4A (Expenses $ 294756274 including grants of $ 337385) (Revenue $ 458251918)
ROBERT PACKER HOSPITAL PROVIDES HEALTHCARE SERVICES TO RESIDENTS OF THE SURROUNDING COMMUNITY ON AN IN-PATIENT AND OUT-PATIENT BASIS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. PLEASE REFER TO THE COMMUNITY BENEFIT STATEMENT IN SCHEDULE O.

SCHEDULE H, PART V, SECTION B, QUESTION 5
"The Robert Packer Hospital (""RPH"") community health needs assessment (CHNA) began with collecting primary data through a 20 question Community Stakeholder Survey from December 20, 2021-February 11, 2022. The Stakeholder Survey focused on Pennsylvania Stakeholders as New York State Chemung and Tioga Counties complete Community Health Needs Assessments as part of the NYS requirement and have community organizations participating in their prioritizing process. This Community Stakeholder Survey incorporated the feedback of individuals who represent the broad interests of the community served by Robert Packer Hospital including individuals living in poverty and in need of emergency assistance or housing, individuals with mental health or substance use disorders, individuals with developmental disorders, older adults, children, and youth. Robert Packer Hospital has not received written comments on the last CHNA or implementation plan. The Community Stakeholder Survey was conducted with outreach to forty-seven community stakeholders that provide services throughout Bradford, Sullivan, and Tioga counties: Survey responses were received from the following organizations: - Abuse & Rape Crisis Center of Bradford County (services to eliminate interpersonal violence) - Bradford County Public Health Department - Bradford Tioga High School (high school students) - Bradford, Sullivan, Susquehanna and Tioga Counties Area Agency on Aging (older adults) - Canton K-12 Schools (children and youth) - Endless Mountain Mission Center (temporary emergency assistance) - Futures Community Support Services (services for individuals with emotional and/or developmental disabilities) - Harbor Counseling (mental health and substance use disorder treatment) - Martha Lloyd Community Services (services for people with intellectual disabilities and autism) - North Penn Legal Services (free legal assistance) - Salvation Army (emergency assistance) - Sayre Public Library - The Main Link (non-clinical consumer run services for mental health consumers) Of these organizations, 5 provide services in Sullivan County, PA, 14 provide services in Bradford County, PA, and 7 provide services in Tioga County, PA. Survey results ranked the biggest problems impacting Bradford, Tioga and Sullivan Counties in sequential order from highest to lowest as: mental health conditions, alcohol and other substance use disorders, poverty, COVID-19 and unemployment. When asked to identify what population experiences the poorest health outcomes in Bradford, Sullivan, and Tioga Counties, community stakeholders identified the top three populations as: individuals living with mental health conditions, individuals living at or near the federal poverty level and individuals in rural areas and individuals with substance use disorders. Stakeholders identified economic stability as the social factor with the most negative influence on the health of Bradford, Sullivan, and Tioga Counties including poverty, household food insecurity, high housing costs and poor housing quality. Over 80 percent of inpatient admissions to Robert Packer Hospital come from five counties including: Bradford, PA, Tioga, NY, Chemung, NY, Steuben, NY and Tioga, PA. Steuben County was not included in this needs assessment, as Guthrie Corning Hospital is collaborating with Steuben County Health Department and S2AY Rural Health Network on their county-wide assessment. In collaboration with Bradford County Public Health Department, the decision was made to include Sullivan County, PA, as Sullivan County does not have a medical center and residents access services through Robert Packer Hospital and the Towanda Campus. During the CHNA process, collaboration with New York Health Departments and S2AY Rural Health Network in Chemung, Tioga and Steuben allowed for the sharing of priorities selected through county CHNA processes. This facilitated input from robust, community wide initiatives that incorporate the voices of community-based organizations in the prioritization of needs. Chemung County in NY has prioritized Prevent Chronic Disease (with a focus on health eating and food security and preventive care and management), and Women, Infants and Children with a focus on Perinatal and Infant Health. Tioga County in New York has selected the three the priority areas: Promote Health Women, Infants and Children, Prevent Chronic Diseases, and Promote Wellbeing and Prevent Mental Illness and Substance Use disorders. The secondary data sources used in the CHNA included data retrieved from Community Commons, data collected through the Strategic Marketing Department (demographic information, discharge data, etc.) and data compiled by Guthrie Medical Group when screening for social determinants of health. Recent indicators of health were collected from Community Commons and compared to state and national data. All information was assembled and a CHNA committee composed of community members, health care providers (physicians, nurses and social workers), administrators, and an individual with experience in public health were invited to review the findings. The data retrieved from Community Commons was stratified into nine categories which included clinical care, health behaviors, health outcomes, COVID-19, healthcare access, economic stability, social and community context, education and neighborhood and built environment. Within the primary service area for RPH, thirty-five indicators of health were identified to be below the state, national, or Healthy People 2030 goal. Once the thirty-five indicators were identified, they were reviewed and ranked by each individual of the CHNA committee using the Hanlon Method. In addition to the CHNA group, this report in its entirety will be shared during regular meetings throughout 2022 and 2023 with the S2AY Rural Health Network, East Central Division of the American Cancer Society, Tioga Partnership for Community Health, and the Bradford, Tioga, Chemung, Schuyler, and Steuben Health Departments for their review, input, and solicitation of written comments."

SCHEDULE H, PART V, SECTION B, QUESTION 7A
"THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM (""SYSTEM""). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 7A, IS THE HOME PAGE FOR THE SYSTEM. THE CHNA CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: https://www.guthrie.org/about-us/community-benefits/community-health-needs -assessment"

SCHEDULE H, PART V, SECTION B, QUESTION 10A
"THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM (""SYSTEM""). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 10A, IS THE HOME PAGE FOR THE SYSTEM. THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY CAN BE ACCESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: https://www.guthrie.org/about-us/community-benefits/community-health-needs -assessment"

SCHEDULE H, PART V, SECTION B, QUESTION 11
FOR A COMPLETE DESCRIPTION ON HOW THE ORGANIZATION IS ADDRESSING THE NEEDS IDENTIFIED IN THE MOST RECENTLY COMPLETED CHNA, SEE THE FOLLOWING: https://www.guthrie.org/about-us/community-benefits/community-health-needs -assessment DUE TO RESOURCE LIMITATIONS, THE FOLLOWING IDENTIFIED NEEDS WERE NOT ABLE TO BE ADDRESSED IN THE IMPLEMENTATION PLAN: - DRUGS AND ALCOHOL - TABACCO USE

SCHEDULE H, PART V, SECTION B, QUESTION 16
"THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM (""SYSTEM""). DUE TO CHARACTER LIMITATIONS, THE WEBSITE LISTED IN SCHEDULE H, PART V, SECTION B, QUESTION 16 IS THE HOME PAGE FOR THE SYSTEM. THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE MADE WIDELY AVAILABLE ON THE ORGANIZATION'S WEBSITE. THESE DOCUMENTS CAN BE ASSESSED AT THE FOLLOWING PAGE INCLUDED IN THE SYSTEM'S WEBSITE: HTTPS://WWW.GUTHRIE.ORG/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTANCE"

SCHEDULE H, PART I, QUESTION 7
DUE TO THE ADOPTION OF ACCOUNTING PRONOUNCEMENT ASC 606, CURRENT YEAR IMPLICIT PRICE CONCESSIONS ARE TREATED AS A CONTRA-REVENUE ITEM ON THE STATEMENT OF REVENUE (CONSISTENT WITH THE PRIOR YEAR TREATMENT OF PATIENT SERVICE BAD DEBTS). INFORMATION REPORTED ON THE SCHEDULE H, PART I, LINE 7 TABLE WAS DERIVED UTILIZING THE RATIO OF COST TO CHARGES CALCULATED USING WORKSHEET 2, EXCEPT LINE 7B, WHICH WAS TAKEN FROM THE MEDICARE COST REPORT, AND LINE 7G, WHICH WAS CALCULATED BASED UPON AN INTERNAL COST ACCOUNTING SYSTEM. WITHIN THE COST ACCOUNTING SYSTEM, SOME PATIENT SEGMENTS WERE BASED ON A RATIO OF COST TO CHARGE - TOTAL DEPARTMENTAL EXPENSE PLUS ALLOCATED OVERHEAD SPREAD BASED ON CHARGES.

SCHEDULE H, PART III, SECTION A, QUESTIONS 2, 3 & 4
THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINES 2 AND 3 ARE BASED ON ACTUAL CHARGES WRITTEN OFF (AMOUNTS THAT ARE DEEMED TO BE UNCOLLECTIBLE AND RECORDED AS IMPLICIT PRICE CONCESSIONS UNDER ACCOUNTING PRONOUNCEMENT ASC 606). ROBERT PACKER HOSPITAL PROVIDES CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THIS IS PART OF THE HOSPITAL'S MISSION. THE HOSPITAL ESTIMATES THAT 10% OF THE BAD DEBT EXPENSE AT COST IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY THAT HAVE NOT FILLED OUT THE PROPER FORMS OR PROVIDED THE PROPER INFORMATION TO QUALIFY FOR THE PROGRAM. THE TEXT OF THE BAD DEBT FOOTNOTE CAN BE FOUND ON PAGE 13 OF THE ELECTONICALLY ATTACHED AUDITED FINANCIAL STATEMENTS FOR THE GUTHRIE CLINIC AND AFFILIATES.

SCHEDULE H, PART III, SECTION C, QUESTION 8
"MEDICARE COSTS WERE DERIVED FROM THE 2021 MEDICARE COST REPORT. THE ORGANIZATION FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL), BAD DEBT AND ASSOCIATED COSTS ARE COMMUNITY BENEFIT AND ARE INCLUDABLE ON THE 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 OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE (""IRC"") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM ""CHARITABLE"" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT ""THE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE,PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM ""CHARITABLE"" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE ""CHARITY CARE STANDARD."" UNDER THE STANDARD, A HOSPITAL MUST PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS WHO CANNOT PAY FOR SUCH SERVICES. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH ""REMOVED"" FROM REVENUE RULING 56-185 ""THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST."" UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE ""COMMUNITY BENEFIT STANDARD,"" HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION 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 THE DEPARTMENT OF TREASURY REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN 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 EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. THE AMERICAN HOSPITAL ASSOCIATION (""AHA"") FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA'S POSITION. AS OUTLINED IN THE AHA'S LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING MEDICARE UNDERPAYMENTS (SHORTFALL) AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD - MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE. FROM THE LATEST DATA PROVIDED BY THE AHA, MEDICARE REIMBURSES HOSPITALS ONLY 87 CENTS FOR EVERY DOLLAR THEY SPEND TO TAKE CARE OF MEDICARE PATIENTS. - MANY MEDICARE BENEFICIARIES, LIKE THEIR MEDICAID COUNTERPARTS, ARE POOR. MORE THAN 42 PERCENT OF MEDICARE SPENDING IS FOR BENEFICIARIES WHOSE INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL. MANY OF THOSE MEDICARE BENEFICIARIES ARE ALSO ELIGIBLE FOR MEDICAID -- SO CALLED ELIGIBLE."" THERE IS EVERY COMPELLING PUBLIC POLICY REASON TO TREAT MEDICARE AND MEDICAID UNDERPAYMENTS SIMILARLY FOR PURPOSES OF A HOSPITAL'S COMMUNITY BENEFIT AND INCLUDE THESE COSTS ON FORM 990, SCHEDULE H, PART I. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY AND SHOULD COUNT AS A QUANTIFIABLE COMMUNITY BENEFIT. BOTH THE AHA AND THIS ORGANIZATION ALSO FEEL THAT PATIENT BAD DEBT IS A COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. LIKE MEDICARE UNDERPAYMENT (SHORTFALLS), THERE ALSO ARE COMPELLING REASONS THAT PATIENT BAD DEBT SHOULD BE COUNTED AS QUANTIFIABLE COMMUNITY BENEFIT AS FOLLOWS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR THOSE WHO DO NOT PAY ALL, OR A PORTION OF THE ALREADY DISCOUNTED BILLED AMOUNTS UNDER OUR FINANCIAL ASSISTANCE POLICY. A 2006 CONGRESSIONAL BUDGET OFFICE (""CBO"") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, 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 REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR 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, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF BAD DEBT IS PENDING 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 BENEFIT"" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES 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 HOSPITAL'S MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS SHOULDER IN SERVING ALL PATIENTS RE"

SCHEDULE H, PART III, SECTION C, QUESTION 9B
ONCE A PATIENT IS APPROVED FOR CHARITY CARE OR AN INSTALLMENT PLAN, THEIR ACCOUNT IS TRANSFERRED TO EITHER THE BUDGET OR CHARITY CARE FINANCIAL CLASS. ACCOUNTS IN THESE FINANCIAL CLASSES ARE NOT PLACED WITH COLLECTION.

SCHEDULE H, PART VI, QUESTION 2
"Robert Packer Hospital (""RPH"") AND THE GUTHRIE CLINIC (""TGC"") emphasize primary health care services, health promotion, and chronic disease prevention and management for the community we serve. RPH's overall approach to community benefit is to examine the intersection of documented unmet community needs and match these needs with organizational strengths. These unmet community needs can be defined as a discrepancy or gap between what is currently available and what the community desires. The overarching goals of this Community Health Needs Assessment (CHNA) are to (1) identify strengths and limitation within RPH's service area; (2) define the needs and assets associated with the community we serve; (3) describe resources such as health professionals, regional economics and communication networks whose goal is to maximize community health. The identified needs will result in the formation of an implementation plan that will build upon the continuum of care currently offered at RPH by clearly linking our clinical services with our community-based services through this community benefit process. The implemented community benefit plan will be integrated into strategic organizational goals of RPH. The plan progress will be monitored to ensure timely implementation. Further collaborative partnerships will be integral to the success of the plan. The Robert Packer Hospital (RPH) community health needs assessment (CHNA) began with collecting primary data through a 20 question Community Stakeholder Survey from December 20, 2021-February 11, 2022. The Stakeholder Survey focused on Pennsylvania Stakeholders as New York State Chemung and Tioga Counties complete Community Health Needs Assessments as part of the NYS requirement and have community organizations participating in their prioritizing process. This Community Stakeholder Survey incorporated the feedback of individuals who represent the broad interests of the community served by Robert Packer Hospital including individuals living in poverty and in need of emergency assistance or housing, individuals with mental health or substance use disorders, individuals with developmental disorders, older adults, children, and youth. Robert Packer Hospital has not received written comments on the last CHNA or implementation plan. The Community Stakeholder Survey was conducted with outreach to forty-seven community stakeholders that provide services throughout Bradford, Sullivan, and Tioga counties: Survey responses were received from the following organizations: - Abuse & Rape Crisis Center of Bradford County (services to eliminate interpersonal violence) - Bradford County Public Health Department - Bradford Tioga High School (high school students) - Bradford, Sullivan, Susquehanna and Tioga Counties Area Agency on Aging (older adults) - Canton K-12 Schools (children and youth) - Endless Mountain Mission Center (temporary emergency assistance) - Futures Community Support Services (services for individuals with emotional and/or developmental disabilities) - Harbor Counseling (mental health and substance use disorder treatment) - Martha Lloyd Community Services (services for people with intellectual disabilities and autism) - North Penn Legal Services (free legal assistance) - Salvation Army (emergency assistance) - Sayre Public Library - The Main Link (non-clinical consumer run services for mental health consumers) Of these organizations, 5 provide services in Sullivan County, PA, 14 provide services in Bradford County, PA, and 7 provide services in Tioga County, PA. Survey results ranked the biggest problems impacting Bradford, Tioga and Sullivan Counties in sequential order from highest to lowest as: mental health conditions, alcohol and other substance use disorders, poverty, COVID-19 and unemployment. When asked to identify what population experiences the poorest health outcomes in Bradford, Sullivan, and Tioga Counties, community stakeholders identified the top three populations as: individuals living with mental health conditions, individuals living at or near the federal poverty level and individuals in rural areas and individuals with substance use disorders. Stakeholders identified economic stability as the social factor with the most negative influence on the health of Bradford, Sullivan, and Tioga Counties including poverty, household food insecurity, high housing costs and poor housing quality. Over 80 percent of inpatient admissions to Robert Packer Hospital come from five counties including: Bradford, PA, Tioga, NY, Chemung, NY, Steuben, NY and Tioga, PA. Steuben County was not included in this needs assessment, as Guthrie Corning Hospital is collaborating with Steuben County Health Department and S2AY Rural Health Network on their county-wide assessment. In collaboration with Bradford County Public Health Department, the decision was made to include Sullivan County, PA, as Sullivan County does not have a medical center and residents access services through Robert Packer Hospital and the Towanda Campus. During the CHNA process, collaboration with New York Health Departments and S2AY Rural Health Network in Chemung, Tioga and Steuben allowed for the sharing of priorities selected through county CHNA processes. This facilitated input from robust, community wide initiatives that incorporate the voices of community-based organizations in the prioritization of needs. Chemung County in NY has prioritized Prevent Chronic Disease (with a focus on health eating and food security and preventive care and management), and Women, Infants and Children with a focus on Perinatal and Infant Health. Tioga County in New York has selected the three the priority areas: Promote Health Women, Infants and Children, Prevent Chronic Diseases, and Promote Wellbeing and Prevent Mental Illness and Substance Use disorders. The secondary data sources used in the CHNA included data retrieved from Community Commons, data collected through the Strategic Marketing Department (demographic information, discharge data, etc.) and data compiled by Guthrie Medical Group when screening for social determinants of health. Recent indicators of health were collected from Community Commons and compared to state and national data. All information was assembled and a CHNA committee composed of community members, health care providers (physicians, nurses and social workers), administrators, and an individual with experience in public health were invited to review the findings. The data retrieved from Community Commons was stratified into nine categories which included clinical care, health behaviors, health outcomes, COVID-19, healthcare access, economic stability, social and community context, education and neighborhood and built environment. Within the primary service area for RPH, thirty-five indicators of health were identified to be below the state, national, or Healthy People 2030 goal. Once the thirty-five indicators were identified, they were reviewed and ranked by each individual of the CHNA committee using the Hanlon Method. The Hanlon Method uses a two-step process to score indicators of health. The first step ensures that each need meets the PEARL test which includes: Propriety - is an intervention suitable?; Economics- does it make economic sense to address the need?; Acceptability- is the community open to addressing this need and will it accept the intervention?; Resources- are resources available?; Legality- is the intervention lawful?. The second step of the Hanlon Method includes assigning a score from 0-10 for each need regarding the (1) size of the problem (2) seriousness of the problem and (3) effectiveness potential of an intervention. Using this methodology, the CHNA group scored each of the unmet needs from which several priority needs were identified for the primary service area of RPH. Once scored and weighted according to the Hanlon method, the results were shared with the CHNA group for discussion. The group was also given the opportunity to adjust any rankings. The Hanlon method prioritized five areas of unmet health care needs. The CHNA Committee integrated the results of the Stakeholder Survey taking into account their understanding of the resources available and experience in providing services. From their discussion and review, the committee identified, in sequential order (highest to lowest score) these priority needs: Primary Care Utilization/Hospitalization, Mental Health, Cancer Screening, Drugs and Alcohol, and Tobacco Use. The CHNA committee assessed which of the top five priorities RPH has capacity to address in the next 3 fiscal years. Due to available resources, the following needs were identified as priorities for intervention over the next three years: 1. Primary Care Utilization/Hospitalization 2. Mental Health 3. Cancer Screening The committee selected primary care utilization/hospitalizations as the top priority area to address. High rates of hospitalization can be offset by focus on pri"

SCHEDULE H, PART VI, QUESTION 3
CHARITY CARE AVAILABILITY AND CONTACT INFORMATION ARE POSTED IN ALL REGISTRATION AREAS AND IN THE HOSPITAL'S BUSINESS OFFICE. THE CHARITY CARE POLICY, APPLICATION, AND CONTACT INFORMATION ARE POSTED ON THE HOSPITAL'S WEBSITE. SELF PAY PATIENTS ARE REFERRED TO THE HOSPITAL'S FINANCIAL COUNSELOR FROM PHYSICIAN OFFICES, SOCIAL WORKERS, OR SELF REFERRED. THE FINANCIAL COUNSELOR AS WELL AS THE BUSINESS OFFICE STAFF FOLLOW UP WITH SELF PAY PATIENTS TO ASSESS THEIR NEED AND ASSIST IN DETERMINING THEIR ELIGIBILITY FOR SECURING A PAYMENT SOURCE (I.E. COBRA COVERAGE, SPECIAL NEEDS PROGRAM, MEDICAID, OTHER FEDERAL/STATE PROGRAMS, OR CHARITY CARE). STAFF ALSO ASSIST WITH THE APPLICATION PROCESS AS REQUESTED BY SELF PAY PATIENTS. THE HOSPITAL'S BILLING STATEMENTS ALSO HAVE INFORMATION REGARDING WHO TO CONTACT IN CASE A PATIENT NEEDS ASSISTANCE MEETING ITS FINANCIAL OBLIGATIONS.

SCHEDULE H, PART VI, QUESTION 5
PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT IN SCHEDULE O FOR MORE INFORMATION REGARDING HOW THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUMNITY.

SCHEDULE H, PART VI, QUESTION 6
"THE ORGANIZATION IS AN AFFILIATE WITHIN THE GUTHRIE CLINIC AND AFFILIATES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM (""SYSTEM""). ALL AFFILIATES ARE COMMITTED TO ENHANCING THE OVERALL HEALTH STATUS OF THE COMMUNITY BY PROVIDING THE HIGHEST QUALITY HEALTHCARE AND RELATED SERVICES IN A COST-EFFECTIVE MANNER AND REGARDLESS OF ABILITY TO PAY. THE SYSTEM STRIVES TO EXCEED THE PATIENTS' EXPECTATIONS BY EMPHASIZING COMMITMENT, COMPETENCE, COLLABORATION, COMMUNICATION AND COMPASSION. THE GUTHRIE CLINIC IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THE GUTHRIE CLINIC OPERATES AS THE TAX-EXEMPT PARENT ENTITY OF A MULTI-CORPORATE HEALTHCARE SYSTEM. IT WAS CREATED TO COORDINATE, SUPERVISE AND ENSURE THE CONTINUATION AND IMPROVEMENT OF THE QUALITY OF HEALTHCARE SERVICES PROVIDED BY ITS QUALIFYING AFFILIATES TO THE COMMUNITY. THE GUTHRIE CLINIC ENSURES THAT ITS SYSTEM PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. THE SOLE MEMBER OR STOCKHOLDER OF EACH ENTITY WITHIN THE SYSTEM IS EITHER THE GUTHRIE CLINIC OR ANOTHER SYSTEM AFFILIATE CONTROLLED OR OWNED BY THE GUTHRIE CLINIC. OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISE THE SYSTEM. ACTIVE HOSPITAL LEGAL ENTITIES INCLUDE CORNING HOSPITAL, GUTHRIE CORTLAND MEDICAL CENTER, ROBERT PACKER HOSPITAL AND TROY COMMUNITY HOSPITAL, INC. EACH OF THESE HOSPITALS OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1. EACH PROVIDE MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. EACH ACUTE CARE HOSPITAL OPERATES AN ACTIVE EMERGENCY DEPARTMENT FOR ALL PERSONS, WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. EACH MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF EACH RESTS WITH ITS BOARD OF DIRECTORS AND THE BOARD OF DIRECTORS OF THE GUTHRIE CLINIC (BOTH BOARDS ARE COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY); AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE, PROGRAMS AND ACTIVITIES. AFFILIATED GUTHRIE CLINIC ENTITIES ARE AS FOLLOWS: CORNING HOSPITAL (""CH"") IS A 65-BED NON-PROFIT ACUTE CARE MEDICAL CENTER LOCATED IN CORNING, NEW YORK. CH IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, CH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, CH OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. GUTHRIE CORTLAND MEDICAL CENTER (""GCMC"") IS A 144-BED NON-PROFIT ACUTE CARE MEDICAL CENTER LOCATED IN CORTLAND, NEW YORK. GCMC IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, GCMC PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, GCMC OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. ROBERT PACKER HOSPITAL (""RPH"") IS A 267-BED NON-PROFIT TERTIARY CARE REFERRAL CENTER LOCATED IN SAYRE, PENNSYLVANIA THAT ALSO OPERATES ROBERT PACKER HOSPITAL AT TOWANDA CAMPUS, A 35-BED NON-PROFIT ACUTE CARE MEDICAL CENTER LOCATED IN TOWANDA, PENNSYLVANIA. RPH IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, RPH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, RPH OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. TROY COMMUNITY HOSPITAL, INC. (""TCH"") IS A 25-BED NON-PROFIT CRITICAL ACCESS HOSPITAL LOCATED IN TROY, PENNSYLVANIA. TCH IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS AN INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES, TCH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, TCH OPERATES CONSISTENTLY WITH THE CRITERIA OUTLINED IN IRS REVENUE RULING 69-545. CORTLAND MEMORIAL FOUNDATION, INC. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THROUGH FUNDRAISING ACTIVITIES, THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF GCMC; A RELATED INTERNAL REVENUE CODE 501(C)(3) TAX-EXEMPT ORGANIZATION, THAT PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. DONALD GUTHRIE FOUNDATION IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION DEVELOPS, GROWS AND CONDUCTS MEANINGFUL QUALITY RESEARCH TO IMPROVE THE LIVES OF PATIENTS AND IS COMPRISED OF THE THREE RESEARCH DEPARTMENTS OF CLINICAL RESEARCH, LEAP TESTING SERVICE AND THE INSTITUTIONAL REVIEW BOARD. THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF THE SYSTEM; WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. GUTHRIE HOME CARE IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(2). THE ORGANIZATION'S MISSION IS TO ESTABLISH, MAINTAIN, AND SUPPORT HOME HEALTH AGENCY, PROVIDE FOR HOME HEALTH SERVICES, PROVIDE FOR HOSPICE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. GUTHRIE MEDICAL GROUP, P.C. IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION SUPPORTS THE HEALTH CARE SYSTEM; PRIMARILY ITS TAX-EXEMPT ACUTE CARE HOSPITALS, WHICH PROVIDE MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. GUTHRIE RISK RETENTION GROUP IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A SUPPORTING ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(3). THE ORGANIZATION OPERATES AS A RISK RETENTION GROUP UNDER THE FEDERAL LIABILITY RISK RETENTION ACT OF 1986 TO THE SYSTEM. THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF THE SYSTEM; WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. REGIONAL MEDICAL PRACTICE, PC IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION SUPPORTS GCMC, WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. SAYRE HOUSE OF HOPE IS AN ORGANIZATION RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAX-EXEMPT PURSUANT TO INTERNAL REVENUE CODE 501(C)(3) AND AS A NON-PRIVATE FOUNDATION PURSUANT TO INTERNAL REVENUE CODE 509(A)(1). THE ORGANIZATION ALLEVIATES THE ADDITIONAL FINANCIAL AND EMOTIONAL BURDENS ON PATIENTS AND FAMILIES WHILE ENDURING A MEDICAL CRISIS BY PROVIDING TEMPORARY HOUSING AND SUPPORT. THE ORGANIZATION SUPPORTS THE CHARITABLE PURPOSES, PROGRAMS AND SERVICES OF THE SYSTEM; WHICH PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUALS IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. OTHER GUTHRIE CLINIC LEGAL ENTITIES INCLUDE THE FOLLOWING: CMH SERVICES, INC. IS AN ENTITY WHOSE SOLE SHAREHOLDER IS GCMC. THE ORGANIZATION PROVIDE DURABLE MEDICAL EQUIPMENT. THE ORGANIZATION S"

SCHEDULE H, PART VI, QUESTION 7
NOT APPLICABLE.

SCHEDULE H, PART VI, QUESTION 4
"ROBERT PACKER HOSPITAL (""RPH"") IS A NOT-FOR-PROFIT COMMUNITY TEACHING HOSPITAL AND AN ENTITY UNDER THE GUTHRIE CLINIC (""TGC""). RPH IS LOCATED IN SAYRE, PA AND IS A 267-BED TERTIARY CARE HOSPITAL THAT SERVES THE SOUTHERN TIER REGION OF NEW YORK AND THE NORTHERN TIER REGION OF PENNSYLVANIA. FORMERLY KNOWN AS TOWANDA MEMORIAL HOSPITAL, THE RPH TOWANDA CAMPUS IS A SATELLITE CAMPUS OF GUTHRIE ROBERT PACKER HOSPITAL, LOCATED 17 MILES SOUTH OF RPH IN TOWANDA, PA. THE TOWANDA CAMPUS IS A 21-BED FACILITY SERVING BRADFORD AND SULLIVAN COUNTIES AND THE SURROUNDING COMMUNITIES. IN ADDITION TO CLINICAL SERVICES, LONG-TERM CARE SERVICES ARE PROVIDED FOR PATIENTS WITH A SKILLED NURSING UNIT AND 94-BED PERSONAL CARE HOME. IN FISCAL YEAR 2021, RPH HAD OVER 14,640 INPATIENT VISITS, MORE THAN 1,900 OUTPATIENT SURGERIES, 16,000 SHORT PROCEDURES AND 4,220 INPATIENT SURGERIES. THE RPH EMERGENCY DEPARTMENT HAD OVER 29,800 VISITS. DURING THE SAME TIME PERIOD, THERE WERE OVER 670 BIRTHS AND 93,000 OUTPATIENT VISITS. IN FISCAL YEAR 2021, THE TOWANDA CAMPUS HAD OVER 300 INPATIENT VISITS, MORE THAN 130 OUTPATIENT SURGERIES AND OVER 12,000 OUTPATIENT VISITS. THE TOWANDA CAMPUS EMERGENCY DEPARTMENT HAD OVER 7,590 VISITS. RPH HAS RECEIVED NUMEROUS NATIONAL AWARDS FOR HIGH QUALITY PATIENT CARE SUCH AS THE PRIMARY STROKE CENTER BY THE JOINT COMMISSION, THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S GET WITH THE GUIDELINES-STROKE SILVER PLUS QUALITY ACHIEVEMENT AWARD AND THE COMMISSION ON CANCER ACCREDITATION. RPH IS A REGIONAL LEVEL II TRAUMA CENTER, ACCREDITED BY THE PENNSYLVANIA TRAUMA SYSTEMS FOUNDATION AND IS SERVED BY GUTHRIE AIR, A REGIONAL AERO-MEDICAL HELICOPTER PROGRAM. RPH OFFERS A FULL RANGE OF DIAGNOSTIC, MEDICAL AND SURGICAL SERVICES INCLUDING GUTHRIE CARDIAC AND VASCULAR CENTER, GUTHRIE RPH CHEST PAIN CENTER, GUTHRIE CANCER AND INFUSION CENTER, GUTHRIE BREAST CARE CENTER, GUTHRIE BEHAVIORAL HEALTH SCIENCE CENTER AND GUTHRIE WEIGHT LOSS CENTER. GUTHRIE RPH MEDICAL IMAGING PROVIDES A WIDE RANGE OF DIAGNOSTIC AND THERAPEUTIC IMAGING STUDIES, INCLUDING: COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING, INTERVENTIONAL RADIOLOGY SERVICES, DIGITAL MAMMOGRAPHY WITH COMPUTER ASSISTED DETECTION, NUCLEAR MEDICINE INCLUDING NUCLEAR CARDIOLOGY AND SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY, POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY, ULTRASOUND INCLUDING VASCULAR AND OBSTETRIC ULTRASOUND, X-RAY AND FLUOROSCOPY. MOREOVER, RPH ALSO HAS TEACHING PROGRAMS IN NURSING, RADIOLOGY, RESPIRATORY THERAPY, LABORATORY SCIENCES, GENERAL SURGERY, FAMILY PRACTICE, INTERNAL MEDICINE, GASTROENTEROLOGY AND CARDIOVASCULAR SPECIALTIES. THESE TEACHING AREAS ARE SUPPORTED BY AN ACTIVE SKILLS LAB AND RESEARCH FOUNDATION. RPH SERVES MOSTLY A RURAL POPULATION OVER A LARGE GEOGRAPHIC AREA FROM SIX COUNTIES COVERING THE TWIN TIER REGIONS OF NEW YORK AND PENNSYLVANIA. THE PRIMARY SERVICE AREA OF RPH FOR THIS REPORT IS DEFINED AS FIVE COUNTIES (BRADFORD, TIOGA AND SULLIVAN IN PENNSYLVANIA AND TIOGA AND CHEMUNG IN NY) FROM WHICH OVER 75% OF THE INPATIENT POPULATION IS DERIVED. THESE FIVE COUNTIES INCLUDE 239,455 PEOPLE (2020 CENSUS), THE MAJORITY OF WHICH ARE WHITE, NON-HISPANIC, AGED 65+. IN THIS GEOGRAPHIC AREA, 40.4% OF INDIVIDUALS AGED 25 PLUS, HAVE AT LEAST A HIGH SCHOOL DIPLOMA, 17.6% HAVE SOME COLLEGE AND 13.0%/8.8% HAVE A BACHELOR'S DEGREE/HIGHER, RESPECTIVELY. FROM 2010 UNTIL 2020 THERE WAS A 4.59% DECREASE IN THE OVERALL POPULATION SERVED BY RPH. FROM 2000-2010, THE POPULATION DECREASED BY 1.01%."