4A (Expenses $ 24876571 including grants of $ 0) (Revenue $ 22906691)
SEE SCHEDULE O.

SCHEDULE H, PART V, SECTION B, LINE 5:
THE CHNA TEAM USED A MULTI-PRONGED APPROACH TO SOLICIT INPUT FROM THE WEST BALTIMORE COMMUNITY REGARDING THEIR HEALTH NEEDS. DATA COLLECTION METHODOLOGIES INCLUDED SURVEYS, STAKEHOLDER INTERVIEWS, AND FOCUS GROUPS. THE TEAM ENGAGED WITH REPRESENTATIVES OF THE COMMUNITY (E.G., MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE AND THE BALTIMORE CITY HEALTH DEPARTMENT) WHO HAD KNOWLEDGE OF PUBLIC HEALTH ISSUES AND INSIGHT INTO THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY THE ORGANIZATION AS WELL AS THE SPECIFIC NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND VULNERABLE POPULATIONS, AND PEOPLE WITH CHRONIC DISEASES. THE CHNA WORK GROUP MET WITH SENIORS, RE-ENTRY RESIDENTS, FAITH-BASED STAKEHOLDERS, COMMUNITY LEADERS, HEALTH CARE PROVIDERS, NEIGHBORHOOD ASSOCIATIONS, REPRESENTATIVES FROM COMMUNITY-BASED ORGANIZATIONS AND OTHER KEY COMMUNITY STAKEHOLDERS WITH AN INTIMATE KNOWLEDGE OF THE WEST BALTIMORE COMMUNITY AND ITS HEALTH NEEDS. TWO HUNDRED SEVENTY-THREE (273) SURVEYS WERE COLLECTED WITHIN THE DEFINED SERVICE AREA. ELEVEN (11) STAKEHOLDER INTERVIEWS AND THREE (3) FOCUS GROUPS WERE CONDUCTED BETWEEN JANUARY AND MARCH 2020. ALL METHODS FOCUSED ON COMMUNITY HEALTH NEEDS, COMMUNITY ASSETS AND RESOURCES AVAILABLE TO RESPOND TO THE COMMUNITY HEALTH NEEDS, BARRIERS AND CHALLENGES TO ACCESSING THE COMMUNITY ASSETS AND RESOURCES, AND WAYS IN WHICH GRACE MEDICAL CENTER COULD HELP ADDRESS THE HEALTH NEEDS.

SCHEDULE H, PART V, SECTION B, LINE 7A:
HTTPS://WWW.LIFEBRIDGEHEALTH.ORG/UPLOADS/PUBLIC/DOCUMENTS/POPULATION%20HEA LTH/GRACE%20MEDICAL%20CENTER_CHNA_FINAL.PDF

SCHEDULE H, PART V, SECTION B, LINE 7D:
COPIES OF THE CHNA WERE DISTRIBUTED TO KEY COMMUNITY PARTNERS.

SCHEDULE H, PART V, SECTION B, LINE 10A:
https://www.lifebridgehealth.org/Uploads/Public/Documents/Grace%20Medical% 20Center/Grace-Medical-Center-Implementation-Plan.pdf

SCHEDULE H, PART V, SECTION B, LINE 11:
"GRACE MEDICAL CENTER CHNA IMPLEMENTATION PLAN IN THE WINTER AND SPRING OF 2019 BON SECOURS HOSPITAL IN SOUTHWEST BALTIMORE CONDUCTED ITS TRI-ANNUAL COMMUNITY HEALTH NEEDS ASSESSMENT (""CHNA""). THE CHNA INCLUDED COMMUNITY MEETINGS, SURVEYS AND INTERVIEWS WITH THOSE WHO HAVE A KNOWLEDGE OF PUBLIC HEALTH, THE BROAD INTERESTS OF THE COMMUNITY SERVED, AS WELL AS SPECIAL KNOWLEDGE OF THE MEDICALLY UNDERSERVED, LOW-INCOME AND VULNERABLE POPULATIONS AND PEOPLE WITH CHRONIC CONDITIONS. THE CHNA WAS COMPLETED AND APPROVED BY THE HOSPITAL BOARD OF DIRECTORS IN JULY 2020. THE FOLLOWING HEALTH AND SOCIAL CONDITIONS WERE IDENTIFIED AS SIGNIFICANT NEEDS OF THE COMMUNITY BEING SERVED: - BEHAVIORAL HEALTH/SUBSTANCE ABUSE/OPIOIDS - CRIME AND RELATED TRAUMA - CHRONIC CONDITIONS - HOUSING AND HOMELESSNESS - ACCESS TO PRIMARY PHYSICIANS - COMMUNITY ENGAGEMENT - CHILDREN'S HEALTH - EMPLOYMENT & WORKFORCE DEVELOPMENT - HEALTH EDUCATION WITHIN THE PUBLIC EDUCATION SYSTEM - TRANSPORTATION - ACCESS TO HEALTHY FOODS - SUPPORT FOR SENIOR SERVICES - YOUTH SERVICES (AGES 5-18) - FINANCIAL COUNSELING AND LITERACY - COORDINATION OF SERVICES ACROSS COMMUNITY PRIOR TO DEVELOPMENT OF AN ASSOCIATED CHNA IMPLEMENTATION PLAN, BON SECOURS HOSPITAL WAS SOLD TO LIFEBRIDGE HEALTH, A MULTI-HOSPITAL HEALTH SYSTEM WITHIN MARYLAND. BON SECOURS HOSPITAL WAS RENAMED GRACE MEDICAL CENTER. IN THE SPRING OF 2021, THE LEADERSHIP OF GRACE MEDICAL CENTER REVIEWED THE COMPLETED CHNA AND PRIORITIZED THE FOLLOWING IDENTIFIED NEEDS FOR DEVELOPMENT OF A CHNA IMPLEMENTATION PLAN FOR APPROVAL AND ADOPTION BY ITS BOARD: - BEHAVIORAL HEALTH/SUBSTANCE ABUSE/OPIOIDS - ACCESS TO PRIMARY AND SPECIALTY CARE PROVIDERS - CHRONIC CONDITIONS - CRIME AND TRAUMA - COMMUNITY ENGAGEMENT & DEVELOPMENT - TRANSPORTATION FOR ITS HOSPITALS' 2018 CHNA IMPLEMENTATION PLANS LIFEBRIDGE HEALTH ORGANIZED ITS PRIORITIZED NEEDS INTO THREE MAJOR CATEGORIES: HEALTH, SOCIAL AND ENVIRONMENTAL, AND ACCESS AND DEVELOPED SPECIFIC GOALS AND ACTIONS. SIMILARLY, GRACE MEDICAL CENTER HAS DEVELOPED A SIMILAR IMPLEMENTATION PLAN FOR THE PRIORITIZED NEEDS ABOVE CONSISTENT WITH THE LIFEBRIDGE HEALTH MODEL. HEALTH -BEHAVIORAL HEALTH/SUBSTANCE ABUSE/OPIOIDS: SUBSTANCE ABUSE TREATMENT PROGRAMMING TO PREVENT OVERDOSE FATALITIES AMONG ENROLLEES IN OPIOID TREATMENT PROGRAMS AS WELL AS THE SOUTHWEST BALTIMORE COMMUNITY IN GENERAL. IMPROVE THE HEALTH STATUS OF RESIDENTS OF SOUTHWEST BALTIMORE BY INCREASING THE NUMBER OF SBIRT INTERVENTIONS AND OVERDOSE SURVIVOR'S OUTREACH PROGRAM (OSOP) REFERRALS. GRACE MEDICAL'S SCREENING BRIEF INTERVENTION REFERRAL TO TREATMENT (""SBIRT"") IS DESIGNED SO THAT ALL PATIENTS THAT ENTER THE HOSPITAL THROUGH THE EMERGENCY DEPARTMENT OR THROUGH A DIRECT ADMISSION ARE SCREENED BY HOSPITAL NURSING STAFF AS PART OF THE NURSING ASSESSMENT. NURSES AND OTHER MEMBERS OF THE HEALTH CARE TEAM REFER PATIENTS AT HIGH RISK TO PEER RECOVERY COACHES (PRCO) TO PROVIDE BRIEF INTERVENTIONS AND REFERRALS TO TREATMENT. -AMBULATORY CLINICS (PRIMARY CARE, MULTI-SPECIALTY, AND PEDIATRIC): IMPROVE AND EXPAND ACCESS TO PRIMARY CARE, PREVENTIVE SERVICES, AND SPECIALTY CARE. IMPROVE THE HEALTH OF THE COMMUNITY BY INCREASING THE NUMBER OF PEOPLE CONNECTED TO A PRIMARY CARE MEDICAL HOME AND INCREASING ANNUAL PRIMARY CARE VISITS -CARE TRANSITIONS, CASE MANAGEMENT, AND COMMUNITY PROGRAMS: IMPROVE THE HEALTH STATUS OF SOUTHWEST BALTIMORE RESIDENTS BY ENGAGING THE COMMUNITY IN SCREENINGS AND EDUCATIONAL EVENTS THAT PROMOTE HEALTHIER LIFESTYLES AND BETTER SELF-MANAGEMENT OF HEALTH AND CHRONIC CONDITIONS. IMPROVE MANAGEMENT OF CHRONIC CONDITIONS BY EARLY IDENTIFICATION OF PATIENTS AT RISK, PROVISION OF CARE, MANAGEMENT OF THOSE WITH CHRONIC CONDITIONS, AND ENROLLMENT INTO CARE MANAGEMENT AND/OR CARE TRANSITIONS PROGRAMS SOCIAL AND ENVIRONMENTAL -CRIME AND TRAUMA: 1. PROVIDE VIOLENCE INTERVENTION & PREVENTION AWARENESS TRAINING FOR ALL GMC STAFF ON ALL FORMS OF VIOLENCE & ABUSE 2. ASSESS NEED FOR ONSITE VIOLENCE RESPONDERS & COMMUNITY VIOLENCE INTERRUPTERS (I.E. ESTABLISH A SAFE STREETS SITE) TO ENSURE THAT PATIENTS WHO HAVE BEEN VICTIMS OF GUN VIOLENCE, STABBINGS, DOMESTIC VIOLENCE, ELDER ABUSE, AND OTHER FORMS OF VIOLENCE HAVE THE SUPPORT NEEDED WHILE AT GRACE MEDICAL AND WITHIN THE COMMUNITY 3. PROVIDE CASE MANAGEMENT, INCLUDING INDIVIDUALIZED NEEDS ASSESSMENTS, TAILORED CASE PLANNING, AND COMMUNITY-BASED CLIENT ADVOCACY, FOR SURVIVORS OF VIOLENCE RELATED TRAUMA 4. PROVIDE TRAUMA RESPONSIVE MENTAL HEALTH SERVICES FOR SURVIVORS OF VIOLENCE RELATED TRAUMA 5. PROVIDE SCHOOL-BASED VIOLENCE PREVENTION SERVICES, INCLUDING ACADEMIC ENRICHMENT OPPORTUNITIES, LIFE SKILLS TRAINING, AND STUDENT SUPPORT GROUPS THROUGH AN EVIDENCE-BASED VIOLENCE PREVENTION CURRICULUM -COMMUNITY ENGAGEMENT AND DEVELOPMENT: MULTIPLE COMMUNITY-BASED INITIATIVES TO ADDRESS KEY HEALTH AND SOCIO-ECONOMIC CHALLENGES IN WEST BALTIMORE. PROMOTE QUALITY, HEALTHY FOOD ACCESS IN WEST BALTIMORE THROUGH AN INITIATIVE, E.G. FOOD EDUCATION, FOOD MARKET OR ORGANIZATIONAL PARTNERSHIP. EXPAND LIFEBRIDGE HEALTH LIVE NEAR YOUR WORK PROGRAM IN THE WEST BALTIMORE SERVICE AREA. IN PARTNERSHIP WITH POPULATION HEALTH AND BALTIMORE CHILD ABUSE CENTER (BCAC), OFFER TWO HEALTH EDUCATION-BASED WORKSHOPS AND/OR EVENTS EACH YEAR TO THE WEST BALTIMORE COMMUNITY. BUILD PARTNERSHIPS WITH TWO WORKFORCE DEVELOPMENT ORGANIZATIONS AND CONDUCT TWO OUTREACH EVENTS PER YEAR TO CONNECT AREA RESIDENTS TO EMPLOYMENT OPPORTUNITIES. ACCESS -TRANSPORTATION: PROVIDE TRANSPORTATION TO COMMUNITY RESIDENTS FOR CLINIC APPOINTMENTS AND DIALYSIS TREATMENTS THE FOLLOWING NEEDS WERE NOT SPECIFICALLY INCLUDED IN THE IMPLEMENTATION PLAN AS THE NEEDS ARE BEING ADDRESSED IN CONJUNCTION WITH OTHER PARTNERING ORGANIZATIONS THAT HAVE NUMEROUS PROGRAMS AND SERVICES AVAILABLE TO ADDRESS MANY OF THE IDENTIFIED COMMUNITY HEALTH NEEDS. - HOUSING AND HOMELESSNESS - COMMUNITY ENGAGEMENT- EMPLOYMENT & WORKFORCE DEVELOPMENT - HEALTH EDUCATION WITHIN THE PUBLIC EDUCATION SYSTEM - ACCESS TO HEALTHY FOODS - SUPPORT FOR SENIOR SERVICES - YOUTH SERVICES (AGES 5-18) - FINANCIAL COUNSELING AND LITERACY - COORDINATION OF SERVICES ACROSS COMMUNITY"

SCHEDULE H, PART V, SECTION B, LINE 16A:
https://www.lifebridgehealth.org/Main/LifeBridgeHealthFinancialAssistance. aspx

SCHEDULE H, PART V, SECTION B, LINE 16B:
https://www.lifebridgehealth.org/Main/LifeBridgeHealthFinancialAssistance. aspx

SCHEDULE H, PART V, SECTION B, LINE 16C:
https://www.lifebridgehealth.org/Main/LifeBridgeHealthFinancialAssistance. aspx

SCHEDULE H, PART V, SECTION B, LINE 22C:
CHARGES FOR ALL HOSPITAL PATIENTS ARE STATE REGULATED. SERVICES ARE CHARGED TO ALL HOSPITAL PATIENTS AT THE SAME RATE. CHARGES FOR INDIVIDUALS FOUND ELIGIBLE FOR FAP BASED ON 300% OR LESS OF THE FEDERAL POVERTY LEVEL (FPL) ARE WRITTEN-OFF IN FULL TO FAP (THERE IS NO PATIENT LIABILITY). CHARGES FOR INDIVIDUALS WHOSE PRESUMPTIVE FPL SCORE IS <200 ARE WRITTEN OFF TO FAP IN FULL (THERE IS NO PATIENT LIABILITY). CHARGES FOR INDIVIDUALS FOUND ELIGIBLE FOR FAP BASED ON THE HSCRC'S FINANCIAL HARDSHIP CRITERIA OF 301%-500% OF FPL ARE CHARGED NO MORE THAN 25% OF THE ANNUAL HOUSEHOLD INCOME PER THE HSCRC'S FINANCIAL HARDSHIP CRITERIA. THE DIFFERENCE BETWEEN THE TOTAL CHARGES AND THE CALCULATED 25% OF THE ANNUAL HOUSEHOLD INCOME IS WRITTEN OFF TO FAP.

SCHEDULE H, PART I, LINE 3C:
GRACE MEDICAL CENTER, INC. PROVIDES SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY. IT DOES NOT PURSUE THE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE AND THOSE AMOUNTS ARE NOT REPORTED AS REVENUE. THE CRITERIA CONSIDER GROSS INCOME AND FAMILY SIZE ACCORDING TO CURRENT FEDERAL POVERTY GUIDELINES. TO QUALIFY, THE PATIENT MUST SHOW PROOF OF INCOME 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. A SLIDING SCALE IS USED TO DETERMINE ELIGIBILITY FOR THOSE WHOSE INCOME EXCEEDS 300%. ELIGIBILITY IS CALCULATED BASED ON THE NUMBER OF PEOPLE LIVING IN THE HOUSEHOLD. THE PROGRAM COVERS UNINSURED, UNDER-INSURED AND PATIENT LIABILITY AFTER INSURANCE(S) PAY. APPROVALS ARE GRANTED FOR A TWELVE MONTH PERIOD OF TIME AND PATIENTS ARE ENCOURAGED TO RE-APPLY FOR CONTINUED ELIGIBILITY.

SCHEDULE H, PART I, LINE 7:
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 PAYOR'S RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAK-OUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. THE COST OF RENDERING SERVICES FOR MEDICAL ASSISTANCE PATIENTS IS APPROXIMATELY EQUAL TO MEDICAID REVENUES IN MARYLAND. THUS, THE NET EFFECT IS APPROXIMATELY ZERO. THE EXCEPTION TO THIS IS THE IMPACT ON THE HOSPITAL OF ITS SHARE OF THE MEDICAID ASSESSMENT. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM.

SCHEDULE H, PART I, LINE 7A - I:
THE FOLLOWING COSTING METHODOLOGIES WERE USED TO CALCULATE LINES 7A THROUGH 7I ON THE COMMUNITY BENEFIT REPORT. OFFSETTING REVENUE - REVENUE FROM THE ACTIVITY DURING THE YEAR THAT OFFSETS THE TOTAL COMMUNITY BENEFIT EXPENSE OF THAT ACTIVITY. IT INCLUDES ANY REVENUE GENERATED BY THE ACTIVITY OR PROGRAM, SUCH AS A PAYMENT OR REIMBURSEMENT FOR SERVICES PROVIDED TO PROGRAM PATIENTS. OFFSETTING REVENUE INCLUDES RESTRICTED GRANTS OR CONTRIBUTIONS USED TO PROVIDE A COMMUNITY BENEFIT, BUT DOES NOT INCLUDE UNRESTRICTED GRANTS OR CONTRIBUTIONS THAT THE ORGANIZATION USES TO PROVIDE COMMUNITY BENEFIT. DIRECT COSTS - DIRECT COSTS INCLUDE SALARIES, EMPLOYEE BENEFITS, SUPPLIES, INTEREST ON FINANCING, TRAVEL AND OTHER COSTS THAT ARE DIRECTLY ATTRIBUTABLE TO THE SPECIFIC SERVICE AND THAT WOULD NOT EXIST IF THE SERVICE OR EFFORT DID NOT EXIST. INDIRECT COSTS - INDIRECT COSTS ARE COSTS NOT ATTRIBUTED TO PRODUCTS AND/OR SERVICES THAT ARE INCLUDED IN THE CALCULATION OF COSTS FOR COMMUNITY BENEFIT. THESE COULD INCLUDE, BUT ARE NOT LIMITED TO, SALARIES FOR HUMAN RESOURCES AND FINANCE DEPARTMENTS, INSURANCE AND OVERHEAD EXPENSES

SCHEDULE H, PART I, LINE 7G:
PART II, COMMUNITY BUILDING ACTIVITIES: GRACE MEDICAL CENTER, INC. ADDRESSES VARIOUS COMMUNITY CONCERNS INCLUDING HEALTH IMPROVEMENT, POVERTY, WORKFORCE DEVELOPMENT, AND ACCESS TO HEALTH CARE. GRACE MEDICAL CENTER, INC. CONDUCTS COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH FAIRS AND SCREENINGS FOR THE COMMUNITIES SERVED. GRACE MEDICAL CENTER, INC. WORKS WITH STATE AND LOCAL LEADERSHIP TO ADDRESS COMMUNITY NEEDS AND PROVIDE HEALTHCARE SERVICES TO THE POOR AND UNDERSERVED.

SCHEDULE H, PART III, LINE 2:
BAD DEBT EXPENSE IS ESTIMATED BY USING HISTORICAL RATES FOR EACH PAYOR AND THE LENGTH OF TIME THE RECEIVABLE HAS BEEN OUTSTANDING. THESE RATES ARE REVISITED FROM TIME TO TIME AND ADJUSTED WHEN DEEMED APPROPRIATE. ANY ADDITIONAL RESERVES ARE DETERMINED BY THE HOSPITAL'S EXECUTIVES.

SCHEDULE H, PART III, LINE 3:
GRACE MEDICAL CENTER, INC. DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH OTHER VARIOUS MEANS SUCH AS ELIGIBLE FOR NON-REIMBURSABLE MEDICAID PROGRAMS, ENROLLED IN MEANS-TESTED SOCIAL PROGRAMS, ENROLLED IN STATE OF MARYLAND GRANT FUNDED PROGRAMS WHERE REIMBURSEMENT IS LESS THAN THE CHARGE, OUT-OF-STATE MEDICAID PROGRAMS, MARYLAND MEDICAID ELIGIBLE AFTER ADMISSION, MARYLAND MEDICAID AND IF THE PATIENT WAS DENIED MEDICAID FOR NOT MEETING DISABILITY REQUIREMENTS.

SCHEDULE H, PART III, LINE 4:
ALL PATIENT ACCOUNTS ARE HANDLED CONSISTENTLY AND APPROPRIATELY TO MAXIMIZE CASH FLOW AND TO IDENTIFY BAD DEBT ACCOUNTS TIMELY. ACTIVE ACCOUNTS ARE CONSIDERED BAD DEBT ACCOUNTS WHEN THEY MEET SPECIFIC COLLECTION ACTIVITY GUIDELINES AND/OR ARE REVIEWED BY THE APPROPRIATE MANAGEMENT AND DEEMED TO BE UNCOLLECTIBLE. EVERY EFFORT IS MADE TO IDENTIFY AND PURSUE ALL ACCOUNT BALANCE LIQUIDATION OPTIONS, INCLUDING BUT NOT LIMITED TO THIRD PARTY PAYOR REIMBURSEMENT, PATIENT PAYMENT ARRANGEMENTS, MEDICAID ELIGIBILITY AND FINANCIAL ASSISTANCE. THIRD PARTY RECEIVABLE MANAGEMENT AGENCIES PROVIDE EXTENDED BUSINESS OFFICE SERVICES AND INSURANCE OUTSOURCE SERVICES TO ENSURE MAXIMUM EFFORT IS TAKEN TO RECOVER INSURANCE AND SELF-PAY DOLLARS BEFORE TRANSFER TO BAD DEBT. CONTRACTUAL ARRANGEMENTS WITH THIRD PARTY COLLECTION AGENCIES WERE USED TO ASSIST IN THE RECOVERY OF BAD DEBT AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. IN SO DOING, THE COLLECTION AGENCIES MUST OPERATE CONSISTENTLY WITH THE GOAL OF MAXIMUM BAD DEBT RECOVERY AND STRICT ADHERENCE WITH FAIR DEBT COLLECTIONS PRACTICES ACT (FDCPA) RULES AND REGULATIONS, WHILE MAINTAINING POSITIVE PATIENT RELATIONS

SCHEDULE H, PART III, LINE 8:
COSTING METHODOLOGY - MEDICARE ALLOWABLE COSTS, TOTAL REVENUE RECEIVED FROM MEDICARE (DSH & IME) AND MEDICARE ALLOWABLE COSTS ARE DERIVED FROM THE ANNUAL MEDICARE COST REPORT. THE INPATIENT ROUTINE COSTS ARE DERIVED FROM THE STEP-DOWN METHODOLOGY BASED ON ACCEPTED STATISTICAL ALLOCATION WITH A UNIFORM PER DIEM COST FOR EACH PAYOR TYPE. THE ANCILLARY MEDICARE ALLOWABLE COSTS ARE INITIALLY DERIVED FROM THE STEP-DOWN METHODOLOGY BUT ARE ALLOCATED TO THE PAYOR TYPES BASED ON THE RATIO OF COST TO CHARGE FOR EACH PAYOR.

SCHEDULE H, PART VI, LINE 6:
SINCE NOVEMBER 1, 2019, GRACE MEDICAL HAS BEEN A COMPONENT OF LIFEBRIDGE HEALTH, A NONPROFIT HEALTH SYSTEM THAT PROVIDES A WIDE VARIETY OF HEALTH CARE AND RELATED SERVICES TO THE RESIDENTS OF CENTRAL MARYLAND. THE COMPONENTS OF THE LIFEBRIDGE SYSTEM WORK TOGETHER CLOSELY TO ENSURE THAT AS MANY AS POSSIBLE OF THE COMMUNITY'S NEEDS ARE MET IN AN INTEGRATED NONDUPLICATIVE MANNER.

SCHEDULE H, PART VI, LINE 7:
THE COMMUNITY BENEFIT REPORT IS FILED IN THE STATE OF MARYLAND.

SCHEDULE H, PART III, LINE 9B:
PATIENTS CAN BE DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE (F.A.) PROSPECTIVELY OR RETROSPECTIVELY. THE F.A. ELIGIBILITY PERIOD EXPIRES ONE YEAR FROM THE MONTH ELIGIBILITY IS APPROVED FOR MEDICALLY NECESSARY SERVICES. THE PATIENT IS ASKED TO PROVIDE THE F.A. APPROVAL LETTER FOR SERVICES PROVIDED WITHIN THE ELIGIBILITY PERIOD. THE HOSPITAL WILL MAKE EVERY EFFORT TO IDENTIFY PATIENTS ELIGIBLE FOR F.A., ALTHOUGH HOSPITAL SYSTEMS DO NOT ALLOW FOR THIS TO BE AUTOMATED. BALANCES APPROVED FOR FINANCIAL ASSISTANCE ARE WRITTEN-OFF TO A ZERO BALANCE AND THEREFORE NOT PURSUED BY INTERNAL COLLECTION PROCESSES OR THIRD PARTY AGENCIES. BALANCES ALREADY PLACED WITH THIRD PARTY AGENCIES ARE WRITTEN-OFF TO A ZERO BALANCE AND THE ACCOUNTS ARE CLOSED AND RETURNED BY THE THIRD PARTY AGENCY.

SCHEDULE H, PART VI, LINE 2:
GRACE MEDICAL CENTER ASSESSES AND CONTINUALLY RESPONDS TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. GRACE MEDICAL CENTER JOINS AN EXISTING COMMUNITY-BASED NEEDS ASSESSMENT EVERY THREE YEARS AND UPDATES ARE PROVIDED BETWEEN ASSESSMENTS. GRACE MEDICAL CENTER INCORPORATES PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. GRACE MEDICAL CENTER RECOGNIZES THE HEALTH OF THE COMMUNITY IS INFLUENCED BY SOCIAL, ECONOMIC, AND ENVIRONMENTAL FACTORS, NOT JUST BY DISEASE AND ILLNESS. OUR COMMUNITY BENEFIT ANALYSIS INCLUDES BOTH QUALITATIVE AND QUANTITATIVE DATA; DEMOGRAPHICS INCLUDING RACE, AGE, AND ETHNICITY; SOCIOECONOMIC DATA INCLUDING INCOME, EDUCATION, AND HEALTH INSURANCE RATES; PRIMARY CARE AND CHRONIC DISEASE NEEDS OF UNINSURED PERSONS; AND DATA ON HEALTH DISPARITIES IN HEALTH OUTCOMES AMONG MINORITY GROUPS. GRACE MEDICAL CENTER COMMUNITY BENEFITS COMMITTEES MEET TO PROVIDE OVERSIGHT TO THE ORGANIZATION'S COMMUNITY BENEFITS PROGRAM. GRACE MEDICAL CENTER WORKS CLOSELY WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS IN THE AREA, PARTNERING WITH SOME TO PROVIDE SERVICES TO AVOID DUPLICATION.

SCHEDULE H, PART VI, LINE 3:
THE FOLLOWING DESCRIBES MEANS USED AT GRACE MEDICAL CENTER TO INFORM AND ASSIST PATIENTS REGARDING ELIGIBLITY FOR FINANCIAL ASSISTANCE UNDER GOVERNMENTAL PROGRAMS AND THE HOSPITAL'S CHARITY CARE PROGRAM. FINANCIAL ASSISTANCE NOTICES, INCLUDING CONTACT INFORMATION, ARE POSTED IN THE BUSINESS OFFICE AND ADMITTING, AS WELL AS POINTS OF ENTRY AND REGISTRATION THROUGHOUT THE HOSPITAL. PATIENT FINANCIAL SERVICES BROCHURE 'FREEDOM TO CARE' IS AVAILABLE TO ALL INPATIENTS. BROCHURES ARE ALSO AVAILABLE IN ALL OUTPATIENT REGISTRATION AND SERVICE AREAS. GRACE MEDICAL EMPLOYS A FINANICAL ASSISTANCE LIAISON WHO IS AVAILABLE TO ANSWER QUESTIONS AND TO ASSIST PATIENTS AND FAMILY MEMBERS WITH THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE. A PATIENT INFORMATION SHEET IS MADE AVAILABLE TO ALL PATIENTS PRIOR TO DISCHARGE. GRACE MEDICAL'S UNINSURED (SELF-PAY) AND UNDER-INSURED (MEDICARE BENEFICIARY WITH NO SECONDARY) MEDICAL ASSISTANCE ELIGIBILITY PROGRAM SCREENS, ASSISTS WITH THE APPLICATION PROCESS AND ULTIMATELY CONVERTS PATIENTS TO VARIOUS MEDICAL ASSISTANCE COVERAGE AND INCLUDES ELIGIBILITY SCREENING AND ASSISTANCE WITH COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AS PART OF THAT PROCESS. ALL HOSPITAL STATEMENTS AND ACTIVE ACCOUNTS RECEIVABLE OUTSOURCE VENDORS INCLUDE A MESSAGE REFERENCING THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR THOSE WHO ARE EXPERIENCING FINANCIAL DIFFICULTY AND PROVIDES CONTACT INFORMATION TO DISCUSS GRACE'S FINANCIAL ASSISTANCE PROGRAM. COLLECTION AGENCIES' INITIAL STATEMENT REFERENCES THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR THOSE WHO ARE EXPERIENCING FINANCIAL DIFFICULTY AND PROVIDES CONTACT INFORMATION TO DISCUSS GRACE'S FINANCIAL ASSISTANCE PROGRAM. ALL HOSPITAL PATIENT FINANCIAL SERVICES STAFF, ACTIVE ACCOUNTS RECEIVABLE OUTSOURCE VENDORS, COLLECTION AGENCIES AND MEDICAID ELIGIBILITY VENDORS ARE TRAINED TO IDENTIFY POTENTIAL FINANCIAL ASSISTANCE ELIGIBILITY AND ASSIST PATIENTS WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. FINANCIAL ASSISTANCE APPLICATION AND INSTRUCTIONS COVER SHEET IS AVAILABLE IN RUSSIAN, SPANISH AND FRENCH. GRACE MEDICAL HOSTS AND PARTICIPATES IN VARIOUS DEPARTMENT OF HEALTH AND MENTAL HYGIENE AND MARYLAND HOSPITAL ASSOCIATION SPONSORED CAMPAIGNS LIKE 'COVER THE UNINSURED WEEK'.

SCHEDULE H, PART VI, LINE 4:
GRACE MEDICAL'S SERVICE AREA INCLUDES 40.5% OF BALTIMORE CITY'S POPULATION. GRACE MEDICAL'S SERVICE AREA IS SIMILAR TO BALTIMORE CITY AND MARYLAND IN REGARD TO AGE AND GENDER, BUT IS DIFFERENT IN TERMS OF RACE/ETHNICITY AND INCOME. THE AREA HAS A LOWER HOUSEHOLD INCOME AND A LARGER PROPORTION OF AFRICAN AMERICANS THAN BALTIMORE CITY AND MARYLAND. THE AREA ALSO EXPERIENCES A HIGHER RATE OF PUBLIC INSURANCE THAN MARYLAND. WITHIN GRACE MEDICAL'S SERVICE AREA'S SEVEN ZIP CODES THERE IS WIDE VARIATION. ZIP CODES 21217 AND 21223 HAVE A POPULATION THAT IS YOUNGER THAN THE OTHER ZIP CODES, WHILE 21215 AND 21216 HAVE A POPULATION THAT IS OLDER THAN THE OTHER ZIP CODES. THERE IS ALSO WIDE VARIATION IN RACE/ETHNICITY AND INSURANCE COVERAGE WITHIN THE AREA. OVERALL, THE AREA IS A MAJORITY AFRICAN AMERICAN, LOW INCOME, AND IN MOST ZIP CODES PUBLICLY INSURED. 40.5% OF BALTIMORE CITY'S RESIDENTS ARE WITHIN GRACE MEDICAL'S SERVICE AREA. ZIP CODES 21215, 21229, AND 21217 COMPRISE THE LARGEST SEGMENTS OF THE AREA, AND REPRESENT 59.6% OF THE TOTAL RESIDENTS IN THE AREA. HOUSEHOLD INCOMES ARE MUCH LOWER IN THE AREA ON AVERAGE THAN THE STATE OF MARYLAND AND BALTIMORE CITY. 29.9% HAVE AN INCOME UNDER $25,000. 55.1% OF HOUSEHOLD INCOMES ARE BELOW $50,000, WHEREAS 50.3% OF BALTIMORE CITY AND 26.3% OF MARYLAND HOUSEHOLD INCOMES ARE BELOW $50,000. 57.3% OF MARYLAND HOUSEHOLD INCOMES ARE $75,000 OR OVER, WHILE 27.6% OF GRACE MEDICAL'S SERVICE AREA HOUSEHOLDS HAVE AN INCOME OF $75,000 OR OVER. THE AREA HAS A HIGHER PERCENT OF INDIVIDUALS THAT HAVE PUBLIC INSURANCE COMPARED TO MARYLAND. MORE THAN 30% OF THEIR POPULATION IS ENROLLED IN PUBLIC INSURANCE. THERE IS ALSO A HIGHER PROPORTION OF UNINSURED PERSONS COMPARED TO BALTIMORE AND MARYLAND. FOUR OF 7 ZIP CODES WITHIN THE GRACE MEDICAL SERVICE AREA HAVE 50% OR MORE OF THEIR POPULATION ENROLLED IN PUBLIC INSURANCE. THE GRACE MEDICAL SERVICE AREA ALSO HAS ONE OF THE HIGHEST DISEASE BURDEN AND SOME OF THE WORST INDICATORS OF SOCIAL DETERMINANTS OF HEALTH OF ANY COMMUNITY IN MARYLAND. THESE NEIGHBORHOODS ESTABLISH THE LOWER EXTREMES FOR HEALTH DISPARITIES IN THE CITY AND THE STATE ACROSS ALL MAJOR CHRONIC ILLNESSES. FAMILIES IN THE ZONE EXPERIENCE POVERTY (20%) AT HIGHER RATES THAN THOSE IN MARYLAND (6%) AND IN BALTIMORE CITY (17%). LIFE EXPECTANCY CAN BE UP TO 12 YEARS SHORTER IN THESE ZIP CODES THAN IN OTHER PARTS OF MARYLAND.

SCHEDULE H, PART VI, LINE 5:
GRACE MEDICAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, GRACE MEDICAL ALSO PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. GRACE MEDICAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. GRACE MEDICAL'S EMERGENCY DEPARTMENT TREATS A LARGE NUMBER OF PATIENTS WHO USE THE FACILITY FOR PRIMARY CARE NEEDS. PATIENT DEMOGRAPHICS REFLECT THE CHANGING COMMUNITY. AS IN OTHER COMMUNITIES, SOME AREA PHYSICIANS PLACE LIMITS ON THEIR ACCEPTANCE OF MEDICAID PATIENTS. IN ADDITION, SOME PRIMARY CARE PHYSICIANS REFER PATIENTS WITH AFTERHOURS NEEDS DIRECTLY TO AREA EMERGENCY ROOMS. COMMUNITY GROUPS AND INDIVIDUALS ARE VERY SUPPORTIVE OF GRACE MEDICAL CENTER.