4A (Expenses $ 192669433 including grants of $ 1273443) (Revenue $ 231636218)
SEE SCHEDULE O

4B (Expenses $ 21108142 including grants of $ 0) (Revenue $ 26387167)
CARROLL COUNTY RADIOLOGY - PROVIDING A FULL ARRAY OF RADIOLOGY SERVICES TO PATIENTS IN THE CARROLL COUNTY AREA.

PART V, SECTION B, LINE 5:
THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, AS WELL AS LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THE CHNA WRITTEN REPORT INCORPORATED EXPERTISE AND PARTICIPATION FROM SUCH COMMUNITY LEADERS AND REPRESENTATIVES, AS WELL AS LEADERS IN PUBLIC HEALTH, INCLUDING REPRESENTATIVES FROM THE CARROLL COUNTY HEALTH DEPARTMENT. AS PART OF THE CHNA, A KEY INFORMANT SURVEY OF 56 COMMUNITY LEADERS FROM A BROAD RANGE OF SECTORS, INCLUDING PUBLIC HEALTH AND MEDICAL SERVICES, NON-PROFIT AND SOCIAL ORGANIZATIONS, CHILDREN AND YOUTH AGENCIES, AND THE BUSINESS COMMUNITY, WAS CONDUCTED. IN ADDITION, THE CHNA INCLUDES FINDINGS FROM THE MARYLAND STATE HEALTH IMPROVEMENT PROCESS (SHIP) AND LOCAL HEALTH DEPARTMENT IMPROVEMENT PLAN. FURTHERMORE, LEADERS FROM THE CARROLL COUNTY HEALTH DEPARTMENT AND THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY ARE MEMBERS OF A COMMITTEE THAT HELPS OVERSEE THE DEVELOPMENT AND EXECUTION OF THE CHNA PLAN.

PART V, SECTION B, LINE 7A AND 7B:
https://healthycarroll.org/wp-content/uploads/2021/04/chna-final-consolida ted-report-2021.pdf

PART V, SECTION B, LINE 10A:
HTTPS://HEALTHYCARROLL.ORG/CB-HIP/

PART V, SECTION B, LINE 11:
PURSUANT TO THE CHNA UNDERTAKEN BY CARROLL HOSPITAL, 13 COMMUNITY HEALTH NEEDS WERE IDENTIFIED. THEN, WORKING COLLABORATIVELY, HOSPITAL AND COMMUNITY PUBLIC HEALTH LEADERS, AS WELL AS THE HOSPITAL'S COMMUNITY BENEFIT PLANNING COMMITTEE, BEGAN PRIORITIZING THE FOCUS FOR ACTION IN THE NEXT THREE YEARS. IN PARTICULAR, A JOINT STRATEGY MEETING WAS CONVENED TO HELP DETERMINE THE PRIORITIZATION OF THE IDENTIFIED COMMUNITY HEALTH NEEDS. DURING THE JOINT STRATEGY MEETING, EACH OF THE 13 IDENTIFIED COMMUNITY HEALTH NEEDS WAS ADDRESSED. THE 13 IDENTIFIED NEEDS WERE PRIORITIZTED BY HOSPITAL AND COMMUNITY PUBLIC HEALTH LEADERS ON THE FOLLOWING CRITERIA: SERIOUSNESS/SIGNIFICANCE/PERVASIVENESS AND THE ABILITY TO IMPACT. FINAL CRITERIA SELECTION WAS DETERMINED BY THE EXECUTIVE COUNCIL MEMBERS OF CARROLL HOSPITAL, IN COLLABORATION WITH THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY BOARD. PURSUANT TO THIS PRIORITIZATION PROCESS, IT WAS DETERMINED THAT THE NEEDS CARROLL HOSPITAL WOULD ATTEMPT TO ADDRESS WOULD BE NARROWED DOWN TO FOUR KEY COMMUNITY BENEFIT ISSUES, SO AS TO MAXIMIZE THE HOSPITAL'S RESOURCES TO ADDRESS NEEDS THE HOSPITAL FELT IT WAS IN THE BEST POSITION TO ATTEMPT TO MEET. THE NEEDS IN PRIORITY ORDER ARE: MENTAL HEALTH, DIABETES, CANCER, AND HEART HEALTH. OBESITY EFFORTS THAT ARE INTERRELATED WITH THE KEY ISSUES OF DIABETES, CANCER AND HEART HEALTH WILL BE A MAIN CONCENTRATION. THESE SAME FOUR KEY ISSUES WILL SIMULTANEOUSLY BE ADDRESSED COLLABORATIVELY WITH OTHER COMMUNITY PARTNERS UNDER THE LEADERSHIP OF THE PARTNERSHIP. IDENTIFIED NEEDS NOT SPECIFICALLY ADDRESSED: AREAS NOT SPECIFICALLY ADDRESSED IN THE HOSPITAL'S PLAN WERE ADDRESSED THROUGH CARROLL COUNTY HEALTH DEPARTMENT'S LOCAL HEALTH IMPROVEMENT PLAN, SUCH AS ILLEGAL SUBSTANCE ABUSE AND OTHER ADDICTIONS. AREAS SUCH AS PHYSICAL INACTIVITY AND AGE-RELATED DISEASES WILL BE ADDRESSED THROUGH THE PARTNERSHIPS ADVANCING HEALTH AND HEALTHY AGING LEADERSHIP TEAMS.

PART V, SECTION B, LINE 16A, FAP:
https://www.lifebridgehealth.org/main/financial-assistance

PART V, SECTION B, LINE 16B, FAP APPLICATION:
https://www.lifebridgehealth.org/main/financial-assistance

PART V, SECTION B, LINE 16C, FAP PLAIN LANGUAGE SUMMARY:
https://www.lifebridgehealth.org/main/financial-assistance

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 CAPPED AT 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 AS CHARITY CARE.

PART I, LINE 3C:
CARROLL HOSPITAL 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 CONSIDERS GROSS INCOME AND FAMILY SIZE ACCORDING TO CURRENT FEDERAL POVERTY GUIDELINES. TO QUALIFY, THE PATIENT MUST HAVE INCOME OF 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.

PART I, LINE 6A:
Carroll Hospital Center, Inc. is included in the Community Health Needs assessment (CHNA) of The Partnership for a Healthier Carroll County.

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 PAYORS' RATES, WHICH DOES NOT ENABLE MARYLAND HOSPITALS TO BREAK-OUT ANY OFFSETTING REVENUE RELATED TO UNCOMPENSATED CARE. IN RECENT YEARS, THE STATE OF MARYLAND HAS CLOSED FISCAL GAPS IN THE STATE MEDICAID BUDGET BY ASSESSING HOSPITALS THROUGH THE RATE-SETTING SYSTEM.

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. PART I, LINE 7E: CARROLL HOSPITAL PROVIDES MEDICAL SERVICES TO ACCESS CARROLL PATIENTS. FOUNDED IN 2005, ACCESS CARROLL IS A JOINT VENTURE BETWEEN CARROLL HOSPITAL, THE CARROLL COUNTY HEALTH DEPARTMENT AND THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY THAT PROVIDES FREE HEALTH CARE TO UNINSURED, LOW-INCOME CARROLL COUNTY RESIDENTS WHO MEET CERTAIN ELIGIBILITY REQUIREMENTS. ACCESS CARROLL CONSISTS OF A HEALTH CARE TEAM INVOLVING VOLUNTEER PHYSICIANS, NURSES AND OTHER MEDICAL PROFESSIONALS WHO WORK TOGETHER TO PROVIDE PATIENTS WITH PRIMARY MEDICAL CARE. MEDICATION ASSISTANCE, SPECIALITY CARE, DIAGNOSTIC AND LABORATORY TESTING, AND PATIENT EDUCATION ARE ALSO AVAILABLE ONSITE. CARROLL HOSPITAL INCURRED $ 1,074,713 IN COST TREATING ACCESS CARROLL PATIENTS IN FISCAL YEAR 2022.

PART I, Line 7G:
INCLUDED IN THESE EXPENSES ARE DIRECT AND INDIRECT COSTS ATTRIBUTABLE TO PHYSICIANS' CLINICS TOTALING $11,427,450. Part II - Community Building THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY, INC., AN AFFILIATE OF CARROLL HOSPITAL AND THE CARROLL COUNTY HEALTH DEPARTMENT, IS A PRIVATE NONPROFIT ORGANIZATION WORKING TO IMPROVE HEALTH BY CONNECTING PEOPLE, INSPIRING ACTION, AND STRENGTHENING COMMUNITY. THE PARTNERHSIP IS A RELATED SECTION 501(c)(3) TAX-EXEMPT ORGANZIATION, AND RECEIVES A MAJORITY OF ITS OPERATING FUNDS FROM CONTRIBUTIONS MADE DIRECTLY BY THE HOSPITAL. THEY SPONSOR PROGRAMS SUCH AS SAFE IN THE SHADE AND FUN IN THE SUN TO HELP REDUCE SUN EXPOSURE AND PROMOTE CANCER PREVENTION. THE CARROLL ANTI-STIGMA RESILIENCE EFFORT (CARE) CAMPAIGN PROMOTES REMOVING THE STIGMA AROUND MENTAL HEALTH TREATMENT. THE PARTNERSHIP ALSO PROMOTES PHYSICAL ACTIVITY WITH THE WALK CARROLL, FITNESS FRIDAYS AND TRYVENT PROGRAMS. CARROLL'S COOKING, COMMUNITY GARDENS AND HEALTHY LIVING SERIES ROUNDS OUT THE PROGRAMS FOR ADVANCING HEALTH AND WELLNESS. CARROLL HOSPITAL ALSO WORKS WITH THE GREATER BALTIMORE REGIONAL INTEGRATED CRISIS SYSTEM TO PROVIDE ALTERNATIVES TO THE EMERGENCY ROOM FOR INDIVIDUALS IN CRISIS.

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.

PART III, Line 8:
COSTING METHODOLOGY: 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.

Part VI, Line 7:
LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: MD

PART III, LINE 3:
CARROLL HOSPITAL CENTER, INC. DETERMINES ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH OTHER VARIOUS MEANS (CREDIT REPORTS, DEBT AND ASSET REVIEWS, AND REFERRALS FROM THE HOSPITAL'S BILLING AGENTS) WHEN THE PATIENT HAS NOT COMPLETED THE FINANCIAL ASSISTANCE APPLICATION. IF A DETERMINATION IS MADE REGARDING THE PATIENT'S INABILITY TO PAY, THE ACCOUNT CAN BE APPROVED FOR FINANCIAL ASSISTANCE ON A PRESUMPTIVE BASIS RATHER THAN BE REFLECTED AS BAD DEBT EXPENSE. OF THE REMAINING BAD DEBT EXPENSE, IT IS ESTIMATED THAT $267,736 IN COST MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. AS DESCRIBED ELSEWHERE, THE HOSPITAL ENGAGES IN MULTIPLE EFFORTS TO INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. THE AMOUNT WAS BILLED TO PATIENTS ONLY BECAUSE THEY, DESPITE THE HOSPITAL'S EFFORTS, DID NOT REQUEST, OR DID NOT COOPERATE WITH, THE HOSPITAL'S EFFORTS TO PROVIDE THEM WITH THE AVAILABLE FINANCIAL ASSISTANCE.

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 ARE USED TO ASSIST IN THE RECOVERY OF BAD DEBT DOLLARS AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. IN SO DOING, THE COLLECTION AGENCIES MUST OPERATE CONSISTENTLY WITH CARROLL HOSPITAL CENTER'S GOAL OF MAXIMUM BAD DEBT RECOVERY AND STRICT ADHERENCE WITH FAIR DEBT COLLECTIONS PRACTICES ACT (FDCPA) RULES AND REGULATIONS, WHILE MAINTAINING POSITIVE PATIENT RELATIONS. SEE AUDITED FINANCIAL STATEMENTS PAGE 16.

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. BY UPDATING A USER-DEFINED FIELD IN CERNER TO IDENTIFY PATIENTS RETURNING FOR SERVICE WHO ARE ALREADY QUALIFIED FOR FINANCIAL ASSISTANCE. 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.

PART VI, LINE 3:
THE FOLLOWING DESCRIBES MEANS USED AT CARROLL HOSPITAL 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. CARROLL HOSPITAL 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 INPATIENTS PRIOR TO DISCHARGE. CARROLL HOSPITAL'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 CARROLL HOSPITAL CENTER'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 CARROLL'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. CARROLL HOSPITAL HOSTS AND PARTICIPATES IN VARIOUS DEPARTMENT OF HEALTH AND MENTAL HYGIENE AND MARYLAND HOSPITAL ASSOCIATION SPONSORED CAMPAIGNS LIKE COVER THE UNINSURED WEEK.

PART VI, LINE 2:
"MONITORING THE HEALTH STATUS OF THE COMMUNITY IS AN ONGOING AND INTERACTIVE PROCESS ENGAGED IN BY THE HOSPITAL, WITH SUBSTANTIAL INVOLVEMENT FROM OUR COMMUNITY VIA THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY, INC. (""THE PARTNERSHIP""), AN ENTITY ESTABLISHED BY THE HOSPITAL AND THE CARROLL COUNTY HEALTH DEPARTMENT SPECIFICALLY TO ASSESS UNMET HEALTH NEEDS IN THE COMMUNITY, EXPAND THE CAPACITY FOR HEALTH AND QUALITY OF LIFE IMPROVEMENT IN THE COMMUNITY, SERVE AS A COLLABORATIVE VEHICLE FOR INTERACTION WITH THE COMMUNITY, AND WITH OUR COMMUNITY, TO DRIVE THE EFFORT TO CREATE A HEALTHIER CARROLL COUNTY. THE PARTNERSHIP IS A RELATED SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION AND RECEIVES A MAJORITY OF ITS OPERATING FUNDS FROM CONTRIBUTIONS MADE DIRECTLY BY THE HOSPITAL. IMPROVEMENT IN THE COMMUNITY HEALTH IMPROVEMENT AREAS (CHIA) IS ONE OF THE HOSPITAL'S GOALS. THE CHIA ARE THE AREAS REQUIRING INDIVIDUAL AND ORGANIZATIONAL ACTION TO ACHIEVE TARGETED IMPROVED STATUS USING THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES' HEALTHY PEOPLE 2030 TARGETS AS THE PRIMARY BENCHMARK. THE HOSPITAL PARTICIPATES ACTIVELY IN MANY OF THE CHIA LEADERSHIP TEAMS COMPRISED OF DIVERSE INDIVIDUALS AND ORGANIZATIONS FROM THROUGHOUT THE HOSPITAL'S SERVICE AREA, WHO SHARE EXPERTISE AND INTEREST IN THE CHIA. WITH SUPPORT AND GUIDANCE FROM THE PARTNERSHIP, THOSE LEADERSHIP TEAMS DEVELOP AND IMPLEMENT ACTION PLANS SPECIFICALLY INTENDED TO ACCOMPLISH TARGETED RESULTS. ""HEALTHY CARROLL VITAL SIGNS"" (DESCRIBED BELOW) ARE THEN AFFIRMED, ARE SPECIFIC TO EACH CHIA LEADERSHIP TEAM AND SERVE AS ONE OF THE PRIMARY TOOLS FOR MEASURING AND REPORTING RESULTS TO THE HOSPITAL LEADERSHIP AND TO THE COMMUNITY. RECENTLY THE HOSPITAL HAS COLLABORATED WITH THE PARTNERSHIP WITH RESPECT TO AN ASSESSMENT OF HEALTH NEEDS VIA MARYLAND'S STATE HEALTH IMPROVEMENT PROCESS (S.H.I.P.), WHICH WAS ORGANIZED TO PRODUCE A LOCAL HEALTH IMPROVEMENT PLAN (L.H.I.P.). THE PARTNERSHIP ORGANIZATION ENTHUSIASTICALLY AGREED TO SERVE AS THE LOCAL COALITION REQUIRED IN THE OPPORTUNITY FOR LINKAGE TO IMPORTANT, VALIDATED INFORMATION ABOUT HEALTH NEEDS IN OUR COMMUNITY AND ONGOING OPPORTUNITIES TO COLLABORATE WITH OUR LOCAL AND STATE HEALTH DEPARTMENT REGARDING IMPLEMENTATION STRATEGIES FOR TARGETED RESULTS. PURSUANT TO THE S.H.I.P. ASSESSMENT, THIRTY-NINE ""HIGH IMPACT OBJECTIVES"" WERE IDENTIFIED BY THE STAFF AT MARYLAND'S DEPARTMENT OF HEALTH AND MENTAL HYGIENE. A CARROLL COUNTY SPECIFIC DATA PROFILE SERVED AS THE BASELINE DOCUMENT. AFTER THOROUGH ANALYSIS, A LEADERSHIP TEAM, WHICH INCLUDED THE HOSPITAL, PRODUCED A LOCAL HEALTH IMPROVEMENT PLAN (L.H.I.P.) ADDRESSING FIVE PRIORITY NEED AREAS. THE S.H.I.P. AND L.H.I.P. PROVIDE ANOTHER IMPORTANT SET OF VERY USEFUL INFORMATION THAT IS BEING FULLY INTEGRATED WITHIN THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND COMMUNITY BENEFIT PLANNING PROCESSES. THE HOSPITAL AND THE PARTNERSHIP HAVE CONDUCTED MULTIPLE PREVIOUS NEEDS ASSESSMENTS, HAVE MADE REAL PROGRESS TOWARD COMMUNITY ENGAGEMENT IN THESE PROCESSES AND HAVE INTEGRATED ANNUAL MEASUREMENT SYSTEMS INTO THE HEALTH IMPROVEMENT WORK KNOWN AS ""HEALTHY CARROLL VITAL SIGNS (HCVS)."" DURING THE 2021 FISCAL YEAR, THE HOSPITAL CONDUCTED ITS FOURTH COMMUNITY HEALTH NEEDS ASSESSMENT IN COMPLIANCE WITH IRS REQUIREMENTS (""CHNA""). SHORTLY THEREAFTER, THE HOSPITAL BEGAN TO UNDERTAKE CERTAIN INITIATIVES IDENTIFIED IN THE CHNA IMPLEMENTATION STRATEGY TO BEGIN TO ATTEMPT TO MEET IDENTIFIED COMMUNITY HEALTH NEEDS."

PART VI, LINE 4:
AS THE ONLY HOSPITAL IN THE COUNTY, CHC'S PRIMARY SERVICE AREA IS THE ENTIRE COUNTY. THE HOSPITAL DOES, HOWEVER, ALSO SERVE PORTIONS OF BALTIMORE, FREDERICK AND MONTGOMERY COUNTIES, AS WELL AS AREAS IN SOUTHERN PENNSYLVANIA. THE GENERAL DEMOGRAPHICS FOR OUR PRIMARY COMMUNITY (CARROLL COUNTY) ARE LISTED BELOW: POPULATION TOTAL POPULATION 2021: 173,873 POPULATION PERCENTAGE CHANGE FROM 2020 TO 2021: 0.6% PERSONS UNDER 5 YEARS OLD, PERCENTAGE IN 2021: 5.4% PERSONS UNDER 18 YEARS OLD, PERCENTAGE IN 2021: 21.9% PERSONS 65 YEARS OLD AND OVER, PERCENTAGE IN 2021: 17.5% FEMALE PERSONS, PERCENTAGE IN 2021: 50.1% PERSONS OF WHITE RACE, PERCENTAGE IN 2021: 90.9% PERSONS OF BLACK RACE, PERCENTAGE IN 2021: 4.1% PERSONS OF HISPANIC OR LATINO ORIGIN, PERCENTAGE IN 2021: 4.3% SOURCE: US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. FAMILY TOTAL NUMBER OF HOUSEHOLDS (2021): 66,197 AVERAGE HOUSEHOLD SIZE (2021): 2.68 PERSONS SOURCE: US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. ECONOMICS MEDIAN HOUSEHOLD INCOME: $104,708 PERCENTAGE OF PERSONS BELOW POVERTY LEVEL: 5.4% SOURCES: CARROLL COUNTY DEPARTMENT OF ECONOMIC DEVELOPMENT AND US CENSUS BUREAU: STATE AND COUNTY QUICKFACTS. OTHER SIGNIFICANT DEMOGRAPHIC CHARACTERISTICS ACCORDING TO THE AMERICAN COMMUNITY SURVEY THE PERCENTAGE OF UNINSURED PATIENTS IN CARROLL COUNTY IS 3.7%. IN FY 2020, OF THE CARROLL COUNTY RESIDENTS THAT WERE HOSPITALIZED (EITHER AT CHC OR OTHER HOSPITALS) 14.1% WERE ENROLLED IN MEDICAL ASSISTANCE PROGRAMS IN CARROLL COUNTY, WHICH INCLUDES MCHIP, PAC, AND MEDICAL ASSISTANCE. THE AVERAGE LIFE EXPECTANCY WITHIN CARROLL COUNTY WAS 79 YEARS.

PART VI, LINE 5:
"CARROLL HOSPITAL CENTER, FOUNDED IN 1961, IS THE SOLE HOSPITAL SERVING THE JURISDICTION OF CARROLL COUNTY, MARYLAND WITH A 2021 POPULATION OF MORE THAN 173,000 PERSONS. CARROLL HOSPITAL CENTER IS THE SECOND LARGEST EMPLOYER IN CARROLL COUNTY WITH OVER 2,000 ASSOCIATES IN FY 2022. CARROLL HOSPITAL CENTER IS ACCREDITED BY THE JOINT COMMISSION. OUR GOVERNING BODY IS COMPRISED PREDOMINANTLY OF INDEPENDENT LEADERS REPRESENTATIVE OF OUR COMMUNITY WHO ASSURE THAT ALL FINANCIAL SURPLUSESTHE HOSPITAL GENERATES ARE USED EXCLUSIVELY TO FURTHER THE CHARITABLE PURPOSES OF THE ORGANIZATION. CARROLL HOSPITAL OFFERS DIVERSE SERVICE LINES INCLUDING COMPREHENSIVE ACUTE CARE SUCH AS MEDICAL, SURGICAL, PERI-NATAL, PEDIATRICS, PSYCHIATRY, MEDICAL AND RADIATION ONCOLOGY, ADULT INTENSIVE CARE AND CARDIOVASCULAR SERVICES, INCLUDING EMERGENCY PERCUTANEOUS INTERVENTIONAL CARDIOLOGY. BOTH HOME-BASED AND INPATIENT HOSPICE CARE ARE PROVIDED THROUGH OUR AFFILIATE, BRIDGINGLIFE, INC. (FORMERLY CARROLL HOSPICE, INC.), DIVERSE DIAGNOSTIC SERVICES ARE PROVIDED AT MULTIPLE LOCATIONS AND INCLUDE BOTH LABORATORY AND RADIOLOGIC CAPABILITIES. THE HOSPITAL PARTICIPATES IN MEDICARE AND MEDICAID PROGRAMS. THERE ARE APPROXIMATELY 450 PHYSICIANS REPRESENTING 38 SPECIALTIES ON CARROLL'S MEDICAL STAFF. THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT (ED) SERVING ALL PERSONS REGARDLESS OF ABILITY TO PAY. AN EXTENSIVE NETWORK OF HOSPITAL AFFILIATED PHYSICIAN PRACTICES ASSURES ADEQUATE AVAILABILITY OF BOTH PRIMARY AND SPECIALTY CARE PHYSICIANS THROUGHOUT THE SERVICE AREA MEETING THE CARROLL HOSPITAL CENTER STANDARDS OF EXCELLENCE AND INCORPORATING THE SAME VALUES AND PRINCIPLES. BUILDING ON ITS LONG TRADITION OF COLLABORATION WITH OUR LOCAL RESIDENTS, THE HOSPITAL, IN JOINT EFFORT WITH THE CARROLL COUNTY HEALTH DEPARTMENT, ESTABLISHED THE PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY, INC. (THE PARTNERSHIP) IN 1999 TO LINK HOSPITAL STRENGTHS, ALONGSIDE THOSE OF OTHER WELL-ESTABLISHED COMMUNITY PARTNERS, TO ACHIEVE AN IMPROVED HEALTH STATUS. THE PARTNERSHIP IS A SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION THAT RECEIVES A MAJORITY OF ITS OPERATING FUNDS FROM CONTRIBUTIONS MADE DIRECTLY BY THE HOSPITAL. THE PARTNERSHIP WAS ESTABLISHED TO: -ASSESS UNMET HEALTH NEEDS IN OUR COMMUNITY -EXPAND THE CAPACITY FOR HEALTH AND QUALITY OF LIFE IMPROVEMENT IN OUR COMMUNITY -SERVE AS OUR COLLABORATIVE VEHICLE FOR INTERACTION WITH THE COMMUNITY -DRIVE THE EFFORT TO CREATE A HEALTHIER CARROLL COUNTY COMMUNITY THIS STRATEGY HAS ALLOWED CARROLL HOSPITAL CENTER TO REMAIN CONTINUALLY WELL-CONNECTED TO THE COMMUNITY, TO LEVERAGE RESOURCES IN ACTION ALONGSIDE THOSE OF OTHER KEY ORGANIZATIONS AND AGENCIES (PARTICULARLY, THE CARROLL COUNTY HEALTH DEPARTMENT) AND TO ASSURE MEASURABLE RESULTS. MONITORING THE HEALTH STATUS OF THE COMMUNITY IS AN ONGOING AND INTERACTIVE PROCESS ENGAGED IN BY CARROLL HOSPITAL CENTER AND THE PARTNERSHIP. CARROLL HOSPITAL CENTER AND THE PARTNERSHIP PURSUE IMPROVEMENT IN THE COMMUNITY HEALTH IMPROVEMENT AREAS (CHIAS) VIA LEADERSHIP TEAMS COMPRISED OF DIVERSE INDIVIDUALS AND ORGANIZATIONS WHO SHARE EXPERTISE AND INTEREST IN THE CHIA. THOSE LEADERS DEVELOP AND IMPLEMENT ACTION PLANS SPECIFICALLY INTENDED TO ACCOMPLISH TARGETED RESULTS. ""HEALTHY CARROLL VITAL SIGNS"" ARE THEN AFFIRMED, ARE SPECIFIC TO EACH CHIA LEADERSHIP TEAM AND SERVE AS ONE OF THE PRIMARY TOOLS FOR RESULTS REPORTING. WWW.HEATLHYCARROLL.ORG IS THE PARTNERSHIP'S WEBSITE WHERE CURRENT SECONDARY DATA, NATIONAL BENCHMARKS, IMPROVEMENT TARGETS AND BEST PRACTICE REFERENCES ARE EASILY AVAILABLE, ARE AS CURRENT AS AVAILABLE, AND ARE AVAILABLE TO ANYONE AT NO COST. CARROLL HOSPITAL CENTER HAS LONG RECOGNIZED THAT PROMOTING THE HEALTH OF ITS COMMUNITY IS ONE OF ITS ESSENTIAL RESPONSIBILITIES. EXTENSIVE COMMUNITY OUTREACH AND LEARNING PROGRAMS ARE OFFERED BY THE HOSPITAL WITH AN EMPHASIS ON DISEASE PREVENTION, EARLY INTERVENTION AND WELLNESS. OUR INTEGRATED APPROACH RECOGNIZES AND STRIVES TO ELIMINATE BARRIERS SUCH AS TRANSPORTATION CHALLENGES OR LIMITED ABILITIES TO PURCHASE ESSENTIAL PRESCRIPTION PRODUCTS; IT ALSO INCLUDES MORE IN-COMMUNITY CARE COORDINATION AND ASSISTANCE WITH NAVIGATING THE OFTEN COMPLEX WORLD OF HEALTH CARE ASSOCIATED SERVICES. CHC IS ONE OF THE FOUNDING AND FUNDING PARTNERS IN A UNIQUE AND HIGHLY SUCCESSFUL INTEGRATED PRIMARY CARE CENTER KNOWN AS ACCESS CARROLL, INC. AT ACCESS CARROLL, INC. THE BARRIERS OF LOW INCOME AND INELIGIBILITY FOR STATE, FEDERAL OR OTHER INSURANCE ASSISTANCE ARE BEING ELIMINATED FOR SIGNIFICANT NUMBERS OF CARROLL COUNTY RESIDENTS WHO ARE RECEIVING THE SAME INTEGRATED PRIMARY AND SPECIALTY CARE SERVICES NEEDED TO MANAGE THEIR ACUTE AND/OR CHRONIC DISEASE ISSUES AS THEIR HIGHER INCOME AND INSURED NEIGHBORS. IN ADDITION TO THE PRIMARY AND SPECIALTY MEDICAL CARE AND CARE MANAGEMENT NAVIGATION ASSISTANCE, THE ACCESS CARROLL PATIENTS RECEIVE DIAGNOSTIC LABORATORY AND RADIOLOGY SERVICES, DENTAL SERVICES, PRESCRIPTION ASSISTANCE AND MORE. CARROLL HOSPITAL CENTER CONTRIBUTED $1,071,508 TO ACCESS CARROLL IN FY22 TO COVER SALARY AND BENEFIT EXPENSES FOR THE EXECUTIVE DIRECTOR, BUSINESS OPERATIONS MANAGER AND RN HEALTH NAVIGATOR, AS WELL AS OPERATIONAL EXPENSES. THE HOSPITAL ALSO PROVIDES LABORATORY AND DIAGNOSTIC IMAGING SERVICES TO ACCESS CARROLL, CAPTURED UNDER CHARITY CARE, WHICH TOTALED $6,049 IN FY22. THESE HEALTH PROMOTION EFFORTS ARE IN ADDITION TO PROGRAMS AND SERVICES THAT SEEK TO HELP PEOPLE CHANGE THEIR LIFESTYLES TO MOVE TOWARD A STATE OF OPTIMAL HEALTH IN MIND, BODY AND SPIRIT. CARROLL HOSPITAL CENTER DEMONSTRATES ITS COMMITMENT TO IMPROVING THE HEALTH AND WELLNESS OF THE COMMUNITIES IT SERVES BY PROVIDING SERVICES AND PROGRAMS THAT ADDRESS CRITICAL NEEDS, INCLUDING HEALTH CARE TO VULNERABLE OR UNDERSERVED PEOPLE, PUBLIC HEALTH PROGRAMS, AND HEALTH EDUCATION, SCREENING AND PREVENTION SERVICES. THESE PROGRAMS AND ACTIVITIES INCLUDED HOSPICE SERVICES, PHYSICIAN SUPPORT, CHARITY/UNCOMPENSATED CARE, EDUCATION PROGRAMS, HEALTH SCREENINGS, SUPPORT GROUPS, HEALTH PROFESSIONS EDUCATION AND COMMUNITY CONTRIBUTIONS. CARROLL HOSPITAL CENTER OFFERS THESE PROGRAMS AND SERVICES NOT ONLY TO ADDRESS THE NEEDS OF PEOPLE WITH CHRONIC OR ACUTE MEDICAL ISSUES, BUT ALSO TO ADDRESS PREVENTION AND EDUCATION TO KEEP OUR POPULATION WELL."

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CARROLL HOSPITAL, A LIFEBRIDGE HEALTH CENTER, IS PART OF AN AFFILIATED HEALTH CARE SYSTEM THAT PROVIDES AN ARRAY OF HEALTH CARE SERVICES TO ITS COMMUNITY. THE HOSPITAL, AS A SOLE COMMUNITY PROVIDER, PROVIDES BOTH INPATIENT AND OUTPATIENT CARE, INCLUDING ESSENTIAL HEALTH CARE SERVICES SUCH AS OBSTETRICS, EMERGENCY SERVICES, PEDIATRIC, AND CRITICAL CARE, WHICH WOULD LIKELY OTHERWISE NOT BE PROVIDED WITHIN CARROLL COUNTY DUE TO THEIR UNPROFITABLE NATURE (HIGH COST SERVICES WITH RELATIVELY LOW REIMBURSEMENT). ADDITIONALLY, THE HOSPITAL IS RELATED TO A GROUP PHYSICIAN PRACTICE (CARROLL HEALTH GROUP), WHICH PROVIDES PRIMARY AND SPECIALTY CARE SERVICES TO THE COMMUNITY. THE PROVISION OF PHYSICIAN SERVICES HELPS MEET AN IDENTIFIED COMMUNITY HEALTH NEED FOR ADDITIONAL PRIMARY AND SPECIALTY CARE PHYSICIANS AND PROVIDERS IN THE COMMUNITY. BRIDGINGLIFE, INC. (FORMERLY KNOWN AS CARROLL HOSPICE, INC.), AN AFFILIATE OF CARROLL HOSPITAL, PROVIDES INPATIENT HOSPICE CARE, AS WELL AS RESIDENTIAL HOSPICE AND PALLIATIVE CARE, TO PATIENTS NEARING THE END OF LIFE. BRIDGINGLIFE PROVIDES PAIN MANAGEMENT AND SYMPTOM CONTROL AND HELPS COORDINATE HOME AND INPATIENT SERVICES. IN ORDER TO PROVIDE COMPREHENSIVE AND COMPASSIONATE CARE, BRIDGINGLIFE UTILIZES AN INTERDISCIPLINARY TEAM, INCLUDING PHYSICIANS, NURSES, SOCIAL WORKERS, CLERGY, PHARMACISTS, AND HOME HEALTH AIDES. FURTHER, BRIDGINGLIFE PROVIDES BEREAVEMENT CARE FOR FAMILY MEMBERS FOR UP TO THIRTEEN MONTHS, AS WELL AS FOR THE BROADER COMMUNITY AS NEEDED.