARH VALUES OUR RELATIONSHIP WITH THE SCHOOL SYSTEMS IN EACH OF OUR COMMUNITIES. WE HAVE WORKED TO PROVIDE COVID-19 INFORMATION AND EDUCATION TO SCHOOL STAFF AS WELL AS WORKED TO PROTECT THEM BY PROVIDING NEEDED SUPPLIES SUCH AS HAND SANITIZER AND REUSABLE FACE MASKS FOR STUDENTS IN EACH ARH COMMUNITY.THROUGHOUT THE PANDEMIC, ARH HAS BEEN AT THE FOREFRONT OF RESPONSE, TREATMENT, AND PREVENTION. WE HAVE RELIED ON THE COLLECTIVE STABILITY, RESOURCES, AND STRENGTH THAT A MULTI-HOSPITAL SYSTEM SUCH AS ARH CAN OFFER TO PROVIDE THE 23 COUNTIES WE SERVE IN KENTUCKY AND WEST VIRGINIA COVID-19 EDUCATION, TESTING, TREATMENT, AND NOW VACCINATIONS.ARH HAS PUT CDC-RECOMMENDED MEASURES IN PLACE TO PROVIDE THE SAFEST POSSIBLE CARE DURING THE COVID-19 PANDEMIC. DURING THIS TIME, ARH HAS EMBRACED TECHNOLOGY TO PROVIDE OUR COMMUNITIES WITH ROBUST VIRTUAL CARE OPTIONS DESIGNED TO ENSURE OUR PATIENTS RECEIVE THE SAFEST MANNER OF CARE FOR THEIR HEALTH CONDITIONS AND COMFORT LEVELS. SOME OPTIONS INCLUDE VIRTUAL OFFICE AND SPECIALIST VISITS IN ADDITION TO A CURBSIDE CARE OPTION WHERE STAFF BRINGS THE ELECTRONIC DEVICE OUT TO THE PATIENT'S VEHICLE FOR THE VISIT. THIS OPTION HAS PROVED HELPFUL FOR PATIENTS WITHOUT ACCESS TO SMARTPHONES AND OTHER DEVICES OR LIMITED INTERNET ACCESS.ARH ALSO LOOKED TO TECHNOLOGY AS IT PREPARED FOR THE ROLLOUT OF THE COVID-19 VACCINE. TO STREAMLINE THE VACCINATION PROCESS THROUGHOUT THE COMMUNITIES WE SERVE, ARH LAUNCHED A CENTRALIZED ONLINE VACCINE SCHEDULING SYSTEM TO ALLOW OUR COMMUNITY MEMBERS TO GET ON THE LIST FOR THE VACCINE. JOINING IN EFFORTS TO BOOST VACCINATION NUMBERS IN THE STATES WE SERVE, ARH HAS WORKED TO MAKE GETTING A COVID-19 VACCINE AS EASY AS POSSIBLE FOR OUR COMMUNITIES WITH SOME LOCATIONS OFFERING A DRIVE-THRU OPTION THAT ALLOWS THE PATIENT TO REMAIN IN THE SAFETY OF THEIR VEHICLE WHEN GETTING THE VACCINE. OTHER LOCATIONS HAVE OFFERED A TRADITIONAL VACCINATION SYSTEM OR A HYBRID VACCINATION MODEL THAT ALLOWS A PATIENT WHO NEEDS TO RECEIVE THE VACCINE FROM THEIR VEHICLES, TO RECEIVE THE VACCINATION THERE, WHILE OTHERS GO INSIDE TO A DESIGNATED AREA INSIDE THE BUILDING FOR THEIR VACCINATIONS. OUTREACH EFFORTS HAVE ALSO INCLUDED PROVIDING VACCINATIONS FOR LOCAL SCHOOL SYSTEMS AND STUDENTS. VACCINATION IS ALSO A SIMPLE PROCESS FOR ARH EMPLOYEES WHO ARE REQUIRED TO BE VACCINATED."

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: HAZARD ARH REGIONAL MEDICAL CENTER, - FACILITY 3: HARLAN ARH HOSPITAL, - FACILITY 2: BECKLEY ARH HOSPITAL, - FACILITY 5: TUG VALLEY ARH REGIONAL MEDICAL CENTER, - FACILITY 4: WHITESBURG ARH HOSPITAL, - FACILITY 6: MIDDLESBORO ARH HOSPITAL, - FACILITY 8: MORGAN COUNTY ARH HOSPITAL, - FACILITY 7: MCDOWELL ARH HOSPITAL, - FACILITY 9: SUMMERS COUNTY ARH HOSPITAL

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
A COMMUNITY STEERING COMMITTEE PROVIDED GUIDANCE OVER THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IN EACH OF ARH'S COMMUNITIES. THIS STEERING COMMITTEE WAS MADE UP OF REPRESENTATIVES FROM VARIOUS ORGANIZATIONS AND AGENCIES THROUGHOUT EACH HOSPITAL'S SERVICE AREA. IN PARTICULAR, SOME OF THE COMMITTEE MEMBERS REPRESENTED THE LOCAL HEALTH DEPARTMENT, SENIOR SERVICES, SCHOOL SYSTEM, SOCIAL SERVICE ORGANIZATIONS, AND EMERGENCY MANAGEMENT. THESE INDIVIDUALS ASSISTED WITH DISTRIBUTING SURVEYS AND ORGANIZING FOCUS GROUPS THROUGHOUT THE COMMUNITY ENSURING THAT VARIED COMMUNITY INTERESTS AND EXPERTISE WERE REPRESENTED. SPECIAL ATTENTION WAS PAID TO ENSURING THAT REPRESENTATION FROM THE PUBLIC HEALTH SECTOR WAS INCLUDED IN THIS ASSESSMENT PROCESS AND THAT THE SENIOR CITIZEN AND UNDERSERVED POPULATION WERE REPRESENTED. A COMPLETE LIST OF THE COMMUNITY STEERING COMMITTEE MEMBERS FOR EACH ARH FACILITY IS INCLUDED IN EACH ASSESSMENT'S FINAL REPORT.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:
THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED BY ARH IN 2021-2022. THIS OFFERED A GOOD OPPORTUNITY TO EXAMINE PROGRESS MADE SINCE THE PREVIOUS CHNA PROCESS WHILE OUTLINING NEW STRATEGIES TO GUIDE ACTIVITIES, OUTREACH, AND AREAS OF IMPROVEMENT FOR RECENTLY IDENTIFIED NEEDS. ALL OF THE NEEDS IDENTIFIED DURING THIS PROCESS WERE REVIEWED AND PRIORITIZED BY EACH FACILITY. SOME NEEDS MAY NOT HAVE BEEN SELECTED AS A HIGH PRIORITY SINCE ANOTHER COMMUNITY AGENCY MAY ALREADY BE ADDRESSING THAT NEED AND REFERRALS JUST NEED TO BE MADE TO THAT PARTNER AGENCY. MEASURES WERE TAKEN TO ENSURE THAT EACH IDENTIFIED NEED WAS EITHER ADDRESSED TO SOME DEGREE BY ARH OR REFERRED TO OTHER APPROPRIATE COMMUNITY ENTITIES. BELOW ARE THE MAIN SYSTEM-WIDE NEEDS IDENTIFIED DURING ARH'S MOST RECENT CHNA. THESE AREAS ARE THE MAIN FOCUS OF THE HOSPITALS' ACTIVITIES:SUBSTANCE ABUSE (DRUGS, ALCOHOL, TOBACCO, AND VAPING)MENTAL HEALTH (SERVICES AND REDUCING STIGMA)OBESITY/DIABETES/PHYSICAL ACTIVITYCOMMUNICATION AND EDUCATIONTHE RESULTS FROM THE MOST RECENT CHNA IDENTIFIED THE NEED FOR ARH'S FACILITIES TO FOCUS ON PROVIDING MORE PREVENTIVE AND EDUCATIONAL SERVICES. FOR SOME COMMUNITIES, THIS ALSO MEANT FURTHER PUBLICIZING THE PREVENTIVE AND EDUCATIONAL SERVICES THAT THEY WERE ALREADY OFFERING TO FURTHER INCREASE COMMUNITY PARTNERSHIPS AND AWARENESS. CHNA RESPONDENTS ALSO REQUESTED INCREASED EDUCATIONAL TOPICS INCLUDING MORE OF A FOCUS ON TOPICS SUCH AS VAPING AND MENTAL HEALTH ALONG WITH THE CHRONIC DISEASE ISSUES OF DIABETES AND HEART DISEASE. AN INCREASE IN THE AVAILABILITY OF SERVICES AND PROVIDERS TO ADDRESS THESE IDENTIFIED HEALTH ISSUES IS ALSO A PROMINENT NEED IN THE REGION, ESPECIALLY THE NEED TO ADD MORE MENTAL HEALTH PROVIDERS. ANOTHER NEED THAT WAS ALSO APPARENT WITH THE MOST RECENT CHNA RESULTS WAS THE NEED TO IMPROVE COMMUNICATIONS. THIS NEED RANGES FROM ENSURING THAT THERE IS FASTER COMMUNICATION REGARDING TEST RESULTS, IMPROVING COMMUNICATION TO THE PUBLIC ON ARH SERVICES AND ACTIVITIES VIA SOCIAL MEDIA, AND PROVIDING MORE PATIENT NAVIGATORS/ADVOCATES TO ASSIST PATIENTS WITH NEGOTIATING THE HEALTHCARE PROCESS.

PART I, LINE 3C:
THE DISCOUNTS ARE BASED ON A SLIDING FEE SCHEDULE STARTING AT 100% OF FPG QUALIFYING FOR FREE CARE, RANGING UP TO UNLIMITED INCOME LEVELS FOR A 40% DISCOUNT ON ALL UNINSURED CARE PROVIDED.

PART I, LINE 7:
THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2.

PART II, COMMUNITY BUILDING ACTIVITIES:
"TODAY APPALACHIAN REGIONAL HEALTHCARE CONTINUES ITS MISSION IN THE MOUNTAINS BY OFFERING RESIDENTS OF EASTERN KENTUCKY AND SOUTHERN WEST VIRGINIA A LOCAL OPTION FOR QUALITY HEALTHCARE SERVICES. ARH HOLDS STEADFAST TO THE MISSION TO, """"IMPROVE HEALTH AND PROMOTE WELL-BEING OF ALL THE PEOPLE IN CENTRAL APPALACHIA IN PARTNERSHIP WITH OUR COMMUNITIES."""" ARH HAS EVOLVED INTO AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SERVING MORE THAN 320,000 RESIDENTS AND EMPLOYING OVER 6,000 PEOPLE ACROSS EASTERN KENTUCKY AND SOUTHERN WEST VIRGINIA WITH HOSPITALS, CLINICS, HOME HEALTH AGENCIES, PHARMACIES AND HOME DURABLE MEDICAL EQUIPMENT STORES. IN FISCAL YEAR 2022, ARH'S NINE HOSPITALS RANGE IN SIZE FROM CRITICAL-ACCESS FACILITIES TO THE SYSTEM'S FLAGSHIP REGIONAL MEDICAL CENTER WITH 358-LICENSED BEDS IN HAZARD, KENTUCKY. ARH IS THE LARGEST PROVIDER OF CARE AND SINGLE LARGEST EMPLOYER IN SOUTHEASTERN KENTUCKY AND THE THIRD LARGEST PRIVATE EMPLOYER IN SOUTHERN WEST VIRGINIA, AND IS CONSISTENTLY RECOGNIZED FOR ITS MEDICAL EXCELLENCE. WHILE PROVIDING THIS REGION WITH QUALITY HEALTHCARE, ARH REINVESTS ANY EARNINGS BACK INTO OPERATIONS TO FURTHER THE SYSTEM'S EFFORTS IN IMPROVING AND ACCESSING HEALTHCARE SERVICES FOR THE REGION. CREATED TO ADDRESS THE UNMET HEALTH NEEDS OF AN UNDERSERVED REGION, ARH LEADERSHIP AND STAFF MEMBERS REALIZE THAT SERVING THIS POPULATION IS ABOUT MORE THAN JUST ADDRESSING THE HEALTH NEEDS, IT IS ALSO ABOUT PREVENTING CHRONIC DISEASES. THROUGH PARTNERSHIPS WITH AREA SCHOOLS, BUSINESSES, ORGANIZATIONS AND HEALTH DEPARTMENTS, ARH IS ONE OF THE PRIMARY SOURCES FOR HEALTH EDUCATION AND DISEASE PREVENTION IN EACH COMMUNITY AND PARTNERS WITH ALL OF THESE VARIOUS COMMUNITY ENTITIES TO FURTHER THESE EFFORTS. ARH SPONSORS MANY COMMUNITY-WIDE WELLNESS EVENTS THROUGHOUT ITS SERVICE AREAS, INCLUDING HEALTH FAIRS AND VARIOUS SUPPORT GROUPS. EACH YEAR, ARH PROVIDES FREE OR DISCOUNTED HEALTH SCREENINGS FOR COLORECTAL, BREAST, AND PROSTATE CANCERS AS WELL AS ROUTINE BLOOD PRESSURE, CHOLESTEROL, GLUCOSE, AND BODY MASS INDEX (BMI) SCREENINGS IN EFFORTS TO PREVENT THE ONSET OF ILLNESSES OR CATCH MEDICAL CONDITIONS BEFORE THEY BECOME LIFE THREATENING. ARH ALSO ACTIVELY UTILIZES ALL FORMS OF MEDIA TO PROMOTE WELLNESS AND EDUCATE THE PUBLIC ON THE SIGNS AND SYMPTOMS OF MANY COMMON HEALTH CONDITIONS. THIS INCLUDES HEALTH EDUCATION NEWSLETTERS THAT ARE MAILED DIRECTLY TO RESIDENTS' HOMES."

PART III, LINE 2:
COSTING METHODOLOGY: TO DETERMINE THE BAD DEBT EXPENSE ON LINE 2, THE BAD DEBT EXPENSE PER THE FINANCIAL STATEMENTS, WHICH CONSISTS OF GROSS CHARGES LESS DISCOUNTS, WAS CONVERTED TO COST USING THE GLOBAL COST-TO-CHARGE RATIO DEVELOPED IN WORKSHEET 2. PATIENT DISCOUNTS ARE NOT REFLECTED IN BAD DEBT. ANY PAYMENTS ON AN ACCOUNT AFTER IT IS WRITTEN OFF TO BAD DEBT RESULT IN A REVERSAL OF THE ENTIRE ACCOUNT OUT OF BAD DEBT, REINSTATEMENT OF THE PATIENT ACCOUNT RECEIVABLE, AND ANY NEGOTIATED DIFFERENCE IN THE FULL AMOUNT OF THE ACCOUNT AND THE PAYMENT MADE IS WRITTEN OFF TO CONTRACTUAL ALLOWANCE. PATIENTS WHO MAY QUALIFY FOR CHARITY CARE BUT DO NOT APPLY CANNOT BE ESTIMATES. ALL PATIENTS ARE EDUCATED ABOUT AND GIVEN EVERY OPPORTUNITY TO APPLY FOR CHARITY CARE AND, THEREFORE, ARH HAS NO INFORMATION FOR THOSE WHO CHOOSE NOT TO APPLY.

PART III, LINE 3:
MANAGEMENT CONTINUALLY MONITORS AND ADJUSTS THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS ASSOCIATED WITH CREDIT RISK.THE CORPORATION'S ABILITY TO COLLECT OUTSTANDING RECEIVABLES IS CRITICAL TO ITS RESULTS OF OPERATIONS AND CASH FLOWS. TO PROVIDE FOR ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE, THE CORPORATION ESTABLISHES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THE PRIMARY UNCERTAINTY OF SUCH ALLOWANCES LIES WITH UNINSURED PATIENT RECEIVABLES AND DEDUCTIBLES, CO-PAYMENTS OR OTHER AMOUNTS DUE FROM INDIVIDUAL PATIENTS.THE CORPORATION HAS AN ESTABLISHED PROCESS TO DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THAT RELIES ON A NUMBER OF ANALYTICAL TOOLS AND BENCHMARKS TO ARRIVE AT A REASONABLE ALLOWANCE. NO SINGLE STATISTIC OR MEASUREMENT DETERMINES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SOME OF THE ANALYTICAL TOOLS THAT THE CORPORATION UTILIZES INCLUDE, BUT ARE NOT LIMITED TO, HISTORICAL CASH COLLECTION EXPERIENCE BY PAYOR, REVENUE TRENDS BY PAYOR CLASSIFICATION AND AGED ACCOUNTS FROM DATE OF SERVICE BY PAYOR. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES.

PART III, LINE 4:
THE CORPORATION HAS AN ESTABLISHED PROCESS TO DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THAT RELIES ON A NUMBER OF ANALYTICAL TOOLS AND BENCHMARKS TO ARRIVE AT A REASONABLE ALLOWANCE. NO SINGLE STATISTIC OR MEASUREMENT DETERMINES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SOME OF THE ANALYTICAL TOOLS THAT THE CORPORATION UTILIZES INCLUDE, BUT ARE NOT LIMITED TO, HISTORICAL CASH COLLECTION EXPERIENCE BY PAYOR, REVENUE TRENDS BY PAYOR CLASSIFICATION AND AGED ACCOUNTS FROM DATE OF SERVICE BY PAYOR. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES.

PART III, LINE 8:
NEARLY ONE HALF OF THE CORPORATION'S PATIENT REVENUES ARE DERIVED FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES. IN TURN, PAYMENTS RECEIVED FROM THE FEDERAL GOVERNMENT FELL SHORT OF THE COST TO PROVIDE SUCH SERVICES BY MORE THAN $23 MILLION. MEDICARE RECIPIENTS RELY HEAVILY ON ARH FOR CARE, IN MANY OF THE COMMUNITIES IT SERVES, ARH IS THE LONE PROVIDER OF ACUTE HOSPITAL CARE. THE CORPORATION CONSIDERS ITS PARTICIPATION IN THE MEDICARE PROGRAM AND THE ASSOCIATED LOSSES RESULTING THEREOF AS AN ESSENTIAL COMPONENT OF COMMUNITY BENEFIT. ACCORDINGLY, WE DEEM THAT $23,145,118 (OR 100%) OF THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 7 BE TREATED AS A COMMUNITY BENEFIT.

PART III, LINE 9B:
THE PROVISIONS IN THE WRITTEN DEBT COLLECTION POLICY ARE THAT CHARITY AND FINANCIAL ASSISTANCE APPLICATIONS ARE VALID FOR 6 MONTHS. AFTER THAT TIME, THE PATIENT MUST REAPPLY AND PRESENT CURRENT FINANCIAL DOCUMENTS AS NECESSARY.

PART VI, LINE 2:
IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT IS CONDUCTED BY ARH EVERY THREE YEARS AND REPORTED ELSEWHERE IN THIS DOCUMENT, ARH CONTINUALLY ASSESSES COMMUNITY NEEDS IN OTHER FORMS AS WELL. THE NEEDS OF THE COMMUNITIES THAT ARH SERVES THROUGHOUT EASTERN KENTUCKY AND SOUTHERN WEST VIRGINIA ARE ASSESSED BY FOLLOWING EMERGING MEDICAL PRACTICE NEEDS AS A WHOLE ACROSS THE NATION AND SPECIFICALLY IN THE APPALACHIAN REGION. THE HEALTH NEEDS ARE EXAMINED BY LOOKING AT HEALTH STATISTICS AND DISEASE PREVALENCE COMPARED TO SERVICE/PHYSICIAN AVAILABILITY. PATIENT AND COMMUNITY SURVEYS ARE REGULARLY CONDUCTED TO ASSESS CONSUMER PERCEIVED NEEDS. LOCAL ADVISORY COUNCILS (LACS) ALSO EXIST IN EACH OF ARH'S HOSPITAL COMMUNITIES. THE COUNCILS ARE COMPRISED OF LOCAL CITIZENS WHO VOLUNTEER TO HELP ARH IMPROVE THE HEALTH OF ITS COMMUNITIES THROUGH REGULAR MEETINGS THAT DISCUSS COMMUNITY HEALTH ISSUES AND HELP ARH IDENTIFY AND ADDRESS THEM. MEMBERS ALSO ADVISE ARH ABOUT IMPROVEMENTS NEEDED AND COMMUNITY PERCEPTIONS OF ARH FACILITIES AND THESE INDIVIDUALS SERVE AS EXCELLENT AMBASSADORS FOR ARH AND ITS SERVICES. THESE INDIVIDUALS HAVE DEMONSTRATED THEIR LEADERSHIP IN LOCAL CIVIC AFFAIRS AND REFLECT A CROSS SECTION OF THE COMMUNITY. QUARTERLY, ONE REPRESENTATIVE FROM EACH OF THESE LACS MEETS TO DISCUSS COMMON ISSUES ACROSS THE SYSTEM AT A REGIONAL ADVISORY COUNCIL MEETING. FROM THIS GROUP OF REPRESENTATIVES, ONE MEMBER IS SELECTED TO ALSO SERVE ON THE HEALTH SYSTEM'S BOARD OF TRUSTEES.

PART VI, LINE 3:
UNDER ARHS FINANCIAL ASSISTANCE PROGRAM AND POLICY, EACH PATIENT WITHOUT MEDICAL COVERAGE FOR RENDERED SERVICES IS OFFERED A 40% DISCOUNT OF GROSS CHARGES AT TIME OF SERVICE. IF THE PATIENT EXTENDS PAYMENT AT TIME OF SERVICE THEY ARE GIVEN ANOTHER 10% DISCOUNT, MAKING THEIR LIABILITY 50% OF GROSS CHARGES. ALL OF THESE DISCOUNTS ARE APPLIED AT TIME OF CHARGE AND BILLED AFTER THE DISCOUNT IS TAKEN. IF SAID PATIENT IS UNABLE TO MEET THE FINANCIAL OBLIGATIONS FOR SERVICE, THEY ARE EDUCATED AND SCREENED FOR POTENTIAL FEDERAL AND/OR STATE ASSISTANCE PROGRAMS. BY DOING THIS, THE PATIENT IS REVIEWED AND EDUCATED BY ON-SITE FINANCIAL COUNSELORS AND/OR ELIGIBILITY AGENCY TO GET THE INDIVIDUAL PLACED IN A PROGRAM. BASED ON INCOME AND FAMILY STATUS, THE PATIENT IS SCREENED IN CONJUNCTION WITH THE FEDERAL AND STATE POVERTY GUIDELINES. AT THIS TIME, ALL APPLICATIONS ARE COMPLETED WITH THE ASSISTANCE OF ARH PERSONNEL AND SUBMITTED FOR APPROVAL. IN THE EVENT AN AGENCY REQUIRES THE PATIENT/GUARANTOR TO APPLY IN PERSON, THE INDIVIDUAL IS ASKED TO MAKE AN APPOINTMENT WITH THAT AGENCY AND FILE THEIR COMPLETED DOCUMENTS. IF THE RESPONSIBLE PARTY IS NOT ELIGIBLE FOR FEDERAL OR STATE ASSISTANCE, THEY ARE ADDITIONALLY SCREENED BY ARH FOR ELIGIBILITY INTO OUR INTERNAL SLIDING FEE SCHEDULE CHARITY PROGRAM FOR ADDITIONAL DISCOUNTS UP TO 100% OF GROSS CHARGES. IF THE PATIENT IS HELD RESPONSIBLE, ADDITIONAL EFFORTS TO ASSIST THE PATIENT ARE OFFERED BY OFFERING REASONABLE PAYMENT PLANS AND DEFERRED PAYMENTS. IN THE EVENT THE PATIENT/GUARANTOR DOES NOT MAKE A REASONABLE EFFORT TO COMPLETE NECESSARY DOCUMENTATION TO APPLY OR BECOME ELIGIBLE FOR A FINANCIAL ASSISTANCE PROGRAM, THEY ARE THEN STILL GIVEN THE INITIAL 40% DISCOUNT AND MOVED THROUGH THE NORMAL COLLECTION PROCESS.

PART VI, LINE 4:
THE RURAL SERVICE AREA COVERED BY ARH IN EASTERN KENTUCKY AND SOUTHERN WEST VIRGINIA INCLUDES MORE THAN 20 COUNTIES. THIS REGION IS FRAUGHT WITH SOME OF THE HIGHEST CHRONIC HEALTH PREVALENCE RATES IN THE COUNTRY FOR LUNG CANCER, DIABETES, AND HEART DISEASE. TO COMPOUND THESE PROBLEMS, MOST OF ARH'S FACILITIES ARE LOCATED IN AREAS THAT ARE AT LEAST PARTIALLY CLASSIFIED AS MEDICALLY UNDERSERVED AREAS AND HEALTH PROFESSIONAL SHORTAGE AREAS BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. IN ADDITION, THE AREAS SERVED BY ARH ALSO FACE UNEMPLOYMENT RATES THAT ARE SUBSTANTIALLY HIGHER THAN STATE AND NATIONAL AVERAGES AND A HIGHER NUMBER OF CITIZENS IN THESE AREAS RANK BELOW THE NATIONAL POVERTY LEVEL. FOR MORE THAN 60 YEARS, ARH HAS CARRIED A HEAVY LOAD IN CARING FOR THIS POPULATION. IN FISCAL YEAR 2022, ARH PROVIDED CLOSE TO $77 MILLION IN UNCOMPENSATED CARE AND DURING THAT SAME FISCAL YEAR, APPROXIMATELY 80 PERCENT OF ARH'S INPATIENTS WERE MEDICARE OR MEDICAID BENEFICIARIES.

PART VI, LINE 5:
"TODAY APPALACHIAN REGIONAL HEALTHCARE CONTINUES ITS MISSION IN THE MOUNTAINS BY OFFERING RESIDENTS OF EASTERN KENTUCKY AND SOUTHERN WEST VIRGINIA A LOCAL OPTION FOR QUALITY HEALTHCARE SERVICES. ARH HOLDS STEADFAST TO THE MISSION TO, ""IMPROVE HEALTH AND PROMOTE WELL-BEING OF ALL THE PEOPLE IN CENTRAL APPALACHIA IN PARTNERSHIP WITH OUR COMMUNITIES."" ARH HAS EVOLVED INTO AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SERVING MORE THAN 320,000 RESIDENTS AND EMPLOYING OVER 6,000 PEOPLE ACROSS EASTERN KENTUCKY AND SOUTHERN WEST VIRGINIA WITH HOSPITALS, CLINICS, HOME HEALTH AGENCIES, PHARMACIES, LONG-TERM ACUTE CARE HOSPITALS, AND HOME DURABLE MEDICAL EQUIPMENT STORES. IN FISCAL YEAR 2022, ARH'S NINE HOSPITALS RANGE IN SIZE FROM CRITICAL-ACCESS FACILITIES TO THE SYSTEM'S FLAGSHIP REGIONAL MEDICAL CENTER WITH 358-LICENSED BEDS IN HAZARD, KENTUCKY. ARH IS THE LARGEST PROVIDER OF CARE AND SINGLE LARGEST EMPLOYER IN SOUTHEASTERN KENTUCKY AND THE THIRD LARGEST PRIVATE EMPLOYER IN SOUTHERN WEST VIRGINIA, AND IS CONSISTENTLY RECOGNIZED FOR ITS MEDICAL EXCELLENCE. WHILE PROVIDING THIS REGION WITH QUALITY HEALTHCARE, ARH REINVESTS ANY EARNINGS BACK INTO OPERATIONS TO FURTHER THE SYSTEM'S EFFORTS IN IMPROVING AND ACCESSING HEALTHCARE SERVICES FOR THE REGION. CREATED TO ADDRESS THE UNMET HEALTH NEEDS OF AN UNDERSERVED REGION, ARH LEADERSHIP AND STAFF MEMBERS REALIZE THAT SERVING THIS POPULATION IS ABOUT MORE THAN JUST ADDRESSING THE HEALTH NEEDS, IT IS ALSO ABOUT PREVENTING CHRONIC DISEASES. THROUGH PARTNERSHIPS WITH AREA SCHOOLS, BUSINESSES, ORGANIZATIONS AND HEALTH DEPARTMENTS, ARH IS ONE OF THE PRIMARY SOURCES FOR HEALTH EDUCATION AND DISEASE PREVENTION IN EACH COMMUNITY AND PARTNERS WITH ALL OF THESE VARIOUS COMMUNITY ENTITIES TO FURTHER THESE EFFORTS. ARH SPONSORS MANY COMMUNITY-WIDE WELLNESS EVENTS THROUGHOUT ITS SERVICE AREAS, INCLUDING HEALTH FAIRS AND VARIOUS SUPPORT GROUPS. EACH YEAR, ARH PROVIDES FREE OR DISCOUNTED HEALTH SCREENINGS FOR COLORECTAL, BREAST, AND PROSTATE CANCERS AS WELL AS ROUTINE BLOOD PRESSURE, CHOLESTEROL, GLUCOSE, AND BODY MASS INDEX (BMI) SCREENINGS IN EFFORTS TO PREVENT THE ONSET OF ILLNESSES OR CATCH MEDICAL CONDITIONS BEFORE THEY BECOME LIFE THREATENING. ARH ALSO ACTIVELY UTILIZES ALL FORMS OF MEDIA TO PROMOTE WELLNESS AND EDUCATE THE PUBLIC ON THE SIGNS AND SYMPTOMS OF MANY COMMON HEALTH CONDITIONS. THIS INCLUDES HEALTH EDUCATION NEWSLETTERS MAILED DIRECTLY TO RESIDENTS' HOMES."

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DURING FISCAL YEAR 2022, ARH'S SERVICES WERE MAINLY ORGANIZED AROUND ITS 9 HOSPITAL SPECIFIC COMMUNITIES ACROSS EASTERN KENTUCKY AND SOUTHERN WEST VIRGINIA. IN EACH OF THESE COMMUNITIES, A HOSPITAL EXISTS ALONG WITH A COMPLIMENTARY ARRANGEMENT OF OTHER ARH SERVICES, WHICH MAY INCLUDE CLINICS, HOME HEALTH AGENCIES, PHARMACIES, AND/OR HOME DURABLE MEDICAL EQUIPMENT STORES. AT THE SYSTEM-LEVEL, VARIOUS HEALTH PROMOTION ACTIVITIES ARE ORGANIZED AND PROMOTED ACROSS THE FACILITIES, INCLUDING THE INTRODUCTION OF NEW SERVICE LINES AND NEW TECHNOLOGY. HOWEVER, IN EACH OF ARH'S 9 COMMUNITIES, VARIOUS COMMUNITY OUTREACH PROGRAMS ARE ALSO UNDERWAY AND AGGRESSIVELY ADDRESSING THE HEALTH CONCERNS OF THAT PARTICULAR AREA WHILE STRONG COMMUNITY COLLABORATION IS BEING DEVELOPED. FROM SENIOR CITIZEN WELLNESS PROGRAMS TO PATIENT ASSISTANCE VIA A CANCER NAVIGATOR, ARH'S COMMUNITIES ARE REAPING THE BENEFITS OF SUCCESSFUL COMMUNITY OUTREACH.