4A (Expenses $ 145161665 including grants of $ 91000) (Revenue $ 160864849)
"AS A MEMBER OF THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM, CIVISTA MEDICAL CENTER, INC. (D/B/A UM CHARLES REGIONAL MEDICAL CENTER, ""UM CRMC"") OPERATES A 99-BED HOSPITAL IN LA PLATA, MARYLAND. UM CRMC IS ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES. ITS ACTIVITIES INCLUDE PROVIDING HEALTHCARE TREATMENT AND CARE TO PERSONS WHO ARE ACUTELY ILL, OPERATING A 24-HOUR EMERGENCY DEPARTMENT WHICH SERVICES ALL COMMUNITY PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. DURING ITS FISCAL YEAR ENDED JUNE 30, 2022, THE HOSPITAL ENGAGED IN THE FOLLOWING ACTIVITIES THAT WERE IN FURTHERANCE OF ITS EXEMPT PURPOSE: PROVIDED INPATIENT SERVICES WHICH INCLUDED 5,492 INPATIENT ADMISSIONS; PROVIDED OUTPATIENT SERVICES WHICH INCLUDED 48,883 EMERGENCY DEPARTMENT VISITS AND 3,598 OUTPATIENT SURGERIES; AND 577 BIRTHS. IN FY22, UM CRMC PROVIDED MORE THAN $11.5 MILLION IN COMMUNITY BENEFITS INCLUDING CHARITY CARE, HEALTH PROFESSIONS EDUCATION, COMMUNITY BENEFIT OPERATIONS, COMMUNITY HEALTH IMPROVEMENT SERVICES, SUBSIDIZED HEALTH SERVICES, AND CASH AND IN-KIND DONATIONS. THIS YEAR, WE PROVIDED AND SUPPORTED PROGRAMS, ACTIVITIES AND SCREENINGS SUCH AS BLOOD PRESSURE, GLUCOSE, BREAST AND CERVICAL CANCER, COLORECTAL CANCER AND STROKE RISK REDUCTION EDUCATION. MOBILE INTEGRATED HEALTH COMPLETED THE SECOND YEAR TO IMPROVE ACCESS TO CARE AND WRAP AROUND HEALTH CARE TO COMMUNITY MEMBERS WITH BARRIERS. IN ADDITION TO PARTICIPATING IN THE PROGRAM UM CRMC WILL CONTRIBUTE FINANCIALLY TO THE PROGRAM FOR 3 YEARS. UM CRMC PROVIDED HEALTH EDUCATION PROGRAMS ON HEART HEALTHY EATING, DIABETES EDUCATION, CANCER EDUCATION, BREAST AND CERVICAL CANCER, TOBACCO CESSATION PROGRAM."

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 - CIVISTA MEDICAL CENTER INC.. From July 2020 to February 2021, the University of Maryland Charles Regional Medical Center undertook a comprehensive assessment of the health needs of Charles County, Maryland. To provide a comprehensive assessment of the health needs of the county, a plan was developed which included five different sources of data: a long online survey of Charles County resident perceptions of health and health behaviors, a short paper survey on health perceptions throughout the county, a focus group with community stakeholders, key informant interviews of community leaders and stakeholders, and a quantitative data analysis of secondary, published data. Data collection occurred between July 2020 and December 2020. Because of meeting restrictions imposed as a result of COVID-19, input from community members with special expertise in public health was obtained through questionnaires submitted via Survey Monkey. 51 responses were received from members of the Partnership for a Healthier Charles County, Charles County Department of Health, Charles County Department of Social Services, Charles County Sheriff's Office, and Health Partners. The use of the multiple data collection methods strengthened the validity of the assessments findings and ensured that Charles County residents had an opportunity to participate in the assessment process and feel invested in its outcome. Due to the COVID-19 pandemic and the limitations on in-person gatherings, only one small focus group was conducted in December 2020. This focus group targeted individuals working in healthcare and community roles associated with access to care and chronic disease prevention and management. A total of eight people participated in this focus group. A total of 561 Charles County residents completed the 27-question online survey that was created using Survey Monkey. The link to the survey was available on the University of Maryland Charles Regional Medical Center website and the Charles County Department of Health website. The first section of the survey asked participants about their perception of health and health services within the county. The second section asked them about their health behaviors, in order to determine their risk for the development of certain health conditions. Most of the respondents were from Charles County (90.6%). The second largest percentage of respondents were from St. Mary's County (4.1%). Only 1.7% reported living outside of Southern Maryland (Charles, Calvert, St. Mary's, or Prince George's). Approximately 68.5% of the respondents were between the ages of 45-74 years. The highest percentage was in the 65-74-year age group (27.1%). The overwhelming majority of the respondents were female (77.4%). Minorities made up 26% of the total survey population. African Americans comprised 22.5% of the respondents. Approximately 3% of the survey respondents self-identified as Hispanic. The survey participants were a highly educated group with 83.7% reporting having had at least some level of college education. Just under half of the group had completed an undergraduate degree or higher (47.4%). Most of the participants were employed and working full-time. Individuals with a household income less than $60,000 made up one-fifth of the 2020 survey (20.2%). Nearly all of the survey participants (98.6%) reported having health insurance. The majority of the participants also reported having dental insurance (78.6%) though this percentage is smaller than those reporting health insurance. Many of the respondents also had vision insurance (64.3%). Only 1.1% of the survey population reported having no type of insurance. The online survey participants were also asked about access to health care: 88.2% have had a routine doctor's visit in the past 12 months and 96.2% receive their routine health care in a primary care physician or provider's office. Many residents (75.3%) were able to see a doctor when needed. If they were unable to see the doctor when needed, the most common reasons were that there were no available appointments (29.3%) or that it was too expensive, and they could not afford it (3.5%). More than three-quarters of respondents (78%) travel outside of Charles County for medical care at some point. Only 5.8% reported that they always travel outside the county for care. The most common medical services that people receive outside of Charles County are specialist doctor appointments (61.4%), dental appointments (22.2%), primary care doctor appointments (19.0%), and surgeries (19.0%). The most common responses among participants were that the quality is better elsewhere (37.1%) and services are not available in Charles County (23.6%). A short five-question survey was distributed throughout the county regarding perceptions of health within the county. A total of 755 short surveys were completed. Ongoing survey collection was conducted at the Charles County Department of Health, the University of Maryland Charles Regional Medical Center's Diabetes Education Center, Wound Healing Center, and Outpatient Rehabilitation. Short surveys were also collected during blood drives at the University of Maryland Charles Regional Medical Center (CRMC) and the La Plata American Legion. CRMC also coordinated with the Charles County Public schools to survey individuals at the meal distribution sites. Particular emphasis was given to the western region of the county that is more eographically isolated.

Schedule H, Part V, Section B, Line 6b Facility 1, 1
Facility 1, 1 - CIVISTA MEDICAL CENTER, INC.. UM CRMC led the effort and covered 100% of the cost of the CHNA however the hospital worked collaboratively with the Charles County Department of Health and the Local Health Improvement Coalition (LHIC) - Partnerships for a Healthier Charles County (PHCC) to complete the CHNA. Executive Leadership of PHCC consists of the CEO of UM CRMC, the County Health Officer, the Superintendent of Charles County Public Schools and the President of the College of Southern of Southern Maryland. Executive Committee of LHIC Charles County Dept. of Health, Dianna Abney, MD, Charles County Health Officer Charles County Public Schools Dr. Maria V. Navarro, Superintendent, College of Southern Maryland Dr. Yolanda Wilson President UM CRMC Noel Cervino President and CEO Steering Committee of LHIC Charles County Dept. of Health Amber Starn Epidemiologist Charles County Public Schools Jennifer Conte Coordinator of Student Intervention Programs College of Southern Maryland Kelly Winters Executive Director of Workforce Development UM CRMC Mary Levy Community Health Specialist, Community Development and Planning Subcommittees: Health Partners Clinic Chrissie Mulcahey, Director Co Chair, Access to Care UM CRMC Mary Hannah Chair, Access to Care Charles County Dept. of Health Mary Beth Klick, Tobacco Prevention Coordinator, Co-Chair, Chronic Disease Prevention and Management Subcommittee UM CRMC Mary Levy Co Chair, Chronic Disease Sub Comm. Charles County Core Services Karyn Black, Director Co-Chair, Behavioral Health Subcommittee Charles County Dept. of Health Angela Deal, Community Health Educator, Co-chair, Chronic Disease Prevention and Management Subcommittee Charles County Department of Health Laura Borawski Community Outreach Worker Co-Chair, Chronic Disease Prevention and Management Subcommittee

Schedule H, Part V, Section B, Line 11 Facility 1, 1
Facility 1, 1 - CIVISTA MEDICAL CENTER, INC.. Cumulative analysis of all quantitative and qualitative data was used to prioritize the top health care needs in Charles County. The priorities were chosen by the Partnerships for a Healthier Charles County's Steering Committee and Subcommittee leaders using the Hanlon Method, a National Association of City and County Health Officials' recommended means for health prioritization. The Hanlon Method scores health conditions based on the size of the problem, seriousness of the problem, and the effectiveness of available interventions. The health priorities chosen include: 1. Disease Prevention and Management Major Cardiovascular Disease (Heart Disease, Hypertension, and Stroke) Obesity and Overweight Diabetes Prevalence Infectious Diseases 2. Behavioral Health Substance Use Disorders Mental Health 3. Access to Care Provider Recruitment and Retention, Emphasis on Mental Health and Primary Care Unnecessary Hospital and Emergency Department Utilization Social Determinants of Health (Transportation, Health Literacy) All 3 priorities outlined in the CHNA are being addressed by UM CRMC either directly (Physician Recruitment), or through partnerships with other organizations (i.e. Chronic Disease Self-Management Program), or through the LHIC, Partnerships for a Healthier Charles County (PHCC) which is co-led and financially supported by UM CRMC. Where a need is appropriately addressed by another community entity, UM CRMC provides leadership and/or funding through the Charles County Health Improvement Plan and the local health coalition (PHCC) to communicate initiatives, provide financial support and/or assistance or data when needed, and review results (i.e., Substance Abuse, Mental Health). Each LHIC team has developed and implemented strategies specific to their identified priorities and reports back quarterly to the LHIC Steering Committee. The hospital provides support and oversight to the teams as a critical member of the LHIC Steering Committee. The Hospital's Director of Community Development and Planning serves as the co-chair of the county LHIC. Notably, in 2022 our Community Health Specialist, Mary Levy, achieved certification to teach the Healthy Heart Ambassador program offered by the Charles County Department of Health. In addition, the hospital began offering the Dare to CARE vascular screening program in conjunction with the Healthy Heart Foundation. UM Charles Regional Medical Group launched our behavioral health office in 2022 to address behavioral health issues. Through the 2021 Regional Partnership Catalyst Program which spans over five years we are able to offer diabetes prevention programs to include diabetes 101, diabetes self-management and prevention and diabetes support group.

Schedule H, Part V, Section B, Line 13 Facility 1, 1
Facility 1, 1 - CIVISTA MEDICAL CENTER, 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 THAT THE FPG INCOME LEVELS.

Schedule H, Part I, Line 3c CRITERIA FOR FREE OR DISCOUNTED CARE
CRMC IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO PERSONS WHO HAVE HEALTH CARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY, FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. 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 THAT THE FPG INCOME LEVELS. THE FAP ALSO USES A FINANCIAL HARDSHIP THRESHOLD WHEN DETERMINING ELIGIBILITY. A PATIENT WITH MEDICAL DEBT EXCEEDING 25% OF FAMILY ANNUAL HOUSEHOLD INCOME MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE.

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

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
9289751

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
As the only hospital serving Charles County, Maryland, University of Maryland Charles Regional Medical Center (UM CRMC) supports programs and activities where the hospital's expertise and resources can influence the fundamental issues that affect the health of the community. A primary way our hospital promotes community health is through membership in the Partnership for a Healthier Charles County, (PHCC) whose membership consists of over 30 nonprofit and county agencies. This organization meets regularly to discuss needs and opportunities for addressing community health in Charles County. UM CRMC supports economic development of the community through leadership participation in organizations such as the Charles County Chamber of Commerce, Charles County Economic Development Commission, Leadership Southern Maryland, the La Plata Business Association, and other organizations. UM CRMC participates in many County, State and Region-wide Emergency Preparedness planning activities and drills with our community partners such as Emergency Services, Fire and Rescue, Department of Health, County Government, FEMA and MEMA. This serves to ensure that in the event of a disaster, the hospital is ready to support and care for our community. Hospital Administration participates in healthcare workforce development, for example through support of College of Southern Maryland Nursing and Allied Health programs. According to a 2018 Medical Staff Development Plan authored by Lifton Associates LLC Charles County, the hospital's primary service area, has a physician shortage for adult primary care physicians. Under medical specialties, the specialties that were deemed highest need were psychiatry, obstetrics/gynecology, neurology, urology, and otolaryngology (ENT.). As a result of the prevailing physician shortage, and to mitigate the effects of the lack of access of the community to medical care, UM CRMC has developed a robust and ongoing physician recruitment and retention program. Of particular note, in 2022 UM Charles Regional Medical Group opened a new urology practice, and a new behavioral health practice.

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 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 A 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 - CIVISTA MEDICAL CENTER INC.: Line 16a URL: https://www.umms.org/charles/patients-visitors/for-patients/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
1 - CIVISTA MEDICAL CENTER INC.: Line 16b URL: https://www.umms.org/charles/patients-visitors/for-patients/financial-assistance;

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

Schedule H, Part VI, Line 2 Needs assessment
In addition to conducting the CHNA every three years, UM CRMC assesses the health care needs of the communities it serves by taking a leadership role in the county and sitting on the Partnerships for a Healthier Charles County (PHCC) steering committee. PHCC, the Local Health Improvement Coalition in Charles County, consists of over 30 key stakeholders. Together, we collaborate to define priority areas using the Hanlon method and develop the Charles County Health Improvement Plan. Community health improvement strategies to address the identified needs are included in the organization's strategic plan.

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

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 HISTORICAL 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 3 Patient education of eligibility for assistance
UM CRMC posts its charity care policy, or a summary thereof, as well as financial assistance contact information in admissions areas, emergency rooms, business offices and other areas of the facility where eligible patients are likely to present. Additionally, the policy and plain language version are available on the hospital's public website. https://www.umms.org/charles/patients-visitors/for-patients/financial-assistance The financial assistance policy (FAP) is written in a culturally sensitive and at an appropriate reading level. It is available in English and Spanish. All Patient Access Customer Service Staff have training in the financial assistance process. At the time of registration every patient is provided an information sheet regarding financial assistance. Additionally, patients are also verbally advised of the existence of our Financial Assistance Policy when practical. If a patient discloses financial difficulty or concern with payment of the bill, the patient is provided with FAP information. A packet with the application, criteria and a documentation checklist is provided. Assistance completing the application is available. Additionally, assistance is provided for patients or their families who qualify and apply for government benefits, i.e. Medicaid and other state programs. Once an application is processed and if it is deemed incomplete, a letter is sent to the patient requesting the missing or incomplete items. Patients may call the Call Center or come into the Patient Access Office and or contact the centralized billing office for assistance.

Schedule H, Part VI, Line 4 Community information
"The University of Maryland Charles Regional Medical Center is Charles County's only hospital and, as such, serves the residents of the entire county. Geography Charles County is located 23 miles south of Washington, D.C. It is one of five Maryland counties, which are part of the Washington, DC-MD-VA metropolitan area. At 458 square miles, Charles County is the eighth largest of Maryland's twenty-four counties and accounts for about 5 percent of Maryland's total landmass. The northern part of the county is the ""development district"" where commercial, residential, and business growth is focused. The major communities of Charles County are La Plata (the county seat), Port Tobacco, Indian Head, and St Charles, and the main commercial cluster of Hughesville-Waldorf-White Plains. Approximately 60 percent of the county's residents live in the greater Waldorf-La Plata area. By contrast, the southern (Cobb Neck area) and western (Nanjemoy, Indian Head, Marbury) areas of the region still remain very rural with smaller populations. Population Charles County has experienced rapid growth since 1970, expanding its population from 47,678 in 1970 to an estimated census of 168,698 in July 2021. The magnitude of growth can be seen in the changes in population density. The 1990 census showed that there were 219.4 individuals per square mile, which increased to 261.5 individuals per square mile by 2000, an increase of 19.2%, and to 364 individuals per square mile by 2020 Source: US Census Bureau Transportation The percent change in the population growth for Charles County has been slightly greater than the change seen in the Maryland population growth. This growth has created transportation issues for the County, in particular for the ""development district"" in the northern part of the county where many residents commute to Washington D.C. to work. The average work commute time for a Charles County resident is 45.0 minutes. Public transportation consists of commuter buses for out-of-county travel and the county-run Van Go bus service for in-county transportation. Source: US Census Bureau Diversity As the population of the county changes, the diversity of the county also increases. The African American population has experienced the greatest increase. In 2000, African Americans made up 26% of the total Charles County population; in 2022, they comprised 52% of the total county population. As of 2019, minorities comprise roughly 66% of the Charles County population. The Hispanic community has also seen increases over the past few years. They now comprise 7% of the total county population. This is the one of the highest percentages among the 24 Maryland jurisdictions. Charles County also has one of the largest American Indian/Native American populations in the state of Maryland at 0.8% of the total county population. The 2019 Charles County gender breakdown is approximately 50/50. Males make up 48.2% of the population, and females make up 51.8% of the county population. Source: US Census Bureau Economy Employment and economic indicators for the county are fairly strong. The US Census estimates that 66.6% of the Charles County population is currently in the labor work force. The census found that approximately 6.7% of Charles County individuals are living below the poverty level; however, this is lower than the Maryland rate of 9.0%. The Charles County median household income was $107,808, well above the Maryland median household income. Source: US Census Bureau Education Charles County has a larger percentage of high school graduates than Maryland (93.2% vs. 90.2%); however, Charles County has a smaller percentage than Maryland of individuals with a bachelor's degree or higher (28.9% vs. 40.2%). Source: 2015-2019 US Census Bureau's American Community Survey 5 year estimates Housing There is a high level of home ownership in Charles County (78.3%). The median value of a housing unit in Charles County is $339,000. The average household size in Charles County is 2.78 persons. Source: 2015-2019 US Census Bureau's American Community Survey 5-year estimates Life Expectancy The life expectancy for a Charles County resident, as calculated for 2018-2020, was 77.9 years. This is slightly above the state average life expectancy of 77.3 years. Source: 2019 Maryland Vital Statistics Report Births There were 1,789 births in Charles County in 2020. Charles County represents 45.2% of the births in Southern Maryland and 2.68% of the total births in Maryland for 2020. Minorities made up just over half of the babies born in Charles County in 2020 (65%). Source: 2020 Maryland Vital Statistics Report"

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), Charles Regional Medical Center 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, UM Charles Regional Medical Center 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. UM Charles Regional Medical Center 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 Charles County

Schedule H, Part VI, Line 5 Promotion of community health
As the only hospital serving Charles County, Maryland, University of Maryland Charles Regional Medical Center (UM CRMC) supports programs and activities where the hospital's expertise and resources can influence the fundamental issues that affect the health of the community. Governance is provided through a community volunteer Board of Directors. UM CRMC's Community Benefits Program utilizes a planned, managed, organized, and measured approach to meeting the identified community needs of the area we serve. The mission is to improve overall community health by improving access to health care, enhancing the health of the community, advancing healthcare knowledge and collaborating with health - providing agency partners. Community health improvement strategies are included in the organization's strategic plan. UM CRMC provided a robust set of community benefits including $15,621,324 million in charity care, health professions education, community benefit operations, community health improvement services, mission driven health care services, cash and in-kind donations and community building activities in FY 2021. This year, we provided and supported programs, activities and screenings such as blood pressure, glucose, breast and cervical cancer, colorectal cancer and stroke risk reduction education. Mobile Integrated Health continued to improve access to care and wrap around health care to community members with barriers. In addition to participating in the program UM CRMC has contributed financially to the program for 5 years. UM CRMC provided health education programs on heart healthy eating, diabetes education, cancer education, breast and cervical cancer, and tobacco cessation. In addition, we sponsored support groups such as stroke support, cardiac support, and the Better Breathers Club. Fiscal year 2022 was a successful year for the Living Well Chronic Disease Self-Management Program, a free, 6-week, evidence-based program to improve the well-being of people living with a variety of chronic conditions. The hospital offers clinics and clinic services such as renal dialysis services and American Red Cross blood drives. We participated in community coalitions and boards such as the United Way, Partnerships for a Healthier Charles County, Charles County Tobacco Coalition, Leadership Southern Maryland, Hospice of the Chesapeake, , Charles County Children's Aid Society, Southern Maryland Food Bank, and others. . We participated in and supported community events such as Christmas Connection, American Cancer Society's Relay for Life, Heart Walk, and more. UM CRMC operates under a unique regulatory system that caps hospital revenues and provides adjustments to allow for population health improvement investments. Under Maryland's global budget revenue model, UM CRMC reports on a regular basis how it is investing in efforts to improve population health. UM CRMC provides on-going services that are fundamental to addressing the identified community health needs that demonstrate the extent to which our commitment to serve our community is integrated into our care delivery model. We have a strong focus on treating patients with chronic conditions. UM CRMC works to coordinate care, ensure smooth transitions and promote disease self-management strategies at every step of a patient's journey - whether at home, in the community, or within our hospital. Our transitional care services help patients newly diagnosed or those that have had a recent hospitalization transition safely back to the community. Transitional nurse navigators provide patients with disease education and self-management strategies, connect them to primary care providers and specialists, and help them overcome any barriers to making follow up appointments. Resources are embedded throughout the hospital and in the community so that every patient receives the same level of care coordination. Case managers and peer recovery coaches are embedded within our emergency department and hospital. We maintain a strong relationship with Chesapeake Potomac Health Home Agency through our Resources Education and Access to Community Health (REACH) program, which helps bring our patients back to achieving wellness in their communities after discharge by offering nurse home visits, medication management, social services, environmental home safety scans, disease-specific education and referral to other community resources as appropriate. Strong relationships also exist with local emergency medical service (EMS) providers through our mobile integrated health program, which delivers effective and efficient care to patients outside of the hospital. Nurses and community health workers function outside traditional emergency response roles, with a focus on maintaining individuals' health at their homes while also providing convenient access to care in the community. Additional care partners include primary care providers, specialists, local department of health, office on aging and other community-based partners. In 2022 UM Charles Regional Medical Center was designated Primary Stroke Center within the State of Maryland. It means, at our hospital we are able to treat some of our acute stroke patients with a specialized thrombolytic medication (clot busting medication). This medication dissolves the clot and helps to restore blood flow to the brain improving the patient's recovery from a stroke. Additionally, as a rural health provider, we recognize the lack of public transportation options is a barrier for patients who need transportation assistance. To address this barrier and improve access to healthcare for low-income, disadvantaged Tri-County residents, we launched the Transportation to Wellness project. For eligible patients, this program provides free, on-demand, curb-to-curb non-emergency medical transportation services to a patient's home after discharge and to post-hospitalization medical appointments. We are proud to serve our community and appreciate our partners who allow us to fulfill our mission. We will always do what is right for the patient, no matter where they are in their health journey, and will always strive to have our patients receive care in the community they reside. As a part of the University of Maryland Medical System (UMMS) we are shaping a new paradigm in care delivery that we believe should be the future standard of care.