4A (Expenses $ 86933510 including grants of $ 10000) (Revenue $ 132727321)
EMMA L. BIXBY MEDICAL CENTER IS AN ACUTE CARE FACILITY PROVIDING INPATIENT AND OUTPATIENT HEALTH CARE SERVICES TO THE GENERAL PUBLIC. - SEE SCHEDULE O.

PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL
PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. FOLLOWING THE FORMAL COUNTY ASSESSMENT SURVEY PROCESS, THE LENAWEE HEALTH NETWORK, COMPRISED OF MULTIPLE COMMUNITY ORGANIZATIONS, COLLABORATED TO DEVELOP A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR LENAWEE COUNTY, WITH PROMEDICA BIXBY AND HERRICK HOSPITALS REPRESENTED ON THIS CHIP COMMITTEE. A GAP ANALYSIS AND RESOURCE ASSESSMENT WAS CONDUCTED AS PART OF THIS PROCESS.IN 2019, PROMEDICA BIXBY AND HERRICK HOSPITALS CONVENED A CHNA COMMITTEE TO REVIEW THE MOST RECENT LENAWEE COUNTY CHA AND CHIP, TAKING INTO ACCOUNT THE GAP AND RESOURCE ASSESSMENTS. THE COMMITTEE THEN SELECTED AND PRIORITIZED KEY HEALTH INDICATORS FOR THEIR DEFINED COMMUNITY, IDENTIFIED RESOURCES AND GAPS IN THESE AREAS, AND DEVELOPED IMPLEMENTATION PLANS TO ADDRESS THESE PRIORITY HEALTH NEEDS IN THE COMMUNITY OVER THE NEXT THREE YEARS. THE CHNA AND STRATEGIC IMPLEMENTATION PLAN WAS DEVELOPED WITH FEEDBACK FROM THE LENAWEE COUNTY HEALTH DEPARTMENT, TO CONFIRM THESE NEEDS FROM A COMMUNITY HEALTH EXPERT PERSPECTIVE. THE LENAWEE HEALTH NETWORK STRATEGIC PLANNING PROCESS INCLUDED INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY. COLLABORATING ORGANIZATIONS INCLUDED:ADRIAN FARMER'S MARKET, CARE PREGNANCY CENTER OF LENAWEE, CATHOLIC CHARITIES OF LENAWEE AND JACKSON, COMMUNITY ACTION AGENCY, FAMILY MEDICAL CENTER, GOODWILL INDUSTRIES, INTERCONNECTIONS DROP IN CENTER, LENAWEE COMMUNITY FOUNDATION, LENAWEE COMMUNITY MENTAL HEALTH AUTHORITY, LENAWEE COUNTY HEALTH DEPARTMENT, LENAWEE DEPARTMENT ON AGING, LENAWEE DEPARTMENT OF HUMAN SERVICES, LENAWEE DEPARTMENT OF VETERANS AFFAIRS, LENAWEE INTERMEDIATE SCHOOL DISTRICT, LENAWEE SUBSTANCE ABUSE PREVENTION COALITION, MCCULLOUGH, VARGAS & ASSOCIATES, MHP SALUD, MICHIGAN OPIOID COLLABORATIVE, MSU EXTENSION, ONE LENAWEE, PROMEDICA BIXBY HOSPITAL, PROMEDICA HERRICK HOSPITAL, REGION 2 AREA AGENCY ON AGING, SIENA HEIGHTS, THE UNITED WAY OF MONROE AND LENAWEE COUNTIES, YMCA OF LENAWEE

PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL
PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY CONDUCTED ITS 2019 CHNA WITH THE FOLLOWING HOSPITAL FACILITY: HERRICK MEMORIAL HOSPITAL, INC.

PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL
PART V, SECTION B, LINE 6B: THE HOSPITAL FACILITY CONDUCTED ITS 2019 CHNA WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO.

PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL
PART V, SECTION B, LINE 11: EMMA L. BIXBY MEDICAL CENTER (DBA PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL) CONDUCTED AND ADOPTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING TAX YEAR 2019 AND INTENDS TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS, LISTED IN ORDER OF PRIORITY: - OPIOIDS AND SUBSTANCE ABUSE - CHRONIC DISEASE PREVENTION - MENTAL HEALTH- CANCER THIS CHNA WAS CONDUCTED AND ADOPTED AT THE END OF TAX YEAR 2019, THEREFORE, THESE HEALTH NEEDS WILL BE ADDRESSED OVER THE THREE TAX YEARS, 2020-2022. EMMA L. BIXBY MEDICAL CENTER DOES NOT INTEND TO ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT GIVEN THAT SOME OF THE IDENTIFIED HEALTH NEEDS ARE EITHER BEING ADDRESSED DURING PHYSICIAN VISITS, GO BEYOND THE SCOPE OF THE HOSPITAL, OR ARE BEING ADDRESSED BY, OR WITH, OTHER ORGANIZATIONS IN THE COMMUNITY. TO SOME EXTENT, RESOURCE RESTRICTIONS DO NOT ALLOW THE HOSPITAL TO ADDRESS ALL OF THE HEALTH NEEDS IDENTIFIED THROUGH THE HEALTH NEEDS ASSESSMENT, BUT MOST IMPORTANTLY TO PREVENT DUPLICATION OF EFFORTS AND INEFFICIENT USE OF RESOURCES, MANY OF THESE ISSUES ARE ADDRESSED BY, AND WITH, OTHER COMMUNITY ORGANIZATIONS AND COALITIONS. THE 2019 SIGNIFICANT HEALTH NEEDS IDENTIFIED, BUT SPECIFICALLY NOT ADDRESSED BY THE HOSPITAL IN ITS 2019 IMPLEMENTATION PLAN INCLUDE: ADULT - HEALTHCARE COVERAGE, UTILIZATION, PREVENTIVE MEDICINE, WOMEN'S HEALTH, MEN'S HEALTH, ORAL HEALTH, HEALTH STATUS PERCEPTIONS, ADULT WEIGHT STATUS, ADULT TOBACCO USE, ADULT ALCOHOL USE, ADULT SEXUAL BEHAVIOR, ADULT MENTAL HEALTH, CANCER, QUALITY OF LIFE, SOCIAL DETERMINANTS OF HEALTH, ENVIRONMENTAL HEALTH, PARENTING; CHILD HEALTH HEALTH AND FUNCTIONAL STATUS. HEALTH CARE ACCESS, EARLY CHILDHOOD, MIDDLE CHILDHOOD, FAMILY AND COMMUNITY CHARACTERISTICS, AND PARENT HEALTH.DUE TO RESTRICTIONS AND REGULATIONS PUT IN PLACE DUE TO THE COVID-19 PANDEMIC, MANY OF THE STRATEGIES MEANT TO BE IMPLEMENTED HAD TO BE DELAYED. LISTED HERE ARE THE STRATEGIES THAT WERE ABLE TO BE MAINTAINED WHILE FOLLOWING PROPER PUBLIC HEALTH GUIDELINES IN PLACE AT THE TIME. ITEMS UNABLE TO BE ADDRESSED IN 2021 WILL BE ADDRESSED IN THE SUBSEQUENT YEAR. EMMA L. BIXBY MEDICAL CENTER DID TAKE THE FOLLOWING ACTIONS DURING TAX YEAR 2021 WITH RESPECT TO ITS MOST RECENT CHNA, CONDUCTED IN 2019:HEALTH NEED IDENTIFIED: OPIOIDS AND SUBSTANCE ABUSESTRATEGY #1 - PARTICIPATE IN COMMUNITY DRUG TAKE BACK DAYS ANNUALLY AND MED SAFE COLLECTION AND DISPOSAL.ACTIONS TAKEN: - 1,048 POUNDS OF DRUGS WERE COLLECTED FROM MEDSAFE BOXES AND DRUG TAKE BACK DAY EVENTS AND DISPOSED OF APPROPRIATELY . STRATEGY #2 - OFFER PEER RECOVERY COACHES FOR THOSE PATIENTS SEEKING HELP WITH SUBSTANCE ABUSE.ACTIONS TAKEN: - FIFTEEN (15) PATIENTS WERE CONNECTED TO PEER RECOVERY COACHES WITH COMMUNITY MENTAL HEALTH & PATHWAYS FOR POST DISCHARGE TREATMENT.STRATEGY #3 - CONTINUE THE ALTO (ALTERNATIVES TO OPIOIDS) PROJECT TO REDUCE THE AMOUNT OF OPIOIDS PRESCRIBED AT DISCHARGE FOR PATIENT PAIN MANAGEMENT. ACTIONS TAKEN:- USING ALTO PROGRAM, IN 2020, THE AVERAGE NUMBER OF DAYS OPIOIDS WERE PRESCRIBED AT DISCHARGE WAS DECREASED TO 3.06 DAYS BY DECEMBER 2020 AND DECREASED FURTHER TO 2.836 IN 2021.HEALTH NEED IDENTIFIED: CHRONIC DISEASE PREVENTION STRATEGY #1 - PROVIDE ANNUAL BLOOD PRESSURE SCREENINGS AT KEY COMMUNITY LOCATIONS. ACTIONS TAKEN: - PROVIDED 82 COMMUNITY PARTICIPANTS WITH BLOOD PRESSURE SCREENINGS AND EDUCATION IN 2021. STRATEGY #2 - PROVIDE ANNUAL BLOOD SUGAR SCREENINGS AT KEY COMMUNITY LOCATIONS.ACTIONS TAKEN: - HOSPITAL PROVIDED THREE(3) NO COST BLOOD SUGAR SCREENINGS AND EDUCATION AT KEY COMMUNITY LOCATIONS IN 2021 DUE TO COVID RESTRICTIONS THESE SCREENINGS WERE ONLY OFFERED IN 4TH QUARTER 2021.STRATEGY #3 - PROVIDE EDUCATION TO THE COMMUNITY ABOUT BLOOD PRESSURE AND BLOOD SUGAR SELF-MONITORING VIA VIRTUAL SUPPORT GROUP MEETINGS.ACTIONS TAKEN: - 40 COMMUNITY MEMBERS RECEIVED SELF-MONITORING EDUCATION RELATED EDUCATION AT BLOOD PRESSURE SUPPORT GROUPS AND DIABETES SUPPORT GROUPSSTRATEGY #4 PROVIDE EDUCATION MATERIALS RELATED TO RESPIRATORY DISEASE (COPD) PREVENTION AND SELF-MANAGEMENT TO PATIENTS AT DISCHARGE AND AT KEY COMMUNITY LOCATIONS.ACTIONS TAKEN: - SECOND QUARTER, DISTRIBUTED TOBACCO CESSATION EDUCATION TO FIVE (5) COMMUNITY MEMBERS AT SCREENING STATION. - 4TH QUARTER DISTRIBUTED COPD EDUCATIONAL TO 30 COMMUNITY MEMBERS AT RESIDENT COALITION 2ND FRIDAY EVENT.STRATEGY #5 CONTINUE TO FUND PROMEDICA FARMS AND VEGGIE MOBILE PROGRAM TO EXPAND THE OUTREACH OF FRESH PRODUCE ACCESS THROUGH COLLABORATIONS WITH LOCAL PRODUCERS AND COMMUNITY AGENCIES.ACTIONS TAKEN: - TOTAL FRESH PRODUCE DONATED TO THE COMMUNITY WAS 5,022.8 POUNDS.STRATEGY #6 SCREEN INPATIENTS FOR FOOD INSECURITY, AND PROVIDE COMMUNITY RESOURCE LISTING, IMMEDIATE FOOD SOURCE, AND VEGGIE MOBILE VOUCHER. ACTIONS TAKEN: - FOUR (4) FOOD AT DISCHARGE BOXES WERE PROVIDED TO INPATIENTS WHO SCREENED POSITIVE FOR FOOD INSECURITY IN 2021.HEALTH NEED IDENTIFIED: MENTAL HEALTHSTRATEGY #1 - DEVELOP AND DISTRIBUTE A MENTAL HEALTH RESOURCE GUIDE TO PATIENTS AND THE COMMUNITY.ACTIONS TAKEN: - 860 MENTAL HEALTH RESOURCE GUIDES WERE DISTRIBUTED TO PATIENTS AND THE COMMUNITY IN 2021, TO IMPROVE ACCESS TO THESE RESOURCESSTRATEGY #2 - PROVIDE COMMUNITY MEMBERS AND PATIENTS WITH MENTAL HEALTH SELF-MANAGEMENT AND PREVENTION EDUCATION MATERIALS.ACTIONS TAKEN:- PROVIDED 682 PACKETS OF MENTAL HEALTH SELF-MANAGEMENT AND PREVENTION EDUCATION MATERIALS TO COMMUNITY MEMBERS AND PATIENTS IN 2021.HEALTH NEED IDENTIFIED: CANCERSTRATEGY #1 - PROVIDE HEALTH EDUCATION RELATED TO SCREENING AND PREVENTION OF CANCER IN LENAWEE COUNTY BY TRAINING HAIR STYLISTS, FOOD PANTRIES, AND KEY COMMUNITY ORGANIZATIONS TO BE CANCER HEALTH ADVOCATES THROUGH THE DELIVERY OF MESSAGES AND EDUCATION TO THE COMMUNITY. ACTIONS TAKEN:-50 EDUCATIONAL PACKETS ABOUT COPD AND LUNG CANCER WERE DISTRIBUTED TO COMMUNITY MEMBERS AT ALL ABOUT ADRIAN RESIDENT EVENTSTRATEGY #2 - CONTINUE PARTICIPATION IN BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCP) FOR FREE WOMEN'S HEALTH SCREENINGS.ACTIONS TAKEN:- 13 WOMEN WERE PROVIDED WITH NO COST WOMEN'S HEALTH SCREENINGS IN 2021 THROUGH THE BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCP).

PART V, SECTION B, LINE 7A
THE 2019 CHNA CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/CHNA/PROMEDICA-BIXBY-AND-HERRICK-HOSPITALS-2019-JOINT-CHNA.PDF

PART V, SECTION B, LINE 10A
THE 2020-2022 CHNA IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/CHNA/PROMEDICA-BIXBY-AND-HERRICK-HOSPITAL-2019-JOINT-CHNA-IMPLEMENTATION-PLAN-2020-2022-.PDF

PART V, SECTION B, LINE 16A:
THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/PATIENT-RESOURCES/UNINSURED_DISCOUNT_POLICY.PDF

PART V, SECTION B, LINE 16B:
THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/PATIENT-RESOURCES/FINANCIAL_ASSISTANCE_APPLICATION.PDF

PART V, SECTION B, LINE 16C:
A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL:HTTPS://WWW.PROMEDICA.ORG/ASSETS/DOCUMENTS/PATIENT-RESOURCES/PLAIN_LANGUAGE_FINANCIAL_ASSISTANCE.PDF

PART I, LINE 3C:
IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY USES INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY STATUS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE.

PART I, LINE 6A:
PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE PROMEDICA HEALTH SYSTEM, INC. ANNUAL COMMUNITY BENEFIT REPORT.

PART I, LINE 7:
PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS, USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. OTHER BENEFITS AMOUNTS REPORTED ON LINE 7 WERE CALCULATED USING COSTS CHARGED DIRECTLY TO THE INDIVIDUAL PROGRAMS VIA THE FINANCIAL ACCOUNTING SYSTEM. AN INDIRECT COST ALLOCATION FACTOR FOR SHARED SERVICES IS ALSO CALCULATED AND INCLUDED IN APPLICABLE PROGRAMS LISTED IN OTHER BENEFITS.

PART III, LINE 2:
"PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL'S ANALYSIS AND ASSESSMENT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND RELATED BAD DEBT EXPENSE USES A RECEIPTS ""LOOK-BACK"" METHOD UTILIZING HISTORICAL PAYMENT DATA ON ACCOUNTS, INCLUDING CONTRACTUAL ADJUSTMENTS FOR PAYER DISCOUNTS, AS WELL AS PATIENT PAYMENTS, SUCH AS CO-PAYS AND DEDUCTIBLES, TO ESTABLISH ANTICIPATED COLLECTABILITY RATES FOR ACCOUNTS RECEIVABLE WITHIN EACH PAYER CATEGORY."

PART III, LINE 3:
PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL ESTIMATED THE POSSIBLE AMOUNT OF FINANCIAL ASSISTANCE WITHIN BAD DEBT EXPENSE BY REVIEWING ACCOUNTS THAT WERE INTERNALLY CODED AS HAVING BEEN PROVIDED A FINANCIAL ASSISTANCE APPLICATION, BUT THAT WAS NOT ADEQUATELY COMPLETED BY THE PATIENT OR GUARANTOR, IN WHICH THE ACCOUNT WAS SUBSEQUENTLY WRITTEN OFF TO BAD DEBT.

PART III, LINE 4:
PROVISION FOR BAD DEBTS AND ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS ARE DISCUSSED ON PAGE 18 AND 19 OF THE ATTACHED PROMEDICA HEALTH SYSTEM AND SUBSIDIARIES CONSOLIDATED FINANCIAL REPORT WITH SUPPLEMENTAL INFORMATION.

PART III, LINE 9B:
FINANCIAL ASSISTANCE DISCOUNTS ARE GRANTED FOR MEDICALLY NECESSARY SERVICES WHEN IT IS DETERMINED THAT THE PATIENT AND FAMILY INCOME MEETS THE CRITERIA ESTABLISHED. PATIENTS WHO HAVE INSURANCE COVERAGE OR WHO ARE ENTITLED TO GOVERNMENTAL ASSISTANCE ARE IDENTIFIED IN ORDER FOR REIMBURSEMENT TO BE OBTAINED. ALL PATIENTS WITH SELF-PAY BALANCES AFTER INSURANCE MAY OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS IF THEY PROVIDE APPROPRIATE DOCUMENTATION THAT THEY SATISFY THE INCOME GUIDELINES. VERIFICATION OF FINANCIAL ASSISTANCE IS PURSUED THROUGHOUT THE INTERNAL COLLECTION PROCESS UNTIL ALL OPTIONS HAVE BEEN EXHAUSTED. ALL PATIENTS, THAT HAVE A SELF-PAY BALANCE, INCLUDING PATIENTS THAT MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE, RECEIVE BILLING STATEMENTS AND PAYMENT REMINDERS. THESE STATEMENTS INFORM ALL PATIENTS OF THE OPPORTUNITY TO SEEK A FINANCIAL ASSISTANCE ADJUSTMENT FOR MEDICALLY NECESSARY SERVICES, THE ELIGIBILITY CRITERIA, AND THE METHOD TO APPLY. IF A FINANCIAL ASSISTANCE APPLICATION HAS NOT BEEN COMPLETED AND/OR REQUESTED INCOME VERIFICATION HAS NOT BEEN RECEIVED FROM A PATIENT WHO COULD POTENTIALLY QUALIFY, THE PATIENT WILL CONTINUE TO RECEIVE BILLING STATEMENTS THROUGH THE NORMAL COLLECTION PROCESS. IF A PATIENT DOES NOT HAVE INSURANCE, A PRESUMPTIVE CHARITY DETERMINATION (WHICH USES PUBLICLY AVAILABLE DATA SUCH AS DEMOGRAPHIC INFORMATION, CREDIT HISTORY, ETC.) MAY BE MADE TO ASSIST WITH QUALIFYING FOR FINANCIAL ASSISTANCE. ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, AN ADJUSTMENT IS PROCESSED. THE PATIENT ACCOUNT ANALYST WILL DETERMINE PATIENT ELIGIBILITY AND CALCULATE THE ADJUSTMENT BASED ON POLICY GUIDELINES. AN ADJUSTMENT FORM IS PREPARED AND APPROVED PER POLICY. UNINSURED PATIENTS MAY BE REQUIRED TO COMPLETE AN APPLICATION AND PROVIDE REQUIRED DOCUMENTATION, INCLUDING ANY DOCUMENTATION REQUIRED TO DETERMINE ELIGIBILITY. UNINSURED PATIENTS ARE NOTIFIED IN WRITING WHETHER OR NOT THEY QUALIFY FOR ANY FINANCIAL ASSISTANCE ADJUSTMENT FOR WHICH THEY HAVE SUBMITTED AN APPLICATION, AND OF ANY REMAINING BALANCE OWED. THE ADJUSTMENT IS THEN APPLIED TO THE PATIENT'S ACCOUNT.PATIENTS MAY BE OFFERED PAYMENT PLANS WHEN APPROPRIATE BASED ON DOCUMENTED FINANCIAL NEED AND CIRCUMSTANCES. LONGER PAYMENT PLANS MAY BE OFFERED ON AN EXCEPTION BASIS FOR CASES WITH UNUSUALLY HIGH BALANCES OR SPECIAL CIRCUMSTANCES DEMONSTRATING AN INABILITY TO PAY. ONCE THE INTERNAL COLLECTION PROCESS HAS BEEN COMPLETED, PATIENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY IF THE PATIENT HAS NOT CONTACTED US REGARDING THEIR DESIRE TO APPLY FOR FINANCIAL ASSISTANCE, SENT IN A FINANCIAL ASSISTANCE APPLICATION, RESPONDED TO REQUESTS FOR ADDITIONAL INFORMATION, OR WE ARE UNABLE TO MAKE A PRESUMPTIVE CHARITY DETERMINATION. IT IS THE EXPECTATION OF THE EXTERNAL COLLECTION AGENCY AS THEY WORK ACCOUNTS TO OFFER FINANCIAL ASSISTANCE WHEN APPLICABLE. THROUGHOUT THE COLLECTION PROCESS, THE COLLECTION AGENCY WILL INFORM UNINSURED PATIENTS OF THE CRITERIA TO OBTAIN FINANCIAL ASSISTANCE ADJUSTMENTS BASED ON FAMILY INCOME AND FAMILY SIZE, AND WILL FORWARD APPLICATIONS FOR PATIENTS WHO SUBMIT THE REQUIRED DOCUMENTATION TO THE CENTRAL BUSINESS OFFICE FOR PROCESSING.

PART VI, LINE 2:
PROMEDICA HEALTH SYSTEM AND HOSPITALS DEMONSTRATE A COMMITMENT TO THE COMMUNITIES IT SERVES AND THEREFORE, BELIEVES IT IS CRITICAL TO UNDERSTAND THE HEALTH CARE NEEDS OF ITS PRIMARY SERVICE AREA. TO THAT END, PROMEDICA HOSPITALS CONDUCT NEEDS ASSESSMENTS IN ITS PRIMARY SERVICE AREAS USING A VARIETY OF METHODOLOGIES TO ASSESS EACH COUNTY'S HEALTH CARE DATA, IDENTIFY GAPS IN HEALTH CARE INITIATIVES, AND MAKE RECOMMENDATIONS FOR THE BETTERMENT OF THE GENERAL COMMUNITY HEALTH. ANALYSIS OF PUBLISHED COUNTY HEALTH DATA, INTERVIEWS WITH KEY STAKEHOLDERS, AND REVIEW OF HISTORICAL AND EXISTING PROMEDICA COMMUNITY ASSESSMENTS ARE ALL MEANS BY WHICH RECOMMENDATIONS FOR THE PROMEDICA COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLANS ARE DEVELOPED. INFORMATION IS REVIEWED AND APPROVED BY HOSPITAL GOVERNANCE LEADERSHIP TO ASSURE THAT PLANS ARE DEVELOPED TO MEET THE NEEDS OF THE COMMUNITY. PUBLISHED COUNTY HEALTH DATACOUNTY HEALTH DATA WERE OBTAINED FROM SEVERAL SOURCES, INCLUDING THE OHIO DEPARTMENT OF HEALTH DATA WAREHOUSE, THE MICHIGAN DEPARTMENT OF HEALTH, AND FORMAL COUNTY ASSESSMENTS CONDUCTED WITHIN THE INDIVIDUAL COUNTIES. ALTHOUGH MOST COUNTIES CONDUCTING A FORMAL ASSESSMENT UTILIZE THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) QUESTIONNAIRE DEVELOPED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) AS THE BASIS OF THE COUNTY QUESTIONNAIRE, COUNTY COMMITTEES TYPICALLY ADD AND/OR CHANGE QUESTIONS TO MEET THE COUNTY'S PERCEIVED NEEDS. PROMEDICA'S COMMUNITY GOALS ARE SET BASED ON THESE DATA.PROMEDICA COMMUNITY HEALTH PLANOVERALL, EMPHASIS IS PLACED ON CLINICAL PROGRAMS FOCUSED ON LEADING CAUSES OF DEATH: CHRONIC DISEASES, MENTAL HEALTH, AND HUNGER/OBESITY DUE TO THE LARGE NUMBERS OF INDIVIDUALS AFFECTED BY THESE DISEASES. THE PRIMARY FOCUS FOR COMMUNITY HEALTH ACTIVITIES ARE RELATED TO EDUCATION, SCREENING, AND PREVENTION OF CHRONIC DISEASES, MENTAL HEALTH ISSUES, AND HUNGER/OBESITY; AND IMPROVING RELATED CONDITIONS THAT RESULT IN HIGH MORBIDITY AND MORTALITY IN OUR COMMUNITIES, WITH SPECIAL EMPHASIS PLACED ON SERVING UNDERSERVED POPULATIONS. AS A SYSTEM, WE ARE ALSO COMMITTED TO WORKING BEYOND OUR FOUR WALLS, ON THE SOCIAL AND ECONOMIC ISSUES THAT IMPACT HEALTH. IN ADDITION, PROMEDICA STRATEGIC PLANNING CONTINUES TO DEVELOP PATIENT-CENTERED, INTEGRATED CLINICAL SERVICE LINES INCLUDING CANCER, CARDIOVASCULAR, BEHAVIORAL HEALTH, SOCIAL DETERMINANTS OF HEALTH, AND MATERNAL FETAL MEDICINE.

PART VI, LINE 3:
THE OPPORTUNITY FOR FINANCIAL ASSISTANCE ADJUSTMENTS IS COMMUNICATED TO PATIENTS AT PROMEDICA HEALTH SYSTEM HOSPITALS THROUGH THE FOLLOWING METHODS:A. DURING THE PRE-REGISTRATION PROCESS FOR SCHEDULED INPATIENTS AND HIGH-DOLLAR OUTPATIENT CASES, THE CENTRALIZED PRE-REGISTRATION STAFF WILL NOTIFY A PATIENT FINANCIAL ADVOCATE TO CONTACT THE PATIENT PRIOR TO SERVICE TO DISCUSS POTENTIAL ELIGIBILITY FOR GOVERNMENT PROGRAMS AND FINANCIAL ASSISTANCE. THE PRE-SERVICE FUNCTION INCLUDES ACCOUNT REGISTRATION, INSURANCE VERIFICATION, PRE-CERTIFICATION AND FINANCIAL COUNSELING.B. ADMITTING LOCATIONS WILL HAVE FINANCIAL ASSISTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE WHEN REGISTERED AS UNINSURED. AT ADMITTING, UNINSURED PATIENTS ARE INFORMED OF THE OPPORTUNITY TO SEEK FINANCIAL ASSISTANCE. C. PATIENT FINANCIAL ADVOCATES ARE AVAILABLE AT THE HOSPITALS TO ASSIST UNINSURED PATIENTS IN COMPLETING THE FORMS. PATIENT FINANCIAL ADVOCATES ATTEMPT TO MEET WITH IN-HOUSE PATIENTS TO ASSESS ELIGIBILITY AND TO ASSIST WITH APPLICATION FOR GOVERNMENT ASSISTANCE PROGRAMS, TO EXPLAIN PATIENT LIABILITY FOR CHARGES, TO PROVIDE AN ESTIMATE OF CHARGES WHEN FEASIBLE, TO EXPLAIN THE OPPORTUNITY FOR FINANCIAL ASSISTANCE, INCLUDING THE CRITERIA AND THE METHOD FOR APPLYING, AND TO EXPLAIN PAYMENT OPTIONS.D. A MESSAGE IS PRINTED ON THE PATIENT BILLING STATEMENTS TO NOTIFY THE UNINSURED PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE, TO EXPLAIN THE ELIGIBILITY CRITERIA, AND TO DESCRIBE THE METHOD TO APPLY.E. A SUMMARY OF THE POLICY FOR UNINSURED PATIENTS IS INCLUDED IN THE STATEMENTS OF UNINSURED PATIENT, AVAILABLE VIA THE PROMEDICA WEB SITE, AVAILABLE AT HOSPITAL REGISTRATION LOCATIONS, OR BY CALLING THE PROMEDICA CUSTOMER SERVICE DEPARTMENT. BUSINESS OFFICE PERSONNEL ALSO NOTIFY UNINSURED PATIENTS OF THE FINANCIAL ADJUSTMENT POLICY THROUGH THE CUSTOMER SERVICE AND COLLECTION DEPARTMENTS.

PART VI, LINE 4:
EMMA L. BIXBY MEDICAL CENTER, DOING BUSINESS AS PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL, LOCATED IN ADRIAN, MI, SERVES AN AREA PRIMARILY AROUND LENAWEE COUNTY AND HAS A SERVICE AREA POPULATION OF APPROXIMATELY 80,000. APPROXIMATELY, 19% OF THE SERVICE AREA IS AGE 65 OR OVER; 60% IS BETWEEN AGE 18 AND 64; MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $55,000; 91% OF THE ADULT POPULATION AGED 25+ HAS A HIGH SCHOOL DEGREE OR LOWER; 45% OF HOUSEHOLDS HAVE AN INCOME OF $50,000 OR LESS. LENAWEE COUNTY HAS A POPULATION OF APPROXIMATELY 99,000 WITH APPROXIMATELY 10% OF FAMILIES BELOW THE POVERTY LEVEL AND AN APPROXIMATE 21% MEDICAID ELIGIBLE RATE. APPROXIMATELY, 7% OF LENAWEE COUNTY IS UNINSURED. THE AVERAGE UNEMPLOYMENT RATE AT THE END OF 2021 FOR LENAWEE COUNTY WAS 4.3%. THE LEADING CAUSES OF DEATH IN LENAWEE COUNTY, BASED ON AGE ADJUSTED MORTALITY RATES ARE HEART DISEASE, CANCER, COVID, UNINTENTIONAL INJURIES/ACCIDENTS, STROKE, LUNG DISEASE, ALZHEIMER'S, AND DIABETES. ACCORDING TO THE 2021 COUNTY HEALTH RANKINGS, LENAWEE COUNTY RANKED 26 OF 83 COUNTIES FOR HEALTH OUTCOMES, 25 OF 83 FOR LENGTH OF LIFE, AND 32 OF 83 FOR QUALITY OF LIFE. THERE ARE NINE HOSPITALS WITHIN A 30-MILE RADIUS OF CHARLES AND VIRGINIA HICKMAN HOSPITAL: HERRICK MEMORIAL HOSPITAL, INC., ST. JOSEPH MERCY SALINE HOSPITAL, FLOWER HOSPITAL, FULTON COUNTY HEALTH CENTER, ST. ANNE MERCY HOSPITAL, CHELSEA COMMUNITY HOSPITAL, THE TOLEDO HOSPITAL, HENRY FORD ALLEGIANCE HEALTH, AND UNIVERSITY OF TOLEDO MEDICAL CENTER.

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EMMA L. BIXBY IS AN INTEGRAL PART OF PROMEDICA HEALTH SYSTEM, INC., WHICH PROMOTES THE HEALTH OF THE COMMUNITY AS AN INTEGRATED DELIVERY SYSTEM. IN 2021:- THERE WERE APPROXIMATELY 300 BOARD MEMBERS FOR PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA), SERVING ON MORE THAN 25 DIFFERENT BOARDS, COMMITTEES, COUNCILS AND FOUNDATIONS. OF THOSE BOARD MEMBERS, MOST LIVE WITHIN PROMEDICA'S OHIO AND MICHIGAN ACUTE CARE SERVICE AREA, WITH THE MAJORITY RESIDING WITHIN THE GREATER TOLEDO AREA WHERE PROMEDICA'S ADULT AND PEDIATRIC TERTIARY HOSPITALS (THE TOLEDO HOSPITAL AND TOLEDO CHILDREN'S HOSPITAL) ARE LOCATED. BOARD MEMBERSHIP IS COMPOSED OF 43% FEMALES, 20% PHYSICIANS, 11% UNDER THE AGE OF 40, AND 18% RACIAL OR ETHNIC MINORITIES. - PROMEDICA NON-PARENT BOARD MEMBERS' DONATION OF TIME AND EXPERTISE, INCLUDING ATTENDING BOARD MEETINGS, RETREATS AND OTHER ACTIVITIES, WERE PERFORMED ON A VOLUNTEER BASIS. - PROMEDICA'S MEDICAL STAFF PRIVILEGES WERE EXTENDED TO ALL QUALIFIED PHYSICIANS AT OUR METRO TOLEDO AND REGIONAL HOSPITALS. QUALIFICATION MAY VARY BY HOSPITAL, BUT ANY PHYSICIAN WHO MET THOSE QUALIFICATIONS WAS GRANTED PRIVILEGES, UPON THEIR REQUEST.- AS PART OF PROMEDICA'S ELECTRONIC HEALTH RECORD (EHR) JOURNEY, THE INFORMATION TECHNOLOGY SERVICES TEAM COMPLETED TWO SYSTEM-WIDE UPGRADES TO THE EPIC PLATFORM. THE UPGRADES ALLOW PROMEDICA TO TAKE ADVANTAGE OF SOME OF THE MANY ENHANCEMENTS THAT EPIC HAS MADE TO ITS SOFTWARE BASED ON USER INPUT.- PROMEDICA PRIMARY CARE PROVIDERS CONTINUED SCREENING PATIENTS FOR RISK FACTORS OF SOCIAL DETERMINANTS OF HEALTH BY ASKING QUESTIONS RELATED TO EDUCATION, EMPLOYMENT, FOOD SECURITY, HOUSING, TRANSPORTATION, AND VIOLENCE. PATIENTS WHO SCREENED POSITIVE FOR ANY OF THE FACTORS WERE CONNECTED TO COMMUNITY PROGRAMS AND RESOURCES FOR ASSISTANCE.- PROMEDICA CANCER INSTITUTE (PCI) COMPLETED MORE THAN 3,300 LUNG CANCER SCREENINGS, NEARLY 55,000 SCREENING MAMMOGRAMS AND NEARLY 13,000 SCREENING COLONOSCOPIES. ADDITIONALLY, PCI CONTINUES TO BE INSTRUMENTAL IN HELPING PROMEDICA IMPLEMENT MONOCLONAL ANTIBODY TREATMENT AT ITS INFUSION CENTERS FOR COVID-19 PATIENTS TO IMPROVE SYMPTOM MANAGEMENT. IN 2021, APPROXIMATELY 8,000 DOSES OF THE TREATMENT WERE PROVIDED. - PROMEDICA SENIOR CARE SKILLED NURSING FACILITIES AND HOME HEALTH AND HOSPICE AGENCIES PROVIDE UNIQUE SERVICES TO VETERANS, HOLIDAY SUPPORT, SUPPORT GROUPS, AND WORKSHOPS TO ANYONE IN THE COMMUNITY WHO NEEDS ADDITIONAL HELP TO GET THROUGH THE LOSS OF A LOVED ONE. PATIENTS AND RESIDENTS' WISHES ARE GRANTED THROUGH THE ORGANIZATION'S HEART'S DESIRE PROGRAM. THROUGH GRANTS FROM THE HOSPICE MEMORIAL FUND, GRIEF CAMPS FOR CHILDREN AND ADULTS ARE OFFERED AS WELL AS EDUCATIONAL SESSIONS AND LIFE CELEBRATION EVENTS. THE FUND ALSO PROVIDES STABILIZING RESOURCES FOR HOSPICE PATIENTS AND FAMILIES IN FINANCIAL DISTRESS DUE TO THE LACK OF OR REDUCTION IN INCOME FROM TERMINAL ILLNESS OR DISEASE.- PROMEDICA CONTINUES TO EXPAND ITS OPTIONS FOR HOSPITAL-LEVEL CARE IN THE COMFORT OF A PATIENT'S HOME. PROMEDICA ACUTE CARE AT HOME COMBINES PROMEDICA'S EXTENSIVE NETWORK OF IN-HOME CARE PROVIDERS WITH A SOPHISTICATED TECHNOLOGY PLATFORM TO DELIVER SEAMLESS AND EFFECTIVE CARE AT HOME FOR PATIENTS WITH SELECT CHRONIC CONDITIONS OR DIAGNOSES SUCH AS HEART FAILURE, PNEUMONIA OR COPD. IN 2021, PROMEDICA ACUTE CARE AT HOME EXPANDED ITS SERVICES TO INCLUDE CARE FOR SELECT ONCOLOGY PATIENTS BY COLLABORATING THE PROMEDICA CANCER CENTER. THE CARE TEAM CONSISTS OF PHYSICIANS, NURSE PRACTITIONERS, REGISTERED NURSES, AND MAY INCLUDE OTHER HEALTHCARE PROFESSIONALS, SUCH AS PHYSICAL OR OCCUPATIONAL THERAPISTS, AS NEEDED.- IN THE METRO TOLEDO AREA, PROMEDICA WORKED CLOSELY WITH LUCAS COUNTY DEPARTMENT OF HEALTH OFFICIALS TO ASSIST WITH MASS COVID VACCINE CLINICS AS WELL AS CLINICS IN UNDERSERVED AREAS OF THE COMMUNITY WHERE VACCINE HESITANCY WAS AN ONGOING CONCERN. ONE OF THE PROJECTS PROMEDICA HELPED SPEARHEAD WAS THE V PROJECT, WHICH WORKED ACROSS THE NORTHWEST OHIO COMMUNITY TO INCREASE VACCINE PARTICIPATION. THE V PROJECT HELPED TO BRING RESOURCES TO PEOPLE IN ZIP CODES THAT HAD LOWER VACCINATION PARTICIPATION RATES WITH THE GOAL OF EASING ANY BARRIERS THAT MAY HAVE PROHIBITED THEM FROM PREVIOUSLY GETTING THEIR VACCINE. - PROMEDICA ALSO ALLOCATED 20% OF THE VACCINES IT RECEIVED TO UNDERSERVED COMMUNITIES. THIS LED TO OTHER OPPORTUNITIES SUCH AS THE PARTNERSHIP WITH THE FIRST CHURCH OF GOD ON COLLINGWOOD IN TOLEDO. LED BY THE PPG CLINICAL OPERATIONS TEAM, VARIOUS TEAMS FROM ACROSS PROMEDICA CAME TOGETHER AND HELD VACCINATION CLINICS ON SUNDAYS. PROMEDICA ALSO EXPANDED PARTICIPATION IN COMMUNITY MASS COVID VACCINE CLINICS AT AN ARE UAW HALL TO REACH A LARGER PROPORTION OF THE UNDERSERVED COMMUNITIES.

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"PROMEDICA HEALTH SYSTEM, INC. (PROMEDICA) IS A NATIONWIDE, MISSION-BASED, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION THAT WAS FORMED IN TOLEDO, OHIO IN 1986. IN 2021 PROMEDICA WAS COMPRISED OF MORE THAN 45,000 EMPLOYEES, NEARLY 850 VOLUNTEERS AND MORE THAN 2,100 PHYSICIANS AND ADVANCED PRACTICE PROVIDERSINCLUDING APPROXIMATELY 1,200 PHYSICIANS AND ADVANCED PRACTICE PROVIDERS EMPLOYED BY PROMEDICA PHYSICIAN GROUP ('PPG"")WHO FORM A PROVIDER NETWORK ACROSS 27 COUNTIES IN NORTHWEST OHIO AND SOUTHEAST MICHIGAN. AS AN INTEGRATED DELIVERY SYSTEM, PROMEDICA PROVIDERS SHARE RESOURCES SUCH AS ADVANCED TECHNOLOGY, QUALITY STANDARDS, SAFETY PRACTICES, MEDICAL EXPERTISE, AND SPECIALTY SERVICES TO ENSURE COMMUNITY MEMBERS HAVE READY ACCESS TO HIGH-QUALITY CARE IN THE MOST APPROPRIATE SETTING IN ORDER TO PROVIDE COST-EFFICIENT SERVICES. IN 2021:- PROMEDICA MEMBERS AND AFFILIATE HOSPITALS INCLUDED: THE TOLEDO HOSPITAL D/B/A PROMEDICA TOLEDO HOSPITAL; PROMEDICA TOLEDO CHILDREN'S HOSPITAL (OPERATING AS PART OF PROMEDICA TOLEDO HOSPITAL); PROMEDICA WILDWOOD ORTHOPAEDIC AND SPINE HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL; FLOWER HOSPITAL, A DIVISION OF PROMEDICA TOLEDO HOSPITAL D/B/A PROMEDICA FLOWER HOSPITAL; BAY PARK COMMUNITY HOSPITAL D/B/A PROMEDICA BAY PARK HOSPITAL; EMMA L. BIXBY MEDICAL CENTER D/B/A PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL,; FOSTORIA HOSPITAL ASSOCIATION D/B/A PROMEDICA FOSTORIA COMMUNITY HOSPITAL; DEFIANCE HOSPITAL, INC. D/B/A PROMEDICA DEFIANCE REGIONAL HOSPITAL; MERCY MEMORIAL HOSPITAL CORPORATION D/B/A PROMEDICA MONROE REGIONAL HOSPITAL; MEMORIAL HOSPITAL D/B/A PROMEDICA MEMORIAL HOSPITAL; AND COMMUNITY HEALTH CENTER OF BRANCH COUNTY D/B/A PROMEDICA COLDWATER REGIONAL HOSPITAL. PROMEDICA ALSO INCLUDES PROMEDICA INSURANCE CORPORATION; PROMEDICA PHYSICIAN GROUP; AND PROMEDICA CONTINUING CARE SERVICES CORPORATION AS WELL AS HUNDREDS OF SKILLED NURSING AND REHABILITATION CENTERS, ASSISTED LIVING FACILITIES AND MEMORY CARE COMMUNITIES, ALL UNDER THE PROMEDICA SENIOR CARE/HCR MANORCARE UMBRELLA.- PROMEDICA MANAGED APPROXIMATELY 2.28 MILLION PPG EMPLOYED PROVIDER ENCOUNTERS, 57,200 SURGERIES, 6,000 BIRTHS, AND MORE THAN 262,600 EMERGENCY ROOM VISITS AND CONTRIBUTED A TOTAL COMMUNITY BENEFIT OF OVER $259,433,000.- PROMEDICA CONTINUED TO OPERATE THREE COMMUNITY FOOD CLINICS, LOCATED AT PROMEDICA BAY PARK HOSPITAL, THE PROMEDICA HEALTH AND WELLNESS CENTER AND PROMEDICA'S CENTER FOR HEALTH SERVICES, TO SERVE PATIENTS WHO SCREEN POSITIVE FOR FOOD INSECURITY AND HAVE A REFERRAL FROM THEIR PRIMARY CARE PROVIDER. PATIENTS ARE ABLE TO RECEIVE FOOD FOR THEMSELVES AND THEIR FAMILY FROM ONE OF THESE FOOD CLINICS. AS PART OF THE PROGRAM, PATIENTS CAN RECEIVE TWO TO THREE DAYS OF SUPPLEMENTAL FOOD. THROUGH DECEMBER 2021, APPROXIMATELY 5,794 VISITS TO THE FOOD CLINIC, IMPACTING MORE THAN 2,093 UNIQUE HOUSEHOLDS, FURTHERED PROMEDICA'S EFFORTS TO REDUCE FOOD INSECURITY. THIS TRANSLATES TO ABOUT 44,100 DAYS' WORTH OF FOOD PROVIDED TO PATIENTS AND FAMILIES, THE EQUIVALENT OF 132,300 MEALS.- FOR ITS MICHIGAN PATIENTS, PROMEDICA PARTNERED WITH THE SOUTH MICHIGAN FOOD BANK TO DISTRIBUTE FOOD RESOURCES TO PROMEDICA PHYSICIANS GROUP OFFICES FOR PATIENTS SCREENING POSITIVE FOR FOOD INSECURITY. IN 2021, 49 PEOPLE WERE SUPPORTED BY THE INITIATIVE. PROMEDICA CHARLES AND VIRGINIA HICKMAN HOSPITAL PROVIDE THE $5 VOUCHERS AT DISCHARGE SO PATIENTS CAN REDEEM FRESH PRODUCE FROM THE VEGGIE MOBILE THAT IS SOURCED FROM PROMEDICA FARMS, LOCAL GROWERS, AND A WHOLESALER. IN 2021, NEARLY 2,560 POUNDS OF PRODUCE WAS GROWN AT PROMEDICA FARMS, 21 PATIENTS IDENTIFIED AS FOOD INSECURE REDEEMED A VOUCHER ISSUED BY A PHYSICIAN OR DISCHARGE PLANNING, AND AN ADDITIONAL 4 PATIENTS WERE PROVIDED A FOOD BOX AND VEGGIE VOUCHER UPON DISCHARGE. - PROMEDICA EBEID INSTITUTE'S MARKET ON THE GREEN PROVIDED BETTER ACCESS TO HEALTHY FOODS IN A DESIGNATED FOOD DESERT, AS WELL AS JOB TRAINING OPPORTUNITIES AND A FINANCIAL OPPORTUNITY CENTER TO PROVIDE FINANCIAL COUNSELING FOR RESIDENTS IN THE UPTOWN TOLEDO NEIGHBORHOOD. ADDITIONALLY, TWO NEW FINANCIAL OPPORTUNITY CENTERS (FOC) WERE OPENED IN FREMONT AND DEFIANCE, OHIO. MUCH LIKE THE FOC LOCATED IN UPTOWN TOLEDO, THE NEW LOCATIONS OFFER SERVICES AND ASSIST LOW TO MODERATE-INCOME FAMILIES WITH SECURING LIVING WAGE JOBS, BUILDING CREDIT, REDUCING DEBT, AND GAINING WEALTH. THE FOC ALSO HELPS INDIVIDUALS NEEDING INCOME SUPPORT (PUBLIC BENEFITS) AND EMPLOYMENT COACHING AND COUNSELING AS WELL AS FREE TAX PREPARATION."