Community Benefit Insight - Tax-exempt hospital

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Endless Mountains Health Systems Inc

Endless Mountains Health Systems

100 Hospital Drive
Montrose, PA 18801

Bed count	25	Medicare provider number	391306	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 232720289

Display data for year:

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

1.22%

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	$ 7,425 0.03 %
Medicaid as % of operating expenses	$ 0 0 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 258,721 1.18 %
Research as % of operating expenses	$ 0 0 %
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.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
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	$ 933,842 4.26 %
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	$ 105,524 11.30 %

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 $ 18407388 including grants of $ 0) (Revenue $ 19982947)
OPERATED A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. DURING THE YEAR ENDED DECEMBER 31, 2021, PATIENT DAYS WERE 2,172, OUTPATIENT VISITS WERE 22,453 AND EMERGENCY DEPARTMENT VISITS WERE 6,423.EMHS ALSO PROVIDED CHARITY CARE TO PATIENTS WHO MET CERTAIN CRITERIA. COST OF CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $7,425 IN 2021.

Facility Information

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

ENDLESS MOUNTAINS HEALTH SYSTEMS, INC.
PART V, SECTION B, LINE 5: TO GUIDE OUR COMMUNITY BENEFIT AND HEALTH IMPROVEMENT EFFORTS, EMHS CONDUCTS A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS. THE 2019 CHNA BUILDS UPON OUR 2013 AND 2016 STUDIES. THE CHNAS ARE ONE WAY WE MONITOR HEALTH STATUS ACROSS SUSQUEHANNA COUNTY. THE CHNA INCLUDES A MIX OF STATISTICAL RESEARCH AND STAKEHOLDER INPUT TO COLLECT AND ANALYZE HEALTH TRENDS THAT IMPACT THE HEALTH OF RESIDENTS.THE 2019 CHNA WAS CONDUCTED FROM SEPTEMBER TO DECEMBER 2019 AND INCLUDED QUANTITATIVE AND QUALITATIVE RESEARCH METHODS TO DETERMINE HEALTH TRENDS AND DISPARITIES WITHIN SUSQUEHANNA COUNTY AS COMPARED TO HEALTH INDICATORS ACROSS PENNSYLVANIA AND THE NATION. PRIMARY STUDY METHODS WERE USED TO SOLICIT INPUT FROM KEY COMMUNITY STAKEHOLDERS AND HEALTH IMPROVEMENT PARTNERS. SECONDARY STUDY METHODS WERE USED TO IDENTIFY AND ANALYZE STATISTICAL DEMOGRAPHIC AND HEALTH TRENDS.SPECIFIC CHNA METHODS AND STAKEHOLDER ENGAGEMENT INCLUDED:-AN ANALYSIS OF SECONDARY DATA, INCLUDING HEALTH, DEMOGRAPHIC, AND SOCIAL MEASURES-A KEY INFORMANT SURVEY OF REPRESENTATIVES FROM HEALTH, SOCIAL SERVICES, EDUCATION, ECONOMIC, AND OTHER COMMUNITY BASED ORGANIZATIONS-PRIORITIZATION AND PLANNING MEETING WITH HOSPITAL LEADERSHIP-DEVELOPMENT OF THREE-YEAR IMPLEMENTATION PLANCOMMUNITY ENGAGEMENT WAS AN INTEGRAL PART OF THE CHNA. IN ASSESSING THE HEALTH NEEDS OF THE COMMUNITY, INPUT WAS SOLICITED AND RECEIVED FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS. THESE INDIVIDUALS PROVIDED WIDE PERSPECTIVES ON HEALTH TRENDS, EXPERTISE ABOUT EXISTING COMMUNITY RESOURCES AVAILABLE TO MEET THOSE NEEDS, AND INSIGHTS INTO SERVICE DELIVERY GAPS THAT CONTRIBUTE TO HEALTH DISPARITIES. A KEY INFORMANT SURVEY WAS CONDUCTED WITH COMMUNITY REPRESENTATIVES WITHIN SUSQUEHANNA COUNTY TO SOLICIT INFORMATION ABOUT HEALTH NEEDS AMONG RESIDENTS. A TOTAL OF 11 INDIVIDUALS RESPONDED TO THE SURVEY, INCLUDING HEALTH AND SOCIAL SERVICE PROVIDERS; COMMUNITY AND PUBLIC HEALTH EXPERTS; CIVIC AND SOCIAL LEADERS; AND OTHERS REPRESENTING UNDERSERVED OR VULNERABLE POPULATIONS.

ENDLESS MOUNTAINS HEALTH SYSTEMS, INC.
"PART V, SECTION B, LINE 11: SECONDARY DATA STATISTICS AND INPUT FROM KEY INFORMANTS WERE CONSIDERED IN DETERMINING COMMUNITY HEALTH PRIORITIES. CONSISTENT WITH THE 2016 CHNA FINDINGS, ENDLESS MOUNTAINS HEALTH SYSTEMS WILL FOCUS ON THE FOLLOWING TWO HEALTH PRIORITIES OVER THE 2019-22 REPORTING CYCLE: ACCESS TO HEALTHCARE AND HEALTH RISK FACTORS & CHRONIC DISEASE. ENDLESS MOUNTAINS HEALTH SYSTEMS DEVELOPED A COMMUNITY HEALTH IMPLEMENTATION PLAN TO GUIDE COMMUNITY BENEFIT ACTIVITIES FOR THE 2020-22 REPORTING CYCLE. THE PLAN BUILDS UPON PREVIOUS HEALTH IMPROVEMENT ACTIVITIES, WHILE RECOGNIZING NEW HEALTH NEEDS AND A CHANGING HEALTH CARE DELIVERY ENVIRONMENT, TO ADDRESS THE MOST PRESSING COMMUNITY HEALTH NEEDS.ACCESS TO HEALTHCAREIN MARCH 2019, EMHS WAS SELECTED TO PARTICIPATE IN THE PENNSYLVANIA RURAL HEALTH MODEL, A PILOT PROGRAM IN PARTNERSHIP WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) INNOVATION CENTER. THE RURAL HEALTH MODEL IS AN ALTERNATIVE PAYMENT MODEL THAT SEEKS TO INCREASE ACCESS TO CARE IN RURAL AREAS, IMPROVE HEALTH OUTCOMES, AND ENSURE FINANCIAL SUSTAINABILITY FOR RURAL HOSPITALS. AS A PROGRAM PARTICIPANT, EMHS WILL BE BETTER POSITIONED TO DELIVER VALUE-BASED CARE AND TRANSFORM CARE DELIVERY TO BETTER MEET COMMUNITY HEALTH NEEDS.EMHS ALSO SOUGHT TO IMPROVE ACCESS TO PRIMARY CARE THROUGH THE RECRUITMENT OF PROVIDERS. SINCE 2016, EMHS RECRUITED ONE PRIMARY CARE PHYSICIAN, PROVIDING CARE IN THE GEOGRAPHIC HPSA OF BRIDGEWATER TOWNSHIP. EMHS ALSO INITIATED STRATEGIES TO EXPLORE TELEMEDICINE OPTIONS TO EXPAND ACCESS TO SPECIALTY CARE SERVICES.EMHS CONTINUED TO PARTNER WITH COMMUNITY-BASED BEHAVIORAL HEALTH PROVIDERS FOR BOTH CRISIS SERVICES AND A WARM HANDOFF PROGRAM FOR PATIENTS SEEN IN THE EMERGENCY DEPARTMENT. NEPA COMMUNITY HEALTH CARE AND SCRANTON COUNSELING CENTER PROVIDE ONSITE PSYCHIATRIC CONSULTATIONS AND DIRECT REFERRALS FOR ADDITIONAL SERVICES.EMHS WORKED TO SCREEN AND IDENTIFY INDIVIDUALS WITHOUT HEALTH INSURANCE SEEN AT THE HOSPITAL. FINANCIAL COUNSELING STAFF MEMBERS ASSISTED IDENTIFIED INDIVIDUALS WITH ELIGIBILITY DETERMINATION AND ENROLLMENT IN SUBSIDIZED HEALTH INSURANCE PROGRAMS.CHRONIC DISEASE PREVENTION & MANAGEMENTSUSQUEHANNA COUNTY RESIDENTS ARE MORE LIKELY TO SMOKE AND EXPERIENCE RESPIRATORY CONDITIONS, PARTICULARLY COPD. EMHS DEVELOPED A COPD MANAGEMENT PROGRAM TO IMPROVE HEALTH OUTCOMES FOR PATIENTS WITH COPD AND REDUCE AVOIDABLE HOSPITAL UTILIZATION. THE PROGRAM PROVIDES CARE MANAGEMENT SERVICES, INCLUDING MEDICATION ADHERENCE SUPPORT, TARGETING HIGH UTILIZER PATIENTS. EMHS ALSO PROVIDES PATIENT EDUCATION, INCLUDING SMOKING CESSATION CLASSES.EMHS HAS PROVIDED DIABETES SELF-MANAGEMENT EDUCATION AND NUTRITION COUNSELING TO PATIENTS AND COMMUNITY MEMBERS AT NO CHARGE SINCE 2014. THE PROGRAM IS AIMED AT EMPOWERING PATIENTS TO EXPERTLY MANAGE THEIR OWN DIABETES CARE TO IMPROVE QUALITY OF LIFE. CORE EDUCATION CONCEPTS INCLUDE DISEASE PROCESS, GLUCOSE MONITORING AND GOALS, MEDICATION ADMINISTRATION, IDENTIFYING AND TREATING HYPERGLYCEMIA AND HYPOGLYCEMIA, SICK DAY MANAGEMENT, FOOT CARE, AND CARBOHYDRATE COUNTING. COUNSELING IS PROVIDED AT THE PATIENT'S PACE AND DIRECTED BY THE PATIENT'S NEEDS, WITH INDIVIDUALIZATION OF GOALS. THE PROGRAM IS OVERSEEN BY A JOINT COLLABORATION OF NURSING STAFF AND A REGISTERED DIETITIAN/CERTIFIED DIABETES EDUCATOR.EMHS IMPLEMENTED THE ""ENDLESS WEIGHS TO HEALTH"" PROGRAM TO PROVIDE COMMUNITY-BASED HEALTHY LIFESTYLE EDUCATION. THE 10-WEEK PROGRAM, LED BY THE HOSPITAL'S REGISTERED DIETITIAN/CERTIFIED DIABETES EDUCATOR, TEACHES BETTER NUTRITION AND PHYSICAL ACTIVITY AS A STARTING POINT FOR BETTER HEALTH, WHILE PROVIDING TOOLS FOR HEALTHY LIFESTYLE BEHAVIOR CHANGE. THE PROGRAM HAS HAD OVER 80 PARTICIPANTS TO DATE.EMHS ALSO IMPLEMENTED ""WALK WITH A DOC,"" A NATIONAL INITIATIVE TO KEEP PEOPLE MOVING FOR A BETTER TOMORROW, THROUGH MOVEMENT AND CONVERSATION. THE PROGRAM, OFFERED IN PARTNERSHIP WITH GEISINGER HEALTH PLAN, KICKED OFF IN APRIL 2019 AND WAS OFFERED ONCE PER MONTH THROUGH NOVEMBER. THE WALKS WERE LED BY DIFFERENT EMHS PHYSICIANS AND INCLUDED DIFFERENT HEALTH TOPIC AREAS, INCLUDING DIET/CHOLESTEROL, PRE-DIABETES, CHILD/ADULT OBESITY, AND VACCINES.SOCIAL DETERMINANTS OF HEALTH PLAY A SIGNIFICANT ROLE IN INDIVIDUAL HEALTH, PARTICULARLY RELATED TO CHRONIC DISEASE PREVENTION AND MANAGEMENT. EMHS INITIATED SCREENINGS AMONG PATIENTS TO IDENTIFY POTENTIAL SOCIAL DETERMINANTS OF HEALTH NEEDS. PATIENTS WITH IDENTIFIED NEEDS WERE CONNECTED WITH THE UNITED WAY OF SUSQUEHANNA COUNTY'S 2-1-1 PROGRAM, A 24/7 HOTLINE FOR HEALTH AND HUMAN SERVICE ASSISTANCE.TO FURTHER ADDRESS SOCIAL DETERMINANTS OF HEALTH NEEDS FOR PATIENTS AND COMMUNITY MEMBERS, EMHS INITIATED A MOBILE FOOD PANTRY IN PARTNERSHIP WITH THE WEINBERG NORTH EAST REGIONAL FOOD BANK. THE PANTRY IS AVAILABLE TO SUSQUEHANNA COUNTY RESIDENTS. DISTRIBUTION TAKES PLACE AT THE HOSPITAL ON THE FOURTH FRIDAY OF THE MONTH FROM 2-4PM. WHILE PRE-REGISTRATION IS REQUIRED, WALKINS ARE WELCOME AFTER 3:30PM. THE EMHS BOARD OF DIRECTORS REVIEWED AND APPROVED THE REPORT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND ADOPTED THE IMPLEMENTATION PLAN TO ADDRESS PRIORITY AREAS ON DECEMBER 27, 2019. BOTH DOCUMENTS WERE MADE WIDELY AVAILABLE TO THE PUBLIC THROUGH THE HOSPITAL'S WEBSITE (WWW.ENDLESSCARE.ORG).DUE TO RESOURCE LIMITATIONS, EMHS WILL NOT DIRECTLY ADDRESS BEHAVIORAL HEALTH AND MATERNAL AND CHILD HEALTH NEEDS, ALTHOUGH WE RECOGNIZE THEY ARE KEY DRIVERS OF POOR HEALTH OUTCOMES WITHIN THE COMMUNITY. WE WILL CONTINUE TO ENGAGE WITH COMMUNITY PARTNERS, INCLUDING THE SUSQUEHANNA COUNTY SUICIDE AWARENESS INITIATIVE, NEPA COMMUNITY HEALTH CARE, AND SCRANTON COUNSELING CENTER, TO COLLABORATIVELY ADDRESS BEHAVIORAL HEALTH NEEDS. WE WILL ALSO PROMOTE EARLY PRENATAL CARE AND REDUCED MATERNAL RISK FACTORS AS PART OF OUR FOCUS ON INCREASING ACCESS TO HIGH QUALITY CARE AND REDUCING THE BURDEN OF CHRONIC DISEASE AMONG RESIDENTS."

PART V, SECTION B LINES 7 AND 10
CHNA WEBSITE:HTTPS://STATIC1.SQUARESPACE.COM/STATIC/5E2A43167C7A0842B4DB6D5D/T/5ECE87D11EBB821DBB038078/1590593492105/ENDLESS+MOUNTAINS+HEALTH+SYSTEMS+FINAL+CHNA+REPORT+FINAL-+2016-12-23.PDFIMPLEMENTATION PLAN WEBSITE:HTTPS://STATIC1.SQUARESPACE.COM/STATIC/5E2A43167C7A0842B4DB6D5D/T/5ECE894A7FB10441648792B8/1590593868192/EMHS+2019+CHNA+FINAL+REPORT+-+2019-12-18.PDF

PART V, SECTION B, LINE 16I:
EMHS DOES NOT HAVE AN LEP POPULATION WITHIN ITS SERVICE AREA, THEREFORE, THE FAP POLICY, APPLICATION, AND SUMMARY, ARE ONLY REQUIRED TO BE IN ENGLISH.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 7:
GLOBAL COST TO CHARGE RATIO WAS UTILIZED TO COMPUTE COST OF CHARITY CARE PROVIDED. ALLOWABLE COST DIVIDED BY TOTAL CHARGES.

PART I, LINE 7G:
INCLUDED IN THE SUBSIDIZED HEALTH SERVICES ARE COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC. TOTAL PHYSICIAN CLINIC COSTS WERE $356,774.

PART I, LN 7 COL(F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $933,842.

PART II, COMMUNITY BUILDING ACTIVITIES:
EMHS AND ITS STAFF SUPPORT LOCAL HEALTH SERVICE AND COMMUNITY SERVICE PROJECTS. THE STAFF OF EMHS CONTRIBUTE BOTH THEIR TIME AND FINANCIALLY TO THE SUSQUEHANNA COUNTY LIBRARY, AMERICAN CANCER SOCIETY, UNITED WAY, AND OTHER WORTHWHILE CAUSES. EMHS WORKS WITH LOCAL EMS PROVIDERS IN PREPARATION FOR NATURAL DISASTERS AND MASS CASUALTY SITUATIONS. EMHS SUPPORTS THE CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM AND PROVIDED ITS STARTUP TRAINING FUNDING. THE AT-RISK ELDERLY AND LOW-INCOME POPULATIONS OF SUSQUEHANNA COUNTY AND SURROUNDING COUNTIES IS BETTER SERVED BY HAVING EMHS AS A PARTNER WITH MULTIPLE SOCIAL SERVICE, EMERGENCY RESPONSE, AND HUMAN SERVICE AGENCIES.

PART III, LINE 2:
BAD DEBT EXPENSE IS CALCULATED BASED ON ACTUAL WRITE-OFFS THROUGHOUT THE YEAR AND IS ESTIMATED AT COST USING THE RATIO OF PATIENT CARE COST TO CHARGES.

PART III, LINE 3:
EMHS ESTIMATED THAT 11.3% OF THE AMOUNT OF BAD DEBT WOULD BE CONVERTED TO UNCOMPENSATED CARE, IF INDIVIDUALS APPLIED. THIS IS BASED ON THE POPULATION STATISTICS FOR POVERTY LEVEL IN SUSQUEHANNA COUNTY, PENNSYLVANIA.

PART III, LINE 4:
ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.

PART III, LINE 8:
ALLOWABLE COSTS WERE DETERMINED USING THE COST-TO-CHARGE RATIO FROM THE MEDICARE COST REPORT. ANY SHORTFALL IN MEDICARE REIMBURSEMENT UNDER COST IS THE PROVISION OF COMMUNITY BENEFIT TO CONTINUE TO PROVIDE CARE TO MEDICARE BENEFICIARIES.

PART III, LINE 9B:
COLLECTIONS ARE PURSUED UP TO THE POINT THAT A PATIENT COMPLETES AND IS APPROVED FOR CHARITY CARE. ONCE CHARITY CARE IS APPROVED, NO FURTHER COLLECTION EFFORTS ARE MADE.

PART VI, LINE 2:
"THE COMPLETION OF THE CHNA ENABLED ENDLESS MOUNTAINS HEALTH SYSTEMS AND ITS PARTNERS TO TAKE AN IN-DEPTH LOOK AT ITS GREATER COMMUNITY. THE FINDINGS FROM THE ASSESSMENT WERE UTILIZED BY ENDLESS MOUNTAINS HEALTH SYSTEM TO PRIORITIZE PUBLIC HEALTH ISSUES AND DEVELOP A COMMUNITY HEALTH IMPLEMENTATION PLAN FOCUSED ON MEETING COMMUNITY NEEDS. ENDLESS MOUNTAINS HEALTH SYSTEMS IS COMMITTED TO THE PEOPLE IT SERVES AND THE COMMUNITIES THEY LIVE IN. HEALTHY COMMUNITIES LEAD TO LOWER HEALTH CARE COSTS, ROBUST COMMUNITY PARTNERSHIPS, AND AN OVERALL ENHANCED QUALITY OF LIFE.A KEY INFORMANT SURVEY WAS CONDUCTED WITH 11 COMMUNITY REPRESENTATIVES TO SOLICIT INFORMATION ABOUT HEALTH NEEDS AND DISPARITIES WITHIN SUSQUEHANNA COUNTY. KEY INFORMANTS WERE ASKED A SERIES OF QUESTIONS ABOUT THEIR PERCEPTIONS OF HEALTH NEEDS IN THE COMMUNITY, HEALTH DRIVERS, BARRIERS TO CARE, QUALITY AND RESPONSIVENESS OF HEALTH PROVIDERS, AND RECOMMENDATIONS FOR COMMUNITY HEALTH IMPROVEMENT.KEY INFORMANTS SERVE DIVERSE POPULATIONS ACROSS SUSQUEHANNA COUNTY. CHILDREN/YOUTH, FAMILIES, AND LOW INCOME/POOR ARE THE MOST COMMONLY SERVED POPULATIONS BY KEY INFORMANTS. ""OTHER"" POPULATIONS INCLUDE INDIVIDUALS WITH BEHAVIORAL HEALTH CONCERNS AND INTELLECTUAL DISABILITIES AND SMALL BUSINESS OWNERS.SEE PART V SECTION B FOR FUTHER INFORMATION ON THE 2019 CHNA."

PART VI, LINE 3:
PATIENTS ARE INFORMED VIA WRITTEN POSTINGS AT THE INTAKE AREA AND FACE-TO-FACE AND TELEPHONE CONSULTATION WITH FINANCIAL SUPPORT STAFF.

PART VI, LINE 4:
ENDLESS MOUNTAINS HEALTH SYSTEMS PROVIDES SERVICE TO RESIDENTS OF SUSQUEHANNA COUNTY AND PARTS OF WYOMING, BRADFORD, LACKAWANNA COUNTIES IN PENNSYLVANIA AS WELL AS PORTIONS OF BROOME COUNTY NY. THE SUSQUEHANNA COUNTY POPULATION OF 43,930 IS EXPECTED TO REMAIN STABLE, DECREASING 0.2% BY 2021. THE POPULATION IS PRIMARILY WHITE WITH LESS THAN 3% OF RESIDENTS IDENTIFYING AS ANOTHER RACE AND LESS THAN 2% OF RESIDENTS IDENTIFYING AS HISPANIC OR LATINO. SUSQUEHANNA COUNTY HAS A HIGHER MEDIAN AGE AND RESIDENTS ARE MORE LIKELY TO SPEAK ENGLISH AS THEIR PRIMARY LANGUAGE WHEN COMPARED TO STATE AND NATIONAL BENCHMARKS. EDUCATION IS THE LARGEST PREDICTOR OF POVERTY AND ONE OF THE MOST EFFECTIVE MEANS OF REDUCING INEQUALITIES. COMPARED TO THE STATE AND NATION, RESIDENTS IN SUSQUEHANNA COUNTY ARE MORE LIKELY TO HAVE ACHIEVED A HIGH SCHOOL DIPLOMA OR EQUIVALENT, BUT LESS LIKELY TO HAVE HAD COLLEGE EXPERIENCE OR A DEGREE. THE EDUCATION STATISTICS ARE CONSISTENT WITH THE OLDER POPULATION AND MORE PROMINENT BLUE COLLAR WORKFORCE.

PART VI, LINE 5:
EMHS HAS AN OPEN MEDICAL STAFF, A BOARD COMPOSED OF COMMUNITY MEMBERS FROM THE AREAS IT SERVES, UTILIZES INCOME TO FURTHER ITS PROVISION OF SERVICE AND ABILITY TO INCREASE THE AVAILABILITY OF MEDICAL CARE TO THE COMMUNITY.

PART VI, LINE 6:
EMHS OPERATES A NOT-FOR-PROFIT ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. EMHS ALSO PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA. THE ONLY AFFILIATED ORGANIZATION IS ENDLESS MOUNTAINS MEDICAL CARE FOUNDATION (EMMCF). EMMCF WAS ESTABLISHED TO SOLICIT CONTRIBUTIONS FROM THE GENERAL PUBLIC SOLELY FOR THE FUNDING OF OPERATIONS AND CAPITAL ACQUISITIONS BY THE HOSPITAL. EMMCF RAISES FUNDS THROUGH A NUMBER OF ACTIVITIES, INCLUDING ANNUAL APPEALS, SPECIAL EVENTS INCLUDING A GOLF TOURNAMENT, MEMORIAL AND TRIBUTE GIVING, PRIVATE AND CORPORATE FOUNDATION GRANTS, AND PLANNED GIVING VEHICLES SUCH AS BEQUESTS.

PART VI, LINE 7, REPORTS FILED WITH STATES
PA

Operating expenses	$ 21,898,365
Total amount spent on community benefits as % of operating expenses	$ 266,146 1.22 %