4A (Expenses $ 435043785 including grants of $ 182659) (Revenue $ 452070637)
See Schedule O

Adventist Health and Rideout
Part V, Section B, Line 5: The 2019 CHNA data collection process can be summarized as follows: 1. Review of prior CHNA reporting efforts;2. Collection of most recently available demographic, socioeconomic and health indicator data; and3. Data gathering from community members. Community input was provided by a broad range of community members using key informant interviews and focus groups. Individuals with the knowledge, information, and expertise relevant to the health needs of the community were consulted. These individuals included representatives from local governmental and public health agencies as well as leaders, representatives, or members of underserved, low-income, and minority populations. Primary data included 13 interviews with 35 community health experts as well as four focus groups conducted with a total of 53 community residents that included seniors, people experiencing homelessness, Hmong community members and Latino community members.Focusing on social determinants of health to identify and organize secondary data, datasets included measures to describe mortality and morbidity and social and economic factors such as income, educational attainment, and employment. Further, the measures also included indicators to describe health behaviors, clinical care (both quality and access), and the physical environment. Data sources include but are not limited to the California Department of Public Health, US Census Bureau, American Community Survey, Robert Wood Johnson Foundation County Health and Roadmaps and the Community Health Vulnerability Index which is a healthcare disparity index based largely on the Community Need Index developed by Barsi and Roth.

Adventist Health and Rideout
Part V, Section B, Line 6a: Hospitals that participated in the 2019 CHNA process included Sutter Surgical Hospital North Valley.

Adventist Health and Rideout
"Part V, Section B, Line 11: The COVID-19 global pandemic has caused extraordinary challenges for Adventist Health hospitals and health care systems across the world including keeping front line workers safe, shortages of protective equipment, limited ICU bed space and developing testing protocols. They have also focused on helping patients and families deal with the isolation needed to stop the spread of the virus, and more recently vaccine roll out efforts. Adventist Health, like other health care systems, had to pivot its focus to meet the most urgent healthcare needs of its community during the pandemic, as well as reassess the ability to continue with some community health strategies due to public health guidelines for social distancing. Adjustments have been made to continue community health improvement efforts as possible, while ensuring the health and safety of those participating. Our 2019 CHNA identified three areas of significant need: access to mental/behavioral/substance abuse services, access to basic needs such as housing, jobs and food, and access to quality primary care health services. Priority Need 1 - Access to Mental/Behavioral/Substance Abuse Services - The goal is to raise awareness and improve access to substance use and mental health services in the emergency department. Strategy 1 - Expand Emergency Department substance use disorders and behavioral health initiatives. Activity 1.1 - Continue Behavioral Health Collaborative in Rideout ER - Although the program has components that are covered by grants, community benefit expenses include parts of the tele-psychiatry services and the Community Well-Being staff time. In 2021, the volume of behavioral health patients in the Adventist Health and Rideout Emergency Department has steadily increased in recent years due to the lack of funding for behavioral health services and lack of facilities/providers in our rural area. In order to deliver the highest quality of care for behavioral health patients in the Emergency Department, Adventist Health and Rideout partnered with county resources to embed county-paid crisis counselors in the Emergency Department 24 hours a day. In 2021, Adventist Health and Rideout's Emergency Department saw 2,341 patients with behavioral health complaints. Using tele-psychiatry services and clear clinical pathways, the team worked together to see 100 percent of the patients with a behavioral health diagnosis. Medications were started or resumed, safety plans designed, and follow up appointments were arranged by the team. As a team, the county and hospital have created a process to provide high quality care to the psychiatric patients in the ED. Activity 1.2 - Implement ED Bridge Program - Adventist Health and Rideout applied and was awarded grant money to start the California Bridge Program. Additional funds were awarded in the middle of the year. Although most program costs were covered by the grant, community benefit expenses include staff time in securing, processing, and coordinating program requirements. These grants have afforded the program the opportunity to hire a Substance Use Navigator, provide ED staff training, and provide 32 ED physician X-waiver credentialing to build the MAT Program. The Substance Use Navigator works to identify people with opioid use disorder in the emergency room. Patients are then able to immediately receive treatment for their withdrawal symptoms with the medication Buprenorphine (Suboxone) and are linked from the ED into continued outpatient treatment in the community clinics. In 2021, although no additional grant funding was not received, the program continues to support 32 ED providers and a substance use navigator. In 2021, the program provided services to 179 individuals. Additional activities include our Meds-to-Beds program. Adventist Health and Rideout is among many hospitals nationwide that has a ""Meds-to-Beds"" program, in which prescription drugs are given directly to patients just before they are sent home from the hospital or emergency room. This program serves as more than just a convenience; for some patients, this is the only way they will obtain necessary medications for chronic medical conditions and other required treatments. Adventist Health and Rideout is not allowed to bill for medications that will be used at home; these drugs must come from an outpatient pharmacy. In order to bridge this gap, Adventist Health and Rideout partnered with the Sutter Pharmacy for both discharge counseling and dispensing of medications. In situations where the patient is unable to pay for the critical medications, Adventist Health and Rideout will pay for the medications at no cost to the patient. Number of Community Members Served: 140.Priority Need 2 - Expand screening and partner with community organizations to increase access to food resources - The goal is to improve access to food resources in the community. Strategy 1 - Expand screening with community organizations to increase food resources. Activity 1 - Expand Food Security Program - To address this need, Adventist Health and Rideout initiated a food security program, which begins with a screening process for all patients that are seen by Adventist Health and Rideout. If a patient is identified as food insecure, a referral is submitted to the Patient Care Coordinator who then follows up with the patient and provides person specific community resources, a connection to a local food pantry, and food upon discharge. In 2021, Adventist Health and Rideout identified 280 admitted patients as food insecure. This number includes the patient population at The Rideout Cancer Center. Of these individuals, 54% were considered homeless, 15% of the individuals who were identified as food insecure are 55 years of age or older and 20% are 65 years of age or older. All individuals served in the Food Security program are vulnerable, lack the resources necessary to obtain food or proper nutrition, and are underserved. In collaboration with the Yuba-Sutter Food Bank and Yuba-Sutter Behavioral Health, Adventist Health and Rideout delivered 282 meals to patients 65 and over. A total of 524 non-perishable food bags were provided to individuals experiencing homelessness through outreach from our Street Medicine Team. In March - May 2021, as part of the response to the Coronavirus, Adventist Health and Rideout partnered with the UDSA - Farmers to Families Program and distributed 1,825 food boxes to families throughout the Yuba-Sutter area. In 2021, The Food Security Program was awarded a grant in the amount of $20,000. This funding has provided the ability to purchase food for the most vulnerable patients and has helped serve families directly associated with our partner agencies. The partnership between the Food Security Program and The Yuba-Sutter Food Bank has increased the number of individuals served and has added more resources to the Yuba-Sutter community. In 2021, a grant in the amount of $80,000 was awarded to hire a Registered Dietitian to help expand the Food Secure Program and assist in providing medically tailored meals as well as develop an on-site food pantry. This program is expected to roll out in 2022. Although the program has components that are covered by grants, community benefit expenses include Community Well-Being staff time and coordination. Additional activities include our bariatric support group. Bariatric support groups were offered, in person, until March of 2020 due to COVID-19. Adventist Health and Rideout developed a way to still deliver these support groups virtually and is still in use as of 2021. Our bariatric surgery support group is offered at no charge to people who have had or plan to have bariatric surgery. The group is a way for patients to gain knowledge and network with each other and support one another in the community. Number of Community Members Served: 17.Priority Need 3 - Access to Quality Primary Care Health Services - The goal is to improve access to primary care services for the community. Strategy 1 - Street Nursing Program"

Part V, Section B, Line 11, continuation:
"Activity 1.1 - Establish and expand street nursing program - Adventist Health and Rideout initiated a street nursing program in response to the growing population experiencing homelessness. In 2021, The Adventist Health Street Nurse Team saw 381 new patients out in the field. The team conducted 2,561 follow up visits, meaning each patient experienced several encounters with our team due to the trust and relationship that was built. The Street Medicine Team reaches out to individuals experiencing homelessness where they are and provides items such as hygiene products and non-perishable food. The Street Medicine Team had 533 outreach visits, which is when the team is out providing supplies and connecting with individuals. The total encounters for the Street Medicine Team in 2021 including new patients, follow up visits, and outreach, was 3,477. In 2021, the program showed significant growth, in staff, in days per week, and in outreach locations made possible by several different awarded grant dollars. The Street Nurse team does outreach with several partner agencies in the streets and river bottoms of the Yuba Sutter Communities. Other outreach locations include Hands of Hope, The Life Building Center, Better Ways, Harmony Village and Prosperity Village. Program Outcomes to note for 2021: 56 clients established care with a primary care doctor; The nurse attended 35 PCP appointments to assist in a warm hand off and help alleviate fear; 140 prescriptions were paid through our 340B program; 157 individuals moved from homelessness and entered into temporary housing such as a shelter; 43 individuals were moved from homelessness and were entered into permanent housing; 314 individuals were seen by the telemedicine doctor out in the field; and 37 were referred to the Substance Use Navigator for resources and referrals to substance use treatment and recovery. Although the program has components that are covered by grants, community benefit expenses include Community Well-Being staff time and coordination. Additional activities include our homeless discharge planning program. In addition to the action already being taken to combat homelessness and assist this vulnerable population, SB 1152 requires hospitals to include plans for coordination of services to shelters, medical care, and behavioral health care in their homeless patient discharge policy. Specifically, hospitals must discharge homeless patients to a social service agency, a nonprofit social services provider, or a governmental service provider. Hospitals must also ensure that these agencies are prepared to accept the patient and the patient has agreed to the placement. Patients experiencing homelessness may also be discharged to their ""residence"" (the principal dwelling place of the patient) or an alternative destination. Under SB 1152, hospitals must ensure and document the following before discharging any homeless patient: The patient must have food and water unless there is a medical reason, they must have weather-appropriate clothing, have a source of follow up care, have a supply of medications, they must have necessary medical durable equipment, they must be offered screening for infectious diseases, must have been offered vaccination, the patient must be alert and oriented to person, place, and time, they must be assisted to enroll in eligible, affordable health insurance coverage, and the patient must have transportation to the discharge destination. The hospital must also maintain a log of homeless patients discharged and locations to which they were discharged. Number of Community Members Served: 904.Other community benefit priority work includes the following programs and program impact: Smoking Cessation Education: Adventist Health and Rideout provides a free smoking cessation program for the community. This program teaches the ""Freedom from Smoking Course"" from the American Lung Association. The class will offer participants a step-by-step plan for quitting smoking and will help assist smokers gain control over their behavior. Number of Community Members Served: 52.Cancer Support Group: Adventist Health and Rideout offers multiple programs for cancer patients and survivors. In addition to treating the body when a patient has cancer, Adventist Health looks for ways to help the emotional healing of our patients as well. Adventist Health and Rideout offers cancer support groups to help play a role in supporting our patients and their loved ones. Unfortunately, due to COVID-19, these support groups were placed on hold. AHRO also offered a ""Chemotherapy and You"" weekly class, prior to COVID-19. This class was designed to help prepare patients and caregivers for treatment. This class also educates on side effects, management, and central line access. AHRO offers a peer navigation program and a wig bank program, which connects patients who lose their hair with wigs through the American Cancer Society. Number of wigs provided: 18.Transportation after Discharge: Adventist Health and Rideout contracts with SP+ to provide transportation services to patients upon hospital discharge, transportation to and from primary care, and to and from oncology appointments. This service is provided at no cost to the patients. In addition to the contract with SP+, the Adventist Health and Rideout Foundation assists cancer center patients, senior care and other patients with transportation needs and more by providing provisions such as gas cards, bus passes and food cards to help low-income patients with their travel needs. A new passenger van was donated to Adventist Health and Rideout by the Geweke Caring for Women Foundation. The van offers patients free transportation to and from the hospital and the cancer center. Number of Community Members Served: 4,724.Community Education Fairs and Events: Adventist Health and Rideout regularly participates in a number of community events where staff volunteers to provide education to the community. However, due to COVID-19, these events were limited. In 2021, Adventist Health and Rideout participated in the BEFAST campaign event where two Stroke RN's participated in two community events handing out flyers on stroke education and prevention. Community Members Served: 157.Community Sponsorship Donations: Adventist Health and Rideout is a nonprofit health system with a long-standing history of providing philanthropic support for projects and programs offered within the communities we serve. As a part of the Adventist Health and Rideout mission, community benefit sponsorships are designed to support community-based programs, activities or events that align with the mission and address community needs. Inspire Hope/World Vision: The Inspire Hope Program is a community-based initiative designed to respond to the growing financial, housing and economic needs within our community. Throughout 2021, our local Inspire Hope program met people where they are at and provided support. Some of the smallest donations are making a huge impact to those we are serving. There is a sense of gratitude with the ability to bring dignity to those who may be at their lowest. Over 2021, we had an average of at least 43 partners that worked collectively to get resources out to our community members with at least 500 people served.Priority needs not addressed:No hospital can address all the health needs identified in its community. Adventist Health and Rideout is committed to serving the community by adhering to its mission, and using its skills, expertise and resources to provide a range of community benefit programs. Significant health needs that will not be directly addressed include the following: Prevention of Disease and Injury through Knowledge, Action, and Access to Resources; Adventist Health and Rideout focuses on wellness and prevention through health education classes and programs. AHRO will continue providing classes and programs to the community. Access and Functional Needs: Access to transportation services is a large need in the primary service area. AHRO currently addresses this need by offering free transportation to and from the hospital, Cancer Center and clinics. In addition to this transportation service, we also provided bus passes, gas cards and food cards to low-income patients to help with travel needs. Access to Specialty and Extended Care: Adventist Health and Rideout is consistently recruiting specialty providers to increase access for the community. We plan to continue these efforts. Active Living and Healthy Eating: Adventist Health and Rideout currently offers free classes on diabetes and other health issues in addition to encouraging healthy lifestyles."

Part V, Section B, Line 11, continuation:
Safe and Violence-Free Environment: Adventist Health and Rideout agrees that this is a huge need throughout the community, but at this time, we feel addressing this need will require dedicated effort from many other community organizations. We cannot tackle this community need on our own. At this time, we believe we can focus efforts and resources on the other prioritized health needs to make a larger impact.

Part V, Section B, Line 13h:
Patients who do not meet the income criteria, may be eligible for financial assistance based on essential living expenses and resources. The following two (2) qualifications must both apply:1. Essential living expenses: Exceed fifty percent (50%) of the household income; and2. Resources: The patient's excess medical expenses (the amount that allowable medical expenses are greater than 50% of annual household income) must be greater than available qualifying assets

Part I, Line 7:
The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on Hospital specific data included in the system-wide combined audited financial statements. The formula used for computation equals financial statement data as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesThe Hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government.

Part II, Community Building Activities:
The Hospital is involved in numerous community building activities which promote the health of the community. Overwhelmingly, we see diseases of despair including suicide, substance abuse, mental health and chronic illnesses plaguing the communities in which we have a significant presence in. These community concerns are addressed through health improvement, education, poverty, workforce development and access to care. This is why we have focused our work around addressing behavior and the systems keeping the most vulnerable people in cycles of poverty and high utilization. In an effort to heal these communities, we have strategically invested in our communities by partnering with national leaders in community well-being. We believe the power of community transformation lies in the hands of the community. Our solution for transformation is to create a sustainable model of well-being that measurably impacts the well-being of people, well-being of place and equity. In 2020, Adventist Health acquired Blue Zones as the first step toward reaching our solution. By partnering with Blue Zones, we will be able to gain ground in shifting the balance from healthcare - treating people once they are ill - to transformative well-being - changing the way communities live, work and play. In 2021, Adventist Health committed to launching six Blue Zone Projects within our community footprint, and as we enter 2022 these projects are active. Blue Zones widens our impact from only reaching our hospitals' communities in four states to a global mission practice. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H.

Part III, Line 2:
Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2.

Part III, Line 3:
The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt.

Part III, Line 4:
The system-wide audited combined financial statements do not contain a footnote describing bad debt expense.

Part III, Line 8:
"The Medicare Cost Report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology. Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever expanding regulatory requirements, shortages of highly skilled labor and involving medical and information technology. The health care ""market basket"" is unrelated to that of the average individual consumer. Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care. These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care. In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals. For further information, please refer to Schedule H, Part III, Section B."

Part III, Line 9b:
"When a patient has requested screening for charity care, the Hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is ""low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest"

Part VI, Line 7, Reports Filed With States
CA

Part VI, Other Information:
In 2021, Adventist Health and Rideout continued to take the following actions in response to the needs created or exacerbated by COVID-19: Continued virtual healthcare visits to keep community members safe and healthy; continued their online symptom tracker; participated in a communitywide effort to vaccinate eligible community members.

Part VI, Line 2:
The Hospital's 2019 CHNA, the 2022 Community Health Plan (CHP) Update for fiscal year 2021, and the 2020 Implementation Strategy adopted in 2020 are posted on the Hospital's website at:https://www.adventisthealth.org/about-us/community-benefit/ The most recent Community Health Needs Assessment, most recent Implementation Strategy report, and the most recent Community Health Plan Updates are also available on the Adventist Health Corporate website at:https://www.adventisthealth.org/about-us/community-benefit/The Community Health Needs Assessment (CHNA) includes both the activity and product of identifying and prioritizing a community's health needs, accomplished through the collection and development of a community health plan. The second component of the CHNA, the community health plan, includes strategies and plans to address prioritized needs with the goal of contributing to improvements in the community's health. Qualitative and quantitative data sources were used in conducting the CHNA. To accomplish the many important systemic goals that are underway in our community, our hospitals support local partners to augment our own efforts and to promote a healthier community. Partnership is not used as a legal term, but a description of the relationships of connectivity that are necessary to collectively improve the health of the regions we serve. One of our objectives is to partner with other nonprofit and faith-based organizations that share our values and priorities to improve the health status and quality of life of the community we serve. This is an intentional effort to avoid duplication and leverage the successful work already in existence in the community.

Part VI, Line 3:
The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the Hospital's website at:https://www.adventisthealth.org/documents/financial-assistance/ENG_PFS-112_Financial-Assistance-Policy.pdfThese documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The Hospital also provides a brochure during the registration process that explains the hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance.

Part VI, Line 4:
The definition of the community served was the primary service area jointly shared by Adventist Health and Rideout and Sutter Surgical Hosptal North Valley (SSHNV). This area was defined by five ZIP Codes: 95901, 95953, 95961, 95991, and 95993. This service area was designated because the majority of patients served by both RMH and SSHNV resided in these ZIP Codes. Adventist Health and Rideout is located in Marysville, CA, and SSHNV is located in Yuba City, CA. Separated by the Feather River, these cities are located adjacent to one another and are part of the Yuba City Metropolitan Statistical Area as designated by the US Office of Management and Budget. The service area is home to over 147,000 community residents, and encompassed portions of both Sutter and Yuba Counties. The rural community is rich in diversity along a number of dimensions.Population characteristics for Sutter County include a median age of 35.6, a poverty rate of 17.5%, a 13.2% uninsured rate, a 52.0% minority rate, a 13.5% disability rate and 37% of residents living with high housing costs. Sutter County has a median income of $52,943.Population characteristics for Yuba County include a median age of 32.2, a poverty rate of 20.8%, a 12.2% uninsured rate, a 43.0% minority rate, a 16.9% disability rate and 41% of residents living with high housing costs. Yuba County has a median income of $48,739.

Part VI, Line 6:
The Hospital is a member of Adventist Health, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area can provide support through remote services such as telepharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals.

Part VI, Line 5:
"Our Hospital's mission is, ""Living God's love by inspiring health, wholeness and hope."" Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the ""triple aim."" The ""Triple Aim"" concept broadly known and accepted within health care includes:1. Improve the experience of care for our residents.2. Improve the health of populations.3. Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1. The distribution of specific health statuses and outcomes within a population; 2. Factors that cause the present outcomes distribution; and 3. Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1. Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2. Improve care quality and patient safety, and 3. Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community."