4A (Expenses $ 151831950 including grants of $ 2276313) (Revenue $ 182795875)
PROVIDING COMPASSIONATE AND EXCEPTIONAL HEALTHCARE WHILE IMPROVING OUR COMMUNITY'S HEALTH. THE HOSPITAL HAD 20,994 INPATIENT DAYS, 3,974 SURGERY VISITS, AND 31,990 EMERGENCY ROOM VISITS DURING THE FISCAL YEAR.

SCHEDULE H, PART V, SECTION B, FACILITY 1, LINE 5
PERSONS WHO REPRESENT THE COMMUNITY: THE CHNA FOR DUNCAN REGIONAL HOSPITAL WAS PERFORMED DURING THE 2019 FISCAL YEAR. SIMILARLY TO THE PRIOR CHNA, A COMMITTEE WAS FORMED THAT COMPRISED OF INDIVIDUALS WHO ENCOMPASSED THE DIVERSITY OF STEPHENS COUNTY. THE HOSPITAL PARTICIPATED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY THE PATHWAYS TO A HEALTHY STEPHENS COUNTY COMMITTEE. THE INDIVIDUALS IN THIS COMMITTEE INCLUDED, BUT WERE NOT LIMITED TO, INDIVIDUALS FROM THE FOLLOWING ORGANIZATIONS: DRH HOSPITAL, PRIMARY CARE PROVIDERS, BEHAVIORAL HEALTH PROVIDERS, STEPHENS COUNTY HEALTH DEPARTMENT, CAMERON UNIVERSITY, RED RIVER TECHNOLOGY CENTER, DUNCAN CHAMBER OF COMMERCE, CITY OFFICIALS OF DUNCAN, MARLOW, COMANCHE, BRAY-DOYLE, FIRST NATIONAL BANK OF VELMA, FIRST BAPTIST CHURCH-MARLOW, DUNCAN POLICE DEPARTMENT AND VARIOUS OTHERS. ADDITIONAL INPUT CAME FROM SURVEYS, FOCUS GROUPS, AND COMMUNITY INFORMANT INTERVIEWS.

SCHEDULE H, PART V, SECTION B, FACILITY 2, LINE 5
PERSONS WHO REPRESENT THE COMMUNITY: THE CHNA FOR JEFFERSON COUNTY HOSPITAL WAS PERFORMED IN THE FALL OF 2018 AND A NEW CHIP COMPLETED THAT BEGAN JULY 1, 2019. THE HOSPITAL HOSTED FOUR COMMUNITY MEETINGS BETWEEN SEPTEMBER, 2018 AND JULY 2019. COMMUNITY MEMBERS WHO PARTICIPATED IN THESE MEETINGS INCLUDED INDIVIDUALS FROM JEFFERSON COUNTY HEALTH DEPARTMENT, WAURIKA PUBLIC SCHOOLS, LOCAL BANKERS, LOCAL BUSINESS OWNERS, RETIRED INDIVIDUALS, WAURIKA NEWSPAPER, A LOCAL PASTOR AND THE WAURIKA CHAMBER OF COMMERCE. ADDITIONAL INPUT CAME FROM SURVEYS THAT WERE MADE AVAILABLE IN BOTH PAPER AND WEB FORMAT. A TOTAL OF 95 SURVEYS FROM THE COMMUNITY WERE COMPLETED.

SCHEDULE H, PART V, SECTION B, FACILITY 1, LINE 6B
CHNA CONDUCTED WITH OTHER ORGANIZATIONS: IN PARTNERSHIP WITH THE STEPHENS COUNTY HEALTH DEPARTMENT, PATHWAYS TO A HEALTHY STEPHENS COUNTY, UNITED WAY OF STEPHENS COUNTY, AND NUMEROUS OTHER ORGANIZATIONS, DUNCAN REGIONAL HOSPITAL PARTICIPATED WITH THESE ORGANIZATIONS TO COMPLETE THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR STEPHENS COUNTY AND JEFFERSON COUNTY OKLAHOMA, IN THE FALL 2018.

SCHEDULE H, PART V, SECTION B, FACILITY 2, LINE 6B
CHNA CONDUCTED WITH OTHER ORGANIZATIONS: THE CHNA FOR JEFFERSON COUNTY HOSPITAL WAS CONDUCTED WITH THE ASSISTANCE OF THE OKLAHOMA OFFICE OF RURAL HEALTH AND JEFFERSON COUNTY HEALTH DEPARTMENT. THE OKLAHOMA OFFICE OF RURAL HEALTH AND JEFFERSON COUNTY HEALTH DEPARTMENT WORKED CLOSELY WITH THE HOSPITAL TO DEVELOP AN ECONOMIC IMPACT OF THE LOCAL HEALTH SECTOR, DEVELOP AND ANALYZE SURVEYS, AND GATHER LOCAL HEALTH DATA.

SCHEDULE H, PART V, SECTION B, FACILITY 1 & 2, LINES 7A, 7D & 10A
WEBSITE WHERE CHNA CAN BE FOUND: THE CHNA AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) CAN BE FOUND AT THE FOLLOWING ADDRESS: HTTPS://WWW.DUNCANREGIONAL.COM/ABOUT-THE-HOSPITAL/COMMUNITY-INVOLVEMENT/ THE CHNA/CHIP REPORT IS PRINTED AND PUT IN WAITING ROOMS AND OTHER PLACES IN THE HOSPITAL.

SCHEDULE H, PART V, SECTION B, FACILITY 1 & 2, LINE 11
NEEDS ADDRESSED AND NOT ADDRESSED IN IMPLEMENTATION STRATEGY: THROUGH CONDUCTING THE CHNA, 4 HEALTH NEEDS WERE IDENTIFIED FOR THE COMMUNITY. THESE NEEDS WERE: - BEHAVIORAL HEALTH/ SUBSTANCE ABUSE - HEALTHY LIVING (HEART DISEASE, PHYSICAL ACTIVITY, HEALTHY FOODS) - SAFETY/INJURY PREVENTION - CANCER AWARENESS/ EDUCATION THE IMPLEMENTATION STRATEGY PRIORITIZED THE FIRST 4 ITEMS LISTED ABOVE TO BE ADDRESSED IN THE HEALTH IMPROVEMENT PLAN. MENTAL HEALTH, HEALTHY LIVING, SAFETY/INJURY PREVENTION AND CANCER WERE CHOSEN BASED ON COMMUNITY HEALTH DATA AND IDENTIFIABLE GAPS IN AVAILABLE CARE SERVICES. IT WAS DETERMINED THAT THESE FOUR ISSUES WOULD ULTIMATELY HAVE THE GREATEST IMPACT ON THE COMMUNITY'S OVERALL HEALTH WHILE ALSO TAKING INTO ACCOUNT THE HOSPITAL'S AVAILABLE RESOURCES. IN THE MOST RECENT CHNA, THE FOUR PRIORITIES WERE IDENTIFIED AS: 1. BEHAVIORAL HEALTH/SUBSTANCE ABUSE: - Behavioral Health Committee meets monthly the second Wednesday of the month at noon. Committee meeting is held on the campus of DRH Health. - Increase education: Handle with Care Introduction and Training / N.E.A.R. Science/ACE's. Co-presented with representatives from the Chickasaw Nation to local schools and coalition meeting. - Hope Rising Ok Initiative with First Lady Sarah Stitt and Chan Hellman (ongoing collaboration) - Planning: Partnership with local resources to offer support through Pathways Hope Centers - Continuing: Collaboration with Hope Navigators in both counties - Planning: Safe kids coalition - In partnership with Safe Kids Oklahoma - Duncan High School/Pathways Youth Coalition (alcohol/tobacco/vaping) - Red Ribbon Week activities x 2 counties. October 2021 - Planning of two additional school youth coalitions (Jefferson county and one additional in Stephens county) - Co-Host with partner, WMPN Drug Take Back Events in both counties 2. HEALTHY LIVING: - Healthy living committee meets monthly at 9:00am at DRH Health Foundation board room. - Wellness Works challenge - May 9 - June 24. Seven week challenge open to greater community of Stephens and Jefferson counties to focus on tobacco use prevention, mindfulness, physical activity, water consumption, healthy fruits/vegetables and sleep. Promoted walking trails and fun family friendly running/walking events. - Annual event: Stampede the Trail - half marathon and 5K (partnership with DRH health Foundation) - Grade school cooking classes - Partnering with OSU Ext office Two-Bite Club. Two bite club, USDA program encouraged kids to try foods from each of the food groups by eating just two bites! - Spring Youth Wellness event: Simmons Center collaboration - Annual event: Women's health event / Youth and families health events held Fall of 2022 - Promotion of Certified Healthy Oklahoma initiative / Education / Technical Assistance: Applications completed Nov 2021. Awards luncheon held Spring (March) 2022 - Promote/Educate on importance of Immunizations including Covid and Flu vaccines. Participated with Public Health Inst of Ok and OU Research Center to host several Covid 19 testing sites and offer Covid 19 and Flu shots in both Stephens and Jefferson Counties. - Promote various cancer screening opportunities through CCSWOk and community health fair events. Global multimedia outlets within DRH health system for patients, family members and visitors. Social media outlets to greater community of Stephens and Jefferson Counties. 3. SAFETY INJURY PREVENTION: - The SHIP committee meets the second Tuesday of the month at the DRH Health Foundation board room. - Host Spring and Fall a one day safety event for local 4th and 5th graders - both counties; focus on safety and unintentional injuries (fire, bicycle, weather, vehicle, ATV, drugs/alcohol/marijuana) - Educational social media focused on K - 12 schools - Local municipal policy review in partnership with Wichita Mountains Prevention Network - Co-host / sponsor of community baby shower: education for new parents and parents to be - Car seat safety checks at school / community events - Explore opportunities to apply for a Safe Kids Coalition - application did not open in 2022 4. CANCER: PROMOTED SCREENINGS TO THE COMMUNITY THROUGH FLYERS, SOCIAL MEDIA AND LOCAL PRESS. UNABLE TO HOST LOCAL IN PERSON EVENT DUE TO COVID PANDEMIC RESTRICTIONS. Local county health department of Stephens and Jefferson counties, DRH Health, DRH Health Foundation, local Chamber of Commerce, Potts Family Foundation, Evolution Foundation, Wichita Mountain Prevention Network, and Public Health Institute of Oklahoma/OU Research Partners and several school districts in both counties.

SCHEDULE H, PART V, SECTION B, FACILITIES 1 & 2, LINES 16A, 16B, & 16C
WEBSITE WHERE FAP, APPLICATION AND PLAIN LANGUAGE SUMMARY CAN BE FOUND: HTTPS://WWW.DUNCANREGIONAL.COM/PATIENTS-VISITORS/BILLING-FINANCE/

SCHEDULE H, PART III, SECTION A, LINE 2
BAD DEBT EXPENSE: BAD DEBT IS DETERMINED BY EVALUATING THE COLLECTIBILITY OF THE SELF-PAY BALANCES BASED ON THE AGING ACCOUNTS RECEIVABLES BALANCE.

SCHEDULE H, PART III, SECTION A, LINE 3
BAD DEBT AS COMMUNITY BENEFIT: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. BAD DEBT EXPENSE SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THIS IS UNCOMPENSATED HEALTHCARE PROVIDED TO RESIDENTS OF THE COMMUNITY.

SCHEDULE H, PART III, SECTION A, LINE 4
BAD DEBT FOOTNOTE: NOT APPLICABLE DUE TO ADOPTION OF ASU 2014-09 TOPIC 606 REVENUE FROM CONTRACTS WITH CUSTOMERS

SCHEDULE H, PART III, SECTION B, LINE 8
COSTING METHODOLOGY: THE ORGANIZATION UTILIZES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED UPON MEDICAID OR MEDICARE DAYS TO TOTAL DAYS, AND THE ANCILLARY PORTION IS APPORTIONED BASED UPON PROGRAM CHARGES TO TOTAL CHARGES.

SCHEDULE H, PART III, SECTION C, LINE 9B
COLLECTION POLICY: IN SUPPORT OF ITS MISSION, THE HOSPITAL VOLUNTARILY PROVIDES FREE CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES AND ARE DEEMED MEDICALLY INDIGENT IN ACCORDANCE WITH THE HOSPITAL'S WRITTEN CHARITY CARE CRITERIA. NO FURTHER COLLECTION EFFORTS ARE MADE.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT: THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ON GOING BASIS, AND EVERY THREE YEARS, THROUGH INVOLVEMENT WITH COMMUNITY PARTNERS AND SURVEYS WITH PHYSICIANS. THE HOSPITAL WILL UNDERGO THE REQUIRED COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOP A COMMUNITY HEALTH IMPLEMENTATION PLAN UNDER THE 501R REQUIREMENTS BY THE REQUIRED TIME. ALSO, PATHWAYS TO A HEALTHY LIVING, A COUNTY HEALTH IMPROVEMENT ORGANIZATION HOLDS MONTHLY COMMUNITY PARTNER MEETINGS VIA WEBEX TO STAY UP TO DATE ON THE NEEDS OF THE COMMUNITY.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: DUNCAN REGIONAL HOSPITAL PROVIDES MANY OPPORTUNITIES FOR PATIENT EDUCATION ON FINANCIAL ASSISTANCE. THE PROGRAMS ARE OUTLINED ON THE HOSPITAL'S WEBSITE, BROCHURES ARE AVAILABLE AT EVERY REGISTRATION POINT, PRE-ADMISSION LETTERS ARE PROVIDED TO SURGERY PATIENTS THAT CONTAIN FINANCIAL ASSISTANCE INFORMATION AND APPLICATIONS ARE GIVEN TO UNINSURED PATIENTS.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: DUNCAN REGIONAL HOSPITAL IS ACTIVELY DELIVERING CARE TO THE STEPHENS COUNTY AREA. ACCORDING TO THE 2010 CENSUS, STEPHENS COUNTY IS A RURAL COUNTY WITH A POPULATION OF 45,048. THIS INCLUDES THE CITY OF DUNCAN WHERE THE HOSPITAL IS LOCATED WITH A POPULATION OF 23,431 RESIDENTS. THE SECOND MOST POPULATED AREA IS MARLOW WITH A POPULATION OF 5,000. THE MEDIAN AGE OF THE POPULATION IS 40.6 YEARS OLD WITH APPROXIMATELY ONE QUARTER OF THE POPULATION UNDER THE AGE OF 19. THROUGH JEFFERSON COUNTY HOSPITAL, DUNCAN IS ALSO ACTIVELY DELIVERING CARE TO THE JEFFERSON COUNTY AREA. THE ESTIMATED POPULATION OF THE COUNTY IS 6,377 WITH A MEDIAN AGE OF 41.6 YEARS OLD. APPROXIMATELY 39.3% OF THE COUNTY'S ADULT POPULATION SUFFERS FROM OBESITY RESULTING IN $2,740 IN ADDITIONAL MEDICAL COSTS PER PERSON AGED 18 & OVER. THE HOSPITAL HAS AN AVERAGE OF 95 DISCHARGES FOR PATIENTS WITH HEART DISEASE AND 12 DISCHARGES FOR PATIENTS WITH DIABETES.

SCHEDULE H, PART VI, LINE 5
"PROMOTION OF COMMUNITY HEALTH: DUNCAN REGIONAL HOSPITAL PROMOTES THE OVERALL HEALTH OF THE COMMUNITY BY CONTINUALLY WORKING TO BRING QUALITY PHYSICIANS TO PARTICIPATE IN OUR OPEN MEDICAL STAFF. SURPLUS FUNDS ARE REINVESTED INTO THE ORGANIZATION TO IMPROVE THE QUALITY OF SERVICES TO THE COMMUNITY. THE HOSPITAL PARTNERS WITH AND PARTICIPATES IN THE CERTIFIED HEALTHY OKLAHOMA INITIATIVE. OVERALL THE HOSPITAL ASSISTED WITH AND OR HAD ENTITIES TOTALING 31 TO BE CERTIFIED HEALTHY. INCLUDED WERE CERTIFIED HEALTHY BUSINESSES, SCHOOLS, CONGREGATIONS, EARLY CHILDHOOD CENTERS AND RESTAURANTS. AMONG THE ORGANIZATIONS CERTIFIED WERE 5 EARLY CHILDHOOD CENTERS, THE ATRIUM CAF', CAMERON UNIVERSITY-DUNCAN, 4 PUBLIC SCHOOLS, 2 CONGREGATIONS AND OTHER LOCAL BUSINESSES. IN MAY 2018, THE ""STOP THE STIGMA"" CAMPAIGN WAS STARTED TO PROVIDE EDUCATION ON THE STIGMA REGARDING MENTAL HEALTH/ILLNESS. COMMUNITY PARTNERS WERE PROVIDED INFORMATION AT VARIOUS COMMUNITY EVENTS AND COUNCIL MEETINGS AND PRESENTED AN OPPORTUNITY TO TAKE A PLEDGE TO WORK TO HELP STOP THE STIGMA IN THEIR COMMUNITIES. THE JEFFERSON COUNTY PATHWAYS COALITION MET WITH VARIOUS COMMUNITY PARTNERS ATTENDING MEETINGS FROM THE COUNTY (SCHOOLS, LAW ENFORCEMENT, PRIVATE SECTOR, AND OTHER NONPROFIT ORGANIZATIONS). MEETINGS WERE HELD VIRTUAL DUE TO COVID PANDEMIC. ADDITIONAL INFORMATION ON LEADERSHIP IN THE COMMUNITY: LEADERS FROM DRH SERVES ON VARIOUS BOARDS WITHIN THE COUNTY INCLUDING BUT NOT LIMITED TO THE FOLLOWING: ROTARY, KIWANIS, LIONS CLUB, SIMMONS CENTER, SAFE CENTER (FORMERLY WOMEN'S HAVEN), BEAUTIFUL DAY (POSITIVE RECOGNITION PROGRAM FOR ELEMENTARY CHILDREN), DUNCAN ENHANCEMENT TRUST AUTHORITY (UNDER DUNCAN CITY COUNCIL), STEPHENS COUNTY HEALTH DEPARTMENT, LEADERSHIP DUNCAN AND ALSO THE LOANED EXECUTIVE PROGRAM THROUGH UNITED WAY. PARTNERED WITH LOCAL PARTNERS AND LEGISLATORS TO DISSEMINATE CENSUS 2020 DATA TO COMMUNITY. COMMUNITY BENEFIT DIRECTOR COMPLETED ACE'S N.E.A.R. SCIENCE TRAINING. THIS EDUCATION WAS PRESENTED TO SCHOOLS, FAITH BASED AND GREATER COMMUNITY TO IMPROVE KNOWLEDGE OF ACE'S, RESILIENCE AND HOPE AND IS PART OF THE SELF HEALING COMMUNITIES STATEWIDE INITIATIVE LEAD BY THE POTTS FAMILY FOUNDATION."

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM: N/A

SCHEDULE H, PART VI, LINE 7
STATE FILING OF COMMUNITY BENEFIT REPORT: N/A

SCHEDULE H, PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE, TOTALING $13,457,784.

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY FOR COMMUNITY BENEFIT COSTS: THE AMOUNTS REPORTED ON THE TABLE ON PART I, LINE 7 WERE CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM COMPLETING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES FROM THE IRS INSTRUCTIONS. WORKSHEETS 4 AND 8 WERE COMPLETED USING THE HOSPITAL'S DIRECT COSTS AND INCOME STATEMENT.

SCHEDULE H, PART I, LINE 3C
FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING OTHER CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: -ASSET LEVEL -INSURANCE STATUS

SCHEDULE H, PART II
COMMUNITY BUILDING ACTIVITIES: DUNCAN REGIONAL HOSPITAL ENCOURAGES ITS LEADERSHIP TEAM MEMBERS TO PARTICIPATE IN LOCAL NOT-FOR-PROFIT AGENCIES. LEADERS FROM DRH SERVE ON VARIOUS BOARDS WITHIN THE COUNTY INCLUDING BUT NOT LIMITED TO THE FOLLOWING: ROTARY, KIWANIS, LIONS CLUB, SIMMONS CENTER, SAFE CENTER (FORMERLY WOMENS HAVEN), BEAUTIFUL DAY (FOR ELEMENTARY CHILDREN), DUNCAN ENHANCEMENT TRUST AUTHORITY, STEPHENS COUNTY HEALTH DEPARTMENT, LEADERSHIP DUNCAN PROGRAM AND ALSO THE LOANED EXECUTIVE PROGRAM THROUGH UNITED WAY. EMPLOYEES PARTICIPATE IN VARIOUS HEALTH EVENTS OFFERED TO THE COMMUNITIES OF STEPHENS AND JEFFERSON COUNTIES SUCH AS THE DOUGLAS SR CENTER HEALTH FAIR, JEFFERSON COUNTY HEALTH FAIR, LADIES FALL HEALTH EVENT, STAMPEDE THE TRAIL, AND WALK TO REMEMBER. THEY ALSO PROVIDE FREE BLOOD PRESSURE/GLUCOSE SCREENINGS AT SENIOR CENTERS AND NURSING HOMES. WE HAVE SOME PHYSICIANS AND NURSES THAT ALSO VOLUNTEER AT THE COMPASSION CLINIC IN DUNCAN. THE HOSPITAL ENCOURAGES PARTICIPATION BY COMPENSATING THE TEAM MEMBERS WHILE THEY ARE PERFORMING THIS WORK OUTSIDE OF THE HOSPITAL. WORKFORCE DEVELOPMENT COSTS REPRESENT THE COSTS OF MAINTAINING A BUILDING USED BY A STATE UNIVERSITY TO EDUCATE NURSES.