4A (Expenses $ 72583241 including grants of $ 0) (Revenue $ 106421548)
See Schedule O.

Schedule H, Part V, Section B, Line 3E
The significant health needs are a prioritized description of the significant health needs of the community and identified through the CHNA.

Schedule H, Part V, Section B, Line 5 Facility 1, 1
Facility 1, 1 - HARFORD MEMORIAL HOSPITAL, INC.. In order to gain a better understanding of the Harford County community, qualitative data was collected by stakeholders from the Local Health Improvement Coalition (LHIC) through a survey. There was also a series of targeted focus groups with the stakeholders and community members. Following the October 2020 Virtual Local Health Improvement Coalition (LHIC) Annual meeting, 46 stakeholders representing diverse community interests filled out a brief survey on health and social determinants. These stakeholders provided particular insight into the challenges facing the medically under-served, low income, marginalized, and minority populations. LHIC Stakeholder Organizations Local Health Department: Harford County Health Department Local Health Improvement Coalition: Behavioral Health Chronic Disease Prevention Wellness Family Health Resilience Local Government: Bel Air Police Department Harford County Council Harford County Emergency Service Harford County Government Harford County Government Planning Zoning Harford County Sheriff's Office Harford County Office on Aging Harford County Parks Rec Harford County Public Libraries Town of Bel Air School - K-12: Harford County Public Schools School - Colleges, Universities: Harford Community College and Towson University Behavioral Health Organizations: Addictions Connection Resource Addiction Recovery Systems Ashley Addiction Treatment BHA Maryland Commitment to Veterans Brantwood Family Services Char Hope Foundation Core Services Agency Department of Juvenile Services District Court of Maryland for Harford County Empowering Minds Resource Center Hannah's Hope Harbor of Grace Recovery Harford County Detention Center Harford County Volunteer Fire Maryland Circuit Court Maryland Coalition of Families Medmark Treatment Centers New Day Wellness and Recovery Center Norkris Services Northern Chesapeake Counseling, LLC Office of Drug Control Policy OIC Counseling Services, Inc. Opioid Operational Command Center Pyramid Healthcare Riverside Treatment Springboard Community Services The Bergand Group The Homecoming Project Upper Bay Counseling Voices of Hope Social Service Organizations: Harford County Department of Social Services Department of Community Services Community/Neighborhood Organizations: Breathe 379 Epicenter Girls on the Run Horowitz Center for Health Literacy Klein's Shoprite LASOS (Linking All So Others Succeed) Mason-Dixon Community Services National Coalition of 100 Black Women Leukemia Lymphoma Society United Way of Central Maryland Y of Central Maryland Other: CareFirst Habitat for Humanity Inner County Outreach Joyce Steinberg - Pharmacist Meghan Crosby Budinger, LCPC, LLC, Mosaic Group Seedco The Judy Center United Healthcare In addition, six focus groups were convened to gather input from targeted groups. These focus groups included members of the Susquehanna Ministerium, participants from the Epicenter (a community center in a predominantly low-income minority community), a diabetes prevention class, MEGAN's Place, key Informants from the Local Health Improvement Coalition (LHIC), and key Informants from a Limited English Proficiency workgroup. An online Community Survey of Harford County residents was conducted between September 2020 and March 2021. The survey was designed to assess health status, health risks and behaviors, preventative health practices, health equity, and health care access primarily related to chronic disease and injury. A total of 1,361 resident surveys were completed. Respondents had diverse, geographical, gender, race, and ethnic backgrounds, however, the survey could not be weighted to offer a statistically representative sample of the community. Following the completion of the CHNA research, the health issues were prioritized and implementation plans were drafted with the help of 44 internal and external partners including health care providers, public health experts, health and human service agencies, and other community representatives during a Priority Setting Meeting held on April 20, 2021. Prioritization Session Participants UNIVERSITY OF MARYLAND UPPER CHESAPEAKE HEALTH Nate Albright, UMUCH Clinical Service Line Patsy Astarita, UMUCH Kaufman Cancer Center Vickie Bands, UMUCH Community Outreach and Health Improvement Heather Beauchamp, UMUCH Emergency Critical Care Leslie Clark, UMUCH Comprehensive Care Center Karen Goodison, UMUCH Clinical Operations Karen Hensley, UMUCH Women Children Gary Hicks, UMUCH Education Bari Klein, Healthy Harford/Healthy Cecil Mark Lewis, UMUCH Heart Vascular Institute Debbie Ostrowski, UMUCH Diabetes Endocrine Christina Pedini, UMUCH Rehab Services Jennifer Redding, UMUCH Behavioral Health Corrie Reed, UMUCH Breast Cervical Program Allen Siegel, UMUCH Chaplain Julie Siejack, UMUCH Community Outreach Lisa Starkey, UMUCH Population Health Kimberly Theis, UMUCH Community Benefit Jennifer Thomas, UMUCH Nursery Pediatrics Barbara Truitt, UMUCH Stroke Center Colin Ward, UMUCH COO HARFORD COUNTY HEALTH DEPARTMENT Marcy Austin, HCHD Deputy Health Officer David Bishai, HCHD Health Officer Christina Claypool, HCHD Health Policy Shelby Graves, HCHD Family Health Ronya Graves, HCHD Health Policy Andrea Pappas, HCHD Behavioral Health COMMUNITY PARTNERS Cindy Abbott, Mason-Dixon Sylvia Bryant, Department of Community Services Margaret Deem, Harford County Government Jeffrey Gahler, Harford County Sheriff's Office Mary Hastler, Harford County Public Libraries Eddie Hopkins, Harford County Emergency Services Mary Nasuta, Harford County Public Schools Michael Nolan, Breath 379 Amy Novak, United Way of Central Maryland Kim Parks-Bourne, Harford County Department of Social Services Reverend Proud, Susquehanna Ministerium Jerry Reyerson, Department of Social Services Amber Shrodes, Harford County Department of Social Services Mary Stapleton, Harford County Public Schools Melynda Velez, Linking All So Others Succeed (LASOS) Pat Vincenti, Harford County Council Karen Winkowski, Harford County Office on Aging

Schedule H, Part V, Section B, Line 6a Facility 1, 1
Facility 1, 1 - HARFORD MEMORIAL HOSPITAL, INC.. HARFORD MEMORIAL HOSPITAL'S CHNA WAS CONDUCTED IN CONJUNCTION WITH ITS RELATED AFFILIATE HOSPITAL, UPPER CHESAPEAKE MEDICAL CENTER.

Schedule H, Part V, Section B, Line 6b Facility 1, 1
Facility 1, 1 - HARFORD MEMORIAL HOSPITAL, INC.. THE HOSPITAL'S CHNA WAS CONDUCTED WITH ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES AS FOLLOWS: HEALTHY HARFORD (A 501(C)(3) ORGANIZATION) AND HARFORD COUNTY HEALTH DEPARTMENT.

Schedule H, Part V, Section B, Line 11 Facility 1, 1
Facility 1, 1 - HARFORD MEMORIAL HOSPITAL, INC.. University of Maryland Upper Chesapeake Health (UMUCH) has prioritized the following health concerns in order of importance: Behavioral Health, Chronic Disease Prevention and Wellness, and Family Stability and Wellness. Key Findings Regarding the Prioritization of Behavioral Health, Prevention and Wellness, and Family Stability and Wellness Community Feedback: The community survey consisted of 47 questions about access to health care, health status and behaviors, and health-related community strengths and opportunities. The top three key health issues of concern to the community were drug and alcohol use, overweight/obesity, and mental health/suicide. The most commonly reported chronic condition in the survey was high blood pressure, affecting 58.3% of respondents. There were also 22.3% of respondents that reported having anxiety disorder and 19.5% of respondents that reported having depressive disorder in the community survey. While the focus group responses varied between groups, there were common themes. Many participants identified a lack of transportation, mental health resources, access/education regarding healthy foods, elder care, and general issues with access to care and lack of awareness of resources as barriers to a healthier community. A key takeaway was that resources exist in the county, but they are often scarce, and many do not know what or where they are, as well as how to access them. A key theme was participants felt that there was a need to create a sense of community and family stability. Secondary Data: Behavioral Health (Mental Health/Substance Use): The state's Behavioral Risk Factor Surveillance System (BRFSS) reported that 18.8% of adults in Harford County were diagnosed with depressive disorder in 2019. From 2017-2020, the hospitalization rate for depression was 90 per 1,000 residents. In addition, the 2019 suicide rate of 11.4 per 100,000 in Harford County was higher than the state average of 10.1 per 100,000. Studies have shown that Adverse Childhood Experiences (ACEs) can be a key health indicator associated with a significant increase in risk for mental illness and chronic disease in adulthood. ACEs are described as traumatic events experienced during childhood such as living with a parent/caregiver with mental illness, physical, sexual, and/or emotional abuse, and an incarcerated household member. The greater the number of ACES on a scale of 0 to 10, the higher the risk, with 4 ACEs or more being the turning point for significant risk. The BRFSS reported that 13.4% of Harford County adults experience 4 or more ACEs. From 2013 to 2017, there was a steady increase in total drug and alcohol-related intoxication deaths in both Harford County and Maryland. This trend was reversed in 2018, and since then there has been a 17% decrease in total drug and alcohol-intoxication related deaths in Harford County. While there has been an overall decline, the overdose problem remains a concern for the county with rates over twice as high as they were a decade ago. In 2020, 84 lives were lost due to drugs or alcohol, and as a community we are working to reduce that number as low as possible. During the pandemic shutdowns, access to mental health was expanded through the use of telehealth. Success with this service modality has fostered both regulatory and legislative changes that will hopefully integrate telehealth options into standard care. Harford County has a mental health HPSA (Health Provider Shortage Area) designation with a population to provider ratio of 500:1. With only 508 total mental health providers in the county, creatively providing increased mental health services is a priority. In response to Behavioral Health, the following actions took place: - Behavioral health education sessions and podcasts on topics related to behavioral health/substance use and the impact trauma has on individuals and families. - Depression Screenings to identify people who have depression so that they can get the help they need. - Partnered with the American Foundation for Suicide Prevention to bring awareness of the Klein Family Crisis Center in harfod County during September Suicide Prevention Month. - Partnered with the Office of Mental Health to co-host Mental Health Family Wellness event. - Participated in Boards, Committees and Stakeholder Meetings to address Mental Health Substance Abuse Disorder issues: * Mental Health Addiction Advisory Council/ Local Health Coalition - Behavioral Health Workgroup/Harford County Opioid Intervention Team Meeting - To advise the county health officer, county executive, county council, and the Secretary of Health and Mental Hygiene on the progress of the county mental health program and on any action needed to improve program; and - To be a county advocate for a comprehensive approach to the prevention and treatment of mental illness and addictions; and - To determine the needs of the mental health and addictions programs in the county; and - To periodically review the availability and quality of mental health and addictions facilities and services in the county; and - To provide representatives for site visit teams that evaluate mental health and addictions facilities and programs in the county. * Law Enforcement Assisted Diversion Operational Workgroup - To recognize and treat substance use and other behavioral health conditions as public health issues and to address social service needs that may give rise to criminal offenses; and - To reduce the cost to the criminal justice system by providing support services instead of prosecution and incarceration when guidelines are met; and - To reduce the harm of drug use to the individual and the community, with a particular emphasis placed on prioritizing the individual's well-being; and - To reduce crime and recidivism (re-arrests); and - To improve community-police relations; and - To reduce overdose deaths in the Town of Bel Air. * Overdose Fatality Review Board - To clinically review all opiate overdose deaths and determine likely gaps in care or solutions to care needs. * Recovery Planning Committee - To participate a community stakeholders workgroup (i.e., Health Department, Office of Drug Control Policy, Department of Social Services, Addiction Connections Resources, Voices of Hope etc.) to plan events and ways to recognize and raise awareness about Recovery. * Adult Public Guardianship Review Board - To review guardianship of a public agency. * All County Providers Workgroup - To share information regarding new laws/legislations, programs, events, services, etc; and - To discuss problems and concerns in the mental health provider community as well as to find out updates about other services and supports offered for mental health patients, as well DHMH and other State wide initiatives are shares by CORE services. * Harford County Trauma Institute Informed Care Steering Committee - To enhance awareness re: impact of trauma on an Enhanced awareness re: impact of trauma on an individual's physical and mental health; and - To improve and increase linkages to behavioral health services; and - To increase use of mobile crisis services and KFHCC vs. law enforcement for behavioral health crisis with the goal of decreasing hospitalizations and emergency petitions and appropriate linkage to care/community resources. * Mental Health Board of Directors - To work collaboratively to plan, develop, enhance, and monitor behavioral health services provided to individuals and families throughout Harford County. * Multi-Disciplinary County Workgroup - To facilitate connections on mental health treatment with local government agencies such as CORE services, Office on aging, APS, Legal Aid, and the Health Department; and - To educate individuals on what mental health treatment can and cannot do and attempt to link agencies with how to connect to services in the County regarding mental health treatment. * Child Fatality Review Board - To improve understanding of how and why children die; to demonstrate the need for and to influence policies and programs to improve child health, safety and protection; and to prevent future deaths. This is accomplished through multi-disciplinary, multi-agency review of individual cases of child deaths. The case review team makes recommendations for improvements to systems and for public and professional education, and advocates for their implementation.

Schedule H, Part V, Section B, Line 11 Facility 1, 2
Facility 1, 2 - HARFORD MEMORIAL HOSPITAL, INC.. * Harford County Police Commission - To partner with community stakesholders to discuss immediate concerns and long term goals relating to law enforcement in Harford County. * Harford County Sexual Assault Team - To work with police detectives from Havre de Grace, Aberdeen, HCSO, a rep from SARC, and the SAFE nurses for the hospital all attend to review sexual assault cases in Harford County. Sexual Assault Forensic Examination (SAFE) Program at UM HMH. The only one of its kind in Harford County, the SAFE Program is a free, confidential service available 24/7 to care for male and female victims of sexual assault from ages 13 and older. This program collaborates with the Harford County Sheriff's Office and local community partners to ensure victims are treated compassionately and respectfully. * Harford County Sheriff's Office Crisis Negotiation Team - To work with the Harford County Sheriff's Office to provide crisis management assistance as part of their Crisis Intervention and Crisis Negotiation Teams; and - To de-escalate mental health crisis situations. Chronic Disease Prevention and Wellness: Unhealthy behaviors such as tobacco/nicotine use, drinking, physical inactivity, and poor nutrition can lead to negative health outcomes and chronic disease. In Harford County, tobacco use has notably been higher than the state average for a number of years. With the advent of e-cigarettes, data has shown that use of e-cigarette vaping devices in middle and high school skyrocketed between 2016 to 2018, with 19.6% and 43% of students, respectively, trying an electronic vapor product at least once. Adult smoking continues to be higher in Harford County (20.6%) compared to the state (13.1%). Heavy drinking is also higher in Harford County at 9.5% compared to 5.4% in the state (adult men having 14 drinks per week and adult women having 7 drinks a week). The BRFSS survey reported 59.4% of adults in the county got the recommended 150 or more minutes of physical activity per week which was higher than the state average of 51.8%. Furthermore, 90% of Harford County residents had access to exercise opportunities. Despite the county's advantages in exercise, it is significant that 72.7% of adults were overweight or obese. This percentage is significantly higher in non-Hispanic Black adults in Harford County (83.9%) compared to white adults (66.9%). The white top 3 causes of death in Harford County for 2019 were heart disease, cancer, and cerebrovascular disease (stroke). If top causes of death remain the same for 2020, COVID-19 would be the third leading cause of death in Harford County. Access to care continues to have an impact on health outcomes as well. An estimated 4.9% of residents do not have a vehicle in Harford County with higher rates in Edgewood (9%). Aberdeen (8.8%) and Havre de Grace (7.5%). The gaps in transportation contribute to the lack of access to services that could lead to better health outcomes and overall wellness. In response to Prevention and Wellness, the following actions took place: Cancer: * Cancer Prevention and Screening Education Sessions to participants at health fairs, organizations, faith based communities and/or local events, as well as via podcasts. * Hosted a Cancer Survivor Day Celebration to celebrate the survival, the power of hope and support, and the sharing of passions that help people through this difficult disease. * HPV education sessions to increase awareness on HPV infections and the acceptance of HPV vaccinations. * Men's Health Education session regarding health issues men face, such as prostate cancer. * Breast and Cervical Cancer Screenings to Uninsured and under insured women of Harford County with a primary focus to increase the number of minority women. * Skin Cancer Screenings to check the skin for moles, birthmarks, or other pigmented areas that look abnormal and provide referrals for follow-up. * Cancer LifeNet Program, a free support system for anyone in Harford and Cecil counties with cancer, no matter where they seek treatment, individuals received navigation and support services to help cope with the physical, financial, psychological and emotional aspects of having cancer. Nurse navigators, social workers and other specialists work alongside people diagnosed with cancer to create a safe and nurturing environment and help them cope with each stage of their cancer journey. Specially trained and with years of experience, this incredible group of professionals really is a lifeline to many, caring not only for patients, but for their families as well. * Acupuncture Clinics to provide evidence-based acupuncture care to individuals to enhance their immune system to restore the body's natural functioning. * Cancer Self-Management Classes, such as Meditation, Mindfulness-based stress reduction, Yoga, and Master Gardening for relaxation and wellness, and Massage Therapy to participants undergoing current cancer treatment. * Cancer Thriving Surviving Classes, a six-week evidence based chronic disease management program for cancer survivors and their caregivers. * Monthly Cancer Support Groups to provide expert speakers, education and support. Support Groups provided were as follows: * Blood Cancer Support Group * Breast Cancer Support Group * CLIMB-Children's Support Group * Head Neck Cancer Support Group * Prostate Cancer Support Group * Healing Through Support Diabetes: * Diabetes Education Sessions for participants through the provision of education and classes, individual patient information sessions, and health fairs, as well as one podcast, to increase knowledge and survival skills. * Monthly Diabetes Support Groups at local Senior Centers to reduce the burden of diabetes and improve quality of life for all people who have, or are at risk for diabetes, and to provide a structured, supportive environment for individuals living with diabetes. * Awarded a Minority Outreach Technical Assistance (MOTA) Grant from the Office of Minority Health and Health Disparities (MHHD), which centered around the yearlong Centers for Disease Control Diabetes Prevention Program. The goals of FY22 were to build infrastructure within Harford County to provide culturally and linguistically appropriate diabetes prevention education to minority populations with the intent of increasing knowledge and engagement in healthy lifestyles: * CDC Evidenced Based Diabetes Prevention Program Classes to improve ability for patients to better manage their disease process and reduce their HbA1c; to increase individual knowledge of their diabetes disease process; and to reduce avoidable ED visits and inpatient admissions. * Water Wednesday Program to faith based communities and public housing complexes to encourage people to drink more water and less sugar sweetened beverages. It also educated people about the importance and health benefits of improved hydration including mental clarity, increased energy, and decreased appetite. * Evidenced Based Living Well with Diabetes Classes to provide support for adults with type 2 diabetes or pre-diabetes to learn skills and increase their confidence in managing their diabetes * Diabetes Risk Assessments and HbA1c screenings to identify individuals at risk for prediabetes and diabetes.

Schedule H, Part V, Section B, Line 11 Facility 1, 3
Facility 1, 3 - HARFORD MEMORIAL HOSPITAL, INC.. Heart Disease and Stroke: * Blood Pressure Follow-Up Program to provide follow-up contact via phone call or letter, to all blood pressure screening participants who have been identified as Stage 2 >140 or >90 and above. * CHF (Chronic Heart Failure) Shoprite Tours to enhance education on dietary needs and challenges to patients with CHF in our community. * Heart Disease Education to teach individuals the risk of heart disease and the conditions that lead to it. * Monthly Cardiac Rehab Support Group for those individuals who have had cardiac or pulmonary events and who may or may not have partaken in our rehab programs. * Monthly Blood Pressure Screenings at Senior Centers, as well as other locations though out Harford County, to provide education and referrals as appropriate. * Cholesterol Screenings throughout Harford County at various locations. To provide participants with total cholesterol, HDL and a ratio. To provide one-on-one counseling and educational material. * Stroke Risk Assessments to increase education and awareness signs and symptoms of stroke. * Partnered with the Greater Baltimore American Heart Association (AHA) to coordinate and plan the Heart and Stroke Walk to raise funds for research and education regarding reducing heart disease risk and mortality. * Participated in the Maryland Stroke Consortium, a statewide stroke consortium. to positively impact the quality of care for patients with stroke via the nursing-focused measures of Dysphagia Screening and Patient Education. * Monthly STEMI Process Action Team meetings to discuss topics related to improvement of the procedures and care for the STEMI patient. Includes discussion of pre-hospital issues and involves representatives from Cecil, Harford, and Baltimore Counties EMS, as well as representatives from Hart to Heart, and the University of Maryland Express Care ambulance services. Infectious Disease: * Covid 19 Mask Distribution to all Title 1 schools in Harford County to slow the spread of Covid-19. * Glo Germ Program to demonstrate handwashing, surface cleaning, hygiene and containment techniques throughout various locations in Harford County.. * Monthly Covid Support Group to provide support to those individuals who have had Covid. * COVID-19 Specimen Collection to provide the community with access to Covid testing to reduce the spread of Covid-19. Injury and Prevention/Falls: * Evidenced Based Stepping On Program to educate and engage older adults to empower them to take steps to reduce their nutrition risk and to increase their strength. * Evidenced Based Tai Ji Quan: Moving for Better Balance to engage older adults in a falls prevention program with tai chi movements to improve stability, coordination, and range of motion, * Falls Risk Assessments to determine if an individual has a low, moderate, or high risk of falling. * Fit Testing to nursing students to ensure they have received the expected level of protection needed when doing clinical rotations, which are required for graduation, in a hospital setting. * Car Fit Program to provide education to older drivers by promoting continued safe driving and mobility by focusing attention on safety, comfort and fit. * Stop the Bleed Training to training individuals in the community on how to stop tramatic bleeding in an emergency by teaching a.) How to use your hands to apply pressure to a wound; b.) How to pack a wound to control bleeding; and c.) How to correctly apply a tourniquet. * Car Seat Safety Education to provide education on the importance of child passenger safety, and to ensure that children of Harford County are property secured in car seats and seat belts while traveling in motor vehicles. Nutrition and Healthy Eating * Stepping Up Your Nutrition to educate and engage older adults to empower them to take steps to reduce their nutrition risk and to increase their strength. Overweight and Obesity * Physician Information Sessions - an online information session where individuals can learn about the different surgical procedures, insurance coverage, diet changes and much more. A surgeon and dietitian is on hand to answer any questions. * Fat Chance! A Close Look at Fast Food Program to provide education on the dangers of high-fat food at popular fast food places by providing a graphic representation of the saturated and unsaturated fat content of common fast foods. * How Sweet It Is - an interactive and visual display of drinks including water, sodas, sport drinks, juice boxes, and popular coffee drinks. The program educates and increases the participants' awareness on the sugar content of popular drinks. * Hydration Program on the importance of drinking water. * My Plate Program to visually help individuals consume a nutrient-rich, calorie appropriate, balanced diet that includes a variety of foods in moderation, and that will better manage their health and weight. * Monthly Weight Loss Support Group to encourage people to eat healthy and get physical activity. * Body Fat Composition Screenings Physical Activity * Activity Wheel - The goal of the game is for participants to learn basic concepts about fitness and the human body. The questions are broken into two different age groups- Grades 1-5 and Grade 6 through adults. Participants spin the wheel and answer the questions. If the person answers the question incorrectly, he or she would then complete the exercise as directed. * Walk with a Doc Program for people of all ages and all abilities to spend time walking with a health care provider to discuss current health topics. Tobacco Use * Smoking Education - Provide education on smoking, tobacco use, and vaping at health events, business, schools and the faith-based community throughout the County. * Vaping Education - Provide education on smoking, tobacco use, and vaping at health events, businesses, schools and the faith-based community throughout the County. * Smoking Cessation Classes - six-week educational class series lead by a certified Tobacco Cessation expert. Respiratory Diseases: * Pulmonary Support Group for participants to learn ways to help problem solve, cope and understand more about their disease. Vaccinations: * Covid-19 Vaccinations at various locations throughout Harford County. * Flu Vaccinations at various locations throughout Harford County with a focus on the senior population. Family Stability and Wellness: A mother's well-being before, during and after pregnancy can affect a child's health from infancy to adulthood. In 2019, 80.4% received first trimester care and 4.8% received late or no care. Low birth weight can lead to poor health outcomes and complications. In 2019, there were 8% of children born in Harford County with a low birth weight. The percent was higher in Black or African American (14.7%) and Hispanic or Latino (10%) mothers. In 2018, the infant mortality rate for Black or African Americans was 10.8 per 1,000 live births compared to 4.2 per 1,000 live births for white mothers. In addition, the rate for substance exposed newborns (SEN) has significantly increased between 2009 and 2018. The rate in Harford County has been higher than the state for at least 9 years. In 2018, there were 38.1 SEN per 1,000 newborn discharges in Harford County compared to 31.4 SEN in Maryland.

Schedule H, Part V, Section B, Line 11 Facility 1, 4
"Facility 1, 4 - HARFORD MEMORIAL HOSPITAL, INC.. In response to Family Health and Resiliency, the following actions took place: * Childbirth Classes provided education by providing access to accurate and up to date information about childbirth to enable individuals to make informed decisions about their care to anyone regardless of where they deliver. * Infant Safety Classes to provide education to new and expectant parents on baby safety, injury prevention and immediate care of common injuries for infants from birth through 12 months of age. * Newborn Classes to provide education on basic infant care, including feeding (breast or bottle), umbilical cord care, circumcision, bathing, positioning baby for sleeping as well as holding and more. * Breastfeeding Support Group to provide women and their families with timely and accurate information, as well as practical and emotional support to promote optimal breastfeeding. * Breastfeeding Warmline to provide important current information related to breastfeeding and a way for a mother to leave a message for a lactation consultant to return her call. Calls are returned daily from 8:30am to 3:30pm. Unlike a hot line where a call is answer immediately a warm line call will be returned within 24hours. * Participated in Boards, Committees and Stakeholder Meetings to address Family Stability issues: * Bel Air Rotary - the main objective of Rotary is service - in the community, in the workplace, and throughout the world. Rotarians develop community service projects that address many of today's most critical issues, such as children at risk, poverty and hunger, the environment, illiteracy, and violence. They also support programs for youth, educational opportunities and international exchanges for students, teachers, and other professionals, and vocational and career development. The Rotary motto is Service Above Self. * Boys and Girls Club of Harford County - to inspire and enable all young people, especially those who need us most, to reach their full potential as productive, caring, responsible citizens * Cherish the Child Planning Committee - To bring together professionals from the fields of child welfare, mental health, education and many other disciplines for a day of learning and networking. The symposium has grown incredibly since its first year and now hosts over 600 individuals from all over Harford County and surrounding jurisdictions. The day features a keynote speaker, breakout sessions and an ending plenary speaker. With the Harford County Department of Social Services as the lead agency, the committee is comprised of professionals and community members from throughout Harford County who share the mission of educating the community on the importance of child protection and treatment. * Community Leadership Board Y of Central Maryland - To focus on promoting and supporting the Y's mission and programs in their local community; raising funds to support the Y's community outreach activities, scholarship programs and capital requirements; and building strong local boards that have the capacity and commitment to support the work of the Y in their community. Community Leadership Board members are dedicated volunteers who share the values of the Y and are committed to working to improve the quality of life for the community through the Y's mission. * The Foundation Board, The Arc Northern Chesapeake Region - To help people with differing abilities build better lives one person at a time. The Arc NCR supports individuals with intellectual and/or developmental disabilities from birth through the end of life, or over ""The Arc of their lifetime."" * Susquehanna River Run - To partner with The Albert Cesky Scholarship Fund, Inc. as the Title Sponsor of the Half Marathon at the inaugural Susquehanna River Running Festival, in Havre de Grace and Perryville. The running festival raises funds for the Al Cesky Scholarship Fund, which provides scholarships to graduating high school student athletes who excel in both athletics and academics. The 5K race takes place within the historic City of Havre de Grace. The Half Marathon covers a scenic route through the City of Havre de Grace, over the Hatem Bridge, through Town of Perryville, around Perry Point and back to Havre de Grace. The Half Marathon Relay features a two-person team, with the first relay leg 6.1 miles and the second 7 miles. * Turkey Trot Planning Committee - to provide support for this major community fundraising event funded by Open Doors Financial Aid to help families throughout central Maryland afford Y programs which keep them and their children active, learning and participating in all the Y has to offer. * Community Outreach Navigator Collaboration - To partner with community stakesholders to discuss immediate concerns and long term goals relating to minority and faithbased populations in Harford County. * Darlington Apple Festival Board - To raise funds that flows right back out into the community. The school PTA counts on this money to supplement services to children. Local churches count on the revenue to support a wide variety of outreach and service that would otherwise not be affordable. Local organizations, such as the Lion's Club, report that they would not be able to support the community as much as they do without the Apple Festival income. * Heal the Sick Program - To equip faith community members and leaders to support congregations' development of health ministries and link such ministries with hospitals, community organizations, public health institutions, and health care providers. * Local Management Board - A program within Harford County Government's Department of Community Services. Local Management Boards (LMBs) exist in each county in the state, working under the purview of the State of Maryland Children's Cabinet and Governor's Office for Children (GOC) to improve the well-being of children and families. * Geriatric Assistance and Information Network (GAIN) - Committee and Board Member Meetings - to improve care for the elderly members of Harford County. * Food Insecurity Commitment - UM Upper Chesapeake Health (UMUCH) has a long history of working alongside community organizations to address food insecurity issues. Prior to COVID-19, more than 23,000 Harford County residents - nearly one in 10, were food insecure, and more than 8,500 residents, which at 4% is higher than the state average, have limited access to healthy food. During COVID-19, food insecurity issues increased by 40% across Harford County. As part of its response to the pandemic, UMUCH alongside, Healthy Harford, convened a Harford County Food Access Workgroup with more than 25 community organizations. In FY22, UMMS donated $1.2 million statewide to help alleviate critical food insecurity. Of those funds, $64,262 was allotted to Harford County via the Maryland Food Bank (MFB). The MFB is a primary provider of food pantry staples for our community, but through this grant, additional food pantries were created and additional access points in high need communities were established. This consisted of five additional food distribution sites in the communities of Edgewood and Aberdeen. UM Upper Chesapeake Health and Healthy Harford supported these food distribution sites through community promotion, spreading the word of their availability, as well as providing onsite services such as blood pressure checks, information on community health resources, and navigation to link residents to services. In addition to supporting food access through the MFB, funds were also used to purchase 80 medically tailored meals through Moveable Feast, Inc. and well as additional prepared meals via Meals on Wheels. * United Way Partnership Board - is composed of local volunteers who advise and inform UWCM on issues specific to Harford County. By pairing this local expertise with county data, we can better understand the needs of our community and what local government and private resources are already being applied. This allows our Community Partnership Board of Harford County to help ""fill in the gaps and ensure every donor dollar does the most good. * Local Health Improvement Coalition Family Health Resilience Workgroup - To focus on connecting pregnant and postpartum women experiencing substance use disorders (SUD) to essential services, treatment, and resiliency resources. For the full implementation strategy, please visit https://www.umms.org/uch/community/assessment-and-implementation-plan"

Schedule H, Part V, Section B, Line 11 Facility 1, 5
Facility 1, 5 - HARFORD MEMORIAL HOSPITAL, INC.. Oral health in Harford County is addressed by the Harford County Health Department through a Dental Care Clinic. The dental clinic provides services to include oral health of children ages 1 -20 enrolled in the Maryland Children's Health Program (MCHP), and pregnant women on the Medical Assistance Program who may not have previously had access to dental care. The clinic is also committed to treating same-day dental emergencies involving infection and trauma. In addition, an FQHC, Beacon Health Center, provides dental services to include pediatric and adult preventative and restorative care, replacement care with dentures, partials, and bridges, emergency care such as extractions and root canals, and cosmetic care.

Schedule H, Part V, Section B, Line 13 Facility 1, 1
Facility 1, 1 - HARFORD MEMORIAL HOSPITAL, INC.. THE FINANCIAL ASSISTANCE POLICY EXPLAINS SEVERAL ELIGIBILITY CRITERIA, INCLUDING PARTICIPATION IN MEDICAID/MEDICARE PROGRAMS AS WELL AS ELIGIBILITY UNDER VARIOUS STATE REGULATIONS. IN ADDITION TO FPG, THE INCOME LEVELS DEFINED BY THE MARYLAND STATE DEPARTMENT OF HEALTH AND MENTAL HYGIENE (MD DHMH) ARE USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. THE MD DHMH INCOME LEVELS ARE MORE GENEROUS THAN THE FPG INCOME LEVELS.

Schedule H, Part I, Line 6b COMMUNITY BENEFIT REPORT
THE ORGANIZATION ANNUALLY FILES A COMMUNITY BENEFIT REPORT AS REQUIRED BY THE MARYLAND HEALTH SERVICES COST REVIEW COMMISSION (HSCRC). THE REPORT CAN BE FOUND AT: HTTPS://HSCRC.STATE.MD.US/PAGES/INIT_CB.ASPX.

Schedule H, Part VI, Line 4 Community Information
The following is a summary description of the community that UMUCH serves as described in our Community Health Needs Assessment and Community Benefit Implementation Plan. A more detailed description, including maps and data tables, can be found in our Community Health Needs Assessment available at: https://www.umms.org/uch/community/assessment-and-implementation-plan POPULATION Demographic characteristics such as age, gender, race, and ethnicity have an impact on people's health. Understanding these characteristics across Harford County is helpful in determining the resources needed for optimum health and well-being of the population. In 2019, the total population of Harford County was estimated to be 252,222, which was a 3.0% increase from 2010 (244,826). The county is located in the northeastern part of the Maryland, with the towns and cities of varying sizes, wealth, and diversity. The Town of Bel Air is the Harford County seat, which has a population of 10,071, or about 4% of the county's population. The cities of Aberdeen and Havre de Grace each make up approximately 10% and 7%, respectively. The remaining population in the county is mostly distributed along the Route 40 corridor and in rural and suburban parts of the county. The table below illustrates the change in population size for Maryland, Harford County, and selected zip codes (U.S. Census Bureau, 2015-2019). The Susquehanna River and Chesapeake Bay form the Northeast and Eastern borders of the county making global climate change and river borne pollution important issues for health over the long term. AGE DISTRIBUTION Data on the age distribution of a county is important in order to monitor aging. The population distribution can also help determine what types of services are needed as well as infrastructure and housing needs. The age category with the largest percentage of the population was adults ages 55-59. The median age for the county in 2019 was 40.9. Harford County has 49% males and 51% females (U.S. Census Bureau, 2015-2019). RACIAL AND ETHNIC DIVERSITY Data on racial and ethnic diversity of a population allows leaders to understand the health disparities and racial gaps. It also allows for organizations to target culturally competent health care services. For example, in Harford County, 7.4% of residents (age 5 and up) speak a language other than English at home. Therefore, it is important for addressing health literacy in the community (U.S. Census Bureau, 2015-2019). There is substantial variation in the levels of racial and ethnic diversity across Harford County. While 78.6% of Harford County is White, almost half of the residents in the Edgewood zip code are Black or African American. The share of the Black or African American population in Edgewood was projected to increase from 2010-2020. The racial composition of Edgewood and Aberdeen have been similar to the state of Maryland while Havre de Grace has been similar to Harford County as a whole (U.S. Census Bureau, 2015-2019). INCOME AND PHYSICAL ENVIRONMENT When compared to the United States, Maryland is a wealthy state, with a median household income of $84,805 compared to the United States at $62,843. Harford County has a higher median household income than the state at $89,147. There has also been a 7% and 6.4% increase in the median household income since 2017 for Maryland and Harford County, respectively. There are significant differences in income across the municipalities in Harford County with Bel Air (21014) at $91,262, Havre de Grace at $79,489, and Aberdeen at $68,942 (U.S. Census Bureau, 2015-2019). The percent of Harford County families that are below the poverty level is 4.7% which is below the state figure of 6.1%. However, there is a range of poverty levels throughout the county. Aberdeen and Edgewood's proportion living below poverty have been estimated at 10.6% and 9.4% respectively spanning the national average of 9.5%. There are also racial disparities of poverty in the county. There are 3.4% of White families who are below the poverty level while 11.3% Black or African American and 6.9% Hispanic or Latino families below the poverty level (U.S. Census Bureau, 2015-2019). The disparity in household incomes in Harford County and the cities of Aberdeen and Edgewood is consistent with the percentage of families whose income is below the poverty level. Both in Maryland and in Harford County, poverty rates are highest in families headed by females. Data shows that there are 17.3% of families below the poverty level in female headed households in Maryland and 18.5% in Harford County, respectively (U.S. Census Bureau, 2015- 2019). The poverty rates in Harford County are also reflected by the percentage of families receiving SNAP (Supplemental Nutrition Assistance Program) benefits with Edgewood having the highest percentage of families and Bel Air having the lowest. The estimated number of households that received SNAP benefits in Harford County in the past 12 months was 7,305, which is an estimated 7.8% of households in Harford County (U.S. Census Bureau, 2015-2019). EDUCATION AND EMPLOYMENT Harford County Public School District has 54 schools. The school district's mission is that each student will attain academic and personal success in a safe and caring environment that honors the diversity of our students and staff. Within the 54 schools, there are 9 Title I schools which aim to ensure academic achievement for at-risk students attending schools in high poverty areas. The schools are located in the southern portion of the County: three in Aberdeen, two in Edgewood and Joppa, and one in Havre de Grace and Abingdon (Harford County Public Schools, 2021). Harford County Public Schools had a total of 38,429 students enrolled in the 2019-20 school year with a 94.3% attendance rate. The high school graduation rate for Harford County was 90.15%, which was higher than the state of Maryland's rate at 86.75% (Maryland State Department of Education, 2019). The Maryland State Department of Education administers assessments each year of each school district in Maryland. Based on the test scores, each school district is ranked by SchoolDigger. Due to the pandemic, school assessments were not taken for the 2019-2020 year. For the 2018-2019 school year, Harford County was ranked 10th out of 24 public school systems in Maryland (SchoolDigger, 2019). This is a slight improvement from the previous year where Harford County was ranked 11th. It was estimated that 92.7% of people 25 years and over in Harford County had a high school diploma or higher and 36.7% had a bachelor's degree or higher in 2019. Additionally, 67.9% of the Harford County population 16 and over were employed while 32.1% were not in the labor force. In addition, 74.3% of Harford County employees were private wage and salary workers, 21.2% were government workers, and 4.5% were self-employed (U.S. Census Bureau, 2015- 2019). HOUSING AND TRANSPORTATION While the median value of homes in 2019 for Harford County ($293,400) is only slightly less than Maryland's ($314,800), the difference when considering housing prices by zip code is dramatic. The median home value for Harford County has increased by 4.1% since 2017. Prices range from below the state value in the Edgewood area, where the median home value is $173,900, to well above the state in the Monkton area, where the median home costs $518,800. The map above shows median home values by zip code (U.S. Census Bureau, 2015- 2019). Rental costs must also be taken into account when assessing the housing landscape of a community. The table above shows monthly mortgage and rental costs for Maryland, Harford County, and selected zip codes from the U.S. Census Bureau. It is estimated that 22% of households rent rather than own their house. Limited access to public transportation is especially troublesome for rural and low income areas of Harford County. Lack of transportation impacts accessing healthcare services. Among workers 16 and over, 4.9% that do not have a vehicle available. Rates are higher along the route 40 corridor with Edgewood at 9%, Aberdeen at 8.8%, and Havre de Grace at 7.5% (U.S. Census Bureau, 2015-2019). There are approximately 56.2% Harford County residents that also work in the county. In addition, there are 40.6% and 3.2% of Harford County residents who work outside the county and state, respectively. The average commute time to work is about 32 minutes. There are just 1.3% of residents that use public transportation according to the 2015-2019 5 year estimates (U.S. Census Bureau, 2015-2019). The Harford Transit Link is the bus system for Harford County that offers 7 bus routes as seen below (Harford County Government, n.d.). While this aids in access to care, there are still gaps in transportation throughout many areas of the county.

Schedule H, Part VI, Line 4 Community Information cont
HEALTH OUTCOMES The health outcomes section reports perceived health status, incidence and prevalence of health conditions in Harford County, hospitalizations, and mortality from certain health conditions. This includes chronic and communicable disease, injury, mental health, and maternal and child health. The previous health factors section that discussed healthy and unhealthy behaviors go hand in hand with health outcomes. PERCEIVED HEALTH STATUS In the BRFSS survey, respondents were asked to rank their overall health from poor to excellent. There was some variation of responses throughout the past 3 years, but an average from 2017-2019 showed 18.1% of residents reported their health was excellent, 38.3% reported very good, 29.9% reported good, 9.7% reported fair, and 3.7% reported poor. LEADING CAUSES OF DEATH AND HOSPITALIZATION In the 2021 County Health Rankings, Harford County was ranked 10th out of 24 jurisdictions for health outcomes. Years of Potential Life Lost (YPLL) is used to measure premature mortality (before age 75) rather than overall mortality in order to focus on deaths that could have been prevented. Based on 2017-2019 data, the YPLL rate was 6,900 per 100,000 for all deaths in Harford County and 7,200 per 100,000 in Maryland. This rate was also significantly higher for African Americans in Harford with the YPLL being 8,400 per 100,000 deaths (County Health Rankings and Roadmaps, 2021 According to the Maryland Vital Statistics Administration, there were 2,209 total deaths in Harford County in 2019 and the top 3 causes causes of death were heart disease, cancer, and cerebrovascular disease (stroke) in both Harford County and Maryland. Chronic obstructive pulmonary disease (COPD) falls closely behind stroke as the 4th leading cause of death in Harford County. If the top causes of death remain consistent for the 2020 Maryland Vital Statistics Annual Report, COVID-19 would likely be the 3rd leading cause of death in Harford County as there were 167 COVID-19 deaths in 2020. The age-adjusted mortality rate from 2017-2019 for all causes was 738.8 per 100,000 deaths in Harford County and 713 per 100,000 deaths in Maryland. The trends of mortality rates for specific diseases are outlined below (Maryland Department of Health Vital Statistics Report, 2019). EMERGENCY DEPARTMENT VISITS The ED visit rate for Harford from 2017-2019 was 919 per 1,000 compared to the state rate of 1,107 per 1,000. The highest rates of ED visits in the county were for residents of Aberdeen (1607.6 per 1,000) followed by Edgewood (1459.62 per 1,000) and Havre de Grace (1378.80 per 1,000) (Chesapeake Regional Information System for our Patients, 2020). The CRISP Reporting System (CRS) reported that the top three conditions associated with an ED visit were hypertension, substance use disorder, and mental health conditions in Harford County (Chesapeake Regional Information System for our Patients, 2020). The state as a whole also had the same top 3 conditions, however, the state had a higher percentage of any mental health condition visits compared to substance use disorder. This may suggest that these conditions were not being treated as successfully in an outpatient setting. CHRONIC AND COMMUNICABLE DISEASES While there has been a slight decrease in mortality rates for heart disease in Harford County, it remains the leading mortality rate in the county. For 2017-2019 the rate was 163 per 100,000 in Harford and 162 per 100,000 in Maryland (Maryland Department of Health Vital Statistics Report, 2019). Cancer mortality rates are worse in Harford County than for the state of Maryland. However, the cancer mortality rates have decreased over the years for both Harford County and Maryland (Maryland Department of Health Vital Statistics Report, 2019). Cancers of the lung, trachea, and bronchus have the highest mortality of all cancers in Harford County (45 per 100,000) and Maryland (38.8 per 100,000). When breaking down the incidence by cancer type, breast and prostate cancer had the top 2 incidence rates in both Harford and the state of Maryland (U.S. Cancer Statistics Working Group, 2020). When broken down by race by type of cancer in Harford County, the incidence rate for prostate cancer in African Americans (239.9 per 100,000) was about 2 times the incidence in Whites (119.6 per 100,000) (U.S Cancer Statistics Working Group, 2020). Cerebrovascular disease (stroke) continues to be one of the top causes of mortality in Harford County. In 2017-2019 the mortality rate was 38 per 100,000 deaths and has slowly been increasing over the years (Maryland Department of Health Vital Statistics Report, 2019). The Behavioral Risk Factor Surveillance System (BRFSS) reported the percentage of adults that were ever told they have a certain chronic condition, outlined in the chart below. It is estimated that about a third of adults have been diagnosed with hypertension (high blood pressure), which increases the risk for heart disease and stroke (CDC). Hypertension also usually presents no symptoms, making it more critical to monitor and take steps to lower the risk. While the diabetes overall estimated diagnoses is 9.3% of Harford adults, this rate is significantly higher in African Americans (19%) versus White (8.3) residents (Maryland Department of Health Behavioral Risk Surveillance System, 2011-2019). A notifiable disease is any condition that, when identified in a patient, is required to be reported to the government so that its incidence can be monitored for potential outbreaks and clustering. The notifiable diseases are then reported to the Centers for Disease Control (CDC). Harford County's Lyme disease rate was more than double the state rate (54.8 per 100,000 compared to 23.5 per 100,000) (Maryland Department of Health Cases of Selected Notifiable Conditions, 2019). MATERNAL AND CHILD HEALTH Maternal characteristics and birth outcomes in Harford County vary by race, indicating health disparities exist for mothers and babies for racial and ethnic minorities. A mother's wellbeing before, during, and after pregnancy can affect the health of a child from infancy to adulthood. Infant's with low birth weight, are more likely to die before their first birthday or have chronic conditions when they get older such as diabetes, heart disease, or high blood pressure. In 2019, there were 2,686 live births in Harford County. Among all of the live births in Harford County, 80.4% received first trimester care and 4.8% received late or no care during pregnancy (Maryland Department of Health Vital Statistics Report, 2019) Live births to unmarried mothers were 34% of all live births and live births to mothers under 20 years old was just 2.3% of all live births. The rates for live births were especially higher in non-Hispanic African American unmarried mothers (61.2%) and Hispanic unmarried mothers (48.4%). The percent of mothers in Harford County with a low birth weight child in 2019 was 8%. This percentage was higher in African American (14.7%) and Hispanic (10%) mothers than for white mothers (6%) (Maryland Department of Health Vital Statistics Report, 2019). Low birth weight babies can lead to poor outcomes and health complications. In 2019, the infant mortality rate in Harford County was 5.6 per 1,000 live births which is slightly below the state at 5.9 per 1,000 live births. While this is a drop from 2018 (6.5 per 1,000), the infant mortality rate is still higher than it had been in prior years, while the infant mortality rate for the state continues to decline (Maryland Department of Health Vital Statistics Report, 2019). Racial disparities in infant mortality and low birth weight births have persisted in Harford County for the past decade. In fact, the rate of infant mortality for Black babies has been more than 3-4 times higher than that of white babies in Harford County for many years. In 2018, the infant mortality rate was 10.8 per 1,000 live births for non-Hispanic Blacks and 4.2 per 1,000 live births for non-Hispanic Whites. Racism, intergenerational stress, and structural inequality continue to fuel maternal and child health disparities in Harford County. In addition, the rate for substance exposed newborns (SEN) has significantly increased from 2009 to 2018 and the rate in Harford has been higher than the state for at least 9 years. In 2018, there were 38.1 SEN per 1,000 newborn discharges in Harford County compared to 31.4 SEN in Maryland (Health Services Cost Review Commission, 2018). While racial data on SEN births in Harford County is limited, the most recent data indicates that the majority of SEN births are to white women in the county. We recognize that, in order for families to achieve and maintain health and resiliency, they must be given a safe space to access essential resources and support.

Schedule H, Part VI, Line 4 Community Information cont
INJURY According to County Health Rankings data for 2021, the overall death rate from injuries (planned and unplanned) in Harford County and Maryland was 82 per 100,000 (County Health Rankings and Roadmaps, 2021). Injuries accounted for 109 deaths in 2019 for Harford County and were the 5th leading cause of mortality. The suicide rate for Harford in 2017-2019 was 11.4 per 100,000 in Harford which was slightly above the state at 10.1 per 100,000 (Maryland Department of Health Vital Statistics Report, 2019). Falls in older adults can lead to serious injury, disability, and prevent a senior from being independent. The 2018 Behavioral Risk Surveillance System (BRFSS) estimates that 22.4% of residents in Harford County ages 45+ had fallen in the last year. In addition, 7.2% of those that fell were injured by the fall (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). BEHAVIORAL HEALTH The Behavioral Risk Factor Surveillance System (BRFSS) survey estimated that in 2019, 18.8% of adults in Harford County were diagnosed with depressive disorder (including depression, major depression, dysthymia, or minor depression) (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). Mental Health can have a huge impact on children as well. The graph below reports the Harford County students that have felt sad or hopeless from the Youth Risk Behavior Survey (YRBS). At least 30% of students 10th thru 12th grade felt sad or hopeless in 2018. While percentages dropped slightly in middle school students from 2016 to 2018, a significant portion of students are still affected by mental illness. The survey also reported that in 2018, 18% of high school students said they had seriously considered suicide in the last year (Maryland Department of Health Youth Risk Behavior Survey, 2019). The BRFSS also looks at adverse childhood experiences (ACEs). The CDC describes ACEs as potentially traumatic events that happen during a person's childhood such as household mental illness, physical, sexual, and/or emotional abuse, and an incarcerated household member. The more ACEs a person has experienced, the more likely they will experience chronic health conditions, mental or behavioral health challenges, or early death. In fact, at least 5 of the top leading causes of death have been linked to ACEs (Centers for Disease Control and Prevention Preventing ACEs, 2021). Also, experiencing 4 or more ACEs is associated with a significant increase in risk for chronic illness and/or suicide. In 2018, the BRFSS estimated that 13.4% of adults experience 4 or more ACEs (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). The CRISP Reporting System (CRS) reports higher rates of hospitalizations in Harford County (90 per 1,000 for 2017-2020) for depression than the state (69 per 1,000 for 2017-2020). The tables below outline the hospitalizations and ED visits for mental health indicators by select zip codes. Rates of depression, schizophrenia, and bipolar disorder were higher in the Edgewood, Aberdeen, and Havre de Grace zip codes than the state average for both total hospitalizations and ED visits. Alzheimer's hospitalizations were particularly higher in Havre de Grace (47.8 per 1,000) and Darlington (48.7 per 1,000) and there were 17.7 per 1,000 ED visits for Alzheimer's as well (Chesapeake Regional Information System for our Patients, 2020). This could be due to Darlington and Havre de Grace having an older population. From 2013 to 2017 there was a steady increase in total drug and alcohol-related intoxication deaths in Harford County and Maryland. From 2018 to 2020, there was about a 17% decrease in total drug and alcohol-intoxication related deaths in Harford County (Maryland Department of Health Unintentional Drug and Alcohol-Related Intoxication Deaths, 2019). There was also a 50% decrease in Heroin deaths from 2019 to 2020. Opioid and fentanyl-related deaths have remained the highest cause of intoxication death over the past few years. ACCESS TO HEALTH CARE Access to health care has a significant influence on a person's overall health and wellbeing. Health insurance is a major contributor to access to care as well as physician shortages and lack of transportation. INSURANCE COVERAGE Health insurance allows more people to receive quality health care and improve overall health and wellness. People without health insurance may be more likely to delay or skip receiving health care or getting preventive screenings due to the cost. The 2019 Behavioral Risk Factor Surveillance System (BRFSS) estimated that 9.6% of Harford County residents were unable to see a doctor due to cost in the past 12 months. In Harford County, 3.4% of residents are uninsured compared to 6.1% of residents in Maryland (U.S. Census Bureau, 2015-2019) While the uninsured rate for the county is relatively low, disparities in coverage exist. 14.2% of Hispanic/Latino residents are uninsured compared to 2.6% white residents (U.S. Census Bureau, 2015-2019). While a small zip-code, Perryman has 44.2% of its residents uninsured. Higher rates of those uninsured were in Darlington (6%), Edgewood (5.2%) and Aberdeen (5.1%) with the lowest uninsured rate in Monkton (0.9%) (U.S. Census Bureau, 2015-2019). ACCESS TO PRIMARY CARE AND PREVENTIVE SERVICE Regular exams and screening tests play a key role in detecting disease early which can lead to proper intervention. Vaccinations such as the flu or coronavirus vaccine also used to stop the spread of disease. Screening exams and vaccinations are typically at no cost to those with insurance. However, various initiatives in the county have led to opportunities for these screenings to be given at little to no cost for those without insurance. The Behavioral Risk Factor Surveillance System (BRFSS) survey estimates that 87.6% of Harford County residents have one or more personal doctors, and this number has ranged from 80.8-90.4% over the past 5 years (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). The 2021 County Health Rankings estimate that there are 140 primary care physicians based on 2018 data (County Health Rankings, and Roadmaps, 2021). The ratio of the population to primary care physicians in Harford County is 1,810:1. This rate has been getting worse over the years and is worse than the state ratio at 1,130:1 (County Health Rankings and Roadmaps, 2021). The Health Resources and Services Administration (HRSA) designates and scores areas in the country that are experiencing a shortage of healthcare facilities. For primary care, the HRSA gave the Edgewood area a Health Professional Shortage Area score of 10 out of a maximum of 26 (Health Resources and Services Administration, n.d.) ACCESS TO BEHAVIORAL HEALTH Mental Health is just as important as physical health for overall health and well-being. Mental Illness can also lead to physical illness such as heart disease and type 2 diabetes. Although the pandemic has made mental health services easier to access through telehealth, the ratio of the Harford County population to mental health providers was 500:1 and there were 508 total mental health providers in Harford County for 2020 (County Health Rankings and Roadmaps, 2021). This ratio is worse than the state at 360:1. When looking at shortage areas in the county for Mental Health, the Health Resources and Services Administration (HRSA) designates Harford County as a whole as a mental health shortage area with a score of 5 out of a maximum of 26 (Health Resources and Services Administration, n.d). There are Opioid Treatment Programs (OTPs) that are hospital and community based that provide medication assisted treatment (MAT), counseling and behavioral therapy to people experiencing opioid use disorders. Harford County has 9 OTP Service Providers, which is the 3rd highest in the state. The county served 43.2 per 1,000 Medicaid eligible at these OTPs, compared to 24.2 per 1,000 in the state in 2019 (Maryland Department of Health Behavioral Health Administration, 2020).

Schedule H, Part VI, Line 4 Community information cont
ACCESS TO ORAL HEALTH Oral health is a key component of overall health and wellbeing and can affect the way we speak, eat, smile, and show emotions. Poor oral health can lead to diseases ranging from cavities to oral cancer. There are an estimated 167 dentists in Harford County and the ratio of the population to dentists is 1,530:1 (County Health Rankings and Roadmaps, 2021). While this ratio has been improving over the years, it is still worse than the state ratio of 1,260:1. Shortages still remain in the county. According to the Health Resources and Services Administration (HRSA) there are oral health shortages in northern Harford County with a shortage score of 10 out of a maximum 26 and in southern Harford County with a shortage score of 14 out of a maximum of 26 specifically for the Medicaid eligible population (Health Resources and Services Administration, n.d).

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
6550670

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
Maryland's regulatory system creates a unique process for hospital payment that differs from the rest of the nation. The Health Services Cost Review Commission, (HSCRC) determines payment through a rate setting process and all payors, including governmental payors, pay the same amount for the same services delivered at the same hospital. Maryland's unique all payor system includes a method for referencing Uncompensated Care in each payors' rates, which does not enable Maryland hospitals to breakout any offsetting revenue related to Uncompensated Care. Community benefit expenses are equal to Medicaid revenues in Maryland, as such, the net effect is zero. Additionally, net revenues for Medicaid should reflect the full impact on the hospital of its share of the Medicaid assessment.

Schedule H, Part II Community Building Activities
Through a variety of community building activities, UMUCH promotes health and wellness in the communities it serves. These activities include community support, coalition building and community health improvement advocacy. UMUCH provides leadership to many community coalitions and collaborative partnerships to improve community health, which include, but are not limited to: Healthy Harford - the healthy communities initiative of Harford County, dedicated to the health and wellness of the northern Chesapeake community. Founded in 1993 as a non-profit 501c3 by leaders from University of Maryland Upper Chesapeake Health, the Harford County Health Department, and Harford County Government, Healthy Harford is a coalition of local government agencies, businesses, non-profits, and citizens dedicated to improving the health of Harford County residents through education, policy changes, improvements in the built environment, increased access to care, and improved care coordination for people with chronic illness. Healthy Harford's mission is to inspire and empower healthy people, healthy families, and healthy communities in mind, body, and spirit, with a focus of improving health and wellness in the Harford County region by promoting healthy lifestyles, building community partnerships, and proving care coordination. The Harford County Local Health Improvement Coalition (LHIC) - jointly led by the Harford County Health Department and UMUCH. This Coalition brings together representatives from the community every October to examine the health of our community and determine a plan for moving forward. Primary health improvement priorities for this Coalition include behavioral health, chronic disease prevention wellness and family health resiliency. The charge for each priority is then lead by a community workgroup. Each workgroup has strategic initiatives, action plans, and measurable goals. They meet either monthly or quarterly and report out at the Annual LHIC meeting. Other community coalitions that UMUCH plays an active role in include: Harford County Cancer Coalition, Suicide Prevention Workgroup, Overdose Fatality Review Team, Citizen Review Board for Children, and Harford County Child Fatality Review Board. All of these committees and coalition are collaborative efforts to address health issues and advocate for policies and programs that improve health in the communities we serve.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
BECAUSE OF THE UNIQUE PAYMENT SYSTEM DESCRIBED ON LINE 2 (ABOVE), THE HOSPITAL IS UNABLE TO ESTIMATE HOW MUCH OF THE AMOUNT REPORTED IN LINE 2 IS ATTRIBUTED TO PATIENTS WHO WOULD APPLY UNDER THE FAP.

Schedule H, Part III, Line 8 Community benefit methodology for determining medicare costs
THE ORGANIZATION FILES ANNUALLY A COMMUNITY BENEFIT REPORT WITH THE STATE OF MARYLAND'S HEALTH SERVICES COST REVIEW COMMISSION (HSCRC). THE HSCRC, WHICH OPERATES UNDER A MEDICARE WAIVER, DOES NOT CONSIDER MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED BY THE ORGANIZATION IS A COST-TO-CHARGE RATIO.

Schedule H, Part V, Section B, Line 16a FAP website
1 - HARFORD MEMORIAL HOSPITAL, INC.: Line 16a URL: https://www.umms.org/uch/patients-visitors/for-patients/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
1 - HARFORD MEMORIAL HOSPITAL, INC.: Line 16b URL: https://www.umms.org/uch/patients-visitors/for-patients/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
1 - HARFORD MEMORIAL HOSPITAL, INC.: Line 16c URL: https://www.umms.org/uch/patients-visitors/for-patients/financial-assistance;

Schedule H, Part VI, Line 7 State filing of community benefit report
MD

Schedule H, Part VI, Line 4 Community Information cont
CRIME In 2017, Harford County had an annual overall crime rate of 1345.6 per 100,000 people and has been on the decline. The most recent available crime data for the state is from 2016, which reported an annual overall crime rate of 2801.3 per 100,000. The crime rate in Maryland has been consistently higher than Harford County for years (Governor's Office of Crime Prevention, Youth, And Victim Services, 2017) The violent crime rate in Aberdeen was 470.7 per 100,000 which is significantly higher than Bel Air, Havre de Grace, or the county average. On the other hand, Bel Air had the highest rate of property crime with the rate of 2621.4 per 100,000, which was significantly higher than the county as a whole or Aberdeen and Havre de Grace (Governor's Office of Crime Prevention, Youth, And Victim Services, 2017). ACCESS TO HEALTHY FOODS AND RECREATIONAL OPPORTUNITIES The 2021 County Health Rankings estimate that during the last few years, 4% of Harford County residents had limited access to healthy foods. This percentage is based on 2015 and 2018 weighted data of those that do not live close to a grocery store and are low income. In addition, 9% of Harford County residents are considered food insecure. This is measured by the percentage of the population who did not have access to a reliable source of food during the past year (based on 2015 and 2018 weighted data). The County Health Rankings created a food environment index in order to score a given area on a scale from 0-10 (0 being the worst and 10 being the best). The score is based on limited access to foods and food insecurity. Harford County was given a score of 8.7 out of 10 which was the same score as Maryland as a whole (County Health Rankings and Roadmaps, 2021). It should also be noted that the US Census estimates that 7.8% of households in Harford County use SNAP benefits (U.S. Census Bureau, 2015-2019). In summary, while most Harford County residents have access to healthy foods and a reliable source of food, there are still gaps in the county. Lacking reliable access to food has been found to be related to poor health outcomes such as obesity and premature mortality. It is estimated that access to exercise opportunities in Harford County is 90% while the state of Maryland is at 93%. This is measured by the percentage of individuals in a county who live reasonably close to a park or recreational facility (County Health Rankings and Roadmaps, 2021). The Harford County public recreation system is a combination of sites owned by municipal, County, State, and Federal government, and the Harford County Board of Education. There are numerous opportunities for Harford County residents to stay active through parks, trails, and recreation centers. Below is a snapshot of the areas and facilities in the public system. Note that this is limited to public facilities and there are additional recreation opportunities through apartment complexes' playgrounds or private gyms. TOBACCO USE In middle and high school students, there was a steep increase in electronic vapor product use from 2016 to 2018. The Youth Risk Behavior Survey (YRBS) showed in 2018, 29.3% of high school students had used an electronic vapor product in the past 30 days. This is more than double the rate from 2016 (14.3%). The electronic vapor product use in Harford County was also about 6% worse than the state (23.0%). Middle school students in Harford County saw a similar spike in electronic vapor use, but still a lower rate than high school students. In 2018, 7% of students used an electronic vapor product in the past 30 days compared to 5.9% in the state. There were also 43% and 19.6% of Harford County high school and middle school students, respectively, that had ever tried an electronic vapor product in 2018 (Maryland Department of Health Youth Risk Behavior Survey, 2019) In adults, smoking rates in Harford have consistently been higher than the state since 2014. In 2019, the number of current smokers in Harford County was 20.6% compared to 13.1% for the state (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). ALCOHOL USE In 2018 it was reported that 8.4% of Middle School students and 31% of High School students currently drank alcohol (Maryland Department of Health Youth Risk Behavior Survey, 2019). For Harford County adults, in 2019, 9.5% reported being heavy drinkers (adult men having 14 drinks per week and adult women having 7 drinks a week). This percentage is higher than the state where it was reported that 5.4% of adults engage in heavy drinking (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). HEALTHY EATING, ACTIVE LIVING, AND OBESITY Diet and exercise habits have a tremendous impact on health and wellbeing. Data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) indicate that only 66.6% of Harford County adults consume one or more servings of fruits per day and only 83.1% consume one or more servings of vegetables daily. The percentage of fruit consumption mirrored the state while the vegetable consumption was about 5% higher in Harford than the state (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). It is recommended that adults engage in 150 minutes of moderate-intensity physical activity per week (or equivalent of vigorous physical activity). The 2019 BRFSS data found that 59.4% of Harford County residents met the recommended physical activity requirements compared to 51.8% of the state (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). Body Mass Index (BMI) can be used as a tool to access health risk, although it does not measure body fat. Harford County's weight breakdown below shows that about 72.7% of adults in 2019 were overweight or obese and only 27.3% were at a healthy weight (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). There has also been about a 10% increase in Harford County residents that are a overweight or obese from 2016 to 2019. Obesity and overweight rates can vary by race as well. In the 2019 BRFSS survey, it was reported that 83.9% of non-Hispanic Black adults in Harford County were obese or overweight, compared to 66.9% Whites (Maryland Department of Health Behavioral Risk Factor Surveillance System, 2011-2019). These racial disparities have been consistent for at least the last few years. Being overweight or obese can put people at risk for other chronic conditions such as heart disease and type 2 diabetes.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE HEALTH SERVICES COST REVIEW COMMISSION (HSCRC) STARTED SETTING HOSPITAL RATES IN 1974. AT THAT TIME, THE HSCRC APPROVED RATES APPLIED ONLY TO COMMERCIAL INSURERS. IN 1977, THE HSCRC NEGOTIATED A WAIVER FROM MEDICARE HOSPITAL PAYMENT RULES FOR MARYLAND HOSPITALS TO BRING THE FEDERAL MEDICARE PAYMENTS UNDER HSCRC CONTROL. IN 2014, MARYLAND'S WAIVER WITH MEDICARE WAS RENEGOTIATED AND UPDATED TO REFLECT THE CURRENT HEALTHCARE ENVIRONMENT. UNDER THIS NEW WAIVER, SEVERAL CRITERIA WERE ESTABLISHED TO MONITOR THE SUCCESS OF THE SYSTEM IN CONTROLLING HEALTHCARE COSTS AND THE CONTINUANCE OF THE WAIVER ITSELF: 1. REVENUE GROWTH PER CAPITA 2. MEDICARE HOSPITAL REVENUE PER BENEFICIARY 3. MEDICARE ALL PROVIDER REVENUE GROWTH PER BENEFICIARY 4. MEDICARE READMISSION RATES 5. HOSPITAL ACQUIRED CONDITION RATE

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE CORPORATION RECORDS REVENUES AND ACCOUNTS RECEIVABLE FROM PATIENTS AND THIRD-PARTY PAYORS AT THEIR ESTIMATED NET REALIZABLE VALUE. REVENUE IS REDUCED FOR ANTICIPATED DISCOUNTS UNDER CONTRACTUAL ARRANGEMENTS AND FOR CHARITY CARE. AN ESTIMATED PROVISION FOR BAD DEBTS IS RECORDED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED BASED UPON ANTICIPATED UNCOMPENSATED CARE, AND IS ADJUSTED AS ADDITIONAL INFORMATION BECOMES AVAILABLE. THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE MODIFICATIONS TO THE PROVISION FOR BAD DEBTS AND TO ESTABLISH AN ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER COLLECTION OF AMOUNTS DUE FROM INSURERS, THE CORPORATION FOLLOWS INTERNAL GUIDELINES FOR PLACING CERTAIN PAST DUE BALANCES WITH COLLECTION AGENCIES. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CORPORATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR BAD DEBTS, ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS, PROVISION FOR BAD DEBTS, AND CONTRACTUAL ADJUSTMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS OR WITH BALANCES REMAINING AFTER THE THIRD-PARTY COVERAGE HAD ALREADY PAID, THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS HISTOICAL COLLECTIONS, WHICH INDICATES THAT MANY PATIENTS ULTIMATELY DO NOT PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE DISCOUNTED RATES AND THE AMOUNTS COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
THE ORGANIZATION EXPECTS PAYMENT AT THE TIME THE SERVICE IS PROVIDED. OUR POLICY IS TO COMPLY WITH ALL STATE AND FEDERAL LAW AND THIRD PARTY REGULATIONS AND TO PERFORM ALL CREDIT AND COLLECTION FUNCTIONS IN A DIGNIFIED AND RESPECTFUL MANNER. EMERGENCY SERVICES WILL BE PROVIDED TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. FINANCIAL ASSISTANCE IS AVAILABLE FOR PATIENTS BASED ON FINANCIAL NEED AS DEFINED IN THE FINANCIAL ASSISTANCE POLICY. THE ORGANIZATION DOES NOT DISCRIMINATE ON THE BASIS OF AGE, RACE, CREED, SEX OR ABILITY TO PAY. PATIENTS WHO ARE UNABLE TO PAY MAY REQUEST A FINANCIAL ASSISTANCE APPLICATION AT ANY TIME PRIOR TO SERVICE OR DURING THE BILLING AND COLLECTION PROCESS, EVEN IN EXCESS OF 240 DAYS FOLLOWING THE FIRST POST-DISCHARGE BILLING STATEMENT. THE ORGANIZATION MAY REQUEST THE PATIENT TO APPLY FOR MEDICAL ASSISTANCE PRIOR TO APPLYING FOR FINANCIAL ASSISTANCE. THE ACCOUNT WILL NOT BE FORWARDED FOR COLLECTION DURING THE MEDICAL ASSISTANCE APPLICATION PROCESS OR THE FINANCIAL ASSISTANCE APPLICATION PROCESS. NO EXTRAORDINARY COLLECTION ACTIONS (ECAS) WILL OCCUR EARLIER THAN 120 DAYS FROM SUBMISSION OF FIRST BILL TO THE PATIENT AND WILL BE PRECEDED BY NOTICE 30 DAYS PRIOR TO COMMENCEMENT OF THE ACTION. AVAILABILITY OF FINANCIAL ASSISTANCE WILL BE COMMUNICATED TO THE PATIENT AND A PRESUMPTIVE ELIGIBILITY REVIEW WILL OCCUR PRIOR TO ANY ACTION BEING TAKEN. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AFTER AN ECA IS INITIATED, THE ORGANIZATION WILL TAKE REASONABLE MEASURES TO REVERSE THE ECAS AGAINST THE PATIENT ACCOUNT.

Schedule H, Part VI, Line 2 Needs assessment
UMUCH assessed the health status of Harford County residents, as individuals and as population groups, and provided population comparisons to residents of Maryland and to the nation as a whole. We examined trends in health indicators of County residents over time, highlighting racial and geographic disparities, and identified areas of poverty and at-risk populations which provided a basis for our public health planning. Data in our assessment came from a variety of National and State sources, including, but not limited to, the United States Census Bureau, Maryland State Health Improvement Plan, Maryland Vital Statistics, the Maryland Behavioral Risk Factor Surveillance survey, the Injuries in Maryland report, and national County Health Rankings. The CHNA includes each of Harford County's 21 zip codes. In keeping with the UMUCH mission of maintaining and improving the health of the people in its communities and providing high quality care to all, the community benefit service area (CBSA) was identified as all of Harford County. The zip codes where the most vulnerable populations reside (21009, 21040, 21001, 21078) were included in the assessment and represent the most concentrated areas of poverty within the county. It is important to note that pockets of concentrated poverty also exist within rural northern zip codes in Harford County. Identifying all of Harford County as the CBSA provides the opportunity to better address the needs of the vulnerable residents of Harford County.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
Information regarding the Financial Assistance program/policy and the number for our patients to contact someone with questions or concerns are as follows: - Posted in registration areas (inpatient, emergency department, Kaufman Cancer Center, Family Birth Place, outpatient testing), waiting areas and by Cashier's offices - Offered to all Self Pay patients at the time of registration - Printed on the back of all patient financial statements - Posted on the UMUCH website - Offered by Billing Department when patients call inquiring about their hospital bill A Financial Counselor is available onsite to assist patients with applying for Financial Assistance. A representative from Hospital Support Services contacts all Self-Pay ED patients and Self Pay inpatients to assist the patient with applying for Medical Assistance. Our Financial Assistance policy is available in English and Spanish. The financial assistance policy for UMUCH is regularly reviewed and to make sure it is available to our patients in a variety of formats and that it is available in culturally/linguistically sensitive manner and at a reading comprehensive level appropriate to the population of our Community Benefit Service Area.

Schedule H, Part VI, Line 6 Affiliated health care system
The University of Maryland Medical System Corporation (UMMS) is a private, not-for-profit corporation providing comprehensive healthcare services through an integrated regional network of hospitals and related clinical enterprises. UMMS was created in 1984 when its founding hospital was privatized by the State of Maryland. Over its 30-year history, UMMS evolved into a multi-hospital system with academic, community and specialty service missions reaching primarily across Maryland. As part of the University of Maryland Medical System (UMMS), UMUCH understands that health care goes beyond the walls of the hospital and into the community it serves. UMMS hospitals are committed to strengthening their neighboring communities. In doing so, UMUCH assesses the community's health needs, identifies key priorities, and responds with services, programs and initiatives which make a positive, sustained impact on the health of the community. With representation from all UMMS hospitals, the Medical System's Community Health Improvement Council coordinates the effective and efficient utilization and deployment of resources for community-based activities and evaluates how services and activities meet targeted community needs within defined geographic areas. UMUCH is committed to health education, advocacy, community partnerships, and engaging programs which focus on health and wellness with the goal of eliminating health care disparities in the Harford County.

Schedule H, Part VI, Line 5 Promotion of community health
"UMUCH aims to strengthen our community through promoting health and wellness with our outreach program, Community Outreach. Community Outreach is dedicated to promoting health and wellness outside of the hospital and to increasing the quality of life in Harford County. Focusing on prevention and improving health outcomes, we provide an expansive variety of health education, screenings, lifestyle management classes and information on referrals and local resources. We promote our programs through various social media outlets, including Facebook, Instagram and Twitter. In addition, we distribute a quarterly publication, ""Maryland Health Matters"", have an up-to-date calendar of events on our website, targeted direct mailing and emails and distribute flyers throughout Harford County focusing on areas of interest such as, senior centers, libraries, churches, grocery stores to name a few. In 2022, Community Outreach had over 17,950 community-wide contacts through our screenings and educational programs, flu and covid vaccination clinics, and support groups. Senior Center/Senior Housing/Assisted Living Programs Harford County is a diverse community with approximately 25% of the population being 55 years old or older. With senior citizens making up a quarter of the community and being the population that utilizes a large proportion of health care services, our community programs are centered around their specific needs, helping to ensure successful and healthy senior living. Community Outreach provided 2,213 screenings, education sessions and vaccinations to Harford County seniors at five senior activity center locations to include Edgewood, Fallston, Havre de Grace, Highland and Bel Air. In addition, to all senior housing centers including Aberdeen Court, Abingdon Gardens, Fairbrooke, St. Johns Commons, St. Johns Towers, Aberdeen and Perryman as well as Parkview at Box Hill, Parkview at Bel Air and Avondale Assisted Living Facilities. Throughout the year, many different health screenings were held during certain months at each senior location, which resulted in: - 941 blood pressure screenings - 69 cholesterol screenings - 80 My Plate education participants - 12 sleep disorder screenings - 241 flu vaccinations - 67 falls risk assessments - 98 skin cancer education participants - 46 men's health participants - 95 colorectal cancer education participants - 78 head and neck education participants - 23 heart health education participants Children's Programs One of the most important jobs parents have is keeping their child safe while riding in a car. Tragically, thousands of young children are killed or injured every year in car accidents. Proper use of car safety seats can help keep children safe - but with so many different car seat options on the market, parents can quickly become overwhelmed. Not only does the community outreach team at UMUCH provide education on choosing the correct seat, they teach parents and caregivers how to properly install the seat as well. UMUCH has five team members who are nationally certified car safety technicians and one who have been specially trained to fit children with disabilities to the proper safety seat. In FY22, Car Seat Education Sessions were provided at 15 locations with a total of 358 participants. At bi-monthly car safety seat checks, technicians review installation of infant, child and booster seats. Proper seat fitting and use is crucial, and safety checks are the best way to ensure seats are being used correctly. Our technicians also support Maryland's Kids in Safety Seats (KISS) program at their installation checks offered throughout Harford County. In FY22, UMUCH technicians have participated in 18 car seat safety checks with a total of 111 car seats being checked for accurate installation. Of these 111 car seats, approximately 75% were incorrectly installed. The UMUCH program continues to grow and has become one of our busiest and most sought after community offerings. In addition to car seat safety, our community outreach team also manages Harford County's car seat assistance program that helps low-income families purchase car safety seats. Based on income, families with demonstrated need are able to receive a new car safety seat for little to no money. The program requires each family to have 60 minutes of car safety seat education, which covers proper seat installation and Maryland car seat laws. Chronic Disease and Wellness Evidence Based Programs With the ever-growing number of people who suffer from chronic diseases, the search for more effective strategies to both prevent and manage these conditions is essential. The use of evidence-based chronic disease self-management programs (CDSMP) is helping people with chronic conditions and their caregivers gain better control over and improve their health. These programs focus on overall health, quality of life and well-being and are designed for both the ill and healthy, empowering them to manage the many factors that affect their health. Facilitators introduce tools needed for daily life when an individual is battling a chronic condition or illness. Participants practice using self-management skills, focus on goal setting and share experiences which can help promote mutual support. Highly interactive, these programs serve as an adjunct to the care provided by primary care doctors and specialists. At UMUCH, a variety of self-management programs are offered by the experts in our Community Outreach department: * Diabetes Prevention Program -A lifestyle change yearlong program facilitated by trained lifestyle coaches to help individuals lose weight, eat healthier, increase physical activity and manage stress. The program consists of weekly and monthly sessions. The goal of the program is to have participants lose 5 to 7% of their body weight and increase their activity to 150 minutes per week. Three classes took place with a total of 31 participants. * Living Well with Diabetes Self-Management - designed for people with Type 1, Type 2, or Pre-diabetes. It is a free six-week program that teaches individuals how to manage their diabetes, ways to maintain or increase their activity level and how the food they eat can affect their blood sugar. Four sessions were provided took place with a total of 26 participants. Flu Clinic Program UMUCH's longstanding flu clinic program was offered throughout the county free of charge or for a nominal free. In FY22, community outreach administered 415 vaccines at 26 different locations. HealthLink Call Center The HealthLink Call Center is responsible for successfully managing large amounts of inbound and outbound calls focusing on physician referrals and registration for community outreach events and programs. In FY22, our call center handled approximately 4,192 calls. Healthy Harford Healthy Harford/Healthy Cecil is the healthy communities' initiative of Harford and Cecil Counties, dedicated to the health and wellness of the northern Chesapeake community - in mind body and spirit. It was formed by leaders from UMUCH, the Harford County Health Department, and Harford County Government - Healthy Harford/Healthy Cecil is a coalition of local government agencies, businesses, nonprofits, and citizens dedicated to improving the health of Harford and Cecil County residents through education, policy changes, improvements in the built environment, increased access to care, and improved care coordination for people with chronic illness. Healthy Harford/Healthy Cecil is financially supported by UMUCH."