4A (Expenses $ 310032645 including grants of $ 175160) (Revenue $ 360075882)
PROVISION OF PATIENT CARE: TO PROVIDE QUALITY HEALTHCARE SERVICES. ALAMANCE REGIONAL MEDICAL CENTER HAD A TOTAL OF 10,604 PATIENT DISCHARGES, 47,711 DAYS OF CARE, 311,395 OUTPATIENT AND TELEHEALTH VISITS AND AN AVERAGE DAILY CENSUS OF 130.7.

ALAMANCE REGIONAL MEDICAL CENTER:
SCHEDULE H, PART V, SECTION B, LINE 5 THE COMMUNITY WAS SURVEYED BY ELON UNIVERSITY POLLING CENTER TO ASSESS COMMUNITY HEALTH PRIORITIES. ADDITIONALLY, FOUR CHARRETTES WHERE CONDUCTED IN PARTNERSHIP WITH UNC-CHAPEL HILL TO GATHER PRIMARY DATA ON CONCERNS RELATED TO HEALTH IN ALAMANCE COUNTY WITH 70 PARTICIPANTS REPRESENTING LATINX, MORROWTOWN, PLEASANT GROVE, AND BURLINGTON HOUSING COMMUNITIES.SECONDARY DATA - INCLUDING US CENSUS, NC STATE CENTER FOR HEALTH STATISTICS, LOCAL AND AGENCY SOURCES - WERE ANALYZED.

ALAMANCE REGIONAL MEDICAL CENTER:
SCHEDULE H, PART V, SECTION B, LINE 6B INSTITUTIONAL PARTNERS INCLUDE HEALTHY ALAMANCE, ALAMANCE COUNTY HEALTH DEPARTMENT, CONE HEALTH- ALAMANCE REGIONAL, ELON UNIVERSITY, IMPACT ALAMANCE, AND THE UNITED WAY OF ALAMANCE COUNTY, AND THE HEALTH EQUITY COLLECTIVE. THE COMMUNITY ASSESSMENT TEAM INCLUDES RESIDENTS WHO ARE MEMBERS OF THE HEALTH EQUITY COLLECTIVE, HEALTHY ALAMANCE, THE ALAMANCE COUNTY HEALTH DEPARTMENT, UNITED WAY OF ALAMANCE COUNTY, IMPACT ALAMANCE, DREAM CENTER, PIEDMONT HEALTH, AND CONE HEALTH.

CHNA SIGNIFICANT NEEDS
SCHEDULE H, PART V, SECTION B, LINE 11 ALAMANCE COUNTY IDENTIFIED THREE HEALTH PRIORITIES IN THE 2021 ALAMANCE COUNTY COMMUNITY HEALTH ASSESSMENT (CHA) - ACCESS TO CARE, EDUCATION, AND ECONOMY. THIS COMMUNITY OPERATES COLLABORATIVELY, WITH AGENCIES PARTNERING TO ADDRESS PRIORITIES. THE HOSPITAL IS A KEY STAKEHOLDER AND PARTNER IN THESE COLLABORATIONS. ACCESS TO CARE: ARMC WORKS THROUGH IMPACT ALAMANCE TO ENSURE THAT ALL COUNTY RESIDENTS HAVE ACCESS TO PHYSICAL ACTIVITY OPPORTUNITIES. IMPACT ALAMANCE OFFERS GRANTS TO AREA AGENCIES TO ADD AND IMPROVE BUILT ENVIRONMENTS. OTHER COLLABORATIONS INCLUDE THE ALAMANCE WELLNESS COLLABORATIVE (AWC) AND THE ALAMANCE FOOD COLLABORATIVE (AFC). AWC CONVENES MULTIDISCIPLINARY PARTNERS TO IMPLEMENT ACTIVE LIVING AND HEALTHY EATING STRATEGIES THROUGHOUT THE COUNTY. THE AFC EXISTS SO THAT PEOPLE LIVING IN ALAMANCE COUNTY HAVE EQUITABLE ACCESS TO AFFORDABLE AND HEALTHY FOOD. TWO OF THEIR PROMINENT INITIATIVES INCLUDE MEALS FOR ALAMANCE COUNTY STUDENTS (MAC'S DINER) TO BRING HOT, NUTRITIOUS MEALS TO CHILDREN IN AREAS OF HIGH CONCENTRATION OF NEED AND THE SUMMER FEEDING PROGRAM THAT PERMITS THE DISTRIBUTION OF MEALS FOR ANY CHILDREN 18 AND UNDER. ANOTHER AREA OF FOCUS IS TO INCREASE ACCESS TO AFFORDABLE HEALTH INSURANCE FOR ALL ALAMANCE COUNTY RESIDENTS. AT THIS TIME, 81.8% OF ADULTS AND 94.2% OF CHILDREN IN ALAMANCE COUNTY HAVE HEALTH INSURANCE. EDUCATION: ONE OF THE BIG EDUCATIONAL GOALS FROM THE ASSESSMENT IS FOR ALL K-12 STUDENTS IN ALAMANCE COUNTY TO STUDY IN EDUCATIONAL SYSTEMS THAT VALUE DIVERSITY, EQUITY, AND INCLUSION FOR ITS STUDENTS, FACULTY, STAFF, AND COMMUNITIES. ARMC PARTICIPATES IN THE PARTNERSHIPS THAT INCLUDE ALAMANCE PARTNERSHIP FOR CHILDREN THE ALAMANCE PARTNERSHIP FOR CHILDREN, ELON ACADEMY, BOYS & GIRLS CLUB OF ALAMANCE COUNTY, IT TAKES A VILLAGE PROJECT, AND POSITIVE ATTITUDE YOUTH CENTER TO PROMOTE EQUITABLE AND INCLUSIVE EDUCATION IN ALAMANCE COUNTY. THERE IS ALSO A FOCUS ON IMPROVING THE 4-YEAR HIGH SCHOOL GRADUATION RATE FOR ALL. ECONOMY: EMPLOYMENT AND FINANCIAL STABILITY INFLUENCE MANY ASPECTS OF HEALTH AND WELL-BEING. HIGHER INCOME, IN TURN, CREATES MORE OPPORTUNITIES FOR A HEALTHY LIFESTYLE, SUCH AS BEING ABLE TO AFFORD TO LIVE IN A SAFE NEIGHBORHOOD WITH PARKS, SIDEWALKS, GOOD SERVICES AND STRONG SCHOOLS. A PRIORITY OF THE 2021 CHA IS TO IMPROVE THE AVAILABILITY OF EQUITABLE EMPLOYMENT OPPORTUNITIES FOR ALL PEOPLE WHO ARE WORKING AGE.

Financial Assistance Policy
SCHEDULE H, PART V, SECTION B, LINE 13B PATIENTS WHO ARE DETERMINED ELIGIBLE BY A THIRD-PARTY VENDOR UTILIZING A SCORING MECHANISM, PROVIDING A PATIENT FINANCIAL PROFILE.

COSTING METHODOLOGY
FORM 990, SCHEDULE H, PART I, LINE 7 THE AMOUNTS REPORTED ON THIS SCHEDULE ARE REPORTED AT COST, COMPUTED USING THE COST TO CHARGE RATIO.

BAD DEBT EXPENSE
FORM 990, SCHEDULE H, PART III, SECTION A, LINES 4 FOR OUR FINANCIAL STATEMENTS, THE DIFFERENCE BETWEEN GROSS CHARGES AND THE AMOUNT WE ESTIMATE WE WILL COLLECT IS CATEGORIZED AS CONTRACTUAL ADJUSTMENT, CHARITY OR BAD DEBT EXPENSE. THE DIFFERENCE BETWEEN GROSS CHARGES AND THE PAYABLE AMOUNT PER THIRD PARTY CONTRACTS OR GOVERNMENT PAYMENT FORMULA IS CATEGORIZED AS CONTRACTUAL ADJUSTMENTS. THE AMOUNT OF THE CONTRACT ALLOWABLE THAT WE ESTIMATE WILL NOT BE COLLECTED IS DIVIDED BETWEEN CHARITY CARE AND BAD DEBT EXPENSE BASED ON THE DEMOGRAPHICS OF OUR PATIENT POPULATION AND OUR ESTIMATE FROM THESE DEMOGRAPHICS AS TO THE PORTION OF THIS UNCOLLECTED AMOUNT APPLICABLE TO INDIVIDUALS QUALIFYING FOR OUR CHARITY CARE POLICY.

MEDICARE SHORTFALL
FORM 990, SCHEDULE H, PART III, SECTION B, LINE 8 THE ENTIRE SHORTFALL IS REPORTED AS COMMUNITY BENEFIT. WE DO NOT RECEIVE ENOUGH IN MEDICARE/MEDICAID REIMBURSEMENTS TO COVER OUR COSTS ASSOCIATED WITH THE PROVISION OF THESE SERVICES, YET WE CONTINUE TO PROVIDE THESE SERVICES TO OUR COMMUNITY, REGARDLESS OF THE REIMBURSEMENT LEVELS. THEREFORE, WE FEEL JUSTIFIED IN REPORTING THIS AS PART OF OUR COMMUNITY BENEFIT.

MEDICARE COSTING METHOD
FORM 990, SCHEDULE H, PART III, SECTION B, LINE 8 THE AMOUNT OF THE MEDICARE SHORTFALL, INCLUDED AS COMMUNITY BENEFIT, IS REPRESENTED AT COST AND IS COMPUTED USING COST TO CHARGE RATIO OF THE CHARGES BOOKED IN THE FINANCIAL STATEMENTS AS MEDICARE.

COLLECTION PRACTICES
FORM 990, SCHEDULE H, PART III, SECTION C, LINE 9B Cone Health will recognize each account turned over to an attorney, collection agency, or judgment taken as a bad debt. A patient's account will be considered a bad debt when the account is 120 days old. Exceptions to this are as follows: 1. Account is in litigation 2. Account is pending Insurance, Medicare, or Medicaid for known reason. 3. Authorized hospital personnel has other knowledge which makes keeping the account active. 4. Authorized hospital personnel recognize prior to 120 days that the account should go to an attorney, outside collection agency, or judgment taken. 5. If charges exceed $10,000 and collection from a third party is doubtful, a judgment should be taken.

PATIENT EDUCATION
FORM 990, SCHEDULE H, PART VI, LINE 3 THE FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO ALL PATIENTS THROUGH MEANS WHICH INCLUDE, BUT ARE NOT LIMITED TO: POSTING ON THE HEALTH SYSTEM'S WEBSITE, INCLUSION WITH ALL BILLING STATEMENTS, POSTING AT CONSPICUOUS LOCATIONS THROUGHOUT THE FACILITY, DISCUSSIONS DURING FINANCIAL COUNSELOR PATIENT INTERVIEWS, AND DURING PATIENT ACCOUNTING CUSTOMER SERVICE PATIENT INTERACTIONS. AFTER RECEIVING A REQUEST FOR FINANCIAL ASSISTANCE AND ANY FINANCIAL INFORMATION OR OTHER DOCUMENTATION NEEDED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE PATIENT WILL BE NOTIFIED OF THEIR ELIGIBILITY DETERMINATION WITHIN A REASONABLE PERIOD OF TIME.

COMMUNITY INFORMATION
FORM 990, SCHEDULE H, PART VI, LINE 4 ALAMANCE COUNTY IS IN CENTRAL NORTH CAROLINA (REFERRED TO AS THE TRIAD REGION) WITH A POPULATION OF 174,055, AS CERTIFIED BY THE NC CENSUS 2020 COUNT. THE COUNTY CONSISTS OF NINE MUNICIPALITIES, THREE OF THEM ARE THE CITIES OF BURLINGTON, MEBANE, AND GRAHAM, AND THE OTHER SIX ARE TOWNSHIPS. THE COUNTY IS LOCATED BETWEEN TWO METROPOLITAN AREAS, THE RESEARCH TRIANGLE TO THE EAST AND THE PIEDMONT TRIAD TO THE WEST. IT IS 150 MILES EAST OF THE APPALACHIAN MOUNTAINS, 200 MILES WEST OF THE ATLANTIC OCEAN, 30 MILES SOUTH OF THE VIRGINIA BORDER, AND 130 MILES NORTH OF THE SOUTH CAROLINA BORDER. TODAY, THE LEADING INDUSTRIES IN ALAMANCE COUNTY CONTINUE TO BE MANUFACTURING, PROFESSIONAL AND TECHNICAL SERVICES AND RETAIL TRADE. LARGE AREAS TO THE NORTH AND SOUTH OF THE THREE LARGEST CITIES ARE SIGNIFICANTLY RURAL. WITH THE TOBACCO BUYOUT, MANY SMALL TO MID-SIZE FARMS ARE MAKING THE TRANSITION TO VEGETABLE FARMING. ALAMANCE COUNTY IS A PREDOMINANTLY WHITE COMMUNITY, WITH 73.6% OF RESIDENTS IDENTIFYING AS WHITE. ABOUT 20.9% OF THE POPULATION IDENTIFIES AS BLACK/AFRICAN AMERICAN; 1.5% AS NATIVE AMERICAN; AND 1.7% AS ASIAN. LASTLY, ABOUT 2.7% OF INDIVIDUALS IDENTIFY WITH TWO OR MORE RACES. ABOUT 13.1% OF THE POPULATION IDENTIFY AS HISPANIC OR LATINO, WHICH IS HIGHER THAN THE STATE AVERAGE OF 9.8%. ALAMANCE COUNTY'S POPULATION BY AGE GROUP IS LIKE THE STATE'S AVERAGE POPULATION BY AGE GROUP. PERSONS UNDER 18 YEARS OF AGE MAKE UP THE HIGHEST PERCENT OF THE POPULATION IN ALAMANCE COUNTY AT 22%, FOLLOWED BY PERSONS 65 YEARS AND OLDER AT 17.10%. THE AGE GROUP WITH THE SMALLEST POPULATION PERCENT IN THE COUNTY IS INDIVIDUALS UNDER THE AGE OF 5 YEARS OLD 5.30%. MALES REPRESENT 47.66% OF THE COUNTY; FEMALES MAKE UP 52.34% OF THE COUNTY. LABORATORY CORPORATION OF AMERICA (DBA LABCORP) IS THE LARGEST PRIVATE EMPLOYER IN THE COUNTY AND ALAMANCE-BURLINGTON SCHOOL SYSTEM IS THE LARGEST PUBLIC EMPLOYER. ELON UNIVERSITY, A NATIONALLY RECOGNIZED FOUR-YEAR LIBERAL ARTS COLLEGE IS ALSO WITHIN THE COUNTY, AS IS ALAMANCE COMMUNITY COLLEGE WHICH OFFERS A VARIETY OF EDUCATION AND TRAINING PROGRAMS.

NEEDS ASSESSMENT
FORM 990, SCHEDULE H, PART VI, LINE 2 THE ASSESSMENT DOCUMENT INCLUDES THE PRIMARY AND SECONDARY DATA FROM A VARIETY OF SOURCES. SECONDARY DATA SPECIFIC TO ALAMANCE COUNTY WAS COLLECTED AND ANALYZED FROM SOURCES AT THE COUNTY-LEVEL AND FROM PUBLICLY AVAILABLE STATE DATABASES, SUCH AS THE NC STATE CENTER FOR HEALTH STATISTICS, US CENSUS, THE CDC AND OTHER VERIFIED SOURCES AS WELL AS FROM LOCAL AGENCY-SPECIFIC DATA. PRIMARY DATA WAS GATHERED VIA A RANDOMIZED TELEPHONE SURVEY AND ONLINE SURVEY OF 528 RESIDENTS CONDUCTED BY THE ELON UNIVERSITY POLL CENTER. QUALITATIVE PRIMARY DATA WAS ALSO COLLECTED THROUGH CHARETTES AND FEEDBACK FROM 70 TOTAL COMMUNITY PARTICIPANTS WERE ALSO COLLECTED.

PROMOTION OF COMMUNITY HEALTH
Form 990, Schedule H, Part VI, Line 5 MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE BOARD OF DIRECTORS IS COMPRISED OF LOCAL COMMUNITY LEADERS AND BUSINESS AND MEDICAL PROFESSIONALS WHO ALL LIVE WITHIN THE HOSPITAL'S PRIMARY SERVICES AREA. THESE LEADERS PROVIDE A SIGNIFICANT NUMBER OF HOURS OF VOLUNTEER SERVICE AND PROVIDE VALUABLE OVERSIGHT TO THE ORGANIZATION'S OVERALL OPERATION. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT, FUNDRAISING AND GENERAL STEWARDSHIP FOR THE ORGANIZATION IN THE COMMUNITY. SURPLUS FUNDS FROM THE HOSPITAL ARE REINVESTED IN THE COMMUNITY. THEY HELP THE HOSPITAL MAINTAIN ACCESS TO PATIENT SERVICES BUT ARE ALSO USED TO IMPROVE ACCESS. FUNDS HELP THE ORGANIZATION PURCHASE NEW EQUIPMENT AS WELL AS EXPAND EDUCATIONAL OPPORTUNITIES ON IMPORTANT HEALTH-RELATED TOPICS.

AFFILIATED HEALTH CARE SYSTEM
FORM 990, SCHEDULE H, PART VI, LINE 6 THE ORGANIZATION IS A MEMBER OF CONE HEALTH SYSTEM. IN ADDITION TO THE SERVICES PROVIDED TO NEIGHBORING COMMUNITIES TO THE WEST IN GUILFORD AND ROCKINGHAM COUNTIES BY THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION, THIS COMPANY OPERATES THREE FULL HOSPITALS, A WOMEN'S HOSPITAL AND A BEHAVIORAL HEALTH HOSPITAL. THE CONE HEALTH MEDICAL GROUP INCLUDES FOUR CORPORATE ENTITIES THAT OPERATE PHYSICIAN PRACTICES ACROSS THE COMMUNITY. THESE INCLUDE PROVIDERS OF BOTH PRIMARY CARE AND A WIDE RANGE OF SPECIALTIES. ALAMANCE COUNTY IS ALSO SERVED BY ALAMANCE EXTENDED CARE WHICH OPERATES A LONG-TERM CARE FACILITY. THE MOSES CONE-WESLEY LONG COMMUNITY FOUNDATION AND IMPACT ALAMANCE FOUNDATION FUNDS NUMEROUS COMMUNITY ORGANIZATIONS THAT ARE CONDUCING ACTIVITIES THAT WILL ADDRESS THE PRIORITIES IDENTIFIED UNDER OUR COMMUNITY NEEDS ASSESSMENT.

COMMUNITY BUILDING ACTIVITIES
FORM 990, SCHEDULE H, PART II ALAMANCE REGIONAL IS INVOLVED IN NUMEROUS ACTIVITIES DESIGNED TO PROMOTE BUILDING OUR COMMUNITY. THESE ACTIVITIES INCLUDE: (1) BUILT ENVIRONMENT IMPROVEMENTS - THE HOSPITAL PARTNERS WITH LOCAL MUNICIPALITIES AND THE SCHOOL SYSTEM ON THE DEVELOPMENT OF PARKS AND PLAYGROUNDS TO PROMOTE PHYSICAL RECREATION. A GREENWAY THAT CONNECTS THE TOWN OF ELON (HOME TO ELON UNIVERSITY) TO DOWNTOWN BURLINGTON WAS FUNDED THROUGH COLLABORATIVE ACTION; THE CITY OF MEBANE BEGAN CONSTRUCTON OF A GREENWAY THAT WILL CONNECT POPULAR DESTINATIONS WITHIN THE CITY. THE WORK TO INSTALL NEW PLAYGROUND EQUIPMENT FOR ELEMENTARY SCHOOLS CONTINUES. (2) ECONOMIC DEVELOPMENT - THE HOSPITAL WORKS TO CREATE NEW EMPLOYMENT OPPORTUNITIES IN AN AREA THAT TRADITIONALLY HAS HIGH UNEMPLOYMENT RATES. THE ORGANIZATION IS HEAVILY INVOLVED WITH THE CHAMBER OF COMMERCE, WITH STAFF MEMBERS SITTING ON SEVERAL BOARDS AND COMMITTEES DESIGNED TO PROMOTE ECONOMIC GROWTH. A PARTNERSHIP BETWEEN GATE CITY DREAM CENTER, IMPACT ALAMANCE AND HEALTHY ALAMANCE RESULTED IN THE CREATION OF A COMMUNITY KITCHEN THAT WILL SERVE AS A TRAINING MODEL AND ENTREPRENEURSHIP INCUBATOR FOR STUDENTS, AS WELL AS PROVIDES COMMERCIAL KITCHEN ACCESS FOR LOCAL CATERERS AND BAKERS TO RENT SPACE TO PRODUCE THEIR PRODUCTS. (3) COMMUNITY SUPPORT - THE HOSPITAL PROVIDES SUPPORT FOR NUMEROUS COMMUNITY AGENCIES INCLUDING THE UNITED WAY, THE FREE HEALTH CLINIC AND SERVICES FOR HEALTHY AGING AND FAMILY CAREGIVERS FOR OLDER ADULTS. THE HOSPITAL IS ALSO INVOLVED HEAVILY IN COUNTY-WIDE EMERGENCY PREPAREDNESS INITIATIVES. IN PARTNERSHIP WITH THE ALAMANCE COUNTY HEALTH DEPARTMENT, CONE HEALTH PROVIDED FREE TESTING, VACCINES, AND INFORMATION SHARING AT CONVENIENT LOCATIONS ACROSS THE COUNTY. AS OF DECEMBER 14, 2021, 56% OF THE ALAMANCE COUNTY POPULATION IS FULLY VACCINATED. THE OUTREACH WORKERS INITIATIVE CONE HEALTH MOBILE CLINIC PARTNERED WITH HEALTHY ALAMANCE AND THE CITY OF BURLINGTON TO PILOT FOR LAY HEALTH ADVISORS TO DELIVER COVID-RELATED HEALTH EDUCATION AND SUPPORT TO COMMUNITIES OF COLOR FOR THOSE AGE 65 AND OLDER. (4) COALITION BUILDING - THE HOSPITAL PARTICIPATES IN NUMEROUS COMMUNITY COALITIONS AIMED AT ADDRESSING HEALTH AND SAFETY ISSUES. THESE INCLUDE BUT ARE NOT LIMITED TO THE HEALTH EQUITY COLLECTIVE; ALAMANCE FOOD COLLABORATIVE; ALAMANCE WELLNESS COLLABORATIVE; HEALTHY MOTHERS, HEALTHY BABIES; THE SAFE KIDS COALITION; THE LATINX HEALTH COALITION; AND THE ALAMANCE NETWORK FOR INCLUSIVE HEALTHCARE. THE NEWLY FORMED ALAMANCE DIGITAL INCLUSION ALLIANCE ORGANIZED TO OFFER DIGITAL LITERACY CLASSES. (5) WORKFORCE DEVELOPMENT - THE HOSPITAL IS A MAJOR SUPPORTER OF ALAMANCE COMMUNITY COLLEGE, THE ELON SERVICE YEAR FELLOWSHIP, AND LOCAL SCHOOL CAREER FAIRS. COLLABORATION WITH THESE PROGRAMS AND INSTITUTIONS ALLOWS THE HOSPITAL TO HELP TRAIN AND RECRUIT HEALTH PROFESSIONALS WHICH ARE NEEDED IN OUR TRADITIONALLY UNDERSERVED AREAS (6) COMMUNITY HEALTH IMPROVE ADVOCACY - HEALTH IN ALL POLICIES (HIAP) IS PROMOTED TO LOCAL MUNICIPALITIES TO GUIDE DECISION MAKING WITH THE CITY OF MEBANE BEING THE MOST RECENT TO ADOPT THIS APPROACH, WHICH ENTAILS FORMALIZING EQUITY COMMITTEES THAT SERVE AS SUPPORTS TO BOTH INITIATIVES AND INTERNAL BOARDS AND INCREASING ADOPTION OF COMMUNITY ENGAGEMENT ACTIVITIES.

DEBT COLLECTION PRACTICES
FORM 990, SCHEDULE H, PART III, SECTION C, LINE 9A THE HOSPITAL MAINTAINS A HARDSHIP SETTLEMENT POLICY WHICH PROVIDES AN OPPORTUNITY FOR PATIENTS TO REQUEST DISCOUNTS ON BALANCES DUE TO THE HOSPITAL IN EXCESS OF $5,000. THE PURPOSE OF THIS POLICY IS TO RECOGNIZE THAT, EVEN AFTER THE ADMINISTRATION OF THE HOSPITAL'S AUTOMATIC DISCOUNT FOR ALL UNINSURED PATIENTS, THERE STILL COULD BE SITUATIONS WHERE THE PATIENT IS EXPERIENCING A FINANCIAL HARDSHIP TO PAY THE BALANCE DUE IN FULL. A PATIENT MAY REQUEST A HARDSHIP SETTLEMENT. FINANCIAL NEED WILL BE DETERMINED BY COMPARING A PATIENT'S TOTAL HOUSEHOLD FINANCIAL RESOURCES AND ASSETS TO THE REMAINING BALANCE. IF IT IS DETERMINED THAT, AFTER ALL THIRD PARTY REIMBURSEMENTS, THE REMAINING BALANCE IS GREATER THAN $5,000 AND 20% OF THE PATIENT'S TOTAL FINANCIAL RESOURCES, THE PATIENT IS ELIGIBLE FOR A HARDSHIP SETTLEMENT. THE APPLICABLE DISCOUNT INCREASES FOR BALANCES THAT MAKE UP A GREATER PERCENTAGE OF THE PATIENT'S TOTAL HOUSEHOLD FINANCIAL RESOURCES. IF, AFTER ALL EFFORTS TO QUALIFY THE PATIENT FOR FINANCIAL ASSISTANCE HAVE BEEN EXHAUSTED AND THE PATIENT REMAINS UNABLE TO PAY BALANCES GREATER THAN $5,000, THE UNPAID PORTION OF THE BILL MAY BE TURNED OVER TO COLLECTIONS.