Community Benefit Insight - Tax-exempt hospital

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Arh Mary Breckinridge Health Service Inc

2260 Executive Drive

Lexington, KY 40505

EIN: 452696517

The hospital that you have selected is part of a multi-facility organization that reports community benefit expenditures in the aggregate and not by individual hospital. The data shown below are for the multi-facility organization. We encourage you to contact the individual hospital directly if you would like community benefit information on the hospital.Learn more

Individual Facility Details: Mary Breckinridge Hospital

130 Kate Ireland Drive
Hyden, KY 41749

3 hospitals in organization:
(click a facility name to update Individual Facility Details panel)

Our Lady Of The Way

Mary Breckinridge Hospital

Barbourville Arh Hospital

Bed count	25	Medicare provider number	181316	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

Arh Mary Breckinridge Health Service IncDisplay data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

3.62%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2012-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 0 0 %
Medicaid as % of operating expenses	$ 1,996,184 2.43 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 896,765 1.09 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 78,229 0.10 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 2,833 0.00 %
Community building* as % of operating expenses	$ 46,813 0.06 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	187
Physical improvements and housing	0
Economic development	15
Community support	75
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	44
Community health improvement advocacy	43
Workforce development	10
Other	0
Persons served (optional)	8,326
Physical improvements and housing	0
Economic development	1
Community support	1,443
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	6,656
Community health improvement advocacy	206
Workforce development	20
Other	0
Community building expense as % of operating expenses	$ 46,813 0.06 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 1,306 2.79 %
Community support as % of community building expenses	$ 20,090 42.92 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 17,341 37.04 %
Community health improvement advocacy as % of community building expenses	$ 6,352 13.57 %
Workforce development as % of community building expenses	$ 1,724 3.68 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 2,419,671 2.95 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 2,124,509 87.80 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 72186273 including grants of $ 167918) (Revenue $ 94249020)
"ARH MARY BRECKINRIDGE HEALTH SERVICES PROVIDES LESLIE, KNOX, MARTIN, AND SURROUNDING COUNTIES AN ABUNDANCE OF HEALTHCARE AND COMMUNITY-ORIENTED SERVICES THROUGH ITS HOSPITALS, CLINICS, AND HOME HEALTH OPERATIONS AS WELL AS COMMUNITY OUTREACH SERVICES.WITH LOCATIONS IN AREAS WITH LARGE UNINSURED OR UNDERINSURED POPULATIONS, ARH MARY BRECKINRIDGE HEALTH SERVICES PROVIDED OVER $1.8 MILLION IN UNCOMPENSATED CARE IN THE PAST YEAR ALONE.MARY BRECKINRIDGE ARH HOSPITAL HAS PROVIDED OUTSTANDING COMMUNITY EDUCATION IN STROKE PREVENTION AND WAS AWARDED THE ""SERVICE AWARD"" BY THE NORTON HEALTHCARE/UNIVERSITY OF KENTUCKY HEALTHCARE - STROKE CARE NETWORK FOR FISCAL YEAR 2022.THE ANNUAL SERVICE AWARD IS EARNED FOR OUTSTANDING COMMUNITY EDUCATION AND PUBLIC AWARENESS EFFORTS. DESPITE THE CONTINUING CHALLENGES EXPERIENCED DURING THE PANDEMIC, MARY BRECKINRIDGE ARH HOSPITAL UTILIZED THE STROKE CARE NETWORK'S STROKE COMMUNITY OUTREACH, PREVENTION, AND EDUCATION (SCOPE) PROGRAM TO CONTINUE VITAL COMMUNITY EDUCATION AND SPREAD THE WORD ABOUT STROKE PREVENTION.AS ONE OF THE 37 AFFILIATE HOSPITALS IN THE STROKE CARE NETWORK, MARY BRECKINRIDGE ARH HOSPITAL HAS ACCESS TO NETWORKING WITH OTHER STROKE CARE CENTERS IN THE TRI-STATE AREA, AN ABUNDANCE OF EDUCATIONAL OFFERINGS AND RESOURCES, AND SUPPORT FROM HIGHER-LEVEL STROKE-CERTIFIED ORGANIZATIONS. MARY BRECKINRIDGE ARH HOSPITAL'S AFFILIATION AND PARTICIPATION WITHIN THE STROKE CARE NETWORK CONTRIBUTE TO THE NETWORK'S OVERALL MISSION OF STRENGTHENING THE STROKE SYSTEM OF CARE THROUGHOUT OUR REGION. AS PART OF THE COMPANY'S EFFORT TO PROMOTE THE BENEFITS OF PREVENTATIVE CARE TOWARD GOOD HEALTH. WHILE IN-PERSON EDUCATION AND OUTREACH ACTIVITIES NORMALLY HELD HAD TO BE MODIFIED DUE TO THE COVID-19 PANDEMIC DURING THIS TIME, ARH MARY BRECKINRIDGE HEALTH SERVICES HELD OVER 580 EVENTS LAST YEAR. THEY PROVIDED NEARLY $975,000 TOWARDS COMMUNITY BENEFIT ACTIVITIES WITH A COMBINED ATTENDANCE OF OVER 11,677 PEOPLE LAST YEAR.ONE MAJOR EVENT THAT IS HELD EACH YEAR IS THE HOSPITAL'S ANNUAL CHILDREN'S CHRISTMAS PARTY, WHERE EACH CHILD IN THE COMMUNITY IS INVITED AND RECEIVES A GIFT AND A TREAT BAG."

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: ARH MARY BRECKINRIDGE HEALTH SERVICES, INC, - FACILITY 2: BARBOURVILLE ARH HOSPITAL, - FACILITY 3: ARH OUR LADY OF THE WAY

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, 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.

Supplemental Information

Schedule H (Form 990) Part VI

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:
THE RURAL SERVICE AREA COVERED BY ARH IN EASTERN KENTUCKY AND SOUTHERN WEST VIRGINIA INCLUDES MORE THAN 4 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 $13M IN UNCOMPENSATED CARE AND DURING THAT SAME FISCAL YEAR, APPROXIMATELY 92 PERCENT OF ARH'S INPATIENTS WERE MEDICARE OR MEDICAID BENEFICIARIES.

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 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 ALSO CONTINUALLY ASSESSES COMMUNITY NEEDS IN OTHER FORMS AS WELL. THE NEEDS OF THE COMMUNITIES THAT MARY BRECKINRIDGE SERVES THROUGHOUT EASTERN KENTUCKY 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 ALSO 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.

PART VI, LINE 3:
MARY BRECKINRIDGE HEALTH SERVICES OBSERVES THE FINANCIAL ASSISTANCE POLICY OF ITS SYTEM AFFILIATE APPALACHIAN REGIONAL HEALTHCARE (ARH). UNDER ARH'S FINANCIAL ASSITANCE 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 AN ASSISTANCE 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 MADE 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 4 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 $2.0M 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:
MARY BRECKINRIDGE HEALTH SERVICES (MBHS) PROVIDES LESLIE, FLOYD, KNOX AND SURROUNDING COUNTIES AN ABUNDANCE OF HEALTHCARE AND COMMUNITY-ORIENTED SERVICES THROUGH ITS MEDICAL FACILITIES AS WELL AS COMMUNITY OUTREACH SERVICES. TODAY, MBHS CONTINUES ITS MISSION IN THE MOUNTAINS BY OFFERING RESIDENTS OF EASTERN KENTUCKY A LOCAL OPTION FOR QUALITY HEALTHCARE SERVICES. MBHS HOLDS STEADFAST TO THE MISSION TO IMPROVE HEALTH AND PROMOTE WELL-BEING OF ALL THE PEOPLE IN CENTRAL APPALACHIA IN PARTNERSHIP WITH OUR COMMUNITIES. MBHS CONSISTS OF THREE CRITICAL ACCESS HOSPITALS AND RELATED CLINIC, PHARMACY, HOME HEALTH AGENCY, AND HOME CARE STORE SERVICES. ALONG WITH THEIR SYSTEM AFFILIATE, APPALACHIAN REGIONAL HEALTHCARE (ARH), MBHS HAS EVOLVED INTO AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SERVING MORE THAN 60,000 RESIDENTS ACROSS EASTERN KENTUCKY. WHILE PROVIDING THIS REGION WITH QUALITY HEALTHCARE, MBHS 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, MBHS 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, MBHS 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. MBHS SPONSORS MANY COMMUNITY-WIDE WELLNESS EVENTS THROUGHOUT ITS SERVICE AREAS, INCLUDING HEALTH FAIRS AND VARIOUS SUPPORT GROUPS. EACH YEAR, MBHS 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. MBHS 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 VI, LINE 6:
DURING FISCAL YEAR 2022, MARY BRECKINRIDGE HEALTH SERVICES (MBHS) EFFORTS WERE MAINLY ORGANIZED AROUND ITS THREE HOSPITAL SPECIFIC COMMUNITIES ACROSS EASTERN KENTUCKY. IN EACH OF THESE COMMUNITIES, A HOSPITAL EXISTS ALONG WITH A COMPLIMENTARY ARRANGEMENT OF OTHER MBHS SERVICES, WHICH MAY INCLUDE CLINICS, HOME HEALTH AGENCIES, PHARMACIES, AND/OR HOME DURABLE MEDICAL EQUIPMENT STORES. IN CONJUNCTION WITH OUR SYSTEM AFFILIATE APPALACHIAN REGIONAL HEALTHCARE (ARH), VARIOUS HEALTH PROMOTION ACTIVITIES ARE ORGANIZED AND PROMOTED ACROSS THE FACILITIES, INCLUDING THE INTRODUCTION OF NEW SERVICE LINES AND NEW TECHNOLOGY. IN EACH OF MBHS'S/ARH'S SERVICE AREAS, 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.