4A (Expenses $ 99109776 including grants of $ 0) (Revenue $ 115531959)
ONEIDA HEALTH IS A NON PROFIT HEALTHCARE PROVIDER FOCUSING ON INPATIENT AND OUTPATIENT SERVICES FOR THE LOCAL COMMUNITY. THE HOSPITAL OFFERS THORACIC AND GENERAL SURGERY PROCEDURES, OB/GYN SERVICES, ENT SERVICES, ORTHOPEDIC SERVICES, ENDOSCOPY, UROLOGY, CARDIAC CLINIC SERVICES AND TESTING, 24/7 EMERGENCY DEPARTMENT, ICU, IMAGING SERVICES INCLUING MRI, PET SCAN AND CT SCAN, OUTPATIENT PHYSICAL THERAPY, A BIRTHING CENTER, SLEEP CENTER AND PULMONARY FUNCTION TESTING, MULTIPLE LAB DRAW STATIONS, A CANCER CENTER AND A SKILLED NURSING FACILITY WITH REHAB AND VENTILATOR UNITS. THE HOSPITAL ALSO OPERATES MULTIPLE PHYSICIAN OFFICES THROUGHOUT THE NEIGHBORING COMMUNITIES THAT PROVIDE FAMILY AND INTERNAL MEDICINE SERVICES TO OUR LOCAL RESIDENTS. KEY STATISTICS FOR 2021 ARE AS FOLLOWS: ADMISSIONS: 3,209, PATIENT DAYS: 11,424, ER VISITS 22,124, SURGERIES: 3,638, VISITS TO PHYSICIAN PRACTICES: 18,868.

ONEIDA HEALTH SYSTEMS INC.
PART V, SECTION B, LINE 5: A COMMUNITY HEALTH IMPROVEMENT PLAN STEERING COMMITTEE, COMPRISED OF THE MADISON COUNTY HEALTH DEPARTMENT, ONEIDA HEALTH AND COMMUNITY MEMORIAL HOSPITAL, MET SEVERAL TIMES BEGINNING IN AUGUST 2018 AND THROUGH THE 2019 CALENDAR YEAR TO DEVELOP THE 2019-2021 COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THIS EFFORT WAS PART OF THE PREVENTION AGENDA 2019-2024, A STATEWIDE EFFORT TO IMPROVE AND REDUCE HEALTH DISPARITIES.THE COMMITTEE REVIEWED CURRENT DATA AND RELATED HEALTH INFORMATION AND RECOGNIZED THE NEED TO SHIFT TO TWO NEW FOCUS AREAS - SPECIFICALLY IN THE AREAS OF SUBSTANCE ABUSE AND LUNG CANCER. THE STEERING COMMITTEE REVIEWED DATA AND HEALTH TRENDS, ALONG WITH VARIOUS DOCUMENTS AND REPORTS INCLUDING: HEALTHECNY HEALTH INDICATOR LIST, NEW YORK STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), NYS HEALTH PROFILES, COUNTY HEALTH RANKINGS & ROADMAPS FROM THE ROBERT WOOD JOHNSON FOUNDATION, CENTRAL DSRIP REGION NEEDS ASSESSMENT, NYS PREVENTION AGENDA DASHBOARD, STUDENT WEIGHT STATUS CATEGORY REPORTING SYSTEM (SWSCR), NYS COMMUNITY HEALTH INDICATOR REPORTS (CHIRS), THE NYS ENVIRONMENTAL PUBLIC HEALTH TRACKER, AND OTHER SOURCES TO DETERMINE THE PRIORITIES. DATA WAS COLLECTED AND PRESENTED TO THE STEERING COMMITTEE BY A MULTIDISCIPLINARY TEAM THAT UTILIZED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS.THE COMMITTEE IDENTIFIED AND ENGAGED NUMEROUS STAKEHOLDERS, TO OBTAIN FEEDBACK, AND ASSIST IN ADDING TO AND/OR UPDATING THE DATA AND EVIDENCE-BASED RECOMMENDATIONS. THE STAKEHOLDERS REPRESENTED SCHOOLS, COMMUNITY BASED ORGANIZATIONS, HEALTHCARE PROVIDERS, MENTAL HEALTHCARE PROVIDERS, EMERGENCY MEDICAL SERVICES, LAW ENFORCEMENT, THE COUNTY HEALTH DEPARTMENT, EMPLOYERS AND RESIDENTS. GROUPS OF PARTNERS WERE CONVENED BASED ON THEIR EXISTING PROGRAMS, AREAS OF EXPERTISE, GENERAL INTEREST AND CURRENT AFFILIATIONS TO PARTICIPATE IN THE MAPP PROCESS. THERE WERE FOUR MAPP ASSESSMENTS COMPLETED COMMUNITY HEALTH STATUS, COMMUNITY THEMES AND STRENGTHS, LOCAL PUBLIC HEALTH SYSTEM AND FORCES OF CHANGE. ONCE THESE WERE COMPLETED, ADDITIONAL, MORE PRIORITY SPECIFIC GROUPS EVOLVED TO DESIGN AND IMPLEMENT THE CHIP AND FUNCTION IN AN ADVISORY CAPACITY.THE CHIP STEERING COMMITTEE MEMBERS : LISA ABBE, DIRECTOR OF BUSINESS DEVELOPMENT ONEIDA HEALTH; MARY PARRY, VP OF OPERATIONS, ONEIDA HEALTH; KEVIN PROSSER, DIRECTOR OF COMMUNITY RELATIONS, ONEIDA HEALTH; ERIC FAISST, DIRECTOR OF PUBLIC HEALTH MADISON COUNTY; AND A REPRESENTATIVE FROM COMMUNITY MEMORIAL HOSPITAL.STAKEHOLDERS WHO WERE ENGAGED: BASSETT HEALTHCARE NETWORK, BEREAN CALVARY CHAPEL, BRIDGES, CANASTOTA PUBLIC LIBRARY, CANCER SERVICES PROGRAM OF THE CENTRAL REGION, CARE NET OF CNY, CAZENOVIA COLLEGE HEALTH AND COUNSELING CENTER, CAZENOVIA FHC OF CMH, CORNELL COOPERATIVE EXTENSION, CHENANGO NURSERY SCHOOL, CITY OF ONEIDA, CITY OF ONEIDA POLICE DEPARTMENT, CNY COMMUNITY FOUNDATION, COLGATE UNIVERSITY, COMMUNITY ACTION, COMMUNITY MEMORIAL HOSPITAL. CROSSROADS COMMUNITY CHURCH, GREAT SWAMP CONSERVANCY, HAMILTON PUBLIC LIBRARY, HCR HOME CARE, HEALTHECONNECTIONS, HELIO HEALTH, HOSPICE AND PALLIATIVE CARE SERVICES, INDEPENDENT LIVING, LIBERTY RESOURCES, MAD CO OFA, MADISON COUNTY ADMINISTRATION, MADISON COUNTY DEPARTMENT OF SOCIAL SERVICES, MADISON COUNTY HEALTH DEPARTMENT, MADISON COUNTY OFFICE OF EMERGENCY MANAGEMENT, MADISON COUNTY PLANNING, MADISON COUNTY RURAL HEALTH COUNCIL, INC., MADISON COUNTY SHERIFF, MADISON COUNTY YOUTH BUREAU, MADISON ONEIDA BOCES, MARY ROSE CLINIC, MOHAWK VALLEY HEALTH SYSTEM, MORRISVILLE LIONS CLUB, MVCAA, INC., NEW WOODSTOCK LIBRARY, ONEIDA CITY SCHOOL DISTRICT, ONEIDA FAMILY YMCA, ONEIDA HEALTH, ONEIDA PUBLIC LIBRARY, SENIORS HELPING SENIORS(R), ST. JOSEPH'S HEALTH, STOCKBRIDGE VALLEY CSD, SUNY MORRISVILLE, THE ARC OF MADISON CORTLAND, THE CHILDREN'S CENTER AT MORRISVILLE STATE COLLEGE, INC., UNITED WAY OF THE VALLEY AND GREATER UTICA AREA, UNIVERSITY POLICE AT SUNY MORRISVILLE, AND WILLARD PRIOR ELEMENTARY SCHOOL.

ONEIDA HEALTH SYSTEMS INC.
PART V, SECTION B, LINE 6A: COMMUNITY MEMORIAL HOSPITAL 150 BROAD ST, HAMILTON, NY 13346

ONEIDA HEALTH SYSTEMS INC.
PART V, SECTION B, LINE 6B: MADISON COUNTY DEPARTMENT OF HEALTH 138 N. COURT ST, WAMPSVILLE, NY 13163

ONEIDA HEALTH SYSTEMS INC.
PART V, SECTION B, LINE 11: THERE ARE A FEW WAYS THAT OH ADDRESSES THE SIGNIFICANT FOCUS AREAS IDENTIFIED BY THE COMMUNITY HEALTH IMPROVEMENT PROJECT. THE FIRST FOCUS AREA CHOSEN BY THE COMMUNITY HEALTH STEERING COMMITTEE MENTAL AND SUBSTANCE USE DISORDERS PREVENTION HAS THREE GOALS TO BE ADDRESSED: SUBSTANCE USE AMONG YOUTH, ALCOHOL-RELATED MOTOR VEHICLE INJURY AND DEATH AND SUBSTANCE ABUSE AMONG ADULTS. MORE SPECIFIC OBJECTIVES THAT WILL BE STRIVED FOR ARE REDUCING THE PERCENTAGE OF YOUTH DRINKING ALCOHOLIC BEVERAGES AND USING ELECTRONIC VAPING PRODUCTS, REDUCING ALCOHOL RELATED MOTOR VEHICLE INJURIES AND DEATHS AND REDUCING THE PERCENTAGE OF BINGE DRINKING AND OVERDOSE REPORTS IN ADULTS.THE STRATEGIES USED TO REDUCE SUBSTANCE ABUSE AMONG YOUTH ARE THE HOSPITAL WILL INFORM AND EDUCATE LOCAL OFFICIALS ON THE RATE SUBSTANCE USE AMONG MADISON COUNTY YOUTH, THEY WILL ASSIST IN IMPLEMENTING A COUNTY WIDE EVIDENCE-BASED FAMILY INTERVENTION PROGRAM FOCUSED ON TEEN ALCOHOL USE, THEY WILL ENCOURAGE COMMUNITY LEVEL INTERVENTIONS SUCH AS PARENT/CHILD CONTRACTS FOR DRIVING PRIVILEGES, ALCOHOL-RESTRICTED/FREE COMMUNITY EVENTS AND PARENTAL INTERVENTIONS AGAIN TEEN BINGE DRINKING; THEY WILL INCLUDE BINGE DRINKING QUESTIONS IN THE EHR (ELECTRONIC HEALTH RECORD), AND THEY WILL ASSIST IN RESEARCHING AND IMPLEMENTING A SCHOOL BASED PROGRAM FOCUSED ON ALCOHOL USE AND RISK AWARENESS.STRATEGIES USED TO REDUCE ALCOHOL-RELATED MOTOR VEHICLE INJURY AND DEATH ARE TO INFORM AND EDUCATE LOCAL OFFICIALS ON SUBSTANCE ABUSE AMONG MADISON COUNTY RESIDENTS, TO INFORM AND EDUCATE LOCAL BUSINESSES ON THE MADISON COUNTY ALCOHOL-RELATED INJURY AND DEATH RATES, AND PROMOTE RESPONSIBLE DRINKING THROUGH STRONG ENFORCEMENT AND PUBLIC AWARENESS.STRATEGIES TO ADDRESS SUBSTANCE ABUSE AMONG ADULTS INCLUDE INFORMING AND EDUCATING LOCAL OFFICIALS ON SUBSTANCE ABUSE AMONG MADISON COUNTY RESIDENTS, CONDUCTING A SMALL MEDIA CAMPAIGN ON PUBLIC AWARENESS OF BINGE DRINKING, INCLUDING BINGE DRINKING QUESTIONS IN THE EHR (ELECTRONIC HEALTH RECORD), IMPLEMENTING AN EVIDENCE BASED INTERVENTION TO ADDRESS BINGE DRINKING ON COLLEGE CAMPUSES AND LAUNCHING A TARGETED CAMPAIGN FOR THOSE POPULATIONS AT RISK FOR OVERDOSING.SPECIFIC ITEMS THE HOSPITAL HAS INITIATED TO TARGET SUBSTANCE ABUSE ARE THE ALTERNATIVES TO OPIOID PROGRAM IN THE EMERGENCY DEPARTMENT AND THE NYS REGISTERED OPIOID OVERDOSE PREVENTION PROGRAM.BEHAVIORAL HEALTH SCREENINGS ARE BEING OFFERED AT SOME OF OH'S LOCATIONS, WHICH CAN ASSIST IN IDENTIFYING SUBSTANCE ABUSE ISSUES. A NEW BEHAVIORAL HEALTH PROGRAM IS ALSO IN DEVELOPMENT, WHICH WILL START IN 2023 AND WILL BE LOCATED ON THE HOSPITAL CAMPUS. THE SECOND FOCUS AREA CHOSEN LUNG CANCER - HAS TWO GOALS TO BE ADDRESSED: TO INCREASE LUNG CANCER SCREENING RATES AND TO REDUCE THE IMPACT OF RADON, WHICH IS THE SECOND LEADING CAUSE OF LUNG CANCER.STRATEGIES TO ENCOURAGE AND INCREASE IN LUNG CANCER SCREENING INCLUDE A MEDIA CAMPAIGN TO INCREASE PUBLIC AWARENESS OF LUNG CANCER AND SCREENING, CONDUCT A HEALTHCARE PROVIDER EDUCATION SERIES ON LUNG CANCER AND SCREENING, INCLUDE SCREENING QUESTIONS IN THE EHR (ELECTRONIC HEALTH RECORD), COLLABORATE WITH INSURERS TO ENSURE SCREENING IS COVERED, PROMOTE ADULT SMOKING CESSATION, PROMOTE SMOKE AND VAPE FREE POLICIES FOR VARIOUS PUBLIC SPACES, INCLUDING SCHOOLS AND WORKPLACES, AND IMPLEMENTING A COUNTY-WIDE EVIDENCE-BASED INTERVENTION TO ADDRESS SMOKING CESSATION FOR PREGNANT WOMEN. WHILE THE COVID-19 PANDEMIC PREVENTED PUBLIC SMOKING CESSATION CLASSES IN 2020 AND 2021, PROVIDERS CONTINUE TO ADDRESS THE SUBJECT AND ENCOURAGE AT FACILITY OFFICES DURING REGULAR PATIENT SCREENINGS.STRATEGIES DEVELOPED TO REDUCE THE IMPACT OF RADON ARE A MEDIA CAMPAIGN TO BRING PUBLIC AWARENESS TO RADON EXPOSURE AND TESTING, CONDUCTING A HEALTHCARE PROVIDER EDUCATION SERIES ON RADON AND SCREENING, INCLUDE SCREENING QUESTIONS IN THE EHR (ELECTRONIC HEALTH RECORD),CREATING A COUNTY-WIDE RADON REFERRAL PROGRAM, CREATE A RESOURCE FOR RADON TESTING AND MITIGATION, INFORMING AND EDUCATION LOCAL OFFICIALS ON THE IMPACT OF RADON ON PUBLIC HEALTH, AND PROVIDING TECHNICAL ASSISTANCE AND EDUCATION FOR A RADON POLICY ADOPTION.CANCER SCREENINGS ARE ALSO BEING OFFERED AS PART OF THE TRINITY ACO/CNY AIM PROGRAM.THESE INITIATIVES WERE CHOSEN BASED ON THE REVIEW OF HEALTH DATA SPECIFIC TO MADISON COUNTY AND NYS AS WELL AS THE NYS PREVENTION AGENDA PRIORITIES. IT WAS ALSO RECOMMENDED BY THE STEERING COMMITTEE THAT ONLY 2 INITIATIVES BE CHOSEN TO INSURE A BETTER SUCCESS RATE IN IMPROVING THE HEALTH OF THE COMMUNITY IN THOSE TWO AREAS. THE OTHER PREVENTION AGENDA PRIORITIES (I.E. ORAL HEALTH, ACCESS TO HEALTH SERVICES AND IMMUNIZATIONS AND INFECTIOUS DISEASE) WHILE NOT ADDRESSED SPECIFICALLY IN THIS YEAR'S CHNA, ARE STILL CONSIDERED IMPORTANT INITIATIVES THAT ARE BEING MONITORED AND ADDRESSED BY THE HOSPITALS AND THE COUNTY THROUGH ITS SERVICES AND COLLABORATIONS WITH OTHER COMMUNITY BASED ORGANIZATIONS AND EVENTS. THE MADISON COUNTY 2019-2021 CHIP IS POSTED ON THE MADISON COUNTY WEBSITE, THE ONEIDA HEALTH WEBSITE AND THE COMMUNITY MEMORIAL HOSPITAL WEBSITE. HARD COPIES HAVE BEEN DISTRIBUTED TO COMMUNITY PARTNERS AND OTHER INTERESTED PARTIES AND ALSO CITY, TOWN AND VILLAGE GOVERNMENTS.

PART I, LINE 7:
FINANCIAL ASSISTANCE IS CALCULATED USING A COST TO CHARGE RATIO. DIRECT OFFSETTING REVENUE FOR FINANCIAL ASSISTANCE IS CALCULATED BY TAKING REVENUES AND A PERCENT OF THE POOL PAYMENTS BASED ON THE LOSS.

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 $ 3,148,544.

PART II, COMMUNITY BUILDING ACTIVITIES:
IN 2021, WHILE LIMITED DUE TO THE COVID-19 PANDEMIC, OH STILL ENGAGED IN A FEW PROMOTIONAL AND EDUCATIONAL ACTIVITIES WITH AND FOR COMMUNITY MEMBERS IN AREAS REGARDING WELLNESS INCLUDING WOMEN'S AND INFANT HEALTH, AND A VARIETY OF OTHER HEALTH TOPICS. OH IS AN IMPORTANT PART OF MADISON COUNTY'S PUBLIC HEALTH INFRASTRUCTURE AND BY DEVELOPING A MORE ACTIVE PARTNERSHIP WITH THE DEPARTMENT OF HEALTH, WE ULTIMATELY CONTRIBUTE TO THE VALUE AND STRENGTH OF THE PUBLIC HEALTH SYSTEM. THE PROCESS FOR PUBLIC INPUT DERIVES FROM THE MADISON COUNTY CHA AND CHIP. THE COMMUNITY HEALTH IMPROVEMENT PLAN STEERING COMMITTEE, COMPRISED OF THE COUNTY HEALTH DEPARTMENT, AND LOCAL HOSPITALS (ONEIDA HEALTH, COMMUNITY MEMORIAL HOSPITAL), MET EVERY SEVERAL TIMES BEGINNING IN AUGUST 2018 THROUGH THE 2019 CALENDAR YEAR TO DEVELOP THE COMMUNITY SERVICE PLAN. SPECIFIC ITEMS THE HOSPITAL HAS INITIATED TO TARGET SUBSTANCE ABUSE ARE THE ALTERNATIVES TO OPIOID PROGRAM IN THE EMERGENCY DEPARTMENT AND THE NYS REGISTERED OPIOID OVERDOSE PREVENTION PROGRAM AND SOME OH LOCATIONS ARE OFFERING BEHAVIORAL HEALTH SCREENINGS AS WELL.CANCER SCREENINGS ARE ALSO BEING OFFERED AS PART OF THE TRINITY ACO/CNY AIM PROGRAM.ONEIDA HEALTH PARTICIPATES IN COALITION BUILDING WITH SEVERAL GROUPS INCLUDING THE CNY ORGANIZATION OF NURSE EXECUTIVES AND LEADERS, THE ONEIDA CHAMBER OF COMMERCE, THE GORMAN FOUNDATION AND SEVERAL MADISON COUNTY GOVERNMENT REPRESENTATIVES.TWO RED CROSS BLOOD DRIVES WERE SPONSORED IN 2021. A HERNIA SCREENING EVENT WAS ALSO HELD.REPRESENTATIVES FROM OH PARTICIPATED IN A BEHAVIORAL HEALTH CONSORTIUM AND OH WAS THE RECIPIENT OF A $800,000 GRANT TO BE SPREAD OVER 4 YEARS TO DEVELOP A NEW BEHAVIORAL HEALTH PROGRAM. THIS IS SLATED TO BEGIN IN 2023.OH IS INVOLVED WITH SEVERAL EDUCATIONAL INSTITUTIONS IN HEALTH PROFESSIONS PROGRAMS AND WORKFORCE DEVELOPMENT PROGRAMS. FOCUSES INCLUDE NURSING, ULTRASOUND, RESPIRATORY THERAPY, PHYSICAL THERAPY AND PHARMACY. REPRESENTATIVES ATTENDED SEVERAL OFF-SITE EVENTS WHICH BOTH RAISED AWARENESS AND MONEY FOR THE CANCER CARE FUND, WHICH BENEFITS CANCER PATIENTS DIRECTLY. A CANCER SURVIVORSHIP PROGRAM ALSO BEGAN IN 2021 AND IS EXPANDING WITH THE INCREASE IN CANCER PATIENTS.AN ADDITIONAL ITEM ONEIDA HEALTH PROVIDES IS A COMMUNITY RESOURCE GUIDE AND SEVERAL LINKS FOR ASSISTANCE ON ITS WEBSITE.

PART III, LINE 3:
PERCENT OF TOTAL EXPENSE IS CALCULATED BY TAKING THE NET COMMUNITY BENEFIT EXPENSES DIVIDED BY TOTAL FUNCTIONAL EXPENSES EXCLUDING BAD DEBT EXPENSE

PART III, LINE 8:
THE EXTENT TO WHICH ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT IS BECAUSE THE CURRENT HEALTHCARE OPERATING ENVIRONMENT IS VERY CHALLENGING IN GENERAL WITH GREAT UNCERTAINITY ABOUT THE IMPACT OF REFORM AND THE CURRENT ECONOMIC SITUATION. LIKE MANY RURAL HOSPITALS, ONEIDA HEALTH FACES THESE AND OTHER CHALLENGES TO ITS ABILITY TO CONTINUE TO SUPPORT ITS SERVICES.RECRUITMENT OF PHYSICIANS TO RURAL AREAS IS A HUGE CHALLENGE FOR HOSPITALS LIKE ONEIDA. OUR LONG TERM ABILITY TO IMPROVE ACCESS TO CARE IS HIGHLY DEPENDENT ON SUCCESSFULLY RECRUITING PHYSICIANS. RECRUITMENT HAS BECOME MORE DIFFICULT AND IS LIKELY TO CONTINUE TO BE A HUGE CHALLENGE GOING FORWARD. NEVERTHELESS, IT IS A HIGH PRIORITY FOR ONEIDA HEALTH.THE HOSPITAL CURRENTLY OFFERS A NUMBER OF PUBLIC HEALTH PROGRAMS INTENDED TO ADDRESS THE PRIORITIES THAT WERE ADDRESSED IN THE MAPP ASSESSMENT PROCESS. THESE PROGRAMS ARE DESCRIBED IN THE FOLLOWING LIST.PRIMARY CARE CENTERS IN VERONA, CHITTENANGO AND CANASTOTA, WHERE 24.3% OF THE PATIENTS SERVICED ARE MEDICAID, UNDERINSURED AND LIMITED OR NO PAY PATIENTS.OPERATION OF A PCAP PRE-NATAL CLINIC THAT SERVICES A PATIENT POPULATION OF PREDOMINANTLY YOUNG, UNMARRIED WOMEN WITH LIMITED RESOURCES AND ACCESS TO ROUTINE MEDICAL CARE.EMERGENCY DEPARTMENT THAT SERVES AS A SAFETY NET FOR PATIENT ACCESS TO SERVICES.OPERATION OF OFFSITE PHLEBOTOMY STATIONS TO INCREASE ACCESS TO THESE SERVICES AND PATIENT CONVENIENCE.PROVIDING A $2,000 IN FUNDS TO JESSICA'S HEROES, A FOUNDATION THAT SUPPORTS CANCER PATIENTS WITH GROCERY AND GAS CARDS, MONEY FOR UTILITIES, MEDICAL BILLS OR OTHER NEEDS.OPERATING THE BABY WEIGH STATION THAT PROVIDES LACTATION CONSULTATION TO NEW MOTHERS, EDUCATION ABOUT BREAST FEEDING, AND ONGOING WEIGHT MONITORING PROGRAMS FOR NEWBORN INFANTS.PATIENT SUPPORT GROUPS INCLUDING CANCER SUPPORT, LAMAZE CLASSES AND OTHERS.PROVIDING THE SERVICES OF TRAINED AND CERTIFIED SEXUAL ASSAULT CURSE EXAMINERS (SANE) IN OUR EMERGENCY DEPARTMENT.PROVIDING LOCAL ACCESS TO HOSPITAL BASED PRIMARY AND SECONDARY CARE SERVICES AND ACCESS TO SPECIALTY CARE THROUGH AFFILIATIONS WITH SPECIALIST PHYSICIAN GROUPS AND REFERRAL HOSPITALS.

PART III, LINE 9B:
IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE NO FURTHER COLLECTION ACTIONS ARE TAKEN. IF PATIENT QUALIFIES FOR LESS THAN 100% ASSISTANCE AND FAILS TO PAY THE BALANCE, OUR CURRENT COLLECTION POLICY REMAINS IN EFFECT.

PART VI, LINE 5:
OTHER INFORMATION:ONE HUNDRED PERCENT OF OH'S SURPLUS REVENUE IS INVESTED BACK INTO SUPPORTING THE ORGANIZATIONS MISSION AND VISION. OH IS GOVERNED BY ELEVEN BOARD MEMBERS WHO WORK AND LIVE WITHIN THE PRIMARY AND SECONDARY MARKET AREA OF THE HOSPITAL. OUR GOVERNANCE STRUCTURE ENSURES THAT THE COMMUNITY AND IT'S INTERESTS ARE STRONGLY REPRESENTED IN IMPORTANT DECISION MAKING. OH MAINTAINS AN OPEN MEDICAL STAFF- MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS. OH ACTIVELY RECRUITS, INCLUDING EMPLOYING WHEN NECESSARY. OH HAS ASSISTED IN RECRUITING A PRIMARY CARE PHYSICIAN AND A PHYSICIAN'S ASSISTANT INTO THE SERVICE AREA, INCLUDING DESIGNATED UNDER SERVED AREAS. OH PROVIDES EMERGENCY SERVICES TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES.

PART VI, LINE 6:
ONEIDA HEALTH SYSTEMS INC. (DBA ONEIDA HEALTH) IS A NEW YORK STATE NOT FOR PROFIT CORPORATION, TAX EXEMPT UNDER SECTION 501(3) OF THE IRS. THE SYSTEM INCLUDES TWO CAPTIVE PROFESSIONAL CORPORATIONS, ONEIDA MEDICAL PRACTICE, P.C. AND ONEIDA MEDICAL SERVICES, PLLC, MULTI-SPECIALTY PHYSICIAN GROUPS. THE PCS ARE THE VEHICLE THROUGH WHICH PHYSICIANS ARE EMPLOYED TO SERVE THE COMMUNITY.

PART VI, LINE 7, REPORTS FILED WITH STATES
NY

PART III, LINE 4:
SIGNIFICANT ESTIMATES MADE BY THE CENTER INCLUDE BUT ARE NOT LIMITED TO, THE ESTIMATED CARRYING VALUE OF INVESTMENT SECURITIES, ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THIRD PARTY PAYER CONTRACTUAL ADJUSTMENTS, ESTIMATED THIRD PARTY SETTLEMENTS, AND ASSUMPTIONS USED IN DETERMINING PENSION AND POSTRETIREMENT LIABILITIES AND RESULTANT BALANCES. THE CURRENT ECONOMIC ENVIRONMENT HAS INCREASED THE DEGREE OF UNCERTAINTY INHERENT IN THOSE ESTIMATES AND ASSUMPTIONS.THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE IS CALCULATED BY MANAGEMENT USING THE AGING METHODOLOGY. IN GENERAL, THE LONGER AN ACCOUNT BALANCE IS OVERDUE, THE LESS LIKELY THE DEBT IS TO BE PAID. THE HOSPITAL MAINTAINS AN ACCOUNTS RECEIVABLE AGING SCHEDULE, WHICH CATEGORIZES EACH PATIENT'S ACCOUNT BY THE LENGTH OF TIME THEY HAVE BEEN OUTSTANDING. EACH AGED CATEGORY'S OVERALL BALANCE IS MULTIPLIED BY AN ESTIMATED PERCENTAGE OF UNCOLLECTIBILITY FOR THAT CATEGORY, AND THE TOTAL OF ALL SUCH CALCULATIONS SERVES AS THE ESTIMATE OF BAD DEBTS. THE ACCOUNTS RECEIVABLE AGING SCHEDULE IS CATEGORIZED BY SERVICE INCLUDING INPATIENT, EMERGENCY ROOM, REFERRED AMBULATORY, AMBULATORY SURGERY, SERIES AND NURSING HOME. EACH SERVICE IS THEN SUB-CATEGORIZED BY FINANCIAL CLASS AND AGED CATEGORY. EACH AGED CATEGORY IS DELINEATED BY 30 DAY INCREMENTS UP TO 180 DAYS OUTSTANDING THEN 180 TO 365 AND OVER 365 DAYS OUTSTANDING. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE CALCULATION IS THE RESULT OF THE FOLLOWING:FOR ALL ACCOUNTS RECEIVABLE EXCLUSIVE OF SELF PAY, 10% OF THE NET EXPECTED PAYMENT FOR ALL ACCOUNTS THAT ARE BETWEEN 0 AND 180 DAYS OUTSTANDING ARE RESERVED FOR BAD DEBT. FOR ALL ACCOUNTS THAT ARE OVER 181 DAYS OUTSTANDING, THE RESERVE FOR BAD DEBT IS 50%. FOR ALL ACCOUNTS THAT ARE OVER 365 DAYS OUTSTANDING, THE RESERVE FOR BAD DEBT IS 100%. THIS CALCULATION IS USED PRIMARILY TO ESTIMATE THE UNCOLLECTIBILITY OF DEDUCTIBLES AND COINSURANCE AFTER INSURANCE PAYMENTS.FOR ALL SELF PAY PATIENTS BETWEEN 0 AND 60 DAYS OLD, 25% OF THE EXPECTED PAYMENT OUTSTANDING IS RESERVED FOR BAD DEBT; FOR BETWEEN 61 AND 90 DAYS OLD, 50% OF THE EXPECTED PAYMENT OUTSTANDING IS RESERVED; FOR 91-120 DAYS OLD, 75% OF THE EXPECTED PAYMENT OUTSTANDING IS RESERVED; AND FOR ALL SELF PAY ACCOUNTS OVER 121 DAYS OLD, 90% OF THE EXPECTED SELF PAY PAYMENT IS RESERVED FOR BAD DEBT. THE ALLOWANCE FOR BAD DEBT RESERVE THAT IS CALCULATED MONTHLY IS COMPARED TO THE ACTUAL RESERVE PER THE GENERAL LEDGER AND ADJUSTED ACCORDINGLY.THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3: THE RATIO OF COST TO CHARGES.THE RATIONALE FOR INCLUDING OTHER BAD DEBT AMOUNTS IN COMMUNITY BENEFIT IS BECAUSE ONEIDA HEALTH (OH) HAS SEEN A SUBSTANTIAL INCREASE IN THE VOLUME OF SELF PAY PATIENTS DUE TO EMPLOYERS CLOSING, REDUCING STAFF OR REDUCING THE HEALTH INSURANCE BENEFITS THAT THEY OFFER THEIR EMPLOYEES. DEDUCTIBLE AND CO-INSURANCE AMOUNTS HAVE INCREASED OVER THE PAST FEW YEARS, WITH THE IMPLEMENTATION OF MORE HIGH DEDUCTIBLE PLANS AND THE AFFORDABLE CARE ACT. OH STAFF IS AVAILABLE TO DISCUSS PATIENT OPTIONS TO RESOLVE THEIR OUTSTANDING BALANCES. THE HOSPITAL OFFERS FINANCIAL ASSISTANCE BASED ON 300% OF THE FEDERAL POVERTY GUIDELINES. PATIENTS RECEIVE INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND ALLOWANCES WITH EACH ORIGINAL STATEMENT. APPLICATIONS CAN BE OBTAINED AT THE HOSPITAL, HOSPITAL CLINICS, REGISTRATION DEPARTMENT AND THE BUSINESS OFFICE AND ON THE HOSPITAL'S WEBSITE (WWW.ONEIDAHEALTH.ORG/FINANCIAL-ASSISTANCE). OH ALSO HAS A DESIGNATED EMPLOYEE TO ASSIST PATIENTS IN APPLYING FOR MEDICAID OR OTHER STATE RUN PROGRAMS FOR LOW INCOME FAMILIES. OH ALSO OFFERS PAYMENT PLANS FOR THOSE PATIENTS WHO ARE UNABLE TO PAY A BALANCE IN FULL. HOSPITAL REPRESENTATIVES WORK WITH PATIENTS TO DEVELOP A PAYMENT PLAN THAT IS AFFORDABLE BY THE PATIENT AND IS REASONABLE FOR THE HOSPITAL. ASSISTANCE WITH ANY FINANCIAL ASPECT IS OFFERED BY THE HOSPITAL BUSINESS OFFICE STAFF. A BUSINESS OFFICE EMPLOYEE IS ALSO LOCATED IN THE HOSPITAL'S REGISTRATION DEPARTMENT, MONDAY THROUGH FRIDAY FROM 7:30 A.M. TO 3:30 P.M., OR ADDITIONAL HOURS BY APPOINTMENT. PATIENTS ARE ABLE TO SCHEDULE APPOINTMENTS WITH BUSINESS OFFICE REPRESENTATIVES TO DISCUSS THEIR OPTIONS. THE BUSINESS OFFICE HAS ALSO ASSISTED PATIENTS WITH BILLINGS THEY MAY HAVE FROM OTHER PROVIDERS WHEN THE PATIENT JUST DOES NOT KNOW OR UNDERSTAND HOW TO HANDLE THE RESOLUTION OF THE ACCOUNTS.IN MANY CASES PATIENTS UTILIZE OUR EMERGENCY ROOM SERVICES FOR TREATMENT OF NON-EMERGENT CARE. UNINSURED PATIENTS ARE ROUTINELY UNEMPLOYED PATIENTS AND THEREFORE IT IS DIFFICULT TO COLLECT PAYMENT FOR SERVICES RENDERED. PATIENTS WHO ARE UNINSURED OFTEN DO NOT SEEK CARE UNTIL IT IS ABSOLUTELY NECESSARY, THEREFORE CREATING A LARGE BALANCE DUE FOR EMERGENCY ROOM SERVICES.OH DOES REQUIRE A PRIOR YEAR'S TAX RETURN (IF FILED) TO ASSIST IN MAKING A DETERMINATION FOR FINANCIAL ASSISTANCE. OH DECISIONS FOR FINANCIAL ASSISTANCE ARE MADE IN FAVOR OF THEIR PATIENTS WHEN IN DOUBT. THERE ARE TIMES WHEN PATIENTS DO NOT WANT TO APPLY FOR ASSISTANCE AS THEY DO NOT WANT ANYONE TO KNOW THEY NEED THE ASSISTANCE. OH HAS MADE DECISIONS TO APPROVE FINANCIAL ASSISTANCE FOR PATIENTS BASED ON A CASE BY CASE SITUATION WHERE IT IS CLEARLY EVIDENT THE PATIENT NEEDS HELP.COSTLY CARE, UNDER FUNDED RATES FROM PAYERS, DELAYS IN PAYMENTS AND INCREASED DENIALS HAVE PUT A BURDEN ON ALL HEALTH CARE FACILITIES.ONEIDA HEALTH OFFERS FREE, CONFIDENTIAL ASSISTANCE. ALL PATIENTS CAN CONTACT OUR FINANCIAL COUNSELOR AT 315-361-2230.

PART VI, LINE 2:
"ONEIDA HEALTH IS COMMITTED TO HELPING ASSESS AND ADDRESS THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH ITS OWN SERVICES AND PROGRAMS, AND COMMUNITY BASED PARTNERSHIPS. A COMMUNITY ASSESSMENT IS A POINT IN TIME EFFORT TO MEASURE THE HEALTH AND WELLBEING OF THE COMMUNITY. IT SERVES AS A BASIS FOR OH'S STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, AND IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. THE COMMUNITY ASSESSMENT WILL SERVE AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES. OH'S PARTICIPATION IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WILL PROVIDE THE OPPORTUNITY TO: -GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES' SERVED-IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATION WITHIN THE COMMUNITY-ENHANCE HOSPITAL/COMMUNITY PARTNERSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION INCLUDING INVOLVEMENT WITH BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS. -PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNING. THE COMMUNITY NEEDS ASSESSMENT PROCESS INVOLVES GATHERING OF TWO TYPES OF DATA ""QUANTITATIVE"" (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND ""QUALITATIVE"" (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS, ETC.). COLLECTIVELY THE DATA WILL HELP SUPPORT SHORT TERM AND LONG TERM PLANNING ABOUT THE ALLOCATION OF CURRENT AND FUTURE RESOURCES. BEGINNING IN AUGUST 2018, AND CONTINUING THOUGH 2019, A COMMUNITY HEALTH ASSESSMENT STEERING COMMITTEE, COMPRISED OF THE MADISON COUNTY DEPARTMENT OF HEALTH, ONEIDA HEALTH, AND COMMUNITY MEMORIAL HOSPITAL REVIEWED THE CURRENT DATA AND RELATED HEALTH INFORMATION AND RECOGNIZED THE NEED TO SHIFT TO TWO NEW FOCUS AREAS - SPECIFICALLY IN THE AREAS OF SUBSTANCE ABUSE AND LUNG CANCER. THE STEERING COMMITTEE REVIEWED DATA AND HEALTH TRENDS, ALONG WITH VARIOUS DOCUMENTS AND REPORTS INCLUDING: THE 2016 MADISON COUNTY COMMUNITY HEALTH ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN, THE PAST HOSPITAL COMMUNITY SERVICE PLANS, HEALTHECNY HEALTH INDICATOR LIST, NEW YORK STATE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), NYS HEALTH PROFILES, COUNTY HEALTH RANKINGS & ROADMAPS FROM THE ROBERT WOOD JOHNSON FOUNDATION, CENTRAL DSRIP REGION NEEDS ASSESSMENT, NYS PREVENTION AGENDA DASHBOARD, STUDENT WEIGHT STATUS CATEGORY REPORTING SYSTEM (SWSCR), NYS COMMUNITY HEALTH INDICATOR REPORTS (CHIRS), THE NYS ENVIRONMENTAL PUBLIC HEALTH TRACKER, AND OTHER SOURCES TO DETERMINE THE PRIORITIES. DATA WAS COLLECTED AND PRESENTED TO THE STEERING COMMITTEE BY A MULTIDISCIPLINARY TEAM THAT UTILIZED THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS.THE PREVENTION AGENDA PRIORITIES SELECTED FOR MADISON COUNTY ARE: 1. MENTAL AND SUBSTANCE USE DISORDERS - WITH GOALS OF REDUCING SUBSTANCE USE AMONG YOUTH, PREVENTING ALCOHOL-RELATED MOTOR VEHICLE INJURY AND DEATH, AND REDUCING SUBSTANCE ABUSE AMONG ADULTS; AND 2. REDUCING LUNG CANCER - WITH GOALS OF INCREASING LUNG CANCER SCREENING RATES AND TO REDUCE THE IMPACT OF RADON, WHICH IS THE SECOND LEADING CAUSE OF LUNG CANCER.ONEIDA HEALTH WILL CONTINUE TO COLLECT AND ANALYZE KEY QUANTITATIVE AND QUALITATIVE DATA TO SUPPORT ON-GOING DECISION MAKING FOR RESOURCE ALLOCATION, IN CONJUNCTION WITH OUR COMMUNITY PARTNERS, TO DETERMINE IMPORTANT DECISION MAKING FACTORS OF NEW PROGRAMS TO MEET THE EMERGING NEEDS OF THE COMMUNITIES WE SERVE. THE CURRENT PRIORITIES OF ONEIDA HEALTH WILL BE TO FOCUS ON THE PRIORITIES IDENTIFIED IN OUR COLLABORATIVE COMMUNITY NEEDS ASSESSMENT AS MENTIONED ABOVE."

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE OHC IS COMMITTED TO:1)PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES.2)CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES.3)ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE.4)BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITY.IN ACCORDANCE WITH NEW YORK STATE RECOMMENDATIONS, OHC HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS OF OUR PATIENTS:1)PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS.2)MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS.3)OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED NEEDS.4)IMPLEMENT POLICIES FOR ASSISTING LOW INCOME PATIENTS IN A CONSISTENT MANNER.5)IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS AND PATIENT PAYMENT OBLIGATIONS.OH IS COMMITTED TO EFFECTIVELY COMMUNICATING WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY WILL BE POSTED AT EACH REGISTRATION SITE INCLUDING BUT NOT LIMITED TO THE HOSPITAL REGISTRATION DEPARTMENT, THE EMERGENCY ROOM, LAB DRAW STATIONS, PHYSICAL THERAPY BUILDING, THE GORMAN BUILDING AND AT THE CLINICS. NOTIFICATION OF THE FINANCIAL ASSISTANCE POLICY WILL BE IDENTIFIED ON THE FIRST BILLING SENT TO ALL PATIENT/GUARANTORS WHO HAVE AN OPEN BALANCE WITH THE HOSPITAL. SIGNS INFORMING PATIENTS OF THE FINANCIAL ASSISTANCE PROGRAM, IN VARIOUS LANGUAGES, WILL ALSO BE POSTED AT EACH REGISTRATION INPUT AREA BASED ON THE SAMPLE LANGUAGE FORMAT FROM THE NEW YORK STATE DEPARTMENT OF HEALTH. THE BROCHURE PROVIDES INFORMATION REGARDING PAYMENT OPTIONS, FINANCIAL ASSISTANCE AND BILLING QUESTIONS. EVERY EFFORT IS MADE TO DETERMINE A PATIENTS ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENTS STAY AFTER STABILIZATION OR COLLECTION CYCLE. OH OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE IS AVAILABLE THROUGH VARIOUS MEANS, PATIENT BROCHURES, NOTICES OR MESSAGING INCLUDED ON PATIENT BILLS AND NOTICES IN PUBLIC REGISTRATION AREAS, INCLUDING EMERGENCY ROOM, OUTPATIENT CLINICS, ADMITTING AND REGISTRATION DEPARTMENTS AND PATIENT ACCOUNTING DEPARTMENTS. OH HAS ESTABLISHED A COLLECTION CYCLE POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. OH MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL CONSISTENT MANNER.OH HAS ONE CERTIFIED FINANCIAL COUNSELOR PREPARED TO WORK WITH PATIENT'S FINANCIAL NEEDS. WITH THIS CERTIFICATION, SHE CAN ASSIST PATIENTS IN OBTAINING INSURANCE COVERAGE THROUGH MEDICAID OR AND EXCHANGE PRODUCT. SHE GOES TO THE INPATIENT ROOMS TO DISCUSS OPTIONS WITH THE PATIENTS AND THEIR FAMILIES.

PART VI, LINE 4:
OH SERVES A FOUR COUNTY SERVICE AREA WITHIN A 25 MILE RADIUS STRETCHING IN EVERY DIRECTION FROM THE CITY OF ONEIDA. THE PRIMARY SERVICE ZIP CODES ARE LOCATED IN MADISON AND ONEIDA COUNTIES WHILE THE SECONDARY SERVICE ZIP CODES ARE LOCATED IN ONONDAGA AND OSWEGO COUNTIES. IN 2021, THE PRIMARY COUNTY MARKET AREA SERVED HAD AN ESTIMATED POPULATION OF 297,782, WHILE THE SECONDARY COUNTIES HAD AN ESTIMATED POPULATION OF 590,623.THERE ARE SEVEN HOSPITALS WITHIN OH'S SERVICE AREA THAT REPRESENT 95% OF THE MARKET PENETRATION. THREE OF THE HOSPITALS PROVIDE PRIMARY HEALTH SERVICES WITHIN THE MARKET AREA SERVED BY OH. FOUR HOSPITALS, THREE TO THE WEST OF OH BY FORTY FIVE MINUTES AND ONE TO THE EAST OF OH BY 35 MINUTES, PROVIDE TERTIARY CARE FOR THIS AREA. THERE ARE APPROXIMATELY 26 HEALTHCARE FACILITIES TOTAL IN MADISON COUNTY.THE US CENSUS BUREAU WILL NOT RELEASE ITS STANDARD 2021 ACS 1-YEAR ESTIMATES DUE TO THE IMPACTS OF THE COVID-19 PANDEMIC. THIS LIMITS SOME DETAIL AVAILABLE FOR REPORTING. HOWEVER, ACCORDING TO THE BUREAU'S 2021 POPULATION TABLES, OH'S SERVICE AREAS EXPERIENCED A 3.40 PERCENT DECREASE IN POPULATION FROM 2010 TO 2021. THE STRESS THAT THIS TREND PLACES ON THE PROVISION OF SERVICES IS COMPOUNDED BY THE HIGHER THAN AVERAGE PROPORTION OF ELDERLY IN THE AREA. 18.49% OF THE POPULATION IN THE ENTIRE SERVICE AREA WAS OVER AGE 65 IN 2021, COMPARED TO 16.5% FOR THE NATION. THE PRIMARY SERVICE AREA, WHICH CONSISTS OF MADISON AND ONEIDA COUNTIES, HAD A POPULATION OF OVER 65 RESIDENTS OF 19.49%. THIS LARGE PERCENTAGE OF ELDERLY PRESENTS SPECIAL CHALLENGES TO HEALTH CARE PROVIDERS BECAUSE THE ELDERLY HAVE THE HIGHEST INCIDENCE OF DISEASE AND MORTALITY IN MOST CATEGORIES AND CORRESPONDINGLY, ARE THE BIGGEST USERS OF HEALTH CARE SERVICES. MEDICARE PAYMENT SHORTFALLS PRESENT AN ADDITIONAL BURDEN FOR RURAL HEALTH CARE PROVIDERS. FOR FISCAL YEAR 2021, 35.54% OF OH'S REVENUES WERE GENERATED FROM MEDICARE PATIENTS.THE MEDIAN HOUSEHOLD INCOME IN OH'S SERVICE AREA FOR 2020 IS ESTIMATED AT $60,507, WHILE THE PERCENT OF INDIVIDUALS BELOW THE POVERTY LEVEL IN THE SERVICE AREA AVERAGES 12.89%, AN DECREASE OF 8.87% FROM PRIOR YEAR. 2021 NUMBERS WERE NOT AVAILABLE. OH IS A DISPROPORTIONATE SHARE HOSPITAL. IN FISCAL YEAR 2021, OUR GENERAL ADMITTANCE PAYER MIX FOR MEDICARE (INCLUDING HMO MEDICARE) WAS 40.0% AND 24.9% FOR THE POOR AND UNDERSERVED. FOR FISCAL YEAR 2021, PAYER MIX FOR THE POOR AND UNDERSERVED IN EMERGENCY DEPARTMENT WAS 37.7%. THIS NUMBER APPEARS TO IMPROVE FROM 2020. VOLUMES HAVE INCREASED IN 2021, COMPARED TO THE REDUCTION THAT OCCURRED IN 2020 DUE TO THE COVID-19 PANDEMIC. HOWEVER, 2021 NUMBERS STILL REFLECT LARGE PERCENTAGES FOR THE POOR AND UNDERSERVED. PRIORITIES OF OUR EMERGENCY ROOM PHYSICIANS INCLUDE AUGMENTING ACCESS TO CARE FOR UNINSURED AND UNDERINSURED INDIVIDUALS, FACILITATING CONNECTION WITH ONE OF OH'S THREE ARTICLE 28 OUTPATIENT CLINICS AND THE PRIMARY CARE PHYSICIANS IN THE SURROUNDING AREAS.IN MARCH, 2020, THE WORLD HEALTH ORGANIZATION DECLARED THE COVID-19 OUTBREAK A PANDEMIC AND THE U.S. FEDERAL GOVERNMENT DECLARED COVID-19 A NATIONAL EMERGENCY. NOT ONLY DID THIS RESULT IN A REDUCTION OF PATIENT VOLUMES DUE TO THE RESTRICTIVE MEASURES MANDATED BY NEW YORK STATE, IT ALSO RESULTED IN THE LOSS OF OPPORTUNITIES FOR OH TO PARTICIPATE IN SEVERAL EVENTS TO CONTRIBUTE TO COMMUNITY HEALTH IMPROVEMENT. THIS DID CONTINUE INTO 2021, BUT ACTIVITIES DID BEGIN TO RESUME AS THE YEAR PROGRESSED. DURING THE COURSE OF A NORMAL YEAR, OH WORKS IN COLLABORATION WITH LOCAL COMMUNITY ORGANIZATIONS TO ADDRESS THE PREVALENCE OF OBESITY, DIABETES, HEART DISEASE/STROKE, AND UNDER AGE PREGNANCY. OH PARTICIPATES IN DIABETES EDUCATION SERVICES AND IN THE FIT KIDS OF MADISON COUNTY PROGRAM WITH THE YMCA TO IMPROVE OUTCOMES FOR OVERWEIGHT YOUTH EDUCATION AND FITNESS. OH OFFERS SMOKING CESSATION PROGRAMS TO BOTH INPATIENTS AND OUTPATIENTS WHO RECEIVE CARE. OH PROMOTES BREASTFEEDING WITH ALL MOTHERS OFFERING CERTIFIED LACTATION CONSULTANTS TO ASSIST IN BREASTFEEDING SUCCESS. THE FIT KIDS SUMMER EVENT, LADIES NIGHT OUT AND SMOKING CESSATION WERE NOT OFFERED IN 2021 DUE TO THE COVID-19 PANDEMIC AS WELL AS VARIOUS OTHER EVENTS AT SCHOOLS AND FAIRS. SOME OTHER PROGRAMS ARE GENERALLY OFFERED AT THE CLINIC LEVELS AS PART OF ROUTINE HEALTH SCREENINGS.