4A (Expenses $ 1283314330 including grants of $ 5198003) (Revenue $ 1249982743)
"SEE SCHEDULE OAT PROVIDENCE, WE USE OUR VOICE TO ADVOCATE FOR VULNERABLE POPULATIONS AND NEEDED REFORMS IN HEALTH CARE. WE PURSUE INNOVATIVE WAYS TO TRANSFORM HEALTH CARE BY KEEPING PEOPLE HEALTHY, AND MAKING OUR SERVICES MORE CONVENIENT, ACCESSIBLE AND AFFORDABLE FOR ALL. IN AN INCREASINGLY UNCERTAIN WORLD, WE ARE COMMITTED TO HIGH-QUALITY, COMPASSIONATE CARE FOR EVERYONE - REGARDLESS OF COVERAGE OR ABILITY TO PAY. WE HELP PEOPLE AND COMMUNITIES BENEFIT FROM THE BEST HEALTH CARE MODEL FOR THE FUTURE - TODAY.TOGETHER, OUR 120,000 CAREGIVERS (ALL EMPLOYEES) SERVE IN 52 HOSPITALS, 1,085 CLINICS AND A COMPREHENSIVE RANGE OF SERVICES ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. THE PROVIDENCE FAMILY INCLUDES:-PROVIDENCE ACROSS SEVEN WESTERN STATES-COVENANT HEALTH IN WEST TEXAS-PROVIDENCE FACEY MEDICAL FOUNDATION IN LOS ANGELES, CA-HOAG MEMORIAL HOSPITAL PRESBYTERIAN IN ORANGE COUNTY, CA-KADLEC IN SOUTHEAST WASHINGTON-PACIFIC MEDICAL CENTERS IN SEATTLE, WA-SWEDISH HEALTH SERVICES IN SEATTLE, WA2021 WAS MARKED BY THREE MAJOR SURGES IN COVID-19 VOLUMES, A NATIONAL SHORTAGE OF HEALTH CARE PERSONNEL, AS WELL AS DEFERRALS OF NON-EMERGENT CARE. EVEN WITH THESE TREMENDOUS CHALLENGES, THE PROVIDENCE FAMILY OF ORGANIZATIONS CONTINUED TO INVEST IN OUR COMMUNITIES, GUIDED BY OUR STRATEGIC PLAN AND OUR COMMUNITY BENEFIT PRIORITIES.FOR MORE INFORMATION GO TO: HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORTENVIRONMENTAL, SOCIAL, AND GOVERNANCE STANDARDSOVER THE LAST TWO YEARS, PROVIDENCE ADVANCED A SOCIAL RESPONSIBILITY FRAMEWORK THAT INCLUDES A STRONGER COMMITMENT TO DIVERSITY, EQUITY, INCLUSION, AND ENVIRONMENTAL STEWARDSHIP. WE UPDATED OUR INTEGRATED STRATEGIC & FINANCIAL PLAN TO MORE CLEARLY EXPRESS OUR COMMITMENT AND ACCELERATION OF THIS IMPORTANT WORK TO ADDRESS SOCIAL, RACIAL, AND ECONOMIC DISPARITIES IN THE COMMUNITIES WE SERVE. PROVIDENCE'S SOCIAL RESPONSIBILITY FRAMEWORK AIMS TO DEPLOY THE ASSETS OF OUR SYSTEM TO SUPPORT COMMUNITY HEALTH IMPROVEMENT, STRENGTHEN LOCAL ECONOMIES AND REDUCE OUR CARBON FOOTPRINT. IN 2021, OUR SUSTAINABLE AND INCLUSIVE PURCHASING PROGRAM COMMITTED TO INCREASE OUR SPEND WITH WOMEN AND MINORITY OWNED BUSINESS ENTERPRISES BY OVER $300 MILLION ACROSS THE NEXT FIVE YEARS. WE ALSO DEPLOY AN INVESTING PORTFOLIO WHICH INCLUDES SHAREHOLDER ADVOCACY, IMPACT INVESTING, AND SOCIALLY CONSCIOUS PORTFOLIO SCREENS. IN 2021, PROVIDENCE MADE PROGRESS TOWARDS ITS CLIMATE COMMITMENT TO BECOME CARBON NEGATIVE BY 2030. WE ARE IMPLEMENTING AN ENVIRONMENTAL STEWARDSHIP SYSTEM STRATEGY THAT ENCOURAGES WASTE REDUCTIONS, EFFICIENT ENERGY AND WATER USE, LOCAL AGRICULTURE PARTNERSHIPS, LESS TOXIC AND FEWER CHEMICAL USE, AND A REDUCTION IN CARBON FROM TRAVEL.ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLCON MARCH 31, 2018, ST. JOSEPH HOSPITAL OF EUREKA, REDWOOD MEMORIAL HOSPITAL, SANTA ROSA MEMORIAL HOSPITAL, AND QUEEN OF THE VALLEY MEDICAL CENTER, COLLECTIVELY THE ""HOSPITALS"", TRANSFERRED ALL OF THEIR NET ASSETS TO ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC, A RELATED 501(C) (3) ORGANIZATION. ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC WAS CREATED TO CONSOLIDATE AND SIMPLIFY THE CURRENT STRUCTURE BY MOVING THE OPERATIONS OF THE HOSPITALS INTO A SINGLE LEGAL ENTITY. THE OPERATION OF THE HOSPITALS WILL REMAIN THE SAME.2021 PROGRAM SERVICE ACCOMPLISHMENTS: (JANUARY 1 - DECEMBER 31, 2021)ST. JOSEPH HEALTH NORTHERN CALIFORNIA IS COMPRISED OF 4 MAIN HOSPITAL FACILITIES: SANTA ROSA MEMORIAL HOSPITAL, QUEEN OF THE VALLEY MEDICAL CENTER, REDWOOD MEMORIAL HOSPITAL AND ST. JOSEPH HOSPITAL EUREKA. EACH HOSPITAL FACILITY HAS ITS OWN SERVICE AREA, CONDUCTS ITS OWN CHNA, PREPARES ITS OWN IMPLEMENTATION STRATEGY AND SUBMITS ITS OWN ANNUAL REPORTS. THE THREE PROGRAM ACCOMPLISHMENTS FOR ST. JOSEPH NORCAL ARE HIGHLIGHTED BELOW: CARE NETWORK, CONTINUUM OF ORAL HEALTH SERVICES AND MOBILE MEDICAL CLINIC.CARE NETWORK:CARE (CARE MANAGEMENT, ADVOCACY, RESOURCES AND EDUCATION) NETWORK IS A NATIONALLY RECOGNIZED, AWARD-WINNING COMMUNITY-BASED PROGRAM THAT PROMOTES CHRONIC DISEASE SELF-MANAGEMENT UTILIZING AN INTERDISCIPLINARY RN, SOCIAL WORK, BEHAVIORAL AND SPIRITUAL APPROACH. SERVICES ARE PROVIDED IN THE CLIENT'S HOME OR AS NEEDED IN A HEALTH PROVIDER OFFICE OR OTHER COMMUNITY SERVICE LOCATION. THE PROGRAM IS AIMED AT CARE COORDINATION AND IMPROVING DISEASE MANAGEMENT AND QUALITY OF LIFE WHILE REDUCING OVERALL GOVERNMENT BURDEN OF HEALTHCARE COST. IN NAPA, CARE NETWORK WORKED WITH MULTIPLE COMMUNITY PARTNERS TO IDENTIFY ELDERLY AND MEDICALLY VULNERABLE INDIVIDUALS EXPERIENCING CHRONIC HOMELESSNESS AND COLLABORATED THROUGH PROJECT HOME KEY TO ENSURE 68 INDIVIDUALS WERE SUCCESSFULLY TRANSITIONED TO HOUSING THROUGH PROJECT HOME KEY. PERMANENT HOUSING WAS SHARED WITH 51 CLIENTS AND 17 CLIENTS WENT TO THE NAPA COUNTY SHELTER. IN SONOMA COUNTY, CARE NETWORK EXPANDED TO ADD TWO ADDITIONAL CLINICIANS TO THE HIGH-UTILIZER TEAM AND TWO SUBSTANCE USE NAVIGATORS, WORKING WITH CLIENTS WITH MENTAL ILLNESS, CO-OCCURRING SUBSTANCE USE DISORDERS, AS WELL AS COMPLEX MEDICAL CONDITIONS THAT REQUIRE CARE COORDINATION, CASE MANAGEMENT AND CONNECTION TO MENTAL HEALTH SERVICES. CARE NETWORK REGION-WIDE HAS BEEN ACCEPTED AS ENHANCED CARE MANAGEMENT PROVIDERS THROUGH PARTNERSHIP HEALTH PLAN OF CALIFORNIA. ACROSS ALL SERVICE AREAS, CARE NETWORK SERVED PATIENTS THROUGH 79,375 ENCOUNTERS.CONTINUUM OF ORAL HEALTH SERVICES:ST. JOSEPH HEALTH NORTHERN CALIFORNIA OFFERS A CONTINUUM OF ORAL HEALTH SERVICES TO ITS COMMUNITIES. THIS INCLUDES A FIXED SITE DENTAL CLINIC LOCATED IN SANTA ROSA, MOBILE DENTAL CLINICS IN BOTH SONOMA COUNTY AND NAPA COUNTY, THE MIGHTY MOUTH SCHOOL-BASED DENTAL DISEASE PREVENTION PROGRAM. THE CLINICS PRIORITIZE SERVICE TO CHILDREN AGES 0-16 YEARS, BUT ALSO SERVE ADULTS WITH URGENT NEEDS. THEY PROVIDE BASIC, PREVENTIVE, EMERGENCY AND COMPREHENSIVE DENTAL CARE WITH A STRONG FOCUS ON PREVENTION AND EDUCATION. OUR FIXED SITE DENTAL CLINIC COMPLETED 7,257 ENCOUNTERS. OUR SONOMA COUNTY MOBILE DENTAL CLINIC AND MIGHTY MOUTH PROGRAMS COMPLETED 992 ENCOUNTERS. OUR NAPA COUNTY MOBILE DENTAL CLINIC COMPLETED 4,431 ENCOUNTERS.MOBILE MEDICAL CLINIC:OUR MOBILE MEDICAL CLINIC SERVES PATIENTS IN THEIR COMMUNITIES AT NO COST. THE PROGRAM SEEKS TO PROVIDE CARE TO THOSE WHO FALL THROUGH THE TRADITIONAL PRIMARY CARE SAFETY NET, AND FOR REASONS RELATED TO TRANSPORTATION, POVERTY, OR OTHER FACTORS, FACE INSURMOUNTABLE BARRIERS TO ACCESSING CARE AT COMMUNITY HEALTH CENTERS OR OTHER MEDICAL HOMES. THE CLINIC OFFERS HEALTH SCREENINGS, TREATMENT OF MINOR MEDICAL PROBLEMS, HEALTH AND NUTRITIONAL EDUCATION, AND INFORMATION AND REFERRALS. IN 2021, IN OUR SERVICE AREA, THE CLINIC SERVED PATIENTS OVER 3,212 ENCOUNTERS AT SEVERAL LOCATIONS, INCLUDING THE CITIES OF SONOMA/BOYES HOT SPRINGS, SANTA ROSA, AND WINDSOR, THE MOBILE HEALTH TEAM ALSO SERVED SEVERAL LOCAL HOMELESS SHELTERS, PROVIDING DIRECT PATIENT CARE IN THE SHELTERS."

QUEEN OF THE VALLEY MEDICAL CENTER (2)
PART V, SECTION B, LINE 3J: PART V, SECTION B, LINE 3ETHE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

QUEEN OF THE VALLEY MEDICAL CENTER (2)
PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS IS BASED ON THE UNDERSTANDING THAT HEALTH AND WELLNESS ARE INFLUENCED BY FACTORS WITHIN OUR COMMUNITIES, NOT ONLY WITHIN MEDICAL FACILITIES. IN GATHERING INFORMATION ON THE COMMUNITIES SERVED BY THE HOSPITAL, WE LOOKED NOT ONLY AT THE HEALTH CONDITIONS OF THE POPULATION, BUT ALSO AT SOCIOECONOMIC FACTORS, THE PHYSICAL ENVIRONMENT, AND HEALTH BEHAVIORS. ADDITIONALLY, WE INVITED KEY STAKEHOLDERS AND COMMUNITY MEMBERS TO PROVIDE ADDITIONAL CONTEXT TO THE QUANTITATIVE DATA THROUGH QUALITATIVE DATA IN THE FORM OF INTERVIEWS AND LISTENING SESSIONS. AS OFTEN AS POSSIBLE, EQUITY IS AT THE FOREFRONT OF OUR CONVERSATIONS AND PRESENTATION OF THE DATA, WHICH OFTEN HAVE BIASES BASED ON COLLECTION METHODOLOGY.IN ADDITION, WE RECOGNIZE THAT THERE ARE OFTEN GEOGRAPHIC AREAS WHERE THE CONDITIONS FOR SUPPORTING HEALTH ARE SUBSTANTIALLY POORER THAN NEARBY AREAS. WHENEVER POSSIBLE AND RELIABLE, DATA ARE REPORTED AT THE ZIP CODE, CENSUS TRACTS, OR CENSUS BLOCK GROUP LEVEL. THESE SMALLER GEOGRAPHIC AREAS ALLOW US TO BETTER UNDERSTAND THE NEIGHBORHOOD LEVEL NEEDS OF OUR COMMUNITIES AND BETTER ADDRESS DISPARITIES WITHIN AND ACROSS COMMUNITIES. CENSUS DESIGNATED GEOGRAPHIES ALSO ENSURE SIMILAR TOTAL POPULATION SIZE, IMPROVING COMPARABILITY.WE REVIEWED DATA FROM THE AMERICAN COMMUNITY SURVEY AND LOCAL PUBLIC HEALTH AUTHORITIES. IN ADDITION, WE INCLUDE HOSPITAL UTILIZATION DATA TO IDENTIFY DISPARITIES IN UTILIZATION BY INCOME AND INSURANCE, GEOGRAPHY, AND RACE/ETHNICITY WHEN RELIABLY COLLECTED.COMMUNITY INPUT:TO BETTER UNDERSTAND THE UNIQUE PERSPECTIVES, OPINIONS, EXPERIENCES, AND KNOWLEDGE OF COMMUNITY MEMBERS, REPRESENTATIVES FROM QUEEN OF THE VALLEY MEDICAL CENTER CONDUCTED 19 STAKEHOLDER INTERVIEWS AND 8 LISTENING SESSIONS, INCLUDING 27 COMMUNITY OUTREACH CAREGIVERS. ALL INTERVIEWS AND LISTENING SESSIONS OCCURRED IN JUNE 2020, DURING WHICH TIME PARTICIPANTS DISCUSSED THE ISSUES AND OPPORTUNITIES OF THE PEOPLE, NEIGHBORHOODS, AND CITIES OF THE SERVICE AREA.OBTAINING ROBUST COMMUNITY INPUT DURING THE COVID-19 PANDEMIC WAS ESPECIALLY CHALLENGING AND PREVENTED QUEEN OF THE VALLEY MEDICAL CENTER FROM COMPLETING ANY IN-PERSON CONVERSATIONS. WHILE STAKEHOLDER INTERVIEWS WERE EASILY ADAPTED TO A VIRTUAL SETTING THROUGH A VIDEO CONFERENCING PLATFORM, IT WAS NOT FEASIBLE TO HOST LISTENING SESSIONS COMPRISED OF COMMUNITY MEMBERS IN THIS SAME WAY. WHILE VIDEO CONFERENCING DOES FACILITATE INFORMATION SHARING, THERE ARE CHALLENGES CREATING THE LEVEL OF DIALOGUE THAT WOULD TAKE PLACE IN PERSON. ADDITIONALLY, DUE TO MANY COMMUNITY ORGANIZATIONS ENGAGING IN COVID-19 RESPONSE, SOME ORGANIZATIONS HAD LIMITED CAPACITY AND WERE NOT ABLE TO PARTICIPATE IN INTERVIEWS.NONPROFIT AND GOVERNMENT STAKEHOLDER INTERVIEWS:A TOTAL OF 19 STAKEHOLDER INTERVIEWS WERE COMPLETED BY REPRESENTATIVES FROM QVMC. STAKEHOLDERS WERE SELECTED BASED ON THEIR KNOWLEDGE OF THE COMMUNITY AND ENGAGEMENT IN WORK THAT DIRECTLY SERVES PEOPLE WHO ARE ECONOMICALLY POOR AND VULNERABLE. QVMC AIMED TO ENGAGE STAKEHOLDERS FROM SOCIAL SERVICE AGENCIES, HEALTH CARE, EDUCATION, HOUSING, AND GOVERNMENT, AMONG OTHERS, TO ENSURE A WIDE RANGE OF PERSPECTIVES. INCLUDED IN THE INTERVIEWS WAS A PUBLIC HEALTH OFFICER FROM NAPA COUNTY PUBLIC HEALTH.CAREGIVER LISTENING SESSIONS:A TOTAL OF 8 LISTENING SESSIONS WERE COMPLETED WITH 27 COMMUNITY OUTREACH CAREGIVERS WHO REPRESENT THE NEEDS AND CHALLENGES OF THE CLIENTS THEY SERVE. PARTICIPANTS INCLUDED 6 NURSES, 13 SOCIAL WORKERS, 3 COMMUNITY HEALTH WORKERS, 3 COMMUNITY HEALTH EDUCATORS, AND 2 OTHER LICENSED STAFF.DATA LIMITATIONS AND INFORMATION GAPS:WHILE CARE WAS TAKEN TO SELECT AND GATHER DATA THAT WOULD TELL THE STORY OF THE HOSPITAL'S SERVICE AREA, IT IS IMPORTANT TO RECOGNIZE THE LIMITATIONS AND GAPS IN INFORMATION THAT NATURALLY OCCUR.-NOT ALL DESIRED DATA WERE READILY AVAILABLE, SO SOMETIMES WE HAD TO RELY ON TANGENTIAL OR PROXY MEASURES OR NOT HAVE ANY DATA AT ALL. FOR EXAMPLE, THERE IS LITTLE COMMUNITYLEVEL DATA ON THE INCIDENCE OF MENTAL HEALTH OR SUBSTANCE ABUSE.-DATA THAT ARE GATHERED THROUGH INTERVIEWS AND SURVEYS MAY BE BIASED DEPENDING ON WHO IS WILLING TO RESPOND TO THE QUESTIONS AND WHETHER THEY ARE REPRESENTATIVE OF THE POPULATION AS A WHOLE.-THE ACCURACY OF DATA GATHERED THROUGH INTERVIEWS AND SURVEYS DEPENDS ON HOW CONSISTENTLY THE QUESTIONS ARE INTERPRETED ACROSS ALL RESPONDENTS AND HOW HONEST PEOPLE ARE IN PROVIDING THEIR ANSWERS.-WHILE MOST INDICATORS ARE RELATIVELY CONSISTENT FROM YEAR TO YEAR, OTHER INDICATORS ARE CHANGING QUICKLY (SUCH AS PERCENTAGE OF PEOPLE UNINSURED) AND THE MOST RECENT DATA AVAILABLE ARE NOT A GOOD REFLECTION OF THE CURRENT STATE.-INFORMATION GATHERED DURING STAKEHOLDER INTERVIEWS AND CAREGIVER LISTENING SESSIONS IS DEPENDENT ON WHO WAS INVITED AND WHO PARTICIPATED. EFFORTS WERE MADE TO INCLUDE PEOPLE WHO COULD REPRESENT THE BROAD INTERESTS OF THE COMMUNITY AND/OR WERE REPRESENTATIVE OF COMMUNITIES OF GREATEST NEED.

QUEEN OF THE VALLEY MEDICAL CENTER (2)
PART V, SECTION B, LINE 6B: QUEEN OF THE VALLEY MEDICAL CENTER COLLABORATED WITH MANY LOCAL GOVERNMENT AGENCIES AND NOT-FOR-PROFIT ORGANIZATIONS.CA GROWER'S ASSOCIATIONCITY OF NAPA, HOUSING DIVISIONCOMMUNITY HEALTH INITIATIVECOPE FAMILYFIRST 5 NAPA COUNTYLGBTQ CONNECTIONMAYOR OF AMERICAN CANYONMENTISNAPA CITY COUNCILNAPA CO OFFICE OF EDUCATIONNAPA COUNTY BOARD OF SUPERVISORSNAPA COUNTY HHSANAPA COUNTY PUBLIC HEALTHNURTURING EMPOWERMENT WORTH SAFETY (NEWS)OLE HEALTH/FQHCON THE MOVEPARTNERSHIP HEALTH PLANPUERTAS ABIERTASUP VALLEY FAMILY CENTERS

QUEEN OF THE VALLEY MEDICAL CENTER (2)
PART V, SECTION B, LINE 11: COMMUNITY HEALTH NEEDS PRIORITIZED:1) HEALTH EQUITY - RACIAL & LGBTQ2) HOUSING & HOMELESSNESS3) MENTAL HEALTH & SUBSTANCE USE4) ACCESS TO HEALTH SERVICESHEALTH EQUITY - RACIAL & LGBTQ:THE DISPROPORTIONATE IMPACT OF COVID-19 ON BLACK, BROWN, INDIGENOUS, AND PEOPLE OF COLOR (BBIPOC), AS WELL AS THE NATIONAL CALL FOR RACIAL JUSTICE HAVE HIGHLIGHTED THE NEED FOR ADDITIONAL COMMUNITY CONVERSATIONS AROUND RACISM AND INEQUITIES. HEALTH INEQUITIES AND SYSTEMIC RACISM ARE PREVENTING BBIPOC COMMUNITIES, PARTICULARLY THE LATINO/A COMMUNITY, FROM ACCESSING OPPORTUNITIES AND LIVING THEIR HEALTHIEST LIVES. DISCRIMINATION ALSO PREVENTS THE LGBTQ+ COMMUNITY FROM RECEIVING RESPONSIVE HEALTH CARE AND VISIBILITY IN THE COMMUNITY. A GREATER COMMITMENT TO EQUITY IN ALL PROGRAMS AND COLLABORATIVES IS WARRANTED.HOUSING & HOMELESSNESS:A MAJOR AND GROWING COMMUNITY NEED IS AROUND MORE SAFE AND AFFORDABLE HOUSING STOCK, PARTICULARLY FOR PEOPLE WITH LOW INCOMES. A LACK OF AFFORDABLE HOUSING LEADS TO OVER-CROWDING AND POOR LIVING CONDITIONS. HOUSING IS FOUNDATIONAL TO ALL OTHER NEEDS; ONCE PEOPLE ARE HOUSED SECURELY, THEY CAN ADDRESS OTHER NEEDS RELATED TO THEIR HEALTH AND WELLBEING. TWO GROUPS ARE OF PARTICULAR CONCERN: THE LATINO/A COMMUNITY AND OLDER ADULTS. THE HOUSING CRISIS IN NAPA HIGHLIGHTS RACIAL AND ECONOMIC INEQUITIES IN THE COMMUNITY, DISPROPORTIONATELY AFFECTING THE LATINO/A COMMUNITY, ESPECIALLY MIXED STATUS FAMILIES. THERE IS ADDITIONAL CONCERN FOR OLDER ADULTS WHO HAVE FEW AFFORDABLE OPTIONS IN THE COMMUNITY, PARTICULARLY THOSE LIVING ON A FIXED INCOME.MENTAL HEALTH & SUBSTANCE USE:THERE IS A GENERAL LACK OF MENTAL HEALTH AND SUBSTANCE USE TREATMENT SERVICES IN THE COMMUNITY. SCHOOL-AGE CHILDREN AND OLDER ADULTS NEED MORE MENTAL HEALTH SUPPORT IN THE CURRENT ENVIRONMENT, INCREASING THE DEMAND FOR SERVICES. THE LATINO/A COMMUNITY IS ALSO UNDERSERVED, ESPECIALLY MIXED STATUS FAMILIES, WITH THE FOLLOWING BARRIERS PREVENTING LATINO/A INDIVIDUALS FROM RECEIVING SERVICES: STIGMA, A LACK OF CULTURALLY RELEVANT EDUCATION AND OUTREACH, AND A LACK OF BILINGUAL AND BICULTURAL PROVIDERS. LGBTQ-FRIENDLY MENTAL HEALTH PROVIDERS ARE ALSO DIFFICULT TO FIND IN THE AREA. THERE IS LIMITED ACCESS TO MENTAL HEALTH SERVICES FOR INDIVIDUALS WHO DO NOT MEET THE HIGH-ACUITY CRITERIA FOR SEVERE MENTAL ILLNESS AT NAPA COUNTY HEALTH AND HUMAN SERVICES, AS WELL AS LIMITED SUBSTANCE USE DISORDER TREATMENT OPTIONS. THE COVID-19 PANDEMIC IS CREATING A MENTAL HEALTH CRISIS; PEOPLE ARE FEELING HOPELESS, AFRAID, STRESSED, ANXIOUS, AND DEPRESSED. THE STRESS FROM THE COVID-19 PANDEMIC IS COMPOUNDING TRAUMA RELATED TO LOCAL FIRES.ACCESS TO HEALTH SERVICES:THERE IS CONCERN AROUND LACK OF ACCESS TO HEALTH INSURANCE FOR MIXED STATUS FAMILIES AS WELL AS PEOPLE LOSING THEIR INSURANCE DUE TO JOB LOSS DURING THE PANDEMIC. A LACK OF SPECIALISTS IN NAPA DISPROPORTIONATELY AFFECTS INDIVIDUALS ON MEDI-CAL OR WITHOUT INSURANCE. WHEN INDIVIDUALS ARE REFERRED TO A SPECIALIST OUTSIDE OF THE AREA, TRANSPORTATION THEN BECOMES A BARRIER TO ACCESSING CARE. LANGUAGE BARRIERS PREVENT SPANISH-SPEAKING INDIVIDUALS FROM RECEIVING RESPONSIVE CARE, AND VIRTUAL INTERPRETERS ARE NOT NEARLY AS EFFECTIVE AS IN-PERSON OPTIONS. ACCESS TO CARE CHALLENGES BECAME ESPECIALLY APPARENT DURING THE COVID-19 PANDEMIC. WHILE TELEMEDICINE HAS IMPROVED ACCESS TO CARE FOR SOME POPULATIONS, FOR OTHERS THIS TRANSITION HAS CREATED ADDITIONAL BARRIERS TO CARE, INCLUDING LACK OF SMART PHONES OR COMPUTERS, LACK OF COMFORT WITH TECHNOLOGY OR STABLE INTERNET ACCESS, LANGUAGE BARRIERS, AND LACK OF PRIVATE SPACE FOR APPOINTMENTS. MANY INDIVIDUALS DO NOT WANT TO TALK TO THEIR PROVIDER ON THE PHONE AND ARE NOT RECEIVING THE CARE THEY NEED.NEEDS BEYOND THE HOSPITAL'S SERVICE PROGRAM:NO HOSPITAL FACILITY CAN FULLY ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. WHILE QUEEN OF THE VALLEY MEDICAL CENTER WILL EMPLOY STRATEGIES TO ADDRESS EACH OF THE FOUR SIGNIFICANT HEALTH NEEDS THAT WERE PRIORITIZED DURING THE CHNA PROCESS, PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS AND GOVERNMENT AGENCIES ARE CRITICAL FOR ACHIEVING THE ESTABLISHED GOALS.QUEEN OF THE VALLEY MEDICAL CENTER WILL COLLABORATE WITH NAPA COUNTY, THE CITY OF NAPA, OLE HEALTH, ADVENTIST HEALTH, MENTIS, ABODE, AND A VARIETY OF LOCAL FAMILY RESOURCE CENTERS THAT ADDRESS THE COMMUNITY NEEDS TO COORDINATE CARE AND REFERRALS TO ADDRESS UNMET NEEDS.FURTHERMORE, ST. JOSEPH HEALTH QUEEN OF THE VALLEY WILL ENDORSE LOCAL NONPROFIT ORGANIZATION PARTNERS TO APPLY FOR FUNDING THROUGH THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND. ORGANIZATIONS THAT RECEIVE FUNDING PROVIDE SPECIFIC SERVICES AND RESOURCES TO MEET THE IDENTIFIED NEEDS OF UNDERSERVED COMMUNITIES THROUGHOUT QUEEN OF THE VALLEY SERVICE AREAS.THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE ADDRESSED WITH THE FOLLOWING EXPLANATION: SJH QUEEN OF THE VALLEY DOES NOT DIRECTLY ADDRESS IMMIGRATION STATUS. HOWEVER, COMMUNITY BENEFIT SERVICES ARE PROVIDED WITHOUT CONSIDERATION OF IMMIGRATION STATUS AND THE MEDICAL CENTER PROVIDES CHARITY MEDICAL CARE. IN ADDITION, QUEEN OF THE VALLEY MEDICAL CENTER AND COMMUNITY BENEFIT PROGRAMS PARTNER WITH MULTIPLE COMMUNITYBASED ORGANIZATIONS TO ADDRESS THE NEEDS OF THE UNDOCUMENTED. WHILE CANCER, HEART DISEASE, DIABETES AND ASTHMA ARE NOT A PRIMARY FOCUS OF THE PLAN, THE SERVICE AREA INCLUDES ST. JOSEPH HEALTH QUEEN OF THE VALLEY MEDICAL CENTER, ST. HELENA HOSPITAL, KAISER CLINIC AND OLE HEALTH THAT PROVIDE MEDICAL SERVICES TO INDIVIDUALS WITH THESE CONDITIONS. ALSO, QUEEN OF THE VALLEY'S CARE NETWORK PROVIDES CARE COORDINATION AND CARE MANAGEMENT FOR LOW INCOME PERSONS WITH COMPLEX MEDICAL CONDITIONS INCLUDING CHRONIC DISEASES SUCH AS THESE. SJH QUEEN OF THE VALLEY DOES NOT DIRECTLY ADDRESS ISSUES OF TRANSPORTATION AND TRAFFIC. AS A PARTNER IN LIVE HEALTHY NAPA COUNTY, QUEEN OF THE VALLEY PARTNERS WITH THE COMMUNITY TO IMPROVE CONDITIONS THROUGH ADVOCACY AND PARTNERSHIPS. IN ADDITION, TRANSPORTATION SUPPORT IS PROVIDED TO QUEEN OF THE VALLEY CARE NETWORK CLIENTS. WHILE ACCESS TO FOOD IS NOT A PRIMARY FOCUS OF THE CB IMPLEMENTATION STRATEGY, SJH QUEEN OF THE VALLEY COMMUNITY BENEFIT PROVIDES FUNDING SUPPORT TO LOCAL SAFETY FOOD NET ORGANIZATIONS, WORKS DIRECTLY WITH COMMUNITY PARTNERS SUCH AS THE FOOD BANK AND LIVE HEALTHY NAPA COUNTY TO EXPAND ACCESS, AND DIRECTLY ASSISTS LOWINCOME CHRONICALLY ILL CARE NETWORK CLIENTS WITH FOOD ACCESS. IN ADDITION, QUEEN OF THE VALLEY WILL COLLABORATE WITH PUBLIC AGENCIES AND COMMUNITYBASED ORGANIZATIONS THAT ADDRESS LANGUAGE BARRIERS AND AFOREMENTIONED COMMUNITY NEEDS, TO COORDINATE CARE AND REFERRAL AND ADDRESS THESE UNMET NEEDS.

QUEEN OF THE VALLEY MEDICAL CENTER (2)
PART V, SECTION B, LINE 13H: BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: SANTA ROSA MEMORIAL HOSPITAL, - FACILITY 3: REDWOOD MEMORIAL HOSPITAL, - FACILITY 4: ST. JOSEPH HOSPITAL OF EUREKA

SJHNC, LLC (GROUP A - 1, 3 & 4) PART V, SECTION B, LINE 3J:
PART V, SECTION B, LINE 3ESANTA ROSA MEMORIAL HOSPITAL (1), REDWOOD MEMORIAL HOSPITAL (3) AND ST. JOSEPH HOSPITAL OF EUREKA (4)THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.

SJHNC, LLC (GROUP A - 1, 3 & 4) PART V, SECTION B, LINE 5:
SANTA ROSA MEMORIAL HOSPITAL (1) THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS IS BASED ON THE UNDERSTANDING THAT HEALTH AND WELLNESS ARE INFLUENCED BY FACTORS WITHIN OUR COMMUNITIES, NOT ONLY WITHIN MEDICAL FACILITIES. IN GATHERING INFORMATION ON THE COMMUNITIES SERVED BY SRMH AND PVH, WE LOOKED NOT ONLY AT THE HEALTH CONDITIONS OF THE POPULATION, BUT ALSO AT SOCIOECONOMIC FACTORS, THE PHYSICAL ENVIRONMENT, AND HEALTH BEHAVIORS. WE ALSO INVITED KEY STAKEHOLDERS AND COMMUNITY MEMBERS TO PROVIDE ADDITIONAL CONTEXT TO THE QUANTITATIVE DATA THROUGH QUALITATIVE DATA IN THE FORM OF INTERVIEWS AND LISTENING SESSIONS. AS OFTEN AS POSSIBLE, EQUITY IS AT THE FOREFRONT OF OUR CONVERSATIONS AND PRESENTATION OF THE DATA, WHICH OFTEN HAVE BIASES BASED ON COLLECTION METHODOLOGY.IN ADDITION, WE RECOGNIZE THAT THERE ARE OFTEN GEOGRAPHIC AREAS WHERE THE CONDITIONS FOR SUPPORTING HEALTH ARE SUBSTANTIALLY POORER THAN NEARBY AREAS. WHENEVER POSSIBLE AND RELIABLE, DATA ARE REPORTED AT THE ZIP CODE OR CENSUS BLOCK GROUP LEVEL. THESE SMALLER GEOGRAPHIC AREAS ALLOW US TO BETTER UNDERSTAND THE NEIGHBORHOOD LEVEL NEEDS OF OUR COMMUNITIES AND BETTER ADDRESS HEALTH DISPARITIES WITHIN AND ACROSS COMMUNITIES.WE REVIEWED DATA FROM THE AMERICAN COMMUNITY SURVEY AND LOCAL PUBLIC HEALTH AUTHORITIES. IN ADDITION, WE INCLUDE HOSPITAL UTILIZATION DATA TO IDENTIFY DISPARITIES IN UTILIZATION BY INCOME AND INSURANCE, GEOGRAPHY, AND RACE/ETHNICITY WHEN RELIABLY COLLECTED.COMMUNITY INPUT:TO BETTER UNDERSTAND THE UNIQUE PERSPECTIVES, OPINIONS, EXPERIENCES, AND KNOWLEDGE OF COMMUNITY MEMBERS, REPRESENTATIVES FROM SANTA ROSA MEMORIAL AND PETALUMA VALLEY HOSPITALS CONDUCTED 11 STAKEHOLDER INTERVIEWS WITH REPRESENTATIVES FROM COMMUNITY-BASED ORGANIZATIONS, INCLUDING 12 PARTICIPANTS FROM JUNE TO JULY 2020. DURING THESE INTERVIEWS, NONPROFIT AND GOVERNMENT STAKEHOLDERS DISCUSSED THE ISSUES AND OPPORTUNITIES OF THE PEOPLE, NEIGHBORHOODS, AND CITIES OF THE SERVICE AREA.THESE 2020 QUALITATIVE FINDINGS SUPPLEMENT THE QUALITATIVE DATA FROM THE 2019 SONOMA COUNTY COLLABORATIVE CHNA COLLECTED FROM AUGUST TO NOVEMBER 2018.OBTAINING ROBUST COMMUNITY INPUT DURING THE COVID-19 PANDEMIC WAS ESPECIALLY CHALLENGING AND PREVENTED SANTA ROSA MEMORIAL AND PETALUMA VALLEY HOSPITALS FROM COMPLETING ANY IN-PERSON CONVERSATIONS. WHILE STAKEHOLDER INTERVIEWS WERE EASILY ADAPTED TO A VIRTUAL SETTING THROUGH A VIDEO CONFERENCING PLATFORM, IT WAS NOT FEASIBLE TO HOST LISTENING SESSIONS COMPRISED OF COMMUNITY MEMBERS IN THIS SAME WAY. WHILE VIDEO CONFERENCING DOES FACILITATE INFORMATION SHARING, THERE ARE CHALLENGES CREATING THE LEVEL OF DIALOGUE THAT WOULD TAKE PLACE IN PERSON. ADDITIONALLY, DUE TO MANY COMMUNITY ORGANIZATIONS ENGAGING IN COVID-19 RESPONSE, SOME ORGANIZATIONS HAD LIMITED CAPACITY AND WERE NOT ABLE TO PARTICIPATE IN INTERVIEWS.NONPROFIT AND GOVERNMENT STAKEHOLDER INTERVIEWS:A TOTAL OF 11 STAKEHOLDER INTERVIEWS WERE COMPLETED BY REPRESENTATIVES FROM SANTA ROSA MEMORIAL AND PETALUMA VALLEY HOSPITALS. STAKEHOLDERS WERE SELECTED BASED ON THEIR KNOWLEDGE OF THE COMMUNITY AND ENGAGEMENT IN WORK THAT DIRECTLY SERVES PEOPLE WHO HAVE LOW INCOMES, HAVE CHRONIC CONDITIONS, AND/OR ARE MEDICALLY UNDERSERVED. SANTA ROSA MEMORIAL AND PETALUMA VALLEY HOSPITALS AIMED TO ENGAGE STAKEHOLDERS FROM SOCIAL SERVICE AGENCIES, HEALTH CARE, EDUCATION, HOUSING, AND GOVERNMENT, AMONG OTHERS, TO ENSURE A WIDE RANGE OF PERSPECTIVES. INCLUDED IN THE INTERVIEWS WAS A REPRESENTATIVE FROM THE SONOMA COUNTY HUMAN SERVICES DEPARTMENT.DATA LIMITATIONS AND INFORMATION GAPS:WHILE CARE WAS TAKEN TO SELECT AND GATHER DATA THAT WOULD TELL THE STORY OF THE HOSPITAL'S SERVICE AREA, IT IS IMPORTANT TO RECOGNIZE THE LIMITATIONS AND GAPS IN INFORMATION THAT NATURALLY OCCUR.- NOT ALL DESIRED DATA WERE READILY AVAILABLE, SO SOMETIMES WE HAD TO RELY ON TANGENTIAL OR PROXY MEASURES OR NOT HAVE ANY DATA AT ALL. FOR EXAMPLE, THERE IS LITTLE COMMUNITYLEVEL DATA ON THE INCIDENCE OF MENTAL HEALTH OR SUBSTANCE ABUSE.- DATA THAT ARE GATHERED THROUGH INTERVIEWS AND SURVEYS MAY BE BIASED DEPENDING ON WHO IS WILLING TO RESPOND TO THE QUESTIONS AND WHETHER THEY ARE REPRESENTATIVE OF THE POPULATION AS A WHOLE.- THE ACCURACY OF DATA GATHERED THROUGH INTERVIEWS AND SURVEYS DEPENDS ON HOW CONSISTENTLY THE QUESTIONS ARE INTERPRETED ACROSS ALL RESPONDENTS AND HOW HONEST PEOPLE ARE IN PROVIDING THEIR ANSWERS.- WHILE MOST INDICATORS ARE RELATIVELY CONSISTENT FROM YEAR TO YEAR, OTHER INDICATORS ARE CHANGING QUICKLY (SUCH AS PERCENTAGE OF PEOPLE UNINSURED) AND THE MOST RECENT DATA AVAILABLE ARE NOT A GOOD REFLECTION OF THE CURRENT STATE.- INFORMATION GATHERED DURING STAKEHOLDER INTERVIEWS AND CAREGIVER LISTENING SESSIONS IS DEPENDENT ON WHO WAS INVITED AND WHO PARTICIPATED. EFFORTS WERE MADE TO INCLUDE PEOPLE WHO COULD REPRESENT THE BROAD INTERESTS OF THE COMMUNITY AND/OR WERE REPRESENTATIVE OF COMMUNITIES OF GREATEST NEED.REDWOOD MEMORIAL HOSPITAL (3) AND ST. JOSEPH HOSPITAL OF EUREKA (4)THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS IS BASED ON THE UNDERSTANDING THAT HEALTH AND WELLNESS ARE INFLUENCED BY FACTORS WITHIN OUR COMMUNITIES, NOT ONLY WITHIN MEDICAL FACILITIES. IN GATHERING INFORMATION ON THE COMMUNITIES SERVED BY THE HOSPITALS, WE LOOKED NOT ONLY AT THE HEALTH CONDITIONS OF THE POPULATION, BUT ALSO AT SOCIOECONOMIC FACTORS, THE PHYSICAL ENVIRONMENT, AND HEALTH BEHAVIORS. ADDITIONALLY, WE INVITED KEY STAKEHOLDERS AND COMMUNITY MEMBERS TO PROVIDE ADDITIONAL CONTEXT TO THE QUANTITATIVE DATA THROUGH QUALITATIVE DATA IN THE FORM OF INTERVIEWS AND LISTENING SESSIONS. AS OFTEN AS POSSIBLE, EQUITY IS AT THE FOREFRONT OF OUR CONVERSATIONS AND PRESENTATION OF THE DATA, WHICH OFTEN HAVE BIASES BASED ON COLLECTION METHODOLOGY.IN ADDITION, WE RECOGNIZE THAT THERE ARE OFTEN GEOGRAPHIC AREAS WHERE THE CONDITIONS FOR SUPPORTING HEALTH ARE SUBSTANTIALLY POORER THAN NEARBY AREAS. WHENEVER POSSIBLE AND RELIABLE, DATA IS REPORTED AT THE ZIP CODE OR CENSUS TRACT LEVEL. THESE SMALLER GEOGRAPHIC AREAS ALLOW US TO BETTER UNDERSTAND THE NEIGHBORHOOD LEVEL NEEDS OF OUR COMMUNITIES AND BETTER ADDRESS DISPARITIES WITHIN AND ACROSS COMMUNITIES.WE REVIEWED DATA FROM THE AMERICAN COMMUNITY SURVEY AND LOCAL PUBLIC HEALTH AUTHORITIES. IN ADDITION, WE INCLUDE HOSPITAL UTILIZATION DATA TO IDENTIFY DISPARITIES IN UTILIZATION BY INCOME AND INSURANCE, GEOGRAPHY, AND RACE/ETHNICITY WHEN RELIABLY COLLECTED.COMMUNITY INPUT:TO BETTER UNDERSTAND THE UNIQUE PERSPECTIVES, OPINIONS, EXPERIENCES, AND KNOWLEDGE OF COMMUNITY MEMBERS, REPRESENTATIVES FROM ST. JOSEPH AND REDWOOD MEMORIAL HOSPITALS CONDUCTED 10 STAKEHOLDER INTERVIEWS WITH REPRESENTATIVES FROM COMMUNITY-BASED ORGANIZATIONS AND 3 LISTENING SESSIONS INCLUDING 14 INTERNAL CAREGIVERS. DURING THESE INTERVIEWS AND LISTENING SESSIONS, CAREGIVERS AND NONPROFIT AND GOVERNMENT STAKEHOLDERS DISCUSSED THE ISSUES AND OPPORTUNITIES OF THE PEOPLE, NEIGHBORHOODS, AND CITIES OF THE SERVICE AREA.OBTAINING ROBUST COMMUNITY INPUT DURING THE COVID-19 PANDEMIC WAS ESPECIALLY CHALLENGING AND PREVENTED ST. JOSEPH AND REDWOOD MEMORIAL HOSPITALS FROM COMPLETING ANY IN-PERSON CONVERSATIONS. WHILE STAKEHOLDER INTERVIEWS WERE EASILY ADAPTED TO A VIRTUAL SETTING THROUGH A VIDEO CONFERENCING PLATFORM, IT WAS NOT FEASIBLE TO HOST LISTENING SESSIONS COMPRISED OF COMMUNITY MEMBERS IN THIS SAME WAY. WHILE VIDEO CONFERENCING DOES FACILITATE INFORMATION SHARING, THERE ARE CHALLENGES CREATING THE LEVEL OF DIALOGUE THAT WOULD TAKE PLACE IN PERSON. ADDITIONALLY, DUE TO MANY COMMUNITY ORGANIZATIONS ENGAGING IN COVID-19 RESPONSE, SOME ORGANIZATIONS HAD LIMITED CAPACITY AND WERE NOT ABLE TO PARTICIPATE IN INTERVIEWS.NONPROFIT AND GOVERNMENT STAKEHOLDER INTERVIEWS:A TOTAL OF 10 STAKEHOLDER INTERVIEWS WERE COMPLETED BY REPRESENTATIVES FROM ST. JOSEPH AND REDWOOD MEMORIAL HOSPITALS. STAKEHOLDERS WERE SELECTED BASED ON THEIR KNOWLEDGE OF THE COMMUNITY AND ENGAGEMENT IN WORK THAT DIRECTLY SERVES PEOPLE WHO HAVE LOW INCOMES, HAVE CHRONIC CONDITIONS, AND/OR ARE MEDICALLY UNDERSERVED. ST. JOSEPH AND REDWOOD MEMORIAL HOSPITALS AIMED TO ENGAGE STAKEHOLDERS FROM SOCIAL SERVICE AGENCIES, HEALTH CARE, EDUCATION, HOUSING, AND GOVERNMENT, AMONG OTHERS, TO ENSURE A WIDE RANGE OF PERSPECTIVES. INCLUDED IN THE INTERVIEWS WAS A REPRESENTATIVE FROM THE HUMBOLDT COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES.CAREGIVER LISTENING SESSIONS:A TOTAL OF 3 LISTENING SESSIONS WERE COMPLETED WITH 14 INTERNAL CAREGIVERS WHO REPRESENT THE NEEDS AND CHALLENGES OF THE CLIENTS THEY SERVE.

SJHNC, LLC (GROUP A - 1, 3 & 4) PART V, SECTION B, LINE 6A:
SANTA ROSA MEMORIAL HOSPITAL (1)MANY LOCAL GOVERNMENT AGENCIES AND NOT-FOR-PROFIT ORGANIZATIONS COLLABORATED WITH ST. JOSEPH HEALTH IN THE CHNA PROCESS. AMONG THESE ARE THE HOSPITAL FACILITIES:- SUTTER HEALTH- KAISER PERMANENTE- SONOMA WEST MEDICAL CENTERREDWOOD MEMORIAL HOSPITAL (3) AND ST. JOSEPH HOSPITAL OF EUREKA (4)ST. JOSEPH HOSPITAL EUREKA CONDUCTED THE CHNA IN PARTNERSHIP WITH REDWOOD MEMORIAL HOSPITAL.

SJHNC, LLC (GROUP A - 1, 3 & 4) PART V, SECTION B, LINE 6B:
SANTA ROSA MEMORIAL HOSPITAL (1)MANY LOCAL GOVERNMENT AGENCIES AND NOT-FOR-PROFIT ORGANIZATIONS COLLABORATED WITH ST. JOSEPH HEALTH IN THE CHNA PROCESS. AMONG THESE ARE THE FOLLOWING ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:- SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES- COMMUNITY CHILD CARE COUNCIL (4CS) OF SONOMA COUNTY- FIRST 5 SONOMA COUNTY- BURBANK HOUSING- COMMUNITY FOUNDATION SONOMA COUNTY- SONOMA COUNTY SHERIFF'S OFFICE- CITY OF SANTA ROSA VIOLENCE PREVENTION PARTNERSHIP- COMMUNITY ACTION PARTNERSHIP OF SONOMA- SONOMA COUNTY ACES CONNECTION- SONOMA COUNTY ECONOMIC DEVELOPMENT BOARD- SONOMA COUNTY PERMIT & RESOURCE MANAGEMENT DEPARTMENT- SONOMA COUNTY ENVIRONMENTAL HEALTH & SAFETY- BUCKELEW PROGRAMS- SONOMA COUNTY OFFICE OF EDUCATION- SONOMA COUNTY COMMUNITY DEVELOPMENT COMMISSION- LA LUZ COMMUNITY CENTER- PETALUMA PEOPLE SERVICES CENTER- SANTA ROSA COMMUNITY HEALTH CENTERS- WEST COUNTY HEALTH CENTERS- PETALUMA HEALTH CARE DISTRICT- PETALUMA HEALTH CENTER- ALLIANCE MEDICAL CENTER- PALM DRIVE HEALTH CARE DISTRICT- NORTH SONOMA COUNTY HEALTH CARE DISTRICT- SONOMA VALLEY HEALTH CARE DISTRICT- RUSSIAN RIVER ARE RESOURCES AND ADVOCATES- COMMUNITY HEALTH INITIATIVE OF THE PETALUMA AREA- LATINO SERVICE PROVIDERS- SONOMA COUNTY HUMAN SERVICES DEPARTMENT- SONOMA COUNTY TASK FORCE ON THE HOMELESS- SONOMA COUNTY HEALTH CARE FOR THE HOMELESS COALITION- MENDOCINO COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES- HEALTH MENDOCINOREDWOOD MEMORIAL HOSPITAL (3) AND ST. JOSEPH HOSPITAL OF EUREKA (4)ST. JOSEPH HOSPITAL EUREKA, ALONG WITH REDWOOD MEMORIAL HOSPITAL, COLLABORATED ON THE CHNA PROCESS WITH THE FOLLOWING ORGANIZATIONS:- HUMBOLDT COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, PUBLIC HEALTH BRANCH- LIVE WELL HUMBOLDT, COMMUNITY STRATEGIES TEAM- BETTY KWAN CHINN HOMELESS FOUNDATION AND DAY CENTER- HUMBOLDT COUNTY OFFICE OF EDUCATION- VETERANS ADMINISTRATION- LATINONET AND HUMBOLDT PROMOTORES DE SALUD- REDWOOD COMMUNITY ACTION AGENCY- NAACP, YUROK TRIBAL COURT, HEALY SENIOR CENTER, HUMBOLDT AREA FOUNDATION, GINA WALKER, MA, LMFT, ARCATA ECONOMIC DEVELOPMENT CORPORATION, LEGAL SERVICES OF NORTHERN CALIFORNIA.

SJHNC, LLC (GROUP A - 1, 3 & 4) PART V, SECTION B, LINE 11:
"SANTA ROSA MEMORIAL HOSPITAL (1), REDWOOD MEMORIAL HOSPITAL (3) AND ST. JOSEPH HOSPITAL OF EUREKA (4)COMMUNITY HEALTH NEEDS PRIORITIZED:1) HOUSING INSTABILITY & HOMELESSNESS2) MENTAL HEALTH & SUBSTANCE USE3) HEALTH EQUITY: RACISM & DISCRIMINATION4) ACCESS TO HEALTH CAREHOUSING INSTABILITY & HOMELESSNESS:THE COST OF LIVING IN SONOMA COUNTY OUTPACES THE INCOME FOR MANY PEOPLE IN THE COMMUNITY, MAKING IT CHALLENGING FOR FAMILIES TO MEET THEIR BASIC NEEDS. HOUSING IS FOUNDATIONAL TO ONE'S HEALTH: PEOPLE WHO ARE STABLY HOUSED ARE BETTER ABLE TO CARE FOR THEIR PHYSICAL AND MENTAL HEALTH. THOSE MOST IMPACTED BY HOUSING STABILITY AND AFFORDABILITY ARE THE LATINO/A COMMUNITY DUE TO INCOME INEQUITIES; YOUTH EXPERIENCING HOMELESSNESS, ESPECIALLY THOSE IDENTIFYING AS LGBTQ+; AND OLDER ADULTS WHOSE FIXED INCOME LIMITS THEIR ABILITY TO AFFORD LOCAL HOUSING PRICES. THERE IS ALSO NEED FOR SUPPORTIVE HOUSING, USING A HOUSING FIRST APPROACH, FOR PEOPLE WITH MENTAL HEALTH CHALLENGES, SUBSTANCE USE DISORDERS, AND OTHER SPECIAL NEEDS. THERE ARE ESPECIALLY FEW RESOURCES FOR PEOPLE WHO ARE UNDOCUMENTED.MENTAL HEALTH & SUBSTANCE USE:ACCESSING QUALITY MENTAL HEALTH AND SUBSTANCE USE SERVICES CAN BE A CHALLENGE FOR MANY. TRAUMA FROM THE RECENT FIRES, COVID-19, AND THE CURRENT POLITICAL CLIMATE CONTRIBUTE TO THE COMMUNITY MENTAL HEALTH NEEDS. THERE IS A PARTICULAR NEED FOR MILD TO MODERATE MENTAL HEALTH SERVICES, PERINATAL MENTAL HEALTH SERVICES, MORE WRAPAROUND CASE MANAGEMENT FOR FAMILIES TO ADDRESS MENTAL HEALTH, AND MORE SUBSTANCE USE DISORDER TREATMENT SERVICES. THERE IS FURTHER NEED FOR MORE BILINGUAL AND BICULTURAL MENTAL HEALTH PROFESSIONALS TO SERVE THE LATINO/A COMMUNITY, INCLUDING THOSE THAT ARE UNDOCUMENTED. SCHOOL-AGE CHILDREN AND OLDER ADULTS ARE TWO ADDITIONAL GROUPS WITH UNMET MENTAL HEALTH NEEDS. MAJOR BARRIERS TO ACCESSING MENTAL HEALTH SERVICES INCLUDE INSURANCE COVERAGE LIMITATIONS, COST OF CARE, AND SHORTAGE OF PROVIDERS RESULTING IN LONG WAIT TIMES FOR APPOINTMENTS.HEALTH EQUITY: RACISM & DISCRIMINATION:STAKEHOLDERS DESCRIBED BEING AT AN ""INFLECTION POINT"" IN ACKNOWLEDGING AND ADDRESSING RACISM IN THE COMMUNITY, WITH MORE PEOPLE TALKING ABOUT THE ISSUE. THEY SHARED RACISM KEEPS PEOPLE IN POVERTY BY LIMITING EDUCATION AND JOB OPPORTUNITIES, LEADING TO MORE BLACK, INDIGENOUS, AND PEOPLE OF COLOR (BIPOC) WORKING IN LOWER-WAGE JOBS, WITH PARTICULAR EMPHASIS ON THE LATINO/A COMMUNITY IN SONOMA COUNTY. HOUSING DISCRIMINATION PREVENTS THE LATINO/A COMMUNITY FROM ACCESSING GOOD-QUALITY, AFFORDABLE HOUSING. RACISM CONTRIBUTES TO INEQUITIES IN THE WAYS DIFFERENT SCHOOLS ARE FUNDED, CONTRIBUTING TO THE OPPORTUNITY GAP. STAKEHOLDERS SHARED PARTICULAR CONCERN FOR THE WAYS IN WHICH XENOPHOBIA AND RACIST POLICIES NEGATIVELY AFFECT THE MENTAL HEALTH AND ECONOMIC SECURITY OF THE LATINO/A COMMUNITY.ACCESS TO HEALTH CARE:STAKEHOLDERS DISCUSSED THE NEED FOR MORE AFFORDABLE HEALTH CARE, AS WELL AS CHALLENGES ACCESSING PRIMARY AND SPECIALTY CARE. THEY NOTED A PARTICULAR NEED FOR MORE CASE MANAGEMENT AND NAVIGATION RESOURCES, ESPECIALLY FOR SPANISH-SPEAKING PATIENTS AND NEW PARENTS. TRANSPORTATION TO CARE IS A CONSISTENT BARRIER FOR MANY, BUT ESPECIALLY OLDER ADULTS. FEARS OF IMMIGRATION ENFORCEMENT AND CHANGES IN PUBLIC CHARGE RULES MAY PREVENT MIXED STATUS HOUSEHOLDS FROM APPLYING FOR MEDI-CAL. A LACK OF CULTURALLY RESPONSIVE AND LINGUISTICALLY APPROPRIATE HEALTH CARE SERVICES AND DOCUMENTATION STATUS MAY PREVENT THE LATINO/A COMMUNITY FROM RECEIVING THE CARE THEY NEED.NEEDS BEYOND THE HOSPITAL'S SERVICE PROGRAM:NO SINGLE HOSPITAL FACILITY CAN FULLY ADDRESS ALL THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. WHILE SANTA ROSA MEMORIAL WILL EMPLOY STRATEGIES TO ADDRESS EACH OF THE FOUR SIGNIFICANT HEALTH NEEDS THAT WERE PRIORITIZED DURING THE CHNA PROCESS, PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS AND GOVERNMENT AGENCIES ARE CRITICAL FOR ACHIEVING THE ESTABLISHED GOALS.SANTA ROSA MEMORIAL HOSPITAL WILL COLLABORATE WITH PETALUMA PEOPLE SERVICES CENTER, LA LUZ CENTER, WEST COUNTY COMMUNITY SERVICES, COMMUNITY ACTION PARTNERSHIP OF SONOMA COUNTY, AND A VARIETY OF LOCAL FAMILY RESOURCE CENTERS THAT ADDRESS THE COMMUNITY NEEDS TO COORDINATE CARE AND REFERRALS TO ADDRESS UNMET NEEDS.WITH RESPECT TO SOME OF THE OTHER NEEDS IDENTIFIED IN THE CHNA PROCESS THAT WERE NOT PRIORITIZED FOR ACTION THROUGH THIS PLAN, WE INTEND TO REMAIN ENGAGED IN ADDRESSING: ORAL HEALTH NEEDS THROUGH OUR ONGOING COMMUNITY DENTAL CLINIC AND MOBILE DENTAL CLINIC; CRIME AND SAFETY THROUGH OUR CONTINUED INVOLVEMENT ON THE SANTA ROSA VIOLENCE PREVENTION PARTNERSHIP; AND INSURANCE AND COST OF CARE THROUGH OUR CONTINUED INVOLVEMENT ON THE COVERED SONOMA AND SONOMA HEALTH ACTION COMMUNITY HEALTH IMPROVEMENT COMMITTEES. WE ALSO INTEND TO INCORPORATE OTHER ISSUES SUCH AS EARLY CHILDHOOD DEVELOPMENT IN OUR BEHAVIORAL HEALTH STRATEGY AS IT IS SUCH A FUNDAMENTAL DETERMINANT OF MENTAL HEALTH LATER IN LIFE AND ECONOMIC INSECURITY IN OUR HOUSING CONCERNS STRATEGY AS IT IS A NECESSARY INGREDIENT IN HOUSING AFFORDABILITY. SIMILARLY, WITH RESPECT TO IMMIGRATION, WE LACK APPROPRIATE EXPERTISE OR COMPETENCY TO OFFER A PROGRAM, BUT WE DEVELOPED A MEDICAL LEGAL PARTNERSHIP WITH A LOCAL LEGAL AID ORGANIZATION THAT ASSISTS RESIDENTS AND PATIENTS WITH IMMIGRATION ISSUES, AMONG OTHERS. AND WHILE FOOD AND NUTRITION IS NOT TO BE DIRECTLY ADDRESSED BY OUR OWN PROGRAMMING, WE ANTICIPATE THAT OUR ONGOING SUPPORT OF LOCAL INITIATIVES AND ORGANIZATIONS INVOLVED IN CARDIOVASCULAR DISEASE PREVENTION WILL INCLUDES A CONSIDERATION AND INCLUSION OF STRATEGIES TO ADDRESS THIS NEED.FURTHERMORE, WE WILL CONTINUE FUNDING OTHER LOCAL NONPROFIT ORGANIZATIONS THROUGH GRANTS FROM OUR CARE FOR THE POOR PROGRAM MANAGED BY THE SRMH COMMUNITY HEALTH INVESTMENT DEPARTMENT, AND WE WILL ENCOURAGE AND ENDORSE LOCAL NONPROFIT ORGANIZATION PARTNERS TO APPLY FOR FUNDING THROUGH THE ST. JOSEPH COMMUNITY PARTNERSHIP FUND. ORGANIZATIONS THAT RECEIVE FUNDING PROVIDE SPECIFIC SERVICES AND RESOURCES TO MEET THE IDENTIFIED NEEDS OF UNDERSERVED COMMUNITIES THROUGHOUT THE SRMH SERVICE AREAS."

SJHNC, LLC (GROUP A - 1, 3 & 4) PART V, SECTION B, LINE 13H:
SANTA ROSA MEMORIAL HOSPITAL (1), REDWOOD MEMORIAL HOSPITAL (3) AND ST. JOSEPH HOSPITAL OF EUREKA (4)THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USED AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT.

SJHNC, LLC (GROUP A - 1, 3 & 4) PART V, SECTION B, LINE 24:
FOR NON-MEDICALLY NECESSARY SERVICES A PATIENT MAY BE CHARGED FULL BILLED CHARGES.

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 5 (CONT):
DATA LIMITATIONS AND INFORMATION GAPS:WHILE CARE WAS TAKEN TO SELECT AND GATHER DATA THAT WOULD TELL THE STORY OF THE HOSPITALS' SERVICE AREA, IT IS IMPORTANT TO RECOGNIZE THE LIMITATIONS AND GAPS IN INFORMATION THAT NATURALLY OCCUR.- NOT ALL DESIRED DATA WERE READILY AVAILABLE, SO SOMETIMES WE HAD TO RELY ON TANGENTIAL OR PROXY MEASURES OR NOT HAVE ANY DATA AT ALL. FOR EXAMPLE, THERE IS LITTLE COMMUNITYLEVEL DATA ON THE INCIDENCE OF MENTAL HEALTH OR SUBSTANCE ABUSE.- DATA THAT ARE GATHERED THROUGH INTERVIEWS AND SURVEYS MAY BE BIASED DEPENDING ON WHO IS WILLING TO RESPOND TO THE QUESTIONS AND WHETHER THEY ARE REPRESENTATIVE OF THE POPULATION AS A WHOLE.- THE ACCURACY OF DATA GATHERED THROUGH INTERVIEWS AND SURVEYS DEPENDS ON HOW CONSISTENTLY THE QUESTIONS ARE INTERPRETED ACROSS ALL RESPONDENTS AND HOW HONEST PEOPLE ARE IN PROVIDING THEIR ANSWERS.- WHILE MOST INDICATORS ARE RELATIVELY CONSISTENT FROM YEAR TO YEAR, OTHER INDICATORS ARE CHANGING QUICKLY (SUCH AS PERCENTAGE OF PEOPLE UNINSURED) AND THE MOST RECENT DATA AVAILABLE ARE NOT A GOOD REFLECTION OF THE CURRENT STATE.- INFORMATION GATHERED DURING STAKEHOLDER INTERVIEWS AND CAREGIVER LISTENING SESSIONS IS DEPENDENT ON WHO WAS INVITED AND WHO PARTICIPATED. EFFORTS WERE MADE TO INCLUDE PEOPLE WHO COULD REPRESENT THE BROAD INTERESTS OF THE COMMUNITY AND/OR WERE REPRESENTATIVE OF COMMUNITIES OF GREATEST NEED.

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 7A:
CHNA WEBSITESANTA ROSA MEMORIAL HOSPITAL (1)HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/CHNA-AND-CHIP-REPORTSREDWOOD MEMORIAL HOSPITAL (3)HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/CHNA-AND-CHIP-REPORTSST. JOSEPH HOSPITAL OF EUREKA (4)HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/CHNA-AND-CHIP-REPORTS

QUEEN OF THE VALLEY MEDICAL CENTER - PART V, SECTION B, LINE 7A:
CHNA WEBSITEHTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/CHNA-AND-CHIP-REPORTS

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 10A:
IMPLEMENTATION STRATEGY WEBSITESANTA ROSA MEMORIAL HOSPITAL (1)HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/CHNA-AND-CHIP-REPORTSREDWOOD MEMORIAL HOSPITAL (3)HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/CHNA-AND-CHIP-REPORTSST. JOSEPH HOSPITAL OF EUREKA (4)HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/CHNA-AND-CHIP-REPORTS

QUEEN OF THE VALLEY MEDICAL CENTER - PART V, SECTION B, LINE 10A:
IMPLEMENTATION STRATEGY WEBSITEHTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT/REPORTS/CHNA-AND-CHIP-REPORTS

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 11 (CONT):
"ST. JOSEPH HOSPITAL OF EUREKACOMMUNITY HEALTH NEEDS PRIORITIZED:1) MENTAL HEALTH & SUBSTANCE USE2) HOMELESSNESS / LACK OF SAFE, AFFORDABLE HOUSING3) RACISM & DISCRIMINATION4) ACCESS TO HEALTH CAREMENTAL HEALTH & SUBSTANCE USE:MENTAL HEALTH AND SUBSTANCE USE ARE RECOGNIZED AS BEING INTERCONNECTED WITH SEVERAL OTHER COMMUNITY NEEDS, WITH A HISTORY OF TRAUMA, CHILD ABUSE/NEGLECT, POVERTY, AND A LACK OF OPPORTUNITIES AS CONTRIBUTORS TO BOTH MENTAL HEALTH CHALLENGES AND SUBSTANCE USE DISORDERS. EXPERIENCES WITH RACISM AND DISCRIMINATION ALSO CONTRIBUTE TO BEHAVIORAL HEALTH NEEDS. THERE IS A LACK OF MENTAL HEALTH AND SUBSTANCE USE SERVICES IN THE COMMUNITY; SPECIFICALLY, LOCAL INPATIENT CARE FOR ADULTS AND YOUTH WITH A SERIOUS MENTAL ILLNESS AS WELL AS FOLLOW-UP CARE FOR PATIENTS ONCE DISCHARGED, AND GENERAL SUPPORT FOR FAMILIES (NEW PARENTS, INFANTS, AND EARLY DEVELOPMENT). THERE ARE INSUFFICIENT PSYCHIATRISTS AND COUNSELORS TO MEET THE COMMUNITY NEED, ESPECIALLY PROVIDERS FOR YOUTH, PEOPLE WHO ARE UNINSURED, AND/OR SPANISH-SPEAKING RESIDENTS, AS WELL AS INSUFFICIENT HARM REDUCTION SERVICES (SAFE AND LEGAL INJECTION SITES AND SYRINGE EXCHANGE PROGRAMS). BARRIERS TO ADDRESSING THESE BEHAVIORAL HEALTH NEEDS INCLUDE STIGMA, COST OF CARE, TRANSPORTATION TO SERVICES WITHIN AND OUTSIDE OF THE COMMUNITY, AND A LACK OF CONTINUITY OF CARE DUE TO PROVIDER TURNOVER.HOMELESSNESS / LACK OF SAFE, AFFORDABLE HOUSING:THE LACK OF AFFORDABLE, SAFE HOUSING STOCK IN HUMBOLDT COUNTY CONTRIBUTES TO INDIVIDUALS WITH LOW INCOMES LIVING UNHOUSED OR IN OVERCROWDED AND UNHEALTHY LIVING CONDITIONS. HOUSING IS RECOGNIZED AS BEING FOUNDATIONAL TO ONE'S HEALTH; PEOPLE WHO ARE STABLY HOUSED ARE BETTER ABLE TO CARE FOR THEIR PHYSICAL AND MENTAL HEALTH AND REMAIN EMPLOYED. THERE IS A LACK OF AVAILABLE HOUSING ALONG THE ENTIRE SPECTRUM: SHELTERS, SUPPORTIVE HOUSING, FAMILY-FRIENDLY TRANSITIONAL HOUSING, PERMANENT-SUPPORTIVE HOUSING, AND LOW- AND VERY LOW-INCOME HOUSING. THERE IS ALSO A LACK OF SERVICES FOR PEOPLE EXPERIENCING HOMELESSNESS, SUCH AS SHOWERS AND ADULT DAY CENTERS, AS WELL AS SUPPORT SERVICES FOR PEOPLE ONCE THEY ARE HOUSED. HOUSING STABILITY AND AFFORDABILITY FOR YOUNG PEOPLE AND PEOPLE WHO ARE UNDOCUMENTED IS OF PARTICULAR CONCERN. HOUSING DISCRIMINATION CONTRIBUTES TO BLACK, BROWN, INDIGENOUS, AND PEOPLE OF COLOR (BBIPOC) HAVING MORE DIFFICULTY ACCESSING GOOD-QUALITY, AFFORDABLE HOUSING.RACISM & DISCRIMINATION:RACISM AND HISTORICAL TRAUMA PREVENT BBIPOC FROM RECEIVING HIGH-QUALITY, RESPECTFUL, AND RESPONSIVE HEALTH CARE SERVICES. THE RECENT HISTORY OF FORCED STERILIZATION OF NATIVE AMERICAN PEOPLE AND EXPERIMENTATION ON BLACK PEOPLE HAS CONTRIBUTED TO DISTRUST OF HEALTH CARE. STAKEHOLDERS NOTED A ""CORROSIVE EFFECT"" OF RACISM ON THE MENTAL HEALTH OF BBIPOC, PARTICULARLY NATIVE AMERICAN COMMUNITIES IN HUMBOLDT COUNTY. THE UNJUST TREATMENT OF LATINO/A WORKERS BY EMPLOYERS AND DISCRIMINATORY HOUSING PRACTICES PREVENT BBIPOC FROM ACCESSING GOOD-QUALITY, AFFORDABLE HOUSING. RACISM IS EVIDENT IN EDUCATION, WITH BBIPOC STUDENTS, PARTICULARLY NATIVE STUDENTS, NOT RECEIVING APPROPRIATE SPECIAL EDUCATION SERVICES AND BEING DISPROPORTIONATELY AND UNFAIRLY DISCIPLINED. STAKEHOLDERS ALSO SHARED EXPERIENCES OF RACISM IN LEGAL SYSTEMS.ACCESS TO HEALTH CARE:THERE IS AN OVERALL LACK OF PRIMARY CARE PROVIDERS AND SPECIALISTS WITHIN HUMBOLDT COUNTY. TRANSPORTATION TO CARE IS A CONSISTENT BARRIER FOR MANY, BUT ESPECIALLY OLDER ADULTS, PEOPLE WITH DISABILITIES, AND THOSE LIVING IN RURAL AREAS. RELIABLE PUBLIC TRANSPORTATION WITHIN THE COUNTY IS A CHALLENGE, AS WELL AS TRAVEL TO SERVICES OUTSIDE THE COUNTY, SPECIFICALLY TRAVELING FROM THE HILLS OF HUMBOLDT INTO EUREKA WHERE MOST SERVICES ARE LOCATED. COST OF CARE IS A MAJOR BARRIER FOR PEOPLE WHO ARE UNINSURED OR UNDERINSURED, ESPECIALLY MIXED STATUS HOUSEHOLDS. APPOINTMENTS DURING WORK HOURS AND DIFFICULTY NAVIGATING THE HEALTH CARE SYSTEM ARE ALSO BARRIERS. THERE IS A LACK OF CULTURALLY RESPONSIVE AND LINGUISTICALLY APPROPRIATE CARE FOR LATINO/A AND NATIVE AMERICAN COMMUNITIES, AS WELL AS A LACK OF RESPECTFUL AND COMPETENT SERVICES FOR TRANSGENDER YOUTH.NEEDS BEYOND THE HOSPITAL'S SERVICE PROGRAM:NO HOSPITAL FACILITY CAN FULLY ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. WHILE ST. JOSEPH HOSPITAL WILL EMPLOY STRATEGIES TO ADDRESS EACH OF THE FOUR SIGNIFICANT HEALTH NEEDS THAT WERE PRIORITIZED DURING THE CHNA PROCESS, PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS AND GOVERNMENT AGENCIES ARE CRITICAL FOR ACHIEVING THE ESTABLISHED GOALS.ST. JOSEPH HOSPITAL WILL COLLABORATE WITH OPEN DOOR COMMUNITY HEALTH CENTERS, THE PUBLIC HEALTH DEPARTMENT, HUMBOLDT STATE UNIVERSITY, THE HUMBOLDT NETWORK OF FAMILY RESOURCE CENTERS, LOCAL PHILANTHROPY, AND OTHERS TO ADDRESS THE COMMUNITY NEEDS AND COORDINATE CARE AND REFERRALS TO ADDRESS UNMET NEEDS.FURTHERMORE, ST. JOSEPH HOSPITAL WILL ENDORSE LOCAL NON-PROFIT ORGANIZATION PARTNERS TO APPLY FOR FUNDING THROUGH THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND. ORGANIZATIONS THAT RECEIVE FUNDING PROVIDE SPECIFIC SERVICES AND RESOURCES TO MEET THE IDENTIFIED NEEDS OF UNDERSERVED COMMUNITIES THROUGHOUT ST. JOSEPH HOSPITAL SERVICE AREAS.THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE ADDRESSED AND AN EXPLANATION IS PROVIDED BELOW:WHILE WE COULD NOT PRIORITIZE ALL OF THE NEEDS IDENTIFIED, WE WILL BE ABLE TO EFFECT MANY OF THE NEEDS BY WORKING ON ROOT CAUSE. FOR EXAMPLE, HEART DISEASE IS NOT A PRIORITY NEED, BUT WE WILL IMPACT THIS HEALTH OUTCOME BY FOCUSING OUR EFFORTS ON PROMOTING GOOD NUTRITION AND FOOD SECURITY. DENTAL CARE IS NOT A PRIORITIZED NEED BUT ST. JOSEPH HOSPITAL IS COMMITTED TO WORKING WITH PARTNERS ON THE MULTI-YEAR DENTAL TRANSFORMATION GRANT OUR PUBLIC HEALTH DEPARTMENT RECEIVED FROM THE CA DEPARTMENT OF HEALTH CARE SERVICES. ADDITIONALLY, ST. JOSEPH HOSPITAL DOES NOT HAVE A PROGRAM IN PLACE TO DIRECTLY PREVENT ASTHMA OCCURRENCE IN OUR SERVICE AREA; HOWEVER, WE PARTNER WITH SEVERAL ENTITIES, INCLUDING THE PUBLIC HEALTH DEPARTMENT THAT DO ADDRESS ASTHMA PREVENTION. FURTHERMORE, OUR EFFORTS TO IMPROVE THE QUALITY OF HOUSING IN OUR SERVICE HAS THE POTENTIAL TO IMPACT ASTHMA OCCURRENCE.IN ADDITION, ST. JOSEPH HOSPITAL WILL COLLABORATE WITH LOCAL ORGANIZATION(S) THAT ADDRESS AFOREMENTIONED COMMUNITY NEEDS, TO COORDINATE CARE AND REFERRAL AND ADDRESS THESE UNMET NEEDS."

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 11 (CONT):
"REDWOOD MEMORIAL HOSPITALCOMMUNITY HEALTH NEEDS PRIORITIZED:1) MENTAL HEALTH & SUBSTANCE USE2) HOMELESSNESS / LACK OF SAFE, AFFORDABLE HOUSING3) RACISM & DISCRIMINATION4) ACCESS TO HEALTH CAREMENTAL HEALTH & SUBSTANCE USE:MENTAL HEALTH AND SUBSTANCE USE ARE RECOGNIZED AS BEING INTERCONNECTED WITH SEVERAL OTHER COMMUNITY NEEDS, WITH A HISTORY OF TRAUMA, CHILD ABUSE/NEGLECT, POVERTY, AND A LACK OF OPPORTUNITIES AS CONTRIBUTORS TO BOTH MENTAL HEALTH CHALLENGES AND SUBSTANCE USE DISORDERS. EXPERIENCES WITH RACISM AND DISCRIMINATION ALSO CONTRIBUTE TO BEHAVIORAL HEALTH NEEDS. THERE IS A LACK OF MENTAL HEALTH AND SUBSTANCE USE SERVICES IN THE COMMUNITY; SPECIFICALLY, LOCAL INPATIENT CARE FOR ADULTS AND YOUTH WITH A SERIOUS MENTAL ILLNESS AS WELL AS FOLLOW-UP CARE FOR PATIENTS ONCE DISCHARGED, AND GENERAL SUPPORT FOR FAMILIES (NEW PARENTS, INFANTS, AND EARLY DEVELOPMENT). THERE ARE INSUFFICIENT PSYCHIATRISTS AND COUNSELORS TO MEET THE COMMUNITY NEED, ESPECIALLY PROVIDERS FOR YOUTH, PEOPLE WHO ARE UNINSURED, AND/OR SPANISH-SPEAKING RESIDENTS, AS WELL AS INSUFFICIENT HARM REDUCTION SERVICES (SAFE AND LEGAL INJECTION SITES AND SYRINGE EXCHANGE PROGRAMS). BARRIERS TO ADDRESSING THESE BEHAVIORAL HEALTH NEEDS INCLUDE STIGMA, COST OF CARE, TRANSPORTATION TO SERVICES WITHIN AND OUTSIDE OF THE COMMUNITY, AND A LACK OF CONTINUITY OF CARE DUE TO PROVIDER TURNOVER.HOMELESSNESS / LACK OF SAFE, AFFORDABLE HOUSING:THE LACK OF AFFORDABLE, SAFE HOUSING STOCK IN HUMBOLDT COUNTY CONTRIBUTES TO INDIVIDUALS WITH LOW INCOMES LIVING UNHOUSED OR IN OVERCROWDED AND UNHEALTHY LIVING CONDITIONS. HOUSING IS RECOGNIZED AS BEING FOUNDATIONAL TO ONE'S HEALTH; PEOPLE WHO ARE STABLY HOUSED ARE BETTER ABLE TO CARE FOR THEIR PHYSICAL AND MENTAL HEALTH AND REMAIN EMPLOYED. THERE IS A LACK OF AVAILABLE HOUSING ALONG THE ENTIRE SPECTRUM: SHELTERS, SUPPORTIVE HOUSING, FAMILY-FRIENDLY TRANSITIONAL HOUSING, PERMANENT-SUPPORTIVE HOUSING, AND LOW- AND VERY LOW-INCOME HOUSING. THERE IS ALSO A LACK OF SERVICES FOR PEOPLE EXPERIENCING HOMELESSNESS, SUCH AS SHOWERS AND ADULT DAY CENTERS, AS WELL AS SUPPORT SERVICES FOR PEOPLE ONCE THEY ARE HOUSED. HOUSING STABILITY AND AFFORDABILITY FOR YOUNG PEOPLE AND PEOPLE WHO ARE UNDOCUMENTED IS OF PARTICULAR CONCERN. HOUSING DISCRIMINATION CONTRIBUTES TO BLACK, BROWN, INDIGENOUS, AND PEOPLE OF COLOR (BBIPOC) HAVING MORE DIFFICULTY ACCESSING GOOD-QUALITY, AFFORDABLE HOUSING.RACISM & DISCRIMINATION:RACISM AND HISTORICAL TRAUMA PREVENT BBIPOC FROM RECEIVING HIGH-QUALITY, RESPECTFUL, AND RESPONSIVE HEALTH CARE SERVICES. THE RECENT HISTORY OF FORCED STERILIZATION OF NATIVE AMERICAN PEOPLE AND EXPERIMENTATION ON BLACK PEOPLE HAS CONTRIBUTED TO DISTRUST OF HEALTH CARE. STAKEHOLDERS NOTED A ""CORROSIVE EFFECT"" OF RACISM ON THE MENTAL HEALTH OF BBIPOC, PARTICULARLY NATIVE AMERICAN COMMUNITIES IN HUMBOLDT COUNTY. THE UNJUST TREATMENT OF LATINO/A WORKERS BY EMPLOYERS AND DISCRIMINATORY HOUSING PRACTICES PREVENT BBIPOC FROM ACCESSING GOOD-QUALITY, AFFORDABLE HOUSING. RACISM IS EVIDENT IN EDUCATION, WITH BBIPOC STUDENTS, PARTICULARLY NATIVE STUDENTS, NOT RECEIVING APPROPRIATE SPECIAL EDUCATION SERVICES AND BEING DISPROPORTIONATELY AND UNFAIRLY DISCIPLINED. STAKEHOLDERS ALSO SHARED EXPERIENCES OF RACISM IN LEGAL SYSTEMS.ACCESS TO HEALTH CARE:THERE IS AN OVERALL LACK OF PRIMARY CARE PROVIDERS AND SPECIALISTS WITHIN HUMBOLDT COUNTY. TRANSPORTATION TO CARE IS A CONSISTENT BARRIER FOR MANY, BUT ESPECIALLY OLDER ADULTS, PEOPLE WITH DISABILITIES, AND THOSE LIVING IN RURAL AREAS. RELIABLE PUBLIC TRANSPORTATION WITHIN THE COUNTY IS A CHALLENGE, AS WELL AS TRAVEL TO SERVICES OUTSIDE THE COUNTY, SPECIFICALLY TRAVELING FROM THE HILLS OF HUMBOLDT INTO EUREKA WHERE MOST SERVICES ARE LOCATED. COST OF CARE IS A MAJOR BARRIER FOR PEOPLE WHO ARE UNINSURED OR UNDERINSURED, ESPECIALLY MIXED STATUS HOUSEHOLDS. APPOINTMENTS DURING WORK HOURS AND DIFFICULTY NAVIGATING THE HEALTH CARE SYSTEM ARE ALSO BARRIERS. THERE IS A LACK OF CULTURALLY RESPONSIVE AND LINGUISTICALLY APPROPRIATE CARE FOR LATINO/A AND NATIVE AMERICAN COMMUNITIES, AS WELL AS A LACK OF RESPECTFUL AND COMPETENT SERVICES FOR TRANSGENDER YOUTH.NEEDS BEYOND THE HOSPITAL'S SERVICE PROGRAM:NO HOSPITAL FACILITY CAN FULLY ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. WHILE ST. JOSEPH HOSPITAL WILL EMPLOY STRATEGIES TO ADDRESS EACH OF THE FOUR SIGNIFICANT HEALTH NEEDS THAT WERE PRIORITIZED DURING THE CHNA PROCESS, PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS AND GOVERNMENT AGENCIES ARE CRITICAL FOR ACHIEVING THE ESTABLISHED GOALS.ST. JOSEPH HOSPITAL WILL COLLABORATE WITH OPEN DOOR COMMUNITY HEALTH CENTERS, THE PUBLIC HEALTH DEPARTMENT, HUMBOLDT STATE UNIVERSITY, THE HUMBOLDT NETWORK OF FAMILY RESOURCE CENTERS, LOCAL PHILANTHROPY, AND OTHERS TO ADDRESS THE COMMUNITY NEEDS AND COORDINATE CARE AND REFERRALS TO ADDRESS UNMET NEEDS.FURTHERMORE, REDWOOD MEMORIAL HOSPITAL, FORTUNA WILL ENDORSE LOCAL NON-PROFIT ORGANIZATION PARTNERS TO APPLY FOR FUNDING THROUGH THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND. ORGANIZATIONS THAT RECEIVE FUNDING PROVIDE SPECIFIC SERVICES AND RESOURCES TO MEET THE IDENTIFIED NEEDS OF UNDERSERVED COMMUNITIES THROUGHOUT REDWOOD MEMORIAL HOSPITAL, FORTUNA SERVICE AREAS.THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE ADDRESSED AND AN EXPLANATION IS PROVIDED BELOW:WHILE WE COULD NOT PRIORITIZE ALL OF THE NEEDS IDENTIFIED, WE WILL BE ABLE TO EFFECT MANY OF THE NEEDS BY WORKING ON ROOT CAUSE. FOR EXAMPLE, HEART DISEASE IS NOT A PRIORITY NEED, BUT WE WILL IMPACT THIS HEALTH OUTCOME BY FOCUSING OUR EFFORTS ON PROMOTING GOOD NUTRITION AND FOOD SECURITY. DENTAL CARE IS NOT A PRIORITIZED NEED BUT REDWOOD MEMORIAL HOSPITAL, FORTUNA IS COMMITTED TO WORKING WITH PARTNERS ON THE MULTI-YEAR DENTAL TRANSFORMATION GRANT OUR PUBLIC HEALTH DEPARTMENT RECEIVED FROM THE CA DEPARTMENT OF HEALTH CARE SERVICES. ADDITIONALLY, REDWOOD MEMORIAL HOSPITAL, FORTUNA DOES NOT HAVE A PROGRAM IN PLACE TO DIRECTLY PREVENT ASTHMA OCCURRENCE IN OUR SERVICE AREA; HOWEVER, WE PARTNER WITH SEVERAL ENTITIES, INCLUDING THE PUBLIC HEALTH DEPARTMENT THAT DO ADDRESS ASTHMA PREVENTION. FURTHERMORE, OUR EFFORTS TO IMPROVE THE QUALITY OF HOUSING IN OUR SERVICE HAS THE POTENTIAL TO IMPACT ASTHMA OCCURRENCE.IN ADDITION, REDWOOD MEMORIAL HOSPITAL, FORTUNA WILL COLLABORATE WITH LOCAL ORGANIZATION(S) THAT ADDRESS AFOREMENTIONED COMMUNITY NEEDS, TO COORDINATE CARE AND REFERRAL AND ADDRESS THESE UNMET NEEDS."

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 13A:
1/1/2021 - 09/17/2021 FACILITY REPORTING GROUP A 100% DISCOUNT WAS UP TO 200% FPL AND 75% DISCOUNT BETWEEN 201% TO 500% FPL. EFFECTIVE 09/18/21 THROUGH 12/31/2021, FACILITY REPORTING GROUP A 100% DISCOUNT WAS UP TO 300% FPL AND 75% DISCOUNT BETWEEN 301% TO 350% FPL.

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 16A:
FINANCIAL ASSISTANCE POLICYHTTPS://WWW.STJOEHUMBOLDT.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIAL-ASSISTANCE/9/18/2021 AND AFTERHTTPS://WWW.PROVIDENCE.ORG/OBP/NORCAL/FINANCIAL-ASSISTANCE

QUEEN OF THE VALLEY MEDICAL CENTER - PART V, SECTION B, LINE 16A:
FINANCIAL ASSISTANCE POLICYHTTPS://WWW.THEQUEEN.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIALASSISTANCE/9/18/2021 AND AFTERHTTPS://WWW.PROVIDENCE.ORG/OBP/NORCAL/FINANCIAL-ASSISTANCE

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 16B:
SANTA ROSA MEMORIAL HOSPITAL (1)FINANCIAL ASSISTANCE APPLICATIONHTTPS://WWW.STJOESONOMA.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIAL-ASSISTANCE/9/18/2021 AND AFTERHTTPS://WWW.PROVIDENCE.ORG/OBP/NORCAL/FINANCIAL-ASSISTANCEREDWOOD MEMORIAL HOSPITAL (3) AND ST. JOSEPH HOSPITAL OF EUREKA (4)FINANCIAL ASSISTANCE APPLICATIONHTTPS://WWW.STJOEHUMBOLDT.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIAL-ASSISTANCE9/18/2021 AND AFTERHTTPS://WWW.PROVIDENCE.ORG/OBP/NORCAL/FINANCIAL-ASSISTANCE

QUEEN OF THE VALLEY MEDICAL CENTER - PART V, SECTION B, LINE 16B:
FINANCIAL ASSISTANCE APPLICATIONHTTPS://WWW.THEQUEEN.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIALASSISTANCE/9/18/2021 AND AFTERHTTPS://WWW.PROVIDENCE.ORG/OBP/NORCAL/FINANCIAL-ASSISTANCE

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, SECTION B, LINE 16C:
SANTA ROSA MEMORIAL HOSPITAL (1)PLAIN LANGUAGE SUMMARYHTTPS://WWW.STJOESONOMA.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIAL-ASSISTANCE/9/18/2021 AND AFTERHTTPS://WWW.PROVIDENCE.ORG/OBP/NORCAL/FINANCIAL-ASSISTANCEREDWOOD MEMORIAL HOSPITAL (3) AND ST. JOSEPH HOSPITAL OF EUREKA (4)PLAIN LANGUAGE SUMMARYHTTPS://WWW.STJOEHUMBOLDT.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIAL-ASSISTANCE/9/18/2021 AND AFTERHTTPS://WWW.PROVIDENCE.ORG/OBP/NORCAL/FINANCIAL-ASSISTANCE

QUEEN OF THE VALLEY MEDICAL CENTER - PART V, SECTION B, LINE 16C:
PLAIN LANGUAGE SUMMARYHTTPS://WWW.THEQUEEN.ORG/PATIENTS-VISITORS/FOR-PATIENTS/PATIENT-FINANCIALASSISTANCE/9/18/2021 AND AFTERHTTPS://WWW.PROVIDENCE.ORG/OBP/NORCAL/FINANCIAL-ASSISTANCE

SJHNC, LLC (GROUP A - 1, 3 & 4) - PART V, LINE 22A AND 22D:
SANTA ROSA MEMORIAL HOSPITALPRIOR TO 09/18/2021 SANTA ROSA MEMORIAL HOSPITALUSED THE PROSPECTIVE MEDICARE OR MEDICAID AGB METHOD. EFFECITVE 09/18/2021 SANTA ROSA MEMORIAL HOSPITAL WENT LIVE ON EPIC AND MOVED TO THE LOOK BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICARE FEE FOR SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12 MONTH PERIOD.REDWOOD MEMORIAL MEDICAL CENTERPRIOR TO 09/18/2021 REDWOOD MEMORIAL MEDICAL CENTER USED THE PROSPECTIVE MEDICARE OR MEDICAID AGB METHOD. EFFECITVE 09/18/2021 REDWOOD MEMORIAL MEDICAL CENTER WENT LIVE ON EPIC AND MOVED TO THE LOOK BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICARE FEE FOR SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12 MONTH PERIOD.ST. JOSEPH HEALTH OF EUREKAPRIOR TO 09/18/2021 ST. JOSEPH HOSPITAL OF EUREKA USED THE PROSPECTIVE MEDICARE OR MEDICAID AGB METHOD. EFFECITVE 09/18/2021 ST. JOSEPH HOSPITAL OF EUREKA WENT LIVE ON EPIC AND MOVED TO THE LOOK BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICARE FEE FOR SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12 MONTH PERIOD.

QUEEN OF THE VALLEY MEDICAL CENTER - PART V, LINE 22A AND 22D
PRIOR TO 09/18/2021 QUEEN OF THE VALLEY MEDICAL CENTER USED THE PROSPECTIVE MEDICARE OR MEDICAID AGB METHOD. EFFECITVE 09/18/2021 QUEEN OF THE VALLEY MEDICAL CENTER WENT LIVE ON EPIC AND MOVED TO THE LOOK BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICARE FEE FOR SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12 MONTH PERIOD.

PART I, LINE 3C:
IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, FPG IS A KEY FACTOR. THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES WERE ALSO CONSIDERED WHEN DETERMINING ELIGIBILITY, INCLUDING BUT NOT LIMITED TO, DISABILITY AND HOMELESSNESS.

PART I, LINE 6A:
SANTA ROSA MEMORIAL HOSPITALSANTA ROSA MEMORIAL HOSPITAL PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT: HTTPS://WWW.PROVIDENCE.ORG/LOCATIONS/NORCAL/SANTA-ROSA-MEMORIAL-HOSPITAL/COMMUNITY-SUPPORTREDWOOD MEMORIAL HOSPITALREDWOOD MEMORIAL HOSPITAL PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT: HTTPS://WWW.PROVIDENCE.ORG/LOCATIONS/NORCAL/REDWOOD-MEMORIAL/COMMUNITY-SUPPORTST. JOSEPH HOSPITAL OF EUREKAST. JOSEPH HOSPITAL OF EUREKA PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT: HTTPS://WWW.PROVIDENCE.ORG/LOCATIONS/NORCAL/ST-JOSEPH-HOSPITAL-EUREKA/COMMUNITY-SUPPORTQUEEN OF THE VALLEY MEDICAL CENTERQUEEN OF THE VALLEY MEDICAL CENTER PREPARES AN ANNUAL REPORT AND IT IS PUBLICLY AVAILABLE AT: HTTPS://WWW.PROVIDENCE.ORG/LOCATIONS/NORCAL/QUEEN-OF-THE-VALLEY/COMMUNITY-OUTREACH/COMMUNITY-BENEFIT

PART I, LINE 7:
SANTA ROSA MEMORIAL HOSPITALTHE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING A COST-TO-CHARGE RATIO USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.REDWOOD MEMORIAL HOSPITAL THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING WORKSHEET 2, A COST-TO-CHARGE RATIO AND GENERAL LEDGER.ST. JOSEPH HOSPITAL OF EUREKATHE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSED ALL PATIENT SEGMENTS.QUEEN OF THE VALLEY MEDICAL CENTERTHE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. THE COST ACCOUNTING SYSTEM ADDRESSED ALL PATIENT SEGMENTS.

PART I, LINE 7G:
NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED.

PART II, COMMUNITY BUILDING ACTIVITIES:
SANTA ROSA MEMORIAL HOSPITALCHI SONOMA COUNTY IDENTIFIED THE NEED TO HOLD HEALTHCARE AND COMMUNITY-BASED ORGANIZATIONAL WEEKLY CONVENINGS. THESE MEETINGS INCREASED COMMUNICATIONS BETWEEN HOSPITAL PARTNERS AND ASSISTED WITH THROUGHPUT FOR OUR PATIENTS REENTERING THE COMMUNITY AFTER HOSPITAL ADMISSIONS. PROVIDENCE CHI SONOMA STAFF HAS CONTINUED TO CONVENE AND FACILITATE THESE MEETINGS WHICH HAVE BECOME A STANDARD COMMUNICATION PIPELINE FOR SONOMA COUNTY CLINICIANS AND ORGANIZATIONS.ST. JOSEPH HOSPITAL OF EUREKATHE ORGANIZATION INVESTED STAFF TIME IN CREATING A HEALTH CAREERS SUMMER INSTITUTE FOR LOCAL HIGH SCHOOL STUDENTS INTERESTED IN HEALTH CAREERS IN PARTNERSHIP WITH THE HUMBOLDT COUNTY OFFICE OF EDUCATION AND LOCAL AREA HIGH SCHOOLS.

PART III, LINE 4:
AS A RESULT OF ADOPTING ASU 2014-09, THE HEALTH SYSTEM CONTINUED TO MAINTAIN AN ALLOWANCE FOR BAD DEBTS RELATED TO PERFORMANCE OBLIGATIONS SATISFIED PRIOR TO JANUARY 1, 2018. THESE ACCOUNTS HAVE ALL BEEN FULLY RESOLVED, THEREFORE THE ALLOWANCE FOR BAD DEBTS HAS DECLINED TO $0 AS OF DECEMBER 31, 2019.

PART III, LINE 8:
THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT.

PART III, LINE 9B:
QUEEN OF THE VALLEY MEDICAL CENTER - REDWOOD MEMORIAL HOSPITAL - ST. JOSEPH HOSPITAL OF EUREKACOLLECTION ACTIVITYPATIENT ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTION POLICY ALSO APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR DISCOUNTED CARE.SANTA ROSA MEMORIAL HOSPITALCOLLECTION ACTIVITYOUR FINANCIAL ASSISTANCE POLICY INCLUDES BILLING AND COLLECTIONS DETAILS. COLLECTION EFFORTS ON UNPAID BALANCES WILL CEASE PENDING FINAL DETERMINATION OF FAP ELIGIBILITY. PROVIDENCE DOES NOT PERFORM, ALLOW, OR ALLOW COLLECTION AGENCIES TO PERFORM ANY EXTRAORDINARY COLLECTION ACTIONS PRIOR TO MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. IT IS STANDARD PRACTICE TO CEASE COLLECTION ACTIVITIES FOR PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. THIS INFORMATION IS INCLUDED IN OUR CHARITY POLICY HOWEVER THIS DETAIL IS NOT ADDRESSED IN OUR COLLECTION POLICY.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEONE WAY SRMH, RMH AND SJHE INFORMS THE PUBLIC OF FAP IS BY POSTING NOTICES. NOTICES ARE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES ARE ALSO POSTED AT LOCATIONS WHERE A PATIENT MAY PAY THEIR BILL. NOTICES INCLUDE CONTACT INFORMATION ON HOW A PATIENT CAN OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES ARE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT ARE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATE LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS ARE OFFERED AN OPPORTUNITY TO COMPLETE THE PATIENT FINANCIAL ASSISTANCE APPLICATION AND ARE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE.

PART VI, LINE 4:
"SANTA ROSA MEMORIAL HOSPITALSANTA ROSA MEMORIAL HOSPITAL (SRMH), FOUNDED BY THE SISTERS OF ST. JOSEPH OF ORANGE, HAS BEEN SERVING THE HEALTHCARE NEEDS OF FAMILIES IN THE COMMUNITY FOR MORE THAN 60 YEARS. DURING THIS TIME, ITS MISSION HAS REMAINED THE SAME: TO CONTINUALLY IMPROVE THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES SERVED. PART OF A LARGER HEALTHCARE SYSTEM KNOWN AS PROVIDENCE ST. JOSEPH HEALTH (PSJH), SRMH IS PART OF A COUNTYWIDE MINISTRY THAT INCLUDES TWO HOSPITALS, URGENT CARE FACILITIES, HOSPICE, HOME HEALTH SERVICES, AND OTHER FACILITIES FOR TREATING THE HEALTHCARE NEEDS OF THE COMMUNITY IN SONOMA COUNTY AND THE REGION. THE MINISTRY'S CORE FACILITIES ARE HOSPITAL (PVH), AN 80-BED ACUTE CARE HOSPITAL, AND SRMH, A FULL SERVICE, STATE OF THE ART 330-BED ACUTE CARE HOSPITAL THAT INCLUDES A LEVEL II TRAUMA CENTER FOR THE COASTAL REGION FROM SAN FRANCISCO TO THE OREGON BORDER. MAJOR PROGRAMS AND SERVICES INCLUDE CRITICAL CARE, CARDIOVASCULAR CARE, STROKE CARE, WOMEN'S AND CHILDREN'S SERVICES, CANCER CARE, AND ORTHOPEDICS. SRMH IS HOME TO THE NORMA & EVERT PERSON HEART & VASCULAR INSTITUTE AND THE UCSF NEONATAL INTENSIVE CARE NURSERY. SRMH PROVIDES SOUTHERN MENDOCINO, NORTHERN MARIN, AND SONOMA COUNTIES' COMMUNITIES WITH ACCESS TO ADVANCED CARE AND ADVANCED CARING. THE HOSPITAL'S SERVICE AREA EXTENDS FROM UKIAH IN THE NORTH, MARSHALL IN THE SOUTH, SONOMA VALLEY IN THE EAST AND BODEGA BAY IN THE WEST. SRMH'S TOTAL SERVICE AREA (TSA) INCLUDES THE CITIES OF SANTA ROSA, PETALUMA, SEBASTOPOL, WINDSOR, HEALDSBURG, ROHNERT PARK, COTATI, SONOMA, CLOVERDALE, UKIAH, AND POINT ARENA.DEFINING THE COMMUNITY:SONOMA COUNTY IS A LARGE, URBAN-RURAL COUNTY ENCOMPASSING 1,575 SQUARE MILES. SONOMA COUNTY RESIDENTS INHABIT NINE CITIES AND A LARGE UNINCORPORATED AREA, INCLUDING MANY GEOGRAPHICALLY ISOLATED COMMUNITIES. THE COUNTY'S TOTAL POPULATION WAS ESTIMATED AT 487,011 AT THE TIME OF THE CHNA. SINCE 2006, THE COUNTY POPULATION HAS GROWN AT AN OVERALL RATE OF 1.8% WITH THE CITIES OF SONOMA, SANTA ROSA AND WINDSOR EXPERIENCING THE FASTEST GROWTH RATES. ACCORDING TO PROJECTIONS FROM THE CALIFORNIA DEPARTMENT OF FINANCE, THE COUNTY POPULATION IS PROJECTED TO GROW BY 8.3% TO 546,204 IN 2020. THIS RATE OF GROWTH IS LESS THAN THAT PROJECTED FOR CALIFORNIA AS A WHOLE (10.1%). THE MAJORITY OF THE COUNTY'S POPULATION RESIDES WITHIN ITS CITIES, THE LARGEST OF WHICH ARE CLUSTERED ALONG THE HIGHWAY 101 CORRIDOR. SANTA ROSA IS THE LARGEST CITY WITH A POPULATION ESTIMATED TO BE NEARLY 171,000 IN 2012 AND IS THE SERVICE HUB FOR THE ENTIRE COUNTY AND THE LOCATION OF THE COUNTY'S THREE MAJOR HOSPITALS. AT LEAST PART OF SONOMA COUNTY, CALIFORNIA, IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA (MUA). THE AREA IS 0.8 SQUARE MILES AND IS LOCATED NEAR DOWNTOWN SANTA ROSA. THE CLOVERDALE AREA IN SONOMA COUNTY IS A DESIGNATED PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA (PC-HSPA). THERE ARE 6,888 CIVILIAN RESIDENTS IN THIS AREA, WHICH IS 307.5 TOTAL SQUARE MILES. SRMH PROVIDES SONOMA COUNTY COMMUNITIES WITH ACCESS TO ADVANCED CARE AND ADVANCED CARING. THE HOSPITAL IS LOCATED IN DOWNTOWN SANTA ROSA, ABOUT 55 MILES NORTH OF SAN FRANCISCO JUST OFF THE HIGHWAY 101 CORRIDOR IN CENTRAL SONOMA COUNTY. SRMH'S PRIMARY SERVICE AREA IS LIMITED TO A TIGHT RADIUS, BUT ITS SECONDARY SERVICE AREA COMPRISES THE ENTIRE COUNTY, PLUS NORTHERN MARIN COUNTY AND SOUTHERN MENDOCINO COUNTY. THE CHNA PROCESS AND DATA GATHERING ADDRESSES SONOMA COUNTY. FOR A COMPLETE COPY OF THE 2017 SRMH CHNA SEE: HTTPS://WWW.STJOESONOMA.ORG/DOCUMENTS/COMMUNITY-BENEFIT/SRMH-CHNA-FY17.PDFSONOMA COUNTY'S UNINCORPORATED AREAS ARE HOME TO 146,739 RESIDENTS, 30.1% OF THE TOTAL POPULATION. A SIGNIFICANT NUMBER OF THESE INDIVIDUALS LIVE IN LOCATIONS THAT ARE VERY RURAL AND GEOGRAPHICALLY REMOTE. RESIDENTS OF THESE AREAS MAY EXPERIENCE SOCIAL ISOLATION AND SIGNIFICANT BARRIERS IN ACCESSING BASIC SERVICES AND SUPPORTS SUCH AS TRANSPORTATION, HEALTH CARE, NUTRITIOUS FOOD AND OPPORTUNITIES TO SOCIALIZE. LOW INCOME AND SENIOR POPULATIONS LIVING IN REMOTE AREAS MAY FACE SPECIAL CHALLENGES IN MAINTAINING HEALTH AND QUALITY OF LIFE. OF THE COUNTY'S TOTAL SENIOR POPULATION, AGE 60 AND OLDER, 12,144 (12%) ARE CONSIDERED ""GEOGRAPHICALLY ISOLATED"" AS DEFINED BY THE OLDER AMERICANS ACT.SRMH TOTAL SERVICE AREA:THE COMMUNITY SERVED BY SRMH IS DEFINED BASED ON THE GEOGRAPHIC ORIGINS OF SRMH'S INPATIENTS. THE SRMH TOTAL SERVICE AREA IS COMPRISED OF BOTH THE PRIMARY SERVICE AREA (PSA) AS WELL AS THE SECONDARY SERVICE AREA (SSA) AND IS ESTABLISHED BASED ON THE FOLLOWING CRITERIA:- PSA: 70% OF DISCHARGES (EXCLUDING NORMAL NEWBORNS)- SSA: 71%-85% OF DISCHARGES (DRAW RATES PER ZIP CODE ARE CONSIDERED AND PSA/SSA ARE MODIFIED ACCORDINGLY)- INCLUDES ZIP CODES FOR CONTINUITY- NATURAL BOUNDARIES ARE CONSIDERED (I.E., FREEWAYS, MOUNTAIN RANGES, ETC.)- CITIES ARE PLACED IN PSA OR SSA, BUT NOT BOTH.THE PSA IS THE GEOGRAPHIC AREA FROM WHICH THE MAJORITY OF SRMH'S PATIENTS ORIGINATE. THE CITIES AND TOWNS IN THE SRMH PSA INCLUDE SANTA ROSA, SEBASTOPOL, WINDSOR, FORESTVILLE, ROHNERT PARK AND COTATI/PENNGROVE. THE SSA IS WHERE AN ADDITIONAL POPULATION OF THE HOSPITAL'S INPATIENTS RESIDE. THE SSA INCLUDES ALL OF SONOMA COUNTY, UKIAH TO THE NORTH IN MENDOCINO COUNTY, AND NORTHERN MARIN COUNTY TO THE SOUTH. THE POPULATION OF THE SERVICE AREA IS 835,741, OF WHICH 328,005 ARE IN THE PSA AND 507,736 RESIDE IN THE SSA.COMMUNITY NEED INDEX (ZIP CODE LEVEL) BASED ON NATIONAL NEED:THE COMMUNITY NEED INDEX (CNI) WAS DEVELOPED BY DIGNITY HEALTH AND TRUVEN HEALTH ANALYTICS. THE CNI IDENTIFIES THE SEVERITY OF HEALTH DISPARITY FOR EVERY ZIP CODE IN THE UNITED STATES AND DEMONSTRATES THE LINK BETWEEN COMMUNITY NEED, ACCESS TO CARE, AND PREVENTABLE HOSPITALIZATIONS. CNI AGGREGATES FIVE SOCIOECONOMIC INDICATORS THAT CONTRIBUTE TO HEALTH DISPARITY (ALSO KNOWN AS BARRIERS):- INCOME BARRIERS (ELDER POVERTY, CHILD POVERTY AND SINGLE PARENT POVERTY)- CULTURE BARRIERS (NON-CAUCASIAN LIMITED ENGLISH);- EDUCATIONAL BARRIERS (% POPULATION WITHOUT HS DIPLOMA);- INSURANCE BARRIERS (INSURANCE, UNEMPLOYED AND UNINSURED);- HOUSING BARRIERS (HOUSING, RENTING PERCENTAGE).THIS OBJECTIVE MEASURE IS THE COMBINED EFFECT OF FIVE SOCIOECONOMIC BARRIERS (INCOME, CULTURE, EDUCATION, INSURANCE AND HOUSING). A SCORE OF 1.0 INDICATES A ZIP CODE WITH THE FEWEST SOCIOECONOMIC BARRIERS, WHILE A SCORE OF 5.0 REPRESENTS A ZIP CODE WITH THE MOST SOCIOECONOMIC BARRIERS. RESIDENTS OF COMMUNITIES WITH THE HIGHEST CNI SCORES WERE SHOWN TO BE TWICE AS LIKELY TO EXPERIENCE PREVENTABLE HOSPITALIZATIONS FOR MANAGEABLE CONDITIONS SUCH AS EAR INFECTIONS, PNEUMONIA OR CONGESTIVE HEART FAILURE COMPARED TO COMMUNITIES WITH THE LOWEST CNI SCORES. (REF ROTH R, BARSI E., HEALTH PROG. 2005 JUL-AUG; 86(4):32-8.) THE CNI IS USED TO A DRAW ATTENTION TO AREAS THAT NEED ADDITIONAL INVESTIGATION SO THAT HEALTH POLICY AND PLANNING EXPERTS CAN MORE STRATEGICALLY ALLOCATE RESOURCES.FOR EXAMPLE, THE ZIP CODE 95407 ON THE CNI MAP IS SCORED 4.2, MAKING IT A HIGH NEED COMMUNITY.OTHER HOSPITALS IN SERVICE AREATHE MINISTRY'S SERVICE AREA IS ALSO SERVED BY SUTTER SANTA ROSA REGIONAL HOSPITAL AND KAISER PERMANENTE SANTA ROSA MEDICAL CENTER AND MEDICAL OFFICES.REDWOOD MEMORIAL HOSPITALCOMMUNITY INFORMATION:REDWOOD MEMORIAL HOSPITAL PROVIDES THE RURAL NORTH COAST AND EEL RIVER VALLEY COMMUNITIES WITH ACCESS TO ADVANCED CARE AND ADVANCED CARING. THE HOSPITAL'S SERVICE AREA EXTENDS FROM EUREKA IN THE NORTH, REDWAY IN THE SOUTH, BRIDGEVILLE IN THE EAST AND IS BORDERED BY THE PACIFIC OCEAN IN THE WEST. OUR HOSPITAL TOTAL SERVICE AREA INCLUDES THE CITIES OF EUREKA, FORTUNA, FERNDALE, RIO DELL AND THE UNINCORPORATED COMMUNITIES OF LOLETA, HYDESVILLE, CARLOTTA, BRIDGEVILLE, SCOTIA, REDCREST, MYERS FLAT, MIRANDA AND REDWAY. THIS INCLUDES A POPULATION OF APPROXIMATELY 78,428 PEOPLE.HOSPITAL TOTAL SERVICE AREA:THE COMMUNITY SERVED BY THE HOSPITAL IS DEFINED BASED ON THE GEOGRAPHIC ORIGINS OF THE HOSPITAL'S INPATIENTS. THE HOSPITAL TOTAL SERVICE AREA IS THE COMPRISED OF BOTH THE PRIMARY SERVICE AREA (PSA) AS WELL AS THE SECONDARY SERVICE AREA (SSA) AND IS ESTABLISHED BASED ON THE FOLLOWING CRITERIA:- PSA: 70% OF DISCHARGES (EXCLUDING NORMAL NEWBORNS)- SSA: 71%-85% OF DISCHARGES (DRAW RATES PER ZIP CODE ARE CONSIDERED AND PSA/SSA ARE MODIFIED ACCORDINGLY)- INCLUDES ZIP CODES FOR CONTINUITY- NATURAL BOUNDARIES ARE CONSIDERED (I.E., FREEWAYS, MOUNTAIN RANGES, ETC.)- CITIES ARE PLACED IN PSA OR SSA, BUT NOT BOTH.THE PRIMARY SERVICE AREA (""PSA"") IS THE GEOGRAPHIC AREA FROM WHICH THE MAJORITY OF THE HOSPITAL'S PATIENTS ORIGINATE. THE SECONDARY SERVICE AREA (""SSA"") IS WHERE AN ADDITIONAL POPULATION OF THE HOSPITAL'S INPATIENTS RESIDE."

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SCHEDULE H, PART VI, LINE 4 (CONTINUED):
"ST. JOSEPH HOSPITAL OF EUREKACOMMUNITY INFORMATION:ST. JOSEPH HOSPITAL EUREKA PROVIDES RURAL NORTH COAST COMMUNITIES WITH ACCESS TO ADVANCED CARE AND ADVANCED CARING. THE HOSPITAL'S SERVICE AREA EXTENDS FROM CRESCENT CITY IN THE NORTH, RIO DELL IN THE SOUTH, WILLOW CREEK/ HOOPA IN THE EAST AND IS BORDERED BY THE PACIFIC OCEAN IN THE WEST. OUR HOSPITAL TOTAL SERVICE AREA INCLUDES THE CITIES AND OF EUREKA, ARCATA, FORTUNA, TRINIDAD, BLUE LAKE, FERNDALE, RIO DELL, CRESCENT CITY AND THE UNINCORPORATED COMMUNITIES OF MCKINLEYVILLE, FIELDS LANDING, BAYSIDE, SAMOA, HOOPA, WILLOW CREEK, LOLETA, KLAMATH, ORICK AND KNEELAND; AS WELL AS NINE FEDERALLY RECOGNIZED TRIBES: RESIGHINI RANCHERIA, BEAR RIVER BAND OF ROHNERVILLE RANCHERIA, BIG LAGOON RANCHERIA, BLUE LAKE RANCHERIA, HOOPA VALLEY TRIBE, KARUK TRIBE, TABLE BLUFF RANCHERIA, TRINIDAD RANCHERIA AND THE YUROK TRIBE. THIS INCLUDES A POPULATION OF APPROXIMATELY 148,828 PEOPLE.HOSPITAL TOTAL SERVICE AREA:THE COMMUNITY SERVED BY THE HOSPITAL IS DEFINED BASED ON THE GEOGRAPHIC ORIGINS OF THE HOSPITAL'S INPATIENTS. THE HOSPITAL TOTAL SERVICE AREA IS THE COMPRISED OF BOTH THE PRIMARY SERVICE AREA (PSA) AS WELL AS THE SECONDARY SERVICE AREA (SSA) AND IS ESTABLISHED BASED ON THE FOLLOWING CRITERIA:- PSA: 70% OF DISCHARGES (EXCLUDING NORMAL NEWBORNS)- SSA: 71%-85% OF DISCHARGES (DRAW RATES PER ZIP CODE ARE CONSIDERED AND PSA/SSA ARE MODIFIED ACCORDINGLY)- INCLUDES ZIP CODES FOR CONTINUITY- NATURAL BOUNDARIES ARE CONSIDERED (I.E., FREEWAYS, MOUNTAIN RANGES, ETC.)- CITIES ARE PLACED IN PSA OR SSA, BUT NOT BOTHTHE PRIMARY SERVICE AREA (""PSA"") IS THE GEOGRAPHIC AREA FROM WHICH THE MAJORITY OF THE HOSPITAL'S PATIENTS ORIGINATE. THE SECONDARY SERVICE AREA (""SSA"") IS WHERE AN ADDITIONAL POPULATION OF THE HOSPITAL'S INPATIENTS RESIDE. THE PSA IS COMPRISED OF EUREKA, ARCATA, MCKINLEYVILLE, BAYSIDE, SAMOA, FIELDS LANDING, AND FORTUNA. THE SSA IS COMPRISED OF CRESCENT CITY, KLAMATH, ORICK, HOOPA, WILLOW CREEK, TRINIDAD, BLUE LAKE, KNEELAND, LOLETA, FERNDALE AND RIO DELL.THE TOTAL SERVICE AREA (TSA) OF ST. JOSEPH HOSPITAL EUREKA INCLUDES APPROXIMATELY 150,000 PEOPLE, WITH ABOUT 124,000 (84%) IN HUMBOLDT COUNTY. 90% OF THE POPULATION OF BOTH HUMBOLDT AND DEL NORTE COUNTIES LIVE IN THE TSA, SO COMPARISONS TO COUNTY DATA ARE ONLY OF LIMITED UTILITY. THE TSA HAS A MEDIAN HOUSEHOLD INCOME OF $40,053, 31.3% OF THIS POPULATION HAS A HOUSEHOLD INCOME BELOW 200% OF FEDERAL POVERTY LEVEL, AND 25.0% OF CHILDREN AND 7.4% OF OLDER ADULTS LIVE BELOW 100% OF FPL. THE RACE/ETHNICITY DATA FOR THE TSA IS PRIMARILY NON-LATINO WHITE AT 71.6%. 12.9% ARE LATINO AND 5.5% ARE AMERICAN INDIAN.THE TSA HAS 9 FEDERALLY RECOGNIZED TRIBAL ENTITIES. THE TSA HAS MANY POCKETS OF HIGH NEED AS IDENTIFIED AS A COMMUNITY NEEDS INDEX SCORE OF BETWEEN 4.2 AND 5.0. THE COMMUNITIES OF EUREKA 95501 AND 95503, HOOPA 95546, ORICK 95555 AND ARCATA 95521 ARE ALL IN THIS HIGHEST NEED CATEGORY.HEALTH PROFESSIONS SHORTAGE AREA - PRIMARY, MENTAL, AND OTHER:THE FEDERAL HEALTH RESOURCES AND SERVICES ADMINISTRATION DESIGNATES HEALTH PROFESSIONAL SHORTAGE AREAS AS AREAS WITH A SHORTAGE OF PRIMARY MEDICAL CARE, DENTAL CARE, OR MENTAL HEALTH PROVIDERS. THEY ARE DESIGNATED ACCORDING TO GEOGRAPHY (I.E., SERVICE AREA), DEMOGRAPHICS (I.E., LOW-INCOME POPULATION), OR INSTITUTIONS (I.E., COMPREHENSIVE HEALTH CENTERS). ST. JOSEPH HOSPITAL AND ITS SERVICE AREA ARE BOTH LOCATED IN A PRIMARY AND MENTAL HEALTHCARE SHORTAGE AREA.MEDICAL UNDERSERVED AREA/MEDICAL PROFESSIONAL SHORTAGE AREA:MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ARE DEFINED BY THE FEDERAL GOVERNMENT TO INCLUDE AREAS OR POPULATION GROUPS THAT DEMONSTRATE A SHORTAGE OF HEALTHCARE SERVICES. THIS DESIGNATION PROCESS WAS ORIGINALLY ESTABLISHED TO ASSIST THE GOVERNMENT IN ALLOCATING COMMUNITY HEALTH CENTER GRANT FUNDS TO THE AREAS OF GREATEST NEED. MEDICALLY UNDERSERVED AREAS ARE IDENTIFIED BY CALCULATING A COMPOSITE INDEX OF NEED INDICATORS COMPILED AND COMPARED WITH NATIONAL AVERAGES TO DETERMINE AN AREA'S LEVEL OF MEDICAL ""UNDER SERVICE"". MEDICALLY UNDERSERVED POPULATIONS ARE IDENTIFIED BASED ON DOCUMENTATION OF UNUSUAL LOCAL CONDITIONS THAT RESULT IN ACCESS BARRIERS TO MEDICAL SERVICES. MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ARE PERMANENTLY SET, AND NO RENEWAL PROCESS IS NECESSARY. THE MAP BELOW DEPICTS THE MEDICALLY UNDERSERVED AREAS/MEDICALLY UNDERSERVED WITHIN A 50 MILE RADIUS FROM ST. JOSEPH HOSPITAL.ALTHOUGH ST. JOSEPH HOSPITAL IS NOT LOCATED IN A MEDICALLY UNDERSERVED AREA/MEDICALLY UNDERSERVED POPULATIONS AREA, LARGE PORTIONS OF THE SERVICE AREA TO THE NORTH, SOUTH AND WEST OF ST. JOSEPH HOSPITAL ARE DESIGNATED AS SHORTAGE AREAS; AND THERE ARE ALSO 14 FEDERALLY QUALIFIED HEALTH CENTERS WITHIN A 50 MILE RADIUS OF ST. JOSEPH HOSPITAL EUREKA. FEDERALLY QUALIFIED HEALTH CENTERS ARE HEALTH CLINICS THAT QUALIFY FOR ENHANCED REIMBURSEMENT FROM MEDICARE AND MEDICAID. THEY MUST PROVIDE PRIMARY CARE SERVICES TO AN UNDERSERVED AREA OR POPULATION, OFFER A SLIDING FEE SCALE, HAVE AN ONGOING QUALITY ASSURANCE PROGRAM, AND HAVE A GOVERNING BOARD OF DIRECTORS. THE ACA INCLUDED PROVISIONS THAT INCREASED FEDERAL FUNDING TO FEDERALLY QUALIFIED HEATH CENTERS TO HELP MEET THE ANTICIPATED DEMAND FOR HEALTHCARE SERVICES BY THOSE INDIVIDUALS WHO GAINED HEALTHCARE COVERAGE THROUGH THE VARIOUS HEALTH EXCHANGES. A LARGE PERCENTAGE OF AREA RESIDENTS DEPEND ON THE FEDERALLY QUALIFIED HEALTH CENTERS TO RECEIVE THEIR HEALTHCARE SERVICES. ADDITIONALLY, MANY OF THE FEDERALLY QUALIFIED HEALTH CENTERS' PATIENTS UTILIZE THE SERVICES OF ST. JOSEPH HOSPITAL-EUREKA.OTHER HOSPITALS IN SERVICE AREAOTHER HOSPITALS IN HUMBOLDT COUNTY INCLUDE REDWOOD MEMORIAL IN FORTUNA AND MAD RIVER COMMUNITY HOSPITAL IN ARCATA.QUEEN OF THE VALLEY MEDICAL CENTERQUEEN OF THE VALLEY MEDICAL CENTER'S TOTAL HOSPITAL SERVICE AREA (TSA) INCLUDES APPROXIMATELY 167,000 PEOPLE AND PORTIONS OF NAPA AND SONOMA COUNTIES. THE PRIMARY SERVICE AREA (PSA) CONSISTS OF THE ZIP CODES FOR THE CITIES OF NAPA AND YOUNTVILLE, AND THE SECONDARY SERVICE AREA CONSISTS OF THE CITIES OF AMERICAN CANYON, ST. HELENA, AND BOYES HOT SPRINGS IN SONOMA. OVER 75% OF THE POPULATION OF THE TSA IS IN NAPA COUNTY, AND APPROXIMATELY 90% OF NAPA COUNTY'S POPULATION IS WITHIN THE TSA.A PREMIUM WINE PRODUCING REGION, THERE IS A LARGE AGRICULTURE AND HOSPITALITY INDUSTRY. ALTHOUGH OFTEN VIEWED AS A COMMUNITY OF WEALTH, THE LARGE NUMBER OF LOW WAGE EARNERS IN THESE INDUSTRIES COMBINED WITH THE HIGH COST OF LIVING LEND TO POCKETS OF POVERTY AND INDIVIDUALS AND FAMILIES HAVING DIFFICULTY MEETING BASIC NEEDS. ETHNIC DIVERSITY OF THE TSA INCLUDE 33.5% LATINO, 54.8% NON-LATINO WHITE WITH 7.2% ASIAN/PACIFIC ISLANDER AND 1.7% BLACK. 16.2% OF THE TSA DO NOT SPEAK ENGLISH ""VERY WELL"".THE MEDIAN HOUSEHOLD INCOME IS $68,468 WITH 22.1% HOUSEHOLDS BELOW 200% OF THE FPL AND 7.6% LIVING BELOW 100% FPL. 15.4% OF CHILDREN AND 7.1% OF OLDER ADULTS LIVE 100% BELOW FPL.QUEEN OF THE VALLEY'S TSA HAS A HIGHER PERCENTAGE OF OLDER ADULTS (18.5%) THAN THE MEDICAL UNDERSERVED AREA/MEDICAL PROFESSIONAL SHORTAGE AREA MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ARE DEFINED BY THE FEDERAL GOVERNMENT TO INCLUDE AREAS OR POPULATION GROUPS THAT DEMONSTRATE A SHORTAGE OF HEALTHCARE SERVICES. THIS DESIGNATION PROCESS WAS ORIGINALLY ESTABLISHED TO ASSIST THE GOVERNMENT IN ALLOCATING COMMUNITY HEALTH CENTER GRANT FUNDS TO THE AREAS OF GREATEST NEED. MEDICALLY UNDERSERVED AREAS ARE IDENTIFIED BY CALCULATING A COMPOSITE INDEX OF NEED INDICATORS COMPILED AND COMPARED WITH NATIONAL AVERAGES TO DETERMINE AN AREA'S LEVEL OF MEDICAL ""UNDER SERVICE"". MEDICALLY UNDERSERVED POPULATIONS ARE IDENTIFIED BASED ON DOCUMENTATION OF UNUSUAL LOCAL CONDITIONS THAT RESULT IN ACCESS BARRIERS TO MEDICAL SERVICES. MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ARE PERMANENTLY SET, AND NO RENEWAL PROCESS IS NECESSARY. QUEEN OF THE VALLEY, ALONG WITH THE MAJORITY OF THE TSA IS LOCATED IN A MEDICALLY UNDERSERVED POPULATIONS AREA, SIGNIFYING THE IMPORTANCE OF THE MEDICALCENTER TO THE COMMUNITY IT SERVES STATE.HEALTH PROFESSIONS SHORTAGE AREA - MENTAL, DENTAL, OTHERTHE FEDERAL HEALTH RESOURCES AND SERVICES ADMINISTRATION DESIGNATES HEALTH PROFESSIONAL SHORTAGE AREAS AS AREAS WITH A SHORTAGE OF PRIMARY MEDICAL CARE, DENTAL CARE, OR MENTAL HEALTH PROVIDERS. THEY ARE DESIGNATED ACCORDING TO GEOGRAPHY (I.E., SERVICE AREA), DEMOGRAPHICS (I.E., LOW-INCOME POPULATION), OR INSTITUTIONS (I.E., COMPREHENSIVE HEALTH CENTERS). ALTHOUGH QUEEN OF THE VALLEY IS NOT LOCATED IN A HEALTH PROFESSIONS SHORTAGE AREA, LARGE PORTIONS OF THE SERVICE AREA TO THE WEST AND NORTH ARE DESIGNATED SHORTAGE AREAS.OTHER HOSPITALS IN SERVICE AREATHERE IS ONE OTHER HOSPITAL IN THE COMMUNITY: ST. HELENA HOSPITAL."

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NEEDS ASSESSMENT:SANTA ROSA MEMORIAL HOSPITALTHROUGH A MIXED-METHODS APPROACH USING QUANTITATIVE AND QUALITATIVE DATA, THE CHNA PROCESS USED SEVERAL SOURCES OF INFORMATION TO IDENTIFY COMMUNITY NEEDS. ACROSS SONOMA COUNTY, INFORMATION COLLECTED INCLUDES PUBLIC HEALTH DATA REGARDING HEALTH BEHAVIORS, MORBIDITY AND MORTALITY, AND HOSPITAL-LEVEL DATA. IN 2019, ST. JOSEPH HEALTH SONOMA PARTNERED WITH SUTTER HEALTH AND KAISER PERMANENTE TO GATHER DATA FROM LISTENING SESSIONS AND INTERVIEWS WITH DIVERSE, LOW-INCOME AND MEDICALLY UNDERSERVED COMMUNITIES IN SONOMA COUNTY. IN 2020, INDIVIDUAL STAKEHOLDER INTERVIEWS WERE CONDUCTED WITH REPRESENTATIVES FROM ORGANIZATIONS THAT SERVE THESE POPULATIONS TO BETTER UNDERSTAND THE IMPACTS OF COVID-19 IN OUR COMMUNITIES. IN ADDITION, STAKEHOLDER PARTICIPATION IN HEALTH ACTION SONOMA COUNTY, A MULTISECTOR COLLABORATIVE, ENSURES ONGOING ASSESSMENT TO ADDRESS SIGNIFICANT NEEDS AS THEY ARISE THROUGHOUT THE YEAR.REDWOOD MEMORIAL HOSPITALIN ADDITION TO THE CHNA, ADDITIONAL COMMUNITY NEEDS EMERGE OVER TIME. TO ENSURE A CONTINUOUS CONNECTION TO EMERGING COMMUNITY NEEDS, REDWOOD MEMORIAL HOSPITAL, FORTUNA COMMUNITY BENEFIT STAFF ARE CORE MEMBERS OF MULTIPLE CROSS-SECTOR COLLABORATIVES INCLUDING AN ACCOUNTABLE COMMUNITY FOR HEALTH, COAD AND LIVE WELL HUMBOLDT (LWH). HUMBOLDT COUNTY PUBLIC HEALTH SERVES AS THE BACKBONE ORGANIZATION OF LWH, AND THIS PUBLIC AND PRIVATE SECTOR COLLABORATIVE CONSISTS OF OVER 20 AGENCIES. FRONTLINE CB CAREGIVERS ALSO PROVIDE ONGOING INFORMATION AND FEEDBACK ABOUT NEEDS THEIR CLIENTS FACE IN REAL TIME. THE ORGANIZATION ALSO PARTNERS WITH HUMBOLDT STATE UNIVERSITY AND OTHER NONPROFITS TO CONDUCT SURVEYS OF VULNERABLE POPULATIONS. IN ADDITION TO LWH, REDWOOD MEMORIAL HOSPITAL, FORTUNA STRATEGIC SERVICES CONDUCT ANALYSIS AND REPORT ON COMMUNITY NEEDS AND TRENDS.ST. JOSEPH HOSPITAL OF EUREKAIN ADDITION TO THE CHNA, ADDITIONAL COMMUNITY NEEDS EMERGE OVER TIME. TO ENSURE A CONTINUOUS CONNECTION TO EMERGING COMMUNITY NEEDS, ST. JOSEPH HOSPITAL COMMUNITY BENEFIT STAFF ARE CORE MEMBERS OF MULTIPLE CROSS-SECTOR COLLABORATIVES INCLUDING AN ACCOUNTABLE COMMUNITY FOR HEALTH, COAD AND LIVE WELL HUMBOLDT (LWH). HUMBOLDT COUNTY PUBLIC HEALTH SERVES AS THE BACKBONE ORGANIZATION OF LWH, AND THIS PUBLIC AND PRIVATE SECTOR COLLABORATIVE CONSISTS OF OVER 20 AGENCIES. FRONTLINE CB CAREGIVERS ALSO PROVIDE ONGOING INFORMATION AND FEEDBACK ABOUT NEEDS THEIR CLIENTS FACE IN REAL TIME. THE ORGANIZATION ALSO PARTNERS WITH HUMBOLDT STATE UNIVERSITY AND OTHER NONPROFITS TO CONDUCT SURVEYS OF VULNERABLE POPULATIONS. IN ADDITION TO LWH, ST. JOSEPH HOSPITAL STRATEGIC SERVICES CONDUCT ANALYSIS AND REPORT ON COMMUNITY NEEDS AND TRENDS.QUEEN OF THE VALLEY MEDICAL CENTERIN ADDITION TO THE CHNA, ADDITIONAL COMMUNITY NEEDS EMERGE OVER TIME. TO ENSURE A CONTINUOUS CONNECTION TO EMERGING COMMUNITY NEEDS, QUEEN OF THE VALLEY COMMUNITY BENEFIT STAFF ARE CORE MEMBERS OF LIVE HEALTHY NAPA COUNTY (LHNC). NAPA COUNTY PUBLIC HEALTH SERVES IS THE BACKBONE ORGANIZATION OF LHNC, AND THIS PUBLIC AND PRIVATE SECTOR COLLABORATIVE CONSISTS OF OVER 40 AGENCIES. LHNC MEETS REGULARLY, HAS A WEB SITE AND SENDS ELECTRONIC NEWSLETTERS AND UPDATES FOR ANY URGENT COMMUNITY NEEDS THAT ARISE BETWEEN MEETINGS. QUEEN OF THE VALLEY IS ALSO ACTIVE IN THE NAPA VALLEY COMMUNITY ORGANIZATIONS ACTIVE IN DISASTER (COAD) AND COMMUNITY LEADERS' COALITION. NAPA COAD DEVELOPS AND ENHANCES PARTNERSHIPS FOR COMMUNICATION, COORDINATION AND COLLABORATION AMONGST THE WHOLE COMMUNITY DURING ALL PHASES OF DISASTER. NAPA'S COMMUNITY LEADERS COALTION WORKS TO MOBILIZE COMMUNITY LEADERS TO COLLECTIVELY ADVOCATE FOR THE NEEDS OF VULNERABLE POPULATIONS THROUGHOUT NAPA COUNTY. QUEEN OF THE VALLEY STRATEGIC SERVICES CONTINUOUSLY CONDUCTS ANALYSIS AND REPORTS ON COMMUNITY NEEDS AND TRENDS.

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SANTA ROSA MEMORIAL HOSPITALPROMOTION OF COMMUNITY HEALTH:SANTA ROSA MEMORIAL HOSPITAL PROVIDES VITAL COMMUNITY HEALTH SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE AND DISCOUNTED CARE. SANTA ROSA MEMORIAL HOSPITAL IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE IN ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS:1) A COMMUNITY BENEFIT COMMITTEE THAT HAS COMMUNITY REPRESENTATION AND ISA SUBCOMMITTEE OF THE BOARD OF TRUSTEES2) OPEN MEDICAL STAFF3) ROBUST COMMUNITY BENEFIT PROGRAMS THAT ADDRESS COMMUNITY HEALTH NEEDS.REDWOOD MEMORIAL HOSPITALPROMOTION OF COMMUNITY HEALTH:REDWOOD MEMORIAL HOSPITAL PROVIDES VITAL COMMUNITY HEALTH SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE AND DISCOUNTED CARE. REDWOOD MEMORIAL HOSPITAL IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE IN ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS:1) A COMMUNITY BENEFIT COMMITTEE THAT HAS COMMUNITY REPRESENTATION AND IS A SUBCOMMITTEE OF THE BOARD OF TRUSTEES2) OPEN MEDICAL STAFF3) ROBUST COMMUNITY BENEFIT PROGRAMS THAT ADDRESS COMMUNITY HEALTH NEEDS.QUEEN OF THE VALLEY MEDICAL CENTERPROMOTION OF COMMUNITY HEALTH:QUEEN OF THE VALLEY MEDICAL CENTER PROVIDES VITAL COMMUNITY HEALTH SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE AND DISCOUNTED CARE. QUEEN OF THE VALLEY IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE IN ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS:1) A COMMUNITY BENEFIT COMMITTEE THAT HAS COMMUNITY REPRESENTATION AND ISA SUBCOMMITTEE OF THE BOARD OF TRUSTEES.2) OPEN MEDICAL STAFF.3) ROBUST COMMUNITY BENEFIT PROGRAMS THAT ADDRESS COMMUNITY HEALTH NEEDS.ST. JOSEPH HOSPITAL OF EUREKAPROMOTION OF COMMUNITY HEALTH:ST. JOSEPH HOSPITAL OF EUREKA PROVIDES VITAL COMMUNITY HEALTH SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE AND DISCOUNTED CARE. ST. JOSEPH HOSPITAL OF EUREKA IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE IN ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS:1) A COMMUNITY BENEFIT COMMITTEE THAT HAS COMMUNITY REPRESENTATION AND ISA SUBCOMMITTEE OF THE BOARD OF TRUSTEES2) OPEN MEDICAL STAFF3) ROBUST COMMUNITY BENEFIT PROGRAMS THAT ADDRESS COMMUNITY HEALTH NEEDS.

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AT PROVIDENCE, WE USE OUR VOICE TO ADVOCATE FOR VULNERABLE POPULATIONS AND NEEDED REFORMS IN HEALTH CARE. WE ARE ALSO PURSUING INNOVATIVE WAYS TO TRANSFORM HEALTH CARE BY KEEPING PEOPLE HEALTHY, AND MAKING OUR SERVICES MORE CONVENIENT, ACCESSIBLE AND AFFORDABLE FOR ALL. IN AN INCREASINGLY UNCERTAIN WORLD, WE ARE COMMITTED TO HIGH-QUALITY, COMPASSIONATE HEALTH CARE FOR EVERYONE - REGARDLESS OF COVERAGE OR ABILITY TO PAY. WE HELP PEOPLE AND COMMUNITIES BENEFIT FROM THE BEST HEALTH CARE MODEL FOR THE FUTURE - TODAY.TOGETHER, OUR 120,000 CAREGIVERS (ALL EMPLOYEES) SERVE IN 52 HOSPITALS, 1,085 CLINICS AND A COMPREHENSIVE RANGE OF HEALTH AND SOCIAL SERVICES ACROSS ALASKA, CALIFORNIA, MONTANA, NEW MEXICO, OREGON, TEXAS AND WASHINGTON. THE PROVIDENCE FAMILY INCLUDES:- PROVIDENCE ACROSS SEVEN WESTERN STATES- COVENANT HEALTH IN WEST TEXAS- PROVIDENCE FACEY MEDICAL FOUNDATION IN LOS ANGELES, CA- HOAG MEMORIAL HOSPITAL PRESBYTERIAN IN ORANGE COUNTY, CA- KADLEC IN SOUTHEAST WASHINGTON- PACIFIC MEDICAL CENTERS IN SEATTLE, WA.- SWEDISH HEALTH SERVICES IN SEATTLE, WA.2021 WAS A YEAR MARKED BY THREE MAJOR SURGES IN COVID-19 VOLUMES, A NATIONAL SHORTAGE OF HEALTH CARE PERSONNEL, AS WELL AS DEFERRALS OF NON-EMERGENT CARE. EVEN WITH THESE TREMENDOUS CHALLENGES, THE PROVIDENCE FAMILY OF ORGANIZATIONS CONTINUED TO INVEST IN OUR COMMUNITIES, GUIDED BY OUR STRATEGIC PLAN AND OUR COMMUNITY BENEFIT PRIORITIES. FOR MORE INFORMATION GO TO: HTTPS://WWW.PROVIDENCE.ORG/ABOUT/ANNUAL-REPORT

SCHEDULE H, PART VI, LINE 4 (CONTINUED):
"REDWOOD MEMORIAL HOSPITAL (CONTINUED)THE PSA IS COMPRISED OF FORTUNA, RIO DELL, EUREKA, FERNDALE AND LOLETA. THE SSA IS COMPRISED OF HYDESVILLE, SCOTIA, CARLOTTA, REDWAY, MYERS FLAT, BRIDGEVILLE, MIRANDA AND REDCREST. THE TOTAL SERVICE AREA (TSA) OF REDWOOD MEMORIAL HOSPITAL INCLUDES APPROXIMATELY 78,000 PEOPLE, OF WHICH 91% IS IN THE PRIMARY SERVICE AREA (PSA). THE SECONDARY SERVICE AREA CONSISTS ENTIRELY OF SMALLER INLAND COMMUNITIES. THE TSA COMPRISES 57% OF THE POPULATION OF HUMBOLDT COUNTY, INCLUDING THE POPULATION CENTERS OF EUREKA AND FORTUNA, BUT EXCLUDING ARCATA AND MCKINLEYVILLE. THERE ARE NOT SUBSTANTIAL DIFFERENCES BETWEEN THE TSA AND COUNTY, BUT THERE ARE MANY COMPARED TO THE STATE. THE TSA IS WORSE THAN CALIFORNIA ON MEDIAN INCOME, $41,192, BUT SIMILAR TO OR SLIGHTLY BETTER ON POVERTY METRICS. THIS MAY INDICATE THAT REVENUE IS MORE EVENLY DISTRIBUTED ACROSS THE SERVICE AREA. THERE ARE HIGHER PERCENTAGES OF OLDER ADULTS, LOWER PERCENTAGES OF CHILDREN, AND FAR MORE NON-LATINO WHITES IN THE SERVICE AREA THAN IN CALIFORNIA (74% IN HUMBOLDT COUNTY COMPARED TO 37% ACROSS CALIFORNIA).THE RACE/ETHNICITY DATA FOR THE TSA IS PRIMARILY NON-LATINO WHITE AT 74.4%. 12.8% ARE LATINO AND 3.1% ARE AMERICAN INDIAN. THE TSA HAS 9 FEDERALLY RECOGNIZED TRIBAL ENTITIES.THE TSA HAS MANY POCKETS OF HIGH NEED AS IDENTIFIED AS A COMMUNITY NEEDS INDEX SCORE OF BETWEEN 4.2 AND 5.0. THE COMMUNITIES OF EUREKA 95501 AND 95503, RIO DELL 95562, LOLETA 95551, AND FORTUNA 95540 ARE ALL IN THIS HIGHEST NEED CATEGORY.HEALTH PROFESSIONS SHORTAGE AREA - PRIMARY, MENTAL, AND OTHER:THE FEDERAL HEALTH RESOURCES AND SERVICES ADMINISTRATION DESIGNATES HEALTH PROFESSIONAL SHORTAGE AREAS AS AREAS WITH A SHORTAGE OF PRIMARY MEDICAL CARE, DENTAL CARE, OR MENTAL HEALTH PROVIDERS. THEY ARE DESIGNATED ACCORDING TO GEOGRAPHY (I.E., SERVICE AREA), DEMOGRAPHICS (I.E., LOW-INCOME POPULATION), OR INSTITUTIONS (I.E., COMPREHENSIVE HEALTH CENTERS). REDWOOD MEMORIAL HOSPITAL AND ITS SERVICE AREA ARE BOTH LOCATED IN A PRIMARY AND MENTAL HEALTHCARE SHORTAGE AREA.MEDICAL UNDERSERVED AREA/MEDICAL PROFESSIONAL SHORTAGE AREA:MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ARE DEFINED BY THE FEDERAL GOVERNMENT TO INCLUDE AREAS OR POPULATION GROUPS THAT DEMONSTRATE A SHORTAGE OF HEALTHCARE SERVICES. THIS DESIGNATION PROCESS WAS ORIGINALLY ESTABLISHED TO ASSIST THE GOVERNMENT IN ALLOCATING COMMUNITY HEALTH CENTER GRANT FUNDS TO THE AREAS OF GREATEST NEED. MEDICALLY UNDERSERVED AREAS ARE IDENTIFIED BY CALCULATING A COMPOSITE INDEX OF NEED INDICATORS COMPILED AND COMPARED WITH NATIONAL AVERAGES TO DETERMINE AN AREA'S LEVEL OF MEDICAL ""UNDER SERVICE."" MEDICALLY UNDERSERVED POPULATIONS ARE IDENTIFIED BASED ON DOCUMENTATION OF UNUSUAL LOCAL CONDITIONS THAT RESULT IN ACCESS BARRIERS TO MEDICAL SERVICES. MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS ARE PERMANENTLY SET, AND NO RENEWAL PROCESS IS NECESSARY.ALTHOUGH REDWOOD MEMORIAL HOSPITAL IS NOT LOCATED IN A MEDICALLY UNDERSERVED AREA/MEDICALLY UNDERSERVED POPULATIONS AREA, LARGE PORTIONS OF THE SERVICE AREA TO THE NORTH, SOUTH AND WEST OF REDWOOD MEMORIAL HOSPITAL ARE DESIGNATED AS SHORTAGE AREAS; AND THERE ARE ALSO 14 FEDERALLY QUALIFIED HEALTH CENTERS WITHIN A 50 MILE RADIUS OF REDWOOD MEMORIAL HOSPITAL.FEDERALLY QUALIFIED HEALTH CENTERS ARE HEALTH CLINICS THAT QUALIFY FOR ENHANCED REIMBURSEMENT FROM MEDICARE AND MEDICAID. THEY MUST PROVIDE PRIMARY CARE SERVICES TO AN UNDERSERVED AREA OR POPULATION, OFFER A SLIDING FEE SCALE, HAVE AN ONGOING QUALITY ASSURANCE PROGRAM, AND HAVE A GOVERNING BOARD OF DIRECTORS. THE ACA INCLUDED PROVISIONS THAT INCREASED FEDERAL FUNDING TO FEDERALLY QUALIFIED HEATH CENTERS TO HELP MEET THE ANTICIPATED DEMAND FOR HEALTHCARE SERVICES BY THOSE INDIVIDUALS WHO GAINED HEALTHCARE COVERAGE THROUGH THE VARIOUS HEALTH EXCHANGES. A LARGE PERCENTAGE OF AREA RESIDENTS DEPEND ON THE FEDERALLY QUALIFIED HEALTH CENTERS TO RECEIVE THEIR HEALTHCARE SERVICES. ADDITIONALLY, MANY OF THE FEDERALLY QUALIFIED HEALTH CENTERS' PATIENTS UTILIZE THE SERVICES OF REDWOOD MEMORIAL HOSPITAL. ALTHOUGH REDWOOD MEMORIAL HOSPITAL IS NOT LOCATED IN A MEDICALLY UNDERSERVED AREA/MEDICALLY UNDERSERVED POPULATIONS AREA, LARGE PORTIONS OF THE SERVICE AREA TO THE NORTH, SOUTH AND WEST OF REDWOOD MEMORIAL HOSPITAL ARE DESIGNATED AS SHORTAGE AREAS; AND THERE ARE ALSO 14 FEDERALLY QUALIFIED HEALTH CENTERS WITHIN A 50 MILE RADIUS OF REDWOOD MEMORIAL HOSPITAL.OTHER HOSPITALS IN SERVICE AREAOTHER HOSPITALS IN HUMBOLDT COUNTY INCLUDE ST. JOSEPH HOSPITAL IN EUREKA, MAD RIVER COMMUNITY HOSPITAL IN ARCATA AND JEROLD PHELPS COMMUNITY HOSPITAL IN GARBERVILLE."