4A (Expenses $ 148210780 including grants of $ 483618) (Revenue $ 198042584)
BARTON HEALTHCARE SYSTEM (BARTON HEALTH) IS A 501( C)(3) COMMUNITY HEALTH SYSTEM THAT INCLUDES A LICENSED 63-BED FULL-SERVICE, GENERAL ACUTE CARE HOSPITAL WITH A 24-HOUR EMERGENCY ROOM; 48 BED SKILLED NURSING AND LONG TERM CARE FACILITY; AND 23 AMBULATORY OUTPATIENT CLINICS. BARTON HEALTH IS A BI-STATE HEALTH SYSTEM SERVING THE GREATER LAKE TAHOE REGION IN ADDITION TO TRANSIENT-BASED PATIENTS. NINE VENTILATORS AND EIGHT EMERGENCY RESCUE VENTILATORS WERE ALSO ON-HAND.BARTON HEALTH PROVIDES EXCEPTIONAL MEDICAL CARE REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY.THE FOLLOWING PROGRAMS ARE COMMUNITY OUTREACH PROGRAMS THAT BENEFIT THE HEALTH OF BARTON HEALTH LAKE TAHOE SOUTH SHORE COMMUNITY.COMMUNITY HEALTH EVENTS: BARTON HEALTH PROVIDES FREE OR DISCOUNTED SERVICES AT COMMUNITY HEALTH EVENTS INCLUDING COMMUNITY HEALTH FAIRS, LAB DRAWS, MAMMOGRAMS, EKG TESTS, VACCINATION CLINICS, CANCER WELLNESS PROGRAM, AND COMMUNITY EVENT MEDICAL SERVICES. YOUTH PROGRAMS: BARTON HEALTH PROMOTES HEALTH WITHIN YOUTH POPULATIONS THROUGH PROGRAMS THAT EDUCATE ABOUT THE RAMIFICATIONS OF DRUG AND ALCOHOL USE; DRUNK DRIVING; THE SPONSORSHIP OF YOUTH ACTIVITIES THAT PROMOTE HEALTH; FREE SPORTS PHYSICALS; SPORTS INJURY PREVENTION; AND HEALTH CAREER PROMOTION ACTIVITIES. COMMUNITY HEALTH EDUCATION PROGRAMS: MAILED COMMUNITY NEWSLETTER; MAILED COMMUNITY BENEFIT REPORT, FREE ONLINE E-NEWSLETTERS AND HEALTH LIBRARY; CHILDBIRTH EDUCATION CLASSES; CHILD/INFANT CPR AND FIRST-AID; NEW MOM'S SUPPORT PROGRAM; AND FREE VIRTUAL COMMUNITY HEALTH WEBINAR SERIES.COLLABORATION: ACCESS EL DORADO INVOLVING PUBLIC AND PRIVATE AGENCIES TO CREATE HEALTHIER COMMUNITIES ESPECIALLY WITHIN OUR VULNERABLE POPULATIONS; TELEHEALTH FOR TAHOE THAT BRINGS ADDITIONAL SPECIALTY HEALTH ACCESSIBLE THROUGH TELEMEDICINE; AND EMERGENCY MANAGEMENT COMMUNITY COUNCIL (BARTON HEALTH HOSTS AND CHAIRS) THAT MEETS WITH AREAS AGENCIES EVERY OTHER MONTH TO DISCUSS EMERGENCY PREPAREDNESS AND EDUCATION WITHIN OUR COMMUNITY. BARTON ADDITIONALLY PARTNERS WITH COVERED CALIFORNIA AS A CERTIFIED ENROLLMENT ENTITY THAT ASSISTS RESIDENTS WITH ENROLLING FOR HEALTH COVERAGE AT NO COST.COMMUNITY HEALTH IMPROVEMENT EFFORTS: BARTON LEADS THE COMMUNITY HEALTH ADVISORY COMMITTEE (25-MEMBER ALL VOLUNTEER COMMUNITY BOARD) WHICH IS FOCUSED ON IDENTIFYING AND THEN ADDRESSING UNMET HEALTH NEEDS. BARTON PARTICIPATES IN THE BEHAVIORAL HEALTH NETWORK (25-MEMBER ALL-VOLUNTEER COMMUNITY ADVISORY BOARD) WHICH IS FOCUSED PRIMARILY ON IDENTIFYING AND ADDRESSING THE GAPS IN OUR COMMUNITY'S MENTAL HEALTH SERVICES. IN ADDITION, THE BARTON FOUNDATION FUNDS THE BARTON HEALTH GRANTS PROGRAM WHICH PROVIDES $100,000 ANNUALLY TO AREA NONPROFITS THAT PROVIDE PROGRAMS AND SERVICES THAT CLOSELY ALIGN WITH OUR COMMUNITY'S NEEDS.LTUSD HEALTH AND WELLNESS TASKFORCE (1 MD AND 2 STAFF).IN RESPONSE TO THE CALDOR FIRE, BARTON HEALTH PARTNERED WITH SIERRA COMMUNITY HOUSE IN TRUCKEE TO PICK UP HIGH QUALITY PROTEINS AND PRODUCE TO PROVIDE FOOD FOR THE TAHOE COALITION FOR THE HOMELESS WHOSE CLIENTS HAD RETURNED TO SOUTH LAKE TAHOE AFTER BEING DISPLACED BUT BEFORE GROCERY STORES WERE OPEN.

4B (Expenses $ 5990594 including grants of $ 0) (Revenue $ 8797978)
THE BARTON COMMUNITY HEALTH CENTER PROVIDES ROUTINE MEDICAL CARE TO MEDICARE AND MEDI-CAL BENEFICIARIES, THOSE WITH INSURANCE BUT VERY HIGH DEDUCTIBLES OR THOSE WHO ARE UNINSURED. SAME DAY APPOINTMENTS ARE USUALLY AVAILABLE WHICH IMPROVES MEDICAL OUTCOMES. THE BARTON COMMUNITY HEALTH CENTER COMBINES THE EFFORTS OF NUMEROUS SKILLED PROFESSIONALS INCLUDING NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS, MEDICAL ASSISTANTS, NURSES, OTHER MEDICAL SUPPORT STAFF, AND CONTRACTS WITH FAMILY AND SPECIALTY PHYSICIANS. SPECIALTY PHYSICIANS WHO SEE PATIENTS AT THE CLINIC INCLUDE PEDIATRICS, SLEEP MEDICINE, ORTHOPEDICS, OBSTETRICS, GYNECOLOGY, CHILD PSYCHIATRY, ADULT PSYCHIATRY, ADHD TREATMENT, UROLOGY, ENT, DERMATOLOGY, INFECTION DISEASE, PSYCHOLOGY, RHEUMATOLOGY, ENDOCRINOLOGY, AND NEUROLOGY. PATIENT ARE SOMETIMES UNDOCUMENTED MIGRANT WORKERS NOT ELIGIBLE FOR MEDI-CAL OR ARE INSURED LOW INCOME PATIENTS WITH VERY HIGH DEDUCTIBLES. UNDERINSURED AND UNINSURED PRIVATE PAY PATIENTS ARE CHARGED ON A SLIDING SCALE BASED ON INCOME AND SERVICES PROVIDED. BARTON'S COMMUNITY HEALTH CENTER SERVES AS A GATEWAY FOR PATIENTS IN NEED OF HEALTH CARE INCLUDING THOSE SEEKING FAMILY PLANNING SERVICES, PRECONCEPTION INFORMATION AND REFERRALS FOR STERILIZATION, LEVEL 1 INFERTILITY SERVICES, STD TREATMENT, REFERRALS FOR HIV SERVICES AND SCREENING FOR DES (DIETHYLSTILBESTROL) EXPOSURE.

4C (Expenses $ 1640878 including grants of $ 0) (Revenue $ 0)
THE HELPING HANDS PROGRAM ASSISTS PATIENTS OF BARTON MEMORIAL HOSPITAL WITH THEIR MEDICAL BILLS. IT MATCHES THE PATIENTS' ABILITY TO PAY ACCORDING TO THEIR UNIQUE CIRCUMSTANCE. PATIENTS ARE ASKED TO COMPLETE AN APPLICATION AND PROVIDE FINANCIAL INFORMATION ABOUT THEIR INCOME TO DETERMINE THEIR ABILITY TO PAY. THE DISCOUNT PATIENTS RECEIVE TOWARD THEIR MEDICAL BILL DEPENDS ON THEIR ADJUSTED GROSS INCOME COMPARED WITH THE U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES POVERTY INCOME GUIDELINES. THE PROGRAM IS DESIGNED FOR THOSE PATIENTS WHO CANNOT AFFORD THEIR MEDICAL BILLS, BARTON HEALTH PROVIDES DISCOUNTS FOR THOSE WITH INCOMES UP THE 350 PERCENT OF THE MOST RECENT POVERTY INCOME GUIDELINES, AND/OR UNDER SPECIAL CIRCUMSTANCES. DURING THE CURRENT YEAR THIS PROGRAM PROVIDED OVER $5.7 MILLION OF GROSS CHARGES IN CHARITY CARE.

BARTON MEMORIAL HOSPITAL
PART V, SECTION B, LINE 5: A COMMUNITY HEALTH PHONE SURVEY WAS CONDUCTED TO RECORD COMMUNITY FEEDBACK. THE SAMPLE DESIGN USED FOR THIS EFFORT CONSISTED OF A STRATIFIED RANDOM SAMPLE OF 400 INDIVIDUALS AGE 18 AND OLDER IN THE PRIMARY SERVICE AREA, SEPARATED INTO FOUR SUB-COMMUNITIES. ONCE THE INTERVIEWS WERE COMPLETED, THESE WERE WEIGHTED IN PROPORTION TO THE ACTUAL POPULATION DISTRIBUTION SO AS TO APPROPRIATELY REPRESENT THE PRIMARY SERVICE AREA AS A WHOLE. ALL ADMINISTRATION OF THE SURVEYS, DATA COLLECTION AND DATA ANALYSIS WAS CONDUCTED BY PRC. ADDITIONALLY, TO SOLICIT INPUT FROM KEY INFORMANTS, THOSE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY ALSO WAS IMPLEMENTED AS PART OF THIS PROCESS.

BARTON MEMORIAL HOSPITAL
PART V, SECTION B, LINE 7D: COMMUNITY PRESENTATIONS TO CHAMBER LEADERSHIP, BARTON AUXILIARY, CITY COUNCIL, COMMUNITY BENEFIT ORGANIZATIONS, SERVICE CLUBS, ETC.

BARTON MEMORIAL HOSPITAL
PART V, SECTION B, LINE 11: THE MOST RECENT CHNA, CONDUCTED IN 2021, IDENTIFIED 12 HEALTH NEEDS, WITH THE TOP THREE PRIORITIES BEING MENTAL HEALTH, SUBSTANCE ABUSE AND ACCESS TO CARE. WHILE ALL 12 NEEDS ARE BEING ADDRESSED, THE ACTION PLAN FOR THE TOP THREE ARE AS FOLLOWS: MENTAL HEALTH: WE HAVE 2 STRATEGIES AS PART OF OUR MENTAL HEALTH ACTION PLAN: STRATEGY 1: EXPAND AND CONTINUE TO PROVIDE MENTAL AND BEHAVIORAL HEALTH SERVICES. RECRUIT ADDITIONAL BEHAVIORAL HEALTH PROVIDERS TO ADDRESS BEHAVIORAL HEALTH NEEDS FOR PATIENTS TRACK AND IMPROVE DEPRESSION SCREENING RATES AT ANNUAL WELLNESS VISITS PURSUE OPPORTUNITIES TO CONTINUE TELE-BEHAVIORAL HEALTH TREATMENT ACCESS FOR MEDI-CAL/CARE PATIENTS THROUGH HEALTHNET GRANT OR OTHER. EXPLORE WAYS TO INTEGRATE MENTAL AND BEHAVIORAL HEALTH SERVICES IN PRIMARY CARE SETTINGS WITH ACES SCREENING STRATEGY 2: SPEARHEAD COMMUNITY COLLABORATION AND ENGAGEMENT TO ENSURE ALIGNMENT OF PROGRAMS AND SUPPORT. SPEARHEAD A SUBCOMMITTEE OF THE COMMUNITY HEALTH ADVISORY COMMITTEE ADDRESSING ACTIONABLE MENTAL AND BEHAVIORAL HEALTH ITEMS. SUBSTANCE ABUSE: WE HAVE 3 STRATEGIES FOCUSED ON ADDRESSING THIS PRIORITY: STRATEGY 1: DEVELOP AND MAINTAIN PATHWAYS ADDRESSING PAIN AND ADDICTION. EXPAND THE MEDICATION ASSISTED TREATMENT PROGRAM TO INCLUDE ADDITIONAL WAIVERED PROVIDERS AND AN EMERGENCY DEPARTMENT BRIDGE PROGRAM AS WELL AS ANY SUPPORTING PROGRAMS THAT HELP REDUCE OPIOID OVERDOSE CONTINUE THE SUBSTANCE USE NAVIGATOR ROLE TO HELP SUPPORT AND COORDINATE CARE FOR IN-PATIENT AND EXPAND TO OUT-PATIENT SETTINGS. SUPPORT ADDITIONAL PROGRAMS AT THE COMMUNITY HEALTH CENTER TO SUPPORT ADDICTION, SUCH AS OUTPATIENT ALCOHOL ABUSE PROGRAM-A MONTHLY INJECTION (VIVITROL) PURSUE OPIOID CARE HONOR ROLL DESIGNATION THROUGH THE CAL HOSPITAL COMPARE TO INCREASE ACCESS TO ADDICTION TREATMENT FOR HOSPITALIZED PATIENTS AND REDUCE OPIOID-RELATED DEATHS. PART OF THE PROGRAM INCLUDES TRAINING FOR HEALTHCARE PROFESSIONALS IN OPIOID SAFETY PRACTICES TO PREVENT NEW OPIOID STARTS, IDENTIFY AND TREAT OPIOID USE DISORDER, PREVENT OVERDOSE AND DEVELOP AN OVERALL CULTURE OF OPIOID SAFETY CONSIDER IMPLEMENTATION OF APPROPRIATE ALTERNATIVE THERAPIES TO PATIENTS THROUGHOUT THE BARTON HEALTH SYSTEM INCLUDING AROMATHERAPY, INTEGRATIVE MEDICINE, MEDITATION, MASSAGE THERAPY AND OTHERS UTILIZE PHYSIATRIST + ANESTHESIOLOGIST FOR NON-OPIOID PAIN MANAGEMENT EDUCATE THE IMPORTANCE OF ALTERNATIVE PAIN MANAGEMENT MODALITIES THROUGH PATIENT-FACING COLLATERAL AND ARTICLES STRATEGY 2: PARTICIPATE IN THE COORDINATED COMMUNITY GROUPS FOCUSED ON SUBSTANCE USE. ATTEND AND PARTICIPATE IN COMMUNITY MEETINGS ADDRESSING EDUCATION AND PREVENTION, INCLUDING TAHOE ALLIANCE FOR SAFE KIDS, EL DORADO COUNTY OPIOID COALITION, AND OTHERS SUPPORT COMMUNITY PREVENTION PROGRAMS AND FUND OPPORTUNITIES, INCLUDING DRUG STORE PROJECT, DEA DRUG TAKE BACK DAY AND OPIOID COALITION CONFERENCE SPEAKING PANEL SUPPORT GRANT FUNDING THAT SUPPORTS COMMUNITY EFFORTS TO HELP DRIVE EDUCATION AND SERVICES FOR SUBSTANCE USE STRATEGY 3: CONDUCT OUTREACH AND EDUCATION ON THE EFFECTS OF ALCOHOL AND DRUG USE. IMPLEMENT AWARENESS CAMPAIGN ANNUALLY THROUGH: LECTURES/WEBINARS, PRESENTATIONS AT THE LOCAL SCHOOLS, ARTICLES, ADVERTISEMENT, WEB AND SOCIAL MEDIA AWARENESS SUBSTANCE USE RESOURCES WILL BE INCLUDED IN THE HEALTH RESOURCE GUIDE UPDATED ANNUALLY CONTRIBUTE TIME, DATA AND OTHER RESOURCES TO FURTHER THE MISSION OF PREVENTION AND EDUCATION AND ENSURE SUCCESSFUL PROGRAM OUTCOMES. PARTICULAR PROGRAMS MAY INCLUDE: PERMANENT DRUG TAKE BACK BINS, IN-HOME LOCK BAGS, AN ALTERNATIVE SUSPENSION PROGRAM AT THE MIDDLE AND HIGH SCHOOLS, AND EDUCATING PARENTS ON THE DANGERS OF ALCOHOL AND DRUG USE FOR TEENAGERS THROUGH COMMUNITY PRESENTATIONS AND THE PARENT TEXTING NETWORK DISSEMINATE APPROPRIATE INFORMATION TO BARTON STAFF AND PHYSICIANS AND COORDINATE INTERNAL TRAININGS AS REQUESTED ACCESS TO CARE: WE HAVE 5 STRATEGIES DESIGNED TO ADDRESS THIS PRIORITY: STRATEGY 1: IDENTIFY ACCESS BARRIERS TO IMPROVE ACCESS STANDARDIZE DASHBOARD ILLUSTRATING BENCHMARKS FOR ACCESS INCLUDING THIRD NEXT AVAILABLE, OPEN PANELS, PROVIDER PATIENT APPOINTMENT VOLUME AND PERCENTAGE OF PCP ASSIGNMENTS INCREASE PRIMARY CARE PROVIDER AVAILABILITY FOR FIRST TIME PATIENTS. INCREASE APPOINTMENT AVAILABILITY THROUGH STANDARDIZING SCHEDULES, AND SUPPORTING PROVIDER EFFICIENCY EXPAND AFTER HOUR APPOINTMENTS WEEKDAYS AND WEEKENDS. RECRUIT PROVIDERS, AS NECESSARY, TO MEET DEMAND AND EXPAND SPECIALTY PROVIDERS. INCREASE MYCHART USAGE PERFORM ANALYSIS ON COMMUNITY HEALTH CARE CENTER EXPANSION TO BETTER MEET LOCAL NEEDS OF UNDERINSURED STRATEGY 2: EXPAND PATIENT-CENTERED CARE MODELS TO IMPROVE STANDARDIZATION AND CONTINUUM OF CARE CREATE STREAMLINED OPERATIONS ACROSS ALL PRIMARY CARE SETTINGS, TO PROVIDE EASIER ACCESS TO CARE THROUGH OPEN SCHEDULING, EXPANDED HOURS, AND INCREASED OPTIONS FOR COMMUNICATION BETWEEN PATIENTS, THEIR DOCTORS, AND SUPPORT STAFF IMPROVE ACCESS AND CARE COORDINATION THROUGH MEETING CRITERIA FOR THE PATIENT CENTERED MEDICAL HOME (PCMH) DESIGNATION AT BARTON FAMILY MEDICINE LOCATION ESTABLISH PCSP DESIGNATIONS TO OUTPATIENT SPECIALTY CLINICS TO CONTINUE CARE COORDINATION STRATEGY 3: INCREASE INSURANCE COVERAGE FOR THE COMMUNITY THROUGH OUTREACH FOR COVERED CALIFORNIA AND MEDI-CAL TRAIN AND MAINTAIN CERTIFICATION FOR BARTON HEALTH EMPLOYEES TO BECOME CERTIFIED ENROLLMENT COUNSELORS FOR COVERED CALIFORNIA MEDI-CAL COUNTY LIAISON TO HAVE OFFICE SPACE AND EDUCATION TO STAFF TO DIRECT PATIENTS FOR ENROLLMENT CONTINUE AS A RESOURCE FOR THE COMMUNITY TO ANSWER QUESTIONS AND ENROLL CONSUMERS INTO MEDICAL HEALTH COVERAGE PROVIDE EDUCATIONAL MARKETING MATERIALS AND ENSURE WEBSITE HAS INFORMATION REGARDING HEALTH INSURANCE OPTIONS FOR THE SOUTH LAKE TAHOE REGION STRATEGY 4: CREATE AND IMPLEMENT AN OUTREACH PLAN FOR THE LATINO COMMUNITY WORK WITH COMMUNITY PARTNERS SUCH AS FAMILY RESOURCE CENTER, SCHOOL DISTRICTS, LAKE TAHOE COMMUNITY COLLEGE, EL DORADO COUNTY COMMUNITY HUB, EL DORADO COUNTY SUBSTANCE USE DISORDER AND UC CALFRESH TO COORDINATE IDEAS AND PLANS TO BEST REACH AND EDUCATE THIS COMMUNITY HOST AND PARTNER IN COMMUNITY GATHERING EVENTS THAT BEST REACH AND SERVE OUR LATINO COMMUNITY REGULARLY PARTICIPATE IN PARENT CAFECITOS PROVIDE TIMELY EDUCATIONAL ARTICLES AND WEBINARS IN SPANISH PARTNER WITH COMMUNITY ORGANIZATIONS TO PROVIDE DIRECT MEDICAL RESOURCES, SUCH AS FLU CLINICS, COVID-19 VACCINATIONS, BLOOD WORK LABS, AND MORE STRATEGY 5: DEVELOP PLAN FOR STATELINE CAMPUS EXPANSION. EXPAND AVAILABILITY AND OFFICE HOURS FOR PRIMARY CARE PROVIDERS AND SPECIALTIES OFFICES AT STATELINE CAMPUS OPEN OUTPATIENT MRI OFFERING AFFORDABILITY AND CONVENIENCE, SIMILAR TO OTHER OUTPATIENT NEVADA FREE-STANDING LOCATIONS DEVELOP AND COMMUNICATE LONG TERM STRATEGY FOR STATELINE, NV CAMPUS WHILE BARTON HEALTH MAY NOT DIRECTLY WORK TO RESOLVE ALL HEALTH ISSUES IDENTIFIED, BARTON IS COMMITTED TO WORKING COLLABORATIVELY WITH COMMUNITY PARTNERS, WHENEVER POSSIBLE, TO HELP ADDRESS HEALTH NEEDS AS THEY OCCUR.

BARTON MEMORIAL HOSPITAL
PART V, SECTION B, LINE 15E: DISCLOSURE UNDER REVENUE PROCEDURE 2015-21:BARTON RECEIVED A COMPLIANCE CHECK INFORMATION REQUEST (REQUEST TYPE 8014) DATED 7/12/2021 FROM THE DEPARTMENT OF TREASURY INTERNAL REVENUE SERVICE. THE REQUEST NOTED THE FOLLOWING ITEMS IN REGARDS TO THE FINANCIAL ASSISTANCE POLICY (FAP): POSSIBLE MISSING FAP REQUIREMENTO THE BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS. O IN THE CASE OF A HOSPITAL THAT DOES NOT HAVE A SEPARATE BILLING AND COLLECTION POLICY, ACTIONS THAT MAY BE TAKEN IN THE EVENT OF NONPAYMENT FAP PLAIN LANGUAGE SUMMARYO INSTRUCTIONS ON HOW AN INDIVIDUAL CAN GET A FREE COPY OF THE FAP AND FAP APPLICATION FORM BY MAIL. O A STATEMENT OF WHICH LANGUAGE TRANSLATIONS ARE AVAILABLE FOR THE FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY OF THE FAP, IF APPLICABLE.O A STATEMENT THAT A FINANCIAL AP-ELIGIBLE INDIVIDUAL CAN'T BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED FOR EMERGENCY OR OTHER MEDICALLY-NECESSARY CARE.ON AUGUST 11, 2021 BARTON PROVIDED THE IRS WITH THE CURRENT FINANCIAL ASSISTANCE POLICY WHICH WAS APPROVED MARCH 2020 TO MEET THE REQUIREMENTS OF IRC SECTION 501(R)(4). BARTON ANNUALLY REVIEWS AND UPDATES AS NECESSARY THE FAP, FAP PLAIN LANGUAGE SUMMARY AND THE BILLING AND COLLECTION POLICY. BARTON ALSO VALIDATES THE DOCUMENTS ARE UPDATED THROUGHOUT THE ORGANIZATION AND ON THE WEBSITE.

FORM 990, SCHEDULE H, PART V, LINE 7A
THE ENTIRE WEBSITE ADDRESS IS:HTTPS://WWW.BARTONHEALTH.ORG/TAHOE/COMMUNITY-HEALTH.ASPX

FORM 990, SCHEDULE H, PART V, LINE 10A
THE FULL WEBSITE ADDRESS IS:HTTPS://WWW.BARTONHEALTH.ORG/UPLOADS/PUBLIC/DOCUMENTS/BARTONIMPLEMENTATIONSTRATEGY2021-SIGNED.PDF

PART I, LINE 3C:
IN ADDITION TO THE FPG, THE HOSPITAL CONSIDERS IF THE PATIENT IS UNINSURED AND/OR UNDERINSURED WHEN DETERMINING IF THEY QUALIFY FOR FREE OR DISCOUNTED CARE.

PART I, LINE 7:
THE COSTING METHODOLOGY USED THE OVERALL COST TO CHARGE RATIO OBTAINED FOR EACH PATIENT SEGMENT AND APPLIED AGAINST GROSS CHARGES FROM THE 2021 COST REPORT. THIS RATIO WAS USED FOR LINES 7A, 7B AND 7G. ACTUAL OPERATING COSTS WERE USED TO CALCULATE LINES 7E, 7F, AND 7I.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES INCLUDES COMMUNITY BENEFIT EXPENSES AND DIRECT OFFSETTING REVENUE RELATED TO PHYSICIAN CLINICS. TOTAL COMMUNITY BENEFIT EXPENSES WERE $1,156,172 AND DIRECT OFFSETTING REVENUE WAS $4,780,897.

PART II, COMMUNITY BUILDING ACTIVITIES:
EMERGENCY MANAGEMENT PREPAREDNESS: BARTON HEALTH CHAIRS AND HOSTS THE EMERGENCY MANAGEMENT COMMUNITY COUNCIL. THIS COUNCIL MEETS EVERY OTHER MONTH WITH AREA AGENCIES TO DISCUSS EMERGENCY PREPAREDNESS AND EDUCATION TO THE SOUTH LAKE TAHOE COMMUNITY. EXERCISE DRILLS, EMERGENCY PREPAREDNESS MATERIALS AND OTHER PROGRAMS COME OUT OF THIS GROUP. THE GROUP WAS DESIGNED WITH THE HEALTH AND SAFETY OF OUR COMMUNITY IN MIND. THE GROUP INCLUDES REPRESENTATIVES FROM BARTON HEALTH, RED CROSS, EL DORADO COUNTY HEALTH AND HUMAN SERVICES, AREA FIRE DEPARTMENTS, POLICE, SHERIFF, HAM RADIO, SCHOOL DISTRICTS, PUBLIC UTILITIES AND OTHER REPRESENTATIVES WHO WOULD HAVE A RESPONSE CAPABILITY IN OUR COMMUNITY. THE PURPOSE IS TO PROTECT THE HEALTH OF OUR COMMUNITY BY BEING PREPARED FOR DISASTERS, AND KNOWING OUR EMERGENCY PARTNERS IN THE EVENT OF AN EMERGENCY TO BETTER FORM A COHESIVE RESPONSE IN THE SOUTH LAKE TAHOE AREA, WHICH WILL ASSIST IN GETTING THE COMMUNITY BACK ON ITS FEET AFTER A DISASTER. THE IMPACT OF THIS PROGRAM IS THE COORDINATION AMONGST LOCAL EMERGENCY PROVIDERS TO ENSURE EMERGENCY READINESS FOR THE NEXT LOCAL DISASTER. BARTON HEALTH FURTHER SUPPORTS VARIOUS ORGANIZATIONS BY PROVIDING HEALTH GRANTS, SPONSORSHIPS AND OTHER SUPPORT. BARTON HEALTH ADDITIONALLY ASSISTS OUR NEEDY PATIENTS BY ASSISTING WITH TRANSPORTATION COSTS AND MEDICATION.COALITION BUILDING: BARTON HEALTH HOSTS THE COMMUNITY HEALTH ADVISORY COMMITTEE (CHAC)THAT IS A COLLABORATIVE OF REPRESENTATIVES OF VARIOUS COMMUNITY AGENCIES AND COMMUNITY MEMBERS THAT MEETS MONTHLY TO ADDRESS TOP COMMUNITY HEALTH NEEDS AS THEY EMERGE.WORKFORCE DEVELOPMENT: BARTON HEALTH FACILITIES ARE DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND TO MAINTAIN PATIENT ACCESS TO ESSENTIAL SERVICES IN OUR COMMUNITY, THE ORGANIZATION INCURS RECRUITMENT COSTS FOR VARIOUS PROVIDERS. BARTON IS A MEMBER OF THE IHCC -INTER HOSPITAL COORDINATION COUNCIL - WHICH IS SPONSORED BY WASHOE COUNTY AND THE QUAD COUNTIES HEALTHCARE COALITION WHICH IS SPONSORED BY DOUGLAS COUNTY.

PART III, LINE 2:
THE AMOUNT OF BAD DEBT REPORTED ON LINE 2 IS BASED ON CHARGES. IN 2018, THE HEALTHCARE SYSTEM ADOPTED ASU 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS WHICH CHANGED THE METHODOLOGY ON THE CALCULATION AND REPORTING OF BAD DEBT EXPENSE.

PART III, LINE 4:
GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HEALTHCARE SYSTEM ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HEALTHCARE SYSTEM ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FOR THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. THE HEALTHCARE SYSTEM DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY IN CERTAIN CIRCUMSTANCES AND FOR CERTAIN SERVICES. BAD DEBT EXPENSE IS RECORDED WHEN THERE IS AN ADVERSE CHANGE IN THESE PATIENT'S ABILITY TO PAY. BAD DEBT EXPENSE FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, WAS $897,184 AND $821,101, RESPECTIVELY.

PART III, LINE 8:
THE ORGANIZATION PROVIDES A BROAD RANGE OF SERVICES TO ITS MEDICARE PATIENTS WITHOUT REGARD TO REVENUE REALIZED FROM THE SERVICES PROVIDED.THE ORGANIZATION IS A RURAL HOSPITAL WITH THE NEAREST ADDITIONAL HOSPITAL APPROXIMATELY 36 MILES AWAY. COSTS EXCLUDED FROM THE ORGANIZATION'S MEDICARE COST REPORT INCLUDE COSTS ASSOCIATED WITH PHYSICIAN CLINICS, THE AUXILIARY, COMMUNITY RELATIONS, AND OTHER NON-REIMBURSABLE COSTS. THE ORGANIZATION UTILIZES THE COST TO CHARGE RATIO AS PROVIDED IN ITS ANNUAL COST REPORT.

PART III, LINE 9B:
THE ORGANIZATION FOLLOWS ALL CHARITY AND COLLECTION GUIDELINES AS OUTLINED IN SB774, THE CALIFORNIA HEALTH AND SAFETY CODE SECTION 127425, AND CMS MEDICARE GUIDELINES.

PART VI, LINE 2:
BARTON HEALTH IS A MEMBER OF NUMEROUS COMMUNITY COLLABORATIVES WORKING TO ADDRESS THE HEALTH NEEDS IN OUR COMMUNITY. BARTON PARTICIPATES IN THE COMMUNITY BEHAVIORAL HEALTH NETWORK COMMITTEE WHICH FOCUSES ON COORDINATING MENTAL HEALTH SERVICES AMONGST OUR COMMUNITY PROVIDERS. WE LEAD THE COMMUNITY HEALTH ADVISORY COMMITTEE, WITH OUR TOP THREE HEALTH PRIORITIES DETERMINING HOW FUNDING AND RESOURCES ARE UTILIZED. ADDITIONALLY, WE ATTEND THE MONTHLY LAKE TAHOE COLLABORATIVE, FOCUSING ON COLLABORATIONS FOR YOUTH; AND WE FILL THE HEALTHCARE SEAT ON OUR COMMUNITY'S DRUG-FREE COMMUNITY COALITION.

PART VI, LINE 3:
EVERY SELF-PAY PATIENT IS SCREENED FOR ELIGIBILITY UNDER OUR FINANCIAL ASSISTANCE POLICY WHICH BEGINS AT ADMISSION OR WHEN OTHERWISE FEASIBLE. IN ADDITION, REFERENCE TO OUR FINANCIAL ASSISTANCE PROGRAM IS POSTED AT THE EMERGENCY ROOM AND ADMITTING DEPARTMENTS, DISCLOSED ON OUR WEBSITE, REFERENCED TO IN THE PATIENT HANDBOOK, AND ON PATIENT BILLING STATEMENTS.

PART VI, LINE 4:
THE PRIMARY SERVICE AREA FOR BARTON MEMORIAL HOSPITAL SITS WITHIN THE SIERRA NEVADA MOUNTAINS ON THE BORDER BETWEEN CALIFORNIA AND NEVADA. THIS AREA ENCOMPASSES THE SOUTH LAKE TAHOE BASIN FROM TAHOMA, CA ON THE WEST THROUGH GLENBROOK, NV ON THE EAST. THE DEMOGRAPHICS FOR THIS AREA ARE AS FOLLOWS: APPROXIMATELY 54% MALE AND 46% FEMALE; 20.6% UNDER THE AGE OF 18, 11.6% AGED 18 TO 24, 30.0% AGED 25 TO 44, 28.1% AGED 45 TO 64, AND 9.8% WHO WERE 65 YEARS OF AGE OR OLDER; 63.5% ARE CAUCASIAN, 28% ARE HISPANIC AND 8.5% REPRESENT OTHER RACES, 13% OF THE COMMUNITY IS LOW INCOME BELOW THE 200% FEDERAL POVERTY LEVEL.

PART VI, LINE 7, REPORTS FILED WITH STATES
CA

PART VI, LINE 5:
AS DESCRIBED IN THE COMMUNITY BENEFIT SECTION OF THE 990, BARTON HEALTH CONTRIBUTES TO OUR COMMUNITY'S HEALTH IN A VARIETY OF WAYS: OUR GOVERNING BODY IS REPRESENTED BY INDIVIDUALS OF OUR COMMUNITY. SURPLUS FUNDS ARE USED TO MAINTAIN A HIGH LEVEL OF PATIENT CARE THROUGH REINVESTMENT. BARTON HEALTH HAS ON OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. OUR LABORATORY OFFERS DISCOUNTED LAB DRAWS; NUMEROUS PHYSICIANS AND EMPLOYEES PARTICIPATE IN OUR FREE COMMUNITY WELLNESS LECTURES; OUR EMERGENCY DEPARTMENT PARTICIPATES IN YOUTH EDUCATION PROGRAMS AND THE DRUG STORE PROJECT; MANY OF OUR NURSES AND PRACTITIONERS PARTICIPATE IN OFFERING MEDICAL COVERAGE FOR SPECIAL EVENTS THROUGHOUT THE COMMUNITY; BARTON PRIMARY CARE OFFER FREE STUDENT SPORTS PHYSICALS; BARTON HEALTH DONATES TO AND SPONSORS YOUTH PROGRAMS AND LOCAL NON-PROFIT ORGANIZATIONS; STAFF FROM VARIOUS DEPARTMENTS LIKE BARTON EDUCATION, FAMILY BIRTHING CENTER, BARTON REHABILITATION PARTICIPATE IN COMMUNITY EVENTS AND HAVE INFORMATION AND EDUCATIONAL BOOTHS FOR THE COMMUNITY; BARTON MEMORIAL HOSPITAL OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.