4A (Expenses $ 878934023 including grants of $ 8055960) (Revenue $ 1049779009)
VALLEY HEALTH'S MISSION IS SERVING OUR COMMUNITY BY IMPROVING HEALTH. VALLEY HEALTH IS COMPOSED OF SIX CORE HOSPITALS; HAMPSHIRE MEMORIAL HOSPITAL, PAGE MEMORIAL HOSPITAL, SHENANDOAH MEMORIAL HOSPITAL, WAR MEMORIAL HOSPITAL, WARREN MEMORIAL HOSPITAL AND WINCHESTER MEDICAL CENTER. VALLEY HEALTH BRINGS TOGETHER 620 LICENSED INPATIENT BEDS, 166 LONG-TERM CARE BEDS, 5,300 EMPLOYEES, AND A MEDICAL STAFF EXCEEDING 600 PROFESSIONALS.DURING 2021 THE SYSTEM PROVIDED THE FOLLOWING SERVICES TO THE COMMUNITY- 200,572 INPATIENT ACUTE CARE DAYS; 279,315 OUTPATIENT REGISTRATIONS AT PHYSICIAN PRACTICES; 51,089 INPATIENT LONG TERM CARE DAYS; 5,414 INPATIENT REHABILITATION DAYS; 44,979 HOME CARE VISITS CONSISTING OF NURSING, PHYSICAL THERAPY, SOCIAL WORK, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, AND HOME HEALTH AIDS; 17,326 SURGICAL PROCEDURES,AND 9,456 INPATIENT PSYCIATRIC PATIENT DAYS.

Facility: A 6 - Part V, Section B, Line 5
Input from persons representing the broad interests of the community, community organizations, local businesses and civic organizations was taken into account via community response sessions, paper/online surveys and individual/ group interviews.

Facility: A 6 - Part V, Section B, Line 6a
Valley Health is comprised of six hospitals, Winchester Medical Center, Shenandoah Memorial Hospital, Warren Memorial Hospital, Page Memorial Hospital, Hampshire Memorial Hospital and War Memorial Hospital. Each hospital has its own assessment and then an overall assessment for Valley Health was produced.

Facility: A 6 - Part V, Section B, Line 7d
https://www.valleyhealthlink.com/About-Us/our-community-commitment/community-health-needs/Community presentations were given in the central, northern and southern regions to various organizations.

Facility: A 6 - Part V, Section B, Line 11
Historically, Valley Health (VH) has used a number of methods to collect relevant data/information on the health needs of the communities it serves. In developing the system report, VHS surveys patients, holds community response sessions, explores state and federal health outcomes databases, and reviews internally-generated patient record and billing data. These initiatives have helped to identify pressing geographic and demographic health needs.VH continues to monitor the needs of the community by conducting a Community Health Needs Assessment (CHNA). VH has conducted a needs assessment in 2010, 2013, 2016 and again in 2019. From the CHNA reports that were created for each of the six hospitals, an implementation strategy plan was created. The implementation strategies describes how each of the hospitals plans to address significant community health needs in 2020 through 2022. These needs were identified in the 2019 CHNA reports published and made widely available to the public on January 2020. The 2019 CHNA and the implementation strategies were undertaken to identify and address significant community health needs based upon the mission of VH and in accordance with proposed Internal Revenue Service (IRS) regulations pursuant to the Patient Protection and Affordable Care Act of 2010. Each of the strategies distinguishes the top items identified by the community and which will be addressed by the hospital and those that will not be addressed at this time and the reason why.Needs the Hampshire Memorial Hospital Will Not AddressNo hospital can address all of the health needs present in its community. Hampshire Memorial Hospital is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a range of important health care services and community benefits. This implementation strategy does not include specific plans to address social and economic factors such as poverty, housing and homelessness, which were significant health needs that were identified in the 2019 Community Health Needs Assessment. As a Critical Access Hospital, Hampshire Memorial Hospital is not ideally suited to be the lead organization in addressing these needs. The hospital does not have services or specific expertise in these areas and is directing its limited resources to other identified significant community health needs.Needs the War Memorial Hospital Will Not AddressNo hospital can address all of the health needs present in its community. War Memorial Hospital is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a range of important health care services and community benefits. This implementation strategy does not include specific plans to address social and economic factors such as poverty, housing and homelessness and health outcomes such as length of life and quality of life:cancer diseases which were significant health needs that were identified in the 2019 Community Health Needs Assessment.As a Critical Access Hospital, War Memorial Hospital is not ideally suited to be the lead organization in addressing these needs. The hospital does not have services or specific expertise in these areas and is directing its limited resources to other identified significant community health needs.Needs the Page Memorial Hospital Will Not AddressNo hospital can address all of the health needs present in its community. Page Memorial Hospital is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a range of important health care services and community benefits. This implementation strategy does not include specific plans to address the following significant social and economic factors such as poverty, housing, and homelessness, health outcomes, and maternal and child health as significant health needs that were identified in the 2019 Community Health Needs Assessment process through community interviews and response sessions.As a critical access acute care hospital, Page Memorial Hospital is not ideally suited to be the lead organization in addressing unmet housing needs or maternal and child health. The hospital does not have services or specific expertise in maternal health, nor permanent housing assistance and is directing its limited resources to other identified significant community health needs. Needs the Shenandoah Memorial Hospital Will Not AddressNo hospital can address all of the health needs present in its community. Shenandoah Memorial Hospital is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a range of important health care services and community benefits. This implementation strategy does not include specific plans to address the following significant social and economic factors such as poverty, housing, and homelessness, health outcomes, and maternal and child health as significant health needs that were identified in the 2019 Community Health Needs Assessment process through community interviews and response sessions.As a critical access hospital, Shenandoah Memorial Hospital does not provide obstetric services. However, Valley Health does provide obstetric services at Winchester Medical Center, Winchester Virginia. In addition, Valley Health affiliated physician practices provide prenatal care in Woodstock, Virginia, in the SMH primary service area, and Luray and Front Royal in the hospital's secondary service area.Needs the Warren Memorial Hospital Will Not AddressNo hospital can address all of the health needs present in its community. Warren Memorial Hospital is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a range of important health care services and community benefits. This implementation strategy does not include specific plans to address the following significant social and economic factors such as poverty, low income families, and homelessness, health outcomes such as cancer diseases and premature deaths, and maternal and child health as significant health needs that were identified in the 2019 Community Health Needs Assessment process through community interviews and response sessions.As an acute care hospital, Warren Memorial Hospital is not ideally suited to be the lead organization in addressing unmet oral and dental health needs or housing needs. The hospital does not have services or specific expertise in permanent housing assistance and is directing its limited resources to other identified significant community health needs. Needs the Winchester Medical Center Will Not AddressNo hospital can address all of the health needs present in its community. Winchester Medical Center is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a range of important health care services and community benefits. This implementation strategy does not include specific plans to address the following significant social and economic factors such as poverty, housing, and homelessness, health outcomes, and maternal and child health as significant health needs that were identified in the 2019 Community Health Needs Assessment process through community interviews and response sessions.As an acute care hospital, Winchester Medical Center is not ideally suited to be the lead organization in these needs in the community. The hospital does not have services or specific expertise in these areas, and is directing its limited resources to other identified significant community health needs. Nonetheless, the hospital intends to provide financial support to Northern Shenandoah Valley Housing Coalition, Dental Clinic of Northern Shenandoah Valley, Sinclair Health Clinic, Good Samaritan Clinic, St. Luke Free Clinic, and Shenandoah Community Clinic.

Facility: A 6 - Part V, Section B, Line 13b
There is a catastrophic financial assistance if income is between 301-500% of FPG and medical bills are more than $25,000. Pt liability would be limited to 30% of income or AGB, whichever is less. Limited to patients in primary and secondary service areas.

Facility: A 6 - Part V, Section B, Line 13h
Certain elective surgeries are excluded, e.g. cosmetic surgery.

Facility: A 6 - Part V, Section B, Line 16j
Financial Assistance Policy, Financial Assistance Policy Application and plain language summary are available at the website https://www.valleyhealthlink.com/Patients-Visitors/For-Patients/financial-assistance/Additionally the FAP is advertised annually in the local newspaper and the policy is distributed to local community organizations that work with individuals that may be eligible for assistance.Website link of Community Health Needs Assessment implementation strategyhttps://www.valleyhealthlink.com/about-us/our-community-commitment/community-health-needs/

Facility: A 6 - Part V, Section B, Line 20e
Valley Health documents determination of whether a patient is eligible for financial assistance if the patient applies for financial assistance. If the patient never applies, there is no effort to determine whether the patient is eligible. The financial assistance policy is posted on the website, various areas throughout the hospital, including ED and registration areas. A notice of financial assistance availability and method to contact Valley Health financial counselors for assistance in applying for financial assistance is printed on all routine monthly billing statements.

Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)
The eligibility criteria for financial assistance are federal poverty guidelines (FPG)(with FPG family income limit for eligibility for free care of 200% and FPG family income limit for eligibility for discounted care of 300%), income level other than FPG and residency. Certain elective surgeries are excluded - e.g. cosmetic surgery

Part I, Line 6a - Related Organization Community Benefit Report
Yes, Valley Health (VH) has prepared a related organization annual community benefit report for the last thirteen years. In addition to developing its own community benefits report, VH has voluntarily provided its annual community benefits data to the Virginia Hospital and Healthcare Association in each of the last thirteen years (2008-2021).

Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense
Bad debt expense is at cost. Cost to charge ratio applied to gross bad debt revenue to arrive at bad debt expense at cost.

Part III, Line 4 - Bad Debt Expense
In evaluating the collectability of accounts receivable, VH analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectibility. Management also reviews troubled, aged accounts to determine collection potential. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), VHS records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received.

Part III, Line 8 - Explanation Of Shortfall As Community Benefit
The organization does not treat any medicare shortfall as community benefit. The amounts are taken directly from the Medicare Cost Reports as filed using a cost to charge ratio method.

Part III, Line 9b - Provisions On Collection Practices For Qualified Patients
Throughout the collection process, Valley Health (VH) solicits information to determine if patients may qualify for charity or discounted assistance. Special attention is paid to patients who have qualified for charity assistance in the past six (6) months and/or have qualified at another facility within VH. For example, a patient who qualified within six months would not be required to submit an application or documentation to support assistance for the latest episode of care. Another example is a current patient would not be required to submit an application or documentation to support assistance if that documentation was on file from another VH hospital.

Part VI, Line 3 - Patient Education of Eligibility for Assistance
Valley Health (VH) rigorously applies the criteria set forth in Code of Virginia 32.1-137.01 regarding informing and educating patient regarding charity assistance opportunities and eligibility. This criteria is applied at all facilities:1. Posting of policies regarding free and discounted care in conspicuous, public areas of our facilities.2. Providing/having a handout of the eligibility criteria and procedures for applying for assistance at the point of service or admission.3. Notifying patients of the availability of assistance through messages on our billing statements.4. Policy and eligibility statements and associated application(s) are available on the VHS public web site (www.valleyhealthlink.com).5. Financial packets are available at the point of admission and through financial counselors located throughout our facilities. 6. VH Financial counselors are available by phone, e-mail, and due to COVID restrictions, limited in person at each VH facility to answer patient questions and assist patients in completing the Financial Assistance Application, as well as to assist in connecting patients with other community assistance programs to help afford the cost of their healthcare.

Part VI, Line 4 - Community Information
Valley Health (VH) serves an eighteen (18) county area of Virginia, West Virginia and Maryland and two independent cities in Virginia. The total coverage area is approximately 6,766 square miles. (Square miles are in parentheses as follows). In the northern Shenandoah Valley of Virginia, VHS provides services to patients residing in Frederick (415), Clarke (177), Warren (214), Shenandoah (512), Page (311), Rappahannock (267), Fauquier (650) and Loudoun (520) counties and the independent cities of Winchester (9) and Harrisonburg (18). In the greater eastern panhandle of West Virginia, VH provides services to patients residing in Jefferson (210), Berkeley (321), Morgan (229), Hampshire (642), Hardy (583), Grant (477) and Mineral (328) Counties. In Maryland, VHS facilities provide services for those residing in Washington (458) and Allegany (425) Counties. With the exception of several large population centers (Winchester, Harrisonburg and a major segment of Loudoun County, VA and Martinsburg, WV), the majority of the service area population resides in a rural-dominated environment.VH has designated three service areas a primary, a secondary and a tertiary service area in which it provides healthcare services, or transportation to services. The primary service area consists of the City of Winchester, Frederick, Clarke, Warren, Shenandoah, Page, Rappahannock Counties of Virginia, and Hampshire, Hardy and Morgan Counties of WV. The secondary service area consists of Jefferson, Berkeley, Grant and Mineral Counties of West Virginia. The tertiary service area consists of Loudoun, Fauquier and Rockingham Counties and Harrisonburg City in Virginia, and Washington and Allegany Counties of Maryland.The total estimated population for both the primary and secondary service area is 521,553. The total estimated population of the primary service area in 2020 was 303,710. The total estimated population of the secondary service area in 2020 was 217,843. The primary service area is projected to grow 5.16% by 2024. The secondary service area is projected to grow 10.2% by 2024. The overall catchment area population is approximately 89% white/Caucasian while the remaining 11% falls into other races/ethnic groups to include Hispanic or Latino population at 5.7%. Since VHs service area is predominantly rural, many of the counties are designated as primary care, dental and/or mental health health professional shortage areas (HPSAs) and/or Medically Underserved Area/Populations by the federal government. VHS provides a wide range of clinical services to the communities it serves through a full network of acute care hospitals (including four critical access hospitals), rural health clinics and other support programs. VHS provides patient access to progressive diagnostic and technologically advanced clinical services to the residents of the regions served.

Part VI, Line 2 - Needs Assessment
"Community health needs were identified by collecting and analyzing data and information from multiple quantitative and qualitative sources. Considering information from a variety of sources is important when assessing community health needs, to ensure the assessment captures a wide range of facts and perspectives and to assist in identifying the highest-priority health needs.Statistics for numerous health status, health care access, and related indicators were analyzed, including from local, state, and federal public agencies, community service organizations in the WMC community, and from Valley Health. Comparisons to benchmarks were made where possible. Details from these quantitative data are presented in the report's body, followed by a review of the principal findings of health assessments conducted by other organizations in the community in recent years.Input from persons representing the broad interests of the community was collected through:56 individual/group interviews with over 200 key informants (January-March 2019); a community health survey with 2,429 respondents; and six community response sessions (April 2019) comprised of 20 additional community stakeholders where preliminary findings were discussed. Interviews and community response sessions included: individuals with special knowledge of, or expertise in, public health; local and state health agencies with current data or information about the health needs of the community; and leaders, representing the medically underserved, low-income, and minority populations, and populations with chronic disease needs. Feedback from community response session participants helped validate findings and prioritize identified health needs.Health care needs assessments seek to identify the most significant health care needs for particular geographic areas or populations. Accordingly, the following topics and data frequently are assessed: 1.Demographics (trends, comparisons, pockets of vulnerable people); 2.Economic issues (unique characteristics, strengths and weaknesses, impacts of state budget cuts); 3.Education issues; 4.Family issues (child care, family violence); 5.Community issues (homelessness, housing, environmental concerns, transportation and traffic, crime, availability of social services); 6.Health status indicators such as: 7.Morbidity rates for various diseases and conditions; and 8.Mortality rates (leading causes of death); 9.Health access indicators (e.g., uninsurance rates, ambulatory care sensitive discharges,use of emergency rooms for non-emergent care) 10.Health disparities indicators, as available; and 11.Delivery system capacity and characteristics. Valley Health defined the geographic areas (communities) to be assessed. The assessments focused on zip codes in each hospital's service area that fall within the 14-county region identified as Valley Health's core service area. In the report, counties and zip codes generally are presented in alphabetical or numerical order. However, these areas may be arranged differently to facilitate drawing conclusions from the data presented. Principal data sets for the quantitative analyses include: 1.Demographic data provided from the US Census Bureau and Weldon Cooper to University of Virginia Weldon Cooper Center for Public Service; 2.Hospital discharge data for Virginia and West Virginia provided by Valley Health System; 3.Health status and access indicators available from the Community Health Status Indicators Project, County Health Rankings, and several other sources; 4.Additional internal data from Valley Health. Identifying the most significant health care needs involves benchmarking and trend analysis. Accordingly, statistics for several health status and health access indicators were analyzed and compared to state-wide and national benchmarks or goals. The assessment considers multiple data sources, including indicators from state and federal agencies. Multiple data sources and stakeholder views are important to assessing the level of consensus that exists regarding community health care needs that represent potential priorities for programmatic response. The assessment also quantified and analyzed ambulatory care sensitive (ACS) discharges. The ACS discharges methodology quantifies inpatient admissions for diabetes, perforated appendixes, chronic obstructive pulmonary disease, hypertension, congestive heart failure, dehydration, bacterial pneumonia, urinary tract infection, asthma, and other conditions that, in theory, could have been prevented if adequate ambulatory care resources were available and accessed by consumers. Findings from the ACS analysis are presented at the county, zip code, and Valley Health hospital-level of detail. The methodologies for quantifying ACS discharges have been well-tested for more than a decade. Disproportionately large numbers of ACS discharges indicate potential problems with the availability or accessibility of ambulatory (primary) care services. The Agency for Healthcare Research and Quality, part of the US Department of Health and Human Services, publishes software and methodologies for assessing ACS discharges. The AHRQ software was applied to analyze the prevalence of ACS discharges in geographic areas served by Valley Health and in each of the hospitals. The ACS analysis provides a single indicator of potential health status, access, and other problems - allowing comparisons to be made reliably across geographic areas and hospitals. This analysis also allows demonstrating a possible ""return on investment"" from interventions that reduce admissions (for example, for uninsured or Medicaid patients) that could have been prevented through better access to ambulatory care resources."

Part VI, Line 7 - States Filing of Community Benefit Report
VA WV

Part VI, Line 5 - Promotion of Community Health
Valley Health (VH) is an active corporate citizen within its service area, engaging in a variety of Community Building Activities every year including coalition building, community health improvement advocacy, community support, economic development, physical improvements and housing and workforce development programs. VHs Community Building Activities include supporting over 100 not for profit organizations, civic groups, and partnership initiatives committed to improving access to healthcare, youth mentoring, aging safely in place, and dying with dignity. Activities include but are not limited to the following: - United Way Day of Caring - Page One Volunteer Day - Project Search - Brain Injury Connections of the Shenandoah Valley Advisory Board - Chamber of Commerce - Leadership ParticipationAlthough many of its Community Building Activities do not provide any form of direct patient care, they provide significant indirect community benefit. VH is the largest employer in its service area, with the largest proportion of skilled workers. As a result, it has an extensive economic impact on the communities where its employees live and work. VH is committed to being an engaged, dependable corporate citizen. Sometimes, this means engaging the community in ways other than the direct provision of healthcare services. The Community Building Activities that VH engages in have tangible benefits to the communities served.

Part VI, Line 6 - Affilated Health Care System
Valley Health System (VHS) is a not-for-profit healthcare system headquartered in Winchester, Virginia, serving a population of 542,288 in an 14-county region of northwest Virginia, the Eastern Panhandle of West Virginia and Western Maryland. Valley Health System includes six acute care hospitals (four of them federally-designated Critical Access Hospitals), a Nationally Accredited Cancer Center, 6 Wellness and Fitness Centers, 30 Primary Care locations, over 600 physicians and advanced practice clinicians, eight Urgent Care centers, and a medical transport division that provides ambulance and wheelchair transports from strategically located stations. The system has a total of 620 licensed inpatient beds and 166 long-term care beds; and approximately 6,205 employees. VH entities have long, strong roots in their communities and contribute significantly to the health of their residents, offering clinical intervention, education, in-kind services and financial support. With our mission of Serving our community by improving health, the organization embraces well-care as seriously as sick-care. Wellness and fitness facilities and programs in each of our six hospital communities offer a continuity of care following outpatient rehabilitation, as well as a friendly, accessible place to maintain fitness. We organize and participate in a variety of community health and safety events throughout our service area, offering free health screenings, prevention and disease management education. Valley Health Heart Attack Risk Program screenings offer an easy check of key cardiac risk factors. Patient education and community programs help demystify the management of diabetes, COPD, asthma, obesity and more. We are actively partnering with regional law enforcement, the courts, and addiction professionals to address the alarming increase in opiate and heroin addiction and death. We provide substantial direct and in-kind support to free clinics in Winchester, Front Royal, Woodstock and Luray, VA and Martinsburg, WV.Valley Health has also invested in creating a technologically advanced, clinically progressive environment to ensure our region has an adequate supply of healthcare providers in the future. Our initiatives to help educate and recruit talented health care providers begin with programs in the regions middle and high schools and extend to partnerships in nursing and allied health with dozens of area colleges. The Shenandoah Valley Family Practice Residency Program, an accredited three-year residency with Medical College of Virginia/Virginia Commonwealth University School of Medicine, prepares new family physicians in office and hospital practice in Front Royal and Winchester. Surgical residents from the VCU School of Medicine (and beyond) complete rotations at Winchester Medical Center.

Part VI - Additional Information
Valley Health (VH) has affiliated hospitals located in Virginia and West Virginia. In the last thirteen years, 2008 - 2021 (including this years filing-2021), VH has voluntarily participated in the statewide Virginia Hospital and Healthcare Associations Annual Community Benefit Survey by providing all relevant community benefit data for its Virginia-affiliated hospitals. Although the State of West Virginia does require certain financial data to be submitted annually, there is no known requirement to provide specific community benefit-related data to the State of West Virginia or the West Virginia Hospital Association.Schedule H Part 1 Line 7 Cost to charge ratio method is used based on worksheet 2 in the instructions. Total operating expense is divided by Total Gross Revenue (Schedule C Medicare Cost Report) to arrive at the cost to charge ratio.Schedule H Part 1 Line 7 A https://www.valleyhealthlink.com/about-us/our-community-commitment/community-health-needs/Schedule H Part 1 Line 7 G Subsidized health services loss calculated based on worksheet 6 in the instructions. Inpatient psychiatric services financial loss is measure after removing losses associated with bad debt, charity and Medicaid.Schedule H Part 1 Column 7 FThe bad debt expense included on Form 990, Part IX, Line 25(A), but subtracted for purposes of calculating the percentage in this column is $57,791,947.Part V Question 10ahttps://www.valleyhealthlink.com/about-us/our-community-commitment/community-health-needs/Part V Question 16aWebsite URL for FAP https://www.valleyhealthlink.com/patients-visitors/for-patients/financial-assistance/Part V Question 16bWebsite URL for FAP Application formhttps://www.valleyhealthlink.com/patients-visitors/for-patients/financial-assistance/Part V Question 16cWebsite URL Plain language summary of the FAPhttps://www.valleyhealthlink.com/patients-visitors/for-patients/financial-assistance/Schedule Part V Line 7 ahttps://www.valleyhealthlink.com/About-Us/Community-Benefit.aspx