4A (Expenses $ 81477180 including grants of $ 13513) (Revenue $ 105858889)
GENERAL HOSPITAL SERVICES PROVIDED TO THE COMMUNITY. THE NUMBER OF PERSONS BENEFITED IN 2022 WAS 172,534 AND THE TOTAL QUANTIFIABLE COMMUNITY BENEFITS WERE $14,708,232.

Schedule H, Part V, Section B, Line 3E
THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IDENTIFIED IN THE CHNA ARE PRIORITIZED ACCORDING TO THE COMMUNITY NEEDS.

Schedule H, Part V, Section B, Line 3 Facility , 1
Facility , 1 - RIVERSIDE SHORE MEMORIAL HOSPITAL. In addition to the required components of the CHNA, Riverside used the opportunity to examine and reflect on many aspects of the areas served by the facility as well as the varied individuals who live and work there. Additional issues examined included, but were not limited to: * Housing insecurity * Broadband internet access * Unemployment rates * Major employers in the region * Food insecurity and number of children accessing free or reduced lunch * Basic literacy and numeracy rates * Populations with limited English proficiency and what those other languages in the market were * Crime rates and types of crimes (against People, Property and Society) * Rates of multiple screenings (i.e., mammography and colonoscopy). We also examined key behaviors (such as smoking and vaccination against COVID-19 and Influenza) as well as some of the motivations behind those behaviors in respect to why or why not individuals had been or intended to be vaccinated against COVID-19. * How individuals felt their lives had been impacted by the pandemic from a physical health, mental / emotional health and financial wellbeing. * Examined preventable hospitalizations, premature mortality and potential life lost by racial group * Causes of death and mortality rates by type (accidental, homicide, natural death, suicide, motor vehicle and gun fatalities) * Types of behavioral health discharges * Deep dive examining impact opioids have had on the community vs the state * Perceived knowledge of how to access existing services in the region for various situations (health, safety, food, housing, etc.) * Perceived bias experienced when seeking care as far as gender, sex, education, insurance states, physical disabilities, language, race, ethnicity, religious beliefs, intellectual disabilities, immigration status, sexual orientation, and age as well as their satisfaction with how the community is addressing issues of diversity, equity, and inclusion. * Perceived trusted sources of health information

Schedule H, Part V, Section B, Line 5 Facility , 1
"Facility , 1 - RIVERSIDE SHORE MEMORIAL HOSPITAL. As described in the CHNA, Riverside conducted a community survey between late November 2021 thru February 2022. The CHNA incorporated input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of and expertise in public health. In addition to the facilities and healthcare organizations named in the question 6a, Riverside collaborated closely with the Virginia Department of Health (VDH), with representatives from the Peninsula and Hampton District offices closely involved with the survey for stakeholders and community members and analyzing results. In fact, the stakeholder survey was sent out under the signature of VDH. Other health districts within VDH also utilized the results. In addition, groups such as the Peninsula Community Health Collaborative (a group that includes the major health systems in Hampton Roads as well as organizations such as the Foodbank of the Virginia Peninsula, Healthy Suffolk, and other non-profit organizations), VOICES (a group focused on listening to minority members of the community). Specific organizations and companies consulted in the process are listed in the CHNA document. Riverside also continues to seek out information year-round - not only within the CHNA process - to ensure we are listening to all members of our community. This is done with various focus groups, patient advisory groups, ""contact us"" inquiries via our website and input from and through our community board members."

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - RIVERSIDE SHORE MEMORIAL HOSPITAL. Yes. Parts of the CHNA were conducted with other hospital facilities. Specifically, Riverside Shore Memorial Hospital, Riverside Doctors Hospital of Williamsburg, Riverside Regional Medical Center, Riverside Behavioral Health Center, Riverside Walter Reed Hospital, Riverside Rehabilitation Hospital and Select Specialty Hospital worked together to pull the same data components and share information on some shared geographic areas as well as shared services and programs. In addition to the hospitals named already, Sentara Health System, Children's Hospital of the King's Daughters and Bon Secours Mercy Health collaborated jointly on the qualitative community and stakeholder surveys.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - RIVERSIDE SHORE MEMORIAL HOSPITAL. Yes. As noted in question 5, Riverside worked closely with organizations such as the Virginia Department of Health and the Foodbank of the Virginia Peninsula.

Schedule H, Part V, Section B, Line 7 Facility , 1
Facility , 1 - RIVERSIDE SHORE MEMORIAL HOSPITAL. In addition to posting online and having paper copies available, Riverside promoted the results through social media channels. Additionally, when Riverside gives community presentations to various organizations, clubs, places of worship, professional groups, or governments the speakers pull heavily from the information included in the CHNA.

Schedule H, Part V, Section B, Line 11 Facility , 1
"Facility , 1 - RIVERSIDE SHORE MEMORIAL HOSPITAL. The COVID-19 pandemic experience demonstrated the impact Riverside could have on the health of our community when all of the resources across the health system were focused on solving the same problem. While during previous CHNA cycles each hospital across Riverside Health System identified unique priorities for each hospital, the 2023 - 2025 cycle decided to focus on two key community health issues across the health system in order to leverage the full strength of the organization to impact the problems. Each hospital across the health system continues to address other community health issues outside of the CHNA process. This may include things like community education and outreach, health screenings, providing critical services, health professions education and partnering with local organizations to address issues of health equity. The CHNA Steering Committee, consisting of clinical and non-clinical staff, reviewed all of the data in the CHNA and identified significant issues that were consistent across all of Riverside's markets. These included: mental health and wellness, opioids and substance use disorder, care of patients living with dementia as well as their caregivers, cardiovascular health and wellness and cancer. The CHNA Steering Committee reviewed the potential areas of focus, examined the qualitative survey results and considered many conversations with community and organization leaders as well as discussed internal projects underway that might allow areas of overlap to enhance existing community efforts. For cardiovascular health & wellness and cancer, it was determined that the plans to address these community health needs were already being addressed through our service line programs focused on these areas. Activities such as screenings, community talks, education on risk factors and signs of stroke and heart attack, exercise opportunities and healthy eating promotion are already a part of the hospital's community work. For mental health and wellness, Riverside has been focused on expanding these services to the broader community by expanding its Hampton facility, Riverside Behavioral Health Center, which is part of Riverside Regional Medical center but located on a separate campus and serves the broader Hampton Roads region. There is current construction of a psychiatric emergency department and the ongoing recruitment of additional mental health practitioners to the region and both a newly identified Associate VP and Service Line Physician Chief for the program. As the health system continues to expand its resources in this area, patients in all of the services areas will continue to benefit through telemedicine access and support as well as being able to tap into the clinical expertise of experts in the field. The remaining two areas were selected for focus as part of the CHNA / Implementation Plan process - Opioid Stewardship and Memory and Dementia Services. Memory and Dementia Care Caring for dementia patients is complex and an ever-moving target. The experience varies by cause and type, individual patient, setting and caregiver support among other variables. With the combined expertise of Riverside's Neurological and Spine Institute and Riverside's Martha W. Goodson Center, Riverside has many key components in place to provide the best care, support and experience for dementia patients and their loved ones. In the 2023-2025 timeframe, Riverside will be delineating a more detailed vision of what memory and dementia services can become, including building additional connections between the different area of the health system for seamless care. In the area of Memory and Dementia Care, Riverside Shore Memorial Hospital will be addressing the complex problems facing patients and their caregivers through the following: * Memory Cafes- While initially planned for the last CHNA process, Memory Cafes had to be put on hold due to concerns about social distancing. Moving forward, RSMH will explore implementing these opportunities in conjunction with community partners so that both patients with dementia issues and caregivers can come together in a relaxed, social environment to share experiences and support each other. These have been successful in the Peninsula and Williamsburg markets, and we look forward to bringing this to Virginia's Eastern Shore. * Purple Flower Project -The Alzheimer's Association notes that Alzheimer's Disease isn't a ""red ""blue"" issue, but one that impacts all Americans, making it a purple issue. A flower - based on a forget-me-not-is chosen to represent those dealing with memory issues or those remembering loved ones lost to dementia. One of RSMH's sister facilities will be piloting a project to use a small purple flower on a door or chart to quietly notify staff that the patient or resident in the room has a memory issue. This notification system along with special training for team members will help staff and volunteers adjust their communications with and expectations of the individual. Following a successful implementation at the other facility, RSMH hopes to implement the same program on the Eastern Shore. * Primary Care Health Coaches- RSMH will evaluate the possibility of having the primary care health coaches at each PCP location on the Eastern Shore go through Teepa Snow training to learn how to best support and care for patients with dementia. If successful, it will be rolled out at other primary locations in the health system. * System Expertise with Martha W Goodson Center - RSMH will also continue to draw upon the resources and expertise in the Martha W. Goodson Center, which focuses on supporting caregivers. Resources include classes, training and other importance support programs."

Schedule H, Part V, Section B, Line 11 Facility , 2
Facility , 2 - Riverside Shore Memorial Hospital - Line 11 continue. Opioid Stewardship and Substance Use Disorder The importance of this issue was clear in both quantitative and qualitative date obtained in the CHNA process. Fatal drug overdoses in Virginia and across the country have risen rapidly in the past 13 years and had a very high increase during the pandemic. Both stakeholders and community members noted that substance use disorder was one of the most important health issues for youth and adults. Working with the experts across the health system, Riverside has identified multiple areas where it can begin to impact some of the complex factors involved. To build the plan for the health system to address this issue in a cohesive manner, the VP of Pharmacy led an interdisciplinary team that included inpatient and outpatient physicians, nurses, pharmacists, mental and behavioral health experts and others representing all the hospitals as well as critical support areas such as the electronic medical record (EMR) team. The team pulled from the National Quality Partners (NQP) Opioid Stewardship Action Team's NQP Playbook: Opioid Stewardship as well as from research, presentations and case studies shared nationally including the great work done by Carillion in the western part of Virginia. The Virginia Department of Health's 2021 Best Practices for Opioid Related Emergencies in the Emergency Department was also used as an important resource. The team reviewed and learned about recommended areas of Primary, Secondary, and Tertiary overdose prevention strategies. Primary strategies focus on preventing the onset of substance use disorder by avoiding exposure to opioids with tactics such as developing evidence-based prescribing guidelines to promote alternate pain management approaches where appropriate, monitoring prescriptions, preventing diversion, executing pain management agreements for chronic pain patients, and educating the public on storage and disposal. Secondary strategies focus on screening for individuals who are high risk for substance use disorder so that more aggressive prevention and treatment approaches can be pursued. Tertiary strategies focus on helping individuals with substance use disorders prevent fatal overdoses using measures to reduce harm and to get off the drug using medication assisted treatment, naloxone prescriptions, and other strategies. There are additional factors that impact this national crisis, such as increasing supply of illegally manufactured opioids available to the public without a prescription, that are outside the scope of this plan currently. Due to the nature of opioids as an addictive and controlled substance, not every aspect of the implementation plan will be publicly detailed. Nonetheless, the team identified projects in each of the prevention areas (primary, secondary, and tertiary). For Primary Overdose Prevention Strategies (Primary strategies focus on preventing the onset of substance use disorder by avoiding exposure to opioids): * While not as visible to the public, Riverside has identified areas to continually monitor and design evidenced based processes to track prescriptions, appropriate use, policy adherence and diversion prevention. This will be done by the pharmacy team, Riverside Medical Group and RSMH staff, the EMR team and other internal support areas. * RSMH will continue partnering with law enforcement and the DEA in hosting a Riverside Drug Take Back Day. * Riverside will create and maintain local partnerships to combat opioid addiction in the community. Riverside will continue working with the Hampton Roads Opioid Working Group, a regional collaborative that uses a community-based and action-oriented approach to reduce opioid-related deaths. * Led by the new Mental and Behavioral Health Service Line leadership, Riverside will identify opportunities throughout Riverside and the community for community outreach and education. Secondary Overdose Prevention Strategies (Identifying those at increased risk of SUD so that more aggressive prevention and treatment approaches can be pursued): * Working across the health system, RHS will develop and implement consistent screening processes to identify those individuals at high risk for developing SUD. * These processes need to be tailored to each setting such as the Emergency Department, surgical patients, inpatient, and in RMG offices; therefore, the process developed for each setting and the resulting next steps will be appropriate for that setting. * Once piloted and finalized at other RHS facilities, these may be implemented at RSMH as well. Tertiary Overdose Prevention Strategies (Assisting individuals living with SUD prevent fatal overdoses using measures to reduce harm and to get off the drug using medication assisted treatment, naloxone prescriptions and other strategies): * Across the health system, there will be different pilot projects addressing this issue. Once a program is successfully implemented and shown to be beneficial, it will be replicated at RSMH. For example, a sister facility will explore piloting a program trialing Medication Assisted Therapy (MAT) beginning in the ED to bridge individuals from the initial emergency visit through the first few days it takes to get into an outpatient MAT program. This may be replicated in other facilities following the pilot. * Riverside will continue to facilitate access to inpatient and outpatient addiction services. * The entire health system will also be able to draw on the expertise of the clinical staff at the Riverside Behavioral Health Center in Hampton. As materials, protocols, telemedicine programs or other opportunities are developed, RSMH will be able to build off those to better serve the individuals in the Greater Hampton Roads region dealing with SUD. While only two areas were selected to officially be part of the CHNA Implementation Plan, other community health initiatives will continue outside of the CHNA process. These include addressing areas such as: * Public health education on wellness and prevention, including nutrition and healthy food * Public education on symptom recognition of signs & symptoms of heart attack and stroke * Mental health and wellness * Vaccinations * Healthy parenting * Cancer prevention & screening * Health equity issues

Schedule H, Part I, Line 3c
RIVERSIDE DOES NOT USE ANY OTHER ASSET THRESHOLD IN DETERMINING FINANCIAL ELIGIBILITY. RIVERSIDE ONLY USES FPL IN DETERMINING FAP-ELIGIBILITY. FREE CARE USES 200% AND DISCOUNTED CARE USES 400% OF THE FPG.

Schedule H, Part I DISCLOSURE IN ACCORDANCE WITH REVENUE PROCEDURE 2015-21
IN ACCORDANCE WITH REVENUE PROCEDURE 2015-21, RIVERSIDE IS DISCLOSING INFORMATION WITH RESPECT TO SECTION 501(R) ISSUES THAT WERE DISCOVERED RELATED TO THE 2017-2021 TAX YEARS AND HOW THEY HAVE BEEN CORRECTED TO SATISFY SECTION 501(R) AND 501(R)(2)(B) REQUIREMENTS. THE CAUSE WAS A GOOD-FAITH EFFORT BY RIVERSIDE TO IMPLEMENT THE REQUIREMENTS OF THE REGULATIONS, HOWEVER THERE WERE SOME MINOR GAPS DUE TO THE DETAILED NATURE OF THE REGULATIONS. IN OCTOBER 2022 WHEN COMPILING INFORMATION TO PREPARE FORM 990 FOR THE 2021 TAX YEAR, RIVERSIDE REALIZED THAT THE FINANCIAL ASSISTANCE POLICY (FAP) ALLOWED A PATIENT TO APPLY FOR FINANCIAL ASSISTANCE WITHIN 180 DAYS OF DISCHARGE BILLING, RATHER THAN THE 240 DAYS REQUIRED UNDER 501(R) REGULATIONS. RIVERSIDE DETERMINED THE NUMBER OF INDIVIDUALS AND DOLLAR AMOUNTS IMPACTED. BELOW IS A SUMMARY OF THE RIVERSIDE SHORE MEMORIAL HOSPITAL ACCOUNTS AND DOLLAR AMOUNTS REFUNDED: Year Accounts Amount 2017 122 $ 7,025.61 2018 107 $ 11,996.45 2019 91 $ 16,150.16 2020 48 $ 4,058.23 2021 36 $ 5,044.38 2022 1 $ 177.25 Total 405 $ 44,452.08 RIVERSIDE PROMPTLY CORRECTED THE FAP POLICY (EFFECTIVE NOVEMBER 1, 2022) TO ALLOW A PATIENT 240 DAYS FROM DISCHARGE BILLING TO APPLY FOR FINANCIAL ASSISTANCE AND ALL PERSONS POTENTIALLY AFFECTED BY THIS OVERSIGHT IN THE POLICY TO DETERMINE IF A REFUND IS REQUIRED. RIVERSIDE HAS PROVIDED REFUNDS ON ALL REQUIRED ACCOUNTS. RIVERSIDE HAS IMPLEMENTED A FINANCIAL ASSISTANCE MODULE IN ITS BILLING SYSTEM TO SUPPORT THE FAP AND TRACK ALL FAP APPLICATIONS AND ACTIONS NEEDED TO COMPLY WITH ITS POLICY. RIVERSIDE ALSO HAS A COMPLIANCE AND AUDIT PROGRAM THAT REVIEWS POLICIES AND PROCESSES FOR COMPLIANCE WITH ALL 501(R) REGULATIONS.

Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation
1429251

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
PART I LINE 7A: THE FINANCIAL ASSISTANCE COST IS FROM THE MEDICARE COST REPORT. PART I LINE 7B: MEDICAID COST AND NET REVENUE ARE DIRECTLY FROM THE MEDICAID COST REPORT. PART I LINE 7E: COMMUNITY HEALTH IMPROVEMENT IS THE ACTUAL COST ACCUMULATED BY THE INDIVIDUALS PARTICIPATING IN THE ACTIVITIES. PART I LINE 7I: CASH AND IN-KIND CONTRIBUTIONS ARE THE ACTUAL CURRENT YEAR DOLLAR VALUE OF THE CASH OR ITEMS GIVEN.

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
Bad debt is the amount remaining on a patient's account after cash payments, third-party payer contractual adjustments, and hospital discounts have been taken. Before the amount is written off to bad debt, the account is sent to a collection agency which returns the account when they have exhausted all possible effort. Upon return, the account balance is written off to bad debt.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
IF THE PATIENT WAS UNINSURED AND HAD A HOUSEHOLD INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL OR WAS INSURED AND HAD A HOUSEHOLD INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, THE PATIENT WOULD QUALIFY FOR 100% FINANCIAL ASSISTANCE AND WOULD NOT BE INCLUDED IN BAD DEBT. THE ONLY POPULATION THAT MAY FALL INTO THE BAD DEBT IS IF THE PATIENT WAS UNINSURED WITH A HOUSEHOLD INCOME BETWEEN 201% AND 400% OF THE FEDERAL POVERTY LEVEL, WHICH RECEIVED A 75% FINANCIAL ASSISTANCE WRITE-OFF OF THE ELIGIBLE BILLED CHARGES. THE PATIENT WOULD HAVE A LIABILITY OF 25% OF THE BILLED AMOUNT. IF THE PATIENT DID NOT PAY THE 25% AMOUNT, THAT LIABILITY COULD BE SENT TO BAD DEBT. THE FINANCIAL ASSISTANCE WRITE-OFF OF 75% IS NOT APPLIED TO BAD DEBT.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
FOOTNOTE 3 OF THE AUDITED FINANCIAL STATEMENTS STATES: IF THE SYSTEM IDENTIFIES SUBSEQUENT ADJUSTMENTS TO THE TRANSACTION PRICE THAT WOULD CAUSE ADVERSE CHANGES IN A PATIENT OR PAYOR'S ABILITY TO PAY, THE AMOUNTS ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE IS INCLUDED IN OPERATING EXPENSES IN THE ACCOMPANYING CONSOLIDATED STATEMENT OF OPERATIONS. THE AMOUNT INCLUDED AS BAD DEBT EXPENSE FOR THE YEARS ENDED DECEMBER 31, 2022, AND 2021 WAS NOT MATERIAL TO THE SYSTEM.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE ORGANIZATION USES CMS COST REPORTING GUIDELINES AND METHODOLOGY TO DETERMINE ALLOWABLE MEDICARE COSTS. THE HEALTH SYSTEM ASSURES THAT THE ESSENTIAL EMERGENCY AND ACUTE CARE SERVICES ARE PROVIDED FOR THE POPULATION'S HEALTH. THE ORGANIZATION BELIEVES THE ENTIRE SHORTFALL SHOULD BE INCLUDED AS COMMUNITY BENEFIT.

Schedule H, Part V, Section B, Line 16a FAP website
- RIVERSIDE SHORE MEMORIAL HOSPITAL: Line 16a URL: https://www.riversideonline.com/patients-guests/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
- RIVERSIDE SHORE MEMORIAL HOSPITAL: Line 16b URL: https://www.riversideonline.com/patients-guests/financial-assistance;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
- RIVERSIDE SHORE MEMORIAL HOSPITAL: Line 16c URL: https://www.riversideonline.com/patients-guests/financial-assistance;

Schedule H, Part VI, Line 7 State filing of community benefit report
VA

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
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.

Schedule H, Part VI, Line 2 Needs assessment
"Assessing, understanding and listening to our communities is an ongoing process at Riverside. The formal CHNA process occurs on a three-year cycle, but it is only one component of how Riverside works to better understand the needs of the communities we serve. Other ways Riverside utilizes to do this include but aren't limited to: a. Community representatives and leaders on our volunteer board of directors that represent a wide range of diverse expertise, interests, professions and geographic areas. b. Committees of patients, family members and residents' family members that provide feedback c. Listening to ""alumni"" consisting of retired employees d. Partnering with local organizations, communities and universities to formally and informally learn about their needs e. Making connections with individual neighborhood and community influencers to host health fairs or provide speakers on topics of interests they seek out f. Meeting with small focus groups on certain topics to better understand how we can address barriers to care and improve clinical outcomes"

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
NOTIFICATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM INCLUDE, BUT ARE NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT'S BILLS, PROVIDING THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IN EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES, PATIENT FINANCIAL SERVICES OFFICES, AND AT OTHER PUBLIC PLACES AS RIVERSIDE HEALTH SYSTEM MAY ELECT. RIVERSIDE HEALTH SYSTEM ALSO PUBLISHES AND WIDELY PUBLICIZES THIS FINANCIAL ASSISTANCE POLICY ON THE FACILITY WEBSITE. THE PLAIN LANGUAGE SUMMARY IS INCLUDED WITH THE BILLING STATEMENT 30 DAYS BEFORE REFERRING A PATIENT'S ACCOUNT TO COLLECTIONS. PATIENTS MAY OBTAIN ADDITIONAL INFORMATION AND/OR PAPER COPIES OF ANY FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, OR APPLICATION IN PERSON BY VISITING ANY RIVERSIDE HOSPITAL DEPARTMENT BY MAIL, VIA OUR WEBSITE, OR BY CALLING OUR CUSTOMER SERVICE CENTER.

Schedule H, Part VI, Line 4 Community information
Virginia's Eastern Shore consists of the southernmost part of the Delmarva Peninsula, and is bordered to the north by Maryland, to the east by the Atlantic Ocean, and to the south and east by the Chesapeake Bay. It is connected to the Hampton Roads region of Virginia by the 23-mile Chesapeake Bay Bridge Tunnel. The 70-mile stretch of land that makes up the Eastern Shore of Virginia is spread across two counties, Accomack to the north and Northampton to the south. The Eastern Shore area is home to just under 45,000 people. Approximately two thirds of the population located in northern Accomack County while one third in Northampton County. The region is defined by the water, both for the major tourism industry as well as by the watermen who work in the aquaculture industry. Agriculture also plays a key role, with poultry farming and processing employing many people in the area. NASA has a continued presence at the Wallops Island flight facility. Despite multiple industries, the Eastern Shore Region lags in economic development and prosperity compared to the rest of Virginia. Riverside Shore Memorial Hospital is the only hospital on Virginia's Eastern Shore. The closest competition is in Salisbury, Maryland to the north or in Virginia Beach across the Bay Bridge Tunnel to the south. Demographically, the region is approximately two thirds Caucasian and one third African American. There is also a growing migrant community in the region which helps serve the agricultural industry, and the Hispanic community is the fastest growing segment in the region. There is also a growing population of Haitian Kreyol speakers that is focused around the poultry processing facilities. 2025 Census projections estimates per capita income at $32,593. U.S. Census Bureau reports indicate that more than 19 percent of the adult (25+) population have not graduated from high school. Due to the rural nature of the region and its historical isolation, the Eastern Shore lags behind the rest of Virginia in areas of infrastructure development, with limited cell phone service and internet access as significant issues as well as limited transportation infrastructure. The Eastern Shore is seeing the aging of the Baby Boomer generation like the rest of Virginia and the country. Individuals age 65+ make up more than 25 percent of the population. The entire region is designated as a Medically Underserved Area.

Schedule H, Part VI, Line 5 Promotion of community health
As noted in other sections, Riverside is always working to serve its communities. In addition to the formal things noted in the CHNA and Implementation Plan, there are countless other ways Riverside works to promote community health in it's service areas, the state and the nation. One of the large ways Riverside works to do this is through education. We have two branches of formal health professions education through the Riverside College of Health Careers and the Riverside Graduate Medical Education Program. Riverside has programs to train future nurses (LPN and RN to BSN programs), medical assistants, CNAs, radiology techs, cardiovascular/ echo techs, OR / surgical techs and PT Assistants. Riverside's Graduate Medical Education program offers residency multiple residency programs include family practice, OB/GYN, emergency medicine and a transitional residency. Riverside also offers residency programs in Pharmacy, Clinical Pastoral Education and will soon be offering a one year Clinical Ultrasound Fellowship Program which is pending accreditation by the Emergency Ultrasound Fellowship Accreditation Council (EUFAC). In addition to these programs, Riverside facilities and practices serve as clinical rotation locations for students in other training programs including nursing, pharmacy, medical students and many others. Additionally, Riverside is involved with education at early levels, such as its partnership with the Achievable Dream Academy in Newport News where Riverside has a clinic to care for students and their families. Or partnering with local community colleges, such as on the Eastern Shore. Riverside also provides multiple scholarships and helps train qualified individuals to take care of the future generations of our communities. And, Riverside works closely with local first responders through the Peninsula EMS and Tidewater EMS societies to train, as well as provide physician support to those programs. We also work and train with local military and first responder groups on regional safety drills addressing scenarios like incidents at the Huntington Ingalls Newport News Shipyard, at the Surry Power Plant and other locations. Community health education is another large part of Riverside's efforts in caring for its communities. The pandemic changed how people seek out, learn and trust health information, and Riverside is proud to serve as a trusted, local source of truth. As part of that, Riverside provides extensive amounts of accessible education to community members in person, online and one on one. Examples include health lectures in person and online, providing speakers to local groups and organizations on a variety of topics, providing valuable content in written blogs and often in infographic forms so individuals at varying literacy levels can use it. We are also active in local community health fairs and other events where we are able to provide various screenings, education and information including awareness of heart attack and stroke symptoms, the importance of calling 911, cancer screenings, smoking and vaping cessation information, cardiovascular health information including healthy diet, exercise, stress management and importance of taking medications and monitoring Hba1c. We also work with specific population groups to identify opportunities to provide education and outreach on topics of specific concern to those individuals. This has included hosting a nationally recognized African American chef to address the importance of diet in heart health and examining how foods traditionally made in an unhealthy way can be adapted to be made healthier while still celebrating family and community culture and traditions. We have also offered cancer screening information specific to the trans community to help provide clarity on complex issues. Another example is providing skin cancer screening and education focused on the Waterman communities on the Eastern Shore, Middle Peninsula and Peninsula that work the Chesapeake Bay harvesting things like crab and oysters and spends so much time exposed to the sun. Another aspect of how Riverside takes care of its communities is by investing in programs, technology and professional to assure they are available when needed. A great example of this is Riverside's commitment to providing OB/GYN services on the Eastern Shore despite the fact that the small population size makes it difficult to make the program break even. But without that program, women on the Shore would have to drive to Maryland where Virginia Medicaid isn't accepted or cross a 25+ mile bridge to Virginia Beach that is closed in high winds and hurricanes. Another example is how Riverside invests in specialists and technology that many health systems this size don't have, such as having neurovascular coverage and a biplane suite to provide the most advanced stroke interventions to the people of our community. Another example is how Riverside partnered with the University of Virginia and Chesapeake Regional Medical Center to bring Gamma Knife and Varian Edge radiosurgery technologies to the area, and those are expanding in the near future. A final example of this investment is how Riverside, in response to the ever-increasing need for mental and behavioral health services, is in the process of building the only freestanding psychiatric emergency room and expanding our mental health services. Other important investments include research, partnering with community groups such as the Urban League and The American Diabetes Association to help address specific needs and concerns locally and nationally. Additionally, our clinical and administrative leaders work with local and state organizations to ensure our public health and healthcare infrastructure is in place to care for our communities in a crisis. This became exceptionally clear during the pandemic when our leaders were key in providing storage and distribution for vaccinations as well as in caring for our communities during crisis points. When COVID-19 went through the poultry processing plants on the Eastern Shore, the health system pulled together to care for the small community and was recognized nationally for its efforts. As the needs evolve, Riverside is there to care for the community, whether it is a tornado, pandemic, mass casualty motor vehicle incident or outbreak of gun violence in our schools.

Schedule H, Part VI, Line 6 Affiliated health care system
Riverside Health System works together to care for its communities across a wide range of geographic regions and services. Each region has a local acute care facility that works to serve the immediate needs of the area. The acute care services (inpatient and outpatient) work closely with our Riverside Medical Group physician practices and Riverside Lifelong Health that addresses senior services including retirement communities, skilled nursing facilities, convalescent and short-term rehabilitation, home health and hospice. The local hospital has a volunteer community board, and RMG and Riverside LLH each have their own volunteer, community board as well. All those boards report up to the Riverside Health System board. Each area works closely on clinical and quality issues for their area (such as HACs in acute care, preventative care in RMG and length of stay in hospice). Staff and physicians work across the areas to provide the best care for the patients and residents. Additionally, the hospital in Newport News serves as a tertiary facility with a Level 2 Trauma center, a certified Comprehensive Stroke Center, a cardiac cath lab, radiosurgery and other acute services not available in the smaller markets.