4A (Expenses $ 98876311 including grants of $ 318437) (Revenue $ 111322974)
Northeastern Vermont Regional Hospital, Inc. is a full service, state of the art, Critical Access Hospital. The Hospital makes its services available to approximately 30,000 residents of the greater St. Johnsbury community. Inpatient services include medical and surgical, intensive care, pediatrics, and obstetrics. The emergency room at NVRH is fully staffed by full-time board certified/eligible physicians. The Ambulatory Surgery Unit has space for 16 pre- and post-operative patients. Over 95% of our surgeries and procedures are conducted through day surgery. These services are supported by the laboratory, diagnostic imaging, MRI, CT scan, cardiac services, rehabilitation, respiratory, and other ancillary services. Surgical specialties include general surgery, neurosurgery, oral/maxillofacial, otolaryngology, obstetrics/gynecology, orthopedics, ophthalmology, and urology. NVRH is one of two Vermont hospitals to have been awarded the international baby-friendly designation by the World Health Organization.NVRH's charity care program is available to patients who are uninsured, underinsured, or have otherwise demonstrated they don't have the financial resources to fully pay for their hospital care. Patients with income levels below 200% of the federal poverty guideline for the applicable family size have their hospital bill discounted by 100%. Patients with income levels between 200% and 400% of the federal poverty guideline receive a discount on their hospital bill between 85% and 47%. Foregone charges, based on established rates, furnished under NVRH's free care program amounted to $1,870,460 during the year ended September 30, 2022.The emergency room at NVRH is fully staffed by full-time physicians and specialized nurses who are trained to deal with all aspects of medical care. Emergency room staff provide pre-hospital provider training and support, participation in local education programs, hospital continuing medical education and quality assurance programs. Care provided by the emergency room is coordinated with appropriate local physician practices. The NVRH pharmacy provides pharmaceutical services for patients, including a complete patient medication profile and computerized monitoring. Our pharmacy staff is a vital component of the healthcare team, consulting with physicians and other health professionals to ensure that patients receive the appropriate drug therapies. NVRH owns four Rural Health Clinics that are staffed with a combination of medical doctors, nurse practitioners, physician assistants and nurse midwives in order to meet the needs of our patients. The four clinics include:1. Corner Medical - a family practice.2. Kingdom Internal Medicine3. St. Johnsbury Pediatrics4. Women's Wellness Center - providing full OB/GYN care.

Northeastern Vermont Regional Hospital
Part V, Section B, Line 5: NVRH conducted a CHNA in 2021. This is the fourth assessment done using the ACA requirement and guidelines. The 2021 CHNA builds on the foundation of the previous assessments. The CHNA used the framework of our regional accountable health community, NEK Prosper. NEK Prosper uses the frameworks of the accountable health community model, Collective Impact, and Results Based Accountability. Likewise, the 2021 NVRH CHNA and companion Implementation Plan use these frameworks. Additionally, the 2021 CHNA is informed by the data compiled, and the community engagement work already done by NEK Prosper, and the overall mission of NEK Prosper to reduce poverty in the region. Although both the population and the percentage of those in poverty are declining for Caledonia and Essex Counties (Source: Vermont State Data Center), we also know that based on the most often used proxy for socio-economic status - income - our region is well below the average and median income compared to the rest of Vermont. Additionally, data shows that the population of Vermont, and our region, is aging faster than other states. Thus, once again low-income families, and older adults were identified as our most vulnerable; consequently, primary source data collection targeted groups of low-income parents and older adults.The entire CHNA and methodology is available at: www.nvrh.org/community-health-needs-assessment/

Northeastern Vermont Regional Hospital
Part V, Section B, Line 11: An update and current evaluation to the CHNA Implementation Plan is available atwww.nvrh.org/community-health-needs-assessment/In recognition of the importance of the social determinants of health in overall health and well-being, NVRH had taken the lead in creating NEK Prosper in 2014. NEK Prosper uses the framework of Accountable Health Communities, the elements of Collective Impact, and the principles of Results Based Accountability. Key organizations that comprise the backbone organizations and leadership team to address the root cause of poor health are the regional mental health agency, housing organization, community action program, Federally-Qualified Health Centers, council on aging, and the Vermont Foodbank. Many other state agencies and community based non-profits make up the body of NEK Prosper. NEK Prosper has identified five outcomes for our community: well-nourished, well-housed, physically healthy, mentally healthy, and financially secure. Workgroups were formed in the NEK Prosper structure to provide strategic direction and results-based focus in each outcome area, and continue to support the grassroots efforts to improve conditions that impact health.

Part I, Line 7:
The Organization used three different methods to allocate costs reported in the table: four physician clinics are rural health clinics: NVRH - Corner Medical, NVRH - St Johnsbury Pediatrics, NVRH - Kingdom Internal Medicine, and NVRH - Women's Wellness Center. Costs for these clinics were taken directly from the Medicare cost report. Costs for other reported programs were direct costs for the program plus an allocation of indirect costs based on a ratio of direct to indirect costs taken from the Medicare cost report. A cost to charge ratio was used to determine the cost of bad debts and free care for all programs reported on the table.

Part I, Line 7g:
The Organization included as subsidized health services costs attributable to four physician clinics.1. NVRH - Corner Medical, a primary care physician clinic. Total costs related to this physician clinic were $3,122,903.2. NVRH - St Johnsbury Pediatrics, a pediatric physician clinic. Total costs related to this physician clinic were $2,105,7573. NVRH - Women's Wellness Center, an obstetrician/gynecological physician clinic. Total costs related to this physician clinic were $2,563,700.4. NVRH - Kingdom Internal Medicine, a primary care physician clinic. Total costs related to this physician clinic were $1,675,016

Part II, Community Building Activities:
Physical Improvements/HousingNVRH Community Garden:NVRH has provided garden space on our campus for community use for 33 years. There are currently 28 garden spots. The garden spots are provided free of charge on a first come, first served basis. The community benefit value is based on the staff time to coordinate the assignment of spots and other correspondence with the gardeners. Workforce development:NVRH is located in a rural area with limited access to public transportation. Poverty is also our primary health disparity. We continue to engage our community and they have expressed the need to access services located close to home. NVRH takes the lead in recruiting both primary care and specialty physicians and mid-level providers to ensure access to care and services locally. The value listed in this section is related to the costs associated with recruiting primary care and specialty providers; as well as loan repayment for many of our providers (MO, NP, PA, etc.). We also support an Associate Degree Nursing Program.

Part III, Line 4:
Please refer to pages 10-13 and 15 of the attached audited financial statements.

Part III, Line 8:
All Medicare allowable costs were taken directly from the Medicare cost report.

Part III, Line 9b:
NVRH provides care to all patients regardless of their ability to pay for services. Patients who indicate they have no insurance receive information about NVRH's Patient Assistance program, including the income level eligibility guidelines, with their first bill and with all subsequent bills. Patient Assistance is provided to those patients who, through a written documentation process, are identified as financially needy. Patients who have qualified for 100% Patient Assistance are not billed for subsequent services for one year. After one year, those patients go through the qualification process again. Financial assistance applications are made readily available to patients, in addition, signs are posted throughout the hospital and clinics and linked on our website.

Part VI, Line 3:
A summary of NVRH's Patient Assistance Program and the income eligibility guidelines are included in the first and all subsequent bills sent to patients identified as self pay. The phone number of a financial counselor is also provided. The counselor is available to discuss eligibility guidelines and the qualification process. The counselor also discusses with patients the availability of Medicaid and other State assistance programs. Information about the NVRH Patient Assistance Program is also available on the NVRH website. Patients can also learn about NVRH's Patient Assistance program via a link to the State's Green Mountain Care Board. The Patient Assistance Program is available to hospital patients as well as patients of all NVRH-owned physician practices.

Part VI, Line 4:
NVRH serves about 30,000 people in Caledonia and Southern Essex Counties in the northeast corner of Vermont. The Hospital is located about 50 miles from the Canadian border to the north, and about 15 miles from the New Hampshire border to the east. Only 3 towns in our service area have a population of more than 2,000 people. Our area is divided equally between males and females. The area is predominately white (95%) and English is the predominant language. The median income is below the state average at $49,758 per household ($64,994 Vermont). Nearly 91% of our adult population ages 25 and older have a high school diploma, and just under 25% have completed a four year college degree, compared to the state average of 33%. Education, healthcare, and social services are the largest employment sectors, followed by retail and then manufacturing. There are three public school supervisory unions, and numerous private and independent schools. There are 3 colleges located in our service area.

Part VI, Line 5:
The Hospital also promoted health and safety throughout the community through the following programs:1. Bike Safety Fair2. Blood Drawings at NVRH3. Health Care Shares4. Community Connections5. Community Gardens6. Community Wellness Calendar7. Diabetes and Nutrition Community-based Outreach and Education8. Healthier Living Workshop/Chronic Pain/Diabetes Prevention Program/Tobacco Cessation9. Harm Reduction - Medication Drop Box10. Lactation Services11. Healthy Homes12. NEK Prosper13. No Sugar Added Obesity Preventions and Reduction14. Substance Misuse Prevention15. Radio Education Program16. Transportation Vouchers17. Veggie Van Go

Part VI, Line 2:
"Assessment of community needs is an ongoing process at Northeastern Vermont Regional Hospital. Northeastern Vermont Regional Hospital (NVRH) achieves openness, inclusiveness, and public participation in strategic planning and decision-making in deliberate ways. NVRH governance structure includes the Northeastern Vermont Regional Corp. (NVRC) Corporators. The nearly 250 Corporators, representing all the towns in our service area, are an invaluable source of wisdom and perspective for hospital leadership. Corporators are key links representing the community, serving as our eyes and ears in the region. The quarterly Corporators meetings are an opportunity for two-way sharing of information. The Corporators share their needs and concerns, as well as those of their families, friends, and neighbors. In return, the Corporators are updated on hospital services, facility enhancements, community health efforts, and other educational topics that enhance their understanding of healthcare and social care. Additionally, Corporator meetings will highlight state and national healthcare issues to provide additional context on the current landscape. The Hospital participates in formal community assessments that are conducted every few years by various community organizations, including the Northeast Prevention Coalition, the Housing Coalition, and the Vermont Department of Health. Hospital staff are active members and partners with these coalitions and organizations. Formal community assessments begin with identifying a problem or purpose. The purpose could be broad, such as ""what are the top priorities in our community or it could be more specific based on the mission of the organization. The local prevention coalitions conduct ongoing community engagement activities, including surveys, public forums, community dinners, and listening sessions.The next step is developing a community profile using secondary source data. Secondary source data is primarily obtained from the Vermont Department of Human Services Community Profiles. These profiles compile data from a variety of sources including the Behavioral Risk Factor Surveillance System (BRFSS), U.S. Census, the Vermont Health Care Cost and Utilization Project, and several other state and national data sources. Primary data is also gathered by identifying and getting input from key stakeholders including community leaders, relevant organizations, and community members. Input is gathered by using one-on-one interviews, surveys (including using online tools like Survey Monkey), and focus forums for all key stakeholder groups. Inventories of existing services, and gap and/or asset mapping are also typically part of the community assessment process.Upon compiling primary and secondary data, a deep analysis is then conducted. Sometimes the focus of an assessment may shift if data reveals a new or more urgent health priority. Reporting the results of the assessment is an important piece of the process. Every effort is made to get summaries and reports back to interested community members and organizations. The 2021 Community Needs Health Assessment Report and Implementation plan were recently completed. The link to access those document are noted here: https://nvrh.org/community-health-needs-assessment/ More and more often, the Hospital and partner organizations are using Collective Impact principles when designing community interventions or deciding on which health services to add or enhance. Collective Impact starts with community engagement and buy in, but goes beyond to ensure that knowledge, power, credit, and results are shared fairly between ""experts and community members."