4A (Expenses $ 45325850 including grants of $ 0) (Revenue $ 48182188)
HOSPITAL SERVICE - FITZGIBBON HOSPITAL IS A 60 BED ACUTE CARE FACILITY SERVING MARSHALL, MO AND THE SURROUNDING COMMUNITIES. THE FACILITY PROVIDES HEALTH CARE WITH A 24 HOUR PHYSICIAN-STAFFED EMERGENCY DEPARTMENT, AN INTENSIVE CARE UNIT, IN AND OUT-PATIENT MEDICAL/SURGICAL SERVICES, AN OBSTETRICS UNIT, A BEHAVIORAL HEALTH UNIT AND A 24 HOUR HOSPITALIST PROGRAM TO SERVE IN-PATIENT NEEDS AT ALL TIMES. ANCILLARY SERVICES SUCH AS RADIOLOGY, LABORATORY, RESPIRATORY THERAPY AND REHABILITATIVE SERVICES ARE AVAILABLE ON SITE. FOR MORE INFORMATION, SEE SCHEDULE O.

4B (Expenses $ 7392507 including grants of $ 0) (Revenue $ 7858367)
CLINIC SERVICE - SPECIALTY CLINICS WITHIN THE HOSPITAL PROVIDE ORTHOPEDIC, WOUND CARE, AND PAIN MANAGEMENT SERVICES TO BOTH IN AND OUTPATIENTS. THESE CLINICS PROVIDED SERVICES TO 5,625 PATIENTS. THE HOSPITAL ALSO SUPPORTS A SEPARATE OUTPATIENT CLINIC ON CAMPUS FOR FAMILY MEDICINE, OB/GYN, GENERAL SURGERY, CHIROPRACTIC, AND PSYCHIATRY STAFFED MEDICAL PROFESSIONALS PRACTICING IN THESE SPECIALTIES FOR FISCAL YEAR 2022 THIS CLINIC PROVIDED SERVICES FOR 23,255 PATIENT VISITS. FIVE SATELLITE FAMILY PRACTICE CLINICS ARE ALSO SUPPORTED BY THE HOSPITAL. THESE CLINICS PROVIDED SERVICES FOR 15,973 PATIENT VISITS.

4C (Expenses $ 686118 including grants of $ 0) (Revenue $ 729355)
COMMUNITY HEALTH SERVICES - HOSPICE AND HOME HEALTH. HOSPICE PROVIDED 898 PALLIATIVE CARE VISITS AND HOME HEALTH PROVIDED 3,457 VISITS. THE HOSPITAL DONATED $15,000 TO OATS IN 2022 AND WILL BE DONATING ANNUALLY TO HELP SUSTAIN IT IN THE MARSHALL COMMUNITY. THE PROGRAM PROVIDED TRANSPORTATION FOR 784 RIDERS DURING FY 2022.

SCHEDULE H, PART V, SECTION B, LINE 5
COMMUNITY INPUT: KEY INDIVIDUALS FROM WHICH INPUT WAS SOUGHT INCLUDED PERSONS WITH EXPERIENCE IN CONDUCTING PRIOR NEEDS ASSESSMENTS, STAFF FAMILIAR WITH ASPECTS OF PUBLIC HEALTH, THOSE INVOLVED IN CARRYING OUT KEY ACTIVITIES DELINEATED UNDER PRIOR IMPLEMENTATION PLANS AND THOSE FAMILIAR WITH APPLICABLE REGULATIONS REGARDING CONDUCTING AND DISSEMINATING THE CHNA. STAFF ALSO INCLUDED THOSE WHOSE ROLES WOULD ENSURE THAT WE RECEIVED INPUT FROM VULNERABLE, CHRONICALLY ILL AND UNDER-SERVED POPULATIONS. STAFF MEMBERS INVOLVED AND WERE: - ANGY LITTRELL, PRESIDENT AND CHIEF EXECUTIVE OFFICER - NANCY HARRIS, CHIEF FINANCIAL OFFICER - AMY WEBER, MANAGER OF BUSINESS DEVELOPMENT, GOVERNMENTAL RELATIONS AND MARKETING - KAREN MOSS, LCSW, BEHAVIORAL HEALTH CONSULTANT FOR RURAL HEALTH CLINICS AND MEDICAL HOME MODEL OF CARE, SERVING PRIMARILY LOW-INCOME AND CHRONICALLY ILL INDIVIDUALS - SARA WALKER, REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR - GINA GLISSON, BSN, R.N., CLINICAL QUALITY DIRECTOR, FITZGIBBON HOSPITAL - RICHARD DEFORD, MARKETING COORDINATOR AND BOARD-CERTIFIED CHAPLAIN FOR THE HOSPITAL AND FITZGIBBON MARY MONTGOMERY HOSPICE - CINDY EAGLE, NURSING ADMINISTRATION SPECIAL PROJECTS AND MARKETING STAFF MEMBER A SECOND PRONG OF OUR DATA COLLECTION ACTIVITIES WAS TO VALIDATE OUR CONCLUSIONS REGARDING THE SOCIAL DETERMINANTS OF HEALTH AFFECTING SALINE COUNTIANS THROUGH THE USE OF ADDITIONAL SECONDARY DATA SOURCES WHICH SPOKE TO SPECIFIC SOCIOECONOMIC INDICATORS, SUCH AS POVERTY, MEDICAID ENROLLMENT FIGURES AND HEALTH LITERACY RATES. A FINAL PRONG OF FITZGIBBON HOSPITAL'S APPROACH TO ITS 2022 CHNA WAS PRIMARY DATA COLLECTION, OR DIRECT OUTREACH TO COMMUNITY STAKEHOLDERS TO PROVIDE INPUT ON ITS ACTIONS AND ACTIVITIES SINCE THE 2013, 2016 AND 2019 CHNA. THROUGH THE SURVEY, WE ALSO SOUGHT INPUT ON CURRENT COMMUNITY HEALTH ISSUES AND OPINIONS ON COMMUNITY HEALTH NEEDS. WE SOUGHT INDIVIDUAL OUTREACH VIA EMAIL, PHONE AND VIA NEWS MEDIA RELEASES, TARGETING PERSONS AND ORGANIZATIONS ACROSS THE BROAD SPECTRUM OF COMMUNITY ORGANIZATIONS, SPECIFICALLY SEEKING INPUT FROM THOSE SUFFERING FROM HEALTH DISPARITIES, LOW-INCOME, DISABILITIES, THE CHRONICALLY ILL, THOSE WITH LANGUAGE BARRIERS AND VARYING SOCIO-ECONOMIC BACKGROUNDS. TO THAT END, THE HOSPITAL LAUNCHED AN ONLINE SURVEY IN JANUARY 2022. AVAILABILITY OF THE ONLINE SURVEY AND A LINK TO THE SURVEY WERE PUBLICLY PROMOTED VIA A NEWS RELEASE IN THE LOCAL NEWSPAPER AND DETAILS WERE ANNOUNCED AT VARIOUS SOCIAL SERVICE ORGANIZATION MEETINGS INCLUDING THE MARSHALL MINISTERIAL ALLIANCE, REPRESENTING NEARLY TWO DOZEN LOCAL PASTORS AND CONGREGATIONS, THE SALVATION ARMY AND A TRANSIENT MINISTRY, A JAIL MINISTRY AND A REST HOME MINISTRY; AND THE INTERAGENCY COUNCIL.

SCHEDULE H, PART V, SECTION B, LINE 6B
CHNA CONDUCTION: A PRIMARY PATHWAY TO SOLICIT INPUT WAS VIA A GROUP MAILING LIST AVAILABLE THROUGH THE SALINE COUNTY INTERAGENCY COUNCIL. THE INTERAGENCY COUNCIL IS A COLLABORATIVE GROUP OF SOCIAL SERVICE AND OTHER GOVERNMENTAL AGENCIES. MEMBERSHIP AND ATTENDEES INCLUDE: - SALINE COUNTY PUBLIC HEALTH DEPARTMENT - KATY TRAIL COMMUNITY HEALTH (FEDERALLY QUALIFIED HEALTH CENTER) - MISSOURI VALLEY COMMUNITY ACTION AGENCY - SALINE COUNTY MENTAL HEALTH ASSOCIATION - THE COMMUNITY FOOD PANTRY - HABITAT FOR HUMANITY - MISSOURI CARE MANAGED MEDICAID PLAN - HOME STATE HEALTH PLAN, MANAGED MEDICAID PLAN - CENTER FOR HUMAN SERVICES, WHICH PROVIDES EMPLOYMENT SERVICES FOR THE DISABLED - THE FOSTER GRANDPARENTS PROGRAM - BURRELL BEHAVIORAL HEALTH - MARSHALL PUBLIC SCHOOLS NURSES AND SOCIAL WORKERS - THE SALINE COUNTY CAREER CENTER, WHICH OFFERS VOCATIONAL AND ADULT EDUCATION - MISSOURI VALLEY COLLEGE - BUTTERFIELD YOUTH SERVICES, NOW GREAT CIRCLE - POWERHOUSE MINISTRIES AND POWERHOUSE COMMUNITY ACTION AGENCY - SALT FORK YMCA - THE AMERICAN RED CROSS - UNITED WAY OF SALINE COUNTY - THE LIGHTHOUSE SHELTER, DOMESTIC VIOLENCE SHELTER - THE CHILDREN'S THERAPY CENTER - TOWER REALTY - MARSHALL PUBLIC LIBRARY - SALINE COUNTY CIVIL AIR PATROL - UNIVERSITY OF MISSOURI EXTENSION SERVICES - BABY GRACE, A COMMUNITY SUPPORT PROGRAM FOR FAMILIES WITH INFANTS AND TODDLERS - 15TH JUDICIAL CIRCUIT CASA, OR COURT-APPOINTED SPECIAL ADVOCATES - WILS - WEST CENTRAL INDEPENDENT LIVING SOLUTIONS, WHICH ALLOWS DISABLED INDIVIDUALS TO MAINTAIN THEIR INDEPENDENCE ADDITIONALLY, WE REACHED OUT VIA ELECTRONIC MEDIA BY CIRCULATING A LINK VIA BOTH COMPANY EMAIL AND INTRANET POSTS AND ENCOURAGED HEALTHCARE STAFF TO ACTIVELY PARTICIPATE IN THE SURVEY. THOSE RECEIVING THE EMAIL AND WHO HAD ACCESS TO THE ONLINE LINK INCLUDED: - FITZGIBBON HOSPITAL MEDICAL STAFF AND PROVIDERS - FITZGIBBON HOSPITAL PATIENT-CENTERED MEDICAL HOME STAFF AND SOCIAL WORKERS - FITZGIBBON HOSPITAL PATIENT CARE COORDINATORS - FITZGIBBON HOSPITAL QUALITY IMPROVEMENT AND INFECTION PREVENTIONIST STAFF - FITZGIBBON HOME HEALTH NURSES AND STAFF - FITZGIBBON MARY MONTGOMERY HOSPICE NURSES AND STAFF - FITZGIBBON HOSPITAL AUXILIARY AMBASSADORS LEADERSHIP LASTLY, WE SOLICITED RESPONSES TO OUR CHNA SURVEY QUESTIONS THROUGH A DATABASE OF PATIENTS USING THE HOSPITAL'S ELECTRONIC HEALTH RECORD, THE FITZCHART PATIENT PORTAL. AN EMAIL WITH THE SURVEY LINK WAS SENT TO MORE THAN 10,000 USERS OF THIS VALUABLE RESOURCE OFFERED WITHOUT COST TO ALL PATIENTS OF FITZGIBBON HOSPITAL. AT THE END OF THE ONLINE SURVEY IN MID-FEBRUARY 2022, A TOTAL OF 366 RESPONSES HAD BEEN COLLECTED, AN 82% INCREASE FROM THE 201 RESPONSES COLLECTED FOR THE 2019 SURVEY AND 88% MORE THAN THE 194 RESPONSES COLLECTED DURING THE 2016 SURVEY. THIS WAS DUE, IN PART, TO THE HOSPITAL'S COLLECTION OF VALID EMAIL ADDRESSES USED TO NOTIFY THE AREA ABOUT COVID-19 TESTING, VACCINE AVAILABILITY AND VACCINE EVENTS. WE USED THAT SAME DATABASE TO DISSEMINATE THE CHNA SURVEY AND TO REQUEST RESPONSES.

SCHEDULE H, PART V, SECTION B, LINE 7A
CHNA LINK: HTTPS://WWW.FITZGIBBON.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

SCHEDULE H, PART V, SECTION B, LINE 11
"ADDRESSING IDENTIFIED NEEDS: IN SELECTING THE HEALTH NEEDS TO ADDRESS, RESULTS WERE AGGREGATED AND ANALYZED. RAW PRIMARY DATA WAS COMPARED WITH SECONDARY DATA, AND THE INVENTORY OF EXISTING SERVICES AND PROGRAMMING WHICH ADDRESS IDENTIFIED HEALTH NEEDS WAS EVALUATED. CONSIDERATION OF EXISTING COMMUNITY RESOURCES, BUDGETARY CONSTRAINTS, AVAILABLE PERSONNEL AND HOSPITAL ""MISSION AND VISION"" WERE ALL VARIABLES IN SELECTING WHICH HEALTH NEEDS TO PRIORITIZE. SPECIAL CONSIDERATION WAS GIVEN IN REGARD TO REACHING DISPARATE SEGMENTS OF OUR COMMUNITY, ESPECIALLY THE UNDERSERVED, AND THE UNIQUE SOCIAL DETERMINANTS OF HEALTH WHICH EXIST IN OUR COMMUNITY: POVERTY AND LITERACY RATES, PHYSICAL ENVIRONMENTS, HEALTHY BEHAVIORS AND ACCESS TO HEALTH CARE SERVICES. IN SELECTING WHICH HEALTH NEEDS TO TARGET, THE CHNA COMMITTEE ALSO CONSIDERED THE FOLLOWING VARIABLES - POOR HEALTH OUTCOMES WHICH EXCEEDED STATE AND NATIONAL AVERAGES, LOCAL SURVEY RESULTS IDENTIFYING BARRIERS TO CARE, COLLABORATIVE ACTIVITIES WITH A HISTORY OF SUCCESS WHICH MAY ALREADY BE UNDERWAY OR IN CURRENT PLANNING STAGES, SELF-REPORTED SOCIAL AND ECONOMIC BARRIERS TO ACHIEVING OPTIMAL HEALTH. WE ALSO CONDUCTED A TREND ANALYSIS COMPARING ROBERT WOODS JOHNSON COUNTY HEALTH RANKINGS HEALTH OUTCOMES CITED IN PRIOR YEAR'S CHNAS. ADDITIONAL HEALTH NEEDS AND/OR BARRIERS TO OPTIMAL AND EQUITABLE ACCESS TO HEALTHCARE WERE IDENTIFIED AS: - COST AND ABILITY TO PAY FOR CARE - TRANSPORTATION BARRIERS - LACK OF HEALTH INSURANCE DUE TO COST - MENTAL HEALTH CONCERNS - POVERTY - HOUSING INSTABILITY - LACK OF AVAILABILITY OF HEALTHY FOODS - LACK OF ACCESS TO SPECIALTY CARE - DRUG ABUSE - FEAR OF COVID-19 - FEAR OF AN ADVERSE DIAGNOSIS, TREATMENT PLAN OR THE HEALTHCARE EXPERIENCE WHILE THOSE HEALTH NEEDS WERE IDENTIFIED, THE COMMITTEE BELIEVES THAT INTERVENTIONS AROUND OVERALL PREVENTIVE CARE AND WELLNESS AS WELL AS HEALTH LITERACY IMPROVEMENT COULD HAVE A ""TRICKLE DOWN"" EFFECT ON MANY OF THE IDENTIFIED NEEDS, INCLUDING CANCER, SMOKING AND MENTAL HEALTH CONCERNS. AFTER DELIBERATION AND THOROUGH CONSIDERATION OF ALL THE FACTORS ABOVE, THE FOLLOWING WERE IDENTIFIED AS OUR POPULATION'S TOP THREE TARGETED HEALTH NEEDS IN THE MOST RECENTLY CONDUCTED CHNA: - HEALTH LITERACY IMPROVEMENT (IDENTIFIED BY 73.5% OF RESPONDENTS AS A FACTOR INFLUENCING HEALTH) - HEALTHY LIFESTYLE ADVOCACY, (WITH RESULTING OBESITY AND RELATED CHRONIC DISEASES A BI-PRODUCT OF THE LACK THEREOF.) OBESITY IN ADULTS WAS IDENTIFIED BY 41.35% AS A SIGNIFICANT HEALTH PROBLEM IN OUR COMMUNITY, AND LACK OF PHYSICAL ACTIVITY WAS IDENTIFIED BY 39.9% AS THE TOP PRESSING HEALTH NEED IN OUR COMMUNITY. EDUCATION AROUND DIET AND/OR EXERCISE WAS IDENTIFIED BY 64.55% OF RESPONDENTS AS THE MOST-NEEDED HEALTH EDUCATION TOPIC NEEDED IN OUR COMMUNITY. - PREVENTIVE CARE AND WELLNESS (THIS INCLUDES EDUCATION ABOUT THE DANGERS OF TOBACCO USE, INCLUDING SMOKING, CHEWING TOBACCO AND ""VAPING,"" AS WELL AS ADDRESSING MENTAL AND BEHAVIORAL HEALTH ISSUES, SUBSTANCE ABUSE, TREATMENTS FOR ANXIETY AND DEPRESSION AND EMPHASIS ON THE VALUE OF REGULAR PREVENTATIVE CARE AND HEALTH SCREENINGS.) THIS UPDATE FOR SCHEDULE H SPECIFICALLY COVERS ACTIVITIES FOR THE PERIOD OF MAY 1, 2021 TO APRIL 30, 2022, ADDRESSING LONGITUDINAL ACTIVITIES AND EVALUATIONS FROM THE 2019 CHNA. IN RESPONSE TO THE RESULT SFO THE MOST RECENTLY CONDUCTED CHNA, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY DELINEATING ACTIVITIES, BOTH INDEPENDENT AND COLLABORATE, WHICH COULD IMPACT THE THREE MOST-PRESSING HEALTH NEEDS IN THE COMMUNITY. HEALTH LITERACY IMPROVEMENT: HEALTH LITERACY IMPROVEMENT CONSISTS NOT ONLY IN IMPROVING THE UNDERSTANDING OF HEALTH TOPICS FOR THE GENERAL POPULATION BUT ALSO IN ENGAGING WITH DIVERSE POPULATIONS AND BROADENING ITS REACH WITH NON-ENGLISH SPEAKERS IN OUR COMMUNITY. THE HOSPITAL MADE A CONCERTED EFFORT IN THIS DIRECTION BY ENSURING ITS MOST IMPORTANT PATIENT EDUCATION MATERIALS WERE TRANSLATED INTO SPANISH. EARLY HEALTH EDUCATION WAS A FOCUS THROUGH THE WORK OF THE WELLNESS COMMITTEE AT MARSHALL PUBLIC SCHOOLS, WHICH IS A CROSS-FUNCTIONAL GROUP OF TEACHERS AND COMMUNITY MEMBERS WHO MEET TO COLLABORATE ON WAYS TO IMPROVE THE HEALTH OF STUDENTS, TEACHERS AND STAFF. AS PART OF THE GROUP, THE HOSPITAL PROVIDED SEVERAL CASES OF TAMPONS FOR THE MARSHALL SCHOOL DISTRICT AFTER A NEED WAS IDENTIFIED THAT PERSONAL HYGIENE AND THE PRICE OF ACQUIRING MENSTRUATION PRODUCTS WERE CAUSING AN ECONOMIC HARDSHIP FOR SOME STUDENTS AT THE SCHOOLS. FITZGIBBON STAFF INTERFACED WITH SOME OF THE YOUNGEST IN OUR COMMUNITY BY SERVING AS PARTICIPANTS IN THE SCHOOL'S HEALTH FAIR FOR ELEMENTARY GRADES. THIS FAIR FOCUSES ON BASIC HEALTHY LIFESTYLES, EXERCISE, MEASURES BODY MASS INDEX AND CONDUCTS NUTRITIONAL EDUCATION. OTHER STAFF MEMBERS SERVED AS GUEST SPEAKERS FOR THE SCHOOL'S HEALTH AND PHYSICAL EDUCATION CLASSES, SPEAKING ON TOPICS RANGING FROM SEXUAL HEALTH, PREGNANCY PREVENTION AND THE IMPORTANCE OF EXERCISE TO UNDERSTANDING FOOD LABELS AND HEALTHY FOOD PREPARATION. HEALTH LITERACY ALSO INCLUDES EDUCATION TO THE ELDERLY OR THOSE BECOMING ELIGIBLE FOR MEDICARE. AT THE TIME OF OPEN ENROLLMENT, THE HOSPITAL PUBLISHED EDUCATIONAL ARTICLES ABOUT BOTH THE MARKETPLACE PLANS AND THEIR AVAILABILITY IN OUR AREA AND ALSO WHICH MEDICARE PLANS WERE OFFERED AND HOW BENEFITS MAY VARY. THE HOSPITAL ALSO PUBLICIZES THE AVAILABILITY OF A LANGUAGE TRANSLATION SERVICE TO THOSE WITH LIMITED ENGLISH PROFICIENCY HEALTHY LIFESTYLE ADVOCACY: MARKETING AND PUBLIC RELATIONS STAFF FIELDED REQUESTS FROM THE PUBLIC AND COMMUNITY GROUPS TO ARRANGE SPEAKERS ON A VARIETY OF TOPICS, INCLUDING OBESITY AND RELATED CHRONIC DISEASES AS WELL AS A NUMBER OF OTHER HEALTH TOPICS SUCH AS GETTING ADEQUATE EXERCISE AND RECOVERING FROM GRIEF. STAFF PREPARED AND PRINTED EDUCATIONAL MATERIALS PER TOPIC AND UPDATED RELEVANT FLIERS POSTED ANNOUNCEMENTS AND HEALTH INFORMATION ON SOCIAL MEDIA PLATFORMS, AND MESSAGING WAS DISPLAYED ON THE HOSPITAL WEBSITE. SIGNAGE ALSO WAS DEPICTED ON THE INTERNAL VIDEO MESSAGING BOARDS SEEN BY PATIENTS AND EMPLOYEES. TOPICS INCLUDED DIABETES EDUCATION, HEALTH DIETS, CARDIOVASCULAR HEALTH AS IT RELATES TO OBESITY, CELIAC DISEASE AND HEALTHY LIFESTYLES, AMONG OTHER TOPICS. HOSPITAL PERSONNEL COLLABORATED WITH AREA SCHOOL DISTRICTS AS PART OF THE DISTRICT'S WELLNESS COMMITTEE AND PUBLICIZED THE AVAILABILITY OF THE ANNUAL HEALTH FAIR, WHICH OFFERS AT-COST SCREENINGS FOR CHOLESTEROL, THYROID FUNCTION, PROSTATE SPECIFIC ANTIGEN AND BLOOD SUGARS, AMONG OTHERS. HOSPITAL PERSONNEL ALSO PUBLICIZED THESE EVENTS AT THE INTERAGENCY COUNCIL, A MULTI-AGENCY GROUP REPRESENTING SOCIAL SERVICE AGENCIES REACHING ACROSS THE SPECTRUM IN OUR COMMUNITY AND COUNTY. OTHER PUBLICITY INCLUDED SHARING INFORMATION WITH THE MINISTERIAL ALLIANCE, WITH REPRESENTATION OF MORE THAN 20 CHURCHES. THEY ALSO PROVIDED HEALTH INFORMATION AT BACK-TO-SCHOOL EVENTS AT WHICH STUDENTS AND THEIR FAMILIES COLLECT FREE MATERIALS AND SUPPLIES PRIOR TO THE START OF SCHOOL IN AUGUST. HOSPITAL-OPERATED CLINICS CONTINUED PARTICIPATION IN THE PRIMARY CARE HEALTH HOME MODEL, IN WHICH NURSE CARE MANAGERS ASSISTED PATIENTS WITH A DIAGNOSIS OF OBESITY OR DIABETES, ENCOURAGING THEM TO TAKE CONTROL OF THEIR WEIGHT. NURSE MANAGERS PROVIDED GUIDANCE AND PROMOTE PERSONAL EMPOWERMENT FOR HEALTHIER CHOICES AND IDENTIFYING DIABETES COMPLICATIONS BY REGULAR MEASUREMENT OF A1C LEVELS. THE ANNUAL HEALTH FAIR CONDUCTED BY FITZGIBBON IN APRIL ALSO OFFERED SCREENING FOR A1C AND BLOOD PRESSURE. THESE TYPES OF HEALTH FAIRS WERE OFFERED IN TWO LOCATIONS: IN MARSHALL AND AT THE CERTIFIED RURAL HEALTH CLINIC IN BRUNSWICK, MO., GRAND RIVER MEDICAL CLINIC. THE HEALTH HOME ALSO PRODUCED A MONTHLY NEWSLETTER FOR HEALTH HOME PATIENTS (MOST OF WHOM HAVE A CHRONIC HEALTH CONDITION) AND THEIR FAMILIES. THE NEWSLETTER IS FILLED WITH PREVENTIVE HEALTH INFORMATION, RECIPES AND OTHER HELPFUL TIPS. A LARGE PART OF HEALTHY LIFESTYLE IS GETTING ADEQUATE EXERCISE AND ENCOURAGING YOUTH TO PARTICIPATE IN ORGANIZED SPORTS. THE FITZGIBBON ORGANIZATION PROVIDING FREE SCHOOL SPORTS PHYSICALS TO ENSURE THAT ANY STUDENT WHO WISHES TO PARTICIPATE IN A SPORT MAY DO SO WITHOUT THE BARRIER OF BEING ABLE TO AFFORD THE STATE-REQUIRED PHYSICAL NEEDED FOR PARTICIPATION. ANY IDENTIFIED HEALTH PROBLEMS WERE REFERRED BACK TO THE ATHLETE AND PARENT FOR FOLLOW-UP. THE HOSPITAL ALSO EMPLOYS A CERTIFIED ATHLETIC TRAINER PERMANENTLY STATIONED AT MARSHALL HIGH SCHOOL TO OFFER CONCUSSION DETECTION AND PREVENTION AND TREATMENT OF THE SCHOOL'S ATHLETES ON THE SIDELINE AND AT PRACTICES. THIS LEADS TO AREA STUDENTS' BETTER BEING ABLE TO LEAD ACTIVE AND HEALTHY LIFESTYLES AND ALLOWS ALL STUDENTS WHO WISH TO PARTICIPATE IN ORGANIZED SPORTS TO DO SO. ANOTHER COLLABORATIVE ACTIVITY WAS THE ADMINISTRATION OF INFLUENZA INJECTIONS AT AREA SCHOOLS, ALLOWING TEACHERS AND THEIR FAMILIES TO RECEIVE THE SHOTS CONVENIENTLY ON-SITE, THUS REDUCING ILLNESS AND ABSENTEEISM. INTERNALLY, THE HOSPITAL RECOGNIZES EMPLOYEES AND MEDICAL STAFF MEMB"

SCHEDULE H, PART V, SECTION C, LINES 16A-C
FAP, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY: HTTPS://WWW.FITZGIBBON.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE

SCHEDULE H, PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25 OF THE FORM 990.

SCHEDULE H, PART 1, LINE 7
COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEET 1. IRS WORKSHEETS 3 AND 6 USED INTERNAL COST ACCOUNTING METHODOLOGY.

SCHEDULE H, PART II
COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION HAS SEVERAL EMPLOYEES INVOLVED IN LOCAL COMMUNITY BOARDS AS WELL AS STATE BOARDS, WHICH ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT AND ADVOCACY.

SCHEDULE H, PART III, SECTION A, LINE 2
BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HEALTH SYSTEMS DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HEALTH SYSTEM'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED APRIL 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.

SCHEDULE H, PART III, SECTION A, LINE 3
BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS DETERMINED USING POVERTY LIMIT DEMOGRAPHIC INFORMATION OBTAINED THROUGH THE US CENSUS BUREAU. THIS AMOUNT EXPENSED BY THE ORGANIZATION IS ATTRIBUTABLE TO LOW INCOME INDIVIDUALS IN THEIR TARGET COMMUNITY AND IS CONSIDERED A COMMUNITY BENEFIT.

SCHEDULE H, PART III, SECTION A, LINE 4
BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE CAN BE FOUND ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.

SCHEDULE H, PART III, SECTION B, LINE 8
COMMUNITY BENEFIT: MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.

SCHEDULE H, PART III, SECTION C, LINE 9B
COLLECTION POLICY: THE ORGANIZATION'S BILLING AND PAYMENT POLICY NOTES: IF ACCOUNTS HAVE ALREADY BEEN CONSIDERED BAD DEBT BY FITZGIBBON HOSPITAL AND CLINICS, THEN FINANCIAL ASSISTANCE/CHARITY CARE IS AN OPTION UNTIL 240 DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT. BAD DEBT IS DEFINED AS EXPENSES RESULTING FROM TREATMENT FOR SERVICES PROVIDED TO A PATIENT WHO HAS NOT MET THEIR FINANCIAL OBLIGATION NOR SET UP AN AGREEABLE PAYMENT ARRANGEMENT WITH FITZGIBBON HOSPITAL AND CLINICS WITHIN 120 DAYS FROM THE DATE THE PATIENT HAS BEEN MADE RESPONSIBLE FOR ANY BALANCES DUE EITHER AFTER INSURANCE HAS PAID THEIR PORTION OR WHEN NO INSURANCE IS INVOLVED.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT: OUR MISSION AT FITZGIBBON HOSPITAL IS TO IMPROVE THE HEALTH OF OUR COMMUNITY. IN ORDER TO MEET THIS MISSION WE STRIVE TO UNDERSTAND THE NEEDS OF OUR COMMUNITY IN SEVERAL DIFFERENT WAYS. OUR LEADERSHIP AND STAFF ARE MEMBERS OF CIVIC CLUBS, BOARDS, AND COMMITTEES. OUR BOARD OF TRUSTEES IS COMPRISED OF MEMBERS FROM COUNTIES THROUGHOUT OUR SERVICE AREA. WE WORK CLOSELY WITH THE HEALTH DEPARTMENT AND OTHER COMMUNITY AGENCIES. STATE, REGIONAL AND LOCAL MEDIAS ARE USED TO MONITOR NEEDS AT ALL LEVELS. WE ALSO BELONG TO MANY HEALTHCARE RELATED ORGANIZATIONS THAT PROVIDE INFORMATION REGARDING USAGE AND NEEDS OF HEALTHCARE IN OUR SERVICE AREA WHICH IS USED TO EVALUATE WHAT WE NEED TO FOCUS ON TO IMPROVE THE HEALTH IN OUR COMMUNITY.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE HOSPITAL USES SEVERAL AVENUES TO PROVIDE PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE. ALL PATIENTS WILL BE OFFERED A PLAIN LANGUAGE SUMMARY AND AN APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) AS PART OF THE INTAKE OR DISCHARGE PROCESS TO/FROM FH. INFORMATION REGARDING THE FAP MAY BE AVAILABLE THROUGH THE HOSPITAL'S PATIENT ACCOUNTS DEPARTMENT AT (660) 831-3730, FH WEBSITE AT WWW.FITZGIBBON.ORG, OR THE FH FACILITY AT 2305 SOUTH 65 HIGHWAY, MARSHALL, MO 65340. THE PATIENT ACCOUNTS DEPARTMENT DEVELOPED A BROCHURE WHICH IS AVAILABLE TO PATIENTS AT THE TIME OF REGISTRATION. THE BROCHURE OUTLINES WHAT THE PATIENT IS TO EXPECT IN THE BILLING PROCESS, HOW TO CONTACT THE DEPARTMENT, AND WHAT ASSISTANCE IS AVAILABLE. WE HAVE A DETAILED POLICY WHICH OUTLINES PATIENT RESPONSIBILITY AND QUALIFICATIONS FOR CHARITY CARE. OUR PATIENT ACCOUNTS REPRESENTATIVES MEET WITH SELF PAY PATIENTS WHEN THEY ARE IN THE FACILITY TO DISCUSS OUR POLICY. OUR CARE COORDINATORS AND SOCIAL WORKERS ALSO EDUCATE OUR PATIENTS ON ASSISTANCE THEY MAY BE ELIGIBLE FOR UNDER FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS. WE ALSO UTILIZE AN OUTSIDE AGENCY TO MAKE CONTACT WITH PATIENTS AND IDENTIFY THOSE THAT MIGHT BE ELIGIBLE FOR ASSISTANCE.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: FITZGIBBON HOSPITAL'S PRIMARY SERVICE AREA IS SALINE COUNTY, MISSOURI WHICH IS A MID-MISSOURI AGRICULTURAL REGION AND INCLUDES THE TOWNS OF MARSHALL AND SLATER, MO. THE SECONDARY SERVICE AREA IS PORTIONS OF THE CONTIGUOUS COUNTIES SURROUNDING SALINE COUNTY. A REPORT FROM THE MISSOURI CENSUS DATA CENTER, POPULATION ESTIMATES WITH COMPONENTS OF CHANGE 2010-2020, EXTRACTED ON JAN 20, 2023, SHOWS THE FOLLOWING: A JULY 2021 POPULATION ESTIMATE OF 23,289. SALINE COUNTY DATA FOR 2021, ACCORDING TO A JULY 1, 2021 U.S. CENSUS BUREAU REPORT, SHOWED THE MEDIAN HOUSEHOLD INCOME WAS $49,705. THE AGE DISTRIBUTION OF THE POPULATION IN SALINE COUNTY IN 2021 SHOWED 18.7% AGED 65 AND OVER. ITS DEMOGRAPHICS ARE PRIMARILY WHITE, WITH 88.1% AS WHITE, NON-LATINO; 11.5% HISPANIC OR LATINO; 5.4% AFRICAN-AMERICAN; 2.7% TWO OR MORE RACES; 1.6% PACIFIC ISLANDER; 1.1% ASIAN AND 1.0% AMERICAN INDIAN.

SCHEDULE H, PART VI, LINE 5
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"AFFILIATED HEALTH CARE SYSTEM: THE AFFILIATED HEALTH SYSTEM INCLUDES THE ACTIVITIES OF JOHN FITZGIBBON MEMORIAL HOSPITAL AND FITZGIBBON HEALTH SERVICES, DOING BUSINESS AS THE LIVING CENTER, (COLLECTIVELY, THE ""COMPANIESTHE ""HOSPITAL""). JOHN FITZGIBBON MEMORIAL HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT, EMERGENCY CARE, PSYCHIATRIC AND SKILLED NURSING SERVICES TO PATIENTS IN THE MARSHALL, MISSOURI, AREA. IT ALSO OPERATES A HOME HEALTH AGENCY IN THE SAME GEOGRAPHIC AREA. IT IS DESIGNATED AS A MEDICARE DEPENDENT HOSPITAL BY MEDICARE EFFECTIVE JANUARY 1, 2007. IN MARCH 2012, THE HOSPITAL WAS DESIGNATED AS A SOLE COMMUNITY HOSPITAL BY MEDICARE. THE COMPANIES ALSO OPERATE A LONG-TERM CARE FACILITY IN MARSHALL, MISSOURI, DOING BUSINESS AS THE LIVING CENTER."