4A (Expenses $ 1941385460 including grants of $ 445251) (Revenue $ 2050311435)
"FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER OPERATES TWO ACUTE-CARE HOSPITALS AND NUMEROUS OUTPATIENT CENTERS, CLINICS AND OTHER SERVICES WHICH MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. SEE SCHEDULE O FOR ADDITIONAL DETAILS.- COMMUNITY REGIONAL MEDICAL CENTER. CRMC IS A TERTIARY ACUTE CARE FACILITY THAT PROVIDES THE PRIMARY SERVICE AREA AND SECONDARY SERVICE AREA WITH THE FOLLOWING SERVICES: (I) THE CENTRAL VALLEY'S ONLY LEVEL I TRAUMA CENTER, (II) THE COMMUNITY REGIONAL BURN CENTER, (III) A LEVEL III NEONATAL INTENSIVE CARE UNIT, (IV) COMPREHENSIVE INPATIENT AND OUTPATIENT SERVICES, INCLUDING TECHNOLOGICALLY ADVANCED MEDICAL/SURGICAL SPECIALTIES SUCH AS CARDIOVASCULAR, NEUROSCIENCE, ORTHOPEDICS AND WOMEN'S AND CHILDREN'S SERVICES, (V) THE COMMUNITY FAMILY BIRTH CENTER, (VI) GENERAL AND SPECIALTY INTENSIVE CARE UNITS, (VII) THE LEON S. PETERS REHABILITATION CENTER, (VIII) INPATIENT AND OUTPATIENT CANCER TREATMENT, (IX) PATHOLOGY AND CLINICAL LABORATORY SERVICES, (X) DIALYSIS TREATMENT FACILITIES, (XI) DIAGNOSTIC RADIOLOGY SERVICES, (XII) SHORT STAY SURGERY SERVICES, (XIII) A CARDIOVASCULAR CARE UNIT, AND (XIV) 24 HOUR EMERGENCY SERVICES. CRMC IS ALSO A TEACHING HOSPITAL THAT IS AFFILIATED WITH UCSF. THE MAIN CAMPUS OF CRMC CONSISTS OF A HOSPITAL BUILDING WITH FIVE AND 10-STORY WINGS, CONNECTED TO A FIVE STORY TRAUMA AND CRITICAL CARE BUILDING. CRMC ALSO PROVIDES (I) BEHAVIORAL HEALTH SERVICES AT A FREESTANDING FACILITY IN NORTHERN FRESNO KNOWN AS THE COMMUNITY BEHAVIORAL HEALTH CENTER (""CBHC""), (II) SUBACUTE AND SKILLED NURSING SERVICES AT A FREESTANDING FACILITY IN NORTHERN FRESNO KNOWN AS THE COMMUNITY SUBACUTE AND TRANSITIONAL CARE CENTER (""CSTCC""), AND (III) HIV AND OMFS SERVICES ARE OFFERED AT THE DERAN KOLIGIAN AMBULATORY CARE CENTER LOCATED ON THE CRMC MAIN CAMPUS (THE ""FRESNO CAMPUS""). - CLOVIS COMMUNITY MEDICAL CENTER. CCMC IS LOCATED IN THE CITY OF CLOVIS (WHICH IS CONTIGUOUS TO THE CITY OF FRESNO), WHERE IT SERVES THE PRIMARY SERVICE AREA AND, TO A LESSER DEGREE, THE SECONDARY SERVICE AREA. THE CHS CAMPUS IN CLOVIS (THE ""CLOVIS CAMPUS"") INCLUDES THE MAIN FACILITY, WHICH CONSISTS OF AN ACUTE CARE HOSPITAL WITH TWO FIVE-STORY TOWER AND A THREE-STORY TOWER CONNECTED TO AN OUTPATIENT SURGERY/ENDOSCOPY/DIAGNOSTIC CENTER. THE FACILITY HAS ALL PRIVATE ROOMS. THE FACILITY PROVIDES: (I) COMPREHENSIVE MEDICAL AND SURGICAL CAPABILITIES, (II) 24-HOUR EMERGENCY CARE, (III) AN INTENSIVE CARE UNIT, (IV) THE COMMUNITY FAMILY BIRTH CENTER, (V) THE MARJORIE E. RADIN BREAST CARE CENTER (VI) SHORT STAY AND INPATIENT SURGICAL SERVICES, INCLUDING ROBOTICS AND ADVANCED MINIMALLY INVASIVE SURGERY, (VII) A LEVEL II NEONATAL INTENSIVE CARE UNIT, (VIII) INPATIENT CANCER TREATMENT, (IX) PATHOLOGY AND CLINICAL LABORATORY SERVICES, (X) ADVANCED DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY, AND (XI) INVASIVE AND NON-INVASIVE CARDIAC SERVICES. OTHER FACILITIES AND SERVICES PROVIDED ON THE CLOVIS CAMPUS INCLUDE: (I) AN OUTPATIENT WOUND CARE CLINIC WITH TWO HYPERBARIC OXYGEN CHAMBERS, (II) AN OUTPATIENT PHYSICAL REHABILITATION CLINIC, INCLUDING LYMPHEDEMA THERAPY, (III) COMMUNITY CANCER INSTITUTE (CCI), A THREE-STORY BUILDING WHICH IS CENTRAL CALIFORNIA'S PREMIER COMPREHENSIVE CANCER CARE CENTER - AND THE ONLY ONE IN THE AREA WITH MANY OUTPATIENT SERVICES IN A SINGLE LOCATION, AND (IV) THE H. MARCUS RADIN CONFERENCE CENTER, WHICH OPENED IN 2012 AND PROVIDES A 214- SEAT AUDITORIUM THAT IS FULLY INTEGRATED FOR TRAINING IN CHS'S OPERATING ROOMS AND FOR BROADCASTING OTHER EVENTS, AND TWO STATE-OF-THE-ART COMPUTER TRAINING LABS.- FRESNO HEART AND SURGICAL HOSPITAL. HEART HOSPITAL IS AN ACUTE CARE FACILITY WITH ALL PRIVATE ROOMS LOCATED IN THE CITY OF FRESNO OVERLOOKING WOODWARD PARK IN NORTHEAST FRESNO. THE FACILITY OPENED IN OCTOBER 2003 AND PROVIDES THE PRIMARY AND SECONDARY SERVICE AREAS WITH (I) CARDIOLOGY AND CARDIAC SURGERY SERVICES, (II) VASCULAR SURGERY SERVICES, AND (III) BARIATRIC AND OTHER MINIMALLY INVASIVE SURGERY SERVICES. THE ORGANIZATION IS THE PRINCIPAL TEACHING HOSPITAL IN THE CENTRAL VALLEY THROUGH A GRADUATE MEDICAL EDUCATION PROGRAM AFFILIATED WITH THE UNIVERSITY OF CALIFORNIA AT SAN FRANCISCO MEDICAL EDUCATION PROGRAM. CHS SUPPORTS A FULLY ACCREDITED EDUCATIONAL PROGRAM WITH CALIFORNIA STATE UNIVERSITY, FRESNO, BY PROVIDING CLINICAL EXPERIENCE TO ITS NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY AND DIETETIC STUDENTS. ADDITIONALLY, THE ORGANIZATION PROVIDES CLINICAL EXPERIENCE TO FRESNO CITY COLLEGE'S NURSING, SURGERY AND RADIOLOGY TECHNOLOGY STUDENTS. CHS ALSO PROVIDES CLINICAL EXPERIENCE TO STUDENTS IN THE SAN JOAQUIN VALLEY COLLEGE LVN TO RN PROGRAM, FRESNO ADULT SCHOOL AND CLOVIS ADULT SCHOOL LICENSED VOCATIONAL NURSE PROGRAMS, AS WELL AS STUDENTS IN MANY OTHER PROGRAMS AT AREA COMMUNITY COLLEGES. EACH OF THE THREE ACUTE HOSPITALS CONDUCTS EDUCATIONAL PROGRAMS FOR THE BENEFIT OF PHYSICIANS, NURSES, TECHNICIANS, MANAGEMENT PERSONNEL, EMPLOYEES, AND THE PUBLIC. IN ADDITION, CHS SPONSORS NUMEROUS HEALTH PROMOTION AND EDUCATION PROGRAMS FOR ITS EMPLOYEES AND MEMBERS OF THE COMMUNITY IN MANY AREAS, INCLUDING ASTHMA, DIABETES, NUTRITION AND WEIGHT CONTROL, STRESS MANAGEMENT, HEALTH AND WELLNESS, AND SMOKING CESSATION. THE ORGANIZATION IS AN ACTIVE PARTNER IN SEVERAL COMMUNITY SERVICE PROJECTS SUPPORTING EDUCATION IN HEALTH CAREERS FOR HIGH SCHOOLS AND OTHER COMMUNITY GROUPS. TO ADDRESS THE NATION-WIDE NURSING SHORTAGE, THE ORGANIZATION HAS IMPLEMENTED SEVERAL SYSTEM-WIDE INITIATIVES TO INCREASE RECRUITMENT AND RETENTION INCLUDING THE IMPLEMENTATION OF A NURSE RESIDENCY PROGRAM AND CLINICAL LADDER, BOTH DESIGNED TO EXPAND THE EDUCATION OF NEW NURSES AND PROMOTE RETENTION OF A HIGHER PERCENTAGE OF THESE NURSES."

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: COMMUNITY REGIONAL MEDICAL CENTER, - FACILITY 2: CLOVIS COMMUNITY MEDICAL CENTER

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONSISTS OF PRIMARY DATA FROM OVER 4,800 INDIVIDUAL INTERVIEWS AND 59 MULTI-LINGUAL FOCUS GROUPS. PARTICIPANTS IN PRIMARY DATA COLLECTION EFFORTS INCLUDED RESIDENTS THROUGHOUT FRESNO, KINGS, MADERA, AND TULARE COUNTIES AND REPRESENTATIVES FROM AND USERS OF HEALTH IMPROVEMENT PROGRAMS SERVING LOW-INCOME AND VULNERABLE POPULATIONS, CHILDREN AND FAMILIES, HOMELESS, LGBTQ+, SENIORS, TRIBAL COMMUNITIES, AS WELL AS BLACK/AFRICAN AMERICAN, HMONG, LATINO AND SPANISH-SPEAKING POPULATIONS. SECONDARY DATA WAS COLLECTED USING GOVERNMENT AND OTHER PUBLIC HEALTH RESOURCES INCLUDING THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, U.S. CENTER FOR DISEASE CONTROL, HEALTHY COMMUNITIES INSTITUTE AND U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:
SEVERAL HOSPITALS COLLABORATED ON THIS REPORT. THE PARTICIPATING HOSPITALS WERE: COMMUNITY REGIONAL MEDICAL CENTER, CLOVIS COMMUNITY MEDICAL CENTER, KAWEAH HEALTH MEDICAL CENTER, SAINT AGNES MEDICAL CENTER, SIERRA VIEW MEDICAL CENTER, AND VALLEY CHILDREN'S HEALTHCARE.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B:
- BINATIONAL OF CENTRAL CALIFORNIA - CALIFORNIA STATE UNIVERSITY, FRESNO STUDENT VOLUNTEERS - CENTRAL VALLEY HEALTH POLICY INSTITUTE - CULTIVA LA SALUD - EVERY NEIGHBORHOOD PARTNERSHIP - FRESNO COUNTY DEPARTMENT OF PUBLIC HEALTH - FRESNO INTERDENOMINATIONAL REFUGEE MINISTRIES - HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA - KINGS COUNTY COMMISSION ON AGING - KINGS PARTNERSHIP FOR PROSPERITY, PROGRESS, AND PREVENTION - MADERA COALITION FOR COMMUNITY JUSTICE - MADERA COUNTY DEPARTMENT OF PUBLIC HEALTH - MOXLEY PUBLIC HEALTH - THE FRESNO CENTER - TULARE COUNTY DEPARTMENT OF PUBLIC HEALTH - TULE RIVER TRIBE PUBLIC HEALTH AUTHORITY - UNITED WAY FRESNO AND MADERA COUNTIES - UNITED WAY OF TULARE COUNTY

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:
COMMUNITY HEALTH SYSTEM (CHS) INTENDS TO TAKE ACTIONS TO ADDRESS THE FOLLOWING HEALTH NEEDS THAT WERE IDENTIFIED IN THE 2021 CHNA: ACCESS TO HEALTHCARE, CHRONIC DISEASE, ECONOMIC STABILITY, MATERNAL AND CHILD HEALTH, AND MENTAL HEALTH. CHS SELECTED HEALTH NEEDS TO PRIMARILY FOCUS EFFORTS ON BASED UPON THE SYSTEM'S CAPACITY TO ADDRESS THE NEEDS, THE STRENGTH OF COMMUNITY PARTNERSHIPS AND THOSE NEEDS THAT CORRESPOND WITH THE HEALTH SYSTEM'S PRIORITIES. CHS WILL ADDRESS THESE HEALTH NEEDS THOUGH A MULTI-FACETED APPROACH INCLUDING, DIRECT PROGRAMS/SERVICES, LEADERSHIP, AND PARTICIPATION IN BROAD MULTI-STAKEHOLDER COALITIONS/COLLABORATIVES AND CONTINUOUS COLLABORATION BETWEEN CHS AND COMMUNITY PARTNERS.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13B:
THE PATIENT'S, OR THE PATIENT'S FAMILY'S MEDICAL EXPENSES FOR COVERED SERVICES (INCURRED AT CHS OR OTHER PROVIDERS IN THE PAST TWELVE (12) MONTHS) EXCEEDS 10% OF THE PATIENT'S FAMILY INCOME.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 16J:
OSHPD HAS CREATED A WEB-BASED SYSTEM THAT WILL ALLOW USERS TO SEARCH, COMPARE, AND VIEW EACH HOSPITAL'S SUBMITTED CHARITY CARE POLICY, DISCOUNT PAYMENT POLICY, ELIGIBILITY PROCEDURES, REVIEW PROCESS, AND APPLICATION FORM. ACCESS OSHPD'S HOSPITAL FAIR PRICING SEARCH SYSTEM AT: HTTPS://SYFPHR.HCAI.CA.GOV/#FRESNO-COUNTY

PART V, SECTION B, LINES 7A AND 7B:
THE HOSPITAL FACILITY'S WEBSITE WHERE THE CHNA REPORT IS AVAILABLE:HTTPS://WWW.COMMUNITYMEDICAL.ORG/ABOUT-US/COMMUNITY-BENEFITOTHER WEBSITE WHERE THE CHNA REPORT IS AVAILABLE:HTTPS://WWW.COMMUNITYMEDICAL.ORG/GETATTACHMENT/51E91F02-6B3C-4BB9-B984-E7AFE3DAB770/COMMUNITYHEALTHSYSTEM_2022CHNA_9-19-22.PDF

PART V, SECTION B, LINE 10:
THE HOSPITAL'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY:HTTPS://WWW.COMMUNITYMEDICAL.ORG/ABOUT-US/COMMUNITY-BENEFIT

SCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP A:
PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.COMMUNITYMEDICAL.ORG/FOR-PATIENTS-FAMILIES/BILLING-AND-INSURANCE/DISCOUNTS-CHARITY-CAREPART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.COMMUNITYMEDICAL.ORG/FOR-PATIENTS-FAMILIES/BILLING-AND-INSURANCE/DISCOUNTS-CHARITY-CAREPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.COMMUNITYMEDICAL.ORG/FOR-PATIENTS-FAMILIES/BILLING-AND-INSURANCE/DISCOUNTS-CHARITY-CARE

PART V, SECTION B, LINE 22D:
UNDER CALIFORNIA LAW (AB 774), THE MAXIMUM THAT A FAP-ELIGIBLE PATIENT MAY BE CHARGED IS THE REIMBURSEMENT RATE OF ANY GOVERNMENT-SPONSORED HEALTH PROGRAMS IN WHICH THE HOSPITAL PARTICIPATES.

PART I, LINE 6A:
THE COMMUNITY BENEFIT REPORT IS ISSUED BY COMMUNITY HEALTH SYSTEM (CHS), A DBA USED BY THE TWO HOSPITALS THAT COMPRISE THE ORGANIZATION.

PART I, LINE 7:
COSTING METHODOLOGY: CHARITY CARE IS ESTIMATED BY CALCULATING THE RATIO OF COST PER ADJUSTED PATIENT DAY (EXCLUDING BAD DEBTS) AND THEN MULTIPLYING THAT RATIO BY THE ADJUSTED PATIENT DAYS ASSOCIATED WITH CHARITY CARE PATIENTS. CHS DOES NOT UTILIZE A COST ACCOUNTING SYSTEM TO ESTIMATE THE COST OF CHARITY CARE.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 127,024.

PART II, COMMUNITY BUILDING ACTIVITIES:
THE 2022 CHNA IS THE THIRD COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY COMMUNITY HEALTH SYSTEM. QUANTITATIVE AND QUALITATIVE DATA WERE COLLECTED TO INFORM DECISIONS ON HOW TO BETTER MEET THE HEALTH NEEDS OF OUR COMMUNITY. WE WANT TO PROVIDE THE BEST POSSIBLE CARE FOR OUR RESIDENTS, AND WE WILL USE THIS REPORT TO HELP GUIDE US IN OUR STRATEGIC PLANNING AND DECISION-MAKING CONCERNING FUTURE PROGRAMS AND HEALTH RESOURCES.THE ASSESSED HEALTH NEEDS ARE LISTED IN ORDER OF COMMUNITY RANKING OF CONCERN AND ARE VALIDATED BY DATA COLLECTION AS FOLLOWS:1. MENTAL HEALTH2. MATERNAL AND CHILD HEALTH3. ACCESS TO CARE (INCLUDES DENTAL AND MENTAL HEALTHCARE)4. CHRONIC DISEASES5. NUTRITION AND PHYSICAL HEALTH (OVERWEIGHT AND OBESITY)6. ACCESS TO CHILDCARE7. PREVENTIVE CARE AND PRACTICES (SCREENINGS, IMMUNIZATIONS/VACCINES, ETC.)8. SUBSTANCE USE (ALCOHOL AND DRUGS)9. COVID-1910. ADVERSE CHILDHOOD EXPERIENCES11. HOUSING AND HOMELESSNESS12. TOBACCO AND NICOTINE13. ECONOMIC STABILITY14. EDUCATION15. ENVIRONMENTAL CONDITIONS (WATER AND AIR)16. FOOD INSECURITY17. TRANSPORTATION18. INTERNET ACCESS19. CRIME AND VIOLENCE20. HIV/AIDS AND STISIMPLEMENTATION STRATEGY:THE 2022 CHNA FINDINGS WERE USED TO SELECT THE PRIORITY HEALTH NEEDS THAT WILL BE ADDRESSED DURING THE FISCAL YEARS 2023-2025. THE DATA COLLECTED IN THE CHNA PROCESS WERE USED TO IDENTIFY POOR HEALTH OUTCOMES, HEALTH DISPARITIES, HEALTH TRENDS AND COMMUNITY PRIORITIES. TO BE SELECTED AS A PRIORITY HEALTH NEED, THE LOCAL DATA HAD TO SHOW A NEED WHEN COMPARED TO STATE AND NATIONAL DATA, AND THE COMMUNITY HAD TO RANK THE HEALTH NEED AS A PRIORITY. THE LIST OF 2023-2025 PRIORITY HEALTH NEEDS WAS FINALIZED BY REVIEWING THE FOCUS AREAS FROM THE PREVIOUS IMPLEMENTATION STRATEGY AND CHS' CAPACITY TO ADDRESS EACH HEALTH NEED.FROM THE SIGNIFICANT HEALTH NEEDS IDENTIFIED AND RANKED BY THE CHNA, CHS CHOSE HEALTH NEEDS THAT CONSIDERED THE HEALTH SYSTEM'S CAPACITY TO ADDRESS COMMUNITY NEEDS, THE STRENGTH OF COMMUNITY PARTNERSHIPS AND THOSE NEEDS THAT CORRESPOND WITH THE HEALTH SYSTEM'S PRIORITIES. THIS IMPLEMENTATION STRATEGY EXPLAINS HOW CHS PLANS TO ADDRESS THE SELECTED PRIORITY HEALTH NEEDS IDENTIFIED BY THE CHNA.THE FIVE PRIORITY HEALTH NEEDS THAT WILL BE ADDRESSED IN THE 2023-2025 IMPLEMENTATION STRATEGY ARE THE FOLLOWING.

PART II:
HEALTH NEED 1 - ACCESS TO HEALTHCAREGOAL: INCREASE ACCESS TO HEALTHCARE SERVICES THROUGH PRIMARY CARE, PREVENTATIVE CARE AND SPECIALTY CARE SERVICES, INCLUDING HIV/AIDS/STIS, FOR MEDICALLY UNDERSERVED RESIDENTS.STRATEGIES: - PROVIDE HEALTH INSURANCE ENROLLMENT ASSISTANCE FOR PERSONS WHO ARE UNINSURED OR UNDERINSURED. - PROVIDE TRANSPORTATION SUPPORT TO INCREASE ACCESS RELATED TO HEALTHCARE SERVICES. - PARTNER WITH FAMILY HEALTH CARE NETWORK'S SPECIAL SERVICES CLINIC TO ADMINISTER THE FEDERAL RYAN WHITE HIV/AIDS PROGRAM AND PROVIDE HEALTHCARE AND CASE MANAGEMENT SERVICES FOR PATIENTS AND THEIR FAMILIES. - PROVIDE IN-HOSPITAL TESTING AND EXAMINATIONS FOR THOSE WHO HAVE EXPERIENCED SEXUAL ASSAULT AND RAPE THROUGH THE SEXUAL ASSAULT FORENSIC EXAMINERS (SAFE) PROGRAM. - OFFER EDUCATION AND ENVIRONMENTAL MODIFICATIONS TO REDUCE THE INCIDENCE OF INJURY, DISABILITY AND DEATH DUE TO TRAUMA THROUGH THE TRAUMA PREVENTION PROGRAM. - WORK IN COLLABORATION WITH COMMUNITY AGENCIES TO INCREASE ACCESS TO HEALTHCARE SERVICES, INCLUDING PRIMARY CARE, SPECIALTY CARE AND MENTAL HEALTH SERVICES. - PROVIDE CASH AND IN-KIND SUPPORT TO NONPROFIT COMMUNITY ORGANIZATIONS THAT PROVIDE PROGRAMS AND SERVICES TO EXPAND HEALTHCARE ACCESS.POPULATIONS:STRATEGIES WILL POSITIVELY IMPACT ALL RESIDENTS, BUT DATA SHOWS THESE POPULATIONS ARE MOST IN NEED: - INSURANCE: AMERICAN INDIAN AND ALASKAN NATIVE RESIDENTS, HISPANIC RESIDENTS, NATIVE - HAWAIIAN/PACIFIC ISLANDER CHILDREN, KINGS COUNTY CHILDREN AND TULARE COUNTY ADULTS - PRIMARY CARE: ASIAN AND MULTIRACIAL RESIDENTS, LOW-INCOME AND UNINSURED RESIDENTS - DENTAL CARE: CHILDREN AND TEENS, LOW-INCOME AND UNINSURED RESIDENTS - MENTAL HEALTHCARE: CHILDREN AND TEENS, AMERICAN INDIAN AND ALASKAN NATIVE, AND ASIAN RESIDENTS, LOW-INCOME AND UNINSURED RESIDENTS - UNMET NEED FOR MENTAL HEALTHCARE: MADERA COUNTY TEENS, FRESNO, KINGS AND TULARE COUNTY ADULTS, PEOPLE WITH MENTAL ILLNESS/MENTAL HEALTH CHALLENGES, PEOPLE WITH SUBSTANCE USE DISORDERS, THOSE EXPERIENCING GRIEF AND LOSS, LOW-INCOME AND UNINSURED RESIDENTS, LGBTQ+ RESIDENTS, FEMALES AND MULTIRACIAL RESIDENTSTHE CHS SERVICE AREA HAS LESS ACCESS TO ALL LISTED HEALTHCARE PROVIDERS THAN CALIFORNIA AS A WHOLE; ACCESS IS PARTICULARLY LOW IN MADERA, KINGS AND TULARE COUNTIES.DESIRED OUTCOMES: - INCREASE HEALTH INSURANCE COVERAGE FOR CHILDREN AND ADULTS - INCREASE YOUTH & ADULT PRIMARY, DENTAL AND MENTAL HEALTHCARE ACCESS - DECREASE UNTREATED YOUTH & ADULT MENTAL HEALTH CONDITIONSOVERALL IMPACT: - INCREASE ACCESS AND QUALITY OF CARE - INCREASE EARLY CHRONIC DISEASE DETECTION AND MANAGEMENT - INCREASE EQUITABLE HEALTH OUTCOMES - INCREASE SELF-RATED HEALTH

PART III, LINE 2:
ADJUSTMENT DUE TO THE PATIENT'S ABILITY TO PAY DUE TO A BANKRUPTCY ARE RECORDED AS BAD DEBT EXPENSE.

PART III, LINE 3:
CHS DOES NOT RECOGNIZE ANY PORTION OF ITS BAD DEBT EXPENSE AS A COMMUNITY BENEFIT.

PART III, LINE 4:
FOOTNOTE FOR BAD DEBT EXPENSE: SEE AUDITED FINANCIAL STATEMENTS NOTE 3, PAGE 17.FOOTNOTE FOR ACCOUNTS RECEIVABLE: SEE AUDITED FINANCIAL STATEMENTS NOTE 2, PAGE 12.

PART VI, LINE 2:
AS PART OF THE AFFORDABLE CARE ACT, THE ORGANIZATION PARTNERED WITH THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA AND MANY OTHER VALLEY HOSPITALS AS WELL AS LOCAL ORGANIZATIONS TO PUBLISH A COMMUNITY NEEDS ASSESSMENT IN 2022. ADDITIONALLY, EACH OF OUR THREE HOSPITALS DEVELOPED IMPLEMENTATION PLANS TO ADDRESS SOME OF THE KEY NEEDS IDENTIFIED IN THE REPORT.

PART VI, LINE 6:
N/A

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

PART II:
HEALTH NEED 2 - CHRONIC DISEASESGOAL: REDUCE THE IMPACT OF CHRONIC DISEASES ON HEALTH AND INCREASE THE FOCUS ON CHRONIC DISEASE PREVENTION AND TREATMENT, INCLUDING THROUGH NUTRITION AND PHYSICAL HEALTH.STRATEGIES: - PROVIDE DIABETES SELF-MANAGEMENT EDUCATION THROUGH THE COMMUNITY DIABETES EDUCATION (CDE) PROGRAM. - HOST THE SWEET SUCCESS PROGRAM, WHICH SUPPORTS WOMEN DIAGNOSED WITH DIABETES DURING PREGNANCY. - FACILITATE HEALTH EDUCATION WORKSHOPS AND PRESENTATIONS ON CHRONIC DISEASE PREVENTION, TREATMENT AND MANAGEMENT, INCLUDING PHYSICAL ACTIVITY, EXERCISE AND NUTRITION. - PARTICIPATE IN HEALTH AND WELLNESS FAIRS AND OFFER PREVENTIVE SCREENINGS. - PROVIDE PUBLIC HEALTH EDUCATION IN THE MEDIA AND AT COMMUNITY HEALTH AWARENESS EVENTS TO ENCOURAGE HEALTHY BEHAVIORS AND PREVENT CHRONIC DISEASES. - PROVIDE SUPPORT GROUPS TO ASSIST THOSE WITH CHRONIC DISEASES. - WORK IN COLLABORATION WITH COMMUNITY AGENCIES TO ADDRESS THE CAUSES AND MANAGEMENT OF CHRONIC DISEASES. - PROVIDE CASH AND IN-KIND SUPPORT TO NONPROFIT COMMUNITY ORGANIZATIONS THAT PROVIDE CHRONIC DISEASE-FOCUSED PROGRAMS AND SERVICES.POPULATIONS:STRATEGIES WILL POSITIVELY IMPACT ALL RESIDENTS, BUT DATA SHOWS THESE POPULATIONS ARE MOST IN NEED:ASIAN, AMERICAN INDIAN AND ALASKAN NATIVE, NATIVE HAWAIIAN/PACIFIC ISLANDER AND BLACK RESIDENTS, NON-BINARY INDIVIDUALS, MEN, TEENS AND OLDER ADULTS.MADERA COUNTY RESIDENTS (HEART DISEASE AND HYPERTENSION), KINGS COUNTY RESIDENTS (HEART DISEASE), TULARE COUNTY RESIDENTS (HYPERTENSION AND DIABETES), FRESNO COUNTY RESIDENTS (HYPERTENSION), OVERWEIGHT AND OBESE RESIDENTS, SEDENTARY RESIDENTS AND OLDER ADULTS.RISK FACTORS INCLUDE HISTORY, SMOKING/SMOKING EXPOSURE, UNHEALTHY DIET, SEDENTARY BEHAVIOR, OVERWEIGHT AND OBESITY, UNPROTECTED SEX, ALCOHOL USE, EXPOSURE TO CERTAIN ENVIRONMENTAL FACTORS, OLDER AGE, LACK OF ACCESS TO HEALTH CARE, LOW-INCOME (MORTALITY RATES), WHITE ETHNICITY (CANCER DIAGNOSIS) AND BLACK ETHNICITY (CANCER MORTALITY).RISK FACTORS INCLUDE FAMILY HISTORY, SMOKING/SMOKING EXPOSURE, EXPOSURE TO AIR POLLUTION, OVERWEIGHT AND OBESITY, OTHER ALLERGIC CONDITIONS, BLACK, AND AMERICAN INDIAN AND ALASKAN NATIVE ETHNICITY AND LOW-INCOME.OVERALL, RESIDENTS OF THE CHS SERVICE AREA HAVE LESS ACCESS TO EXERCISE OPPORTUNITIES, HEART DISEASE, DIABETES, CANCER AND ASTHMA.DESIRED OUTCOMES - INCREASE CHILD AND ADULT PHYSICAL ACTIVITY - INCREASE HEALTHY EATING - INCREASE ACCESS TO COMMUNITY HEALTH WORKERS (CHW)OVERALL IMPACT: - DECREASE CHRONIC DISEASE (HEART DISEASE, DIABETES, CANCER, ETC.) - INCREASE EARLY DETECTION AND MANAGEMENT OF THESE CONDITIONS - DECREASE MORTALITY RATES FROM THESE CONDITIONS - INCREASE QUALITY OF LIFE

PART II:
HEALTH NEED 5 - MENTAL HEALTHGOAL: INCREASE ACCESS TO MENTAL HEALTH SERVICES, INCLUDING ADVERSE CHILDHOOD EXPERIENCES (ACES) AND SUBSTANCE ABUSE, IN THE COMMUNITY.STRATEGIES: - HELP INDIVIDUALS AND FAMILIES CONNECT TO NEEDED RESOURCES (FOOD, HOUSING, NAVIGATING PARENTING, RELATIONSHIPS, ETC.) TO REDUCE MENTAL HEALTH CRISES. - PROVIDE APPROPRIATE MEDICATIONS IN THE EMERGENCY DEPARTMENTS TO SUPPORT PATIENTS EXPERIENCING WITHDRAWAL SYMPTOMS FROM SUBSTANCE ABUSE THROUGH THE BRIDGE PROGRAM. - OFFER COMMUNITY HEALTH EDUCATION, LECTURES, PRESENTATIONS AND WORKSHOPS FOCUSED ON MENTAL HEALTH TOPICS, INCLUDING ADVERSE CHILDHOOD EXPERIENCES (ACES), RELATIONAL HEALTH AND POSITIVE COPING SKILLS. - INCREASE ACCESS TO MENTAL HEALTH SCREENING, INCLUDING ACES SCREENING AND PSYCHOSOCIAL DISTRESS SCREENING. - WORK IN COLLABORATION WITH COMMUNITY AGENCIES TO INCREASE ACCESS TO MENTAL HEALTHCARE SERVICES, ADDRESS TRAUMA AND BUILD RESILIENCE. - PROVIDE CASH AND IN-KIND SUPPORT TO NONPROFIT COMMUNITY ORGANIZATIONS THAT PROVIDE MENTAL HEALTH SERVICES, PROGRAMS AND RESOURCES.POPULATIONS:STRATEGIES WILL POSITIVELY IMPACT ALL RESIDENTS, BUT DATA SHOWS THESE POPULATIONS ARE MOST IN NEED:PSYCHOLOGICAL DISTRESS AND ACCESS TO CARE: MADERA COUNTY TEENS, FRESNO, KINGS, AND TULARE COUNTY ADULTS, PEOPLE WITH MENTAL ILLNESS/MENTAL HEALTH CHALLENGES, PEOPLE WITH SUBSTANCE USE DISORDER, THOSE EXPERIENCING GRIEF AND LOSS, LOW-INCOME AND UNINSURED RESIDENTS, LGBTQ+ RESIDENTS, FEMALES AND MULTIRACIAL RESIDENTS.SUICIDE: FRESNO, KINGS, MADERA AND TULARE COUNTY YOUTH AND ADULTS, MEN, NON-HISPANIC WHITE RESIDENTS, OLDER ADULTS (65+), RESIDENTS WITH A HISTORY OF PSYCHOLOGICAL DISTRESS, SUICIDAL IDEATION, SELF-INFLICTED INJURY AND THOSE EXPERIENCING GRIEF AND LOSS.ACES: LOW-INCOME, FOOD INSECURE AND PRECARIOUSLY HOUSED RESIDENTS, AS WELL AS THOSE LIVING WITH MENTAL HEALTH AND SUBSTANCE USE CHALLENGES.DESIRED OUTCOMES - DECREASE PSYCHOLOGICAL DISTRESS - DECREASE MENTAL HEALTH HOSPITALIZATIONS - INCREASE ACCESS TO MENTAL HEALTHCARE SERVICES - DECREASE ACESOVERALL IMPACT: - INCREASE YOUTH & ADULT MENTAL HEALTH - INCREASE QUALITY OF LIFE - DECREASE SELF-HARM - DECREASE SUICIDE DEATHS

PART III, LINE 8:
MEDICARE SHORTFALL: THE MEDICARE SHORTFALL IS TREATED AS COMMUNITY BENEFIT BECAUSE: (1) NONNEGOTIABLE MEDICARE RATES ARE SOMETIMES OUT-OF-LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; AND (2) BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, HOSPITALS ALLEVIATE THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES.COSTING METHODOLOGY: INPATIENT CARE SERVICES, SKILLED NURSING SERVICES, REHABILITATION SERVICES, AND CERTAIN OUTPATIENT SERVICES RENDERED TO MEDICARE PROGRAM BENEFICIARIES ARE PAID AT PROSPECTIVELY DETERMINED RATES PER DIAGNOSIS. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. CERTAIN INPATIENT NONACUTE SERVICES AND MEDICAL EDUCATION COSTS RELATED TO MEDICARE BENEFICIARIES ARE PAID BASED ON A COST-BASED REIMBURSEMENT METHODOLOGY. PROFESSIONAL SERVICES ARE REIMBURSED BASED ON A FEE SCHEDULE.

PART II:
HEALTH NEED 3 - ECONOMIC STABILITYGOAL: INCREASE ACCESS TO RESOURCES TO ADDRESS HOMELESSNESS, CRIME AND VIOLENCE, FOOD INSECURITY AND ACCESS TO THE INTERNET.STRATEGIES: - CONNECT RESIDENTS TO LINGUISTICALLY AND CULTURALLY APPROPRIATE SERVICES, INCLUDING INTERNET ACCESS RESOURCES, HOUSING RESOURCES AND FOOD AVAILABILITY. - FACILITATE VIOLENCE PREVENTION AND FAMILY STABILIZATION INITIATIVES. - WORK IN COLLABORATION WITH COMMUNITY ORGANIZATIONS AND AGENCIES TO ADDRESS THE IMPACT THAT ECONOMIC STABILITY HAS ON HEALTH AND WELLNESS. - PROVIDE CASH AND IN-KIND SUPPORT TO NONPROFIT COMMUNITY ORGANIZATIONS THAT PROVIDE PROGRAMS AND SERVICES THAT ADDRESS FOOD INSECURITY, CRIME AND VIOLENCE, HOMELESSNESS AND INTERNET ACCESS.POPULATIONS:STRATEGIES WILL POSITIVELY IMPACT ALL RESIDENTS, BUT DATA SHOWS THESE POPULATIONS ARE MOST IN NEED OF SUPPORT WITH HOMELESSNESS, FOOD INSECURITY AND INTERNET ACCESS:THOSE WITH SEVERE MENTAL ILLNESS AND/OR CHRONIC SUBSTANCE USE DISORDER, THOSE EXPERIENCING CHRONIC HOMELESSNESS, SURVIVORS OF DOMESTIC VIOLENCE, VETERANS, YOUTH (AGES 18-24), PEOPLE LIVING WITH HIV/AIDS, BLACK, ASIAN, AND AMERICAN INDIAN AND ALASKAN NATIVE RESIDENTS BLACK, LATINO, ASIAN, AND AMERICAN INDIAN AND ALASKAN NATIVE RESIDENTS, RESIDENTS LIVING IN RURAL AREAS, TULARE COUNTY ADULTS, FRESNO COUNTY RESIDENTS (CHILDREN AND AVAILABILITY OF RESOURCES), MADERA COUNTY RESIDENTS (AVAILABILITY OF RESOURCES), FEMALE HEAD OF HOUSEHOLD (HOH) WITH CHILDREN UNDER 18, CHILDREN UNDER 18, YOUNGER ADULTS (18-39) AND OLDER ADULTS (80+)BLACK AND LATINO HOUSEHOLDS, RURAL HOUSEHOLDS, LOW-INCOME HOUSEHOLDS, LESS-EDUCATED HOUSEHOLDS, OLDER ADULTS (65+) AND RESIDENTS OF KINGS, MADERA AND TULARE COUNTIESDESIRED OUTCOMES: - INCREASE ACCESS TO HEALTHCARE, SOCIAL AND HOUSING SUPPORTS FOR HOMELESS POPULATION - INCREASE AVAILABILITY AND AFFORDABILITY OF HEALTHY FOODS NEIGHBORHOODS - INCREASE HOUSEHOLDS WITH BROADBAND INTERNET ACCESSOVERALL IMPACT: - DECREASE HOMELESSNESS (CHRONIC AND NONCHRONIC) - DECREASE PERCENTAGE OF CHILDREN AND ADULTS THAT ARE FOOD INSECURE - INCREASE EDUCATIONAL AND EMPLOYMENT OPPORTUNITIES AND OUTCOMES - INCREASE HEALTH OUTCOMESHEALTH NEED 4 - MATERNAL AND CHILD HEALTHGOAL: IMPROVE THE HEALTH OF NEW MOTHERS, INFANTS, ADOLESCENTS AND TEENS THROUGH PREVENTIVE AND POSTPARTUM PRACTICES.STRATEGIES: - PROVIDE COMMUNITY HEALTH PROMOTION AND EDUCATION PROGRAMS TARGETING MATERNAL, ADOLESCENT AND TEEN HEALTH ISSUES. - SUPPORT BREASTFEEDING INITIATIVES. - FACILITATE INCREASING ACCESS TO HPV VACCINATIONS AND HPV VACCINATION TRAINING. - ENCOURAGE SCREENINGS FOR DEVELOPMENTAL MILESTONES AND FOR PRENATAL AND POSTPARTUM DEPRESSION. - OFFER EDUCATION AND SUPPORT FOR PARENTS THROUGH COMMUNITY'S MOTHER'S RESOURCE CENTER. - WORK IN COLLABORATION WITH COMMUNITY AGENCIES AND HEALTHCARE PROVIDERS TO INCREASE ACCESS TO PRENATAL CARE, SAFE BIRTHING OPTIONS AND COMPREHENSIVE CHILD HEALTHCARE. - PROVIDE CASH AND IN-KIND SUPPORT TO NONPROFIT COMMUNITY ORGANIZATIONS THAT PROVIDE PROGRAMS AND SERVICES TO IMPROVE MATERNAL AND CHILD HEALTH.POPULATIONS:STRATEGIES WILL POSITIVELY IMPACT ALL RESIDENTS, BUT DATA SHOWS THESE POPULATIONS ARE MOST IN NEED:PRETERM BIRTH AND INFANT MORTALITY: FRESNO, KINGS AND TULARE COUNTY RESIDENTS, BLACK AND AMERICAN INDIAN AND ALASKAN NATIVE RESIDENTS, LOW-INCOME RESIDENTS, TEEN AND OLDER (40+) BIRTHING PERSONSMATERNAL MORBIDITY AND MORTALITY: RESIDENTS OF ALL CHS SERVICE AREA COUNTIES (MORTALITY RATE FOR REGION IS HIGHEST IN CALIFORNIA), PREGNANCIES WITH COMORBIDITIES, OLDER PREGNANT PEOPLE (35+),THOSE LIVING WITH OBESITY, THOSE WHO HAVE PUBLIC OR NO INSURANCE, LOW-INCOME RESIDENTS, LOWEDUCATION RESIDENTS AND BLACK RESIDENTSBREASTFEEDING: ASIAN, MULTIRACIAL AND BLACK PARENTS, PARENTS WITH BARRIERS TO BREASTFEEDING (I.E., WORK SCHEDULE, MENTAL AND PHYSICAL HEALTH CHALLENGES, LACK OF EDUCATION) INFANT AND CHILD HEALTH: VARIOUS GROUPS OF INFANTS, CHILDREN AND TEENS WILL BENEFIT, INCLUDING LOW INCOME AND UNINSURED RESIDENTS, AND RESIDENTS OF KINGS, MADERA AND TULARE COUNTIES IN PARTICULARDESIRED OUTCOMES: - INCREASE ACCESS TO EARLY AND COMPREHENSIVE PRENATAL CARE - INCREASE ACCESS TO INNOVATIVE, CULTURALLY AND LINGUISTICALLY APPROPRIATE BIRTHING PRACTICES, BREASTFEEDING AND SAFE SLEEP EDUCATION - INCREASE HEALTHY BEHAVIORS IN CHILDREN AND YOUTH - INCREASE RESOURCES FOR MOTHERS AND PARENTSOVERALL IMPACT: - INCREASE INFANT AND CHILD HEALTH - DECREASE MATERNAL MORBIDITY AND MORTALITY - DECREASE PRETERM BIRTHS - DECREASE INFANT MORTALITY - DECREASE PREMATURE DEATH AND DISABILITY

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THOSE PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE GENERALLY SUBJECT TO THE NORMAL COLLECTION PROCEDURES FOR ALL PATIENTS. THE FOLLOWING SPECIAL CIRCUMSTANCES MAY APPLY: COMMUNITY HEALTH SYSTEM (CHS) MAY EMPLOY REASONABLE COLLECTION EFFORTS TO OBTAIN PAYMENT FROM PATIENTS. GENERAL COLLECTION ACTIVITIES MAY INCLUDE ISSUING PATIENT STATEMENTS, PHONE CALLS, AND FOLLOW UP LETTERS SENT TO THE PATIENT OR GUARANTOR. CHS SHALL NOT PURSUE COLLECTIONS AND EXTRAORDINARY COLLECTION ACTIONS WHEN: THE PATIENT IS A RYAN WHITE PATIENT, THE PATIENT IS HOMELESS, THE PATIENT HAS SUBMITTED AN APPLICATION FOR FINANCIAL ASSISTANCE AND/OR GOVERNMENT SPONSORED COVERAGE AND THE APPLICATION IS PENDING, CHS IS AWARE THAT THE PATIENT IS ALREADY APPROVED FOR FINANCIAL ASSISTANCE, AND THE PATIENT IS REASONABLY COOPERATING WITH CHS IN AN EFFORT TO SETTLE AN OUTSTANDING BILL. CHS WILL MAKE REASONABLE EFFORTS TO NOTIFY THE PATIENT PRIOR TO ENGAGING IN ANY EXTRAORDINARY COLLECTION ACTIONS. THESE ACTIONS WILL ONLY TAKE PLACE AFTER 150 DAYS FROM THE INITIAL PATIENT STATEMENT. ALL PATIENT STATEMENTS SHALL INCLUDE THE NOTICE OF RIGHTS, WHICH INCLUDES A SUMMARY OF FINANCIAL ASSISTANCE THAT IS AVAILABLE TO ELIGIBLE PATIENTS. ALL PATIENTS MAY REQUEST AN ITEMIZED STATEMENT FOR THEIR ACCOUNT AT ANY TIME.

PART II:
COLLABORATE WITH THE COMMUNITY:IN FALL 2022, CHS AND SEVERAL COMMUNITY PARTNERS MET TO DISCUSS AND VALIDATE THE PRIORITY HEALTH NEEDS THAT THE HEALTH SYSTEM WILL FOCUS ON DURING THE 2023-2025 CYCLE. MOST IMPORTANTLY, CHS AND OUR COMMUNITY PARTNERS SELECTED STRATEGIES THAT WILL BE USED TO ADDRESS THE PRIORITY HEALTH NEEDS. THE STRATEGIES ON THE PREVIOUS PAGES WERE SELECTED AT THAT MEETING AND REFLECT THE EFFORTS BY NOT ONLY CHS BUT ALSO THE PARTNERSHIP OF MANY ORGANIZATIONS IN THE COMMUNITY. THE MEETING RESULTED IN SPECIFIC STRATEGIES THAT THE PARTNERS WILL CONDUCT TO WORK TOGETHER TO ADDRESS THE PRIORITY HEALTH NEEDS OF THE CHS SERVICE AREA.DEVELOP AND ADOPT:IN COMPLIANCE WITH THE IRS REGULATIONS 501(R) FOR CHARITABLE HOSPITALS, A HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND AN IMPLEMENTATION STRATEGY (WRITTEN PLAN) ARE TO BE MADE WIDELY AVAILABLE TO THE PUBLIC AND PUBLIC COMMENT IS TO BE SOLICITED. THESE REPORTS ARE POSTED ON THE CHS WEBSITE:HTTPS://WWW.COMMUNITYMEDICAL.ORG/ABOUT-US/COMMUNITY-BENEFITTHE 2023-2025 IMPLEMENTATION STRATEGY REPORT WAS ADOPTED BY CHS LEADERSHIP BEFORE JANUARY 15, 2023.OTHER HEALTH NEEDS NOT PRIMARILY ADDRESSED:COMMUNITY IS DEDICATED TO ENSURING THE REGION'S IDENTIFIED HEALTH NEEDS ARE ADDRESSED WHENEVER POSSIBLE. TAKING INTO CONSIDERATION OUR EXISTING HEALTH SYSTEM AND COMMUNITY RESOURCES, CHS WILL PRIMARILY FOCUS OUR RESOURCES ON THE FIVE PREVIOUSLY IDENTIFIED HEALTH NEEDS AND WILL NOT PRIMARILY ADDRESS THE OTHER NEEDS IDENTIFIED IN THE CHNA INCLUDING CHILD CARE, EDUCATION, TOBACCO/NICOTINE AND TRANSPORTATION. CHS DOES NOT INTEND TO DIRECTLY EMPHASIZE ENVIRONMENTAL CONDITIONS OUTSIDE OF THE ONGOING EFFORTS TO IDENTIFY INNOVATIVE WAYS TO REDUCE AND RECYCLE CLINICAL AND NONCLINICAL WASTE AND UTILIZE RECLAIMED WATER FOR LANDSCAPING IRRIGATION. ADDITIONALLY, CHS DOES NOT INTEND TO SPECIFICALLY EMPHASIZE COVID-19 INTERVENTIONS BUT WILL CONTINUE TO DELIVER ACUTE MEDICAL CARE AND BE A COMMUNITY RESOURCE FOR COVID-19. CHS WILL STRIVE TO IMPACT THE OTHER IDENTIFIED HEALTH NEEDS AS THEY FALL WITHIN OUR AREAS OF FOCUS AND EXPERTISE AND AS RESOURCES ALLOW. WE WILL CONTINUE TO LOOK FOR OPPORTUNITIES TO PARTNER WITH OTHER ORGANIZATIONS THAT ARE ADDRESSING THESE NEEDS WHERE WE CAN MAKE A MEANINGFUL CONTRIBUTION.THE IMPLEMENTATION STRATEGY WILL BE SUSTAINED BY THE CONTINUOUS COLLABORATION BETWEEN CHS AND COMMUNITY PARTNER RELATIONSHIPS DURING THE 2023-2025 CYCLE.UPDATE AND SUSTAIN:CHS CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY PROCESS EVERY THREE YEARS. HOWEVER, THE IMPLEMENTATION STRATEGY MAY NEED TO BE UPDATED BASED ON CHANGING COMMUNITY NEEDS AND PRIORITIES, CHANGES IN HEALTH SYSTEM RESOURCES AND EVALUATION RESULTS. THE IMPLEMENTATION STRATEGY IS NOT STATIC AND CAN CHANGE AT ANY TIME WITHIN THE CYCLE. REVIEWS AND UPDATES OF THE IMPLEMENTATION STRATEGY SHOULD BE A PART OF THE HEALTH SYSTEM'S OVERALL PLANNING. CHS WILL ACCOMPLISH THIS BY REGULARLY COMMUNICATING WITH COMMUNITY PARTNERS AND REVISITING THE IMPLEMENTATION STRATEGY ON A REGULAR BASIS.EVALUATION OF IMPACT:COMMUNITY HEALTH SYSTEM WILL MONITOR AND EVALUATE THE PROGRAMS AND ACTIONS OUTLINED ABOVE. THE HEALTH SYSTEM ANTICIPATES THE ACTIONS TAKEN TO ADDRESS SIGNIFICANT HEALTH NEEDS WILL IMPROVE HEALTH KNOWLEDGE, BEHAVIORS, AND STATUS, INCREASE ACCESS TO CARE, AND OVERALL HELP SUPPORT GOOD HEALTH. THE HEALTH SYSTEM IS COMMITTED TO MONITORING KEY INDICATORS TO ASSESS IMPACT. OUR REPORTING PROCESS INCLUDES THE COLLECTION AND DOCUMENTATION OF TRACKING MEASURES, SUCH AS THE NUMBER OF PEOPLE REACHED/SERVED AND COLLABORATIVE EFFORTS TO ADDRESS HEALTH NEEDS.TO DEMONSTRATE THE CHS COMMITMENT TO INVESTING IN THE GROWING HEALTH NEEDS OF THE REGION, A STATE-MANDATED COMMUNITY BENEFIT REPORT IS SUBMITTED ANNUALLY. FINALLY, A REVIEW OF THE IMPACT OF THE HEALTH SYSTEM'S ACTIONS TO ADDRESS THESE PRIORITY HEALTH NEEDS WILL BE REPORTED IN THE NEXT SCHEDULED CHNA.IMPLEMENTATION STRATEGY FINAL NOTES:THE 2023-2025 IMPLEMENTATION STRATEGY IS NOT INTENDED TO BE A COMPREHENSIVE CATALOG OF ALL THE WAYS THAT THE HEALTH NEEDS OF THE COMMUNITY ARE ADDRESSED BY THE HEALTH SYSTEM. RATHER, IT IS A REPRESENTATION OF SPECIFIC STRATEGIES, ACTIONS AND ACTIVITIES THAT CHS AND ITS COMMUNITY PARTNERS COMMIT TO UNDERTAKING AND MONITORING AS THEY RELATE TO EACH IDENTIFIED PRIORITY HEALTH NEED.

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COMMUNITY HEALTH SYSTEM (CHS) SHALL WIDELY PUBLICIZE THE FINANCIAL ASSISTANCE POLICY IN A MANNER THAT IS REASONABLY CALCULATED TO REACH, NOTIFY AND INFORM THOSE PATIENTS IN OUR COMMUNITIES WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE, INCLUDING AT A MINIMUM, THE FOLLOWING WAYS: PUBLIC DISPLAYS: COMMUNITY MEDICAL CENTERS SHALL CLEARLY AND CONSPICUOUSLY POST PUBLIC DISPLAYS (OR OTHER MEASURES REASONABLY CALCULATED TO ATTRACT PATIENTS' ATTENTION) THAT NOTIFY AND INFORM PATIENTS ABOUT THIS POLICY IN PUBLIC LOCATIONS AT CHS INCLUDING, AT A MINIMUM, THE EMERGENCY DEPARTMENT, BILLING OFFICE, ADMISSIONS OFFICE, AND OUTPATIENT SETTINGS, INCLUDING OBSERVATION UNITS. THESE SHALL BE POSTED IN ENGLISH, SPANISH, AND HMONG. WEBSITE: THE FINANCIAL ASSISTANCE POLICY, APPLICATION FOR FINANCIAL ASSISTANCE, AND PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY SHALL BE AVAILABLE ON THE HOME PAGE AND MAIN BILLING PAGE, AS WELL AS OTHER PROMINENT PLACES ON CHS' WEBSITE, HTTPS://WWW.COMMUNITYMEDICAL.ORG/FOR-PATIENTS-FAMILIES/BILLING-INSURANCE/FINANCIAL-ASSISTANCE. PERSONS SEEKING INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL NOT BE REQUIRED TO CREATE AN ACCOUNT OR PROVIDE ANY PERSONAL INFORMATION BEFORE RECEIVING INFORMATION ABOUT FINANCIAL ASSISTANCE. MAIL: PATIENTS MAY REQUEST A FREE COPY OF THE FINANCIAL ASSISTANCE POLICY, APPLICATION FOR FINANCIAL ASSISTANCE AND PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY BE SENT BY MAIL.OTHER EFFORTS: CHS WILL PROVIDE A DIGITAL KIT TO RELEVANT COMMUNITY ORGANIZATIONS WHO WILL WIDELY PUBLICIZE THE AVAILABILITY OF THIS POLICY TO AFFECTED PATIENTS IN THE COMMUNITY. CHS OR AN AUTHORIZED REPRESENTATIVE SHALL PROVIDE ALL PATIENTS WITH A COPY OF A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WHICH ADVISES THE PATIENT OF THE MAXIMUM GROSS MONTHLY HOUSEHOLD INCOME PER FAMILY SIZE TO QUALIFY FOR FINANCIAL ASSISTANCE AS FOLLOWS: - AT REGISTRATION: DURING REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE). - EMERGENCY SERVICES: IN THE CASE OF EMERGENCY SERVICES, AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. - OUTPATIENT SERVICES: AT THE OUTPATIENT APPOINTMENT BEFORE THE PROCEDURE TAKES PLACE. - AT DISCHARGE: AT THE TIME OF DISCHARGE, WHEN CHS OR AN AUTHORIZED REPRESENTATIVE OF CHS SHALL ALSO PROVIDE OR OFFER TO PROVIDE ALL UNINSURED PATIENTS APPLICATIONS FOR MEDI-CAL, CALIFORNIA CHILDREN'S SERVICES OR ANY OTHER POTENTIALLY APPLICABLE GOVERNMENT PROGRAM. FOR NOTICES PROVIDED PURSUANT TO SECTION IV.G.2.A.2 AND A.3, THE PLAIN LANGUAGE SUMMARY WILL BE PROVIDED TO PATIENTS WHO ARE CONSCIOUS. IF THE PATIENT IS UNCONSCIOUS OR NOT ABLE TO RECEIVE THE PLAIN LANGUAGE SUMMARY, THEN THE NOTICE MUST BE PROVIDED AT DISCHARGE. FOR PATIENTS NOT ADMITTED TO CHS, THE PLAIN LANGUAGE SUMMARY WILL BE PROVIDED WHEN THE PATIENT IS LEAVING THE FACILITY. IF A PATIENT LEAVES CHS WITHOUT RECEIVING THE PLAIN LANGUAGE SUMMARY, CHS WILL MAIL THE NOTICE TO THE PATIENT WITHIN SEVENTY-TWO (72) HOURS OF PROVIDING THE SERVICES.

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SERVICE AREA: COMMUNITY HEALTH SYSTEMS (CHS) IS HEADQUARTERED IN FRESNO, PROVIDING THE SAN JOAQUIN VALLEY WITH ACUTE CARE, OUTPATIENT CENTERS, CLINICS, HOME CARE, COMMUNITY EDUCATION, PHYSICIAN GROUPS AND A PHYSICIAN RESIDENCY PROGRAM IN CONJUNCTION WITH THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO (UCSF). WITH MORE THAN 11,000 EMPLOYEES, 1,997 AFFILIATED MEDICAL PROVIDERS AND OVER 300 VOLUNTEERS, CHS HAS A 15,000-SQUARE-MILE PRIMARY SERVICE AREA. THAT INCLUDES FRESNO, MADERA, KINGS, TULARE AND MARIPOSA COUNTIES. THE AREA IS AS LARGE AS RHODE ISLAND, CONNECTICUT AND NEW JERSEY COMBINED. CHS ALSO OPERATES THE ONLY COMBINED BURN AND LEVEL 1 TRAUMA UNITS BETWEEN LOS ANGELES AND SACRAMENTO, PROVIDING CRITICAL CARE AND OTHER SPECIALTY SERVICES TO PATIENTS FROM WELL OUTSIDE THE PRIMARY SERVICE REGION. THOSE UNITS ARE LOCATED AT COMMUNITY REGIONAL MEDICAL CENTER (COMMUNITY REGIONAL), WHICH ALSO OPERATES ONE OF THE BUSIEST HOSPITAL EMERGENCY DEPARTMENTS IN THE NATION. CHS CURRENTLY SERVES A POPULATION OF APPROXIMATELY 1.8 MILLION.BOARD OF TRUSTEES: CHS IS GOVERNED BY A VOLUNTEER BOARD OF TRUSTEES COMPRISED OF LOCAL CIVIC LEADERS AND PHYSICIANS. THE TRUSTEES PROVIDE VISION AND POLICY DIRECTION. THIS PROCESS INCLUDES AN ANNUAL REVIEW OF THE PRIOR FISCAL YEAR AND A COMMUNITY-NEEDS EVALUATION TO PRIORITIZE OPERATIONAL ISSUES AND PROVIDE DIRECTION. THE CORPORATE BOARD IS ALSO ACTIVELY INVOLVED IN APPROVING FISCAL APPROPRIATIONS FOR COMMUNITY BENEFITS PROGRAMS, OUTREACH SERVICES AND EDUCATION, AS WELL AS TRADITIONAL CHARITY CARE AND UNPAID COSTS OF PUBLIC PROGRAMS FOR THE MEDICALLY UNDERSERVED. CORPORATE BOARD MEMBERS, PHYSICIANS AND COMMUNITY'S LEADERSHIP TEAM HAVE HELPED IDENTIFY AND FUND COMMUNITY BENEFITS PROGRAMS.

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COMMUNITY HEALTH SYSTEM'S COMMITMENT TO OUR COMMUNITY IS DEMONSTRATED AT EVERY LEVEL OF THE ORGANIZATION. EVIDENCE OF OUR MISSION IS THE CONTINUAL INVESTMENT IN IMPROVING THE HEALTH OF THOSE WE SERVE AND IN OUR WORKFORCE OF MORE THAN 13,000 EMPLOYEES, PHYSICIANS AND VOLUNTEERS. AN INTEGRAL PART OF OUR MISSION IS OUR PATIENT POPULATION THAT INCLUDES MORE THAN 59,000 ADMISSIONS, 218,000 OUTPATIENT VISITS AND 176,000 EMERGENCY DEPARTMENT VISITS EQUALING MORE THAN 453,000 PATIENTS TO WHOM WE PROVIDED QUALITY MEDICAL CARE. OVER THE PAST TWO DECADES, NO OTHER HOSPITAL ORGANIZATION IN THE SAN JOAQUIN VALLEY HAS INVESTED MORE TO ENSURE HEALTHCARE ACCESS TO ALL PEOPLE OF THIS GROWING REGION.CHS STRIVES TO BRING PEOPLE AND ORGANIZATIONS TOGETHER TO IMPROVE COMMUNITY WELLNESS. THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IS ONE WAY WE CAN LIVE OUT OUR MISSION. TO FULFILL THIS MISSION, WE MUST BE INTENTIONAL ABOUT UNDERSTANDING THE HEALTH ISSUES THAT IMPACT RESIDENTS AND WORK TOGETHER TO CREATE A HEALTHY COMMUNITY.A PRIMARY COMPONENT OF CREATING A HEALTHY COMMUNITY IS ASSESSING THE NEEDS AND PRIORITIZING THOSE NEEDS FOR IMPACT. IN 2021 AND 2022, COMMUNITY HEALTH SYSTEM CONDUCTED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY PRIMARY HEALTH ISSUES, CURRENT HEALTH STATUS AND OTHER HEALTH NEEDS. THE RESULTS FROM THE ASSESSMENT PROVIDE CRITICAL INFORMATION TO GUIDE US IN MAKING A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. THE RESULTS ALSO ENABLE COMMUNITY HEALTH SYSTEM TO MEASURE IMPACT AND STRATEGICALLY ESTABLISH PRIORITIES TO DEVELOP INTERVENTIONS AND ALIGN RESOURCES.A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS A TOOL THAT IS USED TO GUIDE COMMUNITY BENEFIT ACTIVITIES AND SEVERAL OTHER PURPOSES. FOR HOSPITALS, IT IS USED TO IDENTIFY AND ADDRESS KEY HEALTH NEEDS AND SUPPORTS THE DEVELOPMENT OF COMMUNITY BENEFIT PLANS MANDATED BY THE STATE OF CALIFORNIA AND THE FEDERAL GOVERNMENT. THE DATA FROM A CHNA IS FURTHERMORE USED TO INFORM COMMUNITY DECISION-MAKING, THE PRIORITIZATION OF HEALTH NEEDS AND THE DEVELOPMENT, IMPLEMENTATION AND EVALUATION OF AN IMPLEMENTATION PLAN OR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP).THE CHNA IS AN IMPORTANT PIECE IN THE DEVELOPMENT OF AN IMPLEMENTATION STRATEGY/CHIP BECAUSE IT HELPS THE COMMUNITY TO UNDERSTAND THE HEALTH-RELATED ISSUES THAT NEED TO BE ADDRESSED. TO IDENTIFY AND ADDRESS THE CRITICAL HEALTH NEEDS OF THE REGION, COMMUNITY HEALTH SYSTEM UTILIZED THE MOST CURRENT AND RELIABLE INFORMATION FROM EXISTING SOURCES AND THEN COLLECTED NEW DATA THROUGH INTERVIEWS, FOCUS GROUPS AND SURVEYS WITH COMMUNITY RESIDENTS AND LEADERS.