4A (Expenses $ 205667206 including grants of $ 6000) (Revenue $ 196704783)
OPERATION OF A 331-BED ACUTE CARE HOSPITAL LOCATED IN RIVERDALE, GEORGIA THROUGH PRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLC, A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES.

4B (Expenses $ 145631767 including grants of $ 0) (Revenue $ 165405716)
OPERATION OF A 214-BED ACUTE CARE HOSPITAL LOCATED IN WOONSOCKET, RHODE ISLAND THROUGH PRIME HEALTHCARE FOUNDATION - LANDMARK, LLC, A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES.

4C (Expenses $ 100212516 including grants of $ 0) (Revenue $ 108893432)
OPERATION OF A 153-BED ACUTE CARE HOSPITAL LOCATED IN SHERMAN OAKS, CALIFORNIA THROUGH PRIME HEALTHCARE FOUNDATION - SHERMAN OAKS, LLC, A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES.

4D (Expenses $ 37874 including grants of $ 0) (Revenue $ 0)
PRIME HEALTHCARE FOUNDATION - REAL ESTATE, LLC

SOUTHERN REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: A COMPREHENSIVE CHNA PROCESS PERFORMED BY SOUTHERN REGIONAL MEDICAL CENTER INCLUDED COLLECTION OF PRIMARY AND SECONDARY DATA. TO PREPARE, A HOSPITAL STEERING COMMITTEE COMPRISED OF SENIOR LEADERSHIP IDENTIFIED CRITERIA TO BE USED AS A GUIDE IN THE DEVELOPMENT AND IMPLEMENTATION OF NEEDS IDENTIFIED IN THE CHNA PROCESS.THE COMMITTEE'S SELECTION OF THE APPROPRIATE GEOGRAPHIC SERVICE AREA WAS BASED ON THE HOSPITAL'S PRIMARY SERVICE AREA (PSA) REPRESENTING ZIP CODES THAT ACCOUNTED FOR 75% OF ANNUAL DISCHARGES FROM THE FACILITY. THE PRIMARY SERVICE AREA INCLUDES SMALL PORTIONS OF LARGE SURROUNDING METROPOLITAN COUNTIES. AFTER TAKING THE BROAD INTERESTS OF THE COMMUNITY SERVED, INCLUDING MEDICALLY UNDERSERVED POPULATIONS, LOW-INCOME PERSONS, MINORITY GROUPS, INDIVIDUALS WITH CHRONIC DISEASE NEEDS, AND THE PHYSICAL LOCATION OF THE HOSPITAL IN RELATION TO THOSE IN NEED WERE TAKEN INTO CONSIDERATION, CLAYTON COUNTY WAS SELECTED AS THE COMMUNITY FOR INCLUSION IN THIS REPORT.THE CHNA COMMITTEE OF COMMUNITY LEADERS AND ORGANIZATIONS WAS IDENTIFIED AND CONVENED TO ENGAGED IN DISCUSSIONS TO PROVIDE THEIR INSIGHT ON COMMUNITY NEEDS FROM THEIR PERSPECTIVE. THESE COMMUNITY STAKEHOLDERS ARE INDIVIDUALS WHO REPRESENT KEY INTERESTS, SUCH AS INVESTED IN OR INTERESTED IN THE WORK OF THE HOSPITAL; SPECIAL KNOWLEDGE OF HEALTH ISSUES; IMPORTANCE TO THE SUCCESS OF THE HOSPITAL CHNA PROJECT; AND FORMAL OR INFORMAL LEADERS OF THE COMMUNITY. THESE LEADERS, PARTNERS, AND REPRESENTATIVES WHO PARTICIPATED IN THE CHNA PROCESS WERE ASKED TO: REVIEW AND ASSESS THE NEEDS OF THE COMMUNITY; REVIEW AVAILABLE AND INADEQUATE COMMUNITY RESOURCES; AND PRIORITIZE THE HEALTH NEEDS OF THE COMMUNITY.A KEY COMPONENT IN THE COMMUNITY HEALTH NEEDS ASSESSMENT IS A SURVEY OF COMMUNITY STAKEHOLDERS COMPLETED USING THE FOCUS GROUP METHOD. THESE STAKEHOLDERS INCLUDED A MIX OF INTERNAL AND EXTERNAL REPRESENTATIVES TO SOUTHERN REGIONAL MEDICAL CENTER: PASTORS, PUBLIC HEALTH OFFICIALS, HEALTH CARE PROVIDERS, SOCIAL SERVICE AGENCY REPRESENTATIVES, GOVERNMENT LEADERS, AND BOARD MEMBERS. DUE TO THEIR PROFESSION, TENURE, AND/OR COMMUNITY INVOLVEMENT, COMMUNITY STAKEHOLDERS OFFER DIVERSE PERSPECTIVES AND INFORMATION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT. THEY ARE INDIVIDUALS AT THE FRONT LINE IN THE COMMUNITY THAT CAN BEST IDENTIFY UN-MET SOCIAL AND HEALTH NEEDS OF THE COMMUNITY.

SHERMAN OAKS HOSPITAL
PART V, SECTION B, LINE 5: A TOTAL OF 8 KEY INFORMANT INTERVIEWS WERE CONDUCTED FOR SHERMAN OAKS HOSPITAL (SOH) SERVICE AREA. EACH INTERVIEW LASTED BETWEEN 30 TO 45 MINUTES. THE KEY INFORMANTS INCLUDED INDIVIDUALS FROM THE LOS ANGELES COUNTY DEPARTMENTS OF HEALTH, MENTAL HEALTH, AND PUBLIC HEALTH, AS WELL AS PUBLIC HEALTH EXPERTS FROM ACADEMIA, LOCAL HOSPITALS, AND CLINICS. UTILIZING A FOCUS GROUP FACILITATION GUIDE, TWO-HOUR FOCUS GROUPS WERE CONDUCTED WITH 34 COMMUNITY MEMBERS, LEADERS, AND SERVICE PROVIDERS. THE COMMUNITY STAKEHOLDERS THAT PARTICIPATED IN THE CHNA REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY AND INCLUDED PUBLIC HEALTH EXPERTS AND OTHER INDIVIDUALS KNOWLEDGEABLE ABOUT THE HEALTH NEEDS FOUND IN THE COMMUNITY. A TOTAL OF 203 WRITTEN SURVEYS WERE ADMINISTERED TO PARTICIPANTS BY KEYGROUP AND SOH STAFF. MOST OF THE SURVEYS WERE SOLICITED FROM SHOPPERS IN THE BUSINESS DISTRICTS SURROUNDING SOH, WITH OTHERS COMING FROM ATTENDEES AT SOH'S FARMERS MARKET, AND ADDITIONAL SURVEYS SOLICITED FROM MEETINGS OF CIVIC GROUPS, CHURCHES, AND OTHER COMMUNITY ORGANIZATIONS. SECONDARY DATA WAS RETRIEVED THROUGH A REVIEW OF PUBLICLY-COLLECTED DEMOGRAPHIC AND HEALTH STATISTICS. EXCEPT ON RARE OCCASIONS, DATA WAS RETRIEVED VIA ELECTRONIC DATA SEARCHES. DEMOGRAPHIC DATA SUCH AS AGE, ETHNICITY, INCOME, INSURANCE, DISEASE PREVALENCE, AND FIVE-YEAR PROJECTED ESTIMATE INFORMATION WAS EXTRACTED FROM THE CENSUS BUREAU INFORMATION FOUND IN THE AMERICAN COMMUNITY SURVEY SECTION OF THE CENSUS WEBSITE. SOME PORTIONS WERE QUOTED FROM VARIOUS DOCUMENTS THAT ANALYZED CENSUS DATA AND ARE CITED AS USED. ADDITIONAL DATA ON EDUCATION ATTAINMENT, REGION OF BIRTH, GRANDPARENTS CARING FOR THEIR GRANDCHILDREN, AND ENGLISH PROFICIENCY WAS GATHERED FROM THE U.S. BUREAU OF CENSUS (AMERICAN FACTFINDER). IN ADDITION, THE DIGNITY HEALTH (DH) COMMUNITY NEED INDEX (CNI) TOOL WAS REVIEWED TO ASSIST WITH THE IDENTIFICATION OF HIGH-NEED AREAS. INFORMATION FOR THIS REPORT CONSISTED OF BOTH SECONDARY AND PRIMARY DATA, AND THEREFORE, THE COLLECTION OF DATA CAME FROM MULTIPLE SOURCES. DATA GATHERED WAS ANALYZED USING METHODS SUCH AS GROUPING AND STATISTICAL ANALYSIS. DATA WAS GROUPED ACCORDING TO HEALTH CONDITIONS, CO-MORBIDITIES, AGE, GENDER, AND ETHNICITY, IN ADDITION TO OTHER SPECIFIC NEEDS FOR THE CHNA REPORT. THE ZIP CODE LEVEL DATA COLLECTED WAS USED TO COMPARE VARIOUS COMMUNITIES IN THE SHERMAN OAKS HOSPITAL SERVICE AREA. THIS COMPARATIVE DATA WAS ANALYZED TO DETERMINE AREAS OF DISPARITY IN THE SOH PSA COMPARED TO THE LARGER AREAS USED FOR COMPARISON. WHERE SIGNIFICANT DEVIATIONS FROM THE LARGE AREA NORMS WERE FOUND, THEY ARE PRESENTED TO SHOW THE IMPORTANT DISPARITIES BETWEEN COMMUNITIES. WHERE THE SOH PSA IS SIMILAR TO THE LARGER AREAS, THE LARGE AREA DATA IS PRESENTED AS REPRESENTATIVE OF THE SOH PSA. IT SHOULD BE NOTED THAT MANY HEALTH CONDITIONS WERE NOT COVERED BY THE VARIOUS SOURCES, SO DIRECT COMPARISON WAS NOT ALWAYS POSSIBLE.

MONTCLAIR HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) USES SYSTEMATIC, COMPREHENSIVE DATA COLLECTION AND ANALYSIS TO DEFINE PRIORITIES FOR HEALTH IMPROVEMENT, CREATES A COLLABORATIVE COMMUNITY ENVIRONMENT TO ENGAGE STAKEHOLDERS, AND AN OPEN AND TRANSPARENT PROCESS TO LISTEN AND TRULY UNDERSTAND THE HEALTH NEEDS OF SAN BERNARDINO COUNTY, CALIFORNIA. THE SECONDARY ANALYSIS WAS PERFORMED ON ALL OF SAN BERNARDINO COUNTY WITH A FOCUS ON THE SOUTHWESTERN CORNER WHERE MOST OF THE POPULATION AND PATIENT ORIGIN RESIDE. IN MAY 2019, MONTCLAIR HOSPITAL MEDICAL CENTER BEGAN A COMMUNITY HEALTH NEEDS ASSESSMENT FOR SAN BERNARDINO COUNTY, AND SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY USING SEVERAL METHODS:- INFORMATION GATHERING, USING SECONDARY PUBLIC HEALTH SOURCES, OCCURRED IN JUNE 2019.- 27 COMMUNITY MEMBERS AND NOT-FOR-PROFIT ORGANIZATIONS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, THE ELDERLY, HEALTH PROVIDERS, AND THE HEALTH DEPARTMENT PARTICIPATED IN TWO FOCUS GROUPS AND ONE INDIVIDUAL INTERVIEW FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES ON JULY 17, 2019.- A COMMUNITY HEALTH SUMMIT WAS CONDUCTED ON JULY 18, 2019, WITH 30 COMMUNITY STAKEHOLDERS. THE AUDIENCE CONSISTED OF HEALTHCARE PROVIDERS, BUSINESS LEADERS, GOVERNMENT REPRESENTATIVES, SCHOOLS, NOT-FOR-PROFIT ORGANIZATIONS, EMPLOYERS, AND OTHER COMMUNITY MEMBERS.

HUNTINGTON BEACH HOSPITAL
PART V, SECTION B, LINE 5: THE HOSPITAL CONCENTRATED ITS EFFORT ON GATHERING QUALITATIVE PRIMARY DATA THROUGH A SERIES OF CONTACTS WITH KEY STAKEHOLDERS THAT REPRESENT THE COMMUNITY THEY ARE A PART OF, INCLUDING GOVERNMENT REPRESENTATIVES, PUBLIC HEALTH REPRESENTATIVES, HEALTHCARE PROVIDERS, COMMUNITY SERVICE PROVIDERS, AND MINORITY GROUP LEADERS. AS WELL, SECONDARY PUBLIC HEALTH SOURCES WERE UTILIZED TO GATHER DATA ON ORANGE COUNTRY, CALIFORNIA, AND THE UNITED STATES AS A WHOLE. PUBLIC HEALTH DATA INCLUDED DEATH STATISTICS, COUNTY HEALTH RANKINGS, AND CANCER INCIDENCE. IN ADDITION, DEMOGRAPHICS AND SOCIOECONOMICS (POPULATION, POVERTY, UNINSURED, UNEMPLOYMENT), ALONG WITH PSYCHOGRAPHICS (BEHAVIOR MEASURED BY SPENDING AND MEDIA PREFERENCES) WERE ALSO UTILIZED IN THIS PROCESS.COMMUNITY MEMBERS PARTICIPATED IN FOCUS GROUPS AND INDIVIDUAL REVIEWS FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES. FURTHERMORE, THERE WAS A COMMUNITY HEALTH SUMMIT CONDUCTED ON WITH COMMUNITY STAKEHOLDERS WHICH INCLUDED HEALTHCARE PROVIDERS, BUSINESS LEADERS, GOVERNMENT REPRESENTATIVES, SCHOOLS, NOT-FOR-PROFIT ORGANIZATIONS, EMPLOYERS, AND OTHER COMMUNITY MEMBERS.THE KEY FINDINGS FROM THE CHNA SHOWED THERE ARE 5 SIGNIFICANT HEALTH NEEDS TO BE THE FOCUS OF THE WORK OF THE COMMUNITY OVER THE NEXT 3 YEARS WHICH ARE: SUBSTANCE MISUSE, HOUSING (ACCORDABLE) AND ACCESS TO HEALTH FOR UNHOUSED POPULATION, MENTAL HEALTH, DIABETES, AND EDUCATION (AS A MEANS OF ESCAPING POVERTY AND IMPROVE HEALTH).

LA PALMA INTERCOMMUNITY HOSPITAL
PART V, SECTION B, LINE 5: THE HOSPITAL CONCENTRATED ITS EFFORT ON GATHERING QUALITATIVE PRIMARY DATA THROUGH A SERIES OF CONTACTS WITH KEY STAKEHOLDERS THAT REPRESENT THE COMMUNITY THEY ARE A PART OF, INCLUDING GOVERNMENT REPRESENTATIVES, PUBLIC HEALTH REPRESENTATIVES, HEALTHCARE PROVIDERS, COMMUNITY SERVICE PROVIDERS, AND MINORITY GROUP LEADERS. AS WELL, SECONDARY PUBLIC HEALTH SOURCES WERE UTILIZED TO GATHER DATA ON ORANGE COUNTRY, CALIFORNIA, AND THE UNITED STATES AS A WHOLE. PUBLIC HEALTH DATA INCLUDED DEATH STATISTICS, COUNTY HEALTH RANKINGS, AND CANCER INCIDENCE. IN ADDITION, DEMOGRAPHICS AND SOCIOECONOMICS (POPULATION, POVERTY, UNINSURED, UNEMPLOYMENT), ALONG WITH PSYCHOGRAPHICS (BEHAVIOR MEASURED BY SPENDING AND MEDIA PREFERENCES) WERE ALSO UTILIZED IN THIS PROCESS.COMMUNITY MEMBERS PARTICIPATED IN FOCUS GROUPS AND INDIVIDUAL REVIEWS FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES. FURTHERMORE, THERE WAS A COMMUNITY HEALTH SUMMIT CONDUCTED ON WITH COMMUNITY STAKEHOLDERS WHICH INCLUDED HEALTHCARE PROVIDERS, BUSINESS LEADERS, GOVERNMENT REPRESENTATIVES, SCHOOLS, NOT-FOR-PROFIT ORGANIZATIONS, EMPLOYERS, AND OTHER COMMUNITY MEMBERS.THE KEY FINDINGS FROM THE CHNA SHOWED THERE ARE 5 SIGNIFICANT HEALTH NEEDS TO BE THE FOCUS OF THE WORK OF THE COMMUNITY OVER THE NEXT 3 YEARS WHICH ARE: SUBSTANCE MISUSE, HOUSING (ACCORDABLE) AND ACCESS TO HEALTH FOR UNHOUSED POPULATION, MENTAL HEALTH, DIABETES, AND EDUCATION (AS A MEANS OF ESCAPING POVERTY AND IMPROVE HEALTH).

ENCINO HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 5: KEY INFORMANT INTERVIEWS WERE CONDUCTED FOR ENCINO HOSPITAL MEDICAL CENTER SERVICE AREA. EACH INTERVIEW LASTED BETWEEN 15 TO 45 MINUTES. THE KEY INFORMANTS INCLUDED INDIVIDUALS FROM THE LOS ANGELES COUNTY DEPARTMENTS OF HEALTH, MENTAL HEALTH, AND PUBLIC HEALTH, AS WELL AS PUBLIC HEALTH EXPERTS FROM ACADEMIA, LOCAL HOSPITALS, AND CLINICS.UTILIZING A FOCUS GROUP FACILITATION GUIDE, A TWO-HOUR FOCUS GROUP WAS CONDUCTED WITH 34 COMMUNITY MEMBERS, LEADERS, AND SERVICE PROVIDERS. THE COMMUNITY STAKEHOLDERS THAT PARTICIPATED IN THE CHNA REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY, AND INCLUDED PUBLIC HEALTH EXPERTS AND OTHER INDIVIDUALS KNOWLEDGEABLE ABOUT THE HEALTH NEEDS FOUND IN THE COMMUNITY.A TOTAL OF 67 WRITTEN SURVEYS WERE ADMINISTERED TO PARTICIPANTS BY KEYGROUP AND EHMC STAFF. MOST OF THE SURVEYS WERE SOLICITED FROM SHOPPERS IN THE BUSINESS DISTRICTS SURROUNDING EHMC, WITH OTHERS COMING FROM ATTENDEES AT EHMC'S FARMERS MARKET, AND ADDITIONAL SURVEYS SOLICITED FROM MEETINGS OF CIVIC GROUPS, CHURCHES AND OTHER COMMUNITY ORGANIZATIONS.

COSHOCTON REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: COSHOCTON REGIONAL MEDICAL CENTER CONDUCTED TWO FOCUS GROUPS AND FOUR INDIVIDUAL INTERVIEWS WITH PARTICPATION FROM 20 COMMUNITY MEMBERS, NOT-FOR-PROFIT ORGANIZATIONS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, THE ELDERLY, HEALTH PROVIDERS, AND THE HEALTH DEPARTMENT FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES ON JUNE 26TH, 2019.AT A MEETING ON AUGUST 8, 2019, COSHOCTON COUNTY HEALTH DEPARTMENT AND THE CITY OF COSHOCTON HEALTH DEPARTMENT, ALONG WITH COSHOCTON REGIONAL MEDICAL CENTER REVIEWED THE RESULTS OF THE CHNA SECONDARY DATA, PRIMARY DATE FROM INTERVIEWS, FOCUS GROUPS AND PRIORITIZED THE MOST SIGNIFICANT COMMUNITY HEALTH NEEDS.

SUBURBAN COMMUNITY HOSPITAL
PART V, SECTION B, LINE 5: IN MAY 2020, SUBURBAN COMMUNITY HOSPITAL BEGAN A COMMUNITY HEALTH NEEDS ASSESSMENT FOR MONTGOMERY COUNTY AND SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. INDIVIDUALS FROM COMMUNITY AND HEALTHCARE ORGANIZATIONS COLLABORATED TO IMPLEMENT A COMPREHENSIVE CHNA PROCESS FOCUSED ON IDENTIFYING AND DEFINING SIGNIFICANT HEALTH NEEDS, ISSUES, AND CONCERNS OF MONTGOMERY COUNTY. THE SEVERAL-MONTH PROCESS CENTERED ON GATHERING AND ANALYZING DATA AS WELL AS RECEIVING INPUT FROM COMMUNITY STAKEHOLDERS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY AS WELL AS REPRESENTING LOW INCOME, MEDICALLY UNDERSERVED AND MINORITY POPULATIONS TO PROVIDE DIRECTION FOR THE COMMUNITY AND HOSPITAL TO CREATE A PLAN TO IMPROVE THE HEALTH OF THE COMMUNITIES. METHODS USED FOR THE CHNA:-INFORMATION GATHERING, USING SECONDARY PUBLIC HEALTH SOURCES, OCCURRED IN MAY AND JUNE 2020.-COMMUNITY MEMBERS PARTICIPATED IN INDIVIDUAL INTERVIEWS FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES ON JUNE 18-19, 2020. -A COMMUNITY HEALTH SUMMIT WAS CONDUCTED ON SEPTEMBER 24, 2020 WITH COMMUNITY STAKEHOLDERS. THE AUDIENCE CONSISTED OF HEALTHCARE PROVIDERS, RELIGIOUS ORGANIZATIONS, BUSINESS LEADERS, GOVERNMENT REPRESENTATIVES, SCHOOLS, NOT-FOR-PROFIT ORGANIZATIONS, EMPLOYERS, AND OTHER COMMUNITY MEMBERS.BOTH PRIMARY AND SECONDARY AND QUANTITATIVE AND QUALITATIVE DATA WERE OBTAINED AND ANALYZED FOR CHNA.-PRIMARY METHODS INCLUDED: -INDIVIDUAL INTERVIEWS WITH COMMUNITY MEMBERS -COMMUNITY HEALTH SUMMIT-SECONDARY METHODS INCLUDED: -PUBLIC HEALTH DATA DEATH STATISTICS, COUNTY HEALTH RANKINGS, CANCER INCIDENCE -DEMOGRAPHICS AND SOCIOECONOMICS POPULATION, POVERTY, UNINSURED, UNEMPLOYMENT -PSYCHOGRAPHICS BEHAVIOR MEASURED

PAMPA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: DATA FOR THIS CHNA WAS COLLECTED FROM PRIMARY AND SECONDARY SOURCES TO IDENTIFY KEY FINDINGS AND GAPS THAT MAY EXIST BETWEEN HEALTH NEEDS AND SERVICES PROVIDED WITHIN THE COMMUNITY. THREE METHODS OF COLLECTION FOR PRIMARY DATA WERE USED: 1) SURVEYS 2) FOCUS GROUPS AND 3) PERSONAL INTERVIEWS. SEVERAL SECONDARY DATA SOURCES WERE REVIEWED AND ANALYZED TO IDENTIFY KEY FINDINGS WITH STRATEGIC IMPLICATIONS AND FOR BENCHMARKING OF THE HOSPITAL'S SERVICE AREA.

MONTCLAIR HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 6A: PARTICIPANTS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE: LOMA LINDA UNIVERSITY BEHAVIORAL MEDICINE CENTER, LOMA LINDA UNIVERSITY MEDICAL CENTER, LOMA LINDA UNIVERSITY MEDICAL CENTER - MURRIETA, LOMA LINDA UNIVERSITY MEDICAL CENTER CHILDREN'S HOSPITAL, PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER, REDLANDS COMMUNITY HOSPITAL, RIDGECREST REGIONAL HOSPITAL, SAN ANTONIO REGIONAL HOSPITAL, SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL, AND SAN GORGONIO MEMORIAL HOSPITAL.

SOUTHERN REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 11: INFORMATION GATHERED FROM THE COMMUNITY STAKEHOLDER DISCUSSIONS, HOSPITAL LEADERSHIP TEAM DISCUSSIONS, AND THE COMPILATION AND REVIEW OF DEMOGRAPHIC AND HEALTH STATUS, AND HOSPITAL UTILIZATION DATA WAS USED TO DETERMINE THE PRIORITY HEALTH NEEDS OF THE POPULATION. A WRITTEN REPORT OF THE OBSERVATIONS, COMMENTS, AND PRIORITIES WAS DEVELOPED. THE COMMITTEE REVIEWED THIS INFORMATION WHICH FOCUSED ON THE IDENTIFIED NEEDS, PRIORITIES, AND COMMUNITY RESOURCES CURRENTLY AVAILABLE. THE COMMITTEE DEBATED THE MERITS OR VALUES OF PRIORITIES, CONSIDERING THE RESOURCES AVAILABLE TO MEET THESE NEEDS. FROM THIS INFORMATION AND DISCUSSION, THE HOSPITAL DEVELOPED THREE PRIORITY NEEDS OF THE COMMUNITY.1. MAINTAIN AND IMPROVE ACCESS TO CARE FOR THE COMMUNITY THAT IS AN UNDERSERVED AREA BY: REDUCING THE SHORTAGE OF HEALTHCARE PROVIDERS WITHIN PRIMARY SERVICE AREA, INCREASING ACCESS TO SERVICES AND HEALTHCARE PROVIDERS, AND DEVELOPING COMMUNITY PARTNERSHIPS TO REDUCE BARRIERS TO APPROPRIATE CARE. 2. INCREASE ACCESS AND PARTICIPATION IN PREVENTIVE SERVICES AND EDUCATION TO TARGETED RESIDENTS IN THIS UNDERSERVED AREA BY: MAINTAINING CHEST PAIN CENTER AND PRIMARY STROKE CENTER ACCREDITATIONS, OFFERING APPROPRIATE EDUCATIONAL PROGRAMMING AND SERVICES, AND ENSURING ACCESS TO TESTING TO PREVENTATIVE SERVICES THROUGH SPECIAL PROGRAMS.3. CONTINUE DRIVE TO INCREASE MENTAL HEALTH SERVICES BY THE COUNTY THROUGH: CLAYTON COUNTY CRISIS STABILIZATION UNIT (CSU) AND COORDINATE ED MENTAL HEALTH CARE. OTHER HEALTH AND SOCIO-ECONOMIC BARRIERS WERE IDENTIFIED BUT NOT ADDRESSED AT THIS TIME. EACH OF THE HEALTH NEEDS ARE IMPORTANT AND IS BEING ADDRESSED BY NUMEROUS PROGRAMS AND INITIATIVES OPERATED BY THE HOSPITAL, OTHER ORGANIZATIONS AND OTHER COMMUNITY PARTNERS OF THE HOSPITAL. HOWEVER, THE HOSPITAL WILL NOT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA DUE TO LIMITED RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO THE PRIORITY HEALTH NEEDS IDENTIFIED ABOVE.OTHER HEALTH AND SOCIO-ECONOMIC BARRIERS NEEDS INCLUDED THE FOLLOWING:- OBESITY AND HEALTHY WEIGHT- DIABETES- WOMEN'S HEALTH SERVICES, INCLUDING BREAST CANCER AND EARLY DETECTION

SHERMAN OAKS HOSPITAL
PART V, SECTION B, LINE 11: SHERMAN OAKS HOSPITAL (SOH) FOCUS GROUPS STARTED WITH OVER 37 ISSUES AND KEYGROUP AND THE VCCC GROUPS LISTED 35, BUT IN BOTH CASES, THE GROUPS NARROWED THE RANGE SIGNIFICANTLY, ARRIVING AT A TOP SIX. THE FIRST TWO ARE CLOSELY RELATED. THEY ARE LISTED BELOW WITH THE HOSPITAL PLAN REGARDING EACH ITEM:1. COORDINATION OF CARE - THE HOSPITAL PLANS TO WORK WITH STEPDOWN PROVIDERS, INCLUDING NURSING AND REHABILITATION HOSPITALS, AS WELL AS HOME HEALTH AGENCIES AND SOCIAL SERVICE AGENCIES, TO DEVELOP PROTOCOLS TO SHARE INFORMATION BACK AND FORTH ABOUT CLIENTS TRANSFERRED FROM ONE SITE TO ANOTHER, WITH PROVISIONS TO ASSIST OTHER PROVIDERS IN MAINTAINING HEALTH STATUS OF TRANSFERRED CLIENTS AS THEY CONTINUE THEIR RECOVERY. ADDITIONAL RESEARCH WILL BE DONE TO CREATE METHODOLOGIES FOR IDENTIFYING HIGH-UTILIZATION CLIENTS AND COORDINATING WITH SOCIAL SERVICE PROVIDERS TO ASSIST IN SUPPORTING THESE CLIENTS IN THEIR HOMES SO THEY DON'T BECOME ADMISSIONS TO THE HOSPITAL.2. TRANSITIONS OF CARE - THE HOSPITAL'S PLAN INCLUDES PROVISIONS TO IMPROVE COMMUNICATIONS BETWEEN THE HOSPITAL AND STEP-DOWN PROVIDERS BOTH BEFORE AND AFTER TRANSITIONS, TO CLARIFY CLIENT NEEDS AND NECESSARY TREATMENT PROTOCOLS UPON TRANSFER, AND FOLLOW-UP COMMUNICATION WITHIN TWO DAYS TO REVIEW CLIENT STATUS AND ADDRESS ANY ISSUES THAT MAY HAVE ARISEN FOLLOWING THE TRANSFER. AS PAYMENT PROGRAMS DEVELOP TO FACILITATE SUCH SERVICES, THE HOSPITAL WILL WORK WITH PROVIDERS TO MAINTAIN AN EQUITABLE REIMBURSEMENT ENVIRONMENT FOR ALL INVOLVED PARTIES.3. PAYMENT ISSUES - THE HOSPITAL PLANS TO INCLUDE PROVISIONS TO CONTINUE ASSURING THAT CLIENTS WHO CAN GET INSURANCE COVERAGE ARE DIRECTED TO THE APPROPRIATE SOURCES. IN ADDITION, SOH WILL CONTINUE TO REVIEW PLANNED AND NEWLY PASSED LEGISLATION TO ENSURE CONTINUING AFFORDABILITY AMONG CLIENTS.4. MENTAL HEALTH - AS A PRIMARY CARE PROVIDER OF MENTAL HEALTH SERVICES, PARTICULARLY IN GERIATRIC SERVICES, THE HOSPITAL IS DEDICATED TO CONTINUING ITS EXISTING SERVICES. AS MORE FOCUS IS DIRECTED TO MENTAL HEALTH ISSUES ASSOCIATED WITH ACUTE ADMISSIONS TO HOSPITALS, THE HOSPITAL IS EXPANDING ITS COORDINATION PRACTICES WITH COMMUNITY PROVIDERS TO IDENTIFY HIGH-INTENSITY USERS OF HOSPITALS SERVICES WITH ACCOMPANYING MENTAL HEALTH ISSUES THAT CAN BE ADDRESSED IN ALTERNATIVE SETTINGS. WITH BETTER COORDINATION, THESE CLIENTS CAN BE DIRECTED TO MORE APPROPRIATE CARE SITES. SOH WILL ALSO RESEARCH OPTIONS TO COORDINATE COMMUNITY CARE SOLUTIONS WITH THE HOSPITAL'S INPATIENT SERVICES AS CRISES ARISE IN THOSE COMMUNITY LOCATIONS.5. DIABETES - THE HOSPITAL'S PLAN IS PRIMARILY FOCUSED ON EDUCATION SINCE CARE FOR ACUTE DIABETES ISSUES IS EXPENSIVE AND OFTEN DELIVERED AFTER THE MOST EFFECTIVE TREATMENTS ARE AVAILABLE. SOH WILL CONTINUE TO PARTICIPATE IN HEALTH FAIRS, AND COORDINATE WITH SCHOOLS AND COMMUNITY GROUPS TO EDUCATE AREA RESIDENTS ON THE RISKS THAT LEAD TO DIABETES.6. HEART DISEASE - THE HOSPITAL'S PLAN INCLUDES EDUCATION REGARDING STROKE AND CARDIAC RISKS, ALONG WITH MAINTAINING STATE-OF-THE-ART SERVICES FOR CARDIAC EMERGENCIES SEEN AT THE HOSPITAL.7. LACK OF KNOWLEDGE ABOUT HEALTH SERVICES - THE HOSPITAL PLANS TO FOCUS ON EDUCATIONAL PROGRAMS THAT TARGET AREA RESIDENTS WHO ARE NOT CURRENT CLIENTS OF THE HOSPITAL, DELIVERED AT HEALTH FAIRS, SCHOOLS, RETIREMENT COMMUNITIES, AND OTHER LOCATIONS WHERE PEOPLE ARE INTERESTED IN LEARNING ABOUT HEALTH OPTIONS. ADDITIONALLY, THE HOSPITAL STAFF MAINTAINS A DATABASE OF INSURANCE OPTIONS THAT CAN BE USED TO BRING UNINSURED CLIENTSINTO THE INSURED RANKS, AND WORKS WITH ELIGIBLE CLIENTS TO GET THEM COVERED. THIS IS AN ONGOING PROCESS AS INSURANCE PROGRAMS CHANGE OFTEN, AND MANY MORE CHANGES ARE POSSIBLE OVER THE NEXT FEW YEARS. THE PREVIOUS SEVEN ISSUES WERE RAISED BY THE HOSPITAL'S FOCUS GROUPS AND LISTED AS THE PRIMARY ISSUES FOR THE HOSPITAL PSA. ADDITIONAL DATA WAS OBTAINED FROM VCCC'S FOCUS GROUPS CONDUCTED AT OTHER LOCATIONS. THESE INTERVIEWS WERECONDUCTED AT VARIOUS HOSPITALS AND OTHER LOCATIONS THROUGHOUT THE COUNTY OF LOS ANGELES' SERVICE PLANNING AREA 2 (SPA 2). THE SPA 2 FOCUS GROUP'S TOP TEN DATA ALSO IDENTIFIED SOME ADDITIONAL ISSUES THAT AFFECT THE GREATER SAN FERNANDO VALLEY AREA AND RESIDENTS OF THE HOSPITAL'S PSA. THE ISSUES NOT INCLUDED IN THE HOSPITAL'S TOP SEVEN ARE ADDRESSED BELOW. THE HOSPITAL STAFF WILL WORK WITH HOSPITALS AND AGENCIES THROUGHOUT THE VALLEY TO ADDRESS THESE ISSUES AS WELL AS THOSE SPECIFIC TO THE HOSPITAL.8. OBESITY - THE HOSPITAL'S PLAN INCORPORATES EDUCATION FOR CHILDREN AND ADULTS ABOUT THE HAZARDS OF OBESITY AND THE PROMOTION OF HEALTHY EATING AND BEHAVIORAL HABITS.9. CANCER - THE HOSPITAL PLANS TO FOCUS ON TRIAGE FOR CLIENTS ADMITTING WITH CANCER SYMPTOMS, TREATMENT FOR THOSE SYMPTOMS EASILY TREATED, AND REFERRAL TO SPECIALTY HOSPITALS FOR THOSE WITH MORE SERIOUS PROBLEMS SINCE THE HOSPITAL DOES NOT SPECIALIZE IN CANCER CARE.10. HYPERTENSION - THE HOSPITAL'S PLAN INVOLVES EDUCATION AND INTERVENTION IN CASES WHERE THE CLIENT IS AT THE HOSPITAL, BUT THE BULK OF THE EDUCATION EFFORT WILL BE IN OUTREACH PROGRAMS, COORDINATED WITH THE SENIOR SERVICES PROGRAMS ALREADY IN PLACE AT THE HOSPITAL, AND DELIVERED TO SITES IN THE COMMUNITY.11. SUBSTANCE ABUSE DISORDER - THE HOSPITAL'S PLAN INVOLVES EDUCATION AND INTERVENTION IN CASES WHERE THE CLIENT IS AT THE HOSPITAL, BUT THE BULK OF THE EDUCATION EFFORT WILL BE IN OUTREACH PROGRAMS. THE EXISTING SENIOR SERVICES PROGRAMS ARE A USEFUL BASE FOR IDENTIFYING AND TREATING SUBSTANCE ABUSE ISSUES WHICH ARE OFTEN PRESENTED AS EITHER ACUTE TRAUMA OR AS CONTRIBUTORS TO A MENTAL HEALTH CRISIS THAT ADMITS TO THE GERIATRIC PSYCH PROGRAM. ADDITIONAL EFFORTS ARE UNDERWAY TO IDENTIFY SERVICE PROVIDERS AND CONTINUING TREATMENT LOCATIONS TO ALLOW TRANSFERS OF ABUSE VICTIMS TO LONGER-TERM RECOVERY PROGRAMS THAT CAN FOLLOW UP ON THE TREATMENT PROVIDED FOR THE ACUTE EPISODE.12. ACCESS TO PRIMARY CARE - AS NOTED IN THE ACCESS TO CARE SECTION OF THIS PLAN, SOH WILL CONTINUE TO ATTEMPT TO FIND INSURANCE COVERAGE FOR ALL WHO PRESENT AT THE HOSPITAL'S ED, AND AS PART OF THAT PROCESS WILL ASSIST IN FINDING A PRIMARY CARE PROVIDER AFFILIATED WITH THE COVERAGE ACHIEVED. IN ADDITION, SOH'S MEDICAL STAFF WILL REACH OUT TO LOCAL CLINICS TO PROVIDE SPECIALTY CARE TO CLINIC PATIENTS AS APPROPRIATE.13. POVERTY - THE HOSPITAL HAS NO CONTROL OVER CLIENTS' INCOMES AND HAS NO RESOURCES TO AUGMENT INCOMES. HOWEVER, AS NOTED IN THE ACCESS TO CARE SECTION OF THIS PLAN, THE HOSPITAL WILL CONTINUE TO ATTEMPT TO FIND INSURANCE COVERAGE FOR ALL WHO ARE PRESENT AT THE HOSPITAL'S ED, AND AS PART OF THAT PROCESS WILL ASSIST IN FINDING A PRIMARY CARE PROVIDER AFFILIATED WITH THE COVERAGE ACHIEVED. SINCE CLIENTS WITH THE LOWEST INCOMES ARE THE ONES MOST LIKELY TO QUALIFY FOR MEDICAL COVERAGE, THIS PROCESS SHOULD MINIMIZE THE TROUBLE CLIENTS HAVE IN SEEKING CARE. THE ISSUES ABOVE ARE THE CONSENSUS ISSUES FROM MANY SOURCES THAT MERIT THE MOST CONSIDERATION BY HOSPITALS IN THE AREA. EACH HOSPITAL HAS DIFFERING ABILITIES TO ADDRESS EACH ISSUE. AS DISCUSSED ABOVE, SHERMAN OAKS HOSPITAL'S IMPLEMENTATION PLAN WILL FOCUS ON THE ISSUES RELATED TO ACCESS AND MENTAL HEALTH.

MONTCLAIR HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 11: TO SUCCESSFULLY MAKE OUR COMMUNITY HEALTHIER, IT IS NECESSARY TO HAVE A COLLABORATIVE VENTURE WHICH BRINGS TOGETHER ALL THE CARE PROVIDERS, CITIZENS, GOVERNMENT, SCHOOLS, CHURCHES, NOT-FOR-PROFIT ORGANIZATIONS, AND BUSINESS AND INDUSTRY AROUND AN EFFECTIVE PLAN OF ACTION. BASED ON THE RESULTS OF THE CHNA, MHMC HAS SELECTED FOUR OF THE IDENTIFIED SIGNIFICANT HEALTH NEEDS TO ADDRESS.1. MENTAL HEALTH2. OBESITY/DIABETES3. EDUCATION4. ACCESS TO CAREMHMC PLANS TO MEET THE MENTAL HEALTH SIGNIFICANT HEALTH NEED BY:1. IMPROVE MENTAL HEALTH EVALUATIONS FROM THE EMERGENCY DEPARTMENT (ED).A. THE HOSPITAL IMPLEMENTED A NEW SERVICE LINE, TELE-PSYCH, TO EVALUATE PATIENTS FROM THE EMERGENCY DEPARTMENT (ED) AND THOSE WAITING TO BE PLACED IN A BEHAVIORAL HEALTH FACILITY TO BE MANAGED IN-HOUSE BY A PSYCHIATRIST. CASE MANAGEMENT WORKS ON THE PROPER PLACEMENT AND ENSURES THAT ONCE THEY ARE MEDICALLY CLEARED, THEY HAVE RESOURCES PROVIDED TO THEM AS A PSYCHOLOGY FOLLOW-UP.2. INCREASE AWARENESS AND DECREASE THE STIGMA OF MENTAL HEALTHA. THE HOSPITAL WILL PARTICIPATE IN FUTURE MENTAL HEALTH SUMMITS FOR SAN BERNARDINO COUNTY.B. MHMC WILL DISTRIBUTE FLYERS ON SUICIDE PREVENTION AT HEALTH FAIRS TO HELP PROMOTE THE 211 SAN BERNARDINO HELPLINE.3. IMPROVE ACCESS TO MENTAL HEALTH SERVICESA. CREATE A NEW SERVICE LINE FOR PATIENTS IN NEED OF BEHAVIORAL HEALTH SERVICES IN PARTNERSHIP WITH SISTER FACILITY GLENDORA OAKS BEHAVIORAL HEALTH (PREVIOUSLY GLENDORA COMMUNITY HOSPITAL) TO PLACE SENIORS 55+ AND WITH CHINO VALLEY MEDICAL CENTER AS THEY WORK TO PARTNER WITH INLAND EMPIRE HEALTH PLAN (IEHP) CREATING BEHAVIORAL HEALTH SERVICES.MHMC PLANS TO MEET THE SIGNIFICANT DIABETES HEALTH NEED BY:1. IMPROVE NUTRITION AND INCREASE EXERCISE FOR STAFF AND COMMUNITY MEMBERS.A. PROVIDE A LECTURE ON NUTRITION WITH A REGISTERED DIETICIAN TARGETING CURRENT EMPLOYEES AND COMMUNITY MEMBERS.B. HOST EXERCISE CLASSES SUCH AS YOGA ON THE FRONT LAWN FOR BOTH STAFF AND PATIENTS.C. ENCOURAGE STAFF TO PARTICIPATE IN COMMUNITY AND CORPORATE HEALTH CHALLENGES.D. PROVIDE PEDOMETERS FOR EMPLOYEES AND PROMOTE A CONTEST TO INCREASE ENGAGEMENT WITH EXERCISE.E. SPONSOR A DIABETES CLASS OFFERED TO THE COMMUNITY BY COLLABORATING WITH THE NEARBY FEDERALLY QUALIFIED HEALTH CENTER (FQHC).2. INCREASE DIAGNOSIS OF DIABETES TO PROVIDE EARLIER INTERVENTIONS.A. PROVIDE COMPLIMENTARY DIABETES SCREENINGS TO THE COMMUNITY AT HEALTH FAIRS.MHMC PLANS TO MEET THE EDUCATION SIGNIFICANT HEALTH NEED BY:1. INCREASE INTEREST IN WORKING IN HOSPITALS.A. PARTICIPATE WITH THE PROMISE SCHOLARS PROGRAM AT THE LOCAL SCHOOLS TO EDUCATE STUDENTS ABOUT WORKING IN A HOSPITAL.

HUNTINGTON BEACH HOSPITAL
PART V, SECTION B, LINE 11: 1. SUBSTANCE MISUSE A GOOD PLACE TO START IN GETTING SUBSTANCE MISUSE UNDER CONTROL AND APPROACHING IT WOULD BE AT THE SCHOOL LEVEL. SCHOOLS ARE A GOOD PLACE TO START TO DECREASE SUBSTANCE MISUSE AS THEY CAN PROVIDE CONTINUOUS EDUCATION, SUPPORT, AND RESOURCES TO KEEP KIDS OFF DRUGS. ONE POSSIBLE SOLUTION MAY BE TO RENEW THE DARE PROGRAM. IN ADDITION, LIMITING ACCESS TO SUBSTANCES CAN BE A SOLUTION. AS WELL, ADDRESSING THE FAMILY UNIT COULD BE LOOKED AT AS SUBSTANCE ABUSE IS A SYMPTOM OF THE LOSS OF VALUES AND PARENTAL SUPERVISION NOT EXISTING. LPIH IS PARTNERING WITH THE LA PALMA POLICE DEPARTMENT TO EDUCATE KIDS ABOUT THE RESULTS OF USING DRUGS. FURTHERMORE, THE HOSPITAL DOES OFFER EDUCATION FOR PATIENTS AND PROTOCOLS TO ASSIST AS SEEN WITH OPIOIDS IN ITS 2019 CHNA PLAN.2. HOUSING THE BIG ISSUE IS NEEDING TO TACKLE AFFORDABLE HOUSING, WHICH CAN LEAD TO A DECREASE IN HOMELESS CHILDREN. FURTHERMORE, THERE NEEDS TO BE AN EFFORT TO PROVIDE HEALTHCARE FOR THE UNHOUSED POPULATION. IN ORDER TO PROVIDE HEALTHCARE FOR THE UNHOUSED POPULATION THERE NEEDS TO BE AN EFFORT TO GO TO THEM AND MEET THEM WHERE THEY ARE. ONE POSSIBLE SOLUTION IS TO PARTNER WITH BE WELL OC TO GET PATIENTS CARE OUTSIDE THE HOSPITAL.3. MENTAL HEALTH A STEP TO DEAL WITH MENTAL HEALTH IS TO START AS EARLY AS POSSIBLE AND WITH KIDS. A SOLUTION IS TO PROVIDE COUNSELORS IN EARLY ELEMENTARY SCHOOL. ANOTHER WAY TO HELP KIDS WOULD BE TO UTILIZE FILTERS FOR KIDS USING ELECTRONIC MEDIA AS SOME ONLINE MEDIA PROMOTES VIOLENCE AND SUPPORT BULLYING. IN ADDITION, HAVING A FOCUS ON COUNSELLING STUDENTS IN COLLEGE COULD HELP A LOT AS THEY TRANSITION TO ADULTHOOD. AND ONE BIG THING THAT CAN HINDER MENTAL HEALTH IS THE EMPHASIS ON INDIVIDUALISM IN THE WEST AS OPPOSED TO COMMUNITY WHICH HINDERS MENTAL HEALTH.4. DIABETES - EDUCATING PEOPLE ON THE CAUSES AND RESULTS OF DIABETES CAN BE A BIG STEP IN ADDRESSING THIS ISSUE. IN ADDITION, HOLDING HEALTH FARIS FOR SCREENING AND TESTING CAN GO A LONG WAY TO ADDRESSING THE ISSUE OF DIABETES. IN CONJUNCTION WITH THE HEALTH FAIRS, TEACHING KIDS ABOUT NUTRITION AND EXERCISE IS ANOTHER WAY TO TACKLE THE ISSUE. FINALLY, WHEN DEALING WITH THE ISSUE OF DIABETES, THERE IS THE FACT THAT UNHEALTHY FOOD LIKE FAST FOOD IS CHEAP, WHILE HEALTHIER FOOD IS MORE EXPENSIVE. ULTIMATELY, FAMILIES AND INDIVIDUALS FROM LOWER SOCIO-ECONOMIC BACKGROUNDS ARE MORE LIKELY TO BE NEGATIVELY IMPACTED BY UNHEALTHY FOOD BEING CHEAPER. CURRENTLY, THE HOSPITAL DOES EDUCATION FOR PATIENTS IN THE FORMS OF ASSESSMENTS, DIETICIAN DISCUSSIONS, AND SELF-MANAGEMENT PROGRAMS.5. EDUCATION 2 BIG FACTORS THAT CAN IMPROVE HEALTH ARE INCOME AND EDUCATION. THE HIGHER THE LEVEL OF BOTH FACTORS, THE BETTER CHANCES THERE ARE AT BETTER HEALTH CARE. AS SEEN ABOVE, CHEAPER UNHEALTHIER FOOD MAY BE AN OPTION FOR THOSE OF LOWER SOCIO-ECONOMIC BACKGROUNDS. TO IMPROVE EDUCATION, OUR EDUCATION SYSTEM WOULD NEED TO BE IMPROVED. SKILLS THAT NEED TO BE IMPROVED FOR THIS ISSUE INCLUDE WRITING SKILLS ALONG WITH COMMUNICATION AND INTERPERSONAL SKILLS. FURTHERMORE, IMPROVING TEACHING COULD GO A LONG WAY TOWARD IMPROVING EDUCATION. CURRENTLY, THE HOSPITAL OFFERS EDUCATION ON TOPICS SUCH AS DIET OR EVEN SUBSTANCE USE.

LA PALMA INTERCOMMUNITY HOSPITAL
PART V, SECTION B, LINE 11: 1. SUBSTANCE MISUSE A GOOD PLACE TO START IN GETTING SUBSTANCE MISUSE UNDER CONTROL AND APPROACHING IT WOULD BE AT THE SCHOOL LEVEL. SCHOOLS ARE A GOOD PLACE TO START TO DECREASE SUBSTANCE MISUSE AS THEY CAN PROVIDE CONTINUOUS EDUCATION, SUPPORT, AND RESOURCES TO KEEP KIDS OFF DRUGS. ONE POSSIBLE SOLUTION MAY BE TO RENEW THE DARE PROGRAM. IN ADDITION, LIMITING ACCESS TO SUBSTANCES CAN BE A SOLUTION. AS WELL, ADDRESSING THE FAMILY UNIT COULD BE LOOKED AT AS SUBSTANCE ABUSE IS A SYMPTOM OF THE LOSS OF VALUES AND PARENTAL SUPERVISION NOT EXISTING. LPIH IS PARTNERING WITH THE LA PALMA POLICE DEPARTMENT TO EDUCATE KIDS ABOUT THE RESULTS OF USING DRUGS. FURTHERMORE, THE HOSPITAL DOES OFFER EDUCATION FOR PATIENTS AND PROTOCOLS TO ASSIST AS SEEN WITH OPIOIDS IN ITS 2019 CHNA PLAN.2. HOUSING THE BIG ISSUE IS NEEDING TO TACKLE AFFORDABLE HOUSING, WHICH CAN LEAD TO A DECREASE IN HOMELESS CHILDREN. FURTHERMORE, THERE NEEDS TO BE AN EFFORT TO PROVIDE HEALTHCARE FOR THE UNHOUSED POPULATION. IN ORDER TO PROVIDE HEALTHCARE FOR THE UNHOUSED POPULATION THERE NEEDS TO BE AN EFFORT TO GO TO THEM AND MEET THEM WHERE THEY ARE. ONE POSSIBLE SOLUTION IS TO PARTNER WITH BE WELL OC TO GET PATIENTS CARE OUTSIDE THE HOSPITAL.3. MENTAL HEALTH A STEP TO DEAL WITH MENTAL HEALTH IS TO START AS EARLY AS POSSIBLE AND WITH KIDS. A SOLUTION IS TO PROVIDE COUNSELORS IN EARLY ELEMENTARY SCHOOL. ANOTHER WAY TO HELP KIDS WOULD BE TO UTILIZE FILTERS FOR KIDS USING ELECTRONIC MEDIA AS SOME ONLINE MEDIA PROMOTES VIOLENCE AND SUPPORT BULLYING. IN ADDITION, HAVING A FOCUS ON COUNSELLING STUDENTS IN COLLEGE COULD HELP A LOT AS THEY TRANSITION TO ADULTHOOD. AND ONE BIG THING THAT CAN HINDER MENTAL HEALTH IS THE EMPHASIS ON INDIVIDUALISM IN THE WEST AS OPPOSED TO COMMUNITY WHICH HINDERS MENTAL HEALTH.4. DIABETES - EDUCATING PEOPLE ON THE CAUSES AND RESULTS OF DIABETES CAN BE A BIG STEP IN ADDRESSING THIS ISSUE. IN ADDITION, HOLDING HEALTH FARIS FOR SCREENING AND TESTING CAN GO A LONG WAY TO ADDRESSING THE ISSUE OF DIABETES. IN CONJUNCTION WITH THE HEALTH FAIRS, TEACHING KIDS ABOUT NUTRITION AND EXERCISE IS ANOTHER WAY TO TACKLE THE ISSUE. FINALLY, WHEN DEALING WITH THE ISSUE OF DIABETES, THERE IS THE FACT THAT UNHEALTHY FOOD LIKE FAST FOOD IS CHEAP, WHILE HEALTHIER FOOD IS MORE EXPENSIVE. ULTIMATELY, FAMILIES AND INDIVIDUALS FROM LOWER SOCIO-ECONOMIC BACKGROUNDS ARE MORE LIKELY TO BE NEGATIVELY IMPACTED BY UNHEALTHY FOOD BEING CHEAPER. CURRENTLY, THE HOSPITAL DOES EDUCATION FOR PATIENTS IN THE FORMS OF ASSESSMENTS, DIETICIAN DISCUSSIONS, AND SELF-MANAGEMENT PROGRAMS.5. EDUCATION 2 BIG FACTORS THAT CAN IMPROVE HEALTH ARE INCOME AND EDUCATION. THE HIGHER THE LEVEL OF BOTH FACTORS, THE BETTER CHANCES THERE ARE AT BETTER HEALTH CARE. AS SEEN ABOVE, CHEAPER UNHEALTHIER FOOD MAY BE AN OPTION FOR THOSE OF LOWER SOCIO-ECONOMIC BACKGROUNDS. TO IMPROVE EDUCATION, OUR EDUCATION SYSTEM WOULD NEED TO BE IMPROVED. SKILLS THAT NEED TO BE IMPROVED FOR THIS ISSUE INCLUDE WRITING SKILLS ALONG WITH COMMUNICATION AND INTERPERSONAL SKILLS. FURTHERMORE, IMPROVING TEACHING COULD GO A LONG WAY TOWARD IMPROVING EDUCATION. CURRENTLY, THE HOSPITAL OFFERS EDUCATION ON TOPICS SUCH AS DIET OR EVEN SUBSTANCE USE.

ENCINO HOSPITAL MEDICAL CENTER
PART V, SECTION B, LINE 11: KEYGROUP CONDUCTED FOCUS GROUP SURVEYS AND INDIVIDUAL PHONE INTERVIEWS WITH REPRESENTATIVES OF AREA HEALTH AGENCIES, SOCIAL SERVICE PROVIDERS, AND LOCAL GOVERNMENT ORGANIZATIONS (COLLECTIVELY, KEY INFORMANTS). OVER 35 HEALTH NEEDS WERE SUGGESTED BY THE KEY INFORMANTS, AND WERE WINNOWED DOWN TO THOSE CONSIDERED MOST IMPORTANT BY THE FOCUS GROUP PARTICIPANTS.1. HOSPITAL SERVICES MARKETING AND OUTREACH THE HOSPITAL'S PLAN INCLUDES A REVAMP OF THE HOSPITAL'S WEBSITE TO MAKE IT MORE SELF-EXPLANATORY AND CUSTOMER FRIENDLY. A PROVIDER SEARCH FUNCTION WILL ALLOW USERS TO FIND SERVICES NEARBY BUT NOT OFFERED AT EHMC. FACEBOOK AND TWITTER PRESENCES ARE IN DEVELOPMENT, ALONG WITH A NEXTDOC FUNCTION. INCREASED PRESENCE AT NEARBY SERVICE GROUPS (ROTARY, CHAMBER OF COMMERCE, ETC.), AND GREATER PARTICIPATION IN LOCAL HEALTH FAIRS AND VALLEY ECONOMIC ALLIANCE PROGRAMS WILL INCREASE VISIBILITY. ADDITIONAL OUTREACH TO LOCAL COMMUNITY SOCIAL SERVICE AND HEALTH AWARENESS ORGANIZATIONS TO COORDINATE SERVICES WITH THE NEEDS EXPERIENCED BY THOSE ORGANIZATIONS WILL ALLOW THEM TO UTILIZE. IN THE COVID-19 ENVIRONMENT, THIS PROCESS IS LIMITED IN SCOPE DUE TO SOCIAL DISTANCE REQUIREMENTS, BUT AS THOSE RESTRICTIONS ARE EASED, INTERACTION WITH OTHER ORGANIZATIONS WILL BE FACILITATED AND EXPANDED.2. MENTAL HEALTH THE HOSPITAL'S PLAN BUILDS ON ITS EXISTING EXPERTISE IN PROVIDING SERVICES TO ELDERLY RESIDENTS WITH MENTAL HEALTH ISSUES, AND EXPANDS INTO ADDITIONAL AREAS RELATED TO MENTAL HEALTH CARE. AS ONE OF THE FEW HOSPITALS WITH BOTH A SECURE SERVICE AND LOWER-INTENSITY BEDS, EHMC IS WELL POSITIONED TO COPE WITH THE EXPECTED INCREASE IN SENIORS WITH DEPRESSION AND/OR OTHER MENTAL HEALTH ISSUES AS THE GENERAL POPULATION AGES. THE COVID-19 PANDEMIC MAY SPEED THE INCREASE IN DEMAND FOR THESE SERVICES, AND THE HOSPITAL WILL MAINTAIN VIGILANCE TO ALLOW IT TO ADDRESS THE NEEDS AS THEY PRESENT THEMSELVES. 3. COMMUNITY SERVICES AWARENESS THE HOSPITAL'S PLAN INCLUDES COMMUNICATION WITH COMMUNITY SERVICES ORGANIZATIONS, AND UPDATES TO THE EXISTING CITY 211 RESOURCE AND OTHER REFERRAL AGENCIES TO MEET SPECIFIC NEEDS OF PATIENTS AND COMMUNITY MEMBERS WITH WHICH THE HOSPITAL COMES INTO CONTACT. AS NEW ORGANIZATIONS ARISE TO ADDRESS NEWLY DEFINED SOCIAL DETERMINANTS OF HEALTH (SDOH), THESE ORGANIZATIONS WILL BE INTEGRATED INTO THE INTAKE AND DISCHARGE PLANNING PROCESS AT THE EHMC TO ASSURE THAT NON-MEDICAL, BUT INFLUENTIAL, LIFESTYLE ISSUES DON'T RESULT IN RE-ADMISSION TO THE HOSPITAL, AND TO EASE THE PATH BACK TO MAXIMUM HEALTH STATUS FOR EACH RESIDENT. 4. HOMELESSNESS ISSUES THE HOSPITAL'S PLAN WILL FOCUS ON CITY AND COUNTY INNOVATIONS TO ASSIST CURRENTLY HOMELESS RESIDENTS OF THE PSA TO FIND HOUSING AND SUPPORTIVE SERVICES TO FACILITATE THEIR RE-ENTRY INTO MAINSTREAM HOUSING, EMPLOYMENT, AND MENTAL HEALTH STATUS. THESE PROGRAMS ARE STILL IN DEVELOPMENT, AND THE ULTIMATE AVAILABILITY OF HOUSING OPTIONS BEYOND THE KNOWN COVID-19 INTERIM SOLUTIONS AS OF THIS REPORT DATE WILL INFLUENCE EHMC'S ABILITY TO PARTICIPATE IN REFERRAL AND TREATMENT PROGRAMS. UNTIL MORE CONCRETE PROGRAMS ARE DEFINED, AND PARTICIPATION REGULATIONS CLARIFIED, EHMC WILL CONTINUE TO MONITOR PLANS AND REFER HOMELESS PATIENTS TREATED AT THE HOSPITAL TO EXISTING SERVICE PROVIDERS AS APPROPRIATE. 5. CHRONIC CARE MANAGEMENT THE HOSPITAL'S PLAN INCLUDES IMPROVED COMMUNICATION WITH COMMUNITY SERVICES ORGANIZATIONS DEALING WITH THE SDOH ISSUES IDENTIFIED AS MEDICAL PRECURSORS. IN ADDITION, AS SERVICES BECOME AVAILABLE TO ASSIST FORMER PATIENTS TO TRANSITION BACK TO THEIR HOME, AND ASSESS THOSE ENVIRONMENTS FOR POTENTIAL HAZARDS AND LIFESTYLE ISSUES, THE HOSPITAL WILL WORK WITH THESE ORGANIZATIONS AND THE PAYORS THAT COVER PATIENTS' HOSPITALIZATION COSTS TO COORDINATE SERVICES THAT WILL MINIMIZE THE POTENTIAL FOR REHOSPITALIZATION, AND CONTRIBUTE TO HIGHER LEVELS OF RESIDENT HEALTH. 6. OBESITY THE HOSPITAL'S PLAN INCLUDES CONTINUATION OF ITS EXISTING PROGRAMS FOR ACUTE INCIDENCES OF DISEASES ASSOCIATED WITH OBESITY, AS WELL AS MAINTENANCE OF OUTPATIENT PROGRAMS ADDRESSING DIABETES AND CARDIAC DISEASE. A NEW PROGRAM COORDINATED WITH EPIC CARDIOLOGY WILL ALLOW GREATER RANGE OF SERVICES, AND IN COORDINATION WITH SHERMAN OAKS HOSPITAL, PROVIDE ADDITIONAL CARDIAC CATHETERIZATION SERVICES IN A NEW CATH LAB SETTING. 7. CANCER - THE HOSPITAL'S PLAN IS RELATIVELY MINIMAL WITH RELATION TO CANCER, SINCE IT DOES NOT SPECIALIZE IN CANCER TREATMENT. ASIDE FROM HANDLING EMERGENCY DEPARTMENT ADMISSIONS FOR ACUTE PROBLEMS, EHMC'S INVOLVEMENT IN CANCER ISSUES WILL BE LIMITED TO REFERRALS TO SPECIALIZED PROVIDERS AS APPROPRIATE. 8. HYPERTENSION THE HOSPITAL'S PLAN INVOLVES CONTINUATION OF EXISTING CARDIAC SERVICES, AND FUTURE PLANS INCLUDE EXPANSION OF INPATIENT SERVICES IN COORDINATION WITH SHERMAN OAKS HOSPITAL IN OPERATING A NEW CARDIAC CATHETERIZATION LAB, WHICH WILL ALLOW FOR MORE PRECISE DIAGNOSIS OF VASCULAR PROBLEMS AND ALLOW FOR INTERVENTIONAL CARDIOLOGY PROCEDURES IMMEDIATELY UPON DIAGNOSIS. THIS EXPANSION WILL BE PUBLICIZED THROUGHOUT THE COMMUNITY TO MAKE THE PUBLIC AWARE OF THE NEW OPTIONS. 9. SUBSTANCE ABUSE DISORDER THE HOSPITAL'S PLAN CENTERS ON ITS EXISTING SENIOR BEHAVIORAL HEALTH PROGRAM, INCLUDING BOTH INPATIENT AND OUTPATIENT SERVICES FOR THOSE WITH BOTH MENTAL HEALTH ISSUES AND SUBSTANCE ABUSE PROBLEMS. THE COMPREHENSIVENESS OF THE PROGRAM, INCLUDING A SENIOR EMERGENCY ROOM, 13-BED SECURED WING FOR INVOLUNTARY ADMISSIONS, AND MULTIPLE TREATMENT MODALITIES ORIENTED TOWARD SENIORS, WILL FACILITATE GROWTH IN THIS AREA AS MORE PSA RESIDENTS MOVE INTO THE APPROPRIATE AGE GROUP. THE PROGRAM'S EXISTING CONNECTIONS TO SOCIAL SERVICE AGENCIES AND STEP-DOWN PROGRAMS WILL ALLOW THE HOSPITAL TO CONTINUE TO MOVE CLIENTS TO APPROPRIATE TREATMENT SETTINGS AS APPROPRIATE. 10. ACCESS TO PRIMARY CARE THE HOSPITAL'S PLAN INCORPORATES EXISTING REFERRAL PROGRAMS TO ASSURE ADMISSIONS FROM THE EMERGENCY DEPARTMENT TO ACCESS PAYMENT PROGRAMS THAT WILL COVER NEEDED CARE, AND WORK WITH PAYORS TO ASSURE THAT FIRST-TIME ADMISSIONS ARE FOLLOWED UPON DISCHARGE TO ASSURE THAT NEEDED FOLLOW UP SERVICES ARE PROVIDED TO KEEP THEM IN THE MANAGED CARE PLAN'S CONTINUUM OF CARE. TO THE EXTENT THAT COVID-19 SYMPTOMS ARE FOUND ON TRIAGE, APPROPRIATE ISOLATION AND CARE PROTOCOLS WILL BE FOLLOWED.11. POVERTY THE HOSPITAL'S PLAN INCLUDES CONTINUATION OF ITS EXISTING PROGRAMS TO CARE FOR PATIENTS WHO PRESENT IN THE EMERGENCY DEPARTMENT AND TO FIND THEM INSURANCE COVERAGE AS AVAILABLE. EHMC WILL ASSIST PATIENTS COMPLETING TREATMENT WITH POVERTY ISSUES SUCH AS HOMELESSNESS, FOOD INSECURITY, MEDICATION INTERACTIONS, OR INADEQUATE HOUSING, TO ACCESS PROVIDERS WHO WILL HELP THEM DEAL WITH THE ISSUES INVOLVED. THE ISSUES ABOVE ARE THE CONSENSUS ISSUES FROM MANY SOURCES THAT MERIT THE MOST CONSIDERATION BY HOSPITALS IN THE AREA. EACH HOSPITAL HAS DIFFERING ABILITIES TO ADDRESS EACH ISSUE. AS DISCUSSED ABOVE, ENCINO HOSPITAL'S IMPLEMENTATION PLAN WILL FOCUS ON THE ISSUES RELATED TO ACCESS AND MENTAL HEALTH.

COSHOCTON REGIONAL MEDICAL CENTER
"PART V, SECTION B, LINE 11: BASED ON THE RESULTS OF THE CHNA FROM INTERVIEWS, FOCUS GROUPS AND PRIORITIZATION FROM COSHOCTON COUNTY HEALTH DEPARTMENT AND THE CITY OF COSHOCTON HEALTH DEPARTMENT, COSHOCTON REGIONAL MEDICAL CENTER HAS SELECTED THREE OF THE IDENTIFIED SIGNIFICANT HEALTH NEEDS TO ADDRESS.1. SUBSTANCE USE/ MENTAL HEALTH2. HEALTHY EATING/ ACTIVE LIVING3. TOBACCO USECOSHOCTON REGIONAL MEDICAL CENTER PLANS TO MEET THE SIGNIFICANT HEALTH NEEDS BY WORKING TO IMPLEMENT THE IDEAS DESCRIBED IN THIS IMPLEMENTATION PLAN.1. SUBSTANCE USE/ MENTAL HEALTHA. PROBLEM:I. LOCAL INCREASE IN SUBSTANCE ABUSE, LEADING TO MENTAL HEALTH ISSUES FOR ABUSER AND FAMILY/CHILDREN.B. SOLUTION:I. GET STAFF INVOLVED WITH COSHOCTON COUNTY DRUG COALITION. THE DRUG COALITION IS A COMMUNITY-BASED EFFORT TO MAINTAIN FOCUS ON SUBSTANCE ABUSE, WORK TOWARD GETTING ANSWERS TO HELP DEFEND AGAINST THE PROBLEM AND EDUCATE THE COMMUNITY ABOUT THE SIGNS AND RISKS OF SUBSTANCE ABUSE.II. INVESTIGATE THE FEASIBILITY OF CREATING A MEDICAL DETOX PROGRAM FOR THE HOSPITAL TO TREAT PATIENTS FOR THE THREE DAYS REQUIRED PRIOR TO ACCEPTANCE INTO A RESIDENTIAL RECOVERY PROGRAM.III. PARTICIPATE IN AND SPONSOR FAMILY AND CHILDREN FOCUSED PROGRAMS IN COLLABORATION WITH FAMILY AND CHILDREN FIRST COUNCIL, WIC, HELP ME GROW AND MATERNAL AND CHILD HEALTH CENTER.1. YOUTH HEALTH DAY2. BABY EXPOIV. USE MARKETING PLATFORMS TO PROMOTE DRUG FREE LIVING AND FAMILY FOCUSED EDUCATION.2. HEALTHY EATING/ ACTIVE LIVINGA. PROBLEM: LACK OF ACTIVE LIFE STYLE AND HEALTHY DIET CONTRIBUTES TO:I. DIABETESII. HEART DISEASEIII. OBESITYIV. HIGH BPB. SOLUTION:I. INCLUDE A CALORIE COUNT ON THE MENU IN THE CAF. PROVIDE FRESH AND NOT PROCESSED FOOD CHOICES FOR STAFF AND COMMUNITY MEMBERS. WITH LIMITED LUNCH DESTINATIONS IN THE COMMUNITY, ADVERTISE THAT WE ARE OPEN TO THE PUBLIC AND SHARE MENU TO SOCIAL MEDIA.II. OFFER FREE SCREENINGS QUARTERLY TO THE PUBLIC (PAD, GLUCOSE AND BP CHECKS).III. PARTICIPATE IN COMMUNITY OUTREACH EVENTS SUCH AS THE ANNUAL HEALTH SAFETY AND WELLNESS EXPO, WHERE WE PROVIDE NO COST SCREENINGS, SUCH AS BLOOD PRESSURE, GLUCOSE AND PAD. WE HAVE PHYSICIANS AND NURSE PRACTITIONERS ON HAND THROUGHOUT THE EVENT TO ANSWER QUESTIONS AND PROVIDE HEALTH INFORMATION AS NEEDED. IV. USE MARKETING PLATFORM TO SHARE EDUCATION, INCLUDING HEALTHY HOLIDAY MEAL PLANNING; HEALTHY FOOD SUBSTITUTIONS; LABEL READING; HEALTHY COOKING ON A BUDGET.V. PARTICIPATE IN YOUTH FOCUSED ACTIVITY PROGRAMS IN CONJUNCTION WITH KIDS AMERICA, SUCH AS KAMP KIWANIS AND YOUTH HEALTH DAY, THAT PUTS A FOCUS ON EXERCISE.VI. EXPAND OUR CARDIOVASCULAR SERVICE LINE TO BRING MORE SERVICES LOCALLY.VII. INVESTIGATE A WOUND MANAGEMENT SERVICE LINE TO HELP PATIENTS WITH DIABETES WHO STRUGGLE WITH WOUNDS THAT WILL NOT HEAL DUE TO THE DISEASE. WITH THE AGE OF OUR POPULATION AND THE PREVALENCE OF DIABETES, ADDING THIS SERVICE LINE WILL HELP PATIENTS WHO EITHER TRAVEL FOR WOUND CARE OR RECEIVE SUB-STANDARD CARE.VIII. HIRE A DIABETIC EDUCATOR TO ASSIST OUR PATIENTS AND COMMUNITY.IX. IMPLEMENT A ""WALK WITH A DOC"" PROGRAM QUARTERLY TO EDUCATE THE COMMUNITY ON THE IMPORTANCE OF PHYSICAL ACTIVITY AND A HEALTHY LIFESTYLE.3. TOBACCO USEA. PROBLEM: THE USE OF TOBACCO CAUSES DISEASES SUCH AS:I. COPDII. CANCERIII. HEART DISEASEB. SOLUTION:I. EXPLORE THE POTENTIAL FOR BRINGING PULMONARY SERVICES TO COSHOCTON REGIONAL MEDICAL CENTER.II. HOSTING OF TOBACCO CESSATION GROUPS AT THE HOSPITAL AVAILABLE TO BOTH THE PUBLIC AND TO OUR INPATIENTS WHO WANT TO ATTEND.III. EDUCATE THE COMMUNITY BY WAY OF SOCIAL PLATFORMS AND PRINT ADVERTISING THAT WE OFFER A PULMONARY REHAB PROGRAM.IV. EXPLORE THE OPPORTUNITY OF GIVING A BILL DISCOUNT FOR ANYONE WHO PARTICIPATES IN A HOSPITAL SPONSORED TOBACCO CESSATION EVENT."

SUBURBAN COMMUNITY HOSPITAL
PART V, SECTION B, LINE 11: BASED ON THE SECONDARY DATA, INTERVIEWS, AND SUMMIT PRIORITIZATION, THE SCH BOARD APPROVED THE FOLLOWING IDENTIFIED NEEDS TO BE THE FOCUS OF THE WORK OF THE MEDICAL CENTER OVER THE NEXT THREE YEARS.1. MENTAL HEALTH ACCESS TO RESOURCES, ADOLESCENT, UNDOCUMENTEDPROBLEM STATEMENT: UNMET MENTAL HEALTH AND SUBSTANCE USE NEEDS FREQUENTLY LEAD TO PREVENTABLE ILLNESS AND DEATH IN INDIVIDUALS, FAMILIES, AND COMMUNITIES.2. OBESITY NUTRITIONPROBLEM STATEMENT: OBESITY, OVERWEIGHT, POOR NUTRITION, AND PHYSICAL INACTIVITY ARE ASSOCIATED WITH PROFOUND, ADVERSE HEALTH CONDITIONS. THESE INCLUDE HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, TYPE 2 DIABETES, HEART DISEASE, SOME CANCERS, AND OTHER LIMITING PHYSICAL AND MENTAL HEALTH ISSUES.IN PENNSYLVANIA, TWO OUT OF THREE ADULTS (6.2 MILLION RESIDENTS) AND ONE OUT OF THREE SCHOOL-AGE CHILDREN (0.5 MILLION) HAVE EXCESS WEIGHT. EVIDENCE LINKS OBESITY, PHYSICAL INACTIVITY, AND POOR NUTRITION TO SHORTENED LIFESPAN. TODAY'S YOUTH ARE IN DANGER OF DYING AT YOUNGER AGES THAN THEIR PARENTS.3. ACCESS TO CARE FOR MINORITY GROUPS, UNDOCUMENTED, HOME HEALTHPROBLEM STATEMENT: LIMITED ACCESS TO QUALITY HEALTH CARE IS A GROWING ISSUE IN MANY COMMUNITIES IN PENNSYLVANIA. LIMITS RELATE TO THE NUMBER OF PRIMARY CARE PRACTITIONERS, CULTURAL COMPETENCY, KNOWLEDGE, LOCATION, AFFORDABILITY, COORDINATION OF COMPREHENSIVE CARE, REIMBURSEMENT, AND TECHNOLOGY, AMONG OTHER THINGS. SUCH LIMITATIONS PREVENT MANY PEOPLE FROM OBTAINING QUALITY PREVENTIVE AND DISEASE MANAGEMENT SERVICES.4. CHRONIC DISEASES HEART DISEASE, DIABETES, OBESITY, ETC.REGARDING THE SELECTED NEEDS, SCH WILL DEVELOP ACTIONABLE STEPS TO ADDRESS LOCAL HEALTH DISPARITIES. OUR EXPERIENCE WITH THE LOCAL IMPACT OF THE COVID-19 PANDEMIC, HIGHLIGHTED A DISPROPORTIONATE IMPACT ON THE BLACK AND HISPANIC POPULATIONS. OTHER AT-RISK POPULATIONS (THOSE WITH UNDERLYING HEALTH CONDITIONS) WERE ALSO SEVERELY IMPACTED. AS A HEALTHCARE LEADER IN MONTGOMERY COUNTY, SCH WILL BE A CATALYST IN ADDRESSING HEALTH DISPARITIES AND BE PART OF SOLUTIONS TO MAKE POSITIVE IMPACTS ON SOCIAL DETERMINANTS OF HEALTH.

PAMPA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 11: FINANCIAL RESOURCES AND FUNDING:FINANCIAL RESOURCES AND FUNDING FOR HEALTHCARE SERVICES ARE LIMITED, THUS PREVENTING PROVIDERS FROM MEETING IDENTIFIED UNMET HEALTH NEEDS IN THE COMMUNITY.THERE IS GROWING CONCERN ABOUT THE INCREASINGLY LIMITED FUNDING AND FINANCIAL RESOURCES AVAILABLE FOR HEALTHCARE SERVICES FROM BOTH PUBLIC AND PRIVATE SOURCES.PROFESSIONAL SHORTAGES:SHORTAGE OF CRITICAL HEALTHCARE WORKFORCE DECREASES NEEDED ACCESS TO HEALTHCARE SERVICES. THERE IS A SHORTAGE OF CRITICAL HEALTHCARE MANPOWER IN A NUMBER OF AREAS INCLUDING PHYSICIANS IN SPECIALTIES SUCH AS FAMILY PRACTICE, PEDIATRICS, OPHTHALMOLOGY, EMERGENCY ROOM, ANESTHESIOLOGY, RADIOLOGY AND PATHOLOGY IN THE COMMUNITY. THERE IS ALSO A SIGNIFICANT NEED FOR MENTAL HEALTH AND SUBSTANCE ABUSE PROVIDERS INCLUDING PSYCHIATRISTS, THERAPISTS, AND COUNSELORS IN THE COMMUNITY.LIMITED ACCESS TO HEALTHCARE SERVICES:ACCESS TO HEALTHCARE SERVICES IS LIMITED, PARTICULARLY FOR VARIOUS AT-RISK POPULATIONS. TRANSPORTATION SERVICES ARE LIMITED, PARTICULARLY IN MORE OF THE OUTLYING, RURAL AREAS, WHICH IN TURN LIMITS ACCESS TO NEEDED HEALTHCARE SERVICES FOR AT-RISK POPULATIONS.ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES FOR AT-RISK POPULATIONS WAS NOTED AS A PARTICULAR PROBLEM.LIMITED ACCESS TO MENTAL HEALTHCARE AND ADDICTION SERVICES:ACCESS TO MENTAL HEALTH SERVICES IS LIMITED, PARTICULARLY FOR VARIOUS AT-RISK POPULATIONS; THEREFORE, THE OFFERING OF NEW OR EXPANDED MENTAL HEALTH SERVICES IS NEEDED TO MEET THESE NEEDS.AVAILABILITY AND ACCESS TO MENTAL HEALTH, ALCOHOL AND SUBSTANCE ABUSE PROVIDERS AND SERVICES ARE SEVERELY LIMITED. IMPROVEMENT IS NEEDED WITH INTERFACING, COORDINATING AND COMMUNICATION AMONG HEALTHCARE AND SOCIAL SERVICE PROVIDERS, PARTICULARLY THOSE IMPACTING LOW INCOME AND OTHER AT-RISK POPULATIONS.ALTHOUGH SERVICES ARE BEING PROVIDED FOR AT-RISK POPULATIONS, THESE SERVICES ARE LIMITED. THIS IS ESPECIALLY TRUE AS IT RELATES TO SERVICES FOR THE SERIOUSLY MENTALLY ILL, DETOX, ADULT ALCOHOL AND DRUG ABUSE, CO-OCCURRING DISORDERS, CHILD AND ADOLESCENT PSYCHIATRIC, AND CHILD AND ADOLESCENT ALCOHOL AND DRUG ABUSE POPULATIONS.DETERMINING THE ENTRY-POINT INTO THE MENTAL HEALTHCARE SYSTEM CAN BE CONFUSING FOR POTENTIAL PATIENTS, PARTICULARLY FOR LOW INCOME/AT-RISK POPULATIONS. THE HOSPITAL EMERGENCY DEPARTMENT IS VIEWED AS A LESS-THAN-IDEAL ENTRY POINT.AS A POINT-OF-ENTRY DURING MENTAL HEALTH CRISES, THE HOSPITAL EMERGENCY ROOM HAS A LIMITED AMOUNT OF SPECIALIZED RESOURCES.COMMUNITY PERCEPTION OF ACCESSIBILITY OF HEALTH EDUCATION, PROMOTION, AND PREVENTIVE SERVICES:THERE IS A PERCEPTION THE COMMUNITY SUFFERS FROM A SHORTAGE OF EDUCATION, PROMOTION, AND PREVENTIVE SERVICES.THERE IS A NEED FOR A RESOURCE BOARD OR SHARED SERVICES SYSTEM LISTING TO PROVIDE INFORMATION ABOUT HOW MUCH SERVICES COST AND WHAT IS AVAILABLE FOR NO COST TO LOW-INCOME AND AT-RISK POPULATIONS.THERE IS A NEED FOR ADDITIONAL AND MORE EFFECTIVE HEALTH EDUCATION, HEALTH PROMOTION AND PREVENTION SERVICES SPECIFICALLY TARGETED AT LOW-INCOME AND AT-RISK POPULATIONS IN SOME REGIONS OF THE SERVICE AREA.TOPICS FOR EDUCATION, PROMOTION, AND PREVENTIVE SERVICES NEEDED INCLUDED: DIABETES, SMOKING, NUTRITION, MENTAL HEALTH AND WOMEN'S HEALTH.THERE IS A NEED FOR EDUCATION ON HEALTH RISKS OF SMOKING IN GRAY COUNTY AND THROUGHOUT THE SERVICE AREA INCLUDING TARGETED EDUCATION OF SCHOOL AGE CHILDREN AND YOUTH.THERE IS A NEED FOR INCREASED PROGRAMS FOR SMOKING CESSATION PROGRAMING AND CAMPAIGNING IN GRAY COUNTY AND THROUGHOUT THE SERVICE AREA.

HUNTINGTON BEACH HOSPITAL
PART V, SECTION B, LINE 13B: APPROVED IN SOME INSTANCES OF HOMELESSNESS/DECEASED WITH NO KNOWN NEXT OF KIN

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 2: LANDMARK MEDICAL CENTER, - FACILITY 12: REHABILITATION HOSPITAL OF RHODE ISLAND

GROUP A-FACILITY 2 -- LANDMARK MEDICAL CENTER PART V, SECTION B, LINE 5:
"A KEY INFORMANT SURVEY WAS CONDUCTED WITH COMMUNITY STAKEHOLDERS TO SOLICIT INFORMATION ABOUT COMMUNITY HEALTH NEEDS. A TOTAL OF 45 INDIVIDUALS RESPONDED TO THE SURVEY, INCLUDING HEALTH AND SOCIAL SERVICE PROVIDERS; COMMUNITY AND PUBLIC HEALTH EXPERTS; CIVIC, RELIGIOUS, AND SOCIAL LEADERS; COMMUNITY PLANNERS; POLICY MAKERS AND ELECTED OFFICIALS; AND OTHERS REPRESENTING DIVERSE POPULATIONS INCLUDING MINORITY, LOW-INCOME, AND OTHER UNDERSERVED OR VULNERABLE POPULATIONS.THESE ""KEY INFORMANTS"" WERE ASKED A SERIES OF QUESTIONS ABOUT THEIR PERCEPTIONS OF COMMUNITY HEALTH INCLUDING HEALTH DRIVERS, BARRIERS TO CARE, COMMUNITY INFRASTRUCTURE, AND RECOMMENDATIONS FOR COMMUNITY HEALTH IMPROVEMENT.LANDMARK MEDICAL CENTER ALSO HELD A COMMUNITY PARTNER FORUM ON MARCH 27, 2019 IN PARTNERSHIP WITH THE WOONSOCKET HEALTH EQUITY ZONE. THE OBJECTIVE OF THE FORUM WAS TO SHARE DATA FROM THE CHNA AND GATHER FEEDBACK ON COMMUNITY HEALTH PRIORITIES, GAPS IN SERVICE DELIVERY, AND OPPORTUNITIES FOR COLLABORATION AMONG ORGANIZATIONS. A TOTAL OF 18 PEOPLE ATTENDED THE FORUM AS REPRESENTATIVES OF LANDMARK MEDICAL CENTER, HEALTH AND SOCIAL SERVICE AGENCIES, SENIOR SERVICES, AND CIVIC ORGANIZATIONS.LARGE GROUP DIALOGUE WAS FACILITATED TO DISCUSS CHNA RESEARCH FINDINGS AND PARTICIPANT PERSPECTIVES. THEMES THAT EMERGED DURING THE FORUM WERE ORGANIZED AROUND ROOT CAUSES OR DRIVERS OF HEALTH DISPARITY. HEALTHY PEOPLE 2020 DEFINES A HEALTH DISPARITY AS ""A PARTICULAR TYPE OF HEALTH DIFFERENCE THAT IS CLOSELY LINKED WITH SOCIAL, ECONOMIC, OR ENVIRONMENTAL DISADVANTAGE."""

GROUP A-FACILITY 2 -- LANDMARK MEDICAL CENTER PART V, SECTION B, LINE 6A:
THE CHNA WAS CONDUCTED IN CONJUCTION WITH EIGHT OTHER HOSPITAL FACILITIES, INCLUDING LANDMARK MEDICAL CENTER. CARE NEW ENGLAND HEALTH SYSTEM: BUTLER HOSPITAL; KENT HOSPITAL; MEMORIAL HOSPITAL OF RHODE ISLAND; WOMEN & INFANTS HOSPITAL OF RHODE ISLAND CHARTERCARE: OUR LADY OF FATIMA HOSPITAL; ROGER WILLIAMS MEDICAL CENTER, LANDMARK MEDICAL CENTER, SOUTH COUNTY HOSPITAL, WESTERLY HOSPITAL

GROUP A-FACILITY 2 -- LANDMARK MEDICAL CENTER PART V, SECTION B, LINE 6B:
THE CHNA WAS CONDUCTED IN PARTNERSHIP WITH HOSPITAL ASSOCIATION OF RHODE ISLAND.

GROUP A-FACILITY 2 -- LANDMARK MEDICAL CENTER PART V, SECTION B, LINE 11:
TO WORK TOWARD HEALTH EQUITY, IT IS IMPERATIVE TO PRIORITIZE RESOURCES AND ACTIVITIES TOWARD THE MOST PRESSING HEALTH AND CROSSCUTTING NEEDS WITHIN COMMUNITIES. IN DETERMINING THE ISSUES ON WHICH TO FOCUS EFFORTS OVER THE NEXT THREE-YEAR CYCLE, LANDMARK MEDICAL CENTER SOLICITED INPUT FROM COMMUNITY PARTNERS AND STAKEHOLDERS TO ALIGN EFFORTS WITH EXISTING INITIATIVES HEADED BY THE RHODE ISLAND DEPARTMENT OF HEALTH, THE HEZS, AND OTHER COMMUNITY PARTNERSHIPS.THE CHNA FINDINGS CONFIRMED THAT MANY RESIDENTS WITHIN THE LANDMARK MEDICAL CENTER SERVICE AREA EXPERIENCE GREATER SOCIOECONOMIC DISPARITIES AND INCREASED HEALTH NEEDS THAN IN OTHER PARTS OF THE STATE. CYCLICAL POVERTY, EXPOSURE TO VIOLENCE, AND POORER HEALTH OUTCOMES LEAD TO SHORTENED LIFE EXPECTANCY FOR MANY RESIDENTS. IN SUPPORT OF CHNA FINDINGS, LANDMARK MEDICAL CENTER WILL FOCUS ON:- BEHAVIORAL HEALTH: REDUCE THE PREVALENCE OF FAMILY TRAUMA- CHRONIC DISEASE: EXPAND ACCESS TO CARE TO REDUCE HEALTH DISPARITIES FOR CHRONIC DISEASE- MATERNAL AND CHILD HEALTH: REDUCE TEEN PREGNANCIES AND IMPROVE BIRTH OUTCOMES FOR MOTHERS AND BABIES

GROUP A-FACILITY 12 -- REHABILITATION HOSPITAL OF RHODE ISLAND PART V, SECTION B, LINE 5:
"A KEY INFORMANT SURVEY WAS CONDUCTED WITH COMMUNITY STAKEHOLDERS TO SOLICIT INFORMATION ABOUT COMMUNITY HEALTH NEEDS. A TOTAL OF 45 INDIVIDUALS RESPONDED TO THE SURVEY, INCLUDING HEALTH AND SOCIAL SERVICE PROVIDERS; COMMUNITY AND PUBLIC HEALTH EXPERTS; CIVIC, RELIGIOUS, AND SOCIAL LEADERS; COMMUNITY PLANNERS; POLICY MAKERS AND ELECTED OFFICIALS; AND OTHERS REPRESENTING DIVERSE POPULATIONS INCLUDING MINORITY, LOW-INCOME, AND OTHER UNDERSERVED OR VULNERABLE POPULATIONS.THESE ""KEY INFORMANTS"" WERE ASKED A SERIES OF QUESTIONS ABOUT THEIR PERCEPTIONS OF COMMUNITY HEALTH INCLUDING HEALTH DRIVERS, BARRIERS TO CARE, COMMUNITY INFRASTRUCTURE, AND RECOMMENDATIONS FOR COMMUNITY HEALTH IMPROVEMENT.LANDMARK MEDICAL CENTER ALSO HELD A COMMUNITY PARTNER FORUM ON MARCH 27, 2019 IN PARTNERSHIP WITH THE WOONSOCKET HEALTH EQUITY ZONE. THE OBJECTIVE OF THE FORUM WAS TO SHARE DATA FROM THE CHNA AND GATHER FEEDBACK ON COMMUNITY HEALTH PRIORITIES, GAPS IN SERVICE DELIVERY, AND OPPORTUNITIES FOR COLLABORATION AMONG ORGANIZATIONS. A TOTAL OF 18 PEOPLE ATTENDED THE FORUM AS REPRESENTATIVES OF LANDMARK MEDICAL CENTER, HEALTH AND SOCIAL SERVICE AGENCIES, SENIOR SERVICES, AND CIVIC ORGANIZATIONS.LARGE GROUP DIALOGUE WAS FACILITATED TO DISCUSS CHNA RESEARCH FINDINGS AND PARTICIPANT PERSPECTIVES. THEMES THAT EMERGED DURING THE FORUM WERE ORGANIZED AROUND ROOT CAUSES OR DRIVERS OF HEALTH DISPARITY. HEALTHY PEOPLE 2020 DEFINES A HEALTH DISPARITY AS ""A PARTICULAR TYPE OF HEALTH DIFFERENCE THAT IS CLOSELY LINKED WITH SOCIAL, ECONOMIC, OR ENVIRONMENTAL DISADVANTAGE."""

GROUP A-FACILITY 12 -- REHABILITATION HOSPITAL OF RHODE ISLAND PART V, SECTION B, LINE 6A:
THE CHNA WAS CONDUCTED IN CONJUCTION WITH EIGHT OTHER HOSPITAL FACILITIES, INCLUDING LANDMARK MEDICAL CENTER. CARE NEW ENGLAND HEALTH SYSTEM: BUTLER HOSPITAL; KENT HOSPITAL; MEMORIAL HOSPITAL OF RHODE ISLAND; WOMEN & INFANTS HOSPITAL OF RHODE ISLAND CHARTERCARE: OUR LADY OF FATIMA HOSPITAL; ROGER WILLIAMS MEDICAL CENTER, LANDMARK MEDICAL CENTER, SOUTH COUNTY HOSPITAL, WESTERLY HOSPITAL

GROUP A-FACILITY 12 -- REHABILITATION HOSPITAL OF RHODE ISLAND PART V, SECTION B, LINE 6B:
THE CHNA WAS CONDUCTED IN PARTNERSHIP WITH HOSPITAL ASSOCIATION OF RHODE ISLAND.

GROUP A-FACILITY 12 -- REHABILITATION HOSPITAL OF RHODE ISLAND PART V, SECTION B, LINE 11:
TO WORK TOWARD HEALTH EQUITY, IT IS IMPERATIVE TO PRIORITIZE RESOURCES AND ACTIVITIES TOWARD THE MOST PRESSING HEALTH AND CROSSCUTTING NEEDS WITHIN COMMUNITIES. IN DETERMINING THE ISSUES ON WHICH TO FOCUS EFFORTS OVER THE NEXT THREE-YEAR CYCLE, LANDMARK MEDICAL CENTER SOLICITED INPUT FROM COMMUNITY PARTNERS AND STAKEHOLDERS TO ALIGN EFFORTS WITH EXISTING INITIATIVES HEADED BY THE RHODE ISLAND DEPARTMENT OF HEALTH, THE HEZS, AND OTHER COMMUNITY PARTNERSHIPS.THE CHNA FINDINGS CONFIRMED THAT MANY RESIDENTS WITHIN THE LANDMARK MEDICAL CENTER SERVICE AREA EXPERIENCE GREATER SOCIOECONOMIC DISPARITIES AND INCREASED HEALTH NEEDS THAN IN OTHER PARTS OF THE STATE. CYCLICAL POVERTY, EXPOSURE TO VIOLENCE, AND POORER HEALTH OUTCOMES LEAD TO SHORTENED LIFE EXPECTANCY FOR MANY RESIDENTS. IN SUPPORT OF CHNA FINDINGS, LANDMARK MEDICAL CENTER WILL FOCUS ON:- BEHAVIORAL HEALTH: REDUCE THE PREVALENCE OF FAMILY TRAUMA- CHRONIC DISEASE: EXPAND ACCESS TO CARE TO REDUCE HEALTH DISPARITIES FOR CHRONIC DISEASE- MATERNAL AND CHILD HEALTH: REDUCE TEEN PREGNANCIES AND IMPROVE BIRTH OUTCOMES FOR MOTHERS AND BABIES

SCHEDULE H, PART V, LINE 7A - SOUTHERN REGIONAL
HTTPS://WWW.SOUTHERNREGIONAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 7A - LANDMARK
HTTPS://WWW.LANDMARKMEDICAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 7A - SHERMAN OAKS
HTTPS://WWW.SHERMANOAKSHOSPITAL.ORG/ABOUT-US/COMMUNITY-BENEFITS.ASPX

SCHEDULE H, PART V, LINE 7A - LA PALMA
HTTPS://WWW.LAPALMAINTERCOMMUNITYHOSPITAL.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 7A - COSHOCTON
HTTPS://WWW.COSHOCTONHOSPITAL.ORG/ABOUT-US/COMMUNITY-SERVICE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 7A - SUBURBAN
HTTPS://WWW.SUBURBANHOSP.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 7A - PAMPA
HTTPS://WWW.PRMCTX.COM/ABOUT-US/QUALITY-PATIENT-SAFETY-CLINICAL-EXCELLENCE/

SCHEDULE H, PART V, LINE 7A - RHODE ISLAND
HTTPS://WWW.LANDMARKMEDICAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 10A - SOUTHERN REGIONAL
HTTPS://WWW.SOUTHERNREGIONAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 10A - COSHOCTON
HTTPS://WWW.COSHOCTONHOSPITAL.ORG/ABOUT-US/COMMUNITY-SERVICE/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART V, LINE 16A - LANDMARK
HTTPS://WWW.LANDMARKMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-GUIDE/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 16A - LA PALMA
HTTPS://WWW.LAPALMAINTERCOMMUNITYHOSPITAL.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 16A - GLENDORA
HTTPS://WWW.PRIMEHEALTHCARE.COM/GIVING-ADVOCACY/PRIME-HEALTHCARE-FOUNDATION/GLENDORA-OAKS-BEHAVIORAL-HEALTH-HOSPITAL.ASPX

SCHEDULE H, PART V, LINE 16A - RHODE ISLAND
HTTPS://WWW.LANDMARKMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-GUIDE/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 16B - LANDMARK
HTTPS://WWW.LANDMARKMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-GUIDE/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 16B - LA PALMA
HTTPS://WWW.LAPALMAINTERCOMMUNITYHOSPITAL.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 16B - GLENDORA
HTTPS://WWW.PRIMEHEALTHCARE.COM/GIVING-ADVOCACY/PRIME-HEALTHCARE-FOUNDATION/GLENDORA-OAKS-BEHAVIORAL-HEALTH-HOSPITAL.ASPX

SCHEDULE H, PART V, LINE 16B - RHODE ISLAND
HTTPS://WWW.LANDMARKMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-GUIDE/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 16C - LANDMARK
HTTPS://WWW.LANDMARKMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-GUIDE/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 16C - LA PALMA
HTTPS://WWW.LAPALMAINTERCOMMUNITYHOSPITAL.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 16C - GLENDORA
HTTPS://WWW.PRIMEHEALTHCARE.COM/GIVING-ADVOCACY/PRIME-HEALTHCARE-FOUNDATION/GLENDORA-OAKS-BEHAVIORAL-HEALTH-HOSPITAL.ASPX

SCHEDULE H, PART V, LINE 16C - RHODE ISLAND
HTTPS://WWW.LANDMARKMEDICAL.ORG/PATIENTS-VISITORS/PATIENT-GUIDE/FINANCIAL-ASSISTANCE/

SCHEDULE H, PART V, LINE 3 - GLENDORA
THE FACILITY DID NOT PREPARE A 2021 CHNA OR IMPLEMENTATION STRATEGY FOR THE SHORT PERIOD ENDING JUNE 15, 2021. THE FACILITY WAS SOLD IN JUNE OF 2021. TREASURY REGULATION SECTION 1.501(R)-3(D)(4) PROVIDES THAT 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.

PART II, COMMUNITY BUILDING ACTIVITIES:
LA PALMA INTERCOMMUNITY HOSPITAL:COMMUNITY HEALTH IMPROVEMENT ADVOCACY: TOGETHER WITH COMMUNITY ORGANIZATIONS, PRIME HEALTHCARE LA PALMA, PROVIDED HEALTH SCREEINGS, NURTRITIONAL COUNSELING, VARIOUS WORKSHOPS, AND TRANSPORTATION TO THE COMMUNITY AND SENIORS. SUBURBAN:COMMUNITY SUPPORT:TOGETHER WITH COMMUNITY ORGANIZATONS, PRIME HEALTHCARE SUBURBAN ORGANIZED VARIOUS VIRTUAL GRIEF SUPPORT CLASSES, FOOD DRIVES, AND CHARITY EVENTS.COALITION BUILDING:PRIME HEALTHCARE SUBURBAN THANKED VARIOUS COMMUNITY PARTNERS FOR THEIR SUPPORT AND DEDICATION DURING THE COVID PANDEMIC BY PROVIDING BASKETS AND FOOD. COMMUNITY HEALTH IMPROVEMENT ADVOCACY:TOGETHER WITH COMMUNITY ORGANIZATIONS, PRIME HEALTHCARE SUBURBAN HELD/ATTENDED VARIOUS WORKSHOPS, AND PROVIDED PREVENTITIVE CARE INCLUDING HEALTH SCREENINGS AND FREE VACCINES.WORKFORCE DEVELOPMENT:PRIME HEALTHCARE SUBURBAN PARTNERED WITH THE CHAMBER OF COMMERCE FOR A JOB FAIR TO SUPPORT THE GREATER MONTGOMERY COUNTY.

PART III, LINE 2:
THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS.

PART III, LINE 3:
LANDMARK & RHODE ISLAND:THE ESTIMATED AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY IS THE ACTUAL BAD DEBT AS EACH HAVE A SEPARATE ACCOUNT.ENCINO & SHERMAN OAKS:THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE FINANCIAL ASSISTANCE POLICY.MONTCLAIR:PATIENTS WHO QUALIFY, AND ARE GIVEN FINANCIAL ASSISTANCE, ARE GROUPED AND CLASSIFIED WITHIN THE PATIENT ACCOUNTING SYSTEMS. THESE ACTUAL AMOUNTS, FROM THE ACTUAL PATIENTS, WERE USED TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO THE FINANCIAL ASSISTANCE POLICY.SUBURBAN, SOUTHERN REGIONAL & COSHOCTON:THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS DEEMED TO BE $0 SINCE THE ACTIVITY ASSOCIATED WITH THE PATIENTS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE IS CAPTURED AS EITHER CHARITY OR POLICY ADJUSTMENT, WHICH ARE DISTINCT FROM BAD DEBT EXPENSE.PAMPA:CHARITY CARE POLICY IS GENEROUS ENOUGH TO ENCOMPASS THE MAJORITY OF OUR ININSURED AND UNDERINSURED RESIDENTS. HAD PATIENTS WITH BAD DEBT HAVE APPLIED, THEY WOULD MOST GENERALLY QUALIFY FOR ASSISTANCE.HUNTINGTON BEACH & LA PALMA:THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS DEEMED TO BE $0 SINCE THE ACTIVITY ASSOCIATED WITH THE PATIENTS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE IS CAPTURED AS EITHER CHARITY OR POLICY ADJUSTMENT, WHICH ARE DISTINCT FROM BAD DEBT.EAST VALLEY GLENDORA:ALL GROSS CHARGES ARE DEEMED CHARITABLE ON ACCOUNTS WHERE A CHARITY APPLICATION HAS BEEN SUBMITTED AND APPROVED.

PART III, LINE 4:
THE BAD DEBT EXPENSE FOOTNOTE IS INCLUDED ON PAGE 8 OF THE AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
THE FOLLOWING HOSPITALS USED THE COST TO CHARGE RATIO TO REPORT THE MEDICARE ALLOWABLE COSTS ON LINE 6:PRIME HEALTHCARE SERVICES - SHERMAN OAKS, LLCPRIME HEALTHCARE SERVICES - MONTCLAIR, LLCPRIME HEALTHCARE SERVICES - ENCINO HOSPITAL, LLCPRIME HEALTHCARE FOUNDATION - SOUTHERN REGIONAL, LLCEAST VALLEY GLENDORA HOSPITAL, LLCPRIME HEALTHCARE SERVICES - LANDMARK MEDICAL CENTERPRIME HEALTHCARE SERVICES - REHABILITATION HOSPITAL OF RHODE ISLANDPRIME HEALTHCARE FOUNDATION - COSHOCTON, LLCTHE FOLLOWING HOSPITALS USED OTHER COSTING METHODOLOGIES TO REPORT THE MEDICARE ALLOWABLE COSTS ON LINE 6:PRIME HEALTHCARE HUNTINGTON BEACH LLCPRIME HEALTHCARE SERVICES - PAMPA, LLCPRIME HEALTHCARE SERVICES - SUBURBAN HOSPITAL, LLCPRIME HEALTHCARE LA PALMA, LLCPAMPATHE COSTING METHODOLOGY WAS BASED ON A CONTRACTUAL MODEL WHERE ALLOWABLE COSTS ARE CALCULATED USING COSTS ACCOUNTING METHODS.HUNTINGTON BEACH & LA PALMATHE COSTING METHODOLOGY WAS BASED ON THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) COST REPORT COMPONENTS.SUBURBANTHE COSTING METHODOLOGY WAS BASED ON THE PERCENTAGE OF TOTAL MEDICARE REVENUES OF TOTAL REVENUES.

PART III, LINE 9B:
PRIME HEALTHCARE NONPROFIT FACILITIES MAY USE THE SERVICES OF AN EXTERNAL COLLECTION AGENCY FOR THE COLLECTION OF PATIENT DEBT. NO DEBT SHALL BE ADVANCED FOR COLLECTION UNTIL THE DIRECTOR OF THE HOSPITAL PFS OR HIS/HER DESIGNEE HAS REVIEWED THE ACCOUNT AND APPROVED THE ADVANCEMENT OF THE DEBT TO COLLECTION. PRIME HEALTHCARE NONPROFIT FACILITIES SHALL OBTAIN AN AGREEMENT FROM EACH COLLECTION AGENCY THAT IT UTILIZES TO COLLECT PATIENT DEBT THAT THE AGENCY WILL COMPLY WITH THE REQUIREMENTS OF THE FINANCIAL ASSISTANCE POLICY AND APPLICABLE STATE LAW.IF A PATIENT DOES NOT APPLY FOR FINANCIAL ASSISTANCE OR IS DENIED FINANCIAL ASSISTANCE AND FAILS TO PAY THEIR BILL, THE PATIENT MAY BE SUBJECT TO VARIOUS COLLECTION ACTIONS, INCLUDING EXTRAORDINARY COLLECTION ACTIONS, SUBJECT TO APPLICABLE STATE LAW. NOTWITHSTANDING THE FOREGOING, NEITHER THE HOSPITAL NOR ANY COLLECTION AGENCY WITH WHICH IT CONTRACTS SHALL ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS (I) AT ANY TIME PRIOR TO ONE HUNDRED FIFTY (150) DAYS FOLLOWING THE FIRST POST-DISCHARGE STATEMENT SENT TO A PATIENT OR (II) WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY. IN ADDITION, AND EVEN IF THE ABOVE TWO CONDITIONS ARE SATISFIED, HOSPITAL OR ITS CONTRACTED COLLECTION AGENCIES MUST SEND A NOTICE TO THE PATIENT AT LEAST THIRTY (30) DAYS BEFORE COMMENCING ANY EXTRAORDINARY COLLECTION ACTIONS, WHICH SPECIFIES THE FOLLOWING: (I) COLLECTION ACTIVITIES THE HOSPITAL OR CONTRACTED COLLECTION AGENCY MAY TAKE, (II) THE DATE AFTER WHICH SUCH ACTIONS MAY BE TAKEN (WHICH DATE SHALL BE NO EARLIER THAN THIRTY (30) DAYS OF THE NOTICE DATE, (III) THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE PATIENTS. A COPY OF THE PLAIN LANGUAGE SUMMARY WILL BE INCLUDED WITH SUCH NOTICE. REASONABLE EFFORTS MUST BE MADE (AND DOCUMENTED) TO ORALLY NOTIFY PATIENTS OF THIS POLICY. IF THE PATIENT APPLIES FOR FINANCIAL ASSISTANCE, ANY EXTRAORDINARY COLLECTION ACTIONS THAT MAY BE IN PROCESS WILL BE SUSPENDED IMMEDIATELY PENDING THE DECISION ON THE PATIENT'S APPLICATION.IN ADDITION, IF A PATIENT IS ATTEMPTING TO QUALIFY FOR ELIGIBILITY UNDER THIS FINANCIAL ASSISTANCE AND IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE HOSPITAL BY NEGOTIATING A REASONABLE PAYMENT PLAN OR MAKING REGULAR PARTIAL PAYMENTS OF A REASONABLE AMOUNT, THE HOSPITAL SHALL NOT SEND THE UNPAID BILL TO ANY COLLECTION AGENCY.THE HOSPITAL SHALL NOT, IN DEALING WITH PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY, USE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.

PART VI, LINE 5:
ALL OF THE HOSPITALS CONDUCT OUTREACH PROGRAMS AS FURTHER DISCUSSED IN ITS CHNA REPORTS.

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

SCHEDULE H, PART VI, LINE 2 - HUNTINGTON BEACH NEEDS ASSESSMENT
FOR THE CHNA THERE WERE 39 INDIVIDUALS FROM 22 COMMUNITY ORGANIZATIONS COLLABORATED TO IMPLEMENT A COMPREHENSIVE CHNA PROCESS FOCUSED ON IDENTIFYING AND DEFINING SIGNIFICANT HEALTH NEEDS, ISSUES, AND CONCERNS OF ORANGE COUNTY. INPUT WAS RECEIVED FROM PERSONS WHO REPRESENTED THE BROAD INTEREST OF THE COMMUNITY IN ORDER TO PROVIDE DIRECTION FOR THE COMMUNITY AND HOSPITAL TO CREATE A PLAN TO IMPROVE THE HEALTH OF THE COMMUNITIES.IN ADDITION, TO GET THE INPUT OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AGENCIES REPRESENTING THOSE POPULATIONS WERE INVITED TO THE FOCUS GROUPS, INTERVIEWS, AND SUMMITS.

PART VI, LINE 2:
SOUTHERN REGIONAL NEEDS ASSESSMENTHEALTH NEEDS ARE GENERALLY ASSESSED THROUGH A STRATEGIC PLANNING PROCESS THAT LOOKS AT THE PRIMARY AND SECONDARY SERVICES AREAS FOR TRENDS IN AGE, INCOME, AND USE RATES FOR VARIOUS SERVICES AND HEALTH CHALLENGES. COMMUNITY NEEDS ARE ALSO BASED ON A NEEDS ASSESSMENT RELATED TO PHYSICIAN SPECIALTIES, FOR EXAMPLE THE SERVICE AREA HAS NEEDS FOR PRIMARY CARE PHYSICIANS. THE ORGANIZATION WORKS WITH LOCAL PHYSICIAN PRACTICES TO SHAPE THIS INFORMATION AND DETERMINE APPROPRIATE OUTREACH FOR PHYSICIAN RECRUITMENT. HEALTH NEEDS ARE INDIRECTLY ASSESSED BY ANALYZING TRENDS FROM SERVICES OFFERED AT THE HOSPITAL AND THE HEALTH STATUS OF THOSE PATIENTS.LANDMARK & RHODE ISLAND NEEDS ASSESSMENTLANDMARK MEDICAL CENTER AND REHABILITATION HOSPITAL OF RHODE ISLAND PARTICIPATE IN THE HEALTH EQUITY ZONE STEERING COMMITTEE, A DOH FUNDED COMMUNITY HEALTH EFFORT COMPRISED OF STAKEHOLDERS AND CONSUMERS FROM NORTHERN RHODE ISLAND. THIS MONTHLY INITIATIVE IS HOSTED AT LANDMARK AND PROVIDES A FORUM FOR DISCUSSION ON COMMUNITY NEED AND OPPORTUNITIES FOR COLLABORATION.ENCINO & SHERMAN OAKS NEEDS ASSESSMENTTHE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY ENCINO HOSPITAL AND SHERMAN OAKS HOSPITAL ARE ASSESSED IN A VARIETY OF WAYS INCLUDING FOCUS GROUPS, SURVEYS, AND DATA ANALYSIS. TO BETTER UNDERSTAND THE HEALTH NEEDS IN THE HOSPITAL SERVICE AREA, NUMEROUS STATE AND COUNTY SOURCES WERE REVIEWED.MONTCLAIR NEEDS ASSESSMENTTHE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY MONTCLAIR HOSPITAL MEDICAL CENTER ARE ASSESSED IN A VARIETY OF WAYS INCLUDING DIRECT INPUT FROM THE COMMUNITY DURING COMMUNITY EVENTS, COMMUNITY PHYSICIANS DURING OUTREACH OPPORTUNITIES, LOCAL POLICE AND FIRE DEPARTMENT AND CITY COUNCIL REPRESENTATION ON OUR BOARD OF DIRECTORS AND TELEPHONE SURVEYS OF PATIENTS AND FAMILIES.LA PALMA AND HUNTINGTON BEACH HOSPITAL NEEDS ASSESSMENTFOR THE CHNA THERE WERE 39 INDIVIDUALS FROM 22 COMMUNITY ORGANIZATIONS COLLABORATED TO IMPLEMENT A COMPREHENSIVE CHNA PROCESS FOCUSED ON IDENTIFYING AND DEFINING SIGNIFICANT HEALTH NEEDS, ISSUES, AND CONCERNS OF ORANGE COUNTY. INPUT WAS RECEIVED FROM PERSONS WHO REPRESENTED THE BROAD INTEREST OF THE COMMUNITY IN ORDER TO PROVIDE DIRECTION FOR THE COMMUNITY AND HOSPITAL TO CREATE A PLAN TO IMPROVE THE HEALTH OF THE COMMUNITIES.IN ADDITION, TO GET THE INPUT OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AGENCIES REPRESENTING THOSE POPULATIONS WERE INVITED TO THE FOCUS GROUPS, INTERVIEWS, AND SUMMITS.COSHOCTON NEEDS ASSESSMENTTHE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY COSHOCTON REGIONAL MEDICAL CENTER (CRMC) WERE ASSESSED BY CONDUCTING SURVEYS WITH MEMBERS OF THE COMMUNITY WHO HAVE A UNIQUE AND SPECIALIZED UNDERSTANDING OF THE NEEDS OF THE POPULATION. CRMC TARGETED THOSE WITH EXPERIENCE IN PUBLIC HEALTH, THE UNINSURED POPULATION, LOW-INCOME POPULATIONS, MINORITY POPULATIONS AND THOSE WHO ARE STRUGGLING WITH CHRONIC DISEASES. CRMC ALSO COLLABORATES WITH LOCAL HEALTH AND SOCIAL SERVICES GROUPS WHOSE REPRESENTATIVES PROVIDE CRITICAL INSIGHT INTO THE FACTORS THAT AFFECT THE HEALTH OF THE VARIOUS POPULATION SEGMENTS.SUBURBAN NEEDS ASSESSMENTTHE HEALTHCARE NEEDS OF THE COMMUNITIES SERVED BY SUBURBAN COMMUNITY HOSPITAL WERE ASSESSED BY CONDUCTING SURVEYS, FOCUS GROUP AND INTERVIEWS WITH COMMUNITY LEADERS WITH SPECIAL KNOWLEDGE OF MEDICALLY UNDERSERVED POPULATIONS IN THE HOSPITAL SERVICE AREA.PRIMARY METHODS INCLUDED: - INDIVIDUAL INTERVIEWS WITH COMMUNITY MEMBERS- COMMUNITY HEALTH SUMMIT SECONDARY METHODS INCLUDED:- PUBLIC HEALTH DATA - DEATH STATISTICS, COUNTY HEALTH RANKINGS, CANCER INCIDENCE- DEMOGRAPHICS AND SOCIOECONOMICS POPULATION, POVERTY, UNINSURED, UNEMPLOYMENT- PSYCHOGRAPHICS - BEHAVIOR MEASURED BY SPENDING AND MEDIA PREFERENCESPAMPA NEEDS ASSESSMENTTHE HEALTH CARE NEEDS TO THE COMMUNITIES SERVED BY PRIME HEALTHCARE SERVICES - PAMPA LLC ARE ASSESSED IN A VARIETY OF WAYS INCLUDING QUESTIONNAIRES THAT ARE MAILED OUT TO THE ENTIRE COMMUNITY AND HANDED OUT AT THE FACILITY.GLENDORA NEEDS ASSESSMENTTHIS COMMUNITY HEALTH NEEDS ASSESSMENT WAS DIRECTED BY GLENDORA COMMUNITY HOSPITAL TO ADDRESS NEEDS FOR RESIDENTS IN THE NEARBY AREA, ACCOUNTING FOR NEARLY 80% OF ALL DISCHARGES FROM THE HOSPITAL IN 2018. ADDITIONAL DATA WAS EXTRACTED FROM VARIOUS COMMUNITY AND GOVERNMENT SOURCES WHICH INCLUDE AREAS OUTSIDE OF GCH'S PRIMARY SERVICE AREA, BUT CONTRIBUTE A SMALL PORTION OF THE HOSPITAL'S UTILIZATION.THE CHNA PROCESS INCORPORATES THREE MAJOR AREAS OF STUDY AND ANALYSIS. THESE INCLUDE:- QUANTITATIVE DATA REVIEW AND ANALYSIS, IN WHICH DATA PROVIDED BY NUMEROUS SOURCES ARE REVIEWED, ANALYZED, AND SUMMARIZED.THE SALIENT CONCLUSIONS DRAWN ARE REPORTED. THESE PROCESSES CONCENTRATE ON USE RATES, DISEASE INCIDENCE, POPULATION RATIOS, AND OTHER NUMERICALLY ORGANIZED DATA. IT SHOULD BE NOTED THAT THE VARIETY OF SOURCES USED INCLUDE MANY DEFINITIONS AND TIME PERIODS. OFTEN DATA PRESENTED MAY NOT RELATE TO THE SAME TIME PERIOD OR POPULATION AS OTHER PRESENTATIONS. SOURCES INCLUDED THE LOS ANGELES COUNTY DEPARTMENT OF HEALTH'S (LADPH) KEY INDICATORS OR HEALTH (KIH), LADPH'S EPIDEMIOLOGY REPORTS, US CENSUS BUREAU DATA, AND OTHER SOURCES FOR AREA-SPECIFIC DATA.- QUALITATIVE DATA IN THE FORM OF WRITTEN SURVEYS. THESE ARE DISTRIBUTED BY PARTICIPATING HOSPITALS, AND THE RESPONSES CONSOLIDATED INTO ONE REPORT, SO SERVICE-AREA-SPECIFIC ANALYSIS WAS NOT POSSIBLE. THE RESULTS ARE LARGELY INTERPRETED TO CROSS-CHECK THE RESPONSES FROM THE KEY INFORMANTS INVOLVED VIA FOCUS GROUPS AND PHONE INTERVIEWS. THE HIGHLY-DETAILED SURVEYS ALSO PRODUCED INFORMATION ABOUT HEALTH STATUS OF THE RESPONDENTS, AS WELL AS THEIR VIEWS ON HEALTH NEEDS IN THE OVERALL AREA.- REPRESENTATIVES OF AREA HEALTH AGENCIES, SOCIAL SERVICE PROVIDERS, AND LOCAL GOVERNMENT ORGANIZATIONS (COLLECTIVELY, KEY INFORMANTS) WERE INVITED TO SEVERAL FOCUS GROUP SESSIONS TO OFFER THEIR OPINIONS AS TO COMMUNITY HEALTH NEEDS. THOSE KEY INFORMANTS WHO COULD NOT MAKE ANY OF THE SESSIONS WERE INTERVIEWED BY PHONE AND THEIR RESPONSES INCORPORATED INTO THE RESPONSES GENERATED BY THE FOCUS GROUPS.EACH METHODOLOGY GENERATES USEFUL DATA IN DIFFERENT WAYS, AND THE CONCLUSIONS DRAWN ADDRESS EACH METHODOLOGY AS APPROPRIATE. IT SHOULD BE NOTED THAT THERE ARE THREE DIFFERENT SERVICE AREAS ADDRESSED IN THIS ANALYSIS

SCHEDULE H, PART VI, LINE 4 - ENCINO COMMUNITY INFORMATION
ENCINO HOSPITAL MEDICAL CENTER PRIMARY SERVICE AREA COVERS 11 ZIP CODES IN THE SAN FERNANDO VALLEY AREA OF NORTHERN LOS ANGELES COUNTY, AND IS HOME TO MORE THAN 278,000 RESIDENTS. DATA GATHERED FROM THE 2010-2017 U.S. CENSUS AMERICAN COMMUNITY SURVEY ESTIMATES SHOW THAT MALE AND FEMALE POPULATIONS ARE SPLIT ALMOST EQUALLY.THE EHMC PSA SHOWS THE GREATEST CONCENTRATION OF RESIDENTS IN THE WORKING AGES (25-64) COMPARED TO SPA 2 OR LOS ANGELES COUNTY, AND CORRESPONDINGLY LOWER PROPORTIONS OF RESIDENTS IN OTHER GROUPS.OUT OF THE TOTAL ENCINO HOSPITAL MEDICAL CENTER PSA POPULATION (278,668), 11% ARE ADULTS 65 YEAR OR OLDER. ABOUT 3% (8,859) ARE OLDER ADULTS AGES 80 PLUS.

PART VI, LINE 3:
"IN ORDER TO ENSURE THAT PATIENTS ARE AWARE OF THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY, THE HOSPITAL SHALL WIDELY DISSEMINATE THE EXISTENCE AND TERMS OF THIS POLICY THROUGHOUT ITS SERVICE AREA. IN ADDITION TO OTHER APPROPRIATE EFFORTS TO INFORM THE COMMUNITY ABOUT THE POLICY IN A WAY TARGETED TO REACH COMMUNITY MEMBERS MOST LIKELY TO NEED FINANCIAL ASSISTANCE, THE FOLLOWING ACTIONS SHALL BE TAKEN:A. WRITTEN NOTICE TO ALL PATIENTSEACH PATIENT WHO IS SEEN AT A PRIME HEALTHCARE FOUNDATION FACILITY, WHETHER ADMITTED OR NOT, SHALL RECEIVE THE PLAIN LANGUAGE SUMMARY. THE NOTICE SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.B. POSTING OF NOTICESTHE NOTICE OF HOSPITAL FINANCIAL AID"" SHALL BE CLEARLY AND CONSPICUOUSLY POSTED IN LOCATIONS THAT ARE VISIBLE TO THE PATIENTS IN THE FOLLOWING AREAS: (1) EMERGENCY DEPARTMENT; (2) BILLING OFFICE; (3) ADMISSIONS OFFICE; (4) OTHER OUTPATIENT SETTINGS; AND (5) THE HOSPITAL'S WEBSITE. THE NOTICES SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.C. NOTICES TO ACCOMPANY BILLING STATEMENTS EVERY POST-DISCHARGE STATEMENT SHALL INCLUDE A COPY OF THE NOTICE REGARDING THE CHARITY CARE & DISCOUNTED PAYMENT PROGRAM PROVIDED BY PRIME HEALTHCARE FOUNDATION. EACH BILL THAT IS SENT TO A PATIENT WHO HAS NOT PROVIDED PROOF OF COVERAGE BY A THIRD PARTY AT THE TIME CARE IS PROVIDED OR UPON DISCHARGE MUST INCLUDE A STATEMENT OF CHARGES FOR SERVICES RENDERED BY THE HOSPITAL.D. AVAILABILITY OF FINANCIAL ASSISTANCE DOCUMENTSTHE HOSPITAL SHALL POST A COPY OF ITS FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY, AND THE FINANCIAL ASSISTANCE APPLICATION ON ITS WEBSITE AND MAKE ALL SUCH DOCUMENTS AVAILABLE FOR FREE DOWNLOAD. SUCH DOCUMENTS SHALL BE AVAILABLE IN THE EMERGENCY ROOM AND ADMISSIONS OFFICE AND BY MAIL UPON REQUEST. THE DOCUMENTS SHALL BE PROVIDED IN NON-ENGLISH LANGUAGES SPOKEN BY A SUBSTANTIAL NUMBER OF THE PATIENTS SERVED BY THE HOSPITAL.E. ACCESSIBILITY TO LIMITED ENGLISH PROFICIENT INDIVIDUALSTHE HOSPITAL SHALL MAKE TRANSLATIONS OF THIS POLICY, THE PLAIN LANGUAGE SUMMARY, AND THE FINANCIAL ASSISTANCE APPLICATION AVAILABLE IN ANY LANGUAGE THAT IS THE PRIMARY LANGUAGE OF THE LESSER OF ONE THOUSAND (1,000)INDIVIDUALS OR FIVE PERCENT (5%) OF THE POPULATION OF THE COMMUNITIES SERVED BY THE HOSPITAL."

SCHEDULE H, PART VI, LINE 4 - MONTCLAIR COMMUNITY INFORMATION
SAN BERNARDINO COUNTY WAS THE PRIMARY FOCUS OF THE CHNA DUE TO THE SERVICE AREA OF MONTCLAIR HOSPITAL MEDICAL CENTER. USED AS THE STUDY AREA, SAN BERNARDINO COUNTY PROVIDED 70% OF INPATIENT DISCHARGES. THE COMMUNITY INCLUDES MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS WHO LIVE IN THE GEOGRAPHIC AREAS FROM WHICH MONTCLAIR HOSPITAL MEDICAL CENTER DRAWS ITS PATIENTS. ALL PATIENTS WERE USED TO DETERMINE THE SERVICE AREA WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER MONTCLAIR HOSPITAL MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY.THE IMPLEMENTATION PLAN WILL FOCUS ON THE SOUTHWEST CORNER OF SAN BERNARDINO COUNTY WHERE THE MAJORITY OF PATIENTS AND POPULATION ARE LOCATED. THE COUNTY OF SAN BERNARDINO IS THE LARGEST COUNTY IN THE U.S. BY AREA. IT IS CLOSE TO THE SIZE OF WEST VIRGINIA AND LARGER THAN EACH OF THE NINE SMALLEST STATES. IT COVERS 20,105 SQUARE MILES. IT IS THE FIFTH MOST POPULOUS COUNTY IN CA AND THE 14TH MOST POPULOUS IN THE U.S. HOWEVER VAST PARTS OF THE COUNTY CONTAIN THINLY POPULATED MOUNTAINS AND DESERTS. ALTHOUGH THE ENTIRE COUNTY'S HEALTH WILL BE ASSESSED, IMPROVEMENT EFFORTS WILL BE FOCUSED ON THE SOUTHWEST PORTION OF THE COUNTY.

SCHEDULE H, PART VI, LINE 4 - COSHOCTON COMMUNITY INFORMATION
THE PRIMARY SERVICE AREA OF COSHOCTON REGIONAL HEALTH CENTER IS DEFINED AS THE COUNTY OF COSHOCTON, ENCOMPASSING A POPULATION OF 36,569 PEOPLE IN THE EASTERN CENTRAL SECTION OF OHIO; 91.86% OF THE HOSPITAL'S DISCHARGED PATIENTS ARE RESIDENTS OF COSHOCTON COUNTY. COSHOCTON COUNTY IS A RURAL COMMUNITY WHOSE POPULATION OF 36,569 (U.S. CENSUS BUREAU, 2015 ESTIMATE) IS DISTRIBUTED WITHIN A LAND MASS OF 564.1 SQUARE MILES.MEDIAN INCOME IS THE ACCEPTED MEASUREMENT OF HOUSEHOLD WEALTH USED TO MAKE COMPARISONS BETWEEN GEOGRAPHIC REGIONS. THE MEDIAN IS DETERMINED BY PLACING ALL EARNINGS IN VALUE ORDER AND FINDING THE EXACT MIDDLE NUMBER. THIS DIVIDES THE HOUSEHOLDS INTO TWO DISTINCT SECTIONS, WITH EXACTLY HALF FALLING BELOW THE MEDIAN AND EXACTLY HALF FALLING ABOVE. THIS IS CONSIDERED A MORE ACCURATE MEASUREMENT THAN AN AVERAGE, SINCE THE MEDIAN IS NOT STATISTICALLY AFFECTED BY DRAMATICALLY HIGH OR LOW INCOME LEVELS. COSHOCTON COUNTY CONTINUES TO LAG BEHIND BOTH OHIO AND THE UNITED STATES IN TERMS OF ITS MEDIAN INCOME LEVEL. ACCORDING TO THE MOST RECENT AVAILABLE DATA, COSHOCTON COUNTY FELL SHORT OF OHIO'S MEDIAN INCOME OF $49,349 AND THE NATIONAL MEDIAN INCOME OF $53,657 WITH A MEDIAN INCOME OF $41,547 IN 2014.

PART VI, LINE 4:
"SOUTHERN REGIONAL MEDICAL CENTER:SOUTHERN REGIONAL MEDICAL CENTER'S PRIMARY SERVICE AREA (PSA) IS DEFINED AS THE AREA FROM WHICH AT LEAST 75% OF THE HOSPITAL'S INPATIENT ADMISSIONS ORIGINATE. THIS DEFINITION IS CONSISTENT WITH STARK LAW PHYSICIAN RECRUITMENT REGULATIONS. (STARK LAW IS SECTION 1877 OF THE SOCIAL SECURITY ACT (42 U.S.C. 1395NN), ALSO KNOWN AS THE PHYSICIAN SELF-REFERRAL LAW.)DEMOGRAPHIC INFORMATION IS PROVIDED BY ZIP CODE WITH THE HOSPITAL'S PSA ENCOMPASSING THIRTEEN (13) ZIP CODES IN CLAYTON, SOUTH FULTON, AND HENRY COUNTIES. DURING THE CALENDAR YEAR 2020, THERE WERE 9,608 INPATIENT DISCHARGES RECORDED. THE 13 ZIP CODES ACCOUNT FOR NEARLY 76% OF SOUTHERN REGIONAL'S INPATIENT DISCHARGES AND, THEREFORE, DEFINE THE HOSPITAL'S PSA. WHILE THE GREATEST PERCENTAGE OF THE SRMC SERVICE AREA POPULATION COMES FROM CLAYTON COUNTY (30236, 30238, 30260, 30273, 30274, 30294, 30296, 30297), THE SERVICE AREA ALSO ENCOMPASSES 5 ZIP CODES FROM FULTON COUNTY (30291, 30349) AND HENRY COUNTY (30228, 30253, 30281).BETWEEN 2019 2021, MANY OF SOUTHERN REGIONAL MEDICAL CENTER'S PSA COUNTIES AND PSA ZIP CODES EXPERIENCED SIGNIFICANT POPULATION GROWTH. DURING THIS TIME SPAN, SRMC PSA COUNTIES' POPULATION GREW BY 58,464 WITH A GROWTH RATE OF 11%.THE POPULATION IN CLAYTON COUNTY AND SURROUNDING ZIP CODES FOR SOUTHERN REGIONAL'S SERVICE AREA ARE MORE DIVERSE, HAVE SUBSTANTIALLY LOWER INCOME EARNINGS, AND FACE GREATER CHALLENGES IN OBTAINING ACCESS TO CARE THAN THE AVERAGE US POPULATION. ADDITIONALLY, THE NUMBER OF UNINSURED INDIVIDUALS IN CLAYTON COUNTY IS DOUBLE THE NATIONAL AVERAGE 18.9% IN CLAYTON COUNTY IN COMPARISON TO 9.2% IN THE U.S. IT NEEDS TO BE NOTED THAT BETWEEN 2018 AND 2019, THE PERCENTAGE OF UNINSURED RESIDENTS IN CLAYTON COUNTY GREW SUBSTANTIALLY AND THE ASSUMPTION FOR 2020 AND 2021 IS THAT THE PERCENTAGE OF UNINSURED RESIDENTS IN THE COUNTY GREW. COMPARED TO INDIVIDUALS WHO HAVE HEALTH COVERAGE, THE UNINSURED ARE MORE LIKELY TO SKIP PREVENTIVE SERVICES AND FORGO ROUTINE HEALTHCARE VISITS ALTOGETHER RESULTING IN PATIENTS PRESENTING IN THE HOSPITAL WITH MULTIPLE AND HIGHER MEDICAL ACUITY LEVELS.LANDMARK MEDICAL CENTER:LANDMARK MEDICAL CENTER SERVES THE FOLLOWING ZIP CODES, PRIMARILY IN PROVIDENCE COUNTY, RHODE ISLAND: 02895 WOONSOCKET, 02896 NORTH SMITHFIELD, 02917 SMITHFIELD, 02876 BURRILLVILLE, 02830 HARRISVILLE, 02859 PASCOAG, 02019 BELLINGHAM, MA, 02703 ATTLEBORO, MA, 02760 NORTH ATTLEBORO, MA, 01516 DOUGLAS, MA, 02038 FRANKLIN, MA, 01756 MENDON, MA, 02828 GREENVILLE, 02865 LINCOLN, 02838 MANVILLE, 02864 CUMBERLAND, 02829 GLOCESTER, 02814 CHEPACHET, 01504 BLACKSTONE, MA, 01529 MILLVILLE, MA, 02671 NORTH ATTLEBORO, MA, 02762 PLAINVILLE, MA, 02035 FOXBORO, MA, 02048 MANSFIELD, MA, 01569 UXBRIDGE, MA, AND 02093 WRENTHAM, MA.THE POPULATION ACROSS LANDMARK MEDICAL CENTER'S SERVICE AREA IS PRIMARILY WHITE WITH LESS THAN 10% OF RESIDENTS IDENTIFYING WITH ANOTHER RACE OR ETHNICITY. THE MEDIAN AGE OF RESIDENTS IS HIGHER THAN THE STATE, AS IS THE MEDIAN HOUSEHOLD INCOME. IN AGGREGATE, BLACK/AFRICAN AMERICAN AND HISPANIC/LATINO RESIDENTS HAVE A LOWER MEDIAN INCOME THAN ASIAN OR WHITE RESIDENTS.SHERMAN OAKS:SHERMAN OAKS HOSPITAL (SOH) SERVICE AREA COVERS 11 ZIP CODES IN THE SAN FERNANDO VALLEY AREA OF NORTHERN LOS ANGELES COUNTY AND IS HOME TO MORE THAN 278,000 RESIDENTS. DATA GATHERED FROM THE 2010-2017 U.S. CENSUS AMERICAN COMMUNITY SURVEY ESTIMATES SHOW THAT MALE AND FEMALE POPULATIONS ARE SPLIT ALMOST EQUALLY. THE HOSPITAL'S SERVICE AREA SPANS CITIES, COMMUNITIES, AND UNINCORPORATED AREAS IN THE SAN FERNANDO VALLEY AND THE LOS ANGELES COUNTY. THE SAN FERNANDO VALLEY IS IN THE SERVICE PLANNING AREA 2 (SPA 2) OF LOS ANGELES COUNTY. WHILE DEFINITIONS CAN VARY REGARDING SERVICE AREAS, OVER HALF OF ALL DISCHARGES FROM SOH ORIGINATED FROM ONLY 11 ZIP CODES. CONCENTRATED ALONG THE SOUTHERN EDGE OF THE SAN FERNANDO VALLEY, THEY INCLUDE ENCINO (91436) NORTH HOLLYWOOD (91605, 91606), PANORAMA CITY (91402), SHERMAN OAKS (91403, 91423), STUDIO CITY (91604), VALLEY VILLAGE (91607), AND VAN NUYS (91401, 91403, 91405, 91406, 91411). THE SOH PRIMARY SERVICE AREA SHOWS THE GREATEST CONCENTRATION OF RESIDENTS IN THE WORKING AGES (25-64) AND LOWER PROPORTIONS OF RESIDENTS IN OTHER GROUPS. LOW-INCOME LEVELS CREATE OBSTACLES TO GAINING ACCESS TO MEDICAL SERVICES, PURCHASING HEALTHY FOODS, AND OTHER NECESSITIES. JUST OVER 6% OF SHERMAN OAKS HOSPITAL SERVICE AREA EARNS LESS THAN $10,000. THE ETHNIC COMPOSITION OF THE SHERMAN OAKS HOSPITAL PRIMARY SERVICE AREA IS LARGELY WHITE (49%) FOLLOWED BY HISPANIC/LATINO (37%), AFRICAN-AMERICAN (4%), AND TWO OR MORE RACES (3%). ALL OTHER GROUPS REPRESENT LESS THAN ONE PERCENT OF ALL RESIDENTS. EDUCATION PLAYS A VERY SIGNIFICANT ROLE IN ALL ASPECTS OF LIFE, INCLUDING MAINTAINING A HEALTHY LIFESTYLE. IN THE SHERMAN OAKS HOSPITAL PRIMARY SERVICE AREA, THE HIGHEST PERCENTAGE OF ADULTS 25 YEARS OR OLDER ARE THOSE WITH A BACHELOR'S DEGREE.HUNTINGTON BEACH HOSPITAL:ORANGE COUNTY WAS THE PRIMARY FOCUS OF THE CHNA DUE TO THE SERVICE AREA OF THE HOSPITAL. IN ORDER TO DECIDE THE AREA, THE PATIENTS OF THE HOSPITAL THAT WERE DISCHARGED IN 2021 WERE EXAMINED AND 30% OF INPATIENT DISCHARGES FOR LPIH IN 2021 CAME FROM ORANGE COUNTY. THE COMMUNITY INCLUDES MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS WHO LIVE IN THE GEOGRAPHIC AREA FROM WHICH THE HOSPITAL DRAWS ITS PATIENTS. ALL PATIENTS WERE USED TO DETERMINE THE SERVICE AREA WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.LA PALMA INTERCOMMUNITY HOSPITAL:ORANGE COUNTY WAS THE PRIMARY FOCUS OF THE CHNA DUE TO THE SERVICE AREA OF THE HOSPITAL. IN ORDER TO DECIDE THE AREA, THE PATIENTS OF THE HOSPITAL THAT WERE DISCHARGED IN 2021 WERE EXAMINED AND 30% OF INPATIENT DISCHARGES FOR LPIH IN 2021 CAME FROM ORANGE COUNTY. THE COMMUNITY INCLUDES MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS WHO LIVE IN THE GEOGRAPHIC AREA FROM WHICH THE HOSPITAL DRAWS ITS PATIENTS. ALL PATIENTS WERE USED TO DETERMINE THE SERVICE AREA WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.GLENDORA COMMUNITY HOSPITAL:THE CHNA PROCESS INVOLVES ANALYSIS OF SEVERAL AREAS THAT ARE GERMANE TO THE PROVISION OF SERVICES TO THE GCH ""COMMUNITY"". THE MOST DIRECTLY APPLICABLE IS THE AREA IMMEDIATELY SURROUNDING THE HOSPITAL: THE CITIES OF AZUSA (ZIP CODE 91702), GLENDORA (91740), BALDWIN PARK (91706), DUARTE (91010), AND ONE POMONA ZIP CODE (91768) ACCOUNT FOR 45% OF ALL DISCHARGES IN 2017. THESE ZIP CODES CONSTITUTE THE PRIMARY SERVICE AREA (PSA). WHILE THE ZIP CODES LISTED IN THE PSA ACCOUNT FOR ALMOST HALF OF ALL DISCHARGES, A SECOND GLENDORA ZIP CODE (91741) AND SURROUNDING CITIES INCLUDING COVINA (91722), EL MONTE (91732), POMONA (91766), SAN DIMAS (91773) AND WEST COVINA (91790) ACCOUNT FOR ANOTHER 34%. THESE ARE CLASSIFIED AS THE SECONDARY SERVICE AREA (SSA). THE TWO SERVICE AREAS TOGETHER ACCOUNT FOR 79% OF ALL DISCHARGES FROM GCH, AND TOGETHER THEY ARE NAMED THE TOTAL SERVICE AREA (TSA). NO ZIP CODES OUTSIDE OF THESE AREAS CONTRIBUTED MORE THAN 1% OF TOTAL DISCHARGES.REHABILITATION HOSPITAL OF RHODE ISLAND:APPROXIMATELY 325 PATIENTS PER YEAR RELY ON INPATIENT CARE AT REHABILITATION HOSPITAL OF RHODE ISLAND (RHRI). REFERRAL PATTERNS INCLUDE STATEWIDE AND OTHER NEW ENGLAND STATES SUCH AS MASSACHUSETTS AND MAINE. HOWEVER, THE PREDOMINANCE OF ADMISSIONS COME FROM THE NORTHERN RHODE ISLAND COMMUNITY. OUTPATIENT THERAPY SERVES APPROXIMATELY 3,338 PATIENTS PER YEAR AND DRAWS MOSTLY FROM NORTHERN RHODE ISLAND AND NEARBY MASSACHUSETTS."

SCHEDULE H, PART VI, LINE 4 - SUBURBAN COMMUNITY INFORMATION
MONTGOMERY COUNTY WAS THE PRIMARY FOCUS OF THE CHNA DUE TO THE SERVICE AREA OF SUBURBAN COMMUNITY HOSPITAL. USED AS THE STUDY AREA, MONTGOMERY COUNTY PROVIDED 88% OF 2019 INPATIENT DISCHARGES. THE COMMUNITY INCLUDES MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS WHO LIVE IN THE GEOGRAPHIC AREAS FROM WHICH SUBURBAN COMMUNITY HOSPITAL DRAWS PATIENTS. ALL PATIENTS WERE USED TO DETERMINE THE SERVICE AREA WITHOUT REGARD TO INSURANCE COVERAGE OR ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER SUBURBAN COMMUNITY HOSPITAL'S FINANCIAL ASSISTANCE POLICY.- THE POPULATION OF MONTGOMERY COUNTY IS PROJECTED TO INCREASE FROM 2019 TO 2024 (0.53% PER YEAR). PENNSYLVANIA IS PROJECTED TO INCREASE 0.23% PER YEAR. THE U.S. IS PROJECTED TO INCREASE 0.77% PER YEAR. - MONTGOMERY COUNTY HAD A HIGHER MEDIAN AGE (41.9 MEDIAN AGE) THAN PA (41.5) AND THE U.S. (38.5). IN MONTGOMERY COUNTY THE PERCENTAGE OF THE POPULATION 65 AND OVER WAS 18.7%, HIGHER THAN THE U.S. POPULATION 65 AND OVER AT 16.0%.- MONTGOMERY COUNTY MEDIAN HOUSEHOLD INCOME AT $90,762 WAS HIGHER THAN PA ($59,112) AND THE U.S. ($60,548). THE RATE OF POVERTY IN MONTGOMERY COUNTY WAS 5.9% WHICH WAS LOWER THAN PA (12.2%) AND THE U.S. (13.1%).- THE HOUSEHOLD INCOME DISTRIBUTION OF MONTGOMERY COUNTY WAS 47% HIGHER INCOME (OVER $100,000), 44% MIDDLE INCOME, AND 11% LOWER INCOME (UNDER $25,000).- THE HEALTH CARE INDEX MEASURES HOW MUCH HOUSEHOLDS SPENT OUT-OF-POCKET ON HEALTH CARE SERVICES INCLUDING INSURANCE PREMIUMS. THE U.S. INDEX WAS 100. MONTGOMERY COUNTY WAS 139, INDICATING 39% MORE SPENT OUT OF POCKET THAN THE AVERAGE U.S. HOUSEHOLD ON MEDICAL CARE (DOCTOR'S OFFICE VISITS, PRESCRIPTIONS, HOSPITAL VISITS) AND INSURANCE PREMIUMS.- THE RACIAL AND ETHNIC MAKE-UP OF MONTGOMERY COUNTY WAS 77% WHITE, 10% BLACK, 6% HISPANIC ORIGIN, 3% MIXED RACE, 8% ASIAN/PACIFIC ISLANDER, AND 2% OTHER. (THESE PERCENTAGES TOTAL TO OVER 100% BECAUSE HISPANIC IS AN ETHNICITY, NOT A RACE.)- FOR BUSINESS PROFILE, 55.8% PERCENT OF EMPLOYEES IN MONTGOMERY COUNTY WERE EMPLOYED IN: HEALTH CARE & SOCIAL ASSISTANCE (18.0%), RETAIL TRADE (12.7%), PROFESSIONAL, SCIENTIFIC & TECH SERVICES (10.1%), MANUFACTURING (8.3%), AND ACCOMMODATION & FOOD SERVICE (6.7%)- MONTGOMERY COUNTY'S JULY 2020 PRELIMINARY UNEMPLOYMENT WAS 12.2% COMPARED TO 12.5% FOR PENNSYLVANIA AND 10.2% FOR THE U.S. THESE RATES ARE UP SIGNIFICANTLY FROM MARCH 2020 PRIOR TO THE SIGNIFICANT INCREASE IN COVID-19 CASES.

SCHEDULE H, PART VI, LINE 4 - PAMPA COMMUNITY INFORMATION
PAMPA IS CONSIDERED A RURAL SERVICE AREA SERVICING ALL SURROUNDING COUNTIES FOR 60+ MILES. PAMPA IS THE SECOND LARGEST CITY IN THE TEXAS PANHANDLE WITH PAMPA ALONE HAVING A POPULATION OF OVER 18,000 PEOPLE AND A MEDIAN AGE OF 36. PAMPA AND ITS SURROUNDING AREAS HAVE A WIDE ARRAY OF CULTURAL DIVERSITY WITH MANY HOMES HAVING 4+ HOUSEHOLD MEMBERS. A MAJORITY OF COMMUNITY MEMBERS ARE MIDDLE TO LOW INCOME AND EVEN BELOW POVERTY LEVEL.THE CHNA WAS CONDUCTED BY THE HOSPITAL DURING 2021 ON BEHALF OF THE APPROXIMATELY 83,706 (2017 US CENSUS) RESIDENTS OF ARMSTRONG, CARSON, COLLINGSWORTH, DONLEY, GRAY, HEMPHILL, HUTCHINSON, LIPSCOMB, OCHILTREE, ROBERTS AND WHEELER COUNTIES LOCATED IN THE PANHANDLE AREA OF TEXAS.THE HOSPITAL'S SERVICE AREA INCLUDES A RURAL AREA WHICH COVERS ROUGHLY 10,083 SQUARE MILES, WITH THE LOCAL ECONOMY AND SURROUNDING AREAS FOCUSED ON HEALTHCARE, AGRICULTURE, OIL AND GAS, TOURISM, AND RETAIL ACTIVITIES. GRAY COUNTY AND ITS POPULATION OF 22,962 REPRESENTS APPROXIMATELY 27% OF THE TOTAL SERVICE AREA POPULATION. MEDIAN AGE IN THE SERVICE AREA IS 38.3 YEARS. THE MEDIAN AGE FOR THE STATE OF TEXAS IS 34.3 YEARS. PERSONS FROM AGE 18 TO 64 REPRESENT THE LARGEST POPULATION RANGE (57.94%) FOR THE SERVICE AREA. THE YOUNGEST AGE RANGE IS 0 TO 4 YEARS, AND THIS RANGE COMPRISED 7.08% OF THE SERVICE AREA.