4A (Expenses $ 148259524 including grants of $ 3404) (Revenue $ 143560613)
SEE SCHEDULE O FOR THE DESCRIPTION OF THE ORGANIZATION'S PROGRAM SERVICE ACCOMPLISHMENTS.

PART V, SECTION B, LINE 5:
IN 2021/ 2022, THE LATEST CYCLE FOR COMPLETING COMMUNITY HEALTH NEEDS ASSESSMENT WAS INITIATED IN LENOIR COUNTY BY LENOIR COUNTY HEALTH DEPARTMENT AND UNC LENOIR HEALTH CARE. LENOIR COUNTY WORKS WITHIN THE HEALTH ENC PARTNERSHIP IN UNIFYING REGIONAL PROCESS AND TIMELINE. COMMUNITY INPUT WAS OBTAINED THROUGH SURVEY PROCESS AND INPUT OF COMMUNITY HEALTH LEADERS USING THE LENOIR COUNTY ALLIANCE FOR A HEALTHY COMMUNITY TO COLLABORATE AND PARTNER IN ESTABLISHING COMMUNITY PRIORITIES FOR THE NEXT THREE YEARS. COMMUNITY PRIORITIES WERE ESTABLISHED IN NO PARTICULAR ORDER AS: + WELLNESS & LIFESTYLE + IMMUNIZATIONS & INFECTIOUS DISEASES + SUBSTANCE ABUSE THE FULL 2021/2022 LENOIR COUNTY CHNA AND UNC LENOIR HEALTH CARE IMPLEMENTATION STRATEGIES AS WELL AS PAST ASSESSMENTS AND STRATEGIES ARE LOCATED AT THE HEALTHY COMMUNITIES TAB UNDER THE MINGES WELLNESS CENTER AT UNCLENOIR.ORG OR THROUGH HTTPS://WWW.LENOIRWELLNESS.ORG/HEALTHY-COMMUNITIES/

PART V, SECTION B, LINE 6A:
THE CHNA WAS MAILED OUT TO COMMUNITY LEADERS

PART V, SECTION B, LINE 11:
UNC Health Lenoir is addressing specific community needs from the 2021-2022 CHNA. 1) A specific concern was the incident spread of COVID-19 in Lenoir County. The desired outcome was to reduce the rate of COVID-19 in Lenoir County through testing, community drives for vaccinations, and developing additional precautions for UNC Health Lenoir. 2) Substance abuse was identified as a specific community concern of legal and illegal drugs abused in Lenoir County. The hospital Emergency Department providers through participation on the UNC Health Lenoir Pain Stewardship committee which facilitated communication with local providers to enhance their knowledge of the pain management process in the emergency department. Pharmacists have presentations to the community about safe medication disposal. There is increased education to the community about alternative pain therapy. 3) Another strategy was Wellness and Lifestyle with a goal of reducing adult obesity. UNC Health Lenoir provided low cost or free on site fitness center and free community walking track which is grant funding for use of the community. There is increased support with community organizations with sponsorships targeting physical activity components of events. 4) Increase nutrition education and healthy food behaviors for residents of Lenoir County. The support has increased for access to fresh fruits and vegetables in the community with events at the Lenoir County Farmer's market. There are scheduled health grocery cart conversation series and community weight loss programming services. During February each year there are heart health education programs. The following Community needs are not addressed: 1) Community transportation with the impact of the COVID this need will be addressed further in the next cycle, 2) Maternal, Fetal, and Infant health was not specifically addressed due to this area being addressed in the community, 3) The cancer program at UCN Health Lenoir achieved accreditation in 2019 and is being addressed with a multi-organization collaborative effort, 4) Also not addressed due to prioritization were: the economy, heart disease, mortality data, and mental health and mental disorders.

PART I, LINE 3C:
PRESUMPTIVE DETERMINATION: IN ADDITION TO DETERMINING ELIGIBILITY FOR FREE CARE USING INCOME LEVELS AND FEDERAL POVERTY GUIDELINES, PATIENTS MAY ALSO QUALIFY FOR FINANCIAL ASSISTANCE BASED ON PRESUMPTIVE DETERMINATION, WHICH UTILIZES A SCORING METHODOLOGY THAT REPRESENTS A PATIENT'S ABILITY TO PAY BASED ON CRITERIA SUCH AS, BUT NOT LIMITED TO, ASSET OWNERSHIP, DEBT PAYMENT TENDENCIES, AND AVAILABLE CREDIT. THIS METHOD MAY BE USED WHEN CIRCUMSTANCES PREVENT FULL COMPLETION OF A FINANCIAL ASSISTANCE APPLICATION. OTHER FACTORS THAT MAY QUALIFY A PATIENT FOR PRESUMPTIVE APPROVAL INCLUDE BEING HOMELESS, DECEASED OR INCARCERATED. MEDICAL INDIGENCE: PATIENTS WHO DO NOT QUALIFY FOR STANDARD FINANCIAL ASSISTANCE BASED ON INCOME CRITERIA MAY QUALIFY FOR CATASTROPHIC ASSISTANCE (MEDICAL INDIGENCE). EXISTING PATIENT BALANCES, AFTER ALL OTHER FINANCIAL RESOURCES (INCLUDING APPLICABLE HEALTHCARE COVERAGE) AVAILABLE TO THE PATIENT HAVE BEEN EXHAUSTED, SHOULD PRODUCE A MEDICAL DEBT-TO-INCOME RATIO OF GREATER THAN OR EQUAL TO 20%. FOR APPROVED CATASTROPHIC FINANCIAL ASSISTANCE, THE PATIENT'S MEDICAL DEBT AFTER INSURANCE WILL BE REDUCED TO 20% OF THE PATIENT'S INCOME AND ASSETS MINUS A STANDARD 6% EXPENSE AND LIABILITY ALLOWANCE. IF A PATIENT HAS NO INCOME, THE PATIENT'S MEDICAL DEBT AFTER INSURANCE WILL BE REDUCED BY 84%. UNINSURED DISCOUNT: PATIENTS WHO HAVE NO HEALTH COVERAGE, NO COVERAGE FROM ANY OTHER THIRD PARTY (SUCH AS THIRD PARTY AUTO LIABILITY COVERAGE), OR WHO OBTAIN SERVICES NOT COVERED BY THEIR HEALTH INSURANCE WILL BE ELIGIBLE FOR A 40% DISCOUNT ON MOST CHARGES. PRE AND POST SERVICE SCREENINGS: PATIENT ACCESS ASSOCIATES WILL CONTACT AND SCREEN MOST PATIENTS WHO ARE PRE-SCHEDULED FOR SERVICES. THIS INCLUDES A SCREENING FOR POSSIBLE MEDICAID ELIGIBILITY AND DISCUSSION OF FINANCIAL ASSISTANCE. MEDICAID ELIGIBILITY SPECIALISTS WILL SCREEN ANY UNINSURED PATIENT ADMITTED AS AN INPATIENT OR OBSERVATION PATIENT WHILE IN-HOUSE TO DETERMINE POSSIBLE MEDICAID PROGRAM ELIGIBILITY FOR FINANCIAL ASSISTANCE ELIGIBILITY.

PART I, LINE 7G:
THE SUBSIDIZED HEALTH SERVICES PROGRAMS INCLUDED DIABETES, ENDOCRINOLOGY, HEMATOLOGY/ONCOLOGY, AND NEONATOLOGY.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY HEALTH EDUCATION PROGRAMMING COMMUNITY HEALTH EDUCATION PROGRAMMING 446 PARTICIPANTS IN ON AND OFF-SITE HEALTH AND WELLNESS PROGRAMMING. PROGRAMMING INCLUDED HEART, STROKE, COVID-19, EXERCISE, NUTRITION AND OTHER HEALTH EDUCATION OFFERINGS. EDUCATION WAS IN PERSON AND VIRTUALLY. GROCERY CART CONVERSATION SERIES A FREE COMMUNITY NUTRITION EDUCATION PROGRAM LED BY REGISTERED DIETITIANS WAS PROVIDED IN ELEVEN ONGOING MONTHLY SESSIONS AT THE PIGGLY WIGGLY ON HERRITAGE STREET IN KINSTON. ADVANCED DIRECTIVES PROVIDED 5 COMMUNITY RESIDENTS WITH SUPPORT IN COMPLETING ADVANCED DIRECTIVES. EMPLOYEE OUTREACH IN COMMUNITY UNC LENOIR EMPLOYEES SHOW GOOD COMMUNITY STEWARDSHIP BY PARTICIPATING IN FUNDRAISING TO SUPPORT THE AMERICAN CANCER SOCIETY RELAY FOR LIFE, LENOIR HOSPITAL FOUNDATION PROJECTS, AND LENOIR- GREENE UNITED WAY. EMPLOYEES WORKED TOGETHER TO GIVE TIME, TALENT AND PERSONAL CASH DONATIONS/PLEDGES OF $98,348 DURING FY22 TOWARDS GREAT CAUSES IN THE COMMUNITY. EMPLOYEES COLLECTED 16,793 POUNDS OF FOOD FOR 17 FAMILIES IN THE FEASTIVAL OF FOOD AND MADE DONATIONS TO THE PANTRIES AT, MARY'S KITCHEN, CANCER CENTER, 4 CHURCH FOOD BANKS, GREENE COUNTY INTERFAITH EMPLOYEES KEPT THE LONG TRADITION OF PLAYING SECRET SANTA TO 25 NEEDY CHILDREN IN THE COMMUNITY. GIFTS THIS YEAR WERE GIVEN TO CHILDREN WITHIN THE GUARDIAN AD LITEM PROGRAM AND FROM THEIR OWN POCKETS. HOSPITAL VOLUNTEER PROGRAM DURING FY 22, 115 VOLUNTEERS INCLUDING YOUTH VOLUNTEERS AND CHAPLAINS PROVIDED 10,745 VOLUNTEER HOURS IN A VARIETY OF HOSPITAL SETTINGS ENRICHING THE PATIENT EXPERIENCE AND PERFORMING THE WORK OF 10 UNPAID FTES. THE COMMUNITY DONATIONS, TOTALING MORE THAN $33,000, FOR LIGHTS OF LOVE FUND A NUMBER OF HOSPITAL ONCOLOGY PROGRAMS AND PROJECTS EACH YEAR. THE GIFT SHOP AND VENDOR SALES RAISED AN ADDITIONAL $81,769 TO SUPPORT HOSPITAL PROJECTS, EMPLOYEE AND TEEN SCHOLARSHIPS, AND ITEMS USED TO ENHANCE THE PATIENT EXPERIENCE. PET THERAPY UNC LENOIR CONTINUED ITS SAFE AND THERAPEUTIC DOG VISITS TO THE PATIENTS ON APPROVED PATIENT CARE UNITS BY HAVING 1 THERAPY DOG. RESEARCH INDICATES THAT PET THERAPY HELPS TO REDUCE AND MANAGE PATIENT'S ANXIETY BY FOCUSING PATIENT'S ATTENTION ON THE DOG, STIMULATES POSITIVE FEELINGS IN PATIENTS, AND OFFERS A MEANS OF RELAXATION AND SOCIAL INTERACTION. OUR PET THERAPY VOLUNTEER, AND HER DOG GYPSI HAD 378 INTERACTIONS WITH VISITORS AND FAMILY MEMBERS AND 1 PATIENT VISIT FROM JULY 1, 2021 - JUNE 30, 2022.

PART III, LINE 3:
THE ORGANIZATION'S BAD DEBT DOES NOT INCLUDE ANY AMOUNTS ATTRIBUTABLE TO THOSE PATIENTS WHO APPLIED FOR AND RECEIVED FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.

PART III, LINE 4:
NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, AND INCLUDES ESTIMATED RETROACTIVE REVENUE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS, AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED, AND SUCH AMOUNTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS, AND INVESTIGATIONS.

PART III, LINE 8:
THE MEDICARE COST REPORT WAS USED TO DETERMINE MEDICARE ALLOWABLE COSTS OF CARE.

PART III, LINE 9B:
PER THE SELF-PAY COLLECTIONS POLICY, IF THERE IS A PENDING FINANCIAL ASSISTANCE APPLICATION OR AN APPROVED APPLICATION, BILLING INDICATORS ARE PLACED ON ACCOUNTS THAT PREVENT COLLECTIONS ACTIVITY FROM HAPPENING. THIS INCLUDES REFERRAL TO OUTSIDE COLLECTION AGENCIES. PATIENT STATEMENTS INCLUDE INFORMATION RELATED TO FINANCIAL ASSISTANCE, WHICH INCLUDES AN AUTO-GENERATED INSERT FOR ANY PATIENT STATEMENT SHOWING A PAST DUE BALANCE, GIVING THE PATIENT AN OPPORTUNITY TO APPLY FOR FINANCIAL ASSISTANCE IF THEY HAVE NOT ALREADY DONE SO. ANY PATIENT BALANCE THAT IS PLACED IN A BAD DEBT COLLECTION STATUS PRIOR TO THE PATIENT APPLYING FOR AND BEING APPROVED FOR FINANCIAL ASSISTANCE IS THEN REMOVED FROM BAD DEBT COLLECTION STATUS AND THE BALANCE ADJUSTED ACCORDINGLY.

PART VI, LINE 5:
THE HOSPITAL BOARD IS COMPRISED OF UNRELATED COMMUNITY MEMBERS. LOCAL PHYSICIANS HAVE PRIVILEGES IN A MAJORITY OF HOSPITAL DEPARTMENTS. SURPLUS FUNDS MAY BE USED TO PURCHASE CAPITAL EQUIPMENT OR OTHER MEDICAL EQUIPMENT USED IN PATIENT CARE. THEY ARE ALSO USED TO PURCHASE TECHNOLOGY, SUCH AS COMPUTER EQUIPMENT, SOFTWARE, AND CONNECTIVITY. THESE FUNDS ALSO SUPPORT GENERAL BUILDING REFURBISHMENTS AS WELL AS REPAIRS AND MAINTENANCE. The hospital recruits physicians for the community and through a partnership with UNC Physician's Network (UNCPN), the hospital financially supports the practices. The UNCPN physicians utilize the EPIC Hospital information system (medical record), the same as the hospital.

PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT:
NORTH CAROLINA

PART VI, LINE 2:
LENOIR MEMORIAL WORKS CLOSELY WITH THE LENOIR COUNTY HEALTH DEPARTMENT TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR LENOIR COUNTY, OUR LARGEST POPULATION SERVED. OUR COMMUNITIES ARE SURVEYED WITH BOTH ENGLISH AND SPANISH SURVEY INSTRUMENTS. LOCAL DEMOGRAPHIC AND HEALTH STATISTICS ARE COMPILED ALONG WITH COMMUNITY SURVEY DATA ABOUT PERCEIVED HEALTH ISSUES IN ORDER TO DEVELOP TARGETED COMMUNITY HEALTH STRATEGIES. LENOIR MEMORIAL PROVIDES LEADERSHIP TO THE LENOIR COUNTY ALLIANCE FOR A HEALTHY COMMUNITY, WHICH IS A BROAD BASE OF COMMUNITY AGENCIES AND ORGANIZATIONS THAT MEET MONTHLY TO PROMOTE A HEALTHY COMMUNITY. LENOIR MEMORIAL ALSO PARTNERS WITH LENOIR, GREENE, AND JONES COUNTIES IN HEALTHY INITIATIVES TO PROMOTE AND SUPPORT HEALTHIER LIVING ACTIVITIES. ANNUAL CANCER REPORTING AND HOSPITAL DIAGNOSIS TRENDS ARE USED TO PRIORITIZE PROGRAMMING, SERVICES, AND INITIATIVES AS WELL AS PHYSICIAN NEEDS ASSESSMENTS.

PART VI, LINE 3:
"THE HOSPITAL INFORMS AND EDUCATES PATIENT AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE BY POSTING SIGNAGE AND MAKING AVAILABLE BROCHURES AND OTHER LITERATURE THROUGHOUT THE FACILITY AND IN SOME CASES, LOCAL PHYSICIAN OFFICES OR OTHER COMMUNITY RESOURCE AREAS. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE ON THE LENOIR WEBSITE AT WWW.UNCLENOIR.ORG OR UNC HEALTH MAIN WEBSITE AT WWW.UNCHEALTHCARE.ORG/PATIENTS-FAMILIES-VISITORS/BILLING-FINANCIAL-ASSISTA NCE/FINANCIAL-ASSISTANCE. PATIENTS CAN ALSO RECEIVE MESSAGING AND APPLY FOR FINANCIAL ASSISTANCE VIA UNC MYCHART, AN ONLINE PATIENT PORTAL. FINANCIAL ASSISTANCE SUMMARIES AND APPLICATIONS CAN ALSO BE REQUESTED AND GIVEN AT THE POINT OF REGISTRATION FOR ANY HOSPITAL SERVICE OR DURING PATIENT ACCESS PRE-SCREENS AND MEDICAID ELIGIBILITY SCREENINGS. ALL FINANCIAL ASSISTANCE-RELATED DOCUMENTS ARE ALSO AVAILABLE IN SPANISH. ADDITIONALLY, SPANISH SPEAKING PATIENTS ARE OFFERED ASSISTANCE THROUGH OUR ONSITE SPANISH LANGUAGE INTERPRETER. THE HOSPITAL ALSO UTILIZES TELEPHONE ""LANGUAGE-LINES"" FOR ASSISTANCE WITH SPANISH OR OTHER LANGUAGE CONVERSATIONS."

PART VI, LINE 4:
LENOIR MEMORIAL HOSPITAL IS LOCATED IN KINSTON, NORTH CAROLINA (POPULATION ESTIMATE APRIL 2020 19,900), WHICH IS THE COUNTY SEAT AND LARGEST TOWN IN LENOIR COUNTY (POPULATION ESTIMATE APRIL 2020 55,122); KINSTON AND OTHER LENOIR COUNTY MUNICIPALITIES CONSTITUTE THE HOSPITAL'S PRIMARY SERVICE AREA. LMH IS DESIGNATED A SOLE COMMUNITY HOSPITAL BY CMS. THOUGH STRONG ECONOMIC AND CORRESPONDING POPULATION GROWTH OCCURRED THROUGHOUT MUCH OF THE URBAN'S AREAS OF NORTH CAROLINA SINCE 2010, LENOIR COUNTY WAS ONE OF FORTY-SEVEN RURAL COUNTIES STATEWIDE THAT LOST POPULATION WITH LENOIR COUNTY DOWN (7.4 PCT OR 4,373), VS. THE NC AVERAGE OF +9.5 PCT. KINSTON'S DECLINE WAS EVEN LARGER THAN LENOIR COUNTY AT 8.2 PCT (1,777). OVER THE LAST TWO DECADES THE LOCAL AREA HAS WITNESSED THE CLOSING OR SIGNIFICANT DOWNSIZING OF FORMERLY LARGE EMPLOYERS PARTICULARLY LIGHT MANUFACTURING ENTERPRISES AS LESS EXPENSIVE LABOR HAS BEEN SOUGHT OVERSEAS. IN THE MOST RECENT YEARS, THE AREA'S CHALLENGES HAVE BEEN EXACERBATED BY THE DRAMATIC NATIONWIDE ECONOMIC DOWNTURN, AND LENOIR COUNTY'S UNEMPLOYMENT RATE HAS TYPICALLY EXCEEDED BOTH STATE AND NATIONAL AVERAGES. THE COUNTY HAS BEEN DESIGNATED TIER 1 I.E., THE RANKING GIVEN TO THE MOST ECONOMICALLY DISTRESSED COUNTIES IN THE STATE BY THE NC DEPARTMENT OF COMMERCE. LENOIR COUNTY RANKS AS THE 16TH MOST DISTRESSED COUNTY IN THE STATE. LENOIR COUNTY WITH 18.8 PCT OF THE POPULATION WITH A DISABILITY IS TWICE THE STATE PERCENTAGE OF 9.4 PCT. POVERTY LEVELS IN KINSTON AND LENOIR COUNTY EXCEED STATE AVERAGES; IN 2021 THE COUNTY'S POVERTY LEVEL WAS 23 PCT AS COMPARED TO THE STATE AVERAGE OF 15 PCT. THE ECONOMICALLY DISADVANTAGED PERCENTAGE OF CHILDREN IN LENOIR COUNTY SCHOOLS WAS 71.5 PCT, AND ALL SCHOOLS WITH ELEMENTARY AND MIDDLE GRADES WERE TITLE 1. PORTIONS OF KINSTON ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS. THE MEDIAN INCOME IN LENOIR COUNTY IS 72.2 PCT OF THE STATE AVERAGE. THE TABLE BELOW PROVIDES CURRENT ESTIMATES OF POPULATION, INCOME, AND POVERTY STATISTICS FROM THE US CENSUS BUREAU, INCLUDING THE AMERICAN COMMUNITY SURVEY. KINSTON COUNTY (KC); LENOIR COUNTY (LC); NORTH CAROLINA (NC) POPULATION CHANGE IN PERCENT, 2010-2020 -8.2 (KC); -7.4(LC); +9.5(NC) PERCENT BELOW POVERTY LEVEL 27.8(KC); 17.2(LC); 12.9(NC) MEDIAN HOUSEHOLD INCOME, 2020 $33,066(KC); $39,402 (LC); $54,602(NC) CHILDREN IN POVERTY BY PERCENT, 2020 49.0(KC); 26.1(LC); 17.9(NC) THE HISTORICAL DEPENDENCE UPON FARMING AND LIGHT MANUFACTURING JOBS, AS WELL AS POVERTY AND EDUCATION LEVELS THAT ARE HIGHER AND LOWER, RESPECTIVELY, THAN NC AVERAGES WILL LIKELY CONTINUE TO BE LIMITING FACTORS TO CONSISTENTLY STRONG OR RAPID ECONOMIC GROWTH. IN ORDER TO ADDRESS THESE CHALLENGES, NUMEROUS AREA ORGANIZATIONS CONTINUE TO WORK TOWARD DEVELOPMENT INITIATIVES THAT WILL CREATE LONG TERM SOCIAL AND ECONOMIC IMPROVEMENT.