4A (Expenses $ 21758466 including grants of $ 0) (Revenue $ 21750733)
CHARLES A. CANNON, JR MEMORIAL HOSPITAL IN LINVILLE IS A 23-BED CRITICAL ACCESS HOSPITAL. THE FULL-SERVICE EMERGENCY DEPARTMENT, IMAGING DEPARTMENT, LABORATORY, REHABILITATION CENTER OFFERING PHYSICAL AND OCCUPATIONAL THERAPIES, AND CARDIOPULMONARY REHABILITATION COMPLETE THE LIST OF SERVICES OFFERED.

FACILITY 1, CHARLES A CANNON JR MEMORIAL - PART V, LINE 3E
THE 2022 CHNA AND RELATED IMPLEMENTATION STRATEGY REPORT IDENTIFIED THE FOLLOWING PRIORITY HEALTH NEEDS FOR THE COMMUNITY- 1) MENTAL/BEHAVIORAL HEALTH 2) HEART & VASCULAR CARE 3) CANCER

FACILITY 1, CHARLES A CANNON JR MEMORIAL - PART V, LINE 5
ARHS REGULARLY COLLABORATES WITH APPALACHIAN DISTRICT HEALTH DEPARTMENT AND TOE RIVER HEALTH DISTRICT TO FACILITATE COMMUNITY EVENTS AND INITIATIVES. APPALACHIAN REGIONAL HEALTHCARE SYSTEM (ARHS) ANALYZED THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) CONDUCTED AND PUBLISHED BY APPALACHIAN DISTRICT HEALTH DEPARTMENT AND TOE RIVER HEALTH DISTRICT TO DETERMINE HOW ARHS HOSPITALS AND MEDICAL OFFICES CAN CONTRIBUTE TO ADDRESSING THE IDENTIFIED PRIORITY HEALTH ISSUES IN THE HIGH COUNTRY. CHNAS WERE CONDUCTED IN THREE COUNTIES: ASHE AND WATAUGA COUNTIES BY APPALACHIAN DISTRICT HEALTH DEPARTMENT AND AVERY COUNTY BY TOE RIVER HEALTH DISTRICT. PRIORITIZED NEEDS WERE SELECTED BASED ON JOINT ANALYSIS OF CONDUCTED COMMUNITY HEALTH OPINIONS SURVEYS (PRIMARY DATA) AND UTILIZING SECONDARY DATA ABOUT WATAUGA, ASHE, AND AVERY COUNTIES. ASHE COUNTY -HOUSING AND TRANSIT AN ESTIMATED 16% OF ASHE COUNTY HOUSEHOLDS HAVE AT LEAST ONE OF FOUR MAJOR HOUSING PROBLEMS (OVERCROWDING, HIGH HOUSING COSTS, LACK OF KITCHEN OR PLUMBING FACILITIES). IN ADDITION, AN ESTIMATED THREE PERCENT OF HOUSEHOLDS, OR 299 HOMES, IN ASHE COUNTY DO NOT HAVE TELEPHONE SERVICES AVAILABLE. AFFORDABLE HOUSING WAS ONE OF THE MOST COMMON RESPONSES TO AN OPEN-ENDED QUESTION ASKED IN THE COMMUNITY HEALTH OPINION SURVEY REGARDING RESOURCES NEEDED IN THE COMMUNITY. -MENTAL/BEHAVIORAL HEALTH ACCORDING TO THE YOUTH RISK BEHAVIOR SURVEY CONDUCTED IN 2017 AT ASHE COUNTY HIGH SCHOOL, DURING THE PAST 12 MONTHS, 27% OF STUDENTS FELT SO SAD OR HOPELESS ALMOST EVERY DAY FOR AT LEAST TWO WEEKS IN A ROW THAT THEY STOPPED DOING SOME OF THEIR USUAL ACTIVITIES. 17% OF ASHE COUNTY HIGH SCHOOL STUDENTS REPORTED HURT THEMSELVES ON PURPOSE WITHOUT INTENDING TO KILL THEMSELVES IN THE PAST 12 MONTHS. IN ADDITION, THE RATE OF SUICIDE IN ASHE COUNTY HAS INCREASED SINCE THE LAST COMMUNITY HEALTH ASSESSMENT FROM 17.8 PER 100,000 PEOPLE (2012-2016) TO 17.9 PER 100,000 PEOPLE (2014-2018). ACCESS TO COUNSELING, REFERRAL SERVICES, CASE MANAGEMENT AND CRISIS MANAGEMENT CONTINUES TO IMPROVE IN ASHE COUNTY. FOR INSTANCE, DAYMARK RECOVERY SERVICES OFFERS MOBILE CRISIS MANAGEMENT SERVICES THAT PROVIDE A COMPREHENSIVE CRISIS INTERVENTION IN THE LEAST RESTRICTIVE ENVIRONMENT WITH A TEAM PERSPECTIVE TO MEET ANY INDIVIDUALS NEEDS. HOWEVER, ACCESS TO PRIVATE MENTAL HEALTH IS EXTREMELY LIMITED IN ASHE COUNTY. -SUBSTANCE USE AND MISUSE PREVENTION SUBSTANCE USE INCLUDES ALCOHOL USE, TOBACCO USE AND OTHER DRUG USE, INCLUDING PRESCRIPTION DRUGS. SUBSTANCE MISUSE IS THE HARMFUL USE OF SUBSTANCES (LIKE DRUGS AND ALCOHOL) FOR NON-MEDICAL PURPOSES. BETWEEN 2014 -2018, ONE IN FOUR DRIVING DEATHS (23.5%) INVOLVED ALCOHOL IN ASHE COUNTY, COMPARED TO 28.2% OF ALL DRIVING DEATHS IN NORTH CAROLINA. AND APPROXIMATELY 17% OF ADULTS IN ASHE COUNTY ARE CURRENT SMOKERS, IN LINE WITH THE NORTH CAROLINA AVERAGE (17%). AVERY COUNTY -MENTAL HEALTH AMONG 2021 AVERY COUNTY COMMUNITY HEALTH SURVEY RESPONDENTS, 10.4% REPORTED FEELING DISSATISFIED OR VERY DISSATISFIED WITH LIFE, SLIGHTLY HIGHER COMPARED TO WESTERN NORTH CAROLINA. APPROXIMATELY, 20% REPORTED MORE THAN SEVEN DAYS OF POOR MENTAL HEALTH IN THE PAST MONTH, LOWER THAN THE REGIONAL AVERAGE. FOUR PERCENT OF AVERY COUNTY RESPONDENTS IN 2021 REPORTED HAVING CONSIDERED SUICIDE IN THE PAST YEAR. AMONG RESPONDENTS TO THE 2021 AVERY COUNTY STUDENT SURVEY, 37% OF HIGH SCHOOL STUDENTS REPORTED FEELING SO SAD OR HOPELESS EVERY DAY FOR TWO WEEKS THAT THEY STOPPED DOING THEIR USUAL ACTIVITIES; FEMALE STUDENTS WERE MORE LIKELY THAN OTHER GROUPS TO REPORT FEELING SAD OR HOPELESS. 12% OF STUDENT RESPONDENTS REPORTED HAVING CONSIDERED SUICIDE IN THE PAST YEAR AND 11% HAD PLANNED HOW THEY WOULD COMMIT SUICIDE. NEARLY FOUR PERCENT REPORTED THAT THEY HAD ATTEMPTED SUICIDE ONE OR MORE TIMES IN THE PAST YEAR (AVERY COUNTY SCHOOLS, 2021). -SUBSTANCE ABUSE SUBSTANCE ABUSE PREVENTION AND INCREASING AVAILABILITY/ACCESS TO MENTAL HEALTH SERVICES IS AN ONGOING ISSUE IN AVERY COUNTY AND ACROSS NORTH CAROLINA. SUBSTANCE ABUSE CAN INCLUDE, BUT IS NOT LIMITED TO, ALCOHOL, TOBACCO, PRESCRIPTION DRUGS AND ILLICIT DRUGS. IMPROVEMENTS HAVE BEEN MADE TO SUBSTANCE ABUSE PREVENTION AND INCREASED MENTAL HEALTH SERVICES, BUT MUCH MORE IS NEEDED. THIS WAS CHOSEN AS A HEALTH PRIORITY DUE TO THE CONCERN ABOUT ABUSE OF ILLEGAL DRUGS AMONG RESIDENTS AND MISUSE OF PRESCRIPTION DRUGS AMONG TEENS AND ADULTS AS WELL AS INCREASED ALCOHOL ABUSE AND THE AMOUNT OF OPIOID RELATED POLICE CALLS IN RECENT YEARS. IN 2021, 47.5% OF AVERY COUNTY RESPONDENTS TO THE COMMUNITY HEALTH SURVEY INDICATED THAT THEIR LIFE HAS BEEN NEGATIVELY AFFECTED BY SUBSTANCE ABUSE, AND APPROXIMATELY 13% OF THE COUNTYS RESPONDENTS REPORTED USING OPIATES/OPIOIDS, WITH OR WITHOUT A PRESCRIPTION, IN THE PAST YEAR. BETWEEN 2015 AND 2020, THE WERE A TOTAL OF 49 EMERGENCY DEPARTMENT VISITS WITH AN OPIOID OVERDOSE DIAGNOSIS AMONG AVERY COUNTY RESIDENTS, AN AVERAGE OF EIGHT PER YEAR. WHILE MUCH ATTENTION HAS FOCUSED ON THE OPIOID CRISIS IN RECENT YEARS, ALCOHOL CONTINUES TO BE A SUBSTANCE WHOSE MISUSE IMPACTS OUR COMMUNITIES. APPROXIMATELY 49% OF AVERY COUNTY COMMUNITY HEALTH SURVEY RESPONDENTS REPORTED CURRENT CONSUMPTION OF ALCOHOL, HIGHER THAN NC DATA AND LOWER THAN THE UNITED STATES. THE PERCENTAGE OF RESPONDENTS ENGAGING IN BINGE DRINKING WAS HIGHER IN AVERY COUNTY (24.4%) THAN ANY OF THE SURROUNDING COMPARATORS. BINGE DRINKING IS DEFINED AS MEN CONSUMING MORE THAN FIVE ALCOHOLIC DRINKS ON ANY ONE OCCASION IN THE PAST MONTH OR WOMEN CONSUMING FOUR OR MORE ALCOHOLIC DRINKS ON ANY ONE OCCASION IN THE PAST MONTH. -FOOD AND NUTRITION IN NOVEMBER 2021, HEALTHY CAROLINIANS OF AVERY COUNTY MEMBERS IDENTIFIED FOOD INSECURITY AS A CHIEF HEALTH CONCERN FOR THE COUNTY. ACCORDING TO FEEDING AMERICA, 16% OF THE AVERY COUNTY POPULATION WAS FOOD INSECURE IN 2019 AND 19.5% OF CHILDREN IN AVERY COUNTY WERE FOOD INSECURE. PARTICIPANTS IN THE 2021 COMMUNITY HEALTH SURVEYS WERE ASKED IF THEY RAN OUT OF FOOD AT LEAST ONCE IN THE PAST YEAR AND IF THEY WERE WORRIED ABOUT RUNNING OUT OF FOOD IN THE PAST YEAR. THOSE WHO SAID YES TO EITHER QUESTION WERE CLASSIFIED AS FOOD INSECURE. AVERY COUNTY DEMONSTRATED A HIGHER PERCENTAGE OF FOOD INSECURITY COMPARED TO WESTERN NORTH CAROLINA. THE NUMBER OF GROCERY STORES DECREASED FROM FIVE IN 2011 TO FOUR IN 2016: THERE ARE THREE LARGE-CHAIN GROCERY STORES IN AVERY COUNTY (AN INGLES IN NEWLAND, A FOOD LION AND A LOWES FOODS IN BANNER ELK). AS OF 2015, NEARLY FOUR PERCENT OF AVERY COUNTY HOUSEHOLDS HAD NO CAR AND LOW ACCESS (MORE THAN ONE MILE DISTANT) TO A GROCERY STORE. IN CONTRAST TO THE GROCERY STORES, FAST FOOD RESTAURANTS APPEAR MORE ABUNDANT IN AVERY COUNTY: THERE WERE 12 FAST FOOD ESTABLISHMENTS IN 2011 AND IN 2016. THERE WERE NO RECREATIONAL OR FITNESS FACILITIES IN AVERY COUNTY IN 2011 AND 2016. WATAUGA COUNTY -MENTAL/BEHAVIORAL HEALTH BEHAVIORAL HEALTH DESCRIBES THE CONNECTION BETWEEN BEHAVIORS AND THE WELL- BEING OF THE BODY, MIND, AND SPIRIT. BEHAVIORAL HEALTH INCLUDES NOT ONLY OUR MENTAL HEALTH, BUT HOW OUR BEHAVIORSSUCH AS EATING HABITS OR USE OF ALCOHOLIMPACT OUR WELL-BEING. ONE IN FIVE ADULTS (18.77%) IN NORTH CAROLINA HAS A MENTAL HEALTH CONDITION. MORE THAN HALF OF ADULTS IN NORTH CAROLINA (54.6%) WITH ANY MENTAL ILLNESS REPORT NOT RECEIVING MENTAL HEALTH TREATMENT OR COUNSELING OF ANY KIND. ONE OUT OF EVERY THREE ADULTS IN NORTH CAROLINA WITH MENTAL ILLNESS ARE UNINSURED. INDIVIDUALS LIVING IN POVERTY EXPERIENCE MENTAL ILLNESS AND MENTAL DISTRESS MORE FREQUENTLY THAN THOSE WHO ARE NOT BURDENED BY POVERTY. IT IS IMPORTANT TO CONSIDER THIS HEALTH DISPARITY WHEN ADDRESSING MENTAL HEALTH IN OUR RURAL COMMUNITY, WHERE 25.3% OF PEOPLE IN WATAUGA COUNTY WERE LIVING IN POVERTY IN 2019. ACCORDING TO THE YOUTH RISK BEHAVIOR SURVEY CONDUCTED IN 2018 AT WATAUGA COUNTY HIGH SCHOOL, DURING THE PAST 12 MONTHS, 30.1% OF WATAUGA HIGH SCHOOL STUDENT RESPONDENTS FELT SO SAD OR HOPELESS ALMOST EVERY DAY FOR AT LEAST TWO WEEKS IN A ROW THAT THEY STOPPED DOING THEIR USUAL ACTIVITIES. APPROXIMATELY 15.4% OF STUDENTS SERIOUSLY CONSIDERED ATTEMPTING SUICIDE IN THE PAST 12 MONTHS. SEEKING PRIMARY HEALTHCARE IS OFTEN THE FIRST STEP TO ACCESSING BEHAVIORAL HEALTHCARE. PRIMARY CARE PROVIDERS ARE NOW MOVING TOWARD A SYSTEM OF INTEGRATED CARE WHERE BOTH GENERAL AND BEHAVIORAL HEALTHCARE ARE PROVIDED. INTEGRATING MENTAL HEALTH, SUBSTANCE MISUSE, AND PRIMARY CARE SERVICES HAS BEEN SHOWN TO PRODUCE THE BEST OUTCOMES FOR PEOPLE WITH MULTIPLE HEALTHCARE NEEDS. -HOUSING AND TRANSIT HOUSING IS AN IMPORTANT SOCIAL DETERMINANT OF PHYSICAL AND MENTAL HEALTH AND WELLBEING. THE QUALITY AND COST OF HOUSING CAN IMPROVE OR WORSEN OUR HEALTH IN MANY WAYS: I. AFFORDABLE HOUSING MAKES MORE RESOURCES AVAILABLE TO PAY FOR HEALTHCARE AND HEALTHY FOOD, WHICH LEADS TO BETTER HEALTH OUTCOMES. II. AFFORDABLE, QUALITY HOUSING ALLEVIATES OVERCROWDING AND LIMITS OUR EXPOSURE TO ENVIRONMENTAL TOXINS. III. STABLE AND AFFORDABLE HOUSING SUPPORTS MENTAL HEALTH BY LIMITING STRESSORS RELATED TO FINANCIAL B

FACILITY 1, CHARLES A CANNON JR MEMORIAL - PART V, LINE 6A
WATAUGA MEDICAL CENTER, A RELATED ORGANIZATION LOCATED AT 336 DEERFIELD ROAD, BOONE, NC, ASSISTED IN CONDUCTING THE 2022 CHNA.

FACILITY 1, CHARLES A CANNON JR MEMORIAL - PART V, LINE 6B
ARHS ANALYZED CHNAS PUBLISHED BY APPALACHIAN DISTRICT HEALTH DEPARTMENT AND TOE RIVER HEALTH DISTRICT TO DETERMINE HOW ARHS HOSPITALS CAN CONTRIBUTE TO ADDRESSING THE DEFINED HEALTH PRIORITIES. THIS REPORT WILL FOCUS ON THE NEEDS OF OUR THREE MAIN SERVICE AREAS: ASHE, AVERY AND WATAUGA. CHNAS WERE CONDUCTED IN EACH COUNTY; ASHE AND WATAUGA BY APPALACHIAN DISTRICT HEALTH DEPARTMENT AND AVERY BY TOE RIVER HEALTH DISTRICT.

FACILITY 1, CHARLES A CANNON JR MEMORIAL - PART V, LINE 11
SEVERAL NEEDS OUTLINED IN THE CHNA PROCESS SUCH AS CHILD ABUSE/NEGLECT, DENTAL PROBLEMS, ALCOHOL AND/OR DRUG USE, SEXUALLY TRANSMITTED DISEASE, TRANSPORTATION, AND FAMILY AND SOCIAL CONNECTIONS HAVE NOT BEEN ADDRESSED IN THIS PLAN. IN INITIAL DISCUSSION AND SUBSEQUENT PRIORITIZATION, ARHS CONSIDERED THE LEVELS TO WHICH SOME NEEDS WERE ALREADY BEING ADDRESSED IN THE SERVICE AREA. ADDITIONALLY, SOME COMMUNITY NEEDS FALL OUT OF THE SCOPE OF EXPERTISE AND RESOURCES OF THE HOSPITAL.

SCHEDULE H, PART I, LINE 7, COLUMN (F)
IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 25,011,415 ADD: EXPENSES ON PART VIII 194,030 DENOMINATOR FOR COLUMN (F) 25,205,445

SCHEDULE H, PART I, LINE 7
"THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S ""A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008"". SEE ALSO THE DESCRIPTION FOR PART III, LINE 2."

SCHEDULE H, PART III, LINE 2
AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE.

SCHEDULE H, PART III, LINE 3
THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 5%) BASED ON AN ANALYSIS OF SELF PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT.

SCHEDULE H, PART III, LINE 4
THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN EVALUATION OF THE OVERALL COLLECTABILITY OF THE ACCOUNTS RECEIVABLE. AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE, THE ACCOUNTS ARE CHARGED AGAINST THE ALLOWANCE.

SCHEDULE H, PART III, LINE 8
MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS.

SCHEDULE H, PART III, LINE 9B
CHARITY WRITE-OFFS ARE SEGREGATED FROM NORMAL BAD DEBTS THROUGH A SEPARATE TRANSACTION CODE. FAMILY INCOME BELOW 200% OF FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% WRITE-OFF. PARTIAL WRITE-OFF IS AVAILABLE FOR FAMILY INCOME BETWEEN 200% AND 300% OF FPG.

SCHEDULE H, PART VI, LINE 2
APPLACHIAN REGIONAL HEALTHCARE SYSTEM (ARHS) STAYS COMMITTED TO PROMOTING HEALTH IN THE HIGH COUNTRY, ENHANCING QUALITY OF LIFE AND SIMPLY MAKING LIFE BETTER. THE HEALTHCARE SYSTEM OFFERS A VARIETY OF HEALTH EDUCATION PROGRAMS, PREVENTION PROGRAMS AND HEALTH SCREENINGS TO ENCOURAGE HEALTHY LIFESTYLES FOR RESIDENTS AND VISITORS. IN ADDITION TO PARTNERING WITH LOCAL HEALTH DEPARTMENTS TO CONDUCT HEALTH NEEDS ASSESSMENTS, ARHS HOSTS ANNUAL HEALTH FAIRS IN OUR PRIMARY SERVICE AREA, WATAUGA AND AVERY COUNTIES. WE ALSO ATTEMPT TO ADDRESS THE NEEDS OF LOW INCOME, UNINSURED RESIDENTS THROUGH TWO PROGRAMS - APPLACHIAN HEALTHCARE PROJECT AND THE LATINO HEALTH PROGRAM WHICH ARE DISCUSSED FURTHER BELOW.

SCHEDULE H, PART VI, LINE 3
PATIENTS ARE EDUCATED ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY (FAP). DURING PRE-REGISTRATION AND REGISTRATION, PATIENTS CAN BE INTERVIEWED BY A PATIENT FINANCIAL ADVOCATE TO DETERMINE WHETHER THE PATIENT HAS A NEED FOR FINANCIAL ASSISTANCE OR POTENTIAL ELIGIBILITY UNDER GOVERNMENT PROGRAMS.

SCHEDULE H, PART VI, LINE 4
THE COMMUNITY CONSISTS OF ASHE, AVERY, AND WATAUGA COUNTIES, A POPULATION OF APPROXIMATELY 98,000 PEOPLE IN NORTHWESTERN NORTH CAROLINA. PLEASE REFER TO THE RECENT COMMUNITY HEALTH NEEDS ASSESSMENT FOR AN IN-DEPTH LOOK AT THE DEMOGRAPHICS. BOTH THE 2019 AND 2022 CHNAS ARE AVAILABLE AT HTTPS://AAPRHS.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.

SCHEDULE H, PART VI, LINE 5
APPLACHIAN REGIONAL HEALTHCARE SYSTEM (ARHS) STAYS COMMITTED TO PROMOTING HEALTH IN THE HIGH COUNTRY, ENHANCING QUALITY OF LIFE AND SIMPLY MAKING LIFE BETTER. THE HEALTHCARE SYSTEM OFFERS A VARIETY OF HEALTH EDUCATION PROGRAMS, PREVENTION PROGRAMS AND HEALTH SCREENINGS TO ENCOURAGE HEALTHY LIFESTYLES FOR RESIDENTS AND VISITORS. IN ADDITION TO PARTNERING WITH LOCAL HEALTH DEPARTMENTS TO CONDUCT HEALTH NEEDS ASSESSMENTS, ARHS HOSTS ANNUAL HEALTH FAIRS IN OUR PRIMARY SERVICE AREA, WATAUGA AND AVERY COUNTIES. WE ALSO ATTEMPT TO ADDRESS THE NEEDS OF LOW INCOME, UNINSURED RESIDENTS THROUGH TWO PROGRAMS - APPLACHIAN HEALTHCARE PROJECT AND THE LATINO HEALTH PROGRAM. APPALACHIAN HEALTHCARE PROJECT IS A COLLABORATIVE EFFORT AMONG THE MEDICAL COMMUNITY TO PROVIDE HEALTHCARE FOR LOW INCOME, UNINSURED RESIDENTS OF WATAUGA AND AVERY COUNTIES. THE PROJECT ENROLLS PERSONS WHO MEET PROGRAM GUIDELINES AND COORDINATES HEALTH CARE ON THE INDIVIDUAL'S BEHALF. COORDINATION OF HEALTH CARE INCLUDES MANAGING REFERRALS TO SPECIALISTS, HELPING PATIENTS GET ACCESS TO MEDICATIONS, AND PATIENT CASE MANAGEMENT. MEDICAL PROVIDERS DONATE MUCH NEEDED CARE TO INDIVIDUALS WHO QUALIFY. THE LATINO HEALTH PROGRAM OF ARHS SEEKS TO IMPROVE THE HEALTH AND WELL-BEING OF LATINOS IN WATAUGA AND AVERY COUNTIES THROUGH INCREASED ACCESS TO CARE, HEALTH EDUCATION, AND OTHER ENABLING SERVICES. BOTH PROVIDE SUBSTANTIAL MEDICAL ASISTANCE TO APPROXIMATELY 500 LOW INCOME, UNINSURED RESIDENTS ANNUALLY. THE GOVERNING BODY OF THE HOSPITAL FACILITY IS PRIMARILY COMPRISED OF PERSONS WHO ARE NOT EMPLOYEES OR CONTRACTORS (NOR FAMILY MEMBERS THEREOF) AND WHO REPRESENT A BROAD SPECTRUM OF THE COMMUNITY. THE HOSPITAL'S MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. SURPLUS FUNDS ARE REINVESTED IN THE FACILITIES AND OPERATIONS. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS, AND OFFER FINANCIAL ASSISTANCE TO INDIVIDUALS SATISFYING ELIGIBILITY REQUIREMENTS.

SCHEDULE H, PART VI, LINE 6
APPALACHIAN REGIONAL HEALTHCARE SYSTEM (ARHS) IS A NOT-FOR-PROFIT ORGANIZATION PROVIDING HEALTH CARE SERVICES TO THE RESIDENTS OF THE MOUNTAIN REGIONS ON NORTHWEST NORTH CAROLINA AND NORTHEAST TENNESSEE. ARHS SERVES AS THE PARENT ORGANIZATION OF A MULTI-ENTITY HEALTHCARE SYSTEM. ARHS IS THE SOLE MEMBER OF WATAUGA MEDICAL CENTER, INC. (WMC), CHARLES A. CANNON, JR. MEMORIAL HOSPITAL (CANNON), INC., APPALACHIAN REGIONAL HEALTHCARE FOUNDATION, INC., ARHS PROPERTIES, INC., APPALACHIAN REGIONAL MEDICAL ASSOCIATES, INC., AND APPALACHIAN REGIONAL BEHAVIORAL HEALTH, INC. WATAUGA MEDICAL CENTER IS A 117-BED REGIONAL REFERRAL MEDICAL COMPLEX, OFFERING BOTH PRIMARY AND SECONDARY ACUTE AND SPECIALTY CARE. WATAUGA MEDICAL CENTER ALSO INCLUDES MANY OUTPATIENT CLINICS AND A DIAGNOSTICS CENTER. CHARLES A. CANNON, JR. MEMORIAL HOSPITAL IS AN ACUTE CARE HOSPITAL WITH A FULL-SERVICE EMERGENCY DEPARTMENT, IMAGING DEPARTMENT, LABORATORY, OUTPATIENT BEHAVIORAL HEALTH, AND THE REHABILITATION CENTERS PHYSICAL AND OCCUPATIONAL THERAPIES. APPALACHIAN REGIONAL HEALTHCARE FOUNDATION, INC. IS THE FUNDRAISING ORGANIZATION FOR THE SYSTEM. APPALACHIAN REGIONAL BEHAVIORAL HEALTH, INC. IS A 37-BED LICENSED INPATIENT MENTAL HEALTH HOSPITAL THAT BEGAN OPERATIONS DURING THE FISCAL YEAR. IT ALSO OPERATES THE OUPATIENT MENTAL HEALTH DEPARTMENT THAT WAS FORMERLY PART OF CANNON. APPALACHIAN REGIONAL MEDICAL ASSOCIATES, INC. (ARMA) PROVIDES PRIMARY CARE, ALONG WITH A WIDE ARRAY OF SPECIALTIES TO SERVE THE NEEDS OF AREA RESIDENTS. SPECIALTIES INCLUDE CARDIOLOGY, ORTHOPAEDICS, OB/GYN, GENERAL SURGERY, UROLOGY, RHEUMATOLOGY, PULMONOLOGY, AND URGENT CARE. ARMA ALSO PROVIDES ADMINISTRATIVE SERVICES, ELECTRONIC MEDICAL RECORDS SYSTEMS, PHYSICIAN RECRUITMENT, AND PHYSICIAN OFFICE MANAGEMENT SERVICES. ARHS PROPERTIES, INC. WAS FORMED TO MANAGE AND MAINTAIN PROPERTIES FOR THE USE OF WATAUGA MEDICAL CENTER, INC. AND CHARLES A. CANNON, JR. MEMORIAL HOSPITAL.