4A (Expenses $ 1100396956 including grants of $ 382750) (Revenue $ 1200283746)
AS PART OF MEETING THE HEALTH CARE NEEDS OF THE SERVICE AREA, CCHS, INC. ADMITTED 35,285 PATIENTS, PROVIDED 219,006 PATIENT DAYS OF CARE, HAD 185,170 EMERGENCY ROOM VISITS AND HAD OVER 599,000 OUTPATIENT VISITS FOR OTHER SERVICES.

CAPE FEAR VALLEY HEALTH SYSTEM
PART V. SECTION B, LINE 3: CAPE FEAR VALLEY HEALTH SYSTEM (CFVHS) PERFORMED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT FOR FY 2022. FOR OUR 2022 CHNA WE COLLABORATED WITH HEALTHENC AND CONDUENT HEALTHY COMMUNITIES INSTITUTE, A COLLABORATIVE OF 22 HOSPITALS AND 21 HEALTH DEPARTMENTS FROM ACROSS EASTERN NC, INCLUDING THE BLADEN, CUMBERLAND, HOKE, AND HARNETT COUNTY HEALTH DEPARTMENTS. COMMUNITY HEALTH ASSESSMENT TEAMS (CHAT) WERE DEVELOPED IN EACH OF THE RESPECTIVE COUNTIES. THE CHAT CONSISTED OF COMMUNITY MEMBERS, STAKEHOLDERS, AND THOSE WORKING IN PUBLIC HEALTH. THE CHATS WERE INSTRUMENTAL IN THE DISTRIBUTION OF OUR SURVEYS IN THE COMMUNITY IN ELECTRONIC AND PAPER FORMAT. UTILIZING THE SURVEYS (PRIMARY DATA) AND DATA FROM THE STATE PLUS FEDERAL SOURCES (SECONDARY DATA), AND CHAT LED FOCUSED GROUPS ASSISTED HEALTHENC IN CREATING A COMPREHENSIVE REPORT FOR EACH OF THE FOUR COUNTIES CAPE FEAR VALLEY HAS A HOSPITAL. THERE WERE A FEW CONTINUOUS THEMES DESPITE THE GEOGRAPHICAL DIFFERENCES IN THE COUNTIES. WORKING WITH THE RESPECTIVE HEALTH DEPARTMENTS IN EACH COUNTY, CAPE FEAR VALLEY HEALTH SYSTEM IDENTIFIED SUBSTANCE ABUSE/MENTAL HEALTH, ACCESS TO HEALTH SERVICES, AND CHRONIC DISEASE MANAGEMENT AS THE AREAS THAT NEEDED TO BE ADDRESSED. THESE AREAS ARE ALL AMONG THE MOST MENTIONED AREAS AMONGST OUR SURVEY RESPONDENTS AND FOCUS GROUP ATTENDEES.THE OUTPATIENT PHARMACIES AT CAPE FEAR VALLEY CONTINUED THE MISSION OF VACCINATING THE PUBLIC AGAINST COVID-19 AND INFLUENZA, WITH BOTH NEW VACCINATIONS AND BOOSTERS. THROUGHOUT THE PANDEMIC AND SINCE THE COVID VACCINE WAS MADE AVAILABLE, CFVHS HAS PROVIDED OVER 180,000 VACCINES TO MEMBERS OF THE COMMUNITY. SYSTEM-WIDE COVID-19 VACCINES IN 2022 AMOUNTED TO 6,961 AND INFLUENZA VACCINES TOTALED 25,198. THE EASE OF ONLINE SCHEDULING AND WALK-IN OPTIONS LED TO VERY SHORT WAIT TIMES AND INCREASED AVAILABILITY TO THESE LIFE-SAVING VACCINES. CAPE FEAR VALLEY NOT ONLY HOSTED REGULAR CLINICS AT OUR HOSPITAL, COMMUNITY PHARMACIES AND CLINICS, BUT ALSO HOSTED EVENTS AT LOCAL HIGH SCHOOLS FOR ADULTS AND STUDENTS, AS WELL AS MULTIPLE OTHER COMMUNITY EVENTS.PHARMACY HAS ALSO EXPANDED INTO THE OUTPATIENT CLINICS AS WELL. CLINICAL PHARMACIST PRACTITIONERS, OR CPPS, ARE NOW AVAILABLE IN FOUR CAPE FEAR VALLEY OUTPATIENT CLINICS INCLUDING FAYETTEVILLE FAMILY, SENIOR HEALTH SERVICES, THE DIABETES AND ENDOCRINE CLINIC, AND THE MEDICAL ONCOLOGY CLINIC AT THE MAIN CAMPUS. THESE ADVANCED PRACTICE PROVIDERS OFFER OUR PATIENTS IN-DEPTH MEDICATION COUNSELING TO IMPROVE OUTCOMES AND HELP EASE THE BURDEN OF HEAVY CASELOADS FOR OUR PROVIDERS. SINCE THE INTRODUCTION OF THE CPP IN THE DIABETES AND ENDOCRINE CENTER, PATIENT A1C LEVELS WERE DRAMATICALLY DECREASED IN PATIENTS RECEIVING MEDICATION COUNSELING FROM THE PHARMACIST. THE CPP POSITION WAS SO WELL RECEIVED THAT ANOTHER CPP WAS PLACED IN THE CLINIC IN 2022 TO FURTHER HELP PATIENTS GET TO THEIR DIABETES GOALS. THE CPP IN THE MEDICAL ONCOLOGY CLINIC CONTINUES TO OFFER CHEMOTHERAPY COUNSELING AND MEDICATION ADVERSE EVENT MANAGEMENT TO THE PATIENTS OF THE CANCER CENTER. THIS HAS ALLOWED FOR THE MEDICAL ONCOLOGISTS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS TO SEE MORE PATIENTS IN THIS EVER-GROWING CLINIC AND IMPROVES PATIENT UNDERSTANDING OF THEIR REGIMENS AND HOW TO COPE WITH THE ADVERSE EFFECTS OF CHEMOTHERAPY.THE RESIDENCY PROGRAM AT CFVHS FOSTERS OUTREACH AMONGST OUR RESIDENTS AND RAISES AWARENESS OF OUR RESIDENCY PROGRAM AND ITS EXPECTED IMPACT. WE WILL CONTINUE OUR AGGRESSIVE OUTREACH EFFORTS TO HELP EDUCATE OUR PATIENTS ABOUT THE VARIOUS RISK FACTORS ASSOCIATED WITH ALL THE IDENTIFIED NEEDS. THE HEALTH SYSTEM ADDED TWO PRIMARY CARE PRACTICES, ONE IN A RURAL COMMUNITY AND THE OTHER TO SERVE TO THE PEDIATRIC POPULATION. ADDITIONALLY, THREE SPECIALTY CLINICS WERE OPENED IN CUMBERLAND AND HARNETT COUNTY TO PROVIDE GREATER ACCESS FOR OUR COMMUNITY TO SPECIALTY PROVIDERS. WE CONTINUE TO STRENGTHEN OUR RELATIONSHIPS WITH OUR LOCAL HEALTH DEPARTMENTS, AREA CHURCHES AND THE SCHOOL SYSTEMS TO BETTER IDENTIFY AREAS OF FUTURE COMMUNITY IMPACT.THE PROVIDER RESIDENCY PROGRAM AT CFVHS HAS GROWN TO INCLUDE ALMOST 250 DOCTORS IN TRAINING IN NUMEROUS PROGRAM AREAS INCLUDING TRADITIONAL ROTATING INTERNSHIP, CARDIOLOGY, EMERGENCY MEDICINE, INTERNAL MEDICINE, OB/GYN, PEDIATRICS, PSYCHIATRY, ORTHOPEDICS, PODIATRY, AND SURGERY. MORE THAN HALF OF ELIGIBLE RESIDENTS HAVE COMMITTED TO WORK AT CFVHS UPON COMPLETION OF THEIR RESIDENCY. IN JANUARY 2021, CFVHS BROKE GROUND ON A STATE-OF-THE-ART EDUCATION AND RESEARCH CENTER FOR MEDICAL RESIDENCY PROGRAMS THAT WILL BENEFIT MEDICAL STUDENTS FOR GENERATIONS TO COME. THE CENTER FOR MEDICAL EDUCATION & RESEARCH AND NEUROSCIENCE INSTITUTE SPANS FIVE FLOORS AND 120,000 SQUARE FEET AND INCLUDES LECTURE HALLS, CLASSROOMS, AND SIMULATION LABS TO PROVIDE RESIDENT MEDICAL STUDENTS WITH HANDS-ON, APPLIED LEARNING WITH SOPHISTICATED TECHNOLOGY. THE FACILITY OPENED JANUARY 2023. THE NEW CENTER FOR MEDICAL EDUCATION ALLOWS CFVMC TO EXPAND TO ITS FULL EDUCATIONAL CAPACITY, THUS, THE RESIDENCY PROGRAM IS POISED TO BRING HUNDREDS OF NEW DOCTORS TO THE REGION IN THE NEXT DECADE.CFVHS ENGAGED 3D CONSULTING TO PROVIDE A PHYSICIAN NEEDS ASSESSMENT BY EACH COUNTY IN OUR SERVICE AREA. THIS ASSESSMENT WAS COMPLETED ON NOVEMBER 9, 2022. BASED ON INTERVIEWS WITH CFVHS PROVIDERS AND EXECUTIVES, THE TOP AREAS WITH IDENTIFIED NEED BASED ON A SHORTAGE OF ALIGNED PROVIDERS, LONG WAIT TIMES, AND OLDER PHYSICIAN BASES WERE: GENERAL PRIMARY CARE, UROLOGY, NEUROLOGY, PEDIATRICS, PULMONOLOGY, VASCULAR SURGERY, GENERAL SURGERY, AND OBGYN. ADDITIONALLY, INTERVIEWS AND SURVEYS WERE CONDUCTED FOR OUR SERVICE AREA WHICH IDENTIFIED PROVIDER SHORTAGES NOTED MOST OFTEN IN NEUROLOGY, ENDOCRINOLOGY, UROLOGY, INTERNAL MEDICINE, AND VASCULAR SURGERY. AVERAGE WAIT TIMES FOR PROVIDERS IN OUR SERVICE AREA EXTENDED BEYOND 30 DAYS FOR SOME SPECIALTIES (NEPHROLOGY: 52 DAYS, SLEEP MEDICINE: 48 DAYS, GENERAL SURGERY: 38 DAYS, AND UROLOGY 34 DAYS). BASED ON CURRENT DEMAND AND SUPPLY IN OUR SERVICE AREA FOR 2022, THE FOLLOWING AREAS HAVE GREATER DEMAND THAN SUPPLY: GENERAL PRIMARY CARE, OBGYN, PEDIATRICS, PSYCHOLOGY, NEUROLOGY, PULMONOLOGY, AND PLASTIC SURGERY. TARGETED PRODUCTIVITY INCREASES AMONG CURRENT EMPLOYED PROVIDERS AND FOCUSED RECRUITMENT EFFORTS ARE EXPECTED TO CONTINUE ACROSS THE HEALTH SYSTEM TO MEET GROWING PATIENT DEMAND.CFVHS FRIENDS OF THE CANCER CENTER FUNDED OVER 161 SCREENING MAMMOGRAMS TO CATCH BREAST CANCER IN EARLIER STAGES. BREAST CANCER AWARENESS OUTREACH EVENTS WERE HELD DURING THE MONTH OF OCTOBER, EDUCATING OVER 900 MEMBERS OF THE COMMUNITY ABOUT BREAST CARE EDUCATION AND BREAST CANCER AWARENESS. HANDS-ONLY CPR INSTRUCTION AND BLOOD PRESSURE CHECKS ARE A SERVICE OFFERED AT MOST OUTREACH EVENTS - OVER 3,500 COMMUNITY MEMBERS ACROSS OUR FOUR COUNTIES WERE REACHED IN 2022. OVER 2,100 COMMUNITY MEMBERS PARTICIPATED IN HEALTH SYSTEM SPONSORED BLOOD DRIVES THAT OFFERED EDUCATION AND BLOOD DONATION TO OUR HOSPITALS. BARIATRIC PEER SUPPORT GROUPS AND PREVENTATIVE EDUCATION EVENTS WERE OFFERED TO APPROXIMATELY 200 MEMBERS OF THE COMMUNITY. STROKE EDUCATION EVENTS WERE HELD TO EDUCATE OVER 200 MEMBERS OF THE COMMUNITY ON IDENTIFYING AND PREVENTING STROKES AS WELL AS CARING FOR YOURSELF AND OTHERS AFTER A STROKE. FITNESS INSTRUCTION EVENTS WERE HELD FOR OVER 1,700 MEMBERS OF THE COMMUNITY TO ENCOURAGE STAYING ACTIVE AND TAKING CARE OF YOUR BODY THROUGH MOVEMENT.STEP UP 4 HEALTH & WELLNESS EXPO IS A PARTNERSHIP BETWEEN CAPE FEAR VALLEY HEALTH FOUNDATION AND METHODIST UNIVERSITY. APRIL 2022 WAS THE FIRST YEAR THIS EVENT TOOK PLACE IN FAYETTEVILLE, NC AND OVER 750 PARTICIPANTS AND 60 VENDORS WERE PRESENT. A 4K OR 1 MILE ROUTE WAS AVAILABLE FOR ATTENDEES TO PARTICIPATE IN WHICH REQUIRED A REGISTRATION FEE WHERE REGISTRANTS COULD CHOOSE THE BENEFICIARY (FRIENDS OF THE CANCER CENTER, CHILDREN'S SERVICES, ETC.). THIS HEALTH-RELATED EDUCATIONAL FESTIVAL FEATURED INFORMATIONAL BOOTHS FOR CFVHS SERVICES AS WELL AS FOOD TRUCKS, MUSIC, AND SPONSOR TABLES. PARTICIPANTS LEARNED ABOUT HANDS-ONLY CPR, RECEIVED FREE WELLNESS CHECKS, AND OTHER HEALTH-RELATED GOODIES.CFVHS CONTINUES TO UTILIZE AND EXPAND THE COMMUNITY PARAMEDIC PROGRAM TO AIDE IN HOME VISITS TO PATIENTS WITH CHRONIC CONDITIONS TO PREVENT READMISSIONS AND TO MAINTAIN STABLE HEALTH OUTCOMES. A GRANT WAS RECEIVED TO SUPPORT THE EXPANSION OF THIS PROGRAM. THIS PROGRAM PROVIDES PATIENTS AND FAMILIES WITH ADDITIONAL EDUCATION AND ROUTINE SUPPORT IN MANAGING THEIR CONDITION.CAPE FEAR VALLEY HEALTH SYSTEM HAS ESTABLISHED A SYSTEM-WIDE OPIOID STEWARDSHIP PROGRAM. WE HAVE ESTABLISHED SEVERAL COMMUNITY PARTNERSHIPS TO ADDRESS SUBSTANCE ABUSE ISSUES IN OUR AREA SUCH AS (FIGHTING ADDICTION THROUGH COMMUNITY EMPOWERMENT TEAMS WITH SOUTHEASTERN REGIONAL AREA HEALTH EDUCATION CENTER (SRAHEC) & CUMBERLAND-FAYETTEVILLE OPIOID RESPONSE TEAMS).

CAPE FEAR VALLEY HEALTH SYSTEM (CONT.)
THE OPIOID STEWARDSHIP PROGRAM EXISTS TO REDUCE OPIOID USE, DECREASE HARM RELATED TO OPIOID USE, AND IDENTIFY PATIENTS WITH POTENTIAL OPIOID USE DISORDERS. THESE GOALS ARE MET BY EDUCATING PATIENTS, IDENTIFYING, AND MONITORING HIGH RISK PATIENTS, SYSTEMIC SCREENING, AND PROVIDING ALTERNATIVE TREATMENT OPTIONS. ORDERING PRACTICES OF OUR PHYSICIANS ARE MONITORED REGULARLY AND ALTERNATIVES FOR PAIN CONTROL ARE OFFERED IN OUR EMERGENCY DEPARTMENTS. KITS ARE PROVIDED THROUGH THE OUTPATIENT PHARMACY TO DISPOSE OF OPIOIDS SAFELY. ADDITIONALLY, SAFE DRUG DISPOSALS ARE LOCATED AT OUR PHARMACIES FOR PRESCRIPTION TAKE-BACK DURING OPERATING HOURS. NARCAN IS AVAILABLE FOR USE ON OUR EMS TRANSPORT VEHICLES.CAPE FEAR VALLEY MEDICAL CENTER IN CUMBERLAND COUNTY HAS SEEN TREMENDOUS GROWTH WHICH HAS ALLOWED FOR ENHANCED CARE FOR OUR COMMUNITY. AN ADDITIONAL VASCULAR SURGEON WAS RECRUITED AND IS CURRENTLY SEEING PATIENTS AND PERFORMING SURGERIES AT CAPE FEAR VALLEY MEDICAL CENTER. THE REPLACEMENT OF OUR CARDIAC CATH & INTERVENTIONAL LAB WAS COMPLETED IN 2022. EXPANSION OF THE CATH LAB THROUGH THE SUPPORT OF ADDITIONAL CARDIOLOGISTS HAS PROVIDED INCREASED COVERAGE FOR OUR COMMUNITY. WE CURRENTLY HAVE TWO FULL TIME AND TWO PART TIME ELECTROPHYSIOLOGY PHYSICIANS SERVING OUR COMMUNITY; IMPROVING OUR ABILITY TO TREAT ATRIAL FIBRILLATION. LASTLY, INTERVENTIONAL HEART CATHETERIZATIONS ARE CONTINUING TO BE PERFORMED AT HARNETT HEALTH AND HAVE SEEN TREMENDOUS GROWTH OVER THE PAST 5 YEARS (287 PROCEDURES PERFORMED IN 2022). THE HEALTH SYSTEM IS OPENING A HEART & VASCULAR CLINIC IN HARNETT COUNTY WHICH IS EXPECTED IN OPEN IN MID-2023.WITH THE SUPPORT OF THE DOROTHEA DIX STATE ALLOCATED FUNDS, CAPE FEAR VALLEY MEDICAL CENTER, LOCATED IN CUMBERLAND COUNTY, BUILT, AND OPENED 16 ADDITIONAL ADOLESCENT BEHAVIORAL HEALTH BEDS DURING CALENDAR YEAR 2022. THESE BEDS ARE OPERATIONAL AND SUPPORTING OUR YOUTH IN NEED OF THESE SERVICES.CFVHS PROPOSES TO BUILD AND OPERATE AN ADOLESCENT INPATIENT PSYCHIATRIC FACILITY AT CENTRAL HARNETT HOSPITAL IN LILLINGTON, NORTH CAROLINA. THE DDPS UNIT IS PLANNED AS A 12-BED FACILITY DESIGNED SPECIFICALLY TO PROVIDE HELP TO ADOLESCENTS GENERALLY FROM AGES 13-17 AND THEIR FAMILIES DURING PERIODS OF ACUTELY EXACERBATED PSYCHIATRIC ILLNESS. THE DDPS UNIT WILL BE A STATE LICENSED PROGRAM DESIGNED TO TREAT PSYCHIATRIC ILLNESS IN ADOLESCENTS THAT ARE NOT SAFE TO BE MANAGED ON AN OUTPATIENT BASIS AND TO PROVIDE STABILIZATION SERVICES TO ALLOW FOR ONGOING TREATMENT UPON DISCHARGE ONCE STABILIZATION HAS OCCURRED. INCLUDED IN THIS SCOPE OF WORK IS THE LAND PURCHASE NEEDED TO PROVIDE SUITABLE SPACE FOR THE CONSTRUCTION OF THIS NEW FACILITY. CFVHS IS UTILIZING FUNDING PROVIDED TO PURCHASE APPROXIMATELY SIX ACRES TO EXPAND THE SIZE OF THE OVERALL CAMPUS WHICH WILL PROVIDE THE SITE FOR THE CONSTRUCTION OF THE ADOLESCENT PSYCHIATRIC UNIT, RECREATIONAL AREAS FOR THE UNIT, APPROPRIATE PARKING, AND EASY CONNECTIONS TO THE MAIN HOSPITAL FACILITY. IN ADDITION, THE FACILITY AT CENTRAL HARNETT HOSPITAL ALLOWS FOR FUTURE EXPANSION SHOULD THE NEED ARISE. CFVHS HAS SECURED $8 MILLION IN FUNDING FOR THIS PROJECT THROUGH DOROTHEA DIX AND THE STATE CAPITAL AND INFRASTRUCTURE FUND SCIF. GROUNDBREAKING FOR THIS PROJECT WILL BE SCHEDULED DURING THE EARLY SUMMER OF 2023, WITH A PROJECTED OPENING DATE OF THE FALL OF 2025.CAPE FEAR VALLEY HEALTH SYSTEM IS CONSTANTLY EVOLVING TO MEET THE NEEDS OF THE COMMUNITIES WE SERVE. THE INTEGRATION OF EPIC AT HARNETT HEALTH WAS SUCCESSFULLY COMPLETED ON OCTOBER 1, 2022. THIS INTEGRATION RESULTED IN A SMOOTH TRANSITION INTO THE HEALTH SYSTEM'S HEALTH INFORMATION RECORD WHICH HAS AIDED IN PROVIDING SEAMLESS CARE TO OUR PATIENTS ACROSS THE COUNTIES THAT WE SERVE. WE HAVE ALREADY BEGUN THE NEXT STEPS FOR OUR NEXT COMMUNITY NEEDS ASSESSMENT TO LEARN IF WE ARE HEADING IN THE RIGHT DIRECTION. OUR VISION IS TO IMPROVE THE QUALITY OF LIFE FOR EVERY LIFE WE TOUCH.CAPE FEAR VALLEY HEALTH SYSTEMPART V, SECTION B, LINE 4: CAPE FEAR VALLEY AND HIGHSMITH RAINEY WORKED COLLABORATIVELY WITH ONE ANOTHER.PART V, SECTION B, LINE 5: COMMUNITY HEALTH ASSESSMENT TEAMS (CHAT) WERE DEVELOPED IN EACH OF THE RESPECTIVE COUNTIES. THE CHAT CONSISTED OF COMMUNITY MEMBERS, STAKEHOLDERS, AND THOSE WORKING IN PUBLIC HEALTH. THE CHAT'S DEVELOPED COMMUNITY HEALTH ASSESSMENT SURVEYS AND DISTRIBUTED THEM IN THE COMMUNITY IN ELECTRONIC AND PAPER FORMAT. UTILIZING THE SURVEYS (PRIMARY DATA) AND DATA FROM THE STATE PLUS FEDERAL SOURCES (SECONDARY DATA), CFVHS WAS ABLE TO IDENTIFY THE MOST PRESSING NEEDS IN OUR COMMUNITIES.PART V, SECTION B, LINE 11: CFVHS WILL CONTINUE OUR AGGRESSIVE OUTREACH EFFORTS TO HELP EDUCATE OUR PATIENTS ABOUT THE VARIOUS RISK FACTORS ASSOCIATED WITH ALL THE IDENTIFIED NEEDS. WE ARE STRENGTHENING OUR RELATIONSHIPS WITH OUR LOCAL HEALTH DEPARTMENTS AND IDENTIFYING POTENTIAL COLLABORATIONS WITH COMMUNITY STAKEHOLDERS. GOING FORWARD THE HOSPITAL IS DEVELOPING AN ADDITIONAL CARDIAC CATHETERIZATION LAB. OUR LUNG NODULE CLINIC HAS MOVED TO THE MAIN CAMPUS FOR BETTER COVERAGE OF POTENTIAL LUNG CANCER PATIENTS.

HIGHSMITH RAINEY HOSPITAL
PART V, SECTION B, LINE 16I: SEE THE RESPONSE TO PART VI, LINE 3

BLADEN COUNTY HOSPITAL
PART V, SECTION B, LINE 16I: SEE THE RESPONSE TO PART VI, LINE 3

HOKE HOSPITAL
PART V, SECTION B, LINE 16I: SEE THE RESPONSE TO PART VI, LINE 3

CAPE FEAR VALLEY HEALTH SYSTEM
PART V, SECTION B, LINE 16I: SEE THE RESPONSE TO PART VI, LINE 3

PART I, LINE 6A:
CUMBERLAND COUNTY HOSPITAL SYSTEM FILES A COMMUNITY BENEFIT REPORT ANNUALLY IN THE STATE OF NORTH CAROLINA TO THE NORTH CAROLINA HOSPITAL ASSOCIATION.

PART I, LINE 7:
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE $150,802,069 IN BAD DEBT DEDUCTIONS WERE OFFSET FROM REVENUES IN THE FINANCIAL STATEMENTS. THERE IS NO NEED TO ADJUST THE TOTAL EXPENSE USED TO CALCULATE THE PERCENTAGES IN PART I, LINE 7, COLUMN (F).LINE 7A - CHARITY CARE COSTS WERE CALCULATED USING A MEDICAID SPECIFIC COST-TO-CHARGE RATIO (CCR) FROM THE MEDICARE COST REPORT. A MEDICAID CCR WAS USED BECAUSE THE MEDICAID POPULATION BETTER REPRESENTS THE UTILIZATION AND ACUITY OF THE CHARITY POPULATION THAN THE USE OF AN OVERALL CCR AS CALCULATED IN WORKSHEET 2. A CCR WAS USED INSTEAD OF A COST ACCOUNTING SYSTEM BECAUSE CHARITY, AS WELL AS BAD DEBTS, REPRESENT ONLY A PORTION OF A PATIENT ACCOUNT THAT IS BEING WRITTEN OFF.

PART I, LINE 7G:
LINE 7B, 7C & 7G - A MEDICAID CCR WAS USED TO ESTIMATE THE MEDICAID FFS & MEDICAID MANAGED CARE AMOUNTS REPORTED ON LN 7B, THE NC HEALTHCHOICE (NC SCHIP PROGRAM) REPORTED ON LN 7C AND THE SUBSIDIZED HEALTH SERVICES REPORTED ON LN 7G. THE COST ACCOUNTING SYSTEM DATA USED DID INCLUDE INFORMATION FROM ALL PATIENT SEGMENTS REGARDLESS OF PAYOR. LN 7G INCLUDES SUBSIDIZED SERVICES FOR FREESTANDING CLINICS AS WELL.

PART II, COMMUNITY BUILDING ACTIVITIES:
"CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. (""CCHS"") CONTINUES TO ENGAGE IN COALITION BUILDING AND WORKFORCE DEVELOPMENT ACTIVITIES IN THE COMMUNITY. COALITION BUILDING PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY NETWORKING WITH OTHER COMMUNITY AGENCIES TO ADDRESS THE HEALTH AND SAFETY ISSUES OF THE COMMUNITY. THE EMPLOYEES OF CCHS UTILIZE THEIR CLINICAL EXPERTISE TO COLLABORATE WITH OTHER COMMUNITY AGENCIES AND COUNTY AND STATE HEALTH DEPARTMENTS TO PROVIDE EDUCATION AND OTHER INITIATIVES THAT BENEFIT THE HEALTH OF PEOPLE IN THE COMMUNITY. WORKFORCE DEVELOPMENT ACTIVITIES INCLUDE THE RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO MEDICAL SHORTAGE AREAS."

PART III, LINE 2:
"IN THE CURRENT YEAR, BAD DEBTS ARE REPORTED AT CHARGES WRITTEN OFF IN THE PERIOD PLUS AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS. SEE THE LINE 4 NOTE BELOW FOR A MORE DETAILED DESCRIPTION OF THE METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 2 PER THE FINANCIAL STATEMENT FOOTNOTE RELATED TO ""PROVISION FOR UNCOLLECTIBLE ACCOUNTS"". DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE REFLECTED IN THE PATIENT BALANCE PRIOR TO ACCOUNTS BEING WRITTEN OFF TO BAD DEBT."

PART III, LINE 4:
AUDITED FINANCIAL STATEMENT FOOTNOTE -THE HEALTH SYSTEM'S PATIENT ACCOUNTS RECEIVABLE IS RECORDED NET OF ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS OF $252,725,000 AT SEPTEMBER 30, 2022. THE HEALTH SYSTEM'S NET PATIENT SERVICE REVENUE IS PRESENTED NET OF PROVISION OF UNCOLLECTIBLE ACCOUNTS OF $185,780,000 FOR THE YEAR ENDED SEPTEMBER 30, 2022.

PART III, LINE 8:
THE COST REPORTED ON LINE 6 ARE PER THE MEDICARE COST REPORT AND WERE CALCULATED BASED ON COST-TO-CHARGE RATIOS. SINCE THE AMOUNTS REPORTED ON LINES 5 & 6 ONLY INCLUDE MEDICARE PART A COSTS AND PAYMENTS, THE OTHER MEDICARE (I.E. - MEDICARE PT C, PHYSICIAN SERVICES, FEE SCHEDULE, NON-ALLOWABLE) COSTS AND PAYMENTS ARE INCLUDED IN THE ATTACHED MEDICARE RECONCILIATION. 0 OF THE MEDICARE SHORTFALL, IF APPLICABLE, REPORTED ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT SINCE THAT PORTION OF THE SHORTFALL WAS RELATED TO THOSE PATIENTS THAT HAD MEDICAID AS A SECONDARY PAYOR AND THEREFORE DEEMED INDIGENT FOR MEDICARE BAD DEBT PURPOSES.

PART III, LINE 9B:
IF PATIENTS ARE DETERMINED TO QUALIFY FOR CHARITY, THEN THE ACCOUNT IS TREATED AS CHARITY RATHER THAN BAD DEBT.

PART VI, LINE 2:
THE MISSION OF CAPE FEAR VALLEY HEALTH SYSTEM IS TO STRENGTHEN THE HEALTH AND WELL-BEING OF THE GREATER CAPE FEAR VALLEY REGION THROUGH HIGH-QUALITY, COMPASSIONATE CARE PROVIDED TO ALL WHO NEED IT. AS A COMMUNITY NOT-FOR-PROFIT ORGANIZATION, WE TAKE SERIOUSLY OUR RESPONSIBILITY TO INVEST OUR RESOURCES AND ENERGIES INTO UNDERSTANDING AND MEETING THE DIVERSE HEALTH CARE NEEDS OF ALL, AND ENSURE THAT EVERYONE, REGARDLESS OF THEIR ABILITY TO PAY, RECEIVES THE CARE THEY NEED. THE SENIOR ADMINISTRATIVE TEAM SERVES IN VARIOUS CAPACITIES ON SEVERAL LOCAL COMMUNITY BOARDS AND GROUPS. AS MEMBERS OF THESE VARIOUS GROUPS, THEY ARE ABLE TO GAIN INSIGHT TO NEEDS OF THE COMMUNITY. OUR COMMUNITY PARTNERS ARE CRITICAL TO HELPING US IMPROVE THE HEALTH AND WELL-BEING OF THE CAPE FEAR VALLEY REGION. TOGETHER, WE CAN COMBINE RESOURCES AND STRENGTHS, POSITIVELY IMPACTING THE GREATEST NUMBER OF PEOPLE. BY WORKING CLOSELY WITH THE COMMUNITY LEADERS, WE ALSO BUILD A GREATER SENSE OF COMMUNITY AND A SHARED COMMITMENT TOWARD OUR COMMON GOAL OF IMPROVING THE COMMUNITY'S HEALTH. THE RESULTS HELP US TO DETERMINE OUR SHORT AND LONG TERM PRIORITIES AS WELL AS STRATEGIES FOR IMPROVING COMMUNITY HEALTH. THOSE COMMUNITY GROUPS AND PARTNERS CCCC, SRAHEC, CCMAP, CHAMBER OF COMMERCE, FAYETTEVILLE AREA PR ALLIANCE, CUMBERLAND FCOUNTY EDUCATION FOUNDATION, COMMUNITIES IN SCHOOLS OF NC, FORT BRAGG REGIONAL ALLIANCE, CARE CLINIC, AND THE METHODIST UNIVERSITY PHYSICIAN ASSISTANT PROGRAM.

PART VI, LINE 3:
UNINSURED PATIENTS ARE SCREENED AT THE TIME OF REGISTRATION FOR THEIR ABILITY TO PAY FOR THEIR HEALTH CARE SERVICES. IF THE PATIENT HAS NO ABILITY TO PAY AND IS DEEMED INELIGIBLE FOR GOVERNMENT PROGRAMS (MEDICARE, MEDICAID, ETC.) THEN THEY ARE INFORMED OF THE HOSPITAL CHARITY PROGRAM. THEY ARE PROVIDED WITH AN APPLICATION AND A LISTING OF THE APPROPRIATE DOCUMENTS NECESSARY TO ESTABLISH ELIGIBILITY FOR THE HOSPITAL CHARITY PROGRAM. ALL PATIENTS RECEIVE A COPY OF OUR CHARITY CARE APPLICATION ACCOMPANYING THE FIRST BILLING STATEMENT.

PART VI, LINE 6:
CUMBERLAND COUNTY HOSPITAL SYSTEM IS A STAND-ALONE HEALTH CARE ORGANIZATION AND IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM.

PART VI, LINE 7, REPORTS FILED WITH STATES
NC

PART VI, LINE 4:
"CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. (""CCHS"") DOING BUSINESS AS CAPE FEAR VALLEY MEDICAL CENTER (""CFVMC"") IS THE FLAGSHIP OF CAPE FEAR VALLEY HEALTH SYSTEM (""CFVHS""). CFVHS OPERATES A VARIETY OF THE HEALTHCARE FACILITIES FROM ITS HEADQUARTERS IN FAYETTEVILLE, NORTH CAROLINA INCLUDING A TERTIARY ACUTE CARE HOSPITAL, A LONG-TERM ACUTE CARE HOSPITAL, A CRITICAL ACCESS HOSPITAL, AN INPATIENT REHABILITATION FACILITY, COUNTY EMERGENCY MEDICAL SERVICES, AN OUTPATIENT PSYCHIATRIC FACILITY, A DETOXIFICATION FACILITY, A WELLNESS CENTER, 14 PRIMARY CARE CLINICS, 16 SPECIALTY CARE CLINICS, 4 WALK-IN CLINICS, AND HEALTH PAVILION NORTH, AN OUTPATIENT COMPLEX. CAPE FEAR VALLEY HEALTH SYSTEM SERVES A SIX-COUNTY SERVICE AREA MADE UP OF THE FIVE COUNTIES CONTIGUOUS TO CUMBERLAND COUNTY, NC, WHICH IS ITS PRIMARY SERVICE AREA. PER INFORMATION FROM THE 2012 ESTIMATED CENSUS DATA, CUMBERLAND HAS A POPULATION OF OVER 326,000 RESIDENTS; THIS WAS A GROWTH OF 6.9% FROM THE 2000 CENSUS DATA. APPROXIMATELY 54.2% OF THE 326,000 RESIDENTS IN OUR PRIMARY SERVICE AREA ARE MINORITIES, COMPARED TO 35.6% FOR THE STATE."

PART VI, LINE 5:
"CHRONIC DISEASES LIKE DIABETES AND OBESITY ARE INCREASING WITHIN OUR COMMUNITY. OUR FACILITY HAS OPENED A DIABETES AND ENDOCRINE CLINIC TO HELP THOSE PATIENTS DIAGNOSED WITH DIABETES. OUR HEALTHPLEX PROVIDES BOTH NUTRITIONAL AND EXERCISE PROGRAMS TO HELP THOSE IN THE COMMUNITY ADDRESS THE PROBLEM OF OBESITY. THE GOAL IS TO HELP ALL RESIDENTS LEARN TO MANAGE THEIR CONDITIONS AND LIVE HEALTHIER LIVES BY ADDRESSING THE CHALLENGES ASSOCIATED WITH THESE CONDITIONS. EXAMPLE OF PROGRAM AT CAPE FEAR VALLEY: CAPE FEAR VALLEY HEALTH SYSTEM'S ""TAKE CHARGE OF YOUR HEALTH"" PROGRAM BEGAN AS AN INITIATIVE TO CLOSE THE HEALTHCARE GAP BETWEEN AFRICAN-AMERICANS AND NON-HISPANIC WHITES IN CUMBERLAND COUNTY THROUGH PUBLIC SERVICE ANNOUNCEMENTS, HEALTH FAIRS, SCREENINGS AND SPEAKING ENGAGEMENTS. IT HAS SINCE BROADENED ITS FOCUS TO ALL OF CUMBERLAND COUNTY. DARVIN JONES IS THE COORDINATOR OF THE ""TAKE CHARGE OF YOUR HEALTH"" PROGRAM. HE SERVES ON THE BOARD OF DIRECTORS OF COMMUNITY HEALTH INTERVENTIONS & SICKLE CELL AGENCY, A NON-PROFIT THAT WORKS WITH INDIVIDUALS WITH SICKLE CELL DISEASE, HYPERTENSION AND DIABETES. DARVIN IS ALSO A MEMBER OF THE CUMBERLAND COUNTY COUNCIL FOR HEALTHY LIVING, A GROUP ASSEMBLED BY THE HEALTH DEPARTMENT, AND THE CUMBERLAND COUNTY SCHOOLS SCHOOL HEALTH ADVISORY COUNCIL. TAKE CHARGE OF YOUR HEALTH IS AFFILIATED WITH EAT SMART, MOVE MORE NORTH CAROLINA, A STATEWIDE INITIATIVE. AT CAPE FEAR VALLEY HEALTH SYSTEM, IT IS IMPORTANT TO US TO GIVE BACK TO OUR COMMUNITY. IN ADDITION TO EMPLOYEE UNITED WAY DONATIONS AND VOLUNTEER TIME, OUR EMPLOYEES PARTICIPATE IN A VARIETY OF COMMUNITY SERVICE INITIATIVES, TO INCLUDE THE HABITAT FOR HUMANITY AND THE FRIENDS OF CANCER RIVER WALK. LAST YEAR OUR EMPLOYEES GAVE OVER $250,000 IN DONATIONS TO VARIOUS COMMUNITY ORGANIZATIONS."