4A (Expenses $ 420061396 including grants of $ 0) (Revenue $ 464726506)
"SURGICAL SERVICES - WAKEMED PROVIDES SURGICAL SERVICES IN FIVE LOCATIONS THROUGHOUT THE COUNTY: WAKEMED RALEIGH CAMPUS, WAKEMED CARY HOSPITAL, WAKEMED NORTH, HOLLY SPRINGS SURGICAL VENTURES AND CAPITAL CITY SURGERY CENTER OF WHICH WAKEMED IS A MAJORITY INVESTOR. BY DELIVERING SURGICAL SERVICES TO ALL WHO SEEK CARE REGARDLESS OF THEIR ABILITY TO PAY AND BY HAVING INPATIENT SERVICES IN THREE DISTINCT LOCATIONS THROUGHOUT THE COUNTY, WAKEMED HAS IMPROVED ACCESS TO THESE NEEDED SERVICES. WAKEMED'S WIDE RANGE OF SURGICAL SPECIALTIES INCLUDE BARIATRIC, CARDIOVASCULAR AND THORACIC, ENT, HEAD AND NECK, ADULT AND PEDIATRIC GASTROINTESTINAL, GENERAL, NEUROSURGERY, OBSTETRICS AND GYNECOLOGY, ORTHOPEDICS, PEDIATRIC, UROLOGY, AND VASCULAR. AS WAKE COUNTY'S ONLY STATE DESIGNATED LEVEL 1 TRAUMA CENTER, WAKEMED PROVIDES COMPREHENSIVE TRAUMA SURGERY FOR GENERAL, ORTHOPEDIC, NEUROSURGERY, AND VASCULAR TRAUMA PATIENTS. BECAUSE ACCESS TO SPECIALTY CARE CONTINUES TO BE A KEY HEALTH CONCERN FACING OUR COMMUNITY, WAKEMED HAS EXPANDED ITS NETWORK OF SPECIALISTS THROUGH WAKEMED PHYSICIANS WHO PROVIDE SUBSPECIALTY CARE TO THE UNINSURED AND UNDERINSURED IN OUR COMMUNITY. OUR STAFF WORKS WITH THE PATIENT TO DISCOUNT THEIR FEES BASED ON INDIVIDUAL INCOME AND NEED. MANY PHYSICIANS ON THE MEDICAL STAFF CONTINUE THIS PRACTICE OF PROVIDING QUALITY CARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN FISCAL YEAR 2022, OUR SURGICAL PATIENTS INCLUDED 31.8% WHO WERE INSURED UNDER MEDICARE, 11.6% WHO WERE INSURED UNDER MEDICAID, AND 4.7% WHO WERE UNINSURED (OR ""SELF-PAY OR CHARITY CARE"")."

4B (Expenses $ 214379057 including grants of $ 0) (Revenue $ 221484405)
"HEART CENTER - WAKEMED'S HEART AND VASCULAR PROGRAM IS ONE OF THE LARGEST AND MOST COMPREHENSIVE CARDIOVASCULAR PROGRAMS IN THE STATE OF NORTH CAROLINA. THIS YEAR, 18,163 CARDIOVASCULAR PROCEDURES WERE PERFORMED INCLUDING SURGERY, DIAGNOSTIC AND INTERVENTIONAL CARDIAC CATHETERIZATIONS AND ELECTROPHYSIOLOGY STUDIES. THOUSANDS MORE PATIENTS WERE TREATED MEDICALLY AS IN AND OUTPATIENTS THROUGHOUT THE SYSTEM. IN FISCAL YEAR 2022, OUR CARDIAC PATIENTS INCLUDED 38.3% WHO WERE INSURED UNDER MEDICARE, 11.9% WHO WERE INSURED UNDER MEDICAID, AND 10.2% WHO WERE UNINSURED (OR ""SELF-PAY OR CHARITY CARE""). WAKEMED HEALTH & HOSPITALS HAS CONSISTENTLY BEEN NATIONALLY RECOGNIZED FOR EXCELLENCE IN BOTH STROKE AND HEART CARE. WAKEMED RALEIGH CAMPUS AND WAKEMED CARY HOSPITAL RECEIVED RECOGNITION FROM THE AMERICAN HEART ASSOCIATION AND THE AMERICAN STROKE ASSOCIATION THROUGH THEIR ""GET WITH THE GUIDELINES (GWTG)"" AWARDS, EACH EARNING GOLD PLUS ACHIEVEMENT AWARDS FOR BOTH STROKE CARE AND FOR HEART FAILURE CARE. THESE RECOGNITIONS SIGNIFY THAT WAKEMED HAS REACHED AN AGGRESSIVE GOAL OF TREATING BOTH STROKE AND HEART FAILURE PATIENTS ACCORDING TO THE GUIDELINES OF CARE RECOMMENDED BY THE AMERICAN STROKE ASSOCIATION, AMERICAN HEART ASSOCIATION, AND AMERICAN COLLEGE OF CARDIOLOGY. BOTH WAKEMED CARY HOSPITAL AND WAKEMED RALEIGH CAMPUS RECEIVED CHEST PAIN CENTER ACCREDITATION BY THE SOCIETY OF CARDIOVASCULAR PATIENT CARE, AND BOTH RECEIVED THE JOINT COMMISSION ADVANCED CERTIFICATION FOR PRIMARY STROKE CENTER. IN ADDITION, WAKEMED RALEIGH CAMPUS RECEIVED A THREE STAR RATING FROM THE SOCIETY OF THORACIC SURGEONS, IS RATED A TOP 50 CARDIOVASCULAR HOSPITAL BY IBM WATSON HEALTH, AND RECEIVED THE 2021 CIGNA CENTER OF EXCELLENCE DESIGNATION FOR HEART SURGERY & CARDIAC CATHETERIZATION AND ANGIOPLASTY. WAKEMED IS THE FIRST US HEALTH CARE SYSTEM TO IMPLEMENT ENHANCED RECOVERY AFTER CARDIAC SURGERY, WHICH CAUSE IT TO BE THE FIRST HOSPITAL TO BE NAMED A CENTER OF EXCELLENCE BY THE ERAS SOCIETY. A KEY SUPPORT SERVICE FOR OUR COMMUNITY, WAKEMED MOBILE CRITICAL CARE SERVICES IS A COMPREHENSIVE MEDICAL TRANSPORT PROGRAM THAT IMPROVES ACCESS TO ACUTE CARE AND FACILITATES TRANSPORT INTO, OUT OF, AND ACROSS THE HEALTH CARE SYSTEM. WAKEMED MOBILE CRITICAL CARE SERVICES TRANSPORTS PATIENTS THROUGHOUT THE REGION AND STATE. IN 2022, THE TEAM TRANSPORTED 20,758 PATIENTS. WAKEMED'S HEART CENTER HAS MADE SIGNIFICANT STRIDES IN PROGRAMS AND SERVICES AIMING TO REDUCE HEART DISEASE AND DIABETES, IMPROVE STROKE OUTCOMES AND IMPROVE PATIENTS' UNDERSTANDING OF DISEASE MANAGEMENT. WE KNOW THAT TEACHING PATIENTS ABOUT THEIR RISK FACTORS FOR HEART DISEASE AND ENCOURAGING HEALTHY BEHAVIORS THROUGH LIFESTYLE CHANGES BUILDS A FOUNDATION FOR A HEALTHIER POPULATION. THUS, THE WAKEMED HEART CENTER PROVIDES A COMPREHENSIVE CONTINUUM OF CARE FOR THE CARDIAC PATIENT FROM OUTREACH EDUCATION AND PREVENTION TO DIAGNOSIS, INTERVENTION, SURGERY, CARDIAC REHABILITATION AND ONGOING DISEASE MANAGEMENT FOR HEART FAILURE DIABETES. FREE EDUCATION PROGRAMS ARE OFFERED REGULARLY FOR OUR PATIENTS, THEIR FAMILY MEMBERS AND THE COMMUNITY TO COMPLEMENT OUR COMPREHENSIVE CARE SERVICES. BECAUSE THE FASTEST INTERVENTION PROVIDES THE BEST OUTCOMES, ALL OF WAKEMED'S EMERGENCY DEPARTMENTS ARE CERTIFIED CHEST PAIN CENTERS. WAKEMED RALEIGH CAMPUS AND CARY HOSPITAL ARE DESIGNATED PRIMARY STROKE CENTERS. ADDITIONALLY, WAKEMED'S HEART CENTER PROVIDES FREE HEALTH SCREENINGS THROUGHOUT THE COMMUNITY INCLUDING CHOLESTEROL SCREENINGS, BLOOD PRESSURE CHECKS, VASCULAR SCREENINGS, AND STROKE ASSESSMENTS. THESE SCREENINGS ARE DESIGNED TO BE A SECONDARY PREVENTION ACTIVITY TO DETECT EARLY ONSET OF DISEASE OR ILLNESS. WAKEMED HEART & VASCULAR PROVIDES NUMEROUS OPPORTUNITIES FOR HEART HEALTH EDUCATION AND CPR TRAINING IN THE COMMUNITY. ONE OF OUR KEY OUTREACH PROGRAMS IS CPR ANYTIME. THIS PROGRAM IS PROVIDED AT MULTIPLE LOCATIONS IN WAKE COUNTY THROUGHOUT THE YEAR AND THE CPR ANYTIME KITS ARE PROVIDED AT NO COST TO PARTICIPANTS. WAKEMED DOES MAKE THE OPPORTUNITY FOR DONATIONS AVAILABLE TO HELP UNDERWRITE SOME OF THE COST AND ALLOW THE PROGRAM TO CONTINUE TO GROW. DONATIONS COVER LESS THAN 5% OF THE OVERALL COST."

4C (Expenses $ 208713794 including grants of $ 0) (Revenue $ 246703549)
EMERGENCY SERVICES- A CRITICAL ISSUE FACING WAKE COUNTY RESIDENTS CONTINUES TO BE ACCESS TO AFFORDABLE HEALTH CARE. TO ADDRESS THIS CHALLENGE, WAKEMED HAS STRATEGICALLY PLACED SIX FULL-SERVICE, EMERGENCY DEPARTMENTS IN KEY GEOGRAPHIC AREAS THROUGHOUT THE COUNTY IN RALEIGH, CARY, NORTH RALEIGH, APEX, BRIER CREEK, AND GARNER. LOCATED IN RALEIGH, WAKEMED ALSO OPERATES THE ONLY CHILDREN'S EMERGENCY DEPARTMENT IN THE COUNTY. BECAUSE PHYSICIAN AVAILABILITY IS KEY TO OPENING ACCESS TO CARE, WAKEMED'S PHYSICIAN PRACTICES, HEALTHPLEXES, AND OUTPATIENT SERVICES ARE CONVENIENTLY POSITIONED THROUGH THE AREA. WAKEMED IS AMONG THE TOP THREE VOLUME PROVIDERS OF EMERGENCY CARE IN NORTH CAROLINA. WAKEMED'S RALEIGH CAMPUS IS ALSO HOME TO WAKE COUNTY'S ONLY LEVEL 1 TRAUMA CENTER, THE HIGHEST DESIGNATION AWARDED TO TRAUMA CENTERS IN NORTH CAROLINA. WAKEMED CARY HOSPITAL EMERGENCY DEPARTMENT IS A LEVEL III TRAUMA CENTER. OUR TRAUMA SERVICES INCLUDE A COMPREHENSIVE RESEARCH PROGRAM, INJURY PREVENTION PROGRAMS, FELLOWSHIP TRAINED TRAUMA SURGEONS ON-SITE 24/7, A MULTI-DISCIPLINARY TEAM OF PROFESSIONALS, THE CLINICAL SUPPORT OF SIX ADULT INTENSIVE CARE UNITS AND A PEDIATRIC INTENSIVE CARE UNIT, AS WELL AS A COMPREHENSIVE ACUTE, INPATIENT AND OUTPATIENT PHYSICAL REHABILITATION PROGRAM. WAKEMED'S EMERGENCY AND TRAUMA SERVICES TREAT ALL PATIENTS WHO PRESENT SEEKING MEDICAL CARE, REGARDLESS OF THEIR ABILITY TO PAY. IN FY 2022, 15% OF OUR TOTAL EMERGENCY PATIENTS WERE INSURED UNDER MEDICARE; 31.1% WERE INSURED UNDER MEDICAID; AND 15.5% WERE UNINSURED SELF-PAY/CHARITY CARE. OVER 46% OF ALL PATIENTS SEEN IN OUR EMERGENCY DEPARTMENTS ARE EITHER MEDICAID OR UNINSURED PATIENT, RESULTING IN WAKEMED PROVIDING CARE OF AN ESTIMATED 72% OF WAKE COUNTY'S UNINSURED AND MEDICAID PATIENTS. ALL STAND-ALONE LOCATIONS SERVE AREAS WHICH ARE OTHERWISE UNDERSERVED.

4D (Expenses $ 880188700 including grants of $ 2750832) (Revenue $ 835469947)
OTHER PROGRAM SERVICES INCLUDE HOSPITAL IN AND OUTPATIENT ANCILLARY CARE SERVICES IN OTHER SPECIALTY AREAS NOT LISTED ABOVE.

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS OF WAKE COUNTY WERE IDENTIFIED IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. THE CHNA PROCESS OFFERS A VALUABLE OPPORTUNITY TO ADDRESS WAKE COUNTY'S MOST PRESSING NEEDS AND ADVANCE RESIDENTS HEALTH AND WELLBEING. A ROBUST PROCESS USING COLLECTED DATA AND SIGNIFICANT COMMUNITY INPUT WAS USED TO IDENTIFY AND PRIORITIZE THE COMMUNITY'S HEALTH NEEDS. A PRIORITIZATION MATRIX WEIGHTED SCORES TO IDENTIFY AND NARROW PRIORITIES THAT WOULD BE INCLUDED IN THE FINAL CHNA REPORT AND LATER INCORPORATED IN IMPLEMENTATION PLANS. SCORES WERE GIVEN BASED ON ANALYSIS OF COLLECTED PRIMARY AND SECONDARY DATA, FOCUS GROUP FINDINGS, TELEPHONE SURVEY RESULTS, ONLINE SURVEY RESULTS, AND STEERING COMMITTEE PRIORITIZATION RESULTS. THE THREE PRIORITY AREAS IDENTIFIED USING THE MATRIX SCORES ARE: 1. AFFORDABLE HOUSING AND HOMELESSNESS 2. ACCESS TO CARE 3. MENTAL HEALTH AND SUBSTANCE USE DISORDERS THE ABILITY TO ACCESS HEALTH SERVICES IS A CRITICAL PUBLIC HEALTH ISSUE, AS PRIMARY AND PREVENTATIVE SERVICES CAN HELP TO PREVENT OR MANAGE CHRONIC ILLNESSES THUS IMPROVING THE HEALTH OF THE COMMUNITY. A LACK OF FACILITIES AND SPECIALISTS IN LOCAL COMMUNITIES ACROSS THE COUNTY WERE NOTED AS BEING BARRIERS TO ACCESSING CARE AS WAS THE NEED FOR MORE SLIDING SCALE PROVIDERS. THE TRADITIONAL HOURS OFFERED BY MANY HEALTHCARE PROVIDERS ALSO CREATE A BARRIER TO ACCESSING CARE FOR MANY INDIVIDUALS AND FAMILIES WHO ARE FORCED TO MISS AN ENTIRE OR PARTIAL DAY OF WORK IN ORDER TO GO TO THE DOCTOR. ENSURING ALL MEMBERS OF OUR GROWING COMMUNITY HAVE ACCESS TO THE HEALTHCARE SERVICES THEY NEED IS CRITICAL TO MAINTAINING THE HEALTH OF WAKE COUNTY. AS SUCH, WAKEMED IS FOCUSED ON IMPROVING ACCESS TO CARE THROUGH CONTINUED GROWTH AND EXPANSION, AS WELL AS DEVELOPMENT OF INNOVATIVE MODELS OF CARE DELIVERY SUCH AS TELEMEDICINE. WAKEMED HAS ADDED NUMEROUS OUTPATIENT LOCATIONS WITH PRIMARY CARE, URGENT CARE AND SPECIALTY PHYSICIAN OFFICES AS WELL AS A IMAGING AND LABORATORY SERVICES. WE ARE SUPPORTING UNINSURED AND UNDERINSURED POPULATIONS NEED FOR CARE THROUGH EXPANDED COMMUNITY CASE MANAGEMENT SERVICES AND THE CENTER FOR COMMUNITY HEALTH WHICH ADDRESSES BOTH THE PHYSICAL AND MENTAL HEALTH NEEDS OF VULNERABLE POPULATIONS THROUGH ITS PROGRAMS. WAKE COUNTY HAS EXPERIENCED AN INCREASE IN THE PREVALENCE AND SEVERITY OF MENTAL HEALTH AND SUBSTANCE ABUSE PROBLEMS OVER RECENT YEARS. AT THE SAME TIME, THE AVAILABILITY OF RESOURCES AND ACCESS TO SERVICES FOR PEOPLE SUFFERING WITH THESE PROBLEMS HAS DECLINED. MENTAL HEALTH/SUBSTANCE USE DISORDERS WAS AN IDENTIFIED PRIORITY IN THE 2013, 2016, 2019 AND AGAIN IN THE 2022 WAKE COUNTY CHNAS. THE MENTAL HEALTH AND SUBSTANCE USE DISORDERS PRIORITY INCLUDES MENTAL HEALTH DISEASE (LIKE DEPRESSION, ALZHEIMER'S, AND SCHIZOPHRENIA), POOR MENTAL HEALTH DAYS, AND HURTING ONESELF, AS WELL AS ALCOHOL, OPIOID, AND ILLEGAL DRUG USE, AND DATA RELATED TO OVERDOSES. LIKE MOST HEALTH SYSTEMS ACROSS THE COUNTRY, WAKEMED HAS SEEN A STEADY INCREASE IN THE DEMAND FOR BEHAVIORAL HEALTH SERVICES PARTICULARLY POST PANDEMIC. AS SUCH, WE HAVE CONTINUED TO INVEST SIGNIFICANT TIME, ENERGY, AND RESOURCES TO INCREASE THE CAPACITY AND BREADTH OF SERVICES NEEDED TO SUPPORT PATIENTS SUFFERING FROM BEHAVIORAL HEALTH CONDITIONS. MANY OF THESE STRATEGIES RELY ON THE STRONG PARTNERSHIPS WE'VE BUILT WITH COMMUNITY-BASED ORGANIZATIONS AND OUR PEER HEALTHCARE ORGANIZATIONS THROUGHOUT WAKE COUNTY. THROUGH THIS NETWORK FOR ADVANCING BEHAVIORAL HEALTH WE ARE CONNECTING PATIENTS TO MUCH NEEDED RESOURCES. IN ADDITION, WAKEMED RECEIVED APPROVAL IN FEBRUARY 2023 FROM THE NC DIVISION OF HEALTH & HUMAN SERVICES TO DEVELOP A 150-BED MENTAL HEALTH HOSPITAL IN WAKE COUNTY. EFFORTS ALSO CONTINUE USING BEST PRACTICES AND AI TECHNOLOGY TO ENSURE WE ARE CONNECTING PATIENTS WITH THE CRISIS, INPATIENT AND OUTPATIENT RESOURCES THEY NEED. HOUSING AND HOMELESSNESS ARE ALSO SOCIAL DETERMINANTS OF HEALTH THAT ROSE TO THE TOP OF THE WAKE COUNTY PRIORITIZATION MATRIX TO BECOME A PRIORITY AREA FOR THE COUNTY TO FOCUS ON OVER THE COMING YEARS. THE HOUSING AND HOMELESSNESS PRIORITY CONTAINS INFORMATION RELATED TO THE COST OF HOUSING, HOUSING CHOICES, AND NUMBER OF PERSONS EXPERIENCING HOMELESSNESS. WAKEMED IS ACTIVELY ENGAGED IN SUPPORTING OUR COMMUNITY'S HOMELESS POPULATION. FOCUSING ON SOCIAL DETERMINANTS OF HEALTH, WE CONTINUE TO EXPLORE INNOVATIVE WAYS TO IMPROVE ACCESS TO CARE FOR PATIENTS IN WAKE COUNTY WHO ARE DEALING WITH HOUSING INSECURITY. IN ADDITION TO OUR EMERGENCY DEPARTMENTS WHO REGULARLY CARE FOR THOSE WITHOUT HOUSING, THE CENTER FOR COMMUNITY HEALTH PROVIDES PRIMARY CARE AND MENTAL HEALTH SERVICES TO THIS POPULATION WHILE COMMUNITY CASE MANAGERS WORK TO CONNECT THEM WITH MUCH NEEDED COMMUNITY RESOURCES.

Schedule H, Part V, Section B, Line 5 Facility A, 1
"Facility A, 1 - THE FOLLOWING RESPONSES APPLY TO ALL FACILITIES WITHIN THE GROUP, UNLESS OTHERWISE NOTED.. THE LIVE WELL WAKE TEAM WORKED FROM JUNE 2021 TO APRIL 2022 TO PLAN, COLLECT AND ANALYZE DATA AND PRIORITIES. AN EIGHT-PHASE PROCESS DEVELOPED BY NCIPH AND INFORMED BY THE COUNTY HEALTH RANKINGS MODEL, EMPHASIZING HOW POLICIES AND PROGRAMS INFLUENCE A VARIETY OF HEALTH FACTORS WHICH LEAD TO HEALTH OUTCOMES. THE PROCESS INCLUDED COLLECTING NEW DATA THROUGH A COMMUNITY HEALTH SURVEY AND FOCUS GROUPS, REVIEWING EXISTING NATIONAL AND STATE SECONDARY DATA. COVID-19 PANDEMIC REQUIRED SOME DATA COLLECTION METHODS TO BE ADJUSTED. THE COMMUNITY HEALTH OPINION SURVEY (CHOS), CAPTURED THE INPUT OF 1073 WAKE COUNTY RESIDENTS. IN ADDITION, 6 FOCUS GROUPS WERE CONDUCTED WITH RESIDENTS TO GAIN AN UNDERSTANDING OF THE STORIES AND EXPERIENCES OF COUNTY RESIDENTS IN SPECIFIC GEOGRAPHIC AREAS AND ON SPECIFIC TOPICS OF INTEREST DETERMINED BY THE STEERING COMMITTEE AND INFORMED BY THE PREVIOUS HEALTH ASSESSMENT. EFFORTS WERE TAKEN TO ENSURE THE BROADEST INTERESTS OF THE COMMUNITY WERE INCORPORATED. AS OUTLINED THROUGHOUT THE 2022 REPORT, A SIGNIFICANT AMOUNT OF DATA AND INFORMATION HAS BEEN REVIEWED AND INCORPORATED IN THIS PROCESS, AND THE PLANNING PARTNERS HAVE BEEN CAREFUL TO ENSURE THAT A VARIETY OF SOURCES WERE LEVERAGED TO DEVELOP A TRULY COMPREHENSIVE REPORT. TO PAINT A MORE COMPLETE PICTURE OF WAKE COUNTY'S HEALTH NEEDS, THE 2022 CHNA PROCESS USED ASSESSMENT METHODS INCLUDING BOTH PUBLICLY AVAILABLE, EXISTING STATISTICAL DATA AS WELL AS NEW DATA THAT WERE COLLECTED DIRECTLY FROM THE COMMUNITY. NEW RESEARCH DATA WAS COLLECTED VIA INTERNET SURVEYS, AND FOCUS GROUPS. IN TOTAL MORE THAN 5,900 PEOPLE PARTICIPATED IN THE PROCESS. TIME PERIOD FOR INPUT: JUNE 2021 THROUGH APRIL 2022. DESCRIPTION OF MEDICALLY UNDERSERVED, LOW-INCOME OR MINORITY POPULATIONS THAT PROVIDED INPUT: MEDICALLY UNDERSERVED INCLUDE THOSE WITHOUT MEDICAL INSURANCE OR ACCESS TO MEDICAL CARE. DATA SUCH AS RATES OF FREE AND REDUCED LUNCH, FOOD INSECURITY, HOMELESSNESS, POVERTY RATES / MEDIAN INCOME DESCRIBED LOW-INCOME RESIDENTS IN THE COUNTY. RACIAL AND ETHNIC MINORITY POPULATIONS, THE HOMELESS POPULATION, LIMITED ENGLISH-SPEAKING HOUSEHOLDS, AND SPANISH-SPEAKING RESIDENTS DESCRIBE THE MINORITY POPULATIONS FROM WHOM DATA WAS GATHERED. INPUT BY MEDICALLY UNDERSERVED, LOW-INCOME OR MINORITY POPULATIONS: THE 2022 CHNA REPORT PROVIDES A SIGNIFICANT AMOUNT OF PRIMARY AND SECONDARY DATA SPECIFIC TO THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS IN WAKE COUNTY. GATHERING SECONDARY DATA WAS EASILY ACCOMPLISHED BY ACCESSING EXISTING SOURCES. IN ADDITION, INPUT FROM NUMEROUS COMMUNITY ORGANIZATIONS WITH KNOWLEDGE OF THE ISSUES THAT NEED TO BE ADDRESSED WITHIN WAKE COUNTY WAS GATHERED THROUGHOUT THE ENTIRE PROCESS. HOWEVER, IT WAS RECOGNIZED THERE ARE LIMITATIONS TO GATHERING PRIMARY DATA IN THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, SUCH AS ZIP CODE/CENSUS TRACT ISSUES, LEGAL AND PRACTICAL ISSUES GATHERING DATA FOR CHILDREN, AND THE POTENTIAL TO INCORPORATE ""STALE"" DATA, THE 2022 CHAT INVESTED A SIGNIFICANT AMOUNT OF TIME AND ENERGY TO TAILOR OUTREACH ACTIVITIES TO REACH THESE POPULATIONS TO GATHER DATA FOR THE FINAL REPORT. THE COMMUNITY HEALTH ASSESSMENT TEAM (CHAT) MADE A CONCERTED EFFORT TO ENGAGE SAFETY NET HEALTHCARE PROVIDERS, AND OTHER PROVIDERS OF SERVICES FOR THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. PARTNERING WITH THESE LOCAL ORGANIZATIONS WITH ACCESS TO THESE POPULATIONS, ALLOWED US TO CONDUCT SIX FOCUS GROUPS SPECIFICALLY TARGETING RESIDENTS OF SOUTHEAST RALEIGH, EASTERN WAKE COUNTY, THOSE SUFFERING WITH MENTAL HEALTH AND SUBSTANCE ABUSE, OLDER ADULTS, THE LATINX COMMUNITY, INDIVIDUALS EXPERIENCING HOMELESSNESS AND TRANSIT RIDERS TO MORE FULLY REPRESENT THE NEEDS OF THE UNDERSERVED POPULATION. YOUTH HAVE BEEN TYPICALLY UNDERREPRESENTED SO THE 2022 CHNA IS THE FIRST WAKE COUNTY CHNA THAT SPECIFICALLY TARGETED YOUTH PARTICIPANTS THROUGH A STORY TELLING/DISCUSSION SERIES OF MEETINGS. LASTLY, THE PRIORITIZATION PROCESS, WHICH CONCLUDED THE DATA COLLECTION PERIOD, PROVIDED THE ENTIRE COMMUNITY OF WAKE COUNTY WITH THE OPPORTUNITY TO DECIDE WHICH ISSUES SHOULD BE THE FOCUS OF CHNA ACTION PLANS FOR THE NEXT THREE YEARS. WAKEMED MANAGEMENT BELIEVES THAT THE 2022 CHNA ADEQUATELY INCORPORATES INPUT FROM THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THE ASSESSMENT WAS LED BY LIVE WELL WAKE IN COLLABORATION WITH NINE ORGANIZATIONS INCLUDING THE AREA'S OTHER HEALTH SYSTEMS, ADVANCE COMMUNITY HEALTH, ALLIANCE HEALTH, CITRIX, WAKE COUNTY HEALTH AND HUMAN SERVICES, WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION."

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - THE FOLLOWING RESPONSES APPLY TO ALL FACILITIES WITHIN THE GROUP, UNLESS OTHERWISE NOTED.. DUKE RALEIGH HOSPITAL, UNC REX AND WAKEMED.

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - THE FOLLOWING RESPONSES APPLY TO ALL FACILITIES WITHIN THE GROUP, UNLESS OTHERWISE NOTED.. THE ASSESSMENT WAS LED BY LIVE WELL WAKE IN COLLABORATION WITH ADVANCE COMMUNITY HEALTH, ALLIANCE HEALTH, CITRIX, WAKE COUNTY HEALTH AND HUMAN SERVICES, AND WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION.

Schedule H, Part V, Section B, Line 7 Facility A, 1
Facility A, 1 - THE FOLLOWING RESPONSES APPLY TO ALL FACILITIES WITHIN THE GROUP, UNLESS OTHERWISE NOTED.. SCHEDULE H, PART V, SECTION B, LINE 7B - OTHER WEBSITE HTTPS://WWW.WAKEGOV.COM/DEPARTMENTS-GOVERNMENT/HUMAN-SERVICES/DATA-AND-REP ORTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - THE FOLLOWING RESPONSES APPLY TO ALL FACILITIES WITHIN THE GROUP, UNLESS OTHERWISE NOTED.. OUR CHNA PRIORITIZATION PROCESS RESULTED IN 3 PRIORITY AREAS FOR WAKE COUNTY THAT WILL BE ADDRESSED OVER THE NEXT THREE YEARS: -ACCESS TO HEALTH SERVICES; -MENTAL HEALTH AND SUBSTANCE ABUSE; AND -HOUSING & HOMELESSNESS. IN THIS CHNA CYCLE, WAKEMED LEADERS CREATED A MORE ROBUST, MEASURABLE IMPLEMENTATION PLAN TO GUIDE OUR ACTIONS IN THESE THREE AREAS, BUT ALSO TO MORE CLOSELY MEASURE OUR EFFORTS TO IMPROVE IN THESE PRIORITY AREAS. WAKEMED'S IMPLEMENTATION PLAN DETAILS ALL OF OUR EFFORTS AND MEASURES OF SUCCESS. (https://www.wakemed.org/assets/documents/community/chna-implementation-plan-2023.pdf)

Schedule H, Part V, Section B, Line 16 Facility A, 1
Facility A, 1 - THE FOLLOWING RESPONSES APPLY TO ALL FACILITIES WITHIN THE GROUP, UNLESS OTHERWISE NOTED.. SCHEDULE H, PART V, SECTION B, LINE 16A - FAP AVAILABLE WEBSITE HTTPS://WWW.WAKEMED.ORG/ASSETS/DOCUMENTS/REGULATORY/PATIENT-BILLING-AND-FINANCIAL-POLICY-ENGLISH.PDF HTTPS://WWW.WAKEMED.ORG/ASSETS/DOCUMENTS/BILLING/FINANCIAL-ASSISTANCE-SPANISH.PDF SCHEDULE H, PART V, SECTION B, LINE 16B - FAP APPLICATION FORM WEBSITE HTTPS://WWW.WAKEMED.ORG/ASSETS/DOCUMENTS/REGULATORY/FINANCIAL-ASSISTANCE-APPLICATION-ENGLISH.PDF HTTPS://WWW.WAKEMED.ORG/ASSETS/DOCUMENTS/BILLING/FINANCIAL-ASSISTANCE-APPLICATION-INSTRUCTIONS-SPANISH.PDF SCHEDULE H, PART V, SECTION B, LINE 16C - PLAIN LANGUAGE FAP SUMMARY WEBSITE HTTPS://WWW.WAKEMED.ORG/ASSETS/DOCUMENTS/REGULATORY/FINANCIAL-ASSISTANCE-POLICY-SUMMARY-ENGLISH.PDF HTTPS://WWW.WAKEMED.ORG/ASSETS/DOCUMENTS/REGULATORY/FINANCIAL-ASSISTANCE-POLICY-SUMMARY-SPANISH.PDF

Schedule H, Part V, Section B, Line 20 Facility A, 1
Facility A, 1 - THE FOLLOWING RESPONSES APPLY TO ALL FACILITIES WITHIN THE GROUP, UNLESS OTHERWISE NOTED.. WAKEMED ALSO NOTIFIED PATIENTS AT ADMISSION AND DISCHARGE OF SERVICES ABOUT THE FINANCIAL ASSISTANCE POLICY AND PROVIDED DOCUMENTATION AS REQUESTED.

Schedule H, Part I, Line 3b
CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE IS AVAILABLE FOR THOSE AT THE 300% OF THE FPG. FURTHER, ALL PATIENTS WITHOUT INSURANCE QUALIFY FOR AN AUTOMATIC 62% DISCOUNT WITHOUT CONSIDERATION OF FPG.

Schedule H, Part I, Line 7
2021 COVID COMMUNITY EFFORTS WAKEMED CONTINUED TO SERVE PATIENTS IMPACTED BY COVID-19. IN LATE 2020, WAKEMED BECAME ONE OF THE FIRST SITES IN THE STATE TO BEGIN OFFERING MONOCLONAL ANTIBODY (MAB) INFUSIONS FOR PATIENTS WITH COVID-19 TO PREVENT DISEASE PROGRESSION AND REDUCE HOSPITALIZATIONS. IN FY 2021, WAKEMED ADMINISTERED OVER 3,000 MAB INFUSIONS. LATE SEPTEMBER, WAKEMED BEGAN EXPANDING ACCESS TO THIS TREATMENT AS PART OF THE NATIONAL CRUSH COVID INITIATIVE, IN CONJUNCTION WITH THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES (NCDHHS), THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) AND KPMG. THE MAB CLINICS WERE LOCATED AT WAKEMED FACILITIES ACROSS WAKE COUNTY, INCLUDING THE NORTH HOSPITAL PHYSICIANS' OFFICE PAVILION, CARY HOSPITAL, RALEIGH CAMPUS AND GARNER HEALTHPLEX. 2020 COVID COMMUNITY EFFORTS WAKEMED'S RESPONSE TO THE PANDEMIC HAS BEEN FAR REACHING INTO THE COMMUNITIES WE SERVE - WELL BEYOND THE CARE PROVIDED IN OUR HOSPITAL DURING THE EARLY MONTHS OF THE PANDEMIC, WAKEMED'S HOME ZIP CODE 27610 HAD THE HIGHEST NUMBER OF POSITIVE COVID-19 CASES IN THE STATE AND THE FOURTH HIGHEST POSITIVE RATE IN NORTH CAROLINA. RECOGNIZING THE NEED TO ENSURE THE HISTORICALLY MARGINALIZED POPULATIONS IN OUR AREA HAD EQUAL ACCESS TO MEDICAL CARE, PROCEDURAL MASKS, EDUCATION AND VACCINE, WAKEMED FOCUSED EFFORTS ON INDIVIDUALS AND FAMILIES IN THE 27610 ZIP CODE. THE RESIDENTS OF 27610 ARE PREDOMINANTLY AFRICAN-AMERICAN AND LATINX. PROTECTION & EDUCATION WAKEMED, WAKE COUNTY, THE CITY OF RALEIGH AND ADDITIONAL COMMUNITY PARTNERS LEVERAGED EXISTING COMMUNITY EVENTS SUCH AS TESTING AND FOOD DISTRIBUTION SITES AND RELATIONSHIPS WITH COMMUNITY ORGANIZATIONS, BUSINESS AND CHURCHES TO PROVIDE MORE THAN 200,000 MASK KITS (A KIT INCLUDES 3 MASKS, HAND SANITIZER, AND BILINGUAL EDUCATION ABOUT PROTECTING YOURSELF DURING THE PANDEMIC) TO DATE. WHAT BEGAN AS AN EFFORT FOR 27610 GREW TO ENCOMPASS RESIDENTS OF 27601 AND 27603. LOW AND NO-COST VIRTUAL CARE DURING THE EARLY MONTHS OF THE PANDEMIC, WAKEMED DEVELOPED VIRTUAL PATHWAYS TO PROVIDE PRIMARY AND URGENT CARE. WAKEMED MADE FREE VIRTUAL VISITS WITH WAKEMED PRIMARY CARE PROVIDERS AVAILABLE TO HOMELESS SHELTERS IN ADDITION TO LOW-COST URGENT CARE VISITS FOR SEVERAL MONTHS. COMMUNITY VACCINE EFFORTS WHEN THE STATE MADE VACCINE AVAILABLE TO RESIDENTS AGE 75+, WAKEMED QUICKLY DEVELOPED DRIVE-THROUGH AND STRIKE-TEAM CLINIC MODELS TO REACH THE UNDERSERVED IN THIS AGE GROUP. STRIKE TEAMS, MOST NOTABLY THE SISTER CIRCLE, MADE UP OF AFRICAN-AMERICAN AND LATINX PHYSICIANS, WORKED WITH CHURCHES AND COMMUNITY CENTERS TO REACH PEOPLE WHERE THEY LIVE, WORK AND WORSHIP. WAKEMED WAS THE FIRST ORGANIZATION TO DEVELOP A SUCCESSFUL DRIVE-THROUGH CLINIC MODEL. VOLUNTEERS FOR ALL OF THESE EVENTS WORKED WEEKDAYS AND WEEKENDS WITHOUT A BREAK FOR MONTHS TO VACCINATE SOME OF THE HARDEST-TO-REACH PEOPLE IN OUR COMMUNITY. WAKEMED'S HEALTH LIVES HERE MOBILE COMMUNITY HEALTH UNIT AND THE WAKEMED CORPORATE & COMMUNITY HEALTH TEAM JOINED COUNTY AND STATE EFFORTS TO VACCINATE PEOPLE AT AREA EVENTS. AND, WAKEMED PHARMACY SERVICES STOCKED COMMUNITY HEALTH PRACTICES THAT SERVE THE UNDERSERVED WITH 45,000 DOSES OF VACCINE AND SUPPLIES TO ADMINISTER IT. TOTAL IMPACT BETWEEN DECEMBER 2020 THROUGH THE END OF 2022, WAKEMED PROVIDED 158,777 DOSES OF MODERNA, PFIZER-BIONTECH AND JANSSEN COVID-19 VACCINE TO INPATIENTS, OUTPATIENTS AND THE COMMUNITY. - 83,545 - WAKEMED VACCINE CLINIC (CLOSED JUNE 24, 2022) - 8,803 - WAKEMED PRIMARY CARE PATIENTS - 21,429 - DRIVE-THROUGH CLINICS AND VARIOUS COMMUNITY EVENTS - 45,000 - WAKEMED PROVIDED TO COMMUNITY HEALTH CARE PROVIDERS SERVING THE UNDERSERVED

Schedule H, Part III, Line 8 MEDICARE COSTING METHODOLOGY
THE MEDICARE ALLOWABLE COSTS WERE DETERMINED FROM THE MEDICARE COST REPORT, AS SPECIFIED IN THE PROVIDER REIMBURSEMENT MANUAL.

Schedule H, Part I, Line 7a
CHARITY CARE IS REPORTED AS THE SYSTEM'S CHARITY CARE AT COST, USING A COST TO CHARGE RATIO CALCULATED AS IN WORKSHEET 2.

Schedule H, Part I, Line 7f
PER MEDICARE COST REPORT.

Schedule H, Part II COMMUNITY BUILDING ACTIVITIES
WAKEMED IS ACTIVELY INVOLVED IN NOT ONLY IMPROVING THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE AND IS ALSO SUPPORTIVE OF COMMUNITY BUILDING ACTIVITIES. WAKEMED HAS BEGUN EFFORTS TO IMPROVE THE NEIGHBORHOOD AROUND THE HOSPITAL AND ENCOURAGE REDEVELOPMENT AND PHYSICAL IMPROVEMENTS. A COALITION OF LOCAL BUSINESS AND COMMUNITY LEADERS ARE WORKING TO REDUCE CRIME, BEAUTIFY THE AREA, ATTRACT RETAIL BUSINESSES AND RESTAURANTS, AND FOSTER NEW MEDICAL DEVELOPMENT AROUND THE MAIN HOSPITAL CAMPUS IN DOWNTOWN RALEIGH, WHICH IS AN ECONOMICALLY DEPRESSED AREA. WE HAVE ALSO INVESTED IN THE WAKE TECHNICAL COMMUNITY COLLEGE FACILITY GROWTH WHICH IS VITAL TO EDUCATING FUTURE NURSES, RADIOLOGY TECHS, EMERGENCY RESPONSE PERSONNEL AND OTHERS. OUR WORKFORCE DEVELOPMENT PROGRAM WORKS WITH YOUTH, HEALTH SCIENCE STUDENTS AND THOSE IN A VARIETY OF HEALTH PROFESSIONS PROGRAMS WITH MENTORING, RESIDENCIES, CLINICAL ROTATIONS, AND EDUCATION ALL WITH THE PURPOSE OF PREPARING FOR THE WORKFORCE OF TOMORROW. WE PARTNER WITH NUMEROUS COLLEGES, UNIVERSITIES, COMMUNITY COLLEGES, AND HIGH SCHOOLS THROUGHOUT THE REGION AND OUR CAMPUS IS HOME TO THE WAKE EARLY COLLEGE HIGH SCHOOL. WAKEMED IS ALSO HOME TO THE WAKE AREA HEALTH EDUCATION CENTER, A PROGRAM OF THE UNIVERSITY OF NORTH CAROLINA WHICH PROVIDES ACCREDITED EDUCATION PROGRAMS TO NURSES, ALLIED HEALTH PROFESSIONALS AND PHYSICIANS THROUGHOUT THE REGION. WAKEMED ALSO WORKS CLOSELY WITH THE INVESTMENT OF CASH AND EXPERTISE FOR THE EIGHT MUNICIPALITIES IN OUR COUNTY AND THE WAKE COUNTY ECONOMIC DEVELOPMENT COUNCIL TO ATTRACT NEW JOBS AND GROW INDUSTRY AND BUSINESS, WHICH ALSO HELPS TO ATTRACT NEW TALENT TO THE AREA FOR GROWING BUSINESSES WITH A FOCUS ON INCLUSION. A HEALTHY ECONOMY ULTIMATELY LEADS TO THE HEALTHIER COMMUNITY. OUR COMMUNITY HEALTH IMPROVEMENT ACTIVITIES ARE NUMEROUS AND INCLUDE BEING THE LEAD AGENCY FOR SAFEKIDS, ENERGIZE, ASTHMA COALITION, COMMUNITY HEALTH PROJECT, AND MORE. EACH IS WORKING TO SUPPORT PROGRAMS AND POLICIES THAT IMPROVE PUBLIC HEALTH AND ACCESS TO HEALTH CARE. WE ARE ALSO PARTNERING WITH COUNTY AND OTHER OFFICIALS, AS WELL AS OTHER COMMUNITY-BASED ORGANIZATIONS, ON INITIATIVES THAT WILL IMPROVE ACCESS TO MENTAL HEALTH SERVICES, A GROWING CRISIS IN OUR COMMUNITY. THE OVERALL GOAL IS TO MAKE OUR COMMUNITY A HEALTHIER PLACE TO LIVE AND WORK.

Schedule H, Part VI, Line 6 AFFILIATED HEALTH CARE SYSTEM
N/A

Schedule H, Part I, Line 7b
MEDICAID COSTS ARE DERIVED FROM OUR COST ACCOUNTING SYSTEM, WHICH ADDRESSES ALL PATIENT SEGMENTS.

Schedule H, Part VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT
WAKEMED PUBLISHES COMMUNITY BENEFIT DATA EACH YEAR ON ITS WEBSITE AND COMPLETES A FULL REPORT EVERY THREE YEARS HIGHLIGHTING THE FINANCIAL IMPACT ON THE COMMUNITY AS WELL AS KEY EFFORTS TO ADDRESS THE PRIORITIES IDENTIFIED IN THE CHNA CORRESPONDING WITH THE TIME FRAME. IT IS AVAILABLE IN PRINT FORM AS ELL AS ON THE WAKEMED WEBSITE. WAKEMED ALSO VOLUNTARILY FILES A SIMILAR COMMUNITY BENEFIT REPORT WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION.

Schedule H, Part I, Line 3c
PATIENTS ARE PROVIDED WITH INFORMATION ABOUT FINANCIAL ASSISTANCE AT REGISTRATION, DISCHARGE, PHONE CALLS (BEFORE AND AFTER SERVICES), ON THE WEBSITE, IN MYCHART. IN ADDITION, A PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE IS SENT WITH EVERY STATEMENT. IN ORDER TO QUALIFY FOR FINANCIAL ASSISTANCE, A PATIENT MUST APPLY AND MEET FINANCIAL ASSISTANCE POLICY (FAP) REQUIREMENTS. WAKEMED ALSO HAS A PRESUMPTIVE CHARITY PROGRAM THAT AUTOMATICALLY RUNS ON ALL ACCOUNTS IN THE BILLING CYCLE.

Schedule H, Part I, Line 7c
COSTS OF OTHER GOVERNMENT PROGRAMS ARE DERIVED FROM OUR COST ACCOUNTING SYSTEM, WHICH ADDRESSES ALL PATIENT SEGMENTS.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE AMOUNT REPORTED IN PART III, LINE 2 IS THE SYSTEM BAD DEBT AT COST. CHARITY AND BAD DEBT ACCOUNTS ARE RECORDED AT CURRENT ACCOUNT BALANCE LEVELS. THE BALANCE MAY BE NET OF CONTRACTUAL ALLOWANCES AND/OR PAYMENTS RECEIVED. FOR EXAMPLE, BAD DEBT OR CHARITY RESULTING FROM AN UNPAID PATIENT LIABILITY AFTER INSURANCE IS RECORDED AT THE AMOUNT UNPAID BY THE PATIENT.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
PATIENTS ARE PROVIDED WITH INFORMATION ABOUT FINANCIAL ASSISTANCE AT REGISTRATION, DISCHARGE, PHONE CALLS, ON THE WEBSITE, AND A PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE IS SENT WITH EVERY STATEMENT. IN ORDER TO QUALIFY A PATIENT MUST APPLY AND MEET FINANCIAL ASSISTANCE POLICY (FAP)REQUIREMENTS.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
"THE TEXT OF THE FOOTNOTE TO WAKEMED'S FINANCIAL STATEMENTS REGARDING BAD DEBT EXPENSE IS AS FOLLOWS: ""WAKEMED HAS PRESENTED ITS PROVISION FOR UNCOLLECTIBLE ACCOUNTS AS A DIRECT REDUCTION OF PATIENT SERVICE REVENUE. BASED ON MANAGEMENT'S INTERPRETATION OF THE REQUIREMENTS OF GASB STATEMENT NO. 34, GOVERNMENTAL HEALTH CARE ORGANIZATIONS ARE REQUIRED TO PRESENT UNCOLLECTIBLE ACCOUNTS AS A COMPONENT OF NET PATIENT SERVICE REVENUE RATHER THAN WITHIN OPERATING EXPENSES."""

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
Treatment of Medicare Shortfall as Community Reports WakeMed believes that all of the $126,509,171 medicare shortfall should be considered a community benefit. The IRS community benefit standard includes the provision of care to the elderly and medicare patients. Medicare shortfalls must be absorbed by the WakeMed hospitals in order to continue treating the elderly in our community. This year, medicare accounted for 38.2% of hospital revenue. The hospital provides care regardless of this shortfall and thereby relieves the federal government.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
APPLICATION OF COLLECTION PRACTICES TO THOSE QUALIFYING FOR FINANCIAL ASSISTANCE WAKEMED PROVIDES MANY OPPORTUNITIES TO EDUCATE PATIENTS ON OUR FINANCIAL ASSISTANCE PROGRAM PRIOR TO DISCHARGE AND AGAIN WHEN THE FIRST BILL IS RECEIVED. IN ORDER TO MAKE SURE WE REACH OUT TO OUR PATIENTS, WE SEND AT LEAST FOUR STATEMENTS AND ALSO MAKE FOLLOW-UP CALLS. EACH STATEMENT REFERENCES THE FINANCIAL ASSISTANCE PROGRAM AND INCLUDES A PLAIN LANGUAGE SUMMARY OF OUR FINANCIAL ASSISTANCE PROGRAM. PATIENTS ARE SCREENED FOR FINANCIAL ASSISTANCE AND ARE GIVEN OPPORTUNITIES TO APPLY. IF A PATIENT CHOOSES NOT TO APPLY, OR DOES NOT QUALIFY, THEY ARE GIVEN THE OPPORTUNITY FOR OTHER PAYMENT ARRANGEMENTS. IF THE PATIENT DID NOT APPLY FOR FINANCIAL ASSISTANCE AND ENDS UP IN COLLECTIONS, AN APPLICATION FOR FINANCIAL ASSISTANCE IS PROVIDED. PRIOR TO SENDING TO COLLECTIONS, ALL PATIENT ACCOUNTS ARE ROUTED THRU A PRESUMPTIVE CHARITY PROCESS WHERE THEY ARE AUTOMATICALLY SCREENED FOR ASSISTANCE. THE PATIENT AT THAT POINT HAS THE OPPORTUNITY TO APPLY; ALL COLLECTION EFFORTS CEASE ONCE THE APPLICATION IS RECEIVED, EVEN IF THE APPLICATION IS MISSING DOCUMENTATION.

Schedule H, Part V, Section B, Line 16a FAP website
A - WAKEMED CARY HOSPITAL: Line 16a URL: SEE PART V, LINE 16J;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - WAKEMED CARY HOSPITAL: Line 16b URL: SEE PART V, LINE 16J;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - WAKEMED CARY HOSPITAL: Line 16c URL: SEE PART V, LINE 16J;

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
"PATIENTS ARE PROVIDED WITH INFORMATION ABOUT FINANCIAL ASSISTANCE AT REGISTRATION, DISCHARGE, PHONE CALLS, AND A PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE IS SENT WITH EVERY STATEMENT. THIS INFORMATION IS ALSO AVAILABLE ON THE WEBSITE. IN ORDER TO QUALIFY, A PATIENT MUST APPLY AND MEET THE FAP REQUIREMENTS. WAKEMED POSTS THE REQUIRED EMTALA NOTICE AT ALL PORTALS OF ENTRY WHERE AN EMERGENCY DEPARTMENT IS PRESENT. THE SIGNAGE NOTES THAT WAKEMED PARTICIPATES IN THE MEDICARE PROGRAM. THE WAKEMED WEBSITE PROVIDES DETAILED INFORMATION REGARDING FINANCIAL ASSISTANCE AND CHARITY CARE. THE PATIENT BILLING AND FINANCIAL INFORMATION POLICY IS INCLUDED IN ALL INPATIENTS' ""MY IMPORTANT PAPERS"" FOLDER AND IS ADDRESSED IN THE PATIENT INFORMATION GUIDE AVAILABLE IN ALL INPATIENT ROOMS. IN ADDITION, THE FINANCIAL ASSISTANCE FORM IS LOCATED ON THE WEBSITE FOR ANY PATIENT TO COMPLETE AND SUBMIT. AS PART OF THE INTAKE PROCESS/REGISTRATION FOR ALL PATIENTS, WAKEMED PROVIDES A COPY OF THE PATIENT BILLING AND FINANCIAL INFORMATION POLICY, WHICH REFERS PATIENTS TO PATIENT FINANCIAL SERVICES IF THEY HAVE CONCERNS REGARDING THEIR ABILITY TO PAY THE BILL. ALL INPATIENTS AND PATIENTS SCHEDULED FOR OUTPATIENT PROCEDURES, AND WHO ARE DESIGNATED ""UNINSURED"" AT THE TIME OF ADMISSION, ARE CONTACTED PERSONALLY BY A FINANCIAL COUNSELOR. IN ADDITION, ANY PATIENT, REGARDLESS OF INSURANCE COVERAGE, MAY REQUEST TO SEE A FINANCIAL COUNSELOR. THE FINANCIAL COUNSELOR WILL ASSESS POSSIBLE MEDICAID ELIGIBILITY AND PROVIDE AN APPLICATION/FINANCIAL STATEMENT THAT IS SUBMITTED TO PATIENT FINANCIAL SERVICES TO REQUEST ASSISTANCE WITH MEDICAL EXPENSES. WAKEMED ALSO HAS ON-SITE EMPLOYEES FROM WAKE COUNTY HUMAN SERVICES TO PROCESS MEDICAID APPLICATIONS FOR RESIDENTS OF WAKE COUNTY. ANY PATIENT WHO IS UNISURED AND MAY BE ELIGIBLE FOR DISABILITY IS REFERRED TO A WAKEMED DISABILITY SPECIALIST WHO ASSISTS WITH THE APPLICATION. WAKEMED INCLUDES INFORMATION REGARDING FINANCIAL ASSISTANCE TO ALL PATIENT BILLING STATEMENTS."

Schedule H, Part VI, Line 7 State filing of community benefit report
NC

Schedule H, Part VI, Line 2 Needs assessment
"NEEDS ASSESSMENT THE COMMUNITY NEEDS ASSESSMENT IS A PROCESS THAT HELPS TO IDENTIFY FACTORS AFFECTING OUR COUNTY, DETERMINE RESOURCES NEEDED TO ADDRESS THESE FACTORS, AND DEVELOP A PLAN OF ACTION TO ADDRESS THE NEEDS OF THE COMMUNITY WE SERVE. THE ASSESSMENT WAS LED BY LIVE WELL WAKE IN COLLABORATION WITH NINE ORGANIZATIONS INCLUDING THE AREA'S OTHER HEALTH SYSTEMS (UNC REX, DUKE HEALTH RALEIGH HOSPITAL, ADVANCE COMMUNITY HEALTH, ALLIANCE HEALTH, CITRIX, WAKE COUNTY HEALTH AND HUMAN SERVICES, AND WAKE COUNTY MEDICAL SOCIETY COMMUNITY HEALTH FOUNDATION. THE PROCESS BEGAN IN JUNE 2021 AND THE FINAL REPORT WAS PUBLISHED IN APRIL 2022. THE CHNA CAN BE FOUND ON THE WAKEMED WEBSITE: https://www.wakemed.org/assets/documents/community/2022-full-report-final.pdf IN ADDITION TO THIS PRIMARY DATA, WAKEMED'S CORPORATE PLANNING DEPARTMENT COLLECTS AND ANALYZES MULTIPLE OTHER SOURCES OF SECONDARY DATA WHICH HELPS US UNDERSTAND DEMOGRAPHIC, SOCIOGRAPHIC, AND HEALTH TRENDS. WITH THE GOAL OF ENHANCING ACCESS, THE STAFF IS ALSO CHARGED WITH FORECASTING FUTURE NEEDS AND PLANNING TO MEET THOSE NEEDS. THIS PROCESS INCLUDES A CAREFUL ANALYSIS OF CURRENT SYSTEM CAPACITIES AND PROJECTS FUTURE NEEDED CAPACITY TO MEET POPULATION GROWTH AND DEMOGRAPHIC CHANGES. IN 2017, THE WAKE COUNTY BOARD OF COMMISSIONERS APPOINTED A POPULATION HEALTH TASK FORCE. THE TASK FORCE CONSIDERED A WEALTH OF DATA, RESEARCH, COMMUNITY FEEDBACK, AND NATIONAL BEST PRACTICES. AS A CONCEPT OF HEALTH, ""POPULATION HEALTH"" IS DEFINED AS 'THE HEALTH OUTCOMES OF A GROUP OF INDIVIDUALS, INCLUDING THE DISTRIBUTION OF SUCH OUTCOMES WITHIN THE GROUP.' IT IS AN APPROACH THAT CONSIDERS BOTH HEALTH OUTCOMES AND THE DETERMINANTS OF THOSE OUTCOMES. OUR GOAL IS TO EMPLOY A BROAD DEFINITION OF ""HEALTH"" WHICH IS A STATE OF COMPLETE PHYSICAL, MENTAL, AND SOCIAL WELL-BEING NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY. STUDIES SHOW THAT ONLY 20 PERCENT OF HEALTH OUTCOMES ARE ACHIEVED THROUGH THE PROVISION OF MEDICAL CARE - THE REST IS A COMBINATION OF A PERSON'S GENETICS, HEALTHY BEHAVIORS, SOCIAL AND ECONOMIC FACTORS, AND THE PHYSICAL ENVIRONMENT. THIS BROAD DEFINITION OF ""HEALTH"" CANNOT BE ACHIEVED SOLELY BY THE PROVISION OF AFFORDABLE, ACCESSIBLE, AND QUALITY HEALTHCARE. IT CAN ONLY BE ACHIEVED BY ALIGNING MEDICAL CARE WITH ""SOCIAL DETERMINATIONS OF HEALTH"" TO MAKE PREVENTION AND WELLNESS ACTIVITIES THE EASY CHOICE AND IMPROVE HEALTH THROUGHOUT ALL STAGES OF LIFE. UNDERSTANDING THAT HEALTH IS IMPACTED BY MORE THAN MEDICAL CARE - INCLUDING SUCH THINGS AS ACCESS TO FOOD, HOUSING, EMPLOYMENT, EDUCATION, SOCIAL SUPPORT, AND A CLEAN ENVIRONMENT - LIVE WELL WAKE STRIVES TO MAKE WAKE COUNTY A HEALTHIER PLACE TO LIVE FOR EVERYONE. LIVE WELL WAKE HAS EMERGED FROM THE WORK OF TWO PRE-EXISTING EFFORTS. THE WAKE COUNTY POPULATION HEALTH TASK FORCE, INITIATED BY THE BOARD OF COMMISSIONERS IN 2018, IDENTIFIED THE NEED FOR A STRUCTURED APPROACH TO CONVENING PARTNERS IN ORDER TO REALIZE THE TASK FORCE'S RECOMMENDATIONS. THIS STRUCTURE ALSO ENSURES ALIGNMENT WITH THE ONGOING COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, WHICH IDENTIFIES THE HEALTH AND RESOURCE NEEDS OF WAKE COUNTY. THROUGH BRINGING TOGETHER STAKEHOLDERS IN THE BROADER COMMUNITY, GOVERNMENT, HEALTHCARE, AND BUSINESS, LIVE WELL WAKE AIMS TO ADDRESS WAKE COUNTY'S BIGGEST CHALLENGES AS OUTLINED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. WORKING GROUPS HAVE BEEN FORMED TO ADDRESS THOSE SIX AREAS AND, USING A RESULTS-BASED ACCOUNTABILITY FRAMEWORK, WILL AIM TO ACCELERATE PROGRESS TOWARDS MAKING THE LIVES OF ALL PEOPLE IN WAKE COUNTY BETTER."

Schedule H, Part VI, Line 4 Community information
WHILE WAKEMED SERVES PATIENTS FROM ALL OF NORTH CAROLINA'S 100 COUNTIES AND BEYOND, ITS PRIMARY SERVICE AREA CAN BEST BE DESCRIBED AS THE COUNTIES CONTIGUOUS TO WAKE COUNTY. THE VAST MAJORITY OF PATIENTS COME FROM WAKE AND JOHNSTON COUNTIES. BOTH COUNTIES HAVE RAPIDLY GROWING SMALLER/SUBURBAN COMMUNITIES CENTERED AROUND THE CAPITAL CITY OF RALEIGH. THESE COMMUNITIES LOOK TO RALEIGH AS THEIR PRIMARY SOURCE FOR TERTIARY LEVEL CARE. THE MARKET IS DEMOGRAPHICALLY DIVERSE AND FIERCELY COMPETITIVE WITH THREE MAJOR HEALTH SYSTEMS COMPETING AGAINST ONE ANOTHER. WAKEMED SHOULDERS THE VAST MAJORITY OF CARE FOR WAKE COUNTY'S UNINSURED AND UNDERINSURED, OFTEN EXCEEDING 80% OF THE BURDEN IN WAKE COUNTY. WAKE COUNTY WAS FOUNDED IN 1771 AND OCCUPIES APPROXIMATELY 860 SQUARE MILES IN THE PIEDMONT REGION OF NORTH CAROLINA. IN 1792, THE CITY OF RALEIGH WAS NAMED THE CAPITAL OF NORTH CAROLINA AND IT REMAINS THE MOST POPULOUS MUNICIPALITY IN WAKE COUNTY. WAKE COUNTY IS HOME TO 12 MUNICIPALITIES. WITH A POPULATION IN EXCESS OF 1,100,000 RESIDENTS, WAKE COUNTY IS THE MOST POPULOUS COUNTY IN THE STATE. WAKE COUNTY HAS EXPERIENCED SIGNIFICANT POPULATION GROWTH OVER RECENT YEARS; THIS GROWTH IS EXPECTED TO CONTINUE ACCORDING TO DATA FROM THE N.C. OFFICE OF STATE BUDGET AND MANAGEMENT, WAKE COUNTY IS PROJECTED TO GROW AT A HIGHER ANNUAL RATE THAN ITS PEER GEOGRAPHIES AT 1.75 PERCENT ANNUALLY FROM 2020 TO 2025, WITH THE ADDITION OF OVER 103,000 PEOPLE. JOHNSON COUNTY IS LOCATED SOUTH OF WAKE AND IS TRANSORMING FROM A RURAL TO SUBURBAN COUNTY. JOHNSON COUNTY IS CURRENTLY THE FASTEST-GROWING COUNTY IN NORTH CAROLINA, WITH A POPULATION PROJECTED TO INCREASE BY OVER 17 PERCENT FORM 2020-2025. AS SHOWN IN THE TABLE BELOW, THE TOTAL POPULATION RESIDENTS OF THESE TWO COUNTIES CURRENTLY EXCEED 1.3 MILLION, AND THAT POPULATION IS PROJECTED TO CONTINUE TO GROW RAPIDLY. THE POPULATION IS FAIRLY DIVERSE. RACE AND ETHNICITY INFORMATION ARE ALSO PRESENTED IN THE TABLE. WAKE COUNTY JOHNSTON COUNTY TOTAL 2020 1,134,824 217,723 1,352,547 2025 1,237,890 256,452 1,494,342 %CHANGE 9.1% (1.75%/ANNUM) 17.8% (3.33%/ANNUM) 10.5% (2.01%/ANNUM) RACE AND ETHNICITY 2025 WHITE 66% 76% 68% BLACK 18% 17% 18% ASIAN 11% 1% 9% OTHER/UNKNOWN 5% 4% 4% HISPANIC* 13% 21% 14% *(NOT CONSIDERED A RACE, INCLUDED IN TOTALS ABOVE)

Schedule H, Part VI, Line 5 Promotion of community health
SINCE OPENING IN 1961, WAKEMED HAS BEEN AN INSTITUTION WITH AN UNWAVERING COMMITMENT TO THE COMMUNITIES IT SERVES BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND FAMILIES WE SERVE. TODAY, WAKEMED OFFERS A BROAD RANGE OF PREVENTIVE, PRIMARY, ACUTE, AND TERTIARY SERVICES. AS WAKE COUNTY'S LARGEST PRIVATE EMPLOYER AND A CORNERSTONE OF THE COMMUNITY, WAKEMED IS AN ASSET RESIDENTS CAN DEPEND ON NOT ONLY FOR THE HIGHEST QUALITY OF HEALTH CARE INSIDE THE HOSPITAL AND OUTPATIENT FACILITIES, BUT FOR COMMUNITY OUTREACH IN THE FORM OF SCREENINGS, CLASSES, SEMINARS, HEALTH FAIRS, PREVENTIVE PROGRAMS, SUPPORT GROUPS, AND OTHER OUTREACH INITIATIVES. WITH THE EXPANSION OF OUR 37 FOOT MOBILE TRUCK, WE HAVE BEEN ABLE TO PROVIDE ACCESS TO VARIOUS SERVICES FOR MANY HIGH RISK TARGET GROUPS IN THE COUNTY. THE MAJORITY OF THE PROGRAMS ARE FREE AND ALL ARE DESIGNED TO IMPROVE HEALTH, EDUCATE, AND ENLIGHTEN BY OFFERING ACCESS TO EXPERTS, RESOURCES, AND HEALTH INFORMATION. IN ADDITION, OUR 2000+ PERSON MEDICAL STAFF IS OPEN AND COMPRISED PRIMARILY OF INDEPENDENT PRACTITIONERS, ALTHOUGH THE NUMBER OF EMPLOYED PHYSICIANS IS GROWING AND NOW TOTALS MORE THAN 450 PHYSICIANS. EACH YEAR WE SERVE, SUPPORT, AND WORK CLOSELY WITH THE COMMUNITY IN MANY WAYS. WE ABSORB THE HEALTH CARE COSTS OF THOSE WHO COME TO US UNABLE TO PAY FOR THEIR CARE. WE EDUCATE AND TRAIN PHYSICIANS AND CAREGIVERS. WE DEVELOP NEW SERVICES AND INITIATIVES TO ENHANCE ACCESS AND MEET THE NEEDS OF THE UNDERSERVED. WE PARTNER WITH A VARIETY OF COMMUNITY-BASED ORGANIZATIONS TO DEVELOP PROGRAMS THAT ANSWER A SPECIFIC COMMUNITY HEALTH NEED. WE PROVIDE DONATIONS TO COMMUNITY CHARITIES AND ORGANIZATIONS WHOSE GOALS SUPPORT OUR MISSION. AND WE OFFER A HOST OF COMMUNITY OUTREACH AND EDUCATION PROGRAMS TARGETED TO THE UNDERSERVED AND AT-RISK POPULATIONS FOR CARDIOVASCULAR DISEASE, DIABETES, STROKE, AND AVOIDABLE INJURIES, AMONG OTHERS. THESE EFFORTS ARE CONSOLIDATED IN A COMMUNITY BENEFIT REPORT AVAILABLE ON OUR WEBSITE: HTTPS://WWW.WAKEMED.ORG/ASSETS/DOCUMENTS/COMMUNITY/COMM-BENEFIT-REPORT-202 0.PDF BEYOND THE CARE CURRENTLY PROVIDED WITHIN OUR FACILITIES, WAKEMED CONTINUES TO DEVELOP PROGRAMS AND SERVICES IN THOSE AREAS WHICH ARE UNDERSERVED AND ARE GROWING. ACCESS TO PRIMARY CARE PROVIDERS IS A CRITICAL NEED. AS A RESULT, WE CONTINUE TO EXPAND OUR NETWORK OF PRIMARY CARE PROVIDERS WHO SERVE COMMUNITY RESIDENTS, REGARDLESS OF THEIR ABILITY TO PAY. WAKEMED HELPS IMPROVE THE HEALTH OF THE COMMUNITY BY OUTREACH THAT TAKES ON MANY FORMS FROM THE DIRECT PROVISION OF CARE TO MENTORING AT-RISK YOUTH. AREAS OF FOCUS FOR THE SYSTEM ARE CENTERED ON: -IMPROVED ACCESS TO CARE THROUGH GEOGRAPHICALLY DISPERSED OUTPATIENT FACILITIES, PRIMARY CARE PHYSICIANS, EMERGENCY DEPARTMENTS, AND NOW VIRTUAL CARE OPTIONS. WE ALSO WORK CLOSELY WITH THE COMMUNITY TO IMPROVE ACCESS AND AFFORDABILITY FOR THE UNDERSERVED POPULATIONS OF THE COMMUNITY. THIS IS DONE IN PART BY COLLABORATING WITH COMMUNITY PARTNERS SO THAT HEALTH CARE GAPS ARE ADDRESSED. -WORKING CLOSELY WITH PATIENTS AND THE COMMUNITY TO PROMOTE AND SUPPORT THE OPTIMAL PREVENTION AND MANAGEMENT OF CHRONIC DISEASES, INJURIES AND ILLNESS IN OUR MOST VULNERABLE POPULATIONS, ESPECIALLY CHILDREN. WE ALSO HAVE AN INCREASED FOCUS ON IMPROVING AND MAINTAINING CARDIOVASCULAR HEALTH, WITH AN EMPHASIS ON ADDRESSING HEART DISEASE, STROKE, AND DIABETES PERTINENT TO BUILDING A HEALTHIER COMMUNITY. -DEVELOPMENT OF A COMPREHENSIVE POPULATION HEALTH PROGRAM ANCHORED BY AN ACCOUNTABLE CARE ORGANIZATION WITH OVER 200,000 COVERED LIVES FROM PARTNERING WITH CMS AND THE MAJOR INSURERS WITHIN THE MARKET. WITH A FOCUS ON QUALITY AND COORDINATION OF CARE, PATIENTS ARE RECEIVING VALUE AND IMPROVING THEIR HEALTH. -DEVELOPMENT OF A COMMUNITY HEALTH POPULATION PROGRAM THAT WORKS WITH OUR MOST VULNERABLE POPULATIONS TO ADDRESS BOTH THEIR HEALTH AND SOCIAL NEEDS SUCH AS A MEDICAL HOME, MEDICATION, HOUSING, AND MORE. IT IS MADE POSSIBLE BY GRANTS AND PARTNERING WITH OTHER COMMUNITY BASED ORGANIZATIONS. -CONTINUING EFFORTS TO EDUCATE HEALTHCARE PROVIDERS OF TODAY AND TOMORROW RECOGNIZING THAT THESE EFFORTS WILL ENSURE A SKILLED WORKFORCE WHICH ULTIMATELY BUILDS A HEATHIER AND STRONGER COMMUNITY. -PROVIDING SUPPORT AND LEADERSHIP IN COMMUNITY BUILDING ACTIVITIES THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS. WE ALSO ENCOURAGE EMPLOYEE, VOLUNTEER AND PHYSICIAN PARTICIPATION, PHILANTHROPIC SUPPORT, AND VOLUNTEERISM IN THE COMMUNITY.