4A (Expenses $ 315587782 including grants of $ 40453255) (Revenue $ 319831317)
BUTLER HEALTHCARE PROVIDERS D/B/A BUTLER MEMORIAL HOSPITAL (BMH) IS AN INDEPENDENT, COMMUNITY-BASED HOSPITAL THAT HAS SERVED BUTLER COUNTY, PA, AND THE SURROUNDING AREA FOR OVER 100 YEARS. BMH EMPLOYS APPROXIMATELY 2,300 PEOPLE. BMH HAS GROWN INTO A REGIONAL REFERRAL CENTER FOR THE AREAS. IT IS THE LARGEST HOSPITAL FACILITY BETWEEN PITTSBURGH AND ERIE. IT IS COMPRISED OF 296 ACUTE CARE BEDS AND A 25 BED SKILLED NURSING FACILITY. BMH SERVES APPROXIMATELY 12,000 ACUTE CARE PATIENTS (ADMISSIONS) AND OVER 350,000 OUTPATIENTS EACH YEAR. BMH MAINTAINS A DEEP COMMITMENT TO ITS COMMUNITY, AS IS DEMONSTRATED THROUGH ITS BROAD SERVICES OFFERING. IT PROVIDES ALL LEVELS OF GENERAL MEDICAL AND SURGICAL CARE, EMERGENCY SERVICES, OBSTETRICS AND GYNECOLOGY SERVICES, A ROBUST PSYCHIATRIC SERVICE, DRUG AND ALCOHOL THROUGH ITS BROAD SERVICES OFFERING. IT PROVIDES ALL LEVELS OF GENERAL MEDICAL AND SURGICAL CARE, EMERGENCY SERVICES, OBSTETRICS AND GYNECOLOGY SERVICES, A ROBUST PSYCHIATRIC SERVICE, DRUG & ALCOHOL TREATMENT, FAMILY SERVICES, PREVENTATIVE & WELLNESS PROGRAMS AND TERTIARY CARDIOVASCULAR CARE. IT ALSO HAS A NETWORK OF APPROXIMATELY 60 CONVENIENT, LOW COST OUTPATIENT SITES THAT ARE LOCATED IN COMMUNITIES THROUGH BUTLER COUNTY AND THE SURROUNDING AREA. A DESCRIPTION OF THE TOP THREE SERVICE LINES FOLLOW. BUTLER MEMORIAL HOSPITAL MEDICAL IMAGING SERVICES PROVIDES THE COMMUNITIES WE SERVE WITH EASY ACCESS TO THE LATEST MEDICAL IMAGING TECHNOLOGIES. BUTLER MEMORIAL HOSPITAL IMAGING SERVICES INCLUDE COMPUTERIZED TOMOGRAPHY (CT), MEDICAL RESONANCE IMAGING (MRI), PET/CT, AND DIGITAL MAMMOGRAPHY. ADDITIONAL IMAGING SERVICE INCLUDE ULTRASOUND (SONOGRAPHY), NUCLEAR MEDICINE, BONE DENSITY TESTING, X-RAYS AND FLUOROSCOPIC STUDIES. BMH'S IMAGING STUDIES ARE INTERPRETED BY ON-SITE BOARD CERTIFIED RADIOLOGISTS TRAINED IN THE FOLLOWING SUBSPECIALTIES; INTERVENTIONAL RADIOLOGY, WOMEN'S IMAGING, MUSCULOSKELETAL IMAGING, BODY IMAGING, NEURORADIOLOGY AND ADVANCED VEIN CARE. BUTLER MEMORIAL HOSPITAL PROVIDED MEDICAL IMAGING SERVICES TO 112,166 PATIENTS. CARDIOLOGY SERVICES AT BUTLER MEMORIAL HOSPITAL PROVIDES ROUTINE CARDIAC CARE, INTERVENTIONAL CARDIOLOGY, ELECTROPHYSIOLOGY OPEN HEART SURGERY AND CARDIAC REHABILITATION. OTHER SERVICE AREAS INCLUDE A DEVICE MANAGEMENT CLINIC, VALVE CLINIC, HEART FAILURE CLINIC AND CHEST PAIN CENTER WITH PCI ACCREDITATION. BUTLER MEMORIAL HOSPITAL LABORATORY HAS STATE-OF-THE ART INSTRUMENTATION COMPLEMENTED BY PROFESSIONAL EXPERTISE IN MICROBIOLOGY, PATHOLOGY, CHEMISTRY, HEMATOLOGY AND CYTOLOGY. OUR LABORATORY PROVIDES BLOOD WORK AND TESTING THROUGHOUT OUR SERVICE AREA, FOR PATIENTS, PHYSICIAN OFFICES AND LONG-TERM CARE FACILITIES AND IS ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLOGISTS (CAP) AND LICENSED BY THE CLINICAL LABORATORY IMPROVEMENT ACT (CLIA). LABORATORY SERVICES VARY BY LOCATION AND COVER ALL OF THE FOLLOWING AREAS: SURGICAL PATHOLOGY, MOLECULAR DIAGNOSTICS, DERMATOPATHOLOGY, CYTOPATHOLOGY, HEMATOPATHOLOGY AND TRANSFUSION MEDICINE. BUTLER MEMORIAL HOSPITAL PROVIDE LABORATORY SERVICE TO OVER 300,000 PATIENTS.

PART V, SECTION B, LINE 5
THERE IS NOT A COUNTY HEALTH DEPARTMENT IN BUTLER COUNTY OR ITS PRIMARY SERVICE AREA. CURRENTLY, PENNSYLVANIA HAS SEVEN COUNTY HEALTH DEPARTMENTS (ALLEGHENY, BUCKS, CHESTER, DELAWARE, ERIE, MONTGOMERY, AND PHILADELPHIA) AND FOUR MUNICIPAL HEALTH DEPARTMENTS (ALLENTOWN, BETHLEHEM, WILKES-BARRE, AND YORK). SEVERAL PUBLIC HEALTH PROFESSIONALS WERE CONSULTED IN THE PROCESS OF THIS COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDING ALLISON ROTH, MHA CANDIDATE (MASTERS IN HEALTH ADMINISTRATION) FROM THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH. SHE WAS A MAJOR CONTRIBUTOR IN DATA COLLECTION AND ANALYSIS. IN JUNE OF 2021, REPRESENTATIVES FROM MANY ORGANIZATIONS WITHIN THE BUTLER COMMUNITY CAME TOGETHER VIA ZOOM (DUE TO COVID RESTRICTIONS) TO DISCUSS THE STRENGTHS AND NEEDS OF THE COMMUNITY. INPUT WAS GATHERED FROM A WIDE RANGE OF INDIVIDUALS AND ORGANIZATIONS THAT REPRESENT THE BROAD INTERESTS OF THE BUTLER REGION; THIS WAS COMPLETED THROUGH A VARIETY OF METHODS INCLUDING INDIVIDUAL ZOOM MEETINGS, GROUP ZOOM MEETINGS, SURVEY MONKEY QUESTIONNAIRES AND PHONE CONVERSATIONS. MULTIPLE MEETINGS WERE HELD TO IDENTIFY THE TOP HEALTH PRIORITIES WITHIN THE PRIMARY SERVICE AREA OF BUTLER COUNTY. BUTLER MEMORIAL HOSPITAL (BMH) COLLECTED HEALTH DATA FROM COUNTY HEALTH RANKINGS, CENTERS FOR DISEASE CONTROL AND PREVENTION, WORLD LIFE EXPECTANCY, PAYS, AND US CENSUS. 529 COMMUNITY MEMBERS COMPLETED ELECTRONIC AND PAPER SURVEYS TO PROVIDE ADDITIONAL DATA AND 36 COMMUNITY STAKEHOLDER SURVEYS WERE ALSO COMPLETED. PARTICIPATING ORGANIZATIONS: . ALLIANCE FOR NON-PROFIT RESOURCES (ANR) - FOOD INSECURE INDIVIDUALS . BUTLER AREA SCHOOL DISTRICT . BUTLER COUNTY CHILDREN'S CENTER- CHILDREN AND LOW-INCOME FAMILIES . BUTLER COUNTY COMMUNITY COLLEGE . BUTLER COUNTY HUMAN SERVICES- AGING, DRUG AND ALCOHOL, CHILDREN & YOUTH, FAIR HOUSING . BUTLER COUNTY PARKS AND RECREATION . BUTLER MEMORIAL HOSPITAL-CARE MANAGEMENT . BUTLER TRANSPORTATION AUTHORITY . CATHOLIC CHARITIES OF BUTLER COUNTY- PEOPLE LIVING IN SHELTERS, HOMELESS OR AT RISK OF BEING HOMELESS, EXPECTANT AND NEW MOTHERS . CENTER FOR COMMUNITY RESOURCES (CCR) - HOMELESS, CHILDREN AND ADULTS WITH MENTAL ILLNESS (INCLUDING SUBSTANCE USE), INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, VETERANS, HIV + INDIVIDUALS . COMMUNITY CARE CONNECTIONS- INFANTS, CHILDREN AND ADULTS WHO HAVE DEVELOPMENTAL DELAYS OR DISABILITIES . COMMUNITY OPTIONS INC.- INDIVIDUALS WITH DISABILITIES . MARS AREA SCHOOL DISTRICT . MEALS ON WHEELS OF BUTLER COUNTY- HOMEBOUND INDIVIDUALS . MONITEAU SCHOOL DISTRICT . NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) -INDIVIDUALS WITH SEVERE MENTAL ILLNESS AND THEIR FAMILIES . VETERANS SERVICES- VETERANS . AC VALLEY SCHOOL DISTRICT . ARC OF BUTLER COUNTY - INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL FOCUS GROUPS MET VIA ZOOM AND DISCUSSED THE DATA COLLECTED FROM ALL THE SOURCES ABOVE. INDIVIDUALS WERE ASKED TO DESCRIBE THE OVERALL HEALTH OF THE REGION. EACH ORGANIZATION WAS ASKED TO IDENTIFY THE TOP THREE HEALTH PRIORITIES FOR THE AREA. THESE ANSWERS WERE ALSO COMPARED AMONGST THE GROUP. THE MAIN THEMES THAT AROSE OUT OF THE FOCUS GROUPS WERE MENTAL/BEHAVIORAL HEALTH, FOOD INSECURITY AND THE ONGOING NEED FOR HEALTH AND NUTRITION EDUCATION AND SUBSTANCE ABUSE AND ADDICTION. OTHER TOP PRIORITY ISSUES IDENTIFIED WERE ACCESS TO CARE, TRANSPORTATION, COVID-19, DIABETES, OBESITY, AND CHILDCARE.

PART V, SECTION B, LINE 11
FUTURE STRATEGIES TO IMPROVE MENTAL HEALTH ISSUES . IMPLEMENT A SYSTEM TO COMMUNICATE TO PARENTS AND STUDENTS OF SCHOOL AND COMMUNITY EVENTS TO INCREASE PARTICIPATION IN EXTRACURRICULAR ACTIVITIES. . DEVELOP SOCIAL NETWORKS FOR CHILDREN TO CONNECT WITH EACH OTHER TO HELP CREATE MEANINGFUL RELATIONSHIPS FOR THOSE WHO DO NOT HAVE THE SOCIAL SKILLS TO DO IT ON THEIR OWN. . DEVELOP BETTER REFERRAL PROCESSES TO ACCESS MENTAL HEALTH SPECIALISTS. WAIT LISTS CAN BE LONG AND IT IS DIFFICULT FOR PEOPLE TO RECEIVE PROPER CARE IN A TIMELY FASHION. . THE BUTLER AREA SCHOOL DISTRICT IS IN THE PROCESS OF HIRING BEHAVIORAL MODIFICATION SPECIALISTS TO HELP CHILDREN DEVELOP AND IMPROVE SOCIAL THEIR SOCIAL SKILLS AND INTERACTIONS. FUTURE STRATEGIES TO IMPROVE SUBSTANCE ABUSE ISSUES . PROVIDE EDUCATION TO PARENTS ON THE SIGNS AND SYMPTOMS OF SUBSTANCE ABUSE. SCHOOLS EDUCATE STUDENTS BUT PARENTS NEED EDUCATION AS WELL. . PROVIDE EASIER ACCESS AND AVAILABILITY TO RECOVERY PROGRAMS. WE NEED TO ADDRESS BARRIERS SUCH AS LACK OF TRANSPORTATION AND ONGOING MENTAL HEALTH ISSUES THAT PREVENT PEOPLE FROM SEEKING HELP. . CONTINUE ONGOING ENGAGEMENT AND COLLABORATION WITH LAW ENFORCEMENT TO HELP INDIVIDUALS OBTAIN THE BASICS LIKE EMPLOYMENT AND A DRIVER'S LICENSE FOR THOSE WHO HAVE A HISTORY OF INCARCERATION. FUTURE STRATEGIES TO IMPROVE HEALTH EDUCATION AND CHRONIC ILLNESS . ENGAGE BUTLER COUNTY FARMS WITH FOOD INSECURE RESIDENTS. THIS PILOT STUDY OF 15 FAMILIES REQUIRED FAMILIES TO BE AT THE 200% FEDERAL POVERTY LINE. THE GOAL OF THIS PROGRAM WAS TO PROVIDE NUTRITION EDUCATION AND HEALTHY MEALS TO FOOD-INSECURE FAMILIES ON A LIMITED BUDGET. A BARRIER IDENTIFIED BY THIS PROGRAM WAS THAT QUALIFIED FAMILIES DID NOT WANT TO IDENTIFY THEMSELVES AS NEEDING ASSISTANCE. . INSTITUTE MORE FARMERS MARKETS IN THE COMMUNITY TO INCREASE ACCESS TO FRESH FRUITS AND VEGETABLES AND PROVIDING HEALTHY RECIPES.

PART V, SECTION B, LINE 16A, 16B, 16C
https://www.butlerhealthsystem.org/patients-visitors/for-patients/financia l-services/charity-care-financial-assistance/

PART I, LINE 7:
THE COSTING METHODOLOGY IS BASED ON THE RATIO OF COST TO CHARGES FROM BUTLER MEMORIAL HOSPITAL'S ACCOUNTING SYSTEM.

PART III, LINE 2:
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $8,531,405.

PART III, LINE 4:
THE FOOTNOTE DESCRIBING THE BAD DEBT EXPENSE CAN BE FOUND ON PAGE 10 OF THE ATTACHED FINANCIAL STATEMENTS.

PART III, LINE 8:
THE COSTING METHODOLOGY IS BASED ON THE RATIO OF COST TO CHARGES FROM BUTLER MEMORIAL HOSPITAL'S ACCOUNTING SYSTEM.

PART III, LINE 9B:
AS PART OF OUR COMMITMENT TO THE HEALTH CARE NEEDS OF OUR COMMUNITY BHM HAS A PROGRAM DESIGNED TO PROVIDE FINANCIAL ASSISTANCE THAT MAY COVER ALL OR PART OF Patient CARE. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS DETERMINED THROUGH AN APPLICATION PROCESS. BMH FOLLOWS THE FEDERAL POVERTY GUIDELINES WHEN DETERMINING THE PATIENT ELIGIBILITY. ONCE THE APPLICATION IS APPROVED, IT WILL BE IN EFFECT FOR SIX MONTHS BEFORE AND AFTER THE APPROVAL DATE. BMH WILL REVIEW ALL ACCOUNTS PRIOR TO PLACEMENT WITH A COLLECTION AGENCY TO SEE IF THE PATIENT IS ELIGIBLE UNDER OUR PRESUMPTIVE CHARITY CARE PROCESS. IF THERE IS NO APPLICATION ON FILE, BHM WILL USE ONE OR MORE OF THE FOLLOWING CRITERIA TO MAKE A DETERMINATION BASED ON: PATIENTS WHO QUALIFY FOR SECTION 8 HOUSING, NO ESTATE, FOOD STAMP ELIGIBILITY, PATIENT IS HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC, OR A LETTER FROM FAMILY OR FRIENDS OF A PATIENT THAT PROVIDE INFORMATION ESTABLISHING THE PATIENT'S INABILITY TO PAY.

PART VI, LINE 2:
WHILE BMH HAS ALWAYS CONSIDERED THE NEEDS OF THE REGION IT SERVES, IT HAS FORMALLY BEEN CONDUCTING COMMUNITY HEALTH ASSESSMENTS FOR OVER 20 YEARS. THESE ASSESSMENTS HAVE ALLOWED THE ORGANIZATION TO APPROPRIATELY ALLOCATE RESOURCES AND DEVELOP SERVICES THAT BEST SUIT THE NEEDS OF BUTLER COUNTY AND SURROUNDING REGIONS. DURING THE CHNA PROCESS IN ATTEMPT TO REACH AS MANY PEOPLE AND DISTINCT POPULATIONS AS POSSIBLE, BMH DISTRIBUTED THE SURVEY USING VARIOUS METHODS. CENSUS DATA SHOWED THAT ONLY 78.5% OF HOUSEHOLDS IN BUTLER CITY (16001) HAD BROADBAND INTERNET, SO PAPER SURVEYS WERE CIRCULATED IN ADDITION TO AN ONLINE VERSION. DUE TO COVID RESTRICTIONS, STAKEHOLDERS AT THE INITIAL ZOOM MEETING WERE GIVEN THE ONLINE SURVEY LINK TO TAKE BACK AND DISTRIBUTE TO THEIR RESPECTIVE POPULATIONS. THEY WERE ALSO ENCOURAGED TO PROMOTE THE ONLINE VERSION OF THE SURVEY AMONGST THEIR ORGANIZATION. THE BUTLER COUNTY COLLABORATIVE FOR FAMILIES (BCF) ALSO DISTRIBUTED THE LINK TO THE ONLINE SURVEY THROUGH THEIR EMAIL LIST. THE BCF IS A MULTI-AGENCY NETWORK THAT COLLABORATES TO PROVIDE SERVICES FOR INDIVIDUALS AND FAMILIES IN BUTLER COUNTY. THE ELECTRONIC VERSION WAS ALSO DISTRIBUTED TO PRIMARY CARE OFFICES IN THE SERVICE AREA. THE EMPLOYEE SURVEY PROMPTED EMPLOYEES WHO LIVE IN BUTLER COUNTY TO TAKE THE GENERAL COMMUNITY SURVEY UPON COMPLETION OF THE EMPLOYEE SPECIFIC QUESTIONNAIRE. BUTLER MEMORIAL HOSPITAL COLLECTED A TOTAL 565 SURVEYS COMPLETED (EITHER ONLINE OR ON PAPER) BY COMMUNITY MEMBERS AND STAKEHOLDERS. THE SURVEY ASKED SEVERAL QUESTIONS REGARDING THE INDIVIDUAL'S HEALTH STATUS AND OTHER FACTORS LINKED TO HEALTH, LIKE DEMOGRAPHICS AND PROXIMITY TO STORES WITH FRESH FRUITS AND VEGETABLES. A SUMMARY OF THE RESULTS FOUND THROUGH THE COMMUNITY SURVEY ARE SHOWN IN OUR RESPONSE FOR VI, LINE 4.

PART VI, LINE 3:
SUPPORTING THOSE IN NEED: BMH CHARITY CARE AND COMMUNITY BENEFIT - BMH PROVIDES FREE CARE TO THOSE PATIENTS WHO HAVE AN OBLIGATION AFTER INSURANCE PAYMENTS, IF ANY. THE AMOUNT OF FREE CARE IS DETERMINED BASED ON THE PATIENT'S INCOME AND FAMILY SIZE. FREE CARE IS PROVIDED TO THOSE WITH INCOMES UP TO 300% OF THE FEDERAL POVERTY GUIDELINE. TO INFORM PATIENTS OF THIS PROGRAM, SIGNS ARE POSTED IN ALL THE REGISTRATION AREAS NOTIFYING THE PUBLIC OF THE AVAILABILITY OF OUR FREE CARE PROGRAM. MORE INFORMATION IS AVAILABLE IN THE PATIENT HANDBOOK AND ON THE SYSTEM WEBSITE WWW.BUTLERHEALTHSYSTEM.ORG UNDER PATIENT & VISITORS TAB THEN SELECT FINANCIAL SERVICES. AT THE TIME OF REGISTRATION, ANY PATIENT IS UNINSURED IS GIVEN A PATIENT NOTICE OF FINANCIAL AID NOTICE. THE NOTICE INSTRUCTS THE PATIENT TO CALL THE PATIENT FINANCIAL ASSISTANCE DEPARTMENT. THE CHARITY CARE APPLICATION IS ALSO ON THE BACK OF OUR PATIENT STATEMENTS.

PART VI, LINE 5:
AS OF MARCH 2021, BUTLER HEALTH SYSTEM PLEDGED ITS PARTICIPATION IN GOOD FOOD, HEALTHY HOSPITALS, A 5-YEAR CDC FUNDED STATEWIDE INITIATIVE TO PROMOTE HEALTH AND WELLNESS IN HEALTH CARE SETTINGS. BUTLER HEALTH SYSTEM IS THE 1ST HEALTH SYSTEM IN SOUTHWESTERN PENNSYLVANIA WITH THIS DESIGNATION. THE GOALS OF THE PROGRAM INCLUDE: . INCREASE OFFERING OF HEALTHIER AND MORE SUSTAINABLE FOOD AND BEVERAGE CHOICES . ELIMINATE INDUSTRIALLY PRODUCED TRANS FATS . DECREASE THE SODIUM CONTENT IN AVAILABLE FOODS . DECREASE THE ADDED SUGAR IN BEVERAGES AND DESSERT OFFERINGS . ALLOW INDIVIDUALS TO MAKE INFORMED CHOICES ABOUT WHAT THEY ARE PURCHASING, SELECTING, AND EATING THROUGH LABELING OF MENU ITEMS . IN OUR FIRST YEAR OF PARTICIPATION, WE RECEIVED THE GOOD FOOD, HEALTHY HOSPITALS BRONZE AWARD AND WE HOPE TO WIN THE SILVER AWARD IN THE NEXT 1-2 YEARS. IN APRIL 2021 THE BUTLER HEALTH SYSTEM OPENED THE FOOD INSTITUTE (FI) ON THE BUTLER CAMPUS. THE MISSION OF THE FI IS TO IMPROVE THE COMMUNITY'S HEALTH BY LINKING PATIENTS TO A MORE NUTRITIOUS LIFESTYLE BY PROVIDING ACCESS TO HEALTHY FOOD OPTIONS AND EMPOWERING LIFESTYLE SELF-MANAGEMENT THROUGH EDUCATION, COACHING, AND CONNECTION TO SERVICES. THE NUTRITION HEALTH LIAISON CONDUCTS NUTRITION COUNSELING DURING THE MONTHLY VISIT, AND PATIENTS HAVE ACCESS TO LIVE AND VIDEO FOOD PREPARATIONS AND HEALTHY RECIPES. AS OF MARCH 31, 2023 WE HAVE HAD 750 REFERRALS WITH A 61% PARTICIPATION RATE. DATA AND CLIENT TESTIMONIALS ARE REVEALING DECREASES IN WEIGHT, BODY MASS INDEX AND BLOOD PRESSURES AND IMPROVED GLUCOSE CONTROL. PATIENTS ARE ALSO CONNECTED TO OTHER COMMUNITY SERVICES AS DETERMINED BY THE SOCIAL DETERMINANTS OF HEALTH QUESTIONNAIRE UPON INTAKE AT THE FI. THE BHS DIETARY DEPARTMENT OBTAINS THE FOOD PROVIDED FOR THE PROGRAM THROUGH A COMPETITIVE PRICING PROCESS. ORDERS ARE PLACED TWICE WEEKLY TO KEEP FOOD FRESH, REDUCE WASTE, AND LIMIT THE POTENTIAL FOR FOOD OUTAGES. THE FI IS A FREE SERVICE PROVIDED TO OUR PATIENTS IN LINE WITH OUR MISSION TO BE A HEALING PRESENCE IN THE COMMUNITY. THE BHS HAS MADE A SIGNIFICANT FINANCIAL INVESTMENT IN DEVELOPING THE FOOD INSTITUTE. THIS INVESTMENT INCLUDES PHYSICAL SPACE, REFRIGERATION, FURNITURE, UTENSILS, DIETARY PERSONNEL, A FULL-TIME NUTRITION HEALTH LIAISON AND A FOOD INSTITUTE TECH. BHS ADMINISTRATION IS COMMITTED TO THE PROGRAM'S SUCCESS AND CONTINUES TO SEEK ADDITIONAL SUPPORT THROUGH GRANTS, MONETARY DONATIONS, AND IN-KIND DONATIONS. AFTER RECEIVING A HRSA GRANT, A SECOND FI WAS OPENED AT THE BHS -CLARION CAMPUS IN NOVEMBER 2022. BMH ALSO PROVIDES EVIDENCE-BASED LIFESTYLE COACHING EDUCATIONAL SEMINARS. THE RESEARCH-BASED APPROACHES INCLUDE VOLUMETRIC WEIGHT MANAGEMENT, DIABETES LIFESTYLE COACHING, DIETARY APPROACHES TO STOP HYPERTENSION (DASH), HEART-HEALTHY EATING LIFESTYLE, THE MEDITERRANEAN LIFESTYLE, AND PLANT-BASED EATING. LIFESTYLE COACHING TO ADDRESS SELF-CARE WAS CREATED DURING COVID-19 TO ADDRESS THE FOUR PILLARS OF HEALTH - EATING RIGHT, MOVE MORE, STRESS LESS, AND SLEEP WELL. THIS FOUNDATION OF HEALTH IS VITAL TO EMOTIONAL AND PHYSICAL WELL-BEING AND HAS BEEN INCORPORATED INTO OTHER ACTIVITIES. THE CLASSES ARE OFFERED VIRTUALLY, IN PERSON AND NOW VIDEO ON DEMAND. THIS VARIETY IN EDUCATIONAL TEACHING TOOLS HAS HELPED EXPAND THE OUTREACH TO INCLUDE SURROUNDING COUNTIES. IN 2022 WE AGAIN PROVIDED OVER 1,100 EDUCATION HOURS TO OUR COMMUNITIES. THROUGH THE COMMUNITY NEEDS ASSESSMENT AND DIRECT FEEDBACK FROM BHS STAFF, TRANSPORTATION TO/FROM CLINICAL SERVICES WAS IDENTIFIED AS A BARRIER FOR ACCESS TO HEALTHCARE. EACH YEAR BHS TRANSPORTS PATIENTS FROM RURAL AREAS AROUND THE REGION. THE BHS FOUNDATION CONTINUES TO RAISE DOLLARS FOR THE MUCH NEEDED TRANSPORTATION FUND TO SUPPORT THIS VITAL NEED. IN AUGUST 2022 A FUNDRAISING EVENT YIELDED $100,000 FOR THE SPECIFIC PURPOSE TRANSPORTATION FUND. BHS IS COMMITTED TO THE PROGRAM'S SUCCESS AND CONTINUES TO SEEK ADDITIONAL SUPPORT THROUGH GRANTS, MONETARY DONATIONS, AND IN-KIND DONATIONS IT IS IMPORTANT TO NOTE THAT THE COVID-19 PANDEMIC CREATED AN INCREASED AWARENESS OF SOCIAL DETERMINANTS OF HEALTH AND THE NEED FOR COMMUNITY-INTEGRATED CARE. IN JANUARY, 2021, THE HEALTH SYSTEM DEVELOPED A NEW POSITION OF CHIEF COMMUNITY HEALTH OFFICER TO FOCUS ON INITIATIVES SPECIFIC TO SOCIAL DETERMINANTS OF HEALTH. THE FOLLOWING IS A LIST OF SOME OF THE ONGOING AND NEWLY DEVELOPED PROGRAMS: 1. HEALTH AND WELLNESS EDUCATIONAL OPPORTUNITIES A. DEVELOP AND IMPLEMENT EDUCATIONAL TEAMS FOR COMMUNITY SUPPORT . HEART HEALTHY DIET SEMINARS - MEDITERRANEAN, DASH, PLANT-BASED, FLEXITARIAN, HEART HEALTHY LIFESTYLES - BHS LIFESTYLE COACHING CLASSES . DIABETES LIFESTYLE COACHING 4 WEEK SERIES - BHS ENDOCRINOLOGY PARTNERSHIP WITH LIFESTYLE COACHING . BRAIN HEALTH SEMINARS - BHS STROKE CENTER . ONGOING VOLUMETRIC WEIGHT MANAGEMENT PROGRAM - BHS LIFESTYLE COACHING . SELF-CARE - BHS EMPLOYEE ASSISTANCE PROGRAM . MENU PLANNING - BHS FOOD INSTITUTE STAFF . LONGEVITY LESSONS - BHS LIFESTYLE COACHING B. ADVANCE LIFESTYLE MEDICINE INITIATIVES TO SUPPORT COMMUNITY NEEDS . ALL CLASSES PIVOTED TO VIRTUAL TO ADDRESS LIFESTYLE EDUCATION NEEDS DURING COVID RESTRICTION. CLASSES ARE BEGINNING TO RESUME IN PERSON AND WE HAVE DEVELOPED A VIDEO ON DEMAND PLATFORM. . WEIGHT MANAGEMENT PROGRAM: CHANGED TO ONGOING PROGRAM INSTEAD OF A 4 WEEK PROGRAM AS EVIDENCE BASED GUIDELINES RECOMMEND AT LEAST 6 MONTHS OF INTERVENTION TO ALLOW BEHAVIOR CHANGE . ADDED SELF-CARE SERIES TO ADDRESS STRESSORS ASSOCIATED WITH COVID AND ITS AFTERMATH . UPDATED DIABETES SERIES TO REFLECT ASSOCIATION OF DIABETES CARE & EDUCATION SPECIALISTS (ACDES) CURRICULUM ADCES7 SELF-CARE BEHAVIORS FOR PEOPLE WITH DIABETES . VIDEO SERIES ON LIFESTYLE COACHING SEMINARS AND CLASSES ADVERTISED ON SOCIAL MEDIA, IN PHYSICIAN OFFICES PATIENT POINT, AND LIFESTYLE COACHING WEBSITE . ADVERTISE 6 MONTH LIFESTYLE COACHING FLYER TO COMMUNITY ON SOCIAL MEDIA C. GROW EDUCATIONAL OUTREACH THROUGH PARTNERSHIPS WITHIN THE COMMUNITY . LOCAL RADIO INTERVIEWS AND NEWSPAPER ARTICLES . OUTREACH TO ALL SURROUNDING COUNTIES INCLUDING CLARION, ARMSTRONG, INDIANA AND VENANGO D. COLLABORATE WITH PAYERS TO BRING HEALTHY INITIATIVES INTO THE COMMUNITY 2. PHYSICIAN ACCESS A. GROW AND EXPAND BHS CARE CENTER TO ENHANCE ACCESS TO CARE . TRANSITIONED ALMOST ALL OF PRIMARY CARE AND ALL OF SPECIALTY CARE TO THE BHS CARE CENTER . PROVIDE UNDISTURBED, PATIENT FOCUSED, AND TIMELY RESPONSES TO PATIENT CALLS . PROVIDE ACCESS TO CLINICAL SUPPORT, MESSAGING PROVIDERS, REQUESTING REFILLS, AND SCHEDULING APPOINTMENTS DURING EXPANDED HOURS EVEN WITH THE PRACTICE IS CLOSED . PROVIDED INSIGHT TO PRACTICE PROVIDERS AND LEADERSHIP TO INCREASE PATIENT ACCESS BY ADDING AVAILABILITY TO THEIR SCHEDULES . BUILD THE PATIENT PORTAL SUPPORT TEAM TO ASSIST PATIENTS IN PROVIDING IMMEDIATE ACCESS TO MESSAGE THEIR PROVIDERS AND REQUEST APPOINTMENTS OUTSIDE OF BUSINESS HOURS . PROVIDED A ONE CALL NUMBER 833-602-CARE TO LOCATE A PROVIDER, PCP OR SPECIALIST THAT MEETS THE PATIENTS' NEEDS BOTH CLINICALLY AND GEOGRAPHICALLY. B. DEVELOP CARE PLANS TO SUPPORT CARE ACROSS THE CONTINUUM . CARE PLANS FOR HEART FAILURE AND COPD WERE COMPLETED AND USED BY OUR CARE TRANSITION COORDINATOR AND AMBULATORY CARE MANAGERS. THESE HAVE BEEN APPROVED AND WILL BE IMPLEMENTED AT CLARION HOSPITAL. A CARE TRANSITION COORDINATOR POSITION WAS ADDED AT CLARION TO WORK WITH COPD PATIENTS WITHIN THE PENNSYLVANIA RURAL HEALTH MODEL (PARHM) GOALS . DEVELOPED A TEAM OF PHYSICIANS, CASE MANAGERS, CARE MANAGERS AND CARE CENTER STAFF TO DEVELOP A PATHWAY FOR PNEUMONIA C. SUPPORT TEAM-BASED CARE INITIATIVES: . DEVELOPED PROCESSES WITH CARE CENTER TEAM TO ASSIST PATIENTS SEARCHING FOR PRIMARY CARE PROVIDERS . WORK IN PROCESS: . STANDARDIZE WORKFLOWS . PROVIDER SCHEDULING TEMPLATES . ANALYZE DATA TO DRIVE OPPORTUNITIES (REDUCE OUTMIGRATION) . PATIENT AND PROVIDER ENGAGEMENT WITH TELEHEALTH/VIDEO VISITS . HIGH RISK DISCHARGE PROJECT - MULTI-DISCIPLINARY TEAM DEVELOPED DISCHARGE PROCESS FOR HIGH RISK PATIENTS, CARE COORDINATION, REDUCE READMISSIONS . WORK IN PROGRESS: USE OF TEAM BASED CARE MODEL FOR OTHER HIGH RISK DIAGNOSES TO REDUCE READMISSIONS 3. SUBSTANCE USE DISORDER EFFORTS A. BMH SUPPORTS DRUG AND ALCOHOL (D&A) PROFESSIONALS BY: . REFORMULATED STAFFING MODELS TO MEET ASAM CRITERIA. (AMERICAN SOCIETY OF ADDICTION MEDICINE . PROVIDED EQUIPMENT AND IT SUPPORT TO CONVERT SERVICES TO TELEHEALTH DURING THE COVID PANDEMIC B. EXPAND COMMUNITY OUTREACH: . BMH AND THE D&A LEADERSHIP MEET QUARTERLY WITH COUNTY OFFICIALS TO DISCUSS NEW TREATMENT NEEDS, BARRIERS WITH CURRENT TREATMENT OPTIONS, AND WAYS TO COMMUNICATE SERVICES TO THE PUBLIC . PARTICIPATION IN RECOVERY EVENTS THROUGHOUT THE YEAR SPONSORED BY VARIOUS HUMAN SERVICE AGENCIES . DISCUSS ADDICTION AND TREATMENT OPTIONS ON LOCAL RADIO (WISR) . PARTICIPATED IN A PUBLIC SERVICE ANNOUNCEMENT WITH KNOCH HIGH SCHOOL TO EDUCATE THE PUBLIC ON THE DANGERS OF SUBSTANCE USE . PARTICIPATED IN THE YEARLY OCTOBER RECOVERY INFORMATION INSERT IN THE BUTLER EAGL

PART VI, LINE 6:
BUTLER HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF BUTLER HEALTHCARE PROVIDERS.

PART VI, LINE 4:
THE PRIMARY SERVICE AREA FOR BMH WAS IDENTIFIED AS BUTLER COUNTY, PENNSYLVANIA. A MAJORITY OF PATIENTS AND VISITS ORIGINATE FROM BUTLER CITY (16001 ZIP CODE). AS SUCH BHS HAS PLACED SEVERAL SERVICE LOCATIONS WITHIN THIS AREA TO MEET THE DEMAND OF THE PRIMARY LOCATION. THE INDIVIDUALS THAT COME FROM SURROUNDING COUNTIES TO RECEIVE MORE ADVANCED SERVICES INCLUDE: ARMSTRONG, WESTMORELAND, CLARION, BEAVER, LAWRENCE, MERCER, VENANGO, AND ALLEGHENY. FOR THE PURPOSE OF SECONDARY DATA COLLECTION, CLARION COUNTY WAS DETERMINED TO BE THE COMMUNITY SERVED. APPROXIMATELY 80% OF THE HOSPITAL'S RESIDENTS RESIDE WITHIN THE COUNTY. BELOW IS A TABLE SUMMARIZING THE COUNTY POPULATION DATA COMPARED TO DATA SPECIFIC TO THE STATE OF PENNSYLVANIA Butler County Pennsylvania 2021 Population Estimate 194,273 12,964,056 Population Percent Change: April 2020-July 2021 .3% -0.3% Median Age (2019) 43.3 years 40.8 years Percent under 18 19.7% 20.6% Percent 65 years and older 19.4% 18.7% Race and Origin White alone, not Hispanic or Latino, Percent 95.8% 81.6% Black or African American, Percent 1.4% 12% American Indian & Alaskan Native alone, Percent 0.2% 0.4% Asian alone, Percent 1.5% 3.8% Hispanic or Latino, Percent 1.6% 7.8% Two or More Races, Percent 1.2% 2.1% Veterans (2016-2020) 12,838 731,411 Education High School Graduate or Higher 95.4% 91.0% Bachelor's Degree or Higher 37.5% 32.3% Median Household Income $72,642 $63,627 Per Capital Income in Past 12 Months $39,906 $35,518 Persons in Poverty, Percent 7.4% 10.9% Percent with a Disability under age 65, 2016-2020 8.5% 9.8% Persons without Health Insurance under age 65, Percent 4.8% 7.0% Table: Butler County Demographics (https://www.census.gov/quickfacts/fact/table/PA,butlercountypennsylvania/ BZA210219) WITHIN THE COUNTY, THERE IS SIGNIFICANT VARIABILITY AMONGST MANY OF THE SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH DEPENDING ON THE LOCATION IN THE COUNTY BECAUSE OF THE LARGE GEOGRAPHIC AREA BUTLER COUNTY ENCOMPASSES. A RECURRING THEME AMONG COMMUNITY STAKEHOLDERS WAS THE ACCESS AND RESOURCES IN THE SOUTHERN PART OF THE COUNTY DIFFERS WITHIN THE COUNTY FROM THE CENTRAL AND NORTHERN AREAS. BECAUSE OF THESE DIFFERENCES, IT SHOULD BE REMEMBERED THAT COUNTY LEVEL DATA ON HEALTH RELATED ISSUES MIGHT BE TILTED TOWARDS THE AFFLUENCE OF THE SOUTH. THE TABLE BELOW SHOWS A SELECT NUMBER OF DISPARITIES THAT EXIST WITHIN THE PRIMARY SERVICE AREA OF BMH. THESE AREAS INCLUDE: ADAMS TOWNSHIP, CRANBERRY TOWNSHIP, BUTLER CITY, AND CENTER TOWNSHIP. BUTLER CITY IS THE IMMEDIATE AREA SURROUNDING BMH, AND CENTER TOWNSHIP IS IN NORTHERN BUTLER COUNTY. ADAMS CRANBERRY BUTLER CENTER TOWNSHIP TOWNSHIP CITY TOWNSHIP (16046) (16066) (16001) (16061) HIGH SCHOOL GRADUATE OR HIGHER, PERCENT 98.8% 97.3% 91.0% 96.8% BACHELOR'S DEGREE OR HIGHER 66.2% 62.0% 22.7% 36.1% MEDIAN HOUSEHOLD INCOME, 2016-2020 $124,982 $108,160 $32,746 $76,100 PER CAPITA INCOME PAST 12 MONTHS, 2016-2020 $69,935 $53,744 $22,127 $42,109 PERSONS IN POVERTY, PERCENT 3.6% 3.1% 24.2% 4.1% PERCENT WITH A DISABILITY, UNDER AGE 65, 2016-2020 3.8% 4.7% 20.4% 10.8% PERSONS WITHOUT HEALTH INSURANCE .8% 2.2% 6.1% 2.6% HOUSEHOLDS WITH BROADBAND INTERNET SUBSCRIPTION, 2016-2020 93.3% 94.9% 78.5% 85.3% (HTTPS://WWW.CENSUS.GOV/QUICKFACTS/FACT/TABLE/ADAMSTOWNSHIPBUTLERCOUNTYPEN NSYLVANIA, CRANBERRYTOWNSHIPBUTLERCOUNTYPENNSYLVANIA, BUTLERCITYPENNSYLVANIA,CENTERTOWNSHIPBUTLERCOUNTYPENNSYLVANIA/BZA210219) LOOKING AT DATA AT THE COUNTY LEVEL, THERE IS A SIGNIFICANT PORTION OF OUR SERVICE POPULATION BEING UNDER-REPRESENTED. THERE ARE DRAMATIC DIFFERENCES IN FACTORS LIKE INCOME, EDUCATION, AND DISABILITY ACROSS THE COUNTY CREATING A DIFFERENT PICTURE OF HEALTH AND THE HEALTH NEEDS OF DEFINED SUBPOPULATIONS WITHIN THE COUNTY.