4A (Expenses $ 28251213 including grants of $ 0) (Revenue $ 28325146)
SEE SCHEDULE OVCU HEALTH TAPPAHANNOCK HOSPITAL (TAPP) WAS ORGANIZED TO OPERATE AS A CHARITABLE COMMUNITY HOSPITAL, LOCATED IN TAPPAHANNOCK, VIRGINIA. THE HOSPITAL CONSISTS OF INPATIENT BEDS AND PROVIDES INPATIENT AND OUTPATIENT SERVICES. MAJOR SERVICES PROVIDED BY THE ORGANIZATION INCLUDE BUT ARE NOT LIMITED TO:- 24 HOUR EMERGENCY SERVICES- GASTROENTEROLOGY- ORTHOPAEDIC SERVICES- PAIN MANAGEMENT- PHYSICAL THERAPY- SURGERY- OUTPATIENT INFUSION THE SERVICES PERFORMED AT THIS FACILITY ARE CONDUCTED BY HOSPITALISTS, SPECIALISITS, NURSES AND OTHER PROFESSIONALS THAT PROVIDE PATIENT AND ADMINISTRATIVE SERVICES NEEDED TO MANAGE A HOSPITAL. SERVICES ARE CONDUCTED AT THE HOSPITAL AND SURROUNDING FACILITIES. THE PROVISION OF MEDICAL CARE TO THE COMMUNITY, REGARDLESS OF THE ABILITY TO PAY, IS DIRECTLY RELATED TO THE FURTHERANCE OF THE ORGANIZATION'S EXEMPT PURPOSES. SPECIFIC SERVICES TO THE COMMUNITY MAY CHANGE YEAR TO YEAR BASED ON SPECIFIC NEEDS, BUT THE ORGANIZATION WILL CONTINUE TO PROVIDE MEDICAL SERVICES TO THE RESIDENTS OF TAPPAHANNOCK AND SURROUNDING COUNTIES REGARDLESS OF THE ABILITY TO PAY.

TAPPAHANNOCK HOSPITAL
PART V, SECTION B, LINE 5: AS DESCRIBED IN THE CHNA, THE ORGANIZATION CONDUCTED A COMMUNITY SURVEY BETWEEN JUNE 2018 AND MAY 2019 TO OBTAIN INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. IN PARTNERSHIP WITH OTHER REGIONAL HEALTHCARE SYSTEMS, THE PENINSULA COMMUNITY HEALTH COLLABORATIVE, NON-PROFIT ORGANIZATIONS AND THE VIRGINIA DEPARTMENT OF HEALTH CONDUCTED A JOINT SURVEY UTILIZING SURVEYMONKEY. THERE WERE TWO VERSIONS OF THE SURVEY: ONE FOR COMMUNITY MEMBERS WHICH WAS DISTRIBUTED ON EACH SYSTEM'S WEBSITE, SOCIAL MEDIA OUTLETS AND COMMUNITY MEETINGS; AND ONE FOR COMMUNITY, MEDICAL AND PUBLIC HEALTH LEADERS WHICH WAS EMAILED TO AN IDENTIFIED LIST OF KEY STAKEHOLDERS JOINTLY FROM ALL OF THE HEALTH SYSTEMS UNDER THE SIGNATURE OF THE MEDICAL DIRECTOR OF THE PENINSULA HEALTH DISTRICT OF THE VIRGINIA DEPARTMENT OF HEALTH. THE SPECIFIC LIST OF ORGANIZATION AFFILIATIONS CAN BE FOUND IN APPENDIX A OF THE CHNA. IN ADDITION TO THE SURVEY, MULTIPLE PUBLIC HEALTH SOURCES WERE CONSULTED IN THE ASSEMBLY OF THE NEEDS ASSESSMENT. THESE INCLUDED CDC'S WONDER DATABASE, VIRGINIA DEPARTMENT OF HEALTH STATISTICS, VIRGINIA HEALTH INFORMATION, URBAN INSTITUTE FOR THE VIRGINIA HEALTH CARE FOUNDATION, AMERICAN COMMUNITY SURVEY AND THE US HEALTH RESOURCES AND SERVICE ADMINISTRATION.TAPPAHANNNOCK HOSPITAL:PART V, SECTION C, LINE 7A:HTTPS://WWW.VCUHEALTH.ORG/TAPPAHANNOCK/COMMUNITY-HEALTH-NEEDS-ASSESSMENTTAPPAHANNNOCK HOSPITAL:PART V, SECTION C, LINE 7D: IN ADDITION TO THE WEBSITE AND THE HARDCOPY AVAILABLE AT THE FACILITY THE REPORT WAS ALSO MAILED TO SEVERAL COMMUNITY LEADERS.TAPPAHANNNOCK HOSPITAL:PART V, SECTION C, LINE 10:HTTPS://WWW.VCUHEALTH.ORG/TAPPAHANNOCK/COMMUNITY-HEALTH-NEEDS-ASSESSMENT

TAPPAHANNOCK HOSPITAL
PART V, SECTION B, LINE 11: AS EXPLAINED IN THE CHNA, THE SIGNIFICANT NEEDS TO BE ADDRESSED INCLUDE:LUNG CANCER: TAPPAHANNOCK HOSPITAL IS OFFERING LOW-DOSE CT SCREENING TO A BROADER GROUP THROUGH PARTICIPATING IN THE PENLUNG REGISTRY.DIABETES / OBESITY / NUTRITION: TAPPAHANNOCK HOSPITAL WILL CONTINUE THE HEALTHY LIVING / HEALTH EATING PROGRAM AND THE LEDWITH LEWIS FREE CLINIC AND WILL EXPAND THE PROGRAM FOR HIGH RISK DIABETICS.AGING SERVICES: TAPPAHANNOCK HOSPITAL WILL CONTINUE TO SUPPORT THE FAMILIES PROGRAM SUPPORTING CAREGIVERS OF INDIVIDUALS LIVING WITH DEMENTIA. WILL ALSO CREATE AWARENESS OF THE BAY AGING DAY CARE CENTER. THIS WAS AN INCREDIBLY CHALLENGING AREA FOR 2020, AS CAREGIVERS FOR LOVED ONES WITH DEMENTIA WERE INCREDIBLY ISOLATED DURING THE PANDEMIC. ONLINE SUPPORT GROUPS AND PRIVATE SOCIAL MEDIA GROUPS WERE CREATED TO HELP SUPPORT THESE IMPORTANT INDIVIDUALS. ADDITIONALLY, ONLINE COURSE MATERIAL WAS DEVELOPED TO HELP FAMILIES COPE DURING SUCH A DIFFICULT TIME. ADDITIONALLY, THE LARGE NUMBER OF INDIVIDUALS IN TAPPAHANNOCK HOSPTIAL MEMORY CARE FACILITIES WERE SUPPORTED BY STAFF DURING THE LONG MONTHS THAT FAMILY AND LOVED ONES WERE UNABLE TO VISIT. STAFF FACILITATED VIRTUAL VISITS, BUT THOSE TYPES OF INTERACTIONS WERE OFTEN VERY CHALLENGING FOR DEMENTIA PATIENTS. HOPEFULLY, AS THE COMMUNITY OPENS UP ONCE AGAIN IN 2021 THERE WILL BE AN INCREASED ABILITY TO PROVIDE SUPPORT FOR THIS SPECIAL POPULATION OF PATIENTS AND CAREGIVERS.HEART DISEASE / CARDIOVASCULAR HEALTH / COPD: TAPPAHANNOCK HOSPITAL WILL IMPLEMENT THE AMBULATORY CARE MANAGEMENT PROGRAM FOR CHF AND COPD USING RESPIRATORY CARE AND REGISTERED NURSE STAFF AT A PRIMARY CARE PRACTICE. TAPPAHANNOCK HOSPITAL WILL ALSO PARTICIPATE IN THE BAY RIVERS TELEHEALTH ALLIANCE BRIDGES TO CARDIOVASCULAR HEALTH PROGRAM. 'DON'T DELAY CARE' MESSAGING WAS A KEY FOCUS ON 2020 AS TAPPAHANNOCK HOSPITAL WORKED TO EDUCATE THE COMMUNITY ABOUT HOW TO SAFELY SEEK CARE IN EMERGENCIES DURING THE PANDEMIC.OPIOID ABUSE: TAPPAHANNOCK HOSPITAL WILL PARTICIPATE IN THE BAY RIVERS TELEHEALTH ALLIANCE OPIOID ABUSE PREVENTION AND TREATMENT PROGRAM.TELEHEALTH / TELEMEDICINE: TAPPAHANNOCK HOSPITAL WILL CONTINUE PARTICIPATING IN THE BAY RIVERS TELEHEALTH ALLIANCE SCHOOL-BASED TELEHEALTH PROGRAM FOCUSED ON THE DELIVERY OF PRIMARY CARE AND BEHAVIORAL HEALTHCARE TO STUDENTS IN FOUR AREA SCHOOL SYSTEMS. IN 2020 RTH'S LONG STANDING INVESTMENT AND EXPERTISE IN TELEHEALTH PROVED INVALUABLE DURING THE PANDEMIC. THE TAPPAHANNOCK HOSPITAL HEALTHCARE ASSOCIATION, INC. GROUP 90-1000718 INFRASTRUCTURE ALREADY IN PLACE WAS ABLE TO BE QUICKLY PUT INTO NEW SERVICE TO MAINTAIN ACCESS TO CRITICAL SERVICES. WITH THE LIMITS OF THE COVID-19 PANDEMIC, TAPPAHANNOCK HOSPITAL HAD TO PIVOT SOME OF THE INITIAL PLANS. THE ITEMS DETERMINED TO NOT BE THE HIGHEST PRIORITIES INCLUDED FOR THE CHNA ARE NOTED BELOW, DUE TO THE LIMITATION OF RESOURCES, THE SIZE OF THE ISSUE AND THE CAPACITY OF EXISTING ORGANIZATIONS TO IMPACT THE PROBLEM (WHICH IS CURRENTLY NOTED).ITEMS ON THE LIST MAY BE ALREADY BEING ADDRESSED THROUGH OTHER TAPPAHANNOCK HOSPITAL PROGRAMS, SUCH AS HEART DISEASE, SMOKING CESSATION PROGRAMS, CHRONIC PAIN, SMOKING, RESPIRATORY CARE, DOMESTIC VIOLENCE AND REPRODUCTIVE HEALTH. SOME ISSUES WERE OUTSIDE OF THE AREA OF EXPERTISE OF THE HEALTH SYSTEM, SUCH AS THE FOSTER CARE SYSTEM. ITEMS SUCH AS INFANT MORTALITY ARE IMPORTANT, BUT NOT NECESSARILY AN ITEM THAT COULD BE IMPACTED SIGNIFICANTLY BY THE HEALTH SYSTEM IN A THREE- YEAR PERIOD AND INSTEAD WILL BE ADDRESSED THROUGH OUR CONTINUED PRE AND POST-NATAL CARE PROGRAMS. OTHER ITEMS NOT RANKED AS TOP HEALTH PROBLEMS THROUGH EITHER THE QUALITATIVE OR QUANTITATIVE DATA ASSESSMENTS INCLUDED: ENVIRONMENTAL HEALTH, DROWNING/WATER SAFETY, AUTISM, HIV/AIDS, DENTAL/ORAL CARE, NEUROLOGICAL PROBLEMS, ARTHRITIS, RENAL DISEASE, ORTHOPEDIC PROBLEMS, SEXUALLY TRANSMITTED INFECTIONS, PHYSICAL DISABILITIES AND BULLYING.TAPPAHANNNOCK HOSPITAL:PART V, SECTION C, LINES 16A, 16B, & 16C:HTTPS://WWW.VCUHEALTH.ORG/TAPPAHANNOCK/BILLING/FINANCIAL-ASSISTANCETAPPAHANNNOCK HOSPITAL:PART V, SECTION C, LINES 20B:WHILE THE HOSPITAL FACILITY MADE REASONABLE EFFORTS TO ORALLY NOTIFY ALL INDIVIDUALS ABOUT THE FAP AND FAP APPLICATION PROCESS, THIS MAY NOT HAVE BEEN UNIFORMLY PERFORMED FOR 100% OF THE PATIENTS RECEIVING TREATMENT DESPITE THE HOSPITAL'S BEST EFFORTS.

PART III, LINE 3:
"FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES, DISCOUNTED ACCORDING TO POLICY, FOR SERVICES RENDERED. HISTORICAL EXPERIENCE HAS SHOWN A SIGNIFICANT PROPORTION OF THE HOSPITAL'S UNINSURED PATIENTS, IN ADDITION TO A GROWING PROPORTION OF THE HOSPITAL'S INSURED PATIENTS, WILL BE UNABLE OR UNWILLING TO PAY FOR THEIR RESPONSIBLE AMOUNTS FOR THE SERVICES PROVIDED. IN ORDER TO ESTIMATE THE NET REALIZABLE VALUE OF THE REVENUES AND ACCOUNTS RECEIVABLES ASSOCIATED WITH THIRD-PARTY PAYORS AND UNINSURED PATIENTS, MANAGEMENT REGULARLY ANALYZES COLLECTION HISTORY. BASED ON THESE HISTORICAL ANALYSES, THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS AND AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOR THIRD PARTY AND UNINSURED PATIENT ACCOUNTS RECEIVABLE BALANCES FOR WHICH THE PATIENT IS RESPONSIBLE.THE ""EMPLOYER"" IS ON ALL PATIENT ACCOUNTS THAT WERE WRITTEN OFF TO BAD DEBT EXPENSE. THOSE ACCOUNTS THAT LISTED NO EMPLOYER WERE ASSUMED TO HAVE QUALIFIED UNDER THE CHARITY CARE POLICY BECAUSE OF THE LACK OF INCOME FROM BEING UNEMPLOYED.PART III, LINE 4:FOOTNOTE 2(E) OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS STATES: THE AUTHORITY RECORDS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS DURING THE PERIOD IN WHICH COLLECTION IS CONSIDERED DOUBTFUL. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS APPROXIMATELY $126,670,000 AT JUNE 30, 2021. ACCOUNTS WAS APPROXIMATELY $69,943,000 AT JUNE 30, 2020."

PART III, LINE 9B:
REASONABLE EFFORTS WILL BE MADE TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SENDING AN ACCOUNT TO COLLECTIONS. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE ACCOUNT IS ADJUDICATED BASED ON THEIR FAP ELIGIBILITY. PATIENTS MAY NEED TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION TO DETERMINE ELIGIBILITY OR MAY REQUEST RECONSIDERATION UNDER THIS FINANCIAL ASSISTANCE POLICY BY SUBMITTING A FINANCIAL ASSISTANCE APPLICATION. UPON RECEIPT OF AN APPLICATION FOR FINANCIAL ASSISTANCE, COLLECTION ACTIONS ARE SUSPENDED UNTIL A FINAL ELIGIBILITY DETERMINATION IS MADE. IF THE PATIENT IS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ACCOUNT WILL BE RETURNED FROM COLLECTIONS AND ALL COLLECTION EFFORTS WILL BE REVERSED.

PART VI, LINE 2:
THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IS THE BEST WAY TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVES. TO SUPPLEMENT THIS DATA, WE ALSO UTILIZED RESOURCES SUCH AS THE VIRGINIA ATLAS OF COMMUNITY HEALTH, DEMOGRAPHIC DATA, AS WELL AS OBSERVING UTILIZATION AND DIAGNOSES TRENDS ACROSS THE SERVICE AREAS AND NATIONALLY. FINALLY, THE ORGANIZATION WORKS CLOSELY WITH OTHER COMMUNITY LEADERS TO IDENTIFY AND RESPOND TO LOCAL NEEDS. HAVING COMMUNITY-BASED BOARDS ALSO ALLOWS FOR CONTINUOUS FEEDBACK FROM INDIVIDUALS LIVING AND WORKING IN THE SERVICE AREA.PART VI, LINE 3:NOTIFICATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM INCLUDE, BUTARE NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT BILLS, PROVIDING THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IN EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITALBUSINESS OFFICES, PATIENT FINANCIAL SERVICES OFFICES, THE FACILITY WEBISTE, AND OTHER PLACES ACCESSIBLE TO THE PUBLIC. PART,VI LINE 1:SEE DETAILS IN SCH H, PART V, SECTION B, LINE 13.

PART VI, LINE 4:
TAPPAHANNOCK HOSPITAL SERVES THE RESIDENTS OF FIVE RURAL COUNTIES (ESSEX COUNTY, WESTMORELAND COUNTY, NORTHUMBERLAND COUNTY, RICHMOND COUNTY, LANCASTER COUNTY, KING & QUEEN COUNTY AND KING WILLIAM COUNTY) WHOSE POPULATIONS ARE SCATTERED THROUGHOUT VIRGINIA'S MIDDLE PENINSULA AND NORTHERN NECK. THE NORTHERN NECK IS THE NORTHERNMOST OF THREE PENINSULAS THAT EXTEND INTO THE CHESAPEAKE BAY OF VIRGINIA AND IS BORDERED ON THE NORTH BY THE POTOMAC RIVER/MARYLAND BORDER AND ON THE SOUTH BY THE RAPPAHANNOCK RIVER. THE REGION IS LIMITED BY WATER CROSSINGS. IN THE FAR WESTERN PORTION OF THE MARKET THERE IS ONE BRIDGE ACROSS THE POTOMAC INTO MARYLAND, AND THERE ARE TWO CROSSING OF THE RAPPAHANNOCK WITH ONE AT EACH END OF THE SERVICE AREA IN TAPPAHANNOCK AND IN LANCASTER COUNTY. THE FERRY TO REACH TANGIER ISLAND (HOME TO 700 IN THE MIDDLE OF THE BAY) DEPARTS OUT OF THIS REGION AS WELL BUT IS RESTRICTED BY SEASONAL DEMAND AND WEATHER. THE AREA IS PARTIALLY A COMMUTER COMMUNITY INTO RICHMOND AND FREDERICKSBURG OR TELECOMMUTING TO DC AND LOCALS WHO WORK IN LOCAL RETAIL, AGRICULTURE AND AS WATERMEN ON THE BAY. THERE IS ALSO A SMALL TOURISM INDUSTRY WHICH CONSISTS OF SERVICES TO WEEKEND AND SUMMER HOMES ON THE WATER. THE HISTORICAL AREAS, SUCH AS GEORGE WASHINGTON'S BIRTHPLACE, DO NOT GARNER AS MUCH TOURISM AS THE RECREATIONAL AREAS TO THE EAST. ONLY TWO TOWNS HAVE A CONCENTRATED POPULATION OF MORE THAN 1,000 PEOPLE. PART VI, LINE 5:THE ORGANZATION PROMOTES COMMUNITY HEALTH AND ITS EXEMPT PURPOSE THROUGH THE MEDICAL SERVICES PROVIDED TO THE RESIDENTS OF THE 5 COUNTIES SERVED, AS WELL AS THROUGH THE IMPLEMENTATON PLAN, WHICH IS BASED ON THE SIGNIFICANT NEEDS REPORTED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. IT ALSO SUPPORTS THE HEALTH OF THE COMMUNITY BY HAVING A COMMUNITY BOARD THAT UNDERSTANDS THE AREA, THE RESIDENTS AND THE PATIENTS OF THE COMMUNITIES SERVED.PART VI, LINE 6:VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY (THE AUTHORITY) IS A PUBLIC CORPORATE BODY AND POLITICAL SUBDIVISION OF THE COMMONWEALTH OF VIRGINIA CREATED AND ESTABLISHED BY AN ACT OF THE GENERAL ASSEMBLY OF THE COMMONWEALTH OF VIRGINIA DURING 1996. THE AUTHORITY IS TAX EXEMPT AS AN INTEGRAL PART OF THE COMMONWEALTH OF VIRGINIA.THE AUTHORITY'S PRINCIPAL ACTIVITY IS OPERATION OF THE MEDICAL COLLEGE OF VIRGINIA HOSPITALS (VCUMC), MCV ASSOCIATED PHYSICIANS (MCVAP), COMMUNITY MEMORIAL HOSPITAL (CMH), TAPPAHANNOCK HOSPITAL (TAPP), CHILDREN'S HOSPITAL (CHILDREN'S), VIRGINIA CHILDREN'S CARE NETWORK (VCCN), UNIVERSITY HEALTH SERVICES, INC. (UHS) AND ARIES INSURANCE SERVICES, LTD (ARIES).ON JANUARY 1, 2021, THE AUTHORITY PURCHASED TAPPAHANNOCK HOSPITAL FROM RIVERSIDE HEALTH SYSTEM, BRINGING THE ORGANIZATION INTO THE AFFILIATED HEALTH CARE SYSTEM KNOWN AS VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM (VCUHS). PART VI, LINE 7:THE ORGANIZATION FILES A COMMUNITY BENEFIT REPORT IN THE COMMONWEALTH OF VIRGINIA.