4A (Expenses $ 471335905 including grants of $ 14604433) (Revenue $ 548781894)
SEE SCHEDULE O

PART V, SECTION B
FACILITY REPORTING GROUP A

FACILITY REPORTING GROUP A CONSISTS OF:
- FACILITY 1: CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, - FACILITY 2: CHKD HEALTH AND SURGERY CENTER, - FACILITY 3: CHKD HEALTH AND SURGERY CENTER

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:
CHKD'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS INCLUDED COLLECTING DATA FROM SEVERAL DIFFERENT SOURCES: A COMMUNITY HEALTH SURVEY (IN COLLABORATION WITH OTHER AREA HOSPITAL SYSTEMS), FOCUS GROUPS AND KEY STAKEHOLDER INTERVIEWS AND HEALTH INDICATOR ANALYSIS.TWO VERSIONS OF THE SURVEY WITH SIMILAR QUESTIONS WERE CIRCULATED ACROSS CHKD'S SERVICE AREA. THE FIRST VERSION WAS A STAKEHOLDER SURVEY IN WHICH MANY PARTICIPANTS PROVIDED (OR HAD KNOWLEDGE OF) HEALTH, PREVENTIVE AND SUPPORT SERVICES, AS WELL AS THE NEEDS OF LOW INCOME AND MINORITY RESIDENTS. THE SECOND VERSION WAS A COMMUNITY SURVEY THAT WAS CIRCULATED MORE BROADLY TO COMMUNITY MEMBERS. THERE WERE A TOTAL OF 11,744 COMMUNITY MEMBERS WHO COMPLETED THE SURVEY QUESTIONS. THERE WERE 1,099 RESPONSES TO THE STAKEHOLDER SURVEY.GIVEN THE PREVIOUSLY IDENTIFIED PRIORITY OF MENTAL AND BEHAVIORAL HEALTH AND AN INTEREST IN HEARING FROM STAKEHOLDERS FROM ACROSS THE REGION WHO WERE FAMILIAR WITH THESE ISSUES, KEY STAKEHOLDER INTERVIEWS AND FOCUS GROUPS WERE CONDUCTED. A TOTAL OF 51 PEOPLE PARTICIPATED IN KEY STAKEHOLDER INTERVIEWS AND FOCUS GROUPS. THERE WERE 4 FOCUS GROUPS CONDUCTED BY VOICES (VIRGINIA ORGANIZATION FOR INCLUSIVE CONCEPTS AND EQUITABLE SOLUTIONS), A THINK TANK THAT FOCUSES ON PROVIDING BEST PRACTICE AND GUIDANCE ON FAIR AND EQUAL TREATMENT, SYSTEMIC AND INSTITUTIONAL RACISM, SOCIO-ECONOMIC ISSUES, AND SOCIAL DETERMINANTS OF HEALTH THAT CREATE IMPEDIMENTS FOR MARGINALIZED AND UNDERSERVED PEOPLE. TWENTY-FOUR PARTICIPANTS FROM ACROSS THE REGION TOOK PART IN THE GROUP DISCUSSIONS ON THE FOLLOWING TOPICS: (1) A HEALTHY WORKPLACE, (2) ACCESS TO HEALTHCARE, (3) ACCESS TO FOOD, (4) EMERGENCIES AND FINANCES.THE 27 KEY STAKEHOLDER INTERVIEWS TARGETED LOCAL PUBLIC HEALTH AND SOCIAL SERVICE DEPARTMENT REPRESENTATIVES, INDIVIDUALS OR ORGANIZATIONS SERVING MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS IN THE COMMUNITY, SCHOOL NURSES FROM LOCAL SCHOOL SYSTEMS PARTICULARLY IN RURAL AND PREDOMINANTLY LOW INCOME AREAS, AND HEALTHCARE AND MENTAL/BEHAVIORAL HEALTHCARE PROVIDERS WHO OFFER SERVICES FOR CHILDREN AND FAMILIES. ORGANIZATIONAL PARTICIPANTS INCLUDED HOSPITALS, COMMUNITY HEALTH CENTERS, SCHOOL SYSTEMS, SOCIAL SERVICES, NON-PROFIT AND OTHER COMMUNITY-BASED ORGANIZATIONS.NATIONAL, STATE AND PRIVATE DATA SOURCES WERE USED IN THE HEALTH INDICATOR ANALYSIS. KEY HEALTH ISSUES WERE IDENTIFIED WHEN MULTIPLE LOCALITIES HAD WORSE RATES OR PERCENTAGES IN COMPARISON TO STATE AVERAGES.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:
A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED FOR CHKD'S THREE LICENSED FACILITIES LISTED IN PART V, SECTION A.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:
AFTER COMPILING ALL OF THE RESULTS FROM THE STAKEHOLDER AND COMMUNITY SURVEYS, FOCUS GROUPS, KEY STAKEHOLDER INTERVIEWS AND HEALTH INDICATOR ANALYSIS, COMMON THEMES AND SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED ACROSS DATA SOURCES. THESE THEMES EITHER AROSE AS PRIORITIES IN AT LEAST TWO OF THE DATA SOURCES OR IF DATA FROM ONE OF THE SOURCES REVEALED OVERWHELMING NEED. THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED: MENTAL/BEHAVIORAL HEALTH, HEALTHY EATING AND ACCESS TO HEALTHY FOODS, ALCOHOL/SUBSTANCE ABUSE, SAFE AND AFFORDABLE HOUSING, PEDIATRIC ASTHMA, INFANT HEALTH, SEXUALLY TRANSMITTED INFECTIONS, AND CHILD ABUSE.CHKD LEADERS REVIEWED RESULTS FROM ALL THREE DATA SOURCES TO BETTER UNDERSTAND THE SIGNIFICANT HEALTH NEEDS AND PRIORITIES TO DETERMINE THE BEST FOCUS FOR ITS IMPLEMENTATION PLAN. INDIVIDUALS AND GROUPS INVOLVED IN THIS PROCESS INCLUDED THE FOLLOWING: THE HOSPITAL'S SENIOR LEADERSHIP TEAM, WHICH INCLUDES ITS CEO, PRESIDENT AND VICE PRESIDENTS; CHKD PHYSICIAN LEADERS; AND CHKD'S PARENT AND FAMILY ADVISORY COUNCIL.GIVEN THE SCOPE AND DEPTH OF THE NEED FOR MENTAL HEALTH CARE AND THE SIGNIFICANT RESOURCES CHKD HAS DEVOTED TO EXPANDING ITS MENTAL HEALTH SERVICES, CHKD IS PRIORITIZING THIS ISSUE IN ITS IMPLEMENTATION PLAN STRATEGY FROM 2022 TO 2024. SINCE THE 2019 CHNA, CHKD HAS MADE SIGNIFICANT PROGRESS TOWARD DEVELOPING A COORDINATED, REGIONAL CONTINUUM OF INPATIENT, OUTPATIENT AND DAY TREATMENT PROGRAMS FOR CHILDREN WITH MENTAL HEALTH CHALLENGES. ADDRESSING PEDIATRIC MENTAL/BEHAVIORAL HEALTH WOULD HAVE A POSITIVE EFFECT ON PEDIATRIC HEALTH AND WELL-BEING OVERALL, AFFECTING MULTIPLE OTHER IDENTIFIED HEALTH NEEDS, SUCH AS VIOLENCE AND ALCOHOL/SUBSTANCE ABUSE. CHKD WILL CONTINUE ITS COMMITMENT TO PREVIOUSLY IMPLEMENTED PROGRAMS INCLUDING ITS EXISTING CHILD ADVOCACY CENTER THAT ADDRESSES CHILD ABUSE.MENTAL/BEHAVIORAL HEALTH: CHKD OPENED CHKD'S CHILDREN PAVILION, A 60-BED PEDIATRIC MENTAL HEALTH HOSPITAL AND OUTPATIENT CENTER IN LATE 2022. THE NEW FACILITY WILL INCLUDE THOUGHTFUL PATIENT AND FAMILY-CENTERED DESIGN, EVIDENCE-BASED TREATMENTS, ACADEMIC TRAINING PROGRAMS, AND CLINICAL RESEARCH TO GUIDE INNOVATION. CHKD'S MENTAL HEALTH IMPLEMENTATION STRATEGY INCLUDES ESTABLISHING A PARTIAL HOSPITALIZATION PROGRAM THAT OFFERS FULL-DAY MENTAL HEALTH TREATMENT, OFFERING AND EXPANDING INTENSIVE OUTPATIENT PROGRAMMING, WORKING WITH OUR COMMUNITY TO ESTABLISH PARTNERSHIPS AND SUPPORT CHILDREN AND ADOLESCENTS IN THEIR TYPICAL ENVIRONMENTS, AND CONTINUING TO OFFER TELEHEALTH FOR OUTPATIENT CARE. CHKD HAS ESTABLISHED 2 OUTPATIENT MENTAL HEALTH FACILITIES FOCUSING ON MENTAL HEALTH THERAPY, PSYCHOLOGICAL ASSESSMENT, AND PSYCHIATRY SERVICES: NEWPORT NEWS HEALTH CENTER AT TECH CENTER AND VIRGINIA BEACH HEALTH CENTER AT LANDSTOWN. IN AN ANSWER TO THE PEDIATRIC MENTAL HEALTH CARE FRAGMENTATION DUE TO THE LACK OF COMMUNICATION BETWEEN A CHILD'S VARIOUS MEDICAL AND MENTAL HEALTH PROVIDERS, CHKD'S GOAL IS TO DEVELOP A COORDINATED CONTINUUM OF CARE ACROSS ITS FACILITIES. WITH ITS BROAD NETWORK OF MORE THAT 300 PEDIATRICIANS, SPECIALISTS, AND SURGEONS IN MORE THAN 40 LOCATIONS THROUGHOUT THE REGION, CHKD HEALTH SYSTEM IS IN A UNIQUE POSITION TO ADDRESS AND IMPROVE CARE FRAGMENTATION. CHKD IS THE REGION'S PARTNER FOR THE VIRGINIA MENTAL HEALTH ACCESS PROGRAM (VMAP), A STATEWIDE INITIATIVE THAT OFFERS PEDIATRICIANS REAL-TIME PHONE CONSULTATIONS WITH BOARD-CERTIFIED CHILD AND ADOLESCENT PSYCHIATRISTS. VMAP ALSO SERVES AS A RESOURCE FOR PEDIATRICIANS WHO ARE LOOKING FOR MENTAL HEALTH CARE AND BEHAVIORAL CONSULTATION FOR A CHILD IN THEIR CARE.CHKD PLANS TO CONTINUE TO COMMIT PROGRAMMING AND RESOURCES TO ITS ONGOING INITIATIVES TO ADDRESS OBESITY, CHILD ABUSE AND INFANT HEALTH. OTHER SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA ARE NOT BEING SPECIFICALLY ADDRESSED IN THE CURRENT IMPLEMENTATION ARE ALCOHOL/SUBSTANCE ABUSE, SAFE AND AFFORDABLE HOUSING, PEDIATRIC ASTHMA, AND SEXUALLY TRANSMITTED INFECTIONS, THESE ARE ALL CONDITIONS THAT CHKD EITHER CURRENTLY PROVIDES CARE FOR AND/OR COLLABORATES WITH OTHER COMMUNITY AGENCIES TO ADDRESS. CHKD REGULARLY AND ROUTINELY OFFERS ITS EXPERTISE AND ASSISTANCE AS WELL AS COMMUNITY RESOURCES TO ADDRESS A BROAD RANGE OF ISSUES RELATING TO THE HEALTH AND WELFARE OF CHILDREN.

FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13H:
PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1. STATE-FUNDED PRESCRIPTION PROGRAMS;2. HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC;3. PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);4. FOOD STAMP ELIGIBILITY;5. SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY;6. ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT AREUNFUNDED (E.G., MEDICAID SPEND-DOWN);7. LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; AND8. PATIENT IS DECEASED WITH NO KNOWN ESTATE.

PART I, LINE 7(E):
THE AMOUNT REPORTED ON PART I, LINE 7(E) INCLUDES $57,312,685 OF COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS.PART I, LINE 7(F):THE AMOUNT OF BAD DEBT INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) THAT WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENT OF TOTAL EXPENSE IN PART I, LINE 7, COLUMN (F) IS $16,067,789.

PART I, LINE 7:
A HYBRID APPROACH WAS USED FOR DETERMINING COSTS RELATED TO COMMUNITY BENEFIT. ACTUAL COSTS FROM ALL PATIENT SEGMENTS ARE IDENTIFIED BY DEPARTMENT IN THE GENERAL LEDGER AND THEN WERE GROUPED INTO LIKE COMMUNITY BENEFIT PROGRAMS. INDIRECT COSTS WERE ADJUSTED FOR COSTS ATTRIBUTABLE TO UNREIMBURSED MEDICAID COSTS REPORTED ELSEWHERE, MARKETING AND GRANT WRITING EXPENSES. THE MEDICAID COSTS ADJUSTMENT WAS CALCULATED USING A COST TO CHARGE RATIO OF APPLICABLE EXPENSES DIVIDED BY TOTAL APPLICABLE CHARGES APPLIED TO MEDICAID REVENUE. THE REMAINING INDIRECT COSTS WERE ALLOCATED PROPORTIONATELY TO THE DIRECT COSTS REPORTED BY DEPARTMENT. IN ADDITION, EXPENSES WERE CALCULATED AT COST AND THEN COSTS RELATED TO CHARITY CARE, BAD DEBT AND MEDICAID WERE REMOVED BEFORE ARRIVING AT THE AMOUNTS FOR COMMUNITY BENEFIT AT COST.

PART III, LINE 2:
BAD DEBT REPORTED IN PART III LINE 2 IS BASED ON THE AMOUNT REPORTED AS BAD DEBT IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE AMOUNT DOES NOT INCLUDE DISCOUNTS OR OTHER ADMINISTRATIVE WRITE OFFS. IF A PATIENT ACCOUNT HAS BEEN WRITTEN OFF TO BAD DEBT AND IS SUBSEQUENTLY COLLECTED, BAD DEBT EXPENSE IS REDUCED IN THAT PERIOD BY THE PAYMENT.PART III, LINE 3:THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS CALCULATED BASED OFF THE PERCENTAGE OF CHARITY CARE EXPENSES AS A PERCENTAGE OF SELF-PAY REVENUE. CHKD DOES NOT MAINTAIN RECORDS THAT TRACK PATIENTS WHO COULD HAVE QUALIFIED FOR CHARITY CARE. THIS AMOUNT IS AN ESTIMATE OF PATIENTS WHO LIKELY WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE POLICY IF SUFFICIENT INFORMATION HAD BEEN AVAILABLE TO DETERMINE THEIR ELIGIBILITY. THIS AMOUNT IS NOT INCLUDED AS COMMUNITY BENEFIT.

PART III, LINE 4:
CHKD PRESENTS BAD DEBT PROVISION ON THE FINANCIAL STATEMENTS AS A DEDUCTION FROM NET PATIENT SERVICE REVENUE PER ACCOUNTING STANDARDS UPDATE (ASU) 2011-07. THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES IS MANAGEMENT'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN THE HOSPITAL'S EXISTING RECEIVABLES. THE HOSPITAL DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE, NET OF PAYMENTS AND DISCOUNTS, AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR THE RECOVERY IS CONSIDERED REMOTE. FOR ADDITIONAL DETAILS SEE FOOTNOTE 17 ON PAGE 32 OF AUDITED FINANCIAL STATEMENTS.PART III, LINE 8:AS A CHILDREN'S HOSPITAL, THE HOSPITAL HAS A SMALL POPULATION OF MEDICARE PATIENTS AND IS PAID LESS THAN COST DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE. THE SHORTFALL WAS CALCULATED USING THE HOSPITAL'S OVERALL COST TO CHARGE RATIO APPLIED TO MEDICARE GROSS CHARGES. THIS SHORTFALL IS NOT SEPARATELY INCLUDED AS A COMMUNITY BENEFIT AS 100% OF IT HAS ALREADY BEEN CAPTURED IN THE APPROPRIATE CATEGORY ON PART I, LINE 7.

PART VI, LINE 6:
AFFILIATED HEALTH CARE SYSTEM:CHKD IS PART OF CHILDREN'S HEALTH SYSTEM, A 501(C)(3) ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. CHKD EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. SURPLUS FUNDS ARE USED TO MEET THE NEEDS OF THE ORGANIZATION AS DETERMINED BY CHKD SENIOR MANAGEMENT AND THE CHS BOARD OF DIRECTORS. HISTORICALLY, SURPLUS FUNDS HAVE BEEN USED FOR A VARIETY OF PURPOSES INCLUDING PATIENT CARE PROGRAMS, CAPITAL IMPROVEMENT NEEDS, RESERVES, ETC.ROLES OF ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED: THE CHILDREN'S HEALTH SYSTEM IS COMPRISED OF SEVERAL ORGANIZATIONS. CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS IS A FREESTANDING CHILDREN'S HOSPITAL THAT PROVIDES A BROAD SPECTRUM OF INPATIENT AND OUTPATIENT CARE SERVICES ACROSS MANY PEDIATRIC SPECIALTIES, INCLUDING EVERYTHING FROM PRIMARY CARE AND WELLNESS INITIATIVES TO NEONATAL AND PEDIATRIC INTENSIVE CARE. OTHER ENTITIES UNDER THE CHILDREN'S HEALTH SYSTEM UMBRELLA INCLUDE:* CHILDREN'S HEALTH FOUNDATION, WHICH MANAGES INVESTMENTS AND FUNDS EDUCATION, RESEARCH AND OTHER PROGRAMS FOR CHILDREN'S HEALTH SYSTEM* CHILDREN'S MEDICAL GROUP, INC., A VIRGINIA STOCK CORPORATION, WHICH OWNS AND OPERATES PEDIATRIC PHYSICIAN PRACTICES* CMG OF NORTH CAROLINA, INC., A NORTH CAROLINA STOCK CORPORATION, WHICH OWNS AND OPERATES A PEDIATRIC PHYSICIAN PRACTICE IN NORTHEASTERN NORTH CAROLINA* CHILDREN'S SURGICAL SPECIALTY GROUP, INC., A VIRGINIA STOCK CORPORATION, WHICH OWNS AND OPERATES PEDIATRIC SURGICAL SUBSPECIALTY PRACTICES, INCLUDING PEDIATRIC GENERAL SURGERY, PEDIATRIC UROLOGY, PEDIATRIC CARDIAC SURGERY, PEDIATRIC ORTHOPEDIC SURGERY, PEDIATRIC NEUROSURGERY AND PEDIATRIC PLASTIC SURGERY.* CHILDREN'S HEALTH INSURANCE, LLC, A CAPTIVE INSURANCE COMPANY INCORPORATED IN SOUTH CAROLINA IS A DISREGARDED ENTITY OF CHKD.* CHKD THRIFT STORES, LLC, A DISREGARDED ENTITY ORGANIZED TO SUPPORT THE CHARITABLE MISSION AND PURPOSE OF CHILDREN'S HEALTH SYSTEM.* CHILDREN'S REAL ESTATE, LLC, IS A DISREGARDED ENTITY ORGANIZED TO SUPPORT THE CHARITABLE MISSION AND PURPOSE OF CHILDREN'S HEALTH SYSTEM.* CHILDREN'S RESEARCH HOLDING, LLC, A DISREGARDED ENTITY ORGANINZED TO SUPPORT THE CHARITABLE MISSION AND PURPOSE OF CHILDREN'S HEALTH SYSTEM.* CHILDREN'S QUALITY CARE, LLC, A DISREGARDED ENTITY ORGANINZED TO SUPPORT THE CHARITABLE MISSION AND PURPOSE OF CHILDREN'S HEALTH SYSTEM.PART VI, LINE 7:FACILITY REPORTING GROUP(S):FACILITY REPORTING GROUP A INCLUDES CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, CHKD HEALTH AND SURGERY CENTER IN NEWPORT NEWS AND CHKD HEALTH AND SURGERY CENTER IN VIRGINIA BEACH. STATE FILING OF COMMUNITY BENEFIT REPORT:VA

PART III, LINE 9B:
"ACCOUNTS WITH AN UNPAID BALANCE OR WITHOUT AN ESTABLISHED PAYMENT PLAN ARE REFERRED TO A COLLECTION AGENCY OR ATTORNEY FOR CONTINUED COLLECTION EFFORTS. CHKD MAKES REASONABLE EFFORTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE/CHARITY CARE BEFORE REFERRING TO A COLLECTION AGENCY OR AN ATTORNEY. REASONABLE EFFORT INCLUDES AND IS NOT LIMITED TO NOTIFICATION ABOUT THE FINANCIAL ASSISTANCE - CHARITY CARE/COLLECTION POLICY POSTED IN ADMISSIONS, EMERGENCY DEPARTMENT OR OTHER DESIGNATED AREAS. THE INFORMATION REGARDING THE POLICY IS INCLUDED IN THE ADMISSION PACKAGE AND ON THE PATIENT BILL. THE HEALTH BENEFITS ANALYST AND CUSTOMER SERVICE REPRESENTATIVE WHO MAY SPEAK WITH THE GUARANTOR BY PHONE PROVIDE THEM WITH FINANCIAL ASSISTANCE INCLUDING CHARITY CARE INFORMATION. THE FINANCIAL ASSISTANCE-CHARITY CARE/COLLECTION POLICY IS AVAILABLE UPON REQUEST AND VIA WWW.CHKD.ORG. CHKD ENSURES ALL COLLECTION PROTOCOLS ARE MET PRIOR TO REFERRAL TO COLLECTIONS AGENCY OR ATTORNEY. APPROVED CHARITY CARE AMOUNT WILL NOT BE SUBJECT TO COLLECTION ACTIVITIES. THE REMAINING BALANCE WILL BE SUBJECT TO CHKD'S STANDARD COLLECTION PROTOCOLS.PART VI, LINE 2:NEEDS ASSESSMENT:AS THE ONLY HEALTHCARE PROVIDER IN VIRGINIA DEVOTED EXCLUSIVELY TO THE NEEDS OF CHILDREN, CHKD ASSUMES THE RESPONSIBILITY OF LEADING THE REGION IN THE PROVISION OF PEDIATRIC CARE AND THE PROMOTION OF CHILDREN'S HEALTH AND IS TRUSTED THROUGHOUT ITS COMMUNITY TO ADDRESS ESTABLISHED AND EMERGENT PEDIATRIC NEEDS WHEREVER AND HOWEVER THEY ARE IDENTIFIED. CHKD USES A VARIETY OF METHODS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. NEEDS ARE IDENTIFIED THROUGH A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT, PARTNERSHIPS AND COLLABORATIONS WITH OTHER MEDICAL, NON PROFIT AND PUBLIC HEALTH AGENCIES AND ORGANIZATIONS AND THROUGH REGIONAL, STATE AND NATIONAL DATA. FROM NOVEMBER 2021 TO APRIL 2022, CHKD CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WITH SUPPORT FROM TOXCEL, LLC, A GAINESVILLE, VIRGINIA-BASED SCIENCE, ENGINEERING AND HEALTH RESEARCH AND CONSULTING FIRM. THIS JOINT CHNA COVERS ALL THREE LICENSED FACILITIES ASSOCIATED WITHIN THE CHKD HEALTH SYSTEM: CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS (CHKD) LOCATED IN NORFOLK AND CHKD'S TWO HEALTH AND SURGERY CENTERS, ONE AT OYSTER POINT IN NEWPORT NEWS AND ONE AT PRINCESS ANNE IN VIRGINIA BEACH. CHKD'S CHNA PROVIDES AN OVERVIEW OF THE PRIMARY AND SECONDARY DATA USED TO IDENTIFY KEY HEALTH ISSUES WITHIN THE CHKD COMMUNITY. IT COMBINES AND COMPARES RESULTS FROM THREE SOURCES: A COMMUNITY HEALTH SURVEY, FOCUS GROUPS, AND KEY STAKEHOLDER INTERVIEWS. CHKD'S CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY CAN BE FOUND AT WWW.CHKD.ORG/COMMUNITYBENEFIT.PART VI, LINE 3:PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:CHKD'S CHARITY CARE ELIGIBILITY CRITERIA AND PROCEDURES FOR APPLYING ARE PROVIDED TO ALL PATIENTS. CHARITY CARE INFORMATION IS INCLUDED IN EVERY INPATIENT ADMISSION PACKET AND DISTRIBUTED TO THE OUTPATIENT DURING THE OUTPATIENT REGISTRATION PROCESS. AN APPLICATION FOR CHARITY CARE, ALONG WITH A LETTER EXPLAINING THE PROCESS, IS SENT TO ANY PATIENT OR GUARANTOR WHO REQUESTS INFORMATION ON ANY PROGRAMS OR PROVISIONS THE HOSPITAL MAY HAVE TO HELP ASSIST PATIENTS OR GUARANTORS IN PAYING THEIR HOSPITAL BILL. THE CHARITY CARE POLICY AND APPLICATION ARE PROMINENTLY DISPLAYED ON THE MAIN ""BILLING"" PAGE OF THE HOSPITAL WEBSITE, JUST ONE CLICK FROM THE HOME PAGE, AT WWW.CHKD.ORG/BILLING/FINANCIAL-ASSISTANCE. PRINTED COPIES ARE ALSO AVAILABLE AT EACH REGISTRATION WORKSTATION. ALL BILLING STATEMENTS MAILED TO GUARANTORS INCLUDE A NOTICE OF THE AVAILABILITY OF CHARITY AND HOW TO OBTAIN THE INFORMATION/APPLICATION. ASSISTANCE WITH THE APPLICATION PROCESS IS AVAILABLE THROUGH THE HEALTH BENEFITS ANALYST (HBA). THE HBA SENDS OUT APPLICATIONS VIA MAIL AND REFERS FAMILIES TO THE HOSPITAL'S WEBSITE. THE UNIT SOCIAL WORKER IS AVAILABLE TO PROVIDE INFORMATION OR REFERRAL TO THE HBA DURING AN INPATIENT STAY.PART VI, LINE 4:COMMUNITY INFORMATION:CHKD IS THE REGIONAL PEDIATRIC REFERRAL CENTER FOR SOUTHEASTERN VIRGINIA, THE EASTERN SHORE OF VIRGINIA AND NORTHEASTERN NORTH CAROLINA. CHKD SERVES THE FOLLOWING REGIONS IN VIRGINIA: ACCOMACK COUNTY, CHESAPEAKE CITY, FRANKLIN CITY, GLOUCESTER COUNTY, HAMPTON CITY, ISLE OF WIGHT COUNTY, JAMES CITY COUNTY, MATHEWS COUNTY, NEWPORT NEWS CITY, NORFOLK CITY, NORTHAMPTON COUNTY, POQUOSON CITY, PORTSMOUTH CITY, PRINCE GEORGE COUNTY, SOUTHAMPTON COUNTY, SUFFOLK CITY, SURRY COUNTY, SUSSEX COUNTY, VIRGINIA BEACH CITY, WILLIAMSBURG CITY AND YORK COUNTY. WITHIN NORTH CAROLINA, CHKD SERVES THE FOLLOWING REGIONS: BERTIE COUNTY, CAMDEN COUNTY, CHOWAN COUNTY, CURRITUCK COUNTY, DARE COUNTY, GATES COUNTY, HERTFORD COUNTY, PASQUOTANK COUNTY AND PERQUIMANS COUNTY. AS REFLECTED IN OUR 2022 CHNA, THIS SERVICE REGION INCLUDED 458,649 PERSONS AGE 0-19. CHKD'S SERVICE AREA COMPRISES A DIVERSE MIX OF URBAN, SUBURBAN AND RURAL COMMUNITIES, AS WELL AS 10 MILITARY INSTALLATIONS. CHKD IS WELL VERSED IN THE SPECIAL NEEDS OF MILITARY FAMILIES AND HAS ONE OF THE HIGHEST TRICARE PAYER PERCENTAGES AMONG THE CHILDREN'S HOSPITALS IN THE NATION.PART VI, LINE 5:PROMOTION OF COMMUNITY HEALTHCHKD PLAYS A UNIQUE ROLE IN ITS COMMUNITY BY PROVIDING PEDIATRICHEALTHCARE SERVICES AVAILABLE NOWHERE ELSE IN THE REGION AND, AT THE SAME TIME, SERVING AS THE SAFETY NET PROVIDER TO THE REGION'S INDIGENT CHILDREN. IN FY 2022, CHKD HAD 4,834 ADMISSIONS RESULTING IN 49,261 PATIENT DAYS. APPROXIMATELY 55 PERCENT OF THESE DAYS, WERE COVERED BY MEDICAID, WHICH IS THE HIGHEST PERCENTAGE BY FAR OF ANY ACUTE-CARE HOSPITAL IN VIRGINIA. CHKD LEADS THE REGION IN EFFORTS TO ADDRESS PUBLIC HEALTH CONCERNS LIKE CHILD ABUSE AND CHILDHOOD OBESITY. IT IS THE SOLE PROVIDER OF PEDIATRIC SUBSPECIALTY CARE FOR CHILDREN WITH CHRONIC ILLNESSES LIKE CANCER AND DIABETES AND EMPLOYS THE REGION'S ONLY PEDIATRIC SURGEONS. THE HOSPITAL'S VIBRANT COMMUNITY OUTREACH PROGRAM COORDINATES PARENT, PROFESSIONAL AND STUDENT PROGRAMS THAT BRING IMPORTANT HEALTH, SAFETY AND WELLNESS INFORMATION TO THOUSANDS OF PARTICIPANTS. CHKD ALSO TAKES AN ACTIVE ROLE IN THE EDUCATION OF PEDIATRICIANS.COMPREHENSIVE INFORMATION ON CHKD'S EFFORTS TO IMPROVE THE HEALTH OF CHILDREN IS AVAILABLE AT WWW.CHKD.ORG/COMMUNITYBENEFIT"