Community Benefit Insight - Tax-exempt hospital

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Armstrong County Memorial Hospital

Armstrong County Memorial

One Nolte Drive
Kittanning, PA 16201

Bed count	154	Medicare provider number	390163	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 250965237

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

8.69%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 382,729 0.29 %
Medicaid as % of operating expenses	$ 6,404,652 4.90 %
Costs of other means-tested government programs as % of operating expenses	$ 170,724 0.13 %
Health professions education as % of operating expenses	$ 82,163 0.06 %
Subsidized health services as % of operating expenses	$ 4,223,921 3.23 %
Research as % of operating expenses	$ 57,495 0.04 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 42,521 0.03 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 10,950 0.01 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 2,622,537 2.00 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 291,102 11.10 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 66323343 including grants of $ 0) (Revenue $ 89831699)
ACMH HOSPITAL PROVIDES OUTPATIENT SERVICES SUCH AS RADIOLOGY, LABORATORY, EMERGENCY VISITS, AMBULATORY SURGERY, AND OTHER VARIOUS SERVICES. DURING THE FISCAL YEAR, TOTAL OUTPATIENT REGISTRATIONS WERE 197,379.

4B (Expenses $ 21116231 including grants of $ 0) (Revenue $ 19965346)
ACMH HOSPITAL PROVIDES INPATIENT SERVICES SUCH AS MEDICAL AND SURGICAL, ACUTE REHAB, SKILLED NURSING, OB/GYN, HOSPITALIST, ICU/CCU, PSYCHIATRIC, MEDICAL WITHDRAW AND NURSERY. ACMH HOSPITAL IS A CERTIFIED PRIMARY STROKE CENTER AND ALSO PERFORMS PERCUTANEOUS CORONARY INTERVENTION TO TREAT NARROWED CORONARY ARTERIES. DURING THE FISCAL YEAR, TOTAL ADMISSIONS WERE 3,489 AND PATIENT DAYS WERE 20,183.

4C (Expenses $ 6508233 including grants of $ 0) (Revenue $ 5975633)
ACMH HOSPITAL PROVIDES RURAL HEALTH CLINICS AT SEVERAL SURROUNDING COMMUNITY LOCATIONS INCLUDING LEECHBURG, ELDERTON, RURAL VALLEY, KITTANNING, WEST HILLS AND NEW BETHLEHEM. TOTAL VISITS FOR ALL PHYSICIAN CLINICS TOTALED 63,034. THE PHYSICIAN CLINICS ALSO OFFER CHARITY CARE UNDER THE SAME POLICY AS ACMH HOSPITAL. TOTAL CHARITY CARE RELATING TO THE PHYSICIAN CLINICS FOR THE CURRENT FISCAL YEAR WAS 1,356. SEE SCHEDULE O FOR MORE INFORMATION.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

SCHEDULE H, PART V, SECTION B, LINE 5
COMMUNITY INPUT: THE COMMUNITY STAKEHOLDERS WHO PARTICIPATED IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT REPRESENTED A CROSS-SECTION OF THE HEALTH AND HUMAN SERVICES AGENCIES IN ARMSTRONG COUNTY. SOME PARTICIPANTS WERE SPECIFICALLY CHOSEN BECAUSE OF THEIR PUBLIC HEALTH KNOWLEDGE AND EXPERIENCE. OTHERS WERE CHOSEN BECAUSE OF THEIR EXPERTISE IN: - CHRONIC HEALTH CONDITIONS IN ARMSTRONG COUNTY - BARRIERS TO HEALTHCARE - KNOWLEDGE OF UNDERSERVED GROUPS OF POPULATION IN ARMSTRONG COUNTY - FORMING ORGANIZATIONAL COLLABORATIONS WITH ACMH HOSPITAL TO MEET HEALTH NEEDS - AN AWARENESS OF THE HEALTH CONCERNS OF THE PEOPLE UTILIZING HEALTHCARE SERVICES - WHERE RESIDENTS OF THE COUNTY ARE GOING FOR HEALTH AND WELLNESS SERVICES - RELIABLE SOURCES OF HEALTH INFORMATION INTERVIEWS WITH THESE STAKEHOLDERS REVEALED CERTAIN BARRIERS TO HEALTH SERVICES AND UNDERSERVED GROUPS OF THE POPULATION IN ARMSTRONG COUNTY WHERE PRIORITY COMMUNITY NEEDS.

SCHEDULE H, PART V, SECTION B, LINE 7A
CHNA URL: HTTPS://WWW.ACMH.ORG/CHNA

SCHEDULE H, PART V, SECTION B, LINE 10A
IMPLEMENTATION STRATEGY URL: HTTPS://WWW.ACMH.ORG/CHNA

SCHEDULE H, PART V, SECTION B, LINE 11
"ADDRESSING IDENTIFIED NEEDS: ACMH IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN OUR MOST RECENT CHNA AS FOLLOWS: 1. NEEDS RELATED TO THE HIGH RATE OF OBESITY IN ARMSTRONG COUNTY. ACMH HAS ALREADY BEGUN TO ADDRESS THIS NEED BY CONTRACTING WITH WILLIAM WHITE, PHD, TO ASSIST IN THE DEVELOPMENT OF A ""CHOOSE HEALTH"" PROGRAM. THE PROGRAM INCLUDES TRAINING ""TRAINERS"" TO HELP MOTIVATE MEMBERS OF THE COMMUNITY TO LOSE WEIGHT, BECOME STRONGER, AND ACHIEVE THEIR LIFE GOALS REGARDLESS OF THEIR AGE AND CO MORBID CONDITIONS. 2. NEEDS RELATED TO SUBSTANCE ABUSE. ACMH HAS ALREADY BEGUN TO ADDRESS THIS NEED BY A. CO-DEVELOPING THE ARMOT PROGRAM TO IDENTIFY SUBSTANCE ABUSE AND GET PATIENTS INTO TREATMENT QUICKLY. (A COLLABORATION WITH THE ARMSTRONG/INDIANA/CLARION DRUG AND ALCOHOL COUNCIL.) B. THE DEVELOPMENT AND CONTINUING SUPPORT FOR THE ARMSTRONG COUNTY VETERANS' TREATMENT COURT. C. THE OPENING OF A FOUR-BED MEDICAL DETOXIFICATION UNIT. D. ACMH'S CONTINUING SUPPORT OF THE DRUGS KILL DREAMS PROGRAM. E. ACMH'S PARTNERSHIP WITH CHILDREN'S HOSPITAL OF PITTSBURGH FOUNDATION TO PARTICIPATE IN THE SMART CHOICES PROGRAM WHICH ADDRESSES SUBSTANCE ABUSE IN CHILDREN AND TEENS. F. A CONTINUATION OF THE DEVELOPMENT OF A PROGRAM FOR DRUG-ADDICTED PREGNANT WOMEN. (THIS WAS STARTED PRE-PANDEMIC, THEN TABLED.) 3. NEEDS RELATED TO MENTAL HEALTH, ACMH HAS BEGUN PLANS TO PROVIDE OUTPATIENT PROVIDER-BASED MENTAL HEALTH SERVICES. 4. NEEDS RELATED TO CHRONIC DISEASE MANAGEMENT AND PREVENTION - ACMH HAS ALREADY BEGUN TO ADDRESS THESE NEEDS THROUGH ACMH'S PARTICIPATION IN THE PENNSYLVANIA RURAL HEALTH MODEL, AND THE DEVELOPMENT OF COMPREHENSIVE TRANSFORMATION PLANS AS WELL IDENTIFIED ACTIONS INCLUSIVE BUT NOT LIMITED TO: A. COLLABORATIVE EFFORTS WITH LOCAL NURSING FACILITIES, B. THE IMPLEMENTATION OF REMOTE-MONITORING SYSTEMS IN PATIENTS' HOMES, C. THE ACMH PARTNERSHIP - ""LIFE ARMSTRONG"" D. THE PROVISION OF DIABETIC PATIENTS TEST KITS TO IDENTIFY FOOT ULCERS BEFORE THEY BECOME BAD ENOUGH TO REQUIRE HOSPITALIZATION. 5. NEEDS RELATED TO UNHEALTHY BEHAVIORS. ACMH WILL LOOK TO ADDRESS THESE NEEDS THROUGH THE ""CHOOSE HEALTH"" PROGRAM. 6. NEEDS RELATED TO PRIMARY CARE PROVIDER SHORTAGES. A. ACMH PLANS TO WORK WITH DUQUESNE UNIVERSITY MEDICAL SCHOOL TO PROVIDE PHYSICIAN ROTATIONS DURING 3RD AND 4TH YEAR MEDICAL SCHOOL AND FUTURE RESIDENCIES IN FAMILY PRACTICE. B. ACMH CONTINUES TO HIRE PHYSICIAN EXTENDERS WHO PROVIDE MANY PRIMARY CARE SERVICES. C. ACMH PLANS TO CONTACT HRSA TO DETERMINE IF ADDITIONAL AREAS IN ARMSTRONG COUNTY ARE NOW ELIGIBLE TO BE CLASSIFIED AS HEALTH PROFESSIONAL SHORTAGE AREAS. 7. NEEDS RELATED TO NURSE AND SOCIAL WORKER SHORTAGES. ACMH IS LOOKING INTO TRAINING ""COMMUNITY EXTENDERS"" -PEOPLE WHO CAN BE TRAINED TO PROVIDE CERTAIN CARE IN LIEU OF A NURSE OR SOCIAL WORKER. 8. NEEDS RELATED TO TRANSPORTATION TO/FROM HEALTHCARE AND WELLNESS SERVICE. ACMH IS WORKING WITH VANTAGE TO MITIGATE THIS NEED. NEEDS NOT BEING ADDRESSED: THE FOLLOWING NEEDS WERE NOT ADDRESSED, DUE TO A LACK OF ABILITY OF ACMH TO AFFECT CHANGE AND A DETERMINATION BY ACMH THAT OTHER COMMUNITY ORGANIZATIONS ARE WORKING TO ALREADY ADDRESS A NEED. 1. DRIVING DEATHS THAT HAD ALCOHOL INVOLVEMENT. THIS IS BEING ADDRESS BY THE STATE POLICE AND BY THE COUNTY THROUGH ITS DUI TASK FORCE. 2. LOW POST-SECONDARY EDUCATION RATE. ACMH DOES NOT HAVE THE ABILITY TO AFFECT CHANGE. 3. LOW FLU VACCINATION RATE AMONG MEDICARE FFS ENROLLEES. ACMH BELIEVES THAT THIS IS AN ABERRATION AS MOST MEDICARE ENROLLEES IN ARMSTRONG COUNTY HAVE MANAGED CARE PLANS SO THE FFS POPULATION IS SMALL AND THOUGHT TO BE TEMPORARY, AS PATIENTS WILL LIKELY MOVE TO A MANAGED CARE PLAN. 4. PREVENTION OF DRUG RELATED DEATHS. THIS IS BEING ADDRESSED BY THE ARMSTRONG/INDIANA/CLARION DRUG AND ALCOHOL COUNCIL, ARC MANOR AND OTHER COUNTY GOVERNMENTAL ORGANIZATIONS. 5. UNEMPLOYMENT. ACMH DOES NOT HAVE THE ABILITY TO AFFECT CHANGE. 6. NEEDS RELATED TO LOW RATES OF COLONOSCOPY AND PROSTATE SCREENINGS. ACMH BELIEVES THAT THIS RATE DECLINE WAS CAUSED BY THE FACT THAT THE AREA LOST ITS GASTROENTEROLOGY PROVIDERS AND WAS EXPERIENCING A SHORTAGE OF UROLOGY PROVIDERS, WHICH HAVE BEEN RESOLVED THROUGH RECENTLY ADDED MEDICAL STAFF."

SCHEDULE H, PART V, SECTION B, LINES 16A-C
FAP, APPLICATION, AND PLS URL: HTTP://ACMH.ORG/BILLING-AND-INSURANCE#FINANCIALASSISTANCE

SCHEDULE H, PART V, SECTION B, LINE 16J
THE FINANCIAL ASSISTANCE POLICY INDICATES: INDIVIDUAL NOTICES INFORMING PATIENTS ABOUT FINANCIAL ASSISTANCE/DISCOUNT WILL BE OFFERED AT THE TIME OF REGISTRATION. SIGNS WILL BE POSTED IN REGISTRATION AREAS OF THE HOSPITAL AND ITS AFFILIATED CLINICS AND PHYSICIAN OFFICES.

Supplemental Information

Schedule H (Form 990) Part VI

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY: THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION ON IRS WORKSHEETS 1 AND 3.

SCHEDULE H, PART I, LINE 7G
SUBSIDIZED HEALTH SERVICES: ARMSTRONG COUNTY MEMORIAL HOSPITAL REPORTS FIVE RHC FACILITIES AS SUBSIDIZED HEALTH SERVICES. WHEN THESE CLINICS WERE ESTABLISHED, THE AREAS IN WHICH THEY ARE LOCATED WERE IN MEDICALLY UNDERSERVED AREAS OR PHYSICIAN SHORTAGE AREAS. ACMH HOSPITAL ALSO REPORTS INPATIENT PSYCH AND SKILLED NURSING UNITS AS SUBSIDIZED HEALTH SERVICES. THE IRS DEFINITION OF A SUBSIDIZED HEALTH SERVICE MEANS CLINICAL SERVICES PROVIDED DESPITE A FINANCIAL LOSS TO THE ORGANIZATION.

SCHEDULE H, PART I, LINE 7, COLUMN F
PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER FORM 990, PART IX, LINE 25.

SCHEDULE H, PART II
COMMUNITY BUILDING ACTIVITIES: THE PRIMARY COMMUNITY BUILDING ACTIVITIES ARE STAFF INVOLVEMENT WITH HEALTHY ARMSTRONG WHICH IS A COLLABORATIVE EFFORT TO IMPROVE THE HEALTH OF FAMILIES AND HELP CHILDREN MAINTAIN A HEALTHY WEIGHT THROUGH IMPROVED NUTRITION AND INCREASED PHYSICAL ACTIVITY. HOSPITAL REPRESENTATIVES ALSO ATTEND CAREER DAYS AT LOCAL SCHOOLS AND PROVIDE TOURS OF THE FACILITY TO EDUCATE STUDENTS ABOUT CAREERS IN HEALTH CARE.

SCHEDULE H, PART III, SECTION A, LINE 2
BAD DEBT EXPENSE: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 014-09 (TOPIC 606). UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.

SCHEDULE H, PART III, SECTION A, LINE 3
BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE: THIS AMOUNT WAS ESTIMATED BY MULTIPLYING THE TOTAL BAD DEBT EXPENSE ON THE AUDITED FINANCIAL STATEMENTS BY THE POVERTY PERCENTAGE FOR ARMSTRONG COUNTY REPORTED ON WWW.CENSUS.GOV.

SCHEDULE H, PART III, SECTION A, LINE 4
BAD DEBT EXPENSE AUDIT FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: PATIENT ACCOUNTS RECEIVABLE REFLECTS THE OUTSTANDING AMOUNT OF CONSIDERATION TO WHICH THE HOSPITAL EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS) AND OTHERS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S RESPONSIBILITY FOR CO-PAYS, COINSURANCE AND DEDUCTIBLES IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED.

SCHEDULE H, PART III, SECTION B, LINE 8
COMMUNITY BENEFIT: SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 5 AND 6.

SCHEDULE H, PART III, SECTION C, LINE 9B
COLLECTION POLICY: PATIENTS RECEIVE CORRESPONDENCE GIVING THEM THE OPPORTUNITY TO CONTACT THE ORGANIZATION TO QUESTION THEIR STATEMENTS AND/OR ESTABLISH PAYMENT ARRANGEMENTS. IF A PATIENT CONTACTS THE ORGANIZATION, IT IS FIRST DETERMINED WHETHER OR NOT THEY MAY BE ELIGIBLE FOR ASSISTANCE THROUGH MEDICAID OR FINANCIAL ASSISTANCE. IF THE PATIENT IS NOT ELIGIBLE FOR ANY OF THE ASSISTANCE LISTED, THEN THE ORGANIZATION WORKS WITH THE PATIENT TO ESTABLISH A PAYMENT PLAN, USUALLY FOR UP TO 12 MONTHS BUT EXTENSION IS ALLOWED FOR EXTENUATING CIRCUMSTANCES. IF AN ACCOUNT IS DETERMINED TO BE UNCOLLECTIBLE AND NO REQUEST FOR ASSISTANCE OR PAYMENT ARRANGEMENTS IS RECEIVED, THE ACCOUNT IS REFERRED TO AN OUTSIDE COLLECTION AGENCY.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT: ACMH REGULARLY USES RELIABLE DATA AVAILABLE ON THE INTERNET TO DETERMINE THE NEEDS OF OUR COMMUNITY. COUNTY HEALTH RANKINGS PULL FROM VARIOUS RELIABLE DATABASES TO PROVIDE INFORMATION ABOUT OUTCOMES, HEALTH FACTORS, ENVIRONMENTAL FACTORS, AND COMMUNITY HEALTH STATUS INDICATORS. WE USE INFORMATION FROM THE DEPARTMENT OF HEALTH REGARDING HEALTH BEHAVIORS. WE ALSO COLLABORATE WITH THE LOCAL SCHOOL DISTRICT AND OTHER COMMUNITY ORGANIZATIONS AND EMPLOYERS TO DETERMINE OUR ROLE IN THE DEVELOPMENT OF HEALTHY FACILITIES, PROGRAMS, AND BEHAVIORS IN ARMSTRONG COUNTY. IN FY2021 ACMH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT AND PUBLISHED THE FINDINGS ON OUR WEBPAGE. THE NEEDS ASSESSMENT TOOK INTO ACCOUNT INFORMATION FROM PRIMARY DATA AS WELL AS SECONDARY DATA.

SCHEDULE H, PART VI, LINE 3
"PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: EACH PATIENT IS ASKED THE QUESTION, ""DO YOU NEED HELP WITH YOUR MEDICAL BILLS?"" AT THE POINT OF REGISTRATION. FOR EVERY PATIENT THAT ANSWERS YES, WE SEND THE PATIENT A COVER LETTER EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAM, AN APPLICATION, AND BASIC GUIDELINES IDENTIFYING INFORMATION NEEDED TO PROCESS THE APPLICATION. ONCE THE PATIENT RECEIVES THE APPLICATION AND COMPLETES THE INFORMATION, THE APPLICATION IS REVIEWED FOR ACCURACY AND POTENTIAL APPROVAL. IF THE PATIENT HAS SUPPLIED ALL THE NECESSARY INFORMATION AND A DECISION IS MADE, AN APPROVED OR DENIED LETTER IS SENT TO THE PATIENT. IF THE PATIENT HAS NOT SUPPLIED ENOUGH INFORMATION TO MAKE A PROPER DECISION, A LETTER DETAILING THE MISSING INFORMATION IS SENT TO THE PATIENT ALONG WITH A FOLLOW UP PHONE CALL. THE APPLICATION IS PRINTED ON THE BACK OF EVERY STATEMENT SENT TO PATIENTS CONCERNING THEIR OUT OF POCKET EXPENSE. WE UTILIZE AN EARLY OUT SELF-PAY VENDOR THAT HAS BEEN TRAINED ON OUR FINANCIAL ASSISTANCE POLICY AND WHEN THEY HAVE CONTACT WITH OUR PATIENTS, THEY ADVISE THEM OF THE PROGRAM AND INITIATE THE APPLICATION PROGRAM WHEN THE PATIENT REQUESTS THEIR ASSISTANCE. THIS VENDOR OFFERS THE FINANCIAL ASSISTANCE APPLICATION ON THEIR WEBSITE LISTED UNDER THE OPTIONS FOR RESOLUTION OF THE OUTSTANDING BALANCE(S). THE HOSPITAL HAS FINANCIAL ASSISTANCE POSTERS PLACED IN STRATEGIC LOCATIONS THROUGHOUT THE FACILITY TO INFORM THEM OF THE PROGRAM OFFERED. WE ARE PARTICIPATING IN HEALTH FAIRS THROUGHOUT THE COUNTY BY ATTENDING AND OFFERING ASSISTANCE WITH THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE."

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION: WE CONSIDER ALL OF ARMSTRONG COUNTY TO BE INCLUDED IN OUR SERVICE AREA AS WE ARE THE ONLY HOSPITAL AND THE ONLY PROVIDER OF EMERGENCY SERVICES. ARMSTRONG COUNTY LIES IN THE RURAL APPALACHIAN REGION AND IS MADE UP OF 45 MINOR CIVIL DIVISIONS. THE MAJORITY OF THESE MUNICIPALITIES ARE DESIGNATED AS EITHER MEDICALLY UNDERSERVED AREAS OR HEALTH PROFESSIONAL SHORTAGE AREAS, OR BOTH, BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES. THERE IS NO PUBLIC TRANSPORTATION SYSTEM FOR MOST OF THE AREA. SOCIOECONOMIC DATA FOR THE REGION SHOWS THAT THE PER CAPITA INCOME OF ARMSTRONG COUNTY IS LOWER THAN THE AVERAGE OF THE UNITED STATES, THE COMMONWEALTH OF PENNSYLVANIA AND THE OVERALL APPALACHIAN REGION. ARMSTRONG COUNTY RESIDENTS ARE OLDER THAN THE AVERAGE RESIDENT OF PENNSYLVANIA AS A WHOLE. A DISPROPORTIONATELY LARGER PERCENTAGE OF OUR POPULATION RESIDES IN RURAL AREAS.

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH: ACMH IS A FOUNDING MEMBER OF THE ARMSTRONG COUNTY COALITION FOR HEALTH AND WELLNESS WHICH EXISTS TO PROMOTE PHYSICAL ACTIVITY AND HEALTHIER FAMILIES THROUGH COMMUNITY DESIGN AND SUPPORT. COALITION MEMBERS CURRENTLY INCLUDE, ELECTED ARMSTRONG COUNTY OFFICIALS, ACMH HOSPITAL PERSONNEL, AND OTHER COMMUNITY LEADERS. THE GOAL OF THE COALITION IS TO REVERSE THREATS TO THE HEALTH AND WELL-BEING OF ARMSTRONG COUNTY CITIZENS WHICH INCLUDE POOR NUTRITION, SEDENTARY LIFESTYLES, AND LIMITED PHYSICAL ACTIVITY BY PROVIDING LEADERSHIP, FUNDING AND TECHNICAL ASSISTANCE IN ORDER TO PROMOTE THE USE OF EXISTING TRAILS AND PARKS, TO OPTIMIZE COMMUNITY DESIGN, TO INCREASE ACCESS TO RECREATIONAL RESOURCES, TO ENHANCE EXISTING FITNESS FACILITIES AND TO PROMOTE EDUCATIONAL PROGRAMS THAT FOCUS ON HEALTHIER LIFESTYLES. ACMH ALSO PARTICIPATES IN HEALTHY ARMSTRONG, A COALITION OF A LARGE NUMBER OF STAKEHOLDERS THAT MEETS MONTHLY TO COMBAT CHILDHOOD OBESITY. HEALTHY ARMSTRONG HAS BEEN AWARDED SEVERAL GRANTS AND HAS ACHIEVED NATIONAL RECOGNITION THROUGH ITS PROGRAM OF USING THE SCHOOL SYSTEM TO PROMOTE INCREASED PHYSICAL ACTIVITY AND NUTRITIONAL EDUCATION. ACMH PARTICIPATES IN ECONOMIC DEVELOPMENT MEETINGS. THE MAJORITY OF BOARD MEMBERS ARE ARMSTRONG COUNTY RESIDENTS AND WERE SELECTED TO REPRESENT THE COMMUNITIES SERVED. ACMH MANAGERS ARE ENCOURAGED TO PARTICIPATE ON THE BOARDS OF OTHER NON-PROFIT HEALTH AND HUMAN SERVICES ORGANIZATIONS. ACMH PROVIDES STRATEGIC PLANNING LEADERSHIP AND FACILITATION TO SMALLER ORGANIZATIONS IN THE COMMUNITY. ACMH WIDELY ADVERTISES ITS FINANCIAL ASSISTANCE/FREE CARE PROGRAMS WHICH ARE INCOME BASED. SINCE ACMH OWNS SEVERAL RURAL HEALTH CLINICS LOCATED IN MEDICALLY UNDERSERVED AREAS IT OFFERS FINANCIAL ASSISTANCE TO LOW INCOME INDIVIDUALS AND FAMILIES FOR ALL TYPES OF HEALTHCARE SERVICES.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM: THE ORGANIZATION IS A MEMBER OF A CONSOLIDATED GROUP, AND THE GROUP'S CONSOLIDATED FINANCIAL STATEMENTS INCLUDE THE ACCOUNTS OF ARMSTRONG COUNTY MEMORIAL HOSPITAL, ARMSCARE, INC., ARMSTRONG HEALTH AND EDUCATION FOUNDATION, ACMH ANESTHESIA SERVICES, ACMH PHYSICIAN SERVICES, GLADE RUN MEDICAL ASSOCIATES INC., AND ARMSTRONG CENTER FOR MEDICINE AND HEALTH, INC. (ACMH, INC.), COLLECTIVELY REFERRED TO AS THE HEALTH SYSTEM. THE HOSPITAL IS A NOT-FOR-PROFIT ENTITY, WHOLLY OWNED BY ACMH, INC. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES IN THE ARMSTRONG COUNTY, PENNSYLVANIA AREA. ACMH, INC. IS A NOT-FOR-PROFIT CORPORATION FORMED TO SUPPORT AND FURTHER THE CHARITABLE ACTIVITIES OF ARMSTRONG COUNTY MEMORIAL HOSPITAL AS WELL AS ANY OTHER SUBSIDIARY ORGANIZATION AND IS THE PARENT ORGANIZATION. ARMSCARE, INC. IS A 95%-OWNED, FOR-PROFIT ENTITY ENGAGED PRINCIPALLY IN THE RENTAL AND SALE OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES. THE FOUNDATION IS A NOT-FOR-PROFIT ENTITY WHOSE PURPOSE IS TO RAISE FUNDS FOR THE BENEFIT OF THE HOSPITAL AND WELLNESS OF THE COMMUNITY. THE HEALTH SYSTEM FORMED ACMH ANESTHESIA SERVICES AND ACMH PHYSICIAN SERVICES IN 2006. THESE ENTITIES WERE ESTABLISHED TO PROVIDE ANESTHESIA AND PHYSICIAN SERVICES TO THE HEALTH SYSTEM. THE HEALTH SYSTEM FORMED GLADE RUN MEDICAL ASSOCIATES, INC. (GLADE RUN) IN 2009, AND IT BEGAN OPERATIONS IN 2010. GLADE RUN IS A NOT-FOR-PROFIT ENTITY ESTABLISHED TO PROVIDE PHYSICIAN SERVICES TO THE HEALTH SYSTEM.

Operating expenses	$ 130,826,186
Total amount spent on community benefits as % of operating expenses	$ 11,375,155 8.69 %