4A (Expenses $ 133028447 including grants of $ 0) (Revenue $ 166278955)
"IN 2021, OLEAN GENERAL HOSPITAL (OGH) DISCHARGED APPROXIMATELY 8,100 PATIENTS AND PROVIDED SERVICES TO APPROXIMATELY 305,000 OUTPATIENT VISITORS.THE OGH CAMPUS IN OLEAN, NY INCLUDES 186 PATIENT ROOMS, TOGETHER WITH COMPREHENSIVE PATIENT, ADMINISTRATIVE AND PHYSICIAN SERVICES AND ACCOMMODATIONS TO MEET THE DIAGNOSTIC, TREATMENT, ADMINISTRATIVE AND EDUCATIONAL NEEDS OF ITS PATIENTS AND MEDICAL STAFF. THE BRMC CAMPUS INCLUDES 50 PATIENT ROOMS AND 95 SKILLED NURSING BEDS. OGH OFFERS PATIENTS AND THEIR FAMILIES A FULL RANGE OF DIAGNOSTIC AND MEDICAL SERVICES, AS WELL AS MANY SPECIALTY SERVICES. A WIDE ARRAY OF MULTI-SPECIALTY PHYSICIANS AND CLINICIANS OFFER SERVICES RANGING FROM CANCER, CARDIAC AND VASCULAR CARE, OB/GYN, GENERAL SURGERY, UROLOGY, WOMEN'S HEALTH, INTERNAL MEDICINE, PEDIATRICS, SLEEP MEDICINE, AND PSYCHIATRIC CARE.2021 WAS A DIFFICULT YEAR TO ACCOMPLISH ""NORMAL"" IMPROVEMENTS AND PROGRAM ACCOMPLISHMENTS AS A RESULT OF THE CONTINUED COVID 19 PANDEMIC. THERE ARE COUNTLESS STORIES OF HEROIC DEEDS BY MANY OF OUR HEALTHCARE WORKERS WHICH MADE A DIFFERENCE IN OUR PATIENTS' LIVES AS WELL AS SIMPLY JUST SAVING LIVES. OUR GREATEST ACCOMPLISHMENT IN 2021 WAS THE CONTINUED EFFORTS AROUND THE PANDEMIC. BELOW WE ALSO HIGHLIGHT A FEW TRADITIONAL AREAS OF FOCUS AT OGH RELATIVE TO OUR ACCOMPLISHMENTS IN 2021.SOME OF THE INITIATIVES THAT WERE REALIZED IN 2021 AT OGH:- PROVIDER RECRUITMENT IS CRITICAL TO OFFER EXISTING AND EXPANDED SERVICES AT A HEALTH SYSTEM. DURING 2021, OGH WAS SUCCESSFUL IN RECRUITING AND PROGRAM DEVELOPMENT IN THE FOLLOWING AREAS:- PRIMARY CARE - HIRED 3 MID-LEVEL PRACTITIONERS;- ORTHOPEDICS - HIRED 2 PHYSICIANS;- UROLOGY - HIRED 1 PHYSICIAN;- GENERAL SURGERY - HIRED 1 PHYSICIAN2021 FINANCIAL PERFORMANCE OLEAN GENERAL HOSPITAL (OGH) REPORTED A NET GAIN OF $1,395,000 FOR 2021 WHICH RESULTS WERE VERY NEGATIVELY IMPACTED BY THE COVID 19 PANDEMIC. REVENUE WAS OVER BUDGET BY $3,900,000 AND EXPENSES WERE OVER BUDGET BY ($10,000,000). STIMULUS FUNDING OF APPROXIMATELY $8,700,000 WAS RECEIVED AGAINST THE 2021 COVID 19 LOSS.DURING 2021 THE IMPLEMENTATION OF THE 2020 FINANCIAL IMPROVEMENT WAS EXECUTED, THE PLAN INCLUDED 17 IMPROVEMENT PROJECTS AND HAS AN ESTIMATED IMPROVEMENT VALUE OF OVER $11,000,000 ANNUALLY AFTER FULL IMPLEMENTATION IN 2023.DURING 2021 QUALITY MATTERS OLEAN GENERAL HOSPITAL (OGH) DEVELOPED A QUALITY IMPROVEMENT PLAN. WHILE 2021 WAS NO DIFFERENT THAN ANY OTHER PLANNING YEAR, THE COVID 19 PANDEMIC FORCED OGH TO FOCUS INTERNALLY ON PLANNING OF POTENTIAL DISASTERS AND ULTIMATELY TAKING CARE OF LARGE NUMBERS OF COVID 19 INFECTED PATIENTS. THIS STALLED A NUMBER OF QUALITY IMPROVEMENT INITIATICES. DESPITE THAT IMPACT, SEVERAL PROJECTS WERE PURSUED DURING 2021 INCLUDING:- DEVELOPED PLANS TO IMPROVE HCAHPS SCORES THROUGH: ORGANIZING THE PATIENT EXPERIENCE COMMITTEE; LEADERSHIP ROUNDING ON FLOORS; INCREASED AWARENESS OF ALL LELVELS OF STAFF ON IMPORTANCE OF CUSTOMER SATISFACTION; FOCUS ON ""COMMIT TO SIT"" PROGRAM AS WELL AS ANSWERING PATIENT CALL BELLS ON A MORE TIMELY BASIS; IMPROVE DISCHARGE INSTRUCTIONS AND PATIENT UNDERSTANDING; IMPROVE BAR CODE MEDICATION SCANNING; IMPROVE PATIENT MED RECONCILIATIONS TO 95% OF ALL PATIENTS; REDUCE OR ELIMINATE STAGE 1, II, AND III PRESSURE ULCERS.DURING 2021 INFORMATION TECHNOLOGY MATTERS:- DEVELOPED AND PROVIDED CHARGE PROCEDURE AND CLAIM DATA TO MEET THE CMS HOSPITAL PRICE TRANSPARENCY RULE.- UPGRADED INTERFACE ENGINE TO THE LATEST VERSION OF CLOVERLEAF, REDESIGN OF ALL BILLING FEEDS TO ELIMINATE POTENTIAL DUPLICATION OF CHARGES.- COMPLETED THE FULL DISASTER RECOVERY TEST FOR THE LEAPFROG INITIATIVE, WHICH ALSO SATISFIED THE ANNUAL RISK ASSESSMENT REQUIREMENTS.- IMPLEMENTED EMOPTI TELE-HOSPITALISTS PROGRAM WHICH ALLOWED FOR REMOTE ACCESS BY PROVIDERS.- INTERQUAL UPGRADE FOR THE CARE MANAGEMENT TEAM.- INSTALLED PHILIPS RESPIRONICS AT THE BRMC SLEEP LAB.- IMPLEMENTED THE NEW PROVATION ENDO SYSTEM FOR OUTPATIENT SURGERY CENTER.- INSTALL/UPGRADE TO THE PATHOLOGY WINSURGE SYSTEM."

OLEAN GENERAL HOSPITAL
PART V, SECTION B, LINE 5: OLEAN GENERAL HOSPITAL AND BRADFORD REGIONAL MEDICAL CENTER ARE A MERGED ORGANIZATION. HOWEVER, THE TWO CAMPUSES HAVE BEEN CONDUCTING INDEPEDENT COMMUNITY HEALTH NEEDS ASSESSMENTS AND COMMUNITY HEALTH IMPROVEMENT PLANS OVER THEIR HISTORIES. THE TWO CAMPUSES ARE IN SEPERATE STATES AND THE SERVICE NEEDS BETWEEN THE TWO SERVICE AREAS ARE DIFFERENT, A DECISION WAS MADE TO CONTINUE TO CONDUCT SEPARATE CHNAS FOR THE TWO CAMPUSES. STARTING IN 2021, CHNAS WILL BE A SINGLE DOCUMENT REPRESENTING BOTH FACILITIES.IN ADDITION, THE THREE-YEAR CYCLES OF THE TWO HOSPITALS ARE DIFFERENT. OLEAN GENERAL HOSPITAL APPROVED ITS MOST RECENT CHNA IN AUGUST 2019. THE LATEST CHNA FOR THE BRADFORD REGIONAL MEDICAL CENTER WAS COMPLETED IN DECEMBER 2018. CHNAS FOR BOTH HOSPITALS APPEAR ON THE WEBSITE FOR OLEAN GENERAL HOSPITAL AND BRADFORD REIOGNAL MEDICAL CENTER (WWW.BRMC-OGH.ORG). OLEAN GENERAL HOSPITAL - THE 2019-2021 CATTARAUGUS COUNTY COMMUNITY SERVICE PLAN (CSP) AND COMMUNITY HEALTH ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHA-CHIP) WERE DEVELOPED IN PARTNERSHIP BETWEEN OLEAN GENERAL HOSPITAL (OGH), WHICH IS PART OF THE UPPER ALLEGHENY HEALTH SYSTEM (UAHS) AND THE CATTARAUGUS COUNTY HEALTH DEVELOPMENT (CCHD). STRATEGY SOLUTIONS, INC. (SSI) WAS ENGAGED BY CCHD AND OGH TO ASSIST WITH THE ASSESSMENT. REPRESENTATIVES FROM OGH AND CCHD WORKED COLLABORATIVELY TO GUIDE AND CONDUCT THE ASSESSMENT. A STEERING COMMITTEE MADE UP OF SENIOR LEADERS OF UAHS, OGH, CCHD, AND RESPRESENTATIVES FROM THE CATTARAUGUS COUTNY HEALTHY LIVABLE COMMUNITIES CONSORTIUM, WHICH INCLUDES LEADING HEALTH AND SOCIAL SERVICE ORGANIZATIONS AND MUNICIPALITIES, PROVIDED ADDITIONAL INPUT. THE COMBINED EXPERTISE, INPUT AND KNOWLEDGE OF THE MEMBERS OF THE STEERING COMMITTEE WAS VITAL TO THE PROJECT. THIS GROUP DESERVES SPECIAL RECOGNITION FOR THEIR TIRELESS OVERSIGHT AND SUPPORT OF THE CSP/CHA-CHIP PROCESS. DURING THE CSP/CHA-CHIP PROJECT, TEN (10) STAKEHOLDERS WERE INTERVIEWED BY SSI. SSI CONDUCTED A COMMUNITY HEALTH SURVEY WITH 669 SURVEYS COMPLETED, AND CCHD CONDUCTED A COMMUNITY HEALTH SURVEY WITH 227 SURVEYS COMPLETED. FINALLY, INFORMATION WAS GATHERED BY THE PROJECT TEAM THROUGH A SERIES OF TEN (10) FOCUS GROUPS WITH A TOTAL OF 56 PARTICIPANTS, INCLUDING A CROSS SECTOR OF COMMUNITY GROUPS. INFORMATION GATHERING EFFORTS ALLOWED THE PROJECT TEAM AND STEERING COMMITTEE TO GAIN A BETTER UNDERSTANDING OF THE HEALTH STATUS, HEALTH CARE NEEDS, SERVICE GAPS, AND BARRIERS TO CARE FOR THOSE LIVING IN CATTARAUGUS COUNTY.FOLLOWING THE CONSOLIDATION OF DATA FOR THE COMMUNITY HEALTH ASSESSMENT (CHA), A PLANNING PROCESS WAS INITIATED TO CREATE A 2019-2021 COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). A TOTAL OF 28 PARTICIPANTS DESIGNATED AS THE CHIP PARTNERSHIP COMMITTEE FOCUSED ON THE TWO HEALT PRIORITIES, WHICH WERE IDENTIFIED THROUGH A RIGOROUS COMMUNITY DATA ASSESSMENT STUDY AND DEVELOPED A GUIDE FOR IMPLEMENTING AN ACTION PLAN. A DISCUSSION OF EVIDENCED-BASED HEALTH RELATED PROGRAMS AND INITIATIVES THAT ARE CURRENTLY OFFERED OR ARE PLANNED FOR THE FUTURE WAS FACILIATED BY STRATEGY SOLUTIONS. BASED ON THIS DISCUSSION, A PLAN TO MEET THE COMMUNITY HEALTH NEEDS WAS DEVELOPED.THE 2019-2021 OLEAN GENERAL HOSPITAL COMMUNITY SERVICE PLAN (CSP) AND THE CATTARAUGUS COUNTY HEALTH DEPARTMENT'S COMMUNITY HEALTH ASSESSMENTS AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHA-CHIP) WERE CONDUCTED TO IDENTIFY SIGNIFICANT HEALTH NEEDS AS OUTLINED BY THE NEW YORK STATE DEPARTMENT OF HEALTH'S 2019-2024 PREVENTION AGENDA. IT ALSO PROVIDES CRITICAL INFORMATION TO OGH, CCHD, AND OTHERS IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. OGH, WHICH NOW INCLUDES BRADFORD REGIONAL MEDICAL CENTER IN BRADFORD, PA, IS A MEMBER HOSPITAL OF UPPER ALLEGHENY HEALTH SYSTEM AND AN AFFILIATE OF KALEIDA HEALTH, BUFFALO, NY. THE RESULTS ENABLE THE HEALTH DEPARTMENT, HOSPITAL AND OTHER COMMUNITY PARTNERS TO STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF RESIDENTS LIVING IN THE SERVICE AREA.TO CONDUCT THE COLLABORATIVE STUDY, OGH AND CCHD RETAINED STRATEGY SOLUTIONS, INC. (SSI), AN ERIE, PA PLANNING AND RESEARCH FIRM WHOSE MISSIONS IS TO CREATE HEALTH COMMUNITIES. THE ASSESSMENT FOLLOWED BEST PRACTICES AS OUTLINED BY THE ASSOCIATION OF COMMUNITY HEALTH IMPROVEMENT (ACHI). THE ASSESSMENT WAS ALSO DESIGNED TO ENSURE OGH COMPLIANCE WITH CURRENT INTERNAL REVENUE SERVICE (IRS) GUIDELINES FOR CHARITABLE 501(C)(3) TAX-EXEMPT HOSPITALS THAT WAS PUBLISHED IN DECEMBER 2014. THE PREVENTION AGENDA IS A SIX-YEAR EFFORT TO MAKE NEW YORK THE HEALTHIEST STATE. DEVELOPED IN COLLABORATION WITH 140 ORGANIZATIONS, THE PLAN IDENTIIES NEW YORK'S MOST URGENT HEALT CONCERNS, AND SUGGESTS WAYS LOCAL HEALTH DEPARTMENTS, HOSPITALS, AND PARTNERS FROM HEALTH, BUSINESS, EDUCATION, AND COMMUNITY ORGANIZATIONS CAN WORK TOGETHER TO SOLVE THEM.THE CSP/CA-CHIP INCLUDES A DETAILED EXAMINTION OF PRIORITY AREAS IDENTIFIED IN THE NYS PREVENTION AGENDA: (1) PREVENT CHRONIC DISEASES; (2) PROMOTE A HEALTHY AND SAFE EVNIRONMENT; (3) PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN; (4) PROMOTE WELL0BEING AND PREVENT MENTAL HEALTH AND SUBSTANCE USE DISORDERS; AND (5) PREVENT COMMUICABLE DISEASES. OTHER AREAS INCLUDED IN THIS CSP/CHA-CHIP THAT MEET THE DECEMBER 2014 IRS REQUIREMENTS INCLUDE: EVALUATION OF THE 2016-2018 (9) CSP/CHA-CHIP, DEMOGRAPHICS AND SOCIS-ECONOMIC INDICATORS, PRIORITIZATION OF NEEDS, AND CHIP/IMPLEMENTATION STRATEG FOR THE NEXT THREE YEARS.A DETAILED PLAN OF IMPLEMENTATION IS DESCRIBED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPLEMENTATION PLAN ON PAGES 149-171.BRADFORD REGIONAL MEDICAL CENTER:THIS REPORT SUMMARIZES A COMPREHENSIVE REVIEW AND ANALYSIS OF HEALTH STATUS INDICATORS, PUBLIC HEALTH, SOCIOECONOMIC, DEMOGRAPHIC AND OTHER QUALITATIVE AND QUANTITATIVE DATA FORM THE PRIMARY SERVICE AREA OF BRMC. THIS REPORT ALSO INCLUDES SECONDARY/DISEASE INCIDENCE AND PREVALANCE DATA FROM MCKEAN COUNTY, THE PRIMARY SERVICE ARES OF THE HOSPITAL. THE DATA WAS REVIEWED AND ANALYZED TO DETERMINE THE TOP PRIORITY NEEDS AND ISSUES FACING THE REGION OVERALL.THE PRIMARY PURPOSE OF THIS ASSESSMENT WAS TO IDENTIFY THE HEALTH NEEDS AND ISSUES OF THE MCKEAN COUNTY COMMUNITY DEFINED AS THE PRIMARY SERVICE AREA OF BRMC. IN ADDITION, THE CHNA USEFUL INFORMATION FOR PUBLIC HEALTH AND HEALTH CARE PROVIDERS, POLICY MAKES, SOCIAL SERVICE AGENCIES, COMMUNITY GROUPS AND ORGANIZATIONS, RELIGIOUS INSTITUTIONS, BUSINESSES, AND CONSUMERS WHO ARE INTERESTED IN IMPROVING THE HEALTH STATUS OF THE COMMUNITY AND REGION. THE RESULTS ENABLE THE HOSPITAL, AS WELL AS OTHER COMMUNITY PROVIDERS, TO MORE STATEGICALLY IDENTIFY COMMUNITY HEALTH PRIORITIES, DEVELOP INTERVENTIONS, AND COMMIT RESOURCES TO IMPROVE THE HEALTH STATUS OF THE REGION. IMPROVING THE HEALTH OF THE COMMUNITY IS THE FOUDNATION OF THE MISSION OF BRMC, AND AN IMPORTANT FOCUS FOR EVERYONE IN THE SERVICE REGION, INDIVIDUALLY AND COLLECTIVELY. IN ADDITION TO THE EDUCATION, PATIENT CARE, AND PROGRAM INTERVENTIONS PROVIDED THROUGH THE HOSPITAL, WE HOPE THAT THE INFORMATION IN THIS CHNA WILL ENCOURAGE ADDITIONAL ACTIVITIES AND COLLABORATIVE EFFORTS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY THAT BRMC SERVES.FACILITATED BY STRATEGY SOLUTIONS, INC., A PLANNING AND RESEARCH FIRM WITH A MISSION TO CREATE HEALTHY COMMUNITIES, THE CHNA FOLLOWS BEST PRACTICES AS OUTLINED BY THE ASSOCIATION FOR COMMUNITY HEALTH IMPROVEMENT, A DIVISION OF THE AMERICAN HOSPITAL ASSOCIATION, AND ENSURES COMPLIANCE WITH INTERNAL REVENUE SERVICE (IRS) GUIDELINES (IRS NOTICE 2011-52) THE PROCESS HAS TAKEN INTO ACCOUNT INPUT FROM THOSE WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITIES SERVED BY BRMC, INCLUDING THOSE WITH KNOWLEDGE OF PUBLIC HEALTH, THE MEDICALLY UNDERSERVED, AND POPULATIONS WITH CHRONIC DISEASE. THE 2018 BRMC CHNA WAS CONDUCTED TO IDENTIFY PRIMARY HEALTH ISSUES, CURRENT HEALTH STATUS, AND HEALTH NEEDS TO PROVIDE CRITICAL INFORMATION TO THOSE IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. THE RESULTS ENABLE COMMUNITY MEMBERS TO MORE STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS, AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF PEOPLE LIVING IN THE COMMUNITY.TWENTY STEERING COMMITTEE MEMEBERS FROM ACROSS THE COMMUNITY PARTICIPATED IN THE PRIORITIZAITON EXERCISE. AFTER PRIORITIZATION AND DISCUSSION, THE BRMC STEERING COMMITTEE IDENTIFIED FOUR NEEDS AS PRIORITIES FOR INTERVENTION AND ACTION PLANNING: CHRONIC DISEASE, ACCESS TO HEALTHCARE, MENTAL HEALTH AND SUBSTANCE ABUSE DISORDERS.

OLEAN GENERAL HOSPITAL
PART V, SECTION B, LINE 6B: IN DEVELOPING THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR CATTARAUGUS COUNTY, OTHER MEMBERS CONSULTED INCLUDED ALLEGANY W. STEUBEN RURAL HEALTH NETWORK, AMERICAN RED CROSS, CANCER SERVICES PROGRAM (ALLEGANY CO.), CATTARAUGUS COUNTY DEPARTMENT OF THE AGING, CATTARAUGUS COUNTY HEALTH DEPARTMENT, CATTARAUGUS COUNTY YOUTH BUREAU, CITY OF OLEAN YOUTH BUREAU, CORNELL COOPERATIVE EXTENSION, DIRECTORS OF INDEPENDENT LIVING, EVERYWOMAN OPPORTUNITY CENTER, HEALTH CARE ACCESS COALITION, HEALTHY COMMUNITY ALLIANCE, HEALTHY SCHOOLS NY, P2 COLLABORATIVE OF WNY, SALAMANCA YOUTH BUREAU, SOUTHERN TIER HEALTHCARE SYSTEMS, SOUTHERN TIER WEST, STRAWW, TOBACCO-REALITY CHECK, TOTAL SENIOR CARE, TRICOUNTY TOBACCO COALITION, AND UNIVERA COMMUNITY HEALTH.

OLEAN GENERAL HOSPITAL
PART V, SECTION B, LINE 11: DBA BRADFORD REGIONAL MEDICAL CENTER: THE HOSPITAL'S EFFORTS IN ADDRESSING SIGNIFICANT NEEDS ARE DESCRIBED IN ITS 2016-2018 COMMUNITY HEALTH NEEDS EXECUTIVE SUMMARY, PAGE 5.

PART I, LINE 7G:
SUBSIDIZED PROGRAMS ARE NOT RECORDED AT THIS LEVEL OF DETAIL. ALL COSTS ASSOCIATED WITH THESE PROGRAMS, INCLUDING IP PSYCHIATRIC DEPARTMENT, EMERGENCY DEPARTMENT AND SALAMANCA CLINIC ARE INCLUDED IN THE AMOUNTS PROVIDED.

PART II, COMMUNITY BUILDING ACTIVITIES:
OVER THE LAST 10 YEARS, THE OLEAN AND BRADFORD AREAS HAD SIGNIFICANT PRIMARY CARE AND SPECIALIST CARE SHORTFALLS. AFTER A FEW YEARS OF SUCCESSFUL RECRUITING, NUMEROUS MID-LEVEL PRIMARY CARE PROVIDERS HAVE BEEN RECRUITED, HOWEVER THERE ARE STILL PHYSICIAN SHORTAGES IN THE PRIMARY CARE SPACE. SPECIALIST PHYSICIANS ARE STILL IN GREAT DEMAND IN THE AREA. THE MOST PRESSING NEEDS CURRETNLY ARE IN: CARDIOLOGY, UROLOGY, DERMATOLOGY, OBSTETRICS, PSYCHIARTY AND GASTROENTEROLOGY.THE HOSPITAL ALSO PROVIDES CLINICIAL ROTATIONS FOR MEDICAL STUDENTS IN INTERNAL AND EMERGENCY MEDICINE THROUGH AN AFFILIATION AGREEMENT WITH LAKE ERIE COLLEGE OF OSTEOPATHIC MEDICINE. IN ADDITION, SAINT BONAVENTURE UNIVERSITY PRE-MEDICAL STUDENTS PARTICIPATE IN A 14 WEEK ROTATION PROVIDING EXPOSURE TO VARIOUS CLINICAL SPECIALTIES AND DIAGNOSTIC MODALITIES, FOR AN IN-DEPTH EXPOSURE TO THE REALITIES OF A CAREER IN MEDICINE. THE UNIVERSITY OF PITTSBURGH AT BRADFORD NURSING STUDENTS PARTICIPATE IN CLINICAL ROTATIONS THROUGH THE BRADFORD CAMPUS.

PART III, LINE 3:
THE RATIONALE USED TO ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE PLAN WAS DETERMINED BY USING THE PERCENTAGE OF INCOMPLETE FINANCIAL ASSISTANCE APPLICATIONS TO TOTAL FINANCIAL ASSISTANCE APPLICATIONS (4%).

PART III, LINE 4:
KALEIDA DETERMINES PATIENT SERVICE REVENUE BY REDUCING THE STANDARD CHARGE TO THIRD PARTY PAYORS BY ANY CONTRACTUAL AMOUNTS OR DISCOUNTS (EXPLICIT CONCESSIONS) AND ESTIMATES ROUTINE UNCOLLECTIBLE AMOUNTS ASSOCIATED WITH THE SERVICE, INCLUDING DEDUCTIBLES, CO-PAYS AND AMOUNTS DUE FROM UNINSURED PATIENTS (COLLECTIVELY, IMPLICIT PRICE CONCESSIONS). KALEIDA DETERMINES ITS ESTIMATES OF EXPLICIT CONCESSIONS BASED ON CONTRACTUAL AGREEMENTS, ITS DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. KALEIDA DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TOPATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. ADJUSTMENTS ARISING FROM A CHANGE IN TRANSACTION PRICE WERE NOT SIGNIFICANT IN 2021 AND 2020.THROUGHOUT THE YEAR, AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, KALEIDA WILL WRITE-OFF THE DIFFERENCE BETWEEN THE AMOUNT BILLED TO THE PATIENT (AND THIRD PARTY PAYORS IF APPLICABLE) AND THE AMOUNT ACTUALLY COLLECTED AGAINST RESERVES ESTABLISHED. MANAGEMENT MONITORS COLLECTION PATTERNS TO DETERMINE THE APPROPRIATENESS OF THE UNDERLYING ASSUMPTIONS USED IN ESTIMATING IS PATIENT SERVICE REVENUE AND RELATED RESERVES.

PART III, LINE 8:
THE ALLOWABLE COSTS REPORTED ON LINE 6 ARE DIRECTLY FROM THE HOSPITAL'S 2021 MEDICARE COST REPORT, WHICH IS PREPARED USING A RATIO OF COST TO CHARGES BASIS (RCC) AS REQUIRED BY MEDICARE.

PART III, LINE 9B:
COLLECTION PRACTICES:I) OGH WILL NOT CAUSE THE FORCED SALE OR FORECLSOURE OF A PATIENT'S PRIMARY RESIDENCE.II) OGH WILL NOT SEND ACCOUNT TO COLLECTION IF THE PATIENT HAS SUBMITTED A COMPLETED APPLICATION FOR FINANCIAL ASSISTANCE, INCLUDING THE REQUIRED DOCUMENTATION, WHILE AN APPLICATION IS PENDING.III) OGH WILL PROVIDE WRITTEN NOTIFICATION TO A PATIENT AT LEAST 30-DAYS BEFORE AN ACCOUNT IS SENT TO COLLECTION. THIS WRITTEN NOTICE MAY BE INCLUDED ON A BILL.IV) OGH REQUIRES THAT A COLLECTION AGENCY HAVE ITS WRITTEN CONSENT PRIOR TO STARTING LEGAL ACTION FOR COLLECTION.V) OGH WILL TRAIN ALL GENERAL HOSPITAL STAFF WHO INTERACT WITH PATIENTS OR HAVE RESPONSIBILITY FOR BILLING AND COLLECTION.VI) OGH WILL MEASURE OUR COMPLIANCE WITH THESE POLICIES.VII) OGH REQUIRES ANY COLLECTION AGENCY UNDER CONTRACT TO FOLLOW OUR FINANCIAL ASSISTANCE POLICY AND PROVIDES INFROMATION TO PATIENT'S ON HOW TO APPLY, WHERE APPROPRIATE.VIII) OGH DOES NOT ALLOW COLLECTION ACTIVITY IF THE PATIENT IS DETERINED ELIGIBLE FOR MEDICAID FOR THE SERVICES THAT WERE RENDERED AND OGH IS ABLE TO COLLECT MEDICAID PAYMENT.

PART VI, LINE 3:
"INSURANCE INFORMATION IS GATHERED DURING THE SCHEDULING AND/OR REGISTRATION PROCESS. IF THE PATIENT INDICATES THAT THEY HAVE NO INSURANCE, REGISTRATION STAFF WILL ASK THE PATIENT FOR PERMISSION TO TRANSFER THEM TO SOURTHERN TIER HEALTHCARE SYSTEMS FOR ASSISTANCE WITH SCREENING FOR ELIGIBILITY FOR GOVERNMENT PROGRAMS (I.E. MEDICAID, CHILD HEALTH PLUS, FAMILY HEALTH PLUS). SOUTHERN TIER HEALTHCARE SYSTEMS' PERSONNEL WILL CONTACT THE PATIENT AND DISCUSS OPTIONS, INCLUDING THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND CAN DISCUSS AND SHARE INFORMATION WITH PATIENTS AT ANY TIME BEFORE, DURING OR AFTER THE EPISODE OF CARE. BILLING STATEMENTS CONTAIN THE FOLLOWING MESSAGE: ""IF YOU HAVE ANY QUESTIONS OR WOULD LIKE TO APPLY FOR OUR FINANCIAL ASSISTANCE PROGRAM, PLEASE CALL OUR OFFICE AT "", THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL WEBSITE TO HELP EDUCATE THE PUBLIC."

PART VI, LINE 6:
OLEAN GENERAL HOSPITAL IS PART OF THE UPPER ALLEGHENY HEALTH SYSTEM (UAHS), ORIGINALLY AN INTEGRATION OF TWO REGIONAL HOSPITALS UNDER A COMMON PARENT ORGANIZATION. UAHS HAS A MISSION OF COLLABORATIVE HEALTH CARE IN THE TWO COMMUNITIES SERVED BY THE INTEGRATED HOSPITALS TO MEET THE HEALTH CARE NEEDS OF THE RESIDENTS AND SURROUNDING AREAS. TO FURTHER THIS INTEGRATION, BRMC WAS MERGED INTO OGH ON JANUARY 12, 2018 AND IS NOW PART OF A 2 CAMPUS HOSPITAL.

PART VI, LINE 7, REPORTS FILED WITH STATES
NY

PART VI, LINE 2:
"THE STRATEGIC PLANNING COMMITTEE OF OLEAN GENERAL HOSPITAL IS CHARGED WITH DEVELOPING A STRATEGIC DIRECTION FOR THE HOSPITAL. OVER THE LAST FEW YEARS THAT COMMITTEE ASSISTED IN THE DEVELOPMENT OF SUSTAINABILITY STRATEGIES FOR THE HOSPITAL INCLUDING THE AFFILIATION WITH A TERTIARY CARE PROVIDER IN 2017 AND THE MERGER OF THE TWO PREVIOUS HOSPITALS (OLEAN GENERAL HOSPITAL AND BRADFORD REGIONAL MEDICAL CENTER INTO THE ONE LEGAL ENTITY OLEAN GENERAL HOSPITAL) IN 2018. IN 2019 THE COMMITTEE BEGAN DEVELOPING ADDITIONAL SUSTAINABILITY STRATEGIES FOR THE SYSTEM INCLUDING LOOKING AT TAKING ADVANTAGE OF THE HOSPITALS VARIOUS STRENGTHS IN DIFFERENT GEOGRAPHIC AREAS. THESE DELIBERTIONS WERE CONCLUDED IN 2020 AND A 17 POINT TRANSFORMATION PLAN WAS IMPLEMENTED INCLUDING CONSOLIDATION OF SURGERY AND HIGHER-END INPATIENT SERVICES TO THE OLEAN CAMPUS. THE PLAN IS ESTIMATED TO HAVE A FINANCIAL IMPACT OF $10M TO OGH FINANCIAL RESULTS ANNUALLY, AFTER 2023.ESSENTIAL TO THE SUCCESS OF ANY STRATEGIC PLAN IS THE HOSPITAL'S ABILITY TO BOTH IMPLEMENT RECOMMENDATIONS MADE WITHIN THE PLAN AND TO RECOGNIZE THE DOCUMENT AS A DYNAMIC AND FLEXIBLE TOOL TO BE USED AS A GUIDGE FOR THE FUTURE. SPECIFIC GOALS AND STRATEGIES MAY OR MAY NOT BE OBTAINED AND, UPON EVALUATION AND THE AVAILABILITY OF NEW INFORMATION AND DEVELOPMENTS, MAY NEED TO BE MODIFIED. A SUCCESSFUL STRATEGIC PLAN RECONGIZES THIS POTENTIAL FOR CHANGE AND IS FLEXIBLE ENOUGH TO ACCOMONDATE NEW OR DIFFERENT OPPORTUNITIES AND CHALLENGES.CRITICAL HEALTHCARE ISSUES:THE HEALTHCARE INDUSTRY IS UNDER CONSTANT SCRUTINY TO PROVIDE AFFORDABLE HEALTH CARE SERVICES THAT ARE ALSO OF THE HIGHEST QUALITY. A HOSPITAL'S ABILITY TO ACCOMPLISH THIS GOAL IS INFLUENCED BY SEVERAL FACTORS. FOLLOWING IS A LISTING OF CRITICAL ISSUES THAT WILL CONTINUE TO AFFECT HOSPITAL'S ABILITY TO PERFORM.1. IMPACT OF COVID 19: THE SINGLE LARGEST EXTERNAL FACTOR AFFECTING HEALTHCARE TODAY IS THE IMPACT OF THE COVID 19 PANDEMIC ON HOSPITALS. ALTHOUGH THE PANDEMIC HIT U.S. HOSPITALS IN EARLY 2020, THE LONG-LASTING EFFECTS WILL BE FELT FOR YEARS TO COME, SEVERAL PHENOMENA CAUSED BY THE PANDEMIC INCLUDE:A. LARGE FINANCIAL LOSSES, DESPITE FEDERAL STIMULUS FUNDING. OGH LOST ($3,600,000) IN 2021, AFTER CONSIDERATION OF $8,700,000 OF STIMULUS FUNDING. PATIENT VOLUMES CONTINUE TO BE DEPRESSED AS A RESULT OF RESOURCE CONSTRAINTS AS WELL AS PATIENT FEARS OVER CONTRACTING COVID.B. STAFFING HAS BEEN IMPACTED GREATLY BY THE PANDEMIC. HIGH ACUITY PATIENTS AND WAVES OF THEM IN A SHORT PERIOD OF TIME COUPLED WITH THE STRESSES OF TAKING CARE OF HIGHLY INFECTIOUS PATIENTS HAS LED TO SIGNIFICANT PROVIDER BURN-OUT. IN FACT, A NATIONAL MOVEMENT OF NURSES LEAVING THEIR POSITIONS AND TAKING ""TRAVELER"" ASSIGHMENTS HAS PUT A HUGE HOLE IN THE STAFFING AT HOSPITALS. REPLACEMENT STAFF, IF AVAILABLE, ARE AT A 200 TO 300 PERCENT INCREASE OVER FORMER COSTS.C. EMERGENCY ROOM WAIT TIMES HAVE SOARED AS A RESULT OF THE PANDEMIC. THIS ALSO IMPACTS PATIENT SATISFACTION NEGATIVELY.2. QUALITY: HEALTHCARE QUALITY AND SAFETY HAVE BEEN STRATGICALLY IMPORTANT FOR SEVERAL YEARS. WIDESPREAD PUBLIC REPORTING OF HOSPITAL QUALITY RESULTS AND VALUE BASED PAYMENT MODELS HAVE POSITIONED QUALITY AT THE FOREFRONT OF HEALTHCARE DELIVERY. RECRUITMENT AND RETENTION OF HIGHLY SKILLED DOCTORS AND NURSES, COMBINED WITH CAPABLE INFORMATION SYSTEMS ARE CRITICAL TO MEET THE HIGH STANDARDS SET TODAY IN HEALTHCARE. CONCEPTS SUCH AS: ""RE-ADMISSIONS"", HOSPITAL ACQUIRED INFECTIONS, FALL FREQUENCY AND PREVENTABLE MEDICATION ERRORS ARE HOUSEHOLD WORDS WHEN IT COMES TO EVALUATING A HOSPITAL'S QUALITY TODAY. HOSPITALSTS MUST MARSHAL THE NOES RESOURCES AND PROVIDE HIGH-END CARE AS COMPARED TO OTHERS. THE VALUE BASED PAYMENT METHODOLOGIES ALSO HAVE SIGNIFCANT FINANCIAL IMPLICATIONS FOR HOSPITALS TODAY. CONSUMERS WILL CONTUNE TO SEEK OUT MORE AND MORE QUALITY DATA UPON WHICH TO BASE CARE DECISIONS ON.3. INFORMATION TECHNOLOGY: HEALTH INFORMATION TECHNOLOGY INCLUDES COMPUTER BASED TOOLS DEVELOPED SPECIFICALLY FOR HEALTH CARE DELIVERY. THESE TOOLS CAN PROVIDE CONICAINS UP-TO-DATE INFORMATION ON THEIR PATIENTS, ACCESS TO THE LATEST MEDICAL KNOWLEDGE AND BEST PRACTICES THROUGH DECISION SUPPORT SYSTEMS. IT IS UNDERSTOOD THAT INVESTMENTS IN NEW CLINICAL AND INFORMATION TECHNOLOGY CAN SIGNIFICANTLY ENHANCE PATIENT SAFETY AND CLINICAL OUTCOMES. COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE), BAR CODING AND ITS POTENTIAL TO REDUCE MEDICATION ERRORS, AND ELECTRONIC MEDICAL RECRODS (EMRS) AND THEIR POSITIVE IMPACT ON MEDICAL ERRORS ARE ALL EXAMPLES OF HEALTH CARE'S USE OF IT SOLUTIONS TO IMPROVE QUALITY. THE FEDERAL GOVERNMENT HAS HIGHLIGHTED THE ROLE OF HEALTH INFORMATION TECHNOLOGY AS A MEANS TO IMPROVE HEALTHCARE QUALITY, SAFETY PROVIDED STIMULUS AND INCENTIVE PAYMENTS TO PROVIDERS TO FACILITATE AND HASTEN THEIR ADOPTION INTO THE CARE DELIVERY PROCESS. EMR'S HAVE BECOME A PRERQUISITE OF ANY DELIVERY SYSTEM THAT INTENDS TO PROVIDE COORDIANTED COST EFFECTIVE CARE.4. PHYSICIANS: PHYSICIANS HAVE EMERGED AS CRITICAL OPERATIONAL AND STRATEGIC PARTNERS TO HOSPITALS. THOSE THAT ARE SUCCESSFUL IN ENGAGING AND COLLABORATING WITH THEIR MEDICAL STAFF WILL B BST ABLE TO DEMONSTRATE HIGH QUALITY MANDATES. THE ABILITY TO SUCCESSFULLY RECRUIT PHYSICIAN WILL BE CRITICAL. AT A TIME WHEN HEALTHCARE EMPHASIZES THE ROLE OF PRIMARY CARE, THERE IS A SPECIAL NEED TO INTENSIFY EFFORTS RECRUIT, RETAIN AND AGGREGATE PRIMARY CARE PROVIDERS. BECAUSE THE VAST MAJORITY OF NEW PHYSICIANS PREFER EMPLOYMENT AS THEIR PRACTICE PREFERENCE, THE ABILITY OF HOSPITALS TO BE ABLE TO OFFER PHYSICIANS A CONTEMPORARY AND COMPETITIVE ""EMPLOYEMENT PLATFORM"" IS ESSENTIAL."

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OLEAN GENERAL HOSPITAL IS LOCATED IN OLEAN, NEW YORK, THE LARGEST CITY IN CATTARAUGUS COUNTY. THE HOSPITAL SERVES APPROXIMATELY 88,000 RESDIENTS OF CATTARAUGUS COUNTY AND THE SURROUNDING AREA. THE POPULATION OF THE AREA IS DISTRIUBTED AS FOLLOWS: 22% UNDER THE AGE OF 18, 60% AGE 18 TO 64, AND 18% 65 AND OLDER. THE ANNUAL HOUSEHOLD INCOME WAS DISTRIBUTED AS FOLLOWS: 27% EARNING LESS THAN $25K, 29% EARNING BETWEEN $25K-$50K; AND 44% EARNING $50K OR HIGHER.THE BRADFORD CAMPUS IS LOCATED IN BRADFORD, PA. THE HOSPITAL SERVES APPROXIMATELY 55,000 RESDIENTS OF MCKEAN COUNTY AND THE SURROUNDING AREA. THE POPULATION OF THE AREA IS DISTRIUBTED AS FOLLOWS: 20% UNDER THE AGE OF 18, 60% AGE 18 TO 64, AND 20% 65 AND OLDER. THE ANNUAL HOUSEHOLD INCOME WAS DISTRIBUTED AS FOLLOWS: 28% EARNING LESS THAN $25K, 30% EARNING BETWEEN $25K-$50K; AND 42% EARNING $50K OR HIGHER.

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5. FINANCE AND CAPITAL: FINANCIAL PERFORMANCE AND ACCESS TO CAPITAL WILL CONTINUE TO BE AMONG THE MOST CRITICAL ISSUES CONFRONTING HOSPITALS. EVEN WITH HEALTHCARE REFORM EFFORTS, HEALTHCARE COSTS WILL CONTINUE TO OUTPACE INFLATION. INCREASING WAGE AND SALARY COSTS, AND RISING HEALTH CARE COSTS IN GENERAL WILL CONTINUE TO OUTPACE INFLATION. INCREASING WAGE AND SALARY COSTS, AND RISING HEALTH CARE COSTS IN GENERAL WILL CONTINUE TO IMPACT OPERATING PERFORMANCE AND PRESS HOSPITALS TO CONTINUE A RELENTLESS FOCUS ON COST MANAGEMENT. ADDITIONALLY, REVENUE STRATEGIES WILL NEED TO BE DEVELOPED TO GENERATE PROFITABLE GROWTH IN PATIENT VOLUME, AS WILL THE NEED TO ENSURE OPTIMAL MANAGEMENT OF ALL REVENUE CYCLE ACTIVITIES. HOSPITALS ARE FACING SIGNIFICANT ANNUAL PAYMENT REDUCTIONS IN TERMS OF DECREASES IN MEDICARE UPDATES, DISPROPORTIONATE SHARE, SNF AND HOMECARE PAYMENTS, AND MEDICAID PAYMENT LEVELS. AS HOSPITALS CONTINUE TO POST LOW OR NO PROFIT MARGINS, INVESTMENT INCOME WILL BE MORE IMPORTANT THAN EVER. HOWEVER, GIVEN THE FACT THAT INVSTMENT INCOME IS A HIGHLY UNCERTAIN COMPONENT OF A HOSPITAL'S OVERALL FINANCIAL HEALTH, HOSPITALS WILL BE DRIVEN TO PURSUE MORE PHILANTHROPY. HOSPITAL CAPITAL SPENDING WILL BE DRIVEN BY GROWING DEMANDS FOR ADVANCED TECHNOLOGY NEEDED TO ENSURE PATIENT QUALITY AND SAFETY, THE NEED TO REPLACE AND UPDATE AGING FACILITIES, AND THE DESIRE AND NEED TO IMPROVE TECHNOLOGY BASED SERVICES.6. RISK MANAGEMENT AND COMPLIANCE: HEALTHCARE'S TECHNOLOGY HAS NEVER BEEN MORE COMPLICATED, PATIENTS' DEMANDS HIGHER, AND THE BUSINESS CHALLENGES GREATER. ACCORDINGLY, COMPREHENSIVE RISK MANAGEMENT PROGRAM ARE ESSENTIAL IN ASSURING CARE DELIVERY SYSTEMS THAT ARE HIGHLY EFFECTIVE IN TERMS OF ASSURING APPROPRIATE LEVELS OF PATIENT SAFETY AND QUALITY. THE DEPARTMENT OF JUSTICE ESTIMATES THAT THE FEDERAL GOVERNMENET LOSES BILLIONS OF DOLLARS ANNUALLY IN HEALTHCARE FRAUD.CONSEQUENTLY, THE GOVERNMENT'S HEALTHCARE FRAUD ENFORCEMENT ACTIVITITES WITH RESPECT TO ALL HEALTHCARE PROVIDERS CONTINUE TO GROW AND EXPAND. WELL ESTABLISHED CORPORATE COMPLIANCE PROGRAMS ARE ESSENTIAL IN TERMS OF ALLOWING HOSPITALS TO IDENTIFY POTENTIAL AREAS OF LIABIILTY AND TO CORRECT PROBLEMS.7. NURSING:NURSES AND NURSING CARE ARE CENTRAL TO THE DELIVERY OF SAFE AND EFFECTIVE PATIENT CARE. ACCORDINTLY, ENSURING AN ADEQUATE NURSING WORKFORCE AND CREATING A WORK ENVIRONMENT THAT SUPPORTS NURSING PRACTICE AND INTERDISCIPLINARY COLLABORATIOIN ARE IMPORTANT PRIORITIES FOR HOSPITALS TODAY.