4A (Expenses $ 29589331 including grants of $ 0) (Revenue $ 45356118)
See Schedule O

4B (Expenses $ 4716444 including grants of $ 0) (Revenue $ 0)
Medicare shortfalls (at cost)18,982 persons served.

4C (Expenses $ 98161 including grants of $ 0) (Revenue $ 0)
Charity care provided (at cost) 1518 persons served.

Facility: Northern Light Blue Hill Hospi - Part V, Section B, Line 5
The Maine Shared CHNA research team conducted a statewide qualitative assessment among stakeholders to identify and prioritize significant health issues in communities across the state. The assessment, coordinated with the Maine CDC, engaged public health expertise throughout the process. Community outreach was conducted between September 2021 and January 2022. All forms of engagement included public forums, community sponsored events, and oral surveys. The purpose of these outreach efforts was to gather feedback on data and to identify health priorities, community assets, and gaps in resources to be used in health improvement planning. Virtual community forums with residents and service providers were held in the county in partnership with the Maine CDC to solicit input from individuals representing populations with health disparities including medically underserved, low-income, or minority populations. The following organizations attended the September 30, 2021, Hancock County Shared CHNA Community Engagement Forum and provided valuable feedback on the Maine Shared CHNA.Persons representing broad interests of the community who were consulted during the engagement process (the following list was extracted from the Hancock County CHNA report, page 20): Aroostook Mental Health Center, Bar Harbor Bank & Trust, Beth C. Wright Cancer Resource Center, Blue Hill Heritage Trust, City of Ellsworth, Community Health & Counseling Services, Department of Health and Human Services/Office of Child and Family Services: Childrens Behavioral Health Services, Downeast Community Partners, Downeast Horizons, Downeast Public Health Council - Maine Center for Disease Control and Prevention, First Congregational Church of Blue Hill, Friends in Action, Hancock County Emergency Management Agency, Healthy Acadia, Healthy Peninsula-Community Health, Hospice Council of Maine, Hospice Volunteers of Hancock County, Maine Community Foundation, Maine Hospice Council, Maine State Senate, Mount Desert Island Hospital, New Ventures Maine, Northern Light Blue Hill Hospital, Northern Light Maine Coast Hospital, Northern Light Health, State of Maine Department of Health and Human Services, Maine CDC Downeast District, Surry Neighbors Helping Neighbors, Town of Bar Harbor, United Way of Eastern Maine, University of Maine Augusta.New this cycle was an expanded effort to reach those who may experience systemic disadvantages and therefore experience a greater rate of health disparities. Two types of outreaches were piloted in this effort.One effort included nine community sponsored events hosted by organizations having statewide reach representing the following communities: Black or African Americans; people who are homeless or formerly homeless; older adults; people who are deaf or hard of hearing; people who define themselves or identify as lesbian, gay, bisexual, transgender, and queer and/or questioning (LGBTQ+); people with a disability; people with a mental health diagnosis; people with low income; and youth.Another effort included conducting oral surveys in collaboration with eight ethnic-based community organizations community health workers in order to better reach Maines immigrant population that included: 1,000 surveys were conducted in either English (32%), Somali, (24%), Arabic (23%), French (8%), Spanish (5%), Lingala (3%), and other languages including Swahili, Maay Maay, Portuguese, Oromo, Eretria, Kirundi, and Amara. When asked for their countries of origin, respondents most commonly cited the United States (212), Iraq (205), Somalia (157), The Democratic Republic of Congo (81), Djibouti (70), Kenya (30), and Mexico (29). Other countries of origin mentioned included Rwanda, Ethiopia, Angola, Syria, Guatemala, South Africa, Palestine, Puerto Rico, Morocco, Afghanistan, El Salvador, Nigeria, Canada, Burundi, Eritrea, France, Honduras, Uganda, Jamaica, Mali, Gabon, Sudan, Nicaragua, Peru, and Brazil.

Facility: Northern Light Blue Hill Hospi - Part V, Section B, Line 6a
The Maine Shared CHNA was conducted through a collaborative effort among Maines four largest health-care systems Central Maine Healthcare, Northern Light Health (legal name Eastern Maine Healthcare Systems), MaineGeneral Health, MaineHealth and the Maine Center for Disease Control and Prevention, an office of the Maine Department of Health and Human Services (DHHS). Northern Light Health member organizations participating in the Shared CHNA included Acadia Hospital, AR Gould Hospital, Blue Hill Hospital, CA Dean Hospital, Eastern Maine Medical Center, Inland Hospital, Maine Coast Hospital, Mayo Hospital, Mercy Hospital, and Sebasticook Valley Hospital. See Line 5s response for a comprehensive list of participating organizations, included other non-Northern Light Health hospitals who were consulted during the engagement process.

Facility: Northern Light Blue Hill Hospi - Part V, Section B, Line 11
Northern Light Health recently conducted their 2022 Shared Community Health Needs Assessment that will inform priority work for implementation in FY23 FY25. In FY22, Northern Light Blue Hill Hospital developed our plan to address significant needs identified in our 2022 Community Health Strategy (aka, implementation strategy). Though priority work from the 2022 Shared CHNA wont begin until FY23, Blue Hill Hospital will be prepared to implement priority work from our 2022 strategy with no gap in implementation efforts between the two CHNA cycles. While conducting the 2022 Shared CHNA research and outreach, Blue Hill Hospital continued to implement priority work from the final year, FY22, of the three-year 2019 Community Health Strategy (implementation years FY20, FY21, and FY22). Below reflect these efforts related to the 2019 Community Health Strategy.The data gathered from the 2019 Shared Community Health Needs Assessment (Shared CHNA) informed Blue Hill Hospitals Community Health Strategy (Implementation Strategy) developed with input from community stakeholders including those who serve priority populations, the local Public Health District Liaison, local business leaders, and community advocates. Priorities were selected after weighing the severity of each priority area, availability of known and effective interventions, determination that the priority area was un-addressed or under-addressed, and community collaborations underway with Blue Hill Hospital. A hospital task force considered the data and identified areas of significant need including priority concerns, intended actions to address the need, programs and resource allocation, planned collaborations, and population of focus. The implementation strategy was presented and adopted by the hospitals governing board. Northern Light Blue Hill Hospital identified three priority areas of focus addressing the significant needs identified in its 2019 CHNA as follows:Social determinants of healthActions taken by Blue Hill Hospital to address this priority in FY22: Northern Light Health made significant progress in Social Determinants of Health (SDOH) screening and intervention. The Northern Light Health SDOH Team defined completed SDOH screening and established a system policy for minimum SDOH screening standards to provide consistency in screening guidelines. During the course of FY22, the SDOH Team worked with Information Systems to continually improve the SDOH Screening Tool based on user recommendations and will continue to manage user requests moving forward. SDOH Team leaders worked with members of Northern Light Health Quality to develop an SDOH screening dashboard which provides real-time screening rates by member organization, practice, provider, and payor type, as well as prevalence of SDOH need from positive screening results. The dashboard is undergoing validation and is anticipated to be available in FY23. Northern Light Health achieved a significant milestone in responding to social health needs when the new Northern Light Health findhelp platform went live on September 13, 2022. Findhelp is a national social care network that will make it easier for patients and providers to find and connect with local resources. The platform is embedded within our electronic health record so that care teams can find and refer patients to resources and has a public portal that community members can access at any time.Substance useActions taken by Blue Hill Hospital to address this priority in FY22: Northern Light Blue Hill Hospital met its objective target of maintaining the number of Medication-Assisted Treatment (MAT) options for opioid use readily available in local communities at four by 9/30/22. This was accomplished by prioritizing ongoing conversations and providing support for staff including training on patient referrals for MAT/Medications for Opioid Use Disorder (MOUD) into the Down East Treatment Center for services. Positive progress was made in 2022 developing strong relationships with MAT/MOUD providers. Collaboration continued with Down East Treatment Center to promote the program and engage patients and providers. Northern Light Blue Hill Hospital maintained focus on substance use, specifically the use of MAT/MOUD, through educational and training offerings for providers and staff. The education provided new providers the opportunity to become MAT/MOUD trained, refreshed protocols, and reinforced the addition of the rapid access into MAT/MOUD in the emergency department for those patients with most limited access.Access to careActions taken by Blue Hill Hospital to address this priority in FY22: Northern Light Blue Hill Hospital exceeded its goal to increase the number of patients accessing non-urgent care by community paramedicine programs from 58 to 64 by 9/30/22. 81 unique patients were served by Memorial Ambulance Corps in FY22, which offered community paramedicine (CP) visits for non-urgent care and support as part of continued community partnership with Blue Hill Hospital. Memorial Ambulance is currently the only remaining active CP team in the Blue Hill catchment area post COVID-19 epidemic. This team of ten volunteers partnered with all available agencies and used any resources available to provide COVID-19 vaccinations during the year, complete medication refill visits, vital sign checks, call patients to check in, and offered reassurance and company for many isolated and lonely residents in Stonington and Deer Isle. Whenever patients were well enough to come off of their program, CP clinicians acted as advocates for their patients and made referrals back into the community to appropriate case workers and organizations, as well as communicating with the hospital or primary care staff of the change in care so the referral status and patient records were up to date. The CP team, care managers and families were in frequent communication of patient needs, making calls to help find resources, including volunteer programs for house repairs and Meals On Wheels to our most vulnerable patients, aligning with our brand promise to improve the health of the communities we serve. One Advanced EMT/RN shared her observation that medication reconciliation that Memorial Ambulance is able to provide is very helpful for the CP patients, particularly when being discharged home from a hospitalization with a change in prescription or dosage. CP clinicians are able to review discharge plans and prescriptions, provide education and reassurance at a time when patients are likely to be overwhelmed or in need of additional support in their own homes. Most improve their medication compliance with a little support, which has led to decreased calls to the primary care offices.Additional information related to actions taken by Northern Light Blue Hill Hospital on the above priorities can be found in their FY22 Progress Report to Our Community at https://northernlighthealth.org/2019-Community-Health-Strategy. Northern Light Blue Hill Hospital considered all priorities identified in the Shared CHNA, as well as other sources, through an extensive review process. While the full spectrum of needs is important, Blue Hill Hospital is currently poised to focus only on the highest priorities at this time. A number of priorities not selected, due to a variety of reasons are listed below:Mental Health - Northern Light Blue Hill Hospital has operationalized numerous mental health protocols in many our practices. Including, but not limited to the use of telepsychiatry services and licensed clinical social workers (LCSW) within our primary care sites, routine screenings for depression and suicide risk assessments with associated action plans for patients positively screened, LACE scores (identifies patients that are at risk for readmission or death within thirty days of discharge) across inpatient and outpatient sites of care include behavioral health diagnoses which are then flagged to primary care nurse care managers, a medical social worker who covers both primary care and inpatient settings, and an embedded LCSW who provides services to our local high school. In addition, our Access to Care priority plans will augment mental health access. Therefore, due to our current and ongoing engagement in a number of mental health initiatives, we have chosen to focus our efforts on other priority areas of need. Older Adult Health/Healthy Aging - Northern Light Blue Hill Hospital is currently engaged in numerous Elder Health and Healthy Aging initiatives in our community inclusive of the following initiatives, with whom we collaborate with Healthy Peninsula (HP), a local not for profit agency focused on community health needs such as Age-Friendly Coastal Communities Collaborative, Choices That Matter (re: Advance Care Planning, end of-life issues), food insecurity, healthy eating (lunches, Magic Food Bus, etc.), and Catalyzing Rural Healthcare Transformation (MEHAF grant focused on Community Paramedicine).

Facility: Northern Light Blue Hill Hospi - Part V, Section B, Line 13h
FPG family income

Facility: Northern Light Blue Hill Hospi - Part V, Section B, Line 16j
"Response for 7a (list URL) is https://northernlighthealth.org/Blue-Hill-HospitalResponse for 7b (list URL) is https://northernlighthealth.org/Community-Health-Needs-Assessment/2022-Shared-CHNA-ReportsResponse for 10a (list URL) is https://northernlighthealth.org/Community-Health-Needs-Assessment/2022-Community-Health-Strategy16j. Response for 16a, 16b, 16c (list url) is https://northernlighthealth.org/Blue-Hill-Hospital under ""Pay My Bill""."

Part I, Line 6a - Related Organization Community Benefit Report
The Northern Light Blue Hill Hospital community benefit report is contained in an annual community benefit report prepared by Northern Light Health which is the parent organization of all related organizations.

Part I, Line 7 - Explanation of Costing Methodology
Ratio of Patient Care Cost-to-Charges is used in calculations.

Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense
The costing methodology used to determine the amount is cost to charge ratio.

Part III, Line 4 - Bad Debt Expense
Patient and trade accounts receivable are stated at the amount management expects to collect from outstanding balances. See Footnote 2 of the attached financial statements, page 16 to 19 - Patient Service Revenue and Accounts Receivable section.

Part III, Line 8 - Explanation Of Shortfall As Community Benefit
Medicare losses should be treated as a community benefit because the losses are incurred in performing an important public service, and Maine hospitals experience one of the lowest Medicare reimbursement rates in the country.

Part III, Line 9b - Provisions On Collection Practices For Qualified Patients
All account guarantors who express an inability to pay inpatient and outpatient services will be screened for eligibility for charity care using an application and guidelines established by Northern Light Blue Hill Hospital. An account may be reconsidered for charity care at any time when new information is available about a patients inability to pay.

Part VI, Line 3 - Patient Education of Eligibility for Assistance
Northern Light Health Financial Counselors screen patients for federal, state or government programs and brochures are displayed at all Northern Light locations. Financial Assistance is widely publicized within the community by the following methods:Offered by receiving a conspicuous written notice on their billing statementsListed on the Northern Light Health web portal www.northernlighthealth.org/billing Posters are displayed in public locations in each hospital facilityPackets are available at all check in locations which include an application, instructions, and a Financial Assistance Policy (FAP) Plain Language SummaryCommunity posters are displayed outside of the organization (On Social Media and/or Food Cupboards, Libraries, Auditoriums, Churches, Banks)

Part VI, Line 4 - Community Information
Located in Blue Hill, Maine, Northern Light Blue Hill Hospital has a service area comprised of both primary and secondary service areas, together referred to as the total service area. Total service areas (TSAs) are developed by the Northern Light Health Planning department based on neighboring zip codes from which a majority of a hospitals inpatient admissions originate. TSAs can sometimes overlap due to hospital locations or because of the specialty services provided by the hospitals.Towns representing Blue Hill Hospitals primary service area include Blue Hill, Penobscot, Castine, Brooksville, Harborside, Sargentville, Sedgwick, Brooklin, Blue Hill falls, Little Deer Isle, Deer Isle, Sunset, Stonington, and Isle Au Haut.Towns representing Blue Hill Hospitals secondary service area include Surry, Ellsworth, East Orland, Bucksport, and Orland.Hancock Countys race/ethnicity and selected demographics are provided below for Blue Hill Hospital based on the hospitals physical location in Hancock County.Hancock County - Race/Ethnicity: American Indian/Alaskan Native 0.5% (254), Asian 1.1% (624), Black/African American 0.9% (469), Native Hawaiian or Pacific Islander 0.1% (75), White 95.9% (52,344), Some other race 0.1% (65), Two or more races 1.4% (770), Hispanic 1.5% (794), non-Hispanic 98.5% (53,807), Total County population 54,601.Hancock County - Selected Demographics: Median household income $57,178, Unemployment rate 5.7%, Individuals living in poverty 10.8%, Children living in poverty 14.2%, 65+ living alone 27.3%, Veterans 10.1%, Gay, lesbian, and bisexual (high school students) 14.3%, Gay, lesbian, and bisexual (adults) 3.0%, Transgender youth (high school students) 1.1%, Persons with a disability 14.6%.Other hospitals serving the Northern Light Blue Hill Hospital community: Based on the State of Maines definition of hospital service area, Northern Light Blue Hill Hospital is the only hospital in this community per Hospital Service Area (HSA) designation. Additionally, the Health Resources & Services Administration designated Blue Hill Hospitals service area as not having medically underserved populations/areas.

Part VI, Line 4 - Community Building Activities
Northern Light Blue Hill Hospital's community building activities include sharing of information about what it's like to work as a Medical Assistant, Registered Nurse, etc. to help address shortage of healthcare workers which directly impacts access to healthcare services.

Part VI, Line 5 - Promotion of Community Health
Northern Light Blue Hill Hospital furthers its exempt purpose by promoting the health of the community through the following activity in FY22:Please refer to Part V, line 11 for information related to Blue Hill Hospitals effort as it furthers its exempt purpose by promoting the health of our community through our Community Health Improvement Plan efforts in FY 22.

Part VI, Line 6 - Affilated Health Care System
The 2022 Maine Shared Community Health Needs Assessment (CHNA) was conducted by Northern Light Health in collaboration with several member/affiliated hospitals, non-affiliated hospitals as well as public health and community organizations across the state. The Maine Shared CHNA informs initiatives to promote community health across the system as well as within each member hospitals local service area. Each member hospital adopted a local implementation strategy referred to as a Community Health Strategy and annual community health improvement plans, tailored to meet local needs.

Part VI, Line 7 - States Filing of Community Benefit Report
N/A