4A (Expenses $ 1324272067 including grants of $ 0) (Revenue $ 1509880543)
I. GENERAL PROGRAM SERVICE INFORMATION SINCE 1915, GEISINGER MEDICAL CENTER (GMC), A 501(C)(3) NOT-FOR-PROFIT CORPORATION, HAS BEEN PROVIDING HIGH-QUALITY HEALTHCARE SERVICES TO MORE THAN TWO MILLION RESIDENTS IN CENTRAL AND NORTHEAST PENNSYLVANIA. GEISINGER IS HOME TO SOME OF THE MOST ADVANCED TECHNOLOGY IN THE COUNTRY, INCLUDING A LEVEL I TRAUMA CENTER, THE REGION'S LONE PEDIATRIC TRAUMA CENTER, THE RENOWNED JANET WEIS CHILDREN'S HOSPITAL, THE STATE-OF-THE-ART HOSPITAL FOR ADVANCED MEDICINE AND CLINICAL RESEARCH FACILITIES. LOCATED IN DANVILLE, PENNSYLVANIA, A PREDOMINANTLY RURAL AREA, GMC OPERATES A 520 BED FACILITY ALONG WITH A 48 BED HOSPITAL LOCATED IN COAL TOWNSHIP, PENNSYLVANIA. PHYSICIANS IN PENNSYLVANIA AND THE SURROUNDING STATES REFER THEIR MOST COMPLEX CASES TO GEISINGER MEDICAL CENTER WHERE THE EXISTENCE OF QUATERNARY HEALTHCARE IN A GENERALLY RURAL AND MEDICALLY UNDERSERVED POPULATION IS UNCOMMON. GMC'S LIFE FLIGHT IS THE LEADER IN MEDICAL AIR TRANSPORTATION IN THE REGION SPECIALIZING IN TRANSPORTING CRITICAL CARE PATIENTS, INCLUDING PREMATURE NEWBORNS, CARDIAC PATIENTS, ORGAN TRANSPLANT PATIENTS AND ACCIDENT VICTIMS. A. SPECIALTIES AND SUBSPECIALTIES GEISINGER CLINIC PHYSICIANS PRACTICING AT GMC PROVIDE SKILLED SERVICES IN NUMEROUS SPECIALTY AND SUBSPECIALTY AREAS. SPECIAL SERVICES AVAILABLE INCLUDE, BUT ARE NOT LIMITED TO: ADULT & PEDIATRIC TRAUMA CENTER MATERNAL FETAL MEDICINE ADULT MEDICAL ONCOLOGY MICROBIOLOGY AERO-MEDICAL SERVICES MINIMALLY INVASIVE SURGERY AIMI (ACUTE INTERVENTION IN MOHS SURGERY MYOCARDIAL INFRACTION) MOLECULAR DIAGNOSTICS ANTICOAGULATION CLINIC MOVEMENT DISORDERS BACLOFEN PUMPS NEUROENDOVASCULAR BAHA (BONE ANCHORED HEARING AID) NEUROMUSCULAR BALANCE CENTER NEUROPSYCH BARIATRIC SURGERY NEUROPATHOLOGY BLOOD BANK NEUROPHYSIOLOGY BLOOD CONSERVATION NEUROSTIMULATORS BODY CONTOURING NEUROTRAUMA BRAIN TUMOR NUCLEAR STRESS TESTING BREAST SURGERY OPEN HEART SURGERY CANCER GENETICS CLINIC OPHTHALMOLOGY (GLAUCOMA, RETINAL, CAPSULE ENDOSCOPY PEDIATRIC, CORNEA, GENERAL, CARDIAC CAT SCAN ANGIOGRAPHY OPHTHALMOPLASTIC SURGERY) CARDIAC MRI TESTING ORTHOPAEDICS (TRAUMA, SPINE, HAND CAROTID STENTING SPORTS MEDICINE, PEDIATRIC, CAT SCAN CARDIAC SCORING JOINT, FOOT/ANKLE, GENERAL) CAT SCAN ORTHOPAEDIC ONCOLOGY CHEMISTRY PEDIATRIC CONGENITAL HEART SURGERY CHEMO-EMBOLIZATION OF LIVER PEDIATRIC GENETICS AND KIDNEY CANCER PEDIATRIC MEDICAL ONCOLOGY CLEFT PALATE CLINIC PEDIATRIC NEURODEVELOPMENT COAGULATION PEDIATRIC OBESITY COCHLEAR IMPLANT PEDIATRIC REHABILITATION COLORECTAL SURGERY PEDIATRIC SURGERY CORNEAL TRANSPLANTS PEDIATRIC UROLOGY CYTOLOGY PEDIATRIC COCHLEAR IMPLANT DEEP BRAIN STIMULATION PEDIATRIC NEUROLOGY/NEUROSURGERY DERMATOPATHOLOGY PET SCANS ECHOCARDIOGRAPHY PODIATRY ELECTROPHYSIOLOGY PRE-SURGERY CENTER EMERGENCY SERVICES PSYCHIATRY (ADOLESCENCE) ENDOVASCULAR PROCEDURES RADIATION ONCOLOGY ENDOVASCULAR GRAFT IMPLANTS EPILEPSY REGIONAL ANESTHESIA PROGRAM EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY RENAL DENERVATION GYNONCOLOGY ROBOTIC SURGERY GYNECOLOGIC & UROPATHOLOGY SKULL BASE SURGERY HEAD AND NECK ONCOLOGY SLEEP DISORDERS LABORATORY HEADACHE SPINAL BIFIDA CLINIC HEART FAILURE SPINAL CORD INJURY HEMATOLOGY SPINE SURGERY HEMATOPATHOLOGY SPINE ASSESSMENT PROGRAM HEPATIC INTRA-ARTERIAL CHEMOTHERAPY STEM CELL TRANSPLANT HIGH DOSE INTERLEUKIN-2 THERAPY STEREOTACTIC RADIOSURGERY HIGH DOSE RATE INTRACAVITARY STRETTA (LASER PROCEDURE) BRACHYTHERAPY STROKE/TELE-STROKE IMMUNOLOGY SURGICAL ONCOLOGY (COLON, LIVER, INFERTILITY PANCREAS, ESOPHAGEAL, & RENAL) INTENSIVE O/P PSYCHIATRIC PROGRAM SURGICAL PATHOLOGY INTERVENTIONAL PAIN MANAGEMENT TRANSCATHETER AORTIC VALVE INTERVENTIONAL RADIOLOGY IMPLEMENTATION INTRA-OPERATIVE HEPATIC ULTRASOUND TISSUE BANKING AND RADIOFREQUENCY ABLATION OF TRAUMATIC BRAIN INJURY LIVER TUMORS TOXICOLOGY KIDNEY, LIVER & PANCREAS TRANSPLANTS TRAUMA SURGERY LASER SURGERY (YAG LASER) UROGYNECOLOGY LVAD (LEFT VENTRICULAR ASSIST DEVICE)VAGAL NERVE STIMULATORS MAGNETIC RESONANCE IMAGING WOUND CARE MEDICATION THERAPY MANAGEMENT PROGRAM B. RESIDENCY, FELLOWSHIP AND ALLIED HEALTH PROGRAMS GMC CONDUCTS 33 GRADUATE MEDICAL EDUCATION RESIDENCY PROGRAMS AND 23 FELLOWSHIP PROGRAMS. THERE WERE 553 GRADUATE PHYSICIANS PARTICIPATING IN THESE PROGRAMS IN THE YEAR ENDED DECEMBER 31, 2021. PROGRAM SPECIALTIES ARE AS FOLLOWS BUT ARE NOT LIMITED TO: RESIDENCY PROGRAMS ANESTHESIOLOGY CLINICAL PSYCHOLOGY DERMATOLOGY EMERGENCY MEDICINE FAMILY MEDICINE GENERAL SURGERY INTERNAL MEDICINE INTERNAL MEDICINE PEDIATRICS NEUROLOGY NEUROLOGICAL SURGERY OBSTETRICS GYNECOLOGY OPHTHALMOLOGY ORAL & MAXILLOFACIAL SURGERY ORTHOPAEDIC SURGERY OTOLARYNGOLOGY PATHOLOGY PHYSICAL MEDICINE & REHABILITATION PEDIATRICS PEDIATRIC DENTISTRY PODIATRY PSYCHIATRY RADIOLOGY UROLOGY FELLOWSHIP PROGRAMS ADDICTION MEDICINE CARDIOVASCULAR MEDICINE CLINICAL CARDIAC ELECTROPHYSIOLOGY CLINICAL INFORMATICS CRITICAL CARE MEDICINE CYTOPATHOLOGY DERMATOPATHOLOGY GASTROENTEROLOGY HOSPICE & PALLIATIVE MEDICINE INTERVENTIONAL CARDIOLOGY MATERNAL FETAL MEDICINE MEDICAL PHYSICS NEPHROLOGY MICROGRAPHIC SURGERY & DERMATOLOGICAL ONCOLOGY PULMONARY CRITICAL CARE MEDICINE RHEUMATOLOGY SPORTS MEDICINE VASCULAR/INTERVENTIONAL VASCULAR SURGERY RADIOLOGY GMC OPERATES FOUR SCHOOLS OF ALLIED HEALTH EDUCATION. THESE SCHOOLS ARE OPERATED WITHIN GMC IN CONJUNCTION WITH VARIOUS COLLEGES AND UNIVERSITIES. IN ADDITION TO CLASSROOM TIME, STUDENTS CONTRIBUTE CLINICAL EDUCATION HOURS AS AN INTEGRAL PART OF THEIR CURRICULUM. DURING THE YEAR ENDED DECEMBER 31, 2021, THE DIETETIC INTERNSHIP PROGRAM HAD FIVE STUDENTS; THE SCHOOL OF RADIOLOGY HAD EIGHTEEN STUDENTS; THE CHAPLAIN SCHOOL HAD FOUR STUDENTS AND THE PHARMACY RESIDENCY PROGRAM HAD FIVE STUDENTS. THE TOTAL COST TO GMC OF PROVIDING RESIDENCY, FELLOWSHIP, ALLIED HEALTH, AND RELATED EDUCATION PROGRAMS, NET OF THIRD-PARTY REIMBURSEMENTS WAS 57,729,414. C. TRAUMA CARE IN OCTOBER 1986 GMC WAS DESIGNATED BY THE PENNSYLVANIA TRAUMA SYSTEMS FOUNDATION AS A REGIONAL RESOURCE TRAUMA CENTER (LEVEL I) BASED ON THE PROVISION OF COMPREHENSIVE TRAUMA CARE 24 HOURS A DAY AND THE CONDUCT OF OUTREACH, EDUCATIONAL AND RESEARCH PROGRAMS IN TRAUMA CARE. IN 1996, THE PENNSYLVANIA TRAUMA SYSTEMS FOUNDATION ACCREDITED GMC AS ADDITIONAL QUALIFICATIONS IN PEDIATRICS. GMC HAS BEEN ACCREDITED AS A LEVEL II PEDIATRIC TRAUMA CENTER. THE TRAUMA CENTER INCLUDES LIFE FLIGHT, A MULTIPLE AIRCRAFT, REGIONAL HELICOPTER SERVICE. LIFE FLIGHT PROVIDES RAPID RESPONSE TO CRITICALLY ILL PATIENTS WHO NEED ADVANCE LIFE SUPPORT CARE AND TRANSPORTATION TO CRITICAL CARE FACILITIES. GEISINGER LIFE FLIGHT OPERATED NINE AIRCRAFT AND TWO GROUND CRITICAL CARE EQUIPPED AMBULANCES FROM SIX OPERATIONAL SITES FOR THE YEAR ENDED DECEMBER 31, 2021. NINE STATE OF THE ART MEDICAL HELICOPTERS INCLUDE TWO BK117S AND SEVEN EC145S. THE GROUND UNITS CONTAIN THE SAME EQUIPMENT AS THE AIRCRAFT FOR CRITICAL CARE GROUND TRANSPORTS. THE BASE LOCATIONS FOR THE YEAR ENDING DECEMBER 31, 2021 WERE IN DANVILLE, SELINSGROVE, STATE COLLEGE, AVOCA, WILLIAMSPORT, MINERSVILLE AND LEHIGHTON PA. THE DISPATCHING OF LIFE FLIGHT FOR INTER-HOSPITAL TRANSFERS AND SCENE CALLS IS AUTHORIZED BY A PHYSICIAN OR OTHER QUALIFIED PERSONNEL AND IS DETERMINED ON AN INDIVIDUAL BASIS ACCORDING TO MEDICAL NEED. IN THE YEAR ENDED DECEMBER 31, 2021, LIFE FLIGHT PROVIDED EMERGENCY TRANSPORTATION TO 4,580 PATIENTS AND SERVED MULTIPLE HOSPITALS IN PENNSYLVANIA AND NEIGHBORING STATES. D. JANET WEIS CHILDREN'S HOSPITAL THE JANET WEIS CHILDREN'S HOSPITAL HOUSES ALL INPATIENT PEDIATRIC BEDS INCLUDING 36 MEDICAL AND SURGICAL, 41 NEWBORN INTENSIVE AND SPECIAL CARE AND 14 PEDIATRIC INTENSIVE CARE BEDS. THE FACILITY ALSO PROVIDES SPACE FOR PEDIATRIC REHABILITATION AND HAS ESTABLISHED AN AMBULANCE TRANSPORT SERVICE FOR NEONATAL RETRIEVALS. THE FACILITY IS CONNECTED WITH THE REST OF THE MEDICAL CENTER AT FOUR OF THE FIVE LEVELS TO ALLOW FOR SMOOTH INTEGRATION OF ANCILLARY AND SUPPORT SERVICES. THE FUNDING FOR THE CONSTRUCTION OF THE JANET WEIS CHILDREN'S HOSPITAL WAS PROVIDED BY THE DONATING PUBLIC, INCLUDING FUNDS RAISED BY THE CHILDREN'S MIRACLE NETWORK TELETHON. THIS FACILITY IS VISIBLE EVIDENCE OF GEISINGER'S COMMITMENT TO THE CHILDREN OF PENNSYLVANIA. FOR THE YEAR ENDED DECEMBER 31, 2021, THE JANET WEIS CHILDREN'S HOSPITAL DISCHARGED 2,696 PATIENTS AND PROVIDED 11,792 PATIENT DAYS OF SERVICE. THE FACILITY AFFORDS MORE EFFICIENT CARE WITH AN IMPROVED LENGTH OF STAY. E. WOMEN'S HEALTH PAVILION THE WOMEN'S HEALTH PAVILION, ON THE CAMPUS OF GMC, WAS DEDICATED AS PART OF THE JANET WEIS CHILDREN'S AND WOMEN'S HOSPITAL IN 2000. THE WOMEN'S PAVILION FEATURES FAMILY-ORIENTED BIRTHING SUITES THAT ALLOW EACH WOMAN TO LABOR, DELIVER AND RECOVER IN THE SAME SPACE. IN ADDITION, THERE ARE SEMI-PRIVATE ROOMS, A NURSERY AND TWO CAESAREAN SECTION OPERATING SUITES. THE GEISINGER WOMEN'S PAVILION IS THE ONLY HOSPITAL IN THE AREA THAT OFFERS COVERAGE BY OBSTETRICIANS, NEONATOLOGISTS, PEDIATRICIANS AND ANESTHESIOLOGISTS 24 HOURS A DAY, SEVEN DAYS A WEEK. OU

GROUP A, FACILITY 1, GEISINGER MEDICAL CENTER - PART V, LINE 3E
PRIORITIZED COMMUNITY HEALTH NEEDS TO WORK TOWARD HEALTH EQUITY, IT IS IMPERATIVE TO PRIORITIZE RESOURCES AND ACTIVITIES TOWARD THE MOST PRESSING AND CROSS-CUTTING HEALTH NEEDS WITHIN THE COMMUNITY. PRIORITIES WERE JOINTLY DETERMINED BY THE CHNA COLLABORATING HEALTH SYSTEMS USING FEEDBACK FROM COMMUNITY STAKEHOLDERS. THROUGH THIS PROCESS, CHNA PARTNERS AFFIRMED THE FOLLOWING PRIORITY HEALTH NEEDS: ACCESS TO CARE BEHAVIORAL HEALTH CHRONIC DISEASE PREVENTION AND MANAGEMENT THESE PRIORITIES ARE CONSISTENT WITH THOSE DETERMINED IN THE PREVIOUS FY2019 CHNA AND REFLECT COMPLEX NEEDS REQUIRING SUSTAINED COMMITMENT AND RESOURCES. MATERNAL AND CHILD HEALTH NEEDS ARE ALSO PREVALENT ACROSS THE SERVICE AREA. WHILE CHNA PARTNERS DID NOT IDENTIFY MATERNAL AND CHILD HEALTH AS A PRIORITY ISSUE DUE TO THE NEED TO FOCUS AVAILABLE RESOURCES, MANY OF THE HOSPITALS SUPPORT MATERNAL AND CHILD HEALTH STRATEGIES AS PART OF THEIR IMPLEMENTATION PLAN. THESE STRATEGIES INCLUDE FREE OR LOW-COST CLASSES AND SUPPORT GROUPS FOR PREGNANT AND NEW MOTHERS, LACTATION CONSULTATION, TREATMENT AND SUPPORT SERVICES FOR MOTHERS IN RECOVERY, SOCIAL ASSISTANCE, AND POSTPARTUM DEPRESSION SCREENING, AMONG OTHERS. CHNA IMPLEMENTATION PLAN TO DIRECT COMMUNITY BENEFIT AND HEALTH IMPROVEMENT ACTIVITIES, CHNA PARTNERS CREATED INDIVIDUAL HOSPITAL IMPLEMENTATION PLANS TO DETAIL THE RESOURCES AND SERVICES THAT WILL BE USED TO ADDRESS HEALTH PRIORITIES. THE IMPLEMENTATION PLANS BUILD UPON PREVIOUS HEALTH IMPROVEMENT ACTIVITIES AND TAKE INTO CONSIDERATION NEW HEALTH NEEDS AND THE CHANGING HEALTH CARE DELIVERY ENVIRONMENT AS DETAILED IN THE 2021 CHNA.

GROUP A, FACILITY 1, GEISINGER MEDICAL CENTER - PART V, LINE 5
"SECTION B., COMMUNITY HEALTH NEEDS ASSESSMENT, LINES 3, 5 AND 6A: CHNA COLLABORATING HEALTH SYSTEMS THE 2021 GEISINGER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL. THE STUDY AREA INCLUDED 15 COUNTIES ACROSS CENTRAL AND NORTHEASTERN PENNSYLVANIA, WHICH REPRESENTED THE HEALTH SYSTEMS' COLLECTIVE SERVICE AREAS. COLLABORATION IN THIS WAY CONSERVES VITAL COMMUNITY RESOURCES WHILE FOSTERING A PLATFORM FOR ""COLLECTIVE IMPACT"" THAT ALIGNS COMMUNITY EFFORTS TOWARD A COMMON GOAL OR ACTION. TO DISTINGUISH UNIQUE SERVICE AREAS AMONG HOSPITALS, REGIONAL RESEARCH AND REPORTING WAS DEVELOPED. CHNA LEADERSHIP THE 2021 CHNA WAS OVERSEEN BY A PLANNING COMMITTEE OF REPRESENTATIVES FROM EACH HEALTH SYSTEM, AS WELL AS A REGIONAL ADVISORY COMMITTEE OF HOSPITAL AND HEALTH SYSTEM REPRESENTATIVES. COMMUNITY HEALTH CONSULTANTS ASSISTED IN ALL PHASES OF THE CHNA, INCLUDING PROJECT MANAGEMENT, DATA COLLECTION AND ANALYSIS, AND REPORT WRITING. CHNA METHODOLOGY THE 2021 CHNA WAS CONDUCTED FROM JULY TO DECEMBER 2020. QUANTITATIVE AND QUALITATIVE METHODS, REPRESENTING BOTH PRIMARY AND SECONDARY RESEARCH, WERE USED TO ILLUSTRATE AND COMPARE HEALTH AND SOCIAL TRENDS AND DISPARITIES ACROSS EACH REGION AND HOSPITAL SERVICE AREA. THE FOLLOWING RESEARCH METHODS WERE USED TO DETERMINE COMMUNITY HEALTH NEEDS: -STATISTICAL ANALYSIS OF HEALTH AND SOCIOECONOMIC DATA INDICATORS; A FULL LISTING OF DATA REFERENCES IS INCLUDED IN THE CHNA -ELECTRONIC SURVEY OF KEY STAKEHOLDERS, INCLUDING EXPERTS IN PUBLIC HEALTH AND INDIVIDUALS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS; A LIST OF KEY INFORMANTS AND THEIR RESPECTIVE ORGANIZATIONS IS INCLUDED IN THE CHNA -DISCUSSION AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS TO DETERMINE THE MOST PRESSING HEALTH ISSUES ON WHICH TO FOCUS COMMUNITY HEALTH IMPROVEMENT EFFORTS COMMUNITY ENGAGEMENT COMMUNITY ENGAGEMENT WAS AN INTEGRAL PART OF THE 2021 CHNA. A VIRTUAL TOWN HALL WAS HELD IN AUGUST 2020 TO ANNOUNCE THE ONSET OF THE CHNA AND ENCOURAGE BROAD STAKEHOLDER PARTICIPATION. A KEY INFORMANT SURVEY WAS SENT TO NEARLY 1,000 COMMUNITY STAKEHOLDERS TO SOLICIT INPUT ON HEALTH DISPARITIES, OPPORTUNITIES FOR COLLABORATION, COVID-19 RESPONSE, COMMUNITY HEALTH PRIORITIES, AMONG OTHER INSIGHTS. CONTINUED COMMUNITY ENGAGEMENT ACTIVITIES ARE PLANNED TO ENSURE ONGOING DIALOGUE AND A FORUM FOR ADDRESSING COMMUNITY HEALTH NEEDS. CHNA IMPLEMENTATION PLAN TO DIRECT COMMUNITY BENEFIT AND HEALTH IMPROVEMENT ACTIVITIES, CHNA PARTNERS CREATED INDIVIDUAL HOSPITAL IMPLEMENTATION PLANS TO DETAIL THE RESOURCES AND SERVICES THAT WILL BE USED TO ADDRESS HEALTH PRIORITIES. THE IMPLEMENTATION PLANS BUILD UPON PREVIOUS HEALTH IMPROVEMENT ACTIVITIES AND TAKE INTO CONSIDERATION NEW HEALTH NEEDS AND THE CHANGING HEALTH CARE DELIVERY ENVIRONMENT AS DETAILED IN THE 2021 CHNA. BOARD APPROVAL THE 2021 CHNA WAS CONDUCTED IN A TIMELINE TO COMPLY WITH IRS TAX CODE 501 (R) REQUIREMENTS TO CONDUCT A CHNA EVERY THREE YEARS AS SET FORTH BY THE AFFORDABLE CARE ACT (ACA). THE RESEARCH FINDINGS WILL BE USED TO GUIDE COMMUNITY BENEFIT INITIATIVES FOR THE HOSPITALS AND ENGAGE LOCAL PARTNERS TO COLLECTIVELY ADDRESS IDENTIFIED HEALTH NEEDS. THE CHNA REPORT WAS PRESENTED TO THE GEISINGER BOARD OF DIRECTORS AND APPROVED IN DECEMBER 2020. GEISINGER IS COMMITTED TO ADVANCING INITIATIVES AND COMMUNITY COLLABORATION TO SUPPORT THE ISSUES IDENTIFIED THROUGH THE CHNA. FOLLOWING THE BOARD'S APPROVAL, ALL CHNA REPORTS WERE MADE AVAILABLE TO THE PUBLIC VIA THE GEISINGER WEBSITE AT HTTPS://WWW.GEISINGER.ORG/ABOUT- GEISINGER/IN-OUR-COMMUNITY/CHNA. THROUGHOUT THIS DOCUMENT THE TERMS ""SYSTEM- OR ""GEISINGER"" SHALL REFER TO THE ENTIRE HEALTHCARE SYSTEM COMPRISED OF GEISINGER HEALTH (""GH"") AS PARENT AND ALL SUBSIDIARY ENTITIES COMPRISING THE SYSTEM."

GROUP A, FACILITY 1, GEISINGER MEDICAL CENTER - PART V, LINE 6A
ALLIED SERVICES REHABILITATION HOSPITAL, HEINZ REHABILITATION HOSPITAL, EVANGELICAL COMMUNITY HOSPITAL, GEISINGER MEDICAL CENTER (INCLUDES GEISINGER-SHAMOKIN AREA COMMUNITY HOSPITAL), GEISINGER ENCOMPASS HEALTH LIMITED LIABILITY COMPANY (DBA GEISINGER ENCOMPASS HEALTH REHABILITATION HOSPITAL), GEISINGER WYOMING VALLEY MEDICAL CENTER (INCLUDES GEISINGER SOUTH WILKES-BARRE), GEISINGER-BLOOMSBURG HOSPITAL, COMMUNITY MEDICAL CENTER (DBA GEISINGER COMMUNITY MEDICAL CENTER), GEISINGER JERSEY SHORE HOSPITAL, GEISINGER-LEWISTOWN HOSPITAL, AND GEISINGER MEDICAL CENTER MUNCY.

GROUP A, FACILITY 1, GEISINGER MEDICAL CENTER - PART V, LINE 7D
THE HOSPITAL'S CHNA AND CHNA IMPLEMENTATION STRATEGY ARE POSTED ON THE HOSPITAL'S WEBSITE AT WWW.GEISINGER.ORG/ABOUT-GEISINGER/COMMUNITY- ENGAGEMENT/CHNA.

GROUP A, FACILITY 1, GEISINGER MEDICAL CENTER - PART V, LINE 11
"WHEN IT COMES TO THE HEALTH OF OUR COMMUNITIES, GEISINGER CONTINUES TO SURVEY THE NEEDS OF THE PEOPLE WE SERVE SO THAT WE MAY ADVANCE MEANINGFUL, MEASURABLE RESPONSES TO CARE FOR THEM. IN OUR MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), GEISINGER AND ITS CHNA PARTNERS SOUGHT INPUT FROM THE PEOPLE SERVED BY EACH OF THE NINE HOSPITALS THAT WERE OPERATING AT THE TIME. OUR RESPONDENTS INCLUDED EXPERTS IN PUBLIC HEALTH AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS. AMONG THE 1 MILLION PEOPLE WE SERVE, WE LOOKED FOR CURRENT COMMUNITY HEALTH NEEDS, EXISTING COMMUNITY RESOURCES TO MEET THOSE NEEDS AND ANY GAPS IN THE CURRENT SERVICE DELIVERY SYSTEM. TOP HEALTH ISSUES ACROSS THE CENTRAL PENNSYLVANIA REGION WE SERVE INCLUDE: -ACCESS TO CARE -BEHAVIORAL HEALTH -CHRONIC DISEASE PREVENTION AND MANAGEMENT MATERNAL AND CHILD HEALTH NEEDS ARE ALSO PREVALENT ACROSS THE SERVICE AREA. WHILE CHNA PARTNERS DID NOT IDENTIFY MATERNAL AND CHILD HEALTH AS A PRIORITY ISSUE DUE TO THE NEED TO FOCUS AVAILABLE RESOURCES, MANY OF THE HOSPITALS SUPPORT MATERNAL AND CHILD HEALTH STRATEGIES AS PART OF THEIR IMPLEMENTATION PLAN. THESE STRATEGIES INCLUDE FREE OR LOW-COST CLASSES AND SUPPORT GROUPS FOR PREGNANT AND NEW MOTHERS, LACTATION CONSULTATION, TREATMENT AND SUPPORT SERVICES FOR MOTHERS IN RECOVERY, SOCIAL ASSISTANCE, AND POSTPARTUM DEPRESSION SCREENING, AMONG OTHERS. MATERNAL AND CHILD POPULATIONS ARE INCLUDED IN THE OVERALL POPULATIONS SERVED WHEN ADDRESSING THE IDENTIFIED AREAS OF COMMUNITY NEED: ACCESS TO CARE, BEHAVIORAL HEALTH AND CHRONIC DISEASE PREVENTION AND MANAGEMENT. IN THIS MANNER BY ADDRESSING THE PRIORITIZED COMMUNITY HEALTH NEEDS, THESE VULNERABLE POPULATIONS' HEALTH NEEDS ARE ALSO POSITIVELY IMPACTED. ACCESS TO CARE OUR ASSESSMENTS CONTINUE TO REVEAL THE NEED FOR ACCESS, ESPECIALLY AMONG OUR VULNERABLE POPULATIONS. THOSE GROUPS INCLUDE THOSE IN RURAL AREAS WHERE THERE MAY BE A SHORTAGE OF CARE PROFESSIONALS, PATIENTS WITHOUT TRANSPORTATION, OLDER PATIENTS WHO HAVE MEDICALLY COMPLEX CONDITIONS, THE HOMEBOUND, THOSE WHO ARE UN OR UNDER INSURED EVEN THOSE WHO AVOID SEEKING MEDICAL CARE FOR CULTURAL REASONS. WITH ALL THAT IN MIND, GEISINGER DESIGNS ITS ACCESS TO CARE COMMUNITY INITIATIVES AROUND REGULAR, RELIABLE ACCESS TO HEALTH SERVICES THAT WILL HELP US DETECT AND TREAT ILLNESS AND PREVENT AND MANAGE DISEASE IN OUR PATIENT POPULATION. AS PEOPLE AGE, THEIR HEALTH NEEDS GET MORE COMPLEX. FOR OPTIMUM HEALTH, OLDER ADULTS NEED TO SPEND MORE TIME WITH PROVIDERS AND BE PROACTIVE ABOUT THEIR CARE. WE FOUND THAT MANY MEMBERS OF OUR GEISINGER GOLD HMO (THE TOP RATED MEDICARE ADVANTAGE PLAN IN PENNSYLVANIA) RARELY SEE THEIR PRIMARY CARE PROVIDERS (PCPS). WHEN THEY DO, THE APPOINTMENTS ARE VERY BRIEF. BASED ON THAT KNOWLEDGE, WE UNDERTOOK A MAJOR INITIATIVE. IN 2020, GEISINGER BUILT ITS FIRST GEISINGER 65 FORWARD SENIOR PRIMARY CARE HEALTH CENTER. THERE ARE NOW NINE 65 FORWARD CENTERS, ALL OF WHICH OFFER SENIOR PATIENTS ACCESS TO PROVIDERS, LONGER APPOINTMENT TIMES (UP TO ONE HOUR), SAME DAY ACUTE CARE APPOINTMENTS AND EXTRAS LIKE WELLNESS AND SOCIAL ACTIVITIES. BECAUSE SO MANY SENIORS ARE SOCIALLY ISOLATED, 65 FORWARD OFFERS A PLACE TO SPEND TIME AND INTERACT WITH OTHERS. ON SITE HEALTHCARE PROFESSIONALS INCLUDE DOCTORS; DIETITIANS; NURSES; PHARMACISTS; A WELLNESS COORDINATOR TO ASSESS FITNESS, DESIGN PERSONAL FITNESS ROUTINES AND HOLD WELLNESS CLASSES; AND HELPERS WHO PROVIDE TRAINING ON DIGITAL DEVICES. AMENITIES INCLUDE A LAB, IMAGING, EXAMINATION ROOMS, MENTAL HEALTH SERVICES, NUTRITION GUIDANCE AND A FITNESS CENTER, ALL DESIGNED FOR SENIORS WITH MOBILITY ISSUES. ANY PLAN FOR REDUCING BARRIERS TO CARE MUST INCLUDE TELEMEDICINE OPTIONS. DURING THE COVID 19 PANDEMIC, TELEHEALTH USE TOOK A MAJOR LEAP NATIONWIDE, AND GEISINGER LEVERAGED THAT OPPORTUNITY TO BECOME RECOGNIZED AS A TOP TELEHEALTH NETWORK IN THE US, FAR SURPASSING NATIONAL AVERAGES FOR TELEMEDICINE USE. THROUGH OUR REGULAR SCHEDULING PROCESS, WE ASK PATIENTS IF THEY WOULD PREFER A TELEHEALTH VISIT. IF SO, WE MAKE AN APPOINTMENT AND SEND AN EMAIL WITH A LINK THAT TAKES THEM DIRECTLY TO THEIR PROVIDER OR ANY OF THE 72 SPECIALTIES AVAILABLE VIRTUALLY. IF THE PATIENT HAS NO INTERNET ACCESS AT HOME, GEISINGER OFFERS TELEHEALTH VISITS VIA THE PATIENT'S NEAREST HEALTH CLINIC. TELEMEDICINE HELPS OUR PATIENTS WITHOUT TRANSPORTATION, AS WELL AS THOSE WHO HAVE TO DRIVE HOURS TO SEE THEIR DOCTOR OR THROUGH INCLEMENT WEATHER, ANY OF WHICH MAY CAUSE THEM TO CANCEL THEIR APPOINTMENT. IN MANY CASES, TELEMEDICINE MEANS OUR PATIENTS WHO ARE WAGE EARNERS DON'T NEED TO CLOCK OUT AND LOSE PAY TO VISIT THEIR DOCTOR. OUR DOCTORS CAN CONNECT WITH THEM BEFORE WORK OR DURING THEIR LUNCH HOUR. IN JUNE OF 2021, IN CONJUNCTION WITH A NATIONWIDE PROVIDER, WE STARTED OFFERING AN ON DEMAND URGENT CARE SERVICE. DURING OUR LOCAL COMMUNITY CARE HOURS, GEISINGER PATIENTS CAN NOW CONNECT WITH A PROVIDER TO ADDRESS THEIR URGENT CARE NEEDS. IN 2021, GEISINGER COMBINED CLINICAL AND POPULATION HEALTH EXPERTISE TO ADDRESS THE ACCESS NEEDS OF TWO PATIENT POPULATIONS: THOSE CHALLENGED BY THE RISING COST OF HEALTH SERVICES AND THE RAPIDLY GROWING SENIOR POPULATION. WE INTEGRATED A VARIETY OF HEALTH AND WELLNESS SERVICES MUCH NEEDED BY THESE TWO GROUPS. THE CARE MODELS INCLUDE TRADITIONAL (OUR HOSPITALS), 65 FORWARD (SENIOR PRIMARY CARE), CONVENIENTCARE (WALK IN CLINICS AND URGENT CARE) AND COMMUNITYCARE CLINICS (URGENT CARE AND PRIMARY CARE) AS WELL AS VIRTUAL HEALTH INITIATIVES. WE CAN NOW MORE READILY ADDRESS ACUTE, CHRONIC AND URGENT CARE NEEDS IN THE LOWEST COST SETTING, WHILE ALSO IMPROVING ACCESS TO OUTPATIENT CARE FOR DISEASE MANAGEMENT AND PREVENTION. IN SEPTEMBER 2021, GEISINGER TOOK A MAJOR STEP TOWARD OUR GOAL OF SUPPORTING COMMUNITY ORGANIZATIONS THAT PROVIDE PRIMARY CARE TO UNDERREPRESENTED AND UNINSURED POPULATIONS IN OUR REGIONS. WE HIRED OUR FIRST CHIEF DIVERSITY OFFICER TO DEVELOP A STRATEGIC PLAN FOR INFUSING DIVERSITY, INCLUSION AND EQUITY INTO THE GEISINGER CULTURE. THE ROLLOUT OF OUR NEW HEALTH EQUITY PROGRAM PROMISES TO POSITIVELY IMPACT OUR RELATIONSHIP WITH UNDER REPRESENTED POPULATIONS. IN AUGUST OF 2021, FIRST AND SECOND YEAR MEDICAL STUDENTS AT GEISINGER COMMONWEALTH SCHOOL OF MEDICINE (GCSOM) SIGNED UP FOR OUR NEW 18 MONTH COMMUNITY IMMERSION PROGRAM THAT WILL WORK TOWARD DEVELOPING A FREE CLINIC IN LACKAWANNA COUNTY. THE LEAHY CLINIC (A PROVIDER OF FREE NON EMERGENCY HEALTHCARE) AT THE UNIVERSITY OF SCRANTON IS DISCUSSING OPTIONS TO LEVERAGE THE GCSOM STUDENTS TO HELP THEM NEGOTIATE PROVIDER CONTRACTS, WITH GEISINGER PARTICIPATING. TO THAT SAME END, GEISINGER HAS DONATED TO A COMMUNITY CLINIC, WHICH OFFERS HEALTHCARE FOR THE UNINSURED IN SUNBURY, AND WILL HELP THE CLINIC WITH MARKETING, REFERRALS, LAB AND X RAY SUPPORT. IN THE INTEREST OF HEALTH EQUITY, GEISINGER HAS ALSO DEVELOPED OUTREACH PROGRAMS WITH COMMUNITY ORGANIZATIONS, NONPROFITS AND FAITH BASED GROUPS TO EDUCATE, INFORM AND DIRECT PEOPLE TO WELLNESS CARE. IN SCRANTON, GEISINGER'S ""BARBERSHOP INITIATIVE"" SUCCEEDED IN MEETING PEOPLE WHERE THEY ARE. AFRICAN AMERICAN PATRONS OF BARBERSHOPS WERE OFFERED FREE DIABETES, HYPERTENSION AND DENTAL SCREENINGS, THEN DIRECTED TO RESOURCES TO HELP IMPROVE THEIR OVERALL HEALTH. AIMING TO MAKE HEALTH ACCESSIBLE TO EVERYONE, IN 2021, GEISINGER PLEDGED TO OPEN THE FIRST PENNSYLVANIA CHAPTER OF ""WALK WITH A DOC, ADVANCING WELLNESS THROUGH NATURE."" THE ORGANIZATION HAS CHAPTERS NATIONWIDE THAT LINK HEALTH AND NATURE VIA DOCTOR LED STROLLS THROUGH LOCAL OUTDOOR RECREATION AREAS. WALKS BEGIN WITH A BRIEF DISCUSSION ON A CURRENT HEALTH TOPIC FOLLOWED BY A WALK AND CONVERSATION WITH THE DOCTOR. IN AUGUST 2021, MEDICAL STUDENTS FROM GCSOM WORKING WITH THE PENNSYLVANIA DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES KICKED OFF OUR FIRST EVENT, AT WHICH 100 PEOPLE PARTICIPATED. WE PLAN TO ORGANIZE MORE WALKS AND EVENTUALLY OPEN A CHAPTER IN EACH LOCATION WHERE GEISINGER HAS A HOSPITAL. HEALTHCARE ACCESS REQUIRES HAVING ENOUGH HEALTHCARE PROFESSIONALS TO SERVE THE PATIENT POPULATION. GEISINGER SUCCESSFULLY RECRUITS AND KEEPS HEALTHCARE PROFESSIONALS WITHIN THE SYSTEM WITH A SERIES OF INITIATIVES. OUR SYSTEMWIDE CLINICAL CO OP PROGRAM HIRES HIGH SCHOOL AND TECHNICAL SCHOOL SENIORS INTERESTED IN HEALTHCARE. THEY WORK AS NURSING ASSISTANTS FOR ONE YEAR AND MAY SHADOW OUR NURSES IN PHLEBOTOMY OR SURGICAL TECH. THESE CO OP PROGRAMS ENCOURAGE MANY TO ENROLL IN NURSING SCHOOL WITH OUR SUPPORT AND COME TO WORK FOR GEISINGER AFTER GRADUATING. OUR NURSE RESIDENCY PROGRAM IS FOR NURSES JUST OUT OF SCHOOL. WE SUPPORT THESE NEW HIRES THROUGH THEIR FIRST AND MOST CHALLENGING YEAR OF NURSING BY EDUCATING THEM WITH RESIDENCY SESSIONS, CLASSES, AND SIMULATIONS TAUGHT BY OUR STAFF. AS PART OF THE NURSE RESIDENCY PROGRAM, WE OFFER A SIX MONTH MEDICAL SURGICAL FELLOWSHIP FOR NEW NURSES WHO WANT TO SPECIALIZE IN CARDIAC, ONCOLOGY, TRAUMA OR SURGERY. FELLOWSHIP COURSES ARE TAUGHT BY OUR NURSES, PHY"

GROUP A, FACILITY 1, GEISINGER MEDICAL CENTER - PART V, LINE 13B
RECENT WAGE STATEMENTS, UNEMPLOYMENT OR OTHER DOCUMENTATION OF BENEFITS OR COMPENSATION RECEIVED MAY BE CONSIDERED IN DETERMINING FINANCIAL ASSISTANCE ELIGIBILITY.

GROUP A, FACILITY 1, GEISINGER MEDICAL CENTER - PART V, LINE 16J
THE FAP, FAP APPLICATION, AND A PLAIN LANGUAGE SUMMARY OF THE FAP ARE WIDELY AVAILABLE AT HTTPS://WWW.GEISINGER.ORG/PATIENT-CARE/PATIENTS-AND- VISITORS/BILLING-AND-INSURANCE/NEED-HELP. IN ADDITION, REGISTRATION PERSONNEL ALSO REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY.

GROUP A, FACILITY 1, GEISINGER MEDICAL CENTER - PART V, LINE 20E
REFER TO RESPONSE FOR PART III, LINE 9B

SCHEDULE H, PART I, LINE 3C
"SUPPORTING DOCUMENTATION FOR ELIGIBILITY MAY CONSIST OF INCOME AND ASSET INFORMATION, INCLUSIVE BUT NOT LIMITED TO: FEDERAL INCOME TAX FORM 1040 FROM THE PRIOR YEAR, PAY STUB COPIES, WRITTEN VERIFICATION OF ANY OTHER INCOME RECEIVED (I.E. SOCIAL SECURITY, ADC, CHILD SUPPORT, ALIMONY, ETC.), CURRENT CREDIT REPORTS AND ASSET VERIFICATION. THE HOSPITAL MAY ALSO UTILIZE INDUSTRY TESTED EXTERNAL ANALYTICAL TOOLS TO QUALIFY PATIENTS FOR UNCOMPENSATED CARE (AKA PRESUMPTIVE CHARITY). GEISINGER PROVIDERS, WITHOUT DISCRIMINATION, CARE FOR ALL EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF THEIR FINANCIAL ASSISTANCE ELIGIBILITY OR ABILITY TO PAY. IT IS THE POLICY OF GEISINGER HOSPITAL FACILITIES TO COMPLY WITH THE STANDARDS OF THE FEDERAL EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR TRANSPORT ACT OF 1986 (""EMTLA"") AND REGULATIONS IN PROVIDING MEDICAL SCREENING EXAMINATION AND SUCH FURTHER TREATMENT AS MAY BE NECESSARY TO STABILIZE AN EMERGENCY MEDICAL CONDITION FOR ANY INDIVIDUAL PRESENTING TO THE EMERGENCY DEPARTMENT SEEKING TREATMENT."

SCHEDULE H, PART I, LINE 6A
COMMUNITY BENEFIT REPORT: A COMMUNITY BENEFIT REPORT IS PROVIDED BY THE HOSPITAL AND ITS RELATED CHARITABLE ORGANIZATIONS TO THE GEISINGER HEALTH FINANCE COMMITTEE EACH YEAR.

SCHEDULE H, PART I, LINE 7G
THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED IN SUBSIDIZED HEALTH SERVICES.

SCHEDULE H, PART I, LINE 7
A COST ACCOUNTING SYSTEM WAS USED TO DETERMINE THE COSTS REPORTED ON LINE 7 AND ADDRESSED PATIENT SEGMENTS BY PAYOR (E.G. MEDICARE, MEDICAID, COMMERCIAL PAYERS, SELF-PAY, ETC.). A COST TO CHARGE RATIO, CALCULATED PURSUANT TO WORKSHEET 2 OF THE FORM 990 INSTRUCTIONS, WAS USED TO CALCULATE THE COST OF CHARITY CARE.

SCHEDULE H, PART III, LINE 2
REFER TO THE RESPONSE FOR PART III, LINE 4.

SCHEDULE H, PART III, LINE 3
PATIENTS' ACCOUNTS ARE MONITORED THROUGHOUT THE BILLING PROCESS AND ARE RECLASSIFIED TO CHARITY CARE (100% DISCOUNTED CARE) WHENEVER A PATIENT BECOMES ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY. DURING CALENDAR 2021, APPROXIMATELY 66% OF THE BAD DEBT ACCOUNTS WERE SUBSEQUENTLY RECLASSIFIED TO UNCOMPENSATED OR CHARITY CARE. THIS AMOUNT WAS IMPACTED BY THE COVID-19 PANDEMIC.

SCHEDULE H, PART III, LINE 4
"PART III, LINES 2 AND 4: GEISINGER HEALTH AND ITS AFFILIATES (""GEISINGER""), THAT INCLUDES THE HOSPITAL, PREPARE AND ISSUE AUDITED CONSOLIDATED FINANCIAL STATEMENTS, ANNUALLY. FOOTNOTE 4, SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES BEGINNING AT PAGE 8 WITHIN THESE FINANCIAL STATEMENTS INCLUDES A DESCRIPTION OF THE ACCOUNTING FOR NET PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE. THIS DISCLOSURE ALSO DESCRIBES THE RELATED EXPLICIT AND IMPLICIT PRICE CONCESSIONS AND BAD DEBTS EXPENSE. CHARITY CARE IS ALSO DESCRIBED IN THE SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES. GEISINGER'S PRICE CONCESSIONS, BAD DEBTS AND CHARITY CARE METHODOLOGIES ARE CONSISTENTLY APPLIED ACROSS ALL CHARITABLE AFFILIATES."

SCHEDULE H, PART III, LINE 8
"PART III, LINE 3-BAD DEBT: MEDICARE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT AND THE COST ACCOUNTING SYSTEM. THE ORGANIZATION BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND THE COST OF BAD DEBT ARE COMMUNITY BENEFIT AND SHOULD BE INCLUDED ON FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW, THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON- DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND IS CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER THE INTERNAL REVENUE CODE (""IRC"") 501(C)(3). SATISFYING THE ""COMMUNITY BENEFIT STANDARD,"" AS ARTICULATED BY THE INTERNAL REVENUE SERVICE (IRS) IN REVENUE RULING 69-545, IS CURRENTLY REQUIRED FOR A HOSPITAL TO BE RECOGNIZED AS A CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE (IRC) 501(C)(3). THIS RULING REMOVED THE PREVIOUS REQUIREMENT OF REVENUE RULING 56-185, KNOWN AS THE ""CHARITY CARE STANDARD,"" THAT IN ORDER TO BE A CHARITABLE ORGANIZATION, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR THEIR CARE. THIS EARLIER RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT MEAN THAT A HOSPITAL WAS CHARITABLE SINCE THAT LEVEL COULD REFLECT THE HOSPITAL'S FINANCIAL ABILITY TO PROVIDE SUCH CARE. REVENUE RULING 56-185 ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT IMPACT A HOSPITAL'S CHARITABLE STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. AS DEVELOPED IN REVENUE RULING 69-545, UNDER THE COMMUNITY BENEFIT STANDARD, HOSPITALS WERE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THIS RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED THOSE WHO COULD PAY FOR THE SERVICES EITHER BY THEMSELVES, THROUGH PRIVATE INSURANCE OR PUBLIC PROGRAMS SUCH AS MEDICARE. IN ADDITION, THE HOSPITAL OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL WAS CHARITABLE BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE ""GENERALLY ACCEPTED LEGAL SENSE"" OF THE TERM CHARITABLE, AS REQUIRED BY TREASURY REGULATION SECTION 1.501 (C)(3)-1(D)(2). THE IRS RULED THAT THE PROMOTION OF HEALTH, LIKE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES OF THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS ""PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY"" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO THOSE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER FACTORS THAT DEMONSTRATED COMMUNITY BENEFIT INCLUDED: SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND FACILITIES AND ADVANCE MEDICAL TRAINING, EDUCATION AND RESEARCH; AND IT WAS CONTROLLED BY A BOARD OF DIRECTORS THAT CONSISTED OF INDEPENDENT CIVIC LEADERS. THE AMERICAN HOSPITAL ASSOCIATION (""AHA"") BELIEVES THAT MEDICARE UNDERPAYMENTS (SHORTFALLS) AND BAD DEBT SHOULD BE REPORTED AS COMMUNITY BENEFIT ON FORM 990, SCHEDULE H, PART I, LINE 7. THIS ORGANIZATION AGREES WITH THE AHA'S LETTER TO THE IRS DATED AUGUST 21, 2007 RESPONDING TO A DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA ARGUED THAT MEDICARE UNDERPAYMENTS (SHORTFALLS) IS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: -PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS REMAINS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. -MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. RECENTLY, MEDICARE REIMBURSES ONLY 92 CENTS FOR EVERY DOLLAR HOSPITALS SPEND TO CARE FOR MEDICARE PATIENTS. THE MEDICARE PAYMENT ADVISORY COMMISSION (""MEDPAC"") IN ITS MARCH 2007 REPORT TO CONGRESS CAUTIONED THAT UNDERPAYMENT WILL GET EVEN WORSE, WITH MARGINS REACHING A 10 YEAR LOW AT NEGATIVE 5.4 PERCENT. -MANY MEDICARE PATIENTS, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 46% OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200% OF THE FEDERAL POVERTY LEVEL. MANY ARE ALSO ELIGIBLE FOR MEDICAID, SO CALLED -DUAL ELIGIBLES"". PENNSYLVANIA REQUIRES NON-PROFIT HOSPITALS TO PROVIDE A MINIMUM LEVEL OF COMMUNITY BENEFIT TO RETAIN EXEMPTION FROM STATE AND LOCAL TAXES. ACCORDING TO STATE GUIDANCE AND CASE LAW, THE UNREIMBURSED COST OF MEDICARE AND BAD DEBT IS CONSIDERED TO BE COMMUNITY BENEFIT FOR STATE TAX EXEMPTION PURPOSES. PART III, LINE 6 ONLY INCLUDES THOSE COSTS THAT ARE PERMITTED TO BE REPORTED IN THE HOSPITAL'S MEDICARE COST REPORT THAT IS REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT. THE HOSPITAL CONSIDERS THE TOTAL MEDICARE UNDERPAYMENTS (SHORTFALL) OF 88,410,091 SHOULD BE REPORTED AS COMMUNITY BENEFIT ON THE FORM 990, SCHEDULE H, PART I, LINE 7. ALONG WITH PROVIDING CARE TO MEDICAID PATIENTS AND PROVIDING FREE OR DISCOUNTED CARE TO OTHER LOW-INCOME PATIENTS, THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. LIKE MEDICAID, MEDICARE DOES NOT PAY THE FULL COST OF PROVIDING CARE TO THESE PATIENTS, FORCING THE HOSPITAL TO USE OTHER FUNDS TO COVER THE SHORTFALL. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THE MEDICARE SHORTFALL AND IS THEREBY PROVIDING ACCESS TO MEDICAL SERVICES FOR THE ELDERLY AND RELIEVING THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR PROVIDING CARE TO MEDICARE PATIENTS. ABSENT THE MEDICARE PROGRAM, IT IS LIKELY THAT MANY MEDICARE PATIENTS WOULD BE ELIGIBLE FOR CHARITY CARE OR OTHER NEED-BASED GOVERNMENT PROGRAMS. THE AMOUNT EXPENDED TO COVER THE SHORTFALL IS MONEY NOT AVAILABLE FOR FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. BOTH THE HOSPITAL AND THE AHA BELIEVE THAT PATIENT BAD DEBT BE REPORTED AS A COMMUNITY BENEFIT ON FORM 990, SCHEDULE H, PART I, LINE 7. LIKE MEDICARE UNDERPAYMENTS (SHORTFALLS), BAD DEBT SHOULD BE REPORTED AS COMMUNITY BENEFIT BECAUSE: -A SIGNIFICANT PORTION OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO FOR MANY REASONS DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY UNDER THE HOSPITAL'S CHARITY CARE OR FINANCIAL ASSISTANCE POLICY (FAP). A 2006 CONGRESSIONAL BUDGET OFFICE (""CBO""), ""NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFIT"", CITED TWO STUDIES INDICATING THAT ""THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE."" -THE CBO REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF THE BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR CHARITABLE MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THE EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ACCORDING TO THE CBO REPORT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. (DURING THE YEAR ENDED DECEMBER 31, 2021, APPROXIMATELY 66% OF THE HOSPITAL'S BAD DEBT WAS SUBSEQUENTLY RECLASSIFIED TO CHARITY CARE.) THE CBO CONCLUDED THAT ITS FINDINGS ""SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE (BAD DEBT AND CHARITY CARE) AS A MEASURE OF COMMUNITY BENEFITS"" ASSUMING THE FINDINGS ARE GENERALIZED NATIONALLY. THE EXPERIENCE OF HOSPITALS NATIONWIDE REINFORCE THAT THEY ARE GENERALIZABLE. AS OUTLINED BY THE AHA, DESPITE THE HOSPITAL'S BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE CHARITABLE MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS' BEAR IN SERVING ALL PATIENTS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. IN ADDITION, THE HOSPITAL INVESTS SIGNIFICANT RESOURCES IN SYSTEMS AND STAFF TRAINING TO ASSIST PATIENTS THAT ARE IN NEED OF FINANCIAL ASSISTANCE. FOR TH"

SCHEDULE H, PART VI, LINE 2
"CHNA COLLABORATING HEALTH SYSTEMS THE 2021 GEISINGER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH GEISINGER, ALLIED SERVICES INTEGRATED HEALTH SYSTEM, AND EVANGELICAL COMMUNITY HOSPITAL. THE STUDY AREA INCLUDED 15 COUNTIES ACROSS CENTRAL AND NORTHEASTERN PENNSYLVANIA, WHICH REPRESENTED THE HEALTH SYSTEMS' COLLECTIVE SERVICE AREAS. COLLABORATION IN THIS WAY CONSERVES VITAL COMMUNITY RESOURCES WHILE FOSTERING A PLATFORM FOR ""COLLECTIVE IMPACT"" THAT ALIGNS COMMUNITY EFFORTS TOWARD A COMMON GOAL OR ACTION. TO DISTINGUISH UNIQUE SERVICE AREAS AMONG HOSPITALS, REGIONAL RESEARCH AND REPORTING WAS DEVELOPED. 2021 CHNA GEOGRAPHIC REGIONS AND PRIMARY SERVICE COUNTIES 1- CENTRAL REGION INCLUDING THE COUNTIES OF COLUMBIA, MONTOUR, NORTHUMBERLAND, SCHUYLKILL, SNYDER AND UNION REPRESENTED BY GEISINGER- BLOOMSBURG HOSPITAL, GEISINGER MEDICAL CENTER (INCLUDES GEISINGER SHAMOKIN AREA COMMUNITY HOSPITAL), GEISINGER ENCOMPASS HEALTH LIMITED LIABILITY COMPANY (DBA GEISINER ENCOMPASS HEALTH REHABILITATION HOSPITAL) AND EVANGELICAL COMMUNITY HOSPITAL. 2- NORTH CENTRAL REGION INCLUDING THE COUNTIES OF CLINTON AND LYCOMING REPRESENTED BY GEISINGER JERSEY SHORE HOSPITAL AND GEISINGER MEDICAL CENTER MUNCY (LICENSED/OPERATIONAL JANUARY 2022) 3- NORTHEAST REGION INCLUDING THE COUNTIES OF LACKAWANNA, LUZERNE, WAYNE AND WYOMING REPRESENTED BY ALLIED SERVICES REHAB HOSPITAL, COMMUNITY MEDICAL CENTER (DBA GEISINGER COMMUNITY MEDICAL CENTER, GEISINGER WYOMING VALLEY MEDICAL CENTER (INCLUDES GEISINGER SOUTH WILKES-BARRE) AND HEINZ REHAB HOSPITAL. 4- WESTERN REGION INCLUDING THE COUNTIES OF CENTRE, JUNIATA AND MIFFLIN REPRESENTED BY GEISINGER-LEWISTOWN HOSPITAL. GEISINGER SYSTEMWIDE CHNA APPROACH THE 2021 CHNA FOCUSED ON THE PRIMARY SERVICE AREAS OF EACH OF GEISINGER'S NINE HOSPITAL CAMPUSES. UNDERSTANDING OVERLAPPING GEOGRAPHIC BOUNDARIES, SOCIOECONOMICS, AND RELATED COMMUNITY INDICATORS, GEISINGER HOSPITALS WERE GROUPED INTO REGIONS TO ALLOW FOR LOCALIZED DATA COMPARISONS. SYSTEMWIDE PRIORITIES WERE DETERMINED TO ADDRESS COMMON NEEDS ACROSS THE WHOLE SERVICE AREA, WHILE INDIVIDUAL HOSPITAL IMPLEMENTATION PLANS OUTLINED SPECIFIC STRATEGIES TO GUIDE LOCAL EFFORTS AND COLLABORATION WITH COMMUNITY PARTNERS. SEE ALSO THE DISCUSSION RELATED TO THE RESPONSE TO PART V, LINE 5."

SCHEDULE H, PART VI, LINE 4
GEISINGER MEDICAL CENTER AND GEISINGER SHAMOKIN AREA COMMUNITY HOSPITAL OPERATE UNDER THE SAME LICENSE, AND AS SUCH ARE CONSIDERED A SINGLE ENTITY FOR PURPOSES OF THE CHNA. GEISINGER ENCOMPASS HEALTH REHABILITATION HOSPITAL IS LOCATED ON THE CAMPUS OF GEISINGER MEDICAL CENTER AND IS OPERATED AS A PARTNERSHIP BETWEEN GEISINGER MEDICAL CENTER AND ENCOMPASS HEALTH CORPORATION. COLLECTIVELY, THE THREE FACILITIES PRIMARILY SERVE RESIDENTS IN 81 ZIP CODES SPANNING 15 COUNTIES IN PENNSYLVANIA. THE PRIMARY SERVICE AREA, IDENTIFIED BASED ON THE PATIENT ZIP CODES OF ORIGIN COMPRISING 80% OF HOSPITAL DISCHARGES IN FISCAL YEAR 2019, IS LARGELY WITHIN THE CHNA CENTRAL REGION. CENTRAL REGION POPULATION TRENDS THE CENTRAL REGION IS PREDOMINANTLY RURAL WITH SMALL POPULATION CENTERS SCATTERED ACROSS THE 6-COUNTY GEOGRAPHY. THE LARGEST POPULATION CENTER IS BLOOMSBURG (COLUMBIA COUNTY) WITH 14,290 RESIDENTS, AND HOME TO BLOOMSBURG UNIVERSITY OF PENNSYLVANIA. OTHER POPULATION HUBS ARE CENTERED AROUND THESE CITIES AND BOROUGHS: POTTSVILLE (SCHUYLKILL COUNTY), WITH 13,965 RESIDENTS; BERWICK (COLUMBIA COUNTY) WITH 10,118 RESIDENTS; SUNBURY (NORTHUMBERLAND COUNTY), WITH 9,487 RESIDENTS; SHAMOKIN (NORTHUMBERLAND COUNTY), WITH 7,092 RESIDENTS; TAMAQUA (SCHUYLKILL COUNTY), WITH 6,784 RESIDENTS; SELINSGROVE (SNYDER COUNTY), WITH 5,861 RESIDENTS; LEWISBURG (UNION COUNTY), WITH 5,600 RESIDENTS; AND DANVILLE (MONTOUR COUNTY), WITH 4,656 RESIDENTS. TOTAL POPULATION OF THE CENTRAL REGION IS APPROXIMATELY 400,000 AND IS PROJECTED TO DECLINE AT A RATE OF 1.5% BY 2025. CONSISTENT WITH MUCH OF PA'S RURAL GEOGRAPHY, THE POPULATION OF MOST COUNTIES IN THE CENTRAL REGION IS DECLINING, WITH THE EXCEPTION OF SNYDER COUNTY AND UNION COUNTY, PROJECTED TO GROW 1.8% AND 1.1%, RESPECTIVELY, BY 2025. THE LARGEST POPULATION DECLINE IS EXPECTED IN NORTHUMBERLAND COUNTY (-3%), WHICH ALSO EXPERIENCED A 3% POPULATION DECLINE SINCE 2017. SCHUYLKILL COUNTY IS PROJECTED TO DECLINE AT 2.7%; COLUMBIA COUNTY AT 0.8%; AND MONTOUR COUNTY AT 0.7%. MORE THAN 20% OF RESIDENTS IN COLUMBIA (20.2%), MONTOUR (23%), NORTHUMBERLAND (22.5%), AND SCHUYLKILL (21.8%) COUNTIES ARE AGE 65 OR OLDER COMPARED TO THE STATE (19.3%) AND NATIONAL (16.6%) AVERAGES. MONTOUR (45.6), SCHUYLKILL (45.4), AND NORTHUMBERLAND (45.2) COUNTIES HAVE THE HIGHEST MEDIAN AGES, COMPARED TO THE STATE (41.5) AND NATION (38.5). AS A WHOLE, THE CENTRAL REGION IS SIGNIFICANTLY LESS DIVERSE THAN STATE AND NATIONAL BENCHMARKS. APPROXIMATELY 90% OR MORE OF THE COUNTIES' POPULATIONS ARE WHITE, COMPARED TO STATE (78.5%) AND NATIONAL (69%) AVERAGES. UNION COUNTY IS THE MOST DIVERSE: 6.5% OF THE POPULATION IS BLACK; 6.3% IS LATINX (OF ANY RACE); AND APPROXIMATELY 2% IS ASIAN. FEDERAL PRISONS WITHIN THE CENTRAL REGION SIGNIFICANTLY IMPACT DEMOGRAPHICS IN SCHUYLKILL AND UNION COUNTIES WITH DISPROPORTIONATE INCARCERATION RATES AMONG BLACK AND BROWN MALES THAT ARE REFLECTED IN CENSUS AND SOCIOECONOMIC DATA. SIMULTANEOUSLY, IN LINE WITH STATEWIDE AND NATIONAL TRENDS, MINORITY POPULATIONS ARE GROWING IN ALL COMMUNITIES ACROSS THE CENTRAL REGION. WITH RESPECT TO THESE COINCIDING TRENDS, DEMOGRAPHIC DATA FOR THESE COUNTIES MUST BE CAREFULLY CONSIDERED TO ACKNOWLEDGE THE IMPACT OF INCARCERATED POPULATIONS ON BROADER COMMUNITY DEMOGRAPHICS. UNION COUNTY DATA ARE PARTICULARLY IMPACTED BY PRISON POPULATIONS, WHICH COMPRISE 3% OF THE TOTAL COUNTY POPULATION. THERE ARE FIVE AMISH SETTLEMENTS ACROSS THE CENTRAL REGION TOTALING APPROXIMATELY 2,000 RESIDENTS. THE ESTIMATED AMISH POPULATION FOR THE REGION INCREASED MORE THAN 8% FROM 1,912 TO 2,072 FROM 2017 TO 2020. PENNSYLVANIA RESIDENTS OVERALL ARE SLIGHTLY MORE LIKELY TO REPORT A DISABILITY WHEN COMPARED TO THE NATION. RESIDENTS OF SCHUYLKILL (18%) AND NORTHUMBERLAND (17%) COUNTIES ARE MORE LIKELY TO HAVE A DISABILITY COMPARED TO THE STATE (14%) AND NATIONAL (13%) AVERAGES. SOCIOECONOMIC TRENDS THE CENTRAL REGION HAS A HISTORY OF COAL MINING, AGRICULTURE, AND MANUFACTURING. WHILE THESE INDUSTRIES HAVE PREDOMINANTLY BEEN REPLACED BY HEALTHCARE AND EDUCATION INDUSTRIES AS ECONOMIC DRIVERS, NATURAL GAS MINING HAS BROUGHT NEW INCOME SOURCES, AND NEW CHALLENGES, TO COMMUNITIES IN THE CENTRAL REGION. CONSISTENT WITH OTHER RURAL COMMUNITIES ACROSS PENNSYLVANIA, THE CENTRAL REGION REFLECTS A PREDOMINANTLY BLUE-COLLAR WORKFORCE; LOWER MEDIAN INCOME LEVELS; RURAL POVERTY; INCREASED FOOD INSECURITY; AVERAGE HIGH SCHOOL GRADUATION RATES WITH LESS HIGHER EDUCATION ATTAINMENT; AND MORE HOME OWNERSHIP WITH LOWER HOUSING COST BURDEN. DESPITE COMMON FACTORS ACROSS THE CENTRAL REGION, DISTINCT DIFFERENCES EXIST ACROSS THE COUNTIES. MONTOUR COUNTY IS HOME TO GEISINGER MEDICAL CENTER, WHICH EMPLOYS THOUSANDS OF CLINICAL AND NON-CLINICAL WHITE-COLLAR WORKERS. THIS WORKFORCE TREND IS REFLECTED IN SOCIOECONOMIC INDICATORS. MONTOUR COUNTY HAS ONE OF THE HIGHEST MEDIAN HOUSEHOLD INCOMES AND LOWEST POVERTY RATES, AND IS THE ONLY COUNTY TO HAVE A HIGHER PERCENTAGE OF RESIDENTS ATTAINING A BACHELOR'S DEGREE THAN THE STATE AND NATION. UNION COUNTY, HOME TO EVANGELICAL COMMUNITY HOSPITAL AND BUCKNELL UNIVERSITY, HAS SIMILAR INCOME AND POVERTY INDICATORS AS MONTOUR COUNTY AND THE SECOND HIGHEST PERCENTAGE OF RESIDENTS ATTAINING A BACHELOR'S DEGREE. SNYDER COUNTY ALSO HAS STRONG ECONOMIC INDICATORS, ALTHOUGH THE COUNTY'S TOP EMPLOYERS, WOOD-MODE, RECENTLY FACED ECONOMIC UNCERTAINTY, WHICH MAY IMPACT FUTURE SOCIOECONOMIC STANDING. ABOUT 33% OF KEY INFORMANT SURVEY RESPONDENTS NAMED POVERTY AMONG THE TOP THREE CONTRIBUTING FACTORS TO HEALTH CONCERNS, RANKING IT AS THE 3 CONTRIBUTOR IN THE REGION. RELATED SOCIOECONOMIC FACTORS, INCLUDING ABILITY TO AFFORD HEALTHCARE AND LACK OF TRANSPORTATION, WERE ALSO IDENTIFIED AS TOP CONTRIBUTORS. OVERALL CENTRAL REGION POVERTY RATES ARE GENERALLY CONSISTENT WITH STATE AND NATIONAL AVERAGES, BUT THERE IS A WIDER DISPARITY BETWEEN PEOPLE OF COLOR AND WHITE RESIDENTS, AND MOST COUNTIES EXCEED STATE AND NATIONAL BENCHMARKS ON THIS MEASURE. SCHUYLKILL AND UNION COUNTIES REFLECT THE HIGHEST DISPARITIES AMONG BLACK AND LATINX RESIDENTS, WITH POVERTY RATES UP TO FIVE TIMES MORE THAN WHITES. THIS SIGNIFICANT DIFFERENCE LIKELY REFLECTS THE IMPACT FROM THE FEDERAL PRISON POPULATIONS IN THESE COUNTIES, BUT NOTABLE DISPARITIES IN NEIGHBORING COUNTIES REINFORCE THE GAP IN POVERTY RATES BETWEEN PEOPLE OF COLOR AND THEIR WHITE NEIGHBORS. IN SNYDER COUNTY, 33% OF BLACK RESIDENTS VERSUS 10% OF WHITE RESIDENTS LIVE IN POVERTY. IN NORTHUMBERLAND COUNTY, 44% OF LATINX RESIDENTS LIVE IN POVERTY COMPARED TO 13% OF WHITE RESIDENTS. IN MONTOUR COUNTY, 41% OF BLACKS VERSUS 11% OF WHITES LIVE IN POVERTY. NORTHUMBERLAND COUNTY HAS A HIGHER PERCENTAGE OF CHILDREN LIVING IN POVERTY (19.5%) RELATIVE TO OTHER COUNTIES. THE COUNTY ALSO HAS A HIGHER PERCENTAGE OF FOOD INSECURE CHILDREN (18%). FOOD INSECURITY AMONG CHILDREN DECLINED IN ALL COUNTIES SINCE THE FY2019 CHNA. CENTRAL REGION RESIDENTS ARE MORE LIKELY TO OWN THEIR HOME, AND ARE GENERALLY LESS COST BURDENED COMPARED TO STATEWIDE AND NATIONAL AVERAGES. HOUSING COST BURDEN IS DEFINED AS SPENDING 30% OR MORE OF HOUSEHOLD INCOME ON RENT OR MORTGAGE EXPENSES. RESIDENTS OF SCHUYLKILL, SNYDER, AND UNION COUNTIES HAVE THE HIGHEST HOME OWNERSHIP RATES, EXCEEDING THE STATE AVERAGE. CENTRAL REGION HOUSING STOCK IS OLDER, PARTICULARLY IN NORTHUMBERLAND AND SCHUYLKILL COUNTIES, WHERE 77%-79% OF HOMES WERE BUILT BEFORE 1980. UNION COUNTY HAS THE NEWEST HOUSING STOCK, FOLLOWED BY MONTOUR COUNTY. FRACKING OR HYDROFRACKING HAS BEEN A CONTROVERSIAL INDUSTRY ACROSS PA AND THE CENTRAL REGION. IT HAS BROUGHT ECONOMIC BENEFIT TO THE CENTRAL REGION, BUT IT HAS ALSO GENERATED CONCERNS ABOUT HEALTH, INCREASED HOUSING RENTAL COSTS, DECREASED PROPERTY VALUES, AND LONG TERM ENVIRONMENT IMPACT. CONTINUED MONITORING OF HEALTH, SOCIOECONOMIC, AND ENVIRONMENTAL FACTORS ARE ESSENTIAL TO BETTER UNDERSTAND THE FULL IMPACT OF THIS INDUSTRY ON THE CENTRAL REGION. AS A RESULT OF THE COVID-19 PANDEMIC, CENTRAL REGION UNEMPLOYMENT RATES MORE THAN DOUBLED IN ALL COUNTIES EXCEPT SNYDER FROM MAY 2019 TO MAY 2020. OF INTEREST, AS OF MAY 2020, CURRENT UNEMPLOYMENT IS LOWER FOR ALL COUNTIES THAN THE STATE AND NATION. HEALTH TRENDS ACCESS TO HEALTHCARE ALL CENTRAL REGION COUNTIES EXCEPT MONTOUR AND UNION HAVE FEWER PRIMARY CARE PROVIDERS THAN THE STATE AND NATION, AND ALL COUNTIES EXCEPT MONTOUR HAVE FEWER DENTISTS AND MENTAL HEALTH PROVIDERS. (NOTE THAT PROVIDER RATES ARE CALCULATED BY THE PRIMARY ADDRESS OF THE OFFICE, AND DO NOT REFLECT SATELLITE LOCATIONS). NORTHUMBERLAND COUNTY HAS THE LOWEST PROVIDER RATES IN THE REGION. ALL COUNTIES EXCEPT UNION ARE DENTAL HEALTH PROFESSIONAL SHORTAGE AREAS (HPSAS); WITHIN UNION COUNTY, MIFFLINBURG IS A DENTAL HPSA. KEY INFORMANT SURVEY RESPONDENTS AFFIRMED THE NEED FOR ADDITIONAL BEHAVIORAL HEALTH SERVICES, PARTICULARLY MENTAL HEALTH SERVICES. MENTAL HEALTH SERVICES WERE THE TOP RANKED MISSING RESOURCE IN THE REGION, IDENTIFIED BY 67.5% OF RESPONDENTS. SUBSTANCE USE DISORDER SER

SCHEDULE H, PART VI, LINE 5
SCHEDULE H, PART I IN ADDITION TO THE NET COMMUNITY BENEFIT COSTS INCURRED BY THE ORGANIZATION AS REPORTED IN SCHEDULE H, PART I, LINE 7; PLEASE REFER TO SCHEDULE O OF THIS FORM 990 FOR THE ORGANIZATION'S NARRATIVE COMMUNITY BENEFIT STATEMENT FOR ADDITIONAL INFORMATION ON HOW THE ORGANIZATION PROMOTES HEALTH AND PROVIDES HEALTHCARE SERVICES TO THE COMMUNITY REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY IN FURTHERANCE OF ITS CHARITABLE TAX EXEMPT PURPOSE.

SCHEDULE H, PART VI
PART VI, LINE 7: FORM 990, SCHEDULE H, PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT: AT THIS TIME, THE HOSPITAL AND ITS AFFILIATES ARE NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE.

SCHEDULE H, PART III, LINE 9B
"THE HOSPITAL IS COMMITTED TO PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND THE HOSPITAL'S COLLECTION ACTIONS ARE CONSISTENTLY APPLIED TO ALL PATIENTS. IT IS THE HOSPITAL'S POLICY TO PROVIDE FINANCIAL ASSISTANCE AND COUNSELING TO PATIENTS WITH LIMITED FINANCIAL MEANS. A PATIENT MAY BECOME ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIAL/BILLING AND COLLECTION PROCESS. IN ANY STAGE OF THE BILLING PROCESS, COLLECTION ACTIONS ARE NOT PURSUED WHENEVER A PATIENT APPLIES AND IS BEING EVALUATED FOR FINANCIAL ASSISTANCE. UNDER NO CIRCUMSTANCES WILL THE HOSPITAL FREEZE OR ATTACH BANK ACCOUNTS OF A PATIENT, ENFORCE LIENS, ACTIVELY PURSUE ASSETS FROM A PRIOR JUDGMENT OR GARNISH THE WAGES OF A PATIENT AND/OR FAMILY MEMBER BEFORE DETERMINING IF THE PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. GEISINGER MANAGEMENT HAS DEVELOPED POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR GOVERNMENTAL PROGRAMS OR FINANCIAL ASSISTANCE FROM GEISINGER AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS. BILLING AND COLLECTION POLICY: THE BILLING AND COLLECTION POLICY IS ADMINISTERED IN ACCORDANCE WITH THE MISSION AND VALUES OF THE HOSPITAL AS WELL AS FEDERAL AND STATE LAW. THE POLICY IS DESIGNED TO PROMOTE APPROPRIATE ACCESS TO MEDICAL CARE FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY WHILE MAINTAINING GEISINGER'S FISCAL RESPONSIBILITY TO MAXIMIZE REIMBURSEMENT AND MINIMIZE BAD DEBT. THE ORGANIZATION'S BILLING AND COLLECTION POLICY IS INTENDED TO TAKE INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. THE ORGANIZATION MAKES SURE THAT PATIENTS ARE ASSISTED IN OBTAINING HEALTH INSURANCE COVERAGE FROM PRIVATELY AND PUBLICLY FUNDED SOURCES, WHENEVER POSSIBLE. ALL BUSINESS OFFICE CUSTOMER SERVICE DEPARTMENT REPRESENTATIVES ARE EDUCATED ON ALL ASPECTS OF THE BILLING AND COLLECTION POLICY AND ARE EXPECTED TO ADMINISTER THE POLICY ON A REGULAR AND CONSISTENT BASIS. BUSINESS OFFICE CUSTOMER SERVICE REPRESENTATIVES ARE HELD ACCOUNTABLE TO TREAT ALL PATIENTS WITH COURTESY, RESPECT, CONFIDENTIALITY AND CULTURAL SENSITIVITY. THE BILLING AND COLLECTION POLICY IS ADMINISTERED IN CONJUNCTION WITH THE PROCEDURES OUTLINED IN INTERNAL ADMINISTRATIVE POLICIES. THE GEISINGER EXECUTIVE VICE PRESIDENT, CHIEF FINANCIAL OFFICER AND VICE PRESIDENT, CHIEF REVENUE OFFICER HAVE OVERALL RESPONSIBILITY FOR THE BILLING AND COLLECTION ACTIVITIES OF THE HOSPITAL. THE BUSINESS OFFICE CUSTOMER SERVICE DEPARTMENT STAFF IS RESPONSIBLE FOR THE DAY-TO-DAY ENFORCEMENT OF APPROVED POLICIES AND PROCEDURES. GEISINGER MAY OFFER EXTENDED PAYMENT PLANS TO PATIENTS WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS. EMERGENCY & MEDICALLY NECESSARY SERVICES: GEISINGER DOES NOT ENGAGE IN ANY ACTIONS THAT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE. THE ORGANIZATION WILL NEVER DEMAND THAT AN EMERGENCY DEPARTMENT PATIENT PAY BEFORE RECEIVING TREATMENT FOR EMERGENCY MEDICAL CONDITIONS. ADDITIONALLY, GEISINGER DOES NOT PERMIT DEBT COLLECTION ACTIVITIES IN THE EMERGENCY DEPARTMENT OR OTHER AREAS WHERE SUCH ACTIVITIES COULD INTERFERE WITH THE PROVISION OF EMERGENCY CARE ON A NONDISCRIMINATORY BASIS. ALL MEDICALLY NECESSARY HOSPITAL SERVICES ARE PROVIDED WITHOUT CONSIDERATION OF ABILITY TO PAY AND ARE NOT DELAYED PENDING APPLICATION OR APPROVAL OF MEDICAL ASSISTANCE OR THE GEISINGER FINANCIAL ASSISTANCE PROGRAM. ADVANCE PAYMENT IS NOT REQUIRED FOR ANY MEDICALLY NECESSARY SERVICES. COMPLIANCE WITH INTERNAL REVENUE CODE SECTION 501(R)(6): GEISINGER DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS (""ECAS"") AS DEFINED BY INTERNAL REVENUE CODE SECTION 501(R)(6) PRIOR TO THE EXPIRATION OF THE NOTIFICATION PERIOD. THE NOTIFICATION PERIOD IS DEFINED AS A 120-DAY PERIOD OR GREATER, WHICH BEGINS ON THE DATE OF THE 1ST POST-DISCHARGE BILLING STATEMENT, IN WHICH NO ECAS ARE INITIATED AGAINST THE PATIENT. SUBSEQUENT TO THE NOTIFICATION PERIOD GEISINGER, OR ANY THIRD PARTIES ACTING ON ITS BEHALF, MAY INITIATE THE FOLLOWING ECAS AGAINST A PATIENT FOR AN UNPAID BALANCE IF THE FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION HAS NOT BEEN MADE OR IF AN INDIVIDUAL IS INELIGIBLE FOR FINANCIAL ASSISTANCE. GEISINGER MAY AUTHORIZE THIRD PARTIES TO REPORT ADVERSE INFORMATION ABOUT THE INDIVIDUAL TO CONSUMER CREDIT REPORTING AGENCIES OR CREDIT BUREAUS ON DELINQUENT PATIENT ACCOUNTS AFTER THE NOTIFICATION PERIOD. THE ORGANIZATION ENSURES REASONABLE EFFORTS HAVE BEEN TAKEN TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY AND ENSURES THE FOLLOWING ACTIONS ARE TAKEN AT LEAST 30 DAYS PRIOR TO INITIATING ANY ECA: 1) THE PATIENT IS PROVIDED WITH WRITTEN NOTICE WHICH: INDICATES THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR ELIGIBLE PATIENTS; IDENTIFIES THE ECA(S) THAT GEISINGER INTENDS TO INITIATE TO OBTAIN PAYMENT FOR THE CARE; AND STATES A DEADLINE AFTER WHICH SUCH ECAS MAY BE INITIATED. 2) THE PATIENT IS PROVIDED WITH A COPY OF THE PLAIN LANGUAGE SUMMARY; AND 3) REASONABLE EFFORTS ARE MADE TO ORALLY NOTIFY THE PATIENT ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. GEISINGER PROCESSES ALL APPLICATIONS FOR FINANCIAL ASSISTANCE SUBMITTED DURING THE APPLICATION PERIOD. THE APPLICATION PERIOD BEGINS ON THE DATE THE CARE IS PROVIDED AND ENDS ON THE 240TH DAY AFTER THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT."

SCHEDULE H, PART VI, LINE 3
"GEISINGER IS COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICES TO OUR COMMUNITY. GEISINGER IS COMMITTED TO A SERVICE EXCELLENCE PHILOSOPHY THAT STRIVES TO MEET OR EXCEED PATIENT EXPECTATIONS. ALL PATIENTS WILL RECEIVE A UNIFORM STANDARD OF CARE THROUGHOUT ALL GEISINGER FACILITIES, REGARDLESS OF SOCIAL, CULTURAL, FINANCIAL, RELIGIOUS, RACIAL, GENDER OR SEXUAL ORIENTATION. GEISINGER STRIVES TO ENSURE THAT ALL PATIENTS RECEIVE ESSENTIAL EMERGENCY AND OTHER MEDICALLY NECESSARY HEALTH SERVICES REGARDLESS OF THEIR ABILITY TO PAY. FOR URGENT AND EMERGENT SERVICES, PATIENTS ARE PROVIDED CARE REGARDLESS OF THEIR ABILITY TO PAY. IN THE EVENT A PATIENT HAS AN EMERGENCY MEDICAL CONDITION; TREATMENT IS NOT DELAYED TO PERMIT AN INQUIRY REGARDING A PATIENT'S METHOD OF PAYMENT OR INSURANCE STATUS. FOR OTHER THAN URGENT AND EMERGENT SERVICES, THE HOSPITAL PROVIDES UNCOMPENSATED CARE, FREE OF CHARGE, OR ON A 100% DISCOUNTED BASIS, TO THOSE PATIENTS WHO DEMONSTRATE AN INABILITY TO PAY. DEPENDING UPON FAMILY SIZE AND INCOME, FREE OR 100% DISCOUNTED SERVICES ARE AVAILABLE TO A PATIENT WITH FAMILY INCOME OF 300% OR LESS OF THE FEDERAL POVERTY GUIDELINES. IT IS THE HOSPITAL'S POLICY TO PROVIDE FINANCIAL ASSISTANCE AND FINANCIAL COUNSELING TO PATIENTS OF LIMITED MEANS. A PATIENT MAY BECOME ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE AT ANY TIME DURING TREATMENT OR DURING THE CONTINUUM OF THE FINANCIAL/BILLING PROCESS. INFORMATION (SIGNS, BROCHURES, ETC.) REGARDING THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES ARE PROVIDED AT THE EMERGENCY ROOM, REGISTRATION AND VARIOUS ACCESS POINTS THROUGHOUT THE HOSPITAL. REGISTRATION PERSONNEL ALSO REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE FINANCIAL ASSISTANCE POLICY. NOTICE OF THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES CAN ALSO BE FOUND ON THE GEISINGER WEB SITE AT WWW.GEISINGER.ORG. PATIENTS ARE ALSO PROVIDED INFORMATION ON THE HOSPITAL'S CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES WITH EACH PATIENT BILL. THE FINANCIAL ASSISTANCE POLICY (""FAP""), THE FAP APPLICATION AND PLAIN LANGUAGE SUMMARY (""PLS"") ARE AVAILABLE ON-LINE. PAPER COPIES ARE AVAILABLE UPON REQUEST WITHOUT CHARGE BY MAIL OR ARE AVAILABLE AT REGISTRATION AREAS WHICH INCLUDES EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL-BASED CLINICS AND PATIENT FINANCIAL SERVICES DEPARTMENTS. ALL FAP DOCUMENTS ARE AVAILABLE IN ENGLISH AND IN THE PRIMARY LANGUAGE OF POPULATIONS WITH LIMITED ENGLISH PROFICIENCY (""LEP"") THAT CONSTITUTE THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE HOSPITAL'S SERVICE AREA. SIGNS OR DISPLAYS ARE CONSPICUOUSLY POSTED IN PUBLIC HOSPITAL LOCATIONS INCLUDING THE EMERGENCY DEPARTMENT, ADMISSIONS DEPARTMENT AND REGISTRATION DEPARTMENT THAT INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. ALL PATIENTS ARE OFFERED A COPY OF THE PLS AS PART OF THE INTAKE AND DISCHARGE PROCESSES. ADDITIONALLY, FINANCIAL COUNSELORS AND CUSTOMER SERVICE REPRESENTATIVES ARE AVAILABLE TO ASSIST PATIENTS WITH CONCERNS."

SCHEDULE H, PART VI, LINE 6
"AS OF DECEMBER 31, 2021, GEISINGER HEALTH AND ITS SUBSIDIARIES (COLLECTIVELY REFERRED TO AS ""GEISINGER"") COMPRISE A PHYSICIAN-LED, INTEGRATED HEALTH SERVICES ORGANIZATION THAT HAS AS ITS MAIN COMPONENTS: (I) AN ARRAY OF HEALTH SERVICES PROVIDERS, INCLUDING SIX WHOLLY-CONTROLLED ACUTE-CARE HOSPITALS WITH MULTIPLE CAMPUSES, A JOINT VENTURE HOSPITAL AND A DRUG AND ALCOHOL TREATMENT FACILITY; (II) MULTISPECIALTY PHYSICIAN GROUP PRACTICES; (III) INSURANCE OPERATIONS, INCLUDING A LICENSED HEALTH MAINTENANCE ORGANIZATION; AND (IV) A COMMUNITY-BASED MEDICAL COLLEGE AND DEGREE-GRANTING INSTITUTION. GEISINGER OPERATES IN 46 OF PENNSYLVANIA'S 67 COUNTIES, WITH A SIGNIFICANT PRESENCE IN CENTRAL AND NORTHEASTERN PENNSYLVANIA. THE HOSPITAL IS AN AFFILIATE WITHIN GEISINGER. SEE SCHEDULE R FOR A LIST OF THE AFFILIATED ORGANIZATIONS COMPRISING GEISINGER. CORPORATE STRUCTURE. THE ORGANIZATIONAL STRUCTURE OF GEISINGER REFLECTS THE STRATEGIC GOAL OF OPERATING AS A FULLY INTEGRATED HEALTHCARE SYSTEM WHOSE CORPORATE COMPONENTS SHARE THE COMMON GOALS OF MANAGING AND IMPROVING THE HEALTHCARE OF ITS PATIENTS AND MEMBERS, WHILE RECOGNIZING AND RESPECTING THE CORPORATE IDENTITY OF EACH ENTITY. THIS INTEGRATION LINKS THE AREAS OF PHYSICIANS, HOSPITALS/CLINICS, AND HEALTHCARE INSURANCE. HISTORY. GEISINGER HAD ITS BEGINNINGS IN THE SMALL COMMUNITY OF DANVILLE, LOCATED IN CENTRAL PENNSYLVANIA ON THE NORTHERN BRANCH OF THE SUSQUEHANNA RIVER. THERE, IN 1915, ABIGAIL A. GEISINGER FOUNDED THE GEORGE F. GEISINGER MEMORIAL HOSPITAL IN MEMORY OF HER HUSBAND. FROM THE BEGINNING, THE NEW HOSPITAL WAS DESIGNED AS A COMPREHENSIVE HEALTHCARE INSTITUTION THAT WOULD OFFER SPECIALIZED MEDICAL CARE TO PEOPLE IN THE RURAL AREAS OF CENTRAL AND NORTHEASTERN PENNSYLVANIA. UNLIKE MOST HEALTHCARE SYSTEMS, WHICH EVOLVED WITH A HOSPITAL FOCUS, GEISINGER'S HISTORY AND TRADITION IS THAT OF A PHYSICIAN-LED AND PHYSICIAN-DRIVEN HEALTHCARE ORGANIZATION. THIS TRADITION BEGAN WHEN MRS. GEISINGER BROUGHT DR. HAROLD FOSS, A MAYO CLINIC TRAINED PHYSICIAN, TO BE HER HOSPITAL'S FIRST CHIEF OF STAFF. TODAY, GEISINGER IS REGARDED AS A NATIONAL MODEL OF HEALTHCARE DELIVERY CENTERED ON A SOPHISTICATED MULTISPECIALTY GROUP PRACTICE. SINCE THE 1970S, GEISINGER'S STRATEGY OF INTEGRATING PHYSICIANS AND HOSPITALS EXPANDED TO INCLUDE THE MANAGEMENT OF HEALTH AND THE FINANCING OF HEALTHCARE SERVICES THROUGH ITS WHOLLY CONTROLLED HEALTH MAINTENANCE ORGANIZATION, GEISINGER HEALTH PLAN. TWO INDEMNITY HEALTH INSURERS, GEISINGER INDEMNITY INSURANCE COMPANY AND GEISINGER QUALITY OPTIONS, INC. WERE ALSO ADDED. SEE SCHEDULE R FOR A LIST OF THE AFFILIATED ORGANIZATIONS COMPRISING GEISINGER."