4A (Expenses $ 820555461 including grants of $ 3064040) (Revenue $ 1123755021)
CHMCA IS THE LARGEST PEDIATRIC HEALTHCARE SYSTEM IN NORTHEAST OHIO, OPERATING 2 CHILDREN'S HOSPITALS IN NORTHEAST OHIO, INCLUDING INPATIENT AND OUTPATIENT SERVICES, 2 EMERGENCY DEPARTMENTS, 4 URGENT CARES, 35 PEDIATRICIAN OFFICES, AND MORE THAN 60 PRIMARY & SPECIALTY LOCATIONS. DURING 2021, CHMCA SERVED OVER 1,268,000 PATIENTS THROUGH ALL OF ITS PROGRAMS.INPATIENT SERVICES INCLUDE AREAS OF ROUTINE CARE, NEONATAL INTENSIVE CARE, PEDIATRIC INTENSIVE CARE, BEHAVIORAL HEALTH, REGIONAL BURN CENTER, HEMATOLOGY/ONCOLOGY, AND EMERGENCY/TRAUMA SERVICES. OUTPATIENT SERVICES OFFERS UNIQUE SERVICES IN A BROAD RANGE OF PEDIATRIC SUBSPECIALTIES SUCH AS REHABILITATION SERVICES, CARDIOLOGY, PLASTIC SURGERY, GENETICS, MATERNAL FETAL MEDICINE, URGENT AND QUICK CARE, ADOLESCENT MEDICINE, PALLIATIVE CARE, PULMONARY MEDICINE, UROLOGY, OPHTHALMOLOGY, ORTHOPEDICS, NEUROLOGY, ALLERGY, DENTAL, ADDICTION SERVICES, PHYSICAL AND OCCUPATIONAL THERAPY, AND INFECTIOUS SERVICES.

FACILITY GROUP A - AKRON
PART V, SECTION B, LINE 5: IN ADDITION TO EXAMINING COUNTY-LEVEL EPIDEMIOLOGIC DATA, INTERVIEWS WERE CONDUCTED WITH COMMUNITY LEADERS REPRESENTING THE BROAD INTERESTS OF A SEVEN-COUNTY AREA FROM MARCH 2019 - MAY 2019 TO GAIN INSIGHT ON WHAT THEY THOUGHT WERE SIGNIFICANT HEALTH NEEDS OF CHILDREN IN THEIR COMMUNITIES, THE FACTORS THAT IMPACT THOSE HEALTH NEEDS, OTHER EXISTING COMMUNITY HEALTH NEEDS ASSESSMENTS, POSSIBLE COLLABORATION OPPORTUNITIES, AND TO GET SUGGESTIONS ON WHAT THE HOSPITALS CAN DO TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (HEREAFTER CHNA). LEADERS FROM THE FOLLOWING COMMUNITY ORGANIZATIONS WERE INTERVIEWED: THESE COMMUNITY LEADERS REPRESENT THE BROAD INTEREST OF THE COMMUNITIES SERVED BY THE HOSPITAL FACILITIES INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME PERSONS, THOSE WITH CHRONIC DISEASE NEEDS AND LEADERS FROM LOCAL PUBLIC HEALTH AGENCIES AND DEPARTMENTS WHO HAVE SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH AND CHILDREN'S HEALTH. THEY ARE ORGANIZED BY COUNTY. ASHLAND: ASHLAND COUNTY JOB AND FAMILY SERVICES ASHLAND PARENTING PLUS MENTAL HEALTH AND RECOVERY BOARD OF ASHLAND COUNTY MEDINA: ALTERNATIVE PATHS BOARD OF DEVELOPMENT DISABILITIES MEDINA COUNTY ALCOHOL AND DRUG ADDICTION AND MENTAL HEALTH (ADAMH) BOARD MEDINA COUNTY CHILDREN SERVICES MEDINA COUNTY HEALTH DISTRICT MEDINA COUNTY JUVENILE COURT UNITED WAY OF MEDINA COUNTY PORTAGE: KENT STATE UNIVERSITY LESBIAN, GAY, BISEXUAL, TRANSGENDER, QUEER AND QUESTIONING PLUS (LGBTQ+) CENTER PORTAGE COUNTY HEALTH DEPARTMENT PORTAGE COUNTY MENTAL HEALTH AND RECOVERY BOARDRICHLAND: RICHLAND COUNTY CHILDREN SERVICES RICHLAND COUNTY HEALTH DEPARTMENT RICHLAND COUNTY MENTAL HEALTH AND RECOVERY SERVICES STARK: CANTON CITY HEALTH DEPARTMENT MASSILLON HEALTH DEPARTMENT STARK COUNTY HEALTH DEPARTMENT STARK COUNTY JOB AND FAMILY SERVICES STARK MENTAL HEALTH & ADDICTION RECOVERY (STARKMHAR) SUMMIT: AKRON CHAPTER, NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF COLORED PEOPLE (NAACP) AKRON FIRE DEPARTMENT, PUBLIC EDUCATION AKRON METROPOLITAN HOUSING AUTHORITY AKRON YMCA AXESSPOINTE FEDERALLY QUALIFIED HEALTH CENTER CITY OF AKRON/FULL TERM FIRST BIRTHDAY GREATER AKRON INITIATIVE COMMUNITY LEGAL AID SERVICES - AKRON GAR FOUNDATION INTERNATIONAL INSTITUTE OF AKRON OHIO HOUSE OF REPRESENTATIVES - STATE REP. TAVIA GALONSKI SUMMA HEALTH SYSTEM SUMMIT COUNTY EXECUTIVE SUMMIT COUNTY ALCOHOL, DRUG AND MENTAL HEALTH (ADM) BOARD SUMMIT COUNTY CHILDREN SERVICES SUMMIT COUNTY COURT OF COMMON PLEAS SUMMIT COUNTY PUBLIC HEALTH SUMMIT EDUCATION INITIATIVE WAYNE: UNITED WAY OF WAYNE COUNTY WAYNE COUNTY COMBINED GENERAL HEALTH DISTRICT WAYNE COUNTY FAMILY AND CHILDREN FIRST COUNCIL COMMUNITY RESIDENT FOCUS GROUPS: IN ADDITION TO INPUT FROM COMMUNITY LEADERS, FOCUS GROUPS WERE CONDUCTED WITH 118 COMMUNITY RESIDENTS IN THE SAME SEVEN-COUNTY AREA FROM FEBRUARY - APRIL 2019. A QUESTIONNAIRE WAS DISTRIBUTED TO THE FOCUS GROUP PARTICIPANTS TO GATHER DEMOGRAPHIC INFORMATION AND BASIC PERCEPTIONS OF COMMUNITY HEALTH. DUE TO THE OBSERVED INFORMATION GAP IN THE EPIDEMIOLOGIC DATA ON CHILD AND YOUTH MENTAL HEALTH ISSUES, HEALTH BEHAVIORS, AS WELL AS FAMILY DYNAMICS, SOCIAL DETERMINANTS OF HEALTH AND TRAUMA, QUESTIONS WERE ASKED TO PROBE MORE DEEPLY ON THESE ISSUES. THE FACILITATION GUIDE AND QUESTIONNAIRE WERE DEVELOPED IN PARTNERSHIP WITH THE CENTER FOR COMMUNITY SOLUTIONS, WHO CONDUCTED CHNA RESEARCH AND ANALYSES. COMMUNITY RESIDENTS WERE RECRUITED TO PARTICIPATE IN THE FOCUS GROUPS THROUGH RELATIONSHIPS WITH COMMUNITY AGENCIES AND INDIVIDUALS REPRESENTING THOSE AGENCIES. WE CONDUCTED FOCUS GROUPS IN SITES WITH COMMUNITY RECOGNITION/FAMILIARITY AND EASE OF ACCESS, INCLUDING A LOCAL PARISH, PUBLIC LIBRARY, COMMUNITY ACTION AGENCY, HOMELESS SHELTER, UNITED WAY OFFICE, NEIGHBORHOOD DEVELOPMENT CORPORATION, TWO FAMILY RESOURCE CENTERS (INCLUDING ONE FOR FOSTER FAMILIES), COMMUNITY LEARNING CENTER AND CHMCA HEALTH CENTER. 57.6% OF PARTICIPANTS WERE FROM SUMMIT COUNTY, AS SESSIONS WERE PLANNED WITH NON-ENGLISH SPEAKING (NEPALI AND KAREN) IMMIGRANTS AS WELL AS HOUSING INSECURE POPULATIONS IN THIS COMMUNITY. THE ADDITIONAL COUNTY BREAKDOWN WAS AS FOLLOWS: 10.2% FROM ASHLAND COUNTY, 8.5% FROM RICHLAND COUNTY, 8.5% FROM STARK COUNTY, 5.9% FROM MEDINA COUNTY, 5% FROM WAYNE COUNTY AND 4.2% FROM PORTAGE COUNTY.

FACILITY GROUP B - MAHONING VALLEY
PART V, SECTION B, LINE 5: - IN ADDITION TO EXAMINING COUNTY-LEVEL EPIDEMIOLOGIC DATA INTERVIEWS WERE CONDUCTED WITH COMMUNITY LEADERS REPRESENTING THE BROAD INTEREST OF A THREE-COUNTY AREA FROM MARCH - MAY 2019 TO GAIN INSIGHT ON WHAT THEY THOUGHT WERE SIGNIFICANT HEALTH NEEDS OF CHILDREN AND FAMILIES IN THEIR COMMUNITIES, THE FACTORS THAT AFFECT THOSE HEALTH NEEDS, OTHER EXISTING COMMUNITY HEALTH NEEDS ASSESSMENTS, POSSIBLE COLLABORATION OPPORTUNITIES, AND TO GET SUGGESTIONS ON WHAT CHMCA CAN DO TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (HEREAFTER CHNA). LEADERS FROM THE FOLLOWING COMMUNITY ORGANIZATIONS WERE INTERVIEWED AND ARE ORGANIZED BY THOSE SERVING THE TRI-COUNTY REGION AND INDIVIDUAL COUNTIES WITHIN. MAHONING VALLEY (TRI-COUNTY REGION) COMMUNITY FOUNDATION OF THE MAHONING VALLEY UNITED WAY OF YOUNGSTOWN AND THE MAHONING VALLEY COLUMBIANA COLUMBIANA COUNTY EDUCATIONAL SERVICE CENTER COLUMBIANA COUNTY HEALTH DEPARTMENT COLUMBIANA COUNTY FAMILY AND CHILDREN FIRST COUNCIL SALEM REGIONAL MEDICAL CENTER MAHONING CITY OF YOUNGSTOWN MAHONING COUNTY CHILDREN SERVICES MAHONING COUNTY JUVENILE COURT DIVISION MAHONING COUNTY MENTAL HEALTH & RECOVERY BOARD MERCY HEALTH - YOUNGSTOWN REGION YOUNGSTOWN CITY HEALTH DISTRICT YOUNGSTOWN NEIGHBORHOOD DEVELOPMENT CORPORATION TRUMBULL CITY OF WARREN TRUMBULL COUNTY BOARD OF DEVELOPMENTAL DISABILITIES (FAIRHAVEN) TRUMBULL COUNTY CHILDREN SERVICES TRUMBULL COUNTY HEALTH DEPARTMENT TRUMBULL COUNTY MENTAL HEALTH & RECOVERY BOARD COMMUNITY RESIDENT FOCUS GROUPS IN ADDITION TO INPUT FROM COMMUNITY LEADERS, FOCUS GROUPS WERE CONDUCTED WITH 23 COMMUNITY RESIDENTS IN THE SAME THREE-COUNTY AREA FROM MARCH - APRIL 2019. IN ADDITION, A QUESTIONNAIRE WAS DISTRIBUTED TO THE FOCUS GROUP PARTICIPANTS TO GATHER DEMOGRAPHIC INFORMATION AND BASIC PERCEPTIONS OF COMMUNITY HEALTH. DUE TO THE OBSERVED INFORMATION GAP IN THE EPIDEMIOLOGIC DATA ON CHILD AND YOUTH MENTAL HEALTH ISSUES, HEALTH BEHAVIORS, AS WELL AS FAMILY DYNAMICS, SOCIAL DETERMINANTS OF HEALTH AND TRAUMA, QUESTIONS WERE ASKED TO PROBE MORE DEEPLY ON THESE ISSUES. THE FACILITATION GUIDE AND QUESTIONNAIRE WERE DEVELOPED IN PARTNERSHIP WITH THE CENTER FOR COMMUNITY SOLUTIONS, WHO CONDUCTED CHNA RESEARCH AND ANALYSES. COMMUNITY RESIDENTS WERE RECRUITED TO PARTICIPATE IN THE FOCUS GROUPS THROUGH RELATIONSHIPS WITH COMMUNITY AGENCIES AND INDIVIDUALS REPRESENTING THOSE AGENCIES. WE CONDUCTED FOCUS GROUPS IN SITES WITH COMMUNITY RECOGNITION AND EASE OF ACCESS, INCLUDING A WIC OFFICE, PUBLIC LIBRARY AND JOB & FAMILY SERVICES COMMUNITY ROOM. 52.2% OF PARTICIPANTS WERE FROM MAHONING COUNTY, 26.1% FROM COLUMBIANA COUNTY, AND 21.7% FROM TRUMBULL COUNTY.

FACILITY GROUP A - AKRON
PART V, SECTION B, LINE 11: THE MEASURED INDICATORS IN THE 2019 CHNA HAVE BEEN ADDRESSED FOR MANY YEARS THROUGH CHMCA'S CLINICAL AND PROGRAMMATIC EFFORTS. OUR HIGHLY QUALIFIED MEDICAL STAFF AND PROFESSIONALS PROVIDE WORLD-CLASS PATIENT CENTERED CARE TO ADDRESS EACH OF THESE INDICATORS THROUGH OUR LOIS AND JOHN ORR FAMILY BEHAVIORAL HEALTH CENTER, CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE, CENTER FOR DIABETES AND ENDOCRINOLOGY, ROBERT T. STONE, MD, RESPIRATORY CENTER, HEART CENTER, DIVISION OF PEDIATRIC PSYCHIATRY AND PSYCHOLOGY, AND THE SHOWERS FAMILY CENTER FOR CHILDHOOD CANCER AND BLOOD DISORDERS. THE 2019 CHNA IDENTIFIED AND PRIORITIZED SEVERAL COMMUNITY HEALTH NEEDS. OUR BOARD OF DIRECTORS APPROVED COMPREHENSIVE IMPLEMENTATION STRATEGIES THAT FOCUSED ON ADDRESSING CONDITIONS RELATED TO BEHAVIORAL HEALTH WITH A FOCUS ON ADVERSE CHILDHOOD EXPERIENCES, ASTHMA, AND INFANT MORTALITY. THE REMAINING IDENTIFIED NEEDS FROM THE CHNA, INCLUDING CONDITIONS RELATED TO CHILD LIFESTYLE FACTORS, CRIME AND VIOLENCE, ACCESS TO HEALTH CARE AND ENVIRONMENTAL FACTORS, WERE NOT FORMALLY SELECTED AS PRIORITIES, BUT WILL BE ADDRESSED AS RELEVANT THROUGH STRATEGIES ASSOCIATED WITH THE THREE PRIORITIES NAMED ABOVE. WE WILL CONTINUE TO LOOK TO CHNA DATA, AS WELL AS OTHER DATA SOURCES, ON THESE CONDITIONS TO GUIDE OUR EFFORTS AND ADVANCE OUR MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. SPECIFIC NEEDS NOT ADDRESSED ALTHOUGH ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED BY THE CHNA ARE IMPORTANT, HOSPITAL TEAMS DELIBERATED AND PRIORITIZED THREE HIGH-PRIORITY AREAS BASED ON THE HOSPITAL'S CURRENT ACTIVITIES, THE POTENTIAL FOR COMMUNITY IMPACT, AND AVAILABLE RESOURCES. CONSEQUENTLY, SEVERAL AREAS WILL NOT BE ADDRESSED THROUGH FORMAL IMPLEMENTATION STRATEGIES. THESE INCLUDE HEALTH AREAS THAT RANKED LOWER DURING THE PRIORITIZATION PROCESS. ADDITIONALLY, CERTAIN HEALTH AREAS WERE BEYOND THE SCOPE OF THE HOSPITAL, WITH SOME HEALTH AREAS REQUIRING MORE RESOURCES THAN WHAT WAS AVAILABLE: - ACCESS TO HEALTH CARE - ORAL HEALTH - CHILD WELL BEING AND BEHAVIOR - FOOD ACCESS & NUTRITION - OBESITY & SCREEN TIME - UNINTENTIONAL INJURIES - OTHER SOCIAL AND ENVIRONMENTAL FACTORS - AFFORDABLE HOUSING & EVICTION - TRANSPORTATION CHMCA CLINICIANS DO NOT PROVIDE CARE SERVICES FOR PREGNANT WOMEN, OTHER THAN THOSE WHOSE BABIES HAVE BEEN DIAGNOSED BEFORE BIRTH OR PRENATALLY WITH A CONDITION OR DISEASE THAT MUST BE MONITORED BY OUR MATERNAL FETAL MEDICINE (MFM) CENTER OR GENETICS CENTER. THEREFORE, OUR EFFORTS TO IMPACT BIRTH OUTCOMES SUCH AS PREMATURITY AND LOW BIRTH WEIGHT ARE BEING CARRIED OUT IN RELATION TO COALITION WORK WITH COMMUNITY AGENCIES AND LOCAL BIRTHING HOSPITALS. THESE INCLUDE ACTIVITIES SUCH AS EDUCATION AND MARKETING OF APPROPRIATE BIRTH SPACING AND LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) PROMOTION. WE DO CARE FOR BABIES BORN AT LOW AND VERY LOW BIRTH WEIGHTS AND PRETERM INFANTS REQUIRING HOSPITALIZATION IN THE NICU ON THE AKRON CAMPUS OR OTHER NICU LOCATIONS THAT WE OPERATE AT CLEVELAND CLINIC - AKRON GENERAL, SUMMA HEALTH SYSTEM, ST. ELIZABETH HOSPITAL IN YOUNGSTOWN AND AULTMAN HOSPITAL IN CANTON, AND THE SPECIAL CARE NURSERY AT OUR MAHONING VALLEY CAMPUS IN BOARDMAN AND WOOSTER. DATA LIMITATIONS AND GAPS DUE TO LIMITED RESOURCES AND TIME CONSTRAINTS, COMPLETE DATA WERE NOT AVAILABLE FOR EVERY VULNERABLE POPULATION, SUCH AS THE HOMELESS OR REFUGEE POPULATIONS. WHERE AVAILABLE, THE MOST CURRENT DATA WERE USED TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. ALTHOUGH THE DATA AVAILABLE ARE RICH WITH INFORMATION, DATA GAPS AND LIMITATIONS EXISTED THAT IMPACTED THE ABILITY TO CONDUCT A MORE THOROUGH AND RIGOROUS ASSESSMENT. THESE INCLUDE: 1. LAG TIME FOR DATA TO BE REPORTED BY THE STATE AND SOME LOCAL SOURCES. 2. PEDIATRIC DATA RELATED TO SUBSTANCE ABUSE, SEXUAL BEHAVIORS, AND OTHER LIFESTYLE FACTORS SUCH AS DIET AND EXERCISE, WERE NOT CONSISTENT ACROSS COUNTIES IN OUR PRIMARY SERVICE AREA. IN ADDITION, THESE DATA ARE LIMITED AND UNDER SAMPLED, NOT ADEQUATELY REPRESENTING THE COMMUNITIES OR SPECIFIC POPULATIONS. 3. ONLY TWO COMPLETE YEARS OF HOSPITAL ENCOUNTER DATA WERE AVAILABLE DUE TO A TRANSITION IN Q4 OF 2015 FROM ICD-9 TO ICD-10 DIAGNOSIS CODES.4. COUNTY AND STATEWIDE CHRONIC DISEASE DATA ARE NOT AVAILABLE FOR CHILDREN. ASTHMA, DIABETES AND OTHER CHRONIC DISEASE DATA REPORTED IN THE CHNA WERE GLEANED FROM OHIO HOSPITAL ASSOCIATION (OHA) HOSPITAL ENCOUNTER DATA. THESE DATA ARE REPORTED BY THE PRIMARY DIAGNOSIS CODE FOR THE ENCOUNTER AND BY PRODUCT GROUP (AN ITEM THAT IS TIED TO BILLING). BECAUSE DIAGNOSIS CODES DO NOT ALWAYS REFLECT UNDERLYING CONDITIONS, THESE DATA ALMOST CERTAINLY UNDERREPRESENT THE TRUE BURDEN OF CHRONIC DISEASE IN THE PEDIATRIC POPULATION.

FACILITY GROUP B - MAHONING VALLEY
PART V, SECTION B, LINE 11: THE MEASURED INDICATORS IN THE 2019 CHNA HAVE BEEN ADDRESSED FOR MANY YEARS THROUGH CHMCA'S CLINICAL AND PROGRAMMATIC EFFORTS. OUR HIGHLY QUALIFIED MEDICAL STAFF AND PROFESSIONALS PROVIDE WORLD-CLASS PATIENT CENTERED CARE TO ADDRESS EACH OF THESE INDICATORS THROUGH OUR LOIS AND JOHN ORR FAMILY BEHAVIORAL HEALTH CENTER, CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE, CENTER FOR DIABETES AND ENDOCRINOLOGY, ROBERT T. STONE, MD RESPIRATORY CENTER, HEART CENTER, DIVISION OF PEDIATRIC PSYCHIATRY AND PSYCHOLOGY, AND THE SHOWERS FAMILY CENTER FOR CHILDHOOD CANCER AND BLOOD DISORDERS. THE 2019 CHNA IDENTIFIED AND PRIORITIZED SEVERAL COMMUNITY HEALTH NEEDS. OUR BOARD OF DIRECTORS APPROVED COMPREHENSIVE IMPLEMENTATION STRATEGIES THAT FOCUSED ON ADDRESSING THE CONDITIONS OF ASTHMA, BEHAVIORAL HEALTH AND ADVERSE CHILDHOOD EXPERIENCES (ACES), AND INFANT MORTALITY. THE REMAINING IDENTIFIED NEEDS FROM THE CHNA, INCLUDING CONDITIONS RELATED TO CHILD LIFESTYLE FACTORS, HEALTH ACCESS, AND ENVIRONMENTAL FACTORS, WERE NOT FORMALLY ADDRESSED THROUGH IMPLEMENTATION STRATEGIES. REASONS FOR THIS VARY. IN SOME CASES, OTHER COMMUNITY AGENCIES WERE DETERMINED TO BE BETTER POSITIONED TO ADDRESS THESE CONDITIONS; OR THERE WERE INSUFFICIENT HOSPITAL RESOURCES (INCLUDING BUDGET, STAFF AND/OR PARTNERSHIPS) IN PLACE. OVERALL, ALIGNMENT WITH HOSPITAL STRATEGIC PRIORITIES AND INVOLVEMENT WITH EXISTING COMMUNITY INITIATIVES PLACED SOME ISSUES ABOVE OTHERS IN TERMS OF FEASIBILITY TO MAKE A MEASURABLE IMPACT. WE WILL CONTINUE TO LOOK TO CHNA AND OTHER DATA ON HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH TO GUIDE OUR EFFORTS AND ADVANCE OUR MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE.SPECIFIC NEEDS NOT ADDRESSED:ALTHOUGH ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED BY THE CHNA ARE IMPORTANT, AN AD HOC COMMITTEE OF HOSPITAL STAFF DELIBERATED AND PRIORITIZED THREE HIGH-PRIORITY AREAS BASED ON THE HOSPITAL'S CURRENT ACTIVITIES, AVAILABLE RESOURCES AND POTENTIAL FOR COMMUNITY IMPACT. CONSEQUENTLY, SEVERAL AREAS WILL NOT BE ADDRESSED THROUGH FORMAL IMPLEMENTATION STRATEGIES. THESE INCLUDE HEALTH AREAS THAT RANKED LOWER DURING THE PRIORITIZATION PROCESS. ADDITIONALLY, CERTAIN HEALTH AREAS WERE BEYOND THE SCOPE OF THE HOSPITAL, WITH SOME HEALTH AREAS REQUIRING MORE RESOURCES THAN WHAT WAS AVAILABLE. THESE INCLUDED:- ACCESS TO HEALTH CARE - ORAL HEALTH - CHILD WELL BEING AND BEHAVIOR - FOOD ACCESS & NUTRITION - OBESITY & SCREEN TIME - UNINTENTIONAL INJURIES - OTHER SOCIAL AND ENVIRONMENTAL FACTORS - AFFORDABLE HOUSING & EVICTION - TRANSPORTATION ADDITIONALLY, CHMCA'S CLINICIANS DO NOT PROVIDE CARE SERVICES FOR PREGNANT WOMEN, OTHER THAN THOSE WHOSE BABIES HAVE BEEN DIAGNOSED BEFORE BIRTH OR PRENATALLY WITH A CONDITION OR DISEASE THAT MUST BE MONITORED BY OUR MATERNAL FETAL MEDICINE (MFM) CENTER OR GENETICS CENTER. THEREFORE, OUR EFFORTS TO IMPACT BIRTH OUTCOMES SUCH AS PREMATURITY AND LOW BIRTH WEIGHT WILL BE CARRIED OUT IN RELATION TO COLLABORATIONS WITH COMMUNITY AGENCIES AND BIRTHING HOSPITALS. THESE INCLUDE ACTIVITIES SUCH AS EDUCATION AND MARKETING OF APPROPRIATE BIRTH SPACING AND LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) PROMOTION, AND SMOKING CESSATION SUPPORT. WE DO CARE FOR BABIES BORN AT LOW AND VERY LOW BIRTH WEIGHTS AND PRETERM INFANTS REQUIRING HOSPITALIZATION IN THE NICU ON THE AKRON CAMPUS OR NICUS THAT WE OPERATE AT CLEVELAND CLINIC - AKRON GENERAL, SUMMA HEALTH SYSTEM AND ST. ELIZABETH HOSPITAL IN YOUNGSTOWN, AND THE SPECIAL CARE NURSERY AT OUR MAHONING VALLEY CAMPUS IN BOARDMAN. DATA LIMITATIONS AND GAPS:DUE TO LIMITED RESOURCES AND TIME CONSTRAINTS, COMPLETE DATA WERE NOT AVAILABLE FOR EVERY VULNERABLE POPULATION, SUCH AS THE HOMELESS OR REFUGEE POPULATIONS. WHERE AVAILABLE, THE MOST CURRENT DATA WERE USED TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. ALTHOUGH THE DATA AVAILABLE ARE RICH WITH INFORMATION, DATA GAPS AND LIMITATIONS EXISTED THAT IMPACTED THE ABILITY TO CONDUCT A MORE THOROUGH AND RIGOROUS ASSESSMENT. THESE INCLUDE: 1. LAG TIME FOR DATA TO BE REPORTED BY THE STATE AND SOME LOCAL SOURCES.2. PEDIATRIC DATA RELATED TO SUBSTANCE ABUSE, SEXUAL BEHAVIORS, AND OTHER LIFESTYLE FACTORS SUCH AS DIET AND EXERCISE, WERE NOT CONSISTENT ACROSS COUNTIES IN OUR PRIMARY SERVICE AREA. IN ADDITION, THESE DATA ARE LIMITED AND UNDER SAMPLED, NOT ADEQUATELY REPRESENTING THE COMMUNITIES OR SPECIFIC POPULATIONS. 3. ONLY TWO COMPLETE YEARS OF HOSPITAL ENCOUNTER DATA WERE AVAILABLE DUE TO A TRANSITION IN Q4 OF 2015 FROM ICD-9 TO ICD-10 DIAGNOSIS CODES. 4. COUNTY AND STATEWIDE CHRONIC DISEASE DATA ARE NOT AVAILABLE FOR CHILDREN. ASTHMA, DIABETES AND OTHER CHRONIC DISEASE DATA REPORTED IN THE CHNA WERE GLEANED FROM OHIO HOSPITAL ASSOCIATION (OHA) HOSPITAL ENCOUNTER DATA. THESE DATA ARE REPORTED BY THE PRIMARY DIAGNOSIS CODE FOR THE ENCOUNTER AND BY PRODUCT GROUP (AN ITEM THAT IS TIED TO BILLING). BECAUSE DIAGNOSIS CODES DO NOT ALWAYS REFLECT UNDERLYING CONDITIONS, THESE DATA ALMOST CERTAINLY UNDERREPRESENT THE TRUE BURDEN OF CHRONIC DISEASE IN THE PEDIATRIC POPULATION.

FACILITY GROUP A - AKRON
PART V, SECTION B, LINE 13H: PATIENTS OR FAMILIES WHO MAY NOT QUALIFY FOR FINANCIAL ASSISTANCE BASED ON RESIDENCE AND INCOME MAY STILL QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON DOCUMENTED EXTENUATING CIRCUMSTANCES WHERE PURSUIT OF PAYMENT WOULD CAUSE UNDUE HARDSHIP ON THE PATIENT/FAMILY. EXTENUATING CIRCUMSTANCES MAY BE BROUGHT TO THE ATTENTION OF THE DIRECTOR, REVENUE CYCLE, AND REVIEWED BY THE FINANCIAL ASSISTANCE COMMITTEE, CHAIRED BY THE CHIEF FINANCIAL OFFICER AND CHIEF MEDICAL OFFICER.

FACILITY GROUP B - MAHONING VALLEY
PART V, SECTION B, LINE 13H: PATIENTS OR FAMILIES WHO MAY NOT QUALIFY FOR FINANCIAL ASSISTANCE BASED ON RESIDENCE AND INCOME MAY STILL QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON DOCUMENTED EXTENUATING CIRCUMSTANCES WHERE PURSUIT OF PAYMENT WOULD CAUSE UNDUE HARDSHIP ON THE PATIENT/FAMILY. EXTENUATING CIRCUMSTANCES MAY BE BROUGHT TO THE DIRECTOR, REVENUE CYCLE, AND REVIEWED BY THE FINANCIAL ASSISTANCE COMMITTEE, CHAIRED BY THE CHIEF FINANCIAL OFFICER AND CHIEF MEDICAL OFFICER.

FACILITY GROUP A - AKRON
PART V, SECTION B, LINE 15E: FINANCIAL COUNSELORS ARE EMPLOYED AT THE HOSPITAL TO DISCUSS THE AVAILABILITY AND APPLICATION FOR ALL FINANCIAL ASSISTANCE FOR ALL PATIENTS.

FACILITY GROUP B - MAHONING VALLEY
PART V, SECTION B, LINE 15E: FINANCIAL COUNSELORS ARE EMPLOYED AT THE HOSPITAL TO DISCUSS THE AVAILABILITY AND APPLICATION FOR FINANCIAL ASSISTANCE FOR ALL PATIENTS.

FACILITY GROUP A - AKRON
PART V, SECTION B, LINE 20E: YES - THIRD PARTY COLLECTION AGENCIES WILL EXPLAIN THE AVAILABILITY OF FREE CARE AND CHARITY CARE AND THE FINANCIAL ASSISTANCE APPLICATION.

FACILITY GROUP B - MAHONING VALLEY
PART V, SECTION B, LINE 20E: YES - THIRD-PARTY COLLECTION AGENCIES WILL EXPLAIN THE AVAILABILITY FOR FREE CARE AND CHARITY CARE AND THE FINANCIAL ASSISTANCE APPLICATION.

PART I, LINE 7:
WE BELIEVE THAT APPLYING A COST-TO-CHARGE RATIO DEVELOPED FOR THE HOSPITAL FACILITY FROM THE OHIO MEDICAID COST REPORT TO HOSPITAL CHARITY CHARGES, AS REPORTED IN DETAIL SCHEDULES USED IN THE PREPARATION OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND OTHER INFORMATION IS THE MOST ACCURATE COSTING METHODOLOGY TO CALCULATE GROSS CHARITY CARE AT COST FOR THE PERIOD. TOTAL HOSPITAL COSTS FROM THE OHIO MEDICAID COST REPORT USED IN THIS CALCULATION INCLUDE ONLY ALLOWABLE AND REIMBURSABLE COSTS. THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) IS OHIO'S METHODOLOGY TO PROVIDE ADDITIONAL PAYMENTS TO HOSPITALS THAT PROVIDE A DISPROPORTIONATE SHARE OF UNCOMPENSATED CARE TO THE INDIGENT AND UNINSURED. THE ESTIMATED HCAP AMOUNT APPLICABLE TO CHARITY CARE IS REPORTED AS DIRECT OFFSETTING REVENUE TO CHARITY CARE EXPENSE.PART I, LINE 7 (B) UNREIMBURSED MEDICAID & 7 (C) OTHER MEANS TESTED WE BELIEVE THAT REPORTING PROGRAM CHARGES, COSTS AND PAYMENTS DIRECTLY FROM CHMCA'S OHIO MEDICAID COST REPORT ALONG WITH SIMILAR CALCULATIONS FOR SERVICES RENDERED BY HOSPITAL EMPLOYED PHYSICIANS AND OTHER PROFESSIONAL PROVIDERS AND SERVICES RENDERED TO OUT-OF-STATE MEDICAID ENROLLEES IS THE MOST ACCURATE METHODOLOGY TO CALCULATE UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAM COSTS. MEDICAID COSTS REPORTED AS TOTAL COMMUNITY BENEFIT EXPENSE HAVE BEEN REDUCED BY ESTIMATED HEALTH PROFESSIONAL COSTS INCLUDED IN THE OHIO MEDICAID COST REPORT AND MEDICAID REVENUES REPORTED AS DIRECT OFFSETTING REVENUE HAS BEEN REDUCED BY ESTIMATED MEDICAID REVENUES RELATED TO HEALTH PROFESSIONAL EDUCATION. TO AVOID DOUBLE COUNTING OF COSTS REPORTED ELSEWHERE IN THIS SCHEDULE, GROSS COSTS FOR OTHER REPORTABLE ITEMS HAVE BEEN REDUCED BY THE TOTAL GOVERNMENT PAYOR MIX PERCENTAGE OF (54.8%) AS REPORTED ON OUR INTERNAL PAYOR MIX REPORT.

PART I, LINE 7G:
OUR EXPRESSIVE THERAPY CENTER WAS BUILT TO ENABLE CHILDREN FACING ILLNESS AND THEIR FAMILIES TO EXPERIENCE WHAT IT MEANS TO BE HUMAN THROUGH WHATEVER CREATIVE ART INSPIRES THEM. THE CHILDREN UTILIZING THESE SERVICES DO NOT NEED TO BE A HOSPITAL PATIENT. THIS SERVICE IS NOT REIMBURSED BY INSURANCE AND IS A NON-REIMBURSABLE COST CENTER FOR MEDICARE. WE RECOGNIZE THIS AS A SUBSIDIZED HEALTH SERVICE. ATHLETIC TRAINERS HELP CHILDREN DEAL WITH SPORTS RELATED INJURIES AND ARE AVAILABLE FOR HIGH SCHOOL SPORTING EVENTS IN CASE OF A SPORTS RELATED INJURY. THE CHILDREN UTILIZING THESE SERVICES DO NOT NEED TO BE A HOSPITAL PATIENT. THIS SERVICE IS NOT REIMBURSED BY INSURANCE AND IS A NON-REIMBURSABLE COST CENTER FOR MEDICARE. WE RECOGNIZE THIS AS A SUBSIDIZED HEALTH SERVICE. THE CHALLENGES THAT ALL HOSPITALS FACED IN 2020 DUE TO THE COVID-19 PANDEMIC CARRIED OVER INTO 2021. VOLUMES, REVENUES, AND REIMBURSEMENTS WERE STILL BELOW PRE-PANDEMIC LEVELS. MANY OF THE ESSENTIAL CHILDREN'S SERVICES PROVIDED WERE STILL REIMBURSED AT LESS THAN COST. CALCULATED SUBSIDIZED HEALTH SERVICES WERE CALCULATED USING OUR MEDICARE COST REPORT RATIO OF COSTS TO CHARGES APPLIED TO OR COMMERCIAL POPULATION TO AVOID DOUBLE COUNTING FOR MEDICAID AND OTHER GOVERNMENT PAYERS. THIS CALCULATED COST WAS THEN REDUCED BY THE AMOUNT AKRON CHILDREN'S RECEIVED FOR PROVIDER RELIEF FUNDING.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 17,214,790.

PART II, COMMUNITY BUILDING ACTIVITIES:
STAYING TRUE TO OUR MISSION, EVERYTHING DONE BY CHMCA IS INTENDED TO BENEFIT THE COMMUNITIES WE SERVE. OUR PRIMARY BENEFIT TO EACH COMMUNITY IS PROVIDING ACCESS TO WORLD-CLASS HEALTH CARE TO THE CHILDREN IN THE REGIONS WE SERVE. ADDITIONALLY, WE PARTICIPATE IN A VARIETY OF OTHER INTERNAL AND COMMUNITY BASED EFFORTS TO IMPROVE THE SOCIAL AND ENVIRONMENTAL CONDITIONS SURROUNDING HEALTH. OUR EFFORTS INCLUDE: LEADERSHIP DEVELOPMENT, UNDER WHICH WE SUPPORT VARIOUS COMMUNITY-BASED PROGRAMS THAT SPECIFICALLY DEVELOP COMMUNITY LEADERS, INCLUDING SUCH PROGRAMS AS LEADERSHIP AKRON (FOR COMMUNITY LEADERSHIP) AND THE CHILD & FAMILY LEADERSHIP EXCHANGE (FOR CLINICAL AND SOCIAL SERVICE LEADERSHIP). WE SUPPORT AND ARE ACTIVELY INVOLVED IN INITIATIVES SUCH AS TORCHBEARERS, WHICH IS FOCUSED ON DEVELOPING AND RETAINING STRONG COMMUNITY LEADERSHIP; COALITIONS AND PARTNERSHIPS, IN WHICH CHMCA IS STRONGLY REPRESENTED IN COMMITTEES AND TASK FORCES ASSIGNED TO ADDRESS SPECIFIC HEALTH INDICATORS AND CONDITIONS, IN ADDITION TO CERTAIN DIVERGENT POPULATIONS LOCATED THROUGHOUT OUR REGION, STATE, AS WELL AS NATIONALLY AND INTERNATIONALLY.AS A TEACHING HOSPITAL, WE PARTNER WITH DOZENS OF HIGHER EDUCATION INSTITUTIONS IN PROVIDING TRAINING AND HANDS-ON INSTRUCTION AND SHADOWING OPPORTUNITIES FOR STUDENTS WHO EMBARK ON HEALTH CARE CAREER TRAJECTORIES. CHMCA PROVIDES FINANCIAL AND IN-KIND STAFF SUPPORT FOR VARIOUS COMMUNITY-BASED ORGANIZATIONS AND INITIATIVES WHOSE MISSIONS ARE AIMED AT IMPROVING CONDITIONS SURROUNDING HEALTH AND WELLBEING FOR CHILDREN AND THEIR FAMILIES WITHIN OUR SERVICE AREA. WE EVALUATE SPONSORSHIP REQUESTS AND DESIGNATE A PORTION OF FUNDS TO ORGANIZATIONS THAT ARE WORKING TO ENHANCE DIVERSITY, EQUITY, AND INCLUSION, PROMOTE YOUTH ENGAGEMENT IN HEALTHY ACTIVITIES, AND OFFER SERVICES THAT HELP TO CLOSE GAPS IN ACCESS. WE ENGAGE IN WORKFORCE DEVELOPMENT EFFORTS THROUGH INITIATIVES SUCH AS THE COLLEGE AND CAREER ACADEMY OF HEALTH AND HUMAN SERVICES AT NORTH HIGH SCHOOL, ESTABLISHED THROUGH A PARTNERSHIP WITH AKRON PUBLIC SCHOOLS. THIS PROGRAM OFFERS HIGH-SCHOOLERS CAREER-FOCUSED PATHWAYS IN HEALTHCARE OPERATIONS, EARLY CHILDHOOD EDUCATION, BIOMEDICAL SCIENCE AND ALLIED HEALTH. THROUGH THE ACADEMY, WE ALSO ASSIST TEACHERS IN TAILORING THEIR CURRICULA TO HEALTH CARE APPLICATIONS.

PART III, LINE 9B:
CHMCA'S POLICY APPLIES TO ALL PATIENTS - INSURED, UNDERINSURED AND UNINSURED. THE POLICY OUTLINES THE STATEMENT CYCLE, ONCE A SELF-PAY BALANCE IS REACHED, A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE MAY BE IDENTIFIED ANY TIME DURING THE REVENUE CYCLE. IF A PATIENT HAS BEEN DETERMINED TO MEET FINANCIAL ASSISTANCE GUIDELINES, FREE OR DISCOUNTED CARE, THE ACCOUNT WILL NOT BE TRANSFERRED TO A COLLECTION AGENCY.

PART VI, LINE 4:
COMMUNITY INFORMATION - GROUP A:CHMCA IS A WORLD-CLASS PEDIATRIC HEALTH CARE INSTITUTION SERVING A REGION OF MORE THAN 25 COUNTIES SPREAD ACROSS NORTHEAST AND NORTH-CENTRAL OHIO, IN ADDITION TO TWO COUNTIES ON THE BORDER OF WESTERN PENNSYLVANIA. THE PERCENTAGE OF PATIENTS WE TREAT THAT ARE ON MEDICAID IS 54.8%. ADDITIONALLY, WE SERVE AS THE MEDICAL HOME FOR CHILDREN WHO ARE PART OF PRIORITY POPULATIONS OR COMMUNITIES THAT ARE CONSIDERED VULNERABLE. THESE INCLUDE FAMILIES LIVING IN POVERTY, BOTH WITHIN THE URBAN CORE AND THE RURAL FRINGE; CHILDREN WHO ARE PART OF THE CHILD WELFARE AND JUVENILE JUSTICE SYSTEMS; CHILDREN FROM NON-ENGLISH-SPEAKING FAMILIES (SUCH AS RECENT IMMIGRANTS AND REFUGEES FROM SOUTHEAST ASIA, THE MIDDLE EAST, AND PARTS OF AFRICA); AND THE AMISH. FOR THE PURPOSES OF THE 2019 CHNA, WE FOCUSED ON A 10-COUNTY REGION REPRESENTATIVE OF WHERE THE MAJORITY OF PATIENTS RESIDE. SEVEN OF THE 10 COUNTIES COMPRISE THE REGION THAT IS SERVED BY OUR AKRON HOSPITAL FACILITY. DEMOGRAPHIC INFORMATION ON THESE COUNTIES IS DETAILED BELOW.HTTPS://WWW.CENSUS.GOV/QUICKFACTS/FACT/TABLE/OH/PST045221ASHLAND COUNTY THERE ARE APPROXIMATELY 52,316 PEOPLE LIVING IN ASHLAND COUNTY, WHICH IS A 0.2% DECREASE SINCE THE 2020 CENSUS. IT HAS 1 CITY, 8 VILLAGES, AND 15 TOWNSHIPS, WITH THE LARGEST BEING THE CITY OF ASHLAND. COMPARED TO THE STATE OF OHIO, ASHLAND COUNTY HAS A SLIGHTLY LARGER PROPORTION OF CHILDREN (UNDER 18 YEARS OLD) AND A LARGER PROPORTION OF OLDER ADULTS (65 YEARS AND OLDER). 3.5% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS LOWER THAN THE STATE OF OHIO, WITH 90.1% HAVING A HIGH SCHOOL DIPLOMA (COMPARED TO 90.8%) AND 22% HAVING A BACHELOR'S DEGREE OR HIGHER (COMPARED TO 28.9%). ANNUAL PER CAPITA INCOME IS LOWER THAN THE STATE AVERAGE BY ABOUT $5,000 PER YEAR, AND THE PERCENTAGE OF ASHLAND COUNTY RESIDENTS LIVING IN POVERTY IS 1.2% LOWER THAN THAT OF THE STATE. MEDINA COUNTY THERE ARE APPROXIMATELY 183,092 PEOPLE LIVING IN MEDINA COUNTY, WHICH IS AN INCREASE OF 0.3% SINCE THE 2020 CENSUS. IT HAS 3 CITIES, 6 VILLAGES, AND 17 TOWNSHIPS, WITH THE LARGEST BEING BRUNSWICK AND THE COUNTY SEAT BEING THE CITY OF MEDINA. COMPARED TO THE STATE OF OHIO, MEDINA COUNTY HAS A SLIGHTLY LARGER PROPORTION OF CHILDREN AND OLDER ADULTS. 4.8% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS HIGHER THAN THE STATE OF OHIO, WITH 94.7% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 33.9% HAVING A BACHELOR'S DEGREE OR HIGHER. SIMILARLY, ANNUAL PER CAPITA INCOME IN MEDINA COUNTY IS HIGHER THAN THE STATE AVERAGE, AND THE PERCENTAGE OF MEDINA COUNTY RESIDENTS LIVING IN POVERTY IS LESS THAN HALF OF THAT OF THE STATE, ALTHOUGH LODI MEETS MEDICALLY UNDERSERVED POPULATION (MUP) DESIGNATION CRITERIA FOR LOW INCOME RESIDENTS. PORTAGE COUNTY THERE ARE APPROXIMATELY 162,382 PEOPLE LIVING IN PORTAGE COUNTY. THIS NUMBER HAS INCREASED BY 0.4% SINCE THE 2020 CENSUS. PORTAGE COUNTY IS COMPRISED OF 29 CITIES, VILLAGES, AND TOWNSHIPS, WITH THE LARGEST BEING THE CITY OF KENT AND THE COUNTY SEAT BEING RAVENNA. COMPARED TO THE STATE OF OHIO, PORTAGE COUNTY HAS A SMALLER PROPORTION OF CHILDREN AND OLDER ADULTS. IN PORTAGE COUNTY, 9.7% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS SLIGHTLY HIGHER IN PORTAGE COUNTY THAN OHIO, WITH 92.5% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 29.9% HAVING A BACHELOR'S DEGREE OR HIGHER. ANNUAL PER CAPITA INCOME IN PORTAGE COUNTY IS SLIGHTLY LOWER THAN THE STATE, AND THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IS 2.7% LOWER THAN THAT OF THE STATE. EAST KENT CITY HAS A MUP (LOW INCOME) DESIGNATION.RICHLAND COUNTY THERE ARE APPROXIMATELY 125,195 PEOPLE LIVING IN RICHLAND COUNTY, WHICH IS A 0.2% INCREASE FROM THE 2020 CENSUS. THERE ARE 29 CITIES, VILLAGES, AND TOWNSHIPS IN RICHLAND COUNTY, WITH THE LARGEST BEING MANSFIELD. COMPARED TO THE STATE OF OHIO, RICHLAND COUNTY HAS A SLIGHTLY LARGER PROPORTION OF CHILDREN AND OLDER ADULTS. IN RICHLAND COUNTY, 13.1% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. THE PERCENTAGE OF RESIDENTS WITH A HIGH SCHOOL DIPLOMA OR HIGHER IS LOWER IN RICHLAND COUNTY THAN IN THE STATE OVERALL, AS IS THE PERCENTAGE OF RESIDENTS WITH A BACHELOR'S DEGREE OR HIGHER. ANNUAL PER CAPITA INCOME IS LOWER AND THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IN RICHLAND COUNTY 0.1% HIGHER THAN OHIO. THE CITY OF MANSFIELD HAS A MUP (LOW INCOME) DESIGNATION. STARK COUNTY THERE ARE APPROXIMATELY 373,834 PEOPLE LIVING IN STARK COUNTY, WHICH IS A 0.3% DECREASE FROM THE 2020 CENSUS. THERE ARE 36 CITIES, VILLAGES, AND TOWNSHIPS IN STARK COUNTY, WITH THE LARGEST BEING THE CITY OF CANTON. COMPARED TO THE STATE OF OHIO, STARK COUNTY HAS A LARGER PROPORTION OF OLDER ADULTS, AND THE PROPORTION OF CHILDREN COMPARED TO THE STATE IS NEARLY EQUAL. IN STARK COUNTY, 12.5% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. THE PERCENTAGE OF RESIDENTS WITH A HIGH SCHOOL DIPLOMA OR HIGHER IS SLIGHTLY HIGHER IN STARK COUNTY COMPARED TO THE STATE, BUT THE PERCENTAGE OF RESIDENTS WITH A BACHELOR'S DEGREE OR HIGHER IS LOWER THAN THE STATE. ANNUAL PER CAPITA INCOME IS LOWER AND PERCENTAGE OF RESIDENTS LIVING IN POVERTY IN STARK COUNTY IS 0.6% HIGHER THAN THE STATE. THERE ARE TWO FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS (MUAS) IN STARK COUNTY: MASSILLON AND EAST CANTON. IN ADDITION, NORTHEAST ALLIANCE WAS DESIGNATED IN 2016 AS A MUP, MEETING THE MEDICAID ELIGIBILITY CRITERION.SUMMIT COUNTY THERE ARE APPROXIMATELY 537,633 PEOPLE LIVING IN SUMMIT COUNTY. SINCE THE 2020 CENSUS, THE POPULATION HAS DECREASED SLIGHTLY, BY 0.5%. THERE ARE 31 CITIES, VILLAGES, AND TOWNSHIPS IN SUMMIT COUNTY, WITH THE LARGEST BEING THE CITY OF AKRON. COMPARED TO THE STATE OF OHIO, SUMMIT COUNTY HAS A SLIGHTLY SMALLER PROPORTION OF CHILDREN AND A SLIGHTLY LARGER PROPORTION OF OLDER ADULTS. IN SUMMIT COUNTY, 22.7 % PERCENT OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS SLIGHTLY HIGHER IN SUMMIT COUNTY THAN IN THE STATE OF OHIO, WITH 92.1% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 32.8% HAVING A BACHELOR'S DEGREE OR HIGHER. SIMILARLY, ANNUAL PER CAPITA INCOME IN SUMMIT COUNTY IS SLIGHTLY HIGHER THAN THE STATE OF OHIO, AND THE PERCENTAGE OF SUMMIT COUNTY RESIDENTS LIVING IN POVERTY IS 0.5% LOWER THAN THAT OF THE STATE. TWO FEDERALLY DESIGNATED MUAS ARE PRESENT IN SUMMIT COUNTY: THE SOUTHEAST AKRON AND SUMMIT SERVICE AREAS.WAYNE COUNTY THERE ARE APPROXIMATELY 116,710 PEOPLE LIVING IN WAYNE COUNTY, WHICH IS AN DECREASE OF 0.2% SINCE THE 2020 CENSUS. THERE ARE 35 CITIES, VILLAGES, TOWNSHIPS, AND UNINCORPORATED COMMUNITIES IN WAYNE COUNTY, WITH THE LARGEST BEING THE CITY OF WOOSTER. COMPARED TO THE STATE OF OHIO, WAYNE COUNTY HAS A HIGHER PROPORTION OF CHILDREN AND OLDER ADULTS. IN WAYNE COUNTY, 4.7% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS LOWER IN WAYNE COUNTY COMPARED TO THE STATE OF OHIO, WITH 86.8% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 22.5% HAVING A BACHELOR'S DEGREE OR HIGHER. THE ANNUAL PER CAPITA INCOME IN WAYNE COUNTY IS LOWER THAN THE STATE OF OHIO, AS IS THE PERCENTAGE OF WAYNE COUNTY RESIDENTS LIVING IN POVERTY. THERE ARE NO FEDERALLY DESIGNATED MUA/PS PRESENT IN THIS COMMUNITY, ALTHOUGH A LARGE NUMBER OF AMISH RESIDING IN WAYNE COUNTY ARE CONSIDERED UNINSURED BECAUSE THEY DO NOT PARTICIPATE IN TRADITIONAL HEALTH INSURANCE PROGRAMS.COMMUNITY INFORMATION - GROUP B:CHMCA IN THE MAHONING VALLEY HAS AND CONTINUES TO SERVE PATIENTS AND FAMILIES FROM MANY COMMUNITIES ACROSS THE REGION. MOST PEOPLE WHO RECEIVE SERVICES FROM THE HOSPITAL ARE RESIDENTS OF MAHONING, TRUMBULL, OR COLUMBIANA COUNTIES. PRIOR TO THE OPENING OF THIS FACILITY, THE APPALACHIAN REGIONAL DEVELOPMENT ACT OF 2008 (S. 496) WAS SIGNED INTO LAW. ONE OF THE COMPONENTS OF THIS LEGISLATION WAS ADDITION OF MAHONING AND TRUMBULL COUNTIES TO THE APPALACHIAN REGION. MAHONING, TRUMBULL, AND COLUMBIANA COUNTIES REPRESENT MOST OF THE PRIMARY SERVICE AREA OF THE BEEGHLY CAMPUS, AND NOW, WITH THIS ACT BECOMING LAW, ALL THREE COUNTIES THAT MAKE UP THE PRIMARY SERVICE AREA OF THIS FACILITY ARE LOCATED WITHIN THE APPALACHIAN REGION. TRUMBULL, MAHONING, AND COLUMBIANA COUNTIES ARE CLASSIFIED BY THE APPALACHIAN REGIONAL COMMISSION AS BEING TRANSITIONAL - THEY HAVE WORSE ECONOMIC RATES THAN THE NATIONAL AVERAGE FOR ONE OR MORE OF THREE ECONOMIC INDICATORS (THREE-YEAR AVERAGE UNEMPLOYMENT, PER CAPITA MARKET INCOME, AND POVERTY), BUT DON'T RATE LOW ENOUGH TO BE CLASSIFIED AS DISTRESSED. IN ADDITION, THESE COUNTIES HAVE SHORTAGES OF PRIMARY CARE HEALTH SERVICES BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AND THEIR SPECIFIC DESIGNATIONS ARE INDICATED WITHIN THE DESCRIPTIONS BELOW.

PART VI, LINE 5:
PROMOTION OF COMMUNITY HEALTH - GROUPS A & B:CHMCA INTENDS THAT ALL OF ITS ACTIVITIES EITHER DIRECTLY PROVIDE HEALTH CARE TO ALL CHILDREN WHO REQUEST OUR SERVICES OR PROMOTE THE HEALTH OF THE COMMUNITY, BOTH BY DIRECT INVESTMENTS IN THE DELIVERY OF PEDIATRIC HEALTHCARE SERVICES AND IN PROVIDING SPECIALIZED INPATIENT AND OUTPATIENT CARE FOR PATIENTS OF ALL AGES THROUGHOUT NORTHEAST OHIO. CHMCA WAS FOUNDED ON THE PRINCIPLE OF SERVING THE NEEDS OF OUR COMMUNITY. WITHIN OUR DOORS, THIS MEANS TREATING ALL CHILDREN AS IF THEY WERE OUR OWN, TURNING NO CHILD OR FAMILY AWAY BASED ON THEIR ABILITY TO PAY. CHMCA'S GOVERNING BOARD OF DIRECTORS IS COMPRISED OF MEMBERS OF THE COMMUNITY THAT MAKES UP THE HOSPITAL'S PRIMARY SERVICE AREA. THEY ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. CHMCA EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITIES WE SERVE. CHMCA'S EXCELLENT REPUTATION IS THE RESULT OF THE SKILLS AND EXPERIENCE OF OUR MEDICAL STAFF AND THE HEALTH PROFESSIONALS WITH WHOM WE COLLABORATE. WE VALUE OUR PARTNERSHIP WITH PRIMARY CARE PHYSICIANS AND REFERRING PROVIDERS AND WORK TOGETHER TO COORDINATE THE CARE OF CHILDREN.WE ALSO MAKE MAJOR INVESTMENTS OF OUR FUNDS AND OTHER RESOURCES IN THE PROVISION OF EDUCATION FOR LAY AND PROFESSIONAL PERSONS, AND IN RESEARCH THAT WILL IMPROVE HEALTH CARE FOR ALL CHILDREN. WE TAKE AN ACTIVE ROLE IN ADVOCATING FOR IMPROVED HEALTH AND IMPROVED ACCESS TO HEALTH CARE FOR ALL. SERVICES AND ACTIVITIES PROVIDED BY CHMCA BENEFIT AND/OR PROMOTE HEALTH TO THE RESIDENTS IN THE COMMUNITIES WE SERVE. THE PRIMARY BENEFIT TO OUR COMMUNITIES IS PROVIDING HEALTH CARE FOR MORE THAN 1,000,000 CHILDREN ANNUALLY. IN ADDITION, WE ENGAGE IN COMMUNITY BUILDING ACTIVITIES, AS DEPICTED IN PART II OF THIS SCHEDULE. CHMCA BRINGS PEDIATRIC PRIMARY CARE FOR BABIES, CHILDREN AND TEENS TO MANY NORTHEAST OHIO NEIGHBORHOODS THROUGH OUR NETWORK OF PEDIATRICIAN OFFICES. EACH OFFICE IS STAFFED WITH BOARD-CERTIFIED PEDIATRICIANS AND EXPERIENCED STAFF. CHMCA ALSO OPERATES REGIONAL HEALTH CENTERS THAT BRING PRIMARY CARE, A RANGE OF SPECIALTY CARE SERVICES, AND AT SOME LOCATIONS, URGENT CARE, UNDER THE SAME ROOF. ANNUALLY, THE AKRON CAMPUS SAW THE FOLLOWING PATIENT ENCOUNTERS IN 2021: 8,309 INPATIENT ADMISSIONS (WHICH INCLUDES OTHER SITES EXCEPT BEEGHLY), 14,933 SURGERIES, 55,340 EMERGENCY ROOM VISITS, AND 238,618 SPECIALIST VISITS.CHMCA'S PAUL AND CAROL DAVID FOUNDATION BURN INSTITUTE PROVIDES SPECIALIZED INPATIENT AND OUTPATIENT CARE FOR BURN VICTIMS OF ALL AGES THROUGHOUT NORTHEAST OHIO. CHMCA IS ONE OF ONLY TWO PEDIATRIC HOSPITALS IN THE COUNTRY THAT TREATS ADULT BURN PATIENTS. EACH YEAR THE BURN INSTITUTE LEADS DOZENS OF OUTREACH AND EDUCATION ACTIVITIES ON FIRE SAFETY, IN ADDITION TO BURN SURVIVORSHIP SUPPORT GROUPS AND CAMPS. THE REBECCA D. CONSIDINE RESEARCH INSTITUTE IS THE HUB FOR RESEARCH ACTIVITY. THE INSTITUTE FACILITATES SPONSORED CLINICAL STUDIES AS WELL AS INTERNAL INVESTIGATOR-INITIATED RESEARCH PROGRAMS ACROSS A SPECTRUM OF RESEARCH SUBJECTS. THE INSTITUTE ALSO OFFERS RESEARCH-ORIENTED EDUCATIONAL OPPORTUNITIES FOR FELLOWS, STUDENTS AND FACULTY FROM AROUND THE GLOBE. ADULT CONGENITAL HEART SERVICE PROVIDES ONGOING MONITORING AND SPECIALIZED CARE FOR ADULTS WITH CONGENITAL HEART DISEASE. AS CHILDREN WITH CONGENITAL HEART DISEASE (CHD) BECOME ADULTS, THEY CAN ACCESS LIFETIME CARE THROUGH OUR CENTER.THE CYSTIC FIBROSIS CENTER PROVIDES DIAGNOSIS AND TREATMENT TO CHILDREN AND ADULTS WITH CYSTIC FIBROSIS (CF), INCLUDING RESPIRATORY THERAPY, PHYSICAL THERAPY, GENETIC COUNSELING AND NUTRITION COUNSELING. THE CENTER ALSO ACTIVELY PARTICIPATES IN CLINICAL TRIALS TO RESEARCH NEW DRUG THERAPIES TO MANAGE CF. THE GENETIC CENTER OFFERS DIAGNOSTIC EVALUATION AND MEDICAL MANAGEMENT OF GENETIC CONDITIONS, BIRTH DEFECTS AND DEVELOPMENTAL DELAYS, AS WELL AS GENETIC TESTING AND GENETIC COUNSELING FOR PEDIATRIC AND ADULT PATIENTS. OUR MATERNAL FETAL TREATMENT CENTER PROVIDES GENETIC COUNSELING AND OBSTETRIC/DELIVERY SERVICES TO HIGH-RISK PREGNANT WOMEN IN THE REGION. TELEHEALTH, WAS A PARTICULARLY GOOD FIT FOR BEHAVIORAL HEALTH SERVICES; IN FACT, THE LOIS AND JOHN ORR FAMILY BEHAVIORAL HEALTH CENTER WAS ONE OF JUST A FEW AREAS THAT PROVIDED MORE UNITS OF SERVICE IN 2021 THAN THE PREVIOUS YEAR. DATA INDICATES THAT CHILDREN STRUGGLED WITH WORSENING MENTAL HEALTH AS A RESULT OF THE PANDEMIC, DUE NOT ONLY TO FEAR AND ANXIETY AROUND THE VIRUS ITSELF, BUT ALSO ITS IMPACT ON SOCIAL CONNECTIVITY AND HOUSEHOLD DYNAMICS. TELEHEALTH BECAME A PIVOTAL PIECE OF FACILITATING ACCESS FOR THOSE SEEKING CARE.THE BEHAVIORAL HEALTH CENTER ALSO LEADS SEVERAL EFFORTS ALIGNED WITH THE CHNA IDENTIFIED NEED OF MENTAL/BEHAVIORAL HEALTH AND ADVERSE CHILDHOOD EXPERIENCES, OR ACES. CHMCA HAS EMBEDDED BEHAVIORAL HEALTH SERVICES WITHIN OUR NETWORK OF PRIMARY CARE OFFICES, THROUGH A COMBINATION OF INTERNAL STAFFING AND FORMAL RELATIONSHIPS WITH COMMUNITY AGENCIES PROVIDING BEHAVIORAL HEALTH SERVICES.OUR CRISIS CARE SERVICE LINE, PSYCHIATRIC INTAKE RESPONSE CENTER (PIRC) OPERATES A 24/7 TELEPHONE TRIAGE SERVICE FOR HIGH-ACUITY BEHAVIORAL HEALTH CONCERNS AND IS HOUSED IN THE EMERGENCY DEPARTMENT AT OUR AKRON CAMPUS. PIRC IS STAFFED BY MASTER'S LEVEL MENTAL HEALTH THERAPISTS WHO PERFORM RISK ASSESSMENTS USING EVIDENCED BASED SCREENING AND ASSESSMENT TOOLS TO DETERMINE PATIENTS' OVERALL LEVEL OF RISK OF HARM TO SELF OR OTHERS ALONG WITH THE APPROPRIATE TREATMENT DISPOSITION. THESE RECOMMENDATIONS ARE THEN SHARED WITH THE ATTENDING PHYSICIAN AND THE PSYCHIATRIST ON CALL IF AN INPATIENT ADMISSION IS INDICATED. SAFETY PLANNING IS FACILITATED WITH THE PATIENT AND PARENT OR LEGAL GUARDIAN, AND REFERRALS MAY BE MADE TO AKRON CHILDREN'S SERVICES OR THOSE AVAILABLE IN THE COMMUNITY AS APPROPRIATE. CHMCA'S PUBLIC SAFETY DEPARTMENT SUPPORTS OUR FOCUS ON MENTAL HEALTH BY PROMOTING CRISIS INTERVENTION TRAINING (CIT) FOR ITS OFFICERS AND OTHER LOCAL LAW ENFORCEMENT. WE ESTABLISHED A SPECIALIZED UNIT CALLED BEHAVIORAL RESPONSE AGAINST VIOLENCE ESCALATION (B.R.A.V.E.) WHICH INCORPORATES CIT CORE PRINCIPLES AND UTILIZES COLLABORATION, DE-ESCALATION, EDUCATION, AND UNDERSTANDING, WHILE TAKING A TRAUMA INFORMED APPROACH. AS A RESULT OF THIS PROGRAM THE COMMUNITY IN WHICH THESE OFFICERS SERVE HAS SEEN A REDUCTION OF VIOLENT BEHAVIOR IN THE MENTALLY ILL POPULATION, SPECIFICALLY JUVENILES, AND REDUCTION IN USE OF FORCE ENCOUNTERS ACROSS ALL DEMOGRAPHICS.CHMCA'S CENTER FOR GENDER AFFIRMING MEDICINE, OPENED IN 2019, PROVIDES SERVICES TO CHILDREN AND ADOLESCENTS WHO IDENTIFY AS TRANSGENDER. THIS VULNERABLE POPULATION IS AT GREATER RISK FOR SUICIDE AND HOMELESSNESS. OUR CLINICIANS IN THE CENTER PROVIDE COMPASSIONATE, COORDINATED CARE THAT INCLUDES PUBERTAL SUPPRESSION, GENDER AFFIRMING HORMONES, MENTAL HEALTH TREATMENT, WELL CHECKS, EDUCATION, AND SUPPORTIVE SERVICES FOR LGBTQ+ YOUTH AND THEIR FAMILIES.CHMCA'S NEONATOLOGY DEPARTMENT OFFERS INTENSIVE CARE TO SICK AND PREMATURE NEWBORNS. ON ANY GIVEN DAY, THERE ARE 45 TO 60 BABIES RECEIVING CARE IN OUR NEONATAL INTENSIVE CARE UNIT (NICU). ABOUT 1/4 OF THESE INFANTS HAVE BEEN IN UTERO FOR FEWER THAN 32 WEEKS, 5 WEEKS LESS THAN WHAT IS CONSIDERED NECESSARY FOR FULL GESTATION. SOME OF THEM ARE AS YOUNG AS 24 WEEKS AND WEIGH IN AT LESS THAN A KILOGRAM. CHMCA'S NEONATAL TEAM IS COMMITTED TO PROVIDING THE MOST EFFECTIVE AND EFFICIENT CARE FOR OUR TINIEST PATIENTS, AS WELL AS PROVIDING PARENTS WITH THE EMOTIONAL AND PRACTICAL SUPPORT THEY NEED. TO THIS END, CHMCA IS PART OF THE VERMONT OXFORD NETWORK, A COLLABORATION OF HEALTH PROFESSIONALS FROM MORE THAN 1,200 NICUS AROUND THE WORLD WHO FOCUS ON RESEARCH, EDUCATION AND PROJECTS THAT IMPROVE THE QUALITY AND SAFETY OF MEDICAL CARE FOR NEWBORNS AND THEIR FAMILIES. CHMCA'S NEONATAL EXPERTISE EXPANDS BEYOND THE LEVEL III NICU AT OUR AKRON CAMPUS. WE ALSO OWN AND OPERATE NEWBORN SPECIAL CARE NURSERIES AT AKRON GENERAL MEDICAL CENTER AND SUMMA HEALTH'S AKRON CITY HOSPITAL IN AKRON; CHMCA'S BEEGHLY CAMPUS IN BOARDMAN; AND ST. ELIZABETH BOARDMAN HEALTH CENTER. A SPECIALLY EQUIPPED AMBULANCE AND PEDIATRIC TRANSPORT TEAM HANDLES THE TRANSFER OF THE NEWBORNS REQUIRING THE LEVEL III NEONATAL INTENSIVE CARE PROVIDED AT CHMCA IN DOWNTOWN AKRON.CHMCA IS A CONTRACTED CARE COORDINATION AGENCY OF THE SUMMIT COUNTY PATHWAYS COMMUNITY HUB. THROUGH THIS RELATIONSHIP, CHMCA AND THE HUB PROVIDE BIDIRECTIONAL REFERRALS OF WOMEN WHO ARE PREGNANT AND UP TO ONE YEAR POSTPARTUM, INCREASING THEIR ACCESS TO RESOURCES SUCH AS PRENATAL CARE, FOOD AND HOUSING ASSISTANCE, ADULT EDUCATION, TOBACCO CESSATION SERVICES, AND OTHERS. COMMUNITY HEALTH WORKERS HELP TO NAVIGATE THESE WOMEN THROUGH THE SYSTEM, ENSURING THEY RECEIVE THE RESOURCES NEEDED TO PROVIDE A HEALTHY ENVIRONMENT FOR THEMSELVES AND THEIR CHILDREN.

PROMOTION OF COMMUNITY HEALTH - GROUP B:
"CHMCA INTENDS THAT ALL OF ITS ACTIVITIES EITHER DIRECTLY PROVIDE HEALTH CARE TO ALL CHILDREN WHO REQUEST OUR SERVICES OR PROMOTE THE HEALTH OF THE COMMUNITY, BOTH BY DIRECT INVESTMENTS IN THE DELIVERY OF PEDIATRIC HEALTHCARE SERVICES AND IN PROVIDING SPECIALIZED INPATIENT AND OUTPATIENT CARE FOR PATIENTS OF ALL AGES THROUGHOUT NORTHEAST OHIO. CHMCA WAS FOUNDED ON THE PRINCIPLE OF SERVING THE NEEDS OF OUR COMMUNITY. WITHIN OUR DOORS, THIS MEANS TREATING ALL CHILDREN AS IF THEY WERE OUR OWN, TURNING NO CHILD OR FAMILY AWAY BASED ON THEIR ABILITY TO PAY. CHMCA'S GOVERNING BOARD OF TRUSTEES IS COMPRISED OF MEMBERS OF THE COMMUNITY THAT MAKES UP THE HOSPITAL'S PRIMARY SERVICE AREA. THEY ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. CHMCA EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITIES WE SERVE. CHMCA'S EXCELLENT REPUTATION IS THE RESULT OF THE SKILLS AND EXPERIENCE OF OUR MEDICAL STAFF AND THE HEALTH PROFESSIONALS WITH WHOM WE COLLABORATE. WE VALUE OUR PARTNERSHIP WITH PRIMARY CARE PHYSICIANS AND REFERRING PROVIDERS AND WORK TOGETHER TO COORDINATE THE CARE OF CHILDREN. CHMCA ALSO OPERATES REGIONAL HEALTH CENTERS THAT BRING PRIMARY CARE, A RANGE OF SPECIALTY CARE SERVICES, AND AT SOME LOCATIONS, URGENT CARE, UNDER THE SAME ROOF. CURRENTLY, OUR HEALTH CENTER SERVING THE MAHONING VALLEY IS LOCATED IN THE CITY OF WARREN. WE ALSO MAKE MAJOR INVESTMENTS OF OUR FUNDS AND OTHER RESOURCES IN THE PROVISION OF EDUCATION FOR LAY AND PROFESSIONAL PERSONS, AND IN RESEARCH THAT WILL IMPROVE HEALTH CARE FOR ALL CHILDREN. WE TAKE AN ACTIVE ROLE IN ADVOCATING FOR IMPROVED HEALTH AND IMPROVED ACCESS TO HEALTH CARE FOR ALL. SERVICES AND ACTIVITIES PROVIDED BY CHMCA BENEFIT AND/OR PROMOTE HEALTH TO THE RESIDENTS IN THE COMMUNITIES WE SERVE. THE PRIMARY BENEFIT TO OUR COMMUNITIES IS PROVIDING HEALTH CARE FOR MORE THAN 1,000,000 CHILDREN ANNUALLY. IN ADDITION, WE ENGAGE IN COMMUNITY BUILDING ACTIVITIES, AS DEPICTED IN PART II OF THIS SCHEDULE. THE AREA'S ONLY PEDIATRIC HOSPITAL, CHMCA'S BEEGHLY CAMPUS OPENED IN DECEMBER 2008. THIS 43-BED PEDIATRIC HOSPITAL OFFERS A FULL RANGE OF PEDIATRIC SERVICES TO THE CHILDREN OF THE MAHONING VALLEY AND SURROUNDING AREAS. THE HOSPITAL PROVIDES ACCESS TO A 24/7 EMERGENCY DEPARTMENT, LABORATORY, RADIOLOGY, OUTPATIENT SURGICAL CENTER, ENDOCRINOLOGY, REHABILITATION AND EEG/ECHO/EKG SERVICES, AS WELL AS A BEHAVIORAL HEALTH CENTER, HEMATOLOGY/ONCOLOGY CLINIC AND INFUSION CENTER AND CHILD ADVOCACY CENTER. CHMCA OPENED A BEHAVIORAL HEALTH CENTER AT BEEGHLY CAMPUS IN 2019 TO BETTER SERVE A GROWING NEED FOR MENTAL AND BEHAVIORAL HEALTH SERVICES FOR YOUTH IN THE MAHONING VALLEY. THE NEW 9,000 SQUARE FOOT BUILDING HAS NINE INDIVIDUAL THERAPY ROOMS AND OPEN SERVICES PREVIOUSLY UNAVAILABLE IN THIS COMMUNITY, INCLUDING A PARTIAL HOSPITALIZATION PROGRAM THAT OFFERS TWO WEEKS OF INTENSIVE INDIVIDUAL AND GROUP THERAPY BUT DOES NOT REQUIRE INPATIENT ADMISSION. IN ADDITION, SOME OUTPATIENT BEHAVIORAL HEALTH SERVICES CAN BE ACCESSED THROUGH CHMCA'S PRIMARY CARE OFFICES THROUGHOUT THE MAHONING VALLEY. ANNUALLY, THE BEEGHLY CAMPUS SAW THE FOLLOWING PATIENT ENCOUNTERS IN 2021: 1,054 INPATIENT ADMISSIONS, 2,012 SURGERIES, 33,271 EMERGENCY ROOM VISITS, AND 42,221 SPECIALIST VISITS. WHILE THE PANDEMIC CONTINUED TO IMPACT CHMCA OPERATIONS IN 2021, WE DEDICATED SIGNIFICANT RESOURCES TO MOBILIZING FOR AND EXECUTING COMMUNITY-BASED COVID-19 VACCINE DELIVERY ONCE IT BECAME AVAILABLE. TO SUPPORT THE SAFE REOPENING OF SCHOOLS, WE MOVED QUICKLY TO SET UP DRIVE-THRU COVID-19 TESTING AT OUR SITES FOR ANY CHILDREN 18 AND UNDER WHETHER OR NOT THEY WERE OUR PATIENTS. CHMCA OWNS AND OPERATES A 19-BED LEVEL II SPECIAL CARE NURSERY AT THE HOSPITAL'S BEEGHLY CAMPUS AND A 25-BED LEVEL IIIB NEONATAL INTENSIVE CARE UNIT AT ST. ELIZABETH HEALTH CENTER. CHMCA'S NEONATAL TEAM IS COMMITTED TO PROVIDING THE MOST EFFECTIVE AND EFFICIENT CARE FOR OUR TINIEST PATIENTS, AS WELL AS PROVIDING PARENTS WITH THE EMOTIONAL AND EDUCATIONAL SUPPORT THEY NEED. CHMCA'S NEONATOLOGY DEPARTMENT OFFERS INTENSIVE CARE TO SICK AND PREMATURE NEWBORNS. ABOUT 1/4 OF THESE INFANTS HAVE BEEN IN UTERO FOR FEWER THAN 32 WEEKS, 5 WEEKS LESS THAN WHAT IS CONSIDERED NECESSARY FOR FULL GESTATION. SOME OF THEM ARE AS YOUNG AS 24 WEEKS AND WEIGH IN AT LESS THAN A KILOGRAM. TO THIS END, CHMCA IS PART OF THE VERMONT OXFORD NETWORK, A COLLABORATION OF HEALTH PROFESSIONALS FROM MORE THAN 1,200 NICUS AROUND THE WORLD WHO FOCUS ON RESEARCH, EDUCATION AND PROJECTS THAT IMPROVE THE QUALITY AND SAFETY OF MEDICAL CARE FOR NEWBORNS AND THEIR FAMILIES. CHMCA'S NEONATAL EXPERTISE EXPANDS BEYOND THE LEVEL III NICU AT OUR AKRON CAMPUS. WE ALSO OWN AND OPERATE NEWBORN SPECIAL CARE NURSERIES AT AKRON GENERAL MEDICAL CENTER AND SUMMA HEALTH'S AKRON CITY HOSPITAL IN AKRON; CHMCA'S BEEGHLY CAMPUS IN BOARDMAN; ST. ELIZABETH BOARDMAN HOSPITAL AND ST. JOSEPH WARREN HOSPITAL. A SPECIALLY EQUIPPED AMBULANCE AND PEDIATRIC TRANSPORT TEAM HANDLES THE TRANSFER OF THE NEWBORNS REQUIRING THE LEVEL III NEONATAL INTENSIVE CARE PROVIDED AT CHMCA IN DOWNTOWN AKRON. CHMCA HAS PRIORITIZED INFANT MORTALITY REDUCTION AS A SIGNIFICANT HEALTH ISSUE IN THE COMMUNITY. WE ARE A CONTRACTED CARE COORDINATION AGENCY OF THE MAHONING VALLEY PATHWAYS COMMUNITY HUB. THROUGH THIS RELATIONSHIP, CHMCA AND THE HUB PROVIDE BIDIRECTIONAL REFERRALS OF WOMEN WHO ARE PREGNANT AND UP TO ONE YEAR POSTPARTUM, INCREASING THEIR ACCESS TO RESOURCES SUCH AS PRENATAL CARE, FOOD AND HOUSING ASSISTANCE, ADULT EDUCATION, TOBACCO CESSATION SERVICES, AND OTHERS. COMMUNITY HEALTH WORKERS HELP TO NAVIGATE THESE WOMEN THROUGH THE SYSTEM, ENSURING THEY RECEIVE THE RESOURCES NEEDED TO PROVIDE A HEALTHY ENVIRONMENT FOR THEMSELVES AND THEIR CHILDREN. CHMCA IS ALSO A NURSE-FAMILY PARTNERSHIP SERVICE PROVIDER, WITH CHILDREN'S HOME CARE GROUP NURSES PROVIDING HOME VISITS TO PREGNANT WOMEN AND THEIR BABIES UP TO TWO YEARS POSTPARTUM. CHMCA BRINGS PEDIATRIC PRIMARY CARE FOR BABIES, CHILDREN AND TEENS TO MANY NORTHEAST OHIO NEIGHBORHOODS THROUGH OUR NETWORK OF PEDIATRICIAN OFFICES, WHICH INCLUDES OFFICES IN AUSTINTOWN, BOARDMAN, EAST LIVERPOOL, LIBERTY TOWNSHIP, LISBON, AND DOWNTOWN WARREN. EACH OFFICE IS STAFFED WITH BOARD-CERTIFIED PEDIATRICIANS AND EXPERIENCED STAFF. REGIONAL HEALTH CENTERS IN WARREN AND NEW PHILADELPHIA OFFER BOTH PRIMARY AND NUMEROUS SPECIALTY CARE SERVICES; AND URGENT CARE IN WARREN.CHMCA'S EXTERNAL AFFAIRS DEPARTMENT OFFERS A VARIETY OF COMMUNITY HEALTH EDUCATION AND OUTREACH PROGRAMS TO CHILDREN AND FAMILIES THROUGHOUT THE SERVICE AREA. THESE INCLUDE INJURY PREVENTION PROGRAMS ON CHILD PASSENGER SAFETY, AND REACH OUT AND READ, A PROGRAM THAT PROMOTES EARLY CHILDHOOD LITERACY BY DISTRIBUTING BOOKS TO CHMCA PRIMARY CARE OFFICES TO PROVIDE CHILDREN DURING WELL VISITS. WE ALSO COORDINATE OUTREACH EVENTS AND OUTREACH KIT DISTRIBUTIONS IN OUR COMMUNITIES BASED ON IDENTIFIED NEEDS AND ALIGNMENT WITH STRATEGIC PRIORITIES. OUR POPULATION HEALTH INITIATIVES DEPARTMENT PROVIDES CASE MANAGEMENT AND CARE COORDINATION SERVICES THROUGHOUT THE HOSPITAL'S SERVICE AREA, WORKING WITH PATIENTS ON A ""HIGH RISK"" REGISTRY TO IMPROVE HEALTH OUTCOMES AND ENHANCE QUALITY OF LIFE. THESE PATIENTS ARE GENERALLY INCOME LIMITED AND MEDICALLY COMPLEX, AND OFTEN HAVE A HIGH NO-SHOW RATE TO THEIR SCHEDULED APPOINTMENTS AND/OR NUMEROUS HOSPITALIZATIONS AND EMERGENCY DEPARTMENT VISITS IN A 12 MONTH PERIOD.ALSO LOCATED IN THE MAHONING VALLEY IS THE DEPARTMENT OF CHRONIC CARE EDUCATION AND SUPPORT, WHICH DELIVERS CHRONIC DISEASE PREVENTION AND SELF-MANAGEMENT PROGRAMMING TO CHILDREN AND THEIR FAMILIES, AS WELL AS DISEASE-SPECIFIC CAMPS AND SUPPORT GROUPS. THE DEPARTMENT DOES NOT GENERATE ANY REVENUE FOR THESE SERVICES, AND PROGRAMS MEET SPECIFIED CRITERIA OF NATIONALLY ACCREDITED DISEASE MANAGEMENT PROGRAMS, AS WELL AS CHMCA CRITERIA AND MONITORING REQUIREMENTS. CHMCA'S SCHOOL HEALTH SERVICES SUPPORTS THE ACADEMIC SUCCESS OF CHILDREN THROUGH HEALTH PROMOTION, EDUCATION AND CHILD ADVOCACY. SCHOOL HEALTH SERVES AS A LIAISON AMONG SCHOOL STAFF, FAMILY, COMMUNITY AND HEALTHCARE PROVIDERS. CHMCA'S PEDIATRIC REGISTERED NURSES WORK CLOSELY WITH SCHOOL STAFFS TO ENSURE A COMPREHENSIVE SCHOOL HEALTH PROGRAM IS IN PLACE. WITH IMMEDIATE ACCESS TO PEDIATRIC HEALTHCARE PROFESSIONALS AT CHMCA, SCHOOLS ARE ASSURED THEIR PROGRAM WILL EFFECTIVELY ADDRESS THE NEEDS OF THEIR STAFF AND STUDENTS. OUR SCHOOL HEALTH SERVICES LETS SCHOOLS FOCUS ON EDUCATING STUDENTS, WHILE WE MANAGE THEIR DISTRICT'S MEDICAL NEEDS.IN ADDITION, CHMCA IMPLEMENTED A SCHOOL-BASED HEALTH CENTER MODEL WITH WARREN CITY SCHOOLS AS PART OF A PILOT PROGRAM IN 2019. SERVICES INCLUDE WELL-CHILD EXAMS (IN PERSON) AND EVALUATION FOR ILLNESS (BY TELEHEALTH TECHNOLOGY) WITH A NURSE PRACTITIONER, AS WELL AS VARIOUS SCREENINGS, WELLNESS ADVICE AND SPORTS PHYSICALS."

PARENTS AND MEMBERS OF CHMCA'S FAMILY-CENTERED CARE COMMITTEE
ESTABLISHED THE PARENT ADVISORY COUNCIL (PAC) IN 1995. IT PROVIDES A WAY FOR PARENTS AND GUARDIANS TO OFFER INPUT ON ISSUES THAT IMPACT THE CARE OF CHILDREN. THE COUNCIL INCLUDES PARENTS WHOSE CHILDREN HAVE RECEIVED CARE AT CHMCA. ADVISORS WILL WORK WITH HOSPITAL LIAISONS TO REPRESENT THE VOICE OF FAMILIES AS WE WORK TOGETHER TO ENHANCE THE DELIVERY OF FAMILY-CENTERED CARE.

PART VI, LINE 6:
AFFILIATED HEALTH CARE SYSTEM - GROUPS A & B:N/A

PART VI, LINE 7:
STATE FILING OF COMMUNITY BENEFIT REPORT - GROUPS A & B:OHIO

PART VI ADDITIONAL INFORMATION:
IN ADDITION TO THE LOCATIONS LISTED IN PART V, SECTION A AND C, CHMCA HAS PHYSICIANS PROVIDING A VARIETY OF SUBSPECIALTY SERVICES AT MANY OTHER LOCATIONS THROUGHOUT NORTHEAST OHIO AND WESTERN PENNSYLVANIA. NOTE: CENSUS AND OTHER DATA REPORTED IN SECTION PART VI IS THE MOST RECENT INFORMATION AVAILABLE.

PART III, LINE 2:
WE BELIEVE THAT APPLYING A COST-TO-CHARGE RATIO DEVELOPED FOR THE HOSPITAL FACILITY FROM THE OHIO MEDICAID COST REPORT TO CHMCA'S PROVISION FOR BAD DEBTS IS THE MOST ACCURATE COSTING METHODOLOGY TO CALCULATE BAD DEBT AT COST FOR THE PERIOD. TOTAL HOSPITAL COSTS FROM THE OHIO MEDICAID COST REPORT USED IN THIS CALCULATION INCLUDE ONLY ALLOWABLE AND REIMBURSABLE COSTS. THEREFORE, THE COST TO CHARGE RATIO MULTIPLIED BY THE BAD DEBT EXPENSE RESULTS IN THE COST OF BAD DEBT. THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) IS OHIO'S METHODOLOGY TO PROVIDE ADDITIONAL PAYMENTS TO HOSPITALS THAT PROVIDE A DISPROPORTIONATE SHARE OF UNCOMPENSATED CARE TO THE INDIGENT AND UNINSURED. GROSS BAD DEBT EXPENSE HAS BEEN REDUCED BY THE ESTIMATED HCAP AMOUNT APPLICABLE TO BAD DEBT EXPENSE. THE ESTIMATED AMOUNT OF BAD DEBT AT COST ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY POLICY IS $-0-. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE AS DESCRIBED IN PART VI, ITEM 3 - PATIENT EDUCATION FOR ASSISTANCE IS PROVIDED. SEE PAGES 12 & 13 TO THE FOOTNOTES TO CHMCA'S AUDITED FINANCIAL STATEMENTS THAT DESCRIBE CHARITY CARE AND IMPLICIT PRICE CONCESSIONS (BAD DEBT). CHMCA RESPECTIVELY SUBMITS THAT SINCE WE ACCEPT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THAT BAD DEBTS AT COST, AS REPORTED HEREIN, REPRESENT AN UNREIMBURSED COST OF PROVIDING CARE TO THE PATIENTS WE SERVE.

PART III, LINE 8:
WE BELIEVE THAT REPORTING PROGRAM CHARGES, COSTS, AND PAYMENTS DIRECTLY FROM CHMCA'S MEDICARE COST REPORT ALONG WITH SIMILAR CALCULATIONS FOR SERVICES RENDERED TO PATIENTS ENROLLED IN MEDICARE ADVANTAGE PLANS AND PATIENTS ENROLLED IN TRICARE IS THE MOST ACCURATE METHODOLOGY TO CALCULATE UNREIMBURSED MEDICARE AND OTHER MEANS-TESTED GOVERNMENT PROGRAM COSTS. TO AVOID DOUBLE COUNTING OF COSTS REPORTED ELSEWHERE IN THE SCHEDULE, GROSS COSTS FOR OTHER REPORTABLE ITEMS HAVE BEEN REDUCED BY THE TOTAL GOVERNMENT PAYOR MIX PERCENTAGE (54.8%) AS REPORTED ON OUR INTERNAL PAYOR MIX REPORT.IN REGARD TO MEDICARE, CHMCA RESPECTFULLY SUBMITS THAT INCLUDED IS ITS UNREIMBURSED INPATIENT COSTS INCURRED IN EXCESS OF THE 1982 TAX EQUITY AND FISCAL RESPONSIBILITY ACT (TEFRA) PER DISCHARGE LIMIT WAS $656,046, UNREIMBURSED OUTPATIENT COSTS INCURRED IN TREATING PATIENTS QUALIFYING FOR MEDICARE END STAGE RENAL DISEASE (ESRD), COMPOSITE REIMBURSEMENT WAS $566,528, UNREIMBURSED COSTS OF PROVIDING CARE TO MEDICARE ADVANTAGE PLAN ENROLLEES WAS $223,167. THE UNREIMBURSED INPATIENT COSTS ARE COSTS INCURRED PRIMARILY IN THE TREATMENT OF BURN VICTIMS WHO ARE MEDICARE ENROLLEES. THE UNREIMBURSED ESRD COSTS ARE COSTS INCURRED IN EXCESS OF THE COMPOSITE RATE REIMBURSEMENT APPLICABLE TO PATIENTS WHO RECEIVE OUTPATIENT MAINTENANCE DIALYSIS. SINCE THESE PROGRAMS ARE GOVERNMENT MEAN TESTED PROGRAMS THAT TYPICALLY REIMBURSE CHMCA LESS THEN IT COSTS TO PROVIDE THAT CARE, WE BELIEVE THAT IT QUALIFIES AS COMMUNITY BENEFIT IN THE SAME REGARD AS MEDICAID.

PART VI, LINE 2:
AKRON (#1); BEEGHLY (#2). CHMCA CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2019 TO ASSESS THE PRIMARY SERVICE AREAS SURROUNDING OUR AKRON HOSPITAL CAMPUS IN COLLABORATION WITH CLEVELAND CLINIC - AKRON GENERAL AND SUMMA HEALTH SYSTEM.ALONG WITH CHNAS, WE REGULARLY PERFORM STRATEGIC PLANNING AS AN ONGOING PROCESS WITH ANNUAL UPDATES. AS PART OF THE ANNUAL UPDATE, WE REVIEW POPULATION AND DEMOGRAPHIC CHANGES IN OUR LARGER SERVICE AREA, FOCUSING PARTICULARLY ON CHILDREN AND FAMILIES. WE GIVE ATTENTION TO THE PROVISION OF HEALTH CARE SERVICES THROUGHOUT OUR REGION, LOOKING AT OUR OWN AND THOSE PROVIDED BY OTHER HEALTH CARE ORGANIZATIONS, USING STATEWIDE DATA INCLUDING ALL PEDIATRIC HOSPITAL DISCHARGES BY ZIP CODE OF PATIENT RESIDENCE. WE ALSO CAREFULLY TRACK THE DEMAND FOR AND SUPPLY OF PHYSICIANS, NURSES, AND ALLIED HEALTH PROVIDERS, AND EVALUATE THE NEED FOR PRIMARY, SECONDARY AND TERTIARY SERVICES THROUGHOUT OUR SERVICE AREA. IN ADDITION, WE ENGAGE IN MULTIPLE EFFORTS TO GAUGE THE NEEDS OF OUR COMMUNITY THROUGH PERIODIC SURVEYS OF THE POPULATION, FOCUSING ON PARENTAL AWARENESS AND PREFERENCE OF PEDIATRIC HEALTH CARE SERVICES, AND ESTIMATING ACTUAL USE OF SERVICES FROM ALL PROVIDERS. WE ARE ACTIVELY REPRESENTED IN DOZENS OF COMMUNITY GROUPS AND GATHER INPUT FROM THESE GROUPS BOTH BY ACTIVE PARTICIPATION AND BY COLLECTING AND REVIEWING COMPREHENSIVE DATA SETS AND STUDIES PRODUCED BY SUCH GROUPS, INCLUDING SCHOOL DISTRICTS, HEALTH AND HUMAN SERVICE AGENCIES, AND CHARITABLE AND ADVOCACY GROUPS. WE MAKE AN EFFORT TO LISTEN TO OUR STAFF, SEEKING AND RECEIVING FEEDBACK FROM OUR 6,600+ STAFF AND THOUSANDS OF VOLUNTEERS AND PHYSICIANS, WHO COLLECTIVELY PROVIDE A RICH SOURCE OF INFORMATION REGARDING COMMUNITY NEEDS AND OPPORTUNITIES. FINALLY, WE ACTIVELY SOLICIT INPUT FROM OUR PATIENTS AND THEIR PARENTS FROM OUR PARENT ADVISORY COMMITTEE AND GATHER FEEDBACK THROUGH PATIENT SURVEY RESULTS AND VIA MULTIPLE WRITTEN AND ELECTRONIC (WEB-BASED) TOOLS.

PART VI, LINE 3:
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - A & B:CHMCA PROVIDES EDUCATION TO PATIENTS TO INFORM THEM THAT THEY MAY QUALIFY FOR CARE AT NO CHARGE OR AT A REDUCED CHARGE IN A VARIETY OF WAYS: - CHMCA HAS SIGNAGE AT ITS REGISTRATION SITES TO INFORM PATIENTS THAT THEY MAY QUALIFY FOR FREE HOSPITAL CARE. APPLICATIONS FOR FREE CARE ARE AVAILABLE AT REGISTRATION SITES AND THROUGHOUT THE HOSPITAL (REQUIRED BY THE OHIO MEDICAID HOSPITAL CARE ASSURANCE (HCAP) RULES).- CHMCA HAS INFORMATION REGARDING ELIGIBILITY FOR FREE CARE ON BILLING STATEMENTS MAILED TO PATIENTS AND THEIR GUARANTORS. - CHMCA EMPLOYS FINANCIAL COUNSELORS TO EXPLAIN THE HOSPITAL'S FREE CARE, CHARITY CARE, AND THE VARIOUS PUBLIC ASSISTANCE PROGRAMS TO UNINSURED AND UNDERINSURED PATIENTS. - CHMCA'S WEBSITE PROVIDES PATIENTS WITH INFORMATION RELATING TO THE HOSPITAL'S FREE CARE, CHARITY CARE AND VARIOUS PUBLIC ASSISTANCE PROGRAMS AVAILABLE. - CHMCA CONTRACTS WITH AN INDEPENDENT VENDOR TO SCREEN PATIENTS FOR PUBLIC ASSISTANCE ELIGIBILITY AND COMPLETION AS WELL AS SUBMISSION OF PUBLIC ASSISTANCE APPLICATIONS.

HTTPS://WWW.CENSUS.GOV/QUICKFACTS/FACT/TABLE/OH/PST045221
TRUMBULL COUNTY THERE ARE APPROXIMATELY 201,335 PEOPLE LIVING IN TRUMBULL COUNTY, WHICH IS A DECREASE OF 0.2% SINCE THE 2020 CENSUS. THERE ARE 7 CITIES AND 5 VILLAGES IN TRUMBULL COUNTY, WITH THE COUNTY SEAT BEING WARREN. COMPARED TO THE STATE OF OHIO, TRUMBULL COUNTY HAS A SLIGHTLY SMALLER PROPORTION OF CHILDREN (UNDER 18 YEARS OLD) AND A LARGER PROPORTION OF OLDER ADULTS (65 YEARS AND OLDER). IN TRUMBULL COUNTY, 8.8% OF THE POPULATION IS BLACK OR AFRICAN-AMERICAN AND 2.1%IS HISPANIC OR LATINO, COMPARED TO 13.2% AND 4.3%, RESPECTIVELY, IN THE STATE OF OHIO. EDUCATIONAL ATTAINMENT IN TRUMBULL COUNTY IS LOWER THAN THE STATE OF OHIO, WITH 89.4% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 19.2% HAVING A BACHELOR'S DEGREE OR HIGHER. SIMILARLY, ANNUAL PER CAPITA INCOME IN TRUMBULL COUNTY IS LOWER THAN THE STATE OF OHIO AND THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IS HIGHER THAN THAT OF THE STATE. IN ADDITION, TRUMBULL COUNTY IS FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA (MUA). MAHONING COUNTY THERE ARE APPROXIMATELY 228,762 PEOPLE LIVING IN MAHONING COUNTY, WHICH IS A DECREASE OF 0.8% SINCE THE 2020 CENSUS. THERE ARE 7 CITIES AND 7 VILLAGES IN MAHONING COUNTY, WITH THE LARGEST BEING YOUNGSTOWN. COMPARED TO THE STATE OF OHIO, MAHONING COUNTY HAS A SMALLER PROPORTION OF CHILDREN AND A LARGER PROPORTION OF OLDER ADULTS. APPROXIMATELY 16% OF THE POPULATION IN MAHONING COUNTY IS BLACK OR AFRICAN-AMERICAN AND 7% IS HISPANIC OR LATINO, COMPARED TO 13.2% AND 4.3%, RESPECTIVELY, IN THE STATE OF OHIO. THE PERCENTAGE OF MAHONING COUNTY RESIDENTS WITH A HIGH SCHOOL DIPLOMA OR HIGHER IS A BIT HIGHER THAN THE STATE OF OHIO, BUT THE PERCENTAGE WITH A BACHELOR'S DEGREE OR HIGHER IS LOWER THAN THE STATE. THE ANNUAL PER CAPITA INCOME IN MAHONING COUNTY IS LOWER THAN THE STATE OF OHIO AND THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IS HIGHER THAN THE STATE AVERAGE. THERE ARE THREE FEDERALLY DESIGNATED MUAS WITHIN MAHONING COUNTY, BOTH RURAL AND NON-RURAL. COLUMBIANA COUNTY THERE ARE APPROXIMATELY 101,310 PEOPLE LIVING IN COLUMBIANA COUNTY, WHICH IS A DECREASE OF 0.6% SINCE THE 2020 CENSUS. THERE ARE 3 CITIES, 11 VILLAGES, AND 18 TOWNSHIPS IN COLUMBIANA COUNTY, WITH THE LARGEST BEING SALEM. COMPARED TO THE STATE OF OHIO, COLUMBIANA COUNTY HAS A SMALLER PROPORTION OF CHILDREN AND A LARGER PROPORTION OF OLDER ADULTS. APPROXIMATELY 2.6% PERCENT OF THE POPULATION IN COLUMBIANA COUNTY IS BLACK OR AFRICAN-AMERICAN AND 2.1% IS HISPANIC OR LATINO, COMPARED TO 13.2% AND 4.3%, RESPECTIVELY, IN THE STATE OF OHIO. THE PERCENTAGE OF COLUMBIANA COUNTY RESIDENTS WITH A HIGH SCHOOL DIPLOMA OR HIGHER IS LOWER THAN THE STATE OF OHIO AND THE PERCENTAGE WITH A BACHELOR'S DEGREE OR HIGHER IS NEARLY HALF THE STATE AVERAGE (14.5% VERSUS 28.9%). THE ANNUAL PER CAPITA INCOME IN COLUMBIANA COUNTY IS LOWER THAN THE STATE OF OHIO AND THE PERCENTAGE OF COLUMBIANA COUNTY RESIDENTS LIVING IN POVERTY IS HIGHER THAN THE STATE AVERAGE. COLUMBIANA IS DESIGNATED AS AN MUA (MEDICAID ELIGIBLE POPULATION) THROUGH A GOVERNOR'S EXCEPTION. ELIGIBLE POPULATION) THROUGH A GOVERNOR'S EXCEPTION. THROUGH A GOVERNOR'S EXCEPTION.

CHMCA IS A LEVEL II PEDIATRIC TRAUMA CENTER AND PARTICIPATES IN SEVERAL
"RESEARCH AND QUALITY/PERFORMANCE IMPROVEMENT EFFORTS TO BETTER UNDERSTAND AND ADDRESS THE NEEDS OF CRITICALLY ILL OR INJURED PATIENTS. THE PEDIATRIC INTENSIVE CARE UNIT (PICU) IS AN ALPHA SITE FOR THE VIRTUAL PICU PERFORMANCE SYSTEM, OR VPS, A CLINICAL QUALITY COLLABORATIVE AIMED AT STANDARDIZING DATA SHARING FOR IMPROVED PATIENT CARE AMONG CRITICAL CARE UNITS.WHILE THE PANDEMIC CONTINUED TO DRAMATICALLY IMPACT CHMCA OPERATIONS IN 2021, WE DEDICATED SIGNIFICANT RESOURCES TO MOBILIZING FOR AND EXECUTING COMMUNITY-BASED COVID-19 VACCINE DELIVERY ONCE IT BECAME AVAILABLE. WITH THE SUPPORT OF THE STATE OF OHIO AND LOCAL HEALTH DEPARTMENTS, OUR TEAMS WORKED WITH LOCAL BUSINESSES, CHURCHES, SOCIAL SERVICE AGENCIES AND SCHOOL DISTRICTS TO CARRY OUT COMMUNITY AND SCHOOL-BASED VACCINE CLINICS FOR ADULTS AND PEDIATRIC PATIENTS ELIGIBLE TO RECEIVE THE VACCINE, SUCH AS THOSE WITH MEDICAL COMPLEXITY. THROUGH THESE CLINICS, WE ADMINISTERED NEARLY 40,000 DOSES OF THE COVID-19 VACCINE. TO SUPPORT THE SAFE REOPENING OF SCHOOLS, WE VACCINATED AKRON-AREA SCHOOL PERSONNEL AND MOVED QUICKLY TO SET UP DRIVE-THRU COVID-19 TESTING AT OUR SITES FOR OUR PATIENTS AS WELL AS OTHER CHILDREN AND YOUTH IN THE COMMUNITY. CHMCA'S EXTERNAL AFFAIRS DEPARTMENT OFFERS A VARIETY OF COMMUNITY HEALTH EDUCATION AND OUTREACH PROGRAMS TO CHILDREN AND FAMILIES THROUGHOUT THE SERVICE AREA. THESE INCLUDE INJURY PREVENTION PROGRAMS ON CHILD PASSENGER SAFETY, AND REACH OUT AND READ, A PROGRAM THAT PROMOTES EARLY CHILDHOOD LITERACY BY DISTRIBUTING BOOKS TO CHMCA PRIMARY CARE OFFICES TO PROVIDE CHILDREN DURING WELL VISITS. WE ALSO COORDINATE OUTREACH EVENTS AND OUTREACH KIT DISTRIBUTIONS IN OUR COMMUNITIES BASED ON IDENTIFIED NEEDS AND ALIGNMENT WITH STRATEGIC PRIORITIES. IN 2021, WE CONTINUED TO SERVE FAMILIES IN-PLACE AND IN CURBSIDE AND OUTDOOR FORMATS TO REDUCE EXPOSURE TO COVID-19. ADDITIONALLY, OUR EDUCATORS DELIVERED THE 7-WEEK, FAMILY-CENTERED AND TRAUMA INFORMED NURTURING FAMILIES PROGRAM CURRICULUM VIRTUALLY, SERVING 105 CLIENTS. OUR POPULATION HEALTH INITIATIVES DEPARTMENT PROVIDES CASE MANAGEMENT AND CARE COORDINATION SERVICES THROUGHOUT THE HOSPITAL'S SERVICE AREA, WORKING WITH PATIENTS ON A ""HIGH RISK"" REGISTRY TO IMPROVE HEALTH OUTCOMES AND ENHANCE QUALITY OF LIFE. THESE PATIENTS ARE GENERALLY INCOME LIMITED AND MEDICALLY COMPLEX, AND OFTEN HAVE A HIGH NO-SHOW RATE TO THEIR SCHEDULED APPOINTMENTS AND/OR NUMEROUS HOSPITALIZATIONS AND EMERGENCY DEPARTMENT VISITS IN A 12 MONTH PERIOD. CHMCA'S SCHOOL HEALTH SERVICES SUPPORTS THE ACADEMIC SUCCESS OF CHILDREN THROUGH HEALTH PROMOTION, EDUCATION AND CHILD ADVOCACY. SCHOOL HEALTH SERVES AS A LIAISON AMONG SCHOOL STAFF, FAMILY, COMMUNITY AND HEALTHCARE PROVIDERS. CHMCA'S PEDIATRIC REGISTERED NURSES WORK CLOSELY WITH SCHOOL STAFF TO ENSURE A COMPREHENSIVE SCHOOL HEALTH PROGRAM IS IN PLACE. WITH IMMEDIATE ACCESS TO PEDIATRIC HEALTHCARE PROFESSIONALS AT CHMCA, SCHOOLS ARE ASSURED THEIR PROGRAM WILL EFFECTIVELY ADDRESS THE NEEDS OF THEIR STAFF AND STUDENTS. OUR SCHOOL HEALTH SERVICES LETS SCHOOLS FOCUS ON EDUCATING STUDENTS, WHILE WE MANAGE THEIR DISTRICT'S MEDICAL NEEDS.IN ADDITION, AS PART OF A PILOT PROGRAM IN 2019, CHMCA IMPLEMENTED A SCHOOL-BASED HEALTH CENTER MODEL IN THE KENMORE-GARFIELD CLUSTER OF AKRON PUBLIC SCHOOLS. SERVICES INCLUDE WELL-CHILD EXAMS (IN PERSON) AND EVALUATION FOR ILLNESS (BY TELEHEALTH TECHNOLOGY) WITH A NURSE PRACTITIONER, AS WELL AS VARIOUS SCREENINGS, WELLNESS ADVICE AND SPORTS PHYSICALS. PARENTS AND MEMBERS OF CHMCA'S FAMILY-CENTERED CARE COMMITTEE ESTABLISHED THE PARENT ADVISORY COUNCIL IN 1995. IT PROVIDES A WAY FOR PARENTS AND GUARDIANS TO OFFER INPUT ON ISSUES THAT IMPACT THE CARE OF CHILDREN. THE COUNCIL INCLUDES PARENTS WHOSE CHILDREN HAVE RECEIVED CARE AT CHMCA. ADVISORS WORK WITH HOSPITAL LIAISONS TO REPRESENT THE VOICE OF FAMILIES AS WE WORK TOGETHER TO ENHANCE THE DELIVERY OF FAMILY-CENTERED CARE."