4A (Expenses $ 130251311 including grants of $ 0) (Revenue $ 164057306)
IRMC CONTINUES TO BE A RESOURCE TO THE COMMUNITY PROVIDING FREE HEALTHCARE RELATED EVENTS PROMOTING EDUCATION, SCREENING PROGRAMS AND FIRST AID SERVICE. THE INSTITUTE FOR HEALTHY LIVING AT IRMC OFFERS HEALTH SERVICES AND EDUCATIONAL PROGRAMS AT NO CHARGE SUCH AS: 3 SIGN OF HEART DISEASE TO NEVER IGNOREABI SCREENINGAGONY OF DE'FEETBLOOD PRESSURE CLINICBONE DENSITY SCREENINGBOTHERED BY BUNIONS EVENTCONTINUED ON SCHEDULE O.BREAST HEALTH EVENT DR. CLARK VIRTUAL EVENTCHEERS TO YOUR HEARTCHOLESTEROL SCREENINGCOLORECTAL EDUCATION SEMINARCOMMUNITY HEALTH COACHINGDIABETES EDUCATIONDR. QURESHI SKIN CARE SEMINARDR. TRALE KNEE PAIN EVENTDR. SCHOLL - VIRTUAL CHRONIC PAIN EVENTFIT NOT FADFARMERS MARKET TABLEFREE S&T WELLNESS GYM MEMBERSHIPSGET YOUR REAR IN GEAR COLORECTAL WALKGINGERBREAD MAN SPORTS NUTRITION GIRLS NIGHT OUTGROCERS FIGHT CANCERGROCERY STORE TOURHC SOCIAL EMOTION LEARNING DAYHEART BREAK IN A BOTTLE - PRESCRIPTION DRUG ABUSE HEART HEALTH EDUCATION AND PILATES - DR. LINTON FRAZIERHEART HEALTH EXPOHERNIA SCREENINGIMPERFECT HEART SEMINARINDIANA CHAMBER OF COMMERCE WOMEN'S SUMMITINDIANA COUNTY FAIRIUP HEALTH FAIRLISTEN TO YOUR HEART - HEART HEALTH SCREENINGMEET THE CRAMERSMENTAL NOTES - MENTAL HEALTH SEMINARPARKINSON SUPPORT GROUP EDUCATIONPELVIC FLOOR SEMINARPROSTATE SCREENINGSENIOR EXPOSMOKING CESSATION PROGRAMSTROKE EDUCATION EVENTTORRANCE HEALTH FAIRTOUCHDOWN FOR HEALTH ORTHOPEDIC EDUCATIONUNTIL THERE'S A CURE - WOMEN'S CANCER EDUCATIONWALK WITH THE DOCSWOMEN'S HEALTH EDUCATION ZOOMYOU ARE THE ONE IN 2021 HEALTH EDUCATION SERIESPREVENTIVE HEALTH SERVICES, GENERAL/OTHER: M. DORCAS CLARK WOMEN'S IMAGING CENTER: THE WOMEN'S IMAGING CENTER AND THEIR STAFF HAVE PARTICIPATED IN NUMEROUS COMMUNITY EVENTS PROVIDING INFORMATION ABOUT THE IMPORTANCE OF BREAST HEALTH. BIRDIE'S CLOSET, A PROJECT DESIGNED TO HELP WOMEN COPE WITH APPEARANCE-RELATED SIDE-EFFECTS OF CANCER TREATMENT, WAS OPENED IN THE WOMEN'S IMAGING CENTER.

INDIANA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 5: IN THE FALL OF 2020, INDIANA REGIONAL MEDICAL CENTER (IRMC) AND PUNXSUTAWNEY AREA HOSPITAL (PAH) FORMALIZED A COLLABORATION UNDER ONE GOVERNING BOARD OF DIRECTORS CALLED THE PENNSYLVANIA MOUNTAINS CARE NETWORK (PMCN). THIS COLLABORATION HELPS TO SUSTAIN A HIGH LEVEL OF PATIENT CARE RESIDENTS ALREADY RECEIVE IN BOTH INDIANA AND JEFFERSON COUNTY.THE HOSPITAL WORKED WITH A CONSULTING FIRM, STRATEGY SOLUTIONS, INC. (SSI). THE PROCESS WAS LED BY THE VP OF PROFESSIONAL AND CORPORATE SERVICES. THE 2021 IRMC AND PAH CHNA WAS CONDUCTED TO IDENTIFY PRIMARY HEALTH ISSUES, CURRENT HEALTH STATUS AND NEEDS TO PROVIDE CRITICAL INFORMATION TO THOSE IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. THE RESULTS ENABLE COMMUNITY MEMBERS TO MORE STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS, AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF PEOPLE LIVING IN THE COMMUNITY.IRMC IDENTIFIED COMMUNITY HEALTH NEEDS THROUGH A COLLABORATIVE PROCESS WITH PENNSYLVANIA MOUNTAIN HEALTH CARE NETWORK (PMCN) HOSPITALS. BUILDING PAST INITIATIVES, THE FY2021 PROCESS INCLUDED A COMPREHENSIVE SURVEY PROCESS, A IRMC CHNA TEAM PRIORITIZATION EXERCISE TO DETERMINE PRIORITIES AND ASSESSMENT OF PAST SUCCESSES AND FAILURES. AS THE CHNA LEVERAGED AND UTILIZED THE HOSPITAL'S PLANNING STAFF, A MULTI-PART PROCESS WAS EMPLOYED TO DEVELOP THIS IMPLEMENTATION STRATEGY AND COMMUNITY BENEFIT PLAN, INCLUDING THE FOLLOWING:- QUANTITATIVE DATA REVIEW AND ANALYSIS:- LITERATURE REVIEWS TO IDENTITY STATE AND NATIONAL BENCHMARKS, AND EVIDENCE BASED STRATEGIES THAT RELATED TO THE INDICATORS/METRICS MEASURED THROUGH THE QUANTITATIVE DATA SOURCES- QUALITATIVE DATA PROVIDED THROUGH THE SURVEY PROCESS AND DIALOGUES WITH COMMUNITY AND HEALTHCARE LEADERS IN THE REGION. THE CHNA UTILIZATIONS OF MULTIPLE TYPES OF RESEARCH ALLOWED FOR DATA COLLECTION ACROSS A BROAD RANGE OF INDICATORS RELATED TO OVERALL POPULATION HEALTH, SOCIAL DETERMINANTS OF HEALTH INCLUDED GEOGRAPHIC LOCATION DIFFERENCES IN HEALTH OUTCOMES AND THE NEEDS OF DISADVANTAGED POPULATIONS INCLUDING UNINSURED PERSON, LOW INCOME PERSONS AND MINORITY GROUPS WITHIN THE REGION. THE PENNSYLVANIA MOUNTAIN HEALTH CARE NETWORK HOSPITALS ARE COMMITTED TO SERVING PATIENTS IN THE REGION AND ARE USING SOUND AVAILABLE DATA TO GUIDE THE PLANNING PROCESS. IN ADDITION TO DATA COLLECTION AND RESEARCH, THE IRMC CHNA TEAM CONDUCTED A COMPREHENSIVE ONLINE SURVEY TO ASSESS THE NEEDS OF THE COMMUNITY AND IDENTIFY HEALTH PRIORITIES AT THE LOCAL LEVEL.IN ADDITION TO THE ASSESSMENT IRMC CHNA ALSO REVIEWED ITS EXISTING COMMUNITY BENEFIT ACTIVITIES- BOTH INTERNALLY AND IN CONJUNCTION WITH ITS PMCN PARTNERS TO ASSESS WHETHER THESE SERVICES WERE PROVIDING VALUE CONSISTENT WITH THE NEEDS OF THE COMMUNITY AND ITS RESIDENTS. SPECIFICALLY, THESE CONSIDERED KEY HEALTH FACTORS AND OUTCOMES RESULTANT FROM ASSOCIATED DEMOGRAPHIC, SOCIAL AND ECONOMIC IMPACTS, THE PHYSICAL ENVIRONMENT, HEALTHCARE ACCESS AND RESOURCE COORDINATION AND BEHAVIORAL TRENDS. BASICALLY CONNECTING THE REGIONS NEEDS TO THAT OF STATE AND NATION. WITH HEALTHY PEOPLE 2020, AND THE CMS STRATEGY CONNECTED TO THE PENNSYLVANIA DEPARTMENT OF HEALTH PRIORITIES, THIS CHNA IS CONNECTED TO EVIDENCE AND DATA BASED PRIORITIES.

INDIANA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 6A: THE COMMUNITY NEEDS ASSESSMENT SERVED INDIANA REGIONAL MEDICAL CENTER AND PUNXSUTAWNEY AREA HOSPITAL.

INDIANA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 11: DURING JULY AND AUGUST 2022 AND THEN OCTOBER 2022, IRMC CONDUCTED AN EVALUATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION STRATEGIES THAT HAVE BEEN UNDERWAY OVER THE FIRST YEAR OF THE IMPLEMENTATION PLAN (JULY 1, 2021, THROUGH JUNE 2022). THE EVALUATION PROCESS INCLUDED SUBMISSION AND REVIEW OF THE OUTCOMES AND IMPACT DATA THAT WAS TRACKED AND REPORTED DURING THE LAST FISCAL YEAR.GOAL 1: IMPROVE HEALTH STATUS BY INCREASING PARTICIPATION IN EDUCATION AND WELLNESS, FOCUSING ON OVERWEIGHT/OBESITY IRMC HAS CONTINUED TO OFFER OUR WELLNESS PROGRAM TO EMPLOYEES AND COMMUNITY PARTNERS - 1,327 PARTICIPANTS THIS YEAR - 833.6 TOTAL POUNDS LOST BY PROGRAM PARTICIPANTS, WITH AN AVERAGE WEIGHT LOSS OF 6.4 POUNDS - OFFERED 25 NUTRITIONAL CHALLENGES WITH 700 PARTICIPANTS, OF WHICH 75 COMPLETED THE CHALLENGE (10.7%)- PROVIDED 245 HEALTH COACHING SESSIONS AND HAD 15 EDUCATIONAL ENCOUNTERS IRMC HAS CONTINUED TO PROMOTE HEALTH AND WELLNESS TO THE COMMUNITY AT-LARGE - 901 PARTICIPANTS IN CORPORATE BEWELL PROGRAM - 15,179 VISITS TO S&T WELLNESS CENTER WITH 1,264 VISITS ON AVERAGE PER MONTH - PROVIDED MEDICAL NUTRITION THERAPY TO 891 PARTICIPANTS WHO LOST A TOTAL OF 25 POUNDS - PROVIDED SERVICES THROUGH THE BARIATRIC CENTER 323 NEW PATIENTS OF WHICH 55 WERE SURGICALFOLLOWED UP WITH 255 PATIENTS PERFORMED 8 BARIATRIC PROCEDURES SURGICAL PATIENTS LOST A TOTAL OF 161.3 POUNDS - OFFERED 23 EDUCATIONAL SESSIONS WITH A TOTAL OF 299 PARTICIPANTS - CONTINUED LEAN WEIGHT MANAGEMENT PROGRAM ONLINE WITH 34 PARTICIPANTS, WITH AVERAGE WEIGHT LOSS OF 11.7 POUNDSGOAL 2: INCREASE ACCESS TO MENTAL HEALTH SERVICES AND SUPPORTS IRMC SERVED A COMMUNITY NEED BY IMPLEMENTING A BH OUTREACH PROGRAM TO CONNECT EMERGENCY DEPARTMENT BH PATIENTS WITH OUTPATIENT - AMBULATORY SOCIAL WORKERS MADE 1,088 REFERRALS - AMBULATORY SOCIAL WORKERS CONNECTED WITH 158 PATIENTS - SPOKE WITH 55 BH PATIENTS POST-DISCHARGE - THE EMERGENCY DEPARTMENT HAD 1,209 BH RELATED VISITS (68% WERE FROM INDIANA COUNTY), WITH AVERAGE WAIT TIME TO TRANSFER TO MENTAL HEALTH FACILITY OF 14.86 HOURS IRMC CONTINUES TO PROVIDE EDUCATION AND OUTREACH - PARTICIPATED IN MENTAL HEALTH AWARENESS MONTH, HAD A TABLE OF RESOURCES AVAILABLE AT IRMC PARK AND ENGAGED IN CONVERSATIONS WITH COMMUNITY MEMBERS - IRMC IS AN ACTIVE MEMBER OF THE SUICIDE TASKFORCE AND INTERVENTION SUBCOMMITTEE IRMC MADE ONLINE RESOURCES AVAILABLE THROUGH THE HOSPITAL'S WEBPAGE AND ADDED LINKS TO OUTSIDE RESOURCESGOAL 3: DECREASE DRUG AND ALCOHOL USE IN INDIANA COUNTY BY CONTINUING TO COLLABORATE WITH THE ARMSTRONG-INDIANA-CLARION DRUG & ALCOHOL COMMISSION AND ARMOT ON PREVENTION, EDUCATION, INTERVENTION AND TREATMENT STRATEGIES IRMC CONTINUES OUR RELATIONSHIP WITH LOCAL PARTNERS - PARTICIPATED IN 7 COMMUNITY COLLABORATIVES - DISTRIBUTED 12 NARCAN KITS IN THE ED- ED LEADERSHIP AND ARMOT COLLABORATED TO DEVELOP STANDARD PROTOCOL FOR THOSE WHO SHOW UP IN ED OF AN OVERDOSE/RECEIVE SUBSTANCE USE DISORDER DIAGNOSIS. PROCESS CHANGED FROM OPT IN TO OPT OUT WHICH INCREASED THE NUMBER OF REFERRALS. - 307 PATIENTS PRESENTED TO THE ED WITH SUBSTANCE USE AS A FACTOR IRMC HAS CONTINUED TO REFER ED PATIENTS TO COMMUNITY PARTNERS - 245 REFERRED TO ARMOT - 85 COMPLETED TREATMENT - 18 PATIENTS RECEIVED BUPRENORPHINE IN THE ED- 8 PATIENTS REFERRED TO OPEN DOOR OR CROSSROADS BY ARMOTIRMC PROVIDES EDUCATION TO STAFF, PROVIDERS AND THE BROADER COMMUNITY IN AN EFFORT TO REDUCE STIGMA - 101 EDUCATIONAL EVENTS WITH 1,117 PARTICIPANTS - 1,117 NARCAN KITS DISTRIBUTED - EDUCATED 61 IRMC STAFF ON STIGMA REDUCTION WITH 100% REPORTING REDUCED STIGMA PRE/POST TRAINING IRMC HAS INCREASED ACCESS TO INPATIENT REHAB THROUGH LOCAL PARTNERSHIPS - 43 PATIENTS CONNECTED TO INPATIENT TREATMENT- 6 PATIENTS REFERRED TO OUTPATIENT TREATMENT- ARMOT PROGRAM HELPS TO INCREASE ACCESS TO INPATIENT TREATMENT FOR PATIENTS AT IRMC IRMC IS WORKING TO INCREASE AWARENESS OF AVAILABLE SERVICES - MARKETING EFFORTS TO PROMOTE WARMLINE FOR 24/7 ACCESS TO SERVICES - MEDIA CAMPAIGN TO PROMOTE AICDAC SERVICES. IRMC MADE ONLINE RESOURCES AVAILABLE THROUGH THE HOSPITAL WEBPAGE WITH LINKS TO EXTERNAL RESOURCES

INDIANA REGIONAL MEDICAL CENTER
PART V, SECTION B, LINE 16J: DIRECT MAILING TO THE COMMUNITY.

PART I, LINE 7:
THE HOSPITAL USED A COST-TO-CHARGE RATIO IN DETERMINING THE FIGURES REPORTED IN THIS TABLE. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES AND AS CALCULATED AND REPORTED ON THE MEDICARE COST REPORT. COMMUNITY PROGRAMS ARE RECORDED IN SPECIFIC GENERAL LEDGER COST CENTERS AND STRUCTURE ON THE COMMUNITY BENEFIT FORMS WITH NUMBER OF PERSONS SERVED.

PART I, LINE 7G:
NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC WERE INCLUDED IN THE AMOUNT ON PART I, LINE 7G.

PART I, LN 7 COL(F):
THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $4,262,580.

PART II, COMMUNITY BUILDING ACTIVITIES:
"OUR MISSION IS TO SERVE THE HEALTHCARE NEEDS OF EVERY LIFE WE TOUCH WITH COMPASSION, RESPECT AND DIGNITY. ALL OF THE PROGRAMS OFFERED MEET COMMUNITY BENEFIT OBJECTIVES AND ARE RELATED TO OUR MISSION. IRMC OFFERS PROGRAMS THAT IMPROVE ACCESS TO HEALTH CARE SERVICES, ENHANCES HEALTH OF THE COMMUNITY WE SERVE, PROVIDES ADVANCED MEDICAL OR HEALTHCARE KNOWLEDGE AND RELIEVES SOME OF THE FINANCIAL OR PROGRAMMATIC BURDEN OF GOVERNMENT ON OUR COMMUNITY.INDIANA REGIONAL MEDICAL CENTER PROVIDES NUMEROUS COMMUNITY PROGRAMS AND ACTIVITIES THAT PROVIDE TREATMENT OR PROMOTE HEALTH AND HEALING TO OUR COMMUNITIES. OUR MOBILE MEDICAL SERVICES CONTINUES TO PROVIDE FREE BLOOD PRESSURE SCREENINGS IN 19 LOCATIONS IN INDIANA COUNTY. WE ALSO CONTINUE TO PARTICIPATE IN NUMEROUS FREE COMMUNITY EVENTS PROVIDING EDUCATION, SCREENING PROGRAMS AND FIRST AID SERVICES. OVER THE PAST YEAR, THE MOBILE MEDICAL HEALTH LOGGED OVER 2,500 PARTICIPANTS.WE ALSO PROVIDE NUMEROUS HEALTH FAIRS REACHING ALMOST 2,200 PARTICIPANTS, AND CLASSES AND EDUCATION PROGRAMS WITH OVER 4,000 PARTICIPANTS. A FEW OF THE FAIRS OR SERVICES PROVIDED ARE: ARTHRITIS, KNEE PAIN AND OSTEOPOROSIS SESSIONS PUT ON BY THE ORTHOPEDIC PHYSICIANS AND THE IRMC SUPPORT CLINICIANS, ""BIKE TO SCHOOL"" (SAFETY FOR CHILDREN), CHESTNUT RIDGE HEALTH FAIR, DIABETES, EXERCISE FOR SENIOR CENTERS, FIRST COMMONWEALTH BANK WEIGHT MANAGEMENT, FORTIFY YOUR SPINE, HEALTHY KIDS DAY, ROUTINE MULTIPHASIC BLOOD DRAWS FOR RURAL AREAS AND COMMUNITY MEMBERS THAT MAY NOT SEEK OUT HEALTH CARE, SERVICES PROVIDED TO NEW FLORENCE SENIOR CENTER AND NORTH CAMBRIA SENIOR CENTER (RURAL FACILITIES IN OUR SECONDARY MARKET AREA AND NO HOSPITAL CLOSE TO THEM), PROSTATE SCREENINGS, VACCINES FOR VETS (VETERANS), SKIN SCREENINGS, AS WELL AS A NUMBER OF OTHERS. THE INSTITUTE FOR HEALTHY LIVING AT INDIANA REGIONAL MEDICAL CENTER OFFERS HEALTH SERVICES AND EDUCATION PROGRAMS TO THE COMMUNITY AT NO CHARGE.THE CENTER FOR DIABETES CARE CONTINUES TO OFFER FREE EDUCATION SERVICES AT VARIOUS LOCATIONS THROUGHOUT THE COUNTY. IN ADDITION, THEY CONTINUE TO BE THE PRIMARY SPONSOR OF THE COUNTY'S DIABETES WALK. EACH MONTH STAFF AND MANAGEMENT AT IRMC PROVIDE SUPPORT TO A LOCAL FOOD BANK.PREVENTIVE HEALTH SERVICES - M. DORCAS CLARK WOMEN'S IMAGING CENTER AND THEIR STAFF HAVE PARTICIPATED IN NUMEROUS COMMUNITY EVENTS PROVIDING INFORMATION ABOUT THE IMPORTANCE OF BREAST HEALTH. BIRDIE'S CLOSET, A PROJECT DESIGNED TO HELP WOMEN COPE WITH APPEARANCE RELATED SIDE-EFFECTS OF CANCER TREATMENT WAS OPENED IN THE WOMEN'S IMAGING CENTER. SUPPORT HEALTH GROUPSFAMILY PROGRAMS - EARLY PREGNANCY, MATERNITY TOUR, DOCTOR DAD, BOF SERIES, BREASTFEEDING, ALL ABOUT BABY, LAMAZE, HOME ALONE, BABYSITTING, LET'S TALK GIRLS, BIG BROTHER, CPR, HEARTSAVER. 1,164 CONTACTS FOR THE YEAR.COMMUNITY CLASSES - PACE, TAI CHI, YOGA, CANCER, STRONG WOMEN, DROP WEIGHT, ORNISH, DIABETES, DROP 10. 3,580 CLASS HOURS.IN 2009, INDIANA REGIONAL MEDICAL CENTER OPENED A NEW FACILITY OFFERING URGENT CARE SERVICES IN THE BLAIRSVILLE COMMUNITY AS A RESPONSE TO MEDICAL SERVICES NEEDED IN THAT AREA. THIS FACILITY IS 12 MILES FROM THE HOSPITAL CAMPUS.IN 2012, INDIANA REGIONAL MEDICAL CENTER OPENED ITS SECOND URGENT CARE FACILITY TO SERVICE THE PRIMARY MARKET SHARE WHERE THERE WAS A NOTED DEMAND FOR THESE SERVICES. THE URGENT CARE CENTERS REQUIRE ADDITIONAL STAFFING ON BEHALF OF THE HOSPITAL AS IT IS A NEW/ADDED LOCATION; HOWEVER, THESE FACILITIES SIGNIFICANTLY IMPROVE THE CYCLE TIME OF THE PATIENT THROUGHOUT AND SERVICES FOR THE NON-EMERGENT SERVICES NEEDED."

PART III, LINE 2:
THE AMOUNT REPORTED IN PART III, LINE 2 IS ACTUAL BAD DEBTS (AT NET, NOT GROSS CHARGES) FOR THE YEAR.

PART III, LINE 3:
"THE AMOUNT REPORTED IN PART III, LINE 3 IS DERIVED BY USING THE MEDICARE COST TO CHARGE RATIO FROM THE COST REPORT.A PORTION OF THE BAD DEBT SHOULD BE INCLUDED AS COMMUNITY BENEFIT AS THE HOSPITAL IS NOT ABLE TO DENY SERVICES TO ANY PATIENT PRESENTING TO THE EMERGENCY DEPARTMENT, REGARDLESS IF THE PATIENTS HAVE THE MEANS TO PAY. THE DEDUCTIBLE AND CO-INSURANCE BALANCES THAT ARE NOT PAID REDUCE THE NET REVENUES DUE TO THE HOSPITAL AS PART OF THE RESPECTIVE PATIENT'S INSURANCE COVERAGE. IN ADDITION, THERE IS A ""COST"" TO THE HOSPITAL FOR TREATING ALL PATIENTS. AS WITH THE UNREIMBURSED AMOUNTS OF THE MEDICAID PATIENT SERVICES, THE HOSPITAL SHOULD BE ABLE TO INCLUDE THE UNREIMBURSED COSTS OF THE SERVICES THAT RESULTED IN NO PAYMENT."

PART III, LINE 4:
THE FOLLOWING IS THE TEXT OF THE FOOTNOTE FROM THE AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: PATIENTS ACCOUNTS RECEIVABLE ARE RECORDED AT NET REALIZABLE VALUE AT THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS IN ACCORDANCE WITH ORGANIZATION'S POLICIES, AND/OR IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED OR UNDERINSURED PATIENTS AND DO NOT BEAR INTEREST. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT REVENUES IN THE PERIOD OF THE CHANGE.

PART III, LINE 8:
100% OF THE SHORTFALL IS A COMMUNITY BENEFIT. THE MEDICARE PROGRAM WAS DESIGNED TO COVER THE COSTS OF THE HOSPITALS USING THE COST BASE YEAR(S). IRMC IS A VERY LOW COST PROVIDER AND IS NOT ABLE TO COVER COSTS SINCE THE SEQUESTRATION REDUCTION, THE LESS ALL THE OTHER DOWNWARD ADJUSTMENTS TO THE NET MBI WHILE THE COSTS OF DRUGS, SUPPLIES, IMPLANTS, CLINCAL STAFF AND HEALTH BENEFITS CONTINUE TO INCREASE 5-20%. IRMC IS A SOLE COMMUNITY PROVIDER NOT RECEIVING SUFFICIENT SCH ADD ON TO COVER COSTS FOR ALL CARE NEEDED (BASE YEAR WAS TOO LONG AGO AND NOT AS RELEVANT TO CURRENT COSTS) TO BE PROVIDED AS THE ONLY PROVIDER IN THE DEFINED GEOGRAPHICAL AREA. ACTUAL AMOUNTS PER THE MEDICARE COST REPORT THAT DETERMINE THE REIMBURSEMENTS, PAYMENTS RECEIVED (THUS SETTLEMENTS) AND COSTS.

PART VI, LINE 3:
AT REGISTRATION, PATIENTS WITHOUT INSURANCE ARE PHYSICALLY PROVIDED INFORMATION ABOUT MEDICAID AND OUR CHARITY CARE POLICY AND ENCOURAGED TO ENROLL (WE ARE AVAILABLE TO ASSIST THE CUSTOMER WITH ENROLLMENT). SIGNAGE IS ALSO POSTED THROUGHOUT THE FACILITY OUTLINING OUR CHARITY CARE PROGRAM. ALSO, ALL PATIENT STATEMENTS REFLECT INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS AVAILABLE TO THE PATIENTS. CHARITY CARE INFORMATION IS ALSO REFERENCED ON THE HOSPITAL'S WEB SITE.

PART VI, LINE 4:
THE POPULATION IN INDIANA COUNTY HAS BEEN DECREASING AND IS PROJECTED TO CONTINUE TO DECREASE INTO 2026. THE POPULATION IS PREDOMINATELY CAUCASIAN (94.3%) AND THERE IS A COMPARABLE NUMBER OF MALES (50.1%) AND FEMALES (49.9%). THE MEDIAN AGE IS 40.2 AND IS PROJECTED TO REMAIN STEADY OVER THE NEXT FIVE YEARS. JUST UNDER HALF OF THE POPULATION IS MARRIED (47.1%), WHILE 9.1% ARE DIVORCED AND 5.6% ARE WIDOWED. ONE IN TEN RESIDENTS (9.7%) DID NOT GRADUATE HIGH SCHOOL, WHILE 42.7% ARE HIGH SCHOOL OR EQUIVALENT GRADUATES. ONE IN TEN (11.0%) HAVE AN ADVANCED DEGREE. THE AVERAGE HOUSEHOLD INCOME IS $65,781, WITH A MEDIAN INCOME OF $50,130. MOST OF THE LABOR FORCE IS EMPLOYED (94.1%), WITH APPROXIMATELY HALF OF THOSE EMPLOYED HOLDING WHITE COLLAR OCCUPATIONS (49.2%).

PART III, LINE 9B:
PATIENTS ARE EXPECTED TO PAY ALL BALANCES IN FULL WITHIN FIFTEEN DAYS OF A FINAL BILLING. IF THIS IS NOT POSSIBLE, PATIENTS WILL BE COUNSELED ON THE USE OF MEDICAL ASSISTANCE OR THE INDIANA CHARITY CARE PROGRAM, I-CARE.ON A MONTHLY BASIS, THE CREDIT SUPERVISOR WILL COMPILE A REPORT LISTING ALL ACCOUNTS, WHICH HAVE BEEN BILLED TO MEDICARE, AND ANY SECONDARY INSURANCE CARRIER WHERE APPLICABLE. A LISTING OF ACCOUNTS WHICH HAVE BEEN BILLED TO MEDICAL ASSISTANCE AS A SECONDARY PAYOR ARE REVIEWED BY THE CREDIT SUPERVISOR FOR AN AUTOMATIC WRITE OFF AFTER MEDICAL ASSISTANCE HAS PROCESSED THE ACCOUNT. ACCOUNTS WHICH HAVE BALANCES AFTER MEDICARE AND ALL SECONDARY PAYORS HAVE BEEN BILLED WILL BE PLACED WITH AN OUTSIDE COLLECTION AFTER TWO UNANSWERED STATEMENTS. AN EXCEPTION WILL BE MADE IN THE EVENT A PATIENT/GUARANTOR DOES NOT FOLLOW THROUGH WITH THE MEDICAL ASSISTANCE APPLICATION PROCESS, WHEN REQUESTED TO DO SO. THE AGENCY WILL ATTEMPT TO COLLECT THE ACCOUNT FOR SIX MONTHS. AFTER THAT TIME THE ACCOUNT WILL BE WRITTEN OFF AS MEDICARE BAD DEBT.THE IRMC COLLECTION POLICY CONTAINS PROVISIONS TO PROVIDE A SOFTER APPROACH FOR THOSE THAT IRMC HAS LEARNED WOULD QUALIFY FOR FINANCIAL ASSISTANCE. UPON RECEIPT OF THE CALL FROM THE PATIENT THAT THERE IS HARDSHIP IN PAYING THE BILL, THE IRMC COLLECTION REPRESENTATIVE SHARES THE INFORMATION FOR APPLICATION FOR BOTH MEDICAL ASSISTANCE AND CHARITY CARE. WHILE THE PATIENT'S ACCOUNT IS IN THIS PROCESS, THEIR ACCOUNT WILL NOT BE PROVIDED TO THE COLLECTION AGENCY.

PART VI, LINE 2:
THE IRMC CHNA WAS CONDUCTED TO IDENTIFY PRIMARY HEALTH ISSUES, CURRENT HEALTH STATUS, AND HEALTH NEEDS TO PROVIDE CRITICAL INFORMATION TO THOSE IN A POSITION TO MAKE A POSITIVE IMPACT ON THE HEALTH OF THE REGION'S RESIDENTS. THE RESULTS ENABLE COMMUNITY MEMBERS TO MORE STRATEGICALLY ESTABLISH PRIORITIES, DEVELOP INTERVENTIONS, AND DIRECT RESOURCES TO IMPROVE THE HEALTH OF PEOPLE LIVING IN THE COMMUNITY.TO GUIDE THIS ASSESSMENT, THE LEADERSHIP AT IRMC FORMED A STEERING COMMITTEE THAT CONSISTED OF HOSPITAL AND COMMUNITY LEADERS WHO REPRESENTED THE BROAD INTERESTS OF THEIR LOCAL REGION. THESE INCLUDED REPRESENTATIVES WHO UNDERSTOOD THE NEEDS AND ISSUES RELATED TO VARIOUS UNDERREPRESENTED GROUPS INCLUDING MEDICALLY UNDERSERVED POPULATIONS, LOW-INCOME PERSONS, MINORITY GROUPS, AND THOSE WITH CHRONIC DISEASE NEEDS, INDIVIDUALS WITH EXPERTISE IN PUBLIC HEALTH, AND INTERNAL PROGRAM MANAGERS. THE IRMC STEERING COMMITTEE MET TWO TIMES BETWEEN MARCH 2021 AND APRIL 2021 TO PROVIDE GUIDANCE ON THE VARIOUS COMPONENTS OF THE CHNA.SEE PART V OF SCHEDULE H FOR FURTHER DISCUSSION ON NEEDS ASSESSMENT.

PART VI, LINE 5:
"IN THE MID-NINETIES, HOSPITALS AND HEALTHCARE FACILITIES BEGAN TO SHIFT THEIR ATTENTION FROM JUST SICK OR HOSPITAL BASED CARE TO INCLUDE ADDRESSING COMMUNITY HEALTH AND DISEASE PREVENTION. AS A FIRST STEP IN THAT DIRECTION, IRMC FORMED A COMMUNITY SERVICE DEPARTMENT WHOSE PURPOSE WAS TO DELIVER EDUCATION AND PREVENTATIVE SCREENINGS TO THE COMMUNITY-AT-LARGE. IN 2005, REALIZING THAT ALMOST EVERY DEPARTMENT IN THE HOSPITAL HAD OPPORTUNITIES TO PROMOTE HEALTH AND WELLNESS, IRMC CREATED THE INSTITUTE FOR HEALTHY LIVING, A VIRTUAL ORGANIZATION COORDINATING ALL ASPECTS OF COMMUNITY OUTREACH AND HEALTH IMPROVEMENT. IMPROVING AND SUSTAINING COMMUNITY HEALTH, HOWEVER, IS A COLLABORATIVE ENDEAVOR THAT INTEGRATES AS MANY KEY STAKEHOLDERS AS POSSIBLE. IN THAT REGARD, IRMC SPEARHEADED THE FORMATION OF THE INDIANA COUNTY COMMUNITY HEALTH ADVISORY COUNCIL (CHAC), AN ENTERPRISE REPRESENTING MEMBERS FROM VARIOUS COMMUNITY AGENCIES, ORGANIZATIONS AND SCHOOLS WHOSE PURPOSE IT IS TO IDENTIFY HEALTH NEEDS IN OUR COUNTY AND TO FIND WAYS TO MEET THEM. THE CHAC HAS BEEN ACTIVE SINCE 1996 AND IRMC SERVES AS ITS BASE AND CHAIRMANSHIP. INDIANA REGIONAL MEDICAL CENTER USES ITS OWN FUNDS TO ENHANCE BOTH THE CLINICAL STRATEGIES AND THE COMMUNITY STRATEGIES.CLINICAL STRATEGIES (A FEW EXAMPLES): RECRUITING ADDITIONAL PHYSICIANS FOR IDENTIFIED COMMUNITY NEEDS, EXPLORE DEVELOPMENT OF A FAMILY PRACTICE RESIDENCY PROGRAM TO FACILITATE RECRUITMENT AND RETENTION, ENLARGE THE MEDICAL FITNESS CENTER, ESTABLISH A WEIGHT LOSS TASK FORCE, DEVELOP A MEDICAL WEIGHT MANAGEMENT CENTER, PROVIDE FLU SHOTS TO ALL INPATIENTS DURING FLU SEASON, PROVIDE PNEUMONIA VACCINE TO ALL NON-VACCINATED INPATIENTS, ETC. COMMUNITY STRATEGIES (A FEW EXAMPLES): PARTNER WITH AGENCIES PROVIDING SERVICES AND EDUCATION TO YOUNG TEENS AND WOMEN, EVALUATE A PARTNERSHIP WITH EARLY HEAD START, IMPROVE VISIBILITY AND INFORMATION AVAILABLE ABOUT THE OB/GYN CLINIC, WORKED TO ESTABLISH PRACTICES IN THE MORE RURAL AREAS OF THE COUNTY THAT REQUIRE THE MEDICAL CENTER TO SUBSIDIZE DELIVERING CARE THERE, ESTABLISHED THE INDIANA AT CHESTNUT RIDGE FACILITY THAT OFFERS PRIMARY CARE AND URGENT-CARE AND WAS A SIGNIFICANT CAPITAL INVESTMENT, IMPLEMENT A PATIENT PORTAL TO IMPROVE PATIENT ACCESS TO MEDICAL RECORDS, BECAME A PROVIDER OF THE WE CAN! (WAYS TO ENHANCE CHILDREN'S ACTIVITY AND NUTRITION), PARTNERED WITH 7 ELEMENTARY SCHOOLS TO INSTALL PROJECT FIT AMERICA, IMPLEMENTED GROCERY STORE TOURS TO ASSIST PEOPLE WITH SEEKING HEALTHY CHOICES, PARTNER WITH 4 GROCERY STORES TO HAVE A DIETICIAN AVAILABLE TO HELP SHOPPERS MAKE HEALTHY CHOICES, CONDUCT THE ANNUAL ""VACCINE FOR VETERANS"" PROGRAM ON VETERANS DAY, EVALUATE THE POTENTIAL FOR PUBLIC PNEUMONIA VACCINE CLINICS, CONTINUE TO PROVIDE FREE FLU AND PNEUMONIA VACCINE TO HIGH-RISK, LOW INCOME RESIDENTS, ETC."

PART VI, LINE 7:
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PART VI, LINE 6:
INDIANA REGIONAL MEDICAL CENTER HAS THE FOLLOWING AFFILIATED ENTITIES:INDIANA HEALTHCARE FOUNDATION CONDUCTS FUNDRAISING ACTIVITIES, SUCH AS THE COLUMBUS DAY GOLF OUTING AND LOVE OF LIFE GALA, IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER. INDIANA REGIONAL MEDICAL CENTER AND PUNXSUTAWNEY AREA HOSPITAL JOINTLY FORMED INDIANA JEFFERSON RADIATION ONCOLOGY, INC. FOR THE PURPOSE OF ENHANCING THE QUALITY AND AVAILABILITY OF RADIATION ONCOLOGY SERVICES OFFERED TO PATIENTS IN INDIANA AND JEFFERSON COUNTIES, PA AND SURROUNDING AREAS.INDIANA HEALTHCARE PHYSICIAN SERVICES, INC. IS A NON-PROFIT HOSPITAL OWNED GROUP OF PRACTICES OWNED AND OPERATED TO SERVE THE RURAL AREAS OF INDIANA AND SURROUNDING COMMUNITIES. WE PROVIDE ACCESSIBLE, COST EFFECTIVE QUALITY HEALTHCARE WITHIN THE RURAL COMMUNITIES OF INDIANA AND SURROUNDING COUNTIES. WE SUPPORT AND WORK COLLABORATIVELY WITH OTHER NON-PROFIT AGENCIES WITHIN OUR SITES.INDIANA HEALTHCARE PROPERTIES HOLDS AND MANAGES PROPERTY IN SUPPORT OF INDIANA REGIONAL MEDICAL CENTER.