4A (Expenses $ 163713588 including grants of $ 711687) (Revenue $ 203235015)
See Schedule O

Feather River Hospital
"Part V, Section B, Line 5: The 2016 CHNA data collection process can be summarized as follows: Review of prior CHNA reporting effortsCollection of most recently available demographic, socioeconomic and health indicator data.Data gathering was accomplished by using a community survey, engaging with community focus groups, and through the ""Together We Can Butte County"" Health Collaborative.Community Survey: The survey was developed to gain insight into issues that affect the health of those living and working in Butte County. It consisted of 36 questions. Participation in the survey was voluntary, and care was taken to ensure that respondents' answers were confidential in accordance with laws pertaining to privacy of personal and protected health information. The survey was made available in English, Spanish, and Hmong; and in both paper and electronic formats for each language. A link to the electronic survey was emailed to the Policy Council, Working Group, and other community partners who were encouraged to forward the link to their contacts. Links to the survey were also posted on the TOGETHER WE CAN! Healthy Living in Butte County website and promoted through social media, including Facebook and Twitter. The paper survey was distributed at key locations in the community including libraries, churches, post offices and community events.Community Focus Groups: The focus groups were comprised of community members at large and key leaders in the community, such as local government officials, religious and community service organizations representatives and medical professionals. Participation in focus groups was solicited by each organization participating in the Hospital Collaborative to ensure the existing validity of the ""Together We Can Butte County"" CHA. There were 113 community members who participated, with an average group size of 12. To solicit feedback, hospitals made their focus groups known by a press release and subsequent newspaper article, local TV news coverage, social media posts (such as Facebook and Twitter), flyers and direct invitations to key community members. During these focus groups each organization discussed and evaluated awareness of the ""Together We Can Butte County"" CHA, discussed and evaluated awareness of the CHNA and CHP for the organization facilitating the group (Feather River Hospital addressed its particular CHNA with its group), and discussed the groups input on health priorities in the community and possible ways to address these needs. Each hospital shared the results but each hospital is responsible for identifying their priority needs.The ""Together We Can Butte County"" Health Collaborative: Hundreds of local agencies and the community including Feather River Hospital members formed a partnership called Together We Can! Healthy Living in Butte County. The partnership's work produced a written countywide Community Health Assessment (CHA) which describes the county's health status, defines areas for improvement and identifies assets that can be mobilized to improve health for everyone in Butte County. The CHA utilizes both primary and secondary data; primary data was collected from community members and stakeholders - using a community survey, while secondary health data was gathered from numerous existing sources. Data is not only provided on a countywide level, but in some instances, is also stratified specific to local communities, age groups, cultures, and other indicators."

Feather River Hospital
Part V, Section B, Line 6a: This report is the result of a unique collaboration with three other hospitals serving the population of Butte County. These hospitals are:1. Enloe Medical Center2. Orchard Hospital3. Oroville Hospital

Feather River Hospital
Part V, Section B, Line 6b: Feather River Hospital collaborated with the Butte County Department of Public Health, the Butte County Health & Human Services Agencies, Together We Can! Healthy Living in Butte County Collaborative, the Center for Healthy Communities at California State University-Chico, the Butte County Tobacco Coalition, the Butte Glen Medical Society, and the American Lung Association to prepare the 2016 Community Health Needs Assessment.

Feather River Hospital
"Part V, Section B, Line 11: Our 2016 CHNA identified three areas of significant needs: access to healthcare, chronic disease, and substance abuse. The main goal was to improve the overall health and wellness of our communities through provision of services, community collaboration and innovation.Priority Need 1 - Access to Healthcare - main objective: to increase availability of Primary Care to population at large by increasing the number of Primary Care providers accepting new patients. Program detail and interventions pertaining to Access to Healthcare were destroyed in the Camp Fire. Staff who may be able to provide duplicate information have since left the area and are unavailable. Interventions:1. Feather River Hospital opened the Center for Health, Wholeness and Hope in October 2017. It is a whole person health and wellness resource hub and education center dedicated to inspiring, supporting, promoting and improving the health and well-being of the residents of Paradise and surrounding communities. It has become a community center for education, services, programs and events. It was opened during severe hot weather to our community members as a cooling station. Non-profit community groups use the center to hold meetings, educational programs and support groups for patient populations with special needs such as cancer, COPD, grief and loss, smoking cessation, weight loss, nutrition, plant based meal preparation, diabetes prevention and ministerial association. It is connected to the local gym which increases foot traffic. It was completely destroyed by the Camp Fire on November 8, 2018. Number of community members served - Unknown due to Camp Fire.2. Transportation can be a barrier to accessing health care services. Insufficient public transportation service or special transportation needs are all potential factors preventing community members from attending scheduled medical appointments or even making timely appointments thereby delaying critical medical care. Adventist Health Feather River offers free transportation to our community members to access our rural health center. Number of community members served by clinic van service - 2,777. 3. A common barrier to accessing health care is the cost of care and the lack of medical insurance. Often this is a matter of community members not knowing how to apply for programs that might be available to them. Feather River Hospital employs Patient Financial Services Application Specialists who assist eligible uninsured patients obtain insurance thereby increasing their ability to meet medical needs. Number of community members served - 867.Priority Need 2 - Chronic Disease - main objective: to increase awareness of health principles and preventative measures to chronic diseases (obesity, heart disease, diabetes, mental health, etc.) by increasing access to health education/wellness coaching and reduce barriers to accessing resources that reduce risk of chronic disease, with emphasis in diabetes and obesity prevention. Additional program detail and interventions pertaining to chronic disease were destroyed in the Camp Fire. Staff who may be able to provide duplicate information have since left the area and are unavailable. Interventions: 1. Nutritional counseling for basic dietary and nutritional wellness by Registered Dietitians. Number of community members served - Unknown due to Camp Fire.2. Ongoing diabetes education and support by diabetic education which includes a Diabetes Survival Camp and support group with two Lifestyle coaches trained to conduct CDC approved diabetes prevention education. Number of community members served - Unknown due to Camp Fire.3. Piloted plant based cooking classes and in-depth education on nutrition. Number of community members served - 540.4. Increased awareness of health principles and measures to improve mental health through bereavement support services including annual ""Day of Remembrance and ""Light Up a Life,"" weekly ""Brunch Bunch,"" various grief support groups, personal phone calls from the bereavement programs. Number of community members served - 479.Priority Need 3 - Substance Abuse - main objective: to reduce the number of those using tobacco by getting current smokers to quit and help prevent adolescents from beginning to smoke. Intervention: Program detail and interventions pertaining to substance abuse were destroyed in the Camp Fire. Staff who may be able to provide duplicate information have since left the area and are unavailable. Priority Areas Not Addressed:On November 8, 2018, the lives of thousands of Butte County residents were changed forever. The devastating 153,000 acre Camp Fire ripped through the town of Paradise, causing residents to flee and businesses to close, including the Adventist Health Feather River Hospital. The Hospital has been out of service since that time. Programs and community partnerships have been halted although we remain unequivocally committed to the immediate and long-term recovery efforts of improving the health experience for all residents of Butte County. In 2019, we will focus our attention on helping the people of the community recover and are involved with other area hospitals to prepare a 2019 Community Health Needs Assessment that considers the new reality of our community. Other identified needs in our community included: mental health, socio-economic factors that influence health, public safety/violence, environment, seniors/aging, and transportation. These were not selected as priorities because we felt at this time we were not positioned to appropriately address these issues on their own. However, they are seen as important elements of the health of our community and we will be keeping them in mind as we focus on our priority areas and continue to build relationships with partners that may be more prepared to address these issues that we can support. Also, we feel that our priority areas are connected to several of the above listed needs, so we will be able to make contributions to them as we understand more about improving the health of our community."

Part I, Line 7:
The costs were determined by using a cost-to-charge ratio. The cost-to-charge computation is based on Hospital specific data included in the system-wide audited combined financial statements. The formula used for computation equals financial statement data labeled as follows:Total expenses - (Provision for bad debts + Other revenue + Interest income)/Gross patient chargesFeather River Hospital is located in a medically underserved area and participates in a quality assurance fee program with the State of California to fund certain Medi-Cal coverage expansions. The state redistributes funds to hospitals that provide patient care to a higher proportion of indigent and medically underprivileged patients, who otherwise would most likely not have access to physicians and other medical services. The community benefit analysis includes receipts from this redistribution that are used to assist in partially offsetting the significant costs associated with providing patient care to this population group. The program may or may not continue in the future based on the State of California's regulations and policies and the approval of the federal government.

Part II, Community Building Activities:
The Hospital is involved in numerous community building activities which promote the health of the communities it serves. Numerous community concerns are addressed, including health improvement, education, poverty, workforce development and access to care. We also encourage our employees to serve on community collaboration boards, health advocacy programs, and physical improvement projects to promote the health of the communities we serve. In addition, we work with neighborhood programs, including schools, work sites and safety net providers to promote health and wellness and prevent disease. These activities are not included elsewhere on Schedule H.

Part III, Line 2:
Uncollected patient accounts are analyzed using written patient financial services policies that apply standard procedures for all patient accounts. The result of the analysis is what is recognized as bad debt expense. For example, all self-pay patients receive a discount. If the discounted account is unpaid after collection efforts, the unpaid balance is classified as bad debt. The cost-to-charge ratio described for Part I, Line 7 is multiplied times the Hospital's bad debt expense. The resulting figure has been reported as bad debts at cost on Part III, Line 2.

Part III, Line 3:
The portion of the bad debts attributed to charity care as reported on Part III, Line 3 was calculated by an independent third-party consulting firm. This is an estimate of additional charity care that would have been granted if patients had cooperated by furnishing family financial information. A statistically valid sampling of patient accounts written-off was evaluated. The evaluation used various factors to determine which patients would have been eligible for charity care. Had the Hospital obtained sufficient information from all patients who qualified for financial assistance, these additional accounts would have been recorded as charity care instead of bad debt.

Part III, Line 4:
The system-wide audited combined financial statements do not contain a footnote describing bad debt expense.

Part III, Line 8:
"The Medicare cost report apportions the Hospital's costs on the basis of inpatient days and ancillary and outpatient charges to establish the costing methodology.Healthcare delivery by hospitals is a complex, highly regulated business in the United States. Healthcare unit cost inflation is driven by compliance with ever-expanding regulatory requirements, shortages of highly skilled labor and evolving medical and information technology. The health care ""market basket"" is unrelated to that of the average individual consumer.Since the 1997 Balanced Budget Act, Medicare annual payment updates have fallen behind actual healthcare cost inflation to the point that Medicare payments to many U.S. hospitals are well below the cost of providing care.These unreimbursed costs are a community benefit for seniors and others in the community as these individuals are continuing to receive care without which many would become dependent on other governmental resources such as Medicaid. The benefit to the community for healthier Medicare recipients is no different than those benefits the community realizes for uninsured and underinsured patients who are eligible for partial and full charity care. Medicare is a safety net for seniors and others. Without Medicare coverage, many individuals would undoubtedly qualify for charity care.In addition to the mismatch between Medicare payment increases and healthcare cost inflation, the highly complex Medicare payment systems and formulas produce disparate payment levels from one hospital to another for the same service. These disparate payment levels create disparate results within groups of hospitals.Reconciliation of Medicare Revenue from the hospital's Medicare Cost Report to GL Revenue Rec. *Medicare Cost Report Revenue 62,006,354 Prior Year Settlements (1,245,960) Cost Report Reimbursable Bad Debts 800,378 Estimates and Accrual Variances 648,721 Other (3,406,260) Total Medicare Revenue 58,803,233 *Note: The Medicare Cost Report revenue does not include the bad debt reimbursement. The Cost Report revenue does include the patient co-pay and deductible amounts. Adding the bad debt reimbursement would have duplicated the revenue already accounted for in the co-pay and deductible amounts."

Part III, Line 9b:
"When a patient has requested screening for charity care, the Hospital must immediately cease collection activity and place the account in a charity pending status. If 100% charity is approved, the entire account balance is written off to charity care. If the patient has a sliding scale liability based on the federal poverty guidelines, they are billed only for that liability. If the patient fails to pay their after-charity liability, they are assigned to a collection agency with an identifier that indicates to the agency that the patient is ""low income and the following criteria must be followed by the agency:1. They may not report the patient to a credit bureau2. They may not file a lawsuit to recover the outstanding liability3. They may not charge interest"

Part VI, Line 7, Reports Filed With States
CA

Part VI, Line 2:
The Hospital's 2016 CHNA, the 2019 Community Health Plan (CHP) Update for fiscal year 2018, the 2018 Community Health Plan (CHP) Update for fiscal year 2017, and the 2016 Implementation Strategy (adopted in May 2017), that includes the 2016 CHP are posted on the Hospital's website at: https://www.adventisthealth.org/about-us/community-benefit/. The CHNA, Implementation Strategy Implementation and the CHPs are also available on the Adventist Health Corporate website at: https://www.adventisthealth.org/about-us/community-benefit/.Hospital leadership serves on a variety of community boards and committees focused on addressing community-specific needs, allowing for ongoing responsiveness to the health care needs of the community and collaboration with local agencies and organizations, enabling maximum effectiveness through collective impact.

Part VI, Line 3:
The plain language summary of the Financial Assistance Policy (FAP) is posted along with the complete FAP policy and FAP Application on the hospital's website at:https://www.adventisthealth.org/patient-resources/financial-assistance/. These documents are available in multiple languages.At the time of registration, patients who are uninsured and underinsured are provided information about government healthcare programs. Patients are also orally informed of their right to request charity assistance. Signs are displayed in the patient business office, patient registration areas and the emergency room in multiple languages informing patients of this right as well. The Hospital also provides a brochure during the registration process that explains the Hospital billing and collection procedures, and how to request financial assistance. In addition, every billing statement sent to patients contains information on how to request financial assistance.

Part VI, Line 4:
Feather River Hospital (FRH) is a 100 bed, not-for-profit, faith-based facility, offering a full range of inpatient, outpatient and emergency services. Operating in the Paradise, CA for more than 60 years, FRH employs more than 1,300 community members, has a medical staff of 180 physicians, and more than 600 volunteers. Paradise is an incorporated town in Butte County, in the northwest foothills of California's Central Valley, in the Sierra. The town is considered part of the Chico Metropolitan Area. The population of Paradise was estimated at approximately 26,000 in 2016, while the population of Butte county, our service area, was estimated at 222,000. Even though its population is primarily white (81.9%), racial and ethnic diversity have been increasing recently in Butte County. Between 2010 and 2013, there was a large increase in the Native Hawaiian/Pacific Islander population, which now represent 0.2%, a moderate increase in the American Indian/Alaska Native population - 2.0% representation and the African American/Black population - 1.6% representation, and a small increase in the Asian population - 4.1% representation at the last census, with the remaining 4.6% being of mixed race or other.

Part VI, Line 6:
The Hospital is a member of Adventist Health System/West, a health care system which provides healthcare services in diverse markets within the Western United States. A member hospital may share some services with other member hospitals in its geographic area, such as clinical, management and support services. Using today's technology, hospitals outside the geographic area are able to provide support through remote services such as tele-pharmacy and robotics surgery. The Corporate Office provides important shared administrative support for member hospitals' rural health clinics and home care agencies, quality of care, other clinical needs, financing and risk management, and shared clinical and financial information technology. As many experienced and new physicians search for alternatives to independent practice, there is also corporate administrative support for hospital affiliated medical groups that engage physicians through employment or other contracts. This provides stability and growth of qualified physicians across many specialties, which is very important to make healthcare services available and to maintain and improve health within the communities served by all member hospitals.

Part VI, Line 5:
"Our Hospital's mission is, ""Living God's love by inspiring health, wholeness and hope."" Our community benefit work is rooted deep within our mission and merely an extension of our mission and service. We have also incorporated our community benefit work to be an integral component of improving the ""Triple Aim."" The ""Triple Aim"" concept broadly known and accepted within health care includes:1) Improve the experience of care for our residents.2) Improve the health of populations.3) Reduce the per capita costs of health care.Our strategic investments in our community are focused on a more planned, proactive approach to community health. The basic issue of good stewardship is making optimal use of limited charitable funds. Defaulting to charity care in our emergency rooms for the most vulnerable is not consistent with our mission. An upstream and more proactive and strategic allocation of resources enables us to help low income populations avoid preventable pain and suffering; in turn allowing the reallocation of funds to serve an increasing number of people experiencing health disparities.Hospitals and health systems are facing continuous challenges during this historic shift in our health system. Given today's state of health, where cost and heartache is soaring, now more than ever, we believe we can do something to change this. These challenges include a paradigm shift in how hospitals and health systems are positioning themselves and their strategies for success in a new payment environment. This will impact everyone in a community and will require shared responsibility among all stakeholders. As hospitals move toward population health management, community health interventions are a key element in achieving the overall goals of reducing the overall cost of health care, improving the health of the population, and improving access to affordable health services for the community both in outpatient and community settings. The key factor in improving quality and efficiency of the care hospitals provide is to include the larger community they serve as a part of their overall strategy. Population health is not just the overall health of a population, but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.Community health can serve as a strategic platform to improve the health outcomes of a defined group of people, concentrating on three correlated stages:1) The distribution of specific health statuses and outcomes within a population; 2) Factors that cause the present outcomes distribution; and 3) Interventions that may modify the factors to improve health outcomes.Improving population health requires effective initiatives to: 1) Increase the prevalence of evidence-based preventive health services and preventive health behaviors, 2) Improve care quality and patient safety, and 3) Advance care coordination across the health care continuum. We will work together with our community to ensure the community health improvements are identified and then targeted for programs to influence behaviors to obtain improved health within the whole community."