4A (Expenses $ 12074441 including grants of $ 46022) (Revenue $ 20060042)
THE ORGANIZATION, FORMERLY KNOWN AS BLUE RIDGE REGIONAL HOSPITAL, INC. BELIEVES THAT PATIENT- AND FAMILY-CENTERED CARE IS THE BEST APPROACH TO MEETING OUR PATIENTS' HEALTHCARE NEEDS. PATIENT AND FAMILY-CENTERED CARE MEANS PATIENTS, THEIR FAMILIES, DOCTORS, NURSES AND OTHER HEALTHCARE PROFESSIONALS FORM A PARTNERSHIP THAT BENEFITS EVERYONE. A FAMILY MEMBER IS RECOGNIZED AS ANYONE WHO PATIENTS REGARD AS SIGNIFICANT IN THEIR LIVES. FAMILIES ARE NOT CONSIDERED VISITORS, BUT ESSENTIAL PARTICIPANTS IN CARE AND DECISIONS THAT AFFECT THE TOTAL HEALING OF THE PATIENT. THE COMPONENTS OF FAMILY-CENTERED CARE ARE RESPECT AND DIGNITY; INFORMATION SHARING; AND PARTICIPATION AND COLLABORATION. THE GOAL IN CARING FOR PATIENTS AT BLUE RIDGE REGIONAL HOSPITAL IS THE SAME FOR PHYSICIANS, MEDICAL STAFF AND FAMILIES TO PROVIDE THE BEST CARE AND OUTCOME FOR THE PATIENT. IT TAKES A COMBINATION OF MODERN MEDICINE, COMPASSIONATE CARE, ADVANCED TECHNOLOGY, DEDICATED STAFF, AS WELL AS CARE PROVIDED BY FAMILIES TO REACH THE BEST POSSIBLE OUTCOME. THE STAFF AT BLUE RIDGE REGIONAL HOSPITAL IS DEDICATED TO CREATING THIS TYPE OF EXPERIENCE FOR EVERY PATIENT AND FAMILY MEMBER WHO ENTERS OUR DOORS.

BLUE RIDGE REGIONAL HOSPITAL, INC.:
"PART V, SECTION B, LINE 4: CHNA Tax Year The organizations last CHNA was conducted in tax year 2015. In accordance with IRC Section 501(r)(3)(d)(4), ""A hospital organization is not required to meet the requirements of section 501(r)(3) with respect to a hospital facility in a taxable year if, before the end of that taxable year, the hospital organization transfers all ownership of the hospital facility to another organization or otherwise ceases its operation of the hospital facility or the facility ceases to be licensed, registered, or similarly recognized as a hospital by a state."" Due to the sale of the hospital facility during the current 2018 tax year, the organization did not conduct a new CHNA. BLUE RIDGE REGIONAL HOSPITAL, INC.: Part v, section b, line 5: The community health needs assessment for blue ridge regional hospital was conducted in partnership with toe river health district, the local public health agency serving Mitchell, yancey and avery counties. In the collaborative assessment process for our community, the toe river health district health department is a key partner. They provided coordination for the local process that we help support and partner to implement. Our process included input regarding the needs of medically underserved, low-income, and minority populations in two ways. (1) as part of our collaborative data collection effort, a community-wide telephone survey was conducted to better understand the specific health needs and status of all of the community, which includes these special populations. (2) in addition, a survey of key informants was conducted to gain input from the individuals and organizations in our community representing the interests of these populations in their local efforts."

BLUE RIDGE REGIONAL HOSPITAL, INC.:
PART V, SECTION B, LINE 6A: REGIONAL PARTNERSHIP: Blue ridge's collaborative community health improvement effort is also supported by a comprehensive partnership with other regional hospitals and local health departments. This initiative, known as wnc healthy impact, represents 16 counties across the western north carolina region working collaboratively to improve community health. Information about this innovative regional collaboration, county-wide community health assessments, and overall regional findings, are made widely available to the public at www.wnchealthyimpact.com.

BLUE RIDGE REGIONAL HOSPITAL, INC.:
Part v, section b, line 6b: the chna was conducted with the mitchell county health department, yancey county health department and the toe river health district.

BLUE RIDGE REGIONAL HOSPITAL, INC.:
PART V, SECTION B, LINE 7D: HTTPS://MISSIONHEALTH.ORG/ OUR-COMMITMENT-TO-YOU/ COMMUNITY-INVESTMENT/ OUR-COMMUNITYS-HEALTH-NEEDS/

BLUE RIDGE REGIONAL HOSPITAL, INC.:
Part v, section b, line 11: provided licensed clinical social work (lcsw) services to more than 400 patients and expanded to serve pediatric patients and offer telehealth services when lcsw is unavailable on-site. Partnered with carolina spine and neurosurgery to offer physiatry services twice per week, with a community-based location offering ease of access. Implemented a care process model (cpm) for chronic pain to help combat the opioid crisis, which includes screenings, patient medication contracts, and provide cross-checks with chronic abuser database. Brrh had 66% compliance in 2018. Brrh developed community education strategies using newspaper ads andother forms of social media, addressing issues like healthy living behaviors, exercise, healthy eating habits, and the importance of annual screenings. Partnered with nc state university and tractor, a local community supported agriculture (csa) program, to offer fresh produce to brrh caregivers on a weekly basis. The produce is locally grown and offered for 21 weeks each year, and caregivers can utilize payroll deduct to help access the program. This partnership will expand with plans for brrh to serve as a hub for community members to participate in the csa as well. Increased services by asheville cardiology, expanding services to mondays and wednesdays, with a physician seeing an average of 16 patients each monday. Provided off-site locations for specialty providers to increase access to services, including ophthalmology, dermatology, spine, kidney and allergy services. Provided local access to 3d mammograms for more than 2000 women, with a funding source for low income women. Provide and maintain 98% intervention rate for primary care patients with tobacco use; cessation counseling is provided during the visit when a patient identifies that they use tobacco. Partnered with mayland community college to offer clinical experiences in brrh primary care locations to medical assisting students. Provided workshops to local high school students, in partnership with mahec, focused on professional development and interviewing skills. Partnered with 16 universities, community colleges and high schools to offer more than 140 clinical experiences to students seeking clinical hours for educational purposes. Partnered with mahec to support family practice residents interested in rural practice, providing clinical experiences to physicians seeking rural, critical access experience in the primary care setting and hosting more than 22 physician residents on-site. There are no significant needs identified which are not being addressed.

BLUE RIDGE REGIONAL HOSPITAL, INC.:
Part v, section b, line 15e: the organization's staff work in collaboration with the patient and appropriate community health and human services agencies and other organizations that assist people in need of health care services to determine available funding sources.

PART V, SECTION B, LINE 10A
HTTPS://MISSIONHEALTH.ORG/WP-CONTENT/UPLOADS/2018/04/2013 -BLUE-RIDGE-REGIONAL-HOSPITAL-IMPLEMENTATION-STRATEGY.PDF PART V, SECTION B, LINE 16A HTTPS://MISSIONHEALTH.ORG/WP-CONTENT/UPLOADS /2018/05/FINASSDISCOUNT_POLICY_04.PDF

PART V, SECTION B, LINE 16B
HTTPS://MISSIONHEALTH.ORG/WP-CONTENT/UPLOADS/ 2018/05/PATIENT_FINANCIAL_ASSISTANCE_PAGE.PDF

PART V, SECTION B, LINE 16C
HTTPS://MISSIONHEALTH.ORG/WP-CONTENT/UPLOADS/ 2018/03/FINASSISTPLAIN_LANGUAGE_SUMMARY_4.PDF

PART I, LINE 7:
Blue ridge regional hospital used the ncha andi reports which are based on the irs guidelines to derive a cost-to-charge ratio used in the calculation of community benefit expense at cost.

PART II, COMMUNITY BUILDING ACTIVITIES:
Serving the community for over 55 years, blue ridge regional hospital plays a vital role in the development and support of the region it serves. Blue ridge regional hospital provides privileges and spaces for visiting specialty physicians on a regular basis. This arrangement allows community residents to receive needed specialty care needing to travel 50 or more miles one way. Employees at blue ridge regional hospital participate and are members of multiple agencies that serve the community as well as many non-profit organizations. Workforce development - as an underserved community with evident medical shortage in all areas of general and specialty health care, blue ridge strives to recruit, obtain and retain physicians and other health care providers to provide services for members of the surrounding communities.

PART III, LINE 2:
The organization uses a cost to charge ratio to estimate bad debt.

PART III, LINE 3:
The organization uses the cost to charge ratio applied to bad debts reclassified to charity care as of the most recent date available after year end.

PART III, LINE 8:
Per the instructions, the medicare cost report is the basis for calculating the costs using allowable costs related to the revenue reported.

PART VI, LINE 9B:
"Patients who qualify for financial assistance and other charity care are notified using the process described in the education of patients' eligibility in part vi, on line 3. Mission's stated policy with respect to financial assistance: ""mission hospital will make every effort to thoroughly screen all patients that are uninsured or underinsured in an effort to identify a source of financial sponsorship. Only after a final determination is made that the patient is not eligible for any source of funding to cover the medical expenses will the account be eligible for consideration of financial assistance. After the notifications and processes referenced above have been completed, standard debt collection policies are in effect for the portion of the bill for which the patient is responsible."

PART VI, LINE 2:
"The organization participates in a community health needs assessment with the most recent assessment completed in 2016. Blue ridge regional hospital serves both yancey and mitchell counties in western north carolina. Both counties are small and rural with populations of: mitchell - 15,579 and yancey - 17,818. Population growth is seen only in the over 65 age group. Both counties are predominantly white with less than 1% african american and 5% hispanic residents. Located in the northern mountains of wnc, both counties are beautiful, clean and green. Both counties are also geographically isolated with higher rates of unemployment and poverty than most nc counties. Both counties are rated at tier 1 county related to economic distress. Mitchell and yancey county residents have a higher than expected rate of chronic illnesses including heart disease and respiratory disease. Health related risk factors include higher rates of obesity or overweight residents, smoke more than most north carolinians and participate in less physician activity. The following section describes how data was obtained, compiled and analyzed in our assessment process. Wnc healthy impact is a partnership and coordinated process between hospitals and health departments in western north carolina to improve community health. As part of a larger, and continuous, community health improvement process, these partners are collaborating to conduct community health (needs) assessments across western north carolina www.wnchealthyimpact.com. Blue ridge regional hospital is also involved in this regional/local vision and collaboration. Participating counties include: buncombe, cherokee, clay, graham, haywood, henderson, jackson, macon, madison, mcdowell, mitchell, polk, rutherford, swain, transylvania and yancey. The data reviewed as part of our community's health needs assessment came from the wnc healthy impact regional core set of data. Wnc healthy impact's core regional dataset includes secondary (existing) and primary (newly collected) data compiled to reflect a comprehensive look at health. The following data set elements and collection are supported by wnc healthy impact data consulting team, a survey vendor, and partner data needs and input: -a comprehensive set of publically available secondary data metrics with our target population compared to the other wnc regions as ""peer"" -set of maps accessed from community commons and nc center for health statistics -telephone survey of a random sample of adults in the county -email key-informant survey Throughout the collaborative health needs assessment process in our community, input was obtained in a number of ways. See below for a list of the organizations that provided input into this process, the period of time they were involved, how their input was obtained, and the nature and extent of their involvement."

PART VI, LINE 4:
BLUE RIDGE REGIONAL HOSPITAL SERVES THE RURAL MOUNTAINOUS AREA OF MITCHELL, YANCEY, LOWER AVERY AND UPPER MCDOWELL COUNTIES IN WESTERN NORTH CAROLINA. THE POPULATION SERVED IS A LARGELY INDIGENT POPULATION AND AN EVER-INCREASING ELDERLY POPULATION. IN 2017 MORE THAN 77% OF THE PATIENT POPULATION WERE MEDICAID, MEDICARE OR SELF-PAY PATIENTS.

PART VI, LINE 5:
THE ORGANIZATION EARNED A 3-STAR RATING IN 2016 FOR MEDICARE HOSPITAL COMPARE FROM CENTERS FOR MEDICARE & MEDICAID SERVICES. THE ORGANIZATION EARNED THE BEST NEW MEDICAL OFFICE BUILDINGS AND OTHER OUTPATIENT FACILITIES (25,000 TO 49,999 SQUARE FEET) AWARD IN 2015 FROM HEALTHCARE REAL ESTATE INSIGHT THE ORGANIZATION EARNED A COMMUNITY VALUE FIVE-STAR AWARD IN 2014 FROM CLEVERLEY & ASSOCIATES

PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT:
NC

PART VI, LINE 3:
BLUE RIDGE REGIONAL HOSPITAL PROVIDES INFORMATION TO OUR PATIENTS REGARDING HOW TO APPLY FOR FINANCIAL ASSISTANCE/CHARITY CARE IN THE FOLLOWING WAYS: A PLAIN LANGUAGE DESCRIPTION OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE, ATTACHED TO BILLING INVOICES, POSTED IN THE EMERGENCY ROOMS OR WAITING ROOMS AND IN THE ADMISSIONS OFFICES. IT IS ALSO PROVIDED IN WRITING TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY, AND UPON REQUEST. THE ORGANIZATION'S INTERNET WEBSITE AND BROCHURES CONTAIN INFORMATION ABOUT FINANCIAL ASSISTANCE THAT OFFER HELP IN OBTAINING FINANCIAL ASSISTANCE, OPTIONS FOR INSURANCE PROCESSING AND PAYMENT FOR SERVICES. IN ADDITION, ASSISTANCE IS OFFERED TO HELP IN DETERMINING IF A PATIENT QUALIFIES FOR STATE AGENCY PROGRAMS AND MEDICAID BENEFITS AS WELL AS ASSISTANCE WITH THE APPLICATION PROCESS. THE WEBSITE AND BROCHURES EXPLAIN THAT THE HOSPITAL OFFERS DISCOUNTS BASED ON CERTAIN CRITERIA AND NOTES THE RANGE OF DISCOUNTS AND HOW HOUSEHOLD INCOME GUIDELINES ARE USED TO DETERMINE DISCOUNT ELIGIBILITY. THE PATIENT IS DIRECTED TO CALL THE CUSTOMER SERVICE CENTER OR VISIT THE HOSPITAL'S BUSINESS OFFICE AND LISTS THE HOURS THE OFFICE AND CENTER ARE OPEN. THERE ARE ALSO MESSAGES ON PATIENT BILLS GIVING INFORMATION ON FINANCIAL ASSISTANCE AND HOW TO CONTACT THE HOSPITAL IF THEY HAVE QUESTIONS OR WANT TO APPLY.

PART VI, LINE 6:
ANC HEALTHCARE, INC. (FKA MISSION HEALTH SYSTEM) IS THE PARENT ORGANIZATION FOR THE CHARITABLE ORGANIZATIONS OF MISSION HOSPITAL, INC.; MISSION HEALTH SYSTEM FOUNDATION, INC.; ANC MISSION MEDICAL ASSOCIATES, INC; ANC BLUE RIDGE HOSPITAL, INC.; ANC MCDOWELL HOSPITAL, INC.; ANC ANGEL MEDICAL CENTER,INC.; ANC TRANSYLVANIA COMMUNITY HOSPITAL, INC.; ANC HIGHLANDS-CASHIERS HOSPITAL, INC. AND MOUNTAIN CARE, INC. (FKA COMMUNITY CAREPARTNERS, INC.) THE SYSTEM'S MISSION IS TO OPERATE AN INTEGRATED HEALTH CARE SYSTEM FOR THE BENEFIT OF THE RESIDENTS OF WESTERN NORTH CAROLINA. MISSION HOSPITAL, INC. IS A REGIONAL INTEGRATED HEALTH FACILITY PROVIDING SUPERIOR CARE AND SERVICE TO PATIENTS AND THEIR FAMILIES THROUGH A FULL CONTINUUM OF INTEGRATED SERVICES, EDUCATION, AND RESEARCH. IT SERVES AS A TRAUMA CENTER TO PEOPLE OF WESTERN NORTH CAROLINA AND THE SURROUNDING COUNTIES. ANC MISSION MEDICAL ASSOCIATES' MISSION IS TO PROVIDE PHYSICIAN SERVICES IN PREDOMINANTLY RURAL AREAS THAT ARE INSUFFICIENTLY SERVED, THEREBY IMPROVING THE HEALTH CARE OF THE GENERAL PUBLIC. IN MANY CASES THIS INVOLVES RECRUITING AND PLACING PRIMARY CARE PHYSICIANS, AS WELL AS PEDIATRIC AND ADULT SPECIALTY SERVICES CLOSE TO WHERE PEOPLE LIVE AND WORK. ANC BLUE RIDGE HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MITCHELL, YANCEY AND SURROUNDING COUNTIES. ANC MCDOWELL HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MCDOWELL AND THE SURROUNDING COUNTIES. MISSION HEALTH SYSTEM FOUNDATION, INC. SUPPORTS THE MISSION AND PROGRAMS OF MISSION HOSPITAL, INC. AND ANC HEALTHCARE, INC. (MISSION HEALTH SYSTEM, INC.) AND OTHER ORGANIZATIONS THAT ARE TAX EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND WORKS TO BENEFIT THE COMMUNITY AND REGION SERVED BY THE ENTITIES LISTED ABOVE. ANC ANGEL MEDICAL CENTER, INC. SERVES AS A COMMUNITY HOSPITAL IN MACON AND SURROUNDING COUNTIES. ANC TRANSYLVANIA COMMUNITY HOSPITAL, INC. SERVES AS A COMMUNITY HOSPITAL IN TRANSYLVANIA AND SURROUNDING COUNTIES. ANC HIGHLANDS-CASHIERS HOSPITAL, INC. SERVES AS A COMMUNITY HOSPITAL FOR JACKSON AND MACON AND SURROUNDING COUNTIES. MOUNTAINCARE, INC. OPERATES AN INPATIENT FACILITY FOR ACUTE REHABILITATION LOCATED IN ASHEVILLE, NORTH CAROLINA, AND PROVIDES A WIDE VARIETY OF POST-ACUTE CARE SERVICES TO RESIDENTS OF WESTERN NORTH CAROLINA, INCLUDING REHABILITATION, HOME HEALTH, ADULT CARE, AND HOSPICE AND PALLIATIVE CARE. MSJHS AND CCP JOINT DEVELOPMENT COMPANY DBA ASHEVILLE SPECIALTY HOSPITAL OPERATES AN INPATIENT FACILITY FOR LONG-TERM ACUTE CARE.