4A (Expenses $ 614844612 including grants of $ 302056) (Revenue $ 829281771)
SEE SCHEDULE H

BETHESDA NORTH HOSPITAL
"PART V, SECTION B, LINE 5: THE REGIONAL CHNA METHODOLOGY AND RESULTS WERE GENERATED THROUGH AN INCLUSIVE, COMPREHENSIVE, AND BALANCED DATA COLLECTION STRATEGY.COMPREHENSIVE DATA COLLECTION THE NEEDS ASSESSMENT UTILIZED A MIXED-METHOD APPROACH TO DATA COLLECTION INCLUDING SECONDARY QUANTITATIVE DATA AND PRIMARY QUANTITATIVE (REGIONAL CHNA COMMUNITY AND PROVIDER SURVEYS) AND QUALITATIVE (FOCUS GROUPS AND INTERVIEWS) DATA. SECONDARY DATA COLLECTION, WHICH BEGAN IN JANUARY OF 2021, SOUGHT TO UNDERSTAND THE GREATEST HEALTH CONDITIONS OF THE REGION, INCLUDING PREVALENCE AND IMPACT ON COMMUNITY MEMBERS. THESE RESULTS INFORMED THE CREATION OF SURVEY ITEMS THAT WERE ORGANIZED AROUND A SET OF CO-CREATED RESEARCH QUESTIONS. EACH DATA COLLECTION STRATEGY ADHERED TO A RECRUITMENT PLAN TO ENSURE A REPRESENTATIVE SAMPLE OF COMMUNITY MEMBERS, VOICES OF MARGINALIZED POPULATIONS, AND PROVIDERS ACROSS THE HEALTH AND SOCIAL SERVICES SECTORS WERE CAPTURED.OVERALL, THE SCOPE OF DATA COLLECTION WAS ROBUST AND INFORMED THE RESULTS OF THIS REGIONAL CHNA. THIS INCLUDES:8,321 COMMUNITY SURVEYS AVAILABLE APRIL, 2021 THROUGH JUNE, 2021, IN FIVE LANGUAGES. WITHIN THIS SAMPLE, REPRESENTATION WAS SEEN ACROSS 26 COUNTIES, MALES, FEMALES, AGES 18-65+, BLACK/AFRICAN AMERICAN, MULTIRACIAL, ASIAN, AMERICAN INDIAN, ALASKAN NATIVE, WHITE, AND HISPANIC/LATINO POPULATIONS. 859 PROVIDER SURVEYS, AVAILABLE APRIL, 2021 THROUGH MAY, 2021, INCLUSIVE OF BEHAVIORAL HEALTH, EDUCATION, EMERGENCY MEDICAL SERVICES, FAITH-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, JUSTICE/CORRECTIONS, MEDICAL CARE (ADULT, GERIATRIC, PEDIATRIC) ORAL HEALTH, ORGANIZATIONS ADDRESSING HEALTH RELATED SOCIAL NEEDS AND SOCIAL DETERMINANTS OF HEALTH, PHARMACEUTICAL, AND PUBLIC HEALTH DEPARTMENTS. - PROVIDERS ALSO REPRESENTED ADMINISTRATION, DIRECT PATIENT CARE, ACADEMIC, SUPPORT STAFF, AND SUPERVISORS/MANAGEMENT. - PROVIDERS REPORTED SERVING A VARIETY OF POPULATIONS INCLUDING CHILDREN/YOUTH, PEOPLE WITH DISABILITIES, ETHNIC MINORITIES, PEOPLE EXPERIENCING HOMELESSNESS, PEOPLE IN THE JUSTICE SYSTEM, VETERANS, YOUNG ADULTS, LOW-INCOME POPULATIONS, AND LGBTQ+ POPULATIONS. 51 FOCUS GROUPS WITH 234 PEOPLE WERE HELD FROM MAY, 2021 THROUGH JULY, 2021, REPRESENTING ALL THREE MSAS. SPECIFICALLY, RECRUITMENT FOR THESE FOCUS GROUPS WERE BASED ON ADVISORY COMMITTEE IDENTIFICATION OF POPULATIONS WHO ARE TRADITIONALLY UNDERREPRESENTED, MARGINALIZED, OR EXPERIENCE GREATEST HEALTH DISPARITIES. - POPULATIONS REPRESENTED IN THESE FOCUS GROUPS INCLUDE ADULT MEN, THOSE EXPERIENCING FOSTER CARE OR FOSTER PARENTING, YOUTH AND ADULTS WITH DISABILITIES, ETHNIC, CULTURAL AND LANGUAGE MINORITIES, FIRST AND SECOND-GENERATION IMMIGRANTS, PEOPLE EXPERIENCING HOMELESSNESS, THOSE INVOLVED IN THE JUSTICE SYSTEM, LOW-INCOME FAMILIES AND INDIVIDUALS, PARENTS, VETERANS, OLDER ADULTS, COMMUNITY MEMBERS WITH LIVED EXPERIENCE OF MENTAL HEALTH AND/OR ADDICTION, AND FIRST RESPONDERS. 38 STAKEHOLDER INTERVIEWS WERE HELD SEPTEMBER 27, 2021 THROUGH OCTOBER 31, 2021, ACROSS HEALTH AND SOCIAL SERVICE PROVIDERS, SPECIFICALLY WITH THE FOLLOWING BEING REPRESENTED: MENTAL HEALTH AND SUBSTANCE USE DISORDER (SUD), PUBLIC HEALTH, HOSPITAL SYSTEMS, FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS), TRANSPORTATION, HOUSING, FOOD ACCESS, HEALTHCARE ACCESS AND POLICY, SCHOOL-BASED HEALTH AND CHILDREN'S HEALTH CARE, MATERNAL AND INFANT CARE, LGBTQ+ HEALTH CARE, PHARMACY ACCESS, AND HEALTHCARE WORKFORCE DEVELOPMENT. DUE TO CHARACTER LIMITATION IN THE SOFTWARE, THESE DATA SOURCES COULD NOT BE INCLUDED IN THIS EXPLANATION. HOWEVER, APPENDIX C OF THE CHNA CONTAINS A DETAILED DESCRIPTION OF EACH DATA COLLECTION STRATEGY INCLUDING THE SAMPLING OR RECRUITMENT STRATEGY, AND ANALYSIS. THIS CAN BE FOUND ON PAGES 59 THROUGH 69 OF THE CHNA POSTED ON TRIHEALTH'S WEBSITE.DATA COLLECTION WAS ALSO COMPREHENSIVE IN THAT COMMUNITY MEMBERS, SOCIAL SERVICE PROVIDERS AND HEALTHCARE PROFESSIONALS WERE NOT ONLY ASKED ""WHAT COULD BE BETTER,"" BUT ALSO ""WHAT IS WORKING."" AS A RESULT, THIS REGIONAL CHNA INCLUDES A COLLECTION OF ASSETS AND RECOMMENDED POLICY AND PRACTICE INITIATIVES IDENTIFIED BY THE COMMUNITY THAT DIRECTLY TIE TO SYSTEM BARRIERS. THE SYMBOL (TO THE LEFT) CAN BE FOUND THROUGHOUT THIS REPORT. THIS SYMBOL IDENTIFIES A POLICY OR PRACTICE THAT ADDRESSES THE HEALTH NEED DISCUSSED IN THAT SECTION. NO DATA INFORMATION GAPS WERE IDENTIFIED WHILE CONDUCTING THE CHNA.CO-CREATED RESEARCH QUESTIONS TO CREATE THE GUIDING RESEARCH QUESTIONS, THE HEALTHCARE PROVIDERS PARTICIPATED IN A GROUP PROCESS, FACILITATED BY MEASUREMENT RESOURCES COMPANY (MRC), TO IDENTIFY THE EMERGING CURIOSITIES RELATED TO COMMUNITY HEALTH. THE EXERCISE FOCUSED ON MOVING BEYOND WHAT IS KNOWN THROUGH SECONDARY DATA AND ASKING QUESTIONS THAT CAN LEAD TO ACTION. THE FOLLOWING RESEARCH QUESTIONS WERE CO-CREATED BY THE ADVISORY COMMITTEE. 1. WHAT ARE THE GREATEST HEALTH NEEDS IN THE COMMUNITY? 2. HOW DO THE GREATEST HEALTH NEEDS DIFFER ACROSS COMMUNITIES AND COMMUNITY MEMBERS? 3. WHAT SOCIAL DETERMINANTS OF HEALTH (SDOH) DRIVE THESE GREATEST HEALTH NEEDS AMONG DIFFERENT COMMUNITIES AND COMMUNITY MEMBERS? 4. WHAT ARE THE SYSTEMIC BARRIERS OF THESE GREATEST HEALTH NEEDS AMONG DIFFERENT COMMUNITIES AND COMMUNITY MEMBERS? 5. WHAT ARE THE STRUCTURAL BARRIERS PROVIDERS FACE IN MEETING THE NEEDS OF THE COMMUNITY? 6. WHAT SPECIFIC ACTION STEPS CAN BE TAKEN BY VARIOUS PARTNERS TO ADDRESS THE ROOT CAUSES AND ACHIEVE MORE EQUITABLE HEALTH OUTCOMES? A. WHAT COMMUNITY-BASED EXPERTISE SHOULD BE LEVERAGED? B. WHAT BEST PRACTICES ARE BEING IMPLEMENTED? TO ANSWER THESE RESEARCH QUESTIONS, A FRAMEWORK WAS DEVELOPED FOR CENTERING EQUITY AND A COMPREHENSIVE UNDERSTANDING OF THE DRIVERS OF HEALTH CONDITIONS. FROM THIS FRAMEWORK, MRC AND THE ADVISORY COMMITTEE CO-CREATED A MIXED-METHOD DATA COLLECTION STRATEGY.EQUITY-CENTERED FRAMEWORK HEALTH EQUITY MEANS EVERYONE HAS A FAIR AND JUST OPPORTUNITY TO BE AS HEALTHY AS POSSIBLE. TO ACHIEVE AN UNDERSTANDING OF HEALTH EQUITY, EACH DATA COLLECTION STRATEGY INCLUDED MECHANISMS TO:1. HEAR THE VOICES OF COMMUNITY MEMBERS AND BE INTENTIONAL ABOUT ENGAGING COMMUNITY MEMBERS WHO ARE HISTORICALLY UNDERREPRESENTED IN COMMUNITY DATA. 2. ASK QUESTIONS ABOUT HEALTH EXPERIENCES, OUTCOMES, BARRIERS, AND SOLUTIONS. 3. DISAGGREGATE THE DATA BY REGION, AGE, RACE, AND GENDER AND OTHER CHARACTERISTICS WITH SUFFICIENT SAMPLE SIZES. 4. USE THE DATA TO CLEARLY IDENTIFY THE UNIQUE EXPERIENCES OF COMMUNITY MEMBERS."

BETHESDA BUTLER HOSPITAL
"PART V, SECTION B, LINE 5: THE REGIONAL CHNA METHODOLOGY AND RESULTS WERE GENERATED THROUGH AN INCLUSIVE, COMPREHENSIVE, AND BALANCED DATA COLLECTION STRATEGY.COMPREHENSIVE DATA COLLECTION THE NEEDS ASSESSMENT UTILIZED A MIXED-METHOD APPROACH TO DATA COLLECTION INCLUDING SECONDARY QUANTITATIVE DATA AND PRIMARY QUANTITATIVE (REGIONAL CHNA COMMUNITY AND PROVIDER SURVEYS) AND QUALITATIVE (FOCUS GROUPS AND INTERVIEWS) DATA. SECONDARY DATA COLLECTION, WHICH BEGAN IN JANUARY OF 2021, SOUGHT TO UNDERSTAND THE GREATEST HEALTH CONDITIONS OF THE REGION, INCLUDING PREVALENCE AND IMPACT ON COMMUNITY MEMBERS. THESE RESULTS INFORMED THE CREATION OF SURVEY ITEMS THAT WERE ORGANIZED AROUND A SET OF CO-CREATED RESEARCH QUESTIONS. EACH DATA COLLECTION STRATEGY ADHERED TO A RECRUITMENT PLAN TO ENSURE A REPRESENTATIVE SAMPLE OF COMMUNITY MEMBERS, VOICES OF MARGINALIZED POPULATIONS, AND PROVIDERS ACROSS THE HEALTH AND SOCIAL SERVICES SECTORS WERE CAPTURED.OVERALL, THE SCOPE OF DATA COLLECTION WAS ROBUST AND INFORMED THE RESULTS OF THIS REGIONAL CHNA. THIS INCLUDES:8,321 COMMUNITY SURVEYS AVAILABLE APRIL, 2021 THROUGH JUNE, 2021, IN FIVE LANGUAGES. WITHIN THIS SAMPLE, REPRESENTATION WAS SEEN ACROSS 26 COUNTIES, MALES, FEMALES, AGES 18-65+, BLACK/AFRICAN AMERICAN, MULTIRACIAL, ASIAN, AMERICAN INDIAN, ALASKAN NATIVE, WHITE, AND HISPANIC/LATINO POPULATIONS. 859 PROVIDER SURVEYS, AVAILABLE APRIL, 2021 THROUGH MAY, 2021, INCLUSIVE OF BEHAVIORAL HEALTH, EDUCATION, EMERGENCY MEDICAL SERVICES, FAITH-BASED ORGANIZATIONS, FEDERALLY QUALIFIED HEALTH CENTERS, JUSTICE/CORRECTIONS, MEDICAL CARE (ADULT, GERIATRIC, PEDIATRIC) ORAL HEALTH, ORGANIZATIONS ADDRESSING HEALTH RELATED SOCIAL NEEDS AND SOCIAL DETERMINANTS OF HEALTH, PHARMACEUTICAL, AND PUBLIC HEALTH DEPARTMENTS. - PROVIDERS ALSO REPRESENTED ADMINISTRATION, DIRECT PATIENT CARE, ACADEMIC, SUPPORT STAFF, AND SUPERVISORS/MANAGEMENT. - PROVIDERS REPORTED SERVING A VARIETY OF POPULATIONS INCLUDING CHILDREN/YOUTH, PEOPLE WITH DISABILITIES, ETHNIC MINORITIES, PEOPLE EXPERIENCING HOMELESSNESS, PEOPLE IN THE JUSTICE SYSTEM, VETERANS, YOUNG ADULTS, LOW-INCOME POPULATIONS, AND LGBTQ+ POPULATIONS. 51 FOCUS GROUPS WITH 234 PEOPLE WERE HELD FROM MAY, 2021 THROUGH JULY, 2021, REPRESENTING ALL THREE MSAS. SPECIFICALLY, RECRUITMENT FOR THESE FOCUS GROUPS WERE BASED ON ADVISORY COMMITTEE IDENTIFICATION OF POPULATIONS WHO ARE TRADITIONALLY UNDERREPRESENTED, MARGINALIZED, OR EXPERIENCE GREATEST HEALTH DISPARITIES. - POPULATIONS REPRESENTED IN THESE FOCUS GROUPS INCLUDE ADULT MEN, THOSE EXPERIENCING FOSTER CARE OR FOSTER PARENTING, YOUTH AND ADULTS WITH DISABILITIES, ETHNIC, CULTURAL AND LANGUAGE MINORITIES, FIRST AND SECOND-GENERATION IMMIGRANTS, PEOPLE EXPERIENCING HOMELESSNESS, THOSE INVOLVED IN THE JUSTICE SYSTEM, LOW-INCOME FAMILIES AND INDIVIDUALS, PARENTS, VETERANS, OLDER ADULTS, COMMUNITY MEMBERS WITH LIVED EXPERIENCE OF MENTAL HEALTH AND/OR ADDICTION, AND FIRST RESPONDERS. 38 STAKEHOLDER INTERVIEWS WERE HELD SEPTEMBER 27, 2021 THROUGH OCTOBER 31, 2021, ACROSS HEALTH AND SOCIAL SERVICE PROVIDERS, SPECIFICALLY WITH THE FOLLOWING BEING REPRESENTED: MENTAL HEALTH AND SUBSTANCE USE DISORDER (SUD), PUBLIC HEALTH, HOSPITAL SYSTEMS, FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS), TRANSPORTATION, HOUSING, FOOD ACCESS, HEALTHCARE ACCESS AND POLICY, SCHOOL-BASED HEALTH AND CHILDREN'S HEALTH CARE, MATERNAL AND INFANT CARE, LGBTQ+ HEALTH CARE, PHARMACY ACCESS, AND HEALTHCARE WORKFORCE DEVELOPMENT. DUE TO CHARACTER LIMITATION IN THE SOFTWARE, THESE DATA SOURCES COULD NOT BE INCLUDED IN THIS EXPLANATION. HOWEVER, APPENDIX C OF THE CHNA CONTAINS A DETAILED DESCRIPTION OF EACH DATA COLLECTION STRATEGY INCLUDING THE SAMPLING OR RECRUITMENT STRATEGY, AND ANALYSIS. THIS CAN BE FOUND ON PAGES 59 THROUGH 69 OF THE CHNA POSTED ON TRIHEALTH'S WEBSITE.DATA COLLECTION WAS ALSO COMPREHENSIVE IN THAT COMMUNITY MEMBERS, SOCIAL SERVICE PROVIDERS AND HEALTHCARE PROFESSIONALS WERE NOT ONLY ASKED ""WHAT COULD BE BETTER,"" BUT ALSO ""WHAT IS WORKING."" AS A RESULT, THIS REGIONAL CHNA INCLUDES A COLLECTION OF ASSETS AND RECOMMENDED POLICY AND PRACTICE INITIATIVES IDENTIFIED BY THE COMMUNITY THAT DIRECTLY TIE TO SYSTEM BARRIERS. THE SYMBOL (TO THE LEFT) CAN BE FOUND THROUGHOUT THIS REPORT. THIS SYMBOL IDENTIFIES A POLICY OR PRACTICE THAT ADDRESSES THE HEALTH NEED DISCUSSED IN THAT SECTION. NO DATA INFORMATION GAPS WERE IDENTIFIED WHILE CONDUCTING THE CHNA.CO-CREATED RESEARCH QUESTIONS TO CREATE THE GUIDING RESEARCH QUESTIONS, THE HEALTHCARE PROVIDERS PARTICIPATED IN A GROUP PROCESS, FACILITATED BY MEASUREMENT RESOURCES COMPANY (MRC), TO IDENTIFY THE EMERGING CURIOSITIES RELATED TO COMMUNITY HEALTH. THE EXERCISE FOCUSED ON MOVING BEYOND WHAT IS KNOWN THROUGH SECONDARY DATA AND ASKING QUESTIONS THAT CAN LEAD TO ACTION. THE FOLLOWING RESEARCH QUESTIONS WERE CO-CREATED BY THE ADVISORY COMMITTEE. 1. WHAT ARE THE GREATEST HEALTH NEEDS IN THE COMMUNITY? 2. HOW DO THE GREATEST HEALTH NEEDS DIFFER ACROSS COMMUNITIES AND COMMUNITY MEMBERS? 3. WHAT SOCIAL DETERMINANTS OF HEALTH (SDOH) DRIVE THESE GREATEST HEALTH NEEDS AMONG DIFFERENT COMMUNITIES AND COMMUNITY MEMBERS? 4. WHAT ARE THE SYSTEMIC BARRIERS OF THESE GREATEST HEALTH NEEDS AMONG DIFFERENT COMMUNITIES AND COMMUNITY MEMBERS? 5. WHAT ARE THE STRUCTURAL BARRIERS PROVIDERS FACE IN MEETING THE NEEDS OF THE COMMUNITY? 6. WHAT SPECIFIC ACTION STEPS CAN BE TAKEN BY VARIOUS PARTNERS TO ADDRESS THE ROOT CAUSES AND ACHIEVE MORE EQUITABLE HEALTH OUTCOMES? A. WHAT COMMUNITY-BASED EXPERTISE SHOULD BE LEVERAGED? B. WHAT BEST PRACTICES ARE BEING IMPLEMENTED? TO ANSWER THESE RESEARCH QUESTIONS, A FRAMEWORK WAS DEVELOPED FOR CENTERING EQUITY AND A COMPREHENSIVE UNDERSTANDING OF THE DRIVERS OF HEALTH CONDITIONS. FROM THIS FRAMEWORK, MRC AND THE ADVISORY COMMITTEE CO-CREATED A MIXED-METHOD DATA COLLECTION STRATEGY.EQUITY-CENTERED FRAMEWORK HEALTH EQUITY MEANS EVERYONE HAS A FAIR AND JUST OPPORTUNITY TO BE AS HEALTHY AS POSSIBLE. TO ACHIEVE AN UNDERSTANDING OF HEALTH EQUITY, EACH DATA COLLECTION STRATEGY INCLUDED MECHANISMS TO:1. HEAR THE VOICES OF COMMUNITY MEMBERS AND BE INTENTIONAL ABOUT ENGAGING COMMUNITY MEMBERS WHO ARE HISTORICALLY UNDERREPRESENTED IN COMMUNITY DATA. 2. ASK QUESTIONS ABOUT HEALTH EXPERIENCES, OUTCOMES, BARRIERS, AND SOLUTIONS. 3. DISAGGREGATE THE DATA BY REGION, AGE, RACE, AND GENDER AND OTHER CHARACTERISTICS WITH SUFFICIENT SAMPLE SIZES. 4. USE THE DATA TO CLEARLY IDENTIFY THE UNIQUE EXPERIENCES OF COMMUNITY MEMBERS."

BETHESDA NORTH HOSPITAL
PART V, SECTION B, LINE 6A: * THE CHRIST HOSPITAL MT. AUBURN, * CINCINNATI CHILDREN'S HOSPITAL (CINCINNATI CHILDREN'S BURNET CAMPUS, CINCINNATI CHILDREN'S LIBERTY CAMPUS, CINCINNATI CHILDREN'S COLLEGE HILL CAMPUS)* ADAMS COUNTY REGIONAL MEDICAL CENTER,* MARGARET MARY HEALTH, * KETTERING HEALTH NETWORK (FORT HAMILTON HOSPITAL, GRANDVIEW MEDICAL CENTER, GREENE MEMORIAL HOSPITAL, KETTERING BEHAVIORAL MEDICINE CENTER, KETTERING MEDICAL CENTER, SOIN MEDICAL CENTER, SOUTHVIEW MEDICAL CENTER, SYCAMORE MEDICAL CENTER)* THE C&F LINDNER CENTER OF HOPE* BON SECOURS MERCY HEALTH (BON SECOURS MERCY HEALTH-ANDERSON HOSPITAL, BON SECOURS MERCY HEALTH-CLERMONT HOSPITAL, BON SECOURS MERCY HEALTH-FAIRFIELD HOSPITAL, BON SECOURS MERCY HEALTH-WEST HOSPITAL, BON SECOURS JEWISH HOSPITAL)* MERCY HEALTH URBANA HOSPITAL* MERCY HEALTH SPRINGFIELD REGIONAL MEDICAL CENTER* PREMIER HEALTH (ATRIUM MEDICAL CENTER, MIAMI VALLEY HOSPITAL, MIAMI VALLEY HOSPITAL NORTH, MIAMI VALLEY HOSPITAL SOUTH, UPPER VALLEY MEDICAL CENTER)* TRIHEALTH (TRIHEALTH BETHESDA BUTLER HOSPITAL, TRIHEALTH BETHESDA NORTH HOSPITAL, TRIHEALTH GOOD SAMARITAN HOSPITAL, TRIHEALTH MCCULLOUGH-HYDE MEMORIAL HOSPITAL, TRIHEALTH GOOD SAMARITAN EVENDALE HOSPITAL)* UC HEALTH (UC HEALTH DRAKE CENTER FOR POST-ACUTE CARE, UC HEALTH UNIVERSITY OF CINCINNATI MEDICAL CENTER, UC HEALTH WEST CHESTER HOSPITAL)* WILSON MEMORIAL HEALTH* WAYNE HEALTHCARE

BETHESDA BUTLER HOSPITAL
PART V, SECTION B, LINE 6A: * THE CHRIST HOSPITAL MT. AUBURN, * CINCINNATI CHILDREN'S HOSPITAL (CINCINNATI CHILDREN'S BURNET CAMPUS, CINCINNATI CHILDREN'S LIBERTY CAMPUS, CINCINNATI CHILDREN'S COLLEGE HILL CAMPUS)* ADAMS COUNTY REGIONAL MEDICAL CENTER,* MARGARET MARY HEALTH, * KETTERING HEALTH NETWORK (FORT HAMILTON HOSPITAL, GRANDVIEW MEDICAL CENTER, GREENE MEMORIAL HOSPITAL, KETTERING BEHAVIORAL MEDICINE CENTER, KETTERING MEDICAL CENTER, SOIN MEDICAL CENTER, SOUTHVIEW MEDICAL CENTER, SYCAMORE MEDICAL CENTER)* THE C&F LINDNER CENTER OF HOPE* BON SECOURS MERCY HEALTH (BON SECOURS MERCY HEALTH-ANDERSON HOSPITAL, BON SECOURS MERCY HEALTH-CLERMONT HOSPITAL, BON SECOURS MERCY HEALTH-FAIRFIELD HOSPITAL, BON SECOURS MERCY HEALTH-WEST HOSPITAL, BON SECOURS JEWISH HOSPITAL)* MERCY HEALTH URBANA HOSPITAL* MERCY HEALTH SPRINGFIELD REGIONAL MEDICAL CENTER* PREMIER HEALTH (ATRIUM MEDICAL CENTER, MIAMI VALLEY HOSPITAL, MIAMI VALLEY HOSPITAL NORTH, MIAMI VALLEY HOSPITAL SOUTH, UPPER VALLEY MEDICAL CENTER)* TRIHEALTH (TRIHEALTH BETHESDA BUTLER HOSPITAL, TRIHEALTH BETHESDA NORTH HOSPITAL, TRIHEALTH GOOD SAMARITAN HOSPITAL, TRIHEALTH MCCULLOUGH-HYDE MEMORIAL HOSPITAL, TRIHEALTH GOOD SAMARITAN EVENDALE HOSPITAL)* UC HEALTH (UC HEALTH DRAKE CENTER FOR POST-ACUTE CARE, UC HEALTH UNIVERSITY OF CINCINNATI MEDICAL CENTER, UC HEALTH WEST CHESTER HOSPITAL)* WILSON MEMORIAL HEALTH* WAYNE HEALTHCARE

BETHESDA NORTH HOSPITAL
PART V, SECTION B, LINE 6B: * THE HEALTH COLLABORATIVE* GREATER DAYTON AREA HOSPITAL ASSOCIATION* ADAMS COUNTY HEALTH DEPARTMENT* AUGLAIZE COUNTY HEALTH DEPARTMENT* BROWN COUNTY HEALTH DEPARTMENT* BUTLER COUNTY HEALTH DEPARTMENT* CHAMPAIGN COUNTY HEALTH DEPARTMENT* CITY OF CINCINNATI HEALTH DEPARTMENT* CITY OF HAMILTON HEALTH DEPARTMENT* CLARK COUNTY HEALTH DEPARTMENT* CLERMONT COUNTY HEALTH DEPARTMENT* CLINTON COUNTY HEALTH DEPARTMENT* DARKE COUNTY HEALTH DEPARTMENT* FAYETTE COUNTY HEALTH DEPARTMENT* GREENE COUNTY HEALTH DEPARTMENT* HAMILTON COUNTY HEALTH DEPARTMENT* HIGHLAND COUNTY HEALTH DEPARTMENT* MIAMI COUNTY HEALTH DEPARTMENT* MONTGOMERY COUNTY HEALTH DEPARTMENT* CITY OF NORWOOD HEALTH DEPARTMENT* CITY OF PIQUA HEALTH DEPARTMENT* PREBLE COUNTY HEALTH DEPARTMENT* SHELBY COUNTY HEALTH DEPARTMENT* SPRINGDALE HEALTH DEPARTMENT* WARREN COUNTY COMBINED HEALTH DISTRICT

BETHESDA BUTLER HOSPITAL
PART V, SECTION B, LINE 6B: * THE HEALTH COLLABORATIVE* GREATER DAYTON AREA HOSPITAL ASSOCIATION* ADAMS COUNTY HEALTH DEPARTMENT* AUGLAIZE COUNTY HEALTH DEPARTMENT* BROWN COUNTY HEALTH DEPARTMENT* BUTLER COUNTY HEALTH DEPARTMENT* CHAMPAIGN COUNTY HEALTH DEPARTMENT* CITY OF CINCINNATI HEALTH DEPARTMENT* CITY OF HAMILTON HEALTH DEPARTMENT* CLARK COUNTY HEALTH DEPARTMENT* CLERMONT COUNTY HEALTH DEPARTMENT* CLINTON COUNTY HEALTH DEPARTMENT* DARKE COUNTY HEALTH DEPARTMENT* FAYETTE COUNTY HEALTH DEPARTMENT* GREENE COUNTY HEALTH DEPARTMENT* HAMILTON COUNTY HEALTH DEPARTMENT* HIGHLAND COUNTY HEALTH DEPARTMENT* MIAMI COUNTY HEALTH DEPARTMENT* MONTGOMERY COUNTY HEALTH DEPARTMENT* CITY OF NORWOOD HEALTH DEPARTMENT* CITY OF PIQUA HEALTH DEPARTMENT* PREBLE COUNTY HEALTH DEPARTMENT* SHELBY COUNTY HEALTH DEPARTMENT* SPRINGDALE HEALTH DEPARTMENT* WARREN COUNTY COMBINED HEALTH DISTRICT

BETHESDA NORTH HOSPITAL
PART V, SECTION B, LINE 7D: COPY AVAILABLE WITHOUT CHARGE.PLEASE CONTACT TRIHEALTH MISSION AND CULTURE BY EITHER TELEPHONE (513-569-6248), E-MAIL (FRANK_NATION@TRIHEALTH.COM) OR MAIL (625 EDEN PARK DRIVE, 9TH FLOOR, CINCINNATI, OHIO 45202).

BETHESDA BUTLER HOSPITAL
PART V, SECTION B, LINE 7D: COPY AVAILABLE WITHOUT CHARGE.PLEASE CONTACT TRIHEALTH MISSION AND CULTURE BY EITHER TELEPHONE (513-569-6248), E-MAIL (FRANK_NATION@TRIHEALTH.COM) OR MAIL (625 EDEN PARK DRIVE, 9TH FLOOR, CINCINNATI, OHIO 45202).

BETHESDA NORTH HOSPITAL
"PART V, SECTION B, LINE 11: 1. SUBSTANCE ABUSE/MENTAL HEALTH - GIVEN THE HIGH PREVALENCE OF SUBSTANCE ABUSE IN THIS AREA, PARTICULARLY OPIOID ABUSE, THE FACT THAT CURRENT WORK IS NOT COMPLETED AND THERE ARE MANY COMMUNITY PARTNERS THAT ARE ENGAGING ALONG WITH TRIHEALTH, SUBSTANCE ABUSE REMAINS ONE OF THE TOP PRIORITY COMMUNITY NEEDS FOR TRIHEALTH AND BETHESDA NORTH HOSPITAL (""BNH""). THE GOAL IS TO IMPROVE EARLY IDENTIFICATION AND TREATMENT, AS WELL AS EDUCATION, TO THOSE IN OUR COMMUNITY WHO NEED THE RIGHT CARE, IN THE RIGHT SETTING, AT THE RIGHT TIME REGARDING SUBSTANCE ABUSE AND MENTAL HEALTH TO IMPROVE HEALTH OUTCOMES. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:SUBSTANCE ABUSE TREATMENT COORDINATORS - PROVIDE RN/SOCIAL WORKER WITH SPECIFIC SUBSTANCE USE TRAINING AND/OR CERTIFICATION AT INPATIENT SERVICES AND EMERGENCY DEPARTMENT LOCATIONS TO ENGAGE, ASSESS, AND PROVIDE APPOINTMENTS TO TREATMENT WITHIN 24-48 HOURS AFTER DISCHARGE. OUTPATIENT ALCOHOL AND TREATMENT PROGRAM - OFFER SUPPORT AND TREATMENT TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, IN A STRUCTURED, OUTPATIENT SETTING. INTEGRATED BEHAVIORAL HEALTH MODEL - DEVELOP A BEHAVIORAL HEALTH CARE MODEL OVER THE NEXT 18 MONTHS TO PROACTIVELY IDENTIFY PATIENT NEEDS USING A COMPREHENSIVE BEHAVIORAL HEALTH ASSESSMENT AND PROVIDE TREATMENT AS INDICATED. BEHAVIORAL HEALTH INTAKE PROGRAM - REFER PATIENTS FROM THE EMERGENCY DEPARTMENT TO THE APPROPRIATE TREATMENT SETTING AND LOCATION. BNH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING REGISTERED NURSES, PHYSICIANS, COMMUNITY HEALTH EDUCATORS, PHILANTHROPIC CASH GRANTS, OUTREACH COMMUNICATION, AND PROGRAM MANAGEMENT SUPPORT. IT WILL DO SO IN PARTNERSHIP WITH BI3, ADDICTION SERVICES COUNCIL, BRIGHTVIEW, TALBERT HOUSE, NAMI OF SOUTHWEST OHIO, URBAN HEALTH PROJECT, CENTER FOR ADDICTION TREATMENT, GOOD SAMARITAN FREE HEALTH CLINIC. 2. MATERNAL/CHILD HEALTH - GIVEN THE HIGH PREVALENCE IN CERTAIN GEOGRAPHIC AREAS, THE FACT THAT CURRENT WORK IS BEING EFFECTIVE AND IS NOT COMPLETED AND THERE ARE MANY COMMUNITY PARTNERS THAT ARE ENGAGING ALONG WITH TRIHEALTH. THE GOAL IS TO REDUCE INFANT MORTALITY RATES IN OUR SERVICE AREA, AS WELL AS IMPROVE OUTCOMES FOR MATERNAL HEALTH WITH EMPHASIS ON EDUCATION, CLINICAL CARE, AND COMMUNITY OUTREACH. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:OB GYN CENTER - THE CENTER WILL PROVIDE OBSTETRICS AND GYNECOLOGICAL SERVICES TO ALL, WITH SPECIAL ATTENTION TO HEALTH DISPARITIES AND THE UNDERSERVED, IMPROVING INFANT MORTALITY OUTCOMES AND WOMEN'S HEALTH. WOMAN CENTERED MEDICAL HOME MODEL - PROGRAM WILL PROVIDE A COMPLEX NETWORK OF CARE, DELIVERED BY DEDICATED CASE MANAGERS, SOCIAL WORKERS, LACTATION CONSULTANTS, BEHAVIORAL HEALTH CONSULTANTS, COMMUNITY HEALTH WORKERS, FINANCIAL COUNSELORS, AND LEGAL AID CONSULTANTS TO PROVIDE EXCELLENT CARE WHILE ADDRESSING SOCIAL DETERMINANTS OF HEALTH. HOPE PROGRAM - PROGRAM WILL PROVIDE PATIENT-CENTERED CARE TO CHEMICALLY DEPENDENT PREGNANT WOMEN IMPROVING BIRTH OUTCOMES AND MATERNAL SUBSTANCE-FREE OUTCOMES. BNH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING RNS, DEDICATED CASE MANAGER, LACTATION EDUCATOR, BEHAVIORAL HEALTH SOCIAL WORKER, DIETICIANS, GENETIC COUNSELORS AND ASSISTANCE WITH TRANSPORTATION, FOOD PANTRY, HOME FURNISHINGS AND BABY ITEMS. IT WILL DO SO IN PARTNERSHIP WITH CRADLE CINCINNATI, URBAN HEALTH PROJECT, MARCH OF DIMES, TALBERT HOUSE FATHERHOOD PROJECT, SWEET CHEEKS DIAPER BANK, START STRONG, THINK FIRST FOR YOUR BABY, HEALTHY BEGINNINGS, HEALTHY MOMS AND BABES, GS FREE CLINIC, EVERY CHILD SUCCEEDS, CRIBS FOR KIDS, CHILDBIRTH EDUCATION ASSOCIATION. 3. ACCESS TO CARE CONTINUING THE WORK OF TRIHEALTH/BETHESDA CLINICS AND THE FREE HEALTH CENTER IS ESSENTIAL TO SUSTAINED GAINS IN IMPROVING ACCESS FOR UN- AND UNDERINSURED PEOPLE. THERE IS AN OPPORTUNITY TO BUILD ON CURRENT SIMILAR WORK THAT FUNDS PATIENTS' ACCESS TO HEALTH CARE VIA RIDES TO APPOINTMENTS, HOME FROM THE EMERGENCY DEPARTMENT AND SO FORTH.THE GOAL IS TO IMPROVE ACCESS TO CARE FOR THE UNDERSERVED POPULATIONS WITH EMPHASIS ON EDUCATION, ASSESSMENT, CARE DELIVERY AND CONNECTION TO RESOURCES WITHIN BNH, TRIHEALTH AND/OR COMMUNITY ORGANIZATIONS AND PROGRAMS. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:GOOD SAMARITAN FREE CLINIC A RELATED TAX-EXEMPT ORGANIZATION TO BNH, IT IS THE ONLY FREE HEALTH CENTER IN SOUTHWEST OHIO OPEN SIX DAYS PER WEEK. IT PROVIDES ACCESS TO COMPREHENSIVE, PERSONALIZED HEALTHCARE SERVICES TO MORE THAN 1500 UNINSURED PATIENTS ANNUALLY. FACULTY MEDICAL CENTER - PROGRAM WILL PROVIDE A COMPLEX NETWORK OF CARE, DELIVERED BY PROVIDERS FROM OUR GRADUATE MEDICAL EDUCATION PROGRAM WHO ARE DEDICATED TO PROVIDING EXCELLENT CLINICAL PRIMARY CARE TO THE UNDERSERVED WHILE ADDRESSING SOCIAL DETERMINANTS OF HEALTH.TRIHEALTH OUTREACH PROGRAMS COORDINATION - IMPROVE COORDINATION OF PROGRAMS DIRECTLY TO THE UNDERSERVED COMMUNITY WITH CONNECTION TO TRIHEALTH AND COMMUNITY ORGANIZATIONS. PROGRAM COORDINATION TO INCLUDE MOBILE MAMMOGRAPHY, FREE HEALTH SCREENINGS, SENIORITY, THINK FIRST EDUCATION, PHARMACY ASSISTANCE, FOOD PROGRAMS, LEGAL AID, ADVOCACY, AND HOUSING REPAIR.BNH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING MAMMOGRAPHY VAN, NURSES, SOCIAL WORKERS, PHYSICIANS, ASSISTANCE WITH FOOD, TRANSPORTATION, LEGAL AID, SPACE AND RESOURCES FOR CLINICS, COMMUNITY WORKERS, MENTAL HEALTH SPECIALISTS. IT WILL DO SO IN PARTNERSHIP WITH PEOPLE WORKING COLLABORATIVELY, LEGAL AID OF GREATER CINCINNATI, FREE STORE FOODBANK, GREATER CINCINNATI FOUNDATION, UNITED WAY, HEALTH COLLABORATIVE, SVDP CHARITABLE PHARMACY, AND VARIOUS COMMUNITY ORGANIZATION EVENTS.4. DISEASE MANAGEMENT - SEVERAL SPECIFIC CHRONIC HEALTH ISSUES HYPERTENSION, DEPRESSION, DIABETES AND CANCERS RESULTING FROM POSTPONED SCREENINGS ALL ARE AFFECTING BLACK MALES IN THE COMMUNITY DISPROPORTIONALLY, SO WERE COMBINED INTO ""DISEASE MANAGEMENT"". THE GOAL IS TO IMPROVE EDUCATION, DATA COLLECTION, ASSESSMENTS, INTERVENTIONS, CULTURALLY COMPETENT CARE AND CARE MANAGEMENT, BNH WILL ADDRESS AND IMPROVE SPECIFIC CHRONIC HEALTH ISSUES THAT ARE IMPACTED BY DISPARITIES, SUCH AS HYPERTENSION, DEPRESSION, DIABETES, AND CANCERS. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:HEALTH DISPARITIES DATA COLLECTION - IMPLEMENT A NEW GRANT FUNDED PROGRAM TO COLLECT HEALTH DISPARITY DATA REGARDING CHRONIC DISEASE TO ASSESS SOCIAL DETERMINANTS OF HEALTH ASSIST WITH INTERVENTIONS AND TRACK OUTCOMES. COORDINATE EXISTING (AND NEW) CHRONIC HEALTH PROGRAMS WITH AN EMPHASIS ON HEALTH DISPARITIES - COORDINATE AND ASSIMILATE CURRENT (AND FUTURE) PROGRAMS THAT ADDRESS CHRONIC DISEASE IN AREAS OF CRITICAL NEED BASED ON ZIP CODES, ETHNICITY, GENDER, AND OTHER SOCIAL DETERMINANTS OF HEALTH. DIVERSITY, EQUITY, AND INCLUSION (DEI) CARE STRATEGY - IMPROVE THE DEI CARE STRATEGY TO FOCUS ON ACCURATE DEI DOCUMENTATION IN EPIC, CULTURALLY COMPETENT CARE MODEL EDUCATION, WORKFORCE DIVERSITY, BOLD PROGRAM, GRADUATE MEDICAL EDUCATION DIVERSITY INITIATIVES, SCHOOL TO WORK PROGRAM, AND SYSTEM DEI TRAINING. TRIHEALTH (OF WHICH BNH IS A PART) PLANS TO ADDRESS THESE INITIATIVES BY CREATING A POSITION OF DIRECTOR OF HEALTH EQUITIES WITHIN THE SYSTEM, CHRONIC HEALTH OUTREACH PROGRAMS AND A COMMUNITY HEALTH NEEDS COMMITTEE AS WELL AS THE UTILIZATION OF NURSES, PHYSICIANS, COMMUNITY HEALTH EDUCATORS, PHILANTHROPIC GRANTS, OUTREACH COMMUNICATION, AND PROGRAM MANAGEMENT SUPPORT. IT WILL DO SO IN PARTNERSHIP WITH BI3, MEHARRY MEDICAL COLLEGE (HBCU), VINCENT BROWN CONSULTING, HEALTH COLLABORATIVE, INTERACT FOR HEALTH, UNITED WAY, LUMERIS, AMERICAN HEART ASSOCIATION, AMERICAN LUNG ASSOCIATION, NAMI, RIDECINCINNATI.IN ITS IMPLEMENTATION PLAN, BNH PROVIDED A LIST OF COMMUNITY RESOURCES AND OTHER TRIHEALTH SYSTEM PROGRAMS AVAILABLE TO HELP ADDRESS THESE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IT SERVES. HOWEVER, DUE TO SOFTWARE CONSTRAINTS, THEY ARE NOT IDENTIFIED HERE. THIS LIST CAN BE FOUND ON PAGES 10-12 OF THE PLAN FOUND AT THE FOLLOWING URL (HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/HEALTH-NEEDS-ASSESSMENT).PLEASE NOTE THAT ALL OF THE ABOVE NEEDS BEING ADDRESSED ARE IN LINE WITH THE STATE HEALTH IMPROVEMENT PLAN (SHIP) 2020-2022. THE SIGNIFICANT HEALTH NEEDS FROM THE 2022 CHNA THAT BNH WILL NOT ADDRESS ARE AS FOLLOWS: ARTHRITIS OR OSTEOPOROSIS, LUNG/RESPIRATORY RELATED CONDITIONS, INCLUDING ASTHMA, AND ORAL/DENTAL DISEASE.THESE NEEDS ARE NOT CURRENTLY BEING ADDRESSED BY BNH AS THEY ARE DEEMED TO BE NOT PARTICULARLY ACUTE WITHIN BETHESDA HOSPITAL'S FOUR-COUNTY COMMUNITY SERVED (HAMILTON, BUTLER, CLERMONT AND WARREN COUNTIES, OHIO) BASED ON THE CRITERIA/RESEARCH USED IN THE DECISION-MAKING PROCESS."

BETHESDA BUTLER HOSPITAL
"PART V, SECTION B, LINE 11: 1. SUBSTANCE ABUSE/MENTAL HEALTH - GIVEN THE HIGH PREVALENCE OF SUBSTANCE ABUSE IN THIS AREA, PARTICULARLY OPIOID ABUSE, THE FACT THAT CURRENT WORK IS NOT COMPLETED AND THERE ARE MANY COMMUNITY PARTNERS THAT ARE ENGAGING ALONG WITH TRIHEALTH, SUBSTANCE ABUSE REMAINS ONE OF THE TOP PRIORITY COMMUNITY NEEDS FOR TRIHEALTH AND BETHESDA BUTLER HOSPITAL (""BBH""). THE GOAL IS TO IMPROVE EARLY IDENTIFICATION AND TREATMENT, AS WELL AS EDUCATION, TO THOSE IN OUR COMMUNITY WHO NEED THE RIGHT CARE, IN THE RIGHT SETTING, AT THE RIGHT TIME REGARDING SUBSTANCE ABUSE AND MENTAL HEALTH TO IMPROVE HEALTH OUTCOMES. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:SUBSTANCE ABUSE TREATMENT COORDINATORS - PROVIDE RN/SOCIAL WORKER WITH SPECIFIC SUBSTANCE USE TRAINING AND/OR CERTIFICATION AT INPATIENT SERVICES AND EMERGENCY DEPARTMENT LOCATIONS TO ENGAGE, ASSESS, AND PROVIDE APPOINTMENTS TO TREATMENT WITHIN 24-48 HOURS AFTER DISCHARGE. OUTPATIENT ALCOHOL AND TREATMENT PROGRAM - OFFER SUPPORT AND TREATMENT TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, IN A STRUCTURED, OUTPATIENT SETTING. INTEGRATED BEHAVIORAL HEALTH MODEL - DEVELOP A BEHAVIORAL HEALTH CARE MODEL OVER THE NEXT 18 MONTHS TO PROACTIVELY IDENTIFY PATIENT NEEDS USING A COMPREHENSIVE BEHAVIORAL HEALTH ASSESSMENT AND PROVIDE TREATMENT AS INDICATED. BEHAVIORAL HEALTH INTAKE PROGRAM - REFER PATIENTS FROM THE EMERGENCY DEPARTMENT TO THE APPROPRIATE TREATMENT SETTING AND LOCATION. BBH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING REGISTERED NURSES, PHYSICIANS, COMMUNITY HEALTH EDUCATORS, PHILANTHROPIC CASH GRANTS, OUTREACH COMMUNICATION, AND PROGRAM MANAGEMENT SUPPORT. IT WILL DO SO IN PARTNERSHIP WITH BI3, ADDICTION SERVICES COUNCIL, BRIGHTVIEW, TALBERT HOUSE, NAMI OF SOUTHWEST OHIO, URBAN HEALTH PROJECT, CENTER FOR ADDICTION TREATMENT, GOOD SAMARITAN FREE HEALTH CLINIC. 2. ACCESS TO CARE CONTINUING THE WORK OF TRIHEALTH/BETHESDA CLINICS AND THE FREE HEALTH CENTER IS ESSENTIAL TO SUSTAINED GAINS IN IMPROVING ACCESS FOR UN- AND UNDERINSURED PEOPLE. THERE IS AN OPPORTUNITY TO BUILD ON CURRENT SIMILAR WORK THAT FUNDS PATIENTS' ACCESS TO HEALTH CARE VIA RIDES TO APPOINTMENTS, HOME FROM THE EMERGENCY DEPARTMENT AND SO FORTH.THE GOAL IS TO IMPROVE ACCESS TO CARE FOR THE UNDERSERVED POPULATIONS WITH EMPHASIS ON EDUCATION, ASSESSMENT, CARE DELIVERY AND CONNECTION TO RESOURCES WITHIN BBH, TRIHEALTH AND/OR COMMUNITY ORGANIZATIONS AND PROGRAMS. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:GOOD SAMARITAN FREE CLINIC A RELATED TAX-EXEMPT ORGANIZATION TO BBH, IT IS THE ONLY FREE HEALTH CENTER IN SOUTHWEST OHIO OPEN SIX DAYS PER WEEK. IT PROVIDES ACCESS TO COMPREHENSIVE, PERSONALIZED HEALTHCARE SERVICES TO MORE THAN 1500 UNINSURED PATIENTS ANNUALLY. FACULTY MEDICAL CENTER - PROGRAM WILL PROVIDE A COMPLEX NETWORK OF CARE, DELIVERED BY PROVIDERS FROM OUR GRADUATE MEDICAL EDUCATION PROGRAM WHO ARE DEDICATED TO PROVIDING EXCELLENT CLINICAL PRIMARY CARE TO THE UNDERSERVED WHILE ADDRESSING SOCIAL DETERMINANTS OF HEALTH.TRIHEALTH OUTREACH PROGRAMS COORDINATION - IMPROVE COORDINATION OF PROGRAMS DIRECTLY TO THE UNDERSERVED COMMUNITY WITH CONNECTION TO TRIHEALTH AND COMMUNITY ORGANIZATIONS. PROGRAM COORDINATION TO INCLUDE MOBILE MAMMOGRAPHY, FREE HEALTH SCREENINGS, SENIORITY, THINK FIRST EDUCATION, PHARMACY ASSISTANCE, FOOD PROGRAMS, LEGAL AID, ADVOCACY, AND HOUSING REPAIR.BBH PLANS TO ADDRESS THESE INITIATIVES BY PROVIDING MAMMOGRAPHY VAN, NURSES, SOCIAL WORKERS, PHYSICIANS, ASSISTANCE WITH FOOD, TRANSPORTATION, LEGAL AID, SPACE AND RESOURCES FOR CLINICS, COMMUNITY WORKERS, MENTAL HEALTH SPECIALISTS. IT WILL DO SO IN PARTNERSHIP WITH PEOPLE WORKING COLLABORATIVELY, LEGAL AID OF GREATER CINCINNATI, FREE STORE FOODBANK, GREATER CINCINNATI FOUNDATION, UNITED WAY, HEALTH COLLABORATIVE, SVDP CHARITABLE PHARMACY, AND VARIOUS COMMUNITY ORGANIZATION EVENTS.3. DISEASE MANAGEMENT - SEVERAL SPECIFIC CHRONIC HEALTH ISSUES HYPERTENSION, DEPRESSION, DIABETES AND CANCERS RESULTING FROM POSTPONED SCREENINGS ALL ARE AFFECTING BLACK MALES IN THE COMMUNITY DISPROPORTIONALLY, SO WERE COMBINED INTO ""DISEASE MANAGEMENT"". THE GOAL IS TO IMPROVE EDUCATION, DATA COLLECTION, ASSESSMENTS, INTERVENTIONS, CULTURALLY COMPETENT CARE AND CARE MANAGEMENT, BBH WILL ADDRESS AND IMPROVE SPECIFIC CHRONIC HEALTH ISSUES THAT ARE IMPACTED BY DISPARITIES, SUCH AS HYPERTENSION, DEPRESSION, DIABETES, AND CANCERS. THE STRATEGY OR PROGRAMS NEEDED TO ACHIEVE THIS GOAL IS AS FOLLOWS:HEALTH DISPARITIES DATA COLLECTION - IMPLEMENT A NEW GRANT FUNDED PROGRAM TO COLLECT HEALTH DISPARITY DATA REGARDING CHRONIC DISEASE TO ASSESS SOCIAL DETERMINANTS OF HEALTH ASSIST WITH INTERVENTIONS AND TRACK OUTCOMES. COORDINATE EXISTING (AND NEW) CHRONIC HEALTH PROGRAMS WITH AN EMPHASIS ON HEALTH DISPARITIES - COORDINATE AND ASSIMILATE CURRENT (AND FUTURE) PROGRAMS THAT ADDRESS CHRONIC DISEASE IN AREAS OF CRITICAL NEED BASED ON ZIP CODES, ETHNICITY, GENDER, AND OTHER SOCIAL DETERMINANTS OF HEALTH. DIVERSITY, EQUITY, AND INCLUSION (DEI) CARE STRATEGY - IMPROVE THE DEI CARE STRATEGY TO FOCUS ON ACCURATE DEI DOCUMENTATION IN EPIC, CULTURALLY COMPETENT CARE MODEL EDUCATION, WORKFORCE DIVERSITY, BOLD PROGRAM, GRADUATE MEDICAL EDUCATION DIVERSITY INITIATIVES, SCHOOL TO WORK PROGRAM, AND SYSTEM DEI TRAINING. TRIHEALTH (OF WHICH BBH IS A PART) PLANS TO ADDRESS THESE INITIATIVES BY CREATING A POSITION OF DIRECTOR OF HEALTH EQUITIES WITHIN THE SYSTEM, CHRONIC HEALTH OUTREACH PROGRAMS AND A COMMUNITY HEALTH NEEDS COMMITTEE AS WELL AS THE UTILIZATION OF NURSES, PHYSICIANS, COMMUNITY HEALTH EDUCATORS, PHILANTHROPIC GRANTS, OUTREACH COMMUNICATION, AND PROGRAM MANAGEMENT SUPPORT. IT WILL DO SO IN PARTNERSHIP WITH BI3, MEHARRY MEDICAL COLLEGE (HBCU), VINCENT BROWN CONSULTING, HEALTH COLLABORATIVE, INTERACT FOR HEALTH, UNITED WAY, LUMERIS, AMERICAN HEART ASSOCIATION, AMERICAN LUNG ASSOCIATION, NAMI, RIDECINCINNATI.IN ITS IMPLEMENTATION PLAN, BBH PROVIDED A LIST OF COMMUNITY RESOURCES AND OTHER TRIHEALTH SYSTEM PROGRAMS AVAILABLE TO HELP ADDRESS THESE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IT SERVES. HOWEVER, DUE TO SOFTWARE CONSTRAINTS, THEY ARE NOT IDENTIFIED HERE. THIS LIST CAN BE FOUND ON PAGES 10 THROUGH 12 OF THE PLAN FOUND AT THE FOLLOWING URL (HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/COMMUNITY/HEALTH-NEEDS-ASSESSMENT).PLEASE NOTE THAT ALL OF THE ABOVE NEEDS BEING ADDRESSED ARE IN LINE WITH THE STATE HEALTH IMPROVEMENT PLAN (SHIP) 2020-2022. THE SIGNIFICANT HEALTH NEEDS FROM THE 2022 CHNA THAT BBH WILL NOT ADDRESS ARE AS FOLLOWS: ARTHRITIS OR OSTEOPOROSIS, LUNG/RESPIRATORY RELATED CONDITIONS, INCLUDING ASTHMA, AND ORAL/DENTAL DISEASE.THESE NEEDS ARE NOT CURRENTLY BEING ADDRESSED BY BBH AS THEY ARE DEEMED TO BE NOT PARTICULARLY ACUTE WITHIN BBH'S COMMUNITY SERVED OF BUTLER COUNTY, OHIO BASED ON THE CRITERIA/RESEARCH USED IN THE DECISION-MAKING PROCESS.AS FOR THE REASON AS TO WHY THE MATERNAL HEALTH COMPLICATIONS PRIORITY IS NOT BEING ADDRESSED, IT IS DUE TO THIS PRIORITY BEING ADDRESSED BY OTHER TRIHEALTH HOSPITALS (SEE THE SCHEDULE H FOR BETHESDA NORTH HOSPITAL WITH THIS FORM 990 AS WELL AS THE SCHEDULE H FOR GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO (EIN 31-0537486)) AS WELL AS OTHER TRIHEALTH PARTNERS."

BETHESDA NORTH HOSPITAL
PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE TO PART I, LINE 3C.

BETHESDA BUTLER HOSPITAL
PART V, SECTION B, LINE 13B: SEE PART VI RESPONSE TO PART I, LINE 3C.

BETHESDA NORTH HOSPITAL
PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE TO PART I, LINE 3C.

BETHESDA BUTLER HOSPITAL
PART V, SECTION B, LINE 13H: SEE PART VI RESPONSE TO PART I, LINE 3C.

PART I, LINE 3C:
"BETHESDA HOSPITAL, INC. UTILIZES THE FEDERAL POVERTY GUIDELINES (""FPG"") IN DETERMINING CHARITY CARE ELIGIBILITY. SEE THE RESPONSES TO PART I, LINES 3A AND 3B.AN INDIVIDUAL'S INCOME UNDER FPG IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR CHARITY CARE. ADDITIONALLY, AN INDIVIDUAL'S INCOME IN RELATION TO HIS/HER MEDICAL EXPENSES IS ALSO TAKEN INTO ACCOUNT AND SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES."

PART I, LINE 6A:
IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION. THE COMMUNITY BENEFIT PROVIDED BY BETHESDA HOSPITAL, INC. IS TRACKED ON A STANDALONE BASIS; HOWEVER, ITS COMMUNITY BENEFIT IS REPORTED IN A REPORT PREPARED BY TRIHEALTH IN COMBINATION WITH ITS RELATED HOSPITALS - THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND MCCULLOUGH-HYDE MEMORIAL HOSPITAL.

PART I, LINE 7:
FOR THE AMOUNTS REPORTED AT COST, IN PART I, LINE 7, BETHESDA HOSPITAL, INC. UTILIZED WORKSHEET 2 - RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H, TO CALCULATE THE COST-TO-CHARGE RATIO.

PART I, LINE 7G:
THE SUBSIDIZED HEALTH SERVICES COMMUNITY BENEFIT AMOUNT REPORTED IN PART I, LINE 7(G) DOES NOT INCLUDE COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS.

PART I, LN 7 COL(F):
BAD DEBT EXPENSE IS NOT INCLUDED ON FORM 990, PART IX, LINE 25. IT IS PRESENTED ON FORM 990, PART VIII, LINE 2 AS A DEDUCTION FROM PATIENT SERVICE REVENUE WHICH CORRESPONDS TO ITS FINANCIAL STATEMENT PRESENTATION. SEE RESPONSE TO PART III, LINE 4. THEREFORE, NO ADJUSTMENT TO TOTAL EXPENSES SHOWN ON FORM 990, PART IX, LINE 25 IS NECESSARY.

PART II, COMMUNITY BUILDING ACTIVITIES:
BETHESDA HOSPITAL, INC. PROVIDED CASH DONATIONS THROUGH TRIHEALTH TO VARIOUS CHARITABLE ORGANIZATIONS WITHIN THE COMMUNITY TO ADDRESS HOMELESSNESS, TO INCREASE EDUCATIONAL OPPORTUNITIES AND TO BUILD AN ECONOMIC INFRASTRUCTURE.

PART III, LINE 2:
SEE PART VI RESPONSE TO PART III, LINE 4.

PART III, LINE 3:
SEE PART VI RESPONSE TO PART III, LINE 4.

PART III, LINE 4:
"BETHESDA HOSPITAL, INC.'S FINANCIAL STATEMENTS ARE AUDITED AS PART OF THE TRIHEALTH AUDIT REPORT.PLEASE NOTE THAT UNDER ACCOUNTING STANDARDS UPDATE NO. 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606), WHICH THE TRIHEALTH SYSTEM ADOPTED DURING THE TAX YEAR 2019 (FISCAL YEAR ENDED JUNE 30, 2020), BAD DEBT IS CONSIDERED AN ""IMPLICIT PRICE CONCESSION AND IS NOT DISTINGUISHED FROM A CONTRACTUAL ADJUSTMENT UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) AND THEREFORE THERE IS NO LONGER A SPECIFIC DISCLOSURE FOR BAD DEBT IN THE CURRENT YEAR AUDIT REPORT.SEE PATIENT SERVICE REVENUE (PART OF FOOTNOTE B - PAGES 19-23) FOR ADDITIONAL DETAIL REGARDING THE ABOVE-MENTIONED STANDARD AS WELL AS HOW THE TRIHEALTH SYSTEM ACCOUNTS FOR PATIENT SERVICE REVENUE.AS FOR THE AMOUNT OF BAD DEBT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, BETHESDA HOSPITAL, INC. DOES NOT REPORT ACTUAL BAD DEBT EXPENSE AS COMMUNITY BENEFIT. IF UPON FURTHER RESEARCH, IT IS ULTIMATELY DETERMINED THAT A PORTION OF BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE UNDER TRIHEALTH'S CHARITY CARE POLICY, THOSE COSTS WOULD BE RECLASSIFIED, AS APPROPRIATE, TO COMMUNITY BENEFIT AT THAT TIME.PLEASE NOTE THAT BAD DEBT EXPENSE IS NOT DETERMINED UNTIL AFTER ALL DISCOUNTS AND ANY ASSOCIATED PAYMENTS ARE TAKEN INTO ACCOUNT. IF ANY PAYMENTS ARE RECEIVED AFTER A PATIENT ACCOUNT IS DETERMINED TO BE BAD DEBT, THE ACCOUNT WILL BE ADJUSTED ACCORDINGLY AT THAT TIME."

PART III, LINE 8:
"BETHESDA HOSPITAL, INC. USES THE ""STEPDOWN METHODOLOGY"" IN DETERMINING THE MEDICARE ALLOWABLE COSTS REPORTED ON THE MEDICARE COST REPORT. THIS METHOD OF COST FINDING PROVIDES FOR THE ALLOCATION OF THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS WHICH UTILIZE SUCH SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. BETHESDA HOSPITAL, INC. DID NOT REPORT ANY MEDICARE SHORTFALL AS COMMUNITY BENEFIT IN PART III, LINE 7 OF THIS SCHEDULE."

PART III, LINE 9B:
AS OF THE FILING OF THIS RETURN, BETHESDA HOSPITAL, INC., AS PART OF TRIHEALTH, INC., MAINTAINS A WRITTEN DEBT COLLECTION POLICY. TRIHEALTH, INC., WHO PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS, WILL NOT INITIATE COLLECTION PRACTICES ON PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BEFORE COLLECTION ACTIONS ARE TAKEN, TRIHEALTH, INC. WILL MAKE REASONABLE EFFORTS, GENERALLY AS EARLY IN THE BILLING PROCESS AS POSSIBLE, TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. AFTER SUCH EFFORTS HAVE BEEN MADE AND A BALANCE REMAINS THAT IS THE RESPONSIBILITY OF THE PATIENT OR GUARANTOR, TRIHEALTH, INC. MAY PURSUE, IN ITS SOLE DISCRETION, WHATEVER ACTIONS IT MAY BE ENTITLED TO TAKE UNDER LAW.

PART VI, LINE 3:
TRIHEALTH, INC. PERFORMS THE BILLING SERVICES FOR ALL AFFILIATED HOSPITALS INCLUDING BETHESDA HOSPITAL, INC. BROCHURES/APPLICATIONS, PROVIDED IN MULTIPLE LANGUAGES, ARE VISIBLE AND AVAILABLE IN THE REGISTRATION AND ADMITTING AREAS OF ALL TRIHEALTH AFFILIATED HOSPITALS. IN ADDITION, THE APPLICATION IS PRINTED ON THE REVERSE SIDE OF A PATIENT'S BILL WITH INSTRUCTIONS ON HOW TO COMPLETE THE APPLICATION AS WELL AS HOW TO RETURN IT. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION. FINALLY, TRIHEALTH INC.'S WEBSITE CONTAINS INFORMATION REGARDING ITS CHARITY CARE AND FINANCIAL ASSISTANCE PROGRAMS WITH DIRECTIONS ON HOW TO CONTACT THE APPROPRIATE PERSONNEL TO INITIATE AN APPLICATION OR ASK QUESTIONS ABOUT THE PROCESS.

PART VI, LINE 6:
IN 1995, THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO AND BETHESDA HOSPITAL, INC. FORMED A PARTNERSHIP CALLED TRIHEALTH IN ORDER TO CREATE AN INTEGRATED HEALTH DELIVERY SYSTEM WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE, WITH AN EMPHASIS ON PREVENTION, WELLNESS AND EDUCATION.THROUGH FIVE (5) HOSPITALS, FIVE (5) AMBULATORY LOCATIONS AND OVER 125 SITES OF CARE (EMPLOYING OVER 600 PHYSICIANS INCLUDING RESIDENTS), TRIHEALTH PROVIDES A WIDE RANGE OF CLINICAL, EDUCATIONAL, PREVENTIVE AND SOCIAL PROGRAMS. TRIHEALTH'S NON-HOSPITAL SERVICES INCLUDE PHYSICIAN PRACTICE MANAGEMENT, FITNESS CENTERS AND FITNESS CENTER MANAGEMENT, OCCUPATIONAL HEALTH CENTERS, HOME HEALTH AND HOSPICE CARE.HTTPS://WWW.TRIHEALTH.COM/ABOUT-TRIHEALTH/

PART VI, LINE 2:
"IN 1896, BETHESDA HOSPITAL, INC. (""BETHESDA"") BEGAN AS A HOME VISITING MINISTRY OF THE METHODIST DEACONESSES TO SERVE THE HEALTH NEEDS OF THE GERMAN IMMIGRANTS LIVING IN CINCINNATI. NOW THAT MINISTRY, ONCE LED BY DEACONESS LOUISE GOLDER AND HER BROTHER REV. CHRISTIAN GOLDER, HAS GROWN INTO SEVERAL HEALTH SERVICES FOR GREATER CINCINNATI. IN 1995, BETHESDA, INC. AND GOOD SAMARITAN HOSPITAL FORMED A PARTNERSHIP TO CREATE A LOCAL HEALTH SYSTEM: TRIHEALTH, INC. (""TRIHEALTH""). THE MISSION OF TRIHEALTH IS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY THROUGH A FULL RANGE OF HEALTH RELATED SERVICES-PREVENTION, WELLNESS AND EDUCATION AND THUS EXEMPLIFY THE FOUNDING SPIRIT OF THE BETHESDA DEACONESSES.THE SERVICES DESCRIBED BELOW, AND OTHERS NOT LISTED, PROMOTE COMMUNITY HEALTH IN ACUTE ILLNESS, IN MANAGEMENT OF CHRONIC DISEASE, AND IN EDUCATION AND PREVENTION MEASURES. PROGRAMS SEEK TO REDUCE THE BURDENS ON THE GOVERNMENT. FOR EXAMPLE, IF BETHESDA DID NOT ADDRESS THE ROOT CAUSES OF LOW BIRTH WEIGHT AND PREMATURITY, THE BURDEN TO GOVERNMENT MEDICAL PROGRAMS SUCH AS MEDICAID WOULD BE EVEN GREATER. CHNAAS A FOLLOW UP TO THE 2018 CHNA, TRIHEALTH, INC. AND ITS HOSPITALS JOINED THIRTY-ONE (31) OTHER HOSPITALS AND TWENTY-TWO (22) HEALTH DEPARTMENTS IN THE GREATER CINCINNATI-DAYTON REGION TO SPONSOR AND FUND A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT FOR 2021. THE COMPREHENSIVE CHNA SPANS TWENTY-SIX (26) COUNTIES. THE REGIONAL CHNA REPORT COVERS GREATER DAYTON AND GREATER CINCINNATI, WHICH INCLUDES NORTHERN KENTUCKY AND SOUTHEASTERN INDIANA. IN THIS REGIONAL CHNA, HEALTH ENCOMPASSES PHYSICAL, MENTAL, AND SOCIAL CONDITIONS. HEALTH CARE IS INCLUSIVE OF HOSPITALS AND EMERGENCY ROOMS, PRIMARY CARE, BEHAVIORAL HEALTH, SPECIALTY CARE (I.E., VISION, DENTAL, CHIROPRACTIC, ETC.) AND SOCIAL SERVICES THAT SUPPORT HEALTH OR LINK COMMUNITY MEMBERS TO HEALTH CARE. THE 2021 CHNA REPORT SHARES DATA FOR THE WHOLE REGION AS WELL AS DETAILED COUNTY-LEVEL DATA. ALSO, THIS REGIONAL CHNA INCLUDES A COMPREHENSIVE DATA-DRIVEN APPROACH TO DEFINE THE CURRENT STATE OF HEALTH AND HEALTH EQUITY WITH THE GOAL OF INFORMING A COLLECTIVE, PRIORITIZE AN ACTIONABLE AGENDA FOR IMPROVING HEALTH OUTCOMES ACROSS THE REGION OVER THE NEXT THREE YEARS. LIKE THE STATEWIDE HEALTH IMPROVEMENT PLAN (SHIP) FOR OHIO, THIS REGIONAL CHNA EXPLORES THE PRIORITY FACTORS THAT INFLUENCE HEALTH INCLUDING PERCEPTIONS OF HEALTHCARE QUALITY AND ACCESS, HEALTH BEHAVIORS AND COMMUNITY CONDITIONS (I.E., SOCIAL DETERMINANTS OF HEALTH). GUIDED BY THE SHIP, THE REGIONAL CHNA FOCUSES ON THE PRIORITY HEALTH OUTCOMES RELATED TO CHRONIC DISEASE, MENTAL HEALTH AND ADDICTION, AND MATERNAL AND INFANT HEALTH. THE RECOMMENDATIONS PUT FORTH IN THIS NEEDS ASSESSMENT SUPPORT THE PRIORITIES OF THE SHIP AND PROVIDE A FRAMEWORK FOR WORKING COLLABORATIVELY IN ADDRESSING DISPARITIES AND BARRIERS TO A HEALTHIER COMMUNITY. A COPY OF THE REGIONAL CHNA CAN BE FOUND AT THE FOLLOWING URL (HTTPS://HEALTHCOLLAB.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/).FROM THIS LARGER REPORT, TRIHEALTH DEVELOPED A CHNA AND ASSOCIATED IMPLEMENTATION STRATEGY FOR EACH OF ITS FACILITIES BASED ON THE COUNTY BREAKDOWN AND DISCUSSION WITH TRIHEALTH LEADERS WITH EXPERTISE IN THE AREAS WHICH NEED TO BE ADDRESSED. THE FULL TEXT OF THESE CHNAS ARE AVAILABLE ON TRIHEALTH'S WEBSITE. SEE SCHEDULE H, PART V, LINE 7A FOR THE URL.PROGRAM SERVICE ACCOMPLISHMENTSFREE AND DISCOUNTED SERVICES ARE PROVIDED FOR THOSE UNABLE TO PAY AND MEETING ELIGIBILITY CRITERIA. THROUGH THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP), BETHESDA SERVES PATIENTS MEETING CRITERIA SET FORTH BY THE OHIO DEPARTMENT OF JOBS AND FAMILY SERVICES. BETHESDA POLICY IS TO PROVIDE CHARITY CARE ON A SLIDING SCALE DISCOUNTING WHEN THE FAMILY INCOME IS UP TO 300 PERCENT OF THE ANNUALLY ESTABLISHED FEDERAL POVERTY GUIDELINE. IT OFFERS AN UNINSURED DISCOUNT FOR MEDICALLY NECESSARY SERVICES FOR THOSE WHO HAVE NO INSURANCE AND WHO DO NOT QUALIFY FOR OTHER FINANCIAL ASSISTANCE OPTIONS. FINANCIAL COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION WHICH IS AVAILABLE ON TRIHEALTH'S WEBSITE AND BROCHURES ABOUT FINANCIAL ASSISTANCE ARE VISIBLE AND AVAILABLE IN HOSPITAL REGISTRATION AND ADMITTING AREAS.DURING THE YEAR, BETHESDA PROVIDED COMMUNITY BENEFIT (INCLUDING UNCOMPENSATED CARE) AS SHOWN ON PART I, LINE 7A. THE AMOUNT OF BENEFIT FOR BOTH TRADITIONAL CHARITY CARE AND FOR THE UNPAID COST OF MEDICAID IS ONE MANIFESTATION OF THE RISING RATES OF PERSONS WITHOUT HEALTH INSURANCE. THE MEDICAID PUBLIC PROGRAM REIMBURSES HOSPITALS FOR SERVICES BUT PAYMENTS MAY NOT ALWAYS COVER THE TOTAL COST OF CARE AND MEDICATIONS. THE UNPAID COST OF MEDICARE IS NOT INCLUDED IN TOTAL COMMUNITY BENEFIT. BETHESDA IS COMMITTED TO FULFILLING THE MISSION OF COMPASSION TO THE VULNERABLE MEMBERS OF THE COMMUNITIES THEY SERVE.BETHESDA PARTICIPATES IN THE REGIONAL TRAUMA SYSTEM THUS PROVIDING THE COMMUNITY WITH ACCESS TO TRAUMA CARE. THE TWO EMERGENCY ROOMS OF BETHESDA PROVIDE 24-HOUR EMERGENCY CARE TO COMMUNITY MEMBERS LIVING IN THE NORTHEAST CORRIDOR OF CINCINNATI AS WELL AS WARREN, BUTLER, AND CLERMONT COUNTIES. BETHESDA IS A LEVEL III TRAUMA CENTER AS VERIFIED BY THE COMMITTEE ON TRAUMA OF THE AMERICAN COLLEGE OF SURGEONS. ONE EXAMPLE OF ONGOING EFFORTS BY BETHESDA TO IMPROVE THE HEALTH OF THE BROADER COMMUNITY ARE PROGRAMS TO ADDRESS THE IDENTIFIED HEALTH NEED OF DIABETES. DIABETES EDUCATORS EXTEND THE EDUCATION TO THE COMMUNITY BY PROVIDING CLASSES TO A DIVERSE POPULATION, FROM AREA INDUSTRIES AND FIREHOUSE GROUPS TO RETIREMENT CENTERS. A DIABETES SUPPORT GROUP MEETS FOR CONTINUED EDUCATION IN CHRONIC DISEASE MANAGEMENT. IN ADDITION, WOMEN NEEDING PREGNANCY AND GYNECOLOGIC CARE CAN ACCESS THIS SERVICE AT THE OB/GYN CENTER AT BETHESDA NORTH HOSPITAL. CARE IS PROVIDED BY THE MEDICAL RESIDENTS IN OBSTETRICS AND GYNECOLOGY, SUPERVISED BY FACULTY PHYSICIANS. FINANCIAL COUNSELORS AND CARE COORDINATORS ASSIST IN FINDING APPROPRIATE COVERAGE, PAYMENT PLANS AND FINANCIAL AID. AS MANY OF THE WOMEN SERVED BY THE OB/GYN CENTER AT BETHESDA NORTH HOSPITAL HAVE LIMITED PROFICIENCY IN ENGLISH, QUALIFIED BILINGUAL STAFF ASSIST IN LANGUAGE INTERPRETATION. THE TRIHEALTH THINK FIRST PROGRAM IS AN ESTABLISHED BETHESDA SERVICE FOCUSED ON INJURY PREVENTION. THE THINK FIRST PROGRAM STAFF WORKS WITH COMMUNITY PARTNERS TO PROVIDE INJURY PREVENTION PROGRAMS AND COMMUNITY AWARENESS EVENTS. COLLABORATING WITH THE EDUCATORS, THE MEDIA, CIVIC CLUBS AND CORPORATIONS, THINK FIRST TEACHES INJURY PREVENTION TO ALL AGE GROUPS. BETHESDA CONTINUES A COMMITMENT TO EDUCATING THE NEXT GENERATION OF HEALTH CARE PROVIDERS--PHYSICIANS AND ALLIED HEALTH PROFESSIONALS. COST IN EXCESS OF GOVERNMENTAL SUPPORT FOR MEDICAL EDUCATION PROGRAMS AS SHOWN ON PART I, LINE 7H.THE BETHESDA PARAMEDIC TRAINING PROGRAM IS A HOSPITAL-BASED PROGRAM ACCREDITED BY THE OHIO DEPARTMENT OF TRANSPORTATION. THROUGH THIS TRAINING PROGRAM, CERTIFIED EMERGENCY MEDICAL TECHNICIANS CAN ADVANCE TO THE PARAMEDIC LEVEL. EDUCATION IS COMPRISED OF DIDACTIC SESSIONS, WITH LAB, FIELD, AND HOSPITAL CLINICAL ROTATIONS. BETHESDA, AS A PART OF TRIHEALTH, COLLABORATES WITH LOCAL AND REGIONAL COLLEGES, UNIVERSITIES AND TRAINING CENTERS TO PROVIDE MENTORING, INTERNSHIPS, CLERKSHIPS, SUPERVISED EDUCATION AND CLINICAL ROTATIONS TO STUDENTS IN HEALTH FIELDS. THESE PARTNERSHIPS HELP STUDENTS LEARN ABOUT AND PREPARE FOR PROFESSIONS IN NURSE PRACTITIONER, RESPIRATORY THERAPY, RADIOLOGY TECHNOLOGY, STERILE PROCESSING, PHLEBOTOMY, MEDICAL LABORATORY, PHARMACY, SPEECH, AUDIOLOGY, PHYSICAL THERAPY, AND OCCUPATIONAL THERAPY. IN CONCLUSION, ASIDE FROM THE CHARITY CARE AND UNPAID COST OF MEDICARE PROGRAMS, BETHESDA PROVIDES THE COMMUNITY WITH HEALTH CARE SERVICES AND PROGRAMS, MEDICAL EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS FOR THE POOR AND THE BROADER COMMUNITY. THIS COMMITMENT TO COMMUNITY HEALTH REVEALS BETHESDA'S FOUNDING SPIRIT OF CONCERN FOR THE VULNERABLE. IT ALSO REFLECTS THE ONGOING, TANGIBLE EFFORTS AND CONTRIBUTIONS OF COUNTLESS EMPLOYEES, PHYSICIANS AND LEADERS LIVING THE CORE VALUES OF STEWARDSHIP AND RESPONSE TO COMMUNITY NEEDS."

PART VI, LINE 4:
WITH BETHESDA NORTH HOSPITAL LOCATED IN MONTGOMERY, OHIO, A SUBURB OF CINCINNATI, AND BETHESDA BUTLER HOSPITAL LOCATED NEAR HAMILTON, OHIO, BETHESDA HOSPITAL, INC. AND THE TRIHEALTH SYSTEM SERVE PRIMARILY HAMILTON, BUTLER, WARREN AND CLERMONT COUNTIES IN OHIO AS WELL AS SOME PERSONS FROM INDIANA AND KENTUCKY. BETHESDA NORTH HOSPITALHAMILTON COUNTY IS THE MOST POPULATED COUNTY IN THE REGION AND IS HOME TO THE LARGEST CITY, CINCINNATI. THE ESTIMATED POPULATION OF THE COUNTY IS 825,000 WITH APPROXIMATELY 13% IN POVERTY AND APPROXIMATELY 8% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. HAMILTON COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $59,000 WITH 92% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (39% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 16% OF THE POPULATION IS 65 YEARS AND OLDER, 64% IS WHITE, 27% IS AFRICAN-AMERICAN, 4% IS HISPANIC, 3% ASIAN AND 2% OTHER.CLERMONT COUNTY IS A LARGE COUNTY WHICH WAS ONCE MOSTLY RURAL BUT HAS BECOME MORE SUBURBAN AND IS ONE OF OHIO'S APPALACHIAN COUNTIES. THE ESTIMATED POPULATION OF THE COUNTY IS 210,000 WITH APPROXIMATELY 9% IN POVERTY AND APPROXIMATELY 7% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. CLERMONT COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $70,000 WITH 90% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (29% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 18% OF THE POPULATION IS 65 YEARS AND OLDER, 93% IS WHITE, 2% IS AFRICAN-AMERICAN, 2% IS HISPANIC, 1.5% ASIAN AND 1.5% OTHER.WARREN COUNTY IS ONE OF THE FASTEST GROWING COUNTIES IN OHIO, BOTH IN RESIDENTIAL AND COMMERCIAL GROWTH. THE ESTIMATED POPULATION OF THE COUNTY IS 247,000 WITH APPROXIMATELY 5% IN POVERTY AND APPROXIMATELY 5% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. WARREN COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $89,500 WITH 94% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (44% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 3.5%. APPROXIMATELY 15% OF THE POPULATION IS 65 YEARS AND OLDER, 84% IS WHITE, 7% ASIAN, 4% IS AFRICAN-AMERICAN, 3% IS HISPANIC, AND 2% OTHER.BETHESDA BUTLERBUTLER COUNTY IS ONE OF THE MOST POPULATED COUNTIES IN THE REGION AND INCLUDES THE CITIES OF HAMILTON, MIDDLETOWN AND OXFORD. THE ESTIMATED POPULATION OF THE COUNTY IS 390,000 WITH APPROXIMATELY 10% IN POVERTY AND APPROXIMATELY 8% OF THE PEOPLE UNDER THE AGE OF 65 ARE WITHOUT HEALTH INSURANCE. BUTLER COUNTY HAS A MEDIAN INCOME OF APPROXIMATELY $69,000 WITH 92% OF THE POPULATION OVER THE AGE OF 24 HAVING A HIGH SCHOOL DIPLOMA OR HIGHER (31% BACHELOR'S DEGREE OR HIGHER) AND AN UNEMPLOYMENT RATE OF ABOUT 4%. APPROXIMATELY 16% OF THE POPULATION IS 65 YEARS AND OLDER, 78% IS WHITE, 10% IS AFRICAN-AMERICAN, 5% IS HISPANIC, 4% ASIAN AND 3% OTHER.

PART VI, LINE 5:
"BETHESDA HOSPITAL, INC. IS COMPRISED OF VARIOUS MEDICAL SERVICES INCLUDING BETHESDA NORTH HOSPITAL (""NORTH""), BETHESDA MEDICAL CENTER AT ARROW SPRINGS (""ARROW SPRINGS"") AND BETHESDA BUTLER HOSPITAL (""HOSPITAL""). ITS BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES. NORTH IS A 458-BED ACUTE TERTIARY TEACHING HOSPITAL. NORTH PROVIDES A 24-HOUR EMERGENCY DEPARTMENT, INTENSIVE CARE UNITS AND A LEVEL II SPECIAL CARE NURSERY. SERVICES ARE OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. IN ADDITION, NORTH HAS AN OPEN MEDICAL STAFF AND A HISTORY OF TRAINING AND EDUCATING MEDICAL RESIDENTS AND HEALTH CARE PROFESSIONALS. FINALLY IN CONCERT WITH THE HATTON INSTITUTE AT THE GOOD SAMARITAN HOSPITAL OF CINCINNATI, OHIO, AN AFFILIATED HOSPITAL, NORTH CONDUCTS MEDICAL AND SCIENTIFIC RESEARCH PROGRAMS INCLUDING STUDIES THAT ARE NOT COMMERCIALLY SPONSORED. NORTH PARTICIPATES IN MEDICARE AND MEDICAID AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS, AND HAS AN ACTIVE CHARITY CARE PROGRAM.ARROW SPRINGS COMPRISES A FULLY STAFFED 24-HOUR EMERGENCY DEPARTMENT, PRIMARY CARE AND SPECIALIST PHYSICIANS, DIAGNOSTIC SERVICES, OCCUPATIONAL MEDICINE, PHYSICAL THERAPY AND A PHARMACY. IT PROVIDES THE SAME HIGH-QUALITY, PATIENT-CENTERED CARE AND SERVICES THAT IS PROVIDED BY NORTH. BUTLER IS AN OVER 50-BED SURGICAL HOSPITAL LOCATED NEAR HAMILTON, OHIO. IT PROVIDES EVERYTHING FROM SURGERY, CARDIOLOGY AND IMAGING TO PHYSICAL THERAPY AND SLEEP STUDIES. WITH EIGHT OPERATING ROOMS, THREE ENDOSCOPY SUITES, TWO PROCEDURE ROOMS AND A FULL-SERVICE 24-HOUR EMERGENCY DEPARTMENT, THE HOSPITAL IS COMPLEMENTED BY ADDITIONAL SERVICES AND PHYSICIAN OFFICES FOR PRIMARY CARE, PEDIATRICS AND SPECIALTY CARE ON CAMPUS.THE BETHESDA HOSPITAL, INC. SERVICES DESCRIBED ABOVE, AND OTHERS NOT LISTED, PROMOTE COMMUNITY HEALTH IN ACUTE ILLNESS, IN MANAGEMENT OF CHRONIC DISEASE, AND IN EDUCATION AND PREVENTION MEASURES WHICH SEEK TO REDUCE THE BURDENS ON THE GOVERNMENT.BETHESDA HOSPITAL, INC. SERVES ALMOST 620,000 PEOPLE ANNUALLY. THIS INCLUDES ALMOST 24,000 ADMISSIONS, APPROXIMATELY 85,000 EMERGENCY ROOM VISITS, MORE THAN 485,000 OUTPATIENT VISITS, AND ALMOST 3,700 NEW BABIES EACH YEAR.SEE RESPONSE TO PART VI, LINE 2 FOR ADDITIONAL INFORMATION."